1. The client/caregiver has a basic understanding of the anatomy and physiology of the renal system.
   1. The kidneys are two bean-shaped organs and are located on each side of the vertebral column at the 12th thoracic vertebrae at the posterior abdominal wall.
   2. Each kidney has a ureter about 25 to 30 centimeters long that connects to the bladder.
   3. The function of the kidneys is to remove waste materials from blood, balance body fluids, and form urine.
2. The client/caregiver can define acute renal failure.
   1. Acute renal failure is the sudden inability of kidneys to remove metabolic waste and concentrate urine without losing electrolytes.
   2. Renal cells are damaged by decreased renal blood flow and a lack of oxygen and other nutrients to the cells.
3. The client/caregiver can list factors that may increase risk of renal failure.
   1. Low blood pressure caused by trauma, surgery, serious illness, septic shock, hemorrhagic shock, burns, or dehydration
   2. Acute pyelonephritis or septicemia
   3. Urinary tract obstruction
   4. Blood transfusion reaction
   5. Autoimmune kidney disease
4. The client/caregiver can recognize signs and symptoms.
   1. Nausea and vomiting
   2. Urinary system changes
      • A decrease in the amount of urine
      • No urination
      • Excessive urination at night
   3. Changes in mental status or mood
      • Drowsiness or lethargy
      • Agitation
      • Delirium or confusion
      • Coma
      • Mood changes
      • Trouble paying attention
      • Hallucinations
   4. Generalized swelling and fluid retention
   5. Flank pain between ribs and hips
   6. Headache
   7. Decreased sensation in hands and feet
   8. Decreased appetite and metallic taste in mouth
   9. Slow, sluggish movements, hand tremor, or seizures
   10. Itchiness
   11. Bruising and prolonged bleeding (nosebleeds, blood in stool)
5. The client/caregiver can list measures to manage acute renal failure.
   1. Follow prescribed diet closely.
      • High in carbohydrates
      • Low in protein
      • Low in sodium
      • Low in potassium
   2. Monitor fluid status closely.
      • Weigh daily using the same scale at the same time each day.
      • Measure intake and output.
      • Restrict fluids as instructed.
   3. Take medication as ordered (possible use of antibiotics and/or diuretic).
   4. Avoid infections, or get prompt treatment of infection.
   5. Follow activity as ordered with regular rest periods.
   6. Provide skin care and oral hygiene:
      1. Keep fingernails short and avoid scratching.
      2. Use lotions to moisturize skin and decrease itchiness.
      3. Use a soft-bristled toothbrush and mouthwash.
   7. Keep follow-up appointments with physician and laboratory tests.
   8. Use Medic Alert card and bracelet.
6. The client/caregiver can list possible complications.
   1. Fluid and electrolyte imbalance
   2. Chronic renal disease
   3. Anemia (loss of blood in the intestines)
   4. End-stage renal disease
   5. Damage to heart or nervous system
   6. Hypertension
   7. Need for dialysis

Resources

National Kidney Foundation
www.kidney.org

National Kidney and Urologic Diseases Information
Clearinghouse
http://kidney.niddk.nih.gov/about/index.htm

Support groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.
Nutrition made incredibly easy. (2003). Philadelphia: Lippincott Williams & Wilkins.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com