Discharge And Home Healthcare Guidelines

Be sure the patient and family understand any medication prescribed, including dosage, route, action, and side effects. If the patient is on immunosuppression therapy, review the medications and strategies to limit infection. Review with the patient all follow-up appointments that are scheduled. Review the need to check with the physician before resuming physical activities. Caution the patient to avoid active physical exercise during and after viral or bacterial infection. Review the nature of the disease process and signs and symptoms to report to the physician.

DRG Category: 331 Mean LOS: 5.1 days

Description: MEDICAL: Other Kidney and Urinary Tract Diagnoses, Age > 17 with CC

N ephrotic syndrome (NS), a clinical syndrome rather than a disease, is characterized by renal glomerular injury and massive loss of protein in the urine. An accompanying loss of serum albumin, an increased level of serum lipids, and massive peripheral edema occur.

Pathophysiological changes are caused by a defect in the glomerular basement membrane, which results in increased membrane permeability to protein, particularly albumin. Loss of albumin through the glomerular membrane reduces serum albumin and decreases colloidal oncotic pressure in the capillary vascular beds. Subsequently, fluid leaks into the interstitial spaces, collects in body cavities, and creates massive generalized edema and ascites. Interstitial fluid shifts cause a decrease in the fluid volume within the vascular bed. The vascular fluid volume deficits stimulate the renin-angiotensin system and the release of aldosterone. These compensatory mechanisms cause renal tubular reabsorption of sodium and water, which further contributes to edema formation. Some patients become markedly immunosuppressed because of the loss of the immunoglobulin IgG in the urine. Enhanced urinary excretion of transferrin may lead to anemia, and loss of antithrombin III may lead to enhanced coagulation.

Complications occur because of the increased tendency for blood coagulation owing to increased blood viscosity. These changes may result in thromboembolic vascular occlusion in the kidneys, lungs, and lower extremities in particular. Other complications include accelerated atherosclerosis, acute renal failure, malnutrition, and a lowered resistance to infection.

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