Renal failure definition

Nursing Diagnosis and Care Plan for Acute Renal Failure- A Student’s Guide

Introduction

Acute renal failure (ARF) is a severe condition that can lead to the accumulation of fluid in the body and other life-threatening complications. Medical practitioners need to be up-to-date on nursing diagnosis and care plans for this potentially fatal illness.

Today’s blog post will cover some basics about acute renal failure and how healthcare professionals treat it. We hope you find this helpful information! Also, as you ready, keep in mind that our professional nursing writers are ready to help in case you get stuck with your nursing assignment. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What Is Renal Failure?

Renal failure is a state in which the kidneys are unable to filter blood properly. Instead of being purified, the blood backs up, causing it to flow through the body inadequately and causing adverse changes in chemistry levels (McGee & Tomaszewski, 2013).  Acute renal failure occurs when the accumulation of fluid is rapid as well as severe. Common causes of acute renal failure result from changes in blood flow, blockage of the urinary tract, and extensive bleeding or shock.

Acute Renal Failure (ARF) Meanings

The term “acute” means that it develops over a short period, whereas “chronic” means that the disorder develops over a long period (McGee & Tomaszewski, 2013).

What Are the Different Levels of Renal Failure?

Renal failure has differing levels of severity, which are classified as:

Acute renal failure – a sudden and rapid decrease in function to the point where dialysis is necessary;

Chronic kidney disease (CKD) stage 1 – the kidneys are still able to function but may begin to lose function within a few years;

Chronic kidney disease (CKD) stage 2 – one or both kidneys have lost 10-59% of their normal functions, which can be managed with proper treatment and care.

Acute Renal Failure Symptoms

Patients suffering from acute renal failure have several symptoms. They may experience

Patients experiencing severe cases of acute renal failure will display the following:

  • Confusion
  • Decreased appetite
  • Reduced pulse and blood pressure
  • Bouts of tingling or numbness in the hands, feet, or arms/legs
  • Severe stomach pain

What Are the Causes for Acute Renal Failure?

Although there are varying causes, acute renal failure (ARF) can be often caused by:

– A medication overdose resulting from kidney malfunction, as well as an accumulation of metabolic waste because the kidneys are not functioning properly 

-Other causes can be attributed to infections, blood clots, blockage of arteries, and stomach bleeding.

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What Are the Risk Factors?

Many risk factors can increase the likelihood of experiencing acute renal failure. The following is a list of potential factors:

-Some medications are known to increase the risk of developing acute renal failure. These include diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), heparin, cyclosporine, and immunosuppressants.

-A history of drug abuse or alcohol use can increase your risk of developing acute renal failure

What Is the Nursing Diagnosis for Acute Renal Failure?

Image: Anorexia is associated with renal failure

According to the DONA International’s list of nursing diagnoses, 11 potential diagnoses can be applied to patients with acute renal failure. The following is a comprehensive list:

  • Decreased cardiac output (Cardiomyopathy)
  • Decreased cardiac index (Cardiomyopathy)
  • Imbalanced nutrition: less than body requirements related to decreased appetite (Anorexia associated with renal failure)
  • Activity intolerance (Anorexia associated with renal failure)
  • Deficient knowledge related to the eating disorder and medication regimen regarding diet restrictions or dosing (Anorexia related to renal failure)
  • Deficient community health nursing care related to insufficient knowledge of patient’s specific treatment that restricts or prohibits eating disorder diet or dosing changes in medication (Anorexia associated with renal failure)
  • Impaired physical mobility (Cardiomyopathy)
  • Risk for reasoning confusion (Cardiomyopathy)
  • Risk for impaired skin integrity related to decreased mobility, thin body tissue (Anorexia associated with renal failure)
  • Disturbed body image (Anorexia associated with renal failure) 

Although the diagnosis can vary from one nurse to another and often depend on the level of education that each nurse has had, the treatments are generally similar.

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What Are Some of the Nursing Interventions for Acute Renal Failure?

Interventions can be categorized into physical comfort measures and cardiovascular monitoring.

Physical Comfort Measures

  • Promptly inform the physician/nursing staff when vital signs are abnormal
  • Monitor blood pressure, heart rate (pulse), and oxygen level
  • Encourage the patient to drink fluids during the hospital stay. Although water is okay, orange juice or grapefruit juice may taste better.
  • Most patients will be given a salt solution every two hours for one to two weeks. 
  • Monitor output of urine, which will be pale or explicit, to confirm kidney functioning and control excretion of metabolic waste products.

When the kidneys begin to work again, average amounts of fluid would be retained by the body. This results in swelling in the ankles and feet due to the excess fluid buildup.

Cardiovascular Monitoring

Assess for the development of cardiovascular symptoms such as:

  • Dizziness
  • Palpitations
  • Fluid retention causing swelling in the ankles and feet
  • Fainting 

Pharmacological Interventions:

Drugs can be used to stabilize the patient and improve their condition. 

Some of these drugs are:

-Furosemide is a diuretic that helps remove excess fluid from the body.    

-Lasix (Furosemide) works by increasing the amount of salt and water excreted by your kidneys. 

-Acetazolamide (Diamox) is a carbonic anhydrase inhibitor by the Parke Davis Company. The drug is indicated in patients with edema, hypernatremia, and elevated blood pressure associated with acute renal failure. Evidence has shown that acetazolamide affects the redistribution of body fluids from areas of the body with low sodium to areas that are well perfused. Acetazolamide can be used in conjunction with Furosemide as an effective therapy for edema and high blood pressure related to acute renal failure.

-Anti-hypertensive medications or vasodilators may also be given to decrease cardiac output, decrease blood pressure, and improve the patient’s condition. 

What Is The Long Term Nursing Care of a Patient With ARF?

After discharge from the hospital, patients are at risk for developing certain symptoms associated with acute renal failure. These include:

  • Symptoms related to fluid overloads such as edema, shortness of breath, swelling, and pulmonary edema
  • Symptoms related to electrolyte imbalance such as muscle spasms, tachycardia (rapid heartbeat), arrhythmias (irregular heartbeat), and nausea
  • Vomiting due to administration of diuretics such as Furosemide. 

How Do I Medicate Acute Renal Failure?

The medications used to prevent the progression of acute renal failure can be categorized into two groups, those administered intravenously and orally.

The following is a list of medications that are used to treat or manage acute renal failure:

-Furosemide (Lasix) – This medication works by increasing urine output by decreasing the reabsorption

Nursing Interventions for an Expectant Mother with ARF

Nursing interventions for an expectant mother with acute renal failure during labor and delivery include:

  • Managing pain control;
  • Monitoring maternal vital signs;
  • Counting amount of output fluid (urine) and
  • Assessing patient response to interventions.

The majority of patients with acute renal failure will receive hemodialysis. For those unable to receive hemodialysis, peritoneal dialysis may be used as a secondary option (McGee & Tomaszewski, 2013). 

Hemodialysis is often performed as an outpatient procedure while the patient is hospitalized for continuing care. It is a medical treatment that clears waste products from the blood, as a person’s kidneys cannot do this independently.

It is important to note that hemodialysis is a treatment that eliminates waste products and excess fluids from the body when normal kidney functioning cannot be maintained on its own. Patients who undergo hemodialysis will have access to a catheter, commonly located in their arm.

The primary concern that nurses have is the patient’s ability to tolerate hemodialysis treatments. Nurses must monitor patients closely during this treatment to ensure that they tolerate it and have as few adverse effects as possible.

Some specific nursing interventions provided include proper assessment, frequent monitoring, and patient education and teaching.

-Assess for signs of bleeding to prevent hemodynamic instability that may result from vascular access complications or inadequate fluid volume replacement.

-Administer prescribed analgesic/analgesic medication before initiation of treatment to decrease pain during hemodialysis procedure.

-Assess and monitor heart rate, respiratory rate, blood pressure during treatment.

Monitor I & O (input-output fluid) balance every few hours to identify any kidney functioning problems and eliminate waste products through urine output.

-Educate patient on signs/symptoms of complications or adverse effects: bleeding, fever, chills, dizziness, anxiety, and confusion. 

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Nursing Care Plan for Acute Renal Failure 

Nursing care plan for acute renal failure includes: –

-Assessment of the patients’ health status,

-Perform necessary nursing interventions and serve as a member of the healthcare team who will help decrease patient suffering until kidney functioning is back to normal. Keep in mind that other factors can also affect the severity and prognosis of acute renal failure, which include: age, cause, duration or stage of disease, and presence or absence of complications.

-In general acute renal failure occurs suddenly, which means that the patient will develop other complications more likely than an inpatient who suffers from chronic renal failure.

-Nurses should keep this in mind while providing nursing care for these patients. -For example, if they suffer from complications such as bleeding and dehydration, nurses should pay extra attention to these signs and symptoms.

By providing a nursing care plan for acute renal failure, nurses will be more helpful members of the patient’s healthcare team.

From the beginning until the end of the disease, the role of nurses is vital because they can act as an effective source that provides needed information and helps decrease patient’s suffering. Moreover, nurses can serve as responsible and active members of the medical team since they have to be aware of the disease and its complications to provide needed nursing interventions such as;

-Provide rehabilitation teaching for the patient so that they will be able to perform self-care effectively

-Educate patients about the importance of diet and nutrition during this disease,

-Identify other possible complications with the patient’s treatment and providing proper nursing interventions to prevent them from happening.

