Acute Renal Failure ARF NCLEX Review Care Plans
Nursing Study Guide on Acute Renal Failure
Acute renal failure (ARF), also known as acute kidney failure or acute renal injury (AKI), occurs when the kidneys lose their ability to filter waste products from the bloodstream.
As these harmful chemicals accumulate, the normal balance of the blood is disrupted. ARF usually progresses in less than a few days.
This condition is most common in chronically hospitalized patients, or critically ill patients.
ARF may be reversible; however, it may also lead to death if not diagnosed early and treated promptly.
Recovery from ARF may be difficult for those with more complex conditions, but not particularly if the patient is normally fit and healthy.
Signs and Symptoms of ARF
- Oliguria – decreased urine output; however, urine output may remain normal in the early stages of ARF/AKI
- Fluid retention and edema, especially on the lower extremities
- Shortness of breath
- Irregular heartbeat
- Chest pain or pressure
- Seizures or coma in severe cases
On other occasions, acute renal failure will have no signs and symptoms and would only be seen via other tests of a different purpose.
Causes and Risk Factors
There are three main causes of acute renal failure: condition that decreases blood flow to the kidneys, direct kidney damage, and blocked ureters.
Decreased blood flow to the kidneys. This condition may be due to blood or fluid loss, use of anti-hypertensives, use of blood thinners, use of non-steroidal anti inflammatory drugs (NSAIDs), and history of heart attack, heart disease, infection, or liver failure.
It may also be due to severe allergic reaction called anaphylaxis, severe burns, or severe dehydration.
Direct kidney damage. Many conditions can lead to direct injury to the kidney, which can result to ARF. These may include:
- Blood clots in the kidney’s veins and arteries
- Cholesterol deposits
- Glomerulonephritis– inflammation of the glomeruli
- Hemolytic uremic syndrome- caused by early destruction of red blood cells
- Lupus – an immune system disorder causing glomerulonephritis
- Medications, such as specific chemotherapy drugs, antibiotics and imaging contrasts
- Scleroderma- a group of rare diseases affecting the skin and connective tissues
- Thrombotic thrombocytopenic purpura – blood disorder
- Toxins – such as alcohol, heavy metals and cocaine
- Rhabdomyolysis- muscle tissue breakdown
- Tumor lysis syndrome- releases toxins that can cause kidney damage
Conditions that cause blocked ureters. Cancers of the bladder, cervix, colon, and prostate can lead to blocked ureters. Also, blood clots in the urinary tract, an enlarged prostate, kidney stones, and bladder nerve damage may eventually lead to ARF.
The risk factors that may increase the chance of developing ARF include the following
Diagnosis of ARF
- Urine output measurements
- Urine test: urine sample analysis
- Blood tests – to check for levels of urea and creatinine
- Imaging tests such as CT scan
- Kidney biopsy – to take a sample of kidney tissue for examination
Complications of ARF
Acute renal failure can lead to different complications, such as:
- Pleural effusion and pulmonary edema. Fluid may build up in the lungs, causing pulmonary swelling and difficulty of breathing.
- Chest pain. ARF can eventually lead to the inflammation of the pericardium, which can cause chest pain or angina.
- Body malaise and fatigue. ARF can result to fluid and electrolyte imbalance, which may lead to muscle weakness and fatigue.
- Permanent kidney injury. If left untreated, ARF can progress into end stage renal disease which would require long-term dialysis treatment.
- Death. The severe loss of kidney function may ultimately lead to death.
Treatment and Prevention of ARF
Hospitalization. Treatment usually involves being admitted to the hospital, but most people who have acute renal failure are already admitted. The length of stay in hospital depends on how fast one recovers and in some cases recovery can be continued at home. Also, the treatment may depend on underlying conditions that led to ARF. Other than treating the injury, the healthcare team will also work hand in hand with the patients in order to prevent any complications from occurring.
Correction of blood and fluid imbalance. Intravenous fluid for inadequate blood volume can be given to an ARF patient as needed. On the other hand, diuretics can be prescribed in case of excess fluid that may lead to edema. Diuretics can help order to decrease swelling in the extremities.
Correction of electrolyte imbalance. If the kidneys do not filter potassium appropriately, the doctor may prescribe mineral supplements to prevent hyperkalemia, ultimately preventing irregular heart rhythms and muscle weakness. Calcium supplement infusion may be recommended in an ARF patient with calcium imbalance.
Dialysis. An ARF patient may benefit from dialysis to prevent further toxin build up while the kidneys are healing. It may also help remove excess potassium in the blood. In dialysis, a machine serves as the artificial kidney and filters the blood of excess wastes then returns it to the body.
Nursing Care Plans for ARF
Nursing Care Plan 1
Nursing Diagnosis: Ineffective Renal Tissue Perfusion related glomerular malfunction to secondary to acute renal failure as evidenced by increase in lab results (BUN, creatinine, uric acid, eGFR levels), oliguria, peripheral edema, hypertension, muscle twitching and cramping, fatigue, and weakness
Desired Outcome: The patient will actively participate in the treatment plan and will be able to demonstrate behaviors that will help prevent complications.
|Assess and monitor vital signs.||To establish baseline data. To monitor the patient’s blood pressure levels as hypertension can worsen kidney damage.|
Fever may indicate disease progression or the presence of an infection.
|Perform the necessary renal function blood tests as ordered. Monitor electrolytes, particularly potassium levels.||To monitor renal function. The kidneys may not be able to filter potassium in the blood in a patient with ARF. This may result to hyperkalemia or high serum potassium levels.|
|Monitor blood glucose levels, especially if the patient is diabetic.||To reduce the stress on the kidneys.|
|Weigh the patient daily. Commence strict Input and Output monitoring. Note the characteristics of the urine.||To assess the fluid volume status of the patient. To check for signs of worsening renal function and perfusion.|
|Administer medications as prescribed. Correct hyperkalemia and/or fluid retention using diuretics.||ARF or AKI is reversible. It can be treated by managing the underlying causes and signs and symptoms, such as hyperkalemia and fluid retention.|
|Encourage the patient to have a low potassium, low phosphorus, and low salt diet. Start a food chart.||The kidneys may not be able to filter potassium in the blood in a patient with ARF. A low potassium diet can give the kidneys rest and prevent further deterioration of renal perfusion and function. On the other hand, too much phosphorus can weaken the bones, so a low phosphorus intake is advised. Too much salt may lead to fluid retention. Food charting can help monitor dietary protein and caloric intake.|
|Refer to the dietitian.||To enable to patient to have specialized advice on renal diet while incorporating his/her food preferences.|
|Encourage the patient to exercise. Refer to the physiotherapy team.||To reduce peripheral edema and to manage obesity, hypertension, fatigue, and weakness.|
To enable to patient to have specialized advice on exercise.
|Prepare the patient for dialysis if indicated.||An ARF patient may benefit from dialysis to prevent further toxin build up while the kidneys are healing. It may also help remove excess potassium in the blood.|
Nursing Care Plan 2
Nursing Diagnosis: Excess Fluid Volume related to decreased renal function secondary to ARF, as evidenced by blood pressure level of 190/100, leg edema, shortness of breath, chest pain, and weight gain
Desired Outcome: The patient will demonstrate a normal fluid balance with vital signs within normal range, normal BMI, and absence of edema, shortness of breath, and chest pain.
|Monitor vital signs every 4 hours, especially the patient’s blood pressure level.||High blood pressure contributes to kidney damage.|
|Monitor the urine’s output.||Oliguria is one of the signs of ARF.|
|Administer anti-hypertensives, diuretics, and/or corticosteroids as prescribed.||Anti-hypertensives – to control the blood pressure Corticosteroids- to reduce any inflammation in the kidneys Diuretics – to correct hyperkalemia and reduce edema and plasma volume|
|Encourage the patient to elevate the legs as often as possible.||To reduce the swelling of the legs|
|Place the patient in fluid restriction, as ordered by the physician. Monitor the input and output (I&O) strictly using a daily chart.||To encourage a balance between the patient’s intake/input and output.|
|Encourage a low salt diet.||Too much salt may lead to fluid retention.|
Nursing Care Plan 3
Nursing Diagnosis: Activity Intolerance related to the disease process of ARF as evidenced by shortness of breath, chest pain, fatigue, muscle weakness,, overwhelming lack of energy, swollen feet, unsteady gait, and verbalization of tiredness
Desired Outcome: The patient will demonstrate alternate periods of desired activities and rest/sleep.
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. Ensure that the exercise is safe to perform during the patient’s current stage of disease.||To create a baseline of activity levels and mental status related to fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.||To gradually increase the patient’s tolerance to physical activity.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Encourage the next of kin, relative, or caregiver of the patient to participate in his/her care, such as monitoring hydration and diet, and activities of daily living where the patient requires a helping hand.||ARF may cause fatigue and exhaustion of the patient, so it is best to have the partner or a caregiver beside him/her at all times and ensure her safety and assist him/ her to perform activities of daily living.|
Other possible nursing diagnoses:
- Imbalanced Nutrition: Less than Body Requirements
- Impaired Urinary Elimination
- Risk for Decreased Cardiac Output
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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