ASUAHAN KEPERAWATAN ANAK DENGAN GLUMERULONEFRITIS AKUT

1. Pengertian Glumerul ne!riti" a#ut $ GNA % a&ala' (en)a#it )ang men)erang gl meruli &ari #e&ua gin*al+ "e,agai "uatu rea#"i imun l gi ter'a&a( ,a#teri atau -iru" tertentu. GNA "ering &itemu#an (a&a ana# umur ./0 ta'un+ le,i' "ering (a&a (ria. 1ia"an)a &i&a'ului le' in!e#"i e#"trarenal+ terutama &i tra#tu" re"(irat riu" ,agian ata" &an #ulit. 2. Eti l gi 3 Fa#t r eti l gin)a ,an)a# &an ,er-aria"i 3 / / / Rea#"i imun l gi 3 in!e#"i lu(u" er)t'emat "u"+ "tre(t 4 4u". 5e&era -a"#uler 3 Hi(erten"i+ DM. K agula"i # agulan )ang men)e,ar $ DI5 % .. Pat !i"i l gi GNA a&ala' a#i,at rea#"i antigen anti, &i &engan *aringan glumerulu" )ang menim,ul#an ,eng#a# &an #ematian "el6"el #a(iler $ e(itel+ mem,ran la(i"an ,a7a'+ &an en& telium.% Rea#"i antigen anti, &i menga#ti!#an *alur # m(lemen )ang ,er&am(a# 4'em ta#"i" #e(a&a ( l)m r! nu#lear $ PMN % le# "it menim,ul#an (ening#atan re"( n (a&a #etiga *eni" "el gl merulu". Tan&a &an ge*ala )ang ,ere!le#"i #e(a&a #eru"a#an glumerulu" &an ter*a&i &an mengeluar#an en"im li" " mal )ang men)erang mem,ran &a"ar gl mer lu" )ang

#e, 4 ran (r tein ma"u# #e&alam urin $ (r teinuri &an eritr "it 8 'ematuri %. Karena (r "e" (en)a#it ,erlan*ut ter*a&ila' (arut )ang ,era#i,at menurunn)a !iltra"i glumerulu" &an ,er&am(a# liguri &an reten"i air+ " &ium &an (r &u# "i"a nitr gen. Ke"emuan)a ini ,er&am(a# mening#atn)a - lume 4airan+ e&em+ &an a" temia )ang )ang &itam(il#an melalui na(a" (en&e#+ e&em )ang &e(en&en+ "a#it #e(ala+ lema' &an an re#"ia.

9. Ge*ala #lini# Ge*ala )ang "ering a&ala' 'ematuri : #a&ang/#a&ang &i"ertai e&ema ringan &i"e#itar mata 8 "eluru' tu,u' umumn)a e&ema ,erat ter&a(at (a&a liguria &an ,ila (a)a' *antung &an 'i(erten"i. 1ila ter*a&i #eru"a#an gin*al ma#a te#anan &ara' a#an tinggi . Su'u tu,u' ti&a# "e,era(a tinggi ta(i &a(at tinggi (a&a 'ari (ertama . Munta' ti&a# na!"u ma#an+ # n"ti(a"i &an &iare ti&a# *arang men)ertai GNA.

Rea#"i imun l gi 1eng#a# ; Kematian Sel/"el #a(iler Glumer lu" <alur # m(lemen a#ti! $4'em ta#"i"% en"im li" " mal men)erang 1GM Keru"a#an glumerulu" $(r teinuri &an 'ematuri%

