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 Imbalanced Nutrition: Less Than Body Requirements
- Nutrition: imbalanced, risk for less than body requirements
Risk factors may include
- Protein catabolism; dietary restrictions to reduce nitrogenous waste products
- Increased metabolic needs
- Anorexia, nausea/vomiting; ulcerations of oral mucosa
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/regain weight as indicated by individual situation, free of edema.
|Assess and document dietary intake.||Aids in identifying deficiencies and dietary needs. General physical condition, uremic symptoms (nausea, anorexia), and multiple dietary restrictions affect food intake.|
|Provide frequent, small feedings.||Minimizes anorexia and nausea associated with uremic state and/or diminished peristalsis.|
|Give patient/SO a list of permitted foods or fluids and encourage involvement in menu choices.||Provides patient with a measure of control within dietary restrictions. Food from home may enhance appetite.|
|Offer frequent mouth care or rinse with diluted acetic acid solution. Give gums, hard candy, breath mints between meals.||Mucous membranes may become dry and cracked. Mouth care soothes, lubricates, and helps freshen mouth taste, which is often unpleasant because of uremia and restricted oral intake. Rinsing with acetic acid helps neutralize ammonia formed by conversion of urea.|
|Weigh daily.||The fasting or catabolic patient normally loses 0.2–0.5 kg/day. Changes in excess of 0.5 kg may reflect shifts in fluid balance.|
|Monitor laboratory studies: BUN, albumin, transferrin, sodium, and potassium.||Indicators of nutritional needs, restrictions, and necessity for and effectiveness of therapy.|
|Consult with dietitian support team.||Determines individual calorie and nutrient needs within the restrictions, and identifies most effective route and product (oral supplements, enteral or parenteral nutrition).|
|Provide high-calorie, low to moderate protein diet. Include complex carbohydrates and fat sources to meet caloric needs and essential amino acids. Avoid concentrated sugar sources. Give anorectic patients small, frequent meals.||The amount of needed exogenous protein is less than normal unless patient is on dialysis. Carbohydrates meet energy needs and limit tissue catabolism, preventing keto acid formation from protein and fat oxidation. Carbohydrate intolerance mimicking DM may occur in severe renal failure. Essential amino acids improve nitrogen balance and nutritional status, stimulate repair of tubular epithelial cells, and enhance patient’s ability to fight systemic complications.|
|Maintain proper electrolyte balance by strictly monitoring levels.||Medications and decrease in GFR can cause electrolyte imbalances and may further cause renal injury.|
|Restrict potassium, sodium, and phosphorus intake as indicated.||Restriction of these electrolytes may be needed to prevent further renal damage, especially if dialysis is not part of treatment, and/or during recovery phase of ARF.|
|Administer medications as indicated:|
||Iron deficiency may occur if protein is restricted, patient is anemic, or GI function is impaired.|
||Restores normal serum levels to improve cardiac and neuromuscular function, blood clotting, and bone metabolism. Note: Low serum calcium is often corrected as phosphate absorption is decreased in the GI system. Calcium may be substituted as a phosphate binder.|
||Necessary to facilitate absorption of calcium from the GI tract.|
||Vital as coenzyme in cell growth and actions. Intake is decreased because of protein restrictions.|
||Given to relieve N/V and may enhance oral intake.|
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