The decision of which nursing diagnoses to use is based upon the symptoms the patient is having, NOT upon his medical diagnoses. This concept is clearly delineated in almost all nursing care plan books in the first chapter(s). The value of knowing a patient's medical diagnoses is to point you in the direction of possible nursing diagnoses you MIGHT be able to use so you won't be spending time searching the 188 NANDA diagnoses looking for just the right one. In other words, it narrows down your search. You still have to assure that your assessment data matches the defining characteristics listed with the nursing diagnoses you are choosing. Knowing a patient's medical diagnoses can also remind you of some of the symptoms you should be seeing in the patient in the event that you've overlooked them in your own data assessment process.
I suspect that you are not fully understanding renal failure. There is such a thing as high output renal failure. An elevated BUN is ALSO a symptom of dehydration. It is possible for a patient with high output renal failure to become dehydrated. You tend to see high output failure in persons who have not yet completed the process of complete renal failure. You have two symptoms supporting a medical diagnosis of dehydration and a nursing diagnosis of Deficient Fluid Volume
. You need to address that. You questioning about why you can't use Excess Fluid Volume lies in learning about the pathophysiology of renal disease and renal failure. What's going on with this urinary frequency? Is there a possibility that this patient has a UTI? Is he incontinent?
So, far you've got Deficient Fluid Volume R/T failure of regulatory mechanisms secondary to ESRD AEB tenting of skin and elevated BUN
- Chronic Kidney Disease
- Chronic Renal Failure
- Kidney School
- Kidney Diseases - links to more information
- Acute Renal Failure - includes information on nonoliguric renal failure
Read up on the pathophysiology of the different types of renal failure. Review your assessment data. I'm guessing that you've missed a few things during your assessment and reading of the patient's medical record. These patients usually have multiple problems and complications going on as a result of the renal disease.