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Tuesday, May 26, 2009

Nursing Care Plan for Nephrotic Syndrome

Nephrotic syndrome isn't a disease but is characterized by marked proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria, increased coagulation, and edema. It results from a glomerular defect that affects the vessels' permeability and indicates renal damage. Some forms of nephrotic syndrome may eventually progress to end-stage renal failure.
All of these diseases increase glomerular protein permeability, which leads to increased urinary excretion of protein, especially albumin, and subsequent hypoalbuminemia.

Causes for Nephrotic syndrome
nephrotic syndrome result from primary (idiopathic) glomerulonephritis:

  • Lipid nephrosis (nil lesions): usually occurs in children
  • Membranous glomerulonephritis
  • Focal glomerulosclerosis
  • Membranoproliferative glomerulonephritis

Other causes of nephrotic syndrome include

  • Metabolic diseases: diabetes mellitus
  • Collagen-vascular disorders: systemic lupus erythematosus,periarteritis nodosa.
  • Circulatory diseases: heart failure, sickle cell anemia, and renal vein thrombosis.
  • Nephrotoxins: mercury, gold, and bismuth.
  • Infections: tuberculosis, enteritis; allergic reactions; pregnancy; hereditary nephritis
  • Neoplastic: multiple myeloma

Treatment For Nephrotic Syndrome
Effective treatment of nephrotic syndrome requires correction of the underlying cause if possible. Supportive treatment, avoid All nephrotoxins .

Nephrotic Syndrome Nursing diagnoses

  • Disturbed body image
  • Excess fluid volume
  • Imbalanced nutrition: Less than body requirements
  • Ineffective tissue perfusion: Renal
  • Risk for infection
  • Risk for injury

Nursing outcomes Nursing Care Plan for Nephrotic Syndrome
The patient will:

  • Express positive feelings about him.
  • Maintain fluid balance.
  • Show no signs of malnutrition.
  • Maintain adequate urine output.
  • Free from signs or symptoms of infection.
  • Avoid or minimize complications.

Nursing interventions Nursing Care Plan for Nephrotic Syndrome

  • Assessment and Document the location and character of the patient's edema.
  • Measure blood pressure with the patient lying down and standing. Immediately report a decrease in systolic or diastolic pressure exceeding 20 mm Hg.
  • If the patients receive a renal biopsy, watch for bleeding and signs of shock.
  • Monitor intake and output and weigh the patient each morning after he voids and before he eats. Make sure he's wearing the same amount of clothing each time you weigh him.
  • Ask the dietitian to plan a low-sodium diet with moderate amounts of protein.
  • Frequently check urine for protein.
  • Monitor plasma albumin and transferrin concentrations to evaluate overall nutritional status.
  • Provide meticulous skin care to combat the edema that usually occurs with nephrotic syndrome.
  • Use a reduced-pressure mattress or padding to help prevent pressure ulcers.
  • To prevent the occurrence of thrombophlebitis, encourage activity and exercise, and provide antiembolism stockings as ordered.
  • Give the patient and family reassurance and support, especially during the acute phase, when edema is severe and the patient's body image changes

Patient teaching and home health care guide for Nephrotic Syndrome

  • If the patients receive immunosuppressants, teach him and family members to report even mild signs of infection.
  • If the patients receive long-term corticosteroid therapy, teach him and family members to report muscle weakness and mental changes.
  • To prevent GI complications, suggest to the patient that he take steroids with an antacid or with cimetidine or ranitidine. Explain that the adverse effects of steroids subside when therapy stops, but warn the patient not to discontinue the drug abruptly or without a physician's consent.
  • Stress the importance of adhering to the special diet.
  • If the physician prescribes antiembolism stockings for home use, show the patient how to safely apply and remove them.


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