A 9-year-old male with nephrotic syndrome presents with increased abdominal discomfort, difficulty breathing when lying flat, and significant pitting edema. His lab results show a serum albumin level of 1.8 g/dL and heavy proteinuria. What is the most appropriate nursing action to address the patient's fluid overload while considering his current condition?

B) Administer prescribed diuretics and monitor urine output closely.

A) Encourage increased oral fluid intake to dilute serum albumin levels.

B) Administer prescribed diuretics and monitor urine output closely.

C) Place the patient in a flat supine position to promote breathing.

D) Restrict protein intake to reduce proteinuria.

A 9-year-old male patient with nephrotic syndrome is experiencing increased abdominal discomfort, difficulty breathing, and significant edema. His laboratory results indicate hypoalbuminemia, hyperlipidemia, and persistent proteinuria. Based on these findings, which nursing intervention should be prioritized to address his current symptoms?

C) Administer prescribed diuretics to reduce edema and pleural effusion.

A) Encourage increased oral fluid intake to promote diuresis.

B) Initiate oxygen therapy to improve respiratory status.

C) Administer prescribed diuretics to reduce edema and pleural effusion.

D) Implement a low-protein diet to minimize proteinuria.

A pediatric patient with nephrotic syndrome is being treated with furosemide for fluid overload and is now showing signs of improved edema but persistent hypertension. Which nursing intervention is most appropriate to implement next to address the patient's elevated blood pressure?

D) Initiate the prescribed ACE inhibitor therapy

A) Educate the mother on reducing the patient's sodium intake

B) Administer an additional dose of furosemide

C) Prepare the patient for a chest X-ray as scheduled

D) Initiate the prescribed ACE inhibitor therapy

A pediatric patient with nephrotic syndrome is experiencing persistent pleural effusion and hypokalemia due to diuretic therapy. Which nursing intervention is the most appropriate to prioritize in addressing the potential complications associated with this patient's current condition?

A) Administer potassium supplements as prescribed and monitor serum potassium levels closely.

B) Encourage the patient to increase oral fluid intake to improve diuretic efficacy and reduce pleural effusion.

C) Educate the family on the signs of fluid overload, such as weight gain and swelling.

D) Position the patient in a high Fowler's position to alleviate respiratory distress from pleural effusion.

A 10-year-old patient with nephrotic syndrome is experiencing persistent pleural effusion and hypokalemia after diuretic therapy. Which nursing intervention is most appropriate to prioritize for ensuring the patient’s safety and preventing further complications?

B) Administer potassium supplementation as prescribed and monitor serum levels

A) Educate the mother on a low-sodium diet to manage hypertension

B) Administer potassium supplementation as prescribed and monitor serum levels

C) Encourage increased fluid intake to help with diuretic side effects

D) Initiate respiratory therapy exercises to improve lung function

A pediatric patient with nephrotic syndrome is experiencing persistent pleural effusion and hypokalemia despite current treatment. The healthcare team has introduced spironolactone to manage fluid overload and prevent further electrolyte imbalance. Which nursing intervention is most important to implement in this scenario?

C) Educate the family on signs of hyperkalemia due to the potassium-sparing diuretic.

A) Encourage increased fluid intake to promote diuresis.

B) Monitor blood pressure closely to assess the efficacy of the ACE inhibitor.

C) Educate the family on signs of hyperkalemia due to the potassium-sparing diuretic.

D) Increase dietary sodium to counteract the effects of spironolactone.

A child with nephrotic syndrome is being treated with diuretics for pleural effusion and has been started on spironolactone. The nurse is monitoring the child's lab results, including serum potassium levels, which have been persistently low. Considering the current treatment plan, which of the following should the nurse prioritize to ensure safe and effective care?

B) Monitor for signs of hyperkalemia as spironolactone is a potassium-sparing diuretic.

A) Increase dietary potassium intake to support the current hypokalemia treatment.

B) Monitor for signs of hyperkalemia as spironolactone is a potassium-sparing diuretic.

C) Discontinue the ACE inhibitor to prevent further electrolyte imbalance.

D) Request an immediate increase in diuretic dosage to address fluid overload.

A 6-year-old boy with nephrotic syndrome is experiencing increased edema and mild muscle weakness despite being on spironolactone. His serum potassium is 3.4 mmol/L, and serum creatinine is 1.0 mg/dL. What is the most appropriate nursing intervention to address his current condition?

C) Monitor for signs of hyperkalemia and adjust potassium supplements as needed.

A) Increase his oral fluid intake to help flush out excess proteins.

B) Encourage a high-protein diet to compensate for protein loss in urine.

C) Monitor for signs of hyperkalemia and adjust potassium supplements as needed.

D) Elevate the legs and apply compression stockings to reduce edema.

A 6-year-old boy with nephrotic syndrome is exhibiting signs of increased edema and mild muscle weakness. His serum potassium is low-normal at 3.4 mmol/L, and serum creatinine has increased to 1.0 mg/dL. Considering these findings, which nursing intervention is most appropriate to address the underlying condition while minimizing potential renal complications?

D) Monitor the child’s fluid intake and output closely and report any significant changes.

A) Increase the dose of spironolactone to enhance diuresis and reduce edema.

B) Collaborate with the healthcare provider to adjust the potassium supplementation regimen.

C) Encourage a high-protein diet to address proteinuria and improve muscle strength.

D) Monitor the child’s fluid intake and output closely and report any significant changes.

nephrotic syndrome child - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased glomerular permeability allows large amounts of protein, especially albumin, to leak into the urine, leading to hypoalbuminemia. This is often due to damage to the glomerular basement membrane and podocyte dysfunction.

• Secondary mechanism: Hypoalbuminemia results in decreased oncotic pressure in the blood vessels, causing fluid to shift into the interstitial spaces and leading to edema. The liver may respond by increasing lipoprotein production, causing hyperlipidemia as a compensatory mechanism.

• Key complication: The loss of immunoglobulins and proteins in the urine can lead to a weakened immune response, increasing susceptibility to infections. Additionally, significant edema can pose risks for complications such as skin breakdown and thrombosis due to altered blood flow.

Patient Profile

Demographics:

9-year-old male, student

History:

• Key past medical history: Diagnosed with nephrotic syndrome 1 year ago; history of recurrent respiratory infections

• Current medications: Prednisolone, Enalapril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Swelling in legs and abdomen, fatigue

• Key symptoms: Edema in lower extremities, abdominal pain, frothy urine, decreased appetite

• Vital signs: Blood pressure 140/90 mmHg, heart rate 110 bpm, respiratory rate 24 breaths/min, temperature 37.8°C (100°F)

Section 1

During a follow-up appointment, the 9-year-old male patient with nephrotic syndrome presents with a change in status, raising concerns about potential complications. The boy's mother reports a new onset of increased abdominal discomfort and difficulty in breathing, especially when lying flat. On physical examination, the edema has progressed, with significant pitting edema now observed in the lower extremities, extending to the upper thighs. Additionally, there is evidence of ascites, confirmed by shifting dullness and a positive fluid wave test. His vital signs reveal an elevated blood pressure of 145/95 mmHg, a heart rate of 115 bpm, and a respiratory rate of 26 breaths per minute, indicating potential respiratory compromise.

In light of these findings, further diagnostic tests are conducted. Blood tests reveal a serum albumin level of 1.8 g/dL, a significant drop from previous readings, and an increased serum cholesterol level of 350 mg/dL. A urinalysis shows persistent heavy proteinuria, with 4+ protein, and a decreased urine output, suggesting worsening renal function. A chest X-ray is ordered and reveals mild pleural effusion, which correlates with the patient's respiratory symptoms. These findings suggest that the nephrotic syndrome is not adequately controlled and that the patient is at risk of developing further complications, such as thrombosis due to hypercoagulability, and worsening respiratory distress due to fluid overload.

The clinical team must now reconsider the management plan, with a focus on addressing fluid overload and controlling blood pressure. The possibility of adjusting the current medication regimen, including the introduction of diuretics to manage edema and pleural effusion, is considered. Additionally, there is a need to ensure the patient's nutritional status is maintained despite hypoalbuminemia. The team also plans to monitor the patient closely for signs of infection, given his immunocompromised state. These steps aim to stabilize the patient's condition and prevent further complications, requiring careful coordination and communication with the patient's family to ensure adherence and understanding of the treatment plan.

Section 2

As the clinical team initiates the revised management plan, they prioritize addressing the patient's fluid overload and hypertension. Diuretics, specifically furosemide, are prescribed to help reduce the significant edema and pleural effusion. However, the team remains cautious of potential electrolyte imbalances, particularly hypokalemia, which could exacerbate the patient's condition. The boy's mother is educated on monitoring fluid intake and output, as well as recognizing signs of dehydration or electrolyte disturbances.

Over the following days, the patient shows some improvement in terms of reduced peripheral edema and decreased abdominal girth, indicating that the diuretic therapy is having the desired effect. However, despite these positive changes, the boy's blood pressure remains elevated, now measured at 140/92 mmHg, and his heart rate is recorded at 110 bpm. The medical team deliberates on the introduction of an ACE inhibitor to better control his hypertension and offer renal protection, considering the ongoing proteinuria and reduced renal function.

In parallel, the team closely monitors the patient for potential complications associated with nephrotic syndrome. The risk of thrombosis remains a concern due to the hyperlipidemia and persistent hypoalbuminemia, with serum albumin levels staying low at 1.9 g/dL. Despite the diuretic therapy, the boy's respiratory rate remains elevated at 24 breaths per minute, prompting a reevaluation of the pleural effusion status. A repeat chest X-ray is scheduled to assess the response to treatment and guide further management. The healthcare team continues to engage the family, ensuring they understand the necessity of adherence to the medication regimen and the importance of follow-up appointments, as the child’s condition remains precarious and requires vigilant observation for any signs of deterioration or new complications.

