Is a sudden decline in renal function, usually marked by increased concentrations of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml of urine in 24 hours); hyperkalemia; and sodium retention.

1. Nursing Path
www.drjayeshpatidar.blogspot.com
Acute Renal Failure Nursing Care Plan &
Management
Description
Is a sudden decline in renal function, usually marked by increased concentrations
of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml
of urine in 24 hours); hyperkalemia; and sodium retention.
Acute renal failure are classified into following:
o Prerenal failure – results from conditions that interrupt the renal blood
supply; thereby reducing renal perfusion (hypovolemia, shock,
hemorrhage, burns impaired cardiac output, diuretic therapy).
o Postrenal failure – results from obstruction of urine flow.
o Intrarenal failure – results from injury to the kidneys themselves
(ischemia, toxins, immunologic processes, systemic and vascular
disorders).
The disease progresses through three clinically distinct phase which is oliguric-
anuric, diuretic, and recovery, distinguished primarily by changes in urine volume
and BUN and creatinine levels.
Complication of ARF include dysrhythmias, increased susceptibility to infection,
electrolyte abnormalities, GI bleeding due to stress ulcers, and multiple organ

2. Nursing Path
www.drjayeshpatidar.blogspot.com
failure. Untreated ARF can also progress to chronic renal failure, end-stage renal
disease, and death from uremia or related causes.
Pathophysiology

3. Nursing Path
www.drjayeshpatidar.blogspot.com
Assessment:
1. Oliguric-anuric phase: urine volume less than 400 ml per 24 hours; increased in
serum creatinine, urea, uric acid, organic acids, potassium, and magnesium; lasts
3 to 5 days in infants and children, 10 to 14 days in adolescents and adults.
2. Diuretic phase: begins when urine output exceeds 500 ml per 24 hours, end
when BUN and creatinine levels stop rising; length is availabe.
3. Recovery phase: asymptomatic; last several months to 1 year; some scar tissue
may remain.
4. In prerenal disease: decreased tissue turgor, dryness of mucous membranes,
weight loss, flat neck veins, hypotension, tachycardia.
5. In postrenal disease: difficulty in voiding, changes in urine flow.
6. In Intrarenal disease: presentation varies; usually have edema, may have fever,
skin rash.
7. Nausea, vomiting, diarrhea, and lethargy may also occur.
Diagnostic Evaluation:
1. Urinalysis shows proteinuria, hematuria, casts. Urine chemistry distinguishes
various forms of ARF(prerenal, postrenal, intrarenal).
2. Serum creatinine and BUN levels are elevated; arterial blood gas (ABG) levels,
serum electrolytes may be abnormal.
3. Renal ultrasonography estimates renal size and rules out treatable obstructive
uropathy.
Primary Nursing Diagnosis
Fluid volume deficit related to excessive urinary output,vomiting,hemorrhage
Other Diagnoses that may occur in Nursing Care Plans For Acute Renal Failure
Ineffective tissue perfusion (renal)
Excess fluid volume
Risk for infection
Therapeutic and Pharmacologic Interventions:
1. Surgical relief of obstruction may be necessary.
2. Correction of underlying fluid excesses or deficits.
3. Correction and control of biochemical imbalances.

4. Nursing Path
www.drjayeshpatidar.blogspot.com
4. Restoration and maintenance of blood pressure through I.V. fluids and
vasopressors.
5. Maintenance of adequate nutrition: Low protein diet with supplemental amino
acids and vitamins.
6. Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement
therapy for patients with progressive azotemia and other life-threatening
complications.
Nursing Interventions:
1. Monitor 24-hour urine volume to follow clinical course of the disease.
2. Monitor BUN, creatinine, and electrolyte.
3. Monitor ABG levels as necessary to evaluate acid-base balance.
4. Weigh the patient to provide an index of fluid balance.
5. Measure blood pressure at various times during the day with patients in supine,
sitting, and standing positions.
6. Adjust fluid intake to avoid volume overload and dehydration.
7. Watch for cardiac dysrhythmias and heart failure from hyperkalemia, electrolyte
imbalance, or fluid overload. Have resuscitation equipment available in case of
cardiac arrest.
8. Watch for urinary tract infection, and remove bladder catheter as soon as
possible.
9. Employ intensive pulmonary hygiene because incidence of pulmonary edema and
infection is high.
10.Provide meticulous wound care.
11.Offer high-carbohydrate feedings because carbohydrates have a greater protein-
sparing power and provide additional calories.
12.Institute seizure precautions. Provide padded side rails and have airway and
suction equipment at the bedside.
13.Encourage and assist the patient to turn and move because drowsiness and
lethargy may reduce activity.
14.Explain that the patient may experience residual defects in kidney function for a
long time after acute illness.
15.Encourage the patient to report routine urinalysis and follow-up examinations.
16.Recommend resuming activity gradually because muscle weakness will be
present from excessive catabolism.

5. Nursing Path
www.drjayeshpatidar.blogspot.com
Documentation Guidelines
Physical findings:Urinary output and description of urine, fluid balance, vital
signs, findings related to original disease process or insult,presence of pain or
pruritus,mental status,GI status, and skin integrity
Condition of peritoneal or vascular access sites
Nutrition: Response to dietary or fluid restrictions, tolerance to food,
maintenance of body weight
Complications:Cardiovascular,integumentary infection
Discharge and Home Healthcare Guidelines
All patients with ARF need an understanding of renal function,signs and symptoms of
renal failure ,and how to monitor their own renal function. Patients who have recovered
viable renal function still need to be monitored by a nephrologist for at least a year.
Teach the patient that she or he may be more susceptible to infection than previously.
Advise daily weight checks. Emphasize rest to prevent overexertion. Teach the patient or
significant others about all medications, including dosage, potential side effects, and drug
interactions. Explain that the patient should tell the healthcare professional about the
medications if the patient needs treatment such as dental work or if a new medication is
added. Explain that ongoing medical assessment is required to check renal function.
Explain all dietary and fluid restrictions. Note if the restrictions are life-long or
temporary.
Patients who have not recovered viable renal function need to understand that their
condition may persist and even become chronic. If chronic renal failure is suspected,
further outpatient treatment and monitoring are needed. Discuss with significant others
the lifestyle changes that may be required with chronic renal failure.