Nephrotic Syndrome

As I begin my fifth year of working as a nurse practitioner in a leading children’s hospital, I am certain the pediatric acute care setting is where I will continue my career of service to children and their families. Although I hold a masters degree in nursing and have been a primary care certified pediatric nurse practitioner for many years, I wish to expand my knowledge of pediatric nursing to encompass the unique and challenging aspects of pediatric acute care.

Renal History: The patient learned that he had kidney disease a few years ago. He had a biopsy in October 2012 that showed IgA nephropathy per TGH records. He started dialysis in 2013. Initially, he started peritoneal dialysis for seven months. He had a lot of side effects

The patient is a 75-year-old female who did see a new pulmonologist (Daniel Kim, DO) as Elvira Aguila, MD left this area. She did have a CT scan done of her lungs. She was told to hold her metformin and had blood work done because of IV contrast. Her creatinine did go up to a high of 1.5, but then on repeat came back to 1.37 with a BUN of 14. I did have her decrease her dose of metformin from 1000 mg b.i.d. to 500 mg b.i.d. She did have a BUN and creatinine done in December of 2014, which showed creatinine of 1.46, BUN of 35. Repeat in March of 2015 showed creatinine of 1.1 with a BUN of 49. The patient has also been found to have proteinuria with a urine microalbuminuria/creatinine

Both of our kidneys functions to filter and excrete waste products and toxins by regulating fluids, electrolytes, and acid based balance. If the Renal blood flow is altered then the glomerular filtration rate will be altered as well. A decrease in systemic pressure stimulates the sympathetic nervous system to constrict the renal artery and decreases filtration and secretion in the kidney. In addition, a tubular obstruction can lead to the reduction of Glomerular filtration rate. An elevated intracellular calcium level due to tubular damage may alter cellular level that increases tubuloglomerular feedback and diminishes GFR. This may be prerenal, intrarenal, or postrenal. The prerenal will result from any condition outside of the kidney that disables the blood to flow to the renal vasculature causing a decrease in perfusion in the glomerulus leading to oliguria. However, both of the kidneys can still return to its full normal function on this stage. Second of the three is intrarenal, where anything can cause a direct damage to both of the kidneys such as infections, toxins, reduce blood supply, hypertension, diabetes, and even glomerulonephritis. The most common intrarenal condition is Acute Tubular Necrosis, where the epithelial layer of the nephrons are damaged causing a change in the concentration of urine, waste filtration, and an imbalance in electrolytes and acid

There were different researches done to show what caused the Mexican War. Some say America and others say Mexico themselves. There has been some insight by Ramón Eduardo Ruiz, David J. Weber, Rodolfo Acuña, and Walter Nugent. From Ramón Eduardo Ruiz’s article, there are mentions of the Manifest Destiny. Manifest Destiny played a role in the New World and in Mexico. In “’From Hell Itself’ The Americanization of Mexico’s Frontier” by David J. Weber, talks about the issues within Mexico that caused them to lose so much of their territory. From Rodolfo Acuña in “Legacy of Hate: The Conquest of Mexico’s Northwest”, the article indicates… From the article “California and New Mexico, 1846-1848: Southward Aggression II” by Walter Nugent, … These

Primary treatments include antibiotic therapy, Fluid resuscitation, and crystalloid. Potential treatments depending on patient status include vasopressors and steroids, ventilator, renal dialysis, blood transfusion, and surgery.

Since the development of this role during the Vietnam war, now many nurses can increase their skills, experience, and education to become one of the most prominent careers any Registered Nurses can be. Therefore, today in the United States, many Nurse Practioners can study and focus on a certain specialty units in their career such as Pediatric Nurse Practioner who can provide care for babies, young children, and school aged children. With Nurse Practioners on the rise in the nursing field, many patients are receiving more satisfactory care from them because they are taking the time to accurately assess, diagnose, and treat their patients with the proper care possible. Without Nurse Practioners, we would not have had a detailed perspective on healthcare and the patient’s health in general. Therefore, Nurse Practioners set an example for every Registered Nurses since history that they have the possibility of advancing in their careers in the medical field by expanding their skills and clinical experiences; as a result, by doing so they can get a different perspective of healthcare that no one has yet to

Hockenberry, M.J., & Wilson, D. (2013). Wong’s essentials of pediatric nursing (9th ed.). St. Louis, MO: Elsevier/Mosby.

