A nurse is caring for an adolescent in the outpatient dermatologist's office.

 

Exhibits

Complete the following sentence by using the lists of options.

A nurse is providing education today on the newly-prescribed medication. The nurse recommends the adolescent notify the provider immediately if

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or

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occurs during therapy.

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.

Rationale for correct choices:

• Mania: The client exhibits classic signs of mania, including decreased need for sleep, excessive energy, impulsive spending, grandiosity, pressured and disorganized speech, and poor self-care. These behaviors reflect a manic episode, often seen in bipolar disorder, which requires careful monitoring and intervention.
• Euphoric mood: The client demonstrates an abnormally elevated and joyous mood, along with inflated self-confidence and excessive sociability. This euphoric mood is a hallmark feature of mania and differentiates it from other psychiatric conditions such as depression or delirium.

Rationale for incorrect choices:

• Major depressive disorder: This disorder presents with persistent low mood, anhedonia, and decreased energy. The client displays the opposite symptoms, including hyperactivity, elevated mood, and impulsivity, making depression an unlikely diagnosis.
• Delirium: Delirium is characterized by an acute change in attention, confusion, and disorientation, often fluctuating throughout the day. While the client is disoriented to place, the presence of sustained elevated mood and hyperactivity supports mania rather than delirium.
• Panic disorder: Panic disorder involves sudden, intense episodes of fear with physical symptoms like palpitations, shortness of breath, and sweating. The client’s presentation is chronic and includes mood elevation and impulsive behaviors, which are inconsistent with panic disorder.
• Catatonia: Catatonia involves motor immobility, mutism, or extreme negativism. The client is highly active, with constant movement and pressured speech, which is the opposite of catatonic presentation.
• Anhedonia: Anhedonia refers to the inability to experience pleasure and is a symptom of depression. The client shows excessive pleasure-seeking behaviors, including socializing and impulsive spending, making anhedonia inconsistent with the current presentation.
• Hypervigilance: Hypervigilance involves heightened alertness and exaggerated startle response, often seen in anxiety or PTSD. The client’s primary features are elevated mood and impulsive behavior rather than persistent vigilance.
• Magical thinking: Magical thinking involves believing that one’s thoughts or actions can influence unrelated events. While the client reports hallucinations, there is no evidence of magical thinking as the hallucinations do not involve causative beliefs.
• Alogia: Alogia is a reduction in speech output, typically seen in schizophrenia or severe depression. The client’s speech is pressured, loud, and disorganized, which is opposite to alogia.