Overview of Renal Failure | Nursing Diagnosis for Renal Failure
Renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease). (Wikipedia.org)
A decrease in renal function can occur in an acute (sudden) or a chronic (progressive) manner.
Acute renal failure can be broken down into pre-renal, renal, and post-renal. Prerenal causes result from diminished renal perfusion. Hypovolemia due to blood or fluid losses, diuretic use, third-spacing of fluids, reduced renal perfusion due to NSAID use or CHF can cause pre-renal failure. Renal failure in acute care patients most commonly results from acute tubular necrosis. Drug related reactions, particularly to antibiotics, may cause an allergic interstitial nephritis. Pylenonephritis or glomerulonephritis may also cause renal failure. Post-renal failure is due to some type of urinary tract obstruction, bladder outlet obstruction, stone, prostate hypertrophy, or compression of ureter due to abdominal mass.
Chronic renal failure is an irreversible disease due to damaging effects on the kidneys caused by diabetes mellitus, hypertension, glomerulonephritis, HIV infection, polycystic kidney disease, or ischemic nephropathy.
Prognosis of Renal Failure | Nursing Diagnosis for Renal Failure
In acute renal failure, kidneys start working following intensive treatment and rectifying the underlying condition that caused the problem. In chronic renal failure, the patient can die as a result of complications of the disease.
Nursing Diagnosis for Renal Failure: Signs & Symptoms and Interpreting Test Result of Renal Failure
Signs and Symptoms of Renal Failure| Nursing Diagnosis for Renal Failure
- Azotemia—elevated BUN and creatinine
- If hypovolemic (pre-renal), tachycardia, orthostatic hypotension, dry skin, and mucous membranes
- Weight loss due to chronic disease
- Abdominal bruit with ischemic nephropathy
- Peripheral edema with third spacing of fluids
- Decreased urinary output
- Uremic pruritis—see excoriations from scratching
- Anemia in chronic disease—kidneys produce erythropoetin
Interpreting Test Result of Renal Failure| Nursing Diagnosis for Renal Failure
- BUN elevated.
- Creatinine elevated.
- BUN/creatinine ratio elevated.
- Urinalysis may show casts (hyaline or granular in acute prerenal; RBC, WBC in renal), proteinuria.
- Glomerular filtration rate decreases in chronic disease.
- Creatinine clearance decreases.
- Renal ultrasound shows decrease in renal size in chronic renal failure; dilation and fluid build up in post-renal failure.
Nursing Diagnosis for Renal Failure: Treatment of Renal Failure
Treatment of Renal Failure | Nursing Diagnosis for Renal Failure
Treatment needs to address the underlying disease process. What will correct one cause may make another cause worse.
- Administer intravenous fluids to correct hypovolemia.
- Administer inotropic agents for patients with CHF to enhance cardiac output.
- Administer antibiotics for pyelonephritis.
- Stent placement or catheter (urethral, suprapubic, nephrostomy) to allow for drainage of urine if blockage present.
- Dialysis.
- Administer erythropoetin to treat anemia.
- Restrict potassium, phosphate, sodium, and protein in diet.
- Administer phosphate binders to reduce phosphate levels.
- Administer sodium polystyrene sulfonate to reduce potassium levels.
- Monitor electrolyte levels.
- Control blood pressure.
- Control blood glucose levels.
Nursing Diagnosis for Renal Failure and Nursing Interventions
Most Common Nursing Diagnosis for Renal Failure
- Impaired urinary elimination
- Ineffective tissue perfusion (renal)
- Fear
Nursing Interventions for Renal Failure
- Monitor vital signs for changes in heart rate or blood pressure.
- Monitor intake and output.
- Assess intravenous site for redness, swelling, or pain.
- Check dialysis access site for signs of infection.
- Check AV shunt for thrill (palpable turbulence of bloodflow; gently feel for flow of blood through shunt) and bruit (audible turbulence of bloodflow; listen with stethoscope for sound of bloodflow through shunt).
- No contrast dye tests.
- No nephrotoxic medication.
- Monitor patient very closely.
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