The nurse is reviewing the plan of care for a newly admitted client who is intoxicated on admission. Which findings should the nurse include as indicators to begin implementing the detoxification medication protocol?

A. History of hypertension: Although the client’s current blood pressure is controlled with atenolol, the need for medication confirms a history of hypertension. Hypertension is a major modifiable risk factor for coronary artery disease and warrants ongoing assessment.

B. Family health history: A strong family history of heart disease and diabetes, particularly in first-degree relatives, significantly increases the client’s risk for cardiovascular events. The genetic predisposition should be explored to assess early markers and implement prevention strategies.

C. Vegetarian diet: A vegetarian diet is generally associated with lower cardiovascular risk due to reduced intake of saturated fats and cholesterol. Unless the diet is poorly balanced or nutrient-deficient, it does not constitute a risk factor that requires further evaluation here.

D. Sexual history: Sexual history may be relevant in certain clinical contexts, such as evaluating HIV risk or sexually transmitted infections, but it is not directly related to the client's cardiac symptoms or concern about hereditary heart disease.

E. Excessive aerobic exercise: The client’s activity level (jogging) is not excessive and is generally healthy, unless it is associated with overtraining or extreme exertion. There is no indication here that excessive exercise is a concern, so further exploration is not needed based on this information.

Rationale for Correct Choices:

• Nephrotic Syndrome: The child’s symptoms, including edema, fatigue, increased weight despite decreased appetite, and proteinuria, point towards nephrotic syndrome. This condition involves the loss of protein (mainly albumin) in the urine, leading to edema. The laboratory result of 2+ protein in the urine and low albumin level of 2.8 g/dL are consistent with nephrotic syndrome.
• Provide a low-salt diet: A low-salt diet is a key intervention in nephrotic syndrome to help manage fluid retention and edema. Sodium causes water retention, which worsens edema, and limiting salt intake can help reduce swelling and manage the symptoms effectively.
• Administer albumin: Administering albumin is important in nephrotic syndrome because it helps replenish the albumin levels in the blood. Restoring the albumin levels can help reduce edema by improving osmotic pressure and preventing fluid from accumulating in the tissues.
• Daily weight: Daily weight monitoring is essential to assess for changes in fluid retention. In nephrotic syndrome, fluid retention can fluctuate, and regular monitoring helps assess the effectiveness of the treatment plan and helps guide further interventions.
• Abdominal girth: Monitoring abdominal girth is necessary to track the extent of fluid accumulation in the abdomen. Abdominal edema is common in nephrotic syndrome, and significant increases in girth could indicate worsening fluid retention.

Rationale for Incorrect Choices:

• Type 1 diabetes: This presents with increased thirst, frequent urination, and weight loss due to elevated blood glucose levels. However, this child is experiencing weight gain despite decreased appetite and has symptoms of edema, which are not typical of diabetes.
• Wilms' tumor: Wilms' tumor presents with an abdominal mass, hematuria, or pain, which is not mentioned in this case. While renal issues could cause edema, the lab results of proteinuria and low albumin suggest nephrotic syndrome rather than a malignancy like Wilms' tumor.
• Hemolytic uremic syndrome: Hemolytic uremic syndrome is characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. The child does not show signs of anemia, low platelets, or kidney failure (such as elevated creatinine), which are key features of HUS.

• Place the child on strict bed rest While it’s important to monitor the child closely, strict bed rest could lead to muscle weakness and decreased mobility. The focus should be on managing edema and ensuring proper fluid balance, not restricting movement.
• Prepare the child for emergency surgery: Emergency surgery is not indicated for nephrotic syndrome, which is a non-surgical condition that can be managed with medications (like albumin) and lifestyle adjustments (such as a low-salt diet).
• Prepare an insulin drip: An insulin drip would be appropriate for managing hyperglycemia, typically seen in diabetic emergencies. However, this child does not show any signs of diabetes or hyperglycemia. The focus is on managing nephrotic syndrome.

• Lymph node size: Lymph node size is monitored in cases of infection or malignancy. In nephrotic syndrome, the primary concern is fluid retention and protein loss, not lymph node enlargement.
• Bladder volume: Bladder volume monitoring is typically relevant in cases of urinary retention or other urinary tract disorders. This child’s primary concern is proteinuria and edema, which are linked to kidney function and fluid balance, rather than bladder volume.
• Ketones: Monitoring ketones is generally relevant in cases of uncontrolled diabetes or prolonged fasting. However, this child is not presenting with symptoms of hyperglycemia or ketosis. Nephrotic syndrome does not typically involve ketones.