Nursing Care and Pathophysiology of Nephrotic Syndrome
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Study Tools For Nursing Care and Pathophysiology of Nephrotic Syndrome
Symptoms of Nephrotic Syndrome (Mnemonic)
Nephrotic Syndrome Pathochart (Cheatsheet)
Abdominal Pain – Assessment (Cheatsheet)
Pitting Edema (Image)
Facial Edema in Nephrotic Syndrome (Image)
Nephrotic Syndrome (Picmonic)
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Outline
Overview
- Kidney disease characterized by loss of protein from plasma into the urine
Pathophysiology
Injury to the glomerular basement membrane increases the permeability. This increase in permeability allows for proteins to move across the membrane and results in proteinuria (protein loss in urine). The loss of albumin causes retention of sodium which causes edema and ascites. (Remember water fallows salt/sodium)
Nursing Points
General
- Causes – Anything that can cause damage to the glomeruli in the kidneys
- Diabetes Mellitus
- Systemic Lupus Erythematosus (SLE)
- Glomerulonephritis
- Patho
- Plasma proteins leak into the urine
- Decreased protein levels in blood
- Decreased oncotic pressure in vessels
- Fluid shift → massive edema
Assessment
- Severe peripheral edema
- Weight gain due to volume overload
- Renal failure symptoms
- Decreased urine output
- Proteinuria
- Hypoalbuminemia
- Fatigue
- Amenorrhea – lack of menstruation in females
- Positive renal biopsy
Therapeutic Management
- Goal = reduce urinary protein excretion, reduce edema, minimize further complications
- Identify and treat cause
- Dietary Changes
- ↓ Na in diet
- Caution – salt substitutes contain potassium chloride
- Balanced protein (MAX 1 g protein/kg/day)
- ↓ Na in diet
- Diuretics
- Bed rest
- Monitor immunologic function
Nursing Concepts
- Fluid & Electrolytes
- Daily weights
- Strict I&O
- Monitor and replace electrolytes as needed
- Administer Diuretics
- Immunology / Infection Control
- May have been initial cause
- Assess for s/s infection
- Monitor CBC
- Hand Hygiene
- Elimination
- Develop potty plan with diuretics
- Provide adequate peri care as needed
- Monitor urine output
Patient Education
- Balanced protein levels in diet
- Sodium restriction in diet
- Comfort and positioning measures to reduce edema
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Nursing Care and Pathophysiology of Nephrotic Syndrome
Transcript
In this lesson we’re going to talk about Nephrotic Syndrome. This is a condition that affects the nephron in the kidneys – if you remember from anatomy, the nephron is the functional unit of the kidneys. This is where the kidneys do their major work – so if it’s not working properly, a lot can go wrong.
So nephrotic syndrome is a disease of the kidneys that is specifically characterized by a loss of proteins into the urine. Normally proteins are too large to escape the capillaries in the glomerulus. But we’ll look in a second how the proteins are able to escape into the urine. So that leads to proteinuria (or protein in the urine) and hypoalbuminemia (or a decreased protein level in the bloodstream). That decreased protein level in the bloodstream leads to massive edema. You can see this is a nephrotic syndrome who is having severe facial edema. Now, anything that can cause damage to the glomerulus can lead to nephrotic syndrome. This includes diabetes, remember it’s very hard on the vessels, or lupus – that autoimmune inflammatory response can cause a lot of damage to the kidneys, and of course glomerulonephritis can cause damage to the glomerulus. We’ll look at that closer in its own lesson.
So let’s quickly explore why this loss of protein into the urine leads to edema. Remember we have something called Oncotic Pressure. Oncotic pressure is controlled by proteins. I remember it this way: “Protein Pulls”. So when we have protein in the blood stream, it pulls fluid and holds it inside. It’s like a magnet. When the patient has nephrotic syndrome, they will dump the protein into the urine, but other kidney mechanisms like diffusion will keep the water in the system. So now we’ve lost protein into the urine, so we no longer have protein here in the vessels, but we still have all this fluid. If there’s no protein in here to be that magnet and hold onto the fluid, then the fluid begins to leak out of the capillaries into the tissues. The less protein in here, the more fluid will leak out.
So what will we see? Well more than anything we’re going to see severe edema. This is usually peripheral edema like in the legs like you see here, it could also be in the arms, around the abdomen, and like you saw previously they could have facial edema as well. But, since the blood vessels don’t discriminate, we can also see significant pulmonary edema. So we’ll hear crackles and the patient could be short of breath. We’ll also see weight gain because of this extra fluid and other signs of renal failure like azotemia and electrolyte abnormalities. Patients will be fatigued from all of this, as you can imagine. Females, especially younger girls, may experience amenorrhea as a result of this protein and fluid shift. And finally, we’ll see a positive renal biopsy.
