Last updated on December 28th, 2023
Here we will formulate sample Acute Renal Failure (ARF) nursing care plans based on a hypothetical case scenario.
It will include three acute renal failure nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales.
20 NANDA nursing diagnosis for chronic kidney disease (CKD)
Case Scenario
A 58-year-old male presents to the ED with complaints of nausea, fatigue, and shortness of breath. The patient has a past medical history of diabetes and hypertension.
The patient says he hasn’t felt well for the last few days but he has been checking his blood sugar and blood pressure, which have both been normal.
The patient also says he hasn’t been urinating very frequently. Thinking he was dehydrated, the patient tried to drink more water, but his urine output did not increase and he started to notice more swelling in his lower extremities.
Upon assessment, the patient is oriented to person, place, and situation but is slightly disoriented regarding the time.
His temperature is 37.3 ˚C, heart rate is 92 BPM, blood pressure is 132/84 mmHg, respirations are 34 breaths per minute, and oxygen saturation is 95% on room air.
His lung sounds reveal scattered crackles. +3 pitting edema is noted in the patient’s lower extremities. The patient’s abdomen appears distended.
A 12-lead EKG is performed, revealing normal sinus rhythm with frequent PVCs.
His blood sugar is 121 mg/dL. His blood work reveals potassium of 6.2 mmol/L, sodium 133 mmol/L, BUN 103 mg/dL, and creatinine 3.7 mg/dL. His hemoglobin and hematocrit are slightly low, 8.5 and g/dL and 27% respectively. The urinalysis reveals a specific gravity of 1.010.
A renal ultrasound is performed and no obstruction is seen.
The patient is admitted to the hospital for Acute Renal Failure.
#1 Acute Renal Failure (ARF) Nursing Care Plan – Risk for electrolyte imbalance
Nursing Assessment
Subjective Data:
- The patient is experiencing nausea, fatigue, shortness of breath, and oliguria.
Objective Data:
- The patient’s sodium is 133 mmol/L, and potassium is 6.2 mmol/L.
- The BUN and creatinine are 103 mg/dL and 3.7 mg/dL respectively.
Nursing Diagnosis
Risk for electrolyte imbalance related to renal dysfunction as evidenced by decreased sodium and elevated potassium, BUN, and creatinine.
Goal/Desired Outcome
Short-term goal: By the end of the shift the patient’s potassium will return to a normal level.
Long-term goal: The patient will have adequate urine output with normal electrolyte laboratory levels.
Acute Renal Failure (ARF) Nursing Interventions with Rationales – Risk for electrolyte imbalance
| Nursing Interventions | Rationales |
| Monitor lab values every 4 hours or as needed. | Hyperkalemia can be lethal so the patient’s potassium should be closely monitored, especially after interventions to decrease potassium and/or after dialysis. |
| Administer IV calcium gluconate. | IV calcium gluconate prevents arrhythmias such as ventricular fibrillation by decreasing the excitability of cardiomyocytes. |
| Administer IV insulin & D50. | The combination of IV insulin and D50 brings potassium into the cells, temporarily lowering the potassium level, but without actually excreting it from the body. D50 should be administered before insulin to prevent an unsafe drop in blood sugar if IV access fails. |
| Administer kayexalate either orally or rectally. | Kayexalate works by exchanging sodium for potassium in the colon, thus excreting potassium from the body. It works over hours, and the patient may experience diarrhea. |
| Place the patient on continuous ECG monitoring. | Patients with hyperkalemia are at significant risk of arrhythmias due to increased cardiac excitability. The ECG should be monitored closely, and rapid efforts to decrease potassium should be taken. |
| Educate the patient about avoiding high-potassium and high-sodium foods | Foods high in potassium include bananas, oranges, apricots, cooked spinach, potatoes, and mushrooms. High sodium foods include salted nuts, canned meats, or frozen meals. |
#2 Acute Renal Failure (ARF) Nursing Care Plan – Impaired urinary elimination
Nursing Assessment
Subjective Data:
- The patient reports not urinating frequently.
