1. 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.

In this case scenario, Carmelita Gomez, an 8-year-old female, presents to the Children’s Clinic with symptoms of nausea, vomiting, tea-colored urine, diffuse abdominal pain, and slight periorbital edema. On examination she had active bowel sounds and tenderness in the four quadrants. Her urine test revealed red cell castings and hematuria. Serum creatinine levels were elevated at 2.3 mg/dL and BUN was 26.1 mg/dL. She also had an 800U antistreptococcal antibody titre, low calcium level, and a serum creatinine of 2.3 mg/dL. This is a sign of post-streptococcal renal disease (PSGN), which occurs following a streptococcal infection.

In this instance, the abnormal laboratory values are BUN, serum creatinine and antistreptococcal antibodies titre. Impaired kidney function is indicated by high serum creatinine levels and elevated BUN. Antistreptococcal antibodies titres indicate a streptococcal infected. Low calcium levels may also be a sign of impaired kidney function, hypoparathyroidism or impaired renal function.

These symptoms are a result of abnormal laboratory values. They include nausea, vomiting tea-colored urine and diffuse abdominal pain. All of these symptoms indicate impaired kidney function or inflammation of theglomeruli.

PSGN’s pathophysiology involves inflammation from a streptococcal infective that leads to damage and inflammation to the kidneys. The inflammation causes impaired kidney function as evidenced in high serum creatinine levels and blood counts, hematuria and red cell castings. Hypoparathyroidism, which is a condition that impairs kidney function, may cause a low level of calcium.

Carmelita’s nursing care should be focused on managing and monitoring her symptoms as well as encouraging kidney function and preventing complications. Monitoring vital signs and monitoring fluid and electrolyte levels is essential. To manage the symptoms and improve kidney function, medications such as antihypertensives and diuretics may be recommended. For prevention of recurrences of PSGN, the patient must be taught how to maintain good hygiene and not come in close proximity with streptococcal-infected people.

One nursing diagnosis appropriate for this patient is “Risk for impaired renal function related to inflammation and damage to the glomeruli as evidenced by elevated serum creatinine and BUN levels, hematuria, and red cell casts.”

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