# 6歲兒童因新發腎病症候群入院：蛋白尿4+、血清白蛋白1.8 g/dL、眼周與下肢水腫、1週體重增3 kg。哪些護理介入適當？請選擇所有適用項目。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374922&lang=zh-tw  
> language: zh-TW  
> subject: Basic Care and Comfort  
> category: BCC

## 題目

6歲兒童因新發腎病症候群入院：蛋白尿4+、血清白蛋白1.8 g/dL、眼周與下肢水腫、1週體重增3 kg。哪些護理介入適當？請選擇所有適用項目。

1

感染預防措施 — 嚴格手部衛生、避免接觸感染者、發燒立即評估；腎病症候群病人因尿中流失免疫球蛋白而處於免疫低下狀態。

2

將飲食蛋白質攝取限制在低於每日每公斤體重0.8克，以減少蛋白尿並降低腎臟負荷，因為高蛋白攝取會加劇蛋白質流失。

3

嚴格監測I&O、每日同時間同體重計量體重、每日腹圍。

4

給予醫囑之類固醇(prednisone)並教導家屬預期副作用(體重增加、情緒變化、高血壓、生長遲滯)以及需緩慢減量、不可突然停藥。

5

皮膚照護包括頻繁翻身與輕柔處理 — 水腫性皮膚脆弱易破損。

## 解析

腎病症候群(大量蛋白尿、低白蛋白血症、水腫、高血脂)護理：嚴格I&O與體重、給予類固醇並教導家屬副作用與減量、感染預防(免疫球蛋白流失)、水腫性皮膚照護。選項4錯誤 — 腎病症候群之蛋白限制已不再常規；現行指引建議正常或適度增加蛋白攝取並充足熱量以防肌肉分解。

## 深入解析

「嚴格限制蛋白」陷阱為最常考之NCLEX腎病症候群錯誤。舊教科書教導限制，現行指引建議正常蛋白(兒童1-1.5 g/kg/日)並限鈉。類固醇減量衛教亦常考 — 突然停藥引發腎上腺危機。

## 臨床情境

**6歲新發腎病症候群**：蛋白尿**4+**、血清白蛋白**1.8 g/dL**、眼周與下肢水腫、**1週體重增3 kg**。醫師已開立prednisone。

## 重要概念

- **腎病症候群** — 蛋白尿 > 3.5 g/24h、低白蛋白 < 3.0、水腫、高血脂；兒童最常見為微小變化疾病。
- **類固醇衛教** — 預期副作用、感染預防、緩慢減量、不可突然停藥(腎上腺危機)；隨食物服用、監測BG。
- **腎病症候群感染風險** — 尿中流失免疫球蛋白加類固醇免疫抑制；嚴格手部衛生與發燒立即評估。

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