Case Study: School-Age Child with Nephrotic Syndrome

Brodie is a 5 year old male who has been complaining of his clothing feeling
right. His parents have noted that the skin around his eyes looks puffy.
Brodies mother also notes that he has not bee acting like himself and
despite his clothing being tight fitting, he has no app[etite and has been
complaining of his belly hurting. Brodie and his parents are referred to a
pediatric nephrologist to rule out the diagnosis of nephrotic syndrome.
1. During the history taking, the nurse asks Brodis mother the following
question: Has Brodie had a cold in the recent past? What would be the
rationale or reasoning behind this question?
The primary cause of nephrotic syndrome is unknown, but the
immune system is thought to have a role and a recent upper
respiratory infection has been noted in many children 2 to 3 days
prior to the onset of edema.
2. The nurse notes that Brodie has +2 pitting edema in his calves and
ankiles. His mother asks the nurse to explain the cause of Brodies swelling.
What would be the nurses BEST response?
The edema that results from nephrotic syndrome occurs from
altered kidney function that allows excess secretion of albumin, a
protein that circulates in the bloodstream. Albumin works to
maintain a certain pressure within the circulating system by
maintaining fluid in the vasculature. With a decrease in albumin,
the fluid from the circulating blood volume shifts into the tissues,
creating edema or the puffiness in Brodies eyes and legs.
3. What diagnostic tests would the nurse expect to be ordered for Brodie
and what would their findings be that would reflect nephrotic syndrome?
a. Dipstick of urine will test positive for protein levels, and the
urine will be frothy in appearance due to the high protein levels.
b. A protein:creatinine ratio > 1.0 (norms are <0.2 in children
greater than 2 years of age)
c. Increased serum levels of sodium, cholesterol, and triglycerides
and decreased albumin levels (<2.5mg/dL)

4. These diagnostic findings confirm nephrotic syndrome. Brodies parents

initial question is:Is this a life-long syndrome that Brodie will always have?
What would be the nurses BEST response?
The nurse would explain that some children will relapse several
times during childhood but most will outgrow the syndrome
during their teen years.

5. The nurse assesses Brodies vital signs with particular attention to his
blood pressure. Brodies blood pressure is 108/68. Interpret this blood
pressure based on Brodie age and recent diagnosis.
A blood pressure of 108/68 is within the normal range for a 5 year
old boy. Assessment of blood pressure for a child diagnosed with
nephrotic syndrome is critical and since hypertension is noted in
25% of children with the syndrome.

6. What would be the expected treatment plan for Brodie? (Give at least 13
suggestions)
The goals of medical treatment and nursing care management for
the child and parents experiencing the diagnosis of nephrotic
syndrome involve the following:
a. Education about dietary restrictions (salt and water restriction)
b. Diuretic therapy and administration of steroids. Treatment goals
are as follows:
1. relieve symptoms
2. Prevent complications
3. Prevent or delay progressive kidney damage
4. Treat causative disorder (if known)
The following care interventions meet these goals:

1. Prednisone for 4 to 8 weeks with a gradual tapering off of

the drug
2. Intravenous Lasix and intravenous administration of
albumin to increase the delivery of Lasix to the kidneys
3. Nursing assessments for signs of hypertension or cardiac
overload during albumin administration, and clinical manifestations
of hypovolemia with diuretic administration that includes daily or
twice daily weight and weight measurement after Lasix
administration and strict recording of intake and output.
4. Prevention of infection risk due to steroids by careful hand
washing and standard precautions and strict aseptic technique with
any invasive procedures; restriction of visitors with active infection
while hospitalized and educating the parent about limiting large
crowds while on steroids once discharged.
5. Frequent and routine assessment of skin for a breakdown in
its integrity due to severe edema; meticulous skin care, frequent
turning and positioning, and a therapeutic mattress; restrictive
clothing; and monitoring tape or identification wristbands for
constriction of the skin.
6. A diet high in calories, normal amounts of protein, and low
in sodium, with normal fluid intake except in cases of extreme
edema.
7. Promotion of rest by encouraging quiet activities and
scheduled rest periods.