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A Case Study on Chronic Obstructive Pulmonary Disease

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A Case Study On Chronic Obstructive Pulmonary Disease In Partial Fulfillment of the Requirements for the degree Master of Arts in Nursing Major in Medical-Surgical Nursing Submitted To: Prof. Regie B. Tumala Submitted By: Aiceledne M. Else BIOGRAPHIC DATA Name: DR Age: 3 years & 8 months Gender: Male Date of birth: May 2, 2005 Existing Diagnosis: Acute Glomerulonephritis, Post infection Past Medical History: Mother claimed that it’s DR’s 3rd hospitalization: first, was last 2008 for a diagnosis of Dengue; second was last February 16, 2009 for a kidney infection and presently for his condition of Acute Glomerulonephritis.

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Immunizations: * Hepatitis B – 3x (complete) * DPT – 3x (complete) * BCG – complete * OPV – complete * Measles- complete Habits and Lifestyles: Personal Habits: Takes a bath daily, brushes his teeth once a day after breakfast, and likes to bite his nails. Diet: Eats three times a day with dried fish and rice as the main course. He also likes to eat pork if available as claimed by mother. He loves to eat junk foods and softdrinks often.

Sleep/rest patterns: Sleeps 8-10 hours a day. Recreation/hobbies: Plays with his friends and cousins, often watches TV

Psychosocial History: Patient lives with her grandmother and mother as a single parent. He regularly plays with her cousins who live in the same place. He stays indoors most of the time being cared for by mother or grandmother. History of Present Illness: Patient was admitted last February 16, 2009 due to a kidney infection and discharged on February 21, 2009 with home medications of Cotrimoxazole and Phenoxymethyl and Multivitamins. Mother claimed she forgot how often the medicines were given. 1 day PTA had low grade fever with edema on face.

Mother noticed the edema but took the child’s condition for granted thinking that it was just an allergic reaction to some foods he might have eaten. He was made to take paracetamol. Several hours PTA, had high grade fever and puffiness of the face and both lower extremities. The patient’s condition was then associated with a tea-colored urine, thus, mother decided to seek medical consultation. FAMILY HISTORY WITH GENOGRAM: The patient has a familial history of hypertension and heart disease. + ER + MR + MA + JA RR DR MR RR X DR LEGEND: + DECEASED X PATIENT FEMALE MALE Acute Glomerulonephritis Heart Failure

HYPERTENSION GORDON’S FUCTIONAL HEALTH PATTERN with remarks: HEALTH PERCEPTION- HEALTH MANAGEMENT PATTERN Mr. R. M. defined health or being healthy as “ being in the best overall condition a person can be”. With his disease condition his food is prepared for him mainly consisting of rice, fish or meat and vegetables in small portions because he gets tired easily even from eating. He takes bronchodilators and anti-hypertensive medications for his blood pressure, he also has an oxygen tank near him at all times. Although diagnosed with COPD and hospitalized twice for the condition, he still smokes a few sticks a day.

Asked why he continues with this habit, he verbalized “naa na man ni, nya maglisod na man ko undang. Tiguwang na bitaw ko, mamatay lang gihapon ko sooner or later”. Remark: Risk for infection related to chronic disease and insufficient knowledge NUTRITIONAL- METABOLIC PATTERN The patient eats 3 times a day prepared for him. He eats rice, sea foods or meat and vegetable but only in small quantities because he tires easily even in this basic activity. He also asks for fruits and fruit juices from time to time. When he gets hungry between meals he is served with sandwiches or arozcaldo, but only eats a few bites or spoons.

He does not like to eat junk foods or soft drinks. He does like to drink coffee and water throughout the day. Although he has been eating as much as he could, he is still losing weight. Remark: Imbalanced nutrition less than body requirements related to inability to ingest food characterized by inadequate food intake less than recommended daily allowance ELIMINATION PATTERN Mr. R. M. urinates 4-5 times a day although unmeasured he states that it is of normal amount, what he usually urinates even before he got sick. He defecates around 2 times a week.

Often times it becomes difficult for him to defecate and he strains to push the feces out, when this happens he asks his son to give him a suppository so it would be easier to move his bowel. Remarks: constipation related to abdominal muscle weakness. ACTIVITY-EXERCISE PATTERN Mr. R. M wakes up at 6 or 7 in the morning. Takes his breakfast and then goes back to his room to rest for an hour or so, then takes a shower after which he dress up with the help of his son or their maid, usually in putting on his shirt. He then stays in his room ready the news paper or a book, sometimes falling asleep before he is called for lunch.

After lunch he goes back to his room and stays inside, watching television and taking a nap. Dinner is served at 7 in the evening where he has to once again go down from his room in the second floor to the first floor in the dining room. His walk from his room in the second floor to the first floor and from his room to his bath room is basically all the exercise that he gets in a day because he gets tired easily and much movement and activity causes difficulty in breathing. Remarks: Activity intolerance related to imbalance between oxygen supply and demand. Fatigue related to disease state

SLEEP-REST PATTERN Mr. R. M gets an ample amount of sleep and rest in a day. He sleeps for 8-10 hours a night, from 9 in the evening to 7 in the morning. He also takes naps throughout the day from a couple of minutes to an hour, 2-3 times in a day. Although he gets an ample amount of sleep a day, the quality of sleep and rest he gets is poor due to the fact that he has difficulty breathing even during sleep. He wakes up from time to time and has to be in an upright position. Remarks: Disturbed sleep pattern related to shortness of breath COGNIVITVE-PERCEPTUAL PATTERN Mr. R.

M has always been a good student ever since he was a young boy until he finished his studies as a Commerce graduate from the University of Southern Philippines. The patient can comprehend and follow instructions. He can remember special dates relevant for himself and his family. He can feel soft touch, pressure, hot and cold, and pain. He is able to observe and use from both sides of his body. He is oriented to time, place and person. He is awake, aware and conscious. Remarks: readiness for enhanced knowledge SELF-PERCEPTION- SELF-CONCEPT PATTERN Mr. R. M. thinks he looks old and useless.

He believes that he is no longer of any use to his family. He thinks that he is a burden to his family because of his disease and sometimes wishes he never got the disease or for it to be over with so that his son can go on with his life and be with his wife in Manila instead of in Carcar taking care of him. He thinks that he looks awful and he is ashamed of going out to mingle with his family and friends because of how he looks now. Remarks: Situational low self-esteem related to disturbed body image. ROLE-RELATIONSHIP PATTERN Mr. R. M a father of two children.

His oldest, a boy which is taking care of him while managing a small eatery. A daughter, a nurse in California. He is and has been married for 39 years now since November 2, 1972. He has been an active part in his children’s parenting and was very close to the both of them, even when they got married they still stayed with him. He has been with his wife since high school but she is not living with him right now for she is in New York working as a care taker. His brothers and sisters live near him but is not very close with them anymore, they have had some issues due to the property left to the, by their parents.

He now only lives with his son and 3 grandchildren. He does is not active in taking care of his grand children and his outgoing and friendly demeanor has changed as well. He does not go out to walk with his relatives and neighbors, nor does he play chess and cards with his friends because he did not like to be seen while he was sick Remarks: Impaired social interaction related to self-concept disturbance. SEXUALITY-REPRODUCTIVE Mr. R. M. claimed that the only person that he has ever had sex with was his wife, who is also his high school girl friend. He and his wife had sex for the first time during their honeymoon.

