Nursing Management and Complication of Acute Renal Failure (ARF)

Definition of Renal Failure:

Renal failure may be defined as failure to renal excretion leading to retention of nitrogenous waste products of metabolism including creatinine & urea.

Kidney failure, also known as renal failure or renal insufficiency, is a medical condition of impaired kidney function in which the kidneys fail to adequately filter metabolic wastes from the blood.

Definition of Acute Renal Failure (ARF):

Acute Renal Failure (ARF) is characterized by an acute and usually reversible deterioration of renal function which develops over a period of days or weeks and results in uraemia.

Nursing management of acute renal failure (ARF)
Fig: Nursing management of acute renal failure (ARF)

Investigations of Acute Renal Failure (ARF):

All the investigations of acute renal failure have presented in the following:

  • Urine for RME, C/S: Volume reduced, increased specific gravity, pus cell, RBC cast may present.
  • Blood: FBC, Platelet count, blood film, blood culture.
  • Blood urea, serum creatinine raised.
  • Serum electrolytes: Hyperkalaemia, hyponatraemia, metabolic acidosis.
  • X-ray of KUB region, Chest X-ray.
  • Ultrasonography of KUB region.
  • Intravenous urology.
  • Renal biopsy.

Nursing Management of Acute Renal Failure (ARF):

1. Emergency resuscitative measure:

  • Hyperkalaemia: Calciumgluconate 10 ml l 10% IV, infusion of 25% glucose and d if hyperglycaemia insulin (12 unit IV)
  • Acidosis: 10% NaHCO3

2. General management:

  • Fluid and electrolyte balance: Fluid requirement is 500 ml plus previous day output.
  • Nutrition: Restriction of protein to about 40 g/day (0.5 – 1 gm/kg/day in children) and adequate calorie.
  • Control of symptoms: If infection, antibiotic, hypertension; antihypertensive.

3. Management of oliguric phase:

  • Restriction of movement (absolute bed rest),
  • Restriction of fluid (previous day output + 500 ml),
  • Restriction of protein (about 40 mg day),
  • No restriction of carbohydrate or fat,
  • Restriction of fruits (especially K* fruit),
  • Restriction of salts,
  • If patient’s condition is deteriorating, go for peritoneal dialysis or haemodialysis.

4. Management of diuretic phase:

  • Adequate amount of fluid orally or parenterally to replace 3-5 liters of urine that is produced daily.
  • Adequate maintenance of electrolytes balance with serum electrolytes estimation daily.
  • Restriction of protein.
  • Strict control of infection should be maintained.
  • Haemodialysis or peritoneal dialysis (if indicated).

5. Infection control: by antibiotic

6. Drugs: NSAIDs and ACE inhibitors should be avoided.

Complication of Acute Renal Failure:

Complications of acute renal failure are listed in the below:

  1. Oedima,
  2. Electrolytes imbalance: Hyperkalaemia, hyponatraemia,
  3. Acid base imbalance: Metabolic acidosis,
  4. Hyperuricemia,
  5. Infections,
  6. Undergo chronic renal failure (CRF),
  7. Bleeding manifestations,
  8. Cardiac,
  9. Uraemic pericarditis,
  10. Cardiac arrhythmias,
  11. Hypertension.

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