Nursing Care

After a medical diagnosis is made, a treatment plan will be ordered.  While administering and adhering to this treatment plan, the nurse needs to come up with a plan of care to ensure that all elements of the patient's system are functioning to the maximum capacity.  Below are five nursing diagnoses that should be considered during care of a patient with MCD: 

1. Fluid Volume Excess: Hypervolemia, fluid overload
This diagnosis would be made based on the fluid retention and subsequent weight gain and ascites that the patient would experience.

2. Pain
A patient may be experiencing chest pain due to excess fluid being retained between the lung and the lung cavity.

3. Nutrition, Altered: Less than body requirements - starvation, weight loss, anorexia
Recall that one of the symptoms of MCD is anorexia, the lack of appetite.  A patient who experiences anorexia for a prolonged period of time during the onset, diagnosis and treatment of MCD, may experience significant weight loss and altered nutrition.

4. Urinary Retention
Recall that a patient with minimal change disease experiences oliguria or a lack of urination.  

5. Risk for Infection
The treatment of MCD, glucocorticosteroids, often causes a compromise in immune function.  During this time, the patient will need to take care to stay healthy.   



A plan that a nurse may follow when caring for a patient with MCD may look like this:

Potential problem	Related to...	Plan and Outcome	Nursing Intervention
Risk for Infection	A compromised immune system secondary to a corticosteroid regimen	Patient will remain free from signs of infection throughout the duration of the steroid regimen Patient's WBC count will remain within normal limits.	Practice good hand hygiene Educate patient, family and friends on yearly immunizations Educate patient's family and friends on keeping distance when sick and practicing good  hand hygiene

References:
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick22.html

http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick36.html

https://evolve.elsevier.com/Resources/100530_global_0001#/content/289099256