Nursing Diagnosis

Last week we took a look at the ways nurses care for patients with CKD throughout the various stages.  This week we will look at some nursing diagnoses related to CKD and ESRF.  Below I have listed five that I think particularly relate to the information presented in this blog.  In the table I have highlighted Decreased Cardiac Output.  I have chosen this nursing diagnosis to look at in depth because I want to emphasize the connection of heart disease and kidney failure.  Kidney damage can lead to cardiac damage, which can lead to more kidney damage, and so on.  As nurses, it is of upmost importance that we are always thinking about the whole patient, and promoting the bio-psychosocial well being of our patients.

5 Nursing Diagnoses to Consider when working with CKD patients

1. Decreased Cardiac Output r/t congestive heart failure, elevated potassium levels interfering with conduction system
2. At risk for injury (osteoporosis, neuropathy, muscle weakness)
3. Risk for electrolyte imbalance (Renal dysfunction)
4. Activity intolerance (Risk factor: anemia, decreased CO)
5. Risk for Powerlessness (Risk factor: Chronic illness 

Nursing Diagnosis with Care Plan

	Decreased Cardiac Output (CO)
Actual or Potential	Actual
Related to	Elevated potassium levels Altered heart rate Altered heart rhythm Altered stroke volume Altered afterload
Plan/Outcome	Patient will achieve adequate cardiac output as evidence by blood pressure, pulse rate and rhythm within define limits; strong peripheral pulses; brisk capillary refill; no chest pain or shortness of breath; adequate urinary output; ability to tolerate activity Patient will not have side effects from cardiac medications Patient will understand how to remain free of cardiac disease
Nursing Intervention	Listen to heart and lungs Assess for hypertension Patient education about ACE-I and ARBs, and other cardiac medications including the importance of taking them regularly Assess for chest pain Assess activity level Patient education on eating a heart healthy diet Refer patient to rehabilitation services if needed Patient education on the importance of being active, interspersed with times of rest Encourage patient to perform self-care, and to take control of their medical condition whenever possible Patient education on daily weights, and monitoring blood pressure at home Help patient quit smoking Help the patient identify stress reduction techniques that will work for them, and teach new ones they might be able to use Discuss advanced directive and end-of-life care options before the patient’s health declines

For more examples of nursing diagnosis and plans of care check out the following websites Nursing Care Blog and Nurse Labs.  

 

References

Ackley BJ, Ladwig GB.  Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. 10^th ed. Maryland Heights, MO: Mosby Elsevier; 2012.