4 Best Nursing Care Plans for Renal Failure

This article discusses Nursing Care Plans for Renal Failure plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.


Renal failure is a severe disorder that can cause the body to fill with fluid and cause additional life-threatening problems. Nursing diagnosis and care strategies for this potentially lethal condition must be up to date for medical practitioners.

Renal failure often called chronic kidney disease (CKD), is an irreversible long-term disorder marked by a gradual loss of kidney function.

It can eventually progress to end-stage renal failure (ESRF), which necessitates dialysis or a kidney transplant.

Roles of Kidney in the human body

They manage fluid balance, regulate electrolytes and pH levels, filter out and excrete waste and toxins, and help produce hormones.

Due to the kidneys’ many bodily functions, the signs and symptoms of RF can be varied and can progress as kidney function declines.

RF treatment aims to slow the disease progression by addressing the underlying cause.

Signs and Symptoms of Chronic Renal Failure

1. Oliguria — low urine output of fewer than 400 mL per day; anuria — no urine output.

2. Nausea and vomiting.

3. Loss of appetite.

4. Fatigue and weakness.

5. Decrease in mental sharpness.

6. Muscle twitching and cramping.

7. Swelling of feet and ankles.

8. Persistent itching.

9. Chest pain — occurs when the fluid builds up around the heart’s lining.

10. Shortness of breath if fluid builds up in the lungs.

11. Hypertension.

12. Sleep problems.

Causes Renal Failure

Some diseases can result in chronic renal failure. These include:

1. Type 1 or Type 2 Diabetes. Diabetes causes micro and macrovascular complications. Kidneys are often affected by the damage to the renal blood vessels, which will cause damage and reduction to the kidney functions. RF is quite common in patients with diabetes — with diabetes as the usual cause of their RF.

2. Hypertension. Hypertension can cause vascular issues, affecting the blood vessels in the kidneys, reducing function and causing damage.

3. Glomerulonephritis. Glomeruli are found in the nephrons in the kidneys. It is a network of blood vessels that filters the blood. Prolonged inflammation of these parts of the kidneys can lead to chronic renal failure.

4. Interstitial nephritis. Unresolved or prolonged interstitial nephritis can cause swelling between kidney tubules leading to RF.

5. Polycystic kidney disease. Clusters of cysts can sometimes build up in the kidneys. If unresolved, it can lead to RF as a complication.

6. Long-term obstruction of the urinary tract from conditions such as enlarged prostate, kidney stones, and some cancers.

7. Vesicoureteral reflux. Urine is the product of the filtration of fluids by the kidneys. It is excreted out of our body through the urethra. However, urine can go the other way, which can cause damage to the kidneys and related organs.

8. Pyelonephritis. If left untreated or prolonged, a kidney infection can cause permanent damage to the kidneys.

9. Cardiovascular Disease. Like in diabetes, cardiovascular problems can cause RF by affecting and damaging the blood vessels in the kidneys.

Risk Factors for Renal Failure

Smoking- can cause vascular damage that can affect kidney function

Obesity — obese patients require heightened metabolic demands causing the kidneys to be overworked, leading to RF if not addressed

Race — African American, Native American or Asian-American descent; RF is noted to be higher in races known to have a higher prevalence of hypertension and cardiovascular disease.

Family history of kidney disease

Abnormal kidney structure -anatomical issues can cause changes to kidney functions which can lead to RF.

Older age- organs decline and lose function as the human body ages.

Complications of Renal failure

1. Fluid retention. Kidneys play a role in regulating fluid volume; hence, reduction in its function can cause peripheral edema, pulmonary edema, and pericardial effusion.

2. Hyperkalemia. Extra Potassium in the body is excreted through the kidneys.

Impairment to this function can cause a build-up of Potassium in the bloodstream.

3. Cardiovascular disease. Kidneys help in the fluid regulation in the body. It also helps in the regulation of blood pressure thru hormone regulation. Changes in these processes can cause hypertension which is commonly related to cardiovascular problems.

4. Weak bones and an increased risk of bone fractures. RF causes reduced Vitamin D production and low phosphorous levels causing hypocalcemia. The body compensates by moving the calcium from the bones to the bloodstream causing weak bones.

5. Anemia. RF causes a reduction in the production of Erythropoietin — a hormone that triggers the bone marrow to produce red blood cells.

6. Decreased sex drive, erectile dysfunction, or reduced fertility. The causes of these complications in RF is multifactorial. RF can affect hormonal balance, cardiovascular function, and psychological health, which can cause changes in the patient’s sexual health.

7. Neurological complications. Regulation of waste in the body is one of the many essential roles of the kidneys. The build-up of the waste can cause neurological problems.

