OUR LADY OF FATIMA UNIVERSITY

Valenzuela City
College of Nursing

A case study
about
NEPHROTIC SYNDROME

In Partial Fulfillment of the Requirements in NCMB 418 - Related Learning Experience

Nursing Care of Clients with Life-Threatening Conditions, Acutely Ill, Multi-organ
Problems High Acuity & Emergency Situations (Acute & Chronic)

Submitted to:
Prof. Evangeline Serilla Salas MAN, RN, RM

Submitted by:
Lariosa, Ainah Francesca
Lopez, Lyden Blaire
Maac, Katrina
Magsakay, Grace Ann
Malacas, Ma. Kristina
Malaga, Shirly
Marzan, Joshua

GROUP 3E
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

I. Learning Objectives
This case study aims to broaden the students’ knowledge and develop their skills and attitude in
the care of clients with Nephrotic Syndrome, learners will:
● Understand the disease process, diagnostic criteria, and pathophysiology of Nephrotic
Syndrome and describe the treatment and management of the patient.
● Apply the nursing process to the care of clients with Nephrotic Syndrome. Set
measurable and achievable short- and long-range goals
● Establish appropriate nursing diagnosis based on the assessment data gathered.
● Provide proper interventions to meet the health needs of the client.
● Formulate and present drug studies of medications given to the client as a part of
treatment regimen.
● Provide appropriate recommendations for the patient's continued recovery.

II. Introduction
Nephrotic syndrome is a sign that
kidneys are not working right.
Nephrotic syndrome has high levels of
protein in urine, low levels of protein in
the blood, and high cholesterol.
Nephrotic syndrome is not a disease. It
is a warning that something is
damaging the kidneys. Without
treatment, that problem could cause
kidney failure, so it's important to get
treatment right away. There are tiny
blood vessels in the kidneys that filter
waste and extra water from the blood.
When these filters are damaged, it can
cause nephrotic syndrome. Protein
helps move water from the tissues into
the blood. Healthy kidneys keep the
right amount of protein in the blood. Damaged kidneys let protein slip from the blood into the
urine. Without enough protein in the blood, fluid builds up in the tissues. This can cause swelling.

Many things can cause this blood vessel damage, including diabetes, lupus, infection, certain
cancers, and some medicines. The most common early symptoms of nephrotic syndrome, in both
children and adults, is swelling in the tissues around the eyes or in the feet or ankles. It may also
have swelling in the lungs that can make it hard to breathe. But many people who have nephrotic
syndrome don't have symptoms. Treatment for nephrotic syndrome depends on the cause and the
age of the person who has the condition. Medicines, changes in diet, and care for other
conditions. These treatments may reverse, slow or prevent further kidney damage.
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

Nephrotic syndrome is uncommon, but it plays an important role in the development of kidney
disease. The illness affects roughly 3 adults per 100,000 people per year. According to reports, the
incidence of minimum change illness in children is 2 per 100,000 (Yolanda Smith, 2021).

Severe swelling (edema), particularly around the eyes and in the ankles and feet, is one of the
signs and symptoms of nephrotic syndrome. Foamy urine is caused by an overabundance of
protein in your urine. Weight increase as a result of fluid retention.

III. Patient’s Profile

Name: R.D.L

Age: 14 years old

Sex: Female

Nationality: Filipino

Religion: Roman Catholic

Address: Valenzuela City

Medical Diagnosis: Nephrotic Syndrome secondary to Anemia

Date and Time of Admission: Dec 11, 2022 | 02:40am

Admitting Physician: Charmie C. Francisco Lanuzga M.D

History of present Illness

As stated by her mother, December 5 they went to a health center for a medical checkup and
showed tea-colored urine. During December 11 they went to Valenzuela Medical City due to the
signs and symptoms such as swelling on the face and feet shown on the patient.

IV. Physical Assessment

A. GENERAL/ Overall health status - Awake

- Conscious and coherent

 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

- with Heplock and nasal cannula in place

B. INTEGUMENT (SKIN, HAIR, NAIL) - No lesions

- No foul ordor

- No masses

C. HEAD - Head size is appropriate to body size.

- No nodules or masses upon palpation

D. EARS - Align symmetrically within corner of the

eyes

- No tenderness

- No discharges

- No swelling/redness

E. EYES - (+) Periorbital Edema

- No discharges

F. NOSE AND SINUSES - Symmetric and straight.

- No watery discharges.

- Air moves freely as the client breathes

through nares.

- Not tenderness, masses and pain noted upon

palpation.

