End Stage Renal Disease (ESRD) nursing diagnosis requires a thorough understanding of the condition and its impact on patient care. This comprehensive guide explores essential nursing diagnoses, interventions, and care plans for patients with ESRD, helping healthcare professionals provide optimal care.
Understanding End Stage Renal Disease
End Stage Renal Disease represents the final stage of chronic kidney disease, where kidney function has deteriorated to less than 15% of normal capacity. At this stage, patients require either dialysis or kidney transplantation to survive.
Key Clinical Manifestations
End Stage Renal Disease affects multiple body systems and presents with various symptoms:
- Cardiovascular: Hypertension, edema, chest pain
- Respiratory: Shortness of breath, pulmonary edema
- Gastrointestinal: Nausea, vomiting, decreased appetite
- Neurological: Confusion, drowsiness, seizures
- Musculoskeletal: Muscle cramps, bone pain
- Integumentary: Dry skin, pruritus, pallor
- Hematologic: Anemia, easy bruising, bleeding
Nursing Assessment for ESRD
Physical Assessment
Vital Signs
- Monitor blood pressure for hypertension
- Check respiratory rate and effort
- Assess temperature for signs of infection
- Evaluate heart rate and rhythm
System-Specific Assessment
- Cardiovascular: Check for edema, assess heart sounds
- Respiratory: Listen for crackles, monitor for dyspnea
- Neurological: Evaluate mental status, check for tremors
- Skin: Look for color changes, assess turgor
- Musculoskeletal: Check for muscle weakness, bone tenderness
Laboratory Values
- BUN and creatinine levels
- Electrolyte panel
- Complete blood count
- Arterial blood gases
- Glomerular filtration rate
Top 5 Nursing Care Plans for ESRD
1. Fluid Volume Excess
Nursing Diagnosis Statement:
Fluid Volume Excess related to decreased kidney function as evidenced by edema, shortness of breath, and weight gain.
Related Factors:
- Compromised regulatory mechanisms
- Decreased kidney function
- Excessive fluid intake
- Sodium retention
Nursing Interventions and Rationales:
- Monitor daily weights and compare them to dry weight
Rationale: It helps detect fluid retention early - Assess breath sounds and respiratory status
Rationale: Identifies pulmonary edema - Implement strict intake and output monitoring
Rationale: Ensures compliance with fluid restrictions - Educate the patient about fluid and sodium restrictions
Rationale: Promotes self-management
Desired Outcomes:
- Patient maintains weight within 2-3% of dry weight
- The patient demonstrates an understanding of fluid restrictions
- The patient remains free of respiratory distress
2. Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to immunosuppression and invasive procedures.
Related Factors:
- Uremia
- Malnutrition
- Invasive procedures
- Decreased immune function
Nursing Interventions and Rationales:
- Monitor temperature and vital signs
Rationale: Early detection of infection - Maintain a strict aseptic technique
Rationale: Prevents introduction of pathogens - Assess access sites for signs of infection
Rationale: Early identification of complications - Educate patient about infection prevention
Rationale: Promotes self-care and prevention
Desired Outcomes:
- The patient remains free from infection
- The patient demonstrates proper hand hygiene
- Patient identifies early signs of infection
3. Impaired Nutrition
Nursing Diagnosis Statement:
Impaired Nutrition: Less than Body Requirements related to uremia and dietary restrictions.
Related Factors:
- Uremic symptoms
- Dietary restrictions
- Altered taste sensation
- Poor appetite
Nursing Interventions and Rationales:
- Monitor nutritional intake and weight
Rationale: Tracks nutritional status - Collaborate with dietitian
Rationale: Ensures appropriate dietary planning - Administer prescribed supplements
Rationale: Supports nutritional needs - Provide small, frequent meals
Rationale: Improves intake tolerance
Desired Outcomes:
- The patient maintains stable weight
- The patient adheres to the prescribed diet
- The patient demonstrates improved appetite
4. Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to fatigue and anemia.
Related Factors:
- Anemia
- Electrolyte imbalances
- Muscle weakness
- Fatigue
Nursing Interventions and Rationales:
- Assess activity tolerance
Rationale: Determines appropriate activity level - Plan activities during peak energy
Rationale: Maximizes participation - Encourage progressive activity
Rationale: Builds endurance safely - Monitor vital signs with activity
Rationale: Ensures safe activity levels
Desired Outcomes:
- The patient participates in daily activities
- The patient maintains stable vital signs during activity
- The patient reports improved energy levels
5. Ineffective Coping
Nursing Diagnosis Statement:
Ineffective Coping related to chronic illness demands and lifestyle changes.
Related Factors:
- Complex treatment regimen
- Lifestyle modifications
- Uncertainty about future
- Loss of independence
Nursing Interventions and Rationales:
- Assess coping mechanisms
Rationale: Identifies areas needing support - Provide emotional support
Rationale: Promotes psychological well-being - Refer to support groups
Rationale: Connects patient with peers - Teach stress management techniques
Rationale: Enhances coping skills
Desired Outcomes:
- The patient verbalizes feelings appropriately
- The patient demonstrates effective coping strategies
- The patient participates in support system activities
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Elendu C, Elendu RC, Enyong JM, Ibhiedu JO, Ishola IV, Egbunu EO, Meribole ES, Lawal SO, Okenwa CJ, Okafor GC, Umeh ED, Mutalib OO, Opashola KA, Fatoye JO, Awotoye TI, Tobih-Ojeanelo JI, Ramon-Yusuf HI, Olanrewaju A, Afuh RN, Adenikinju J, Amosu O, Yusuf A. Comprehensive review of current management guidelines of chronic kidney disease. Medicine (Baltimore). 2023 Jun 9;102(23):e33984. doi: 10.1097/MD.0000000000033984. PMID: 37335639; PMCID: PMC10256423.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Ricardo AC, Roy JA, Tao K, Alper A, Chen J, Drawz PE, Fink JC, Hsu CY, Kusek JW, Ojo A, Schreiber M, Fischer MJ; CRIC Study Investigators. Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease. J Gen Intern Med. 2016 Jan;31(1):22-9. doi: 10.1007/s11606-015-3452-x. Epub 2015 Jul 3. PMID: 26138006; PMCID: PMC4700009.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- van Dipten C, van Berkel S, van Gelder VA, Wetzels JFM, Akkermans RP, de Grauw WJC, Biermans MCJ, Scherpbier-de Haan ND, Assendelft WJJ. Adherence to chronic kidney disease guidelines in primary care patients is associated with comorbidity. Fam Pract. 2017 Aug 1;34(4):459-466. doi: 10.1093/fampra/cmx002. PMID: 28207923.
