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Nursing Interventions for Acute Renal Failure

Submitted by lifenurses on Tuesday, 8 December 2009No Comment

Nursing Intervention, Evaluation, Out Come, Patient Teaching and Home Healthcare Guidelines Nursing Care Plans For Acute Renal Failure.

Nursing interventions with nursing diagnosis; Excess Fluid Volume, Risk for Infection, Imbalanced Nutrition: Less Than Body Requirements, Risk for Injury, Disturbed Thought Processes.

No	Nursing Diagnose	outcome	Interventions	Evaluation
1	Excess fluid volume related to decreased Glomerular filtration rate and sodium retention	Achieving fluid and electrolyte balance	Monitor for signs and symptoms of hypovolemia or hypervolemia because regulating capacity of kidneys is inadequate. 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. Adjust fluid intake to avoid volume overload and dehydration Measure blood pressure regularly with patient in supine, sitting, and standing positions. Auscultate lung fields for rales. 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. Administer cation exchange resin (sodium polystyrene sulfonate [Kayexalate]) orally or rectally to provide more prolonged correction of elevated potassium. Watch for cardiac arrhythmia and heart failure from hyperkalemia, electrolyte imbalance, or fluid overload. Have resuscitation equipment on hand in case of cardiac arrest. Instruct patient about the importance of following prescribed diet, avoiding foods high in potassium. Prepare for dialysis when rapid lowering of potassium is needed. Administer blood transfusions during dialysis to prevent hyperkalemia from stored blood. Monitor acid base balance.	Blood pressure stable, no edema or shortness of breath
2	Risk for infection related to alterations in the immune system and host defenses	Preventing infection	Monitor for all signs of infection. Be aware that renal failure patients do not always demonstrate fever and leukocytosis. Remove bladder catheter as soon as possible; monitor for UTI. Use intensive pulmonary hygiene high incidence of lung edema and infection. Carry out meticulous wound care. If antibiotics are administered, care must be taken to adjust the dosage for renal impairment.	No signs and symptom of infection
3	Imbalanced nutrition: less than body requirements related to catabolic state, anorexia, and malnutrition associated with acute renal failure	Maintaining adequate nutrition	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. Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories. Weigh daily. Monitor BUN, creatinine, electrolytes, serum albumin, prealbumin, total protein, and transferrin. Be aware that food and fluids containing large amounts of sodium, potassium, and phosphorus may need to be restricted. Prepare for hyperalimentation when adequate nutrition cannot be maintained through the GI tract.	Food intake adequate, maintaining weight
4	Risk for injury related to GI bleeding	Preventing GI bleeding	Examine all stools and emesis for gross and occult blood. Administer H₂-receptor antagonist, such as cimetidine (Tagamet) or ranitidine (Zantac), or nonaluminum or magnesium antacids as prophylaxis for gastric stress ulcers. If H₂-receptor antagonist is used, care must be taken to adjust the dose for the degree of renal impairment. Prepare for endoscopy when GI bleeding occurs	Stools heme negative
5	Disturbed thought processes related to the effects of uremic toxins on the central nervous system (CNS)	Preserving neurologic function	Speak to the patient in simple orienting statements, using repetition when necessary. Maintain predictable routine, and keep change to a minimum. Watch for and report mental status changes somnolence, lassitude, lethargy, and fatigue progressing to irritability, disorientation, twitching, and seizures. Correct cognitive distortions. Use seizure precautions”padded side rails, airway and suction equipment at bedside. Encourage and assist patient to turn and move because drowsiness and lethargy may prevent activity. Use music tapes to promote relaxation. Prepare for dialysis, which may help prevent neurologic complications.	Appears more alert, sleeps less during the day

Nursing Key outcomes Nursing Care Plans for Acute Renal Failure

Key outcomes for ARF, Patient will:

Perform activities of daily living without excessive fatigue or exhaustion.
Maintain hemodynamic stability.
Achieving fluid and electrolyte balance.
Preserving neurological function
Remain free from signs or symptoms of circulatory overload.
Verbalize the importance of balancing activities with adequate rest periods.
Discuss fears or concerns.
Preventing Gastro intestinal GI bleeding
Verbalize appropriate food choices according to his prescribed diet.
Patient’s oral mucous membrane will remain intact.
The patient’s skin integrity will remain intact.
Demonstrate skill in managing the urinary elimination problems.
Maintain adequate urine output.
The patient will remain free from signs or symptoms of infection.
Family members will verbalize the effect the patient’s condition has on the family unit.
The patient will avoid or minimize complications.

Patient Teaching and Home Healthcare Guidelines Nursing Care Plans for ARF

Every patient with Acute Renal Failure ARF need to understanding of renal function, signs and symptoms of Acute Renal Failure. Patients who have not recovered viable renal function need to understand that their condition may persist and even become chronic. And who have recovered viable renal function still need to be monitored by a nephrologists and If chronic renal failure is suspected, further outpatient treatment and monitoring are needed

Explain that she or he may be more susceptible to infection than previously.

Reassure the patient and family by clearly explaining all diagnostic tests, treatments, and procedures
Teach the patient or significant others about all medications, including dosage, potential side effects, and drug interactions.
Explain that the patient should tell the healthcare professional about the medications if the patient needs treatment such as dental work or if a new medication is added.
Explain that ongoing medical assessment is required to check renal function.
Explain all dietary and fluid restrictions. Note if the restrictions are life-long or temporary.
Discuss with significant others the lifestyle changes that may be required with chronic renal failure
Tell the patient about his prescribed medications, and stress the importance of complying with the regimen.
Stress the importance of following the prescribed diet and fluid allowance.
Instruct the patient to weigh him daily and report sudden increase of weight.
Advise the patient against overexertion. If he becomes dyspneic or short of breath during normal activity, tell him to report it to his physician.
Teach the patient how to recognize edema, and report this finding to the physician.