HELP! Need answer to ? about nursing dx CRF

[TNMommy]

Okay,

So, I need to know what kind of nursing dx to give a pt. with chronic renal failure, anemia, hypertension, weakness of LE. She was admitted for hip fx. I have already done a care plan on impaired physical mobility, but I need to do another plan on her for the chronic renal failure. The only thing, she does not have any edema, fluid in lungs, and the facility has not put her on any kind of fluid restriction. Her labs indicate chronic renal failure, but none of the other characteristics in my care plan book relate. I want to go with Ineffective Protection, but at the same time, I find this to be kind of vague.

If anyone could help, that would be great! By the way, it looks like she is in Stage 4. Just before being put on dialysis and/or renal transplant.

[niko1999 RN BSN]

Could you maybe do something about the impaired hydration? People with CRF are constantly at risk for becoming dehydrated. Dehydration can lead to dizziness, mental confusion ect. So I would base it around that, but that is just me. So you could try something like impaired hydration r/t decreased ability for kidneys to properly filtrate a/e/b dilute urine? Still kind of new at this, but I hope this gives you an idea!

[Daytonite, BSN, RN]

A nursing diagnosis has to do with how the patient is responding to their medical and other problems in their life. If you want your care plan to reflect how the patient is dealing with their CRF you need to assess how they are responding to it. What symptoms of CRF do they have? How is it affecting their ADLs? What medications are they taking, why and are they having any side effects from them? Since you included none of this information there is no further help I can give you except to advise that nursing problems (nursing diagnoses) are based on abnormal data that is collected when assessing the patient. The abnormal data becomes the symptoms, or evidence, proving the existence of the nursing problems which we then label with nursing diagnoses.

[amy323red]

I am not sure how many dx you need but, if she is going to go on dialysis does she have the knowledge to deal with this huge chg in her life? Deficient knowledge R/T? Is she following the strict renal diet regimen? Most dialysis pts spend several hrs a day, 3 days a week on machine. Yes, they can have big problem after dialysis with dehydration. Taylor the plan to pts situation and needs.

[TNMommy]

Okay, the thing is that they do not seem to be treating her renal failure. She is on hypertension meds, anticoagulent meds, meds for constipation. Her labs indicate stage 4 renal failure. She has anemia, osteoporosis, did have a stage II pressure ulcer. She just is not exhibiting any excess fluid volume that you would expect with renal failure. Her hypertension is under control and within normal limits. She has borderline bradycardia. Since she is stage 4 renal failure, she is not on dialysis either. No excess weight gain either.

[Daytonite, BSN, RN]

Then you need to address her constipation, anemia (assess for signs of anemia), the osteoporosis, the Stage II pressure ulcer (you need to describe it) and the bradycardia and underlying cause for it. Those are her immediate nursing problems that she needs help with.