Nursing management of the patient with chronic renal failure includes the following:

a. Gastrointestinal.

(1) Symptomatic treatment for nausea, vomiting, and diarrhea.

(2) Encourage a nutritious, appetizing diet of the patient’s preferred foods to combat anorexia and improve nutritional status.

b. Hematological.

(1) Administer vitamin and mineral supplements as ordered.

(2) Observe skin and mucous membranes for evidence of bleeding or bruising.

(3) Implement the use of soft bristle toothbrush and electric razor.

c. Integumentary.

(1) Use mild cleansers to avoid further skin irritation.

(2) Apply soothing lotions (p.r.n.).

(3) Administer prescribed antipruritics to combat itching.

d. Cardiovascular.

(1) Administer prescribed medications for control of hypertension, pulmonary edema, and congestive heart failure.

(2) Monitor vital signs.

(3) Observe for dependent edema.

(4) Auscultate lungs for the presence of fluid.

e. Metabolic.

(1) Observe strict I & O.

(2) Monitor blood levels of electrolytes.

(3) Check weight daily and assess for fluid retention.

(4) Implement prescribed dietary modifications.

(a) Sodium restriction to decrease water retention.

(b) Limited protein to decrease protein metabolism (protein metabolism will result in more nitrogenous wastes that cannot be filtered by the kidneys).

(c) Any dietary protein allowed must be of high biological value to provide the essential amino acids.

(d) High carbohydrate diet to provide energy and decrease protein metabolism.

(e) Potassium restrictions to avoid hyperkalemia (cellular potassium is released during protein metabolism. Hyperkalemia, or potassium intoxication, can cause severe cardiac arrhythmia’s).

f. Neurological.

(1) Frequent assessment of level of consciousness.

(2) Observation for mental status changes.

(3) Encourage family to report noted personality changes.

(4) Administer prescribed medications to manage muscle spasms and convulsive seizures.