The nurse is reviewing the Nurses' Notes. Vital Signs, and Laboratory Results from week 2 at 1200. Click to highlight the findings that indicate the child's prescribed therapy has been effective. To deselect a finding, click on the finding again. Nurses' Notes Week 2, 1200: Child is back at the provider's office for a follow-up appointment following discharge from the hospital. Child was discharged with a prescription for oral prednisone. Child states they feel better, but the medication makes them feel different. Skin warm to the touch. Skin turgor without tenting. Capillary refill less than 2 seconds. Periorbital area without edema. Bowel sounds active in all 4 quadrants. Last bowel movement 1 day ago soft and formed. Child reports no pain with urination. Nonpitting edema noted in lower extremities. Vital Signs Week 2, 1200: Temperature 38.8° C (101.8° F) Heart rate 90/min Respiratory rate 18/min Blood pressure 140/76 mm Hg

The evaluation of therapeutic effectiveness in Minimal Change Nephrotic Syndrome (MCNS) focuses on the reversal of the core pathological symptoms: edema and fluid shifts. Effective corticosteroid therapy (Prednisone) repairs the glomerular basement membrane, stopping the leakage of protein into the urine. As serum albumin levels rise, fluid moves from the tissues back into the vascular space, leading to improved peripheral perfusion, resolution of edema, and normalization of hydration status. Rationale for correct findings: • Improved skin turgor indicates better hydration status and restoration of intravascular volume. Initially, the child had skin tenting, suggesting dehydration despite edema from fluid shifting into interstitial spaces. Resolution of tenting shows that fluid balance is improving and circulating volume is more stable. This is an important sign that treatment is helping correct nephrotic fluid imbalance. • A capillary refill of less than 2 seconds reflects normal peripheral perfusion and improved circulation. Previously, delayed capillary refill suggested poor intravascular volume and decreased tissue perfusion. Improvement indicates better vascular filling and more effective fluid management. This supports that the prescribed therapy is successfully improving circulatory status. • Resolution of periorbital edema is a strong indicator that excess fluid retention is decreasing. Periorbital swelling is a classic early sign of nephrotic syndrome caused by hypoalbuminemia and fluid leakage into tissues. Its absence suggests reduced protein loss and better fluid regulation. This finding strongly supports therapeutic improvement. • A soft, formed bowel movement indicates improvement from the previous loose, liquid stools and hyperactive bowel sounds. This suggests better gastrointestinal function, improved nutritional intake, and reduced fluid loss from diarrhea. Stabilization of bowel patterns helps support hydration and overall recovery. It reflects improved systemic status after treatment. Rationale for incorrect findings: • The presence of any edema suggests that fluid retention has not completely resolved. Although nonpitting edema may be less severe than previous pitting edema, it still indicates persistent abnormal fluid accumulation. Full therapeutic effectiveness would ideally show resolution of edema rather than its continued presence. This finding requires continued monitoring rather than being considered a clear success. • An elevated temperature is concerning and does not indicate improvement. Fever may suggest infection, which is especially important because prednisone therapy suppresses immune function. Children receiving corticosteroids are at increased risk for infection and require close observation. This finding suggests a possible complication rather than effective therapy. • This blood pressure is elevated for a 7-year-old child and is concerning rather than reassuring. Hypertension may result from steroid therapy, fluid retention, or renal complications. It does not indicate successful resolution of nephrotic syndrome and may require further evaluation. Elevated blood pressure should be followed closely rather than considered a sign of effective treatment.