Chronic Kidney Disease Nursing Care Plan

What is chronic kidney disease (CKD)?

The kidney acts like a filter. It sifts waste from the bloodstream, maintaining the body's internal balance. When kidney function declines, waste and toxins accumulate in the body, which can lead to serious health complications such as fluid retention, electrolyte imbalances, and, ultimately, chronic kidney disease.

Chronic kidney disease (CKD), also a chronic renal failure, denotes kidney damage or an estimated glomerular filtration rate (eGFR) lower than 60 ml/min/1.73 square meters. It lasts at least three months or longer (Vaidya & Aeddula, 2022). Over time, renal replacement therapy is often required to maintain patient health and quality of life.

CKD, a leading cause of death in the United States, affects about 37 million adults, with many unaware of their condition. At the same time, 360 individuals begin dialysis treatment for kidney failure daily (Centers for Disease Control and Prevention, 2022).

This chronic renal disease represents a considerable public health disadvantage due to its high prevalence, underdiagnosis, and the significant demand for dialysis treatment. Thus, early detection and prevention efforts are of critical importance.

Symptoms of chronic kidney disease

During the early stages, CKD's symptoms aren't usually apparent and only tend to show in the later stages (4 or 5). However, here are the chronic kidney disease symptoms that you need to look out for (NHS, 2023; National Kidney Foundation, 2020):

• Weight loss and poor appetite
• Swollen ankles, feet, or hands
• Shortness of breath
• Tiredness
• Blood in urine
• Increased or urination frequency
• Difficulty sleeping
• Itchy skin
• Muscle cramps
• Nausea
• Headaches
• Erectile dysfunction (in men)
• Foamy urine
• Itchy or dry skin

Note that some of these appear in the late stages. Encourage your patients to seek medical advice if they suspect signs and symptoms of CKD.

Causes of chronic kidney disease

Understanding what causes CKD helps diagnose and treat it. The top causes are diabetes and high blood pressure. Other causes of kidney disease include genetic disorders (like polycystic kidney disease), infections, nephrotoxic drugs, lupus, and more (National Institute of Diabetes and Digestive and Kidney Diseases, 2016).

If you have a patient with diabetes and high blood pressure, you have to ensure that they manage these conditions because they also affect CKD progression. Aside from these, individuals should also be mindful of other risk factors such as obesity, being over 60, having a family history of CKD or kidney failure, experiencing past acute kidney injury (AKI), and using tobacco products.

Stages of chronic kidney disease

CKD has five stages, assessed through the estimated glomerular filtration rate (eGFR) and the urine albumin-creatinine ratio (uACR) test, measured in ml/min per 1.73 meters squared. The glomerular filtration rate (eGFR) tells us how well the kidneys clean the blood, while the urine albumin-creatinine ratio (uACR) test checks for protein in the urine, which can indicate kidney damage.

Here are the stages and the essential information you need to know about them (American Kidney Fund, 2022; National Kidney Foundation, 2023):

• Stage 1 (eGFR 90 ml/min per 1.73 m squared or higher): Mild kidney damage, with normal kidney function.
• Stage 2 (eGFR 60-89): Mild kidney damage, noticeable through either the presence of protein in the urine or physical damage, yet kidney function is relatively normal.
• Stage 3a (eGFR 45-59): Mild to moderate loss of kidney function leading to impaired waste and fluid filtration, potentially causing additional health issues like high blood pressure and bone disease, along with symptoms like fatigue and swelling.
• Stage 3b (eGFR 30-44): Much like in Stage 3a, but with proper treatment and a healthy lifestyle, numerous individuals in Stage 3 avoid progressing to further stages.
• Stage 4 (eGFR 15-29): In this stage, severe kidney damage occurs, and kidney function is significantly impaired. This marks the final stage before kidney failure.
• Stage 5 (eGFR less than 15): Severe kidney damage or kidney failure, where accumulated waste leads to severe illness and complications. This stage necessitates dialysis or kidney transplant for survival.

As a healthcare provider, you must conduct repeat tests to confirm which chronic kidney disease stage your patient can be categorized into.

How nurses assess and diagnose chronic kidney disease

Assessing and diagnosing CKD involves various processes. Here are some of the usual procedures to confirm the disease's presence.

Review the patient's health history

Gather information about the patient's medical history, including past illnesses, family history of kidney disease, and any medications or treatments they have received. This helps determine potential risk factors and underlying conditions that may contribute to chronic kidney disease.

Physical examination

Nurses perform a comprehensive physical examination to assess for signs and symptoms of CKD, including high blood pressure, skin changes, and abnormalities in the abdomen or urinary system.

Diagnostic evaluation

Blood tests, urine tests, imaging studies like ultrasound or CT scans, and additional tests are used to objectively confirm the diagnosis, assess severity, and identify underlying causes or complications of CKD.