- presence of nasal cannula

 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

G. NECK - No presence of contusions

H. MOUTH - Dry and pale lips noted upon inspection

- Tonsils not enlarged

- No palpable nodules

- No gums bleeding noted

I. RESPIRATORY - Symmetrical chest expansion

- No retraction

- with shortness of breath

J. ABDOMEN - Abdominal skin is intact.

- No Distended abdomen noted

L. CARDIOVASCULAR - Skin color of the palm of the hand and feet

is pale.

- bluish nail beds upon inspection.

- Symmetric pulse volumes, full pulsations of

peripheral pulses.

- elevation in blood pressure

M. MUSCULOSKELETAL - Posture is good, able to stand straight and

can walk alone properly but slowly.

- Movement of muscles has coordination.

 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

N. UPPER EXTREMITIES - No rashes

- No edema
- No cyanosis
- No wounds
- with heplock

O. LOWER EXTREMITIES - No rashes

- (+) pitting edema
- No wounds

V. Anatomy & Physiology

The renal system primarily functions as the

body’s filtering system. This system comprises
the kidney, ureters, urinary bladder and the
urethra. As mentioned, the overall function of
the system filters approximately 200 liters of
fluid a day through the renal blood flow which
allows for toxins, metabolic waste products and
excess ions to be excreted while keeping
essential substances in the blood.

The kidneys, a pair of purplish-brown organs

located below the ribs and towards the middle
of the back, regulate plasma osmolarity by modulating the amount of water, solutes, and
electrolytes in the blood. It ensures long term
acid-base balance and also produces erythropoietin
which stimulates the production of red blood cells. It
also produces renin for blood pressure regulation
and carries out the conversion of vitamin D to its
active form.

In addition, the kidneys filter urea from the blood

through the tiny filtering units called nephrons.
These nephrons each consist of a ball formed of
small blood capillaries, called a glomerulus, and a
small tube called a renal tubule. Urea, combined
with water and other waste substances, collectively form the urine as it passes through the
nephrons and down the renal tubules of the kidneys. The ureters then carry the formed urine to
the bladder, the triangle-shaped, hollow organ located in the lower abdomen. The bladder's walls
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

relax and expand to store urine, and contract and flatten to empty
urine through the urethra. The typical healthy adult bladder can
store up to two cups of urine for two to five hours. Specific
landmarks of the bladder are identified upon examination in order
to elucidate presence of irregularities. The trigone is the
triangle-shaped region proximal to the junction of the urethra and
the bladder, it is enclosed by the right and left lateral walls, and the
posterior wall as well as the dome. The sphincter muscles of the
urinary system aid in maintaining the formed urine from leaking
while the nerves found in the bladder predict the time of
micturition process, the contraction of the detrusor muscle and
relaxation of the internal and external urethral sphincter.
Afterwards, the urethra, distal portion of the urinary tract, allows
the urine to be excreted from the body.
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

VI. Pathophysiology
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

VII.Course in the Ward

DATE and TIME DOCTOR’S ORDER NURSING

RESPONSIBILITIES

December 11, 2022

2:40 AM ➢ Low salt and low fat diet ➢ Monitored the vital signs
➢ Oral fluid limitation: 715 cc/day ➢ Monitored I and O
➢ O2 support: 1L/min ➢ Monitred fluid
➢ Monitor vital signs q4 consumption
➢ Monitor intake and output qshift ➢ Weighed the patient
➢ Weigh the patient daily ➢ Administered
medications
MEDICATIONS: ➢ Prepared the patient for
➢ Ampicilin 750 mg IV q6 laboratory tests
ANST,
➢ Furosemide 38 mg IV q8 with
BP precautions

DIAGNOSTIC TESTS:
➢ CBCPC
➢ Serum electrolytes
➢ ASO
➢ BUN
➢ Blood Typing
➢ Coomb’s test
➢ Reticulocyte count
➢ Lipid profile
➢ Albumin
➢ Creatinine
➢ KUB UTZ.

REFER:
➢ Pedia nephrotomy
➢ Hematology

5:00 PM ➢ PRBC 250 cc

➢ CBC after 4 hours of BT ➢ Performed blood
transfusion
POST BT MEDICATIONS: ➢ Monitored for allergic
reactions
➢ Hydrocortisone 190g TIV q8
➢ Administerd post BT
x 6 doses medications
➢ Dipenhydramine 38 g TIV q8 ➢ Informed the laboratory
x 6 doses for another CBC for the
➢ Paracetamol 300 mg TIV q6 x patient
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

6 doses.

