Nursing Care in Acute kidney Failure

Acute kidney Failure, also known as Acute Renal Failure, refers to the immediate deterioration of basic renal function, which causes a sharp drop in glomerular filtration and an increase in nitrogen products in the blood. This condition is potentially reversible, however, if it is not handled properly and on time, it can lead the patient to Chronic Renal Insufficiency.

The etiology depends physiopathologically on its location, so three can be described:

  • Prerenal: It is due to the poor contribution of blood to the glomerular capillary, without affecting it structurally, so it can be said that with the appropriate treatment and care it is highly reversible.
  • Renal or intrarenal: This is caused by an injury of the kidney parenchyma, usually by toxic. It is also considered reversible and has four phases: 1) Start or exposure to the toxic; 2) Oliguric, lasting from eight to fourteen days, observing diuresis below 400 ml / day; 3) Polyuria, lasts about ten days, but the nitrogen bodies are still elevated in blood and 4) Recovery phase: It refers to the improvement of renal function, this phase can last up to six months, being its highest difficulty, the ability to concentrate urine.
  • Postrrenal or Obstructive: As its name says, it occurs due to obstruction of the urinary tract, which if properly corrected, will evolve favorably.


  • Vital signs according to medical indication (depend on the patient’s condition).
  • Strict water balance.
  • Monitor respiratory pattern.
  • Rest + 30 ° backrest.
  • Diet for a patient with kidney Insufficiency (in general it should be composed of 10 – 15% of proteins, 55 – 70% of carbohydrates and 20 – 30% of lipids).
  • Weight every day (if the patient’s condition allows it).
  • Trans-urethral tube care (if necessary).
  • Take and timely report of laboratory tests according to medical advice.
  • Dilute the indicated drugs to the limit of their solubility to reduce the supply of liquids.
  • Comply diuretics according to medical indication.
  • Changes in position (depends on the patient’s condition).
  • To guide the patient and family about the treatment and prevention of future events.

Nursing care in the IRA is aimed at recovering kidney function and minimizing the risk of recurrence, so it is very important education that we provide to both the patient and his family.

Nursing diagnoses (according to NANDA) applicable:

  • Risk of electrolyte imbalance (195).
  • Excess volume of liquids (26).
  • Nausea. (134)
  • Interruption of family processes (60).
  • Risk of deterioration of skin integrity (47).

Diet for kidney failure

What is a diet for kidney failure? A diet for kidney failure controls the amount of protein and phosphorus in the diet. It is also possible that you have to limit your intake of calcium, sodium and potassium. A diet for kidney failure can help decrease the amount of waste the body produces, which can help the kidneys work better. That could also help delay total kidney failure. The diet may change over time as the health condition changes. You may also need to make other changes in your diet if you have other health problems, such as diabetes.

What kind of changes do I need to make to follow a diet for kidney failure?

  • You will need to limit the amount of protein you eat to help you decrease waste in the blood. Foods that are high in protein include meat, poultry (chicken and turkey), fish, eggs and dairy products (milk, cheese, yogurt). The doctor will tell you how much protein you should eat each day.
  • You may need to limit the amount of phosphorus you consume. The kidneys can not eliminate the additional phosphorus that accumulates in the blood. This could cause the bones to lose calcium and weaken. Foods that are high in phosphorus are dairy products, beans, peas, nuts and whole grains. Phosphorus is also found in cocoa, beer and cola. The doctor will tell you how much phosphorus you should include in your diet each day.
  • You will need to limit sodium if you have high blood pressure or if you have extra fluid in your body. Limit sodium intake to 1500 mg every day. Table salt, canned foods, soups, salty snacks and processed meats, such as lean meats and sausages, are high in sodium.
  • You may need to limit potassium if your doctor tells you that your potassium levels in the blood are too high. Potassium is found in fruits and vegetables. You may need to limit the consumption of fruits and vegetables that are high in potassium.
  • You may need to limit the intake of fluids that you consume each day. If the body retains fluids, you will have inflammation and liquids may accumulate in the lungs. This can cause other health problems, such as shortness of breath.

What foods can I include? Ask the dietitian how much potassium, phosphorus, liquid and protein you should consume each day. The dietitian will inform you how many servings you can have from each of the food groups below. The approximate amount of these nutrients is listed next to each food group. Read the food label to find the exact amount.

