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 goal for clients 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 11 nursing care plans (NCP) 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
Risk for Decreased Cardiac Output
Risk
for Decreased Cardiac Output: At risk for inadequate blood pumped by the heart
to meet metabolic demands of the body.
Risk factors may
include
·
Fluid
imbalances affecting circulating volume, myocardial workload, and systemic
vascular resistance (SVR)
·
Alterations
in rate, rhythm, cardiac conduction (electrolyte imbalances, hypoxia)
·
Accumulation
of toxins (urea), soft-tissue calcification (deposition of calcium phosphate)
Possibly evidenced
by
Not
applicable. Existence of signs and symptoms establishes an actual nursing
diagnosis.
Desired Outcomes
Maintain
cardiac output as evidenced by BP and heart rate within patient’s normal range;
peripheral pulses strong and equal with prompt capillary refill time.
|
Nursing
Interventions
|
Rationale
|
|
Auscultate heart and lung sounds. Evaluate presence of
peripheral edema, vascular congestion and reports of dyspnea.
|
S3 and S4 heart sounds with
muffled tones, tachycardia, irregular heart rate, tachypnea, dyspnea,
crackles, wheezes,edema and jugular distension suggest HF.
|
|
Assess presence and degree of hypertension: monitor BP;
note postural changes (sitting, lying, standing).
|
Significant hypertension can occur because of disturbances
in the renin-angiotensin-aldosterone system (caused by renal dysfunction).
Although hypertension is common, orthostatic hypotension may occur because of
intravascular fluid deficit, response to effects of antihypertensive
medications, or uremic pericardial tamponade.
|
|
Investigate reports of chest pain,
noting location, radiation, severity (0–10 scale), and whether or not it is
intensified by deep inspiration and supine position.
|
Although hypertension and chronic HF may cause MI,
approximately half of CRF patients on dialysis develop pericarditis,
potentiating risk of pericardial effusion or tamponade.
|
|
Evaluate heart sounds (note friction rub), BP, peripheral
pulses, capillary refill, vascular congestion, temperature, and sensorium or
mentation.
|
Presence of sudden hypotension, paradoxic pulse, narrow pulse pressure,
diminished or absent peripheral pulses, marked jugular distension, pallor,
and a rapid mental deterioration indicate tamponade, which is a medical
emergency.
|
|
Assess activity level, response to activity.
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Weakness can be attributed to HF and anemia.
|
|
Monitor laboratory and
diagnostic studies:
|
|
|
Imbalances can alter electrical conduction and cardiac
function.
|
|
Useful in identifying developing cardiac failure or
soft-tissue calcification.
|
|
Administer antihypertensive drugs such as prazosin (Minipress), captopril (Capoten), clonidine (Catapres), hydralazine (Apresoline).
|
Reduces systemic vascular resistance and renin release to
decrease myocardial workload and aid in prevention of HF and MI.
|
|
Prepare for dialysis.
|
Reduction of uremic toxins and correction of electrolyte
imbalances and fluid overload may limit and prevent cardiac manifestations,
including hypertension and pericardial effusion.
|
|
Assist with pericardiocentesis as indicated.
|
Accumulation of fluid within pericardial sac can
compromise cardiac filling and myocardial contractility, impairing cardiac
output and potentiating risk of cardiac arrest.
|
Acute Pain
Pain is a discomfort that is caused by the stimulation of the nerve endings. Any trauma that the kidney experience (by any causes or factors) perceive by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his flank area.
Assessment
Patient may manifest:
- Facial Grimaces
- Guarding behaviors
- Costovertebral pain/ Flank pain
- Limited ROM
- Body weakness
- Facial Mask
- Narrowed Focus
- Sleep Disturbance
- Diaphoresis
- RR & BP changes
- Acute Pain
- Patient will demonstrate use of relaxation skills to relieve pain.
- Patient will report relief/control of pain.
|
Nursing
Interventions
|
Rationale
|
|
Establish rapport.
|
To get the cooperation of the patient and SO.
|
|
Monitor and record vital signs.
|
To obtain baseline data.
|
|
Assess pt’s general condition
|
To obtain baseline data
|
|
Accept patient’s description of pain.
|
Pain is a subjective experience and cannot be felt by
other.
|
|
Perform a comprehensive assessment of pain (location,
onset, characteristics, and frequency)
|
To be able to compare changes from previous reports to rule
out worsening of underlying condition/developing complications
|
|
Determine possible pathophysiology and causes of pain
|
To know underlying condition that leads to pain and
possible management that would not further aggravate pain.
|
|
Assess patient’s perception along with behavioral and
physiological responses.
|
To know clients attitude towards pain and use of specific
pain and medication.
|
|
Perform pain assessment each time pain occurs, note and
investigate changes from previous report.
|
To rule out worsening of underlying condition /
development of complication.
|
|
Assess patient’s description of pain.
|
To acknowledge the pain experience convey acceptance of
client’s response to pain.
|
|
Observe nonverbal cues including how client walks, holds
body, sits, facial expressions, cool fingertips/ toes, which can mean
constricted vessels
|
Observation may/ may not be congruent with verbal reports
indicating need for further evaluation.
|
|
Assess for referral pain as appropriate
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To help determine possibility of underlying condition or
organ dysfunction requiring treatment.
|
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Review patient’s previous experiences with pain and
methods found either helpful or unhelpful for pain control in the past.
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To rule out worsening of pain due to methods used.
|
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Explore method for alleviation/ control of pain.
|
Timely intervention is more likely to be successful in
alleviating pain.
|
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Encourage verbalization of feelings about the pain.
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To allow out let for emotions and enhance coping mechanism.
|
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Provide quite environment, calm activities and adequate
rest reinforce
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To prevent fatigue and lessen stimuli.
|
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Provide comfort measures such as back rub, change
position, use of heat/ cold.
|
To provide non-pharmacologic pain management.
|
|
Instruct/encourage use of relaxation exercise such as
focused breathing.
|
This is a form of relaxation technique that helps decrease
level of pain.
|
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Encourage diversional activities such as TV and
socialization with others.
|
Provides diversionary activities that help block the
perception of pain by the brain.
|
|
Assist with self-care activities.
|
To able to perform ADL’s and maintain good hygiene.
|
|
Assist in treatment of underlying disease process causing
pain.
|
Evaluate effectiveness of therapies.
|
|
Provide for individualized physical therapy/ exercise
program that can be continued by the client discharge refer to physical
therapist.
|
To continue therapeutic effect and wellness for the
patient
|
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Administer analgesics as ordered.
|
Pharmacologic mgmt for pain
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Source: Nurseslabs
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