Nursing Diagnosis for Chronic Kidney Disease
According to Doenges (1999) and Lynda Juall (2000), nursing diagnoses that appear in patients with CKD are:
- Decreased Cardiac Output.
- Fluid and Electrolyte imbalances.
- Imbalanced Nutrition.
- Ineffective Breathing Pattern.
- Impaired Skin Integrity.
Nursing Interventions for Chronic Kidney Disease
Decreased Cardiac Output related to increased cardiac load.
Goal:
- Decreased cardiac output does not occur with the outcome criteria:
- maintain cardiac output and blood pressure with evidence of cardiac frequency in the normal range, strong peripheral pulses, and the same with capillary refill time.
intervention:
1 Auscultation of heart and lung sounds.
R: The presence of tachycardia, irregular heart rate.
2 Assess for hypertension.
R: Hypertension may occur due to interference with the system of the renin-angiotensin-aldosterone system (caused by renal dysfunction).
3 Investigate complaints of chest pain, note the location, radiation, severity (0-10 scale).
R: HT and CRF can cause pain.
4 Assess activity level, response to activity.
R: Fatigue can also accompany CRF anemia.
Fluid and Electrolyte imbalances related to secondary edema (fluid volume unbalanced because of the retention of Na and H2O).
Goal: Maintain ideal body weight without excess fluid with outcome criteria: no edema, the balance between inputs and outputs.
intervention:
1 Assess fluid status with daily weigh, balance input and output, skin turgor, vital signs.
2 Limit your fluid intake.
R: fluid restriction akn determine ideal body weight, urine output, and response to therapy.
3 Explain to the patient and family about the liquid restrictions.
R: Understanding to increase cooperation of patients and families in the fluid restriction.
d. Instruct the patient / teach the patient to record the use of fluid intake and output mainly.
R: To determine the balance of inputs and outputs.
Imbalanced Nutrition, Less Than Body Requirements related to anorexia, nausea, vomiting.
Goal: Maintain adequate nutrient inputs to the outcome criteria: demonstrate stable weight.
intervention:
1 Monitor the consumption of foods / liquids.
R: Identifying nutritional deficiencies.
2 Notice of nausea and vomiting.
R: Symptoms that accompany the accumulation of endogenous toxins that can alter or lower income and require intervention.
3 Give food a little but often.
R: The portion of a smaller can increase food intake.
4 Increase visits by people nearby during meals.
R: Provides transfer and improve the social aspects.
5. Provide frequent mouth care.
R: Lowering stomatitis oral discomfort and unwelcome taste in the mouth that can affect food intake.
Ineffective Breathing Pattern related to hyperventilation secondary: compensation via respiratory alkalosis.
Goal: breathing pattern back to normal / stable.
intervention:
1 Auscultation of breath sounds, note the presence of crakles.
R: To declare the existence of the collection of secretions.
2 Teach patient effective coughing and deep breathing.
R: Cleaning the airway and facilitate the flow O2.
3 Adjust the position as comfortable as possible.
R: Preventing the occurrence of shortness of breath.
4 Limit to move.
R: Reduce workload and prevent tightness or hypoxia.
Impaired Skin Integrity related to pruritis
Goal: The integrity of the skin can be maintained with the outcome criteria: Maintain intact skin, Shows behaviors / techniques to prevent damage to the skin.
intervention:
1 Inspection of the skin to change color, turgor, vascular, note the presence of redness.
R: Indicates area of poor circulation or damage that may lead to the formation of pressure sores / infections.
2 Monitor fluid intake and hydration of the skin and mucous membranes.
R: Detecting the presence of dehydration or overhydration affecting circulation and tissue integrity.
3 Inspection of the area depends on edema
R: Tissue edema is more likely to be damaged / torn.
4 Change positions as often as possible.
R: Reduce pressure on edema, poorly perfused tissue to reduce ischemia.
5. Give skin care.
R: Reduce drying, skin tears.
6 Maintain a dry linen.
R: Lowering dermal irritation and the risk of skin damage.
7 Instruct the patient to use a damp and cold compresses to put pressure on the area pruritis.
R: Eliminate the discomfort and reduce the risk of injury.
8 Encourage wear loose cotton clothes.
R: Preventing direct dermal irritation and improve skin moisture evaporation.
Nursing Management for Chronic Kidney Disease
