hey everyone it's SE Earth register nurse rn.com and in this video I'm going to be going over nephrotic syndrome and this video is part of an inlex review series over the renal system and as always at the end of this YouTube video you can access the free quiz that will test you on this condition so let's get started first let's start out talking about what is nephrotic syndrome this is a set of symptoms due to damage to the filtering structure of the kidney and this leads to a massive amount of proteins being leaked into the urine so let's take a step back and let's look at the nephron let's see what's going on in this condition okay so your nefron in your kidney that is the functional unit of the kidney in a nutshell what it does is it produces urine and it has several structures to it and the problem here in this condition is with the glomerulus now your glomus is the filtering structure of the kidney so it takes your blood it receives the blood from the apir arterial and this is fresh blood that's came from the heart and it's going to take and it's going to filter ions and water and waste and things like that into Bowman's capsule then it's going to travel down through the renal tubules where it's going to be secreted excreted and what you don't need it's going to be turned into urine and you're going to pee it out well normally this glomerulus is not permeable to proteins they're too large to get through there along with red blood cells but for this condition we're just concentrating on proteins and what happens is that they leak through here they go down through Bowman's capsule and to the renal tubules and you're just voiding out all this protein that needs to stay in your blood because protein does its job in the bloodstream and here in a second you're going to see what type of proteins we're losing and why it's going to cause problems in these patients who have severe nephrotic syndrome so how much exactly can these patients lose in their urine of protein per day they can lose three G or more so as you can see they're going to have a massive amount of protein Uria now let's look at the proteins that can be lost in the urine because this is where you're going to start seeing those signs and symptoms and for your nursing exams you really want to remember these signs and symptoms because they like to compare this condition nephrotic syndrome with acute glomo nephus which is one of those other conditions that we talked about in the previous lecture okay so the main type of protein that is being lost in this condition is albumin and what does albumin do it does a lot of things but one of the important things it does is it regulates oncotic pressure so if you losing all this albumin out of the blood because it's being filtered into the urine what's going to happen to the blood levels of albumin in the body they are going to drop and whenever they drop you're not going to be regulating oncotic pressure very well so the patient is going to to have a sign and symptom when you look at their Labs they're going to have hypo Aluma alumin emia and what happens when um albumin levels drop the patient will start to get swelling major swelling also called edema in the body you may first start to see it in the face and around the eyes and as the this syndrome gets worse and worse they will begin to get it in their legs their feet their arms and then their belly aides now why is this happening okay let's think about albumin here we have just a simple drawing of like the capillary and alumin hangs out in your blood and alumin regulates water so in a sense think of albumin and water together as a magnet it keeps it with it to prevent it from really flowing too much of it flowing in this interstitial TI tissue right here because in your capillaries you have these finestra which are pores that allow water to flow in and out and other substances into this interstitial tissue so the albumin controls that well if we start deleting getting rid of these albumin proteins they start going away what's going to happen water has no albumen to cling to so it's just going to start going out into the interstitial tissue and you're going to be getting major major swelling now the low albumin level also causes problems with our cholesterol and triglyceride levels okay here we have the liver in response to those low albumin levels the liver says hey we need to make more albumin because we know if this body doesn't have enough alumin we're going to have major issues so it tries to make more albumin but in the process of doing this it leads the liver to also make more cholesterol and triglycerides so in severe cases whenever you check lab work you will notice that this patient will have hyper lipidemia and this condition nephronic syndrome we're really talking about it with our pediatric patients for the encl exam and when you have a two to 5year old because this is what um ages this can occur in and you see high cholesterol levels is going to throw up a red flag because young children should not have high cholesterol levels now albumin was the main thing that's really going to be messed up in this condition other proteins that the patient can lose in the urine are proteins that help fight infection called immunoglobulins and this is going to increase the patient risk for infection because they've lost those proteins that help with the immune system plus some treatments for this condition are like corticosteroids and we learned in our endocrine series that corticosteroids suppress the immune system so it's like a double whammy for these patients so you want to be thinking risk for infection what is my role as the nurse so be thinking of that and in here in a second we'll be talking about nursing interventions next these patients are going to lose proteins that play a role in preventing clot formation so if we're losing proteins that are preventing um random blood clots from forming in our body what's a patient at risk for increased blood clots so as a nurse you want to watch for signs and symptoms of a possible pulmonary embolism uh for a deep vein thrombosis things like that now let's talk about the causes of nephrotic syndrome because remember nephrotic syndrome is not a disease it's a set of symptoms associated with that disease and we have primary causes and secondary causes first let's look at primary okay primary causes are associated with a problem with the kidney itself so something's wrong with those glami uh the most common type of disease that can cause this is called minimal change disease and this most commonly affects our pediatric P patients from ages 2 to 5 and the reason for this disease is not truly understood they know when they go in and they look at those glami that they can only see changes to the glami when they use a really strong microscope called the electron microscope not with a regular one they have to use a electron so they see that hey there's something wrong with this glami that's allowing all these proteins to leak into the urine another type of cause is called focal segmental glos sclerosis and this is where there is scarring to the glami which again allows all those proteins leak into the urine and then the third type is membrano proliferative glomerulo nephritis and this is where you have thickening of the glami due to an antibody collection in those glami then we have secondary causes and secondary causes are where a disease is causing damage to the kidney those glomi and some diseases include lupus diabetes metis hepatitis heart heart failure HIV or medications like ineds and one thing you want to remember about this condition is that the patient can go into remission but they can also relapse so whenever you are educating the patient or the child's parents you want to teach them those signs