A nurse is caring for a client who became physically aggressive and had to be placed in mechanical restraints. Which of the following actions should the nurse take while the client is in restraints?

Rationale:

A. A colleague who uses assertive communication: Assertive communication is a positive professional skill that promotes clarity and mutual respect. It involves expressing needs and opinions confidently while respecting the rights of others, not bullying behavior.

B. A colleague who is mindful of the personal space of other colleagues: Respecting personal space reflects professional courtesy and helps maintain a comfortable work environment. It does not represent any form of bullying or intimidation.

C. A colleague who negotiates with others for a win-win situation: Negotiation aimed at mutual benefit demonstrates collaboration and problem-solving, which are constructive workplace behaviors, not bullying tactics.

D. A colleague who finds fault with other colleagues: Habitually criticizing or fault-finding without constructive intent is a form of workplace bullying. This behavior undermines morale, creates a hostile environment, and can damage professional relationships.

Rationale for correct choices:

• Nephrotic syndrome: The child exhibits classic features, including periorbital edema, hypoalbuminemia, hypercholesterolemia, proteinuria, and foamy urine. These findings indicate significant protein loss and fluid retention, which are hallmark signs of nephrotic syndrome.
• Administer oral corticosteroids: Corticosteroids reduce kidney inflammation and proteinuria in nephrotic syndrome, helping to achieve remission. Timely administration is essential to control edema, restore albumin levels, and improve the child’s overall nutritional status and well-being.
• Encourage a low sodium diet: A low-sodium diet helps minimize fluid retention and edema, which are major complications of nephrotic syndrome. Reducing sodium intake also supports blood pressure control and prevents additional strain on the kidneys while the child is being treated.
• Abdominal girth: Measuring abdominal girth tracks the accumulation of fluid in the abdomen and the progression of edema. It provides a noninvasive, simple way to monitor the effectiveness of treatment and to detect early signs of worsening fluid retention.
• Urine specific gravity: Monitoring urine specific gravity helps evaluate kidney function and the concentration of solutes, including protein. Changes in this parameter reflect the child’s response to therapy and assist the nurse in assessing disease progression.

Rationale for incorrect choices:

• Chronic kidney disease: Chronic kidney disease develops gradually and usually shows slow, progressive renal impairment over time. The rapid onset of periorbital edema, hypoalbuminemia, hypercholesterolemia, and proteinuria in this child is more consistent with nephrotic syndrome rather than CKD.
• Hemolytic uremic syndrome: HUS typically presents after a diarrheal illness and is characterized by anemia, thrombocytopenia, and acute kidney injury. This child’s lab results show elevated platelets and normal hemoglobin levels, which are inconsistent with HUS.
• Acute glomerulonephritis: Acute glomerulonephritis presents with hematuria, mild edema, and hypertension. In contrast, this child has significant proteinuria, hypoalbuminemia, and hypercholesterolemia, which are hallmark features of nephrotic syndrome.
• Administer IV antibiotics: There is no clinical or laboratory evidence of infection in this child. Antibiotics would not address the underlying kidney pathology or the protein loss associated with nephrotic syndrome, so they are not indicated at this time.
• Initiate peritoneal dialysis: Dialysis is indicated only for severe renal failure or life-threatening complications. This child maintains adequate urine output and does not show signs of renal failure, making dialysis unnecessary.
• Initiate contact precautions: Nephrotic syndrome is not a contagious condition. Implementing contact precautions would not provide any benefit for this child and is not part of standard management.
• Bilirubin: Bilirubin monitoring is relevant for liver disease or hemolysis but is not related to nephrotic syndrome unless there is comorbid hepatic dysfunction, which is not present in this case.
• Head circumference: Head circumference monitoring is primarily used in infants to assess brain growth and development. It does not provide useful information about nephrotic syndrome progression in a school-age child.
• HbA1c: HbA1c measures long-term blood glucose control for diabetes management. It has no relevance in assessing nephrotic syndrome, its complications, or the child’s response to treatment.