Chronic renal failure (CRF) or chronic kidney disease (CKD) is the end result of a gradual, progressive loss of kidney function. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.
The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.
Nursing Care Plans
The nursing care planning goal for with chronic renal failure 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.
Below are 17 nursing care plans (NCP) and nursing diagnosis for patients with chronic renal failure or chronic kidney disease:
- Risk for Decreased Cardiac Output
- Risk for Ineffective Protection
- Disturbed Thought Process
- Risk for Impaired Skin Integrity
- Risk for Impaired Oral Mucous Membrane
- Deficient Knowledge
- Excess Fluid Volume
- Acute Pain
- Impaired Renal Tissue Perfusion
- Impaired Urinary Elimination
- Imbalanced Nutrition: Less than Body Requirements
- NEW Activity Intolerance
- NEW Disturbed Body Image
- NEW Anticipatory Grieving
- NEW Risk for Infection
- NEW Risk for Injury
- Other Possible Nursing Care Plans
Risk for Injury
Nursing Diagnosis
- Risk for Injury
May be related to
- Renal failure
Possibly evidenced by
- [not applicable]
Desired Outcomes
- Child will not experience injury as evidenced by BP remains, Hgb and Hct remain > (specify lower limit), Child denies bone pain or sensory loss.
| Nursing Interventions | Rationale |
|---|---|
| Assess blood pressure for alterations; administer antihypertensives ordered. | Provides data regarding hypertension evident in advanced renal disease. |
| Assess for sensory loss, confusion neurologic and changes in consciousness. | Reveals possible changes in neurologic status as kidney function deteriorates and uremic syndrome appears. |
| Assess I&O, electrolyte panel, and creatinine; administer diuretics as ordered. | Provides an indication of renal function affecting output with water and electrolyte retention as the disease progresses and nephrons are destroyed. |
| Assess bone pain and deformities affecting ambulation and activities; administer supplemental vitamin D, calcium, and alkalizing agents, as ordered. | Provides an indication of osteodystrophy caused by a calcium-phosphorus imbalance resulting in bone demineralization and growth retardation; kidney disease results in the inability to synthesize vitamin D needed to absorb calcium; acidosis causes dissolution of alkaline salts of bone, phosphate is increased, and calcium decreased as glomerular filtration is reduced. |
| Monitor RBC, Hct, Hgb and administer iron and transfusion of packed red blood cells, as ordered. | Indicates the presence of anemia caused by the depleted production of erythropoietin by the declining kidneys and inadequate iron intake in a restricted diet. |
| Assess the presence of acidosis by pH, bicarbonate losses and administer alkalizing agents. | Provides an indication of impending metabolic acidosis due to the failure of the kidneys to excrete metabolic acids that are byproducts of metabolism; the hydrogen ion is retained and bicarbonate is lost as the tubules are unable to reabsorb it. |
| Instruct parents and child in dietary needs, to decrease sodium, potassium, phosphorous, calcium, iron in the diet, to limit protein and water intake as ordered and amounts allowed; provide a list of allowed foods and sample menus for planning. | Promotes compliance with dietary inclusions or restrictions depending on the degree of renal failure. |
| Educate parents on medication administration including actions, dosage, frequency, side effects to report. | Guarantees compliance with correct medication administration; long-term medications are given for disease to avoid complications and uremic syndrome. |
| Educate parents and child about dialysis procedure and frequency if appropriate; include biologic, psychological and social effects. | Supplies information if dialysis is required; usually based on creatinine level which indicated the ability of the kidneys to excrete waste materials and the degree of renal failure. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 15 Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans
A teaching plan on Urosepsis
Nursing care plan on cardiorenal syndrome
Thank you Matt :) This helped me understand how to do a care plan. I was asked to do one without them showing us a sample first so I was completely lost. Thank you!
Good lesson
It’s really helpful 💕
Hi Matt,
I’m an RN BSN WCC x 25 years. What you’re doing is great. Keep up the good work. Only suggestion is to broaden examples of applicable POC’s in the community. Community nursing is becoming highly skilled. Especially with Covid. In many cases of CKD, in the community, the CG becomes a huge part of the POC. Teach and Assess must be added to POC.
Keep going! Its not enough for our nursing students to pass the boards. They need to understand critical thinking, and be creative/problem solve now more than ever.
Best,
Sue
Hi Sue,
We’ll do our best to include your suggestion on our nursing care plans (which we are currently updating). And I agree: thinking critically is a must skill. Thank you so much for your kind words!