Nursing care plans for chronic kidney disease help nurses monitor the progression of the disease and provide treatment when signs or symptoms indicate that intervention is needed.
Chronic kidney disease (CKD) is a progressive condition that happens when your kidneys are damaged and can no longer process and filter your blood the way they should. This leads to waste and fluid retention and increasing symptoms as the condition progresses. Eventually, CKD
Nursing care plans help healthcare professionals treat people with CKD. These plans provide guidelines for monitoring and maintaining specific levels of markers such as blood pressure, blood glucose, and fluid balance.
The plans also indicate when interventions are needed to bring these levels within set ranges or goals that have been identified for each stage of the disease.
Following CKD care plans can help relieve symptoms, prevent complications (such as secondary heart conditions), and slow disease progression.
Progressive stages of chronic kidney disease
CKD progresses in stages. In each successive stage, your kidneys function less and your symptoms are typically more severe. By stage 5, dialysis or a kidney transplant is necessary. The five stages of kidney disease are:
- Stage 1: kidney damage but a normal or increased glomerular filtration rate (GFR) — the rate of blood filtering through your kidneys — of more than 90 milliliters per minute (mL/min)/1.73 meters squared (m²)
- Stage 2: mild reduction in GFR — 60 to 89 mL/min/1.73 m²
- Stage 3a: moderate reduction in GFR — 45 to 59 mL/min/1.73 m²
- Stage 3b: moderate reduction in GFR — 30 to 44 mL/min/1.73 m²
- Stage 4: severe reduction in GFR — 15 to 29 mL/min/1.73 m²
- Stage 5: kidney failure with GFR of less than 15 mL/min/1.73 m² or dialysis
Nursing care plans help healthcare professionals monitor and manage CKD progression by identifying appropriate measurements of kidney-related functions specific to each stage of the disease.
If your GFR does not fall within the identified range for your stage of CKD, healthcare professionals can begin interventions to help address the issue.
Impaired urinary elimination
One function CKD care plans monitor is how well you can eliminate, via urination, the fluids you take in.
Nurses keep track of output, which is how much and how often you urinate in relation to the amount of liquid you consume throughout the day. If you are not urinating enough, healthcare professionals may use interventions such as diuretic medication or insertion of a catheter.
A nurse might also take steps to prevent infection, such as cleaning your pelvic area, and might provide education to you and your loved ones about urinary elimination in CKD.
Fluid retention
Fluid retention occurs when your body holds onto too much liquid. It can lead to symptoms such as swelling in your legs, ankles, and feet; confusion; and difficulty breathing.
If you have CKD, nurses will continuously monitor you for this issue by weighing you, measuring your urine output, assessing any swelling, and listening to your breath sounds. If they find symptoms of excess fluid retention, they will begin interventions such as:
- restricting fluids
- giving you diuretic medications
- treating any areas of swelling to prevent skin breakdown
- preparing you for dialysis treatments if you have stage 5 CKD
Electrolyte imbalance
An electrolyte imbalance occurs when the balance of chemicals such as sodium, calcium, and potassium in your body becomes unhealthy.
Nurses will monitor your lab results and other vital signs daily to maintain this balance. If they suspect an imbalance, they may begin interventions such as providing lactose solution, giving diuretic medications, and suggesting dietary changes.
High blood pressure
High blood pressure is very common in people with CKD. Nurses monitoring your CKD will take your blood pressure regularly.
The frequency will depend on the stage of your CKD and on how high your previous blood pressure readings have been. Interventions might include diuretic medications and education on dietary and lifestyle changes.
Working with your care team
It’s important to work closely with your medical team to manage symptoms of CKD. Nurses and other healthcare professionals might recommend that you take steps at home, such as monitoring your blood pressure or urine output daily.
If your healthcare team has advised you to take these steps, it’s important to track your results and report any changes to your care team.
Managing CKD doesn’t end when you leave a hospital or medical office. There are also steps you can take at home to help manage your condition. They include:
- following your prescribed renal diet
- working with a dietitian on the best ways to eat healthfully while on your renal diet
- sticking to any fluid restrictions your care team has recommended
- staying active
- monitoring your blood pressure (at a frequency recommended by your care team)
- monitoring your blood sugar if you have diabetes (at a frequency recommended by your care team)
- taking all medications exactly as prescribed
- quitting smoking, if you smoke
- getting plenty of rest
Can nursing care plans prolong kidney function and outlook?
Yes. Nursing care plans and interventions can help slow the progression of kidney disease and prolong kidney function.
Can nursing care plans reverse or stall the progressive stages of chronic kidney disease?
You can’t reverse CKD, but interventions such as a nursing care plan can help slow the progression and prevent secondary conditions such as heart disease.
What other health problems can occur due to chronic kidney disease?
Chronic kidney disease can lead to complications such as:
- anemia
- hypercalcemia
- heart disease
- a weakened immune system
- weakened bones
- seizures
When will I need to have dialysis or a kidney transplant, and how will I know?
Typically, dialysis or a kidney transplant will be necessary if your kidney function drops to about 15% of normal. This is considered stage 5 CKD. At this point, you might experience symptoms such as severe nausea, shortness of breath, and muscle cramping.
Nursing care plans help healthcare professionals monitor and manage CKD progression by providing guidelines for identifying and resolving issues with fluid retention, urinary output, electrolyte balance, and other kidney-related functions.
If kidney-related functions aren’t falling within the identified range for a specific stage of kidney disease, CKD care plans will recommend interventions to help address the issue.
Common interventions include diuretic medications, dietary changes, and patient education. You can also follow care plans at home to manage your CKD and help slow its progression.