He has produced 2 off springs with his wife. He claimed to never acquired any sexually transmitted disease. He has not been able to have sex with his wife for a long time now, he estimates it has been around 8 years since his wife is now in New York working to provide him and his son. Remarks: ineffective sexuality pattern related to lack of significant other. COPING-STRESS TOLERANCE Mr. R. M. states that he is tired from his disease and that sometimes he wishes that it would already end but he said that he would never think of ending his own life because of his fear in the Lord and being eternally damned.

He feels that he is becoming a big burden to his wife and son. He wishes that he could do more for his family despite of his disease. His wife and children has been very supportive of him and tries to cheer him up. When he gets to talk to his wife he feels better. When relative and friends come and visit him it also uplifts his spirit and makes him feel that even though he sometimes wishes that this would end, there is still a life worth living. Remarks: readiness for enhanced coping related to available support system. VALUE- BELIEF PATTERN Mr. R. M. is a Roman Catholic.

He prays every day when he wakes up and before he goes to sleep. He believes in God and that he has been very blessed with his life and family. Although he has a chronic disease that causes him to think negative thoughts at times, he still believes in what the Bible says and that his time will come, in God’s will his suffering will end. Remarks: Readiness for enhanced spiritual well-being. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN * Delivery: NSVD * No complications when she was pregnant. * Labored for 5 hours and gave birth to his son at Bacong health center by a midwife. * Complete immunization at Bacong health center. Had 2 previous hospitalizations, first was last 2007 for a Dengue case and second was last February 16, 2009 with a diagnosis of kidney infection * Heredofamilial disease of hypertension and heart failure. * Not using diapers. * Has not been been diagnosed with any forms of disease. * Lolo smokes and drinks around the patient * Patient hasn’t incurred any injury or falls. * Plays and collects toy trucks, robots. * If child is having fever, mother goes to the health center and asks for medication such as Biogesic, Tempra, Calpol. * Mother verbalized “dili kayo ni siya tig inom ug tubig. * Doesn’t use any herbal medication or preparation. * MOTHER’S GENERAL HEALTH STATUS * Stays in the house. * Single parent. * Doesn’t smoke and drink any alcoholic beverages. * Has no heredo-familial disease. NUTRITIONAL-METABOLIC PATTERN * Mother started breastfeeding right after birth until now. Drinks Bearbrand milk 5 times a day. * Has no discomfort in sucking milk. * No vitamins. * Mother verbalized “kusog siya mo kaon usahay, samot na kung karne and sud-an, pero kung dili, wala gyud pud. ” * Mother verbalized “kung tubu-an siya ug tango, dili na siya ganahan mu kaon. ” * No known allergies. Eats junk foods a lot. * Loves to drink soft drinks. * Doesn’t eat vegetables as claimed by mother. * Preferably eats meat, salty and sweet foods as claimed by grandmother. * Mother claimed that child eats with the family. * Breastfeeds 6-10 times a day. * Has absence of any lesions from skin. ELIMINATION PATTERN * BOWEL Frequency: 2-3 x/day Color: yellowish to brownish Consistency: hard stools Discomfort: Absent * URINE Frequency: 4-5 x/day Color: yellowish to brownish urine Discomfort: None Mother verbalized “wala ra man siya reklamo sauna nga sakit ipangihi. ” Lola verbalized, “dili gyud ni siya tig inom ug tubig. ” SWEAT Perspires a lot. * No complications at home.

ACTIVITY/ EXERCISE PATTERN * Mother is the one who bathes the child. * Bathes the chikd 3 times a day. Usually early morning, during lunch time and before going to sleep. * Shampoo: Palmolive * Soap: Palmolive * Toothpaste: Colgate * Mother verbalized “sige nako siya ug ilisan kay ug mag dula, singot man kaayo. ” * Changes clothes 3-4 times a day. * Watches TV, plays with cousins. * Easily cries. * Collects toy trucks. * Have many friends. * Lola verbalized, “sa balay sige ra ni ug mata ug sige ra ni ga dula. ” SLEEP-REST PATTERN * Onset: 8:00 PM * Awakening: 4:00 AM Mother verbalized “dalamanon pud ning bataa. Kusog kayo mangihi sa among higdaan. ” * Sleeping position: prone * No sleeping interruptions. * Sleeps with his mother. * Mother sleeps at around 8:30 PM and wakes up at 4:00 AM. COGNITIVE/ PERCEPTUAL PATTERN * Mother verbalized “tabian man ni siya kayo nga pagka bata. Samok man gain kayo usahay. ” * Responds to people and answers to people whenever asked. * Mother verbalized, “salaputon kayo ni siya, kada adlaw gyud dagway siya ga sapot. ” * Have many friends. * Plays with neighbors and cousins * Not afraid of animals. SELF-PERCEPTION-SELF-CONCEPT PATTERN Mother verbalized “palangga kayo namu ni akong anak. ” * Child is happy and jolly as claimed by mother. * Plays with his cousins and neighbors. * Easily cries if he is experiencing pain or when someone Teases him. * Mother verbalized, “salaputon kayo ni siya, kada adlaw gyud dagway siya ga sapot. ” * Have many friends. * Lola verbalized “mu hilak ni siya kung sunlugon siya. ” * Cries whenever his wants are not met. ROLE-RELATIONSHIP PATTERN * Baby lives with his lolo, lola, mother, aunt, cousin and his uncle. * Mother is a single parent. * Problems are usually on the financial aspect. * All in the family shows attention, care, love nd affection to the child. * Lola verbalized “palangga kaayo ni sya sa tanan. ” * Mother verbalized,  ‘mo duol ra man ni siya bisag kinsa, wala ra ni siyay pili. ” * Mother verbalized “close kaayo mi ani niya. ” * lola verbalized, “magdula na sila sa iyang mga cousins permi. ” * Mother verbalized “ug mag sapot siya,isuroy nako siya Sa Plaza. ” * Lola claimed that she watches over the child when Mother is not around. * Talks to child and spanks the child when he commits mistake. * Child has temper tantrums. * No problems with family relationships. * Has many close friends. SEXUALITY-REPRODUCTIVE PATTERN Only child in the family. * Gender: male * Uses male’s clothing. * No problems with reproductive system. * Mother has no problems with reproductive system. COPING STRESS TOLERANCE PATTERN * Mother claimed that when having problems, goes to mother and express anger or concerns. * Mother verbalized “effective kung naa mi problema, nya sturyahon ra namo, sigurado gyud nga ma sulbad ra. ” * Mother verbalized “mu hilak ra ni siya kung naa Masakitan siya. ” * When having problems, they stroll and relax. * Talks and asks advices from his mother if Encountering a problem. VALUE-BELIEF PATTERN * Mother claimed that he values her family

A lot, specially her child. * Values God. * Don’t believe in “binisaya” * Roman Catholic. * Prays to God. * Goes to church sometimes. E. Review of System-All Subjective Complaints Note: these statements were verbalized by the mother ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM Kidneys The kidneys are located in the back of the upper abdomen and are protected by the lower ribs and rib cartilage of the back. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.

Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney Ureters The ureters are two slender tubes that run from the sides of the kidneys to the bladder. Their function is to transport urine from the kidneys to the bladder. Bladder The bladder is a muscular organ and serves as a reservoir for urine. Located just behind the pubic bone, it can extend well up into the abdominal cavity when full. Near the outlet of the bladder is a small muscle called the internal sphincter, which contract involuntarily to prevent the emptying of the bladder.

In males, the bladder is superior to the prostate, and separated from the rectum by the rectovesical excavation. In females, the bladder is separated from the rectum by the rectouterine excavation, and it is separated from the uterus by the vesicouterine excavation. Urethra The urethra is a tube that extends from the bladder to the outside world. It is through this tube that urine is eliminated from the body. Kidneys The kidneys regulate the volume and concentration of fluids in the body by producing urine. Urine is produced in a process called glomerular iltration, which is the removal of waste products, minerals, and water from the blood. The kidneys maintain the volume and concentration of urine by filtering waste products and reabsorbing useful substances and water from the blood. The kidneys also perform the following functions: * Detoxify harmful substances (e. g. , free radicals, drugs) * Increase the absorption of calcium by producing calcitriol (form of vitamin D) * Produce erythropoietin (hormone that stimulates red blood cell production in the bone marrow) * Secrete renin (hormone that regulates blood pressure and electrolyte balance)

The kidneys are a pair of bean-shaped organs located below the ribs near the middle of the back. They are protected by three layers of connective tissue: the renal fascia (fibrous membrane) surrounds the kidney and binds the organ to the abdominal wall; the adipose capsule (layer of fat) cushions the kidney; and the renal capsule (fibrous sac) surrounds the kidney and protects it from trauma and infection. Parts of the Kidney * Kidneys – are bean-shaped organs, each about 4 to 5 inches (12 centimeters) long. One lies on each side of the spinal column, just behind the abdominal cavity, which contains the digestive organs. Renal artery – a branch of the aorta which carries blood into the kidney. * Renal vein – carries blood away from each kidney. * Nephrons – are microscopic units that filter the blood and produce urine. Each kidney contains about one million nephrons. * Glomerulus – filters blood; contain a network of tiny blood vessels known as capillaries. * Bowman’s capsule – a thin-walled, bowl-shaped structure. * Tubule – drains fluid (now considered urine) from the space in Bowman’s capsule. Each tubule has three interconnected parts: the proximal convoluted tubule, the loop of Henle, and the distal convoluted tubule. Collecting duct – drains urine from the tubule. * Cortex – outer part of the kidneys; Medulla – inner part of the kidneys; All glomeruli are located in the cortex, while tubules are located in both the cortex and the medulla. * Calix – a cuplike structure which collects urine from the collecting duct. * Renal pelvis – located near the hilus, collects the urine flowing from the calyxes BLOOD SUPPLY The kidneys continuously cleanse the blood and adjust its composition, so it is not surprising that they have a very rich blood supply.

Approximately one-quarter of the total blood supply of the body passes through the kidneys each minute. The arterial supply each kidney is the renal artery. As the renal artery approaches the hilus, it divides into segmental arteries. Once inside the pelvis, the segmental arteries break up into l arteries, each of which gives of several branches called interobar arteries, which travel through the renal columns to reach the cortex. At the medullary-cortex junction, interlobar arteries give off the arcuate arteries, which curve over the medullary yraids.

Small interobar arteries then branch off the arcuate and run outward to supply the cortex tissue. Venous blood draining from the kidney flows through veins that trace the pathway of the arterial supply but in reverse direction-interlobular veins to arcuate veins to interlobar veins to the renal vein, which emerges from the kidney hilus. (There are no lobar or segmental veins) Process of Filtration and Excretion Water and Electrolyte Balance: Blood travels to each kidney through the renal artery, which enters the kidney at the hilus , the indentation in the kidney that gives it its bean shape.

Blood flows from the renal artery into progressively smaller arteries, the smallest being the arterioles. From the arterioles, blood flows into glomeruli, which are tufts of microscopic blood vessels called capillaries. Blood exits each glomerulus through an arteriole that connects to a small vein. The small veins join to form a single large renal vein, which carries blood away from each kidney. Blood enters a glomerulus at high pressure. Much of the fluid part of blood is filtered through small pores in the glomerulus, leaving behind blood cells and most large molecules, such as proteins.

The clear, filtered fluid enters Bowman’s space and passes into the tubule leading from Bowman’s capsule. In healthy adults, about 47 gallons (180 liters) of fluid is filtered into the kidney tubules each day. Nearly all this fluid (and the electrolytes contained in it) is reabsorbed by the kidney; only about 1. 5 to 2% is excreted as urine. For this reabsorption to occur, different parts of the nephron actively secrete and reabsorb different electrolytes, which pull the water along, and other parts of the nephron vary their permeability to water, allowing more or less water to return to the circulation.

The fluid filtered from the blood by the glomerulus then travels down a tiny tube-like structure called a tubule, which adjusts the level of salts, water, and wastes that are excreted in the urine. In the first part of the tubule (the proximal convoluted tubule) most of the sodium, water, glucose, and other filtered substances are reabsorbed and ultimately returned to the blood. In the next part of the tubule (the loop of Henle), sodium, potassium, and chloride are pumped out; thus the remaining fluid becomes increasingly dilute.

The dilute fluid passes through the next part of the tubule (the distal convoluted tubule), where most of the remaining sodium is pumped out in exchange for potassium and acid, which are pumped in. Fluid from the tubules of several nephrons enters a collecting duct. In the collecting ducts, the fluid may remain dilute, or water can be absorbed from the fluid and returned to the blood, making the urine more concentrated. Water reabsorption is regulated by antidiuretic hormone (produced by the pituitary gland) and other hormones.

These hormones help to regulate kidney function and control urine composition to maintain body water and electrolyte balance. While the blood is in the kidneys, water and some of the other blood components (such as acids, glucose, and other nutrients) are reabsorbed back into the bloodstream. Left behind is urine. Urine is a concentrated solution of waste material containing water, urea (a waste product that forms when proteins are broken down), salts, amino acids, by-products of bile from the liver, ammonia, and any substances that cannot be reabsorbed into the blood.

Urine also contains urochrome, a pigmented blood product that gives urine its yellowish color. The urine drains from the collecting ducts of many thousands of nephrons into a cuplike structure (calix). Each kidney has several calices, all of which drain into a single central chamber (renal pelvis). Urine drains from the renal pelvis of each kidney into a ureter and into the bladder. The urine is ejected from the bladder and out of the body through the urethra. The male urethra ends at the tip of the penis; the female urethra ends just above the vaginal opening. FLUID PRESSURES

Body fluids shift between the interstitial space and the vascular space in the capillary as a result of differences in the hydrostatic pressure and the oncotic (colloid osmotic) pressure. Hydrostatic pressure is pressure due to water volume in the vessels. Oncotic pressure is the pressure exerted by plasma proteins. Filtration occurs at arterial ends of the capillaries because the hydrostatic pressure is greater than the oncotic pressure. Therefore, is pushed out of the vessels into tissue space. At the venous end of the capillary, the oncotic pressure, and fluid is pulled back into the capillary from the interstitial space.

