OBJECTIVES

General Objective:To be able to learn and understand the disease

process and its corresponding nursing care management to the patient having Post-infectious Glomerulonephritis.

Specific Objective:1. To present the patient’s profile and health history with its Gordon’s Pattern of Functioning.2. To present and discuss about post-infectious glomerulonephritis, with its etiology and clinical manifestations3. To present and discuss the normal anatomy and physiology of urinary system.4. To present the Physical assessment of the patient5. To correlate the laboratory results to the

client’s clinical manifestation.

6. To present and discuss the pathophysiology of Post-infectious Glomerulonephritis

7. To present the nursing care plan to the patient according to priority.

8. To present the drugs prescribed to the patient and the nursing considerations

INTRODUCTION

Glomerulonephritis is an immunologic disorder that causes inflammation and increased cells in the glomerulus.

Glomerulonephrits encompasses a variety of diseases, most of which are caused by immunologic reaction that result in proliferative and inflammatory changes in glomerular structure. It is usually manifested by either a nephrotic syndrome or a nephritic syndrome.

Nephrotic syndrome is a set of clinical manifestations caused by protein wasting secondary to diffuse glomerular damage. Manifestations include proteinuria (>3.5 g/day), hypoalbuminemia and edema. Nephritic syndrome refers to set of clinical manifestations that includes hematuria and at least one of the following: oliguria (urine output <400ml/24 hour), hypertension, elevated blood urea nitrogen (BUN) level or decreased GFR. Nephritic syndrome is common with many types of glomerulonehpritis, including immunoglobulin A (IgA) nephropathy and Henoch-Schönlein purpura.

NURSING HEALTH HISTORY

C l i e n t P r o f i l e

Name: Patient ZAddress: Brgy. Sabang, Palompon, LeyteReligion: Roman CatholicGender: MaleAge: 6 years oldBirthdate: 11-17-2005

Date of Admission: January 5, 2012Chief Complaint: Facial Puffiness

H i s t o r y o f P r e s e n t I l l n e s sA case of Patient Z, 6 years old, living at Brgy.

Sabang, Palompon, Leyte, was admitted for the first time at Eastern Visayas Regional Medical Center, with a chief complaint of “Ning burot man ang iyang naong og sige siya ug kahilanti” as verbalized by the mother of the client.

12 days PTA, the client had a fever, the mother gave him Paracetamol and no other interventions were done.

11 days PTA, the client still had a fever. He also had an epistaxis, no management was done.

10 days PTA, the client’s fever still persisted. He also experienced difficulty in breathing and headache. He vomited once which is approximately 300ml, his vomitus was composed of small amount of his recent intake but most of it was saliva. He also had tea-colored urine with approximate amount of 240ml. Manifestation of the signs and symptoms prompted them to seek medical consultation at St. Paul’s Hospital. There the client was given with Co-amoxiclav (15mg/kg/day BID x 7 days) and Cetirizine (0.25mg/kg/dose OD).

5 days PTA, the client went back to St. Paul’s Hospital with facial puffiness and fever. He had another check-up and was advised to continue prescribed medication and to have a CBC and urinalysis.

2 days PTA, the client went back to St. Paul’s Hospital to get the result of CBC and urinalysis which revealed UTI and abnormalities on the CBC count. The doctor ordered to have the client ultrasound.

1 day PTA, the client returned to St. Paul’s Hospital to have ultrasound which revealed Pyelonephritis. The client was recommended to be admitted at the EVRMC.

P a s t H i s t o r yClient didn’t have chickenpox, mumps, measles,

and asthma and has no known food and drug allergies. He had a complete immunization when he was a baby. No history of surgeries, accidents, injuries, and hospitalization. He had taken medications before he was admitted to EVRMC such as co-amoxiclav and cetirizine.

Client had a complete immunization, as claimed by the mother of the client.

D e v e l o p m e n t a l H i s t o r yAt 12 months, the client can stand alone and able

to obey commands. At 15 months, the client can walk well alone. At 2 years old, he can run well and was toilet trained by day. At 3 ½ years old, the client can already stand on one foot. At 4 ½ years old, the client can already dress by himself. At 5 years old, he can already write alphabets and tells stories. At 6 years old, he can already walk heal to toe.

M a t e r n a l H i s t o r y

The maternal history of the mother of the client is G5 T5 P0 A0 L5 M0, had no complications during pregnancy and deliveries. The client was delivered full term via NSVD at home assisted by “hilot”.

Had prenatal check-ups on their Health Center at Palompon, Leyte and received 5 doses of Tetanus Toxoid injections on her prenatal check-ups and was given FeSO4 supplements one tab once a day.

She is a non-smoker, non-alcoholic drinker. She had no history of severe bleeding and severe vomiting.

F a m i l y H i s t o r y o f I l l n e s s Both sides of their family have a history of

hypertension and the grandmother of the client on the maternal side who is deceased had a heart problem. No other known debilitating diseases such as DM, asthma, and allergies.

L i f e s t y l e

The client usually sleeps at eight in the evening and wake up at six in the morning. He doesn’t have difficulty in sleeping. They usually eat 3 meals a day. In the morning, he usually eats 3 pandesal with milo. During lunchtime, his typical meal is fish, vegetables and rice. He can consume at least 1-2 cups of rice and drinks approximately 1 glass of water each meal. During week days, he usually goes to school at seven in the morning accompanied by his mother and goes back home four in the afternoon.

At school, he likes to eat junk foods and plays with his classmates during free time. On weekends, he usually takes 1 hour of nap in the afternoon and after his nap he usually plays outside their house with his friends. The client usually does his relaxation by playing with his toys and watching TV.

S o c i a l D a t aThe client was born on November 17, 2005, and

was born and raised in Palompon, Leyte. He is a grade 1 pupil in Palompon. He lives with his family in a house made up of light materials with electricity and their water source is from NAWASA. He has 4 siblings and he is the 5th child. Usually, the father of the client is the one who does the financial planning since he is the only one who is working in their family.

The client is much closer to his mother because she is the one whom he confides to in times of problems. Also his mother is the one who monitors him at home and in school and the one who takes care of him when he is sick.

The family has a good relationship with each other, but sometimes conflicts are inevitable especially if their family is suffering from crisis. The family has a good relationship towards their neighbors and they have no conflicts with each other.

P s y c h o l o g i c D a t aThe client has no history of any psychiatric

illness.

P a t t e r n s o f H e a l t h C a r eAccess to health care is a problem for them because

of long periods of travel from Palompon to Tacloban. They have their health center in Palompon, Leyte, but it is inadequate to meet their needs for care.

The family is supported with PHILHEALTH and it helped them reduce payment to their bills at the hospital.

The family usually consults to a “Tambalan” before seeking consult to a doctor because of financial constraints. They sometimes use herbal medicine such as calamansi juice or lagundi leaves to relieve cough and colds.

The family usually consults to a “Tambalan” before seeking consult to a doctor because of financial constraints. They sometimes use herbal medicine such as calamansi juice or lagundi leaves to relieve cough and colds.