CHILD HEALTH NURSING

CASE SCENERIO ON NEPHROTIC SYNDROME

Master Rhythm Rai aged 2.5 year presented to the pediatric emergency department with the
chief complains of generalized swelling of the body since 5 days ,swelling started from the
face followed by swelling of abdomen , upper and lower limbs. The child was diagnosed with
nephrotic syndrome.

History of illness

The patient was apparently well 5 days back when his mother noticed swelling of his face,
which was acute in onset and gradually progressing towards the abdomen and bilateral upper
and lower limbs with refusal to feeds.

• The swelling is painless and pitting in nature.

• The overlying skin was normal and there is no history of itching and rashes.

Antenatal:

• No ANC visits

• No TT vaccines

• No iron and calcium taken

Perinatal history:

• Normal term, spontaneous vaginal delivery at (patient not sure of exact date)

• Baby cried at birth.

• Baby weight:-2.0 kg

• Breast feeding at 4 hours of life.

Post natal history:

• No h/o Excessive bleeding

• No other complications

Dietary History:

• Tea+ 1 cup rice+ 1 cup daal+ 1 cup potato curry

Immunization history:

• Immunization as per EPI schedule with strictly all vaccines given to child

Developmental History

• H/o normal developments

• Explore drawers, runs ups and downstairs

• Asks for food , toilets etc

*On Examination

*General condition:

• facial puffiness +ve

• Edema +ve, bilateral pitting edema of limbs

• No any scar marks of infection

Vitals

• Pulse: 110/min; regular

• RR: 22/min

• Temp: 98 F

• BP: 90/60 on rt arm in sitting

*Anthropometry
• Weight: 13.5 kg

GIT:

Abdomen distended,umbilicus central, all quadrant moving symmetrically with respiration,

no venous prominence, no scar marks, hernia site are intact.

On palpation: no local rise in temperature, no tenderness no any lump and organ

On percussion: shifting dullness present

• Biochemical Parameter

 High protein 20 g/L and a large amount of blood in Urine.

 Serum albumin of 18 g/L (normal 32 g/L to 56 g/L)- Low
 Serum triglycerides of 2.17 g/L (normal 0.31 g/L to 1.41 g/L) - High
 Serum cholesterol of 150mg/dl (normal 30mg/dl to 65mg /dl )- High

 Urine Microscpic Test

 WBCs - 2-3/HPF
 RBCs- 8-10/HPF
 Epithelial cells- 3-5/HPF

Management and Treatment

 Sryp Ritocef 100mg x PO x BD

 Tab Emsolone 25 mg x PO X OD
 Sryp Digene 250 mg x PO x BD

REQUIREMENTS:

 Kardex

 Nurses Notes

 Medicine cards if administered

 Investigation chart

 Feeding chart
 Nursing process according to NANDA diagnosis

 Immunization schedule

 Growth and Development:

 Head to foot examination

 Play therapy and play materials

Health Education
Follow –up &Medication schedule
Nephrotic Syndrome diet
Immunization
Prevention of infection
 KARDEX

Sn Nursing care plan

no Medication Dose Route Fre Tim
que e
ncy Time

1. Sryp Ritocef 100 mg Oral BD 8-8  Monitor client’s weight daily. 7 am

-8  Monitor Vitals 7:15am

2. Emsolone 25 mg Oral OD 8pm
 Assess nutritional daily patterns-
8-8 food preference, caloric intake, 7:30 am
3. Sryp Digene 250 mg Oral BD and diet history.
2
 Identify potential sources of
excess fluid (e.g., food,
medications used)

 Schedule medications in such a

way that they are not administered
immediately prior meals. 8 am

 Provide low sodium and low fat

diet .

 Encourage parents to provide six 9 am

small nutrient-dense meals instead
of three larger meals daily to
reduce the feeling of fullness.

 Provide chosen play activities as

tolerated

 Allow for rest periods after

activity.

 Encourage parents to stay with 11 am

child
12 pm
 Involve the parents in care of
child.

 Provide information regarding

hospital routines and modalities
of treatment.
  Teach parents regarding side
effects of cortico- steroids.
 Teach parents regarding aseptic
techniques to prevent infection.

 Explain parents regarding kidney

function and disease condition.

Name: Master Rhythm Age: 2.5 years

Rai
Diagnosis: Nephrotic IP No: 1234
Syndrome
Religion: Hindu Doctor:

TPR & BP Diet: Low sodium

diet(1,500 to 2,000 mg
per day)

Actual problems:

 Edema
 Refusal to feeds
 Hematuria
Potential problems:

 Infection
 Anaemia
 NURSES NOTES:

Name: Master Abbas Diagnosis: Nephrotic

Syndrome
Age/Sex: 2.5 years /Male
IP No: 1234

Nursing Interventions
Date Diet Tim
e
16/04/1 Low  The baby looks alert, facial puffiness, distended abdomen , 7 am
9 sodium bilateral pitting edema of limbs.
and low
fat diet 7:10 am
 Vitals stable

 Weight- 19 Kgs 7: 15 am
Abdominal girth- 30 cms

 Intake: 900 ml
 Output: 650 ml 7:20 am

 Parents expressed child prefers vegetarian diet and takes five

meals a day

 Informed the parents to limit fluid intake upto 1000 ml/ day by
providing measuring cup. 8 am

 Restricted sodium 1,500 to 2,000 mg per day and included low to

9 am
moderate protein in diet.

 Scheduled medications in such a way that they are not

administered immediately prior meals.

 Informed parents to provide low sodium vegeterian diet like plain

bread, cereals, milk, fruits and vegetables.
 Provided drawing book for drawing. 11 am

 Provided rest in between the activities

 Parents accompanied infant and assisted in care (hold, feed,

diaper change)

 Provided information regarding hospital routines and modalities of

treatment.

 Explained to parents regarding side effects of cortico-steriod that

12 pm
child will have weight gain, roundness of the face
.hyperactivity ,slower growth rate ,a slight increase in body hair
especially on the arms, legs and back etc

 Taught parents regarding aseptic techniques like strict

handwashing, use of sterile equipments and strict hygiene of child.

 Taught parents regarding kidney function and disease condition.

 Function of the kidneys is to remove waste products and excess

fluid from the body. These waste products and excess fluid are
removed through the urine.

 Nephrotic syndrome is a kidney disorder.

 The condition causes your childs body to pass too much protein in
his urine resulting in swelling, particularly in feet and ankles.
.