There are some conditions in which this system does not work smoothly and fluid remains in the tissue spaces. When there is a low level of plasma/serum protein, oncotic pressure in the vascular fluid is decreased and less water is absorbed into the vascular space. Likewise, when the hydrostatic pressure is high because of fluid overload, the pressure gradient opposes fluid reabsorption into the venous end of the capillary. The functions of water are numerous, and without sufficient water, cells of the body deteriorate and life cannot be sustained

Kidneys are complex organs whose primary task is to remove wastes, excess fluid and unneeded electrolytes from your body. Any condition that interferes with kidney function can lead to a potentially dangerous buildup of waste products in your bloodstream. Glomerulonephritis is a type of kidney disease that hampers the kidneys’ ability to remove waste and excess fluids. Also called glomerular disease, glomerulonephritis can be acute, referring to a sudden attack of inflammation, or chronic, which comes on gradually.

Acute glomerulonephritis refers to a specific set of renal diseases in which an immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, mesangium, or capillary endothelium. The damaged glomeruli cannot effectively filter waste products and excess water from the bloodstream to make urine. The kidneys appear enlarged, fatty, and congested. Acute glomerulonephritis is defined as the sudden onset of hematuria, proteinuria, and red blood cell casts. This clinical picture is often accompanied by hypertension, edema, and impaired renal function.

CAUSES OF AGN: * Streptococcal infection of the throat ( strep throat ) or skin ( impetigo) * Hereditary diseases * Immune diseases, such as lupus * Type 1 diabetes and Type 2 diabetes * High blood pressure * Vasculitis (inflammation of the blood vessels) * Viruses ( HIV , hepatitis B virus , and hepatitis C virus) * Endocarditis (infection of the valves of the heart) RISK FACTORS: Risk factors for glomerulonephritis include: * Family history of glomerulonephritis * The presence of a known cause of glomerulonephritis SIGNS AND SYMPTOMS OF AGN: fatigue * nausea and vomiting * shortness of breath * disturbed vision * high blood pressure * swelling, especially noted in the face, hands, feet, and ankles * blood and protein in the urine, resulting in a smoky or slightly red appearance DIAGNOSIS: * Urinalysis—test to look for blood, protein, bacteria, and other evidence of kidney damage in the urine * Blood tests—tests to check how well the kidneys are functioning and to look for medical conditions that may be causing glomerulonephritis * Ultrasound —a test that uses sound waves to reate images of the kidneys * Abdominal CT scan —a type of x-ray test that uses a computer to create detailed images of the structures of the abdomen and kidneys * Kidney biopsy—removal of a sample of kidney tissue with a needle to test for glomerulonephritis MANAGEMENT: The main objectives in the treatment of acute glomerulonephritis are to: * decrease the damage to the glomeruli * decrease the metabolic demands on the kidneys * improve kidney function DIETARY MANAGEMENT In order to rest the kidney during the acute phase, decreased sodium and protein intake may be recommended.

This diet avoids protein catabolism and allows the kidney to rest because it handles fewer protein molecules and metabolites. The amount of protein allowed is dependent upon the amount lost in the urine, and the requirements of the individual patient. Sodium limitations depend on the amount of edema present. Fluid restrictions are adjusted according to the patient’s urinary output and body weight. Complications: 1. Acute kidney Failure Acute kidney failure is the sudden loss of the kidneys’ ability to perform their main function — eliminate excess fluid and waste material from the blood.

When the kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in the body. It can be serious and generally requires intensive treatment. Unlike the chronic form, however, acute kidney failure is reversible and if in good health, kidneys will function within a few weeks. If acute kidney failure occurs in the context of severe chronic illness — a heart attack, stroke, overwhelming infection or multiorgan failure — the outcome is often worse. * Signs and symptoms: Decreased urine output, although occasionally urine output remains normal * Fluid retention, causing swelling in the legs, ankles or feet * Drowsiness * Shortness of breath * Fatigue * Confusion * Seizures or coma in severe cases * Chest pain related to pericarditis, an inflammation of the sac-like membrane that envelops your heart * Screening and diagnosis: If the doctor suspects acute kidney failure, he or she is likely to order urine and blood tests to check for chemical abnormalities such as increased levels of urea, creatinine and potassium. The doctor may measure both the quantity and quality of your urine output. Treatment: The first goal is to treat the illness or injury that originally damaged the kidneys. Once that’s under control, the focus will be on preventing the accumulation of excess fluids and wastes in your blood while the kidneys heal. This is best accomplished by limiting fluid intake and following a high-carbohydrate, low-protein, low-potassium diet. The doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate) to prevent the accumulation of high levels of potassium in the blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias).

Dialysis Most of the time, dialysis is required to help remove toxins and excess fluids from the body. Dialysis is a mechanical way of filtering waste from your blood. It can replace the function of the kidneys. Dialysis treatment for acute kidney failure is usually done at a hospital or dialysis center, not at home. 2. Chronic Kidney Failure Chronic kidney failure usually develops slowly, with few signs or symptoms in the early stages. Many people with chronic kidney failure don’t realize they have a problem until their kidney function has decreased to less than 25 percent of normal.

High blood pressure and diabetes are the most common causes of chronic kidney failure. The main goal of treatment of chronic kidney failure is to halt or delay progression of the disease. Chronic kidney failure can progress to end-stage kidney disease, where the kidneys function at a fraction of normal capacity. At this point, either artificial filtering (dialysis) or a kidney transplant will be required. * Signs and Symptoms: * High blood pressure * Unexplained weight loss * Anemia * Nausea or vomiting * A general sense of discomfort and unease (malaise) * Fatigue * Headaches that seem unrelated to any other cause Decreased mental sharpness * Muscle twitches and cramps * Bloody or tarry stools, which could indicate bleeding in your intestinal tract * Yellowish-brown cast to your skin * Persistent itching 3. Nephrotic Syndrome This is a group of signs and symptoms that may accompany glomerulonephritis and other conditions that affect the filtering ability of the glomeruli. Nephrotic syndrome is characterized by high protein levels in the urine, resulting in low protein levels in the blood, high serum cholesterol, and swelling of the eyelids, feet and abdomen. * Symptoms * Swelling (edema ) general * around the eyes * in the extremities, especially the feet and ankles * Swollen abdomen * Foamy appearance of the urine * Weight gain (unintentional) from fluid retention * Poor appetite * High blood pressure Prognosis: In acute glomerulonephritis, symptoms usually subside in two weeks to several months, with 90% of children recovering without complications and adults recovering more slowly. PREVENTION: Prevention of glomerulonephritis is best accomplished by avoiding upper respiratory infections, as well as other acute and chronic infections, especially those of a streptococcal origin.

Cultures of the infection site, usually the throat, should be obtained and antibiotic sensibility of the offending organism determined. Prompt medical assessment for necessary antibiotic therapy should be sought when infection is suspected. The use of prophylactic immunizations is recommended as appropriate. PHARMACOLOGIC MANAGEMENT Antibiotic therapy is essential for management of underlying infections, which may be contributing to on-going antigen-antibody responses. Iron and vitamin supplements may be ordered if anemia develops.

