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Nursing QUESTION #9264
Question 1
A child with nephrotic syndrome presents with generalized edema, massive proteinuria, hypoalbuminemia, and hyperlipidemia. The nurse should monitor MOST closely for which life-threatening complication?
  • Hypercalcemia
  • Spontaneous bacterial peritonitis and thromboembolism✔️
  • Hyperkalemia
  • Hypertensive encephalopathy
Correct Answer Explanation

Nephrotic Syndrome — classic tetrad:

  1. Massive proteinuria (>\(3.5\,\text{g/day}\) in adults; \(>40\,\text{mg/m}^2/\text{hr}\) in children)
  2. Hypoalbuminemia (<\(2.5\,\text{g/dL}\))
  3. Generalized edema (periorbital, pedal, ascites)
  4. Hyperlipidemia + lipiduria

Life-threatening complications and mechanisms:

ComplicationMechanism
Spontaneous Bacterial Peritonitis (SBP)Loss of immunoglobulins (IgG) and complement factors in urine → immunosuppressed
ThromboembolismLoss of anticoagulant proteins (Protein C, S, antithrombin III) + increased clotting factors + hyperviscosity
Hypovolemic shockSevere hypoalbuminemia → fluid shifts
InfectionEdema as culture medium + immunosuppression from steroids

Treatment (minimal change disease — most common in children):

  • Prednisolone: \(60\,\text{mg/m}^2/\text{day}\) for 4–6 weeks, then alternate day
  • Salt restriction, fluid restriction
  • Penicillin V prophylaxis (infection prevention)
  • Furosemide + albumin for severe symptomatic edema