Planning of Nursing Care
- Promote nonnal urinary pattern or releive excess fluid
- Administer medication as prescribed
- Protect the children from secondary infection
- Control oedema and maintain proper fluid balance
- Provide nuitritious and therapeutic diet
- Prevent infection and'prevent skin breakdown
- Provide emotional support and educate the parents
- Provide proper follow up and discharge advises.
Implementation of Nursing Care
Administration of Medication
Your responsibility is to give exact and accurate, prescribed dose of corticosteroids i.e. prednislone which is given in a daily dose of 2 mg/kg up to (maximum of 80 mg) in divided doses for 24 hours. This helps to reduce the protein excretion. The therapy is 4 continued until the child is protein free and then the dose is tapered for about 1 to 31 weeks before discontinuing the drug. Your major responsibility as a nurse in drug administration is to watch the child for any untoward side effects of the drug, such as gastrointestinal bleeding and ulcers, behavioural or personality changes. These should be immediately reported.You need to be aware of relapse in which case additional steroid therapy is prescribed.
Control Oedema and Maintain Fluid Balance
It is your responsibility to monitor the sodium and fluid intake. Salt intake is restricted during oedema and the child may be assessed for venous stasis, ascites which is measured by measuring abdomina girth. Drugs to relieve oedema are accurately given and daily weight record and strict intake out output record must be maintained daily.
Nutrition and Therapeutic Diet
Child should be provided with well balanced diet with high protein content. The carbohydrate and fat content of diet should be high enough to prevent protein utilisation. Since these children have poor appetite, small quantities of attractively arranged favourite foods should be served to them. Meeting the child's daily nutritional needs assists in healing and prevents tissue break down and infection.
Prevent Infection and Skin Breakdown
The child with nephrotic syndrome is prone to get infection, and oedema may lead to skin break down. You as a nurse need to be careful in monitoring the vital signs to assess any sign of infection. So that appropriate antibiotic therapy as prescribed may be administered. The child with oedema should be assessed daily for any break in skin. The skin breakdown should be prevented by good skin care i.e. daily bath, frequent change of position, avoiding the friction to skin etc. Edematous eyelids should be cleaned with warm saline swabs. Support should be provided to edematous scrotum. Other measures include avoiding exposure to heat or cold, provide loose clothing and avoid irritation, and keep the enils short to avoid scratching in order to prevent mechanical skin injury.
Emotional Support and Education to Parents
Problems resulting from nephrotic syndrome like, growth abnormalities, oedema and ascites may create disturbance in these children, so these children should be encouraged to express their feelings about themselves and disease outcome. They should be given moral and psychological support to overcome worry and fear.