ABHILASHI COLLEGE OF NURSING,

TANDA MANDI,H .P.

CASE STUDY
ON
NEPHROTIC SYNDROME
SUBMITTED TO: SUBMITTED BY:
Mrs. Pallavi Mehra Mrs. Swati Sharma
Associate professor (CHN) M.Sc. nursing 1st year
A.C.O.N. ACON

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INDEX

SL NO. CONTENT PAGE NO.

1 History collection 3

2 Immunization schedule 6

3 Growth and development 6

4 Physical examination 7

5 Investigations 10

6 Medications 12

7 Anatomy and physiology 14

8 Disease condition 16

9 Nursing diagnosis 20

10 Nursing care plan 21

11 Theory application 27

12 Health education 30

13 Summary and conclusion 31

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14 Bibliography 32

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 HISTORY COLLECTION

IDENTIFICATION DATA
Name of the child : Ms. Pranjal

Age : 2 years

Sex : Female

Father’s name : Mr. Ram lal

Cr NO : 164387

Date of admission : 11-06-2022

Religion : Hindu

Address : vill jughan teh. Sunder Nagar Distt. Mandi H.P.

Diagnosis : Nephrotic syndrome

Dr. Incharge : Dr. NagRaj

ILLNESS HISTORY
 Chief complaints:
Child is admitted in the Subhash Chander Bose Zonal Hospital Mandi and Res on 11.06.16 with the complaints of:

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  Excessive weight gain since 4 days
 Edema in ankle & feet since 4 days
 Periorbital puffiness since 3 days
 Respiratory distress since in 2 days
 Weakness since 2 days
 Present medical history : My patient is complaining Excessive weight gain , peri orbital puffiness , Edema in ankle &
feet , respiratory distress
 Past medical history :no significant past medical history
 Present surgical history: No significant present surgical history
 Past surgical history : No significant past surgical history

FAMILY HISTORY

Family tree Key:

- Male

- Female

- Patient

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Family composition

S. Name of family Age Sex Relation with Education Occupation Health status
No. members patient
1. Mr. Ramavthar 34 Yrs Male Father 10th Business Healthy

2. Mrs. Saroj 31 Yrs Female Mother 8th House wife Healthy

3. Neethesh 7 Yrs Female Herself Nursery - Healthy

4. Anita 2 Yrs Male Brother - - Nephrotic

Syndrome

SOCIO ECONOMIC HISTORY

The child’s father is a business man. The Family monthly income is 7000 Rs/-. The family is living in their own
house. All general facilities like lighting, water, sanitation facilities are available in their house.

PERSONAL HISTORY:

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  Personal history : Personal hygiene is not maintained.
 Dietary : My patient is taking renal diet according to Dr order .
 Sleep /rest : Patient sleeping pattern is interrupted due to disease condition. He is taken 18 hours sleep daily.
 Elimination : Patient have normal urine & patient is not able to pass stool .
 Activity & exercise : My patient activity is dull.
 Habits : My patient is not having any bad habits.
 Allergy : Patient is having allergy in cold things

NATAL HISTORY
Antenatal history
During the antenatal period the mother had regular antenatal checkup and took 2 doses of TT.

Intranatal history
Baby is delivered by normal vaginal delivery; baby has no history of any congenital deformity. Crying was good and
birth weight was 2.8 kg.
Post natal history
Mother and baby condition was normal. There was no history of any post natal complication

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IMMUNIZATION
SR.NO. VACCINE GIVEN NOT GIVEN
1 BCG 
2 OPV 
3 DPT 
4 Hepatitis 
5 Measles 
6 MMR 

GROWTH & DEVELOPMENT

MILESTONE BABY PICTURE BOOK PICTURE

 Social smile 3 months 6 weeks
 Sitting without 6 months 8 months
support
 Transfers object from 8 months 7 months
one hand to another
hand
 Standing without

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 support 11months 9 months
 Say simple sentances
18 month 2 years

PHYSICAL EXAMINATION
 GENERAL APPEARANCE :
Body built : fatty
Nourishment : over weight
Look : fatigue
Mental status : Normal
Posture : normal

 ANTHROPOMETRIC MEASUREMENT
Height : 94 cm
Weight : 18kg
HC : 50cm
CH : 53cm
MAC : 18 cm

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  VITALS :

SR. NO. VITAL SIGN PATIENT VALUAE NORMAL VALUE

1 Temperature 101`F 98.6`f

2 Pulse 140beats/min 120-140beats/min
3 Respiration 60breaths/min 40-60/breaths min
4 Blood pressure 60/30 mm of hg 60/40 mm of hg

 HEAD

Scalp- Scalp is clean & sebum production is normal. Size of skull is relatively largely
Hairs – Hairs are black in colour & quantity of hairs is good, No infection
 EYES
Eyebrows-Eyebrows are present.
Eyelids- Eyelids are edematous
Discharges- No discharge
Vision- vision is normal
Lens – lens is normal

 EARS

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 Discharge- no any kinds of discharges present
Hearing ability- hearing ability is normal.

