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) for Nephrotic Syndrome:
- Excess Fluid Volume
- Imbalanced Nutrition: Less Than Body Requirements
- Deficient Knowledge
- Risk For Infection
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- Lack of exposure to information about the disease
Possibly evidenced by
- Expressed need for information about the disease, drug administration, follow-up care and procedures
- Anxiety associated with relapse of disease
- Parents verbalize understanding of cause and treatment for illness.
|Assess knowledge of disease, signs and symptoms of relapse, dietary and activity aspects of care, medication administration and side effects, monitoring urine and vital signs.||Provides information about education needs for follow-up care.|
|Assess anxiety level and need for assistance in the care of the ailing child and possible relapse.||Anxiety will hinder the ability to learn.|
|Educate parents and child about the cause of the child’s illness and expected treatments. Encourage questions and allow time for discussion.||Teaching supplies required information about the condition and management.|
|Notify parents that immunizations may|
|Promotes safety measure to avoid complications in an immunocompromised child.|
|Educate about the administration of medications including reversible side effects of steroid and immunosuppressive when discontinued abruptly; that they must be stopped gradually to avoid complication.||Promotes compliance of proper medication administration and what can be expected from drug therapy.|
|Educate parents and child possiblity|
for relapse to prevent infection.
|Avoids the risk of infection that may precipitate a relapse.|
|Demonstrate and allow for parents to|
return demonstrate urine testing by
dipstick for albumin, monitor for edema, taking daily weights and blood pressure, and to immediately notify physician on changes of increased weight or presence of albumin in urine.
|Facilitates monitoring of possible relapse of disease.|
|Offer parents and child with praise and encouragement as they acquire skills.||Positive reinforcement improves willingness to learn new skills.|
|Reinforce physician instructions about sodium restriction, activity progression, and pacing.||Promotes a return to usual patterns of living.|
|Provide information about the disease, its causes, need for frequent hospitalizations if the disease becomes prolonged or is a relapsing type with remissions and exacerbations.||Promotes understanding of disease process and importance of compliance with therapy to prevent exacerbation.|
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Genitourinary Care Plans
Care plans related to the reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy | 6 Care Plans
- Mastectomy | 14+ Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 6 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans