What is the priority nursing diagnosis in a patient with end-stage renal disease?

This nursing care plan is for patients who have renal failure. Renal failure is where a patient’s kidneys lose the ability to remove toxins and waste from the body. Due to this the body will build up excess levels of potassium, calcium, phosphate,  creatinine, urea, and anemia.

This can be deadly to a patient if these excess levels are not removed. Hemodialysis may be ordered by a doctor to help removes excess creatinine, urea, and water from the body.

Renal failure can be caused by many things such as drug toxicity, uncontrolled diabetes or hypertension, genetic predisposition, virus, or infection etc.

Below is a nursing care plan with diagnosis and nursing interventions/goals for patients with renal failure.

What are nursing care plans? How do you develop a nursing care plan? What nursing care plan book do you recommend helping you develop a nursing care plan?

This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions.

Important Disclosure: Please keep in mind that these care plans are listed for Example/Educational purposes only, and some of these treatments may change over time. Do not treat a patient based on this care plan.

Care Plans are often developed in different formats. The formatting isn’t always important, and care plan formatting may vary among different nursing schools or medical jobs. Some hospitals may have the information displayed in digital format, or use pre-made templates. The most important part of the care plan is the content, as that is the foundation on which you will base your care.

Nursing Care Plan for Renal Failure

If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Otherwise, scroll down to view this completed care plan.

Scenario

A 65 year old patient is admitted with renal failure. The patient is alert and oriented times 3. The patient reports he decided to go to his doctor’s office because he has been unable to “pee” for the past 4 days and he was sent here to the ER. He states he has “may be peed three drops” of urine over the past 4 days and that the “drops” were very dark brown. The patient also states he has been forcing fluids because he thought may be he was dehydrated but says that the fluids seems to be going into his legs and he has gained 12 lbs over the past 3 days. He states he normally weighs 165 lbs. You note the patient has 4+ pitting edema in his legs and fine crackles through out his lungs. The patients VS are BP 180/110, HR 85, oxygen saturation 91% on RA, Temp 99.6, and RR 19. The patient labs are Potassium 6.0, Hgb 8.0, Hct 29.3, BUN 6.5, and Creat 52. The MD ordered for the patient to have dialysis today.

Nursing Diagnosis

Excess fluid volume related to compromised regulatory mechanisms secondary to acute renal failure as evidence by peripheral edema and weight gain.

Subjective Data

Patient reports he decided to go to his doctor’s office because he has been unable to “pee” for the past 4 days and he was sent here to the ER. He states he has “may be peed three drops” of urine over the past 4 days and that the “drops” were very dark brown. The patient also states he has been forcing fluids because he thought may be he was dehydrated but says that the fluids seems to be going into his legs and he has gained 12 lbs over the past 3 days.

Objective Data

A 65 year old patient is admitted with renal failure. The patient is alert and oriented times 3. You note the patient has 4+ pitting edema in his legs and fine crackles through out his lungs. The patients VS are BP 180/110, HR 85, oxygen saturation 91% on RA, Temp 99.6, and RR 19. The patient labs are Potassium 6.0, Hgb 8.0, Hct 29.3, BUN 6.5, and Creat 52. The MD ordered for the patient to have dialysis today.

Nursing Outcomes

-The patient will have negative or equal intake and output during hospitalization.

-The patient will have decreased peripheral edema of 1+ or less within 48 hours.

-The patient will have 30 cc or greater of urinary output during a 24 hour period.

-The patients BUN and creatinine will be within normal range within 36 hours.

-The patient will weigh 165lbs or less by discharge.

-The patient will verbalized the importance of daily weights and limiting salt intake by discharge.

-The patient will name 5 foods that contain high salt intake to avoid by discharge.

-The patient will verbalize understanding about how hemodialysis works before dialysis.

Nursing Interventions

-The nurse will monitor the patient intake and output every shift.

-The nurse will assess the patient’s peripheral edema every shift.

-The nurse will monitor the patients urinary output every shift.

-The nurse (if needed per md order) will place foley catheter to monitor urinary output more closely.

-The nurse will call any abnormal BUN and creatinine result to the md.

-The nurse will weigh the patient daily.

-The nurse will educate the patient about the importance of daily weights and limiting salt intake by discharge.

-The nurse will educate the patient about 5 foods that contain high salt intake to avoid by discharge.

-The nurse will educate the patient about how hemodialysis works before patient has dialysis.

Chronic Renal Failure NCLEX Review and Nursing Care Plans

Chronic renal failure (CRF), also known as chronic kidney disease (CKD), is an irreversible long-term condition characterized by a gradual decline in kidney function.

Over time, it can lead to end-stage renal failure (ESRF) which will require the need for dialysis or a kidney transplant.

Kidneys play important roles in the human body.

They manage fluid balance, regulate electrolytes and pH levels, filter out and excrete waste and toxins, and help in the production of hormones.

Due to the kidneys’ many bodily functions, the signs and symptoms of CRF can be varied and can progress as the kidney function declines.

The treatment of CRF aims at slowing the disease progression by addressing the underlying cause.

Signs and Symptoms of Chronic Renal Failure

1. Oliguria – low urine output of less than 400 mL per day; anuria – no urine output
2. Nausea and vomiting
3. Loss of appetite
4. Fatigue and weakness
5. Decrease in mental sharpness
6. Muscle twitching and cramping
7. Swelling of feet and ankles
8. Persistent itching
9. Chest pain – occurs when the fluid builds up around the heart’s lining
10. Shortness of breath if fluid builds up in the lungs
11. Hypertension
12. Sleep problems

Causes and Risk Factors of Chronic Renal Failure

Some diseases can result in chronic renal failure. These include:

1. Type 1 or Type 2 Diabetes. Diabetes causes micro and macrovascular complications. Kidneys are often affected by the damage to the renal blood vessels which will cause damage and reduction to the kidney functions. CRF is quite common in patients with diabetes – with the diabetes as the usual cause of their CRF.
2. Hypertension. Hypertension can cause vascular issues which can affect the blood vessels in the kidneys therefore reducing function and causing damage.
3. Glomerulonephritis. Glomeruli are found in the nephrons in the kidneys. It is a network of blood vessels that filters the blood. Prolonged inflammation of these parts of the kidneys can lead to chronic renal failure.  
4. Interstitial nephritis.  Unresolved or prolonged interstitial nephritis, can cause swelling in between kidney tubules leading to CRF.
5. Polycystic kidney disease. Clusters of cysts can sometimes build up in the kidneys. If unresolved, it can lead to CRF as a complication.
6. Long-term obstruction of the urinary tract from conditions such as enlarged prostate, kidney stones, and some cancers.
7. Vesicoureteral reflux. Urine is the product of the filtration of fluids by the kidneys. It is excreted out of our body through the urethra. However, urine can go the other way which can cause damage to the kidneys and related organs.
8. Pyelonephritis. Kidney infection if left untreated or if prolonged can cause permanent damage to the kidneys.
9. Cardiovascular Disease. Just like in diabetes, cardiovascular problems can cause CRF by affecting and damaging the blood vessels in the kidneys.

The following are risk factors that can affect the development of CRF:

• Smoking– can cause vascular damage that can affect kidney function
• Obesity – obese patients require heightened metabolic demands causing the kidneys to be overworked leading to CRF if not addressed
• Race – African American, Native American or Asian-American descent; CRF is noted to be higher in races known to have higher prevalence of hypertension and cardiovascular disease.
• Family history of kidney disease
• Abnormal kidney structure -anatomical issues can cause changes to kidney functions which can lead to CRF
• Older age- organs decline and lose function as the human body ages.

