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:

  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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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.

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Nursing Diagnosis

Assessment

Patient may manifest: 

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  • 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 InterventionsRationale
Establish rapportTo gain patient’s trust and cooperation.
Monitor and record vital signsTo assess precipitating and causative factors.
Assess possible risk factorsTo obtain baseline data
Monitor and record vital signs.To obtain baseline data
Assess patient’s appetiteTo note for presence of nausea and vomiting
Note amount/rate of fluid intake from all sourcesTo prevent fluid overload and monitor intake and output
Compare current weight gain with admission or previous stated weightTo monitor fluid retention and evaluate degree of excess
Auscultate breath soundsFor presence of crackles or congestion
Record occurrence of dyspneaTo 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 indicatedTo lessen fluid retention and overload.
Record I&O accurately and calculate fluid volume balanceTo monitor kidney function and fluid retention.
Weigh clientWeight 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.
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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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