8. Decreased immune response. Reduction in immunity is commonly seen in patients with RF. This can lead to increased susceptibility to infections.

9. Pericarditis. Uremic pericarditis can happen because of the build-up of toxins in the human body.

10. Irreversible damage to the kidneys (end-stage kidney disease).

Diagnosis of Renal Failure

1. History taking and Physical exam — a detailed medical and family history will be taken by the health care provider when diagnosing the chronic renal failure. A physical examination will also be done to correlate with the results of diagnostic procedures.

2. Blood tests — creatinine and urea are blood markers that reflect kidney function; estimated glomerular filtration rate (eGFR) can help indicate the stage of kidney disease.

3. Urine tests — to give health care providers information about the patient’s kidney function

4. Imaging tests such as CT scan— to gather information about the current structure and size of the kidneys and other related organs.

5. Kidney biopsy — to collect a tissue sample that will be examined under the microscope, which can give a lot of information as to what is causing the kidney problem

Treatment for Chronic Renal Failure

Chronic renal failure is irreversible and often non-curable.

Measures can be taken to manage signs and symptoms, reduce complications, and slow the progression of the disease. If treatment options are unsuccessful, the damage can lead to end-stage kidney disease, requiring the need for dialysis or kidney transplant.

The treatment includes treating the underlying cause of RF. However, this is not always successful as the disease may persist and progress.

Addressing the complications and signs and symptoms is central to the treatment of RF.

Medications. The following medications can be used to manage RF:

1. Antihypertensive medications — drugs such as angiotensin-converting enzymes inhibitors (ACE inhibitors) or angiotensin II receptor blockers are prescribed to regulate blood pressure and preserve kidney function.

2. Anti-cholesterol drugs — cholesterol levels must be regulated to reduce the risks of cardiovascular problems.

3. Diuretics — relieve swelling; these can help address the fluid balance by excreting excess fluids in the body.

4. Medications to protect the bones — Calcium, Vitamin D, and phosphate supplements can be given to support the bones of RF patients.

5. Medications to treat anemia — erythropoietin is usually given to patients with RF to address anemia, reducing associated weakness and fatigue.

6. Low protein diet. A low protein diet is usually prescribed to patients with RF. The body’s protein processing causes the accumulation of wastes that are filtered by the kidneys. Reduction of dietary protein means reducing waste products, giving the kidneys rest and preventing further deterioration of renal perfusion and function.

7. Lifestyle changes. The patient should be encouraged to undergo a smoking cessation program to prevent further vascular damage. An exercise regimen as recommended by the physiotherapy team should also be considered. If the patient has diabetes, diabetes should be well-controlled as worsening of this condition can affect kidney function.

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Nursing care plans for renal failure
Nursing Care Plans for Renal Failure

Nursing Care Plans for Renal Failure

Nursing Care Plan 1: Risk for Decreased Cardiac Output

Nursing Diagnosis: Risk for Decreased Cardiac Output

Risk factors

Fluid imbalances affect circulating volume, myocardial workload, and systemic vascular resistance (SVR).

Alterations in rate, rhythm, cardiac conduction (electrolyte imbalances, hypoxia)

Accumulation of toxins (urea), soft-tissue calcification (deposition of calcium phosphate)

Desired Outcomes

Maintain cardiac output as evidenced by BP and heart rate within patient’s normal range; peripheral pulses strong and equal with prompt capillary refill time.

Nursing InterventionsRationale
Auscultate heart and lung sounds. Evaluate the presence of peripheral edema, vascular congestion and reports of dyspnea.S3 and S4 heart sounds with muffled tones, tachycardia, irregular heart rate, tachypnea, dyspnea, crackles, wheezes, edema, and jugular distension suggest HF.
Assess presence and degree of hypertension: monitor BP; note postural changes (sitting, lying, standing).Significant hypertension can occur because of disturbances in the renin-angiotensin-aldosterone system (caused by renal dysfunction). Although hypertension is common, orthostatic hypotension may occur because of intravascular fluid deficit, response to effects of antihypertensive medications, or uremic pericardial tamponade.
Investigate reports of chest pain, noting location, radiation, severity (0–10 scale), and whether or not it is intensified by deep inspiration and supine position.Although hypertension and chronic HF may cause MI, approximately half of RF patients on dialysis develop pericarditis, potentiating the risk of pericardial effusion or tamponade.
Evaluate heart sounds (note friction rub), BP, peripheral pulses, capillary refill, vascular congestion, temperature, and sensorium or mentation.The presence of sudden hypotension, paradoxic pulse, narrow pulse pressure, diminished or absent peripheral pulses, marked jugular distension, pallor, and a rapid mental deterioration indicate tamponade, which is a medical emergency.
Assess activity level, response to activity.Weakness can be attributed to HF and anemia.
Monitor laboratory and diagnostic studies:
Electrolytes (potassium, sodium, calcium, magnesium), BUN and Cr;Imbalances can alter electrical conduction and cardiac function.
Chest x-rays.Helpful in identifying developing cardiac failure or soft-tissue calcification.
Administer antihypertensive drugs such as prazosin (Minipress), captopril (Capoten), clonidine (Catapres), hydralazine (Apresoline).Reduces systemic vascular resistance and renin release to decrease myocardial workload and aid in preventing HF and MI.
Prepare for dialysis.Reducing uremic toxins and correcting electrolyte imbalances and fluid overload may limit and prevent cardiac manifestations, including hypertension and pericardial effusion.
Assist with pericardiocentesis as indicated.Accumulation of fluid within the pericardial sac can compromise cardiac filling and myocardial contractility, impairing cardiac output and potentiating the risk of cardiac arrest.

