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.
- Excess Fluid Volume
- Risk for Decreased Cardiac Output
- Risk for Imbalanced Nutrition: Less Than Body Requirements
- Risk for Infection
- Risk for Deficient Fluid Volume
- Deficient Knowledge
- Other Possible Nursing Care Plans
Risk for Decreased Cardiac Output
- Risk for decreased cardiac output
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.
- 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.
|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:|
||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.|
||In addition to its own cardiac effects, calcium deficit enhances the toxic effects of potassium.|
||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:|
||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.|
||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.|
||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.|
||May be used to correct acidosis or hyperkalemia (by increasing serum pH) if patient is severely acidotic and not suffering from fluid overload.|
||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 nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 14+ Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans