Group 12 End Stage Renal Disease

SMART Outcome

Nursing Diagnosis

Excess fluid volume related to compromised regulatory mechanisms as evidenced by elevated HR, JVD, and pulmonary congestion (Sommers & Fannin, 2023).

Patient will maintain balanced fluid volume by having equal or close to equal intake and output measurements by discharge (Wagner, 2023).

Nursing Actions

Monitor & Restrict

I + O

Monitor Labs

(BUN, Creatinine, Electrolytes)

Daily Weight

Work w/ Dietician (Renal Diet)

Assess for fluid overload S & S

(lungs, edema)

Interventions

(Ackely et al., 2023)

(Wayne. 2023)

Work w/ Case Management (Treatment Options )

What is it?

Work w/

Nephrologist

Discuss coping mechanisms

B

End stage renal disease refers to the last stage of kidney failure; the kidneys have sustained significant damage and loss of function to the point it can no longer support the body (End Stage Renal Disease, 2023).

Laboratory

Physical signs & Symptoms

Tests

Normal Range

Condition Results

High (28mg/dL) Kidneys are not excreting wastes

8-21 mg/dL

BUN

ABG

Metabolic Acidosis

Balanced ABG

>3mg/dL (5mg/dL) Kidneys are not excreting wastes

0.5-1.2 mg/dL

Creatinine

<95% decrease (50 mL/min/1.73^2)

F: 75-115 mL/min/1.73^2

M: 85-125 mL/min/1.73^2

Creatine

Clearance

Less than 15 mL/min/1.73 m2 due to lose of kidney function

eGFR

Greater than 90 mL/min/1.73 m2

(Potter et al., p. 1048, 2023)

(Sommers & Fannin, 2023)

- Bladder Distension

- Sudden weight gain

- Swelling of the extremities + pitting edema

-Elevated Heart Rate

-Jugular vein distention (JVD)

-Pulmonary Congestion

- Muslce cramps + twitches (Sommers & Fannin, 2023).

Medications

Sodium Polystyrene Sulfonate

Hematopoietic growth factors

Antihypertensives

Diuretics

Potential complications

• Orally or by enema: to facilitate passage of resin through the intestinal tract
• Exchanges sodium for potassium in the GI tract, leading to the elimination of potassium

• Loop and thiazide diuretics
• Control fluid overload early in the disease if the patient is not anuric (total absence of urinary output)

End Stage Renal Disease

• Angiotensin-converting enzyme (ACE) inhibitors; beta-adrenergic antagonists
• Used to treat underlying Hypertension

• Epoetin alfa, darbepoetin (ESAs)
• Stimulates RBC production to treat underlying anemia

(Sommers & Fannin, 2023)(Hashmi, 2023)

"Keepin it renal"

• Fluid & electrolyte imbalance
• Metabolic acidosis
• Drug toxicity
• Extracellular fluid volume excess
• Urinary retention
• Pulmonary edema
• Complete failure: Need for kidney transplant or dialysis (Sommers & Fannin, 2023)

Diagnostic Imaging

B

CT (Computed Tomography)

- Detect structural abnormalities + size/ shape

- Evaluation of blood flow + vacular anatomy

- Guide interventions ( biopsies)

Renal Ultrasound

- Visualizing kidney structure

- Detecting abnormalities

- Assessing blood flow (Doppler)

- Guiding procedures (biopsies, drainage catheters)

Alexa Brown

Ashley Campos

Jasper Dullano

Linh Le

Destini Olsen

Alex Salvatierra

MRI/ MRA

- Visualize kidney anatomy

- Assess blood flow

- Assess any renal masses

- Guidance for interventions (biospies/ drainage catheters)

Renal Nuclear Medicine Imaging

- Assess kidney function

- Assess blood flow

- Detect structural abnormalities

- Urinary drainage

Precipitating risks & factors

(Sommers & Fannin, 2023)(Banker, 2023)

• Hypertension
• Diabetes Mellitus
• Nephrotoxic medications (Sommers & Fannin, 2023).
• Autoimmune disease: Lupus (End Stage Renal Disease, 2023).

References

Ackley, B.J., Ladwig, G.B. & Flynn Makic, M.B. (2023). Nursing diagnosis handbook and evidence-based guide to planning care (13th ed). Elsevier.

St. Louis, MO.

End stage renal disease (ESRD). (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/end-stage-

renal-disease-esrd

End-stage renal disease - Symptoms and causes - Mayo Clinic. (2023). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/end-stage-

renal-disease/symptoms-causes/syc-20354532

Potter, P.A., Perry, A. G., Stockert, P.A., & Hall, A.M. (2023). Fundamentals of nursing (11thed). Mosby Elsevier. St. Louis, MO

Sommers, M. S. & Fannin, E. F. (2023). End stage renal disease in Disease and Disorders: A nursing therapeutic manual (7th ed.). In Nursing

Central for Apple iOS [Mobile application software]

Wagner, M. (2023a, October 31). Acute kidney injury (AKI): Nursing diagnoses & care plans. NurseTogether. https://www.nursetogether.com/

acute-kidney-injury-nursing-diagnosis-care-plan/#:~:text=Accurate%20monitoring%20of%20intake%20and,the%20risk%20of%20fluid%20overload.

Wagner, M. (2023, November 4). End-stage renal disease (ESRD): Nursing diagnoses, care plans, Assessment & Interventions. NurseTogether.

https://www.nursetogether.com/end-stage-renal-disease-nursing-diagnosis-care-plan/

Wayne, G. (2023). Fluid volume excess (hypervolemia) nursing care plan & management. Nurseslabs. https://nurseslabs.com/excess-fluid-

volume/#:~:text=The%20following%20are%20the%20common,60%20to%20100%20beats%2Fmin.

Banker, H. (2023, August 28). Nuclear renal scan. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK562236/

Hashmi, M. F. (2023, August 28). End-stage renal disease. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK499861/

B