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:
- 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
Excess Fluid Volume
Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hypertrophied leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.
Nursing Diagnosis
Assessment
Patient may manifest:
- Edema
- Hypertension
- Weight gain
- Pulmonary congestion (SOB, DOB)
- Oliguria
- Distended jugular vein
- Changes in mental status
Diagnosis
- Fluid Volume Excess R/T decrease glomerular filtration rate and sodium retention
Planning
- Patient will demonstrate behaviors to monitor fluid status and reduce recurrence of fluid excess
- Patient will manifest stabilize fluid volume AEB balance I&O, normal VS, stable weight, and free from signs of edema.
| Nursing Interventions | Rationale |
|---|---|
| Establish rapport | To gain patient’s trust and cooperation. |
| Monitor and record vital signs | To assess precipitating and causative factors. |
| Assess possible risk factors | To obtain baseline data |
| Monitor and record vital signs. | To obtain baseline data |
| Assess patient’s appetite | To note for presence of nausea and vomiting |
| Note amount/rate of fluid intake from all sources | To prevent fluid overload and monitor intake and output |
| Compare current weight gain with admission or previous stated weight | To monitor fluid retention and evaluate degree of excess |
| Auscultate breath sounds | For presence of crackles or congestion |
| Record occurrence of dyspnea | To evaluate degree of excess |
| Note presence of edema. | To determine fluid retention |
| Measure abdominal girth for changes. | May indicate increase in fluid retention |
| Evaluate mentation for confusion and personality changes. | May indicate cerebral edema. |
| Observe skin mucous membrane. | To evaluate degree of fluid excess. |
| Change position of client timely. | To prevent pressure ulcers. |
| Review lab data like BUN, Creatinine, Serum electrolyte. | To monitor fluid and electrolyte imbalances |
| Restrict sodium and fluid intake if indicated | To lessen fluid retention and overload. |
| Record I&O accurately and calculate fluid volume balance | To monitor kidney function and fluid retention. |
| Weigh client | Weight gain indicates fluid retention or edema. |
| Encourage quiet, restful atmosphere. | To conserve energy and lower tissue oxygen demand. |
| Promote overall health measure. | To promote wellness. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023Â (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to 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 | 11Â Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 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 | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans
A teaching plan on Urosepsis
Nursing care plan on cardiorenal syndrome
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!
Good lesson
It’s really helpful 💕
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!