 NOSE
Nasal septum- nasal septum is normal
Discharge- watery discharges
Nostril- Nostril are normal in shape but rashes are seen.

 ORAL CAVITY
Lips – lips are pink in colour.
Tongue- tongue is pink.
Teeth – teeth are examined carefully for their time of eruption.

 NECK
Alignment – neck alignment is normal.
Movement – movement of neck is good.
Glands & lymph nodes – Enlarge glands & lymph nodes.

 RESPIRATORY SYSTEM
Respiratory distress- Patient is having respiratory distress.

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 Respiratory rate- respiratory rate is 60 breaths / min.

 CARDIOVASCULAR SYSTEM
Apical pulse rate – Pulse rate is 140/min

 ABDOMEN – Abdoment is distended. Auscultation is done to determine the presence of flatus. The bowel sound are normal
liver , spleen , stomach & bladder are percussed.

 MUSCULOSKELETON SYSTEM:
Body alignment- Body alignment is good.
Movement – movements are normal
Joint – joints are not having any deformity.
Upper and lower limbs--Edema over ankles

 NERVOUS SYSTEM: Eye , Motor & verbal response are normal. Patient give responses to stimuli.

 GENITALIA : Vulval edema is present

INVESTIGATION

Sl.No. Investigation Patients value Normal value Remarks

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A. Hematology Decrease
1. Hemoglobin 11.5 mg/dl 14-16 mg/dl Normal
2. Total WBC count 15,000 cells/cumm 4000-11000 cells/cumm Slightly
3. PCV increased
4. Differential count
 Polymorphs 80% 40-75% Normal
 Lymphocytes 16% 20-45% Normal
 Eosinophils 4% 1-6% Normal
 Monocytes 00% 2-10 Normal
 Basophils 00% 0-1 Normal
5. MCV 77.6fl 70-90 Normal
6. MCH 26.5pg 27-32 Normal
7. MCHC 34% 32-40 Normal
8. ESR ½ hr 15 mm 06
Up to 20mm Slightly
1hr 30 mm 24 increased

B. Biochemistry 86 mg/dl 70-140 mg/dl

Blood sugar 38 mg/dl 15-40mg/dl
Blood urea 0.8 mg/dl .5 – .9 mg/dl
Sr. Creatinine 137mEq/l 135-145mEq/l
Slightly

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 Serum Na 5.2mEq/l 3-5mEq/l increased
Serum K 112mEq/l 96-108
Serum Chloride 21 0-39
SGPT
C. INFECTIO
Urine N
Present -
PRESENT
Macroscopic
Nill -
Albumin
Sugar
15-20/hpf -
Planty/hpf -
Microscopic
3.5/hpf -
Pus cells
Present -
RBC’s
Nill -
Epithelial cells
Bacteria
Cast
Crystal
others

 USG Complete abdomen: hepatomegaly, minimal bilateral pleural effusion and small bowel wall thickening seen.

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 MEDICATION CHART
Name of the drug Dose Route Frequency Action Use Side effect Nurse responsibility

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Inj. Cefftriaxone 1 gm IV BD Broad It is used to treat the  Nausea  Prepare the
spectrum semi serious infection  Vomiting solution by adding
synthetic third Bacterecimia  Diarrhea diluents properly.
generation immunologic,  Abdominal  Administered after
cephalosporin infection, and pain food, slowly.
antibiotic antimicrobial activity  Anorexia  Closely observe

 Pruritis the child for side

 Fever effect.

