Nephrotic Syndrome & Anaphylactis Flashcards
Why does Nephrotic Syndrome occur ?
believed to be a autoimmune process that occurs 4-8 days after a viral infection
- with kids its usually after a strep infection
- many cases idiopathic
- increases glomerular permeability to protein (especially albumin)
What are the main clinical manifestations of nephrotic syndrome ?
- massive proteinuria
- edema (especially facial)
- hypoalbuminemia
- hypercholesterolemia
- weight gain
- decreased volume of urine (high urine specific gravity, dark (concentrated) & frothy (due to protein))
- pallor
- irritability
- susceptible to infections
- tachycardia
- vomiting
Why may a corticosteroid be used in a pt with nephrotic syndrome ?
Prednisone
- to calm/suppress his immune system
Why may Furosemide (Lasix) be prescribed in a pt with nephrotic syndrome ?
to pull fluid from the interstitial space back into the vessels
- this way the kidneys can excrete that extra fluid
What are some RN interventions for someone with nephrotic syndrome ?
- daily weights
- turn q2 hrs & skin care
- diet (low fat, no salt, fluid restriction)
- activity
- strict I&Os
- medications
- family support and home care
What are the goals of nephrotic syndrome tx ?
- to decrease urinary protein loss
- controlling edema
- balance nutrition
- prevent or treat any infection
- minimize complications of treatment
What is the pathophysiology of nephrotic syndrome ?
- there is renal glomerular damage which leads to protein in the urine
- loss of protein/albumin in the blood causes the fluid to shift out of the vessels into the interstitial tissues
- this causes edema and your BP may go up or down
- hyperlipidemia will occur because the liver makes albumin so it will detect the low levels and start to increase albumin production but at the same time will also produce cholesterol
Why causes an allergic reaction ?
the immune system produces antibodies that identify a allergin as harmful, even when it’s not
- initial exposure may have mild reaction but then repeated exposure can make the reaction worse
- heredity impacts development of allergies
- usually occurs after several ingestions of the food
What is some prevention for allergies ?
- breastfeeding infants exclusively until 4-6 months
- introduction of foods to infants by 6 months, especially high allergy causing foods
- avoidance of foods that cause reaction
- kids with egg allergy shouldn’t be given the flu vaccine
What are some clinical manifestations of food allergies ?
- Systemic: anaphylaxis, growth failure
- GI: abdominal pain, V/D, cramping
- Respiratory: cough, wheezing, rhinitis (inflammation of nasal cavity, runny nose, infiltrates, watery eyes, red eyes
- Cutaneous: urticaria (hives), rash, atopic dermatitis
What are some diagnostic tests for allergies ?
- double-blind, placeba-controlled food challege (gold standard): have the kids eat food but won’t tell them what the food has in it (not to be used alone in diagnosis but in adjunct)
- skin prick test
- serum IgE measurements
- trial elimination diet
What are some manifestations of anaphylaxis ?
Immediate (mins to hrs) to delayed (2-48 hrs)
- Neurologic (can precede reaction): restless, irritable, anxiety, HA, dizziness, paresthesia (pins or needle), disorientation
- Cutaneous: flushing, urticaria, angioedema (swelling of throat/lips/face)
- Respiratory: bronchoconstriction, pulmonary edema, hemorrhage
- Cardiac: vasodilation, hypotension (because of vasodilation & histamine release) , impaired cardiac output, poor perfusion
What is the treatment for anaphylaxis ?
- Mild reaction (only 1 system affected and no respiratory or cardiac involvement): antihistamine like diphenhydrmine (Benadryl) or cetrizine
- Moderate or Severe (more then 1 system or cardiac/respiratory involvement): first establish airway, Epinephrine, fluids