Section 3

As the team continues to monitor the patient's condition, new diagnostic results reveal that while the peripheral edema has decreased, the pleural effusion persists and has shown only marginal improvement on the repeat chest X-ray. This finding correlates with the boy's elevated respiratory rate, suggesting that the fluid in the pleural space is still significant enough to impact his breathing. Additionally, the lab results indicate a concerning drop in his serum potassium level, now at 3.0 mmol/L, likely a consequence of the ongoing diuretic therapy. This hypokalemia poses a risk of cardiac complications and could be contributing to the elevated heart rate.

In response to these findings, the clinical team adjusts the management plan to address these lingering issues. Potassium supplementation is initiated to correct the electrolyte imbalance and prevent further complications. The possibility of using a different diuretic or adjusting the dose of furosemide is discussed to better manage the pleural effusion without exacerbating hypokalemia. Given the persistent hypertension, an ACE inhibitor is introduced with careful monitoring of renal function to avert further decline. The team educates the mother on signs of potential complications such as muscle weakness or palpitations due to low potassium levels and the importance of maintaining follow-up appointments for ongoing evaluation of the child's condition.

With these interventions, the healthcare team aims to stabilize the patient's status and prevent progression of the complications associated with nephrotic syndrome. The next steps in the patient's journey will involve close observation of how he responds to these adjustments, particularly monitoring blood pressure, serum potassium levels, and respiratory status, while also remaining vigilant for any signs of thrombotic events or worsening renal function. The family is encouraged to maintain open communication with the healthcare team to ensure the child receives timely care should new symptoms arise.

Section 4

As the healthcare team continues to monitor the child, they observe some changes in his clinical status. Over the next 48 hours, his respiratory rate remains elevated around 30 breaths per minute, though he shows slight improvement in his comfort level. However, the boy begins to exhibit new signs of fatigue and mild muscle weakness, raising concerns about the effectiveness of the potassium supplementation. A repeat serum potassium test confirms that levels are still suboptimal, only rising to 3.2 mmol/L. This necessitates an adjustment in the potassium supplementation dosage to more aggressively correct the hypokalemia.

In conjunction with these findings, a follow-up chest X-ray reveals persistent pleural effusion, suggesting that the current diuretic regimen isn't sufficiently addressing the fluid overload. The team decides to trial spironolactone, a potassium-sparing diuretic, in hopes of managing the pleural effusion more effectively without exacerbating the electrolyte imbalance. Concurrently, blood pressure readings remain elevated at around 138/88 mmHg, warranting close monitoring to assess the efficacy of the newly introduced ACE inhibitor and to prevent potential renal complications.

Despite these challenges, the boy's albumin levels show slight improvement, indicating a positive response to dietary adjustments and protein intake. The team remains vigilant, educating the family on observing any new symptoms like increased weakness, changes in urine output, or swelling, and emphasizes the importance of maintaining regular follow-up appointments. The goal is to achieve a delicate balance in managing the nephrotic syndrome complications, ensuring the child’s safety while working towards long-term stability.

Section 5

As the healthcare team continues their vigilant monitoring, there is a notable change in the boy's status over the next 24 hours. His respiratory rate begins to stabilize, decreasing to 24 breaths per minute, which is a promising sign of improved respiratory function. However, new complications arise as the child starts to exhibit signs of increased edema, particularly around the ankles and eyelids. This swelling suggests that despite the introduction of spironolactone, fluid retention is still a significant issue. Additionally, the mild muscle weakness persists, and the child appears more lethargic, with a decrease in playfulness and interaction, which concerns both the care team and his family.

Laboratory results reveal a slight increase in serum potassium levels, now at 3.4 mmol/L, indicating a gradual response to the adjusted potassium supplementation. Nevertheless, this remains at the lower end of the normal range, prompting the team to consider further adjustments or additional supplementation strategies. The serum creatinine level has slightly increased to 1.0 mg/dL, necessitating careful monitoring for potential renal impairment due to ongoing hypertension and fluid management challenges. Meanwhile, a repeat urinalysis shows persistent proteinuria, highlighting the ongoing nephrotic state and the difficulty in achieving complete remission.

Given these developments, the team plans to reassess the current treatment plan, focusing on optimizing diuretic therapy and considering potential adjustments to antihypertensive medications. The goal is to minimize the risk of renal complications while addressing the persistent edema and electrolyte imbalances. The family is kept informed and involved in discussions regarding the next steps, with an emphasis on monitoring the child for worsening edema, changes in urine output, or any new symptoms, ensuring a collaborative approach to care and decision-making.