NURSING CARE

OF PATIENT WITH
ACUTE RENAL
FAILURE

PRESENTED BY
H. RUFUS RAJ .MSN
Lecturer, Al-Shifa college of nursing
 What is Renal failure
?

Renal failure is the partial or

complete impairment of kidney
function resulting in an inability to
excrete metabolic waste products
& water, as well as causing
functional disturbances of all body
systems.
 What is Acute renal failure?

Acute renal failure is a clinical

syndrome characterised by rapid loss of
renal function with progressive azotemia

ARF is often ARF usually develops

associated with over hours or days
oliguria which is a with progressive
decrease in urinary elevations of BUN,
outputto 400 ml/day creatinine, & potassiun
with or without oliguria
ETIOLOG
Y
Contd…
PROGRESSIVE EVENTS IN
ARF
 CLNICAL COURSE OF ARF
INITIATING PHASE

OLIGURIC PHASE

DIURETIC PHASE

RECOVERY PHASE
CLINICAL MANIFESTATIONS
URINARY
Ø Decreased urinary output
Ø Proteinuria RESPIRATORY
Ø Decreased specific gravity ØPulmonary edema
Ø Decreased osmolality ØPlural effusions
Ø Increased urinary sodium

GASTROINTESTINAL
ØNausea & vomiting
CARDIOVASCULAR
ØAnorexia
ØVolume overload
ØStomatitis
ØHeart failure
ØBleeding
ØHypotension
ØDiarrhea
Hypertension
ØConstipation
ØPericarditis
ØPericardial effussion
ØDysrhythmias Contd…..
Contd….

HEMATOLOGIC
METABOLIC Ø Anemia
ØIncreased BUN
Ø Increased suspectibility to
ØIncreased creatinine
infection
ØDecreased sodium
ØIncreased potassium
Ø Defect in platelet
functioning
ØDecreased pH
ØDecreased bicarbonate
ØDecreased calcium
NEUROLOGIC
ØIncreased phosphate
ØLethargy
ØSeizures
ØAsterixis
ØMemory impairment
 DIAGNOSTIC STUDIES
HISTORY & PHYSICAL EXAMINATION
IDENTIFICATION OF THE
PRECIPITATING CAUSE

LABORATORY STUDIES
Serum creatinine & BUN
Serum electrolytes
Urinalysis
 MANAGEMENT
Treatment of the precipitating cause
Fluid restriction (600ml plus previous 24
hrs fluid loss)
Nutritional therapy
Measures to lower potassium
Calcium supplements or phosphate
binding agents
Parentral nutrition
Enteral nutrition
Dialysis
Nutritional therapy
Adequate protein
intake (0.6-2
g/kg/day)
Potassium restriction
Phospahate restriction
Sodium restriction
Daily calorie
requirement – 30-35
kcal/day
Sodium restricted to
 DIALYSIS
INDICATIONS
Volume overload resultinf g in
compromised cardiac or pulmonary
status
Elevated potassium level with ECG
changes
Metabolic acidosis
BUN level (>120 mg/dl)
Significant change in mental status
Pericarditis, pericardial effusion, cardiac
tamponade
 Peritoneal dialysis
v Peritoneal dialysis uses the lining
of the abdominal cavity as a filter
to clean blood and remove excess
fluid.
v A catheter is implanted into the
abdomen by a minor surgical
procedure and a fluid (dialysate
solution) is infused through this.
v The dialysate solution, left for a
few hours, capture and eliminate
the waste products from your
blood.
v The most common form of
peritoneal dialysis called
continuous ambulatory peritoneal
dialysis (CAPD) changes dialysate
four times a day.
 Hemodialysis
Ø Hemodialysis uses a mechanical
membrane (dialyzer) with a special
filter that removes waste and
excess water from the blood.

Ø The patient is connected to the

machine by a tube running from a
conduit created surgically between
a large artery and vein.

Ø The blood is circulated through the

artificial kidney, which removes
toxins and wastes. The blood is
then returned to your body.
NURSING PROCESS
 LIST OF NURSING
DIAGNOSES
1. Excess fluid volume related to renal failure & fluid
retention.
2. Risk for infection related t invasive lines , uremic
toxins, & altered immune responses secondary to
kidney failure.
3. Imbalanced nutrition: less than body requirement
related to altered metabolic sate & dietary restrictions.
4. Disturbed thought processes related to effects of
uremic toxins on CNS.
5. Fatigue related to anemia. Metabolic acidosis, &
uremic toxins.
6. Anxiety related to disease process, therapeutic
interventions & uncertainty of progress.
THANK YOU
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