Chronic renal failure (CRF) is the end result of a gradual, progressive loss of kidney function. Causes include chronic infections (glomerulonephritis, pyelonephritis), vascular diseases (hypertension, nephrosclerosis), obstructive processes (renal calculi), collagen diseases (systemic lupus), nephrotoxic agents (drugs, such as aminoglycosides), and endocrine diseases (diabetes, hyperparathyroidism).
This syndrome is generally progressive and produces major changes in all body systems. The final stage of renal dysfunction, end-stage renal disease (ESRD), is demonstrated by a glomeruler filtration rate (GFR) of 15%–20% of normal or less.
Nursing Care Plan for Chronic Renal Failure:
Nursing Priorities & Discharge Goals
NURSING PRIORITIES
- Maintain homeostasis.
- Prevent complications.
- Provide information about disease process/prognosis and treatment needs.
- Support adjustment to lifestyle changes.
DISCHARGE GOALS
- Fluid/electrolyte balance stabilized.
- Complications prevented/minimized.
- Disease process/prognosis and therapeutic regimen understood.
- Dealing realistically with situation; initiating necessary lifestyle changes.
- Plan in place to meet needs after discharge.
Nursing Care Plan for Chronic Renal Failure: Nursing Diagnosis & Intervention
Nursing Diagnosis Of Chronic Renal Failure:
- Cardiac Output, risk for decreased related to 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).
Nursing Intervention of Chronic Renal Failure with Rationale:
Hemodynamic Regulation (NIC)
Independent
- Auscultate heart and lung sounds. Evaluate presence of peripheral edema/vascular congestion and reports of dyspnea. Rationale: S3/S4 heart sounds with muffled tones, tachycardia, irregular heart rate, tachypnea, dyspnea, crackles, wheezes, and edema/jugular distension suggest HF.
- Assess presence/degree of hypertension: monitor BP; note postural changes, e.g., sitting, lying, standing. Rationale: 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. Rationale: Although hypertension and chronic HF may cause MI, approximately half of CRF patients on dialysis develop pericarditis, potentiating risk of pericardial effusion/tamponade.
- Evaluate heart sounds (note friction rub), BP, peripheral pulses, capillary refill, vascular congestion, temperature, and sensorium/mentation. Rationale: Presence of sudden hypotension, paradoxic pulse, narrow pulse pressure, diminished/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. Rationale: Weakness can be attributed to HF and anemia.
Collaborative
- Monitor laboratory/diagnostic studies, e.g.: Electrolytes (potassium, sodium, calcium, magnesium), BUN/Cr; Rationale: Imbalances can alter electrical conduction and cardiac function; Do Chest x-rays. Rationale: Useful in identifying developing cardiac failure or soft-tissue calcification.
- Administer antihypertensive drugs, e.g., prazosin (Minipress), captopril (Capoten), clonidine (Catapres), hydralazine (Apresoline). Rationale: Reduces systemic vascular resistance and/or renin release to decrease myocardial workload and aid in prevention of HF and/or MI.
- Prepare for dialysis. Rationale: Reduction of uremic toxins and correction of electrolyte imbalances and fluid overload may limit/prevent cardiac manifestations, including hypertension and pericardial effusion.
- Assist with pericardiocentesis as indicated. Rationale: Accumulation of fluid within pericardial sac can compromise cardiac filling and myocardial contractility, impairing cardiac output and potentiating risk of cardiac arrest.
Nursing Care Plan for Chronic Renal Failure