Injury to the glomerulus and the tubules presents the onset of Intra-renal failure (Matzke, 2011). Some of the frequent causes for Intra-renal failure are glomerulonephritis; pyelonephritis; and tubular injury. Post-renal failure develops from things like ureteroliths, tumors, or anatomic impediments. Opposite of the acute form, the chronic form has a slow onset that has no early stage symptoms. It is important to know that following an acute episode a chronic renal episode often follows, and at this juncture the damage is irreversible. Glomerulonephritis and pyelonephritis combined, has been reported to be the forerunner in as much as half the cases from acute to chronic renal failure. Diabetes mellitus, renal vascular disease, such as atherosclerosis, hypertension, polycystic kidney disease, drug damage, and nephrolith are all examples of other causes of CKD (Pradeep, 2014). Biopsies of kidneys that suffered with CKD reveal smaller kidneys with scarring on the tubules.

"Mockingbirds don’t do one thing except make music for us to enjoy. They don’t eat up people’s gardens, don’t nest in corn cribs, they don’t do one thing but sing their hearts out for us. That’s why it’s a sin to kill a mockingbird.”-To Kill A mocking Bird. Although rarely mentioned in the book, the idea of killing a mocking bird appears very significant in Harper lee's To Kill A Mockingbird, hence the title. Lee uses this idea of the literal killing an innocent bird as a representation for the major underlying theme of racism. To Lee, the mockingbird represented the innocent inhabitants of Maycomb Alabama who, through racism, suffered hate, persecution, and murder.

The primary role of a pediatric nurse is to deliver developmentally-appropriate patient-centered care. Pediatric nurses must truly understand that kids of different ages have different developmental abilities and skills, which is necessary for ensuring proper care. It’s important for pediatric nurses to understand the particular needs of children and how those needs change throughout each developmental stage- infancy, toddlerhood, preschool age, adolescence, etc. Additionally, being able to communicate appropriately with children and their guardians is a key

The nurse is also vital in communicating health matters between home and school as well as health care providers and school. Chikani and Plonski-Fuqua (2006) state that the most common medical conditions a nurse may encounter include asthma, diabetes, severe allergies, stoma tube care, NG tube care, behavioral health, epilepsy, and cerebral palsy. In order to provide appropriate care for the students the school nurse must have experience in an acute care setting, pediatric assessment, mental health experience and good knowledge of developmental stages of children. Most school nurses work individually so it is important that the nurse is capable of providing the right interventions and is able to recognize emergency situations.

The proletariats are seen as slaves to the bourgeois and because of that there is a division and hostility between the two classes. The bourgeoisie benefit from the cheap wages and manual labour of the proletariats, thus making more profit out of their work. This hostility leads to the proletariat becoming aware of their collective power to create changes in wages and working conditions they were unsatisfied through the help of communication technologies. The bourgeoisie do help the proletariat by educating them in order to organize the workers for their own political interest. As the proletariat increase in number and become more organized, members of the bourgeoisie realize that the proletariats are a threat to their class. Marx along with

Glomerulonephritis (GN), or the inflammation of glomeruli, is a leading cause of renal failure worldwide. Inflammation is characterized by vascular fragility, infiltration of leukocytes, and edema. Glomerular disease may manifest by three major syndromes: nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis (RPGN). Nephritic syndrome consists of sudden onset of hematuria, non-nephrotic range proteinuria (1.5 g/24 h), active sediment with red blood cell (RBC) casts or dysmorphic RBCs, acute renal failure, and hypertension. Nephrotic syndrome is characterized by heavy proteinuria (>3.5 g/24 h), edema, hypoalbuminemia, and hyperlipidemia. RPGN is characterized by active sediment (RBC casts and dysmorphic RBCs) and rapid development of acute renal failure usually over a period of weeks to months. Glomerulonephritis accounts for the majority of progressive renal disease in many parts of the world.

This condition can be treated at anytime by an antibiotic like penicillin. Since this condition can damage the organs, it is better to get it treated sooner than later. It is also important to keep going back to the doctors to get blood work done repeatedly to make sure that the infection is totally cleared up.