The nurse is speaking with the parents of a 4 year old child following a family discussion with the health care provider about the child's terminal condition and the possibility to transition to end-of-life care. The parents state, "We don't think we can make this decision right now. What would you do? Choose the nurse's BEST response.

Options A (increased ability of tissue to retain fluid) and B (reduced blood pressure) are not typical signs of improvement in Nephrotic Syndrome. The primary focus is on reducing protein loss and alleviating edema.

Option C. Increased diuresis and decreased protein loss in urine.

Nephrotic Syndrome is characterized by increased urinary protein loss, resulting in hypoalbuminemia, edema, and other symptoms. Improvement in Nephrotic Syndrome is typically indicated by:

Increased diuresis: An increase in urine output suggests that the child is excreting excess fluid, which can help reduce edema (swelling).

Decreased protein loss in urine: A reduction in proteinuria (loss of protein in the urine) is a positive sign, as it indicates that the damaged kidney glomeruli are functioning more effectively in retaining protein.

Option D (decreased protein levels in serum) is also not a clear sign of improvement. While it may be related to reduced protein loss in urine, it does not directly reflect the overall improvement of the condition. Monitoring protein levels in the urine (proteinuria) is a more specific indicator of Nephrotic Syndrome management.

A. Neutropenic Precautions: Neutropenia refers to a low neutrophil count, a type of white blood cell responsible for fighting infections. While children with leukemia are at risk for neutropenia due to the disease and its treatment, the primary concern in this scenario is the critically low platelet count and the risk of bleeding. Neutropenic precautions focus on preventing infections.

B. Droplet Precautions: Droplet precautions are used when dealing with respiratory infections that are transmitted through respiratory droplets, such as coughing or sneezing. This is not the primary concern for a child with leukemia and a low platelet count, as the main risk is bleeding due to the low platelet count.

C. Bleeding Precautions: Leukemia, especially in a child with a critically low platelet count, puts the child at a high risk of bleeding. Platelets are essential for blood clotting, and when they are severely decreased, even minor injuries can lead to excessive bleeding. The nurse should take precautions to minimize the risk of bleeding. This includes avoiding invasive procedures, using a soft toothbrush, and ensuring that the child does not participate in activities that could result in injury.

D. Contact Precautions: Contact precautions are used to prevent the transmission of infectious diseases through direct contact. While a child with leukemia may have a weakened immune system and be at risk of infections, the primary concern in this case is the critically low platelet count and the risk of bleeding. Contact precautions are more relevant in cases of contagious diseases where physical contact could transmit the infection.