A 4 ylo white male presents with generalized edema and abdominal distention prod
ID: 3517269 • Letter: A
Question
A 4 ylo white male presents with generalized edema and abdominal distention producing respiratory difficulties HPI. the child had a URI two weeks ago PE. Normotensive with facial pitting edema, free ascitic fluid in the peritoneal cavity that is shifting. Fundoscopic exam was normal. Labs. UA: 4+ proteinemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia with decreased serum ionic calcium. Moderately elevated BUN and Creatinine. Normal complement. Gross pathology: Kidneys slightly enlarged, elevated, and yellowish, Imaging: N/A Micro pathophysiology: Nothing of significance, normal renal biopsy (no evidence of immune complex depositions). 1) As discussed in class, what would be four (4) nursing differential diagnoses? (1point) 2) Please provide a short term managerial protocol for this patient. (1.5 point) 3) please provide a long-term nursing management protocol for this patient. (2.5 points)Explanation / Answer
1) the basis of differential diagnosis is;
Heavy Proteinuria( 3 gm per day)
Hypoalbunemia
Hypercholestremia
Hypertriglycedimia
Elevaated BUN
This is differentiated from nephritic syndrome as no hyperlipidemia occurs in it.
Diagnosis can be made by;
Urine analysis for the presence of proteins,creatinine and urine cast.
Kidney biopsy.
2) short term managementis by;
Administer albumin intravenously (heavy proteinuria can be treated).
Give diuretics for half an hour to treat edema.
3) long term management is for; hyperlipidemia and all.
It is done by medical nutrition therapy that is patient is given energy rich diet low but In saturated fats or fat free diet.
Use of hypolipidaemic drugs as statins.
Avoiding diet rich in salt as it causes water retention
Therapy with corticosteroids can be given for kidney damage,it decreases proteinuria and risk of infection.They also help in resolving edema.
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