Nur 264: Nursing Across the Lifespan III
Unit 4 & 5 Case Study
Eric is 8-years-old and lives with his 65-year-old grandmother. Jimmy weighs 95 lbs and is 53“ tall. Eric has gained 30 pounds over the last few weeks. His grandmother says that his clothes are getting tight and uncomfortable, his shoes hurt his feet because they are so tight, and that his “private parts look like they will pop if they were stuck with a pin”. He has been having watery diarrhea for two weeks and is very tired all the time. Eric no longer goes out to play with friend in the evening, but lays on the couch and naps. He hasn’t been eating much either. Eric’s grandmother said that he has not used the bathroom as much lately, but when he does, his “water is foamy”. She brought him to the ER because she fears something is wrong with him.
During the assessment stria were noticed on his abdomen and thighs, with 3+ pitting edema to the scrotum, ankles, and feet. Puffiness is noted in his face and hands. His VS are T 98.7 orally, P 116, R 28, BP 84/52. Pertinent labs are Na 143, K 4.8, glucose 102, BUN 23, creatine 1.3, albumin 2.8, Hgb 13.5, Hct 43%. His urine contains 4+ protein. Eric is determined to have nephrotic syndrome.
IVF: D5.5 with 10 meq KCl/liter at 70 ml/hr
Pediatric diet with no added salt
VS every 4 hours
Call for BP <80/50
Norvasc 40 mg for BP > 125/86 and call MD
Prednisone 80 mg po once daily
25% Albumin 40g IV over 2 hours daily
Lasix 35 mg IV daily after albumin infusion is complete
Weight twice a day
1. What protein from the body is being excreted in the urine? What is causing this to occur? How is this related to Eric’s symptoms?
Albumin is being excreted in the urine due to increased glomerular basement membrane permeability. The lack of protein (hypoalbuminemia) results in a change in the osmotic pressure, leading to a shift of fluid from the blood to the interstitial spaces (third spacing). This condition is further worsened by the body’s reaction to decreased volume in the bloodstream. The kidneys retain sodium and water which contributes to further edema.
2. Is Eric more likely to have hypertension, hypotension, or both? Why?
Eric could possibly exhibit either hypertension or hypotension. The decreased blood volume stimulates the kidneys to retain sodium and water, and the heart rate to increase. This could contribute to hypertension because the body is compensating for decreased blood volume. Due to third spacing and water leaving the bloodstream, the child may exhibit hypotension secondary to decreased blood volume. The body is not compensating enough to maintain blood pressure.
3. What are the rationales for the above orders?
D5.5 would be the fluid of choice because of its hypotonicity. You would want to give a hypotonic fluid to decrease the osmolality of the blood by increasing water and decreasing Na. Potassium would need to be added to maintain the serum potassium...