  • Starches: These foods contain around 2 grams of protein, 90 calories, 80 mg of sodium, 35 mg of potassium and 35 mg of phosphorus.
    • 1 slice of bread (French, Italian, with raisins, light rye or white fermented dough), small loaves or 6-inch tortillas.
    • The ½ of bread for hamburger or for hot dog, English bread or a small donut
    • ¾ cup of cereal
    • ½ cup of cream of rice, cream of wheat, flour or cooked semolina
    • ½ cup cooked pasta (noodles, macaroni, spaghetti) or cooked rice
    • 4 (2 inches) of unsalted biscuits
    • 1 ½ cup of plain popcorn
    • 10 pretzels without salt or 9 tortilla chips
    • 10 vanilla wafers or 4 sugar cookies wafers, sweet butter cookies or sugar cookies
  • Vegetables: A serving of these foods contain about 1 gram of protein, 25 calories, 15 mg of sodium and 20 mg of phosphorus. The amount of sodium on the list is for canned or unsalted vegetables. A portion is equal to ½ cup, unless another amount is indicated.
    • Low in potassium (less than 150 mg): 
      • Green peas or soybean germ
      • Raw cabbage, cauliflower or eggplant
      • Canned cucumbers, onions or corn
      • All types of lettuce (1 cup)
      • 1 raw small carrot or 1 raw celery stalk
      • Fresh and canned mushrooms (mushrooms have 40 mg of phosphorus or more per serving)
    • Potassium medium (150-250 mg): 
      • 5 asparagus antlers
      • Broccoli or celery
      • Vegetable mixture
      • Green peas or pea (Peas have 40 mg or more of phosphorus per serving)
      • Pumpkin or zucchini
  • Fruits: A serving of these foods contain about ½ gram of protein, 70 calories and 15 mg of phosphorus. Each serving is equivalent to ½ cup, unless otherwise indicated.
    • Low in potassium (less than 150 mg): 
      • Apple juice, apple sauce or a small apple
      • Blueberries
      • Cranberries or cranberry juice cocktail
      • Canned pears
      • Grapes or grape juice
      • Peaches or canned pears
      • Pineapple or strawberries
      • 1 tangerine
      • Watermelon
    • Potassium medium (150-250 mg): 
      • Peaches or fresh pears
      • Cherries
      • Mango or papaya
      • Small grapefruit or grapefruit juice
  • Dairy products: The following foods have about 4 grams of protein, 120 calories, 80 mg of sodium, 185 mg of potassium and 110 mg of phosphorus.
    • ½ cup of milk (fat-free, low-fat, whole, buttermilk or chocolate milk)
    • ½ cup plain or fruit flavored yogurt, milk or snow ice cream
    • 1 slice of cheese
    • Lactose-free milk substitutes: These foods have ½ gram of protein, 140 calories, 40 mg of sodium, 80 mg of potassium and 30 mg of phosphorus. One serving is equivalent to ½ cup of frozen lactose free dessert, covered in frozen dessert lactose-free or lactose-free cream.
  • Meats and other foods with protein: These foods contain around 7 grams of protein, 65 calories, 25 mg of sodium, 100 mg of potassium and 65 mg of phosphorus. Do not use salt when preparing these foods.
    • 1 oz cooked beef, pork or poultry
    • 1 ounce of any fish, lobster, shrimp, clam, tuna, canned salmon without salt or sardines without salt
    • 1 ½ ounces of crab or oyster
    • 1 large whole egg or 2 large egg whites, or ¼ cup of egg substitute without cholesterol
  • Fats: These foods have very little protein and around 45 calories, 55 milligrams of sodium, 10 milligrams of potassium and 5 milligrams of phosphorus. It includes healthy fats, such as unsaturated fats, which are listed below.
    • 1 teaspoon margarine or mayonnaise
    • 1 teaspoon oil (safflower, sunflower, corn, soy, olive, peanut, canola)
    • 1 tablespoon of salad dressing made with oil (like Italian) or 2 tablespoons of salad dressing made with mayonnaise (like ranch)

What foods should I limit or avoid?

  • Starches: The following foods have added sodium and phosphorus.
    • 1 bun or small bun
    • 2 x 2 inches square cake
    • 1 (4 inch) pancake or waffle
    • ½ cup of oatmeal
    • ½ cup whole grain or bran
    • 1 piece of corn bread
    • ¾ ounce pretzel with salt in chopsticks or rings
    • 4 crackers in sandwich
  • Meat and protein foods: The following meats and cheeses are high in sodium.
    • 1 ounce of gourmet meat, such as beef, ham or turkey
    • 1 ounce canned salmon or sardines
    • ¼ cup cottage cheese
    • Processed cheese, such as American cheese and cheese spread
    • Smoked or cured meat, such as meat, bacon, ham, sausages for hot dogs and chorizo
  • Vegetables: The following vegetables are high in potassium. Each serving has more than 250 mg of potassium. One serving equals ½ cup, unless another amount is indicated.
    • Artichoke or a ¼ a whole avocado
    • Brucelas, cabbages or okra
    • Potatoes
    • Spinach
    • Sweet potato (sweet potato contains 40 mg of phosphorus or more per serving)
    • Tomatoes, regular or low-sodium tomato juice or ¼ cup of tomato sauce
    • pumpkin
    • Fresh Beets
  • Fruit: The following fruits are high in potassium. Each serving has more than 250 mg of potassium.
    • 1 cup of canned or fresh apricots, or 5 dried apricots
    • 1 small nectarine (2 inches wide)
    • 1 small orange or ½ cup of orange juice
    • ¼ cup of dates
    • ⅛ cup of sweet melon
    • 1 small banana
    • ½ cup of prune juice or 5 dried prunes
  • Fats: Limit the consumption of fats that are not healthy, such as saturated fats, which are listed below.
    • 1 teaspoon butter
    • 2 tablespoons of coconut
    • 1 tablespoon of coffee powder
    • 1 teaspoon solid butter
  • Others: The following are foods high in sodium.
    • Frozen foods and soups and fast foods, such as hamburgers and pizza (see label for serving size)
    • Seasoned salt, such as onion or garlic salt
    • Barbecue sauce, catsup, mustard and chili sauce
    • 2 medium green olives or 3 large black olives
    • Soy sauce, meat sauce and teriyaki sauce

What other dietary guidelines should I follow?

  • It may be necessary for you to take a vitamin and mineral supplement (such as calcium). Take only the supplement that the doctor recommends.
  • Avoid the use of salt substitutes because they contain potassium. They could cause them to excessively increase potassium levels in the blood.
  • When shopping, read the nutritional information that comes on the food labels. This information may also help you follow the diet for kidney failure. Ask the doctor for information about how to read food labels.

What are the risks of not following the diet for kidney failure? It could take a while to learn to follow the diet for kidney failure. If you do not eat enough food, you may not get the calories, protein and other nutrients your body needs. I could lose weight. If you do not follow the diet for kidney failure, the kidneys will work harder. This could cause a total renal failure to happen sooner. If you have total renal insufficiency, you will need to receive dialysis treatments.

When should I contact my doctor? Contact your doctor if:

  • You are gaining or losing weight very quickly.
  • He has shortness of breath.
  • You have nausea or vomiting.
  • He feels very weak and tired.
  • He has difficulty following the diet for kidney failure.

Kidney failure: How to choose a treatment

The kidneys filter waste from the blood and regulate other body functions. When your kidneys fail, you need a treatment that does the work that your kidneys normally do.

If you have kidney failure you should make some decisions about your treatment. You may choose not to receive any treatment. If you choose to receive treatment, your options include hemodialysis, which uses a machine to filter blood out of your body; peritoneal dialysis, which uses the lining of your abdomen to filter the blood inside your body; and kidney transplantation, in which a new kidney is placed in your body. Each treatment has advantages and disadvantages. Your decision regarding treatment will have a major impact on your daily life, for example, on your ability to keep your job if you work. You are the one who can decide what is most important. Reading this booklet is a good way to know your options so you can make an informed decision. And, if you discover that the option you choose does not adapt well to your life, you can change your treatment. With the help of health professionals, your family and friends, you can live a full and active life

When the kidneys fail

Healthy kidneys filter the blood by removing excess fluid, minerals and waste. The kidneys also produce hormones that keep bones strong and blood healthy. When the kidneys fail, harmful waste accumulates in the body, blood pressure can rise, and the body can retain excess fluid and not produce enough red blood cells. When this happens, you need treatment to replace the job of your kidneys.

Treatment option: hemodialysis

Hemodialysis cleans and filters the blood using a machine to temporarily remove hazardous waste from the body, and excess salt and water. Hemodialysis helps control blood pressure and helps the body maintain the proper balance of important chemicals, such as potassium, sodium, calcium and bicarbonate.

Dialysis can replace part of the functions of the kidneys. Medications, special diets and restriction in the consumption of liquids are also necessary. What you can eat and drink, and how much medicine you will need will depend on the treatment you choose.

Diet for hemodialysi

Hemodialysis and a proper diet contribute to reducing the waste that accumulates in the blood. In all dialysis centers there is a dietitian available to help you plan your meals according to your doctor’s instructions. When choosing foods remember

  • consume balanced amounts of high protein foods such as meat, chicken and fish.
  • Control the amount of potassium you eat. Potassium is a mineral found in: salt substitutes; some fruits such as bananas and oranges; the vegetables; the chocolate; and the nuts. Consuming too much potassium can be dangerous for the heart.
  • limit the amount of liquids you drink. When the kidneys are not working, water quickly accumulates in the body. Excess fluid causes your tissues to swell and can cause high blood pressure, heart problems, cramping, and low blood pressure during dialysis.
  • avoid salt. Salty foods thirst and make the body retain water.
  • limit the consumption of foods such as milk, cheese, nuts, dried beans and sodas / dark sodas. These foods contain large amounts of mineral phosphorus. Having too much phosphorus in the blood takes calcium from the bones, which weakens them, makes them fragile and can cause arthritis. To prevent bone problems, your doctor may give you special medications, which you should take with meals every day according to the instructions.
  • For more information on choosing the right foods, see the NIDDK booklet, Eat Well to Feel Good During Hemodialysis Treatment.

Advantages and disadvantages
All people respond differently to similar situations. What can be a negative factor for some could be positive for others. Consult the following list on the general advantages and disadvantages of hemodialysis performed at a center and at home.