Nursing Care Plan - Nephrotic Syndrome

NEPHROTIC SYNDROME

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein^[1](proteinuria at least 3.5 grams per day per 1.73m² body surface area)^[2] from the blood into the urine.

Kidneys affected by nephrotic syndrome have small pores in the podocytes, large enough to permit proteinuria (and subsequentlyhypoalbuminemia, because some of the protein albumin has gone from the blood to the urine) but not large enough to allow cells through (hence no hematuria). By contrast, in nephritic syndrome RBCs pass through the pores, causing hematuria.

Case:                                 Age: 4years old                                

N U R S I N G C A R E P L A N

Assessment	Nursing Dx	S. Explanation		Planning	Implementation	Rationale	Evaluation
Subjective: “Namamanas ang kanyang mga binti at mukha” Objective ·         4 year old  ·         Irritability ·         Body malaise ·          (+) Protein wasting ·         (+) Edema (Periorbital, Edema in the sacrum and ankles) ·         Ascites ·         (+) Skin erosion on all extremities ·         Tachycardia (125 bpm) ·         Tachypnea (30 cpm) Hx: Diet low in protein because of extreme financial constraints to regularly buy meat Pertinent laboratory values ·         Eosinophils: .13 (0-0.5) (+) WBC in urine ·         K: 2.42 (3.5-5.5) ·         (+) Bacteria in urine – Pus cell: 7-10 hpF	Increased fluid volume related to fluid loss into interstitial space secondary to a decreased oncotic pressure	Financial constraints ↓ Failure to suffice the dietary needs of the child, particularly in protein and potassium ↓ Malnutrition ↓ Damage to nephrons ↓ Inability to filter wastes and fluid from the blood ↓ Massive renal loss of protein (Proteinuria: Hallmark sign) ↓ Decreased albumin circulating levels ↓ Decreased oncotic pressure ↓ Fluid is lost into interstitial spaces ↓ Periorbital edema, Edema in the sacrum ankle and hands, Ascites ↓ Stimulation of the renin angiotensin-aldosterone axis & ADH ↓ Extension and maintenance of edema, HPN		Discharge outcome: Upon discharge, the patient will be able to: a. Maintain adequate fluid volume as evidenced by vital signs within normal limits, and absence of edema Short term outcome: After 8 hours of nursing intervention, the patient will be able to: a. Verbalize performance of 3 out of 3 nonpharmacologic ways to facilitate fluid excretion b. Verbalize adherence to prescribed therapeutic regimen c. Have a notable decrease in edema	Independent: ·         Monitor vital signs and weight daily. ·         Limit free water oral intake ·         Provide low sodium-high protein & potassium diet. Provide additional eggs whites twice a day ·         Place in semi-fowler’s position as appropriate a ·         Evaluate edematous extremities, change position frequently ·         Promote early mobility ·         Suggest interventions such as frequent oral care, hard candy Collaborative ·         Monitor lab results: serum albumin, triglycerides, electrolytes, urinary protein, WBC ·         Administer salt-poor albumin and diuretics as prescribed ·         Administer electrolytes as prescribed	Alterations in vital signs may indicate further problems. It is also used as a comparison for progress or for the baseline data. A decrease or increase in weight may indicate rising or falling fluid volume To allow increased intake of nutritious fluids with or between meals Protein loss causes hypovolemia and activation of the renin-angiotensin system. A great source of protein is the egg whites. Given the situation of the client, they don’t have to pay largely to regularly buy this. Hepatic lipoproteins compensate for the sever loss, this causes sodium retention and further contribute s to the edema. Potassium is needed for good muscle contractions. To facilitate movement of diaphragm involving respiratory effort To reduce pressure and prevent skin breakdown Facilitate excretion and promote better circulation. Thus reduces stasis and tissue injury To relieve fluid restriction discomfort Albumin causes shift of fluids into cardiovascular system, enhancing diuretic effects	Discharge outcome: Outcome Achieved Upon discharge, the patient was able to maintain adequate fluid volume as evidenced by vital signs within normal limits, and absence of edema Short term outcome: Outcome Achieved After 8 hours of nursing intervention, the patient was able to verbalize performance of 3 out of 3 nonpharmacologic ways to facilitate fluid excretion, verbalize adherence to prescribed therapeutic regimen and have a notable decrease in edema Recommendation: Terminate the plan