A nurse is providing teaching to a parent of a preschooler who has eczema.

Which of the following instructions should the nurse include in the teaching?

Choice A rationale: Yellow nasal discharge in a toddler with acute nephrotic syndrome signifies a potential upper respiratory tract infection, which is critically important. Children with nephrotic syndrome are highly susceptible to infections due to significant urinary loss of immunoglobulins, leading to an immunocompromised state. Furthermore, corticosteroid treatments, often prescribed for nephrotic syndrome, suppress the immune system. An infection can precipitate a relapse of the syndrome, lead to severe complications like peritonitis or sepsis, and requires prompt evaluation and potentially antibiotic therapy to prevent life-threatening outcomes.

Choice B rationale: Poor appetite is a non-specific symptom in toddlers with nephrotic syndrome and does not typically indicate an immediate, life-threatening complication. It can be attributed to generalized malaise, abdominal discomfort due to ascites, or even side effects of medications such as corticosteroids. While important to monitor for nutritional status and overall well-being, it does not carry the same urgency as signs of infection, which can rapidly lead to severe health deterioration in an immunocompromised child.

Choice C rationale: Facial edema is a cardinal clinical manifestation of acute nephrotic syndrome, resulting from profound hypoalbuminemia. Reduced plasma oncotic pressure causes fluid to shift from the intravascular space into the interstitial space, leading to generalized edema, often prominently in the face. This finding is expected and indicates the disease process itself, rather than an acute, unexpected complication requiring immediate reporting, unless there is a sudden, significant worsening or associated respiratory compromise.

Choice D rationale: Irritability in a toddler can be a manifestation of general discomfort, illness, or even a side effect of corticosteroid therapy, which can cause mood disturbances and behavioral changes. While it warrants assessment to identify the underlying cause, irritability is a non-specific symptom and does not directly indicate an urgent, life-threatening complication of nephrotic syndrome requiring immediate medical intervention, unlike the signs of an acute infection in an immunocompromised child.

Chronic glomerulonephritis is a condition that causes inflammation of the glomeruli, which are tiny filtering units in the kidneys.
This can lead to poor kidney function and an increase in waste products in the bloodstream.
Blood urea nitrogen (BUN) is a waste product that is normally filtered by the kidneys and excreted in urine.
A BUN level of 50 mg/dL is higher than the normal range, indicating poor kidney function.
Choice B is incorrect because a serum phosphorus level of 4.0 mg/dL is within
the normal range for adults.
Choice C is incorrect because a serum potassium level of.8 mEq/L is within the normal range for adults.
Choice D is incorrect because proteinuria (the presence of protein in urine) is a
common finding in glomerulonephritis.