The nurse is caring for a client with hepatitis C. The client’s brother states, “I do not want to get this infection, so I'm not going into his hospital room." How would the nurse respond?

Nephrotic syndromeis characterized by massive proteinuria, hypoalbuminemia, and severe edema. The glomerular damage allows large amounts of plasma proteinsto leak into the urine. For patients who still have a normal glomerular filtration rate (GFR), the dietary goal is to replace the lost proteins to maintain oncotic pressureand support cellular repair, while also managing the metabolic complications like hyperlipidemia and fluid retention.

Rationale:

A.Carbohydrate intake does not need to be decreased in nephrotic syndrome unless the patient has comorbid diabetes. In fact, adequate carbohydrate intake is necessary to provide energy and prevent the body from breaking down protein for fuel (the protein-sparing effect). The client’s focus should remain on protein and lipid management rather than simple carbohydrate restriction.

B.While vitamin C is important for general immune health and tissue repair, there is no specific scientific requirement for "increased" intake as a primary treatment for nephrotic syndrome. The condition is defined by protein loss and lipid derangement, not a vitamin deficiency. The dietary teaching must prioritize the macros that are directly affected by the glomerular leaking.

C.The client should increase protein intakeif their GFR is normal to compensate for the massive amounts of albumin lost in the urine. High-quality protein helps rebuild serum protein levels, which is essential for maintaining oncotic pressure and reducing interstitial edema. This statement shows the client understands how to nutritionally offset the primary hallmark of their disease, which is proteinuria.

D.While hyperlipidemia occurs in nephrotic syndrome, the primary diet education for a patient with normal GFR and massive protein loss focuses on protein replacement. Decreasing fat is a secondary goal to manage high cholesterol levels, but it does not address the fundamental issue of hypoalbuminemia. The most direct and essential dietary intervention is the replenishment of protein stores.

An ileostomyinvolves the surgical creation of an opening into the ileum, bypassing the entire colon. The resulting stoma must be vibrant and moist, reflecting adequate microvascular perfusion. Any compromise in the arterial supply or venous drainage of the stoma can lead to tissue necrosisand ischemia, making visual inspection of the stoma the most critical postoperative nursing assessment for viability.

Rationale:

A.A sweetish odor from ileostomy output is not a clinical emergency and can be influenced by diet or medications. While changes in odor are worth noting for the patient's comfort, they do not indicate a life-threatening complication. Odor management is a secondary concern compared to the physical integrity and blood supply of the newly created stoma.

B.While it is true that an ileostomy pouch must be worn at all times because the output is continuous and liquid, this is a lifestyle and hygiene instruction. It does not address the immediate surgical safety of the patient. The most important information must always prioritize the detection of acute physiological failure, such as the loss of blood flow.

C.Calling the provider if the stoma is bluish or pale is the most important instruction because it indicates ischemiaor infarction. A healthy stoma should be beefy red or pink, signifying adequate oxygenation. A color change to blue, purple, or pale signifies a lack of blood perfusion, which is a surgical emergency requiring immediate intervention to save the tissue.

D.Describing the initial postoperative output is helpful for setting expectations, but it is a normal finding rather than a warning sign of a complication. Dark green liquid is common as the bowel begins to function. While the patient should know this is normal, the priority of teaching must always be focused on identifying abnormal, dangerous changes in stoma health.