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Nursing care plans for renal failure
Nursing Care Plans for Renal Failure

Nursing Care Plan 2: Disturbed Thought Process

Nursing Diagnosis: Disturbed Thought Process

It may be related to:

Physiological changes: accumulation of toxins (e.g., urea, ammonia), metabolic acidosis, hypoxia; electrolyte imbalances, calcifications in the brain

Possibly evidenced by:

Disorientation to person, place, time

Memory deficit; altered attention span, decreased ability to grasp ideas

Impaired ability to make decisions, problem-solve

Changes in sensorium: somnolence, stupor, coma

Changes in behaviour: irritability, withdrawal, depression, psychosis

Desired Outcomes

  • Regain/maintain an optimal level of mentation.
  • Identify ways to compensate for cognitive impairment/memory deficits.
Nursing InterventionsRationale
Assess the extent of impairment in thinking ability, memory, and orientation. Note attention span.Uremic syndrome’s effect can begin with minor confusion, irritability and progress to altered personality or inability to assimilate information and participate in care. Awareness of changes provides an opportunity for evaluation and intervention.
Ascertain from SO patient’s usual level of mentation.Provides comparison to evaluate progression and resolution of impairment.
Provide SO with information about the patient’s status.Some improvement in mentation may be expected with the restoration of more normal levels of BUN, electrolytes, and serum pH.
Provide a quiet or calm environment and judicious use of television, radio, and visitation.Minimizes environmental stimuli to reduce sensory overload and confusion while preventing sensory deprivation.
Reorient to surroundings, person, and so forth. Provide calendars, clocks, outside windows.Provides clues to aid in the recognition of reality.
Present reality concisely, briefly, and do not challenge illogical thinking.Confrontation potentiates defensive reactions and may lead to patient mistrust and heightened denial of reality.
Communicate information and instructions in simple, short sentences. Ask direct, yes or no questions. Repeat explanations as necessary.May aid in reducing confusion and increase the possibility that communications will be understood and remembered.
Establish a regular schedule for expected activities.Aids in maintaining reality orientation and may reduce fear and confusion.
Promote adequate rest and undisturbed periods for sleep.Sleep deprivation may further impair cognitive abilities.
Monitor laboratory studies such as BUN and Cr, serum electrolytes, glucose level, and ABGs (Po2, pH).Correction of elevations or imbalances can have profound effects on cognition or mentation.
Provide supplemental O2 as indicated.Correction of hypoxia alone can improve cognition.
Avoid the use of barbiturates and opiates.Drugs typically detoxified in the kidneys will have increased half-life and cumulative effects, worsening confusion.
Prepare for dialysis.Marked deterioration of thought processes may indicate worsening of azotemia and general condition, requiring prompt intervention to regain homeostasis.

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Nursing care plans for renal failure
Nursing Care Plans for Renal Failure

Nursing Care Plan 3: Risk for Impaired Skin Integrity

Nursing Diagnosis: Risk for Impaired Skin Integrity

Risk factors may include:

  1. Altered metabolic state, circulation (anemia with tissue ischemia), and sensation (peripheral neuropathy)
  2. Alterations in skin turgor (edema/dehydration)
  3. Reduced activity/immobility
  4. Accumulation of toxins in the skin

Possibly evidenced by:

Not applicable. The existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

Maintain intact skin.

Demonstrate behaviours/techniques to prevent skin breakdown/injury.

