Effect assessment of evidence-based nursing in combination with clinical nursing pathway on nephrotic syndrome care in children: A protocol for systematic review and meta-analysis.

BACKGROUND: Childhood nephrotic syndrome is widespread in pediatric nephrology. In most cases, it needs hospitalization for patient management. An increasing number of studies report that proper nursing care could promote the rate of treatment and improve post-treatment prognosis. Clinical nursing pathways refer to innovative nursing modes with high-quality, excellent efficacy, and low costing treatment. There are reports on how nursing methods that utilize data combine with clinical nursing pathway to enhance nephrotic syndrome care in kids. However, the results remain controversial. Therefore, it is necessary to conduct this study to systematically explore how evidence-based nursing combined with clinical nursing pathway plays a role in nephrotic syndrome care among children. METHODS: This study protocol will conduct a comprehensive search on MEDLINE, Cochrane Library, CINAHL, EMBASE, Scopus, Chinese National Knowledge Infrastructure, WanFang, and Web of Science electronic databases to identify relevant research articles from inception to April 25, 2021. Studies in both English and Chinese languages are used for this study. This study protocol will analyze randomized controlled trials that investigated the role of evidence-based nursing combined with clinical nursing pathway to care for nephrotic syndrome in children. Two authors will independently screen the search results, select suitable studies for inclusion, extract the characteristics and outcome data of the selected studies, and evaluate the risk of bias based on standard Cochrane methodology. Any discrepancies will be resolved by consensus. RESULTS: The present study will summarize high-quality evidence to systematically explore how a nursing model based on evidence combined with clinical nursing pathway influences the caring of children with nephrotic syndrome. CONCLUSION: The present study will summarize the direct and indirect evidence to judge whether evidence-based nursing combined with clinical nursing pathway can improve the treatment and post-treatment prognosis in children with nephrotic syndrome. ETHICS AND DISSEMINATION: This study does not require an ethical approval. REGISTRATION NUMBER: April 25, 2021.osf.io/bcrdk/ (https://osf.io/bcrdk/).

Proceso de atención de enfermería a un paciente pediátrico en el transcurso de una biopsia renal / Nursing care process to a paediatric patient during a renal biopsy

DESCRIPCIÓN DEL CASO: Paciente de 13 años que ingresa en hospital de tercer nivel, procedente de consultas externas de Nefrología pediátrica del mismo hospital para biopsia renal, al sufrir, en valoraciones anteriores, episodios de hematurias microscópicas persistentes, macroscópicas intermitentes y proteinuria en rango nefrótico. DESCRIPCIÓN DEL PLAN DE CUIDADOS: La unidad de enfermería pediátrica del hospital estableció un plan de cuidados inicial al ingreso y postquirúrgico ajustados a la patrones funcionales de Marjory Gordon, considerando los patrones relacionados con temor en el niño, ansiedad y cavilación de la familia, resultando de estos hechos la activación del protocolo de acogida, aumento del nivel de estrés debido a modificación ingesta alimentos, aumentar el afrontamiento en la fase postquirúrgica así como dolor, riesgo de infección, disconfort, sobrepeso por alimentación insana y hematurias postbiopsia. EVALUACIÓN DEL PLAN: Durante el ingreso hospitalario de 4 días previo a la biopsia se le realizaron pruebas bioquímicas de sangre y orina de 24 horas y estudio de anemia. Los progenitores se mostraban muy interesados por la evolución de las pruebas y como contener la ansiedad y tener calmado al hijo debido al conocimiento de que le harían una punción. Mientras se encontraba hospitalizado no cumplía los requisitos nutricionales. Al día siguiente de la biopsia fue dado de alta con unas pautas para comenzar con una alimentación más sana. CONCLUSIONES: La taxonomía NANDA/NOC/NIC permite trabajar en la enfermería basada en los hallazgos, dando respuesta a las necesidades reales de los pacientes para contribuir a mejorar la práctica clínica

