The following list of nursing diagnoses are considered to be part of the comprehensive care plan for patients with Chronic Kidney Disease and may be used by a registered nurse in the provision of care to these patients.
Chronic Kidney Disease Nursing Diagnosis
1 Decrease in urine output
- At least daily
- Less than 400 mL/day
- Less than 30 mL/hr for more than 2 hours during a 24-hour period (unless the patient is receiving adequate fluid intake)
- Less than 1 mL/kg/hr for more than 2 hours during a 24-hour period (unless the patient is receiving adequate fluid intake)
Urinary output may be decreased due to dehydration. This can occur when you do not drink enough fluids, or if you have kidney damage.
2 Excess fluid volume
Fluid overload is not the same as fluid retention.
Fluid overload is when a patient’s body retains too much fluid. This can result in swelling, weight gain, shortness of breath and other complications.
Fluid retention is an increase in water content of tissues due to excessive amounts of sodium (salt).
3 Acute Pain
Acute pain is a sudden onset of discomfort that can be caused by trauma or illness. Chronic pain, on the other hand, is constant and lasts for a prolonged period of time. Pain can be experienced as acute or chronic, depending on its cause. Chronic pain may occur due to injury or illness and includes headaches, backaches and joint problems such as arthritis. Acute pain can also have several causes including surgery or broken bones which require immediate treatment. If you experience any type of discomfort that doesn’t go away within a few days after its onset—whether it’s sharp shooting pains or dull aches—be sure to see your doctor immediately so he/she knows what’s causing your symptoms so that they can help treat them accordingly!
4 Loss of control over body functions.
Loss of control over body functions is defined as the inability to perform activities that a person once could do. It often results from damage to the brain or spinal cord, but it can also be caused by other health problems, such as chronic kidney disease.
Loss of control over body functions may be caused by:
- Injury or illness (such as a stroke)
- Certain medications (such as those used before surgery)
5 Impaired gas exchange
- Impaired gas exchange related to fluid overload
- Impaired gas exchange related to pulmonary edema
- Impaired gas exchange related to pleural effusion
- Impaired gas exchange related to pulmonary hypertension
- Impairment of effective respiratory mechanics due to pulmonary fibrosis (lung disease)
Fatigue is a common symptom of chronic kidney disease (CKD). This can be a subjective symptom, meaning that it can be difficult to measure. Fatigue can result from many factors including electrolyte imbalances, anemia and poor nutrition.
7 Ineffective airway clearance
Assess the patient’s airway clearance.
- To understand the patient’s condition, ask the following questions:
- What is your diagnosis?
- How are you feeling?
- Assess the patient’s breathing:
- Breathing rate, depth, and ease of breathing (e.g., dyspnea). Use a stethoscope for possible crackles or wheezing sounds in the lungs. If you feel comfortable doing so, take their pulse as well (palpate carotid artery). Be sure to record your findings in your care plan or progress notes section of EMR system or paper chart when documenting this assessment information from now on.
8 Ineffective breathing pattern
- Ineffective breathing pattern: The patient’s breathing pattern is ineffective, meaning that it does not provide adequate oxygenation.
9 Decreased cardiac output or cardiac dysrhythmia
Decreased cardiac output or cardiac dysrhythmia are related conditions. Cardiac output is the amount of blood pumped by the heart in one minute, while a cardiac dysrhythmia is a problem with the heart rate or rhythm.
Cardiac output can be affected by cardiac dysrhythmia. For example, if you have scarring from chronic kidney disease, it can lead to decreased cardiac output and an increased risk for developing arrhythmias (irregular heartbeats).
10 Individualize the interventions to meet the patient’s specific needs.
Individualize the interventions to meet the patient’s specific needs.
Nursing diagnoses are not intended as a substitute for clinical judgment. The nurse must use critical thinking skills, knowledge base and individualized decision making to determine which nursing interventions are most appropriate for each patient or situation.
- Include the patient in the decision making process by asking them what they want to accomplish through treatment and care. Give them choices when possible, such as pain relief methods that can be used along with other therapies (e.g., physical therapy).
- Focus on goals and preferences that you have identified together with your patient as important to his or her overall health status; do not focus solely on one organ system when establishing goals of care because this may lead you into a limited scope of practice that could result in inadequate planning for other areas where intervention may need more attention than just treating kidney problems alone (e.g., wound care).
There are many ways to approach the diagnosis and treatment of CKD. The key is to individualize the interventions to meet the patient’s specific needs. With chronic kidney disease, it’s important for nurses not only to understand their role in caring for patients but also what they can do as members of a team seeking solutions together!