Nursing Intervention for Acute Renal Failure
To the nursing intervention, the nurses should be have good knowledge to decide which phase of his/her patient related to the acute renal failure. Base on that information, bellow are some nursing intervention they can do to the patient with acute renal failure :
- Oliguric-anuric phase ; In this phase, the client's urine output falls bellow 400 ml/day. With resultant electrolyte imbalance, metabolic acidosis, and retention of nitrogenouse wastes from non functioning nephrons. This pahse may last up to 14 days. The Nurses should be follow these steps :
- Maintain the client on complete bed rest, organize care to provide long rest periods. Activity increase the rate of metabolism, which increase production of nitrogenouse waste product.
- Implement intervention to prevent infection and the complications of immobility. Because She/He is on bed rest, the client becomes susceptible to the hazards of immobility. Infection is a serious risk and the leading cause of death in client with acute renal failure.
- Observe the client for metabolic acidosis to identify complication of renal failure.Observe the fluid and electrolyte balance hourly.
- Insert an indwelling urinary catheter and measure output and specific gravity hourly. These action allow the nurse to monitor the kidneys, which have the major role in regulating fluid and electolyte balance. High potassium levels can occur.
- Provide only enough fluid intake to replace urine output to avoid an edema caused by excessive fluid intake.
- Monitor the client's diet to provide high carbohydrates, adequate fats, and low protein. If client receives high calories from fat and carbohydrate metabolism, the body doesn't break down protein for energy. Protein is thus available for growth and repair.
- Reduce the client's potassium intake to help prevent elevated potassium levels. Protein catabolism causes potassium release from cells into the serum.
- Observe for the arrhytmias and cardiac arrest to identify complications of high serum potassium.
- Provide frequent oral hygiene to avoid tissue irritation and sometime ulcer formation caused by urea and other acid waste products excreted through the skin and mucous membranes.
- Provide the client with hard candy and chewing gum to stimulate saliva flow and decrease thirst.
- Maintain skin care with cool water to relive pruritus and remove uremic frost (white crystal formed on skin from excretion of urea).
- Administer stool softeners to prevent colon irritation from high levels urea and organic acids.
- Provide emotional reassurance to the client and family members to help decrease anxiety levels caused by the fact that the client has an acute illness with unknown prognosis.
- Explain treatments and progress to the client to help reduce anxiety.
- Provide hemodialysis or peritoneal dialysis as ordered.
- Early diuretic phase ; During early diuretic phase, which last about 10 days, the client excretes a large volume (over 3,0000 ml/day) of very dilute urine. The glomeruli are beginning to function effectively, but tubules aren't, and the client still experiences electrolyte imbalance, retention of nitrogenous waste product and metabolism acidosis. The nurse should be do intervention such as ;
- Assess fluid and electrolyte balance to identify continued fluid and electrolyte imbalance when the renal tubules aren't functioning.
- Assess the emotional status of the client and family members to provide support because the prognosis is still uncertain.
- Continue interventions used during the oliguric phase.
- Late Diuretic phase ; In the late diuretic phase, the client is still excreting more fluid than normal. Urine specific gravity is increasing because the tubules are beginning to function effectively. Fluid, electrolyte and acid-base balances are returning to normal. In this condition, The nurse should do the following steps ;
- Continuing implementations of the early diuretic phase. Allow the client to engage in nonstrenuous activity for brief periods and increase the activity level gradually. Don't let him/her become fatigued which may increase the rate of metabolism and overwork the kidneys.
- Teach the client to prevent infection and to avoid the factors that caused renal failure to help prevent a recurrence.