Nursing Care Plan (NCP) for Chronic Kidney Disease

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Outline

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 Outcome

Maintain optimal control of blood pressure and blood glucose, avoid further progression of the 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

  • 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
  • Monitor and manage blood sugar
  • Keeping blood sugar in the optimal range if a diabetic can help reduce the stress on the kidneys
  • Assess the 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 the lungs. Listen for friction rub and pulmonary crackles or congestion
  • 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
  • Evaluate mental status
  • Notice changes in mental status and confusion. Cerebral edema and stroke are possible complications.
  • Monitor I & O
  • Monitor kidney functions and calculate fluid retention. Daily weights at the same time each day on the same scale can also help determine the amount of fluid being retained.
  • Measure for decreased output <400 mL/24 hr period may be evidenced by dependent edema
  • Insert an indwelling catheter as appropriate
  • To help monitor fluid balance and characteristics of urine
  • Palpate abdomen
  • To assess for fluid retention
  • Restrict fluids
  • Closely monitor fluid intake to prevent overload and help reduce retention and promote the emptying of the bladder.
  • 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.

Writing a Nursing Care Plan (NCP) for Chronic Kidney Disease

A Nursing Care Plan (NCP) for Chronic Kidney Disease starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, we’re going to talk about chronic kidney disease and how you can easily put this into a nursing care plan. 

 

So, first we have to collect our data. So, the data really it’s just an assessment. It’s just our assessment findings. So, the subjective data is going to be from the patient. The subject of data for a patient with this is that they are going to have maybe a loss of appetite that they complain of to you. The patient could have some nausea. Maybe they were super tired and fatigued. They might tell you that they feel like they’re a little bit more swollen. They have some edema. They might be super itchy. They might have a bunch of nocturia happening, that urinary frequency, and happening at night time, just because the urine is not very concentrated. So they’re just constantly diuresing. 

 

Then our objective data is the things the nurse observes, the nurse sees or witnesses on lab work or whatever it may be. So, our patient with chronic kidney disease, let’s say we note some swelling, so we can also assess the edema that’s happening, some weight gain; We note in their chart that they have started to gain some weight or a lot of weight. They could have a hypertension that is just totally uncontrolled because remember, those kidneys are an important piece to that hypertension and blood pressure regulation. We also might see on lab work, some elevated serum creatinine. So, all these kinds of things are our objective data and now we’re going to take that data and we’re going to analyze. So, analyzing the data is going to help us to diagnose and prioritize. 

 

So first, we start with what is the problem here? What is the problem? Well, so we have kidneys that aren’t working, right? They’re not working the way that they should be. So, we have lots of swelling happening. For my hypothetical patient with swelling…  I’m going to have this client have some uncontrolled hypertension and along with that swelling, some ascites happening. 

 

So, that’s all that fluid in the abdomen, fluid where it shouldn’t be, so what needs to be improved here? Well, for our patient, we need to help manage the symptoms, right? So, we’re going to manage whatever they have going on. Unfortunately, this is a chronic thing, right? Chronic kidney disease. Well, we can help fix things somewhat, some of the symptoms and help to not worsen anything. So, we’re going to manage the symptoms and issues such as hypertension and just prevent further complications. 

 

So, what is the priority for us for this patient? It’s the uncontrolled hypertension, cause that’s a big problem. So, we want to try to fix that and just overall regulation to prevent the further complications. So, let’s look at this a little bit further. So, our how questions. How did you know it was a problem? Well, this is where you’re going to link whatever data you have collected on your client. Now, we have linked some of the data on my hypothetical patient I made up here with hypertension, the ascites, all that. So, you’re going to link your data. So, for us we have hypertension. So, we knew it was a problem, the edema, polyuria, just because it’s that unconcentrated urine in the ascites. So, lots of things for this patient, how are we going to address it? Well, BP meds, if they’re ordered, hopefully right? 

To help fix that hypertension, we can just further assess and monitor, monitoring the heart and the lungs. Remember, we’re getting some extra stress put on that heart, so we want to monitor that and make sure we don’t get fluid back up into the lungs, just from all the extra fluid. Then we want to monitor lab work. So, especially the GFR because remember that glomerular filtration rate is going to tell us the extent of the chronic kidney disease, so we want to make sure it’s not worsening. We can also help with some education. Maybe this client does not eat properly and we wanted to make sure they’re well-educated on nutrition and fluid restrictions that might need to happen. 

 

How am I going to know if it gets better? Well, we’re going to have no worsening symptoms. The edema should improve because we’re going to hopefully get rid of some of that excess fluid and our labs are going to be better. We will also have our hypertension more under control. So, just be normotensive right? Our blood pressure will be more in a normal range for this patient. So, let’s translate what all of this means. We’re going to pick our high level nursing concepts. So, for my patient, I’m going to pick perfusion. I’m going to pick fluid balance and I’m going to pick patient education, always a good one.

 

Alright, so here’s where we transcribe. We take our problems and our priority, our data that we’ve collected, which is our assessment pieces and interventions. So, what we are going to do about the assessment that we found, this is why the rationale is why this intervention should work and what do we expect to see? Alright. so we start with perfusion fluid, bounce and patience. So, our data shows that this patient has uncontrolled hypertension. Our intervention is going to be just an anti-hypertensive medication that we can give, whatever that may be. That’s going to work for this patient, our rationale, well, this is going to help to reduce the blood pressure and will allow for better blood flow to the kidneys, right? So, better blood flow to help those kidneys work as best they can. So, better filtration and reduce damage. Then our expected outcome will be normotensive. Now remember for this patient, it might not be our normal, like 112 or 117 over 80 or whatever, are normal for this patient still might be slightly elevated, but we want to bring them down to more of a normal range and then we’ll have improved kidney filtration.

 

So, fluid balance, our patient is showing us signs of all the edema, right? The ascites, we have fluid all over the place, all over in different places and sometimes the wrong places. So, that’s our data. How are we going to intervene? Well for this patient, we are going to monitor the I’s and the O’s. We are going to get daily weights and perhaps a fluid restriction. So, why are we going to do this? Well, it’s going to give us a better picture when we’re monitoring the I’s and O’s of how much the body is holding onto, so what’s coming in and what’s going out and then limit and reduce the excess fluids. So, by doing the fluid restriction, we can help to reduce that excess fluid that the body is holding onto. 

 

Our expected outcome is that our lab work will be improved and that our edema will hopefully be improved as well. Our patient education… So, let’s just say this client is showing us data that they need diet education, and perhaps they have diabetes. So, we need education on that because diabetes is going to worsen or uncontrolled diabetes will worsen kidney function. 

So, our interventions, well, they need a renal diet and they need blood glucose control education. This is going to prevent further damage to the kidneys, right? If we give them a good renal diet, and if they’re in good blood sugar control, then that will prevent further damage. So, our patient with patient education is going to verbalize and demonstrate an understanding. 

 

Alright guys, let’s review these key points for our care plan. So, first always collect your information, get that data, the subjective and objective data, analyze it, which is going to help you to diagnose and prioritize what the problems are. Ask your how questions, then you can plan, implement, evaluate and translate. So, those are those concise terms, those concepts, and then transcribe. So, whatever form works for you, just get your care plan on paper and separate it out into your interventions, your rationale, and what you expect to see. 

 

Alright guys, that was it for our chronic kidney disease care plan, check out all the care plans we have available to you on NURSING.com. We love you. Go out and be your best self today and as always, happy nursing!

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