Nursing Care Plan for Chronic Kidney Disease Sample
How to complete Nursing Care Plan for Chronic Kidney Disease
Instructions
Nursing Care Plan (NCP) for Chronic Kidney Disease
Comprehensive Nursing Care Plans Instructions
- All NCPs must be submitted to the TurnItIn DRAFT and FINAL tabs found in the Assignments tab
- Late submission will result in a grade of “0”
- TurnItIn rating must either be a “yellow”, “green” or a “blue”
- Any ratings in “red” will not be graded
- The care plan is to be written in a narrative “paper” format
- Type double-spaced using 12-font (use only one style for the entire document)
- Your work should be between 8 to 10 pages long, excluding title page and references
- Less than 8 pages will not be accepted
- Follow APA 7th edition writing style
- Use course textbook or articles from peer-reviewed journals published in the last five years in your citations
- Your work must have the essential key elements listed below
Essential Elements of Comprehensive Nursing Care Plan (NCP)
- Title Page – Your name, course name, semester, and name of instructor
The following headings must be included and clearly written as such. If you do not indicate these headings, your work will be returned and marked unsatisfactory:
- Introduction – Narrate general survey/overview of the patient including reason for Include all relevant medical-surgical and psychosocial histories. Integrate relevant events during hospitalizations (e.g., surgeries, procedures, incidents such as a fall etc.). Which day of admission/post-operative day did you care for this patient?
- Assessment – Discuss key head-to-toe assessment data in an organized, coherent and systematic manner. Synthesize key information into the general picture of the patient’s reason for admission and relevant medical-surgical and psychosocial
- Pathophysiology – Discuss the pathophysiology and etiology of your patient’s key diagnosis and co-morbidities. Note: Use your own words & cite sources. Synthesize relationship between admission illness and significant past medical history (PMH) Explain pathophysiology of main signs and symptoms your patient is Relate relevant labs/diagnostic tests done during this hospitalization in the discussion
- Diagnostic Procedures & Laboratory Results – List laboratory results, diagnostic test results (e.g., X-ray, ultrasound) using the table Type this section single-spaced
| Diagnostic Procedure/Laboratory Test Results | Rationale
Indicate specific reason(s) for doing or obtaining this test for your patient |
Analysis of Results Indicate if normal or abnormal (e.g., high or low values) and correlate results with patient’s health problems by providing explanation of abnormalities noted
|
- Medications – List current medications/intravenous solutions the patient is Type medications as written in the prescriber’s order. Indicate the specific reason why your patient is prescribed the medication. Type this section single-spaced using this example:
| Medication (as ordered by M.D./NP)
– Classification – How does the medication work (chemical action)? |
Specific Reason For Taking Them? (Example: To treat Hypertension and HF) | Side Effects, Contraindications and lab values to be monitored
(Only important ones) |
Patient and Family Teaching
(Only specific and relevant instruction for that drug) Never write: Take as directed? |
| Aspirin 81 mg P.O. Daily Classification: Antiplatelet Chemical Action:
Blocks Thromboxane A2 to prevent platelet aggregation. |
Prophylaxis to prevent MI/Angina
Note: If you write the meds is for pain, mention the location of pain. If you write the meds is for infection, write to site of infection.
|
Note: each item must be labeled as below
Adverse Reactions: Bleeding, Tinnitus
Contraindications: Allergy, PUD
Lab Values: no special monitoring but should monitor CBC, PT/INR and PTT for patients on anticoagulants |
Teach patient about compliance with meds, use soft bristle toothbrush and use electric shaver as appropriate.
Note: Do not write: advice patient not drink alcohol if the patient does not drink alcohol. Or do not write: tell patient to use an electric razor if the patient does not shave
|
- Intravenous Fluid – write here the exact order of the IV fluid as written in the electronic order. If the patient has no IV fluid order, write “N/A”
- Nursing Care Plan – Use table Do not copy a Care Plan from a book. Your Care Plan should be individualized and must include psychosocial as well as physical priorities. Typed this section single-spaced using the table below.
- Write three (3) priority actual or potential (e.g., Risk for…) nursing diagnoses, including one psychosocial
- Write at least three (3) nursing interventions for each Interventions should address quality, safe, culturally competent, and interprofessional care.
- Write a rationale for each intervention and cite sources
- Evaluation – discuss if outcomes were met or not met and Or, alternatively, you can discuss if interventions were implemented or not and why. Elaborate in this section, using both objective and subjective data, to make your points and final impression. How might you intervene in the future if your initial attempt did not work?
| Nursing Diagnoses (List 3 priority
Nursing Diagnoses in order of priority. Must include one psychosocial nursing diagnosis) |
Expected Outcomes (Must complete short- & long-term goals for EACH priority nursing diagnosis listed. Goals should be SMART: specific, measurable, attainable, realistic, & time-framed) | Nursing Interventions & Rationales
(Evidenced based rationale for each intervention for each priority nursing diagnosis. Describe in your own words with references cited here & in reference list in APA format) |
Evaluation (How did/will you evaluate the effectiveness of
planned interventions listed in previous column? HINT: Assess attainment of SMART goals) |
| Type single-space |
- References – List all sources cited in the text using APA 7th edition formatting.
Solution : Nursing Care Plan for Chronic Kidney Disease Sample
Nursing Care Plan for Chronic Kidney Disease
Student’s Name
Institutional Affiliation
Date
Nursing Care Plan for Chronic Kidney Disease
Introduction
This care plan is for TM, a 45-year old African-American male who was diagnosed with chronic kidney disease two years ago. The patient was admitted to the emergency department of the facility after he complained of breathing difficulties, shortness of breath, decreased urination, nausea and vomiting, swelling in the legs, ankles, and feet, fatigue, and general weakness. The patient was admitted for management of fluids, electrolyte balance, blood pressure, and renal function monitoring.
Patient’s Social History: TM lives with his wife in a small apartment. The two have two boys and one girl. They live in the same compound with TM’s parents. He reports that his spouse, children, and mother are the main support system he has. The patient is a protestant and is a spiritual man.
Past Medical History: The patient has a history of hypertension, depression, heartburn, diabetes, deep vein thrombosis, and obesity. The patient’s immunization is up-to-date. No history of major surgeries. The patient denies allergies to food or medicine. The patient reports history of anxiety and depression. He denies history for violence.
Smoking History: The patient was a heavy smoker, smoking at least 40 packs per year. He also took alcohol which he stopped 2 years ago after being diagnosed with chronic kidney disease.
Recent vital signs
Temperature 35.80C, Blood pressure 169/94 mmHg, Pulse rate= 92bpm, Respiratory rate= 22bpm, SPO2= 92%, pain=7/10, LPM=3, Weight= 132kg, Height=2.1m.
Assessment (Head to Toe)
General: The patient reports neat and answers all questions accordingly. He reports fatigue, general weakness and loss of appetite, chills, and irregular heartbeat. The patient is oriented to person, place, and time.
Psychiatric: The patient reports anxiety and depression. She is under medication for depression.
HEENT: the patient denies any injury to the head. He reports history of headache and nausea. He reports of having sometimes experienced blurred, double vision, difficulties in hearing, and hearing loss. He also reports of nasal congestion, sneezing, and severe itching.
Skin, hair, and nails: The patient’s skin is pale, rough, scaly, and dry and is itching. Skin rash can be seen. His hair sometimes breaks and falls. His nails are white on the upper part.
Cardiovascular: The chest is symmetrical, and he reports increased heart rate, chest pain and pressure. The patient denies edema in the heart.
Lymphatic: The patient has swollen lymph nodes.
Abdomen: Soft and tender. Bowel sounds present.
Respiratory: The patient reports shortness of breath, breathing difficulties, pulmonary congestion, and increased respiratory and pulse rate, blood pressure and fatigue.
GI: The patient reports nausea, headache, hiccups, nosebleed, dyspepsia, anorexia, chest pain, and vomiting.
GU: The patient reports constipation, decreased intestinal motility, blood in stool, dark brown urine, and increased frequency of urination especially at night.
Musculoskeletal: Loss of skeletal muscle, poor coordination, muscle weakness, and increased risk for falls. The patient has also reported swelling in the arms, face, legs, and ankles.
Neurologic: The patient is experiencing cognitive impairment, motor abnormalities, and mood disturbances. The patient denies dizziness, numbness, or paralysis.
Endocrine: Bone mass loss, extraskeletal calcification, and reduced hormone production by kidneys, and decreased renal parenchyma mass.
IVs: N/A
Pain assessment: Chest pain due to uremic pericarditis (7/10).
Fall Risk: High Risk (65%).
Pathophysiology and aetiology
Chronic kidney disease is a progressive disorder characterized by structural and functional damage to the kidney for at least 3 months, with or without decreased glomerular filtration rate (GFR). The condition occurs when the glomerular filtrate rate is less than 60 mL/min/1.73m2 that us at least 3 months with or without kidney damage (Usherwood & Lee, 2021). The risk factors for the development of the disorder include being obese, hypertension, diabetes, smoking, cardiovascular disease, and history of acute kidney injury (Usherwood & Lee, 2021). Several unmodifiable risk factors for the condition include a history of kidney disease and being 6o years.
The pathology of chronic kidney disease is based on several structural and physiological processes. The first stage is where the rate of renal blood flow exceeds 400ml/100g of tissue per minute which exposes the renal tissues to excessive quantities of harmful circulating agents. Secondly, glomerular filtration is dependent on high intra and transglomerular pressure which leads to glomerular hypertension that causes hemodynamic injury to the glomerular capillaries. The third mechanism is where the glomerular membrane creates electrostatic barriers, allowing plasma proteins to enter into the glomerular filtrate (Usherwood & Lee, 2021). When combined, these abnormalities cause deterioration in the kidneys, making them lose their ability to filter toxins. This affects other organs leading to chronic renal disease.
Chronic kidney disease is classified based on the level of kidney functions as estimated by glomerular filtration rate (GFR).
- Stage 1: Normal GFR (Above 90 mL/min/1.73m2) with persistent microalbumin. This stage is also known as kidney damage with normal or elevated GFR.
- Stage 2: GFR 60-89 mL/min/1.73m2 with persistent microalbumin. This stage is described as kidney damage with mildly lowered GFR.
- Stage 3: GFR 30-59 mL/min/1.73m2. this phase is described as moderate kidney damage with lowered GFR.
- Stage 4: GFR 15-29 mL/min/1.73m2. The stage refers to severe kidney damage with decreased GFR.
- Stage 5: GFR below 15 mL/min/1.73m2 or end stage renal disease or kidney failure.
Individuals at stage 3-5 are defined to have chronic renal failure (CRF). The most common causes of CRF include being diabetic, hypertension, and chronic gloemerulonephritis (Niemczyk et al., 2018).
Diagnostic Procedures & Laboratory Results
| Diagnostic Procedure/Laboratory Test Results | Rationale
Indicate specific reason(s) for doing or obtaining this test for your patient |
Analysis of Results Indicate if normal or abnormal (e.g., high or low values) and correlate results with patient’s health problems by providing explanation of abnormalities noted
|
| Full blood count | · To measure the levels of creatinine in blood
· To measure the levels of red blood cells and white blood cells |
Creatinine level 4.5 mg/dL Normal (0.6-1.2mg/dL.
WBC lowered 4.3 X109/L (Normal 4.5-11.0 X109/L) RBC levels 3.8 X109/L. (Normal 4.0-5.9 X1012/L) |
| Erythrocyte sedimentation rate (ESR) | · To estimate systemic inflammation | Elevated ESR 22 mm/h (Normal 0-15 mm/hr in men. |
| Protein-urine tests (Urinalysis) | · To check for elevated proteins in urine | Elevated proteins in the urine at 1.1g/d. |
| Estimated glomerular filtrate rate | · To diagnose kidney disease | 24 mL/min/1.73m2
(Normal GFR 60 and above) |
| Urine -albumen-to-creatine ration (UACR) | · To diagnose albuminuria | Elevated albumin in urine at 42mg/g.
(Normal UACR 30mg/g. and below. |
| Kidney biopsy | To diagnose a suspected kidney problem, to assess the severity of kidney condition, and to monitor treatment | Scarring, unusual deposits, and structural abnormalities of the kidney |
Medical treatment
Treatment of patients with chronic kidney disease is aimed at reducing CVD risk, delaying CKD progression, addressing complications, and managing underlying causes.
| Medication (as ordered by M.D./NP)
– Classification – How does the medication work (chemical oo)?
|
Specific Reason For Taking Them? (Example: To treat Hypertension and HF) | Side Effects, Contraindications and lab values to be monitored
(Only important ones) |
Patient and Family Teaching
(Only specific and relevant instruction for that drug) Never write: Take as directed? |
| Sodium Zirconium Cylosilicate
Classificaiton: Potassium removing agents. Works by removing excessive potassium in the blood |
To treat hyperkalemia | Side effects of the drug include swelling in almost all parts of the body, decreased urine, nausea, muscle pain and weakness, seizures, and loss of appetite.
The medication can cause swelling in different parts of the body. The drug should not be prescribed to patients with either severe constipation or bowel obstruction. |
Advice the patient to take the medication as prescribed to improve on its effectiveness. Missed doses should be taken immediately when remembered. The patient should never take double dose to make up for the missed dose.
The patient should also follow the established nutritional instructions to attain maximum benefits from the medicine. |
| Trade name: Enalapril 5mg PO qDay
Generic name: Vasotec Classification: Angiotensin converting enzyme (ACE) inhibitors. Enalapril works by blocking substances in the body that cause blood vessels to thicken. This relaxes blood vessels and lowers blood pressure.
|
To reduce blood pressure | Common side effects include hypotension, rapid fall in blood pressure, fever, headache, dizziness, diarrhoea, mild rash, blurred vision, neutropenia, nausea, and stomach pain.
The drug is contraindicated in patients suffering from aortic stenosis, myocardial infarction, stroke, collagen vascular disease and renal impairment. Lab values to be monitored include blood pressure, temperature, renal functioning, complete blood count, BUN, and serum creatinine. |
· Educate the patient that to take this medication as prescribed for maximum benefits.
· Educate the patient on some of the adverse side effects such as severe vomiting, sweats and shaking, and high temperature and the need to report them to healthcare provider for appropriate action. · An overdose of the drug can cause dizziness and increased hear beat. In such cases, the patient should report these symptoms to their providers.
|
| 50 mg PO BID Tambocor
Generic name: Flecainide Classification: Anti-arrhythmic agents. The drug works by inhibiting the action of sodium and potassium ion channels, thereby raising the depolarization threshold and correcting arrhythmias and addressing shortness of breath.
|
To treat irregular heart rhythm, shortness of breath | Common serious side effects include dizziness, blurred vision, headache, muscle weakness, stomach pain, increased heartbeat, and constipation.
Tambocor is contraindicated in patients with second or third-degree AV block, cardiogenic shock and sick sinus syndrome. Lab values to be monitored when using Tambocor include EKG, renal function tests, and blood pressure.
|
The medication should be taken after food since it is more effective when one has constant amount of food in the blood.
The drug causes blurred vision and dizziness and as such, once it has been taken, the patient should not drive or operate machineries. |
| 100 units/mL, Daily, Subcutaneous Insulin Glargine
Trade name: Insulin Glargine, Lantus, and Basaglar. Classification: Long-acting insulin Works by replacing the insulin produced by the body and helps move sugar from the blood into other parts of the body. It also stops the liver form producing more sugar.
Solostar Generic name: Insulin Glargine, Lantus 100 Unit Classification: Biguanides |
To treat blood sugar levels (type 1 diabetes) and its symptoms | Common side effects include rapid increase in weight, swelling of the feet, shortness of breath, low blood potassium, increased thirst, tingling of hands, feet, and lips, anxiety, blurred vision, dizziness and drowsiness, and urination, and irregular heartbeat.
The medication is contraindicated in patients with fever, diarrhoea, thyroid disease, and hepatic disease. Some of the laboratory values to be monitored include blood glucose monitoring, potassium concentrations, respiratory rate, heartbeat, blood pressure, and breathe sounds. |
Advise the patient never to take insulin glargine if they have low blood sugar levels. Therefore, the patient should monitor his blood sugar levels regularly before taking this medication. Furthermore, the patient and family members should be advised to have any quick-acting sugar to treat low sugar levels.
The medication causes drowsiness, dizziness, double vision, and tingling of hands. Therefore, the patient should be cautioned not to drive or operate any machinery when under the medication. |
| 150mg, two times a day PO Moclobemide
Brand name: Manerix, Amira, Clobemix, Depnil etc. Generic name: Moclobemide Classificaiton: Antidepressant Works by selectively inhibiting the MAO-A leading to a decrease in metabolizing and destruction of monoamines, thereby relieving depressive symptoms.
|
To treat the patient’s depression and social anxiety | The medication can cause blurred vision, increased and irregular heartbeat, emotional problems, neck stiffness, slurred speech, and severe headache.
The medication should not be taken by individuals with acute confusional state, patients under the age of 18 years or individuals allergic to tricyclic antidepressants, and selective serotonin reuptake inhibitors. Laboratory values to be monitored in patients taking Moclobemide include CBC, hepatic functional panel, electrolyte balance, and renal function tests. |
Moclobemide can cause severe hypertension when combined with benzphetamine. The patient should inform the healthcare provider if he is under benzydamine.
The patient should take the drug as directed at the end of meals. However, he should avoid excessive intake of mature cheese, yeast extracts, and soya beans extracts.
|
| 120mg 3 times a day PO Xenical
Brand name: Xenical Generic name: Orlistat Classification: |
To treat obesity and underlying symptoms. | Some of the common side effects of the drug include pain in the bladder, body chills, coughing, nausea and diarrhoea, pale stool, loss of appetite, muscle pain, sore throat, sleep disturbances, runny nose, ear congestion, abdominal pain, increased bowel movement, back pains, and difficulties breathing.
Xenical is contraindicated in patients with cholestasis and those who are hypersensitive to orlistat and its components. Laboratory values to monitor include body max index (BMI), waist circumference, and lipid profile. |
The patient should receive nutritionally balanced, calorie-reduced diet to improve the effectiveness of the drug.
The drug should be taken at least one hour after meals. If a meal is skipped, the medication should also be skipped. The patient should be advised to reports to their healthcare providers in case of adverse events such as hepatic dysfunction such as dark urine, seizures, yellowing of eyes, loss of appetite, and severe abdominal pain. |
| 5 mg PO BID Eliquis
Brand name: Eliquis Genetic name: Apixaban Classification: Anticoagulant or Factor Xa inhibitors Works by inhibiting and blocking free and clot-bound FXa and prothrombinase activity, thereby inhibiting clot growth. This prevents thrombin generation and thrombus development.
|
For treating deep vein thrombosis | Side effect of the drug include dizziness, bleeding from nose and gums, headache, nausea and vomiting, Joint pain, tarry of black stool, swelling of face, chest pain and tightness, wheezing, ease bruising, and uncontrolled bleeding after an injury.
The drug is contraindicated in patients who are hypersensitive to apixican and pathological bleeding. Lab values to monitor in patients taking Eliquis is kidney function
|
The patient should report any serious side effect of the drug to a healthcare provider for appropriate action.
The patient should not drive or operate machines once he has taken the medication as it causes dizziness and loss of consciousness. |
Intravenous Fluid: N/A
Nursing care plan
| Nursing Diagnoses (List 3 priority
Nursing Diagnoses in order of priority. Must include one psychosocial nursing diagnosis.) |
Expected Outcomes (Must complete short & long term goals for EACH priority nursing diagnosis listed. Goals should be SMART: specific, measurable, attainable, realistic, & time-framed) | Nursing Interventions & Rationales
(Evidenced based rationale for each intervention for each priority nursing diagnosis. Describe in your own words with references cited here & in reference list in APA format.) |
Evaluation (How did/will you evaluate the effectiveness of
planned interventions listed in previous column? HINT: Assess attainment of SMART goals.) |
| Excessive fluid volume related to kidney’s kidney dysfunction, retention of sodium and water, decreased urine output, and compromised regulatory system as evidenced by altered mental functioning, edema, pulmonary congestion, breath sounds, and imbalanced intake and output | · The patient will remain free of swelling and improved lung sounds after 1 day
· The patient will maintain a balance between his intake and output |
· Restrict fluids intake to reduce fluid overload
· Administer medication to enhance waste elimination and reduce complications. · Restrict sodium intake and ideal body weight to reduce excessive fluids in the body (Belleza, 2023). |
The patient was able to attain a balanced body fluid volume, reduced swelling, and improved lung sounds. |
| Impaired urinary elimination related to chronic kidney disease as evidenced by urinary retention, dysuria, and incontinence | The patient will produce at least 350ml of urine every day | · The nurse should assess the patient’s urinary elimination pattern to understand the patient’s problems and the interventions to implement and to promote healthy elimination.
· Assess urine the color, amount, and odor to check for signs of infections and potential complications. · Administer fluids and medications. Fluids and medications help promote urinary elimination, prevent fluid overload, and reduce complications (Wagner, 2023). |
The patient was able to produce 350 ml of urine after 24 hours. Therefore, this reduced the patients dysuria and incontinence. |
| Cognitive impairment symptoms related to the disease progression as evidenced by irritability, loss of attention, and confusion | The patient will gain his cognitive abilities | · Assess the patient’s cognitive impairment in attention, memory, language and execution functions. This is critical as it will enable the nurse understand the specific cognitive abilities affected to tailor interventions towards them (Vera, 2023).
· Encourage the patient to participate in physical activities. Such activities help improve cognition especially to patients with terminal conditions. · Promote adequate rest and sleep. This will help reduce conditions such as daytime somnolence, sleep apnea, and insomnia, thereby promoting cognitive abilities (Vera, 2023). |
The patient was able to improve his cognitive abilities as evidenced by a reduction in irritability, confusion, and improved consciousness. |
References
Belleza, M. (2023). Chronic renal failure. https://nurseslabs.com/chronic-renal-failure/
Niemczyk, S., Niemczyk, L., & Romejko-Ciepielewska, K. (2018). Basic endocrinological disorders in chronic renal failure. Polish Journal of Endocrinology, 63(3), 250-257.
Usherwood, T. & Lee. V. (2021). Advances in chronic kidney disease pathophysiology and management. Australian Journal of General Practice, 50(4), 188-192.
Vera, M. (2023). 11 Chronic renal failure nursing care plans. https://nurseslabs.com/chronic- renal-failure-nursing-care-plans/
Wagner, M. (2023). Chronic kidney disease (CKD/CRF) nursing diagnosis and care plan. https://www.nursetogether.com/chronic-kidney-disease-nursing-diagnosis-care-plan/
