Chronic kidney disease (CKD), also known as chronic renal failure (CRF), is marked by a gradual and irreversible decline in kidney function. The kidneys, known for their remarkable adaptability, can mask the early stages of kidney disease. Often, significant nephron loss occurs before the condition is detected. In fact, individuals in the initial phases of CKD are frequently asymptomatic, and noticeable symptoms may only emerge as the disease progresses into later stages.
This article aims to provide a comprehensive overview of nursing diagnoses relevant to patients with renal failure. We will delve into the stages of CKD, the nursing process involved in patient care, and specific nursing diagnoses commonly associated with this condition. This guide is designed to enhance understanding and improve the quality of care for individuals facing renal failure.
Stages of Chronic Kidney Disease
Chronic Kidney Disease is classified into five stages based on the Glomerular Filtration Rate (GFR), a key indicator of kidney function:
- Stage 1: Kidney damage with normal or increased GFR (≥ 90 mL/min/1.73 m2)
- Stage 2: Kidney damage with mild decrease in GFR (60-89 mL/min/1.73 m2)
- Stage 3a: Moderate decrease in GFR (45-59 mL/min/1.73 m2)
- Stage 3b: Moderate decrease in GFR (30-44 mL/min/1.73 m2)
- Stage 4: Severe decrease in GFR (15-29 mL/min/1.73 m2)
- Stage 5: Kidney failure (End-Stage Renal Disease – ESRD) with GFR < 15 mL/min/1.73 m2 or requiring dialysis
As CKD progresses, the kidneys’ ability to filter toxins diminishes, leading to systemic effects and potentially irreversible damage to other organ systems. Stage 5 CKD, or End-Stage Renal Disease (ESRD), necessitates renal replacement therapy, such as dialysis or kidney transplantation, to sustain life.
The Nursing Process in Chronic Kidney Disease
The primary objectives in managing and treating CKD are to preserve existing kidney function, minimize cardiovascular disease risks, prevent complications, and enhance patient comfort. Nurses play a vital role in promoting health activities that can delay or prevent CKD onset. Educating patients about the disease process and encouraging adherence to necessary lifestyle adjustments are crucial nursing responsibilities.
Effective nursing care begins with a thorough nursing assessment, encompassing physical, psychosocial, emotional, and diagnostic data collection. The following sections will explore both subjective and objective data relevant to chronic kidney disease, providing a foundation for accurate nursing diagnosis and care planning.
Nursing Assessment for Renal Failure Patients
A comprehensive nursing assessment is crucial for identifying appropriate nursing diagnoses for patients with renal failure. This assessment involves reviewing health history, performing physical examinations, and analyzing diagnostic procedures.
Review of Health History
1. General Symptom Inquiry: The clinical manifestations of CKD arise from the retention of waste products like creatinine, urea, phenols, electrolytes, and excess water. Symptom presentation varies widely based on disease severity. Nurses should inquire about common symptoms, including:
- Fatigue and weakness: Due to anemia and toxin buildup.
- Loss of appetite (anorexia): Caused by uremia and metabolic disturbances.
- Edema: Fluid retention due to impaired kidney function.
- Shortness of breath (dyspnea): Pulmonary edema or anemia-related hypoxia.
- Changes in urine output: Oliguria (decreased urine) or anuria (absent urine) in later stages, polyuria (increased urine) in early stages for some conditions.
2. Risk Factor Identification: Certain factors increase susceptibility to CKD. Nurses should identify these risks:
- Advanced age: Kidney function naturally declines with age.
- Ethnicity: Higher prevalence in African Americans, Native Americans, and Asian Americans.
- Family history of kidney disease: Genetic predisposition.
- Congenital kidney or urinary tract defects: Structural abnormalities.
3. Medical History Documentation: CKD often results from underlying diseases or conditions that compromise kidney function. A detailed medical history is essential, noting conditions such as:
- Hypertension: A leading cause and consequence of CKD.