Syp. Cytralka 1 tsp PO TDS Maintaining It is used to treat and  Nausea  Administer after
mixing with water
alkalinity of the control the acidity of  Vomiting
blood and blood and urine  Observe the baby
 Headache for side effect
urine
 Drowsiness
 Instruct the patient
 Pruritis if any problems
 Dizziness arises after
administration of
 Dermatitis the drug
 Diarrhea
 Hypertensio
 Administer with
n
Tab. Emset 110mg PO BD Prevention of nausea
It is selective in proper direction
and vomiting post

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 receptor operatively  Dizziness  Monitor fluid and
antagonist, it  Light electrolyte balance
stimulates headache  Closely observe
vagal efferent  Constipation side effect
through the  Dry mouth
serotonin  Diarrhea
receptor and
 Sedation
initiate the
vomiting reflux
Fever reduction  Observe the
Syp. Paracetamol 1Tea PO SOS
It produce temporary relief by patient if he having
spoon
analgesia by mild to moderately  Anorexia fever then given
unknown pain  Nausea the drug
mechanism  Vomiting  Check for side
and antipyretic  Chills effect
by direct action  Check the fever
 Diarrhea
on every 1/2 an
 Abdominal
hypothalamus hourly
pain
heat regulating
 Lethargy
centre

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 ANATOMY AND PHYSIOLOGY

Kidney
The kidney lies on the posterior abdominal wall one on each side of the vertebral column, behind the peritoneum
and below the diaphragm. They extend from the level of the 12 th thoracic vertebra to the thyroid lumber vertebra. The right
kidney is usually slightly lower than the left probably because of the considerable space occupied by the liver.
Kidneys are bean shaped organs about 11 cm long, 6 cm wide, 3 cm thick and weight 150 gm.
Gross structure of the kidney
There are three areas of tissue which can be distinguished,
 A fibrous capsule, surrounding the kidney
 The cortex, a raddish-brown layer tissue
 The medulla, the inner most layer consisting of pale conical shaped striations, the renal pyramids
Macroscopic structure of kidney
The kidney is composed of about one million functional units, the nephron and a small number of collecting tubules
The nephron
The nephron consists of a tubule closed at one end, the other end opening into a collecting tubule. The closed or
blind end Is indented to form the cup shaped glomerular capsule (Bowman’s capsule).
Continuing from the glomerular capsule the remainder of the nephron is about 3 cm long and has 3 parts;
 The proximal convoluted tubule
 The medullary loop (loop of Henle)

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  The distal convoluted tubule
The walls of the glomerules and glomerular capsule consist of a single layer of flattened epithelial cells
The nerve supply to the blood vessels of the kidney consists of sympathetic and parasympathetic nerves.

Function of kidney

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 1. Formation of urine: there are three process involved in Formation of urine:
 Simple filtration
 Selective reabsoption
 Secretion
2. Water balance and urine output
3. Electrolyte balance

NEPHROTIC SYNDROME
DEFINITION
The nephrotic syndrome is a clinically defined state characterized by:

 Proteinuria- an excess of seum protein in the urine

 Hypoalbuminemia

 Hyperlipidaemia- an excess of lipid or fat in the blood

 Generalized edema

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TYPES

Sl.No. BOOK PICTURE PATIENT PICTURE

1. Minimal change nephrotic syndrome (primary)  Minimal change nephrotic syndrome

Secondary nephrotic syndrome (primary)
2. Congenital nephrotic syndrome
3. (usually child die by second year of life without
kidney transplant)

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 PATHOPHYSIOLOGY

Glomerular Protein
permeability

Massive urinary
protein loss

Hypoproteinemia

Decreased vascular Decreased colloidal Edema

volume oncotic pressure

Decreased renal Increased secretion Tubular Na + H2 O

blood flow of aldosterone reabsorption

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ETIOLOGY

Sl.No. BOOK PICTURE PATIENT PICTURE

1. Idiopathic (90%)  Idiopathic

2. Secondary (10%)
 Chronic Glomerulonephritis
 Diabetes mellitus
 Renal vein thrombosis
 Malignant hypertension
 P. malaria infection
 Amyloidosis
 Syphilis
 Hepatitis B
 Sickle Cell Disease
 Drug toxicity
 Ventriculoatrial shunt infection

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CLINICAL MANIFESTATION

Sl.No. BOOK PICTURE PATIENT PICTURE

1. Edema: initially around the eyes and ankles.  Edema over eyes and ankles present
Later it becomes generalized
Ascites
2. Hydrothorax
3. Scrotal; swelling or vulval edema  Scrotal; swelling or vulval
4. Pallor-anemia
Anorexia and malnutrition  Pallor-anemia
5. Vomiting, diarrhea  Anorexia and malnutrition
6. Abdominal distension  Vomiting, diarrhea
7. Respiratory distress  Abdominal distension
8. Rectal prolapsed  Respiratory distress
9. Irritability, lassitude
10. RBC in urine
11.  RBC in urine
12.

