End-Stage Renal Disease (ESRD) Nursing Diagnosis & Care Plan – devshopsimplenursing

End-Stage Renal Disease (ESRD) Nursing Diagnosis & Care Plan

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By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
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As kidney function declines, small imbalances can quickly turn into bigger problems — fluid overload, electrolyte shifts, and changes in mental status. 

For nurses, that means staying alert to early signs and acting fast. A well-defined ESRD nursing diagnosis helps organize care in a way that’s clear, focused, and responsive — so nothing important gets overlooked, even when the situation is complex.


What is End-Stage Renal Disease?

ESRD marks the most advanced phase of chronic kidney disease (CKD), where there’s a decline in kidney function to less than 10-15% of normal capacity. 

At this point, kidneys can no longer maintain fluid, electrolyte, or waste balance. Patients usually require dialysis or a kidney transplant for survival.

Signs and Symptoms of End-Stage Renal Disease

The clinical presentation of ESRD can vary widely, often developing gradually before escalating. 

These symptoms frequently lead to further evaluation and the development of a nursing diagnosis for end-stage renal disease. Recognizing these signs early supports timely intervention and helps prevent complications.

  • Persistent nausea and vomiting
  • Fatigue and weakness
  • Fluid retention (edema in legs, ankles, feet)
  • Dyspnea
  • Confusion or reduced mental clarity
  • Hypertension
  • Pruritus (itching)
  • Anemia
  • Muscle cramps and twitches

Nursing Process for End-Stage Renal Disease

The nursing process includes:

  • Assessment
  • Diagnosis
  • Planning
  • Implementation
  • Evaluation

End-Stage Renal Disease Nursing Assessment

Assessment is the foundation for every intervention that follows. 

With ESRD, the focus is on what the kidneys can’t do anymore and how to keep the body in balance.

  • Monitor weight and fluid intake/output.
  • Evaluate for signs of uremia (confusion, pericarditis, or itching).
  • Monitor lab values (BUN, creatinine, GFR, potassium, sodium, calcium, phosphate).
  • Assess for edema, dyspnea, and signs of fluid overload.
  • Evaluate access site for hemodialysis (AV fistula/graft).
  • Assess the patient’s understanding of ESRD and treatment regimen.

End-Stage Renal Disease Nursing Diagnosis

Common nursing diagnoses for ESRD include:

End-Stage Renal Disease Nursing Interventions

With an ESRD nursing diagnosis in hand, the focus shifts to interventions — daily actions that stabilize the patient and support long-term management.

  • Strictly monitor daily weight and intake/output.
  • Educate the patient on fluid, sodium, potassium, and phosphorus restrictions.
  • Administer medications (phosphate binders, erythropoietin, antihypertensives) as prescribed.
  • Prepare and monitor for dialysis treatments.
  • Support psychosocial well-being through education and counseling.

Nursing Goals and Expected Outcomes for End-Stage Renal Disease

Use clearly defined goals to monitor patient response and determine whether ESRD interventions are working as intended.

  • Patient will maintain stable fluid and electrolyte balance
  • Patient will demonstrate understanding of dietary restrictions
  • Patient will experience decreased uremic symptoms
  • Patient will report improved quality of life
  • Patient will remain free of infection

Nursing Care Plans for End-Stage Renal Disease

These targeted care plans address some of the most frequent and high-risk complications seen in patients with ESRD. 

Each one outlines how to assess, intervene, and support recovery, while keeping care aligned with the patient’s evolving needs.

Care Plan #1 – Fluid Volume Overload

Diagnostic Statement

Excess fluid volume related to decreased renal excretion secondary to ESRD as evidenced by weight gain, edema, dyspnea, and hypertension

Expected Outcomes

  • Patient will maintain weight within 1–2 lbs of dry weight
  • Patient will exhibit decreased edema and improved respiratory status

Assessment

  • Monitor daily weights, blood pressure, lung sounds, and peripheral edema.
  • Assess fluid intake/output and dietary sodium intake.

Interventions

  • Restrict fluid intake as ordered (usually 1 to 1.5 liters per day).
  • Educate the patient on a sodium-restricted diet.
  • Administer diuretics (if residual renal function allows).
  • Prepare for and monitor the effects of dialysis sessions.
  • Elevate edematous limbs and monitor respiratory status closely.

Care Plan #2 – Risk for Electrolyte Imbalance

Diagnostic Statement

Risk for electrolyte imbalance related to impaired renal excretion of potassium, sodium, calcium, and phosphorus

Expected Outcomes

  • Patient will maintain normal electrolyte levels within prescribed limits
  • Patient will report signs and symptoms of electrolyte imbalances promptly

Assessment

  • Monitor lab values (potassium, calcium, phosphate, and sodium).
  • Evaluate the electrocardiogram for signs of hyperkalemia (peaked T-waves, arrhythmias).
  • Assess for muscle weakness, twitching, and confusion.

Interventions

  • Educate the patient on foods low in potassium and phosphorus.
  • Administer phosphate binders and calcium supplements as prescribed.
  • Collaborate with dietary services for meal planning.
  • Prepare for emergent dialysis if electrolyte levels are critically abnormal.

Care Plan #3 – Impaired Renal Function Leading to Uremia

Diagnostic Statement

Impaired renal function leading to accumulation of nitrogenous wastes (uremia) related to ESRD as evidenced by pruritus, fatigue, confusion, and nausea

Expected Outcomes

  • Patient will verbalize understanding of signs of uremia
  • Patient will report improvement in symptoms following dialysis

Assessment

  • Assess mental status, level of fatigue, nausea, and pruritus.
  • Monitor lab values (BUN and creatinine).
  • Evaluate skin integrity due to itching.

Interventions

  • Maintain dialysis schedule and monitor response to treatment.
  • Encourage rest periods and cluster care to reduce fatigue.
  • Provide skin care and use anti-itch creams as prescribed.
  • Administer antiemetics for nausea if needed.
  • Promote balanced nutrition with renal-safe dietary choices.

Patient Education and Discharge Planning

Every nursing diagnosis for end-stage renal disease should include an education plan tailored to the patient’s treatment, lifestyle, and specific risks.

  • Teach the importance of treatment adherence, dialysis schedules, and follow-ups.
  • Educate the patient on renal diet (low protein, potassium, sodium, phosphorus).
  • Discuss fluid restrictions and weight monitoring.
  • Instruct the patient on the signs of complications (infection, electrolyte imbalance).
  • Provide resources for psychosocial support, including counseling and support groups.
  • Review medications and potential side effects.

Recommended Resources on End-Stage Renal Disease

Need more tools to support an ESRD nursing diagnosis or care plan? 

These organizations provide evidence-based guides, patient tools, and ongoing education.

Nursing Care Plan Resources

A Clear Plan with Confident Care 

Patients living with ESRD rely to catch changes early, explain what’s happening, and make decisions that protect their health.

That’s where a focused ESRD nursing diagnosis makes a difference. It helps nurses deliver care that’s personal, responsive, and rooted in what the patient needs.

References and Sources