- Diabetes Mellitus: Another major cause of CKD (diabetic nephropathy).
- Cardiovascular disease: Shared risk factors and disease progression links.
- Primary kidney diseases: Glomerulonephritis, polycystic kidney disease, etc.
- Inherited kidney diseases: Such as polycystic kidney disease, Alport syndrome.
- Urinary tract obstructions: Kidney stones, tumors, prostate enlargement causing prolonged blockage.
- Cancer: Certain cancers and cancer treatments can damage kidneys.
- Recurrent kidney infections (pyelonephritis): Repeated infections can lead to scarring and CKD.
- Recurrent urinary tract infections (UTIs): Especially if complicated or ascending.
- Vesicoureteral reflux: Urine backflow into kidneys, causing damage.
4. Lifestyle and Environmental Factor Assessment: Certain lifestyle and environmental exposures can exacerbate kidney damage. These include:
- Nephrotoxic substance exposure: Mold toxins, heavy metals (arsenic, lead), certain medications, industrial solvents.
- Obesity: Associated with increased risk of diabetes and hypertension, indirectly contributing to CKD.
- Smoking: Impairs renal blood flow and accelerates CKD progression.
5. Medication Review: Many medications are processed by the kidneys. Nurses must review all medications, including over-the-counter (OTC) and prescription drugs, that could harm the kidneys:
- Statins: Rarely, can cause rhabdomyolysis leading to kidney damage.
- Pain medications: NSAIDs (nonsteroidal anti-inflammatory drugs) and high doses of opioids can be nephrotoxic, especially with chronic use.
- Antibiotics: Aminoglycosides, vancomycin, and others can be nephrotoxic.
- Antiretrovirals: Some HIV medications can affect kidney function.
- Antidiabetics and insulin: Dosage adjustments may be needed as kidney function declines; some oral agents are contraindicated in CKD.
- Antacids: Excessive use of some antacids can lead to electrolyte imbalances and kidney issues.
Physical Assessment
1. Asymptomatic Early Stages: Many patients in CKD stages 1-3 are asymptomatic. Clinical manifestations of endocrine and metabolic changes, especially fluid and electrolyte imbalances, typically become apparent in stages 4-5. Early, subtle symptoms might include fatigue and mild edema in hands and feet.
2. Metabolic Acidosis Assessment: Stages 4 and 5 CKD indicate severe kidney damage, with compromised toxin and waste product filtration, potentially leading to metabolic acidosis. Assess for later-stage symptoms:
- Oliguria or anuria: Markedly reduced or absent urine output.
- Edema: Generalized edema, including periorbital or sacral edema.
- Muscle cramps: Electrolyte imbalances (hypocalcemia, hyponatremia).
- Nausea and vomiting: Uremia and gastrointestinal effects of toxins.
- Loss of appetite: Worsening anorexia.
- Shortness of breath: Pulmonary edema, worsening anemia.
3. Fluid and Electrolyte Balance Alteration Determination: Kidney dysfunction disrupts fluid and electrolyte regulation. Monitor for complications:
- Hypertension: Fluid overload and renin-angiotensin system activation.
- Peripheral edema: Fluid retention in extremities.
- Pulmonary edema: Fluid accumulation in lungs, causing respiratory distress.
- Hyperkalemia: Elevated potassium levels due to impaired excretion.
- Hyperphosphatemia: Elevated phosphate levels due to impaired excretion.
- Hypocalcemia: Decreased calcium levels secondary to hyperphosphatemia and reduced vitamin D activation.
4. Anemia Monitoring: Anemia, a common CKD complication, results from decreased erythropoietin production. Assess for anemia signs:
- Fatigue and weakness: Reduced oxygen-carrying capacity.
- Activity intolerance: Due to fatigue and dyspnea.
- Feeling cold: Poor circulation and reduced metabolism.
- Pale skin (pallor): Reduced hemoglobin.
