Fluid and Sodium Restrictions

[lifelearningrn, BSN, RN]

How does your school deal with a little with nephrotic syndrome? I have a Kinder that is on Na and fluid restrictions of 750mg Na and 750ml fluids daily. Mom has provided me with nothing to indicate how much he is getting at home. I asked her to send him with a bottle and pack his lunch until the doctor can fill out orders for dietary (most meals served here go over the daily allowance of sodium!) accommodation but she has done neither. I gave his teacher a bottle of water (and instructed not to allow him other fluids) and at the end of the day I'll document his intake, and let mom know. What else can I do?? The cafeteria won't accommodate without the dietary form from the doctor.

[scuba nurse, BSN, MSN, RN]

Can you call the doctors office and ask for specific instructions? Tell them it is urgent. If the parent is not willing to provide you with what he has done at home, the best you can do is to provide her with what was done at school and she has to work around that. It is so sad that parents don't help out their children. Good luck!

[OldDude]

What do you have from the physician about this?

[Flare, ASN, BSN]

out of curiosity i checked out "new and improved" menus. Which on the plus side do include calories and sodium (but no carbs ) and the lunches served here are sodium heavy as well. You can't force the parent to send in lunch and even then you have no control over what they send. Like if mom sends in a lunchable that kid's na count is toast. Document everything. Document what the parents sent for lunch, document the lack of communication and md notes document what the child eats for lunch. It's a huge pain for you, but you have you CYA in situations like this. Ideally, a meeting should take place between you, the cafeteria manager, the teacher and perhaps the principal to come up with a best practices type plan.

[lifelearningrn, BSN, RN]

What do you have from the physician about this?

Just a letter stating he is being treated for nephrotic syndrome and has a daily max of 750mg/750ml when not in remission. The child was in the hospital over the weekend with a 'flare up' so mom brought me his discharge instructions (basically stating "good" and "bad" food/drink choices. I guess I need to try and talk to the doctor.

[OldDude]

There's going to have to be information exchange between parents and you or this will start skirting with medical neglect.

[ruby_jane, BSN, RN]

Document everything. Document what the parents sent for lunch, document the lack of communication and md notes document what the child eats for lunch. It's a huge pain for you, but you have you CYA in situations like this. Ideally, a meeting should take place between you, the cafeteria manager, the teacher and perhaps the principal to come up with a best practices type plan.

That x 1000. Also...don't underestimate that the cafeteria manager can't or won't help. S/he can't restrict food without proper documentation, true...but you can do a little training and the staff may be able to help the student make better choices.

Let us know how this turns out.