December 12, 2022

7:50 AM ➢ Low salt and low fat diet ➢ Monitored the patient’s
➢ Oral Fluid Restriction: 715 diet
cc/day ➢ Monitored vital signs
➢ Monitor vital signs q4 ➢ Monitored fluid
➢ Monitor I and O consumption
➢ Weigh the patient ➢ Monitored I and O
➢ Administered
MEDICATIONS: medications
➢ Ampicilin 750 mg IV q6 ➢ Weighed the patient
ANST,
➢ Furosemide 38 mg IV q8 with
BP precautions
5:00 PM

➢ Oral Fluid Restriction: 820 ➢ Monitored fluid

cc/day consumption
DIAGNOSTIC TEST: ➢ Obtain request for C3
➢ C3 test test

10: 30 PM
➢ Monitor BP every 3 minutes ➢ Monitored BP q30 mins
➢ Furosemide 38 mg TIV ➢ Administered
medication

December 13 20,22 ➢ Nifedipine 10 mg SL ➢ Administered

12:00 AM ➢ Monitor vital signs q1 medication
➢ Monitored vital signs

1:00 PM ➢ ANA Anti-DSDNA ➢ Secured consent

5:00 PM ➢ Oral Fluid Restriction: 850 ➢ Monitored I and O

cc/day

December 14, 2022

8:00 AM ➢ Low salt and low fat diet ➢ Monitored patient’s diet
➢ Monitor vital signs q1 ➢ Monitored vital signs

MEDICATIONS:
➢ Prednisone 20 mg per tab every
after meal. ➢ Administered
➢ Nifedipine 10 mg/capsule. medications

December 15, 2022

8:00 AM ➢ Monitor vital signs q1 ➢ Monitored vital signs q1:
➢ Low salt and low fat diet BP: 130/90 mmHg
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

➢ Oral Fluid Restriction: 850 cc/day T: 37 C

➢ O2 support: 1L/min. Followed up P:90 bpm
the request RR: 20 cpm
MEDICATIONS: O2 sat: 99%.
➢ Ampicilin 750 mg IV q6, ➢ Monitored fluid
➢ Furosemide 38 mg IV q8 with BP consumption
precautions ➢ Monitored diet
➢ Nifedipine 10 mg SL PRN ➢ Followed up the request
➢ Prednisone 20 mg 1 tab, 3 times a for C3 and ANA
day. Anti-dsDNA
➢ Administered
medications

December 16, 2022

8:00 AM ➢ Monitor vital signs q1 ➢ Monitored I and O
➢ Oral Fluid Restriction: 1240 ➢ Monitored the patient’s
cc/day vital:
BP: 110/20 mmHg,
T: 36 C
RR: 18 cpm
P:89 bpm
O2 sat: 99%
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

VIII. Gordon’s Functional Health Patterns

FUNCTIONAL HEALTH BEFORE DURING

PATTERN HOSPITALIZATION HOSPITALIZATION

Health Perception and According to the patient’s The patient is compliant to

Health Management mother, her daughter the medications and medical
experiences vomiting and interventions prescribed for
there is an evident facial and her condition.
feet swelling.

Nutritional and Metabolic The patient has a good The patient is placed under a
Pattern appetite. She usually eats 3 low salt and low fat diet that
meals a day with snacks in affects her appetite. However,
between. She loves to eat with the help of her mother,
carbohydrates rich food like she was still able to eat 3
pizza and fries, as well as meals in a day.
sweetened bananas.

Elimination Pattern The patient has a normal The patient defecated once
bowel pattern and usually and had a urine output of 400
defecates once a day. ml for 8 hours.
However, last December 5 the
patient urinated a tea-colored
urine.

Activity - Exercise Pattern The patient does not really The patient was not able to do
perform exercises, but she any physical activity as she
frequently dances. seems weak and needs
assistance every time she
does something. She is
usually lying down and
sometimes sits in the
monobloc beside her bed.

Sleep - Rest Pattern She usually sleeps 7 to 8 Her sleep and rest periods are
hours a day. usually interrupted with
nurse's rounds because her
vital signs need to be
monitored every 1 hour.

Cognitive - Perceptual The patient did now show any Her cognitive and mental
Pattern signs of cognitive capabilities remained intact.
dysfunctions and can freely
communicate with the nurses.

Self-concept Pattern She believes that the medical Her major concern is to be
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

interventions and procedures discharged. She is hopeful

will be helpful to alleviate her and positive.
condition.

Role Relationship Pattern She has two brothers and a Due to the hospital's policy,
twin sister, whom she only her mother was able to
considers her best friend. accompany her and take good
care of her.

