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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Fatigue

Fatigue: An overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.

May be related to

  • Discomfort

Possibly evidenced by

  • Easily fatigued with any activity
  • Extreme edema
  • Lethargy

Desired Outcomes

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  • Child will alternate activity with rest periods.
Nursing InterventionsRationale
Assess extent of fatigue, weakness, degree of edema and difficult movement or activity in bed.Reveals information regarding fatigue and tendency of lying in the prone position and not moving or changing position.
Plan activities with consideration and observe for changes in behavior following an activity.Enhances endurance while avoids fatigue; disease condition, steroid therapy, and inactivity result in mood swings and irritability in the child.
Reinforce bed rest during the most acute stage.Prevents energy expenditure when edema is severe.
Provide chosen play activities as tolerated and modify the schedule to allow for rest periods and after activity.Provides stimulation and activity within tolerance level as edema is relieved.
Allow for quiet play accompanied by an
open activity and encourage the child to establish own limits when feasible.
Promotes independence and control of situations.
Advise child to rest during times of exhaustion.Decreases fatigue and conserves energy.
Inform parents and child that complete
participation in activities will be permitted as the disease is resolved.
Promotes a return to active life for the child.
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See Also

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