Acute Renal Failure: Not Just a Medical Condition
Beth Stroud, RN, BSN, Graduate
Student
Murray State
University
Acute renal failure (ARF) has become increasingly common in patients with critical illnesses. Up to two-thirds of
intensive care unit (ICU) patients develop ARF with the leading cause being sepsis (Kosinski, 2009). Treatment of
ARF has been associated with higher costs and the following adverse outcomes: increased length of stay, excess
mortality of 30-71%, need for chronic dialysis in the patients who survive, and the requirement of discharge to
short-term or long-term care facilities (Uchino, Kellum, Bellomo, Doig, Morimatsu, Schetz, Tan, Bouman, Macedo,
Gibney, Tolwani, & Ronco, 2005). Despite the prevalence of the disease and the need for evidence-based
guidelines, over 57 different definitions exist for the critical condition.
Early recognition of ARF has been instrumental in improving patient outcomes. Interdisciplinary collaboration is
essential for prompt identification of risks and for completing accurate ongoing assessments. Treatment of ARF
includes multiple pharmacological and non-pharmacological components such as mechanical ventilation, vasoactive
intravenous medications, nutritional support, and dialysis.
Based on the complexity of ARF, healthcare institutions are challenged with the need to provide complex care to
obtain optimal patient outcomes. The American Association of Critical Care Nurses’ (AACN) Synergy Model provides a
framework for institutions to correlate the patients’ characteristics and care needs with the nurses’ competencies
in order to achieve optimal outcomes (Kaplow & Hardin, 2007). The purpose of this article is to demonstrate the
use of the Synergy Model in obtaining optimal patient outcomes in the following case study.
Case Study: Acute Renal Failure and Sepsis
John is a 43 year old, white male who is single, has no children, is unemployed, and is uninsured. He has
been treated for hypertension and erectile dysfunction for the past 3 years and has presented to the
emergency department four times in the last month with complaints of not being able to urinate. His home
medications include Aspirin 81 mg daily, Plavix 75 mg daily, Metoprolol 50 mg twice a day, and Viagra as needed;
however, he has only been taking his Viagra since he lost his job three months ago. He has developed urinary
retention and has been catheterizing himself at home for approximately one week with the foley catheter he pulled
out of the trash at his last emergency room visit.
His older sister, the only surviving relative, has brought him to the emergency department with confusion,
hypothermia, tachycardia, tachypnea, hypotension, neutropenia, bandemia, anemia, and thrombocytopenia. His
admitting blood urea nitrogen (BUN) and creatinine were 65 and 7.5 mg/dl, respectively. His urinalysis revealed
white blood cells (WBC) too numerous to count and trace of red blood cells (RBC). His potassium level was 5.8.
Blood cultures revealed a gram-negative septicemia.
After being admitted and transferred to the ICU, John had a rapid decline in respiratory status and was intubated
and mechanically ventilated. Fluid replacement was started using crystalloid solutions. Norepinephrine was started
IV to manage the hypotension and maintain an adequate blood pressure. An infectious disease practitioner was
consulted and John was started on aggressive antibiotic, antifungal, and antiviral therapy. The nephrologist
ordered continuous renal replacement therapy (CRRT) to treat John’s ARF since he was too unstable to tolerate
hemodialysis.
AACN Synergy Model
The American Association of Critical Care Nurses’ (AACN) Synergy Model for Patient Care is a conceptual framework
used to guide nursing practice. The Synergy Model places the patient as the central focus and suggests matching the
competencies and skills of the nurse to the patient’s care needs. The model identifies eight patient
characteristics and eight nursing competencies and describes the relationship to outcomes for the patient, nurse,
and the healthcare system. The Synergy Model is particularly important in critical care areas which require nurses
to have greater competencies and skill sets to meet the needs of the critically ill patients such as John.
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