A nurse is collecting data from a 1-year-old child who has Wilms’ tumor. Which of the following findings should the nurse expect?

Choice A reason: Polyuria is not typical in nephrotic syndrome, which causes oliguria due to fluid retention from hypoalbuminemia and reduced oncotic pressure. Proteinuria leads to edema, not excessive urination. Polyuria occurs in conditions like diabetes insipidus, making this an incorrect expected finding for nephrotic syndrome’s pathophysiology.

Choice B reason: Periorbital edema is a hallmark of nephrotic syndrome, resulting from massive proteinuria and hypoalbuminemia, reducing plasma oncotic pressure. This causes fluid leakage into interstitial spaces, particularly around the eyes, due to loose tissue. It’s an expected finding, reflecting the disease’s impact on fluid balance in affected children.

Choice C reason: Orange-tinged urine is not associated with nephrotic syndrome. Proteinuria causes foamy urine, but color changes suggest hematuria or bilirubinuria, seen in other conditions like glomerulonephritis. Edema from fluid retention is more characteristic, making orange-tinged urine an incorrect expected manifestation in this condition.

Choice D reason: Hypertension may occur in nephrotic syndrome due to fluid overload or renin-angiotensin activation but is less common in minimal change disease, the most frequent pediatric form. Periorbital edema is a more consistent and early sign due to hypoalbuminemia, making it the primary expected manifestation over hypertension.

Choice A reason: Educating parents about complications like renal failure in acute glomerulonephritis is important for long-term management but is not the priority in acute care. Fluid overload from impaired glomerular filtration causes edema, requiring daily weight monitoring to assess fluid status and guide diuretic therapy, making education secondary in this context.

Choice B reason: Daily weight checks are the priority in acute glomerulonephritis, as fluid retention from impaired glomerular filtration causes edema and hypertension. Weight gain indicates worsening fluid overload, guiding diuretic or fluid restriction therapy. This prevents complications like pulmonary edema, making it the most critical nursing action in acute management.

Choice C reason: A no-salt-added diet reduces sodium retention in glomerulonephritis, helping manage hypertension and edema. However, it is less urgent than monitoring fluid status via daily weights, which directly assesses fluid overload severity. Dietary changes support treatment but are secondary to tracking weight for timely intervention.

Choice D reason: Maintaining a saline lock ensures IV access for potential medications in glomerulonephritis but does not directly address fluid overload, the primary acute concern. Daily weight monitoring better assesses edema and guides therapy to prevent complications like heart failure, making saline lock maintenance a lower priority action.