Nursing Care Plan

Nursing Management of Nephrotic Syndrome

Nursing Diagnoses 2015-17:
Definitions and Classification
(NANDA Nursing Diagnoses)


Nephrotic Syndrome

Definition

Nephrotic syndrome is a condition where there is a change in renal function, which is characterized by:
  • hypoproteinemia
  • edema
  • hyperlipidemia
  • proteinuri
  • ascites
  • decrease in urine output

The existence of the glomerular injury is usually followed by a:
  • proteinuria
  • hypoalbuminemia
  • hyperlipemia
  • edema
  • proteinuria increased
  • increased glomerular permeability to protein loss
  • plasma.

Etiology
  • Primary renal parenchymal disease
  • Acute post-streptococcal glomerulonephritis
  • Idiopathic Glomerular
  • Systemic Diseases
  • DM, renal abnormalities that are characteristic of diabetes is diabetic nephropathy
  • Amyloidosis / associated with chronic diseases such as tuberculosis, chronic osteomiliti, lung abscess, ulcerative colitis and neoplasms.
  • SLE is known as lupus nephritis. SN is a clinical manifestation of SLE
  • Mechanical circulatory disorders
  • Renal vein thrombosis
  • The increase in renal venous pressure can lead to increasing the basal membrane permeability resulting in leakage of plasma
  • Right heart syndrome
  • Proteinurin to congestive heart disease.

Pathophysiology
  • In nephrotic syndrome, type III hypersensitivity reaction occurs in which the immune complex precipitated in the tissue.
  • Activation of the complement system also stimulates vaksoaktive amines (including histamine) and this substance causes retraction of endothelial cells thus increasing vascular permeability.
  • Changes in membrane glomerolus, causing increased permeability, allowing the proteins (especially albumin) out through the urine (proteinurine).
  • Decreased oncotic pressure causing albumin moves from intra vascular space into interstitiel.
  • Transfer of proteins to the interstitial cavity causing lipoproteinemia.
  • It stimulates the liver to compensate by increasing the production of lipoproteins and increased concentrations of blood fats (hyperlipidemia).
  • When the liver is not able to compensate for damage in fat and protein metabolism.
  • Transfer of protein exit the vascular system, causing fluid to move into the space plasma interstitisel resulting edema and hypovolemia.
  • Decrease in vascular volume stimulates renin angiotensin system, which allows the secretion of aldosterone and antidiuretic hormone (ADH).
  • Aldosterone stimulates increased reabsorsi distal tubules of the sodium and water, leading to increased edema.

Clinical Manifestas
  • weight increased
  • anorexia
  • edema anasarka
  • abdominal pain
  • swelling of the face, especially around the eyes
  • voleme urine decreased, sometimes colored thick and foamy
  • pale skin
  • the child becomes irritable, tiredness / lethargy
  • celulitis, pneumonia, peritonitis or sepsis
  • azotemia
  • blood pressure is usually normal / up slightly
Nursing Management of Nephrotic Syndrome
a. Focus Assessment
  • Urinary System (oliguric, urine retention, proteinurin and urine discoloration).
  • Fluid and electrolyte balance (excess fluid, edema, ascites, weight gain, dehydration)
  • Circulation (increased blood pressure)
  • Neurology (decreased level of consciousness due to dehydration)
  • Breathing (shortness of breath, tachypnea)
  • Mobility (redness, malaise)

b. Nursing Diagnosis
  1. Impaired Urinary Elimination related to Na and water retention.
  2. Excess Fluid Volume related to edema
  3. Imbalanced Nutrition Less Than Body Requirements related to damage protein metabolism
  4. Ineffective Breathing Pattern related to suppression of the diaphragm due to ascites

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