Acute Renal Failure: Nursing Management & Interventions Pt 2

Part one of our discussions on acute renal failure nursing management, we focused on two interventions – Kayexalate and Dopamine. These two belong to the four nursing processes that are required to manage acute renal failure. To easily remember, you can think of the acronym – HDTV. H stands for hyperkalemia while D stands for dopamine.

In this lecture, we will tackle the remaining two processes – T and V.

Before discussing the remaining two interventions, we’ll quickly go through the first two.

Kayexalate for Hyperkalemia

Kayexalate is the first thing that is given to acute renal failure clients due to the presence of hyperkalemia. Hyperkalemia is just one of the complications of having acute renal failure, and the only way to get it out of the body is through the potty which involves urination and fecal excretion. If urine is not being produced due to acute renal failure, potassium will be expelled through the anus with the help of Kayexalate.


Dopamine helps in renal vasodilation and at the same time, vasoconstricting the peripheral body, causing an increase in pressure. Low blood pressure is one of the main causes of acute renal failure; therefore, dopamine will help in the hyperperfusion of the kidneys.

The T and V

Now, the last two types of intervention are a bit difficult to comprehend because both are concerned with volume.

So, the main goal is to push volume through the kidney which can be referred to as, “tickling the kidney.” Tickling the kidney simply means increasing the perfusion which will lead to increased blood volume and oxygen. By doing so, we’re trying to get the client from the oliguric phase to the diuretic phase in the hopes that the condition will eventually lead to the recovery phase.

After giving dopamine to dilate the blood vessels in the kidneys, fluid is then pushed into the diuretic phase. This is where the T and V come in.

Total Volume

Giving total volume or a bolus of IV fluid means giving more fluid to the client; much like pouring fluid with the use of IV normal saline.

The kidneys are similar to washer machines. Imagine if these washer machines have too much accumulation of mud and are broken. By dilating the renal arteries and pushing more volume, we are restarting the organ and are getting rid of the mud inside the washer machines.

Volume Depletion

Diuretics are given to make sure that the kidneys are receiving sufficient volume. This is what we refer to as the volume depletion stage. Since the primary goal is to get fluid going into the kidneys and have it restarted, diuretics will push the volume through the kidneys. Lasix (Furosemide), the most popular loop diuretic, is a potassium-depleting medication given to acute renal failure clients.

A Summary

In retrospective, when a client in an oliguric phase, the kidneys are not working, and the basic goal is to achieve a diuretic phase. This is done by increasing the amount of perfusion in the kidneys through an IV bolus. Diuretics are given to make sure that there is enough volume that is being pushed inside the kidney to have it restarted and enter the diuretic phase. Once the client’s kidneys are rebooted, the next goal is to achieve the recovery phase.

In our next lecture, we will talk about creatinine clearance tests and how it is connected to clients with renal failure.

Illustration Provided By Injury Map