# A 7-year-old child with nephrotic syndrome is being discharged home after initial treatment. Which discharge instruction is most important for the nurse to emphasize to the parents? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542529 > language: ko > subject: Child Health ## 문제 A 7-year-old child with nephrotic syndrome is being discharged home after initial treatment. Which discharge instruction is most important for the nurse to emphasize to the parents? ## 보기 1. Monitor daily weight and urine output to detect fluid retention 2. Administer prescribed corticosteroids to reduce proteinuria 3. Monitor for signs of infection and seek immediate medical attention for fever **✔ 정답** 4. Restrict dietary sodium and fluids to control edema **정답: 3** ## 해설 Children with nephrotic syndrome are immunosuppressed and at high risk for infections. Monitoring for signs of infection and seeking immediate care for fever is the priority over fluid intake, diuretics, or activity restriction. ## 심화 해설 Understanding the Priority Discharge Need in Nephrotic Syndrome When a child with nephrotic syndrome is discharged, all the listed instructions are important components of ongoing care. However, the question asks for the most important instruction to emphasize. This requires prioritizing based on the greatest risk to the child's safety, a core NCLEX-RN principle. The pathophysiology of nephrotic syndrome involves a loss of proteins, including immunoglobulins, in the urine. This creates a state of relative immunodeficiency. Furthermore, the cornerstone of treatment, as noted in the provided research on health behaviors for these children, involves corticosteroid therapy [1]. Corticosteroids are potent immunosuppressants. The combination of a pre-existing immune deficit from protein loss and the immunosuppressive effects of treatment places the child at a significantly elevated risk for serious, potentially life-threatening infections. Analyzing the Options Through a Safety Lens * Option 1: Monitoring daily weight and urine output is a key strategy for detecting fluid retention and assessing the disease's status. While essential for long-term management, a change in fluid status typically develops over hours to days, allowing time for intervention. * Option 2: Administering prescribed corticosteroids is critical for inducing remission and reducing proteinuria [1]. However, this is a standard medication instruction. The priority in discharge teaching isn't just to give the medication, but to teach the parents about the most dangerous side effect of that medication—infection risk. * Option 3: Monitoring for signs of infection and seeking immediate medical attention for fever directly addresses the most acute, life-threatening risk. A fever in an immunosuppressed child is a medical emergency. It can indicate spontaneous bacterial peritonitis, sepsis, or other severe infections that can decompensate rapidly. This instruction empowers the parents to act on a critical warning sign. * Option 4: Restricting dietary sodium and fluids helps control edema but is a supportive, not emergent, measure. Fluid restriction is also used cautiously in children and is not the highest priority safety teaching point at discharge. The research underscores that nursing interventions for these children are heavily focused on improving health behaviors to manage the condition effectively [1]. The most critical health behavior for parents to adopt immediately post-discharge is vigilance for infection, because the consequence of a delay in treatment is catastrophic. Using Maslow's hierarchy of needs and the ABCs (Airway, Breathing, Circulation) as a framework, preventing sepsis directly protects physiological integrity and circulatory status, making it the highest priority.References (research sources) - [1]Impact of family-centered care combined with the transtheoretical model on health behaviors of children with nephrotic syndrome.Research articleWang J, Zhang H, Yang Y, Xi X, Gu L. (2026) · DOI: 10.12669/pjms.42.4.15552 ## 임상 시나리오 Infection Surveillance in Nephrotic SyndromePrioritizing the Life-Threatening Risk of Sepsis The most critical discharge teaching for nephrotic syndrome is early recognition of infection. The combination of urinary immunoglobulin loss and corticosteroid therapy creates profound immunosuppression, making common pathogens lethal. Parents must seek immediate medical attention for a temperature of 38.0°C (100.4°F) or higher. Do not administer antipyretics without contacting the provider, as they can mask a critical diagnostic sign. CautionSigns of spontaneous bacterial peritonitis (abdominal pain, distension) or sepsis require emergency evaluation. Delaying antibiotic therapy significantly increases mortality risk in this population. ## 핵심 개념 - **Nephrotic Syndrome** — A kidney disorder causing the body to excrete too much protein in the urine, leading to edema, hypoalbuminemia, and hyperlipidemia. - **Immunoglobulin Loss** — The urinary wasting of antibodies in nephrotic syndrome, which creates a state of relative immunodeficiency and increases infection susceptibility. - **Corticosteroid Immunosuppression** — The primary treatment for nephrotic syndrome that reduces proteinuria but further suppresses the immune system, elevating the risk of serious bacterial infections. - **Spontaneous Bacterial Peritonitis** — A life-threatening infection common in nephrotic syndrome patients with ascites, often presenting with fever and abdominal pain. - **Priority Setting** — An NCLEX strategy using Maslow's hierarchy and the ABCs (Airway, Breathing, Circulation) to identify the most critical intervention for patient safety. ## 같은 주제 문제 - [A 5-year-old child with nephrotic syndrome is being assessed by the nurse. 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