You are on page 1of 22

ASKEP KLIEN DENGAN OVERLOAD CAIRAN

Lestari Sukmarini, MNS 2010


Page 1

Definisi
OVERLOAD=HIPERVOLEMIA=FLUID EXCESS NANDA: peningkatan retensi cairan isotonik, meningkatnya jumlah total sodium

tubuh dan cairan total tubuh.


Suatu keadaan dimana terjadi peningkatan volume cairan ekstrasel terutama Intravaskular melebihi kemampuan tubuh mengeluarkan air melalui ginjal, saluran cerna dan kulit.

Compromised regulatory mechanisms for sodium and water (CHF, CKD, Liver
failure), Hypervolemia (or "Fluid overload") is the medical condition where there is too much fluid in the blood. The fluid can either be intravascular or extravascular

and result in edema.


An expansion of extracellular volume involving interstitial or vascular space.

Page 2

Intake cairan

Intake Na+

Hipervolemia

Retensi garam: Heart failure Liver cirrhosis Nephrotic syndrome Corticosteroid therapy Hyperaldosteronism Intake rendah protein

Fluid shift into intravascular: Remobilisasi cairan setelah penanganan luka bakar Pemberian cairan hipertonik mis: mannitol atau hypertonic saline Pemberian plasma proteins, mis albumin

Page 3

Page 4

G e j a l

Weight gain Edema Bounding pulses Shortness of breath; orthopnea Pulmonary congestion on x-ray Abnormal breath sounds: crackles (rales) Change in respiratory pattern Third heart sound (S3) Intake greater than output
Page 5

Decreased hemoglobin or hematocrit Increased blood pressure Increased central venous pressure (CVP) Increased pulmonary artery pressure (PAP) Jugular vein distension Change in mental status (lethargy or confusion) Oliguria Specific gravity changes Azotemia Change in electrolytes Restlessness and anxiety
Page 6

Edema
Lokal edema = tangan/kaki General edema = anasarka Mekanisme: Tekanan hidrostatik kapiler Tek onkotik kapiler = hipoalbumin Tek onkotik interstisial
Page 7

Lung edema

Page 8

Fluid dynamics at the capillary

CHP = Capillary Hydrostatic Pressure COP = Capillary Osmotic Pressure IFHP = Interstitial Fluid Hydrostatic Pressure IFOP + Interstitial Fluid Osmotic Pressure Page 9

Fluid exchange

Page 10

PENGKAJIAN
Tanda gejala: dyspnea, orthopnea PF: edema, BB , TD, asites, crackles,ronkhi, wheez, DVJ,gallop. Hemodinamik: CVP Riwayat & faktor resiko: Retensi Na & air: CHF, CH, SN, glukokortikosteroid Fungsi ginjal abnormal Pemberian cairan intravena >> Perpindahan cairan interstisial ke plasma. Page 11

PEMERIKSAAN DIAGNOSTIK
Ht BUN/kreat meningkat pada gagal ginjal BJ urin/sodium urin Osmolality serum/urin GDA: hipoksemia, asid resp (edema paru) Chest X-Ray: tanda kongesti vaskuler pulmoner

Page 12

Management overload
Memperbaiki penyakit dasar Weight daily Monitor ketat I/O: pantau infus! Diet rendah garam 0.5-1 gr/hr (n= 3,5 gr/hr) Restriksi cairan (min IWL: 40 ml/jam) Pemberian diuretik Edema: elevasi kaki, ubah posisi Asites: paracentesis Edema paru: oksigen Ultrafiltrasi
Page 13

Examples Acidifying salts Arginine vasopressin receptor 2 antagonists Aquaretics Ethanol, Water CaCl2, NH4Cl amphotericin B, lithium citrate Goldenrod, Juniper

Mechanism inhibits vasopressin secretion

Location (numbered in distance along nephron) 1. 1.

inhibit vasopressin's action

5. collecting duct

Increases blood flow in kidneys 1.

Na-H exchanger antagonists


Carbonic anhydrase inhibitors

dopamine[8]
acetazolamide[8], dorzolamide

promote Na+ excretion


inhibit H+ secretion, resultant promotion of Na+ and K+ excretion

2. proximal tubule[8]
2: proximal tubule

Loop diuretics

bumetanide[8], ethacrynic 3. medullary thick ascending inhibit the Na-K-2Cl symporter acid[8], furosemide[8], torsemide limb glucose (especially in promote osmotic diuresis uncontrolled diabetes), mannitol 2. proximal tubule, descending limb

Osmotic diuretics

Potassium-sparing diuretics

amiloride, spironolactone, triamterene, potassium canrenoate.

inhibition of Na+/K+ exchanger: Spironolactone inhibits aldosterone action, Amiloride 5. cortical collecting ducts inhibits epithelial sodium channels[8] inhibit reabsorption by Na+/Clsymporter inhibit reabsorption of Na+, increase glomerular filtration rate 4. distal convoluted tubules

Thiazides

bendroflumethiazide, hydrochlorothiazide caffeine, theophylline, theobromine

Xanthines

1. tubules

Page 14

Kerja diuretik

Page 15

Efek diuretik?
Evaluasi pemberian diuretik: Tanda dehidrasi forced diuresis Perubahan kadar elektrolit: hiponatremia hipo/hiperkalemia Perubahan asam basa

Page 16

Diagnosa Kep & Intervensi


1. Gangguan pertukaran gas b.d perubahan membran alveolar-kapiler sekunder thdp kongesti vaskular pulmoner yg tjd pada pertambahan CES. pantau adanya sesak,ansietas,batuk sputum berbusa, krekles, ronkhi, takikardia,takipnea. Pantau GDA thdp adanya hipoksemia & alkalosis respiratorik Posisikan semi-fowlers Berikan O2 sesuai protokol
Page 17

2. Kelebihan volume cairan b.d kelebihan intake/gg mekanisme regulasi. Monitor I/O Observasi dan dokumentasi adnya edema Timbanag BB tiap hari Pantau dan restriksi diet rendah garam Pembatasan cairab Higiene oral membran mukosa oral tetap lembab dan utuh Dokumentasi respon thdp diuretik: produksi urin? Observasi tanda dehidrasi
Page 18

Edukasi klien-keluarga
Monitor I/O Tanda gejala overload: edema, BB > Gejala yg memerlukan lapor segera mis: sesak anafas, nyeri dada, nadi irreguler Kepatuhan thdp terapi, diet, pembatasan cairan Pentingnyapenimbangan BB/hari

Page 19

Page 20

Page 21

Page 22