A nurse is planning care for a child who is in the acute stage of nephrotic syndrome. Which of the following interventions should the nurse include in the plan of care?

Increase fluid intake to 2 L/day.

Weigh the child once per day.

Position the child supine at bed time.

Limit calorie intake to 45 cal/kg/day.

Answer and Explanation

The Correct Answer is B

A.   In nephrotic syndrome, there is significant protein loss leading to edema. Increasing fluid intake would exacerbate the problem. Fluid restriction is often necessary.
B.   Daily weight monitoring is crucial in nephrotic syndrome to assess fluid retention and the effectiveness of treatment. Weight gain indicates fluid accumulation.
C.   Elevating the child's head and legs can help reduce edema. Supine positioning might worsen it.
D.   Adequate nutrition is essential for healing and recovery. Restricting calories is not necessary and could be harmful.

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Correct Answer is C

Explanation

A. Increasing oral fluid intake would not necessarily improve dialysate outflow. This could worsen the issue if the problem is related to fluid overload.
B. Increasing dwell time might allow more time for fluid and waste removal, but it's not the most appropriate action in this case. The primary concern is the lack of outflow, which suggests a potential obstruction or other issue.
C. Changing the child's position can help to reposition the catheter and improve drainage. This is a reasonable action to try.
D. A bruit indicates increased blood flow to the area. While it's important to assess for this, it's not the most immediate action to take.

A. Secure the restraints with a quick-release knot. B. Assess the child every 4 hr while in restraints. C. Request that the provider renew the prescription for restraints every 48 hr. D. Tie the restraints to the side rails of the child's bed.

Correct Answer is A

Explanation

A. A quick-release knot allows for the restraints to be removed swiftly in case of an emergency. This is important to ensure that the child can be freed quickly if needed, such as if there is a sudden change in the child’s condition or an emergency arises.
B. This is not adequate for ensuring the child’s safety. Regular assessments are critical for monitoring the child's physical condition, circulation, and overall comfort while in restraints. Typically, the child should be assessed at least every 15-30 minutes, depending on the facility’s policy and the child’s condition, to prevent complications such as skin breakdown, impaired circulation, or increased distress.
C. The renewal of a restraint order typically must occur more frequently than every 48 hours. According to most regulations and facility policies, restraint orders are usually valid for a shorter period, often 24 hours, and must be renewed daily by a provider.
D. This is not appropriate and can be dangerous. Restraints should never be tied to bed rails because this can cause serious injury if the child moves or if there is any sudden movement of the bed. Instead, restraints should be secured to a part of the bed frame that moves with the bed and does not pose a risk of injury. Proper restraint attachment helps avoid entrapment and injury.

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A nurse is planning care for a child who is in the acute stage of nephrotic syndrome. Which of the following interventions should the nurse include in the plan of care?

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