Case study 4
As a group Jared Fuhol, Samantha Thompson, and Karen Engh have looked over the signs and symptoms present in this case. Abnormal lab values, red-brown foamy urine, costovertebral tenderness, elevated blood pressure, puffiness in his face, a temp of 37.8°C, and a history of a fairly recent sore throat, we have all agreed that this 12 year-old boy has acute glomerulonephritis.
According to the MayoClinic.com glomerulonephritis is a defined as a type of kidney disease that damages your kidneys' ability to remove waste and excess fluids. Staff, Mayo.Clinic(2009)
Glomerulonephritis can be an acute or chronic condition, in this patient we are looking at an acute condition, it is caused from many different factors but in this case, it looks like it is cause is from a past infection, as evident by a sore throat two weeks prior. Streptococcal infections in the throat, if left untreated, can have renal effects and cause glomerular injury. Ignatavicius, D. D & M. Workman. (2009).
Glomerulonephritis is an inflammation of the glomeruli and can damage your kidneys so that they lose their ability to filter the blood efficiently; this allows excessive proteins to be excreted into the urine. Dangerous levels of waste and excess fluid can also accumulate in the body if the kidneys are not working properly. As seen in this boy's urinalysis, with albumin levels at 250 mg/24 hours, BUN levels at 90/100ml, creatinine clearance rate of 50ml/min, and a specific gravity of 1.030. Staff, Mayo. Clinic. (2009)
The excess fluid also caused the blood pressure in the patient to rise to 135/90. Since this is an acute case, this boy's temperature is still with in normal range at 37.8 degrees Celsius.
However his blood labs showed high levels of both RBC's and WBC's. The high WBC's is an indicator of mild to moderate leukocytosis , while the high RBC's may be an indicator of erythropoietin from renal disease according to Nursing Guide to Laboratory and Diagnostic Tests. Malarkey, L. M, & M. McMorrow. (2005)
If the glomerulonephitis had been going on longer or the patient had waited to come in, I think we would have seen a higher temperature from the infection progressing. (In my head)
Patients with glomerulonephritiss have various signs and symptoms, depending on whether you have the acute or chronic form, and the cause of the disease. The first indication that something is wrong may present as symptoms or from the abnormal results of a routine urinalysis during a check up with your healthcare provider. Staff, Mayo. Clinic. (2009)
Signs and symptoms may include; cola-colored urine which is from red blood cells in the urine, this patient's urinalysis showed both abnormal RBC cast as well as numerous RBC present in his urine, foamy urine is due to excess protein-this patient's protein level is high.
Another common sign is high blood pressure, also seen in this case at 135/90, fluid retention with swelling- evident in this patient's face, also edema of the hands, feet and abdomen. This boy also is showing signs of fatigue possibly from anemia or kidney failure, and less frequent urination, is among the most common symptoms according to the Mayo clinic web site. Staff, Mayo. Clinic. (2009)
(A) red-brown colored urine
(H) specific gravity:1.03
(A) RBC's: numerous
(A) cast's: RBC/epithelial cells
(L) Creatinine: 50ml/min
(H) albumine: 250mg/24hr
(H) BUN: 90mg/100ml
(H) RBC's: 3.8 million/mm³
(H) Total WBC's: 12,000/mm³
Fischbach, F. T, & M. Dunning III. (2004).
Malarkey, L. M, & M. McMorrow. (2005)
Fischbach, F. T, & M. Dunning III. (2004). A Manual of Laboratory and Diagnostic Tests. (Vol. 7th edition, Quincy. McDonald, Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Malarkey, L. M, & M. McMorrow. (2005). Nursing Guide to Laboratory and Diagnostic Tests. ( Brain. Dennison, Ed.). St. Lois, Missouri: Elsevier Saunders.
Staff, Mayo. Clinic. (2009, Sep. 26 ). In Mayoclinic.com. Retrieved Oct. 28, 2009, from http://www.mayoclinic.com/health/pulmonary-embolis
Ignatavicius, D. D, & M. Workman. (2009). Medical-Surgical Nursing. (Vol. 6th edition Volume 1, Lee. Henderson, Ed.). St. Lois, Missouri: Saunders.