COURSE IN THE WARDS

Day 1 (July 13,2017)

 Objective Data Assessment Intervention
Active, Afebrile Acute - Pt. was admitted to Pedia subspecialty
(+) periorbital edema
(-) respiratory distress
Glomerulonephritis ward
(-) cough and colds - Consent secure for admission
(-) peripheral edema with - Low salt low fat diet
Full pulses
- Insert heplock
BP = 130/90 - CBC, Urinalysis, BUN, Crea, Urine C/S,
HR = 105 ASO
RR = 32
T = 36.5 oC - Monitor I and O per shift every shift
Height = 109 - Monitor vitals signs every 4 hours
Weight = 19.8 kg
BSA = 0.59 - Limit oral fluid intake to 600ml per day

I and O
I O - Give stat dose of Furosemide 20 mg IV
6:00 2:00 =
2:00 10:00 = 50 250 now, then maintain at 20mg IV every 12
10:00 6:00 = 100 400 hours with BP precaution.
 Labs: Result NV
ASO 200 <200 todd unit
BUN 3.20 2.5 6.4 mmo/L
Crea 23.5 62.0 115.0 umol/L
Hgb 113 140 180 g/L
Hct 0.35 0.40 0.54 vol%
Plt 456 150 450 X 109
WBC 10.2 5.0 10.0

Neutrophil 0.43 0.50 0.70

Lymphocytes 0.41 0.20 0.50
Eosinophil 0.04 0.0 0.06
Monocytes 0.10 0.02 0.09
Basophil 0.02 0.0 0.02
Day 2 (July 14,2017)
 Objective Data Assessment Intervention
11 a.m.

Awake, conscious, AGN - Continue BP monitoring to

ambulatory every 4 hours
Afebrile - Maintain heplock
Good oral intake - Cont. IV medication
(+) cough - For repeat urinalysis
Clear breath sounds
No abdominal pain
Full pulses

BP :100/70
I/O : 150/650
- Start Ampicillin 500mg thru
Chest X ray done Pneumonia both lungs IV every 6 hours
Objective Data Assessment Intervention
12:30 pm

BP: AGN For KUB UTZ and urine CS

Temp: 36.2 Weigh patient daily and record
HR : 106 Hold repeat urinalysis
RR: 25 Maintain furosemide every 12
hours
Intake : 500ml Continue BP monitoring every 4
Output: 450ml hours
Monitor input and output every
shift
 MANAGEMENT
Management Signs and symptoms Rationale

Furosemide Excretion of excess fluid volume

(20mg IV q12)
Fluid and Sodium Restriction
(Approx. 400ml / day)
Weight monitoring
Vital signs
Urine output
Nifedipine SL (0.5- 2mg/kg/dose q
4-6)
Ampicillin 500mg IV q6 for 10 days
through; blocks the NaK2Cl pump in
TAL-H
To attain normal levels of water and
Edema and Hypertension sodium
To document improvement in
condition
Alternative medication if
furosemide treatment fails
Infection Recommended to limit the spread
of the nephritogenic organisms

Bed rest Hematuria May lessen the degree of

hematuria
 MANAGEMENT
Management Other complications Rationale

Dialysis Uremia To eliminate excess nitrogenous

waste in the blood
Diuretics Heart failure

Potassium restriction Electrolyte imbalance

IV sodibicarb Acidosis To compensate for the loss of
bicarbonate
Dialysis Acute Renal failure To remove waste and excess water
from the blood