-Educate the public about the risks, causes, and stages of acute renal failure will help people learn more about how to manage it effectively.

Patients with acute renal failure can have the risk of infection during a treatment period, so nurses should keep this in mind while providing a nursing care plan for them.

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Image: Importance of diet and nutrition during renal failure

Acute Renal Failure (ARF) Complications

-Unable to conceive a child if not treated

-Increased risk for infection

-Altered ability to tolerate therapies.

-Risk for Injury: Due to dehydration and electrolytes disturbance patient is at increased risk of fluid overload, which may, in turn, lead to edema or bloating of the patient

– Disturbed Sleep Pattern: Due to the symptoms related to acute renal failure patient may experience disturbance in sleep pattern. This will directly affect his health and decrease his physical activity level that can lead to more complications.

– Delayed Cough Reflex: There will be the development of pulmonary edema or a pleural effusion inpatient due to fluid accumulation that will interfere with his respiration and effective cough reflex.

– Anxiety: The disease itself may make the patient anxious about whether or not they can continue living their life the way they would like, along with everyday activities. There is also a possibility of having fears related to dialysis treatments, such as the needle used for the procedure, and fear of infection due to frequent hospital visits.

-Impaired Skin Integrity: There is a possibility of improper functioning of glomerulus, which will lead to protein urea or uremia. It can also increase the permeability of capillaries, thereby resulting in fluid leakage from capillaries into interstitial tissues (McGee & Tomaszewski, 2013). 

-Risk for Infection: Due to the increased production of protein and urea in the body, a patient may also become more vulnerable to infection. The deficiency of functioning renal cells due to acute renal failure complicates this further.

Acute Renal failure has a direct impact on the patient’s health and quality of life. The most common effects that the disease will have are nephrotoxicity or nephrotic syndrome.

Other effects of the disease are related to the kidneys not functioning correctly and therefore cannot keep up with their excretory functions.

Decreased ability of patient in recovering from damage caused by this disease (for example, hypoxia or dehydration). Thus patient will be at increased risk for acquiring infections and complications (including lesion development), and above all patient’s course of treatment will be prolonged compared with other patients.

-Increased blood cholesterol.

-Changes in the patient’s body water content, which may cause edema.

-Decreased immunoglobulin production by the liver due to increased urea production in kidneys that are not functioning correctly.

Decreased cardiac output due to decreased blood pressure. This is as a result of a decrease in the glomerular filtration rate caused by acute renal failure.

Acute Kidney Failure (ARF) Disease Management

Acute renal failure management depends on the degree of alteration in the patient’s renal function.

At the early stages of the disease, if there is only a slight decrease in blood output and urine output, the patient can be managed at home with some dietary alterations. It may not be necessary to use injectable medications. However, in cases where a decrease in renal function is significant, it may be necessary to use injectable drugs as part of the management plan.

Ensuring compliance with the medication regimen is one major factor in achieving good outcomes for patients with different conditions (Park, Park, & Lee, 2015).

Patients will need to take medications regularly and often over a long period. If a patient is not taking their medications regularly and as prescribed, it will lead to an increased risk of developing complications of the disease.

The complications may include the development of chronic renal failure, hyperkalemia, hypertension, or liver dysfunction.

Thus, understanding how to encourage patients with chronic diseases to improve compliance effectively is one primary focus for many researchers and clinicians.

Acute Renal Failure (ARF) Treatment

Treatment will vary depending on the severity as well as if it is a first-time occurrence or not. 

For example, in mild cases, fluids may need to be removed and electrolytes replaced. However, if extreme measures are required, dialysis may be necessary.

The following are common treatments prescribed for acute renal failure:

  • Transferring the patient to a specialized hospital unit
  • Fluid and electrolyte imbalance – fluids need to be removed from the body to allow proper fluid levels. This is done through hemodialysis (blood filtration) or peritoneal dialysis (fluid exchange through the abdominal cavity)
  • Medication – it’s essential for patients to be monitored for potassium levels (because medications tend to increase blood pressure and may result in hyperkalemia or a buildup of potassium in the bloodstream). It is also crucial that calcium levels are closely monitored.

You may also check our guide on the treatment for metabolic alkalosis

Acute Renal Failure (ARF) Prognosis

Fortunately, the prognosis for acute renal failure is more favorable than one may think. Despite common misconceptions, acute renal failure patients can still lead happy and healthy lives after a period of proper treatment and care.

For example, in mild cases of acute renal failure where dialysis is not required as treatment, patients can return home and resume their daily lives (McGee & Tomaszewski, 2013). 

In severe cases where dialysis is necessary to treat acute renal failure or if all four kidneys have been entirely damaged, there are a few options available. It’s important to note that the patient would end up on a kidney transplant waiting list.

