The nurse is caring for a hospitalized client who has chronic renal failure. Which of the following nursing diagnoses are most appropriate for this client? Select all that apply.
A. Excess Fluid Volume
B. Imbalanced Nutrition; Less than Body Requirements
C. Activity Intolerance
D. Impaired Gas Exchange
E. Pain
Correct Answer: A, B, & C.
Appropriate nursing diagnoses for clients with chronic renal failure include excess fluid volume related to fluid and sodium retention; imbalanced nutrition, less than body requirements related to anorexia, nausea, and vomiting; and activity intolerance related to fatigue.
Option A: Renal disorder impairs glomerular filtration that results in fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion, and HPN at the same time due to decrease GFR, nephron hypertrophied leading to decreased ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.
Option B: Due to restricted foods and prescribed dietary regimen, an individual experiencing renal problems cannot maintain ideal body weight and sufficient nutrition. At the same time, patients may experience anemia due to decreased erythropoietic factors that cause a decrease in the production of RBC causing anemia and fatigue.
Option C: Assess the extent of weakness, fatigue, ability to participate in active and passive activities. Provides information about the impact of activities on fatigue and energy reserves. Encourage quiet play, reading, watching tv, games during times of fatigue. Provides relaxation, stimulation and requires minimal energy expenditure.
Option D: For optimal cell functioning the kidneys excrete potentially harmful nitrogenous products – urea, creatinine, and uric acid. But because of the loss of kidney excretory functions, there is impaired excretion of nitrogenous waste products causing an increase in laboratory results of BUN, creatinine, and uric acid.
Option E: The nursing diagnosis of pain is not commonly related to chronic renal failure. Pain is discomfort that is caused by the stimulation of nerve endings. Any trauma that the kidney experiences (by any causes or factors) perceived by the body as a threat, the body releases cytokine and prostaglandin causing pain which is felt by the patient at his flank area.
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