CLINICAL CASE: A 13-year-old patient admitted to a third-level hospital from paediatric nephrology outpatient clinics for a renal biopsy after suffering, in previous evaluations, episodes of intermittent macroscopic and persistent microscopic haematuria and nephrotic-range proteinuria. DESCRIPTION OF THE CARE PLAN: The hospital paediatric nursing unit established an initial care plan on admission and after surgery adjusted to Gordon's functional patterns, considering the patterns related to fear in the child, anxiety and family melancholy, resulting in the activation of the reception protocol, increased stress level due to food intake modification, increased coping in the post-surgical phase as well as pain, risk of infection, discomfort, overweight due to unhealthy eating and post-biopsy haematuria. EVALUATION OF THE CARE PLAN: During the 4-day hospital stay prior to the biopsy, 24-hour blood and urine biochemical tests and anemia study were performed. The parents were very interested in the evolution of the tests and how to contain anxiety and keep the child calm due to the knowledge that they would do a blood puncture. While he was hospitalized, he did not meet the nutritional requirements. The day after the biopsy, he was discharged with guidelines to start a healthier diet. CONCLUSIONS: The NANDA/NOC/NIC taxonomy allows working in nursing based on findings, responding to the real needs of patients to help improve clinical practice

Homeward Bound: A Case Series of Cross-Cultural Care at End of Life, Enhanced by Pediatric Palliative Transport.

For most families, the preferred location of death for their child is home, yet most children still die in the hospital. Many children with life-threatening and life-limiting illness are medically dependent on technology, and palliative transport can serve as a bridge from the intensive care unit to the family's home to achieve family-centered goals of care. Palliative transport may also present an opportunity to prioritize cultural care and rituals at end of life which cannot be provided in the hospital. We describe a case series of pediatric patients from communities espousing markedly diverse cross-cultural values and limited financial resources. Specific cultural considerations at end of life for these children included optimizing the presence of the shared community or tribe, the centrality of healing rituals, and varied attitudes toward withdrawal of life-sustaining medical treatment. By addressing each of these components, we were able to coordinate palliative transport to enhance cross-cultural care and meaning at end of life for children with life-limiting illness.

The many faces of minimal change nephrotic syndrome: an overview and case study.

Idiopathic nephrotic syndrome is the most common form of nephrotic syndrome in the pediatric population. Three major histopathological findings have been identified. The most common is that of minimal change nephrotic syndrome. Most of these cases respond well to oral steroids and achieve long-term remission. For those that become steroid dependent, the clinical course can be quite difficult. The case study included demonstrates some of the difficulties that can be encountered and questions that still exist with management of this diagnosis.

Enfermagem e famílias de crianças com síndrome nefrótica: novos elementos e horizontes para o cuidado / Nursing and families of children with Nephrotic Syndrome: new elements and horizons to care

O objetivo deste estudo é compreender como as crianças com Síndrome Nefrótica estão sendo cuidadas, buscando identificar novos elementos contextuais e horizontes para reconstruir o cuidado de enfermagem, tendo como foco a família. Trata-se de um estudo qualitativo com apoio teórico-metodológico na hermenêutica, fundamentada principalmente em Gadamer e Ricouer. Foi realizado com famílias de crianças com Síndrome Nefrótica usuárias do Ambulatório de Nefrologia Pediátrica do Hospital Universitário Júlio Müller da Universidade Federal de Mato Grosso, em Cuiabá. Para a coleta de dados foram usados o histórico de enfermagem da família, a construção do genograma e do ecomapa, a análise de documentos e a entrevista. Seis famílias e quatro membros da equipe do serviço de saúde participaram do estudo, totalizando 42 participantes. Os encontros aconteceram no hospital ou no domicílio das famílias. Os resultados foram discutidos em quatro temas: Apresentação das famílias, no qual elas são mostradas por meio das suas biografias, projetos, personagens e contexto. Elas têm em comum história de perdas, afastamento das origens, morte de pessoas significativas, separações, paternidades presumidas e outros problemas de saúde além da doença da criança em foco. Não são famílias 'convencionais' e têm uma grande mobilidade no espaço geográfico. As condições materiais de existência são sofríveis. Padecem pelas condições próprias da doença e pela ausência de políticas sociais que dêem suporte ao seu cotidiano. ...

Self-care in Chinese school-age children with nephrotic syndrome.

