End-Stage Renal Disease Nursing Care Plan: 2 Sample Plans and Interventions

End-stage renal disease is the last stage of kidney failure, when the kidneys can no longer keep the client alive without dialysis or a transplant. Fluid, potassium, and waste build up quickly between treatments. Your priorities are fluid and potassium safety, protecting the dialysis access, and supporting the client with a demanding lifelong treatment.

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

Kidney failure with little or no urine output
Fluid intake above the limit between dialysis sessions

As evidenced by

Weight gain between dialysis sessions
Edema
Hypertension
Shortness of breath and crackles

PLANNING · EXPECTED OUTCOMES

Short-term goals

Client gains no more than the ordered amount, often 1 to 2 kg (2.2 to 4.4 lb), between dialysis sessions

Long-term goals

Client follows fluid and sodium limits and attends all dialysis sessions

ASSESSMENT

Weight before and after dialysis
Blood pressure, lung sounds, and edema
Intake and any urine output
Potassium, BUN, and creatinine

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Restrict fluids as ordered, often based on urine output plus a set amount	Without working kidneys, extra fluid stays in the body.
Weigh before and after dialysis	The change shows how much fluid was removed.
Hold antihypertensives before dialysis if ordered	Dialysis removes fluid and can drop BP too low.
Teach ways to manage thirst like ice chips, sugar-free gum, and small cups	These help the client stay within the fluid limit.

EVALUATION

Weight gain between sessions is within the goal
Lungs are clear
Client tracks daily fluid intake

CARE PLAN 2 · NURSING DIAGNOSIS

Risk for Injury

Risk factors

Arteriovenous fistula or graft that can clot or bleed
High potassium levels
Infection risk at the access site

PLANNING · EXPECTED OUTCOMES

Short-term goals

Fistula has a palpable thrill and audible bruit every shift

Long-term goals

Client protects the access and is free of clotting, bleeding, and infection

ASSESSMENT

Thrill (feel) and bruit (listen) over the fistula every shift
Access site for redness, swelling, and drainage
Potassium level and cardiac rhythm

INTERVENTIONS AND RATIONALES

INTERVENTION	RATIONALE
Check for thrill and bruit every shift and report if absent	Loss of either can mean the access has clotted.
Do not take BP, draw blood, or start IVs in the access arm	Pressure and punctures can damage or clot the access.
Teach the client not to carry heavy items, wear tight sleeves, or sleep on the access arm	These can block blood flow through the access.
Report potassium above the normal range and watch the monitor	High potassium can cause deadly dysrhythmias.

EVALUATION

Thrill and bruit are present
Access site is free of infection
Client explains how to protect the access arm

Practice this in Priority Care

Decide which renal client needs you first, from high potassium to a missing bruit.

Play Priority Care

Quick answers

What should the nurse assess on an AV fistula every shift?

Feel for a thrill and listen for a bruit. Both mean blood is flowing through the access.

Which arm should be used for a BP reading in a client with a fistula?

The arm without the fistula. Never take a BP or draw blood in the access arm.

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