Nephrotic syndrome is a kidney disorder characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and improving patient outcomes through comprehensive care planning.
Causes (Related to)
Nephrotic syndrome can develop due to various underlying conditions and factors affecting kidney function:
- Primary kidney diseases:
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous nephropathy
- Secondary causes:
- Diabetes mellitus
- Systemic lupus erythematosus
- Amyloidosis
- HIV infection
- Risk factors include:
- Genetic predisposition
- Autoimmune disorders
- Certain medications
- Infections
- Cancer
Signs and Symptoms (As evidenced by)
Nephrotic syndrome presents with characteristic signs and symptoms that nurses must recognize for accurate diagnosis and treatment.
Subjective: (Patient reports)
- Fatigue and weakness
- Decreased appetite
- Foamy urine
- Shortness of breath
- Abdominal pain
- Joint pain
- Difficulty with movement due to edema
Objective: (Nurse assesses)
- Generalized edema
- Weight gain
- Decreased urine output
- Elevated blood pressure
- Pallor
- Ascites
- Laboratory findings:
- Proteinuria >3.5g/24hrs
- Hypoalbuminemia <3.5g/dL
- Elevated cholesterol
- Elevated triglycerides
Expected Outcomes
The following outcomes indicate successful management of nephrotic syndrome:
- The patient will demonstrate reduced edema
- The patient will maintain optimal fluid balance
- The patient will show improved nutritional status
- The patient will maintain normal blood pressure
- The patient will demonstrate an understanding of disease management
- The patient will avoid complications
- The patient will adhere to the prescribed medication regimen
Nursing Assessment
Monitor Vital Signs
- Check blood pressure every 4 hours
- Monitor heart rate and respiratory rate
- Track daily weight
- Assess temperature
Evaluate Fluid Status
- Monitor intake and output strictly
- Assess edema location and degree
- Check for ascites
- Evaluate skin turgor
- Monitor for signs of fluid overload
Assess Nutritional Status
- Monitor protein intake
- Track caloric intake
- Assess appetite
- Monitor weight changes
- Check albumin levels
Monitor for Complications
- Assess for thrombosis signs
- Watch for infection indicators
- Monitor for respiratory distress
- Check for signs of malnutrition
- Evaluate for renal failure symptoms
Review Medication Compliance
- Assess understanding of medications
- Monitor response to treatment
- Check for side effects
- Verify proper administration
- Document adherence
Nursing Care Plans
Nursing Care Plan 1: Excess Fluid Volume
Nursing Diagnosis Statement:
Excess Fluid Volume related to decreased plasma oncotic pressure secondary to hypoalbuminemia as evidenced by peripheral edema, weight gain, and decreased urine output.
Related Factors:
- Decreased plasma protein levels
- Sodium and water retention
- Impaired kidney function
- Altered membrane permeability
Nursing Interventions and Rationales:
- Monitor daily weights at the same time and conditions
Rationale: Indicates fluid status changes and treatment effectiveness - Assess edema location and degree
Rationale: Tracks progression of fluid retention - Maintain strict I&O records
Rationale: Helps evaluate fluid balance and treatment effectiveness - Administer diuretics as prescribed
Rationale: Promotes fluid elimination and edema reduction
Desired Outcomes:
- The patient will demonstrate decreased edema
- The patient will maintain a stable weight
- The patient will show improved urine output
- The patient will maintain an effective breathing pattern
Nursing Care Plan 2: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to decreased immune function and protein loss as evidenced by low albumin levels and immunosuppressive therapy.
Related Factors:
- Compromised immune system
- Protein loss in urine
- Use of immunosuppressive medications
- Presence of edema
Nursing Interventions and Rationales:
- Monitor for signs of infection
Rationale: Enables early detection and treatment - Maintain aseptic technique
Rationale: Prevents introduction of pathogens - Educate about infection prevention
Rationale: Empowers patient to prevent infections
Desired Outcomes:
- The patient will remain free from infection
- The patient will demonstrate proper hygiene techniques
- The patient will identify early signs of infection
Nursing Care Plan 3: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to protein loss and decreased appetite as evidenced by hypoalbuminemia and unintentional weight loss.
Related Factors:
- Protein loss through urine
- Poor appetite
- Altered metabolism
- Dietary restrictions
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Provide high-protein meals as ordered
Rationale: Helps replace protein losses - Monitor serum albumin levels
Rationale: Indicates nutritional status and treatment effectiveness
Desired Outcomes:
- The patient will maintain adequate nutritional intake
- The patient will demonstrate improved albumin levels
- The patient will maintain a stable weight
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to fatigue and fluid retention as evidenced by weakness and decreased ability to perform ADLs.
Related Factors:
- Generalized weakness
- Edema
- Fatigue
- Altered metabolism
Nursing Interventions and Rationales:
- Assess activity tolerance
Rationale: Determines appropriate activity level - Assist with ADLs as needed
Rationale: Prevents exhaustion while maintaining function - Encourage progressive activity
Rationale: Builds strength and endurance
Desired Outcomes:
- The patient will demonstrate improved activity tolerance.
- The patient will perform ADLs independently
- The patient will maintain energy conservation
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about nephrotic syndrome management as evidenced by questions about self-care and verbalized misconceptions.
Related Factors:
- Complex disease process
- New diagnosis
- Multiple medication regimens
- Lifestyle modifications required
Nursing Interventions and Rationales:
- Provide disease education
Rationale: Increases understanding and compliance - Teach medication management
Rationale: Ensures proper treatment adherence - Demonstrate self-monitoring techniques
Rationale: Enables early detection of complications
Desired Outcomes:
- The patient will verbalize understanding of the disease process
- The patient will demonstrate proper self-care techniques
- The patient will identify warning signs requiring medical attention
References
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