tim,ul (arut !ung"i glumerulu" ,er#urang

Peng#a*ian #e(era7atan 3 1. I&entita" Klien3 GNA a&ala' "uatu rea#"i imun l gi )ang "ering &itemu#an (a&a ana# umur ./0 ta'un le,i' "ering (a&a (ria 2. Ri7a)at (en)a#it "e,elumn)a 3 A&an)a ri7a)at in!e#"i "tre(t # #u" ,eta 'em liti# &an ri7a)at lu(u" eritemat "u" atau (en)a#it aut imun lain. .. Ri7a)at (en)a#it "e#arang 3 Klien mengelu' #en4ing ,er7arna "e(erti 4u4ian &aging+ ,eng#a# "e#itar mata &an "eluru' tu,u'. Ti&a# na!"u ma#an+ mual + munta' &an &iare. 1a&an (ana" 'an)a "utu 'ari (ertama "a#it. 9. / Pertum,u'an &an (er#em,angan 3 Pertum,u'an 3 11 = >?0/@82=2> #g $ 1e'rman %+ menurut ana# umur > ta'un 1,n)a a&ala' 11 umur A ta'un = 2B #g &itam,a' @/0 l, (erta'un = 2A / 2> #g+ tinggi ,a&an ana# 1.C 4m. Na&i CB61BB?8menit+ &an RR 1C/2B?8menit++ te#anan &ara' A@/ 1BC8AB/AC mm Hg. Ke,utu'an #al ri 0B/CB #al8#g118'ari. Gigi (emanen (ertama 8m lar +umur A/0 ta'un gigi "u"u mulai le(a"+ (a&a umur 1B611 ta'un *umla' gigi (ermanen 1B/11 ,ua'. / Per#em,angan 3 P"i# " "ial 3 Ana# (a&a tuga" (er#em,angan in&u"tri D in!eri rita"+ &a(at men)ele"ai#an tuga" meng'a"il#an "e"uatu P"i# "e#"ual 3 @. Peng#a*ian Per( la Su'u ,a&an n rmal 'an)a (ana" 'ari (ertama "a#it. Da(at ter*a&i #ele,i'an ,e,an "ir#ula"i #arena a&an)a reten"i natrium &an air+ e&ema (a&a "e#itar mata &an "eluru' tu,u'. Klien mu&a' mengalami in!e#"i #arena a&an)a &e(re"i "i"tem imun. A&an)a mual + munta' &an an re#"ia men)e,a,#an inta#e nutri"i )ang ti&a# a&e#uat. 11 mening#at #arena a&an)a e&ema. Perlu#aan (a&a #ulit &a(at ter*a&i #arena uremia. 2%. P la elimina"i 3 elimina"i al-i ti&a# a&a gangguan+ elimina"i uri 3 gangguan (a&a glumerulu" men)e,a#an "i"a/"i"a meta, li"me ti&a# &a(at &ie#"#re"i &an ter*a&i (en)era(an #em,ali air &an natrium (a&a tu,ulu" )ang ti&a# mengalami gangguan )ang men)e,a,#an liguria "am(ai anuria +(r teinuri+ 'ematuria.

1%. P la nutri"i &an meta, li#3

.%. P la A#ti!ita" &an lati'an 3 Pa&a Klien &engan #elema'an malai"e+ #elema'an t t &an #e'ilangan t nu" #arena a&an)a 'i(er#alemia. Dalam (era7atan #lien (erlu i"tira'at #arena a&an)a #elainan *antung &an &an te#anan &ara' mutla# "elama 2 minggu &an m ,ili"a"i &u&u# &imulai ,ila te#anan &&ara' "u&a' n rmaal "elama 1 minggu. A&an)a e&ema (aru ma#a (a&a in"(e#"i terli'at retra#"i &a&a+ (engggunaan t t ,antu na(a"+ tera,a + au"#ulta"i ter&engar rale" &an #re#el" + (a"ien mengelu' "e"a#+ !re#uen"i na(a". Kele,i'an ,e,an "ir#ula"i &a(at men)e,a,#an (emm,e"aran *antung $ Di"(nea+ rt (nea &an (a"ien terli'at lema'% + anemia &an 'i(erten"i )ang *uga &i"e,a,#an le' "(a"me (em,ulu' &ara'. Hi(erten"i )ang meneta( &a(at men)e,a,#an gagal *antung. Hi(erten"i en"e!al (ati meru(a#an ge*ala rang tua ti&a# mengeta'ui "ere,rum #arena 'i(erten"i &engan ge*ala (engli'atan #a,ur+ (u"ing+ munta'+ &an #e*ang/#e*ang. GNA mun4uln)a ti,a/ti,a (en)e,a, &an (enanganan (en)a#it ini. 9%. P la ti&ur &an i"tira'at 3 Klien ti&a# &a(at ti&ur terlentang #arena "e"a# &an gatal #arena a&an)a uremia. #eleti'an+ #elema'an malai"e+ #elema'an t t &an #e'ilangan t nu" @%. K gniti! ; (er"e(tual 3 Pening#atan ureum &ara' men)e,a,#an #ulit ,er"i"i# #a"ar &an ra"a gatal. Gangguan (engli'atan &a(at ter*a&i a(a,ila ter*a&i en"e!al (ati 'i(erten"i. Hi(ertemi ter*a&i (a&a 'ari (ertama "a#it &an &itemu#an ,ila a&a in!e#"i #arena inumnita" )ang menurun. A%. Per"e("i &iri 3 Klien 4ema" &an ta#ut #arena urinen)a ,er7arna mera' &an e&ema &an (era7atan )ang lama. Ana# ,er'ara( &a(at "em,u' #em,ali "e(erti "emula 0%. Hu,ungan (eran 3 Ana# ti&a# &i,e"u# le' teman E temann)a #arena *au' &an ling#ungan (era7atann )ang ,aru "erta # n&i"i #riti" men)e,a,#an ana# ,an)a# &iam. C%. T leran"i # (ing >%. Nilai #e)a#inan 3 Klien ,er& a mem ' n #e"em,u'an "e,elum ti&ur. Pemeri#"aan (enun*ang 3 1. 2. LED tinggi &an H, ren&a' Kimia &ara'3 Serum al,umin turun "e&i#it+ "erum # m(lemen turun+ ureum &an #reatinin nai#. Titer anti"tre(t li"in umumn)a nai# $ #e4uali in!e#"i "tre(t # # )ang men&a'ului