Corticosteroids decreases antibody synthesis and suppress inflammatory responses thus preventing further glomerular damage. Volume overload and hypertension are treated with diuretics and antihypertensive drugs. DRUG STUDIES List of Medications prescribed: * Cefuroxime 325 mg IVTT q 6 hours ANST (-) * Paracetamol 120mg/5ml, 6ml q 4 hours * Mltivitamins +fe 1 tsp OD * Captopril 25 mg/tab, ? tab OD CAPTOPRIL Generic name: Captopril Brand name: Capoten Classification: ACE Inhibitor INDICATIONS: * Hypertension * Diabetic nephropathy * Heart failure * Left ventricular dysfunction after acute MI ACTION:

Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure. Dosage: Captopril 25 mg/tab ? tab OD ADVERSE REACTIONS CNS: dizziness, fainting, headache, malaise, fatigue, fever. CV: tachycardia, hypotension, angina pectoris. GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysgeusia, nausea, vomiting. Hematological: leucopenia, agranulocytosis, thrombocytopenia, pancytopenia, anemia.

Metabolic: hyperkalemia. Respiratory: dry, persistent, nonproductive cough, dyspnea. Skin: urticarialrash, maculopapular rash, pruritus, alopecia. Other: angioedema. CONTRAINDICATIONS & CAUTIONS * Contraindicated in patients hypersensitive to drug or other ACE inhibitors. * Use cautiously in patients with impaired renal function or serious autoimmune disease, especially systemic lupus erythemaotus, and in those who have been exposed to other drugs that affect WBC counts or immune response. NURSING CONSIDERATIONS: * Monitor patient’s blood pressure and pulse rate frequently. Alert: Elderly patients may be more sensitive to drug’s hypotensive effects. * Assess patient for signs of angioedema. * Drug causes the most frequent occurrence of cough, compared with other ACE inhibitors. PATIENT TEACHING: * Instruct patient to take drug 1 hour before meals; food in the GI tract may reduce absorption. * Inform patient that light-headedness is possible, especially during first few days of therapy. Tell him to rise slowly to minimize this effect and to report occurrence to prescriber. If fainting occurs, he should stop drug and call prescriber immediately. * Tell patient to use caution in hot weather and during exercise.

Lack of fluids, vomiting, diarrhea, and excessive perspiration can lead to light-headedness and syncope. * Advise patient to report signs and symptoms of infection, such as fever and sore throat. * Urge patient to promptly report swelling of the face, lips, or mouth, or difficulty breathing. PARACETAMOL Generic name: Paracetamol Brand name: Tempra Classification: paraaminophenol derivative INDICATIONS: * Mild pain or fever ACTION: Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandid in the CNS or of other substances that sensitize pain receptors to stimulation.

The drug may relieve fever through central action in the hypothalamic heat-regulating center. ADVERSE REACTIONS Hematologic: hemolytic anemia, leucopenia, neutropenia, pancytopenia. Hepatic: jaundice. Metabolic: Metabolic: hypoglycemia. Skin: rash, urticaria. Dosage: Paracetamol 120 mg/5 ml 60 ml q4h PRN for T 38 C. NURSING CONSIDERATIONS: * Use liquid form for children and patients who have difficulty swallowing. * In children, don’t exceed five doses in 24 hours. PATIENT TEACHING: * Tell parents to consult prescriber before giving drug to children younger than age 2. Advise parents that drug is only for short-term use; urge them to consult prescriber if giving to children for longer than 10 days. * Tell patient not to use for marked fever(temperature higher than 103. 1’F [39. 5’C]), fever persisting longer than 3 days, or recurrent fever unless directed by prescriber. FERROUS FUMARATE Generic name: Ferrous fumarate Brand name: Femiron Classification: hematinic INDICATIONS: * Iron deficiency ACTION: Provides elemental iron, an essential component in the formation of hemoglobin. CONTRAINDICATIONS & CAUTIONS: Contraindicated in patients with primary hemochromatis or hemosiderosis, hemolytic anemia (unless patient also has iron deficiency anemia), peptic ulcer disease, regional enteritis, or ulcerative colitis. * Contraindicated in those receiving repeated blood transfusions. * Use cautiously on long-term basis. Dosage: Multivitamins with Fe I tsp OD. NURSING CONSIDERATIONS: * GI upset may be related to dose. * Between-meal doses are preferable, but drug can be given with some foods, although absorption may be decreased. * Check for constipation; record color and amount of stools. Monitor hemoglobin level, hematocrit, and reticulocyte count during therapy. PATIENT TEACHING: * Tell patient to take tablets with juice (preferably orange juice) or water but not with milk or antacids. * Tell patient to take suspension with straw and place drops at back of throat to avoid staining teeth. * Advise patient not to substitute one iron salt for another; the amount of elemental iron may vary. * Advise patient to report constipation and change in stool color or consistency. CEFUROXIME EXETIL Generic name: Cefuroxime Exetil Brand name: Zinacef Classification: Second-generation cephalosporin Indications:

Serious lower respiratory tract infection, UTI, skin or skin structure infections, bone or joint infection, septicaemia, meningitis and gonorrhea, acute bacterial maxillary sinusitis, pharyngitis and tonsillitis, otitis media, uncomplicated UTI Action: second-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability, usually bactericidal. Adverse Reactions: CV: phlebitis, thrombophlebitis GI: diarrhea colitis, nausea, anorexia, vomiting Hematologic: haemolytic anemia, thrombocytopenia, eosinophilia Skin: maculopapular and erythematous rashes, urticaria, pain, temperature elevation

Contraindications: * Contraindicated in patients hypersensitive to the drug or other cephalosporins. * Use cautiously in patient hypersensitive to penicillin because of possibility of cross-sensitivity with other beta lactam Nursing Considerations: * Before giving drug, ask patient if he is allergic to penicillins or cephalosporins. * Obtain specimen for culture and sensitivity tests before giving first dose. * Absorption of oral drug is enhanced by food. * Monitor patients for signs and symptoms of superinfection. Patient teachings: * Tell patient to take drug as prescribed, even after he feels better. Instruct patient to notify prescriber about rash, loose stools, diarrhea, and evidence of superinfection. * Advise patient receiving drug IV to report discomfort at IV insertion site. MEDICAL MANAGEMENT Acute glomerulonephritis is usually self-limiting, so management is aimed at treating symptoms, preservingkidney function and treating complications promptly. Pharmacologic treatment depends on a case-to-case basis. If there is residual streptococcal infection, then penicillin is thedrug of choice; however, other antibiotics can also be given. Loop diuretics and antihypertensives are used to controlhypertension.

Sodium is restricted, as is fluid intake becauseof fluid volume excess. Carbohydrates are given liberally to provide energyand to reduce catabolism of proteins. As for proteins, thereare two schools of thought: dietary restriction or increasedintake. Dietary restriction is merited only when there isnitrogen retention (elevated BUN) and/or renal insufficiency. However, due to albuminuria, the client loses more proteinsthan can be replaced. Hence, most diets would include foodshigh in albumin and other complete proteins, such as eggwhites and dairy products Full low sat diet is prescribed by physician in order not to aggravate client’s condition having a c/c of edematous face and extremities with tea-colored urine. * Constant monitoring of v/s especially BP determines any deviation that may indicate complication/s for immediate interventions. * Lab exams such as the CBC, UA, BUN, and Creatinine assists in proper diagnosis of the patient’s condition. * Replenishes lost fluid and electrolytes brought about by fever of patient. Since he is unable to tolerate oral medications, IV is the best route for medication administration. Pharmacologic interventions provide immediate relief to Daniel’s discomforts. Paracetamol, anti antipyretic, for his fever and Cefuroxime, an antibiotic, to treat his infection, multivitamins + fe treat anemia, Captopril for his renal hypertension. MIO determines the total amount of fluid intake and output of patient. Also determines Daniel’s reactions and tolerance to administered medication. SURGICAL MANAGEMENT Surgery is not used to treat glomerulonephritis. If the kidney is abscessed or completely destroyed, a nephrectomy may be performed. NURSING MANAGEMENT

Nursing interventions focuses on decreasing discomfort, reducing complications, and providing patient education. It is ideal to work with the client in developing a schedule for daily hygiene that limits fatigue and over exertion. Cluster care to provide for rest periods, and assist the patient with relaxation techniques. Assist children with the usual bedtime rituals, increase activity gradually as symptoms subside. While on bed rest, assist the patient to a new position every 2 hours. Changing the patient’s position prevents pulmonary complications. Appropriate fluid balance is important.