PURPOSE: To identify the levels of self-care in Chinese school-age children with primary nephrotic syndrome. STUDY DESIGN METHODS: Descriptive study of 66 school-age children hospitalized at least once for nephrotic syndrome who were followed medically at the affiliated hospitals of Sun Yat-sen University. Demographic data and information about nephrotic syndrome self-care were obtained by interviewing patients' families. Frequency distributions were used for the analysis. RESULTS: Of 66 patients studied, 60 had high levels of self-care practices. High levels of self-care were found for 83% of 6 to 8 year olds, 95% of 9 to 10 year olds, all 11 to 12 year olds. CLINICAL IMPLICATIONS: This study can help nurses to understand cross-cultural implications of self-care practices for Chinese school-age children. The findings also can guide nurses to assess promote self-care practices of pediatric patients.

Traveling through the decades: a special relationship between a pediatric nephrology nurse and a young adult.

The young adult that M.K. has become is in part of a result of the supportive relationship that I established with M.K. and her family over a decade ago. Viewing M.K. as a part of a family unit and not just as an isolated patient enabled the entire nephrology team to assist the family in dealing with the monumental medical problems that they have confronted. I am proud of the young woman that M.K. has become, and I am gratified by the relationship that we have shared for the past 16 years. It is this type of relationship that reminds me of why I decided to become a nurse many years ago.

Nephrotic syndrome: pathophysiology and treatment.

Nephrotic syndrome refers to the symptoms caused by renal injury in which large amounts of protein are lost in the urine. Common manifestations of the syndrome are proteinuria, edema, hypoalbuminemia, hyperlipidemia, and hypercoagulability. Recent research has presented findings that contradict some of the accepted theories regarding the pathophysiology of some symptoms of the syndrome. Accurate understanding of these pathophysiological mechanisms underlying the symptoms seen in nephrotic syndrome is necessary for caregivers to determine the appropriate treatment for these patients.

Case study of a patient with severe nephrotic syndrome.

M.T. battled SLE for 9 years before renal failure occurred. She is now free of extrarenal symptoms of lupus, as has been described elsewhere (Ziff & Hilderman, 1983). The patient has regained here appetite, lost 13 pounds, recovered some strength and reestablished her social network. Without the severe proteinuria, M.T. has a chance to improve her nutritional status and increase her albumin. Her pulmonary status may also improve if she can refrain from smoking. Although fatigue is a debilitating feature of lupus, M.T. has increased stamina and is learning energy conservation techniques. Immediately after surgery, she did experience problems with bleeding, pneumonia, and pleural effusions, but the medical and nursing management prevented serious adverse outcomes. Fluid balance is no longer problematic, and M.T. is approaching her ideal body weight as her nutritional status improves. Her serum albumin has increased to about 2.6 gm/dl with some decrease in her proteinuria.

Nephrotic syndrome: a nursing care plan based on current pathophysiologic concepts.

The classic conception of the pathophysiology of the nephrotic syndrome (NS) is now being seriously questioned, on the basis of current research findings. New conceptions of the syndrome, with its proteinuria, hypoalbuminemia, and edema, are providing explanations for the discrepancies between the original theory and clinical data from individual patients, particularly related to edema formation. Many of the edema-preventing mechanisms are normal in patients with NS, but may fail when plasma osmotic pressure falls significantly. Plasma volumes, blood volumes, and blood pressures of patients with NS have been found to be generally normal or slightly increased, in contrast to the classic "hypovolemia" theory. Activation of the renin-angiotension-aldosterone system is variable and cannot fully explain the sodium and water retention. The decreased renal filtration rates and abnormal sodium retention/excretion rates are now best explained by an intrarenal defect, on the basis of multiple research approaches. These research conceptions of the pathophysiology of NS are significant for nurses because they can be used in patient assessment, interpretation of patient data, monitoring during treatment, collaboration about the plan of care, development of nursing care plans, and patient teaching. Several nursing diagnoses may be appropriate for patients with NS: alteration in fluid volume: excess; potential for infection; alteration in nutrition: less than body requirements, potential alteration in comfort; knowledge deficit; and potential disturbance in self-concept: body image.