Saint Louis

University
School of Nursing

Nursing Care Plan

Chronic Kidney Disease Stage

5

Pathophysiology
Non Modifiable
Risk
- Male

Modifiable Risk
- Hypertension
- Increased protein
and cholesterol
intake
- Smoker
- Use of analgesic

Decreased renal blood flow

Primary kidney disease
Urine outflow obstruction
Increased
BUN
Decreased GFR
Dilute
Polyuria

Dehydration

Risk for fluid volume

deficit related to
hypertrophy of neurons

Loss of non
excretory
renal
function

Hypertrophy of remaining
neurons

Inability to concentrate
urine

Further loss of nephron

function

Decrease
Calcium
Absorption

Failure to
convert
inactive
Failure to
produce
erythropoieti
n

Risk for ineffective renal

perfusion related to
decreased renal blood
Increased
Serum
Creatinine
Loss of
Sodium in
Urine
Hyponatremi
a

Risk for electrolyte

imbalance related to loss
of sodium in urine and
decreased calcium
absorption

Hypocalcaem
ia
Ineffective peripheral
tissue perfusion related to
anemia
Activity intolerance
related to anemia

Anemia
Imbalance nutrition: less
than body requirements
related to anemia

Impaired
insulin action

Erratic blood
glucose

Risk for unstable blood

glucose related to
impaired insulin action

Loss of
excretory
renal
function

Decreased
Excretion of
nitrogenous
waste

Decreased
sodium
reabsorption
in tubule

Decreased
Uremia

Water
Retention

Increased
BUN,
Creatinine
Uric Acid

Hypertension
Heart Failure
Edema

Altered Taste

Decreased
potassium
excretion

Decreased
hydrogen
excretion

Hyperkalemi
a

Metabolic
acidosis

Risk for
electrolyte
imbalance related
to decreased
potassium

Ineffective peripheral
tissue perfusion
related to
hypertension

Excess fluid related to

sodium and fluid
retention as
manifested by edema

Risk for fluid volume

deficit related to
hypertrophy of neurons
Reference
Nowak et al., 2010, Pathophysiology, Lippincott
Williams and Wilkins; New York
Huether et al., 2009, Understading Pathophysiology,
3rd Edition, Lippincott Williams and Wilkins

I.

Prioritization
Problem

Justification

1. Ineffective peripheral tissue perfusion Ineffective peripheral tissue perfusion

related to decreased hemoglobin in
related to hypertension prioritized as
the blood
problem one because in ABC, it is
under the circulation of blood in the
body.
2. Excess fluid related to sodium and The second prioritized problem is
fluid retention as manifested by
excess fluid related to sodium and
edema
fluid retention as manifested by
edema because fluid is important and
should be balance in amount in order
to prevent other complications such
as difficulty of breathing. Fluid also
falls under the physiologic need of
man
3. Imbalance nutrition: less than body It is prioritized as third problem since
requirements related to anemia
in physiologic needs of man in
OFFTERAS is comes after fluid.
4. Activity intolerance related to anemia

It is prioritized as fourth problem

since in physiologic needs of man in
OFFTERAS is comes after food.

5. Risk for fluid volume deficit related to These problems are less prioritized
hypertrophy of neurons
since they are only risks and not an
actual problem. These risks are then
arranged according to OFFTERAS
6. Risk for electrolyte imbalance related
which are the physiologic needs of
to loss of sodium in urine and
man.
decreased calcium absorption
7. Risk for fluid volume deficit related to
hypertrophy of neurons