Question

A 4 y/o white male presents with generalized edema and abdominal distention producing respiratory difficulties.

HPI. the child had a URI two weeks ago

PE. Normotensive with facial pitting edema, free ascitic fluid in the peritoneal cavity that is shifting. Fundoscopic exam was normal.

Labs. UA: 4+ proteinemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia with decreased serum ionic calcium. Moderately elevated BUN and Creatinine. Normal complement.

Gross pathology: Kidneys slightly enlarged, elevated, and yellowish,

Imaging: N/A

Micropathophysiology: Nothing of significance, normal renal biopsy (no evidence of immune complex depositions).

3) please provide a long term nursing management protocol for this patient. (2.5 points)

Answer 1

Edema is the condition where excess fluid is accumulated in the interstitium, present under skin and in various cavities of body and it can finally leads to severe pain. The effusion of higher water content into extracellular fluid would cause generalized edema. This condition is seen in all body tissues of infants under fluid loss. This is going to occur in children and infants due to alteration in fluid and electrolyte levels inside the body.

Factors contribute to edema such as

Due to an increase in hydrostatic pressure.

Due to increase in oncotic pressure or tissue colloidal pressure

Reduced pressure within blood vessels.

Increased permeability of blood vessel wall

Deviation in water retaining characteristics of tissues.

Long term nursing management:

Apply gentle massage after treatment can highly helpful.

Keep the affected area clean and allow it for proper ventilation.

Reduce the intake of salt.

By using drugs like Morphine can reduces anxiety.

Usefull therapies:

Oxygen therapy: high flow either by mechanical ventilation or ETT intubation and non rebreather mask.

Diuretic therapy (lasix) reduces fluid overload.

Vasodialator therapy (Nitroglycerin): It can reduce the blood returning amount of to the heart and reduces resistance which the heart must pump.

Contractility enhancement therapy: Improves the ability of the heart muscle to pump more blood from the ventricle and decrease in fluid backing up into the lungs.