- Deficient Knowledge related to Inadequate information about ESRD and Inadequate interest in learning as evidenced by Inquiries about ESRD and Inaccurate follow-through of instructions
- Excess Fluid Volume related to Sodium retention and Imbalanced electrolytes
Uncontrolled hypertension ss evidenced by Edema, Pulmonary congestion and Electrolyte imbalances - Imbalanced Nutrition less than Body Requirements related to Uremic toxins, Metabolic acidosis and food aversion as evidenced by Fluid and electrolyte imbalances, Weight loss and Anorexia
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbalizes poor understanding Seeks additional information Objective data: -Inaccurate demonstration or teach-back of instructions -Inability to recall instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition -Avoiding eye contact or remaining silent during teaching | Deficient Knowledge related to Inadequate information about ESRD and Inadequate interest in learning as evidenced by Inquiries about ESRD and Inaccurate follow-through of instructions | Patient will verbalize understanding of ESRD, its symptoms, and its management. Patient will adhere to the treatment plan as evidenced by lab values within the expected ranges. Patient will not develop complications from ESRD | 1. Instruct the patient on lifestyle modifications. Arm the patient with information so they can make informed decisions. Instruct patients that simple changes such as exercise, quitting smoking, and adhering to their medication regimen can preserve kidney function. 2. Allow inquiries about dialysis and kidney transplant. Remain approachable, so the patient feels at ease asking questions. Dialysis and kidney transplants require life-long maintenance, and support from nurses can enhance adherence. 3. Instruct on appropriate diets. Adhering to a kidney-friendly diet can be difficult. The patient may need to limit salt, potassium, and fluids. Provide easy-to-understand written instructions on foods the patient should limit. 4. Have the patient verbalize symptoms of concern. Teach the patient about the signs of developing complications from ESRD. Dyspnea, confusion, changes in urination, weight gain, high blood pressure, and muscle cramps require immediate assessment. 5. Educate on fistula care. A fistula is created to allow for vascular access with dialysis. Complications such as infection or bleeding can occur as it heals. Instruct on proper care and when to alert the healthcare provider if concerns arise. | Patient verbalized that they understood of ESRD, its symptoms, and its management. Patient adhered to the treatment plan as evidenced by lab values within the expected ranges. Patient developed complications from ESRD |
| Subjective data: Difficulty breathing Anxiety Weight gain or swelling Objective data: -Shortness of breath -Adventitious breath sounds -Abnormal electrolyte levels -High blood pressure -Edema -Decreased haemoglobin or haematocrit -Jugular vein distention -Oliguria -Pulmonary congestion/edema | Excess Fluid Volume related to Sodium retention and Imbalanced electrolytes Uncontrolled hypertension ss evidenced by Edema, Pulmonary congestion and Electrolyte imbalances | Patient will achieve an acceptable fluid balance as evidenced by intake and output documentation. Patient will remain free from symptoms of excess fluid like edema and dyspnoea. Patient will display electrolytes within an acceptable range. | 1. Administer albumin as indicated. Patients with ESRD often have low albumin (hypoalbuminemia). Albumin is a plasma protein that maintains intravascular oncotic pressure, preventing fluid from leaking out of the blood vessels and into the extravascular space. 2. Promote diuresis. Loop diuretics (such as furosemide) are the drug of choice for ESRD to excrete the extra fluid out of the body to relieve edema and pulmonary congestion. 3. Limit sodium intake. Because the kidneys cannot effectively remove extra sodium and fluid from the body, sodium and fluid build-up in the tissues and circulation. Sodium will be restricted in the diet. 4. Elevate oedematous extremities. Elevating oedematous extremities promotes venous return and reduces edema. 5. Restrict fluids as ordered. Maintaining proper fluid balance is crucial since regular hydration can lead to harmful fluid buildup in ESRD. Ensure adherence to daily fluid restrictions. 6. Regulate the blood pressure. Too much fluid in the blood arteries can elevate the blood pressure and further damage the kidneys. Renal artery stenosis is when the kidneys’ blood vessels constrict and cause high blood pressure. | Patient achieved an acceptable fluid balance as evidenced by intake and output documentation. Patient remained free from symptoms of excess fluid like edema and dyspnoea. Patient displayed electrolytes within an acceptable range. |
| Subjective data: Verbalizes don’t want to eat anything Objective data: -Fluid and electrolyte imbalances -Constipation -Diarrhoea -Nausea -Vomiting -Weight loss -Anorexia -Lethargy | Imbalanced Nutrition: Less Than Body Requirements related to Uremic toxins, Metabolic acidosis and food aversion as evidenced by Fluid and electrolyte imbalances, Weight loss and Anorexia | Patient will report receiving the recommended intake of protein, potassium, sodium, and phosphorus. Patient will remain free from fluid and electrolyte imbalances. | 1. Encourage strict fluid management. As CKD progresses to ESRD, fluid elimination becomes impaired, and edema occurs along with elevated blood pressure and an increased risk for congestive heart failure. For patients who are on dialysis, it is recommended to limit fluid intake to 32 ounces per day. 2. Encourage adequate protein intake. A low-protein diet can delay the progression of kidney disease and prevent complications. However, ESRD patients on dialysis will need more protein in their diet, with recommendations of at least 1.2 grams/kg of body weight for those on haemodialysis and slightly more for patients on peritoneal dialysis. 3. Instruct the patient to limit foods high in potassium, sodium, and phosphorus. Patients diagnosed with ESRD have difficulty regulating potassium, sodium, and phosphorus. It is recommended to avoid eating foods like dried fruits, bananas, processed cheese, nuts, potatoes, organ and processed meats, and beans. High phosphorus levels negatively impact calcium and bone strength and may be treated with phosphate binders to absorb phosphorus before the body does. 4. Instruct on supplements as prescribed. Patients with ESRD are often deficient in most vitamins and may not be able to receive them through their restricted diet. Patients may be prescribed vitamins D, C, and E, B complex, L-carnitine, iron, and calcium to improve nutrition and anaemia. 5. Provide nutritional counselling. Patients should receive individualized nutritional counselling based on their lab results, weight, subjective symptoms, and socioeconomic status (access to food and income). Nurses can request patients keep a nutritional log to closely monitor if the patient demonstrates understanding and improvement in their diet compared to objective findings. | Patient reported of receiving the recommended intake of protein, potassium, sodium, and phosphorus. Patient remained free from fluid and electrolyte imbalances. |