Nephrotic syndrome
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.
Group of clinical signs and symptoms caused by excessive protein loss in urine
Manifestations of nephrotic syndrome in peds
Edema
Anorexia
Fatigue
Abdominal pain
Increased weight
Respiratory infection
Which
diagnostic finding is present when a child has primary nephrotic syndrome?
a. Hyperalbuminemia
b. Positive ASO titer
c. Leukocytosis
d. Proteinuria
D. Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.
Rationales
Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss.
ASO titer is negative in a child with primary nephrotic syndrome.
Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.
Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane.
Which finding indicates that a child receiving prednisone for primary nephrotic syndrome is in remission?
a. Urine is negative for casts for 5
days.
b. Urine is up to a trace for protein for 5 to 7 days.
c. Urine is positive for glucose for 1 week.
d. Urine is up to a trace for blood for 1 week.
B. The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is up to trace for protein for 5 to 7 days.
The absence of casts in the urine gives no indication about the child's response to treatment. The child with primary nephrotic syndrome is considered to be in remission when the urine is negative for protein for 5 to 7 consecutive days.
The child receiving steroids for the treatment of primary nephrotic syndrome is considered in remission when the urine is up to trace for protein for 5 to 7 days.
Remission is achieved when the urine is negative for protein for 5 to 7 consecutive days. It is not unusual for glucose to test positive if the child is taking prednisone.
The presence or absence of hematuria is not used to determine remission in primary nephrotic syndrome.
Which statement by a parent of a child with nephrotic syndrome indicates an understanding of a no-added-salt diet?
a. "I can give my child sweet pickles."
b. "My child can put ketchup on his hotdog."
c. "I can let my child have potato chips."
d. "I do not put any salt in foods when I am cooking."
D. A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating.
All types of pickles are high in sodium and should not be served to the child on a no-added-salt diet.
The child should not be allowed to eat hotdogs; they are considered a cured or processed meat and are high in sodium.
Potato chips are a high-sodium food and should not be included in the child's diet when sodium intake is restricted.
A no-added-salt diet means that no salt should be added to foods, either when cooking or before eating.
What is an appropriate intervention for a child with nephrotic syndrome who is edematous?
a. Teach the child to minimize body movements.
b. Change the child's position every 2 hours.
c. Avoid the use of skin lotions.
d. Bathe every other day.
B. Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas.
The
child with edema is at risk for impaired skin integrity. It is important for the child to change position frequently to prevent skin breakdown.
Frequent position changes decrease pressure on body parts and help relieve edema in dependent areas.
Applying lotion to the skin helps to increase circulation.
Bathing daily removes irritating body secretions from the skin.
The nurse closely monitors the temperature of a child with
nephrotic syndrome. The purpose of this is to detect an early sign of which possible complication?
a. Infection
b. Hypertension
c. Encephalopathy
d. Edema
A. An exacerbation of the disease can occur after an infection.
An exacerbation of the disease can occur after an infection.
Temperature is not an indication of hypertension or edema.
Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.
Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.
A nurse is planning care for a child admitted with nephrotic syndrome. Which interventions should be included in the plan of care? Select all that apply.
a. Administration of antihypertensive medications
b. Daily weights
c. Salt-restricted diet
d.
Frequent position changes
e. Teaching parents to expect tea-colored urine
Correct: B,C,D. child with nephrotic syndrome will need to be monitored closely for fluid excess so daily weights are important. The diet is salt restricted to prevent further retention of fluid. Because of the fluid excess, frequent position changes are required to prevent skin breakdown.
Incorrect: A,E:
Nephrotic syndrome does not require antihypertensive medications. These are administered for acute glomerulonephritis. Tea-colored urine is expected with acute glomerulonephritis, but not nephrotic syndrome. The urine in nephrotic syndrome is frothy indicating protein is being lost in the urine.