- Difficulty concentrating: Brain hypoxia.
- Lightheadedness or dizziness: Cerebral hypoperfusion.
- Heart palpitations: Compensatory tachycardia.
Diagnostic Procedures
1. CKD Screening: Screening tests are crucial for early CKD detection, especially in at-risk individuals:
- Urinalysis: Detects protein (albuminuria), blood (hematuria), and other abnormalities.
- Urine albumin-creatinine ratio (ACR): Quantifies albuminuria, a key CKD marker.
- Serum creatinine: Measures kidney function; elevated levels indicate impaired function.
- Estimated GFR (eGFR): Calculated using serum creatinine, age, sex, and race; provides a standardized measure of kidney function using the CKD-EPI equation.
2. Blood Tests: Additional serum tests help assess underlying conditions and CKD complications:
- Complete blood count (CBC): Evaluates for anemia (low hemoglobin, hematocrit).
- Basic metabolic panel (BMP): Assesses electrolytes (sodium, potassium, calcium, bicarbonate), BUN, creatinine, glucose.
- Serum albumin levels: May be low in CKD due to protein loss and malnutrition.
- Lipid profile: Evaluates cardiovascular risk factors, as dyslipidemia is common in CKD.
3. Bone Status Determination: CKD-Mineral Bone Disorder (CKD-MBD) is a significant complication. Assess bone status with:
- Serum calcium and phosphate: Evaluate mineral imbalances.
- 25-hydroxyvitamin D: Assesses vitamin D deficiency, common in CKD.
- Alkaline phosphatase: Elevated levels may indicate bone turnover.
- Intact parathyroid hormone (PTH) levels: Elevated PTH signifies secondary hyperparathyroidism due to hypocalcemia and vitamin D deficiency.
4. Imaging Scans: Renal imaging provides structural information about the kidneys and surrounding tissues:
- Renal ultrasonography: Non-invasive, assesses kidney size, structure, obstruction.
- Retrograde pyelography: X-ray imaging of the urinary tract after contrast dye injection, used to identify obstructions.
- Computed tomography (CT) scan: Detailed cross-sectional images, useful for detecting masses, stones, and structural abnormalities.
- Magnetic resonance imaging (MRI): Provides detailed soft tissue imaging, useful in specific situations.
- Renal radionuclide scanning: Assesses kidney function and blood flow.
5. Kidney Biopsy: Percutaneous kidney biopsy is performed when the diagnosis remains unclear after initial workup or to guide management based on the severity of renal involvement in diagnosed conditions. It provides tissue samples for microscopic examination.
Common Nursing Diagnoses for Patients with Renal Failure
Based on the comprehensive assessment, several nursing diagnoses are commonly identified in patients with renal failure. These diagnoses guide the nursing care plan and interventions. Here are some key nursing diagnoses:
1. Excess Fluid Volume
Nursing Diagnosis: Excess Fluid Volume related to kidney dysfunction, decreased urine output, sodium retention, inappropriate fluid intake, and compromised regulatory mechanisms.
Defining Characteristics:
- Edema (peripheral, pulmonary, generalized)
- Adventitious breath sounds (crackles/rales)
- Pulmonary congestion
- Jugular vein distention (JVD)
- Oliguria
- Weight gain
- Elevated blood pressure
- Altered mental status (confusion, restlessness)
- Imbalanced intake and output
Expected Outcomes:
- Patient will maintain stable fluid balance, evidenced by absence of edema, clear lung sounds, and balanced intake and output.
- Patient will verbalize understanding of fluid restrictions and sodium-restricted diet.
Nursing Interventions:
- Monitor lung sounds: Assess for crackles or wheezing, indicating pulmonary edema. Rationale: Early detection of fluid overload in the lungs allows for prompt intervention.
- Accurate intake and output (I&O) monitoring: Document all fluid intake (oral, IV, enteral) and output (urine, drains, emesis). Rationale: I&O balance is crucial for assessing fluid status and guiding fluid management.
- Daily weight monitoring: Weigh patient at the same time each day, using the same scale and clothing. Rationale: Weight changes are a sensitive indicator of fluid gain or loss; 1 kg weight gain equals approximately 1 liter of fluid retention.
- Fluid restriction: Implement fluid restrictions as prescribed by the physician, considering all sources of fluid intake. Rationale: Fluid restriction prevents further fluid overload and complications.
- Sodium restriction education: Educate patient and family about sodium-restricted diets and hidden sources of sodium. Rationale: Sodium contributes to fluid retention; dietary sodium restriction helps manage fluid volume.
- Administer diuretics: Administer prescribed diuretics (loop, thiazide, potassium-sparing) and monitor effectiveness. Rationale: Diuretics promote fluid excretion through the kidneys.
- Edema care: Elevate edematous extremities, promote skin integrity, and reposition frequently. Rationale: Elevating extremities aids venous return and reduces edema; preventing skin breakdown in edematous tissues is crucial.
- Prepare for dialysis: For patients with severe fluid overload unresponsive to diuretics, prepare for dialysis as indicated. Rationale: Dialysis is an effective method for removing excess fluid and waste products in ESRD.
- Monitor laboratory values: Review BUN, creatinine, electrolytes (sodium, potassium), and hematocrit. Rationale: These labs reflect kidney function and electrolyte balance, guiding medical and nursing management.
2. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to disease process (uremia), anorexia, dietary restrictions, nausea/vomiting, and metabolic acidosis.
Defining Characteristics:
- Weight loss
- Poor appetite/anorexia
- Nausea and vomiting
- Altered taste sensation (metallic taste)
- Muscle wasting
- Decreased serum albumin
- Electrolyte imbalances
- Fatigue and weakness
- Constipation or diarrhea
Expected Outcomes:
- Patient will maintain or gain weight as appropriate, demonstrating adequate nutritional intake.
- Patient will verbalize strategies to improve appetite and manage dietary restrictions.
- Patient will exhibit stable electrolyte and protein levels within acceptable limits.
Nursing Interventions:
- Assess nutritional status: Obtain dietary history, assess food preferences and aversions, monitor weight trends, and calculate BMI. Rationale: Baseline nutritional assessment guides individualized dietary interventions.
- Monitor laboratory values: Review serum albumin, prealbumin, electrolytes, BUN, creatinine, and lipid profile. Rationale: These labs provide objective data on nutritional status and metabolic function.
- Small, frequent meals: Encourage small, frequent meals rather than large meals to improve appetite and reduce nausea. Rationale: Smaller meals are often better tolerated and can improve overall intake.
- Dietary modifications: Collaborate with a renal dietitian to develop an individualized meal plan that addresses protein, potassium, phosphorus, and sodium restrictions while meeting caloric needs. Rationale: Renal diets are complex and require expert guidance to ensure adequate nutrition while managing CKD complications.
- Nutritional supplements: Administer prescribed oral or enteral nutritional supplements to increase caloric and protein intake. Rationale: Supplements can help bridge nutritional gaps, especially when appetite is poor.
- Anti-emetics: Administer prescribed anti-emetics to manage nausea and vomiting. Rationale: Controlling nausea and vomiting improves comfort and facilitates oral intake.
- Oral hygiene: Provide frequent oral hygiene to improve taste sensation and appetite. Rationale: Uremia can cause unpleasant taste changes; good oral hygiene can help.
- Enteral or parenteral nutrition: If oral intake is insufficient, prepare for enteral (tube feeding) or parenteral (IV nutrition) as prescribed. Rationale: These are alternative nutrition routes when oral intake is inadequate to meet nutritional needs.
- Education on renal diet: Educate patient and family about the renal diet, including food choices, meal preparation, and label reading. Rationale: Patient education is crucial for long-term adherence to dietary recommendations.
3. Impaired Urinary Elimination
Nursing Diagnosis: Impaired Urinary Elimination related to kidney dysfunction and altered glomerular filtration.
Defining Characteristics:
- Oliguria (decreased urine output < 400 mL/day)
- Anuria (absent urine output)
- Urinary retention
- Dysuria (painful urination – less common in CKD itself, but can be present with UTIs)
- Urinary incontinence (less common, but possible due to fluid overload and edema)
- Nocturia (increased urination at night – early CKD in some conditions like polycystic kidney disease)
- Altered urine color or odor (cloudy, concentrated urine)
Expected Outcomes:
- Patient will maintain urine output within acceptable limits for their condition, without signs of complications from impaired elimination.
- Patient will verbalize understanding of changes in urinary patterns expected with CKD.
Nursing Interventions:
- Monitor urine output: Accurately measure and document urine output, noting color, clarity, and odor. Rationale: Urine output is a direct indicator of kidney function and fluid balance.
- Assess for bladder distention: Palpate and percuss the bladder to assess for urinary retention, especially in patients with oliguria. Rationale: Retention can exacerbate fluid overload and urinary tract complications.
- Catheterization (if indicated): If urinary retention is present and patient cannot void, prepare for intermittent or indwelling catheterization as prescribed. Rationale: Catheterization may be necessary to relieve urinary retention and monitor output in specific situations.
- Diuretic administration: Administer diuretics as prescribed and monitor their effectiveness on urine output. Rationale: Diuretics promote urine production and fluid excretion.
- Fluid management: Carefully manage fluid intake, balancing the need for hydration with the risk of fluid overload. Rationale: Fluid management is crucial to optimize kidney function without causing fluid overload.
- Education on urinary changes: Educate patient about expected changes in urinary patterns as CKD progresses, including oliguria and potential need for dialysis. Rationale: Patient education helps manage expectations and promotes adherence to treatment plans.
- Monitor for UTI: Assess urine for signs of urinary tract infection (UTI), such as cloudy urine, foul odor, dysuria, and fever. Rationale: CKD patients are at increased risk for UTIs, which can further compromise kidney function.
4. Risk for Decreased Cardiac Output
Nursing Diagnosis: Risk for Decreased Cardiac Output related to fluid overload, electrolyte imbalances (hyperkalemia, hypercalcemia), anemia, hypertension, and accumulation of uremic toxins.
Risk Factors (As evidenced by):
- Hypertension
- Fluid overload (edema, JVD, pulmonary congestion)
- Electrolyte imbalances (hyperkalemia, hyperphosphatemia, hypocalcemia)
- Anemia
- Uremic toxins
- History of cardiovascular disease
- Dysrhythmias
Expected Outcomes:
- Patient will maintain adequate cardiac output, evidenced by stable vital signs (BP, HR), absence of dyspnea, and adequate peripheral perfusion.
- Patient will verbalize understanding of factors that can compromise cardiac function in CKD.
Nursing Interventions:
- Monitor vital signs: Regularly monitor blood pressure, heart rate, and rhythm. Rationale: Vital signs are key indicators of cardiovascular status.
- Assess for signs of decreased cardiac output: Assess for dyspnea, orthopnea, chest pain, palpitations, edema, fatigue, and decreased peripheral pulses. Rationale: Early identification of these signs allows for timely intervention.
- Monitor ECG: Monitor ECG for dysrhythmias, especially in the presence of electrolyte imbalances (hyperkalemia). Rationale: Hyperkalemia can cause life-threatening dysrhythmias.
- Fluid management: Strictly adhere to fluid restrictions and monitor fluid balance closely. Rationale: Fluid overload increases cardiac workload.
- Antihypertensive medications: Administer prescribed antihypertensive medications and monitor effectiveness. Rationale: Controlling hypertension reduces cardiac afterload and strain.