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DIAGNOSTIC EVALUATION

Sl.No. BOOK PICTURE PATIENT PICTURE

1. Urine Analysis Macroscopic

 Proteinuria- marked Albumin : Present
 Casts- numerous Sugar : Nill
 Hematuria- absent Microscopic
Pus cells 15-20/hpf
RBC’s: Planty/hpf
Cast: Present
2. Hematology
Blood sugar
Blood urea  All the investigations done
Sr. Creatinine
Serum Na
Serum K
Serum Chloride
3. Blood pressure monitoring
4. Ultrasonography

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MANAGEMENT

Sl.No. BOOK PICTURE PATIENT PICTURE

A. PHARMACOLOGICAL
1. Corticosteroids1.5mg/kg/day
2. Antibiotic  Inj. Ceftriaxone
3. Antipyretic  Syp. Paracetamol
4. Albumin infusion 1g/kg/day
B. DIET
Protein, salt and fluid restriction  Protein, salt and fluid restriction done

NURSING MANAGEMENT

Data clustering:

Data collected from baby parents, health personal and by physical examination.

Data validation:

The collected data is validated by physical examination investigation and patient records and reports.

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NURSING DIAGNOSIS

 Excessive Fluid volume related to disease condition

 Fatigue related to increased work of breathing
 Altered body temperature related to pyrexia ( 101`f )
 Vomiting related to disease condition
 Knowledge deficit related to care of child
 Parent’s anxiety related to respiratory distress & hospitalization

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ASSESSMENT NURSING GOALS INTERVENTION IMPLEMENTATION RATIONAL EVALUATION
DIAGNOSIS
SUBJECTIVE Ineffective To improve Assess the Patient condition was To know the base Expected
DATA: breathing breathing condition of the assessed. line data of the outcome partially
Patient’s pattern related pattern for patient. patient. met as evidence
parents to disease adequate by breathing
complaining condition & ventilation Check the vital Vital sign was checked. To know the pattern was
about difficulty in coughing signs. ( tem-100`f, physiological normal, difficulty
breathing. resp.30/min) condition of the reduced.
body.
OBJECTIVE
DATA: Provide Nebulization was To remove cough.
After observation nebulization. given.( duelin)
it was found that
breathing Give oxygen Oxygen therapy was To increase the
difficulty due to therapy. given. ( 2 Ltr) breathing pattern.
disease condition.
Provide medication. Medication was given . To decrease the
( antibiotics ) infection.

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ASSESSMENT NURSING GOALS INTERVENTION IMPLEMENTATION RATIONAL EVALUATION
DIAGNOSIS
SUBJECTIVE Fatigue related To promote Assess the Patient condition was It will help to know Expected
DATA: to increased adequate condition of the assessed. the base line data of outcome partially
Patient’s work of rest patient. the patient. met as evidence
parent breathing by weakness was
complaining reduced.
about weakness. It will decreased the
Gentle handling Tapid sponging given temperature.
OBJECTIVE during care. with care.
DATA:
After observation
it was found that It will help to
weakness due to Provide calm & calm & quit maintain rest.
regular coughing quit environment. environment was given.

Encourage mother worm , comfort, safety It will help to patient

to provide worm , was provided. feel a sence of
comfort, safety. wellbeing.

ASSESSMENT NURSING GOALS INTERVENTION IMPLEMENTATION RATIONAL EVALUATION

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 DIAGNOSIS
SUBJECTIVE Altered body To maintain Assess the Patient condition was It will help to know Expected
DATA: temperature body condition of the assessed. the base line data of outcome partially
Patient’s related to temperature patient. the patient. met as evidence
parents pyrexia. It will help to know by body
complaining (101`f) Check the vital Vital sign was checked. the physiological temperature was
about high body signs. ( tem-101`f, resp. condition of the maintained.
temperature. 55/min) body.
It will help to reduce
OBJECTIVE fever.
DATA: Provide tapid Tapid sponging was
After observation sponging. given. It will help to
it was found that enhance the felling
high body Maintain oral Oral hygiene was of well being.
temperature due hygiene. maintained It will help to
to pyrexia . decrease body
temperature.
Provide medication. Medication was given .
(Tab Crocin )
ASSESSMENT NURSING GOALS INTERVENTION IMPLEMENTATION RATIONAL EVALUATION

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 DIAGNOSIS
SUBJECTIVE Imbalanced To improve Assess the Patient condition was It will help to know Expected
DATA: nutritional less the condition of the assessed. the base line data of outcome partially
Patient’s than body nutritional patient related to the patient. met as evidence
parents requirement status of the nutritional status . by nutritional
complaining related to tumor patient status is
about less ,decreased Before meals oral Oral hygiene was It will help to maintained or
interested in nutritional hygiene is provided. improve intake. improved.
eating or intake provided.
anorexia.
Provide fluid diet Dalia , soup was It will help to easy
OBJECTIVE according to taste provided. digestion of food.
DATA: of the patient.
Because of It will help to know
vomiting patient Check the daily Weight was checked. the weight of the
was less weight of the patient.
interested in patient.
eating.

ASSESSMENT DIAGNOSIS GOAL PLANNING INTERVENTION RATIONAL EVALUATION

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SUBJECTIVE Knowledge Parents will Assess the parent’s Assessed the level of To get the baseline Expected
DATA:
deficit related to gain level of knowledge knowledge data outcome partially
Parents complaint care of child knowledge met as evidence
not having
regarding Allow the parents Allowed the parents to To clarify their by parents are
knowledge
regarding child’s care of child to ask their doubts ask their doubts doubts able to give care
condition
to child.
Provide health Provided health It will help to gain

OBJECTIVE education regarding education regarding knowledge about

DATA: the disease disease condition disease condition
Knowledge
condition
deficit

Educate the parents Educated the parents It will help to gain

about care of child about care of child knowledge about
care of child

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 Self care
hygienic needs
nutritional needs
elimination needs
THEORY APPLICATION safety and security needs

Orem’s self care deficit theory

Self care agency Therapeutic self care demands

Nutritional needs
Patient is unable to perform this action died Fluid electrolytes imbalance
to unconsciousness Infection control

Self care deficit

Nursing agency

Administered medication
Chest physiotherapy
Oral care, Back care, eye care, Tracheotomy and catheter care
Maintenance of IV fluids and maintain
33 intake and output of patient.
Nursing system

A. wholly compensatory system

Nurse action

Accomplish the patient self care, Therapeutic self

care needs, Administration of IV fluids, Patient
activity limited, Medications, injections,
suctioning, Maintaining intake and output of the
patient

- Compensate for the patient inability to

engage in self care.
- Providing health care, back care, oral care,
eye care, and positioning, active and
passive exercise for patient.

- Support and protect patient

- Bed side railing prevent falling
- Boxer restraints prevent removal of tubes
and self injury.
- Proper suctioning and measure to prevent
infections 34
B. Partially compensatory system
Perform some self care measures to patient:
- Sponge bath, mouth care, eye care,
administration medication and IV fluids.

Nurse
Actions Compensate some self care limitation, change
the dress

Assist the patient as required:

- Help the patient to turn in bed.

Performs some self care measures;

Turning the patient from one position to another
position

Patient
Actions Regular self care
Help in self care

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HEALTH EDUCATION

1. Personal hygiene
 Educate the family member to maintain personal hygiene of the client such as mouth care, back care, sponge
bath and provide clean clothes for patient
2. Diet
 Instructed to family member to give nutritional diet rich in CHO & iron
 Restrict salt, protein and extra fluids for the child
3. Exercise
 Explained the relatives to make the client perform coughing and breathing exercise
 Explained the limit exercise to be performed by the client
 Explained the relatives to help the patient in moving
4. Medication:
 Taught the relatives about medication and give medicine on correct time.
 To monitor side effect of drugs. if present inform to doctor
5. Follow up
 Explained to relatives about the possible complication that may occur and to contact with physicians
 Give medicine on time
 Taught about importance of follow up regularly.

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SUMMARY

The child Pranjal , 2 years old female, admitted on 11/06/22 in Subhash Chander Bose Zonal hospital Mandi with the
complaints of edema over feet, weakness, abdominal distension and fever and diagnosed as a case of nephrotic syndrome. This is
medically treated. I provided care for this child till 5 days. Now my patient is fully oriented & moderate in activity

CONCLUSION

I have taken case study of Pranjal 2 yr old in Subhash Chander Bose Zonal hospital Mandi . I have taken the case for 5days
and have discussed about disease condition and its management of nephritic syndrome. It was a nice experience for me to study the
case.

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BIBLIOGRAPHY
 Ghai.O.P (2003), ”Essential Pediatric,“ 5th edition, published by Jaypee brothers medical publisher, New Delhi, page
no.369-72
 Gupta Suraj (2004), “Short Textbook of Pediatric,” 10 th edition, published by Jaypee brothers medical publisher, New
Delhi, page no. 439-41.
 Jacob & Singh (2003), “Paediatric Nursing,” 2nd edition, published by N.R. Brothers, Indore, page no. 234-38
 Marlow and Redding (2002), “The Text Book of Pediatric Nursing,”6th edition published by P. Saunders Company,
Philadelphia, page no. 834-40
 Parthsarathy A. (2002), “IAP Text Book of Pediatrics,”2 nd edition, Jaypee brothers medical publisher, New Delhi, page
no.476-80

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