Now, our goal for these patients is to reduce the amount of protein excreted in the urine and reduce the load of edema in the patient’s system. We also want to minimize any further complications like respiratory distress from the pulmonary edema or permanent kidney damage. So the first thing we want to do is identify and treat the cause. Especially if it’s an infectious source, we can reverse that and prevent significant renal damage. We’ll put the patient on a low sodium diet to prevent any further fluid. The sodium water balance in the system is the only thing keeping this thing from spiraling out of control. Now we used to put these patients on a high protein diet, but the evidence shows we just want to make sure it’s balanced and that they’re getting sufficient protein. So we look for a protein intake of 1g of protein per kg of body weight per day. Sometimes we’ll administer IV albumin if they’re acutely ill, but for the most part, we just want to make sure they’re not eating a LOW protein diet. And then, we’ll give diuretics to get this fluid out of their system and especially off their lungs so relieve these symptoms.
So our top priority concepts for patients with nephrotic syndrome are, obviously, fluid & electrolytes, and elimination, but also immunology. We know that some sort of infection or immune process or possibly even diabetes is causing this protein shift so we want to assess for infection and monitor that situation. Make sure you check out the care plan attached to this lesson to see more detailed nursing interventions and rationales.
So, let’s recap. Nephrotic syndrome is a condition of damage in the kidneys characterized by a loss of protein into the urine. That loss of protein in the bloodstream causes fluid to leak out of the vessels causing massive edema in the body. We want to treat the cause and give diuretics. We also want them to make sure they’re getting enough protein in their diet. Our goal is to stop the protein loss, get the fluid off, and prevent any further complications like respiratory distress or permanent kidney damage.
So that’s it for Nephrotic Syndrome, make sure you check out the resources attached to this lesson to learn more! Now, go out and be your best selves today. And, as always, Happy Nursing!
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Study Plan Lessons
Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
Blood Grouping
Blood Plasma
Blood Pressure (BP) Control
Breathing Control
Breathing Movements
Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
EKG (ECG) Waveforms
Electrolytes – Location in Body Nursing Mnemonic (PISO)
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid & Electrolytes Course Introduction
Fluid Volume Deficit
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Nursing Care Plan (NCP) for Fluid Volume Deficit
Renal (Kidney) Fluid & Electrolyte Balance
Renal (Kidney) Acid-Base Balance
Respiratory Functions of Blood
Tonicity of Solutions – Live Tutoring Archive
Trach Suctioning
12 Points to Answering Pharmacology Questions
ACLS (Advanced cardiac life support) Drugs
Anti-Infective – Antifungals
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
Barbiturates
Buspirone (Buspar) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Hydralazine
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin Mixing
Interactive Pharmacology Practice
IV Infusions (Solutions)
IV Push Medications
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
Medication Errors
Meperidine (Demerol) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
Olanzapine (Zyprexa) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Rh Immune Globulin in Pregnancy
SubQ Injections
The SOCK Method – Overview
Introduction to Metabolism
Anti-Infective – Antifungals
Antiviral Agents for Treatment
Hb (Hepatitis) Vaccine
Infection or Inflammation? The Quick & Dirty on CBCs – Live Tutoring Archive
Infection or Inflammation? The Quick & Dirty on CBCs 2 – Live Tutoring Archive
Infection Stages
Key Nutrients in the Prevention of Chronic Disease
Nursing Care Plan (NCP) for Infection
Tonicity of Solutions – Live Tutoring Archive
Viruses & Fungi
Scientific Notation & Measurement
Care for Asian-Indian Patient Populations
Care for Hispanic Patient Populations
Care for Native American Patient Populations
Care of Vulnerable Populations
Caring for African Patient Populations
Child Abuse/Neglect – Warning Signs Nursing Mnemonic (CHILD ABUSE)
Communicable Diseases
Community Health Course Introduction
Community Health Tool Nursing Mnemonic (MAP-IT)
Continuity of Care
Cultural Care
Environmental Health
Epidemiology
Fire and Electrical Safety
Health Promotion & Disease Prevention
High Risk Behavior Nursing Mnemonic (HEADSS)
Levels of Prevention
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Technology & Informatics
Program Planning
1st Degree AV Heart Block
Acute Confusion
Acute Coronary Syndrome (ACS)
Acute Respiratory Distress
Aneurysm & Dissection
Atrial Fibrillation (A Fib)
Calling for RRT, Code Blue
Crush Injuries
Delegation of Tasks to Assistive Personnel for Certified Emergency Nursing (CEN)
Drugs for Bradycardia & Low Blood Pressure Nursing Mnemonic (IDEA)
Dysrhythmia Emergencies
EKG Basics – Live Tutoring Archive
Fall and Injury Prevention
Heart (Heart) Failure Exacerbation
Hypertension (HTN) Concept Map
Hypertensive Emergency
Increased Intracranial Pressure
Legal & Ethical Issues in ER
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Pulmonary Embolism
Rapid Sequence Intubation
Premature Ventricular Contraction (PVC)
Premature Atrial Contraction (PAC)
Safety Check Nursing Mnemonic (MADLE)
Stress and Crisis
Supraventricular Tachycardia (SVT)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Aggressive & Violent Patients
Cultural Awareness and Influences on Development
Developmental Stages and Milestones
Erikson’s Theory of Psychosocial Development
Handling Death and Dying
Kohlberg’s Theory of Moral Development
