Diagnosis help and priority with renal failure

[tnstudent21]

I'm in a bit of a dilemma trying to write up a care plan. Two things are holding me back. 1.) actual problem vs risk for. This age old debate has been brought up several times here and I've read through them, but still a bit uncertain. 2.) I can't come up with a nursing diagnosis for this situation:

90 yrs old male, admitted for back pain ( compression fracture ). Pain is under control. Alerted to person but not time/place. History of hypertension and dementia. Urine appears slightly concentrated w/ 500 mL output in last 20 hours (intake roughly the same). BUN elevated to double normal level, creatinine elevated slightly. Hemoglobin and Hemtocrit decreased also. Electrolytes all in balance except calcium, which is low. Pt. is not dehydrated, no signs of edema.

Because of the dark urine, elevated BUN and creatinine I'm sure the renal system is compromised in some way. But what can I use as a diagnosis? A urinary analysis and kidney scan results are not available.

I have an actual diagnosis- pain r/t the compression fracture. But the renal system is of more importance because of it's role in homeostasis, so would an at risk for trump an actual diagnosis here? The renal failure has not been officially diagnosed medically yet, it's a new occurrence.

[nurseprnRN, BSN, RN]

Just remember: "Dehydration" is a medical diagnosis, not a nursing diagnosis. It's a related factor/causation for a number of nursing diagnoses, though.

[NurseCollins799]

Yes I have three nursing diagnosis books. I thought about the ineffective tissue perfusion but I have no data to support that other than elevated BUN and creatinine levels do you think that would be enough? The intake is pretty much equal to the output, so I can't use excess fluid volume unless I used it as an at risk for.[/quote']

The kidneys can be adequately perfused but have some other primary disease that leads to poor waste clearance and thus elevated BUN and creatinine