A nurse is caring for a school-age child in the pediatric unit.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing. 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Rationale for correct choices:

• Nephrotic syndrome: The child shows hallmark signs of nephrotic syndrome—periorbital edema, fatigue, frothy urine, hypoalbuminemia (1.4 g/dL), hyperlipidemia (cholesterol 465 mg/dL), massive proteinuria (24 mg/dL), and specific gravity of 2.066. The elevated platelets and ESR also support an inflammatory renal process.
• Administer oral corticosteroids: Corticosteroids like prednisone are the first-line treatment for nephrotic syndrome as they reduce proteinuria by suppressing immune-mediated damage to the glomeruli.
• Encourage a low-sodium diet: A low-sodium diet helps control edema by minimizing fluid retention, which is especially important in children presenting with ascites and periorbital swelling.
• Abdominal girth: Measuring abdominal girth helps track changes in ascites and monitor the effectiveness of fluid management interventions like diet and medication.
• Urine specific gravity: Monitoring urine specific gravity assesses kidney concentration ability and fluid balance. Persistently elevated values may indicate worsening proteinuria or fluid imbalance

Rationale for incorrect choices:

• Acute glomerulonephritis: Although this condition can cause hematuria and edema, it typically follows a streptococcal infection and presents with hypertension, gross hematuria, and low urine output not massive proteinuria or hyperlipidemia.
• Chronic kidney disease: CKD develops over time and is characterized by progressive decline in renal function. This child’s symptoms and labs point more toward an acute or relapsing condition like nephrotic syndrome.
• Hemolytic uremic syndrome: HUS is associated with recent diarrheal illness, thrombocytopenia, anemia, and acute kidney injury—not heavy proteinuria or hypoalbuminemia. Platelet count here is high, not low as seen in HUS.
• Initiate contact precautions: Contact precautions are not routinely required for nephrotic syndrome unless there’s an active infection or immunosuppressive therapy risk—neither of which is indicated in the current scenario.
• Initiate peritoneal dialysis: Dialysis is reserved for end-stage renal disease or severe fluid overload unresponsive to other treatments. The child’s kidney function here, while abnormal, does not yet warrant dialysis.
• Administer antibiotics: There’s no evidence of bacterial infection—no fever, elevated WBC count, or infectious focus. Antibiotics are not appropriate without signs of infection.
• Head circumference: Head circumference is useful in infants for monitoring brain growth but irrelevant in school-age children with kidney disorders.
• Bilirubin: Bilirubin levels assess liver function and jaundice; they’re not relevant in evaluating nephrotic syndrome progression.
• HbA1c: HbA1c measures long-term glucose control in diabetes, not kidney function or protein loss. It's unrelated to the child’s current presentation.