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Nursing Care Plan for Acute Renal Failure

Pathophysiology

Also known as acute kidney injury (AKI), is measured by the buildup of waste in your body and altered fluid levels because the kidneys are failing to do their job. The cause of the renal failure can also change the pathophysiology. There are three main causes: 1) decreased blood flow to the kidneys, 2) direct injury to the kidney/tissues, and 3) blockage of urine excretion. Inflammation to the kidneys or their structures (nephrons) can cause the kidneys to fail. Blockage of urine can cause a backup in the kidney, not allowing them to continue to filter out waste from the body or manage fluid levels.

Etiology

There are many causes of kidney failure. For example, low blood perfusion to the kidneys can cause acute kidney failure from causes such as an infection/antibiotic use, hypotension potentially from blood loss (hemorrhage) or fluid loss (vomiting/ diarrhea), or even other organ failure (heart attack, liver failure). Another reason for kidney failure could be direct damage to the structures of the kidney itself. The biggest offender of kidney damage is sepsis, but also anything that can cause inflammation in the vessels of the kidneys (Vasculitis) as well as the attempt to treat it with too many NSAIDs can cause direct damage to the kidneys. Lastly, if the urine cannot be excreted, this can cause kidney failure. Kidney stones, enlarged prostates and some cancers can present problems for the urinary tract’s ability to excrete urine.

 

Desired Outome

Return normal functioning of the kidney’s, including the nephrons, blood vessels, urethra, and ureters. Have the kidney labs be within normal limits and hopefully not have the patient on dialysis.

Acute Renal Failure Nursing Care Plan

Subjective Data:

  • Increased thirst
  • Dizziness
  • Flank pain
  • Hematuria
  • Oliguria
  • Recent antibiotic usage
  • Over usage of NSAIDs
  • Recent blood transfusion
  • Chest pain/pressure
  • Confusion

Objective Data:

  • Hypertension
  • Orthostatic Hypotension
  • Atrial fibrillation
  • JVD
  • Pulmonary Edema/Rales
  • Edema

Nursing Interventions and Rationales:

  1. Strict intake and output measurement
    • It is important if the kidney’s are not functioning to measure the patient’s I&Os. Notify the physician if there is a deficit greater than 5-10%.
  2. Medications to watch: Statins, NSAIDS, Aspirin
    • Be mindful of medications that can become toxic when the kidneys aren’t functioning at their prime.

      Try to limits these drugs, watch labs and antibiotic troughs. Look out for signs
  3. Statins NSAIDS Aspirin Acetaminophen Insulin Some antibiotics Herbal supplements
    • Be mindful of medications that can become toxic when the kidneys aren’t functioning at their prime.

      Try to limits these drugs, watch labs and antibiotic troughs. Look out for signs and symptoms of overdose.

      Here are the most common signs and symptoms of overdose. *note this is not a comprehensive list*

      Statins: muscle pain and weakness.

      NSAIDS: N/V, headache, dizziness and blurred vision.

      Aspirin: ringing in the ears (tinnitus), decreased hearing.

      Acetaminophen: N/V/D, irritability, convulsions, coma.

      Insulin: Hyperinsulinemia from the body building up resistance to insulin.

      Some antibiotics: Neuro symptoms like seizures, confusion, neuropathy.

      Herbal supplements: Various, depends on the herbal supplement.
  4. Monitor lung sounds and edema
    • You want to make sure fluid balance is carefully monitored. A backup in the lungs would cause crackles and a back up systemically would cause pitting edema in the legs.
  5. Diuretic administration: Furosemide (Lasix) Bumetanide (Bumex) Spironolactone (Aldactone)
    • This is very important… diuretics are going to make the patient PEE… lots and lots of PEE. Do not under any circumstances administer a diuretic without a bathroom plan. And a word to the wise, have a backup plan. Meaning if you have a walkie talkie patient with functioning arms and a strong call light finger, I still would set up a bedside commode just.in.case. I walk them to the bathroom or assist them in any way needed, but it is possible that they do not know how urgent their situation is and I can clean up pee, but you can’t clean up that patients dignity.

      Diuretics work on different parts of the nephrons. The goal of diuretics is to help the kidneys rid the body of salt (notice I didn’t say sodium (Na+)?) and fluids. It is important to note for every Na+ molecule there is a compound of one water (H20) that follows it. Psssst: potassium is a salt...

      There are three kinds of diuretics: Loop, Thiazide, and potassium sparing.

      Loop: works on the loop of henle and excretes Na+, K+, and Ca-. (Yikes! Watch your patient’s electrolytes!)

      Thiazide: Works on the distal convoluted tubule and blocks the Na+/Cl- symporter (which reabsorbs...you guessed it Na+ and Cl-). This symporter is responsible for about 5% of Na+ reabsorption. So monitor your patient’s sodium and chloride. Oh, and your K+...Why? Because K+, Cl- and Na+ have direct relationships!

      Potassium-Sparing: Works on the Na+/K+ pumps in the collecting ducts of the kidney by blocking the effects of aldosterone at that site. Aldosterone has the collecting ducts reabsorbing Na+ and thus water, and for ever Na+ absorbed, one molecule of K+ is excreted. So this diuretic does the opposite of that, saves a K+ and excretes a Na+ and H20.

      Most commonly used diuretics in acute kidney failure:
      -Furosemide: Loop
      -Bumetanide: Loop
      -Spironolactone: Potassium-Sparing
  6. Monitor Potassium Potassium (K+) Normal range: 3.5 - 5.0 mEq/L
    • As Furosemide is the front line and best treatment for kidney failure, nurses must be careful to watch the patient’s potassium levels (Remember: Furosemide is potassium wasting).

      Potassium (K+): is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen with enter the cell as this happens it will force potassium out of the cell, a 0.1 decrease in pH will cause a 0.5 increase in K+
  7. Diet changes and control Fluid restriction Salt restriction
    • Educating the patient on decreased sodium intake as well as strict fluid intake is vital when in any sort of kidney failure.

      However, if patient is on a potassium wasting diuretic, educate about potassium (bananas, sweet potatoes, etc.)
  8. Monitor Kidney Labs Blood Urea Nitrogen (BUN) Normal Range: 7-20 mg/dL Creatinine (Cr) Normal Range: 0.7-1.4 mg/dL
    • This measures how well treatment is working, you want the labs to be moving back to normal limits.

      Blood Urea Nitrogen (BUN): measures the amount of urea in the blood. When protein is broken down ammonia is formed. Ammonia is converted to urea in the liver and is eventually excreted in the kidneys.

      Creatinine (Cr): is a byproduct of creatine metabolism, and it is excreted by the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable.

References

Date Published - May 16, 2017
Date Modified - Jun 26, 2017