Sexual-Reproductive She had not yet reached She had not yet reached
Pattern menarche. menarche.

Coping or Stress Tolerance The patient talks to her The patient expresses her
mother whenever she is concerns to her mother and
anxious and seeks comfort diverts her attention watching
from her as well. random videos on social
media

Value and Belief Pattern Their family usually goes to The patient prays at night for
church and attends the mass her faster recovery
every sunday.

IX. Laboratory and Diagnostic Procedures

TEST PARAMETERS RESULT REFERENC INTERPRETATION

E RANGE

URINALYSIS ALBUMIN 1.00 Patient's urine tested positive

(PROTEIN) mg/dL on Albumin, which indicates
that her kidneys are not
working well because protein
leaks through her kidney's
filter. This is a sign that her
kidneys are damaged.

BLOOD & RED 290 0-2.3 Her urine tested positive on

BLOOD CELLS blood which is confirmed by
the Red Blood Cell detected
on her urine, which explains
why she is Anemic.
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Valenzuela City
College of Nursing

TRANSPAREN SLIGHTL Her urine is slighty turbid

CY Y because of the red blood
TURBID cells present in the urine,
and it might also appear
foamy because of the
presence of Protein.

COMPLETE RBC 3.78 4.0 - 4.5 her RBC are significantly

BLOOD x10^12/L decreased, same with her
COUNT Hemoglobin and
(CBC) Hematocrit which explains
HEMOGLOBIN 103 g/L 120 - 140 why she is having a hard
time breathing, because
there are less cells that
HEMATOCRIT 0.319% 0.370 - carries oxygen to her
0.470% body. 2 days after, she had
blood transfusion which
helped her hemoglobin to
go from 61 to 103 mg/dL.

WBC 2.40 5.0 - 10.00 her WBC are significantly

x10^9/L decreased, which signifies
that her immune system
dropped, and she is clearly
Immunocompromised.

NEUTROPHILS 63. 7% 40.0 - 75.0 Neutrophils significantly

decreased which makes her
susceptibles in bacterial
infections.

EOSINOPHIL 0.0% 1.0 - 4.0 an occasional low number

of eosinophil cells, it
doesn't pose a major threat
in health because other
cells in immune system
compensate for the lack of
eosinophils.

BASOPHIL 0.4% 0.0 - 1.0 Normal

 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

LYMPHOCYTE 31. 3% 20.00 - 0.00 Normal

S

MONOCYTES 4.6% 2.0 - 6.0 Normal

MCV 84.4 fl 80.0 - 94.0 Normal

MCH 27.2 pg 27.5 - 33.2 Decreased MCH indicates

the presence of iron
deficiency anemia.

RDW 16.8 % 11.0 -15.0 Increased RDW may be a

sign of anemia or a related
condition.

Platelet Count 232 150-440 Normal

x10^9/L

CHEMISTRY LIPID PROFILE 8.43 All parameters such as

TESTS mmol/L Cholesterol, Triglycerides,
LDL are high, except the
VLDL and HDL which is
because of her kidney
disease.

ALBUMIN 20.1 g/L 35.0 - 53 .0 her Albumin levels on her

Serum is decreased maybe
because she is excreting
some of it on her urine.

CREATININE 183.3 70.0 - 115.0 her Creatinine levels are

µmol/L increased, clearly
indicating that her kidneys
are damaged, and might
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

suggest hemodialysis in
the future.

C3 TEST 54.7 82 - 180 C3 Complement helps

mg/dL your body to kills bacteria
& viruses. Hers are
decreased, making her an
easy target of bacteria
and virus-causing disease.

RETICULOC 1.80% 0.50-1.50 - her retics count are

YTE COUNT slightly high, indicating
that her bone marrow are
releasing young and
immature RBCs called
reticulocytes to
compensate to the
decreased amount of
mature RBCs in the blood
stream

PERIPHERA There are abnormalities

L BLOOD on her blood, as seen
SMEAR under the microscope.
Her RBCs varies in
different sizes and shapes,
which is called
Anisopoikilocytosis. It has
elliptocytes, schistocytes,
and teardrop shaped RBCs
mainly because she has
Anemia.