- Electrolyte management: Monitor and manage electrolyte imbalances, particularly potassium and calcium, through medications and dietary modifications. Rationale: Electrolyte imbalances can directly impact cardiac function.
- Anemia management: Administer erythropoiesis-stimulating agents (ESAs) and iron supplements as prescribed to manage anemia. Rationale: Anemia reduces oxygen delivery and increases cardiac workload.
- Dialysis preparation: Prepare patient for dialysis if conservative measures fail to manage fluid overload and electrolyte imbalances. Rationale: Dialysis removes excess fluid and electrolytes, improving cardiac function.
- Patient education: Educate patient about the relationship between CKD and heart health, emphasizing medication adherence, diet, and lifestyle modifications. Rationale: Patient understanding and engagement are crucial for long-term cardiac health management.
5. Risk for Electrolyte Imbalance
Nursing Diagnosis: Risk for Electrolyte Imbalance related to impaired kidney function and altered regulatory mechanisms.
Risk Factors (As evidenced by):
- Renal failure
- Decreased glomerular filtration rate
- Dietary intake (excess or deficit)
- Medications (diuretics, antacids)
- Fluid imbalances
- Dialysis treatments
Expected Outcomes:
- Patient will maintain serum electrolyte levels within normal limits, as evidenced by laboratory values and absence of signs and symptoms of electrolyte imbalance.
- Patient will verbalize understanding of factors contributing to electrolyte imbalances in CKD and strategies for management.
Nursing Interventions:
- Monitor electrolyte levels: Regularly monitor serum electrolytes, including sodium, potassium, calcium, phosphorus, and magnesium. Rationale: Early detection of imbalances allows for prompt intervention.
- Assess for signs and symptoms of electrolyte imbalances: Assess for muscle weakness, cramps, dysrhythmias, altered mental status, nausea, vomiting, and other signs specific to each electrolyte imbalance (e.g., hyperkalemia, hyponatremia, hypercalcemia, hyperphosphatemia). Rationale: Clinical manifestations can indicate specific electrolyte disturbances.
- Dietary management: Educate patient about dietary modifications to manage electrolyte levels, such as potassium, phosphorus, and sodium restrictions. Rationale: Diet is a primary factor influencing electrolyte balance in CKD.
- Medication administration: Administer prescribed medications to correct electrolyte imbalances, such as potassium binders (sodium polystyrene sulfonate), phosphate binders (calcium acetate, sevelamer), and calcium supplements. Rationale: Medications are often necessary to correct significant electrolyte abnormalities.
- Diuretic management: Monitor electrolyte levels closely when administering diuretics, as they can affect electrolyte balance (e.g., loop diuretics can cause potassium loss). Rationale: Diuretics can exacerbate or create new electrolyte imbalances.
- Dialysis management: For patients on dialysis, ensure dialysis treatments are effective in removing excess electrolytes and maintaining balance. Rationale: Dialysis is a key intervention for managing electrolyte imbalances in ESRD.
- Patient education: Educate patient about the importance of electrolyte balance, dietary restrictions, medication adherence, and recognizing signs and symptoms of imbalances. Rationale: Patient education empowers self-management and early detection of problems.
- Lactulose administration: Consider administering lactulose for hyperkalemia as it promotes fecal excretion of potassium. Rationale: Lactulose is an alternative method to lower potassium levels.
