Genitourinary Class Work

Scenario: You are caring for a 5-year-old child admitted to the pediatric floor with fluid overload. The child has a history of nephrotic syndrome, which prompts you to review the patient’s chart and provide appropriate care.

1. Pathophysiology and Characteristics of Nephrotic Syndrome

• Pathophysiology:
  • Nephrotic syndrome is a kidney disorder characterized by increased glomerular permeability, leading to significant protein loss in the urine (proteinuria).
  • The loss of proteins, particularly albumin, from the blood leads to decreased oncotic pressure, resulting in fluid shifting from the vascular space into the interstitial spaces, causing edema.
  • The liver compensates by producing more lipoproteins, leading to hyperlipidemia. The immune system is also affected due to the loss of immunoglobulins in the urine, increasing susceptibility to infections.
• Characteristics:
  • Edema: This is a hallmark of nephrotic syndrome, most commonly seen as periorbital (around the eyes), abdominal (ascites), and, in some cases, lower extremity edema.
  • Proteinuria: Urine tests reveal significant protein levels, usually more than 3.5 grams per day.
  • Hypoalbuminemia: Low levels of albumin in the blood due to its loss in urine.
  • Hyperlipidemia: Elevated cholesterol and triglyceride levels due to increased lipoprotein production by the liver.
• Typical Age Group:
  • Nephrotic syndrome most commonly affects children between the ages of 2 and 6 years old. The most frequent form in children is Minimal Change Disease (MCD), which accounts for about 85-90% of cases.

2. Answering the Student Nurse’s Question: Why No Lower Extremity Edema?

• Response:
  • In children with nephrotic syndrome, edema commonly starts as periorbital (around the eyes) and ascites (fluid accumulation in the abdomen) due to the lower tissue resistance in these areas and the gravitational effects when lying down.
  • Lower extremity edema is more common in adults due to the effects of gravity when they are upright, causing fluid to accumulate in the legs. In children, especially those who spend more time lying down, fluid is more likely to accumulate in the face and abdomen.

3. Ensuring Consistent and Accurate Daily Weights

• Best Practices for Accurate Daily Weights:
  • Same Time Every Day: Weigh the patient at the same time each day, preferably in the morning before breakfast and after voiding, to avoid fluctuations due to food and fluid intake.
  • Same Scale: Use the same scale each time to ensure consistency in measurement.
  • Minimal Clothing: Weigh the patient in minimal clothing to avoid additional weight from clothing and accessories.
  • Same Conditions: Try to ensure the patient is weighed under the same conditions, such as before any medications that might affect fluid balance (e.g., diuretics).
  • Document Carefully: Record the weight immediately after measuring, noting any significant changes from the previous day.