Daily monitoring of weight, intake, and output helps determine the progress of the edema and thus provides an estimate of renal function. Daily measuring of edematous parts also provides useful, objective data. To ensure patient’s compliance with the prescribed dietary management, it is the nurses responsibility to inform and instruct the patient and S. O. regarding fluid and nutritional requirements. Summary of Nursing Care Plans 1. Altered comfort pain related to urine retention secondary to the disease process 2. Fatigue related to presence infection secondary to disease process 3.

Risk for Altered Nutrition: Less than body requirements related to decreased appetite secondary to the disease process #1 Altered comfort: Pain related to urine retention secondary to disease process Cues & Evidences: Subjective: * Mother verbalized “gareklamo man ni siya nga sakitan siya pag mangihi siya. ” * Lola verbalized “mo ingon gyud siya nga yayay iyang tiyan. ” * Mother verbalized “mag kulismaot gyud iyang nawong kung mangihi siya. Objective: * Vital signs: T = 37. 2°C PR = 128 bpm strong and regular RR = 28 cpm regular and effortless BP = 90/60 mmHg * Abdominal guarding noted. Facial grimacing noted when child urinates. * Irritability noted * Loss of appetite * Perspires a lot. * URINALYSIS 02/23/09 Color: brown yellowWBC: 20,200 Transparency: turbidNeutrophils: 61 Sp. Gravity: 1. 030Lymphocytes: 27 Protein: #2Monocyes: 6 pH: 6. 0Eosinophils: 5 Microscopic examination:Basophils; 1 Pus cells: 70-90/hpfPlatelet: 498,000 RBC: TNTC Epith. Cells: rare Amorph Urates: rare Bacteria: few CBC 02/23/09 Hemgloboin: 7. 5 Hematocri: 21. 9 Objectives: At the end of our 1 day care, patient will verbalize adequate relief of pain as evidenced by: 1. Vital signs will be in a normal range especially his blood pressure. . Laboratory exams results will return to normal levels. 3. Pain is relieved or controlled. 4. Absence of facial grimacing. 5. Absence of abdominal guarding. 6. Irritability will be reduced or lessened. 7. Increase willingness to eat. INTERVENTIONS: Independent: * Assess and monitor vital signs every 4 hours or as frequent as possible. According to Betty Neuman, a person is a dynamic composite of physiological, sociocultural and developmental variables functioning as an open system which interacts with, adjusts to, and is adjusted by the environment, which is viewed as a stressor and stressors disrupt the system.

So a change in vital signs would mean that there is a disruption in a person’s normal functioning or system so assessing the vital signs would serve as baseline data for the patient. * Instruct patient too report pain. According to Imogene King, the nurse-client relationship is a vehicle for nursing in which the nurse and the client is affected by each other’s behaviour. Instructing the patient to verbalize any pain he is experiencing would signal the nurse to institute relief measures because each affects the other. * Eliminate additional stressors or sources of discomfort whenever possible.

According to Dorothy Johnson, the nurse must reduce the stress the client is experiencing so the client can move more easily through the recovery process. It is said that patients may experience exaggeration in pain or a decreased ability to tolerate painful stimuli if environmental, intrapersonal, or intrapsychic factors are further stressing them. * Provide toys, games for quiet play. According to Hildegard Peplau, nursing is a significant, therapeutic and interpersonal process that functions to help on the reduction of tension, stress and frustration. It aims to provide creative, constructive, productive, personal living.

Providing toys for the patient reduces tensions and stresses he is experiencing as well as distracting his attention from the pain he is experiencing. * Provide rest periods to facilitate comfort, sleep and relaxation. According to Florence Nightingale, the nurse should facilitate the body’s reparative process by manipulating the client’s environment to include appropriate noise, light, comfort, socialization and hope. And also the patient’s experiences of pain may become exaggerated as a result of fatigue. So a quiet environment and a darkened room are measures geared toward facilitating rest. Provide non pharmacologic pain management strategy such as soothing bed bath. According to Lydia Hall, the goal of nursing is to provide care and comfort for the client during the disease process. The nurse acts as a care giver to the patient so providing non-pharmacologic interventions such as a soothing bed bath can reduce perceptions of pain and may foster a sense of control and care for the patient. Collaborative: * Anticipate needs of analgesics or additional methods of pain relief. According to Joyce Travelbee, the nurse must assist the individual to cope with illness, regain health and attain maximal level of health.

She emphasizes that a nurse should empathize, sympathize to what the patient is going through during the illness. So as a nurse we should direct early interventions may decrease to total amount of analgesic required since one can most effectively deal with pain by preventing it. * Give analgesics as ordered. According to Myra Estrine Levine, a nurse should be supportive or therapeutic to help the individual for the fast recovery from illness. Administering pain medications would aid in the fast recovery of health of the patient and with that, we can evaluate its effectiveness or for any untoward response to the body. Apply heat or cold compress as ordered. According to Betty Neuman, the nurse must assist an individual to attain level of wellness and comfort by means of purposeful interventions such applying hot moist compresses on the affected area to have a penetrating effect. The warmth rushes to the blood to the affected areas to promote healing while cold compresses may reduce local edema and promote some numbing, thereby promoting comfort. EVALUATION: At the end of our 1 day care, patient manifested relief of pain as evidenced by: * Partially met. Vital signs T = 37. 3°C PR = 128 bpm strong and regular RR = 28 cpm regular and effortless

BP = 130/90 mmHg. * Met-Laboratory abnormal results decresed. CBC 02/27/09 Hemgloboin: 7. 9 Hematocri: 23. 7 WBC: 8,700 Neutrophils: 42 Lymphocytes: 47 Monocyes: 6 Eosinophils: 5 Basophils; 5 Platelet: 462,000 * Met- patient verbalized “wala na ga yayay ang akong tiyan ron ma. ” * Met- absence of facial grimacing noted and abdominal guarding. Child is cheerful and playful especially to student nurses. * Met-Child was more friendly and enthusiastic to student nurses assigned to him. * Met-patient was able to consume ? of his meal share. #2 Fatigue related to presence of infection secondary to disease process.

Cues & Evidences: Subjective: * Mother verbalized “ga luya man ni siya anang nag sakit siya. ” * Lola verbalized, “na puyo ni siya, imbis lihok man unta ni kayo. Sige ra man unta ni siya ug dalagan. ” * Lola verbalized “ni ingon siya nako ganina nga dili sa siya mo kaon kay kapoy pa kuno. ” Objective: * Vital signs: T = 37. 2°C PR = 128 bpm strong and regular RR = 28 cpm regular and effortless BP = 90/60 mmHg * Laboratory exams: URINALYSIS 02/23/09 Color: brown yellow Transparency: turbid Sp. Gravity: 1. 030 Protein: #2 pH: 6. 0 Microscopic examination: Pus cells: 70-90/hpf RBC: TNTC Epith.

