Nursing Care Plan for Chronic Renal Failure - CRF

Chronic Renal Failure - CRF

Chronic renal failure (CRF) is the progressive loss of kidney function. The kidneys attempt to compensate for renal damage by hyperfiltration (excessive straining of the blood) within the remaining functional nephrons (filtering units that consist of a glomerulus and corresponding tubule). Over time, hyperfiltration causes further loss of function.

Chronic loss of function causes generalized wasting (shrinking in size) and progressive scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that most patients begin to experience symptoms of kidney failure.


Signs and Symptoms

Chronic renal failure (CRF) usually produces symptoms when renal function — which is measured as the glomerular filtration rate (GFR) — falls below 30 milliliters per minute (< 30 mL/min). This is approximately 30% of the normal value. When the glomerular filtration rate (GFR) slows to below 30 mL/min, signs of uremia (high blood level of protein by-products, such as urea) may become noticeable. When the GFR falls below 15 mL/min most people become increasingly symptomatic.


Nursing Care Plan for Chronic Renal Failure - CRF

Nursing Assessment for Chronic Renal Failure - CRF

1. Activity / rest

Symptoms :

• The weakness malaise
• Sleep disturbance (insomnia / restless or somnolen)

Signs :

• Muscle weakness, loss of tone, decreased range of motion

2. Circulation

Symptoms :

• History prolonged or severe hypertension
• Palpitations, chest pain (angina)

Signs :

• Hypertension, strong pulse, general and light socket tissue edema in the feet, palms
• The pulse is weak, smooth, orthostatic hypotension
• Cardiac Dysrhythmias
• Pale skin
• Friction rub pericardial
• The tendency of bleeding

3. Ego integrity

Symptoms :

• Stress factors, such as financial problems, relationships with other people
• Feeling helpless, hopeless

Signs :

• Reject, anxiety, fear, anger, personality changes, easily aroused

4. Elimination

Symptoms :

• Decrease in urinary frequency, oliguria, anuria (failure stage)
• Diarrhea, constipation, abdominal bloating

Signs :

• Change the color of urine, the sample thick yellow, brown, reddish, cloudy
• Oliguria or anuria

5. Food / fluid Symptoms :

• Increased weight fast (edema), weight loss (malnutrition)
• Anorexia, nausea / vomiting, heartburn, unpleasant metallic taste in the mouth (breathing ammonia)

Signs :

• abdominal distension / anxiety, liver enlargement (final stage)
• Edema (general, depending)
• Changes in skin turgor / humidity
• Ulceration of gums, bleeding gums / tongue
• Decrease in muscle, subcutaneous fat loss, no powerful appearance

6. Neurosensori Symptoms :

• Muscle cramps / spasms, restless leg syndrome, burning sensation in the head, blurred vision
• soles of feet
• numb / tingling and weakness of extremities especially the lower (peripheral neuropathy)

Signs :

• Impaired mental status, such as inability to concentrate, memory loss, confusion, decreased level of consciousness, decreased field of attention, stupor, coma
• Seizures, muscle fasciculation, seizure activity
• thin hair, thin and brittle nails.

7. Pain / comfort Symptoms :

• headache, muscle cramps / leg pain, pelvic pain

Signs :

• cautious behavior / distraction, anxiety

8. Respiratory Symptoms :

• dyspnea, shortness of breath, paroxysmal nocturnal, cough with or without sputum.

Signs :

• dyspnea, respiratory Tachypnoea kusmaul
• productive cough with watery pink sputum (pulmonary edema)

9. Security Symptoms :

• Itchy skin, there is / recurrent infections

Signs :

• pruritus
• Fever (sepsis, dehydration)

10. Sexuality Symptoms :

• amenorrhea, infertility, decreased libido

11. Social interaction Symptoms :

• Difficulty lowered condition, eg unable to work, maintain the function of roles in the family

12. Counseling

• History of diabetes mellitus in the family (Resti chronic renal failure), polycystic disease, hereditary nephritis, urinary calculus
• History of exposure to toxins, drug samples, environmental toxins
• The use of nephrotoxic antibiotics current / recurrent.

Nursing Diagnosis and Nursing Intervention for Chronic Renal Failure - CRF

1. Decrease in cardiac output related to an increased cardiac load

Goal :
Decrease in cardiac output does not occur with the

Result Criteria :
Maintain cardiac output with evidence of blood pressure and cardiac frequency in the normal range, strong peripheral pulse and equal to the capillary filling time.

Nursing Intervention :

• Auscultation of heart and lung sounds
  Rational : There is an irregular heart frequency tachycardia
• Review of hypertension
  Rational : Hypertension may occur due to disturbances in the system renin-angiotensin-aldosterone system (caused by renal dysfunction)
• Assess complaints of chest pain, perhatikanlokasi, rediasi, weight (scale 0-10)
  Rational : Hypertension and chronic renal failure can cause pain
• Assess the level of activity, response activity
  Rational : Fatigue may accompany chronic renal failure

2. Changes in nutrition: less than the needs associated with anorexia, nausea, vomiting

Objective :
Maintain adequate nutrition inputs

Reasult Criteria :
Shows stable weight

Nursing Intervention :

• Monitor the consumption of food / fluid
  Rational : Identifying nutritional deficiencies
• Watch for nausea and vomiting
  Rational : Symptoms that accompany the accumulation of endogenous toxins that can alter or reduce revenue and require intervention.
• Give the patient a little food but often.
Rational : a smaller portion to increase the input of food
• Increase visits by people closest to during meal.
  Rational : Provide diversion and increase the social aspect.
• Give frequent oral care
  Rational : Reducing the discomfort of oral stomatitis and feeling unwelcome in the mouth that can affect food inputs.