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 Infection
Risk factors may include
- Depression of immunologic defenses (secondary to uremia)
- Invasive procedures/devices (e.g., urinary catheterization)
- Changes in dietary intake/malnutrition
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.
- Experience no signs/symptoms of infection.
|Promote good hand washing by patient and staff.||Reduces risk of cross contamination.|
|Avoid invasive procedures, instrumentation, and manipulation of indwelling catheters whenever possible. Use aseptic technique when caring and manipulating IV and invasive lines. Change site dressings per protocol. Note edema, purulent drainage.||Limits introduction of bacteria into body. Early detection of developing infection may prevent sepsis.|
|Provide routine catheter care and promote meticulous perineal care. Keep urinary drainage system closed and remove indwelling catheter as soon as possible.||Reduces bacterial colonization and risk of ascending UTI.|
|Encourage deep breathing, coughing, frequent position changes.||Prevents atelectasis and mobilizes secretions to reduce risk of pulmonary infections.|
|Assess skin integrity.||Excoriations from scratching may become secondarily infected.|
|Monitor vital signs.||Fever (higher than 100.4°F) with increased pulse and respirations is typical of increased metabolic rate resulting from inflammatory process, although sepsis can occur without a febrile response.|
|Monitor WBC count with differential.||Although elevated WBCs may indicate generalized infection, leukocytosis is commonly seen in ARF and may reflect injury within the kidney. A shifting of the differential to the left is indicative of infection.|
|Obtain specimen(s) for culture and sensitivity and administer appropriate antibiotics as indicated.||Verification of infection and identification of specific organism aids in choice of the most effective treatment. Note: A number of anti-infective agents require adjustments of dose and/or time while renal clearance is impaired.|
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