ZAMBIAN ROYAL MEDICAL UNIVERSITY

LESSON PLAN

COURSE: PAEDIATRICS NURSING

TOPIC: NEPHROTIC SYNDROME
TARGET GROUP: SECOND YEAR STUDENTS (NURSING)
CLASS TARGET: 60
DATE: 27/9/23
DURATION: 2hrs
VENUE: CLASSROOM
TEACHING METHOD: LECTURE AND DISCUSSION
VISUAL AIDS: MAKER, WHITE BOARD, LAPTOP AND LCD PROJECTOR.
PRESENTER: KENNEDY SHELEMANI
SUPERVISOR: MR KASENGE.
Introduction.

The kidneys play an important role in maintenance of fluid homeostasis and excretion of waste products from the body. Any imbalance in the
fluid volume can cause serious implications that could lead to structural changes and or damage. Nephrotic syndrome is a collection of
symptoms due to kidney damage.

General objectives:
By the end of this session the second year student should be able to aquire knowledge on acute glomerulonephritis.

Specific objectives
At the end of the session second year nursing student should be able to:
I. Define Nephrotic Syndrome
II. State the types of Nephrotic Syndrome
III. Outline the causes of Nephrotic Syndrome
IV. Describe the pathophysiology of Nephrotic Syndrome
V. State the signs and symptoms of Nephrotic Syndrome
VI. Discuss the management of Nephrotic Syndrome
VII. Mention Complications of Nephrotic Syndrome
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OBJECTIVES METHOD VISUAL AID ACTIVITY ACTIVITIES ON
5min Define acute Nephrotic Syndrome is a group of clinical Lecture and Laptop, LCD, Explaining, Listening, What is
nephrotic findings due to kidney damage as opposed discussion. projector, asking and writing short Nephrotic
syndrome. to a specific disorder characterized by board, markers answering notes, asking syndrome?
proteinuria, hypoalbuminemia, questions, and answering
hyperlipidemia and oedema. (Mohan, showing slides questions
2019)

5min State the types There are two types of nephrotic lecture and Laptop, LCD, Explaining, Listening, What are the
of Nephrotic syndrome. These include: discussion projector, asking and writing short types of
Syndrome 1. Primary Nephrotic syndrome board, markers answering notes, asking Nephrotic
It is the most common type of questions, and answering syndrome?
nephrotic syndrome in children, showing slides questions
which begins in the kidneys and
affects only the kidneys.
2. Secondary Nephrotic syndrome
The syndrome is caused by other diseases.
This is common in adults.
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5min Outline the Primary Nephrotic syndrome lecture and Laptop, LCD, Explaining, Listening, What are the
causes of 1. Minimal change disease. discussion projector, asking and writing short causes of
Nephrotic It is the most common cause of nephrotic board, answering notes, asking Nephrotic
Syndrome syndrome. It involves damage to the markers questions, and Syndrome?
glomeruli that can be seen only with an showing answering
electron microscope. The exact cause of slides questions
minimal change disease is unknown
therefore known to cause idiopathic
nephrotic syndrome.
2.Focal segmental glomerulosclerosis is
scarring in scatted regions of the kidneys
3. Memebranoproliferative
glomerulonephritis is a group of disorders
involving deposits of antibodies that build
up in the glomeruli, causing thickening and
damage. Antibodies are proteins made by
the immune system to protect the body
from foreign substances such as bacteria
Secondary Nephrotic syndrome
Some diseases that can cause secondary
nephrotic syndrome include diabetis, HIV,
cancer, strep throat,Hepatitis.
TIME SPECIFIC CONTENT TEACHING AUDIO TEACHERS STUDENT EVALUATION
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ES
20min Describe When the glomeruli are functioning properly, they lecture and Laptop, LCD, Explaining, Listening, How can you
the keep protein in the blood from leaking into the discussion projector, asking and writing short describe the
pathophysio urine. Healthy kidneys allow less than 1 gram of board, answering notes, asking pathophysiology
logy of protein to escape through the urine in a day. markers questions, and answering of Nephrotic
Nephrotic Nephrotic syndrome presents as a tetrad of showing questions syndrome?
Syndrome manifestations that is proteinuria greater than 3.5g slides
in 24 hours, hypercholesterolemia, oedema and
hypoalbuminemia. This tetrad occurs after a series
of events in the glomerulus. When there is an
insult to the renal system the body responds by
inflammation leading to podocyte damage
allowing protein passage which should not pass in
normal cases. Loss of protein causes proteinuria
which at times is accompanied by heamaturia.
During protein loss antibodies also are lost as they
equally are protein and this increases their risk to
developing infection. Protein loss will lead to less
protein in the blood called hypoalbuminemia.
TIME SPECIFIC CONTENT TEACHING AUDIO TEACHERS STUDENT EVALUAT
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ES AID
Describe This signals the liver to produce proteins to lecture and Laptop, Explaining, Listening,
the compensate and in turn the liver produces not only discussion LCD, asking and writing short
pathophysio protein but cholesterol resulting in projector, answering notes, asking
logy of hypercholesterolemia this then increases the board, questions, and answering
acute presence of lipids in urine. A reduction in protein markers showing slides questions
glomerulon especially albumin will lead to a reduced oncotic
ephritis. pressure and hence fluid will move into the
interstitial space leading to oedema. Movement of
water reduces the volume of fluid in the vascular
space which in turn leads to a decrease in the
venous return to the heart. When venous return has
reduced to the heart the heart begins to pump less
blood too. A decrease in blood supply will reduce
the renal supply further reducing the glomerular
filtration rate. A reduction in glomerular filtration
rate (GFR) will cause production of rennin to
activate rennin angiotensin aldosterone system
which will retain sodium further retaining water
into circulation. This however can cause an
increase in oedema because of hypoalbuminemia.
The loss of protein (anti thrombin III) will lead to
hypercoagulability and a thrombus may form.
Formation of a thrombus will increase the risk of
venous thrombosis, deep vein thrombosis and
pulmonary embolism.
TIME SPECIFIC CONTENT TEACHING AUDIO TEACHERS STUDENT EVALUATION
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5min State the  Oedema due to loss of albumin that lecture and Laptop, LCD, Explaining, Listening, What are some
signs and maintains the oncotic pressure. The edema discussion projector, asking and writing short of the signs of
symptoms appears first around the eyes and ankles as board, markers answering notes, asking nephrotic
of the swelling advances, the edema becomes questions, and answering syndrome?
Nephrotic generalized with a pendulous abdomen full showing questions
Syndrome with fluid (ascites). Edema of the scrotum slides
on the male is characteristic
 Hypoalbuminamia due to loss of protein
albumin in urine
 Proteinuria because of increased
glomerular porosity
 Lipiduria due to hyperlipidermia
 Hematuria due to loss of clotting factors
and increased porosity
 Dehydration due increased salt and water
loss
 Dislipidemia
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State the signs  Anemia because of blood loss through lecture and Laptop, LCD, Explaining, Listening,
and symptoms urine(Hematuria) discussion projector, asking and writing short
of Nephrotic  Difficulty in breathing because of board, answering notes, asking
Syndrome pulmonary edema markers questions, and
 Anorexia showing answering
 Foamy appearance of urine slides questions
 Weight gain (unintentional) from
fluid retention
 Poor appetite
 High blood pressure, Patients of
Nephrotic Syndrome, whether young
or old, have raised blood pressure.
TIME SPECIFIC CONTENT TEACHING AUDIO TEACHER STUDENT EVALUATIO
OBJECTIVE METHOD VISUAL AID S ACTIVITIES N
S ACTIVITY
30min Discuss the MANAGEMENT lecture and Laptop, LCD, Explaining, Listening, What
management GOALS discussion projector, asking and writing short investigation
of Nephrotic  To relieve symptoms board, markers answering notes, asking is done for
Syndrome  Delay progressive kidney damage questions, and answering acute
 To prevent complications showing questions glomerulonep
INVESTIGATIONS slides hritis?
HISTORY
H/O swelling around the eyes and ankles,
difficulties in breathing, poor appetite,
passing of blood in urine.
PHYSICAL EXAMINATION
oedema on the eyes and ankles, pallor
LABORATORY
1.urine samples will reveal;
Urinalysis reveals marked proteinuria
especially albumin in urine
Hematuria(not usually present though a
few red blood cells may appear in urine)
2.Blood samples will reveal;
Blood serum protein level is reduced
An increase in the level of cholesterol in
the blood ( hyperlipidemia)
TIME SPECIFIC CONTENT TEACHING AUDIO TEACHERS STUDENT EVALUATI
OBJECTIVE METHOD VISUAL ACTIVITY ACTIVITIE ON
S Treatment AID S
Discuss the DRUG THERAPY lecture and Laptop, Explaining, Listening,
management discussion LCD, asking and writing short
Treatment of the disorder that projector, answering notes, asking
causes the condition is necessary board, questions, and
to control nephrotic syndrome. markers showing slides answering
Treatment may be needed for life. questions

Controlling blood pressure is the

most important measure to delay
kidney damage. Angiotensin-
converting enzyme (ACE)
inhibitors or angiotensin receptor
blockers (ARBs) are the medicines
most often used in this case. ACE
inhibitors may also help decrease
the amount of protein loss in the
urine. Example- captopril 25mg
PO BD, increase gradually based
on response( may start lower in
some patients) High cholesterol
and levels should be treated to
reduce the risk of heart and blood
vessel problems. Medications to
reduce cholesterol and
triglycerides may be needed, most
commonly statins
TIME SPECIFIC CONTENT TEACHING AUDIO TEACHERS STUDENT EVALUATIO
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S
Discuss the Corticosteroids lecture and Laptop, LCD, Explaining, Listening,
treatment The drug commonly used is discussion projector, board, asking and writing short
prednisone which will produce markers answering notes, asking
diuresis in 7-14 days Exmple questions, and answering
predinisolone 2mg/kg of body weight showing slides questions
for 6 days then 1.5mg/kg for 6weeks
Immunosuppressant therapy may
be used to reduce symptoms and
prevent further relapses in patients
who do not respond to
corticosteroids. Cyclophosphamide is
the drug commonly used
Specific nursing management lecture and Laptop, LCD, Explaining, Listening,
Aims discussion projector, board, asking and writing short
1. To ensure that the patient has markers answering notes, asking
appropriate weight loss and questions, and answering
decreased abdominal girth showing slides questions
2. To promote nutrition
3. To maintain skin integrity
4. To prevent infection
To promote rest and enable the
patient engage in diversional
activities
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AID
Discuss the Monitoring fluid intake and output lecture and Laptop, LCD, Explaining, Listening,
nursing Accurately monitor and document intake and discussion projector, asking and writing short
management output using a fluid balance chart. Weigh the board, answering notes, asking
patient at the same time every day on the same markers questions, and answering
scale in the same clothing. Measure the showing questions
patient’s abdomen daily at the level of the slides
umbilicus, and make certain that all staff
personnel measure at the same level. The
abdomen may be greatly enlarged with ascites.
The abdomen may even be marked with striae
(stretch marks). Test the urine regularly for
albumin and specific gravity. Albumin can be
tested with reagent strips dipped into the urine
and read by comparison with a color chart on
the reagent strips container.

Improving nutritional intake

The ascites diminishes the appetite because of
the full feeling in the abdomen
2. The patient may be lethargic and simply not
interested to eat
3.A no added salt or low salt diet may be
unappealing to the patient.
TIME SPECIFIC CONTENT TEACHIN AUDIO TEACHER STUDENT EVALUAT
OBJECTIVE G VISUAL S ACTIVITIE ION
S METHOD AID ACTIVIT S
Y
Promoting skin integrity lecture and Laptop, Explaining Listening,
The patient’s skin is stretched with edema and becomes discussion LCD, , asking writing short
thin and fragile. Inspect all skin surfaces regularly for projector, and notes, asking
breakdown. Because the patient is lethargic, turn and board, answering and
position the patient every 2 hours. Protect skin surfaces markers questions, answering
from pressure by means of pillows. Protect overlapping showing questions
skin surfaces from rubbing by careful placement of gauze. slides
Bath the patient regularly and thoroughly wash the skin
surfaces that touch each other with soap and water and
dry them completely.
If the scrotum is edematous, use a soft cotton support to
provide comfort.
Promoting energy conservation
Bed rest is common during the edema stage of the
condition. The patient rarely protests because of his or her
fatigue and the edema makes movement difficult. When
diuresis occurs several days after beginning treatment
with prednisone, the patient may be allowed more
activity, but balance the activity with rest periods and
encourage the patient to rest when fatigued. Plan
appropriate activities that interest the patient. Involve the
family in providing some of these activities.
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S AID
Preventing infection
The patient with nephrotic syndrome is
especially at risk of respiratory infections
because the edema and the corticosteroid
therapy lower the body’s defenses. Protect the
patient from anyone with an infection that is
staff, family, and visitors. Hand washing and
strict medical asepsis are essential. Monitor
vital signs every 4 hours and observe for any
signs of infection.

10min Mention Complications of nephrotic syndrome results lecture and Laptop, Explaining, Listening, What are
some of the from abnormalities directly related to the discussion LCD, asking and writing short some of the
complication nephrotic syndrome and secondary from therapy projector, answering notes, asking complicatio
s of used for its treatment. The complications board, questions, and answering ns of
nephrotic include: markers showing questions nephrotic
syndrome 1.Infection including pneumococcal pneumonia slides syndrome?
2.Atherosclerosis
3.Acute kidney failure
4.Chronic kidney disease
5.Congestive cardiac failure
6.hypovolaemia

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OBJECTIVE METHOD VISUAL AID ACTIVITIES ACTIVITIES ON
 Nursing Aims lecture and Laptop, LCD, Explaining, Listening, What are
management  To relieve pain discussion projector, board, asking and writing short some of the
using  To allay anxiety markers answering notes, asking aims we
APROPHEN  To prevent bed sores questions, and consider
EMA  To prevent complication showing answering when caring
 To improve the nuritional balance slides questions the patient
 To prevent injuries with
 To promote rest nephrotic
syndr
Observations
Observe the vital signs i.e temperature,
pulse, respiration and frequently checking
of BP which will give us a clue to the
severity of the disease and early signs of
the complications.
 Note and report any deviation from
normal of vital signs.
 Monitor character and volume of
urine to note deviation from normal.
 Observe the respirations to detect
tachycardia and report accordingly

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OBJECTIVE METHOD VISUAL ACTIVITIES ACTIVITIES N
AID
 Nursing Position lecture and Laptop, Explaining, Listening,
management discussion LCD, asking and writing short
Patient can assume a position of comfort coupled
using projector, answering notes, asking
APROPHEN with frequent change of position to prevent board, questions, and
EMA markers showing slides answering
pressure sore formation. Careful positioning is
questions
important to prevent infection and promote
comfort. Preferably air mattresses or reduced
pressure mattresses should be used as they promote
comfort and prevent pressure sore formation.
Psychological care
Explain the condition to the patient and the family
to make them know what is wrong. Allow the
patient and relatives verbalize fears, concerns and
worries, for example patient and parents may
worried about the body disfigurement because of
oedema and give appropriate reassurance to allay
anxiety

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OBJECTIVE METHOD VISUA ACTIVITIES ACTIVITIES ON
L AID
Nursing Nutrition and Fluids lecture and Laptop, Explaining, Listening,
 management. Promote adequate nutrition. Low sodium intake discussion LCD, asking and writing short
projecto answering notes, asking
should be encouraged to prevent more fluid
r, board, questions, and answering
retention which can worsen oedema. markers showing slides questions
Recommended protein intake should be 1g/kg body
weight to replace lost proteins as well as prevent
buildup of wastes in the blood. Dietetic guidelines
should be drafted in to know the quantities of the
calories and vitamins to boost energy and the
immunity. Fluid intake should be restricted to 1
litre in 24 hours and a fluid balance chart should be
maintained to monitor the intake and output.
Hygiene
Offer oral hygiene regularly to help reduce metallic
taste. Prevent infection because urinary protein
losses impair body defenses. Invasive procedures
must be avoided or performed under strict aseptic.

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OBJECTIV METHOD VISUAL AID ACTIVITIE ACTIVITIES ION
E S
Nursing Heath education lecture and Laptop, LCD, Explaining, Listening,
 Management Disease information and how to prevent discussion projector, board, asking and writing short
using infection should be discussed with the markers answering notes, asking
(APROPHE patient. Explain to the patient the need to questions, and answering
NEMA) take prescribed drugs and follow the showing questions
frequency. If patient on steroids, explain to slides
him that adverse effects will subside as
therapy stops and patient should be warned
not to stop drugs abruptly or without the
doctor’s advice as this might worse the
condition.
Health education
 Encourage the patient’s mother/caretaker
to observe the review dates to monitor
the progress his condition.
 Educate patient’s mother to assess for
fluid status

SUMMARY

Nephrotic Syndrome is a group of clinical findings due to kidney damage as opposed to a specific disorder characterized by; very high levels of
protein in the urine, a condition called proteinuria, low levels of protein in the blood, swelling, especially around the eyes, feet, and hands and
high cholesterol. The cause of Nephrotic Syndrome, the signs and symptoms, the pathophysiology and the management. Finally, the
complications of Nephrotic Syndrome.

ASSIGNMENT
Write 5 points in your books, you would include in the information education and communication (I.E.C) you will give to a patient with
Nephrotic syndrome. I will check the books on 1/10/23

EVALUTION
1. What is Nephrotic Syndrome?
2. What are the types of Nephrotic Syndrome?
3. What are the causes of Nephrotic Syndrome?
4. How can you describe the pathophysiology of Nephrotic Syndrome?
5. What are the signs and symptoms of Nephrotic Syndrome?
6. How do you manage a patient with Nephrotic Syndrome?
7. What are the Complications of Nephrotic Syndrome?

REFERENCES
1. Haesh Mohan (2002), Textbook of Pathology, 4th edition, Jaypee Brothers medical publishers, New Delhi, India
2. Nicholas A. B, Nicki R. C, Brian R. W and John A. A. H (2019),Davidson’s principles & practice of medicine, 20th edition, Churchill
Livingstone Elsevier. London. UK.
3. Suzanne C. S, Janice.L. H, Brenda G. B and Kerry H. C (2018), Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 12th
edition, Wolters Kluwer Health, Hong Kong, China
4. Lewis M.S., Heitkemper M.M., and Dirksen R.S. (2019), Medical-Surgical Nursing, Mosby Elsevier, USA.
5. Longmore M., Wilkinson B.I., and Rajagopalan R.S. (2020), Oxford Handbook of Clinical Medicine, 6th Edition, Oxford University
Press, New York.