Nursing care plan for

patient with renal failure

Presented by :

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 Obstructive uropathy
• Is an interference with the flow of
urine at any site along the urinary
tract which cause urine accumulation
causing infection and then renal
failure
• Caused by stones ,tumors pregnancy
and prostatic hyperplasia

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 Renal failure
• Loss of renal function
• May be acute or chronic
• The acute renal failure is an abrupt
reduction in renal functions
associated with oligurea (less than
400/day),fatigue,anorexia,nausea and
vomiting

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 Causes of acute renal
failure
• The most common cause of acute
renal failure is impaired renal blood
flow
• Renal vasoconstriction and vascular
disease (hypertension)
• Urinary tract obstruction

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 Clinical manifestations
• Oligurea (less than 400ml/day)
• Anuria(less than 50/day)
• Fatigue
• Anorexia
• Nausea
• Vomiting
• Increase creatinine and urea level in serum

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 Patient profile
• 59y female ,married
• Date of admission : 21-3-2004
• With acute renal failure secondary to
obstructive uropathy
• Uncontrolled diabetes mellitus
• Hypertension
• No previous hospitalization
• R leg pain caused by edema ( grade 0-1)

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 Physical assessment
• Height : 152 cm – weight :64 kg
• with recent loss of weight due to diarrhea and vomiting
for about 4 months
• Patient diet : renal – diabetic diet
• Allergic to eggs
• Vital signs:
1. Tem: 36.9 (oral)
2. BP: 180/83 mmHg
3. Respiration: 18 /min – reg
4. P: 85/min
5. Peripheral pulses : present

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 Lab results
BUN 13.2 H 2.1-7.1
Na 136 136-145
K 4.4 3.5-5.1
chloride 109 H 98-107
Bicarbonate 21 L 23-29
Glucose 7.4 H 3.9-5.8
fasting)
Creatinine 205 H 53-97
Calcium 1.92 L 2.10-2.55
Phosphorus 1.40 0.87-1.45
Mg .47 L .63-1.05 8
 Pharmacological therapy
Drug name Dose/ freq. Reason Nursing Patient
consideration response

Norfloxacin 4ooMG Antibiotic to Don’t No signs of

PO Q12 H prevent administer with infection
infection food

Amlodipine 5 MG PO QD Antihypertensiv Monitor BP PB within

e and cardiac normal
rhythm

Insulin SQ Q6H To control blood Monitor serum Patient glucose

regular sugar glucose level level is
freq controlled
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 Other therapies
• IV solutions:
½ normal saline 100ml/hr
Prescribed to prevent dehydration which
may caused by diarrhea and vomiting
• Catheter :
22 G inserted on 21-3 and last changed was
on 27-3
Done to prevent further accumulation of
urine which may lead to infection of UT

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 Collaborative problems
• Obstructive uropathy
• Acute renal failure
• Diabetes mellitus
• Hypertension

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 Nursing diagnoses
• fluid volume excess related to decrease urine out
put and retention of sodium and water
• Altered nutrition ,less than body requirements
related to anorexia nausea and vomiting
• Activity intolerance related to fatigue and
retention of waste products
• Knowledge deficit about diabetes self care and
control of disease process

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Nursing care plan
supportive nursing assessment data :

• Subjective data: • Objective data :

Abdominal distention, R leg edema (0-1),
R leg pain ,vomiting increase blood
,diarrhea and pressure, decrease
anorexia urine out put (less
than 400)and
increase urea and
creatinine level in
blood

nursing diagnoses: fluid volume excess related to decrease

urine output and retention of sodium and water
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 Nursing care plan
Goals & expected Planning Nursing Evaluation
outcomes interventions
goal :maintenance of Assess fluid status Daily weigh Patient stated normal
ideal body Limit fluid intake to Assess intake and out urine out put (more
weight without prescribed volume put than 400)
excess fluid Identify potential Assess skin turgor and BP decreased
Expected outcomes : sources of fluid presence of edema Ideal body weight is
Demonstrate no rapid Explain to the patient Assess neck vain for maintained
weight changes and family the purpose distention No neck vain distended
Maintains dietary and of restriction Assess BP and P and No edema
fluid respiratory rate and
restriction rhythm to provide base
Exhibit normal skin line data
turgor Assess fluid used to
without edema take medication
Exhibit normal vital Assist patient to cope
signs with her disease
Exhibit no neck vain
distention
Decrease thirst
Decrease dryness of
oral
Mucous membrane 14
Nursing care plan
supportive nursing assessment data :

• Subjective data : • Objective data :

Vomiting ,anorexia, Decrease body
nausea weight, decrease
calcium,
bicarbonate ,Mg
level in blood

Nursing diagnoses : altered nutrition ,less than body requirement

related to anorexia ,nausea ,vomiting and dietary restriction
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 Nursing care plan
Goals & expected planning Nursing Evaluation
outcomes : interventions
Goal: maintenance of Assess nutritional Assess weight Nutritional status
adequate nutritional status to provide changes improved
intake base line data Assess lab values for Ideal body weight
Expected outcomes : Identify factors ( protein, creatinine maintained
Take protein of high contributed to iron) Normal lab values
biologic value, high nutritional intake Provide preference for protein , iron and
calorie food within Assess patient food or palatable to creatinine
dietary restriction nutritional dietary patient BP within normal
Take medication pattern to plan the Count calories
that doesn’t cause proper meals Assess for anorexia
nausea or anorexia ,vomiting, nausea
No rapid changes in Assess for patient
weight understanding of
dietary restriction
Encourage in take of
protein with high
biologic value
Lower sodium intake
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 Quick questions
• What is the main cause of acute renal
failure in this patient?
• What other diseases that the patient has
and progress her condition?
• What is difference between an urea and
oligurea ?
• What was the cause of prescription of IV
solution in this case ?

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