6 Acute Renal Failure Nursing Care Plans


Acute renal failure (ARF), also known as acute kidney failure or acute kidney injury, is the abrupt loss of kidney function. The glomerular filtration rate (GFR) falls over a period of hours to a few days and is accompanied by concomitant rise in serum creatinine and urea nitrogen. If left untreated, acute renal failure may complicate to chronic renal failure.

The annual incidence of acute renal failure is 100 cases for every million people in the United States. It is diagnosed in 1% of hospital admissions.

Nursing Care Plans

Nursing goal of treating patients with acute renal failure is to correct or eliminate any reversible causes of kidney failure. Provide support by taking accurate measurements of intake and output, including all body fluids, monitor vital signs and maintain proper electrolyte balance.

Here are six (6) nursing care plans (NCP) and nursing diagnosis for patients with acute renal failure: 

  1. Excess Fluid Volume
  2. Risk for Decreased Cardiac Output
  3. Risk for Imbalanced Nutrition: Less Than Body Requirements
  4. Risk for Infection
  5. Risk for Deficient Fluid Volume
  6. Deficient Knowledge
  7. Other Possible Nursing Care Plans

Risk for Decreased Cardiac Output

Nursing Diagnosis

Risk factors may include

  • Fluid overload (kidney dysfunction/failure, overzealous fluid replacement)
  • Fluid shifts, fluid deficit (excessive losses)
  • Electrolyte imbalance (potassium, calcium); severe acidosis
  • Uremic effects on cardiac muscle/oxygenation

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • Maintain cardiac output as evidenced by BP and HR/rhythm within patient’s normal limits; peripheral pulses strong and equal with adequate capillary refill time.
Nursing InterventionsRationale
Monitor BP and HR.Fluid volume excess, combined with hypertension (common in renal failure) and effects of uremia, increases cardiac workload and can lead to cardiac failure. In ARF, cardiac failure is usually reversible.
Observe ECG or telemetry for changes in rhythm.Changes in electromechanical function may become evident in response to progressing renal failure and accumulation of toxins and electrolyte imbalance. Peaked T wave, wide QRS, prolonged PR interval is usually associated with hyperkalemia. Flat T wave, peaked P wave, and appearance of the U waves usually indicate hypokalemia. Prolonged QT interval may reflect calcium deficit.
Auscultate heart sounds.Development of S3/S4 is indicative of failure. Pericardial friction rub may be only manifestation of uremic pericarditis, requiring prompt intervention and possibly acute dialysis.
Assess color of skin, mucous membranes, and nail beds. Note capillary refill time.Pallor may reflect vasoconstriction or anemia. Cyanosis is a late sign and is related to pulmonary congestion and/or cardiac failure.
Note occurrence of slow pulse, hypotension, flushing, nausea and vomiting, and depressed level of consciousness.Use of drugs (like antacids) containing magnesium can result in hypermagnesemia, potentiating the neuromuscular dysfunction and risk of a respiratory or cardiac arrest. Use aluminum-hydroxide-based antacid.
Monitor for GI bleeding by guaiac testing all stools for blood.Gastrointestinal bleeding is a known complication of renal failure; however, its pathogenesis remains uncertain. Some have attributed gastrointestinal bleeding to the effects of uremia on the gastrointestinal mucosa; others have suggested that uremia may affect platelet adhesiveness, which may explain the prolonged gastrointestinal bleeding seen in patients with renal failure. In addition, the role of heparinization and the widespread use of antiplatelet agents in patients on dialysis have been implicated in the etiology of gastrointestinal bleeding.
Investigate reports of muscle cramps, numbness of fingers, with muscle twitching, hyperreflexia.Neuromuscular indicators of hypocalcemia, which can also affect cardiac contractility and function.
Maintain bed rest or encourage adequate rest and provide assistance with care and desired activities.Reduces oxygen consumption and cardiac workload.
Monitor laboratory studies: 
  • Potassium.
During oliguric phase, hyperkalemia is present but often shifts to hypokalemia in diuretic or recovery phase. Any potassium value associated with ECG changes requires intervention. Note: A serum level of 6.5 mEq or higher constitutes a medical emergency.
  • Calcium.
In addition to its own cardiac effects, calcium deficit enhances the toxic effects of potassium.
  • Magnesium.
Dialysis or calcium administration may be necessary to combat the CNS-depressive effects of an elevated serum magnesium level.
Administer and/or restrict fluids as indicated.Cardiac output depends on circulating volume (affected by both fluid excess and deficit) and myocardial muscle function.
Provide supplemental oxygen if indicated.Maximizes available oxygen for myocardial uptake to reduce cardiac workload and cellular hypoxia.
Administer medications as indicated:
  • Inotropic agents: digoxin (Lanoxin)
May be used to improve cardiac output by increasing myocardial contractility and stroke volume. Dosage depends on renal function and potassium balance to obtain therapeutic effect without toxicity.
  • Calcium gluconate
Serum calcium is often low but usually does not require specific treatment in ARF. Calcium gluconate may be given to treat hypocalcemia and to offset the effects of hyperkalemia by modifying cardiac irritability.
  • Aluminum hydroxide gels (Amphojel, Basaljel)
Increased phosphate levels may occur as a result of failure of glomerular filtration and require use of phosphate-binding antacids to limit phosphate absorption from the GI tract.
Temporary measure to lower serum potassium by driving potassium into cells when cardiac rhythm is endangered.
  • Sodium bicarbonate or sodium citrate
May be used to correct acidosis or hyperkalemia (by increasing serum pH) if patient is severely acidotic and not suffering from fluid overload.
  • Sodium polystyrene sulfonate (Kayexalate) with or without sorbitol.
Exchange resin trades sodium for potassium in the GI tract to lower serum potassium level. Sorbitol may be included to cause osmotic diarrhea to help excrete potassium.
Prepare for/assist with dialysis as necessary.May be indicated for persistent dysrhythmias, progressive HF unresponsive to other therapies.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans and nursing diagnoses related to reproductive and urinary system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
  • hello.
    i am happy to get help from ur this page.i was assigned fr this acute renal failure toic.i have done my assignment by taking help this page.i am obliged.shabana hameed.RN,BSCN.

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