Decreased Cardiac Output and Impaired Skin Integrity - NCP Chronic Kidney Disease

Nursing Care Plan for Chronic Kidney Disease

Chronic Kidney Disease (CKD) / CRF is a kidney disorder that is progressive and irreversible in which the ability of the body fails to maintain metabolism and fluid and electrolyte balance, causing uremia (retention of urea and other nitrogen garbage in the blood).

Causes of Chronic Kidney Diseas

CKD / CRF may be caused by systemic diseases are as follows:

1. DM.
2. Chronic Glomerulonefrtitis.
3. Pyelonephritis.
4. Toxic agents.
5. Uncontrolled hypertension.
6. Urinalysis tract obstruction.
7. Vascular disorders.
8. Infection.

Clinical manifestations of Chronic Kidney Disease

1. Cardiovascular system: includes hypertension (due to fluid retention and sodium from activation of the renin-angiotensin-aldosterone system), congestive heart failure and pulmonary edema (due to excess fluid) and pericarditis (due to irritation of the pericardial layers by uremic toxins).
2. Integrumenurum system: severe itching (pruritus). Granules is a penunpukkan uremic urine crystals in the skin, hair thin and rough.
3. Gastrointestinal System: anorexia, nausea, vomiting.
4. Neurovascular system: changes in the level of consciousness, inability to concentrate, and muscle spasms kedura.
5. Pulmonary System: krekels, sputun thick, deep breath and kusmaul.
6. Reproductive system: amenorrhea, testicular atrifi.

Nursing Diagnosis : Decreased Cardiac Output related to increased cardiac load

Goal: Decrease in cardiac output does not occur

Expected outcomes : maintain cardiac output and blood pressure with evidence of cardiac frequency in the normal range, strong peripheral pulses and capillary refill time is equal to.

Intervention:
1. Auscultation of heart and lungs.
R /: The presence of an irregular heart rate tachycardia.

2. Assess for hypertension.
R /: Hypertension may occur due to interference with the system of the renin-angiotensin-aldosterone system (caused by renal dysfunction).

3. Investigate complaints of chest pain, note the location, severity (0-10 scale).
R /: HT and CRF can cause pain.

4. Assess the level of activity, response to activity.
R /: Fatigue can also accompany CRF anemia.



Nursing Diagnosis : Impaired Skin Integrity related to pruritis

Goal : Skin integrity can be maintained

Expected outcomes :
Maintaining intact skin.
Shows the behavior / technique to prevent skin damage.

Intervention :
1. Inspection of the skin to change color, turgor, vascular, note any redness.
R / : Indicates areas poor circulation or damage that may lead to the formation of pressure sores / infections.

2. Monitor fluid intake and hydration of the skin and mucous membranes.
R / : Detecting the presence of dehydration or overhydration affecting circulation and tissue integrity

3. Inspection of the area depends on the edema.
R / : Tissue edema is more likely to be damaged / torn.

4. Change positions as often as possible.
R / : Lowering pressure on edema, poorly perfused tissue to reduce ischemia.

5. Give skin care.
R / : Reduce drying, skin tears.

6. Maintain a dry linen.
R / : Lowering dermal irritation and the risk of skin damage.

7. Instruct the patient to use a damp and cold compresses to put pressure on the area pruritis.
R / : Eliminate the discomfort and reduce the risk for injury.

8. Encourage wear loose cotton clothes.
R / : Prevent direct dermal irritation and improve skin moisture evaporation.

Sample of Nursing Care Plan for Heart Failure - Decreased Cardiac Output

Nursing Care Plan for Heart Failure 
 
Nursing Diagnosis : Decreased Cardiac Output 

NANDA Definition:

Inadequate blood pumped by the heart to meet metabolic demands of the body

Nursing Diagnosis:

Decreased cardiac output related to Altered heart rate and rhythm AEB bradycardia

characterized by:

• with pale conjunctiva, nail beds and buccal mucosa
• irregular rhythm of the pulse
• bradycardic
• pulse rate of 34 beats / min
• generalized weakness

Short-Term Objectives:
the patient Will Participate in activities That Reduced the workload of the heart.

Long-Term Objectives:
Will the patient be Able to display hemodynamic stability.

Nursing Interventions Decreased Cardiac Output Congestive Heart Failure:

1. Auscultation apical pulse; examine the frequency, the heart rhythm.
Rational: Usually tachycardia (even at rest) to compensate for the decrease in ventricular contractility.

2. Record the heart sounds.
Rational: S1 and S2 may be weak due to decreased pumping action. Gallop rhythm common (S3 and S4) is generated as the flow of blood to the porch of distension. Mur-mur may indicate incompetence / stenosis of the valve.

3. Palpation of peripheral pulses.
Rational: The decrease in cardiac output may show decreased radial artery, popliteal, dorsalis, pedis and posttibial. The pulse may disappear fast or irregular pulse to be palpable and alternan.

4. Monitor blood pressure.
Rational: In Congestive Heart Failure early, moderate or chronic blood pressure may increase. In Congestive Heart Failure-up body could no longer compensate and hypotension can not be normal again.

5. Assess against pale skin and cyanosis.
Rational: Pale, indicating reduced peripheral perfusion secondary to cardiac output adekutnya not; vasoconstriction and anemia. Cyanosis may occur as refrakstori Congestive Heart Failure. The area of ​​pain is often colored blue striped atu because of increased venous congestion.

6. Give supplemental oxygen by nasal cannula / mask and drugs as indicated (collaboration).
Rationale: Increased dosage of oxygen to the need to counter the effects of myocardial hypoxia / ischemia.