Lekshmipriya   Monali S Jadhav   Jyoti Sunil Deshmukh   Utpal
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Case study - Lekshmipriya
“A New Lease of Life”
A case study on a child who recovered from an acute renal failure.
Meet Lekshmipriya, a 8 year old girl from Government Primary School, Vadalivilai in Nagercoil was suffering with kidney problem (acute renal failure). She belongs to a poor family and her father was working as a sweeper in a local body and he was not able to afford the cost of treatment. On receiving the case details, we went to her home and discussed with her parents and enlisted her as a social division case of Awakening Jagriti on 5th March 2008. According to her parents she was suffering with swelling in her face and no urine out put, she was admitted at Kanyakumari Medical College Hospital, Nagercoil for treatment. Doctors from this hospital referred the child to Sri Avittom Tirunal (SAT) Hospital, Trivandrum.

We told her parents to take the child to Sri Avittom Tirunal Hospital (SAT) hospital, Trivandrum as per the advice of the Doctors in Kanyakumari Medical College Hospital, Nagercoil and assured our support. Parents admitted the child at Pediatric Intensive Care Unit, in SAT Hospital, Trivandrum on 6th March 2008. Dr.Susan, Pediatric Nephrologist, Medical College Hospital has been attending the child for diagnosis and treatment. Awakening Jagriti staff members made frequent visit to Sri Avittom Tirunal Hospital to know the progress in her health condition.

According to Dr.Susan, child was suffering with Hemolytic Uremic Syndrome (HUS); it is an acute renal failure. Child was suffering with blood clotting within the capillaries, the smallest blood vessels in the body, due to which her kidneys could not filter and dispose of the urea and other waste products build up in the bloodstream. Her condition was critical when she was admitted at SAT hospital. Necessary investigations were done; proper medicines were administered to regulate her blood pressure and her blood parameters. Initially she was underwent peritoneal dialysis and then she underwent hemodialysis. Later child underwent Continuous Ambulatory Peritoneal Dialysis (CAPD) as it would facilitate her kidney to take rest and rejuvenation.
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CAPD procedures were started on 7th April 2008. In order to do CAPD a small operation was done under general anesthesia to insert a CD catheter into her abdomen. CAPD took place inside her body using the natural lining of the abdomen called the Peritoneum. Awakening Jagriti has provided the catheter and other accessories for CAPD. A staff from Baxter Company, who supplies the CAPD accessories, assisted the nurse in SAT hospital, Trivandrum during the CAPD procedure for the child. Later parents were also trained for carrying out the CAPD; Register is maintained to monitor the progress. After three weeks of CAPD there was a gradual improvement in her health condition, urine out put increased. Until second week of May 2008 she underwent CAPD at hospital. As there was a progress in her kidney function, Doctor has advised her parents to continue the CAPD in child’s home. During the second week of May child was discharged from hospital and advised to continue CAPD at her home.

We have accompanied the child to SAT hospital for follow up. Regular investigations were done. According to Doctor blood pressure of the child is normal; child should take high protein diet, child has to under go regular CAPD for another two months to regain normal renal function. During the first week of June 2008 child started to make urine output of more than a liter per day.

During the next follow up Doctor advised the parents to admit the child at SAT hospital on 19th June 2008 to closely observe her health condition with out CAPD. According to Dr.Susan, child’s kidney started function, 30% function observed; therefore she would undergo dialysis once in a week. Doctor has advised modification in her diet to enable the kidney to function well. Child has been discharged from hospital on 28th June 2008.

After this follow up to SAT hospital, as per Doctor’s advice child started to attend the school regularly. Catheter was safely covered with a special cloth belt. Once in a week she underwent CAPD at her home for two months. On 13th August child was admitted at SAT hospital, Trivandrum to remove the catheter from her abdomen through a minor surgery. Catheter was successfully removed from her body and child was discharged from hospital on 27th August 2008. Now child is keeping fine and attending the school regularly. Dr.Susan appreciated our timely intervention for this deserving child and told that child has got a new life with our support; otherwise recovery from this critical illness could not have been possible. We have sincerely thanked Dr.Susan and her team for their concerted efforts to save the life of this child.
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Monali S Jadhav

Date of Birth : 14.5.1991
Sex : Female
Diagnosis : Cerebral Palsy Athetoid
Medical History :
Full term normal delivery. Birth weight-6lbs. H\o-Neonatal Jaundice with high fever. H\o of Delayed Milestones.
Early Intervention Program :
All India Institute of Physical Management Mumbai, NCCP Mumbai, and CSE Pune.

Monali joined Jagriti School in 2000

Entry Level Assessment
Physical Profile-Fairly good head control- could come up to independent sitting and maintain the same for less than 5 minutes. She could crawl with support. Gross reach grasp and release.

Normal hearing and ENT reports
Normal vision

Speech and Language
Communication Non–Verbal. Receptive language age appropriate for Expressive language she was using gestures eye and hand pointing differential vocalization for her immediate needs. In addition using a basic picture board/bliss symbols. Drooling present. No chewing.
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Cognitive Skills
Basic conceptualization skills present. Picture reading present. Play was established.

Social and behaviour
Was social. Temper tantrums and irritability present.

Activities of daily living (ADL)
Totally dependent on all activities of daily living-brushing, grooming, toileting, feeding, dressing and undressing.

Current Profile
  Monali has completed her Schooling and is attending the Sheltered Workshop.
  She can walk fairly well in a coordinated manner.
  She has developed gross manipulative gross hand skills.
  She has achieved good communicative skills and uses the same effectively in her day to day dealings
  She has transferred the academic learning into her day to day functional and vocational purposes.
  She can perform 75% of the ADL activities independently.
  She is able to manipulate herself very well in the environment
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