17 Chronic Renal Failure Nursing Care Plans


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:

  1. Risk for Decreased Cardiac Output
  2. Risk for Ineffective Protection
  3. Disturbed Thought Process
  4. Risk for Impaired Skin Integrity
  5. Risk for Impaired Oral Mucous Membrane
  6. Deficient Knowledge
  7. Excess Fluid Volume
  8. Acute Pain
  9. Impaired Renal Tissue Perfusion
  10. Impaired Urinary Elimination
  11. Imbalanced Nutrition: Less than Body Requirements
  12. NEW Activity Intolerance
  13. NEW Disturbed Body Image
  14. NEW Anticipatory Grieving
  15. NEW Risk for Infection
  16. NEW Risk for Injury
  17. Other Possible Nursing Care Plans

Risk for Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

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 InterventionsRationale
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
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.

See Also

You may also like the following posts and care plans:

Genitourinary Care Plans

Care plans related to the reproductive and urinary system disorders:

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