Carmelita Gomez, age 8, is brought to the Children’s Clinic by her mother because she is nauseated and has vomited three times in the past 24 hours. Her urine has turned “tea colored”. Carmelita is lethargic and she is complaining of diffuse abdominal pain. Ten days ago she had a sore throat and fever and stayed home from school for two days. She was not seen by a health care provider at that time. Upon questioning, Carmelita cannot remember needing to urinate in the past 12 hours. On exam, Carmelita is irritable and listless. She has slight periorbital edema. Carmelita has active bowel sounds with no palpable abdominal masses, but she is tender in all four quadrants. Carmelita is given a presumptive diagnosis of poststreptococcal glomerulonephritis (PSGN), pending laboratory tests.
Her laboratory values are:
Serum creatinine: 2.3 mg/dL
BUN 26.1 mg/dL
Serum sodium: 142 mEq/L
Specific gravity 1.025
Phosphorous: 6.3 mEq/dL
Calcium: 7 mEq/dL
UA: hematuria 4+, red cell casts
Antistreptococcal antibody titre: 800U
POINTS TO PONDER:
- Which lab values are abnormal?
- What clinical manifestations correspond to the abnormal values?
- Describe the changes (pathophysiology) in the body causing each abnormal value and link the value to a clinical manifestation present in the patient?
- Which values are within normal limits?
- What nursing care needs to be implemented?
- Provide one nursing diagnosis appropriate to this patient.
- Urinalysis p.1146 (Leeuwen, pg. 546-552)
- Culture p.230
- Kidney stone analysis p.696 (Leeuwen, pg. 61,265,426,444)
Case Study Rubric
What do the labs indicate specific to this patient
values and signs and symptoms
The relationship between the abnormal Signs & Symptoms and lab values is clearly demonstrated. **Must be specific**
Pathophysiology used to demonstrate connections between lab results, manifestations and disease process.
Expected care to be given for exhibited s/s and lab values. Expected correction of lab values based on care given. Patient education to prevent recurrence of abnormal lab values.