Asuhan Keperawatan Dengan Klien Gagal Ginjal

Rabu, Januari 13, 2010

Kasus: Tgl 29-04, 09.20Tn. S, 24 tahun, datang ke rumah sakit dengan keluhan utama sesak nafas, RPS: Os adalah penderita CRF ec. GNC, HD rutin seminggu 2X tiap hari senin dan kamis, sejak 6 th yll. Os juga menderita DC ec. HHD. 2 hari SMRS os sesak nafas, batuk (+), demam (-), DD (+), PND(+),mual/muntah (-/-), BAK (-)sudah 2 hari, RPD: HT (+), DM (-) Pemeriksaan fisik Ku tampak sesak , gizi cukup, kesadaran CM, Konjuntiva anemis (+/+), sklera ikterik(-/-), L: JVP tak meningkat., Th: cardiomegali, SI-II murni, bising(-), Pulmo: sonor, RBB +/+,A: H/L ttb, asites (-) E: edema - - , VS: TD 150/90 mmHg, N 92x/mnt, R 28 x/mnt, T 370C case: Date 29-04, 09.20Tn. S, 24, came to the hospital with a chief complaint of shortness of breath, RPS: Os is ec CRF patients. GNC, HD routine 2X week every Monday and Thursday, from 6 th yll. Os is also suffering from DC ec. HHD. 2 days SMRs os shortness of breath, cough (+), fever (-), DD (+), PND (+), nausea / vomiting (- / -), BAK (-) is 2 days, RPD: HT (+) , DM (-) physical examination I looked crowded, enough nutrition, awareness CM, Konjuntiva anemis (+ / +), sclera jaundice (- / -), L: JVP not increased., Th: cardiomegali, SI-II pure, noisy (-), Pulmo: resonant , RBB + / +, A: H / L CCTs, ascites (-) E: edema -, VS: BP 150/90 mmHg, 92x/mnt N, R 28 x / mnt, T 370C

Chronic Kidney Disease could be known if the following criteria has met:

1. Kidney damage for equal or more than 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR 2. GFR <60 mL/min/1.73m2 for greater than or equal 3 months, with or without kidney damage Stages of Chronic Kidney Disease This is according to National Kidney Foundation Stage 1 Description GFR (mL/min/1.73m2 ) Greater than or equal 90

2 3 4 5

Kidney damage with normal or increased GFR Kidney damage with 60-89 mild decrease of GFR Moderate decrease of 30-59 GFR Severe decrease of GFR15-29 Kidney Failure Less than 15 (dialysis)

Risk Factors
1. Diabetes most common cause of chronic kidney disease worldwide; obesity is an 2.

3. 4. 5.
6.

additional factor for diabetes Hypertension systolic hypertension is of particular concern. Beginning at around age 50, systolic blood pressure rises and continues to rise with age. Autoimmune disease Systemic infection Urinary stones or lower urinary tract obstruction Exposure to certain toxic drugs cyclosporins and othe immunosuppressive agents and corticosteriods

Diagnostic Evaluation: 1. Urinalysis reveal that casts found in urine are helpful in determining the type of kidney disease 2. Blood analyses may include levels of createnine, blood urea nitrogen, serum electrolytes and pH 3. Ultrasonography can detect a tumor or hydronephrosis 4. Computed tomography and magnetic resonance imaging demonstrate vessel disorders 5. Kidney arteriography and venography can show damage to kidney vasculature 6. Proteinuria screening persistent proteinuria is usually the first indicator of kidney damage. Signs and symptoms: 1. swelling, usually of the lower extremities 2. fatigue 3. weight loss 4. loss of appetite 5. nausea or vomiting 6. a change in urination (change in volume and frequency) 7. change is sleep pattern 8. headaches 9. itching 10. difficulties in memory and concentration Complications:
1. Cardiovascular disease hypertension may also contribute to the development and 2. 3. 4. 5.

increase the risk of stroke Anemia when kidneys are damaged there is a decrease in erythropoietine, a hormone that stimulates production of red blood cells Bone disease disorders of calcium and phosphorus metabolism may develop early Malnutrition alteration of the bodys response to insulin as well as other metabolic functions (such as erythropoietin formation and vitamin D matebolism) Decreased functional status and well-being includes complex regimen, adverse effects and the possible or actual loss of job and income

Medical Management: 1. Peritoneal dialysis 2. Hemodialysis 3. Kidney Transplantation Nursing Management: 1. Proper assessment for risk factors that might cause a rapid decline 2. Encourage self-management such a blood pressure monitoring and glucose monitoring 3. Administer prescribe medications ( ion exchange resin, alkalizing agents, antibiotics, erythropoietin, folic acid supplements) 4. Maintain strict fluid control

5. Encourage intake of high biologic value protein (eggs, dairy products and meats) 6. Encourage adequate rest