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 Deficient Fluid Volume
- Risk for Deficient Fluid Volume
Risk factors may include
- Excessive loss of fluid (diuretic phase of ARF, with rising urinary volume and delayed return of tubular reabsorption capabilities)
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.
- Display I&O near balance; good skin turgor, moist mucous membranes, palpable peripheral pulses, stable weight and vital signs, electrolytes within normal range.
|Measure I&O accurately. Weigh daily. Calculate insensible fluid losses.||Assessment can help estimate fluid replacement needs. Fluid intake should approximate losses through urine, nasogastric or wound drainage, and insensible water losses (diaphoresis, metabolism).|
|Provide allowed fluids throughout 24-hr period.||Diuretic phase of ARF may revert to oliguric phase if fluid intake is not maintained or nocturnal dehydration occurs.|
|Monitor BP (noting postural changes) and HR.||Orthostatic hypotension and tachycardia suggest hypovolemia.|
|Note signs and symptoms of dehydration: dry mucous membranes, thirst, dulled sensorium, peripheral vasoconstriction.||In diuretic or postobstructive phase of renal failure, urine output can exceed 3 L/day. Extracellular fluid volume depletion activates the thirst center, and sodium depletion causes persistent thirst, unrelieved by drinking water. Continued fluid losses including inadequate replacement may lead to hypovolemic state.|
|Control environmental temperature; limit bed linens as indicated.||May reduce diaphoresis, which contributes to overall fluid losses.|
|Monitor laboratory studies||In nonoliguric ARF or in diuretic phase of ARF, large urine losses may result in sodium wasting while elevated urinary sodium acts osmotically to increase fluid losses. Restriction of sodium may be indicated to break the cycle.|
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