A toddler diagnosed with nephrotic syndrome has a nursing diagnosis of excess fluid related to fluid accumulation (generalized edema). Which nursing intervention would be the priority to include in the nursing plan of care?

Seizure Precautions

Ambulation

Daily weight

Keep bed position flat

Answer and Explanation

The Correct Answer is C

A) Seizure Precautions:

While seizure precautions are important in certain clinical situations, they are not directly related to the excess fluid and generalized edema associated with nephrotic syndrome. Nephrotic syndrome is primarily characterized by proteinuria, hypoalbuminemia, and fluid retention, which can lead to edema. Seizure precautions would not directly address the fluid imbalance in this context.

B) Ambulation:

Ambulation involves walking or movement and is not a priority intervention for addressing excess fluid and generalized edema. The primary concern in nephrotic syndrome with fluid accumulation is to manage the fluid balance and prevent further complications related to edema, such as respiratory distress or compromised circulation.

C) Daily weight:

This is the correct priority intervention. Daily weight monitoring is crucial in managing fluid balance and assessing the effectiveness of treatment in a child with nephrotic syndrome and fluid accumulation. Sudden weight gain can indicate worsening edema, while weight loss might indicate a response to treatment. Daily weight monitoring provides essential information to adjust fluid and medication management accordingly.

D) Keep bed position flat:

While maintaining a flat bed position may help improve venous return and fluid distribution, it is not the priority intervention for managing excess fluid and generalized edema in a child with nephrotic syndrome. Monitoring daily weight and adjusting treatment based on weight changes are more directly related to addressing the fluid imbalance.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. Always infantize the child

Incorrect Explanation: "Infantizing" a child with a growth hormone deficiency is not a relevant or appropriate approach.

Explanation: Growth hormone deficiency is a medical condition that affects a child's growth. Treating the child as an infant could potentially have negative psychological and social effects. It's important to provide appropriate support and understanding without treating the child differently due to their medical condition.

B. Monitor for leukemia

Incorrect Explanation: Monitoring for leukemia is not directly related to growth hormone deficiency.

Explanation: Growth hormone deficiency primarily affects a child's growth and development due to inadequate production of growth hormone. While there might be certain health concerns associated with the condition, monitoring for leukemia is not a common aspect of managing growth hormone deficiency.

C. Help the parents set realistic goals based on the child's age and abilities

Correct Explanation: This is an important aspect to include in teaching.

Explanation: When a child is diagnosed with growth hormone deficiency, it's crucial for parents to set realistic expectations regarding their child's growth. Growth hormone therapy can help, but it's essential to understand that the child's growth might still differ from their peers. Setting realistic goals based on the child's age and abilities can help manage expectations and provide appropriate support.

D. This illness is only seen in males

Incorrect Explanation: Growth hormone deficiency is not limited to males.

Explanation: Growth hormone deficiency can affect individuals of any gender. It is not exclusive to males. The condition results from insufficient production of growth hormone by the pituitary gland, and it can occur in both males and females.

A. Allow for adjustment of rules to correlate with the child's behavior. B. Allow for imaginative play with peers without supervision. C. Provide a flexible schedule that adjusts to the child's interests. D. Establish a reward system for positive behavior

Correct Answer is C

Explanation

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects communication, social interaction, and behavior. When planning care for a child with ASD, it's important to consider their individual needs and strengths.

A) Allow for adjustment of rules to correlate with the child's behavior:

Children with ASD often benefit from consistent routines and clear expectations. Adjusting rules based on behavior might confuse the child and undermine the structure they rely on for understanding their environment.

B) Allow for imaginative play with peers without supervision:

Children with ASD can struggle with social interactions and may need guidance to engage in play with peers successfully. Unsupervised imaginative play might lead to challenges or misunderstandings, making supervision and support important.

C) Provide a flexible schedule that adjusts to the child's interests:

This is a crucial intervention. Many children with ASD find comfort in routines, but rigidity can be detrimental. A flexible schedule that incorporates the child's interests can enhance engagement, motivation, and learning. It provides structure while accommodating the child's preferences.

D) Establish a reward system for positive behavior:

Reward systems can be effective for motivating positive behaviors in children with ASD. Visual cues and rewards are often helpful in reinforcing desired behaviors. This intervention can encourage appropriate social interactions and communication.

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A toddler diagnosed with nephrotic syndrome has a nursing diagnosis of excess fluid related to fluid accumulation (generalized edema). Which nursing intervention would be the priority to include in the nursing plan of care?

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