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5 Nursing Diagnosis with Interventions for Chronic Kidney Disease


Nursing Diagnosis for Chronic Kidney Disease

According to Doenges (1999) and Lynda Juall (2000), nursing diagnoses that appear in patients with CKD are:
  1. Decreased Cardiac Output.
  2. Fluid and Electrolyte imbalances.
  3. Imbalanced Nutrition.
  4. Ineffective Breathing Pattern.
  5. 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

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