Acute Renal Failure

Acute Renal Failure

1. Assessment

   • History taking
     • urine colour, odour, hematuria, urinary frequency, nocturne (Lewis et al., 2014 & James et al., 2013)
     • Family history
       • chronic diseases, hereditary diseases
     • Health History
       • Diagnosed medical condition, Previous surgeries and problems, Past medical conditions, Allergies, Risk Factors, medications (Lewis et al., 2014)
   • Physical examination
     • Focused examination
       • Heart and Lungs, chest, GI, GU (Lewis et al., 2014)
     • Vital signs
       • Temperature, BP, Weight
   • Diagnostic
     • Urine
       • Urine analysis, Protein, specific gravity, Albumin (Fry & Farrington, 2006)
     • Blood
       • CBC, BUN, Electrolyte, sr. creatinine,LFT, ABG
     • Imaging Studies
       • Renal USG, CT, MRI, Renal biopsy (Lewis et al., 2014)
     • Kidney Function
       • GFR, Creatnine clearance, Cystatin C, Estimating GFR (Lewis et al., 2014)
   • Signs & Symptoms
     • Decrease urine output, fluid retention, SOB, fatigue, irregular heart beat (Lewis et al., 2014)
   • Assessment

2. Planning

   • Collaborative Therapy
     • Treating precipitating cause
       • Ensure kidney perfusion, Eliminate cause, Manage sign and symptoms, Prevent complications (Lewis et al., 2014)
     • Fluid restriction
       • allowance=600ml +previous 24hr fluid loss (lewis et al., 2014)
     • nutritional therapy
       • Carbohydrate, fat and protein intake, potassium and sodium restriction, fat emulsion IV infusion (Lewis et al., 2014)
     • Anticipate TPN
       • Concentrated TPN formula
     • Measures to lower potassium
       • restrict dietary potassium, limit or discontinue medication that exacerbate potassium level
   • Patient
     • Observe signs of inflammation,Examine oral mucosa, Auscultate lung sounds, Review lab and diagnostic tests, Evaluate patient's mental status and LOC, Adhere to treatment and follow up care (Lewis et al., 2014 & James et al., 2013)
   • Family
     • Psychological support, counselling, Financial management, living condition,
     • Knowledge
       • Diet, Activity, Follow up, medication (James et al., 2013)
     • Lab work, diagnostic test
   • Discharge planning
     • Home care
       • Drink less fluid, measure I/O, Weight daily, Know when to see medical attention, practice good hygiene (Kellum &Lameire, 2013)
     • Follow up care
       • • Signs of a bladder infection, No urine output, back pain, swelling Lewis et al., 2014)

3. Implementation

   • ACUTE INTERVENTION
     • Adequate renal perfusion, isotonic fluid, hemodynamic monitoring, fluid electrolyte balance, weight daily, observe s/s of hypoglycaemia, protect from infection, skin/mouth care (CAANT, 2018 & Lewis et al., 2014)
   • Health Promotion
     • monitor s/s of drugs, Assess fluid loss, replace loss, monitor I/O, Careful follow up (Lewis et al., 2014)
   • Ambulatory and home care
     • Family
       • Psychological support, counselling, financial hardship
     • Patient
       • Dietary restriction, rest and activity, follow up care (CAANT, 2018)

4. Evaluation

   • Family
     • knowledge
       • providing care, rest and activity, diet, medication (Kellium &Lameire, 2013)
   • patient
     • Knowledge
       • Signs of infection, warning signs, risk factors, medication regimen, infection prevention, diet, follow up(Lewis et al., 2014 & Kellum & Lameire, 2013)
     • physical
       • cardiac function, Laboratory parameter, functional changes, volume depletion (James et al., 2013)

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