The nurse is caring for a child diagnosed with nephrosis. Symptoms that are characteristic of nephrosis include which of the following? (Select all that apply)

Choice A reason: Syrup of ipecac is obsolete for acetaminophen overdose, as it delays definitive treatment like N-acetylcysteine. Acetaminophen causes hepatotoxicity via toxic metabolites, requiring specific antidote administration. Ipecac risks aspiration and is ineffective post-gastric lavage, making it an inappropriate choice for managing this potentially life-threatening overdose.

Choice B reason: Vitamin K treats bleeding from anticoagulant overdose, not acetaminophen toxicity, which causes hepatotoxicity by depleting glutathione, leading to liver damage. Vitamin K does not address acetaminophen’s metabolic effects, making it irrelevant. N-acetylcysteine is needed to restore glutathione and detoxify metabolites, making this choice incorrect.

Choice C reason: N-acetylcysteine is the antidote for acetaminophen overdose, replenishing glutathione to detoxify the toxic metabolite NAPQI, preventing liver damage. Administered post-gastric lavage, it reduces hepatotoxicity risk, especially if given within 8 hours of ingestion, making it the expected treatment to protect the child’s liver function.

Choice D reason: Activated charcoal adsorbs toxins in the gut but is less effective post-gastric lavage, as the stomach is already cleared. Acetaminophen’s rapid absorption requires N-acetylcysteine to prevent hepatotoxicity. Charcoal may be used early but is secondary to the antidote, making it less critical in this scenario.

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.