Nursing InterventionsRationale
Inspect the skin for changes in colour, turgor, vascularity. Note redness, excoriation. Observe for ecchymosis, purpura.Indicates poor circulation or breakdown areas that may lead to decubitus formation and infection.
Monitor fluid intake and hydration of the skin and mucous membranes.Detects the presence of dehydration or overhydration that affect circulation and tissue integrity at the cellular level.
Inspect dependent areas for edema. Elevate legs as indicated.Edematous tissues are more prone to breakdown. Elevation promotes venous return, limiting venous stasis and edema formation.
Change position frequently; move patient carefully; pad bony prominences with sheepskin, elbow or heel protectors.Decreases pressure on edematous, poorly perfused tissues to reduce ischemia.
Provide soothing skincare. Restrict use of soaps. Apply ointments or creams (lanolin, Aquaphor).Baking soda, cornstarch baths decrease itching and are less drying than soaps. Lotions and ointments may be desired to relieve dry, cracked skin.
Keep linens dry, wrinkle-free.Reduces dermal irritation and risk of skin breakdown.
Investigate reports of itching.Although dialysis has largely eliminated skin problems associated with uremic frost, itching can occur because the skin is an excretory route for waste products such as phosphate crystals (associated with hyperparathyroidism in ESRD).
Recommend patient use cool, moist compresses to apply pressure (rather than scratch) pruritic areas. Keep fingernails short; encourage the use of gloves during sleep if needed.Alleviates discomfort and reduces the risk of dermal injury.
Suggest wearing loose-fitting cotton garments.It prevents direct dermal irritation and promotes evaporation of moisture on the skin.
Provide foam or flotation mattress.Reduces prolonged pressure on tissues, limiting cellular perfusion, potentiating ischemia and necrosis.

Nursing Care Plan 4: Risk for Impaired Oral Mucous Membrane

Nursing Diagnosis

  • Risk for Impaired Oral Mucous Membrane

Risk factors may include

  • Lack of/or decreased salivation, fluid restrictions
  • Chemical irritation, conversion of urea in saliva to ammonia

Possibly evidenced by

  • Not applicable. The existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

  • Maintain the integrity of mucous membranes.
  • Identify/initiate specific interventions to promote healthy oral mucosa.

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Nursing care plans for renal failure
Nursing Care Plans for Renal Failure
Nursing InterventionsRationale
Inspect oral cavity; note moistness, the character of saliva, presence of inflammation, ulcerations, leukoplakia.Provides an opportunity for prompt intervention and prevention of infection.
Provide fluids throughout a 24-hr period within a prescribed limit.Prevents excessive oral dryness from a prolonged period without oral intake.
Offer frequent mouth care and rinse with 0.25% acetic acid solution; provide gum, hard candy, breath mints between meals.Mucous membranes may become dry and cracked. Mouth care soothes, lubricates, and helps freshen mouth taste, often unpleasant because of uremia and restricted oral intake. Rinsing with acetic acid helps neutralize ammonia formed by the conversion of urea.
Encourage good dental hygiene after meals and at bedtime. Recommend avoidance of dental floss.Reduces bacterial growth and potential for infection. Dental floss may cut gums, potentiating bleeding.
Recommend patient stop smoking and avoid lemon or glycerine products or mouthwash containing alcohol.These substances are irritating to the mucosa and have a drying effect, potentiating discomfort.
Provide artificial saliva as needed (Ora-Lube).It prevents dryness, buffers acids, and promotes comfort.
Administer medications as indicated, such as antihistamines: cyproheptadine (Periactin).It may be given for relief of itching.


Finally, acute renal failure (ARF) is a common clinical condition that can be caused by various factors and must be treated utilizing various approaches. Nurses can be influential members of the healthcare team if they better understand the disease.

They can also provide appropriate nursing interventions to help patients suffering from acute renal failure. Nurses can provide vital information to patients who desire to learn more about the disease while delivering nursing care.

Other nursing diagnoses for patients with acute renal failure should be explored as well. Change in Health Status, Injury Risk, Disturbed Sleep patterns, Delayed Cough Reflex, Anxiety, Infection Risk, Impaired Skin Integrity, and Ineffective Coping are all on the list.

Related FAQs

1. What are the nursing care plan for renal failure?

Nursing goal of treating patients with acute renal failure is to correct or eliminate any reversible causes of kidney failure. Provide support by taking accurate measurements of intake and output, including all body fluids, monitor vital signs and maintain proper electrolyte balance

2. What is an appropriate nursing diagnosis for a client with chronic kidney disease CKD ?

Diagnosis. Based on the assessment data, the following nursing diagnoses for a patient with chronic renal failure were developed: Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water.

3. What are the main goals of nursing care of a client with CRF?

The nursing care planning goal for with chronic renal failure is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

4. How can nurses manage the symptoms of CKD?

Role of primary care nurses

Enhancing self-management can be achieved by: Educating patients on the importance of blood pressure control ensuring they are aware that reducing raised blood pressure is a key factor in preventing progression of CKD. Encourage home blood pressure monitoring where appropriate.

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