The nurse is reviewing the Provider Prescriptions from week 1 at 1230.

The nurse is providing teaching to the guardians and their child about the newly prescribed diagnostic test. Select the 3 statements the nurse should make when providing teaching.

Minimal change nephrotic syndrome is the most common cause of nephrotic syndrome in children and is characterized by increased glomerular permeability, leading to massive protein loss in the urine. This results in hypoalbuminemia, edema, hyperlipidemia, and fluid retention. Nursing care focuses on monitoring fluid status, preventing complications, supporting medication therapy, and educating caregivers. Careful assessment of edema, urine protein, and response to corticosteroid treatment is essential for effective management.

Rationale:

A. Checking urine for protein is important because proteinuria is the hallmark finding of nephrotic syndrome and helps evaluate disease severity and response to treatment. Persistent +++ protein in the urine reflects continued glomerular damage and albumin loss. Regular monitoring helps determine whether prednisone therapy is improving kidney function.

B. Educating guardians about corticosteroid therapy is necessary because prednisone is the primary treatment for minimal change nephrotic syndrome. Families should understand the importance of adherence, possible side effects such as increased appetite, mood changes, infection risk, and the need to avoid abrupt discontinuation.

C. Monitoring the effects of antihypertensive therapy is not indicated because there is no prescription for antihypertensive medication in the provider’s orders. Although blood pressure should be monitored routinely, specific antihypertensive therapy is not part of the current treatment plan. The priority is managing edema and protein loss.

D. Limiting the child’s intake of sodium is appropriate because sodium retention contributes to worsening edema and fluid overload in nephrotic syndrome. A low-sodium diet helps reduce swelling, control fluid accumulation, and improve comfort. This is especially important when facial puffiness, periorbital edema, and pitting edema are already present.

E. Encouraging the child to play with other children during therapy is inappropriate because activity is ordered to be limited, and corticosteroid therapy increases susceptibility to infection. The child may also have fatigue and edema, making rest more beneficial. Reducing exposure to infections is an important part of care while receiving prednisone.

F. Measuring abdominal girth is correct because fluid retention can lead to ascites and worsening abdominal edema in nephrotic syndrome. Daily abdominal girth provides an objective way to monitor fluid accumulation and response to treatment.

Safe medication administration in pediatric clients requires strict adherence to patient identification protocols to prevent medication errors. Toddlers are unable to reliably identify themselves, so nurses must use approved identifiers before giving any medication. Standard practice involves using at least two unique identifiers such as the identification band and medical record information. Verification must be objective, accurate, and independent of room location or assumptions made by staff or family members.

Rationale:
A. Asking another nurse to confirm the toddler’s identity does not replace the nurse’s responsibility to use approved identifiers. While double-checking may be helpful in some situations, identification must be based on objective sources such as the ID band and medical record. Relying only on another nurse increases the risk of assumption-based errors.

B. Asking the parent to confirm the toddler’s identity can be supportive but should not be the primary identification method. Parents may be distracted, stressed, or unfamiliar with formal identification details used in the medical record. Safe practice requires verification using institutional identifiers rather than relying solely on verbal confirmation from family members.

C. Checking the toddler’s room number against the ID band is unsafe because room numbers are not approved patient identifiers. Clients may be transferred, rooms may be reassigned, and relying on location increases the risk of medication errors. Room number should never be used as a primary method for patient identification.

D. Checking the toddler’s ID band against the medical record is the correct action because it uses reliable and institution-approved identifiers. The ID band contains unique information such as the child’s full name and medical record number, which should match the medication administration record. This method ensures the medication is given to the correct child and supports patient safety standards.