and symptoms of nephrotic syndrome and these signs and symptoms will include protein Uria which again is going to be massive cuz remember these patients are losing about three grams or more of protein per day in the urine which will cause the urine to look different it can be dark and it will be foamy or frothy looking another thing they'll have remember hypo alumin emia where they're going to have low albumin in the blood which is going to lead to edema it can start out small like you can see it in the face around the eyes typically early in the morning it'll be worse and this will progress where it will go to the extremities in the legs and in the hands the ankles and in the abdomen where they can have acies and again the face and the eyes which will lead them to feel really tired fatigued because they're carrying all this extra fluid and it will cause them to lose their appeti they won't feel like eating anorexia because they have all this extra fluid especially if they get atis and that will be pushing on that stomach causing them not to feel hungry and they will be gaining weight so a lot of times the patients parents will say they're not even eating they feel horrible but I notic that they're gaining all this weight so I don't know where the weight's coming from because it's they're not eating and what it is is because they're retaining all this water from the low albumin in the blood which is caused remember the water to go into that interstial tissue because it's not regulating on IC pressure anymore and again because of the low albumin level in the blood this is going to lead to hyper lipidemia so you're going to see those high lipid levels now let's look at our nursing interventions what are we going to do for this patient who has nephrotic syndrome okay we know that they are going to possibly have fluid overload a demmon swelling they are at risk for infection they have possible hyperlipidemia and they risk for blood clot so we want to taper our nursing and interventions make sure we're monitoring them for complications from those potential things so first thing we really want to do is we want to monitor that fluid status closely and we're going to do that by performing daily weights getting them up every morning weighing them on a standing scale and looking at that weight comparing it to yesterday are they gaining weight or they losing weight we want to monitor their intake and output I's and O's very closely because chances are they're probably going to be on a fluid restriction so we want to know exactly how much they are consuming and the doctor May order diuretics to help them it'll stimulate those nephrons in the kidney and allow them to void out that extra fluid and they may order IV albumin to help replace that albumin level that's already low and if that is happening you definitely want to watch that output so for your pediatric patients you want to make sure they're putting out at least 1 milliliter per hour per kilogram based on their weight and for adults at least 30 cc's per hour cuz diuretics can be really hard on the kidneys and we want to make sure we're not sending them into renal failure then you want to assess the swelling that's going on is it decreasing or is it getting worse and you want to watch that swelling in the abdomen the AES by measuring the abdominal girth now because they have swelling in those extremities they are at risk for skin breakdown over those areas they very vulnerable for that and remember these patients are at risk for infection so we don't want to have the skin breakdown cuz that's going to allow easy access for bacteria to get in there and harbor that sight and that patient can't fight that infection how they normally could so we want to frequently turn them we want to make sure that they're wearing loose clothing like gowns make sure they're not tight and use any sensitive tapes because if you use really sticky hard tape that on a swollen area and you go to remove it if you don't do it with care you can rip off that top layer of skin now that will lead us to our next nursing intervention we want to prevent infection because again just to recap they're losing possibly those proteins that help fight infection in the urine and they may be on some type of treatment to help with this condition to help suppress the immune system which sometimes are corticosteroids or immune suppressors and if they're on corticosteroids we want to monitor that blood sugar because remember we learned in our endocrine series that corticosteroids can cause hyperglycemia so how to prevent infection meticulous handwashing we'll perform that we want to also educate the patient themselves and the family members monitor their temperature especially are they running a fever and look at that heart rate and blood pressure because we're monitoring for sept sepsis if they have Tac cardia increased heart rate low BL blood pressure not doing good respiratory status compromis may be in septic shock and we want to limit the number or performing invasive procedures during this time because again we don't want to introduce bacteria into places where the patient because they're not able to fight this infection next we want to monitor them for blood clots and again that's because we're losing those proteins that help decrease prevent the body from making a blood clot so so we want to make sure we're watching the respiratory status uh are they have an increased respiratory rate are they having difficulty breathing where they weren't before are their oxygen sat is their oxygen saturation decrease where it was high how's their heart rate are they complaining of chest pain that can be um signs and symptoms of a pulmonary embolism and I have definitely seen that so that can happen if um a PE develops another thing is a deep vein thrombosis uh DVT you want to check those extremities while you're looking at those for swelling and see if you see any red warm swollen areas that are painful Um this can happen in the legs or in the arm and this could be a sign and symptom of a deep vein thrombosis which you would want to let the doctor know so they could confirm that another thing is you want to implement the diet for whatever the physician orders and educate the patient about it and their family typically they're on a low sodium diet because of all the swelling we have going on more sodium you get in the body more water likes to just stay there because sodium and water love each other along with the fluid restriction and another type of diet that may be implemented on top of this is a lowfat diet because they can have hyperlipidemia because of those low albumin levels causing the liver to make more cholesterol and triglycerides so you want to inform them about that now about the relapse again like I said patients can go into remission but they can also relapse so you want to educate the patient especially the parents if this is a pediatric patient on those signs and symptoms of what of what may be happening when they're going into relapse so they can get overthe counter kits to monitor for protein in the Ura because that's what's happening with this condition and also they'll be wanting to look at the urine how does it look is it frothy that's a sign that there's protein in the urine weight gain are they noticing that there child or they're gaining all this weight all of a sudden so they'll want to be weighing the child every day get that part of their morning routine and looking for any swelling and also the risk of infection especially if this patient is taking those corticosteroids or those immune suppressors they need to avoid people who are sick wash their hands and things like that so this wraps up this lecture on nephrotic syndrome thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos