Chronic Renal Failure

Chronic Renal Failure CRF Nursing Diagnosis Interventions and Care Plans

Chronic Renal Failure CRF NCLEX Review Care Plans

Nursing Study Guide for Chronic Renal Failure (CRF)

Chronic renal failure (CRF), also known as chronic kidney disease (CKD), is an irreversible long-term condition characterized by a gradual decline in kidney function.

Over time, it can lead to end-stage renal failure (ESRF) which will require the need for dialysis or a kidney transplant.

Kidneys play important roles in the human body.

They manage fluid balance, regulate electrolytes and pH levels, filter out and excrete waste and toxins, and help in the production of hormones.

Due to the kidneys’ many bodily functions, the signs and symptoms of CRF can be varied and can progress as the kidney function declines.

The treatment of CRF aims at slowing the disease progression by addressing the underlying cause.

Signs and Symptoms of Chronic Renal Failure

  1. Oliguria – low urine output of less than 400 mL per day; anuria – no urine output
  2. Nausea and vomiting
  3. Loss of appetite
  4. Fatigue and weakness
  5. Decrease in mental sharpness
  6. Muscle twitching and cramping
  7. Swelling of feet and ankles
  8. Persistent itching
  9. Chest pain – occurs when the fluid builds up around the heart’s lining
  10. Shortness of breath if fluid builds up in the lungs
  11. Hypertension
  12. Sleep problems

Causes and Risk Factors of Chronic Renal Failure

Some diseases can result in chronic renal failure. These include:

  1. Type 1 or Type 2 Diabetes. Diabetes causes micro and macrovascular complications. Kidneys are often affected by the damage to the renal blood vessels which will cause damage and reduction to the kidney functions. CRF is quite common in patients with diabetes – with the diabetes as the usual cause of their CRF.
  2. Hypertension. Hypertension can cause vascular issues which can affect the blood vessels in the kidneys therefore reducing function and causing damage.
  3. Glomerulonephritis. Glomeruli are found in the nephrons in the kidneys. It is a network of blood vessels that filters the blood. Prolonged inflammation of these parts of the kidneys can lead to chronic renal failure.  
  4. Interstitial nephritis.  Unresolved or prolonged interstitial nephritis, can cause swelling in between kidney tubules leading to CRF.
  5. Polycystic kidney disease. Clusters of cysts can sometimes build up in the kidneys. If unresolved, it can lead to CRF as a complication.
  6. Long-term obstruction of the urinary tract from conditions such as enlarged prostate, kidney stones, and some cancers.
  7. Vesicoureteral reflux. Urine is the product of the filtration of fluids by the kidneys. It is excreted out of our body through the urethra. However, urine can go the other way which can cause damage to the kidneys and related organs.
  8. Pyelonephritis. Kidney infection if left untreated or if prolonged can cause permanent damage to the kidneys.
  9. Cardiovascular Disease. Just like in diabetes, cardiovascular problems can cause CRF by affecting and damaging the blood vessels in the kidneys.

The following are risk factors that can affect the development of CRF:

  • Smoking- can cause vascular damage that can affect kidney function
  • Obesity – obese patients require heightened metabolic demands causing the kidneys to be overworked leading to CRF if not addressed
  • Race – African American, Native American or Asian-American descent; CRF is noted to be higher in races known to have higher prevalence of hypertension and cardiovascular disease.
  • Family history of kidney disease
  • Abnormal kidney structure -anatomical issues can cause changes to kidney functions which can lead to CRF
  • Older age- organs decline and lose function as the human body ages.

Complications of Chronic Renal Failure

The kidneys play many important functions in the human body. A reduction in its function can cause complications such as:

  1. Fluid retention. Kidneys play a role in the regulation of fluid volume hence, reduction to its function can cause peripheral edema, pulmonary edema, and pericardial effusion.
  2. Hyperkalemia. Extra Potassium in the body is excreted through the kidneys. Impairment to this function can cause build-up of Potassium in the blood stream.
  3. Cardiovascular disease. Kidneys help in the fluid regulation in the body. It also helps in the regulation of blood pressure thru hormone regulation. Changes in these processes can cause hypertension which is commonly related to cardiovascular problems.
  4. Weak bones and an increased risk of bone fractures. CRF causes reduced Vitamin D production and low phosphorous levels causing hypocalcemia. The body compensates by moving the calcium from the bones to the blood stream causing weak bones.
  5. Anemia. CRF causes a reduction in the production of Erythropoietin – a hormone that triggers the bone marrow to produce red blood cells.
  6. Decreased sex drive, erectile dysfunction, or reduced fertility. The causes of these complications in CRF is multifactorial. CRF can affect hormonal balance, cardiovascular function, and psychological health – all of which can cause changes in the patient’s sexual health.
  7. Neurological complications. Regulation of waste in the body is one of the many important roles of the kidneys. Build-up of the waste can cause neurological problems.
  8. Decreased immune response. Reduction in immunity is commonly seen in patients with CRF. This can lead to increased susceptibility to infections.
  9. Pericarditis. Uremic pericarditis can happen because of the build-up of toxins in the human body
  10. Irreversible damage to the kidneys (end-stage kidney disease)

Diagnosis of Chronic Renal Failure

  1. History taking and Physical exam – a detailed medical and family history will be taken by the health care provider when making a diagnosis of chronic renal failure. Physical examination will also be done to correlate with the results of diagnostic procedures.
  2. Blood tests – creatinine and urea are blood markers that reflect kidney function; estimated glomerular filtration rate (eGFR) can help indicate the stage of kidney disease
  3. Urine tests – to give health care providers information about the patient’s kidney function
  4. Imaging tests such as CT scan– to gather information about the current structure and size of the kidneys and other related organs
  5. Kidney biopsy – to collect a tissue sample that well be examined under the microscope, which can give a lot of information as to what is causing the kidney problem

Treatment for Chronic Renal Failure

Chronic renal failure is irreversible and often non-curable.

Measures can be taken to manage signs and symptoms, reduce complications, and to slow the progression of the disease.

If treatment options are unsuccessful, the damage can lead to end-stage kidney disease, which will then require the need for dialysis or kidney transplant.

The treatment includes treating the underlying cause of CRF.

However, this is not always successful as the disease may persist and progress.

Addressing the complications and signs and symptoms is central to the treatment of CRF.

Medications. The following medications can be used to manage CRF:

  1. Antihypertensive medications – drugs such as angiotensin-converting enzymes inhibitors (ACE inhibitors) or angiotensin II receptor blockers are prescribed to regulate blood pressure and preserve kidney function.
  2. Anti-cholesterol drugs – cholesterol levels must be regulated to reduce the risks of cardiovascular problems.
  3. Diuretics – to relieve swelling; these can help address the fluid balance by excreting excess fluids in the body.
  4. Medications to protect the bones – Calcium, Vitamin D, and phosphate supplements can be given to support the bones of CRF patients.
  5. Medications to treat anemia – erythropoietin is usually given to patients with CRF to address anemia which can reduce associated weakness and fatigue.
  6. Low protein diet. Low protein diet is usually prescribed to patients with CRF. The body’s processing of protein causes accumulation of wastes which are filtered by the kidneys. Reduction of dietary protein means reduction of waste products, giving the kidneys rest and preventing further deterioration of renal perfusion and function.
  7. Lifestyle changes. The patient should be encouraged to undergo a smoking cessation program to prevent further vascular damage. An exercise regimen as recommended by the physiotherapy team should also be considered. If the patient is diabetic, the diabetes should be well-controlled as worsening of this condition can affect kidney function.

Nursing Care Plans for Chronic Renal Failure

Nursing Care Plan 1

Nursing Diagnosis: Ineffective Renal Tissue Perfusion related to glomerular malfunction secondary to chronic renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, eGFR levels), oliguria or anuria, peripheral edema, hypertension, muscle twitching and cramping, fatigue, and weakness

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

InterventionRationale
Assess and monitor vital signs.To establish baseline data. To monitor the patient’s blood pressure levels as hypertension can worsen kidney damage.
Fever may indicate disease progression or the presence of an infection.
Perform the necessary blood tests as ordered.To monitor renal function.
Monitor blood glucose levels, especially if the patient is diabetic.To reduce the stress on the kidneys.
Weigh the patient daily. Commence strict Input and Output monitoring. Note the characteristics of the urine.To assess the fluid volume status of the patient. To check for signs of worsening renal function and perfusion.
Administer medications as prescribed.CRF or CKD is irreversible; however, treating underlying causes and managing signs and symptoms can improve the patient’s quality of life and prevent further complications.
Encourage the patient to have a low protein diet. Start a food chart.  Reduction of dietary protein means reduction of waste products, giving the kidneys rest and preventing further deterioration of renal perfusion and function. Food charting can help monitor dietary protein and caloric intake.
Refer to the dietitian.To enable to patient to have specialized advice on renal diet while incorporating his/her food preferences.
Encourage the patient to exercise. Refer to the physiotherapy team.To reduce peripheral edema and to manage obesity, hypertension, fatigue, and weakness.
To enable to patient to have specialized advice on exercise.

Nursing Care Plan 2

Impaired Urinary Elimination related glomerular malfunction to secondary to chronic renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, and eGFR levels), oliguria or anuria, and urinary retention

Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.

InterventionsRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern (i.e. prior to CRF/CKD).To establish baseline data on urinary elimination pattern.
Weigh the patient daily. Commence strict Input and Output monitoring. Note the characteristics of the urine.To assess the fluid volume status of the patient. To check for signs of worsening renal function and perfusion.
Palpate the bladder and observe for bladder distention. Use a bladder scan as needed.To check for bladder distention and bladder retention.
Teach the patient some lifestyle changes including proper perineal hygiene, adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting.To promote wellness and prevent urinary tract infection (UTI). Chronic renal failure is a major risk factor for UTIs due to reduced immunity and related metabolic disorders. Wiping the perineal area from front to back rather than back to front can prevent the travel of normal flora of the anus to the urethra where they become UTI-causing pathogens. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.  

Other possible nursing diagnoses:

  • Imbalanced Nutrition: Less than Body Requirements
  • Excess Fluid Volume
  • Risk for Decreased Cardiac Output

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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