mengenai #ulit "a*a %. .. <umla' urin mengurang+ 1<n)a ren&a' + al,umin F+ erittr "it FF+ leu# "it F &an ter&a(at "ilin&er leu# "it+ Eri &an 'ialin. 9. Kultur &ara' &an tengg r #an 3 &itemu#an #uman "tre(t 4 4u" 1eta Hem liti4u" g l A @. IGP 3 Te"t !ung"i Gin*al n rmal (a&a @B H (en&erita A. 1i ("i Gin*al 3 "e4ara ma#r "# (i" gin*al tam(a# mem,e"ar+ (u4at &an ter&a(at titi#/titi# (er&ara'an (a&a # rte#. Mi#r "# (i" ttam(a# 'amm(ir "emua gl merulu" ter#ena. Tam(a# (r li!era"i "el en& tel gl merulu" )ang #era" "e'ingga lumen &an ruang "im(ai 1 7man + In!iltra"i "el e(itel#a("ul &an "el PMN &an m n "it. Pa&a (emeri#"aan mi#r "# ( ele#tr n tam(a# 1GM ti&a# teratur. Ter&a(at gum(alan 'um(" &i "u, e(itel mung#in &i,entu# le' gl ,ulin/gama+ # m(lemenn &an antigen "tre(t # #u".

Diagn "a #e(era7atan 3 1. Int leran"i a#ti!ita" ,.&. #e#urangan (r tein &an &i"!ung"i gin*al 2. P ten"ial #ele,i'an - lume 4airan ,.&. reten"i air &an natrium "erta &i"!ung"i gin*al. .. P ten"ial ter*a&i in!e#"i $ ISK+ l #al+ "i"temi# % ,.&. &e(re"i "i"tem imun 9. P ten"ial gangguan (er!u"i *aringan3 #ri"i" 'i(erten"i. @. Peru,a'an integrita" #ulit ,.&. im ,ili"a"i+ uremia+ #era(u'an #a(iler &an e&ema. A. Kurang (engeta'uan )ang ,er'u,ungan &engan #urangn)a in! rma"i tentang (r "e" (en)a#it+ (era7atan &iruma' &an in"tru#"i e-alua"i. "ere,ral8#ar&i (ulm nal ,.&. re"i#

Ren4ana #e(era7atan 1. Int leran"i a#ti!ita" ,.&. #e#urangan (r tein &an &&i"!ung"i gin*al Tu*uan 3 Klien &a(at t leran"i &engan a#ti!ita" )ang &ian*ur#an. Ren4ana
1. 2. .. 9. @. Pantau ,erle,i'an #e#urangan (r tein )ang 1. 2. .. 9. @. 1eri#an a#ti!ita" A. 0. Ren4ana a#ti!ita" &enga 7a#tu i"tira'at. Ren4ana#an 4ara (r gre"i! untu# #em,ali ,era#ti!ita" n rmal : e-alua"i lati'an "elama (em,ata"an A. 0. $ (r teinuri+ al,uminuria %

Ra"i nal
Ke#urangan (r tein ,eerle,i'an &a(at menim,ul#an #elela'an. Diet )ang a&e#uat &a(at mengem,ali#an #e'ilangan (r tein tinggi TKTP ,er!ung"i mengganti#an Tira' ,aring mening#at#an mengurangi (enggunaan energi. Lati'an (enting untu #mem(erta'an#an tun " t t Ke"eim,angan a#ti!ita" &an i"tira'at mem(erta'an#an #e"egaran. A#ti!ita" (en)a#it )ang ,erta'a( men*aga #e"em,angan &an ti&a# mmem(er(ara' (r "e"

Guna#an &iet (r tein untu# mengganti (r tein )ang 'ilang. 1eri #ar, 'i&rat. Tira' ,aring &iet tinggi

te#anan &ara' &an 'aluaran (r tein urin.

2.

