17 Chronic Renal Failure Nursing Care Plans

March 10, 2014

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:

Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

Lack of exposure/recall, information misinterpretation
Cognitive limitation

Possibly evidenced by

Questions/request for information, statement of misconception
Inaccurate follow-through of instructions, development of preventable complications

Desired Outcomes

Verbalize understanding of condition/disease process and potential complications.
Verbalize understanding of therapeutic needs.
Correctly perform necessary procedures and explain reasons for the actions.
Demonstrate/initiate necessary lifestyle changes.
Participate in treatment regimen.

Nursing Interventions	Rationale
Review disease process and prognosis and future expectations.	Provides knowledge base from which patient can make informed choices.
Review dietary restrictions, including:
Phosphorus (carbonated drinks, processed foods, poultry, corn, peanuts) and magnesium (whole grain products, legumes);	Retention of phosphorus stimulates the parathyroid glands to shift calcium from bones (renal osteodystrophy ) , and accumulation of magnesium can impair neuromuscular function and mentation.
Fluid and sodium restrictions when indicated.	If fluid retention is a problem, patient may need to restrict intake of fluid to 1100 cc (or less) and restrict dietary sodium. If fluid overload is present, diuretic therapy or dialysis will be part of the regimen.
Discuss other nutritional concerns such as regulating protein intake according to level of renal function (generally 0.6 – 0.7g per k of body weight per day of good quality protein, such as meat, eggs).	Metabolites that accumulate in blood derive almost entirely from protein catabolism; as renal function declines, proteins may be restricted proportionately. Too little protein can result in malnutrition. Note: Patient on dialysis may not need to be as vigilant with protein intake.
Encourage adequate calorie intake, especially from carbohydrates in the nondiabetic patient.	Spares protein, prevents wasting, and provides energy. Note: Use of special glucose polymer powders can add calories to enhance energy level without extra food or fluid intake.
Discuss drug therapy, including use of calcium supplements and phosphate binders such as aluminum hydroxide antacids (Amphojel, Basalgel) and avoidance of magnesium antacids (Mylanta, Maalox, Gelusil); vitamin D.	Prevents serious complications (reducing phosphate absorption from the GI tract and supplying calcium to maintain normal serum levels, reducing risk of bone demineralization or fractures, tetany); however, use of aluminum – containing products should be monitored because accumulation in the bones potentiates osteodystrophy. Magnesium products potentiate risk of hypermagnesemia. Note: Supplemental vitamin D may be required to facilitate calcium absorption.
Stress importance of reading all product labels (drugs and food) and not taking medications without prior approval of healthcare provider.	It is difficult to maintain electrolyte balance when exogenous intake is not factored into dietary restrictions, (hypercalcemia can result from routine supplement use in combination with increased dietary intake of calcium – fortified foods and medications containing calcium).
Review measures to prevent bleeding and hemorrhage, (use of soft toothbrush, electric razor); avoidance of constipation, forceful blowing of nose, strenuous exercise and contact sports.	Reduces risks related to alteration of clotting factors and decreased platelet count.
Instruct in self – observation and self-monitoring of BP, including scheduling rest period before taking BP, using same arm or position.	Incidence of hypertension is increased in CRF, often requiring management with antihypertensive drugs, necessitating close observation of treatment effects (vascular response to medication).
Caution against exposure to external temperature extremes (heating pad or snow).	Peripheral neuropathy may develop, especially in lower extremities (effects of uremia, electrolyte and acid-base imbalances), impairing peripheral sensation and potentiating risk of tissue injury.
Establish routine exercise program within limits of individual ability; intersperse adequate rest periods with activities.	Aids in maintaining muscle tone and joint flexibility. Reduces risks associated with immobility (including bone demineralization), while preventing fatigue.
Address sexual concerns.	Physiological effects of uremia and antihypertensive therapy may impair sexual desire and performance.
Identify available resources as indicated. Stress necessity of medical and laboratory follow- up.	Close monitoring of renal function and electrolyte balance is necessary to adjust dietary prescription, treatment or make decisions about possible options such as dialysis and transplantation.
Identify signs and symptoms requiring immediate medical evaluation (Low -grade fever, chills, changes in characteristics of urine and sputum, tissue swelling and drainage, oral ulcerations;	Depressed immune system, anemia, malnutrition all contribute to increased risk of infection.
Numbness and tingling of digits, abdominal and muscle cramps, carpopedal spasms;	Uremia and decreased absorption of calcium may lead to peripheral neuropathies.
Joint swelling and tenderness, decreased ROM, reduced muscle strength;	Hyperphosphatemia with corresponding calcium shifts from the bone may result in deposition of the excess calcium phosphate as calcifications in joints and soft tissues. Symptoms of skeletal involvement are often noted before impairment in organ function is evident.
Headaches, blurred vision, periorbital and sacral edema, “red eyes”;	Suggestive of development and poor control of hypertension, or changes in eyes caused by calcium.
Review strategies to prevent constipation, including stool softeners (Colace) and bulk laxatives (Metamucil) but avoiding magnesium products (milk of magnesia).	Reduced fluid intake, changes in dietary pattern, and use of phosphate – binding products often result in constipation that is not responsive to nonmedical interventions.Use of products containing magnesium increases risk of hypermagnesemia.