Exhibits

The nurse is reviewing the prescription and planning the appropriate pain management.

Complete the following sentence by choosing from the lists of options.

For best pain management, the nurse should give... of acetaminophen every 4 hours as scheduled.

A. Weight gain. While albumin administration increases intravascular volume, leading to temporary fluid retention, the goal in nephrotic syndrome is to shift fluid from the interstitial spaces back into circulation. The expected outcome is a reduction in edema, not an overall weight gain. A persistent increase in weight could indicate continued fluid retention rather than treatment effectiveness.
B. Reduction of edema. Nephrotic syndrome is characterized by hypoalbuminemia, which causes fluid to leak from the blood vessels into the tissues, leading to generalized edema. Albumin 25% IV works by increasing oncotic pressure, drawing fluid back into the bloodstream. Once in circulation, excess fluid is excreted by the kidneys, resulting in decreased swelling, especially in the face, abdomen, and lower extremities.
C. Improved caloric intake. Nephrotic syndrome affects fluid balance but does not typically lead to reduced appetite unless complications arise. While improved well-being may lead to better nutritional intake, this is not the primary expected outcome of albumin therapy.
D. Reduction of fever. Fever is not a direct symptom of nephrotic syndrome, though it may occur with infections due to immunosuppression from protein loss. Albumin therapy does not have antipyretic properties, so a reduction in fever would not indicate the medication’s effectiveness in managing nephrotic syndrome.

• Remove some of the baby's clothing – Overdressing can contribute to heat retention and excessive sweating, worsening miliaria. Removing extra layers helps cool the baby and reduce further irritation.
• Clean the area with warm water – Gently cleansing with warm water (without harsh soaps) helps soothe the rash, prevent secondary infections, and remove sweat buildup.

• Alert child protective services – There is no evidence of neglect or abuse. Overdressing is common, especially in new parents who may not be aware of proper temperature regulation for infants.
• Swab the area and send for a culture – Miliaria is a benign and self-limiting condition that does not require a culture unless there are signs of secondary bacterial infection (e.g., pustules, drainage, fever).
• Hold the vaccines – There is no contraindication to routine vaccinations due to heat rash. Vaccinations should proceed as scheduled unless the baby has a moderate to severe illness (e.g., fever, systemic infection).

• Temperature – Overheating can lead to worsening miliaria, dehydration, or even heat exhaustion in infants. Monitoring temperature ensures the baby is not overdressed or exposed to excessive heat.
• Parent’s understanding of education – Since the father was not aware that overdressing contributed to the rash, assessing his understanding of proper clothing choices and environmental temperature regulation is essential for preventing recurrence.

• White blood cell count – Miliaria is not an infectious process, so WBC monitoring is unnecessary unless an infection is suspected.
• Weight – While weight monitoring is important for general growth, it is not a key indicator for assessing heat rash progression.
• Hygiene – Poor hygiene is not the primary cause of miliaria. The issue is blocked sweat glands, not dirt or infection, so monitoring hygiene is not the priority.