References
- Chronic Kidney Disease. (2023, July 10). In NurseTogether. https://www.nursetogether.com/chronic-kidney-disease-ckd-nursing-diagnosis/
- End-Stage Renal Disease (ESRD) Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/
- Excess Fluid Volume Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/excess-fluid-volume-nursing-diagnosis-care-plan/
- Imbalanced Nutrition Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/imbalanced-nutrition-nursing-diagnosis-care-plan/
- Impaired Urinary Elimination Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/impaired-urinary-elimination-nursing-diagnosis-care-plan/
- Risk for Decreased Cardiac Output Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/decreased-cardiac-output-nursing-diagnosis-care-plan/
- Risk for Electrolyte Imbalance Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/risk-for-electrolyte-imbalance-nursing-diagnosis-care-plan/
- Subjective vs. Objective Data Nursing: Key Differences. (2023, July 10). In NurseTogether. https://www.nursetogether.com/subjective-vs-objective-data-nursing/
- Nursing Interventions: Comprehensive Guide. (2023, July 10). In NurseTogether. https://www.nursetogether.com/nursing-interventions/
- Nursing Diagnosis: Comprehensive Guide for Nurses. (2023, July 10). In NurseTogether. https://www.nursetogether.com/nursing-diagnosis/
- Nursing Care Plans (NCP): Ultimate Guide and Examples. (2023, July 10). In NurseTogether. https://www.nursetogether.com/nursing-care-plans/
- Fatigue Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/fatigue-nursing-diagnosis-care-plan/
- Edema Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/edema-nursing-diagnosis-care-plan/
- Shortness of Breath (Dyspnea) Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/shortness-of-breath-dyspnea-nursing-diagnosis-care-plan/
- Hypertension Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/hypertension-nursing-diagnosis-care-plan/
- Diabetes Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/diabetes-nursing-diagnosis-care-plan/
- Kidney Stones Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/kidney-stones-nursing-diagnosis-care-plan/
- Cancer Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/cancer-nursing-diagnosis-care-plan/
- Urinary Tract Infection (UTI) Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/urinary-tract-infection-nursing-diagnosis-care-plan/
- Obesity Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/obesity-nursing-diagnosis-care-plan/
- Smoking Nursing Diagnosis & Care Plan: Guide. (2023, July 10). In NurseTogether. https://www.nursetogether.com/smoking-nursing-diagnosis-care-plan/
- Nausea Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/nausea-nursing-diagnosis-care-plan/
- Pulmonary Edema Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/pulmonary-edema-nursing-diagnosis-care-plan/
- Hypokalemia & Hyperkalemia Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/hypokalemia-hyperkalemia-nursing-diagnosis-care-plan/
- Activity Intolerance Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/activity-intolerance-nursing-diagnosis-care-plan/
- Vertigo Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/vertigo-nursing-diagnosis-care-plan/
- Hypocalcemia & Hypercalcemia Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/hypocalcemia-hypercalcemia-nursing-diagnosis-care-plan/
- Hyponatremia & Hypernatremia Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/hyponatremia-hypernatremia-nursing-diagnosis-care-plan/
- Altered Mental Status Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/altered-mental-status-nursing-diagnosis-care-plan/
- Pressure Ulcers (Bed Sores) Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/pressure-ulcers-nursing-diagnosis-care-plan/
- Malnutrition Nursing Diagnosis & Care Plan Guide. (2023, July 10). In NurseTogether. https://www.nursetogether.com/malnutrition-nursing-diagnosis-care-plan/
- Metabolic Acidosis Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/metabolic-acidosis-nursing-diagnosis-care-plan/
- Constipation Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/constipation-nursing-diagnosis-care-plan/
- Diarrhea Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/diarrhea-nursing-diagnosis-care-plan/
- Urinary Retention Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/urinary-retention-nursing-diagnosis-care-plan/
- Risk for Infection Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/risk-for-infection-nursing-diagnosis-care-plan/
- Abdominal Pain Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/abdominal-pain-nursing-diagnosis-care-plan/
- Decreased Cardiac Output Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/decreased-cardiac-output-nursing-diagnosis-care-plan/
- Hypotension Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/hypotension-nursing-diagnosis-care-plan/
- Risk for Electrolyte Imbalance Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/risk-for-electrolyte-imbalance-nursing-diagnosis-care-plan/
- Acute Respiratory Failure Nursing Diagnosis & Care Plan. (2023, July 10). In NurseTogether. https://www.nursetogether.com/acute-respiratory-failure-nursing-diagnosis-care-plan/
