NCLEX PEDIA 3

Nephrosis (Nephrotic Syndrome)
General information

Autoimmune process leading to structural alteration of glomerular membrane that results in increased permeability to plasma proteins, particularly albumin
Course of the disease consists of exacerbations and remissions over a period of months to years
Commonly affects preschoolers, boys more often than girls

Pathophysiology
Plasma proteins enter the renal tubule and are excreted in the urine, causing proteinuria.
Protein shift causes altered oncotic pressure and lowered plasma volume.
Hypovolemia triggers release of renin and angiotensin, which stimulates increased secretion of aldosterone; aldosterone increases reabsorption of water and sodium in distal tubule.
Lowered blood pressure also stimulates release of ADH, further increasing reabsorption of water; together with a general shift of plasma into interstitial spaces, results in edema.
Prognosis is good unless edema does not respond to steroids.

Medical management

Drug therapy
Corticosteroids to resolve edema
Antibiotics for bacterial infections
Thiazide diuretics in edematous stage
Bed rest
Diet modification: high protein, low sodium

Assessment findings
Proteinuria, hypoproteinemia, hyperlipidemia
Dependent body edema
Puffiness around eyes in morning- due to circulatory congestion
Ascites
Scrotal edema
Ankle edema
Anorexia, vomiting, and diarrhea, malnutrition
Pallor, lethargy
Hepatomegaly

Nursing interventions
Provide bed rest.
Conserve energy.
Find activities for quiet play.
Provide high-protein, low-sodium diet during edema phase only.
Maintain skin integrity. Do not use Band-Aids.
Avoid IM injections (medication is not absorbed into edematous tissue).
Turn frequently.
Obtain morning urine for protein studies.
Provide scrotal support.
Monitor I&O, vital signs and weigh daily.
Administer steroids to suppress autoimmune response as ordered.
Protect from known sources of infection.

1. 2 Y.O OLD WITH NRPHROTIC SYNDROME ON REMISSION, WHAT IS THE PRESCRIBED DIET:
A.LOW SALT, LOW FAT
B.REG DIET WITH NO ADDED SALT

ANSWER: B. LOW SALT DIET IS INDICATED DURING EXACERBATIONS.