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 Deficient Fluid Volume

Nursing Diagnosis

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.

Desired Outcomes

  • Display I&O near balance; good skin turgor, moist mucous membranes, palpable peripheral pulses, stable weight and vital signs, electrolytes within normal range.
Nursing InterventionsRationale
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 studiesIn 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.

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.
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