NURSING CARE PLAN

NURSING
CUES DIAGNOSIS RATIONALE OBJECTIVES RATIONALE EVALUATION
INTERVENTION
Excess Fluid Volume Nephrotic Syndrome is a Child will be able to Monitor intake and Accurate measurement Objective met. Patient
Subjective: related to decreased disease with symptoms of maintain a stable vital output determines fluid maintained stable vital
“Di man sakit. kidney function as edema, proteinuria, signs throughout shift balance. signs all throughout the
Nanhupong raman ko..” evidenced by periorbital hypoalbuminemia and shift.
and facial puffiness hypercholesterolemia. Monitor vital signs Fluid volume excess may
“Nikalit raman ko Sometimes there is lead to elevated BP.
manhupong. Sa tiil man hematuria, hypertension
toh nagsugod…” and reduced kidney Assess the oral mucous Oral hygiene reduces
function. membranes and dryness of mouth and
Subjective: elasticity of skin turgor mucous membranes.
https://www.nurseananda.top/2011/06
BP:110/90 mmhg This disease occurs /nursing-diagnosis-and-nursing.html
PR: 98 bpm suddenly, especially in
RR: 22 cpm children. Usually in the Child will achieve ideal Weigh child daily; Utilize Daily body weight is a Objective met. Patient
T: 36.7C form of oliguria with dark- body weight without same weighing scale good indicator of maintains normal
colored urine, or urine is excess fluids every day. hydration status. A weight for age with BMI
thick due to heavy weight gain of more of 13.
proteinuria. than 0.5 kg/day suggests
fluid retention.
http://ross-
robinson.blogspot.com/2011/06/nursing- Instruct parents to Oral hygiene reduces
care-plan-for-nephrotic-syndrome.html
provide frequent oral dryness of mouth and
hygiene. mucous membranes.

Teach parents regarding Knowing the disease

kidney function and condition enables the
disease condition. parents to follow
through with the
therapeutic regimen.

https://nurseslabs.com/nephrotic- https://nurseslabs.com/nephrotic-
syndrome-nursing-care-plans/ syndrome-nursing-care-plans/
 NURSING CARE PLAN

NURSING
CUES DIAGNOSIS RATIONALE OBJECTIVES RATIONALE EVALUATION
INTERVENTION

Subjective: Risk for infection related Treatment for nephrotic Child’s temperature will Assess for an increase in Indicates presence of Objective met. Patient
“Di man sakit. to inadequate secondary syndrome includes not exceed 37.5 C during temperature, respiratory infectious process as a maintained normal
Nanhupong raman ko..” defenses treating the underlying the shift. changes (dyspnea, result from steroid and temperature all
condition that's causing productive cough with immunosuppressant throughout the shift.
“Nikalit raman ko it and taking yellow sputum), urinary therapy administered to
manhupong. Sa tiil man medications. Nephrotic changes (cloudy, foul- improve body defenses
toh nagsugod…” syndrome can increase smelling urine), skin and lessen relapse rate.
your risk of infections Child’s breath sounds changes (tenderness, Objectives met. Patient
Subjective: and blood clots. Your will be clear bilaterally. redness, swelling). had clear breath sounds
BP:110/90 mmhg doctor may recommend upon auscultation.
PR: 98 bpm medications and dietary Assess immunization People with incomplete
RR: 22 cpm changes to prevent status and history. immunizations may not
T: 36.7C these and other have sufficient acquired
complications of active immunity.
Patient a history of nephrotic syndrome.
pneumonia Maintain and teach Promotes preventive
medical aseptic measures against
https://www.mayoclinic.org/diseases-
techniques and infection.
conditions/nephrotic- handwashing when
syndrome/symptoms-causes/syc-
20375608
providing care.

Administer antibiotic Prevents or treats

therapy as ordered. infection depending on
the result of culture and
sensitivities.

Advise parents to Allows for prompt

immediately notify the medical intervention to
physician of sign or avoid relapse.
symptom of infection.

Child’s urine will be Appearance of urine. Cloudy, turbid, foul- Partially met. Patient’s
clear without odor smelling urine with urine was light yellow
visible sediment is but no foul odor.
 NURSING CARE PLAN
https://nurseslabs.com/nephrotic-
syndrome-nursing-care-plans/5/
indicative of urinary
tract or bladder
infection.

https://nurseslabs.com/nephrotic-
syndrome-nursing-care-plans/5/

NURSING
CUES DIAGNOSIS RATIONALE OBJECTIVES RATIONALE EVALUATION
INTERVENTION

Subjective: Deficient knowledge Symptoms may disappear completely if the Parents verbalize Assess knowledge of Provides information Objectives met.
“Unsa na nga related to lack of nephrotic syndrome is caused by a understanding of disease, signs and about education needs Patient and SO was
medisina Sir?” exposure to treatable disorder, such as an infection, cause and symptoms of relapse, for follow-up care. able to express
“para asa na?” as information about cancer, or drugs, provided the condition is treatment for dietary and activity understanding of
verbalized by the the disease as treated early and effectively. This situation illness. aspects of care, the condition the
mother evidenced by occurs in about half the cases in children medication patient has.
expressed need for but less often in adults. If the underlying administration and side
Subjective: information about disorder responds to corticosteroids, effects, monitoring urine
BP:110/90 mmhg the disease, and sometimes progression of the disease is and vital signs.
PR: 98 bpm drug administration. halted, and less often the condition
RR: 22 cpm partially or, rarely, completely reverses. Educate parents and Teaching supplies
T: 36.7C When the syndrome is caused by HIV child about the cause of required information
infection, it usually progresses relentlessly, the child’s illness and about the condition and
Patient a history of often resulting in complete kidney failure in expected treatments. management.
pneumonia 3 or 4 months. When the cause is systemic Encourage questions and
lupus erythematosus or diabetes mellitus, allow time for
Patient’s SO drug treatment often stabilizes or discussion.
expressed decreases the amount of protein in the Promotes compliance of
inadequate urine. However, some people do not Educate about the proper medication
knowledge of the respond to drug treatment and develop administration of administration and what
disease of her chronic kidney disease that progresses to medications including can be expected from
patient. kidney failure within a few years reversible side effects of drug therapy.
steroid and
immunosuppressive
https://www.merckmanuals.com/home/kidney- when discontinued
and-urinary-tract-disorders/kidney-filtering- abruptly; that they must
disorders/nephrotic-syndrome be stopped gradually to
avoid complication.
NURSING CARE PLAN

Educate parents and Avoids the risk of

child possiblity infection that may
for relapse to prevent precipitate a relapse.
infection.

Provide information Promotes understanding

about the disease, its of disease process and
causes, need for importance of
frequent hospitalizations compliance with therapy
if the disease becomes to prevent exacerbation.
prolonged or is a
relapsing type with
remissions and https://nurseslabs.com/nephrotic-
syndrome-nursing-care-plans/4/
exacerbations.
https://nurseslabs.com/nephrotic-
syndrome-nursing-care-plans/4/