Nephrotic Syndrome (Nephrosis), Glomerulonephritis and Nursing Management

– It is injury of the glomeruli of the kidney. It is a syndrome characterized by edema and proteinuria, hypoproteinemia and hyperlipidemia.

– The most common age is from 2-7 years. Male to female ratio is 2:1.

Causes of Nephrotic Syndrome

– Primary: the most common form and not associated with systemic disease.

– Secondary: can occur as a result of secondary renal involvement associated with systemic disease such as infection.

Clinical Manifestations of Nephrotic Syndrome

• Edema is usually appears first around the eyes and ankles, then the edema becomes generalized. The edema of the scrotum on the male is characteristic.

• Anorexia, irritability and loss of appetite.

• Malnutrition, the child is double his or her weight. After diuresis the malnutrition becomes quite apparent.

• Child is usually susceptible to infection and repeated respiratory conditions.

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Treatment of Nephrotic Syndrome

– The management of neprhotic syndrome is a long process:

• Corticosteroid therapy

• Diuretic to decrease edema

Nursing Management of Nephrotic Syndrome

Nursing diagnosis :

• Fluid volume excess related to fluid accumulation in tissue.

• Risk for altered nutrition: less than body requirements related to anorexia.

• Risk for impaired skin integrity related to edema.

• Activity intolerance related to fatigue.

• Risk for infection.

• Deficit of family knowledge related to care of a child with nephrotic syndrome.

Nursing Intervention:

• Assess and document intake and output.

• Wight the child at the same time every day.

• Offer six small meals may help increase the child’s total intake better than 3 meals/day. Increase protein diet. low in carbohydrates and fats.

• No added salt diet

• Inspect all skin surfaces regularly for breakdown. Turn the position of the child every 2 hours.

• Protect skin surfaces from pressure by means of pillows.

• Bed rest is common during the edema stage.

• Bath the child regularly, wash the skin surfaces that touch each other with soap and water and dry it.

• Protect the child from any one with infection (staff, visitors and other children).

• Hand washing and strict medical asepsis are essential.

• Monitor vital signs every carefully and observe for early signs of infections.

• Providing family support and teaching:

– Prevention of infection

-Treatment plan

– Skin care

– Importance of regular follow up of child’s condition

Glomerulonephritis

– It is an inflammation of the glomeruli of the kidneys. Age incidence (4-12 year)

Etiology

• Certain types of group A beta hemolytic streptococci.

• Streptococcal infection of the upper respiratory tract or skin.

• Viruses, parasites and bacteria.

Clinical Manifestations of Glomerulonephritis

• Puffy face (edema) and discolored urine (hematuria). Urine is brown cola or tea colored.

• Decreased urine output, abdominal pain, anorexia, weight again, pallor, low grade fever.

• Hypertension is a frequent complication, hypertension can be severe to cause enough headaches, visual disturbances, sleepiness, coma or seizures.

• Dyspnea, tachypnea and cough may be present.

Nursing Management of Glomerulonephritis

• Fluid restrictions and diet high in carbohydrates and fats and low in protein, sodium and potassium or both.

• Administer Anti hypertensive and diuretics as ordered

•  Antibiotics.

• Provide nursing care as mentioned in nephrotic syndrome

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