ANTI-STREP - negative on SteprolysiN

TOLYSIS O O Test, meaning she has
TEST no existing bacterial
infection, specifically
streptococcus infection
 OUR LADY OF FATIMA UNIVERSITY
Valenzuela City
College of Nursing

ULTRASOUN - There are no

D OF THE pathological findings
KIDNEYS found. Her kidneys and
AND urinary bladder are still
URINARY normal.
BLADDER
X.DRUG STUDY

FUROSEMIDE
MECHANISM OF INDICATION/RA CONTRAINDICA NURSING
DRUG ADVERSE EFFECT
ACTION TIONALE TION CONSIDERATIONS

Generic Name: It is thought to Used for ● Anuria -

Furosemide impede sodium and excretion of Na not present ● GI: Dry ● Monitor patient’s
chloride and water that in the mouth intake and output
Therapeutic reabsorption from manages the patient's ● Respiratory ● Monitor signs
Class: the ascending Henle edema of the clinical and symptoms of
- Nausea,
Diuretic, loop and the distal patient caused by manifestati
Vomiting hypokalemia
antihypertensive renal tubules. In Nephrotic on.
which the inhibition Syndrome. ● GU- ● Encourage taking
Pharmacologic promotes renal frequent potassium
Class: excretion of water, urination containing food
Sulfonamide loop sodium, chloride, ● Skin - such as banana
diuretic magnesium, diaphoresis and apple
hydrogen, and ● Monitor patient’s
Dosage: calcium by
blood pressure
38 mg increasing
potassium excretion and pulse
Frequency: and plasma volume.
Q8

Form:
Solution for
Injection (ampule)
Route of
Administration:
I.V

AMLODIPINE
MECHANISM OF INDICATION/RAT CONTRAINDICATI NURSING
DRUG ADVERSE EFFECT
ACTION IONALE ON CONSIDERATIONS

Generic Name: Inhibiting the Patient having ● Monitoring of

Amlodipine inflow of calcium episodes of high ● Hypersensit ● CNS - patient's heart rate,
ions into vascular blood pressures ivity to weakness, and blood pressure
smooth muscle of 180/100, drug - not fatigue
Therapeutic Class: and cardiac 160/110 ● Support patient in
manifested ● Respiratory
Antihypertensive muscle reduces by the ambulating due to
- shortness of weakness
peripheral patient
Pharmacologic vascular breath
Class: resistance,
Calcium channel resulting in a Some are manifested
blocker decrease in blood by patient possibly
pressure. due to anemia
Dosage:
5 mg

Frequency:
OD
Form:
Tablet

Route of
Administration:
PO

PREDNISONE
DRUGS MECHANISM INDICATION/RATI CONTRAINDIC ADVERSE NURSING
OF ACTION ONALE ATION EFFECTS CONSIDERATIONS

● CNS -
● Generic Reduces Patient manifested a restlessness, ● Administer in the
Name: inflammation serious systemic headache, morning, after
Prednisone by reversing disease, this is ● Hypersen dizziness meal of the patient
directed to reducing sitivity to ● GI - dry ● Monitor for blood
● Therapeutic increased
proteinuria and drug mouth, pressure
Class: Anti capillary nausea, ● Monitor for
edema of the ● Active
inflammatory permeability in patient. vomiting cushingoid and
, cells. untreated ● Respiratory adrenal
Immunosuppr Suppresses infection - cough, insufficiency
essant immune system wheezing symptoms
All are not
● Pharmacolo by reducing
manifested by the
gic Class: lymphatic
patient.
Corticosteroi activity.
d
 ● Dosage:
20mg
● Frequency:
TID
● Form: Tablet
● Route of
Administrati
on: PO

AMPICILIN
DRUGS MECHANISM OF INDICATION CONTRAINDIC SIDE EFFECTS NURSING
ACTION ATION CONSIDERATIONS

Generic Name: Bactericidal action This medication is Hypersensitivity to

Ampicilin against sensitive indicated for the ampicillin or any ● GI: Dry ● Explain the purpose
organisms; inhibits patient since she component of the Mouth, and importance of
synthesis of has a 2.40 x10^9/L formulation. Nausea and the drug to the
bacterial cell wall of WBC which vomiting,
Therapeutic patient.
causing death signifies that her diarrhea,
Class: Broad immune system abdominal ● Check IV sites
Spectrum dropped. pain carefully for signs of
antibacterial thrombosis or drug
reaction.
Pharmacologic ● Monitor for pain or
Class: Penicillin ● HYPERSENS
discomfort at sites,
derivative ITIVITY:
Rash, fever, unusual bleeding or
wheezing, bruising, mouth
anaphylaxis sores, rash hives,
Dosage: fever, itching, severe
750 mg diarrhea, difficulty of
breathing.
Form:
Solution

