Chronic Kidney Disease Nursing Care Plan: 2 Sample Plans and Interventions

Chronic kidney disease is a slow loss of kidney function over months to years, often caused by diabetes and high blood pressure. As the kidneys fail, fluid, potassium, phosphorus, and waste build up. Your priorities are fluid and electrolyte balance, protecting remaining kidney function, and teaching the renal diet.

A · AssessmentD · DiagnosisP · PlanningI · InterventionE · Evaluation

Each care plan below follows the nursing process (ADPIE).

CARE PLAN 1 · NURSING DIAGNOSIS

Excess Fluid Volume

Related to

Reduced kidney filtration
Sodium and water retention

As evidenced by

Weight gain
Edema
High blood pressure
Crackles in the lungs

PLANNING · EXPECTED OUTCOMES

Short-term goals

Weight stays within 1 kg (2.2 lb) of the target each day
Lungs remain clear

Long-term goals

Client follows fluid and sodium limits at home and keeps a stable weight

ASSESSMENT

Daily weight
Strict intake and output
Blood pressure, edema, and lung sounds
BUN, creatinine, GFR, and potassium

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Restrict fluids and sodium as ordered	Limits prevent fluid overload when the kidneys cannot remove water.
Give antihypertensives and diuretics as ordered	Controlling BP slows kidney damage.
Teach the client to weigh daily and report sudden gain	Weight is the best sign of fluid buildup.
Avoid nephrotoxic drugs such as NSAIDs and use contrast dye carefully	These can further harm the kidneys.

EVALUATION

Weight is stable
Edema is decreasing
Client names foods high in sodium to avoid

CARE PLAN 2 · NURSING DIAGNOSIS

Risk for Electrolyte Imbalance

Risk factors

Reduced kidney excretion of potassium and phosphorus
Diet high in potassium or phosphorus

PLANNING · EXPECTED OUTCOMES

Short-term goals

Potassium stays between 3.5 and 5.0 mEq/L

Long-term goals

Client follows the renal diet and keeps electrolytes in range at follow-up visits

ASSESSMENT

Potassium, phosphorus, and calcium
Cardiac rhythm if potassium is high
Muscle weakness and numbness

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Teach limits on high-potassium foods such as bananas, oranges, potatoes, and tomatoes	High potassium can cause deadly dysrhythmias.
Give phosphate binders with meals as ordered	Binders hold phosphorus from food so it leaves in the stool.
Teach the client to avoid salt substitutes	Many salt substitutes contain potassium.
Refer to a renal dietitian	A dietitian helps plan meals that meet many limits at once.

EVALUATION

Potassium is in range
Client takes binders with meals
Client lists high-potassium foods

Practice this in Chart Review

Read kidney labs and spot the values that need action.

Play Chart Review

Quick answers

When should phosphate binders be taken?

With meals or snacks, so they bind the phosphorus in food.

Why should clients with CKD avoid NSAIDs?

NSAIDs reduce blood flow to the kidneys and can speed up kidney damage.

For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.