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:

Excess Fluid Volume

Excess Fluid Volume: Increased isotonic fluid retention

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.

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.