Acute Renal Failure Definition

Acute renal failure (ARF) is the rapid

breakdown of renal (kidney) function that
occurs when high levels of uremic toxins
(waste products of the body's metabolism)
accumulate in the blood. ARF occurs when the
kidneys are unable to excrete (discharge) the
daily load of toxins in the urine.
 types
• Based on the amount of urine that is excreted
over a 24-hour period, patients with ARF are
separated into two groups :
• Oliguric: patients who excrete less than 500
milliliters per day (< 16 oz/day)
• Nonoliguric: patients who excrete more than
500 milliliters per day (> 16 oz/day)
 Acute Renal Failure Causes
• Causes of acute kidney failure fall into one of the
following categories:
• Prerenal: Problems affecting the flow of blood
before it reaches the kidneys
• Postrenal: Problems affecting the movement of
urine out of the kidneys
• Renal: Problems with the kidney itself that
prevent proper filtration of blood or production
of urine
 Acute Kidney Failure Symptoms
• Acute Kidney Failure Symptoms
• The following symptoms may occur with acute kidney failure. Some
people have no symptoms, at least in the early stages. The
symptoms may be very subtle.
• Decreased urine production
• Body swelling
• Problems concentrating
• Confusion
• Fatigue
• Lethargy
• Nausea, vomiting
• Diarrhea
• Abdominal pain
• Metallic taste in the mouth
• Seizures and coma may occur in very severe acute kidney failure.
 Nursing Care Plan for ARF - Acute Renal
Failure
• Acute Renal Failure Nursing Assessment
• Activity and Rest
Symptoms:
Fatigue, weakness, malaise

Signs:
Muscle weakness and loss of tonus
 Circulation
Signs:
Hypotension / hypertension (including malignant
hypertension, eclampsia / hypertension due to
pregnancy).
Cardiac dysrhythmia.
Pulse weak / soft orthostatic hypotension (hipovalemia).
Strong pulse (hipervolemia).
Edema public network (including the periorbital area of
the sacrum ankle).
Pale, bleeding tendency
 Elimination

Symptoms:
Changes in the pattern of urination, increased frequency, polyuria
(early failure), or decrease the frequency / oliguria (final phase)
Dysuria, doubt, encouragement, and retention (inflammation /
obstruction, infection).
Abdominal bloating, diarrhea or constipation.

Signs:
Change the color of dark yellow urine samples, red, brown,
cloudy.
Oliguric (usually 12-21 days), polyuria (2-6 liters / day).
• Food / Fluids
Symptoms:
Increased weight (edema), weight loss
(dehydration).
Nausea, vomiting, anorexia, heartburn
Use of diuretics

Signs:
Changes in skin turgor / humidity.
Edema (General, bottom).
 Neurosensori
• Neurosensori
Symptoms:
Headaches, blurred vision.
Muscle cramps / spasms, syndrome "Restless legs".

Signs:
Impaired mental status, examples of decline in the field
of attention, inability to concentrate, memory loss,
confusion, decreased level of consciousness (azotemia,
electrolyte imbalance / acid-base.
Seizures, seizure activity.
• Pain / Leisure
Symptoms:
Body aches, headache

Signs:
Cautious behavior / distraction, anxiety

• Respiratory
Symptoms:
Shortness of breath

Signs:
Takipnoe, dispnoe, increased frequency, kusmaul, ammonia
breath, productive cough with thick pink sputum (pulmonary
edema).
• Comfort
Symptoms:
Transfusion reaction

Signs:
Fever, sepsis (dehydration), or skin ptekie ekimosis,
pruritus, dry skin.
•  
• Counseling / Learning
Symptoms:
Family history of polycystic disease, hereditary nephritis,
urinary stones, malignancies., a history of exposure to
toxins, (drugs, environmental toxins), nephrotic repeated
use of drugs eg aminoglycosides, amphotericin, anesthetic
vasodilator.
• Acute Renal Failure Nursing Diagnosis
• Excess fluid volume related to decreased
Glomerular filtration rate and sodium
retention.

• Imbalanced nutrition: less than body

requirements related to catabolic state,
anorexia, and malnutrition associated with
acute renal failure.

• Risk for infection related to alterations in the

immune system and host defenses.
• Acute Renal Failure Nursing Intervention

1.Excess fluid volume related to decreased Glomerular filtration rate and sodium
retention.

Goal : Achieving fluid and electrolyte balance

Nursing Intervention
• Monitor urinary output and urine specific gravity; measure and record intake and output
including urine, gastric suction, stools, wound drainage, perspiration (estimate).
• Monitor serum and urine electrolyte concentrations.
• Monitor for signs and symptoms of hypovolemia or hypervolemia because regulating
capacity of kidneys is inadequate.
• Inspect neck veins for engorgement and extremities, abdomen, sacrum, and eyelids for
edema.
• Evaluate for signs and symptoms of hyperkalemia, and monitor serum potassium levels.
• Administer sodium bicarbonate or glucose and insulin to shift potassium into the cells.
• Instruct patient about the importance of following prescribed diet, avoiding foods high in
potassium.
• Prepare for dialysis when rapid lowering of potassium is needed.
• 2. Imbalanced nutrition: less than body requirements related to
catabolic state, anorexia, and malnutrition associated with acute renal
failure.

Goal :
Maintaining adequate nutrition

Nursing Intervention
• Monitor BUN, creatinine, electrolytes, serum albumin, prealbumin,
total protein, and transferin.
• Be aware that food and fluids containing large amounts of sodium,
potassium, and phosphorus may need to be restricted.
• Offer high-carbohydrate feedings because carbohydrates have a greater
protein-sparing power and provide additional calories.
• Work collaboratively with dietitian to regulate protein intake according
to impaired renal function because metabolites that accumulate in
blood derive almost entirely from protein catabolism.
• Prepare for hyper alimentation when adequate nutrition cannot be
maintained through the GI tract.
•  
• 3. Risk for infection related to alterations in the immune
system and host defenses.

Goal :

Nursing Intervention
• Remove bladder catheter as soon as possible; monitor for
UTI.
• Use intensive pulmonary hygiene high incidence of lung
edema and infection.
• Monitor for all signs of infection. Be aware that renal failure
patients do not always demonstrate fever and leukocytosis.
• If antibiotics are administered, care must be taken to adjust
the dosage for renal impairment.