Page 1089 - Saunders Comprehensive Review For NCLEX-RN

may also be restricted).
5. Corticosteroid therapy is prescribed as soon as the
diagnosis has been determined; monitor the child
closely for signs of infection and other adverse effects
of corticosteroids (see Chapter 47).
6. Immunosuppressant therapy may be prescribed to
reduce the relapse rate and induce long-term
remission, or, if the child is unresponsive to
corticosteroid therapy, immunosuppressant therapy
may be administered along with the corticosteroid.
7. Diuretics may be prescribed to reduce edema.
8. Plasma expanders such as salt-poor human albumin
may be prescribed for a severely edematous child.

9. Instruct parents about testing the urine for

protein, medication administration, side effects of
medications, and general care of the child.

10. Instruct parents on the signs of infection and

the need to avoid contact with other children who
may be infectious.
IV. Hemolytic-Uremic Syndrome
A. Description
1. Hemolytic-uremic syndrome is thought to be
associated with bacterial toxins, chemicals, and
viruses that cause acute kidney injury in children.
2. It occurs primarily in infants and small children 6
months to 5 years old.
3. Clinical features include acquired hemolytic anemia,
thrombocytopenia, kidney injury, and central nervous
system symptoms.

B. Assessment

1. Triad of anemia, thrombocytopenia, and kidney
failure (Box 37-3)
2. Proteinuria, hematuria, and presence of urinary casts
3. Blood urea nitrogen and serum creatinine levels
elevated; hemoglobin and hematocrit levels decreased
C. Interventions
1. Hemodialysis or peritoneal dialysis may be

prescribed if a child is anuric (dialysate solution is
prescribed to meet the child’s electrolyte needs).
2. Strict monitoring of fluid balance is necessary; fluid
restrictions may be prescribed if the child is anuric.
3. Institute measures to prevent infection.
4. Provide adequate nutrition.

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