5 Nephrotic Syndrome Nursing Care Plans


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

Risk For Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

May be related to

  • Inadequate secondary defenses

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child’s temperature will remain <99° F.
  • Child’s breath sounds will be clear bilaterally.
  • Child’s urine will be clear without foul odor.
Nursing InterventionsRationale
Assess for an increase in temperature, respiratory changes (dyspnea, productive cough with yellow sputum), urinary changes (cloudy, foul-smelling urine), skin changes (tenderness, redness, swelling).Indicates presence of infectious process as a result from steroid and immunosuppressant therapy administered to improve body defenses and lessen relapse rate.
Maintain and teach medical aseptic
techniques and handwashing when providing care.
Promotes preventive measures against infection.
Maintain warmth for the child, regulate
room environmental temperature
and humidity.
Avoids chilling and susceptibility to upper respiratory infection.
Provide private room or share room with children who are free from infections.Protects the child from transmission of microorganism.
Administer antibiotic therapy as ordered.Prevents or treats infection depending on the result of culture and sensitivities.
Advise parents and child to avoid
exposure to persons with existing infections.
Provides an understanding of susceptibility to infections.
Advise parents to immediately notify the physician of sign or symptom of infection.Allows for prompt medical intervention to avoid relapse.

See Also

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