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Outline
A 4-year-old child has been admitted to the hospital with nephrotic syndrome. The little boy has ascites and swollen legs and arms. The nurse on the med-surg unit is preparing for the child and his mother and father to arrive from the Emergency Department.
What should the nurse make sure is in this child’s room?
- Scale for measuring daily weights
- Measuring tape to measure circumference of the stomach as well as the arms and legs to monitor if edema is getting worse
- PUC (pediatric urine cup that sticks to the child under their clothes) to measure strict intake and output (I&O’s)
The family arrives to the room and the little boy gets weighed in and measured. The first set of vital signs show hypertension, as to be expected. The nurse sets up the television and call light and asks if there are any questions. Mom asks about when her son will be able to eat because he hasn’t eaten all day.
What is the appropriate type of meal to have as a diet order?
- Low fat, low sodium diet.
- In nephrotic syndrome, the kidneys lose so much protein that the liver tries to compensate and there is an increase in lipids in the blood.
- There is also an excess of fluid retention, so sodium should also be restricted
- Protein should be balanced based on the patient’s weight and needs – consult a dietician
The nurse checks the patient’s orders for an antihypertensive medication order to bring the blood pressure down. The eMAR shows Labetalol and a few other medications.
What other medications would the nurse expect to be ordered for this patient?
- Corticosteroids and diuretics.
- The mortality rate is greatly decreased the sooner the patient starts corticosteroids and this is the most important medication to start right away.
The child has been medicated and the mother asks the nurse what the plan of care is.
How will the child be monitored and how can we explain to the mother and father that the treatment plan is working?
- The plan involves monitoring serum albumin and urinalysis.
- The patient is improving when the serum albumin increases and the protein in the urine decreases.
- Daily weights, strict I&O’s and measurements will show improvement as well.
- Inform the parents that our concern is fluid build-up on the lungs leading to infection so close monitoring of the respiratory system with O2 saturation and listening to breath sounds will help to catch any fluid build-up in the lungs early on for quicker treatment to prevent infection.
- Daily weights will be performed and a decrease in weight is a sign of improvement as well as measurements of the wrists and ankles to monitor edema.
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