The nurse is caring for a client hospitalized with nephrotic syndrome. Based on the client's treatment, the n… - DHS Staff Nurse - 2018 (Shift-2nd)

DHS Staff Nurse - 2018 (Shift-2nd)

Medical & Surgical Nursing

Hard

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Nephrotic syndrome is characterized by the loss of large amounts of protein, including immunoglobulins (antibodies), in the urine, which compromises the client's immune system.
The primary treatment often involves corticosteroids, which are powerful immunosuppressants, further increasing the risk of infection.
Infection is a major and potentially life-threatening complication for clients with nephrotic syndrome.
Limiting visitors is a crucial infection control measure to minimize the client's exposure to pathogens from outside the hospital environment.

Option B: A low-protein diet is contraindicated as it can worsen malnutrition and hypoalbuminemia due to the significant protein losses in the urine.
Option C: Dialysis is a treatment for complete or near-complete kidney failure (ESKD), not a standard intervention for nephrotic syndrome.
Option D: Offering additional fluids would worsen the severe, generalized edema that is a hallmark of nephrotic syndrome.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management and complications of nephrotic syndrome to guide bedside assessment, documentation, and the next nursing action.
Infection is a leading cause of morbidity and mortality in patients with nephrotic syndrome. Nurses must be vigilant in monitoring for signs of infection (fever, cough, sore throat) and implementing strict infection control protocols.
Nursing care involves a comprehensive assessment, including daily weights, strict intake and output monitoring, measurement of abdominal girth, and assessing for edema and signs of thromboembolism (another major complication).
What if? If the client presented with signs of a skin infection on their edematous legs (cellulitis), the nurse's priority would shift to administering prescribed antibiotics promptly and providing meticulous skin care, as edematous tissue is fragile and prone to breakdown.

How to Approach the Question

First, identify the core diagnosis: nephrotic syndrome. Recall its key characteristics: massive proteinuria, hypoalbuminemia, and severe edema.
The question asks for an action based on the 'treatment.' Think about the standard treatments for nephrotic syndrome, primarily corticosteroids to suppress the immune response.
Consider the combined effect of the disease (loss of infection-fighting proteins) and the treatment (immunosuppression). This points to a high risk of infection.
Evaluate each option in this context:
Limiting visitors directly addresses the high risk of infection.
A low-protein diet is generally incorrect and can cause harm.

Concept Tested & Keywords

Concept Tested: Nursing management and complications of nephrotic syndrome.
Stem keywords: nephrotic syndrome, hospitalized, treatment
Lead-in keywords: nurse should
Clinical cues: The phrase 'based on the client's treatment' points towards considering the side effects of common medications used for nephrotic syndrome, such as corticosteroids.