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.
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.
- 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 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.
- Experience no signs/symptoms of bleeding/hemorrhage.
- Maintain/demonstrate improvement in laboratory values.
|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:|
|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).|
|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.|
|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:|
|Corrects many of the symptoms of CRF resulting from anemia by stimulating the production and maintenance of RBCs, thus decreasing the need for transfusion.|
|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.|
|May be given prophylactically to reduce or neutralize gastric acid and thereby reduce the risk of GI hemorrhage.|
|Inhibits bleeding that does not subside spontaneously or respond to usual treatment.|
|Straining to pass hard-formed stool increases likelihood of mucosal and rectal bleeding.|
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Genitourinary Care Plans
Care plans related to the 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 | 6 Care Plans
- Mastectomy | 14+ 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 | 6 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans