Nursing Care of Diabetic Nephropathy

The nurse can take an active role in encouraging lifestyle changes, monitoring medication regimens, and advocating for appropriate screening tools and frequency for patients with diabetic nephropathy. The nurse and patient working together should aim for:

·      A regular exercise program.

·      Weight loss if indicated by BMI greater than 25.

·      Cessation of smoking

·      A low Sodium Diet

o   Advise patient to check food labels

·      Avoid NSAIDS & other nephrotoxins

·      Target Blood pressure less than 130/80

·      Target HgbA1C less than 7%

o   Check every 3 months

·      Reduce LDL cholesterol levels

·      Consider prescribing aspirin

·      Adjust medication dosing for level of eGFR

·      Discontinue metformin for eGFR ≤ 30. Use with caution or discontinue for eGFR < 60.

•            Monitor glucose closely and consider stopping long acting glyburide in patients with declining eGFR

The following is a great resource for nursing managements of diabetic nephropathy. This document provides tangible tasks that a RN can work towards together with her patient:

http://www.kidneyhealth.ca/wp/wp-content/uploads/pdfs/MRP-diabetic-guidelines.pdf

Diabetic Nephropathy Management Guidelines – to be used concomitantly with Kidney Disease Referral Pathway. Manitoba Renal Program.

http://www.kidneyhealth.ca/wp/wp-content/uploads/pdfs/MRP-diabetic-guidelines.pdf

Ackley, B.J. & Ladwig, G.B. (2011). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. St. Louis, Missouri: Elsevier.