Overview of Childhood Growth & Development
Overview of Developmental Theories
Growth and Development – Prenatal
Piaget’s Theory of Cognitive Development
Vocabulary
Brief CPR (Cardiopulmonary Resuscitation) Overview
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
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Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Day in the Life of a Labor Nurse
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OB Non-Stress Test Results Nursing Mnemonic (NNN)
Oxytocin (Pitocin) Nursing Considerations
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Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
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Prolapsed Umbilical Cord
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Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Terbutaline (Brethine) Nursing Considerations
Transient Tachypnea of Newborn
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Cardiac Terminology
Hematology Oncology & Immunology Terminology
MedTerm Basic Word Structure
Psychiatry Terminology
ACE (angiotensin-converting enzyme) Inhibitors
Acute Renal (Kidney) Module Intro
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Angiotensin Receptor Blockers
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Cardiac Stress Test
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Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Central Line Dressing Change
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Chest Tube Management
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Circulatory Checks (5 P’s) Nursing Mnemonic (The 5 P’s)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Coagulation Studies (PT, PTT, INR)
Clopidogrel (Plavix) Nursing Considerations
Complications of Immobility
Continuous Renal Replacement Therapy (CRRT, dialysis)
COPD Concept Map
Cor Pulmonale – Signs & Symptoms Nursing Mnemonic (Please Read His Text)
Coronary Artery Disease Concept Map
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
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Dementia and Alzheimers
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Management
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diltiazem (Cardizem) Nursing Considerations
Discharge (DC) Teaching After Surgery
Diverticulitis Complications Nursing Mnemonic (Please Fix His Abscess SOon)
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Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Dopamine (Inotropin) Nursing Considerations
Encephalopathies
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Essential NCLEX Meds by Class
Evaluation of Irregular Moles Nursing Mnemonic (ABCDE)
Fibromyalgia
Fluid Volume Overload
Gastrointestinal (GI) Bleed Concept Map
Genitourinary (GU) Assessment
Glaucoma
Glipizide (Glucotrol) Nursing Considerations
Hearing Loss
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Hemodialysis (Renal Dialysis)
Heparin (Hep-Lock) Nursing Considerations
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
HMG-CoA Reductase Inhibitors (Statins)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hyperthermia (Thermoregulation)
Hypertonic Solutions (IV solutions)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoparathyroidism
Hypotonic Solutions (IV solutions)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
Individualized Physical Assessments for Certified Perioperative Nurse (CNOR)
Informed Consent
Insulin Mnemonic (Ready, Set, Inject, Love)
Intake and Output (I&O)
Integumentary (Skin) Important Points
Interventions for Aphasia Nursing Mnemonic (PROP)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Isoniazid (Niazid) Nursing Considerations
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Losartan (Cozaar) Nursing Considerations
Macular Degeneration
Malignant Hyperthermia
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Mechanical Aids
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meniere’s Disease
Metabolic Acidosis (interpretation and nursing diagnosis)
Methylprednisolone (Solu-Medrol) Nursing Considerations
Mobility & Assistive Devices
Montelukast (Singulair) Nursing Considerations
Myocardial Infarction Nursing Mnemonic (MONATAS)
Naproxen (Aleve) Nursing Considerations
Neurogenic Shock for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Compartment Syndrome
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Epididymitis
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Thoracentesis (Procedure)
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan for Amputation
Nursing Care Plan for Compartment Syndrome
Nursing Care Plan for Distributive Shock
Nursing Case Study for Pneumonia
Nursing Case Study for Diabetic Foot Ulcer
Oncology Important Points
Oxygen Delivery Module Intro
Pain and Nonpharmacological Comfort Measures
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Patient Consent for Treatment for Certified Emergency Nursing (CEN)
Patient Communication Techniques for Certified Perioperative Nurse (CNOR)
Patients with Communication Difficulties
Perioperative Nursing Course Introduction
Peritoneal Dialysis (PD)
Pneumonia Concept Map
PPE Donning & Doffing
Pressure Ulcers/Pressure injuries (Braden scale)
Propylthiouracil (PTU) Nursing Considerations
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Sepsis Concept Map
Sepsis Labs
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Specialty Diets (Nutrition)
Stages of Hepatitis Nursing Mnemonic (PIP)
Strabismus
Stroke Assessment (CVA)
TB Drugs Nursing Mnemonic (RIPE)
The Medical Team
Thrombolytics
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Trach Care
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Understanding Blood Pressure Meds! – Live Tutoring Archive
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasopressin
Warfarin (Coumadin) Nursing Considerations
Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Infections for Certified Emergency Nursing (CEN)