Nursing Interventions for Acute Renal Failure

SimpleNursing Editorial Team Jun 29, 2018
Nurse with clipboard next to dialysis machine - nursing interventions for acute renal failure title card

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  1. Nursing Interventions for Acute Renal Failure
  2. Nursing Interventions for Hyperkalemia
  3. Kayexalate Nursing Considerations
  4. Dopamine Nursing Considerations
  5. Total Volume & Volume Depletion

Acute renal failure (ARF) is a serious condition that requires prompt and effective management. Nursing interventions for acute renal failure involve monitoring and managing the patient’s fluid and electrolyte balance.

In cases of total volume depletion, the nurse should ensure that the patient receives adequate fluid replacement through intravenous (IV) fluids or blood products, as appropriate. And in cases where volume overload is a concern, the nurse should closely monitor the patient’s fluid intake and output and implement strategies to minimize fluid retention. 

Nursing Interventions for Acute Renal Failure

  • Monitor vital signs, including blood pressure, heart rate, and respiratory rate, is essential to detect any changes that may indicate worsening of the condition.
  • Administer medications such as diuretics, antihypertensives, and antibiotics that may be prescribed to manage symptoms and prevent complications. 
  • Assess for signs of infection. Patients with ARF are at increased risk for infections, especially urinary tract infections. This includes fever, chills, and increased white blood cell count, and notify the physician if necessary.
  • Provide proper nutrition. Patients with ARF may require a diet limiting protein, sodium, and potassium intake. 
  • Educate the patient and family about the condition, treatment, and self-care strategies. This may include medication information, dietary restrictions, and complications such as hyperkalemia.

Normally, the kidneys play a crucial role in maintaining electrolyte balance, including potassium. In ARF, the kidneys cannot effectively filter and eliminate waste products, including potassium, from the blood. 

This can result in an increase in serum potassium levels, which can be dangerous and potentially life-threatening. Hyperkalemia can cause cardiac arrhythmias, muscle weakness, and respiratory distress.

Hyperkalemia is a complication of ARF and occurs due to the impaired ability of the kidneys to regulate potassium levels in the blood. 

Nursing Interventions for Hyperkalemia

To manage hyperkalemia in ARF, nursing interventions may include:

  • Monitor serum potassium levels frequently to detect hyperkalemia and guide treatment.
  • Restrict potassium intake. Patients with hyperkalemia may need to limit their dietary intake of potassium.
  • Assist in dialysis. Dialysis is a common treatment for hyperkalemia in ARF. It involves using a machine to filter the blood and remove excess potassium and other waste products.
  • Administer medications such as loop diuretics, insulin, and glucose to lower serum potassium levels. These medications work by promoting potassium excretion or shifting potassium into the cells. Kayexalate and Dopamine are also used for ARF and hyperkalemia treatments.

Kayexalate Nursing Considerations

Kayexalate is the first thing that is given to ARF patients due to the presence of hyperkalemia. If urine is not being produced, potassium will be expelled through the anus with the help of Kayexalate.

Nursing considerations for Kayexalate include: 

  • Monitoring serum potassium levels before and after administration and bowel obstruction.
  • Ensuring adequate fluid intake to prevent dehydration.
  • Checking for drug interactions before administering the medication.

Dopamine Nursing Considerations

Dopamine is a medication used to treat hypotension by increasing blood pressure and improving blood flow to vital organs.

It helps in renal vasodilation, and at the same time, vasoconstricting the peripheral body. This causes an increase in pressure. Low blood pressure is one of the main causes of ARF –  therefore, dopamine will help in the hyperperfusion of the kidneys.

Nursing considerations for dopamine include: 

  • Monitoring blood pressure and heart rate before and during administration and for signs of extravasation. 
  • Assessing for adverse effects such as tachycardia or dysrhythmias.
  • Checking for drug interactions before administering the medication.

Total Volume & Volume Depletion

The main goal with ARF treatment is to push volume through the kidney, which can be referred to as, “tickling the kidney.” Tickling the kidney means increasing the perfusion, leading to increased blood volume and oxygen. 

By doing so, we’re trying to get the patient from the oliguric phase to the diuretic phase, hoping 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 patient – 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 restart the organ and get 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 ARF patients.

Read more about stages of renal failure here.

Acute Renal Failure Nursing Interventions Conclusion

In retrospective, when a patient is 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 ensure enough volume is being pushed inside the kidney to have it restarted and enter the diuretic phase. Once the patient’s kidneys are rebooted, the next goal is to achieve the recovery phase.

Cut Down Time on Studying the Endocrine System

The endocrine system is complex with conditions such as ARF. To pass your classes and exams, you have to spend plenty of time you might not have on studying.

SimpleNursing is created specifically to help nursing students easily pass classes and tests. Check out our question banks, videos with rationales, study guides, and much more.

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