A nurse is caring for a client who is at 38 weeks of gestation, is in active labor, and has ruptured membranes. Which of the following actions should the nurse take?

• Nephrotic Syndrome: The child presents with periorbital and abdominal edema, foamy dark-colored urine, significant proteinuria (24 mg/dL), hypoalbuminemia (1.4 g/dL), and hyperlipidemia (cholesterol 465 mg/dL), all of which are classic indicators of nephrotic syndrome. The elevated ESR and low sodium further support an inflammatory renal process with fluid retention.
• Chronic Kidney Disease: CKD is a long-term progressive decline in kidney function. This child shows acute findings with severe proteinuria and low albumin, consistent with nephrotic syndrome, not CKD.
• Acute Glomerulonephritis: Usually presents with hematuria (cola-colored urine), hypertension, and mild proteinuria. This client has severe proteinuria, hypoalbuminemia, and edema, which are more typical of nephrotic syndrome.
• Hemolytic Uremic Syndrome: Commonly follows a gastrointestinal illness and includes anemia, thrombocytopenia, and acute kidney injury. This child’s platelets are elevated, not low, and there's no history of diarrheal illness, making HUS unlikely.
• Encourage a low sodium diet: Sodium restriction helps manage fluid retention and edema which are key concerns in nephrotic syndrome. It also prevents worsening of ascites and periorbital swelling.
• Administer oral corticosteroids: This is the first-line treatment for idiopathic nephrotic syndrome, especially in children. Corticosteroids reduce glomerular permeability, limiting protein loss in the urine and promoting remission.
• Initiate peritoneal dialysis: Dialysis is only indicated in severe renal failure, which this child does not have. There’s no indication of uremia or electrolyte crisis, so dialysis is not appropriate at this stage.

• Intake and output: Essential for assessing fluid balance. Children with nephrotic syndrome may retain fluid or have decreased urine output, making I&O a crucial measure.
• Daily weight: This is the most accurate way to track fluid retention or loss. Daily weight is important for evaluating response to treatment, especially as edema resolves.

• Head circumference: This is monitored in infants and toddlers, especially to assess for hydrocephalus or growth delays. It is not relevant for a school-age child with kidney issues.

• HbA1C: A measure of long-term blood glucose control, used for diagnosing and managing diabetes. Has no relevance in the diagnosis or management of nephrotic syndrome.
• Urine specific gravity: While useful in initial diagnosis (and already elevated), it is not the best indicator of ongoing progress. Daily weight and I&O are more practical and reliable for assessing edema and treatment response.

A. Platelet count. While important for evaluating bleeding risk, platelet count is not directly used to adjust or determine daily warfarin dosing. Warfarin affects the coagulation cascade, not platelet function.
B. aPTT. The activated partial thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. It assesses the intrinsic pathway of coagulation and is not sensitive to warfarin’s effects on the clotting factors.
C. Fibrinogen level. Fibrinogen is involved in clot formation, but its measurement is not part of routine warfarin management. It is more relevant in evaluating bleeding disorders or disseminated intravascular coagulation (DIC).
D. INR. The international normalized ratio (INR) is the primary lab value used to monitor the effectiveness and safety of warfarin therapy. It helps guide daily dosing by reflecting how long it takes blood to clot, with therapeutic ranges typically between 2.0 and 3.0 for most conditions.