A nurse is planning to teach a group of newly licensed nurses about hypermagnesemia. Which of the following manifestations should the nurse include in the teaching?

Rationale for correct choices:

• Nephrotic syndrome: The child exhibits classic features, including periorbital edema, hypoalbuminemia, hypercholesterolemia, proteinuria, and foamy urine. These findings indicate significant protein loss and fluid retention, which are hallmark signs of nephrotic syndrome.
• Administer oral corticosteroids: Corticosteroids reduce kidney inflammation and proteinuria in nephrotic syndrome, helping to achieve remission. Timely administration is essential to control edema, restore albumin levels, and improve the child’s overall nutritional status and well-being.
• Encourage a low sodium diet: A low-sodium diet helps minimize fluid retention and edema, which are major complications of nephrotic syndrome. Reducing sodium intake also supports blood pressure control and prevents additional strain on the kidneys while the child is being treated.
• Abdominal girth: Measuring abdominal girth tracks the accumulation of fluid in the abdomen and the progression of edema. It provides a noninvasive, simple way to monitor the effectiveness of treatment and to detect early signs of worsening fluid retention.
• Urine specific gravity: Monitoring urine specific gravity helps evaluate kidney function and the concentration of solutes, including protein. Changes in this parameter reflect the child’s response to therapy and assist the nurse in assessing disease progression.

Rationale for incorrect choices:

• Chronic kidney disease: Chronic kidney disease develops gradually and usually shows slow, progressive renal impairment over time. The rapid onset of periorbital edema, hypoalbuminemia, hypercholesterolemia, and proteinuria in this child is more consistent with nephrotic syndrome rather than CKD.
• Hemolytic uremic syndrome: HUS typically presents after a diarrheal illness and is characterized by anemia, thrombocytopenia, and acute kidney injury. This child’s lab results show elevated platelets and normal hemoglobin levels, which are inconsistent with HUS.
• Acute glomerulonephritis: Acute glomerulonephritis presents with hematuria, mild edema, and hypertension. In contrast, this child has significant proteinuria, hypoalbuminemia, and hypercholesterolemia, which are hallmark features of nephrotic syndrome.
• Administer IV antibiotics: There is no clinical or laboratory evidence of infection in this child. Antibiotics would not address the underlying kidney pathology or the protein loss associated with nephrotic syndrome, so they are not indicated at this time.
• Initiate peritoneal dialysis: Dialysis is indicated only for severe renal failure or life-threatening complications. This child maintains adequate urine output and does not show signs of renal failure, making dialysis unnecessary.
• Initiate contact precautions: Nephrotic syndrome is not a contagious condition. Implementing contact precautions would not provide any benefit for this child and is not part of standard management.
• Bilirubin: Bilirubin monitoring is relevant for liver disease or hemolysis but is not related to nephrotic syndrome unless there is comorbid hepatic dysfunction, which is not present in this case.
• Head circumference: Head circumference monitoring is primarily used in infants to assess brain growth and development. It does not provide useful information about nephrotic syndrome progression in a school-age child.
• HbA1c: HbA1c measures long-term blood glucose control for diabetes management. It has no relevance in assessing nephrotic syndrome, its complications, or the child’s response to treatment.

Rationale:

A. Obtain filterless IV tubing: Blood transfusions require specialized IV tubing with an in-line filter to remove clots and debris. Using filterless tubing would increase the risk of transfusing particulate matter into the client’s bloodstream.

B. Place the blood in a warmer for 1 hr: Blood should only be warmed if specifically prescribed and done using an approved device immediately before administration. Prolonged warming increases the risk of bacterial growth and hemolysis.

C. Use a 24-gauge IV catheter: Packed RBCs should be administered through a larger-bore catheter (typically 18–20 gauge) to allow adequate flow and prevent hemolysis. A 24-gauge catheter is too small for efficient transfusion.

D. Prime IV tubing with 0.9% sodium chloride: Normal saline is the only compatible solution for priming and administering blood products. It prevents clotting and hemolysis while ensuring that the blood flows freely without interacting with other IV solutions.