Cells: rare Amorph Urates: rare Bacteria: few CBC 02/23/09 Hemgloboin: 7. 5 Hematocri: 21. 9 WBC: 20,200 Neutrophils: 61 Lymphocytes: 27 Monocytes: 6 Eosinophils: 5 Basophils; 1 Platelet: 498,000 * Aided by grandmother or mother when urinating, eating and changing. * Appears weak as noted. * Perspires a lot. * Has decreased appetite especially when served with food appropriate for his condition. * Skin appears yellowish with good capillary refill and skin turgor. * Stays inside the crib most of the time. * Irritable as noted. * Tiredness is evident. * Refuses to participate in nurses procedures. Cries easily as noted. Objectives: At the end of our care, the patient will have increased energy and be able to participate actively in normal activities as evidenced by: 1. Vital signs within the normal range especially blood pressure. 2. Can demonstrate self-care like urinating, feeding and changing his clothes all by himself. 3. Verbalization of wanting to stroll at the bridge area. 4. Absence of irritability. 5. Absence of weariness should be evident. 6. Shows willingness to participate in nurses procedures (like in vital signs taking). 7. Displays increase willingness to eat his meals. 8.

Skin appears well hydrated with good capillary refill and skin turgor. INTERVENTIONS: * Assess and monitor vital signs every 4 hours or as frequent as possible. According to Betty Neuman, a person is a dynamic composite of physiological, sociocultural and developmental variables functioning as an open system which interacts with, adjusts to, and is adjusted by the environment, which is viewed as a stressor and stressors disrupt the system. So a change in vital signs would mean that there is a disruption in a person’s normal functioning or system so assessing the vital signs would serve as baseline data for the patient. Assess patient for activity tolerance. According to Betty Neuman, health undergoes constant change and conditions and functions of these should be provided with appropriate interventions so assessing the activity tolerance of the patient can provide baseline information so that identification may be planned. Elevations in pulse, blood pressure, and respiratory rate may indicate physiologic intolerance of activity. * Provide period of rest and sleep with a quiet environment. Provide rest periods between care activities.

This helps to facilitate maintenance of rest, provision of quiet environment aids in client’s wellness and it also prevents excess fatigue because according to Florence Nightingale, the manipulation of the environment contributes to the client’s health. * Increase activity and patient participation gradually. According to Myra Estrine Levine in her Conservation model, the goal of nursing is to promote adaptation and maintenance of wholeness so gradual and steady patient participation can increase level of adaptation of client thereby providing time to build up tolerance, and increases self-esteem Discuss with the patient and the family the importance of activity, planning schedules with alternating rest and activity and methods of conserving energy. According to Peplau, nursing is an educative instrument, a maturing force that aims to promote forward movement of personality and through giving the parents such information may facilitate motivation to increase level knowing that decreased energy will be expended and he will be able to accomplish more activity. EVALUATION: At the end of our 1 day care, the patient manifested increased energy as evidenced by: Partially met- Vital signs T = 37. 3°C PR = 128 bpm strong and regular RR = 28 cpm regular and effortless BP = 130/90 mmHg. * Partially met- child was able to feed himself alone but was still assisted by grandmother when urinating and changing. * Met- child and student nurses strolled at the bridge area 3 times * Met-Child was more friendly and enthusiastic to student nurses assigned to him. * Partially met- child participated when he was given morning care by student nurses but still cries and resists having his vital signs taken. * Partially met- child was able to consume ? f his meal share. * Partially met- Skin appears slightly pale with good capillary refill and skin turgor. #3 Risk for altered nutrition less than body requirements related to decrease appetite secondary to disease process Cues & Evidences: Subjective: * Grandmother verbalized, “ginagmay ra jud ni siya sige ginakaon bisan sa balay mi. ” * Mother verbalized, child has voided tea-colored urine accompanied by pain upon urination PTA. * Mother further verbalized, “dili gyud ni siya makalibang kada adlaw ug kung makalibang man, ginagmay ra. * Preferably eats meat, salty and sweet foods as claimed by grandmother. Objective: * Vital signs: T = 37. 2°C PR = 128 bpm strong and regular RR = 28 cpm regular and effortless BP = 90/60 mmHg * URINALYSIS 02/23/09 Color: brown yellow Transparency: turbid Sp. Gravity: 1. 030 Protein: #2 pH: 6. 0 Microscopic examination: Pus cells: 70-90/hpf RBC: TNTC Epith. Cells: rare Amorph Urates: rare Bacteria: few CBC 02/23/09 Hemgloboin: 7. 5 Hematocri: 21. 9 WBC: 20,200 Neutrophils: 61 Lymphocytes: 27 Monocytes: 6 Eosinophils: 5 Basophils; 1 Platelet: 498,000 Full low salt diet * Observed grandmother offering coffee to the child even contraindicated. * Current weight: 13 kgs. * Urinated 5x with tea-colored foul smelling urine. * Dental caries present on both upper and lower teeth. * Observed to be drinking only few sips of water. * Usually says “NO” when eating time. * Has decreased appetite especially when served with food appropriate for his condition. * Skin appears yellowish with good capillary refill and skin turgor. Objectives: At the end of our 1 day care client will experience balanced nutrition as evidenced by: 1.

Vital signs will be in a normal range especially his blood pressure. 2. Laboratory exams results will return to normal levels. 3. Experience adequate intake of appropriate nutrients for normal growth and development. 4. Family members will verbalize increase food intake of client. 5. Skin appears well hydrated with good capillary refill and skin turgor. 6. Mucous membranes appears pinkish 7. Family or significant others choose and offer appropriate food for the child. 8. Will urinate clear yellowish and non-foul. 9. Absence of discomforts during urination INTERVENTIONS: Independent: * Assess vital signs.

According to Betty Neuman, a person is a dynamic composite of physiological, sociocultural and developmental variables functioning as an open system which interacts with, adjusts to, and is adjusted by the environment, which is viewed as a stressor and stressors disrupt the system. baseline data for the patient. * Assess history of food intake. According to Virginia Henderson, one of the persons needs is adequate nutrion, so a nurse must be mindful in assessing the intake of the child toprovide information needed to evaluate nutritional pattern, habits and adequacy and also to assist the sick child for its fast recovery. Place child in position of comfort for feeding. Place child within an easy reach of food. According to Florence Nightingale, a nurse should manipulate the client’s environment to include noise, comfort, nutrition and hygiene for the body’s reparative process. Providing most appropriate position of the child enhances movement of solid food by gravity and peristalsis, prevents vomiting and aids in increasing its appetite. * Instruct parents to use flavouring agents such as lemons during meals.

According to Ida Orlando, the nurse should interact with the client and his family to meet the immediate need for help. In our case instructing parents to use flavouring agents could enhance the child’s food satisfaction and stimulate appetite. * Teach parents to avoids sugar and salts in diet; offer nutritious between-meal snacks. According to Martha Rogers, the goal of nursing is to promote and maintain health, prevent illness and care for and rehabilitate the sick. Teaching the proper nutritional intake for their child educates them maintaining and promoting the health status of the child. Promote a pleasant and relaxing environment for the child during meals and prevent or minimize unpleasant odors and sights According to Florence Nightingale, the nurse should facilitate the body’s reparative process by manipulating the client’s environment to include appropriate noise, light, comfort, socialization and hope. So providing a pleasant environment could enhance child’s food intake and minimize negative effect on appetite or eating. * Teach about proper preparation and storage of foods; hand wash before preparing or handling food.

