Nursing Diagnosis for Renal Failure

The kidneys make urine by filtering water and waste from the bloodstream, then sending it to the bladder for storage. The kidneys can shut down (renal failure) because of diabetes, drug toxicity (some antibiotics, chemotherapy), or cardiovascular disease. Nursing diagnoses are problem statements that guide nursing care. Below are several nursing diagnoses that apply to patients with renal failure.

#1: Alterations in fluid balance related to decreased kidney function.

• Blood moves from the lungs to the heart and then to other parts of the body. In renal failure, excess fluids in circulation strain the heart, causing blood pressure to rise. If the heart becomes overwhelmed, fluids back into the lung, the person becomes short of breath, and heart failure may occur. A person with renal failure may have swelling (face, arms, legs), weight gain, and difficulty breathing. The nurse listens for fluid in his lungs with a stethoscope and assesses breathing (rate, effort). If he is struggling to breathe, he may require intubation (breathing is done by a machine) until the excess fluid is removed by dialysis.

#2: High risk for injury related to hyperkalemia (too much potassium).

• Potassium is essential for normal heart, muscle, and nerve function. Excess amounts are normally removed by the kidneys; in renal failure, hyperkalemia can cause arrhythmias (abnormal heart rhythms), which can be fatal. The nurse checks the labs for the potassium level --- if it is high, she notifies the physician, who may order intravenous glucose, insulin, and calcium to move the potassium from the bloodstream and back into the cells. The nurse monitors the patient for symptoms of hyperkalemia: weakness, fatigue, weak pulse. Dialysis may even be necessary to correct the potassium level.

#3: Alteration in comfort related to fatigue.

• The bone marrow, or spongy part of the bone, produces red blood cells (RBCs) that carry oxygen to the tissues. When the body needs more oxygen, the kidneys produce erythropoietin, a hormone that tells the bone marrow to produce more RBCs. In renal failure, low levels of erythropoietin do not stimulate RBC production, and the body does not get enough oxygen. Thus, someone with renal failure feels weak and tired. The nurse can help by assisting him as needed and minimizing disturbances at night.

#4: Anxiety related to receiving medical diagnosis.

• Anxiety is normal when patients learn that they have renal failure. Severe anxiety can be debilitating, and the nurse needs to assess her patient's level of anxiety. She should speak to him in a calm voice and use simple sentences. The nurse administers an anti-anxiety agent if the patient wants it. When his nerves settle, he will be more relaxed and better able to focus on learning about his condition and how to take care of himself.

In Summary

• The body is thrown off balance when the kidneys shut down. Nurses, who are at the forefront in caring for people in renal failure, develop nursing diagnoses to provide the best care possible.