Frequency:
Q6

Route of
Administration:
IV

NIFEDIPINE
MECHANISM OF NURSING
DRUGS ACTION INDICATION CONTRAINDICA SIDE EFFECTS CONSIDERATIONS
TION
Generic Name: Nifedipine is a Nifedipine is used Nifedipine is CNS: headache, ● Monitor patient
Nifedipine Calcium channel to manage high contraindicated in dizziness, fatigue, carefully (BP, cardiac
blocking agent that blood pressure. It patients who are nervousness, sleep rhythm, and output)
Brand Name: selectively blocks lowers blood allergic to disturbances. ● Teach significant
Procardia ion influx across pressure by nifedipine. others of the patient
cell membranes of relaxing the blood CV: peripheral edema, the common side
Therapeutic cardiac muscles and vessels so the heart angina, hypotension, effects of the drug
Class: vascular smooth does not have to arrhythmias, and to report any
Anti-Hypertensive muscle without pump as hard severe effects at
changing serum Dermatologic: once.
Pharmacologic calcium Flushing, rash, pruritus, ● Ensure that the
Class: concentrations. dermatitis patient does not chew
-Calcium channel or divide
blocker GI: nausea, sustained-release of
-Antiarrhythmic Constipation, diarrhea, tablet.
-Vasodilator cramps, flatulence

Dosage: OTHER: nasal

10mg/Tab congestion, cough,
fever, chills, shortness
Frequency: of breath, muscle
Q6, PRN cramps

Route of
Administration:
Oral Route
 Nursing Care Plan 1

ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS KNOWLEDGE

Excess Fluid Hypoproteinemia Independent:

Subjective: Volume related Short term: Short term:
to decreased
“Nagmamanas ang kidney function
↓ After 2 hours of nursing
1. Establish
rapport with
1. To gain
trust and After 2 hours of
binti at paa ng and fluid intervention, the patient the patient and confidence nursing
anak ko” as Decreased oncotic and mother will mother. in giving intervention, the
accumulation
verbalized by the pressure verbalize understanding care to the patient and mother
patient’s mother. secondary to of dietary and fluid were able to
the nephrotic patient.
limitations, demonstrate verbalize
Objective: syndrome as ↓ behaviors to monitor 2. Monitor the 2. To assess
understanding of
evidenced by fluid intake and output patient’s intake dietary and fluid
for renal
- Pitting pitting edema Hypovolemia and verbalize knowledge and output limitations and
impairmen
edema: grade and altered about sign and symptoms strictly and demonstrate
t and also
2 blood pressure. and demonstration of behaviors to
↓ follow up care.
accurately. necessary
for
monitor fluid intake
- Changes in and output and
determinin
vital signs verbalize knowledge
Na+ and water g the
about sign and
retention amount of
- V/S taken After 3 days of symptoms and
fluid that
as follows: ↓ continuous nursing
intervention, the patient
has to be
demonstration of
follow up care.
Edema replaced
T: 36.2 will manifest: and lower
↓
Excess fluid the risk of
BP: 147/86 1. Vital signs within fluid
volume normal range After 3 days of
overload.
RR: 20 continuous nursing
3. Monitor vital
2. Nearly absence of intervention, the
signs every 1 3. To obtain
patient manifested
PR: 82 edema hour. data for
vital signs within
compariso
O2: 100 normal range and
n.
nearly absence of
edema from grade 2
4. Assess skin, 4. To serve
Input: 715 cc/hr face, feet and as to grade 1.
areas of edema. parameter
Ouput: 400 ml/hr of severity
of fluid
excess. GOAL was MET.

5. Daily
5. Weigh the body
patient daily by weight is
using the same the best
weighing scale indicator
and clothing. of fluid
status.

6. To reduce
6. Instruct the the dryness
parent to of mouth
provide and
frequent oral membrane
hygiene. s.

7. Advise the 7. To
parent to limit regulate
the fluid intake the
as ordered. patient’s
fluid
balance.
Fluid
restriction
is advised
and
indicated
for patients
 with
edema.

8. To help
8. Encourage regulate
patient to fluid
consume a low balance
salt, low fat and reduce
and high fluid
potassium. retention.

9. To help
mobilize
9. Encourage the edema
bed rest for a and
few days and prevent
assist in thrombose
ambulation s and
after few days elevation
of medications. of venous
return.

10. Educate the

10. Urine
mother of the should be
patient in urine collected
collection and and tested
instructed to for protein
keep a record to
of results. determine
the
severity of
protein
loss.

11. Educate patient 11. Knowledg

and mother the e and skills
 signs and about the
symptoms of care
disease and increases
importance of independe
medical nce and
attention. confidence
.

Dependent
Interventions:

1. Administer 12. Diuretics

diuretic like help to
furosemide 38 reduce
mg q8 IV as tissue
ordered. edema.
 Nursing Care Plan 2
ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE

Subjective: Decreased Within 4-8 hours Independent: Independent: .

"Lagi nga ako Cardiac Output Renal glomerular of nursing After 4 hours of
nababahala sa related to damage intervention the 1. Establish 1. It helps in nursing
BP niya dahil increased pt will be able to: rapport with the building trust and intervention the
laging mataas" peripheral patient and alleviates anxiety patient was able to
as verbalized by vascular
↓ a.Demonstrate mother and distress and demonstrate a
the mother's resistance as adequate cardiac enhances blood pressure of
Proteinuria patients'
patient. evidence by BP output as 130/80.
of 147/86 and the ↓ evidenced by involvement in
pt is lethargic. Decreased oncotic blood pressure decisions about
pressure within normal their care
Objective: parameters. 2. Monitor the
- lethargic ↓ b.Have patient's vital 2. It can help to (Goal was
BP: 147/86 knowledge about signs every manage partially met.)
T: 36.2 Hypovolemia the causative hour. hypertension and
HR: 82bpm factors prevent serious
RR: 20cpm ↓ c. health problems.
Decreased renal
blood flow
3. Check for 3. To assess the
Renin release peripheral blood flow
pulses. through
Performed peripheral
Edema capillary refill tissues.
↓ test
Decreased cardiac
output
4. Fluid and salt
4. Monitor the retention and
fluid balance
 and weight gain. increased fluid
Weigh the pt volume may
regularly. occur from
compromised
regulating
systems. Edema
is a
distinguishing
feature of heart
failure.
5. Monitor the
I&O of the 5. Reduced cardiac
patient. output results in
reduced
perfusion of the
kidneys, with a
resulting
decrease in urine
output.

6. Assess for 6. Close monitoring

reports of of the patient's
fatigue and response helps as
reduced activity a guide for
intolerance. appropriate
activity
progression

7. Educate the pt 7. For them to have

and the patient's the knowledge
SO about the
 cause of and help them to
increased blood alleviate their
pressure. anxiety.
a. Inform the
mother that
the
increased
BP of the
patient may
be the cause
by the side
effects of
the
medication
that is given
to the
patient
8. .These dietary
limitations may
8. Advise the aid in the
patient to limit regulation of
fluids and your child's fluid
sodium balance.

DEPENDENT:

1.Administer the 1. Used to treat high

prescribed blood pressure
medications by the
 physician.

A. Amlodipine

Nursing Care Plan 3

ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE

Independent: Independent:
Objective: Risk for Hypoproteinemia Short term: After 1 hour of
infection 1. Establish 1. To gain trust rendering nursing
- Changes related to ↓ After 1 hour of rapport with and intervention, the
in vital inadequate rendering the patient confidence in patient and mother
signs defenses and Decreased proteins in nursing and mother. giving care to was able to
treatment of the blood intervention, the the patient. demonstrate
- V/S immunosuppr patient and understanding
taken as essants ↓ mother will be regarding
follows: able to 2. Monitor importance of
Risk for infection demonstrate and reported 2. Monitoring early recognition
T: 36.2 understanding any signs for the sign of infection as
regarding the and and evidenced by
BP: 147/86 importance of symptoms symptoms of verbalizing the
early recognition of infection. the body is signs and
RR: 20 of infection as essential to symptoms of
evidenced by communicate infection.
PR: 82 verbalizing the health
signs and problems and
O2: 100 symptoms of trigger the
infection. search for Long term:
- solution.
Laboratory Long term After 1 week of
result: consistent nursing
T. Protein: 51.9 After 1 week of intervention, the
– LOW consistent patient was able to
nursing 3. Monitor 3. Fever is not develop
WBC: 2.40 intervention, the vital signs often the first infection as
x10^9/L - LOW patient will not especially sign of an evidenced by
develop temperature. infection. A absence of signs
infection as temperature and symptoms of
evidenced by of up to 38º C infection by
absence of signs may indicate maintaining
and symptoms of infection; a temperature in
infection. very high normal range and
temperature breath sounds are
accompanied clear bilaterally.
by sweating
and chills
may indicate
septicemia. GOALS ARE
PARTIALLY
MET.
4. Maintain
and advised 4. Aseptic
the patient’s technique
family to decreases the
practice chances of
medical transmitting
aseptic or spreading
technique pathogens.
and This also
handwashin interrupts the
g before chain of
giving care infection.
to the Handwashing
patient. is the most
common and
 simplest way
to maintain
asepsis.

