10 Nursing Care Plans for Acute Renal Failure | Case Studies

Acute Renal Failure (ARF), also known as Acute Kidney Injury (AKI), is a sudden loss of kidney function that results in the accumulation of waste products, fluid imbalance, and electrolyte disturbances. For nursing students preparing for the NCLEX, understanding how to develop a comprehensive nursing care plan for acute renal failure is essential for both exam success and clinical practice. In this guide, we’ll outline 10 detailed care plans based on NANDA nursing diagnoses, including goals, interventions, and rationales, all relevant for NCLEX preparation.

1. Impaired Urinary Elimination

• Related To: Decreased glomerular filtration rate

• As Evidenced By: Oliguria, dark and concentrated urine

• Goal: Patient will demonstrate adequate urinary output within 24–48 hours.

• Interventions:

  • Monitor input/output hourly.

  • Assess for signs of fluid retention (edema, weight gain).

  • Educate patient on the importance of hydration.

• Rationale: Monitoring output helps track renal recovery or decline.

2. Excess Fluid Volume

• Related To: Fluid retention due to decreased excretion

• As Evidenced By: Edema, elevated BP, crackles in lungs

• Goal: Maintain fluid balance with no signs of overload.

• Interventions:

  • Restrict fluids as ordered.

  • Monitor daily weight and vital signs.

  • Administer diuretics if prescribed.

• Rationale: Prevents pulmonary complications and heart strain.

Case Study Of Excess Fluid Volume

Mr. J, a 70-year-old with hypertension, presents with bilateral leg edema and shortness of breath. Lab results show increased BUN and creatinine. You implement fluid restriction, monitor weight daily, and educate the patient on signs of worsening overload.

3. Risk for Electrolyte Imbalance

• Related To: Altered kidney filtration and excretion

• As Evidenced By: Hyperkalemia, hyponatremia

• Goal: Maintain electrolyte levels within normal limits.

• Interventions:

  • Monitor serum potassium, sodium, and calcium levels.

  • Provide low-potassium diet.

  • Administer calcium gluconate if potassium is dangerously high.

• Rationale: Electrolyte imbalance can lead to arrhythmias and neuromuscular dysfunction.

Case Study For Risk for Electrolyte Imbalance

John, a 45-year-old recovering from trauma-induced AKI, shows rising potassium levels. You place him on cardiac monitoring, prepare for potential Kayexalate administration, and teach the importance of dietary potassium limits.

4. Ineffective Renal Tissue Perfusion

• Related To: Reduced blood flow due to hypovolemia or obstruction

• As Evidenced By: Decreased urine output, increased BUN/creatinine

• Goal: Improve perfusion to restore kidney function.

• Interventions:

  • Administer IV fluids or vasopressors as needed.

  • Monitor renal labs regularly.

  • Position patient to promote renal perfusion.

• Rationale: Enhancing blood flow can prevent permanent renal damage.

Case Study For Ineffective Renal Tissue Perfusion

A post-op patient becomes hypotensive and urine output drops to 10 ml/hr. You implement interventions to maintain MAP >65 mmHg, assess for hypovolemia, and communicate renal perfusion concerns to the healthcare team.

5. Fatigue

• Related To: Metabolic waste accumulation

• As Evidenced By: Patient reports exhaustion, low activity tolerance

• Goal: Increase energy levels through rest and treatment.

• Interventions:

  • Encourage rest periods between activities.

  • Monitor hemoglobin levels and consider transfusion if necessary.

  • Provide emotional support.

• Rationale: Rest conserves energy and supports healing.

Case Study For Fatigue

Mr. L, a dialysis-dependent AKI patient, reports feeling too weak to attend physical therapy. You prioritize energy conservation, schedule rest periods, and evaluate hemoglobin levels to address potential anemia.

6. Imbalanced Nutrition: Less Than Body Requirements

• Related To: Anorexia, dietary restrictions

• As Evidenced By: Weight loss, decreased appetite

• Goal: Maintain adequate nutrition to support healing.

• Interventions:

  • Collaborate with dietitian for renal-friendly meals.

  • Encourage small, frequent meals.

  • Monitor protein intake carefully.

• Rationale: Prevents muscle breakdown and supports metabolic needs.

Case Study For Imbalanced Nutrition: Less Than Body Requirements

A 60-year-old female with decreased appetite and nausea due to AKI loses 5 pounds in a week. You coordinate with a renal dietitian and educate her on protein intake and phosphate restrictions, while monitoring her daily intake.

7. Risk for Infection

• Related To: Invasive procedures (dialysis), weakened immunity

• As Evidenced By: Foley catheter, vascular access devices

• Goal: Remain infection-free throughout hospitalization.

• Interventions:

  • Use aseptic technique for all procedures.

  • Monitor for signs of infection (fever, redness, WBC count).

  • Educate patient about hygiene and infection signs.

• Rationale: Infection can exacerbate renal failure and delay recovery.

Case Study For Risk for Infection

A 50-year-old AKI patient with a Foley catheter develops a mild fever. You ensure sterile catheter care, educate on hand hygiene, and assess for signs of UTI or bloodstream infections.

8. Anxiety

• Related To: Fear of disease progression, dialysis

• As Evidenced By: Restlessness, verbalized fear

• Goal: Patient will verbalize reduced anxiety.

• Interventions:

  • Provide clear information about treatment and prognosis.

  • Offer emotional support and active listening.

  • Involve family members in care and decisions.

• Rationale: Education and support reduce uncertainty and fear.

Case Study For Anxiety

A 38-year-old newly diagnosed with AKI is visibly anxious about dialysis and prognosis. You offer emotional support, explain procedures, and involve family in care discussions.

9. Risk for Impaired Skin Integrity

• Related To: Edema, immobility

• As Evidenced By: Fluid-filled skin, decreased mobility

• Goal: Maintain intact skin during treatment course.

• Interventions:

  • Reposition patient every 2 hours.

  • Inspect skin regularly for redness or breakdown.

  • Use pressure-relieving devices.

• Rationale: Prevents complications like pressure ulcers.

Case Study For Impaired Skin Integrity

A bedbound AKI patient with edema is at high risk for pressure ulcers. You implement a turning schedule, assess bony prominences, and apply barrier creams to reduce breakdown.

10. Deficient Knowledge

• Related To: Lack of information about disease, treatments

• As Evidenced By: Patient questions, noncompliance

• Goal: Patient will demonstrate understanding of care plan.

• Interventions:

  • Provide education about acute renal failure and management.

  • Use simple language and visual aids if necessary.

  • Evaluate learning through teach-back.

• Rationale: Knowledge promotes active participation in care.

Final Thoughts

Mastering a nursing care plan for acute renal failure not only helps you pass the NCLEX but also prepares you to provide safe and effective care in real-life clinical settings. Acute renal failure (now commonly termed acute kidney injury or AKI) demands vigilant assessment, timely intervention, and a holistic understanding of both the disease process and patient needs. By incorporating NANDA-approved nursing diagnoses, individualized goals, evidence-based nursing interventions, and clear rationales, you develop the critical thinking necessary for success in your nursing career.