Nursing Care for DN

Nursing Care for DN

There are many ways and levels at which a nurse can help care for a patient with DN. Care for patients with DN will differ depending on how far along their disease has progressed. I will break the care into what I consider "out-patient care" and "in-patient care" because that makes the most sense to me, and I think that is the most significant way to break them down. However, lots of care techniques could overlap, and obviously nurses can do "in-patient type care" if they do home visits, etc...

Out-patient care
Nurse who care for DN patients in out-patient setting will do a lot of patient education on diet/medications, urine screening, BP control, and blood glucose control. Patients who are on ACE inhibitors, like enalapril or lisinopril, for their BP may feel the side effects cough, low BP or dizziness; this may lead them to believe they are getting sicker. Nurses will need to educate patients on how to incorporate a low-sodium diet into their lifestyle. Regular urine screenings are also important to monitor the regular release of protein in the urine, to track whether the condition is wrsening or improving.

In-patient care
For patients who are in the hospital because of the severity of their kidney disease, the nurse will care for them in a more involved manner. To prevent edema and retained ECF, daily weigh-ins allow nurses to see exactly how much fluid their patients are retaining. Monitoring stricts I/O's also aids the nurse in getting a clear picture of exactly how much fluid his/her patient is retaining. The nurse will be the first person aware of his/her patient's edema/fluid status, and is in prime position to recommend a diuertic if necessary. When treating DN patients on diuertics, the nurse should monitor serum levels of potassium, as diuretics can lead to a K deficiency. With patients in the hospital, the nurse is also able to more closely monitor glucose and BP.


"Diabetic Nephropathy." Diabetes Care. 25 (2002): 585-89. Retrieved from http://care.diabetesjournals.org/content/25/suppl_1/s85.full#sec-5

Aiello, J. H. "Preventing Diabetic Nephropathy: The Role of Primary Care." Nurse Practitioner 23.2 (1998): n. pag. Web

So...what's a nurse to do?

So... what's a nurse to do about it?

Nurses normally are not the ones "curing" patients with diabetic nephropathy. But guess what- neither are doctors! It takes a team of health care professionals to care for a patient with DN, with each of them doing their respective part. And it is crucial that a nurse define and understand his or her scope of practice in the care process.

Some of the main problems that nurses deal with will involve fluid, hydration, and nutrition. This is because the kidneys of patients with DN are no longer able to filter out glucose from the urine effectively. This leads to a shift in oncotic pressure in the kidney's blood vessels, causing the body to rid itself of its excess urine along with the excess glucose. However, when the body starts losing all of its fluid through urination, renin is produced to stimulate vasoconstriction and shunting blood away from the kidneys. When the blood doesn't go through the kidneys, it becomes full of waste product, and also the kidneys lose their blood supply.

So all of these shifting fluid and pressure levels in the body lead to lots of problems involving electrolyte balances, dilution, and concentration etc. It is important for the nurse to recognize when her patient may be overhydrated, dehydrated, or be suffering from an electrolyte imbalance.

Some common nursing diagnosing addressing the problems of DN include: deficient fluid volume, imbalanced nutrition: less than the body requires, fatigue, decreased tissue perfusion, and urinary retention.

Nursing Care Plan for DN
Nursing Diagnosis	Plan	Goals
Patient has decreased tissue perfusion, due to insufficient renal filtration and subsequent vasoconstriction	Monitor patient’s vital signs regularly Request an order for an ACE inhibitor or similar drug to stimulate vasodilation and consequently lower the BP Instruct and education patient on how to stick to a low-sodium diet	The patient’ BP will drop from HTN and stay within the normal limits for BP Patient’s extremities will remain warm and without cyanosis or pallor Patient will have good capillary refill (under 3 seconds) The patient will understand the ACE inhibitor medication regimen and the importance it plays in his health

 

Gulanick, M., & Myers, J. (2009). Online care plan constructor. Nursing care plans:Nursing diagnosis and intervention (6th ed.). Retrieved February 20th, 2015 from
http://www1.us.elsevierhealth.com/ME...ex.cfm?plan=02

Lewis, S., Dirksen, S., Heitkamper, M., & Bucher, L (2014). Medical-Surgical Nursing. Saint Louis, MO: Elsevier.