5. Maintain a 5. To avoid
warm and chills and
comfortable susceptibility
environment to URTI.
by
regulating
the room
temperature
and
humidity.

6. Educate the 6. Common

client and signs and
family symptoms of
regarding infection
the early include:
onset of fever, feeling
infection tired or
and when to fatigued
see a doctor. swollen
lymph nodes
in the neck,
armpits, or
groin,
headache and
nausea or
 vomiting

7. Advise
parent and
child to 7. To prevent
avoid the spread of
exposure to microorganis
persons with m and
exposure or provides
share a understandin
room with g of
children free susceptibility
from to infections.
infections.

Dependent
Interventions:

1. Administere 1. Prednisone is
d an
prednisone immunosuppr
20 mg TID essant which
PO as helps to
ordered. prevent
inflammation
but can
reduce ability
of the body to
fight
infections.
 2. Administere 2. Ampicillin is
d ampicillin an antibiotic,
750 mg q6 this will
IV as prevent
ordered. infection
formation.

DISCHARGE PLANNING

Take all the prescribed medications.

Medications

○ Amlodipine 5mg OD
○ Prednisone 20 mg TID
○ Nifedipine 10mg/Tab q6, PRN

Environment / Exercise ● Advised the mother to walk with the child at least 10 - 20 minutes.
● Moderate-intensity exercises may be effective and safe for pediatric patients with nephrotic
syndrome in the acute phase.(like dancing, walking.) Exercise therapy may be beneficial to
improve physical function and prevent decline during hospitalization in pediatric nephrotic
syndrome patients.
 Treatment ● Steroid treatment can generally manage the symptoms of nephrotic syndrome. Most children with
nephrotic syndrome respond well to steroids and are not at risk of kidney failure.
● Advised the mother that follow-up care is a key part of her child's treatment and safety

Health Teaching
● Wash your hands often, especially before eating and after being in public places.
● Follow your doctor's advice for the amounts of protein and potassium you need in your diet.
● Advise the mother to take all the medications that are prescribed by the physician.

When to call a doctor:

Treatment ● Symptoms that don’t get better, or get worse

● New symptoms
● Nausea or vomiting, or abdominal pain
● Unexpected weight gain or swelling in the legs, ankles, or around the eyes
● Dark colored urine
● Less no urine

● Advice the mother that her child should take a low salt and low fat diet.
Diet
Be aware of and try to limit the “Salty Six”, which include:

○ Breads, rolls, bagels, flour tortillas, and wraps.Cold cuts and cured meats.
○ Pizza.
○ Poultry (much poultry and other meats are injected with sodium. Check the Nutrition
Facts for sodium content or read the package for a description of a solution, for example,
"Fresh chicken in a 15% solution.")
○ Soup.
 ○ Sandwiches
● Limit fluid intake
● Keep track of how much fluid your child drinks.
● Advise the mother that her child can eat fresh or frozen vegetables (green beans, lettuce,
tomatoes), low-sodium canned vegetables, and potatoes.

Spiritual Encourage the mother to give full support to the child and to stay by her side. Encourage the significant
others to pray. Remind her to seek protection from God.
References:
Enawgaw, B., Workineh, Y., Tadesse, S., Mekuria, E., Addisu, A., & Genetu, M. (2019).

Prevalence of Anemia and Associated Factors Among Hospitalized Children Attending

the University of Gondar Hospital, Northwest Ethiopia. EJIFCC, 30(1), 35–47.

Iorember, F. (2016, December 21). Anemia in nephrotic syndrome: approach to evaluation and

treatment. SpringerLink.

https://link.springer.com/article/10.1007/s00467-016-3555-6?error=cookies_not_supporte

d&code=b76398b4-e9ea-4264-9640-8031047125f3

Li, P., Yin, Y. L., Li, D., Woo Kim, S., & Wu, G. (2007). Amino acids and immune function.

British Journal of Nutrition, 98(2), 237–252. https://doi.org/10.1017/s000711450769936x

Nephrotic Syndrome. (2019, November 19). Johns Hopkins Medicine.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/nephrotic-syndrome

NHS website. (2022, October 7). Nephrotic syndrome in children. nhs.uk.

https://www.nhs.uk/conditions/nephrotic-syndrome/

Renin: Production, Function, Levels & Testing. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/body/22506-renin

Sickle cell anemia - Symptoms and causes. (2022, March 9). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc

-20355876

Wang, C. S., & Greenbaum, L. A. (2019). Nephrotic Syndrome. Pediatric Clinics of North

America, 66(1), 73–85. https://doi.org/10.1016/j.pcl.2018.08.00