Complications of Chronic Renal Failure

The kidneys play many important functions in the human body. A reduction in its function can cause complications such as:

1. Fluid retention. Kidneys play a role in the regulation of fluid volume hence, reduction to its function can cause peripheral edema, pulmonary edema, and pericardial effusion.
2. Hyperkalemia. Extra Potassium in the body is excreted through the kidneys. Impairment to this function can cause build-up of Potassium in the blood stream.
3. Cardiovascular disease. Kidneys help in the fluid regulation in the body. It also helps in the regulation of blood pressure thru hormone regulation. Changes in these processes can cause hypertension which is commonly related to cardiovascular problems.
4. Weak bones and an increased risk of bone fractures. CRF causes reduced Vitamin D production and low phosphorous levels causing hypocalcemia. The body compensates by moving the calcium from the bones to the blood stream causing weak bones.
5. Anemia. CRF causes a reduction in the production of Erythropoietin – a hormone that triggers the bone marrow to produce red blood cells.
6. Decreased sex drive, erectile dysfunction, or reduced fertility. The causes of these complications in CRF is multifactorial. CRF can affect hormonal balance, cardiovascular function, and psychological health – all of which can cause changes in the patient’s sexual health.
7. Neurological complications. Regulation of waste in the body is one of the many important roles of the kidneys. Build-up of the waste can cause neurological problems.
8. Decreased immune response. Reduction in immunity is commonly seen in patients with CRF. This can lead to increased susceptibility to infections.
9. Pericarditis. Uremic pericarditis can happen because of the build-up of toxins in the human body
10. Irreversible damage to the kidneys (end-stage kidney disease)

Diagnosis of Chronic Renal Failure

1. History taking and Physical exam – a detailed medical and family history will be taken by the health care provider when making a diagnosis of chronic renal failure. Physical examination will also be done to correlate with the results of diagnostic procedures.
2. Blood tests – creatinine and urea are blood markers that reflect kidney function; estimated glomerular filtration rate (eGFR) can help indicate the stage of kidney disease
3. Urine tests – to give health care providers information about the patient’s kidney function
4. Imaging tests such as CT scan– to gather information about the current structure and size of the kidneys and other related organs
5. Kidney biopsy – to collect a tissue sample that well be examined under the microscope, which can give a lot of information as to what is causing the kidney problem

Treatment for Chronic Renal Failure

Chronic renal failure is irreversible and often non-curable.

Measures can be taken to manage signs and symptoms, reduce complications, and to slow the progression of the disease.

If treatment options are unsuccessful, the damage can lead to end-stage kidney disease, which will then require the need for dialysis or kidney transplant.

The treatment includes treating the underlying cause of CRF.

However, this is not always successful as the disease may persist and progress.

Addressing the complications and signs and symptoms is central to the treatment of CRF.

Medications. The following medications can be used to manage CRF:

1. Antihypertensive medications – drugs such as angiotensin-converting enzymes inhibitors (ACE inhibitors) or angiotensin II receptor blockers are prescribed to regulate blood pressure and preserve kidney function.
2. Anti-cholesterol drugs – cholesterol levels must be regulated to reduce the risks of cardiovascular problems.
3. Diuretics – to relieve swelling; these can help address the fluid balance by excreting excess fluids in the body.
4. Medications to protect the bones – Calcium, Vitamin D, and phosphate supplements can be given to support the bones of CRF patients.
5. Medications to treat anemia – erythropoietin is usually given to patients with CRF to address anemia which can reduce associated weakness and fatigue.
6. Low protein diet. Low protein diet is usually prescribed to patients with CRF. The body’s processing of protein causes accumulation of wastes which are filtered by the kidneys. Reduction of dietary protein means reduction of waste products, giving the kidneys rest and preventing further deterioration of renal perfusion and function.
7. Lifestyle changes. The patient should be encouraged to undergo a smoking cessation program to prevent further vascular damage. An exercise regimen as recommended by the physiotherapy team should also be considered. If the patient is diabetic, the diabetes should be well-controlled as worsening of this condition can affect kidney function.

Nursing Diagnosis in CKD

Nursing Care Plan for CKD 1

Nursing Diagnosis: Ineffective Renal Tissue Perfusion related to glomerular malfunction secondary to chronic renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, eGFR levels), oliguria or anuria, peripheral edema, hypertension, muscle twitching and cramping, fatigue, and weakness

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

Nursing Care Plan for CKD 2

Impaired Urinary Elimination related glomerular malfunction to secondary to chronic renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, and eGFR levels), oliguria or anuria, and urinary retention

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

More CKD Nursing Diagnosis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.