Next steps after diagnosis

After finding out a patient has CKD, nurses and the healthcare team should work together to make a plan that fits the person's needs and how severe their kidney disease is. This might mean doing things to slow down progression, dealing with any symptoms or problems, teaching the person how to take care of themselves, like taking medicines, changing their diet, or making lifestyle changes, and making sure they get checked regularly to see how their kidneys are doing and to change the plan if needed.

How to use our Chronic Kidney Disease Nursing Care Plan template

Using our Chronic Kidney Disease Nursing Care Plan is easy. Just follow the steps below:

Step 1: Download the template

Begin by downloading the provided CKD care plan template. This template includes columns for assessment, diagnosis, goals and outcomes, interventions, and evaluation.

Step 2: Gather patient information

Collect relevant patient data, including name, age, sex, nurse in charge, and healthcare provider. Ensure accuracy to personalize the individual's care plan.

Step 3: Assess the patient

Assess the patient's condition. This may include evaluating renal function, fluid intake, electrolyte balance, anemia, blood pressure, and related symptoms.

Step 4: Determine nursing diagnoses

Based on the assessment findings, identify nursing diagnoses related to CKD. Consider factors such as impaired kidney function, fluid retention, electrolyte imbalances, hypertension, and anemia.

Step 5: Establish goals and outcomes

Set achievable goals and outcomes to guide patient care. These may include stabilizing kidney function, managing complications, controlling blood pressure, improving fluid balance, and enhancing the quality of life.

Step 6: Plan interventions

Develop interventions to address the identified nursing diagnoses and achieve the established goals. This may involve medication administration, dietary modifications, lifestyle changes, patient education, and collaboration with the healthcare team.

Step 7: Implement the care plan

Execute the planned interventions promptly. Provide patient education, monitor treatment responses, and ensure care plan compliance.

Step 8: Evaluate patient response

Evaluate the effectiveness of the care plan interventions regularly. Monitor patient progress, reassess kidney function and other relevant parameters, and adjust the care plan as needed. Document all assessments, interventions, patient responses, and outcomes accurately and thoroughly.

Common nursing interventions for CKD

Chronic kidney disease is a challenging condition that deeply needs the expertise and compassion of healthcare professionals. Here are some common nursing interventions for kidney diseases:

• Medication: Nurses administer prescribed medications to manage symptoms and complications of CKD, such as hypertension and anemia. During this, they also closely observe for adverse effects to ensure patient safety and efficacy of treatment.
• Lifestyle changes: Lifestyle modifications, including regular exercise, smoking cessation, and limiting alcohol consumption, aid in managing CKD.
• Dietary management: Nurses collaborate with dietitians to develop personalized dietary plans tailored to the patient's nutritional needs and CKD stage. They emphasize the importance of sodium restriction and adequate protein intake to slow disease progression and prevent complications.

Taking steps toward your patients' health will give them hope for facing this challenge.

Benefits of having a comprehensive care plan

As healthcare professionals, you know CKD's impact on patients' lives. This is a drive to provide the best possible care and support. Thus, a care plan is a necessity. Here are some benefits you can gain from having one:

• Slow disease progression: A CKD care plan helps slow disease progression by implementing medication management and lifestyle modifications to preserve kidney function.
• Optimize diagnostic procedures: It optimizes diagnostic procedures by guiding healthcare providers on when and how to perform tests to monitor kidney function and prevent complications early.
• Enhanced patient education: Patients receive tailored education about CKD through the care plan. This empowers them to actively manage their condition and make educated decisions about their health.
• Improved coordination of care: By outlining clear goals, interventions, and evaluations, a CKD care plan facilitates better coordination among healthcare team members, ensuring comprehensive and cohesive care for the patient.

Remember that each patient is unique, and their care plan should also be tailored to their needs.

References

American Kidney Fund. (2022, October 26). Stages of kidney disease. https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease

Centers for Disease Control and Prevention. (2022, February 28). Chronic kidney disease basics. https://www.cdc.gov/kidneydisease/basics.html

National Institute of Diabetes and Digestive and Kidney Diseases. (2016, October). Causes of chronic kidney disease. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/causes

National Kidney Foundation. (2020, May 15). Facts about chronic kidney disease. https://www.kidney.org/atoz/content/about-chronic-kidney-disease#signs-and-symptoms

National Kidney Foundation. (2023, July 11). Stages of chronic kidney disease (CKD). https://www.kidney.org/atoz/content/stages-chronic-kidney-disease-ckd

NHS. (2023, March 22). Symptoms - chronic kidney disease. https://www.nhs.uk/conditions/kidney-disease/symptoms/

Vaidya, S. R., & Aeddula, N. R. (2022, October 24). Chronic kidney disease. National Institutes of Health; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535404/