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NCM 118 - Lesson 14 (Acute Renal Failure)

This document provides an overview of acute renal failure (ARF), including its phases, risk factors, clinical manifestations, diagnosis, treatment, and nursing interventions. It describes the three phases of ARF - oliguric, diuretic, and recovery. Risk factors are grouped as pre-renal, intra-renal, and post-renal. Signs and symptoms include oliguria, arrhythmias, edema, altered mental status, and electrolyte imbalances. Treatment involves identifying and treating the underlying cause, fluid management, correcting electrolyte abnormalities, and initiating dialysis in severe cases. Nursing goals are to maintain homeostasis, nutrition, prevent infection and skin breakdown.

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Bobby Christian Duron
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86 views3 pages

NCM 118 - Lesson 14 (Acute Renal Failure)

This document provides an overview of acute renal failure (ARF), including its phases, risk factors, clinical manifestations, diagnosis, treatment, and nursing interventions. It describes the three phases of ARF - oliguric, diuretic, and recovery. Risk factors are grouped as pre-renal, intra-renal, and post-renal. Signs and symptoms include oliguria, arrhythmias, edema, altered mental status, and electrolyte imbalances. Treatment involves identifying and treating the underlying cause, fluid management, correcting electrolyte abnormalities, and initiating dialysis in severe cases. Nursing goals are to maintain homeostasis, nutrition, prevent infection and skin breakdown.

Uploaded by

Bobby Christian Duron
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Lesson 14

ACUTE RENAL FAILURE

CONTENTS

I. Introduction
II. Assessment
a. Risk Factors / Predisposing Conditions
b. Clinical Manifestations
c. Diagnostic Examination/ Laboratory Tests
III. Treatment / Nursing Intervention/Goals
IV. Self Test / Self Directed Learning / Critical Thinking Drill
V. References/Further Readings

I. Introduction
 The abrupt loss of renal function may occur over several days or over hours.
 Phases of Acute Renal Failure (ARF)

A. Oliguric Phase
1. Urinary output decreases to less than 400 ml per 24 hours
2. Increase in BUN, creatinine, uric acid, potassium and presence of metabolic acidosis
3. Duration is often 10-15 days

B. Diuretic Phase
1. Begins with gradual increase in urine output
2. BUN and creatinine levels decreases
3. Monitored for hypokalemia, hyponatremia and dehydration
4. Duration may last for 2-3 weeks

C. Recovery Phase
1. May have minimal permanent loss of renal function
2. Duration may last for 3-12 months

II. Assessment

A. Risk Factors/Causes

1. Pre-renal (renal ischemia) – Hemorrhage, heart failure, shock, edema, vascular obstruction
2. Intra-renal (kidney tissue damage) – blood hemolysis in transfusion, nephrotoxic medication,
glomerulonephritis, pyelonephritis
3. Post-renal (renal obstruction) – renal calculi, benign prostatic hypertrophy, urethral stricture

B. Clinical Manifestations
1. Oliguria (less than 400ml/day)
2. Arrythmias (due to hyperkalemia) and congestive heart failure
3. Pulmonary edema
4. Anemia (caused by impaired erythropoietin
5. Altered mental status (in advanced cases due to uremia)
6. Fluid retention
7. Hyperkalemia
8. Metabolic Acidosis

C. Diagnosis
1. Elevated creatinine, BUN, and potassium levels
2. Proteinuria, RBC and WBC present in urine, specific gravity is decreased
3. Renal ultrasonography or scan

III. Treatment
A. Medical
1. Identify and treat precipitating cause of acute renal failure
2. Diuretic therapy may be used with some fluid challenges
3. Decrease serum potassium level
a. Sodium polysterene sulfonate (Kayexalate) – cation exchange resin to eliminate
potassium ions
b. IV hypertonic glucose and regular insulin - to move potassium into IC space
4. Sodium bicarbonate to correct metabolic acidosis

B. Dietary
1. Fluid restriction
2. Increase carbohydrates; decrease protein, potassium and sodium

C. Dialysis (indicated for cases with fluid overload, BUN levels of more than 120, metabolic
acidosis, elevated potassium, pericardial effusion, pulmonary edema)

IV. Nursing Intervention


Goal # 1: To maintain client in normal homeostasis and monitor renal function

A. Monitor accurate I and O record; check daily weight


B. Check for any signs of fluid overload or retention
C. Check electrolyte balance and renal parameters (BUN, serum creatinine)

Goal # 2: To maintain nutrition


A. Maintain dietary restrictions on sodium, potassium and protein
B. Increase calorie and carbohydrate intake
C. Limit fluids; small frequent feedings

Goal # 3: To prevent infection


A. Assess for development of infectious processes due to impaired immune system

Goal # 4: To prevent skin breakdown


A. Frequent turning and positioning
B. Beds and protective measures against decubitus ulcers
C. Frequent range of motion and activities to increase circulation

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