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 Ineffective Protection

Risk factors may include

  • Abnormal blood profile (suppressed erythropoietin production/secretion; decreased RBC production and survival; altered clotting factors; increased capillary fragility)

Possibly evidenced by

  • Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

  • Experience no signs/symptoms of bleeding/hemorrhage.
  • Maintain/demonstrate improvement in laboratory values.
Nursing InterventionsRationale
Note reports of increasing fatigue, weakness. Observe for tachycardia, pallor of ski and mucous membranes, dyspnea, and chest pain. Plan patient activities to avoid fatigue.May reflect effects of anemia and cardiac response necessary to keep cells oxygenated.
Monitor level of consciousness and behavior.Anemia may cause cerebral hypoxia manifested by changes in mentation, orientation, and behavioral responses.
Evaluate response to activity, ability to perform tasks. Assist as needed and develop schedule for rest.Anemia decreases tissue oxygenation and increases fatigue, which may require intervention, changes in activity, and rest.
Limit vascular sampling, combine laboratory tests when possible.Recurrent or excessive blood sampling can worsen anemia.
Observe for oozing from venipuncture sites, bleeding, ecchymotic areas following slight trauma, petechiae; joint swelling or mucous membrane involvement (bleeding gums, recurrent epistaxis, hematemesis, melena, and hazy or red urine.Bleeding can occur easily because of capillary fragility and altered clotting functions and may worsen anemia.
Hematest GI secretions and stool for blood.Mucosal changes and altered platelet function due to uremia may result in gastric mucosal erosion and GI hemorrhage.
Provide soft toothbrush, electric razor; use smallest needle possible and apply prolonged pressure following injections or vascular punctures.Reduces risk of bleeding and hematoma formation.
Monitor laboratory studies:
  • RBCs, Hb and Hct;
Uremia (elevated ammonia, urea, other toxins) decreases production of erythropoietin and depresses RBC production and survival time. In CRF, Hb and Hct are usually low but tolerated; (patient may not be symptomatic until Hb is below 7).
  • Platelet count, clotting factors;
Suppression of platelet formation and inadequate levels of factors III and VIII impair clotting and potentiate risk of bleeding. Note: Bleeding may become intractable in ESRD.
  • Prothrombin time (PT) level.
Abnormal prothrombin consumption lowers serum levels and impairs clotting.
Administer fresh blood, packed RBCs (PRCs) as indicated.May be necessary when patient is symptomatic with anemia. PRCs are usually given when patient is experiencing fluid overload or receiving dialysis treatment. Washed RBCs are used to prevent hyperkalemia associated with stored blood.
Administer medications, as indicated:
  • Erythropoietin preparations (Epogen, EPO, Procrit);
Corrects many of the symptoms of CRF resulting from anemia by stimulating the production and maintenance of RBCs, thus decreasing the need for transfusion.
  • Iron preparations: folic acid (Folvite), cyanocobalamin (Rubisol-1000);
Useful in managing symptomatic anemia related to nutritional or dialysis-induced deficits. Note: Iron should not be given with phosphate binders because they may decrease iron absorption.
  • Cimetidine (Tagamet), ranitidine (Zantac); antacids;
May be given prophylactically to reduce or neutralize gastric acid and thereby reduce the risk of GI hemorrhage.
  • Hemostatics or fibrinolysis inhibitors such as aminocaproic acid (Amicar);
Inhibits bleeding that does not subside spontaneously or respond to usual treatment.
  • Stool softeners (Colace); bulk laxative (Metamucil).
Straining to pass hard-formed stool increases likelihood of mucosal and rectal bleeding.

See Also

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Genitourinary Care Plans

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