Nursing Care Plan for Chronic Renal Failure

Chronic renal failure (CRF) occurs when the kidneys cannot adequately expel waste products and toxins from the body. The disease process is slow, accumulating over several months or years. Eventually, the kidneys become so damaged that they are unable to excrete wastes or regulate the body's delicate fluid balance, leading to end-stage renal failure. A nursing care plan for CRF includes regularly assessing the patient, monitoring nutrition and reducing the risk of infection.

Assessment

• Most patients with chronic renal failure will have to undergo hemodialysis or a kidney transplant. Nursing care for these two procedures involve regular assessment. A nursing care plan for chronic renal failure will include asking the patient about urine output or any difficulty in urinating. The color and quantity of urine should also be assessed, with any abnormal discoloration promptly reported to the physician. The patient should also be assessed for and asked about any weight fluctuations or edema in the extremities. Medical history, vital signs, skin turgor, and level of consciousness or mental clarity should also be assessed. If the patient is in post-operative condition, vital signs should be assessed every two to four hours, or as directed by a physician.

Imbalanced Nutrition

• A nursing care plan for patients with chronic renal failure will most likely include the nursing diagnosis of imbalanced nutrition. The imbalance in nutrition is related to urinemia and restrictions on what the patient is allowed to eat. Dietary intake might be less than what is required to maintain nutrition balance. The nursing care plan will use nursing interventions such as monitoring intake and output and administering antiemetics, if ordered. Small meals and nutritious snacks should also be provided and encouraged. Mouth care before eating might help improve the patient's appetite and sense of taste. If the imbalance in nutrition becomes more serious, total parenteral nutrition (TPN) might become necessary. The TPN site should be monitored regularly, as well as all other IV lines.

Infection

• Patients with chronic renal failure are at risk for infection related to a compromised immune system. A nursing care plan should include the use of standard precautions and proper hand-washing techniques. The white blood cell count should also be monitored because that will help indicate whether an infection is present. Intravenous lines also provide another entrance for harmful microorganisms. IV lines, sites and vital signs should be assessed every four to six hours for infection, redness or abnormality. Encourage ambulation, position changes, coughing and deep breathing exercises as soon as the patient is able because they will help prevent respiratory infections.