Acute Renal

Failure
 DEFINITION
• is defined as an abrupt or rapid decline
in renal filtration function.
• RESULTS WHEN THE KIDNEYS ARE
UNABLE TO REMOVE METABOLIC
WASTE AND PERFORM THEIR
REGULATORY FUNCTIONS.
ANATOMY AND PHYSIOLOGY
OF THE KIDNEY
 categories
• Pre renal - hypoperfusion of the
kidneys
• Intrarenal - actual damage to the
kidney flow
• Post renal – obstruction to urine
flow
 phases
• Initiation period
• Oliguria period
• Diuresis period
• Recovery period
 causes
• A sudden, serious drop in blood
flow to the kidneys.
• Damage from some medicines,
poisons, or infections.
• A sudden blockage that stops urine
from flowing out of the kidneys.
 You have a
greater chance
of getting
acute renal
failure if:
• You are an older adult.
• You have a long-term
health problem such as
kidney or liver disease,
diabetes, high blood
pressure, heart failure, or
obesity.
• You are already very ill
and are in the hospital or
intensive care, (ICU) Heart
surgery or belly surgery or
a bone marrow transplant
can make you more likely
to have kidney failure.
 symptoms
• Little or no urine when you
urinate.
• Swelling, especially in your legs
and feet.
• Not feeling like eating.
• Nausea and vomiting.
 symptoms
• Feeling confused, anxious and restless,
or sleepy.
• Pain in the back just below the rib cage.
This is called flank pain.
• Some people may not have any
symptoms.
 ASSESSMENT
AND DIAGNOSTIC
METHODS
• Bun, creatinine, electrolyte
analyses.
• Urine output measurements.
• Renal ultrasonography, CT and
MRI scans.
Nursing
process
 assessment
• Take nursing history and
perform PE particularly for
patients at risk for ARF.
• Monitor intake and output
for indications if failing
renal function.
 assessment
• Assess diagnostic test values and
monitor patients response to
therapy regularly for signs of
progress of deterioration.
• Direct attention to patients
primary disorder, monitor for
complications.
 diagnosis
• Fluid volume excess r/t decreased
urine output.
• Activity intolerance r/t fatigue,
toxins and fluid buildup.
• Deficit knowledge regarding
condition and its treatment.
 diagnosis
• Risk for impaired skin
integrity r/t edema, toxins or
impaired tissue perfusion.
• Risk for infection r/t
intravenous lines or catheters
or uremic toxins.
 Nursing
interventions
• Stay focused on the primary
disorder and monitor for
complications.
• Assist in emergency treatment of
fluid and electrolyte imbalances.
 Nursing
interventions
• Assist progress and response to
treatment; provide physical and
emotional support.
• Keep family informed about the
condition and provide support.
 Nursing
interventions
• Screen parenteral fluids, all
oral intake and all medications
for hidden sources of
potassium.
• Monitor cardiac function and
musculoskeletal status for
signs of hyperkalemia.
 Nursing
interventions
• Pay careful attention to
parenteral and oral intake, gastric
and stool output, wound drainage
and perspiration, changes in body
weight, edema, distention of the
jugular veins, changes in heart
and breath sounds and increased
DOB.
 Nursing
interventions
• Auscultate lungs for moist
crackles.
• Assess for generalized
edema by examining
presacral area regularly.
 treatment
Your doctor or a kidney specialist
(nephrologist) will try to treat the
problem that is causing your kidneys
to fail. At the same time, the doctor
will try to:
• Help your kidneys rest. You may
have dialysis. This treatment uses a
machine to do the work of your
kidneys until they recover. It will help
you feel better.
 treatment
• Prevent other problems. You may
take antibiotics to prevent or treat
infections. You also may take
other medicines to get rid of extra
fluid and keep your body’s
minerals in balance.
 treatment
• You can help yourself heal by taking your
medicines as your doctor tells you to. You
also may need to follow a special diet to
keep your kidneys from working too hard.
You may need to limit sodium, potassium,
and phosphorus. A dietitian can help you
plan meals.