Renal failure has different levels of severity, which are classified as:

Acute renal failure – a sudden and rapid decrease in function to the point where dialysis is necessary;

Chronic kidney disease (CKD) stage 1 – the kidneys are damaged by more than 20% but do not require dialysis; Chronic kidney disease (CKD) stage 2 – one or both kidneys have lost 10-59% of their functions, which can be managed with proper treatment and care (McGee & Tomaszewski, 2013).

RRTs (renal replacement therapy) have also helped patients by giving them a better quality of life following the onset of renal failure. This is especially true in patients who have had a chronic renal failure for more than three years (Gupta & Mehta, 2013).

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What is the Most Important Nursing Diagnosis for a Patient in ARF End Stage?

The most critical nursing diagnosis to consider regarding patients with end-stage renal disease is imperative. 

There are three main categories of nursing diagnosis for this patient population:  respiratory, circulatory, and elimination (Merriam, 2009).

Respiratory Disorders – these involve difficulty breathing or decreased respiratory drive. Dehydration is a common cause of respiratory disorders in end-stage renal disease patients. By remaining well hydrated, most problems can be easily managed and avoided.

End-Stage Renal Disease – Hypotension

Sepsis is a severe complication that may occur if bacterial or fungal infections enter the bloodstream. If left untreated, it can result in multiple organ failures or even death (Merriam, 2009).

Surgical complications – this is a severe complication that will require careful assessment by the nurse. Examples include fluid volume deficit, electrolyte imbalances, bleeding disorders, infection(s), and conditions due to reduced immunity. 

Dietary deficiencies- many patients with end-stage renal disease have malabsorption issues or other digestion complications. To maintain a patient’s health and well-being, a safe and adequate diet must be maintained for them to remain healthy.

Elimination Disorders – these include problems with the urinary tract (Merriam, 2009). Patients are also at risk for severe fluid or electrolyte imbalances that will need to be closely monitored by the nurse.

Post Transplantation Patient – related nursing diagnoses include:  “Urinary Elimination”, “Kidney Function, Ineffective”, and “Fluid Volume Deficit” (Merriam, 2009).  

Nursing Care for End-Stage Renal Disease

To provide quality care to patients with renal failure, the nurse needs to assess the patient’s mental and physical status on admission.

The nurse will need to determine if any baseline laboratory values are out of the normal range (McGee & Tomaszewski, 2013). They may also need to check for a history of fluid or electrolyte imbalances before determining the best treatment course of action.

Aseptic technique and universal precautions should be initiated when the patient’s condition is stable enough to begin treatment (McGee & Tomaszewski, 2013). This is necessary for proximal tubing, connecting to a dialysis machine or a catheter bag, and any intravenous lines.

Blood pressure and heart rate will need to be regularly monitored as part of the patient’s ongoing care (McGee & Tomaszewski, 2013). The nurse needs to closely monitor the amount of fluid that goes into or out of the body and ensure that electrolyte levels remain within a normal range (McGee & Tomaszewski, 2013). 

The nurse will also need to maintain an accurate medication administration record and document all errors with medications or IV treatments.

The patient may stop eating to avoid gaining weight due to their fluid during their dialysis treatment. To prevent complications from this, the nurse can recommend eating finger foods in small amounts rather than meals.


Image: Document all errors that occur with medications or IV treatments for renal failure

Complications Related to ARF End-Stage

Common complications related to end-stage renal disease may arise cardiac complications and hypotension (McGee & Tomaszewski, 2013). If these occur, nurses will need to ensure that the patient is resting comfortably and closely monitor vital signs and their overall condition (McGee & Tomaszewski, 2013). 

These complications may be avoided by completely adhering to the steps outlined in the medication administration record and avoiding any errors or oversights. If these precautions are not taken, severe electrolyte imbalances can result. 

Dialysis patients will require a special diet, as they may have poor digestion and other complications (McGee & Tomaszewski, 2013). The nurse will need to address any problems related to nutrition or elimination that may occur. 

The patient should have their blood pressure and heart rate monitored periodically throughout the day to prevent hypotension from occurring (McGee & Tomaszewski, 2013). 

Conclusion

In conclusion, acute renal failure (ARF) is a common clinical problem with various causes and needs to be treated using different methods. With more understanding of this disease, nurses can act as influential members of the healthcare team.

Moreover, they can provide suitable nursing interventions to decrease patient’s suffering during acute renal failure. By providing nursing care, nurses can also provide valuable information for patients who want to learn more about this disease.

Other nursing diagnoses could be considered for patients with acute renal failure as well. This list includes: Change in Health Status, Risk for Injury, Disturbed Sleep Pattern, Delayed Cough Reflex, Anxiety, Risk for Infection, Impaired Skin Integrity and Ineffective Coping.

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