Acute Renal Failure (ARF), also known as Acute Kidney Injury (AKI), is a sudden decline in kidney function that can lead to severe complications and potentially life-threatening conditions. This nursing diagnosis focuses on identifying and treating ARF symptoms, preventing complications, and promoting recovery.
Causes (Related to)
Acute Renal Failure can develop due to various factors affecting kidney function:
- Pre-renal causes:
- Severe dehydration
- Blood loss
- Heart failure
- Shock
- Severe burns
- Intrinsic renal causes:
- Acute tubular necrosis
- Glomerulonephritis
- Medications (NSAIDs, aminoglycosides)
- Contrast dye exposure
- Rhabdomyolysis
- Post-renal causes:
- Urinary tract obstruction
- Kidney stones
- Enlarged prostate
- Tumors
- Blood clots
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Decreased urine output
- Fatigue and weakness
- Nausea and vomiting
- Confusion
- Flank pain
- Loss of appetite
- Metallic taste in mouth
- Shortness of breath
Objective: (Nurse assesses)
- Oliguria (<400 mL/24 hours) or anuria
- Elevated BUN and creatinine levels
- Electrolyte imbalances
- Fluid overload signs
- Edema
- Elevated blood pressure
- Abnormal heart rhythm
- Changes in mental status
Expected Outcomes
- Patient will maintain adequate fluid balance
- Patient will demonstrate improved kidney function
- Patient will maintain electrolyte balance within normal limits
- Patient will avoid complications
- Patient will verbalize understanding of condition and treatment plan
- Patient will demonstrate adherence to prescribed treatment regimen
Nursing Assessment
Monitor Vital Signs and Fluid Status
- Check blood pressure, pulse, and respiratory rate
- Monitor intake and output strictly
- Assess for edema
- Monitor daily weights
- Check for signs of dehydration or fluid overload
Assess Laboratory Values
- Monitor BUN and creatinine levels
- Check electrolyte levels
- Monitor complete blood count
- Track acid-base balance
- Review urinalysis results
Evaluate Cardiovascular Status
- Assess heart sounds and rhythm
- Monitor for chest pain
- Check peripheral pulses
- Assess for edema
- Monitor for signs of fluid overload
Monitor Neurological Status
- Assess level of consciousness
- Check orientation
- Monitor for confusion
- Assess for lethargy
- Document any seizure activity
Check for Complications
- Monitor for signs of infection
- Assess for bleeding
- Check for uremic symptoms
- Monitor for electrolyte imbalance signs
- Assess for cardiac complications
Nursing Care Plans
Nursing Care Plan 1: Fluid Volume Excess
Nursing Diagnosis Statement:
Fluid Volume Excess related to decreased kidney function as evidenced by edema, increased blood pressure, and weight gain.
Related Factors:
- Decreased glomerular filtration rate
- Sodium and water retention
- Impaired regulatory mechanisms
- Decreased urine output
Nursing Interventions and Rationales:
- Monitor fluid intake and output strictly
Rationale: Ensures accurate fluid balance assessment - Weigh the patient daily at the same time
Rationale: Tracks fluid status changes - Restrict fluids as ordered
Rationale: Prevents fluid overload - Monitor for signs of fluid overload
Rationale: Enables early intervention
Desired Outcomes:
- The patient will maintain an appropriate fluid balance
- The patient will demonstrate decreased edema
- The patient will maintain a stable weight
- The patient will show normal vital signs
Nursing Care Plan 2: Risk for Electrolyte Imbalance
Nursing Diagnosis Statement:
Risk for Electrolyte Imbalance related to kidney dysfunction as evidenced by abnormal laboratory values.
Related Factors:
- Impaired regulatory function
- Altered fluid balance
- Medication effects
- Treatment regimen
Nursing Interventions and Rationales:
- Monitor electrolyte levels frequently
Rationale: Detects imbalances early - Administer medications as prescribed
Rationale: Corrects electrolyte abnormalities - Monitor for signs of imbalance
Rationale: Enables prompt intervention
Desired Outcomes:
- The patient will maintain electrolyte levels within the normal range
- The patient will demonstrate no signs of electrolyte imbalance
- The patient will verbalize understanding of dietary restrictions
Nursing Care Plan 3: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to the inflammatory process and edema as evidenced by verbal reports of flank pain and discomfort.
Related Factors:
- Tissue inflammation
- Fluid retention
- Kidney distention
- Associated muscle tension
Nursing Interventions and Rationales:
- Assess pain characteristics
Rationale: Determines appropriate interventions - Administer prescribed pain medication
Rationale: Provides comfort and reduces stress - Position patient comfortably
Rationale: Minimizes discomfort
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved comfort
- The patient will use effective pain management strategies
Nursing Care Plan 4: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to edema and decreased mobility as evidenced by skin tension and decreased tissue perfusion.
Related Factors:
- Fluid retention
- Decreased activity
- Poor tissue perfusion
- Altered nutrition status
Nursing Interventions and Rationales:
- Assess skin condition regularly
Rationale: Identifies early signs of breakdown - Implement pressure relief measures
Rationale: Prevents skin breakdown - Maintain skin hygiene
Rationale: Promotes skin integrity
Desired Outcomes:
- The patient will maintain intact skin
- The patient will demonstrate proper skincare
- The patient will identify signs of skin breakdown
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to acute illness and uncertain prognosis as evidenced by expressed concerns and restlessness.
Related Factors:
- Threat to health status
- Treatment uncertainty
- Role changes
- Financial concerns
Nursing Interventions and Rationales:
- Provide clear information
Rationale: Reduces anxiety through understanding - Listen to patient concerns
Rationale: Allows emotional expression - Teach coping strategies
Rationale: Enhances stress management
Desired Outcomes:
- The patient will verbalize decreased anxiety
- The patient will demonstrate effective coping strategies
- The patient will express understanding of condition and treatment
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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