Acute Kidney Failure Oliguric Phase: Comprehensive Nursing Care Strategies

Managing the oliguric phase of acute kidney failure requires a well-structured nursing care plan that combines general supportive measures with targeted interventions. This critical stage is marked by significantly reduced urine output, placing patients at high risk for fluid overload, electrolyte imbalances, and systemic complications. Effective care during this period plays a pivotal role in stabilizing the patient's condition and preventing further deterioration.

General Nursing Care Principles

Patients in the oliguric phase must remain on strict bed rest to reduce metabolic demands and support cardiovascular stability. As renal function declines, cardiac workload increases, making physical exertion potentially dangerous. However, prolonged immobility can lead to serious complications such as deep vein thrombosis (DVT), muscle atrophy, and pressure ulcers. Therefore, passive range-of-motion exercises and assisted limb movements should be incorporated into the daily routine to maintain circulation and joint flexibility.

Nutritional support is another cornerstone of care. A diet rich in carbohydrates and vitamins is generally recommended to meet energy needs while minimizing protein metabolism. For non-diabetic individuals, a high-calorie, low-protein intake helps reduce nitrogenous waste accumulation. Protein consumption should be carefully limited to 0.6–0.8 grams per kilogram of body weight per day. Patients should avoid high-potassium foods—including bananas, oranges, potatoes, and tomatoes—as impaired kidneys cannot effectively excrete potassium, increasing the risk of life-threatening arrhythmias.

Dietary fiber is important to prevent constipation, which can exacerbate discomfort and affect overall recovery. Meals should consist of easily digestible semi-solid foods fortified with essential vitamins and minerals. Diabetic patients require close glucose monitoring, with carbohydrate intake adjusted to maintain glycemic control without compromising nutritional goals.

Specialized Clinical Interventions

Fluid Management and Input/Output Monitoring

One of the most critical aspects of care during the oliguric phase is strict fluid restriction. Since urine output is drastically reduced, any excess fluid intake can quickly lead to volume overload, pulmonary edema, and heart failure. All fluid sources—including oral drinks, IV fluids, and even food moisture—must be meticulously tracked. Daily weights, accurate intake and output records, and close observation for signs of fluid retention (such as swelling or shortness of breath) are essential components of effective management.

Skin and Oral Hygiene Maintenance

Due to limited mobility and potential metabolic imbalances, patients are vulnerable to skin breakdown and infections. Regular repositioning, use of pressure-relieving mattresses, and gentle skin cleansing help prevent pressure injuries. Special attention should be paid to bony prominences such as the sacrum, heels, and elbows.

Oral care is equally important. Uremic patients often experience dry mouth, mucosal irritation, and bad breath due to toxin buildup. Routine mouth rinsing with saline or prescribed solutions, along with lip moisturization, enhances comfort and reduces infection risks.

Monitoring for Electrolyte and Vital Sign Instability

Frequent assessment of electrolyte levels—especially potassium, sodium, calcium, and phosphorus—is crucial. Hyperkalemia is particularly dangerous and may require emergency treatment. Nurses must also continuously monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of sepsis, fluid imbalance, or cardiac distress.

Early recognition of abnormalities allows for timely intervention, improving prognosis and reducing the likelihood of progression to more severe stages of kidney injury. Collaborative care involving nephrologists, dietitians, and nursing specialists ensures a holistic and patient-centered approach throughout the oliguric phase.