17 Chronic Renal Failure Nursing Care Plans

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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:

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  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
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Disturbed Thought Process

Nursing Diagnosis

May be related to

  • Physiological changes: accumulation of toxins (e.g., urea, ammonia), metabolic acidosis, hypoxia; electrolyte imbalances, calcifications in the brain

Possibly evidenced by

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  • Disorientation to person, place, time
  • Memory deficit; altered attention span, decreased ability to grasp ideas
  • Impaired ability to make decisions, problem-solve
  • Changes in sensorium: somnolence, stupor, coma
  • Changes in behavior: irritability, withdrawal, depression, psychosis

Desired Outcomes

  • Regain/maintain optimal level of mentation.
  • Identify ways to compensate for cognitive impairment/memory deficits.
Nursing InterventionsRationale
Assess extent of impairment in thinking ability, memory, and orientation. Note attention span.Uremic syndrome’s effect can begin with minor confusion, irritability and progress to altered personality or inability to assimilate information and participate in care. Awareness of changes provides opportunity for evaluation and intervention.
Ascertain from SO patient’s usual level of mentation.Provides comparison to evaluate progression and resolution of impairment.
Provide SO with information about patient’s status.Some improvement in mentation may be expected with restoration of more normal levels of BUN, electrolytes, and serum pH.
Provide quiet or calm environment and judicious use of television, radio, and visitation.Minimizes environmental stimuli to reduce sensory overload and confusion while preventing sensory deprivation.
Reorient to surroundings, person, and so forth. Provide calendars, clocks, outside window.Provides clues to aid in recognition of reality.
Present reality concisely, briefly, and do not challenge illogical thinking.Confrontation potentiates defensive reactions and may lead to patient mistrust and heightened denial of reality.
Communicate information and instructions in simple, short sentences. Ask direct, yes or no questions. Repeat explanations as necessary.May aid in reducing confusion, and increases possibility that communications will be understood and remembered.
Establish a regular schedule for expected activities.Aids in maintaining reality orientation and may reduce fear and confusion.
Promote adequate rest and undisturbed periods for sleep.Sleep deprivation may further impair cognitive abilities.
Monitor laboratory studies such as BUN and Cr, serum electrolytes, glucose level, and ABGs (Po2, pH).Correction of elevations or imbalances can have profound effects on cognition or mentation.
Provide supplemental O2 as indicated.Correction of hypoxia alone can improve cognition.
Avoid use of barbiturates and opiates.Drugs normally detoxified in the kidneys will have increased half-life and cumulative effects, worsening confusion.
Prepare for dialysis.Marked deterioration of thought processes may indicate worsening of azotemia and general condition, requiring prompt intervention to regain homeostasis.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans and nursing diagnoses related to reproductive and urinary system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
  • 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!

  • 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!

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