Nursing Care Plan for Chronic Kidney Disease

Pathophysiology

Chronic kidney disease includes conditions that  damage the kidneys and decrease their ability to effectively filter waste products from the blood. Chronic kidney disease (CKD) develops slowly over time and often presents with no symptoms. Progressed kidney disease may lead to kidney failure which may require dialysis and lead to death.

Etiology

The two most common causes of CKD are uncontrolled hypertension and diabetes mellitus.  Long term elevated pressure of hypertension within the artery walls and damage to the blood vessels from excess glucose can reduce the blood flow to the kidneys causing improper filtration of waste. Prolonged obstruction, as with kidney stones, or recurrent urinary tract infections may also damage the kidneys and inhibit their ability to filter and remove waste products into the urine.

Desired Outome

Maintain optimal control of blood pressure and blood glucose, avoid further progression of disease to cardiac involvement, maintain optimal fluid balance,  and prevent complications.

Chronic Kidney Disease Nursing Care Plan

Subjective Data:

  • Loss of appetite
  • Nausea
  • Fatigue and weakness
  • Muscle twitches and cramps
  • Peripheral edema
  • Persistent itching
  • Urinary frequency, nocturia
  • Chest pain
  • Shortness of breath

Objective Data:

  • Decreased mental agility
  • Swelling of feet and ankles
  • Weight gain
  • Poorly controlled hypertension
  • Elevated serum creatinine

Nursing Interventions and Rationales:

  1. Monitor vitals
    • Maintain reasonable blood pressure to help protect the kidneys from further damage

      Tachycardia may indicate

      Fever may indicate infection and further disease progression
  2. Monitor and manage blood sugar
    • Keeping blood sugar in the optimal range if diabetic can help reduce the stress on the kidneys
  3. Assess cardiopulmonary system: Auscultate heart and lungs for abnormal sounds
    • Fluid retention from improper glomerular filtration may collect in the myocardium resulting in stress on the heart and in the lungs. Listen for friction rub and pulmonary crackles or congestion
  4. Monitor lab/diagnostic studies: Glomerular Filtration Rate (GFR) <60 indicates kidney disease, <15 indicates kidney failure, CT / Ultrasound Kidney biopsy (if necessary), Chest x-ray - if indicated
    • GFR- is a blood test that can show the degree of kidney function available. It is a calculation of creatinine levels, race, age, gender and other factors.

      Albumin- urine albumin test- healthy kidneys do not allow albumin into the urine. Albumin in the urine may indicate decreased kidney function.

      CT / Ultrasound- this imaging may be helpful to view the kidneys to determine if there are tumors or other unusual characteristics of the kidneys
  5. Evaluate mental status
    • Notice changes in mental status and confusion. Cerebral edema and stroke are possible complications.
  6. Monitor I & O
    • Monitor kidney function and calculate fluid retention.
      Daily weights at the same time each day on the same scale can also help determine amount of fluid being retained.

      Measure for decreased output <400 mL/24 hr period may be evidenced by dependent edema
  7. Insert indwelling catheter as appropriate
    • To help monitor fluid balance and characteristics of urine
  8. Palpate abdomen
    • To assess for fluid retention
  9. Restrict fluids
    • Closely monitor fluid intake to prevent overload and help reduce retention and promote emptying of the bladder.
  10. Nutrition education
    • A renal diet is low in protein and sodium. The kidneys are compromised and unable to remove the waste produced by processing proteins (BUN).

      Choose foods low in saturated and trans fat to prevent and lower fat deposits in the blood vessels.

      Choose lower potassium foods to avoid hyperkalemia caused by excess potassium retention.

References

Date Published - Oct 30, 2018
Date Modified - Nov 1, 2018