# A 6-year-old is admitted with newly diagnosed nephrotic syndrome: proteinuria 4+, serum albumin 1.8 g/dL, periorbital and pedal edema, and weight gain of 3 kg over 1 week. Which nursing interventions are appropriate? Select all that apply.

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> language: en  
> subject: Basic Care and Comfort  
> category: BCC

## Question

A 6-year-old is admitted with newly diagnosed nephrotic syndrome: proteinuria 4+, serum albumin 1.8 g/dL, periorbital and pedal edema, and weight gain of 3 kg over 1 week. Which nursing interventions are appropriate? Select all that apply.

1

Implement infection prevention measures — meticulous hand hygiene, avoid sick contacts, prompt fever evaluation; nephrotic patients are immunocompromised due to urinary loss of immunoglobulins.

2

Restrict dietary protein intake to less than 0.8 g/kg/day to decrease proteinuria and reduce renal workload, as high protein intake exacerbates protein losses.

3

Monitor strict intake and output, daily weight at the same time and scale, and abdominal girth daily.

4

Administer prescribed corticosteroids (prednisone) and educate the family about expected side effects (weight gain, mood changes, hypertension, growth delay) and the need for slow tapering — never abrupt discontinuation.

5

Provide skin care including frequent repositioning and gentle handling — edematous skin is fragile and breaks down easily.

## Explanation

Nephrotic syndrome (massive proteinuria, hypoalbuminemia, edema, hyperlipidemia) nursing care: strict I&O and weight, corticosteroid administration with family teaching about side effects and tapering, infection prevention (immunoglobulin loss), edematous skin care. Choice 2 is wrong — protein RESTRICTION is no longer routine in nephrotic syndrome; current guidelines recommend NORMAL or moderately increased protein with adequate calories to prevent muscle catabolism.

## In-depth explanation

The "restrict protein severely" trap is one of the most-tested NCLEX nephrotic syndrome errors. Old textbooks taught restriction; current guidelines recommend NORMAL protein (1-1.5 g/kg/day in children) with sodium restriction. Steroid taper teaching is also high-yield — abrupt stop causes adrenal crisis.

## Clinical scenario

**6-year-old with new-onset nephrotic syndrome**: proteinuria **4+**, serum albumin **1.8 g/dL**, periorbital and pedal edema, weight gain **3 kg in 1 week**. Provider has started prednisone.

## Key concepts

- **Nephrotic syndrome** — Proteinuria > 3.5 g/24h, hypoalbuminemia < 3.0, edema, hyperlipidemia; minimal change disease most common in children.
- **Corticosteroid teaching** — Expected side effects, infection precautions, slow taper required, never abrupt stop (adrenal crisis); take with food, monitor BG.
- **Nephrotic infection risk** — Loss of immunoglobulins in urine plus immunosuppression from corticosteroids; meticulous hand hygiene and prompt fever evaluation.

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