A nurse is caring for a client who is wearing antiembolic stockings. Which of the following interventions should the nurse include in the plan of care?

• Nephrotic Syndrome: The child presents with periorbital and abdominal edema, foamy dark-colored urine, significant proteinuria (24 mg/dL), hypoalbuminemia (1.4 g/dL), and hyperlipidemia (cholesterol 465 mg/dL), all of which are classic indicators of nephrotic syndrome. The elevated ESR and low sodium further support an inflammatory renal process with fluid retention.
• Chronic Kidney Disease: CKD is a long-term progressive decline in kidney function. This child shows acute findings with severe proteinuria and low albumin, consistent with nephrotic syndrome, not CKD.
• Acute Glomerulonephritis: Usually presents with hematuria (cola-colored urine), hypertension, and mild proteinuria. This client has severe proteinuria, hypoalbuminemia, and edema, which are more typical of nephrotic syndrome.
• Hemolytic Uremic Syndrome: Commonly follows a gastrointestinal illness and includes anemia, thrombocytopenia, and acute kidney injury. This child’s platelets are elevated, not low, and there's no history of diarrheal illness, making HUS unlikely.
• Encourage a low sodium diet: Sodium restriction helps manage fluid retention and edema which are key concerns in nephrotic syndrome. It also prevents worsening of ascites and periorbital swelling.
• Administer oral corticosteroids: This is the first-line treatment for idiopathic nephrotic syndrome, especially in children. Corticosteroids reduce glomerular permeability, limiting protein loss in the urine and promoting remission.
• Initiate peritoneal dialysis: Dialysis is only indicated in severe renal failure, which this child does not have. There’s no indication of uremia or electrolyte crisis, so dialysis is not appropriate at this stage.

• Intake and output: Essential for assessing fluid balance. Children with nephrotic syndrome may retain fluid or have decreased urine output, making I&O a crucial measure.
• Daily weight: This is the most accurate way to track fluid retention or loss. Daily weight is important for evaluating response to treatment, especially as edema resolves.

• Head circumference: This is monitored in infants and toddlers, especially to assess for hydrocephalus or growth delays. It is not relevant for a school-age child with kidney issues.

• HbA1C: A measure of long-term blood glucose control, used for diagnosing and managing diabetes. Has no relevance in the diagnosis or management of nephrotic syndrome.
• Urine specific gravity: While useful in initial diagnosis (and already elevated), it is not the best indicator of ongoing progress. Daily weight and I&O are more practical and reliable for assessing edema and treatment response.

A. Use short sentences when communicating with the client. In a panic level of anxiety, the client has impaired concentration, perception, and understanding. Using short, simple sentences helps the client process communication more easily and reduces cognitive overload.
B. Tell the client to sit alone in a private place and reflect on the situation. A client in a panic state may feel unsafe or overwhelmed when left alone. Supervision and a calm presence are essential until the anxiety level decreases.
C. Encourage the client to talk about his feelings. Clients in a panic state are often unable to verbalize or reflect on their emotions clearly. Talking about feelings is more appropriate once the anxiety has decreased to a moderate level.
D. Have the client journal about what is happening to him. Journaling requires organized thought and concentration, which is not possible during a panic-level anxiety episode. It may be useful later, during a lower level of anxiety.