Nursing

Nursing care
care plan
plan for
for
patient
patient with
with renal
renal failure
failure

Presented by :

1
 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

2
 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

3
 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

4
Clinical manifestations
• Oligurea (less than 400ml/day)
• Anuria(less than 50/day)
• Fatigue
• Anorexia
• Nausea
• Vomiting
• Increase creatinine and urea level in serum

5
 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)

6
 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

7
 Lab results
BUN H 13.2 2.1-7.1
Na 136 136-145
K 4.4 3.5-5.1
chloride H 109 98-107
Bicarbona L 21 23-29
te
Glucose H 7.4 3.9-5.8
(fasting
Creatinine H 205 53-97
Calcium L 1.92 2.10-2.55
Phosphoru 1.40 0.87-1.45
s 8
Pharmacological therapy
Drug Dose/ Reason Nursing Patient
name .freq conside respons
ration e
Norflox 4ooMG Antibiotic Don’t No signs
acin PO Q12 H to administe of
prevent r with infection
infection food
Amlodip MG PO 5 Antihyper Monitor PB within
ine QD tensive BP and normal
cardiac
rhythm
Insulin SQ Q6H To control Monitor Patient
regular blood serum glucose
sugar glucose level is
9
level freq controlle
 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

10
Collaborative problems
• Obstructive uropathy
• Acute renal failure
• Diabetes mellitus
• Hypertension

11
 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

12
Nursing care plan
supportive nursing assessment data :

• Subjective data: • Objective data :

Abdominal R leg edema (0-1),
distention, R leg increase blood
pain ,vomiting pressure, decrease
,diarrhea and urine out put (less
anorexia 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 & Planning Nursing Evaluation
expected interventions
outcomes
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 distention No neck vain
Maintains dietary and purpose of restriction Assess BP and P and distended
fluid respiratory rate and No edema
restriction rhythm to provide
base line data
Exhibit normal skin
turgor Assess fluid used to
without edema take medication
Assist patient to cope
Exhibit normal vital
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 15
 Nursing care plan
Goals & expected planning Nursing Evaluation
outcomes : interventions
Goal: maintenance Assess nutritional Assess weight Nutritional status
of adequate status to provide changes improved
nutritional intake base line data Assess lab values Ideal body weight
Expected Identify factors for ( protein, maintained
outcomes : contributed to creatinine iron) Normal lab values
Take protein of high nutritional intake Provide preference for protein , iron
biologic value, high Assess patient food or palatable to and creatinine
calorie food within nutritional dietary patient BP within normal
dietary restriction pattern to plan the Count calories
Take medication proper meals Assess for anorexia
that doesn’t cause ,vomiting, nausea
nausea or anorexia Assess for patient
No rapid changes understanding of
in weight 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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