Objective Data:
- The urinalysis reveals a specific gravity of 1.010.
- +3 pitting edema is noted in the patient’s lower extremities.
- The BUN and creatinine are 103 mg/dL and 3.7 mg/dL respectively.
Nursing Diagnosis
Impaired urinary elimination related to oliguria secondary to acute kidney injury as evidenced by low specific gravity, +3 pitting edema, and elevated BUN and creatinine.
Goal/Desired Outcome
Short-term goal: By the end of the shift the patient’s BUN and creatinine will remain stable or begin to decrease.
Long-term goal: The patient will retain full kidney function, independent of dialysis.
Acute Renal Failure (ARF) Nursing Interventions with Rationales – Impaired urinary elimination
| Nursing Interventions | Rationales |
| Consider CRRT. | Continuous renal replacement therapy is a type of temporary dialysis used for patients with acute kidney injuries, particularly those that are hemodynamically unstable. |
| If utilizing CRRT, prepare for temporary dialysis catheter placement. | Vascular access with a specialized catheter must be obtained before initiating CRRT. Dialysis catheters are large-bore double lumen catheters, generally placed in an internal jugular, femoral, or subclavian vein. |
| If acute renal failure becomes an end-stage renal failure, consider hemodialysis or peritoneal dialysis. | Hemodialysis and peritoneal dialysis are types of dialysis used for chronic or end-stage renal patients. |
| Assess for reversible causes of acute kidney injury. | Blood loss, drug reactions, hypotension, and heart failure are potential causes of acute kidney injuries. |
#3 Acute Renal Failure (ARF) Nursing Care Plan – Excess fluid volume
Nursing Assessment
Subjective Data:
- The patient reports not urinating frequently.
Objective Data:
- +3 pitting edema is noted in the patient’s lower extremities and his abdomen is distended.
- The BUN and creatinine are 103 mg/dL and 3.7 mg/dL respectively.
Nursing Diagnosis
Excess fluid volume related to decreased urine output secondary to kidney injury as evidenced by +3 pitting edema and elevated BUN and creatinine.
Goal/Desired Outcome
Short-term goal: By the end of the shift, the patient’s urine output will be at least 30 ml an hour.
Long-term goal: The patient’s BUN and creatinine will return to normal levels, urine output will normalize, and no excess swelling or edema will be present.
Acute Renal Failure (ARF) Nursing Interventions with Rationales – Excess fluid volume
| Nursing Interventions | Rationales |
| Closely monitor intake and output. | Close documentation of I&O will help determine the patient’s fluid status and guide the plan of care. |
| Perform a daily weight. | To assess fluid status, a daily weight should be taken at the same time and via the same route (bed scale, standing scale, etc.) End-stage renal disease patients who are dependent on dialysis are generally aware of their “dry weight” (or post-dialysis weight) which is used to assess their individual fluid status. |
| Monitor urine-specific gravity. | Patients with an acute kidney injury are unable to concentrate urine, therefore the urine specific gravity is low. |
| Monitor for physical signs of fluid volume overload. | Physical signs of fluid volume overload include edema, ascites, a positive fluid wave in the abdomen, or jugular vein distention. |
| Impose a fluid restriction. | Fluids should be limited in the acute phases of a kidney injury. |
20 NANDA nursing diagnosis for chronic kidney disease (CKD)
Conclusion
To conclude, here we have formulated a scenario-based nursing care plan for Acute Renal Failure. Prioritized nursing diagnosis includes risk for electrolyte imbalance, impaired urinary elimination, and excess fluid volume.
Additionally, this sampleARFnursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales.
Recommended Readings & References
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Comer, S. and Sagel, B. (1998). CRITICAL CARE NURSING CARE PLANS. Skidmore-Roth Publications.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
