Prioritized Nursing Diagnoses: Nephrotic Syndrome - With Rationale

Nephrotic Syndrome

Gino, 7 year-old boy was admitted to the pediatric ward due to excessive protein wasting, edema and hypertension. Based on the client’s clinical manifestations proteinuria of 3.7 gm/day, the boy is diagnosed of Nephrotic Syndrome.
Other laboratory results revealed presence of WBC in urine, decreased serum albumin, high cholesterol and low density lipoproteins.
Upon physical examination, there is periorbital edema, soft and pitting edema in the sacrum, ankles and hands. There is also beginning ascites. 
Vital signs are as follows: BP- 160/100 mmHg; Apical pulse- 125 bpm; RR-30 cpm; Temp 37.8C
History revealed that two years ago Gino was admitted in the same hospital because of chronic glomerunephritis. The mother reported that Gino is irritable most of the time. Gino also complained of frequent headache and body malaise. 

Management includes: Cyclophosphamide ( Cytoxan); Dextran; low sodium diet containing liberal amount of potassium, decreased protein and cholesterol, increases Carbohydrates
Gino is scheduled for kidney needle biopsy. And he is maintained on bed rest

Pertinent Data	Nursing Diagnosis	Rank	Justification
·         7 year old male ·         Hx of Chronic glomerulonephritis ·         Irritability ·         Frequent headache ·         Body malaise ·         (+) Protein wasting ·         (+) Edema (Periorbital, Edema in the sacrum, ankle and hands) ·         Beginning ascites ·         (+) HPN (160/100mmHg) ·         Tachycardia (125 bpm) ·         Tachypnea (30 cpm) ·         Hyperthermia (37.8) ·         (+) Proteinuria 3.7 gm/day ·         (+) WBC in urine ·         Decreased serum albumin ·         High cholesterol and LDL (Hyperlipidemia)	Increased fluid volume related to decreased oncotic pressure and water retention	1	This is the prioritized problem because a further increase in the fluid volume decreases the intravascular volume which decreases the blood volume subsequently. This increase in blood volume causes all the rest of the following problems that we have identified.
	Decreased cardiac output related to aldosterone release secondary to juxtoglomerular cell release of renin	2	This is the second priority because it is caused by our first problem, which is the increased fluid volume from the loss of albumin and decreased oncotic pressure. Decreased cardiac output also causes decreased perfusion to the organs.
	Decreased tissue perfusion related to vasoconstriction secondary to aldosterone release	3	Decreased tissue perfusion is the third priority because it is caused by the decrease in cardiac output thus also decreasing the systemic blood flow to the entire system.
	Fatigue related to decreased systemic blood flow secondary to vasoconstriction	4	This is the fourth priority because it does not place the patient in a life-to-death situation. Meaning it does not require immediate attention. The patient having body malaise means that there is a decrease in Krebbs cycle that produces energy for the patient. We also have to solve all the previous problems first before we can solve this particular one.
	Risk for infection related to loss of immunosurveilance secondary to loss of plasmin	5	This is the last priority because the risk for infection merely needs proper monitoring, maintenance and utmost care in the usage of the aseptic technique. The client is immunosuppressed mainly because of the loss of plasmin which is needed for immunosurveilance.