Nursing Care Plan Acute Renal Failure - ARF

Acute Renal Failure Definition

Acute renal failure (ARF) is the rapid breakdown of renal (kidney) function that occurs when high levels of uremic toxins (waste products of the body's metabolism) accumulate in the blood. ARF occurs when the kidneys are unable to excrete (discharge) the daily load of toxins in the urine.

Based on the amount of urine that is excreted over a 24-hour period, patients with ARF are separated into two groups :

• Oliguric: patients who excrete less than 500 milliliters per day (< 16 oz/day)
• Nonoliguric: patients who excrete more than 500 milliliters per day (> 16 oz/day)

Acute Renal Failure Causes

Causes of acute kidney failure fall into one of the following categories:

• Prerenal: Problems affecting the flow of blood before it reaches the kidneys
  
  
• Postrenal: Problems affecting the movement of urine out of the kidneys
  
  
• Renal: Problems with the kidney itself that prevent proper filtration of blood or production of urine

Acute Kidney Failure Symptoms

The following symptoms may occur with acute kidney failure. Some people have no symptoms, at least in the early stages. The symptoms may be very subtle.

• Decreased urine production
  
  
• Body swelling
  
  
• Problems concentrating
  
  
• Confusion
  
  
• Fatigue
  
  
• Lethargy
  
  
• Nausea, vomiting
  
  
• Diarrhea
  
  
• Abdominal pain
  
  
• Metallic taste in the mouth

Seizures and coma may occur in very severe acute kidney failure.


Nursing Care Plan for ARF - Acute Renal Failure

Acute Renal Failure Nursing Assessment

1. Activity and Rest
   Symptoms:
   Fatigue, weakness, malaese
   
   Signs:
   Muscle weakness and loss of tonus
2. Circulation
   
   Signs:
   Hypotension / hypertension (including malignant hypertension, eclampsia / hypertension due to pregnancy).
   Cardiac dysrhythmia.
   Pulse weak / soft orthostatic hypotension (hipovalemia).
   Strong pulse (hipervolemia).
   Edema public network (including the periorbital area of the sacrum ankle).
   Pale, bleeding tendency
3. Elimination
   Symptoms:
   Changes in the pattern of urination, increased frequency, polyuria (early failure), or decrease the frequency / oliguria (final phase)
   Dysuria, doubt, encouragement, and retention (inflammation / obstruction, infection).
   Abdominal bloating, diarrhea or constipation.
   
   Signs:
   Change the color of dark yellow urine samples, red, brown, cloudy.
   Oliguric (usually 12-21 days), polyuria (2-6 liters / day).
4. Food / Fluids
   Symptoms:
   Increased weight (edema), weight loss (dehydration).
   Nausea, vomiting, anorexia, heartburn
   Use of diuretics
   
   Signs:
   Changes in skin turgor / humidity.
   Edema (General, bottom).
5. Neurosensori
   Symptoms:
   Headaches, blurred vision.
   Muscle cramps / spasms, syndrome "Restless legs".
   
   Signs:
   Impaired mental status, examples of decline in the field of attention, inability to concentrate, memory loss, confusion, decreased level of consciousness (azotemia, electrolyte imbalance / acid-base.
   Seizures, seizure activity.
6. Pain / Leisure
   Symptoms:
   Body aches, headache
   
   Signs:
   Cautious behavior / distraction, anxiety
7. Respiratory
   Symptoms:
   Shortness of breath
   
   Signs:
   Takipnoe, dispnoe, increased frequency, kusmaul, ammonia breath, productive cough with thick pink sputum (pulmonary edema).
8. Comfort
   Symptoms:
   Transfusion reaction
   
   Signs:
   Fever, sepsis (dehydration), or skin ptekie ekimosis, pruritus, dry skin.
9. Counseling / Learning
   Symptoms:
   Family history of polycystic disease, hereditary nephritis, urinary stones, malignancies., a history of exposure to toxins, (drugs, environmental toxins), nephrotic repeated use of drugs eg aminoglycosides, amphotericin, anesthetic vasodilator.

Acute Renal Failure Nursing Diagnosis

1. Excess fluid volume related to decreased Glomerular filtration rate and sodium retention.
2. Imbalanced nutrition: less than body requirements related to catabolic state, anorexia, and malnutrition associated with acute renal failure.
3. Risk for infection related to alterations in the immune system and host defenses.

Acute Renal Failure Nursing Intervention

1.Excess fluid volume related to decreased Glomerular filtration rate and sodium retention.

Goal : Achieving fluid and electrolyte balance

Nursing Intervention

• Monitor urinary output and urine specific gravity; measure and record intake and output including urine, gastric suction, stools, wound drainage, perspiration (estimate).
• Monitor serum and urine electrolyte concentrations.
• Monitor for signs and symptoms of hypovolemia or hypervolemia because regulating capacity of kidneys is inadequate.
• Inspect neck veins for engorgement and extremities, abdomen, sacrum, and eyelids for edema.
• Evaluate for signs and symptoms of hyperkalemia, and monitor serum potassium levels.
• Administer sodium bicarbonate or glucose and insulin to shift potassium into the cells.
• Instruct patient about the importance of following prescribed diet, avoiding foods high in potassium.
• Prepare for dialysis when rapid lowering of potassium is needed.

2. Imbalanced nutrition: less than body requirements related to catabolic state, anorexia, and malnutrition associated with acute renal failure.

Goal :
Maintaining adequate nutrition

Nursing Intervention

• Monitor BUN, creatinine, electrolytes, serum albumin, prealbumin, total protein, and transferrin.
• Be aware that food and fluids containing large amounts of sodium, potassium, and phosphorus may need to be restricted.
• Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories.
• Work collaboratively with dietitian to regulate protein intake according to impaired renal function because metabolites that accumulate in blood derive almost entirely from protein catabolism.
Prepare for hyperalimentation when adequate nutrition cannot be maintained through the GI tract.

3. Risk for infection related to alterations in the immune system and host defenses.

Goal :

Nursing Intervention

• Remove bladder catheter as soon as possible; monitor for UTI.
• Use intensive pulmonary hygiene high incidence of lung edema and infection.
• Monitor for all signs of infection. Be aware that renal failure patients do not always demonstrate fever and leukocytosis.
• If antibiotics are administered, care must be taken to adjust the dosage for renal impairment.

Source : http://www.nephrologychannel.com/arf/index.shtml http://www.emedicinehealth.com/acute_kidney_failure/page3_em.htm#Acute%20Kidney%20Failure%20Symptoms