5 Chronic Renal Failure Nursing Care Plans

Chronic renal failure (CRF), also known as chronic kidney disease (CKD), is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment. CRF can develop insidiously over many years, or it may result from an episode of a cure renal failure from which the client has not recovered.

Few symptoms may develop until after more than 75% of glomerular filtration is lost; then the remaining normal parenchyma deteriorates progressively, and symptoms worsen as renal function decreases. If the condition goes unchecked, uremic toxins will accumulate and produce potentially fatal physiologic changes in all major organ systems. If the patient cannot tolerate it, maintenance dialysis or kidney transplantation can sustain life.

Diabetes mellitus and hypertension are the main causes of chronic renal failure, accounting for two-thirds of cases. Glomerulonephritis, chronic infections, congenital anomalies like polycystic kidneys, vascular diseases, systemic lupus erythematosus and long-term aminoglycoside therapy gradually destroy the nephros and eventually cause irreversible renal failure. Similarly, acute renal failure that fails to respond to treatment becomes chronic renal failure.

Nursing Care Plans

This post has five chronic renal failure nursing care plans.

Nursing Goal

The nursing goal for client’s with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

1. Fluid Volume Excess


Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hypertrophied leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.

Assessment

Patient may manifest: 

  • Edema
  • Hypertension
  • Weight gain
  • Pulmonary congestion (SOB, DOB)
  • Oliguria
  • Distended jugular vein
  • Changes in mental status

Diagnosis

  • Fluid Volume Excess R/T decrease glomerular filtration rate and sodium retention

Planning

  • Patient will demonstrate behaviors to monitor fluid status and reduce recurrence of fluid excess
  • Patient will manifest stabilize fluid volume AEB balance I & O, normal VS, stable weight, and free from signs of edema.
Nursing Interventions Rationale
Establish rapport To gain patient’s trust and cooperation.
Monitor and record vital signs To assess precipitating and causative factors.
Assess possible risk factors To obtain baseline data
Monitor and record vital signs. To obtain baseline data
Assess patient’s appetite To note for presence of nausea and vomiting
Note amount/rate of fluid intake from all sources To prevent fluid overload and monitor intake and output
Compare current weight gain with admission or previous stated weight To monitor fluid retention and evaluate degree of excess
Auscultate breath sounds For presence of crackles or congestion
Record occurrence of dyspnea To evaluate degree of excess
Note presence of edema. To determine fluid retention
Measure abdominal girth for changes. May indicate increase in fluid retention
Evaluate mentation for confusion and personality changes. May indicate cerebral edema.
Observe skin mucous membrane. To evaluate degree of fluid excess.
Change position of client timely. To prevent pressure ulcers.
Review lab data like BUN, Creatinine, Serum electrolyte. To monitor fluid and electrolyte imbalances
Restrict sodium and fluid intake if indicated To lessen fluid retention and overload.
Record I&O accurately and calculate fluid volume balance To monitor kidney function and fluid retention.
Weigh client Weight gain indicates fluid retention or edema.
Encourage quiet, restful atmosphere. To conserve energy and lower tissue oxygen demand.
Promote overall health measure. To promote wellness.

2. Acute Pain


Pain is a discomfort that is caused by the stimulation of the nerve endings. Any trauma that the kidney experience (by any causes or factors) perceive by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his flank area.

Assessment

Patient may manifest: 

  • Facial Grimaces
  • Guarding behaviors
  • Costovertebral pain/ Flank pain
  • Limited ROM
  • Body weakness
  • Facial Mask
  • Narrowed Focus
  • Sleep Disturbance
  • Diaphoresis
  • RR & BP changes

Diagnosis

Planning

  • Patient will demonstrate use of relaxation skills to relieve pain.
  • Patient will report relief/control of pain.
Nursing Interventions Rationale
Establish rapport. To get the cooperation of the patient and SO.
Monitor and record vital signs. To obtain baseline data.
Assess pt’s general condition To obtain baseline data
Accept patient’s description of pain. Pain is a subjective experience and cannot be felt by other.
Perform a comprehensive assessment of pain ( location , onset, characteristics, frequency) To be able to compare changes from previous reports to rule out worsening of underlying condition/developing complications
Determine possible pathophysiology and causes of pain To know underlying condition that leads to pain and possible management that would not further aggravate pain.
Assess patient’s perception along with behavioral and physiological responses. To know clients attitude towards pain and use of specific pain and medication.
Perform pain assessment each time pan occurs, note and investigate changes from previous report. To rule out worsening of underlying condition / development of complication.
Assess patient’s description of pain. To acknowledge the pain experience convey acceptance of client’s response to pain.
Observe nonverbal cues including how client walks, holds body, sits, facial expressions, cool fingertips/ toes, which can mean constricted vessels Observation may/ may not be congruent with verbal reports indicating need for further evaluation.
Assess for referral pain as appropriate To help determine possibility of underlying condition or organ dysfunction requiring treatment.
Review patient’s previous experiences with pain and methods found either helpful or unhelpful for pain control in the past. To rule out worsening of pain due to methods used.
Explore method for alleviation/ control of pain. Timely intervention is more likely to be successful in alleviating pain.
Encourage verbalization of feelings about the pain. To allow out let for emotions and enhance coping mechanism.
Provide quite environment, calm activities and adequate rest reinforce To prevent fatigue and lessen stimuli.
Provide comfort measures such as back rub, change position, use of heat/ cold. To provide non-pharmacologic pain management.
Instruct/encourage use of relaxation exercise such as focused breathing. This is a form of relaxation technique that helps decrease level of pain.
Encourage diversional activities such as TV and socialization with others. Provides diversionary activities that help block the perception of pain by the brain.
Assist with self-care activities. To able to perform ADL’s and maintain good hygiene.
Assist in treatment of underlying disease process causing pain. Evaluate effectiveness of therapies.
Provide for individualized physical therapy/ exercise program that can be continued by the client discharge refer to physical therapist. To continue therapeutic effect and wellness for the patient
Administer analgesics as ordered. Pharmacologic mgmt for pain

3. Altered Renal Tissue Perfusion


For optimal cell functioning the kidney excrete potentially harmful nitrogenous product-Urea, Creatinine, Uric Acid but because of the loss of kidney excretory functions there is impaired excretion of nitrogenous waste product causing in increase in Laboratory result of BUN, Creatinine, Uric Acid Level.

Assessment

  • Increase in Lab results (BUN, Creatinine, Uric Acid Level)
  • Oliguria
  • Anuria
  • Edema
  • Pulmonary Congestion
  • Hypertension
  • Hematuria

Diagnosis

  • Altered Renal Perfusion RT Glomerular Malfunction

Planning

  • Patient will demonstrate participation in his/her recommended treatment program.
  • Patient  will demonstrate behavior/lifestyle changes  to prevent complications
Nursing Interventions Rationale
Establish rapport To get the cooperation of the patient and SO.
Monitor and record vital signs. To obtain baseline data
Assess patient’s general condition. To obtain baseline data.
Determine factors related to individual situation and note situation that can affect all body system. To assess causative and contributing factors
Note characteristic of urine: measure urine specific gravity. To assess for hematuria and proteinuria and renal impairment.
Ascertain usual voiding pattern To compare with current situation.
Note presence, location intensity duration of pain. May indicate pain on affected organ
Note mentation status and review lab result such as BUN and creatinine levels. increase BUN and creatinine levels may alter mentation
Monitor BP, ascertain patient’s usual range. GFR may increase rennin and raise BP.
Observe for dependent generalized edema. To note degree of impairment of renal function.
Measure urine output on a regular schedule and weigh daily. To assess renal perfusion and function.
Provide diet restriction as indicated, while providing adequate calories. Calories to meet body’s need while restriction of protein helps limit BUN.
Encourage discussion of feelings regarding prognosis or long term effects of discussion. To decrease anxiety about condition and correct his wrong ideas about condition.
Identify necessary changes in lifestyle and assist client to incorporate disease management to ADLs. To promote wellness and prevent further progression of complication.
Assess patient emotional/psychological factors affecting the current situation. Stress or depression may be increasing the effect of an illness or depression might be the result of being forced into inactivity.
Establish realistic activity goal with patient. Enhance commitments to promoting optical outcomes.
Give information about positive signs of improvement such as improve vital signs/ circulation. To provide encouragement.
Provide physiologic support. Maintain calm attitude but admit concerns if questioned by the client/SO. Honestly can be reassuring when so much activity or worries are apparent to the client or SO.
Review expectations of the patient/SO. To establish individual goals.
Give patient information that provides evidence of daily/weekly progress. To sustain motivation.
Encourage patient to maintain positive attitude; suggest use of relaxation technique such as guided imagery as appropriate. To enhance sense of well being.
Administer medication as ordered. For faster recovery. It is used to treat the client’s disease condition.
Promote overall health measure. To promote wellness.

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