5 Nephrotic Syndrome Nursing Care Plans

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Nephrotic syndrome is an alteration of kidney function caused by increased glomerular basement membrane permeability to plasma protein (albumin). Altered glomerular permeability result in characteristic symptoms of gross proteinuria, generalized edema (anasarca), hypoalbuminemia, oliguria, and increased serum lipid level (hyperlipidemia).

Nephrotic syndrome is classified either by etiology or the histologic changes in the glomerulus. Nephrotic syndrome is further classified into three forms: primary minimal change nephrotic syndrome (MCNS), secondary nephrotic syndrome, and congenital nephrotic syndrome. The most common type of nephrotic syndrome is MCNS (idiopathic type) and it accounts for 80% of cases of nephrotic syndrome. MCNS can occur at any age but usually, the age of onset is during the preschool years. MCNS is also seen more in male children than in female children. Secondary nephrotic syndrome is often associated with secondary renal involvement from systemic diseases. Congenital nephrotic syndrome (CNS) is caused by a rare autosomal recessive gene which is localized on the long arm of chromosome 19. Currently, CNS has a better prognosis due to early management of protein deficiency, nutritional support, continuous cycling peritoneal dialysis (CCPD), and renal transplantation. The prognosis for MCNS is usually good, but relapses are common, and most children respond to treatment.

Nursing Care Plans

Nursing care planning for a client with nephrotic syndrome include relief from edema, enhance nutritional status, conserve energy, supply sufficient information about the disease, importance of strict compliance with the medication and nutritional therapy, and absence of infection or prevention of a relapse.

Here are five (5) nursing care plans (NCP) and nursing diagnosis (NDx) for Nephrotic Syndrome:

  1. Excess Fluid Volume
  2. Imbalanced Nutrition: Less Than Body Requirements
  3. Fatigue
  4. Deficient Knowledge
  5. Risk For Infection
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Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.

May be related to

  • inability to ingest and digest foods and absorb nutrients

Possibly evidenced by

  • Anorexia
  • Weight loss
  • Edema of intestinal tract affecting absorption
  • Rejection of low salt diet
  • Loss of protein [negative nitrogen balance]

Desired Outcomes

  • Client will consume a nutritionally balanced diet.
Nursing InterventionsRationale
Monitor client’s weight daily (using the same scale with the child in the same clothing at the same time of the day).Parents need to weigh children to monitor fluid and nutritional status.
Assess child’s nutritional daily patterns including food preference, caloric intake, and diet history.Dietary patterns are considered in planning meals.
Encourage high potassium, low-fat, low sodium diet with moderate amounts of protein.A high potassium diet maintains therapeutic serum potassium level, especially if the child is receiving a potassium-wasting diuretic; A low-sodium diet helps prevent or decrease fluid retention; Protein intake is needed to compensate for protein loss.
Provide comfortable and delightful environment during meal times.Reduces unpleasant factors that add to appetite loss.
Consider six small nutrient-dense meals instead of three larger meals daily to reduce the feeling of fullness.Eating small, frequent meals diminishes the feeling of fullness and reduces the stimulus to vomit.
Schedule medications in such a way that they are not administered immediately prior meals.Taking of medications before meals may produce a feeling of fullness that contributes to anorexia.
Refer to a dietitian for a comprehensive nutrition assessment and methods for nutritional support.A dietician determines the client’s daily requirements of specific nutrients to promote sufficient nutritional intake.
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See Also

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