According to Joyce Travelbee, the nurse must assist an individual and the family prevent and cope with illness and maintain the highest maximal degree of health. So educating the family on proper food handling and storage prevents spoiling and contamination of foods that may cause gastrointestinal symptoms or problems. * Provide good oral care as necessary. According to Dorothea Orem, the nurse assists the individual in the provision, support and management of self-care to maintain and improve human function at some level of effectiveness.

Providing the child good oral hygiene would aid in increasing his appetite and as well as promoting comfort. Collaborative: * Initiate and monitor IV administration of nutrients as prescribed. According to Faye Glenn Abdellah’s 21 nursing problems, the nurse must facilitate the maintenance of fluid and electrolyte balance in the body of the patient so by providing and monitoring the IV of the patient provides short term fluid and nutritional support via peripheral vein. * Administer vitamins/mineral supplements as prescribed.

According to Virginia Henderson, the nurse must work interdependently with other health care workers to assist the client gain health as quickly as possible and in gaining the strength he lacks so administering vitamins and supplements provides or replaces the necessary substances that may be deficient if absorption is impaired, reduces peristalsis and infectious process affective nutritional status. Evaluation: At the end of our 1 day care, the client manifested improved nutritional intake as evidenced by: * Partially met- Vital Signs: T = 37. 3°C

PR = 128 bpm strong and regular RR = 28 cpm regular and effortless BP = 130/90 mmHg * Laboratory results: CBC 02/27/09 Hemogloboin: 7. 9 Hematocri: 23. 7 WBC: 8,700 Neutrophils: 42 Lymphocytes: 47 Monocytes: 6 Eosinophils: 5 Basophils; 5 Platelet: 462,000 * Met- Has improved appetite, able to consume half of his share for every meal. * Partially met- Skin appears slightly pale with good capillary refill and skin turgor * Partially met- Mucous membranes appears slightly pale * Met- Family verbalized importance of child’s diet and increase fluid intake. Partially met- Voided 8x with brownish yellow urine. * Met- No complaints of any discomforts during urination. * Met- increased fluid intake and energy level. INTAKE: 430 ml OUTPUT: 280 ml DISCHARGE PLANNING * Exercise / Environment Patient should not do strenuous activities, walking will do. Advice patient & her family to try to have or maintain safe, clean, comfortable & calm environment. * Treatment Ensure follow up & self care. Advice patient & family to take in time prescribed medicines. Ensures dietary restrictions on salt. * Health teaching/ Hygiene

Describe to the patient signs & symptoms to be reported immediately (eg. Blood in the urine, foamy urine, swelling on the face, legs & abdomen) Advice to immediately consult physician if signs and symptoms of the disease persists. Remind the patient & family of the check-up schedules & appointments. * Diet Assure low sodium, low protein diet. Limitation of fluid & salt intake. READINGS & UPDATES ON DISEASE Kidney Donation Keeps Band Playing Members of a musical group often share many things, but they don’t usually share organs.

That changed last month for Barb Sellman, singer and guitarist in local band North of the Border, when she gave one of her kidneys to improve the life of her bandmate and friend Al McKenzie. North of the Border is a five-member country and classic rock group that formed four years ago. Through the group, Sellman got to know McKenzie, and the two bonded over a love of music and performing before she learned of his kidney disease. “When I first met Al, I didn’t realize how sick he was,” said Sellman. Even when he started dialysis, we could see that he was still struggling. We’d play a gig and it would tire him out – sometimes he wouldn’t be able to play through until the end of the night. ”   Sellman explained that as McKenzie progressed through various treatments, she and other members of the band joked about finding him a spare kidney. One day, Sellman was struck with the realization that giving her fellow musician an essential organ could be more than just a joke. “I started thinking that this might be something real, something I could do.   Inspired by Nellie Jairam, a coworker of Sellman’s who recently donated a kidney to her husband Gervindradeo Krishn, Sellman began doing her research. After conferring with her doctor, soon, she and McKenzie were on the road to Winnipeg’s donation clinic for extensive compatibility testing. “Every time I went in to be tested, it worked out. We were a match. The further we got in the testing, the more excited I got because it all just seemed to fit together. ”   Early this year, Sellman received a phone call inviting her in to have surgery. On Feb. 4, one of Sellman’s kidneys was removed and given to McKenzie. “It’s been overwhelming,” said McKenzie of his friend’s donation. “How do you ever thank someone for something like this? ” McKenzie will remain in Winnipeg for continued testing until the end of the month, as a precaution against organ rejection. As the third member of his family to have received an organ transplant as a result of kidney disease, North of the Border’s keyboard player reports that he is feeling optimistic about the future. “After the surgery, the only thing Barbara told me was to take care of her kidney and to take care of myself. I vowed to make some changes in my lifestyle, because I realize how important it is that I’ve been given a second chance. ”

Source: “Kidney donation keeps bands playing. ” Wheatcityjournal. March 13, 2008. http://www. wheatcityjournal. ca/news_item. aspx? news_id=2668. (May 12, 2008) BIBLIOGRAPHY * Black. J. & Hawks, J. (2005). Medical – Surgical Nursing: Clinical Management for Positive Outcomes 7th ed. Singapore: Elsevier.  * Black, J. & Jacobs E. (1993). Luckmann & Corensen’s Medical-Surgcal Nursing: A Pathophysiologic Approach. 4th ed. Philadelphia: Saunders. * Copstead, L. & Banasik, J. (2005). Pathophysiology 3rd ed. Philadelphia: Saunders. * Kee, J. & Hayes E. (2003) Pharmacology: A Nursing Process Approach. (4th Ed. ) USA: ELSEVIER SCIENCE PTE LTD. * Lewis, S. M. , Heitkemper, M. M. & DIrksen, S. R. (2004). Medical- surgical nursing: assessment and management of clinical problems. 6th ed. USA: Mosby * Marieb, E. N. (2002). Essentials of Human Anatomy and Physiology. 6th ed. Philippnes: Addison Wesley Longman. * Mosby’s Pocket Dictionary of Medicine, Nursing, & Allied Health. 2002). Mosby: Philadelphia. * Pillitteri, Adele. (2003). Maternal & Child Health Nursing: Care of the childbearing 7 childrearing family. 4th edition. Wolters Kluwer Company: Philadelphia. * Potter, P. and Perry, A. (2002). Fundamentals of Nursing. 5th ed. Vol 1 & 2. Elsevier (Singapore) Pte Ltd: Philippines. * Smeltzer, S. , et. al. (2008). Brunner & Suddarth’s Textbook of Medical- Surgical Nursing. (11th Ed). USA: Lippincott Williams & Wilkins * www. greenjournal. org/cgi/content/abstract/110/6/1279? ck=nck

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A Case Study on Chronic Obstructive Pulmonary Disease. (2017, Feb 04). Retrieved from https://graduateway.com/a-case-study-on-chronic-obstructive-pulmonary-disease/

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