Nursing Interventions for CRF

Nursing Interventions for Chronic Renal Failure CRF

Chronic renal failure (CRF) is the progressive loss of kidney function. The kidneys attempt to compensate for renal damage by hyperfiltration (excessive straining of the blood) within the remaining functional nephrons (filtering units that consist of a glomerulus and corresponding tubule). Over time, hyperfiltration causes further loss of function.

Chronic loss of function causes generalized wasting (shrinking in size) and progressive scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that most patients begin to experience symptoms of kidney failure.

Nursing Interventions for Chronic Renal Failure

Nursing Diagnosis
  • Ineffective tissue perfusion (renal)
  • Excess fluid volume
  • Risk for infection
  • Risk for deficient fluid volume.

Planing and Goal
  • The client will have normal fluid and electrolyte levels
  • The client will experience no preventable complication
  • The client will understand the means by which His/Her family members will implement health teaching after discharge.

  1. Observe the client for metabolic acidosis to identify complication of renal failure.Observe the fluid and electrolyte balance hourly.
  2. Insert an indwelling urinary catheter and measure output and specific gravity hourly. These action allow the nurse to monitor the kidneys, which have the major role in regulating fluid and electolyte balance. High potassium levels can occur.
  3. Provide only enough fluid intake to replace urine output to avoid an edema caused by excessive fluid intake.
  4. Monitor the client's diet to provide high carbohydrates, adequate fats, and low protein. If client receives high calories from fat and carbohydrate metabolism, the body doesn't break down protein for energy. Protein is thus available for growth and repair.
  5. Reduce the client's potassium intake to help prevent elevated potassium levels. Protein catabolism causes potassium release from cells into the serum.
  6. Observe for the arrhytmias and cardiac arrest to identify complications of high serum potassium.
  7. Provide frequent oral hygiene to avoid tissue irritation and sometime ulcer formation caused by urea and other acid waste products excreted through the skin and mucous membranes.
  8. Provide the client with hard candy and chewing gum to stimulate saliva flow and decrease thirst.
  9. Maintain skin care with cool water to relive pruritus and remove uremic frost (white crystal formed on skin from excretion of urea).
  10. Administer stool softeners to prevent colon irritation from high levels urea and organic acids.
  11. Provide emotional reassurance to the client and family members to help decrease anxiety levels caused by the fact that the client has an acute illness with unknown prognosis.
  12. Explain treatments and progress to the client to help reduce anxiety.
  13. Provide hemodialysis or peritoneal dialysis as ordered.