Nephrotic Syndrome Patients

You're providing care to a 6 year old male patient who is receiving treatment for nephrotic syndrome. Which assessment finding below requires you to notify the physician immediately? A. Frothy, dark urine B. Redden area on the patient's left leg that is swollen and warm C. Elevated lipid level on morning labs D. Urine test results that shows proteinuria

B ~ Patients with nephrotic syndrome are at risk for hypercoagulability (blood clot formation) due to the loss of proteins in the urine that prevent blood clot formation. Option B represents a possible deep vein thrombosis, which will appear as a redden, warm, and swollen area on the extremity. Options A, C, and D are common findings with nephrotic syndrome, which are expected.

As the nurse, you know that it is important to implement a low sodium diet for a patient with nephrotic syndrome. However, it is important to implement what other type of diet due to another complication associated with this syndrome? A. Low-phosphate B. Low-fat C. High-carbohydrate D. Low-potassium

B ~ Patients with nephrotic syndrome can experience hyperlipidemia. Why? Remember that in this condition there will be low amounts of albumin in the blood. This decrease of albumin in the blood causes the liver to make more albumin, BUT while it does this it also makes more cholesterol and triglycerides...hence increasing lipid levels. Therefore, the patient should follow a low-sodium and low-fat diet as well.

Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

B ~ The objectives of therapy for the child with minimal change nephrotic syndrome include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimization of complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Excretion of urinary protein and fluid retention are part of the disease process and must be reversed.

The mother of a child, who was recently diagnosed with nephrotic syndrome, asks how she can identify early signs that her child is experiencing a relapse with the condition. You would tell her to monitor the child for the following: (SATA) A. Weight loss B. Protein in the urine using an over-the-counter kit C. Tea-colored urine D. Swelling in the legs, hands, face, or abdomen

B, D ~ The patient will NOT experience weight loss but weight GAIN as a sign of relapse with this condition. In addition, the urine will appear dark and foamy. Tea-colored urine indicates there is blood in the urine, which is NOT common with nephrotic syndrome.

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (SATA) a. Weight loss b. Facial edema c. Cloudy smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

B, D, E ~ A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

You're collecting a urine sample on a patient who is experiencing proteinuria due to nephrotic syndrome. As the nurse, you know the urine will appear: A. Tea-colored B. Orange and frothy C. Dark and foamy D. Straw-colored

C ~ The urine will appear dark and foamy due to the high amount of proteins present in the urine. Remember in nephrotic syndrome the patient is losing a massive amount of protein per day (3 grams per day) and this will cause the urine to foam.

Which is a common side effect of short-term corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite

D ~ Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

Which patient below is NOT at risk for developing nephrotic syndrome? A. An 8 year old male with diabetes mellitus. B. A 5 year old female diagnosed with minimal change disease. C. A 10 year old male with Lupus. D. A 7 year old male recently diagnosed with Goodpasture's Syndrome.

D ~ The patients in options A-C are all at risk for nephrotic syndrome. The patient in option D is at risk for acute glomerulonephritis.

What is the normal lab value for Serum Creatinine?

0.6-1.2 mg/dL

What is the normal lab value for Urine Specific Gravity?

1.01-1.03

What is the normal lab value for serum PHOSPHORUS?

2.4-4.1 mg/dL

What is the normal lab value for Urine Potassium?

25-100 mEq/L/day

What is the normal lab value for serum ALBUMIN?

3.5-5.5 g/dL

What is the Normal Osmolality of Urine?

300-900 mOsm/kg

Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis

A ~ Corticosteroids are the first line of therapy for minimal change nephrotic syndrome. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

What is the normal lab value for Urine pH?

4.8-7.5

What is the normal lab value for Urine Sodium?

40-220 mEq/day

What is the normal lab value for Urine RBCs?

<4 RBC/HPF

A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include which of the following as a nursing diagnosis for this patient? A. Risk for infection B. Deficient fluid volume C. Constipation D. Overflow urinary incontinence

A ~ A patient with nephrotic syndrome is at risk for infection due to the potential loss of proteins (immunoglobulins) in the urine that help fight infection. In addition, medication treatment for nephrotic syndrome may include corticosteroids or immune suppressors, which will further suppress the immune system. Option B is wrong because the patient will be experiencing fluid volume overload (not deficient). Option C and D are wrong because constipation and overflow urinary incontinence are not common findings with nephrotic syndrome.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.

A ~ High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

B ~ Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A -hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate

B ~ Salt is usually restricted (but not eliminated) during the edema phase. The child has little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

What are the normal Creatinine Clearance values?

Men 107-139 mL/min Women 87-107 mL/min

What is the normal Glomerular Filtration Rate (GFR)?

Men >130 mL/min/m2 Women >120 mL/min/m2

List the GFR rates in the different stages of renal failure.

Stage 1 = <90 mL/min Stage 2 = <60 mL/min Stage 3 = <45 mL/min Stage 4 = <30 mL/min Stage 5 = <15 mL/min

The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema

A ~ Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection. Temperature is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with minimal change nephrotic syndrome. The child will most likely have neurologic signs and symptoms.

You're providing education to a group of nursing students about nephrotic syndrome. A student describes the signs and symptoms of this condition. Which signs and symptoms verbalized by the student require you to re-educate the student about this topic? (SATA) A. Slight proteinuria B. Hypoalbuminemia C. Edema D. Hyperlipidemia E. Tea-colored urine F. Hypertension

A, E, F ~ The patient with nephrotic syndrome will experience massive proteinuria (not slight) along with low albumin in the blood (hypoalbuminemia), edema, and high cholesterol and triglyceride levels. It is not common for the patient to experience tea-colored urine or hypertension (rare) this is very common with acute glomerulonephritis.