nursing diagnosis

[gigi69]

Hi, I am a first year Nursing student. I need to come up with a nursing diagnosis for Chronic Hypotension, and ESRD (end-stage renal disease). Can anyone give me any suggestions? Thanks so much

[meandragonbrett]

There are lots of different ones you could use.

Decreased Cardiac Output

Ineffective Tissue perfusion

Activity intolerance

Fatigued

Imbalanced nutrition

Nausea

Risk for infection

Risk for injury.

There are tons you could use. Telling us your patient is hypotensive and ESRD is not enough information to construct a diagnosis.

[Daytonite, BSN, RN]

with chronic renal failure you are often going to see patients with the following symptoms:

• elevated plasma creatinine levels
  
• elevated bun
  
• elevated potassium levels
  
• urine, if produced, has practically no electrolytes at all in it
  
• symptoms of vitamin d deficiencies (look for bone pain and problems with the teeth, osteomalacia)
  
• anemia due to inadequate production of erythropietin by the kidney (lethargy, dizziness, low hematocrit)
  
• platelet disorders with prolonged bleeding times
  
• evidence of the development of metabolic acidosis requiring dialysis
  
• hypertension due to the excess fluid retention, acidosis and hypersecretion of rennin (may not be the case with your patient)
  
• loss of attention, difficulty solving problems, peripheral neuropathy (pain and burning in the legs and feet)
  
• loss of motor coordination
  
• twitching
  
• fasciculations
  
• stupor
  
• anorexia
  
• nausea
  
• vomiting
  
• mouth ulcers
  
• stomatitis
  
• peptic ulcers
  
• gi bleeding
  
• abnormal pigmentation of the skin
  
• pruritis
  
• increased risk of infection due to suppression of cell-mediated immunity and the reduction of lymphocytes

you would also assess your patient's ability to independently perform adls and what they can't do

• eating and drinking
  
• toileting
  
• bathing
  
• dressing
  
• ability to move and get where they need to go
  
• communicate
  
• sleep and rest
  
• diversional activity

list all the abnormal items your patient has and that is the list you use to begin to determine what nursing diagnoses you will need to use. if you can give me a list of your patient actual symptoms (defining characteristics) i will help you choose and write the nursing diagnostic statements.

in your other thread you were wondering about how a esrd patient could have hypotension. hypotension can occur when there is hypoperfusion of the tissues caused by some kind of vascular occlusion(s), due to the action of antihypertensives or antidepressants, prolonged immobility, any condition that produces volume depletion, conditions where there has been multiple central nervous system degenerative changes and sometimes just being of great elderly age. chronic adrenal insufficiency and diabetes can cause hypotension. the kidneys are closely linked to the regulation of blood pressure and when they are in failure, then the blood pressure is not going to be adequately regulated. does your patient have any of these?

symptoms that occur with hypotension include dizziness, blurring of vision, syncope or fainting. it is important to know these because as nurses, it is these symptoms that we have to act upon. did your patient have any of these?

i have seen hypotension occur in long term dialysis patients and it was almost always associated with them either being dehydrated (yes! it can happen) or it was an affect associated with their medications. keep in mind that when these patients receive medications for hypertension or depression, their bodies do not metabolize them as efficiently, so they tend to build up with the other toxins in their body. they are removed with the other toxins when the patient has their regular hemodialysis treatment. for this reason, these patient's tend to get lower doses of these kinds of medications. is it possible that this hypotension is just now being discovered? if so, it is something the doctor will need to investigate. as nurses, our job is to prevent the patient from injury as a result of the effect of the hypotension (dizziness or fainting). so, in this case, the only thing you may be able to do with this particular problem of hypotension is to use a nursing diagnosis of risk for injury r/t effect of medications, if that is the underlying cause of the hypotension.

when you are in clinical it is always a big help to thoroughly review the patient's chart because there is often important information there that will lead you to the underlying pathophysiology of what is going on with the patient even though the doctor may not have come out and definitely stated it. (https://allnurses.com/forums/2228927-post5.html) sometimes we just have to be detectives and figure this stuff out.

[VickyRN, MSN, DNP, RN]

In addition to Daytonite's excellent post, I have noticed that renal patients are very cold intolerant (feel cold all the time - need the room sauna hot and then covered with blankets), are at risk for pathologic fractures (doesn't take much force to break their bones and very difficult to heal properly) and they are very prone to GI bleeds and hemorrhage.

In terms of nursing diagnosis for hypotension & ESRD:

Deficient Fluid Volume r/t excessive fluid losses/ shifts via ultrafiltration AEB Pt BP of ---/--- on (date)

Etiology could also be fluid restrictions or adverse effects of medications... You need to review your patient pathophysiology for the exact etiology :)

Hope this helps :)