P ten"ial #ele,i'an - lume 4airan ,.&. reten"i air &an natrium "erta &i"!ung"i gin*al. Tu*uan 3 Klien ti&a# menun*u#an #ele,i'an - lume 4airan Ren4ana
1. 2. .. 9. @. A. Pantau &an la( r#an tan&a &an ge*ala #ele,i'an 4airan 3 U#ur &an 4atat inta# &an ut(ut "etia( 9/C *am 5atat *umla' &an #ara#teri"ti# urine U#ur ,erat *eni" urine tia( *am &an tim,ang 11 tia( 'ari K la, ra"i &engan gi i &alam (em,ata"an &iet natrium &an (r tein 1eri#an e" ,atu untu# meng ntr l ra"a 'au" &an maa"u#an &alam (er'itungan inta# 0. Pantau ele#tr lit tu,u' &an ,"er-a"i a&an)a tan&a #e#urangan ele#tr lit tu,u' / Hi( #alemia 3 #ram a,&+letargi+aritmia / Hi(er#alemia 3 #ram t t+ #elema'an / Hi( #al"emia 3 (e#a rang"ang (a&a C. 0. .+9.<umla' + #ara#teri"ti# urin &an 11 &a(at menun*u#an a&an)a #eti&a# "eim,angan 4airan. @.Natrium 4airan. Rang"angan merang"ang (u"at 'au" Mem "eim,angan nit r ele#tr lit a&an)a #eti&a# &an menentu#an &ingin &&a(at &an (r tein mening#at#an "m larita" "e'ingga ti&a# ter*a&i retri#"i

Ra"i nal
1+2. Mem nit r #ele,i'an 4airan "e'ingga &a(at &ila#u#an tin&a#an (enanganan

tin&a#an (enanganan )ang te(at.

neur mu"#uler / #e*ang / Uremia 3 #a4au mental+ letargi+geli"a' C. Ka*i e!e#ti!ita" (em,erian ele#tr lit (arenteral &an ral C.Pem,erian ele#tr lit )ang te(at men4ega' #eti&a# "eim,angan ele#tr lit. Hi(er! "!atemia3 'i(ere!le#"i+(are"te"ia+ #ram t t+ gatal+

.. P ten"ial ter*a&i in!e#"i $ ISK+ l #al+ "i"temi# % ,.&. &e(re"i "i"tem imun Tu*uan 3 Klien ti&a# mengalami in!e#"i "etela' &i,eri#an a"u'an #e(era7atan. Ren4ana
1. Ka*i imun "u(re"an e!e#ti!ita"

Ra"i nal
(em,erian 1.Imun "u(re"an ,er!un"i mene#an "i"teem imun ,ila (em,eriann)a ti&a# e#e!ti! ma#a tu,,u' a#an "angat rentan ter'a&a( in!e#"i 2.In&i#at r a&an)a in!e#"i

2. .. 9. @. A. 0. C. >.

Pantau leu# "it Pantau "u'u tia( 9 *am Per'ati#an #ara#teri"ti# urine+ # la, ra"i *i##a #eru' &an ,er,au Hin&ari (ema#aian alat8#ateter (a&a "aluran uriine Pantau tan&a &an ge*ala ISK &an la#u#an tin&a#an (en4ega'an ISK. Guna#an &an an*ur#an te'ni# 4u4i tangan )ang ,ai#. An*ur#an La#u#an integrita" #ulit (a&a #lien untu# meng'in&ari rang terin!e#"i (en4ega'an #eru"a#an

..Mem nit r "u'u ; menganti(a"i in!e#"i 9. @. A. 0. C. >. Urine #eru' mmenun*u#an a&an)a in!e#"i "aluran #emii' Kateter &a(at men*a&i me&ia ma"u#n)a #uman #e "aluran #emi' Mem nit r a&an)a in!e#"i "e'ingga &a(at &ila#u#an tin&a#an &engan 4e(at Te'ni# 4u4i tangan )ang ,ai# &a(at memutu" rantai (enularan. Si"tim imun )ang terganggu memu&a'#an untu terin!e#"i. Keru"a#an integrita" #ulit meru(a#an 'ilangn)a ,arrier (ertama tu,u'

1B. An*url#an (a"ien am,ula"i &ini.

9.

P ten"ial gangguan (er!u"i *aringan3 "ere,ral8#ar&i (ulm nal ,.&. re"i# #ri"i" 'i(erten"i. Tu*uan 3 Klien ti&a# mengalami (eru,a'an (er!u"i *aringan. Ren4ana Ra"i nal
1. 2. .. Kri"i" 'i(erten"i men)e,a,#an "u(la) &ara' #e rgan tu,u' ,er#urang. Te#anan E!e#ti!ita" &ara' )ang tinggi men)e,a,#an "u(la) &ara' ,er#urang. ,at anti 'i(erten"i (enting

1.

Pantau tan&a &an ge*ala #ri"i" 'i(erten"i $ Hi(erten"i+ ta#i#ar&i+ ,ra&i#ar&i+ #a4au mental+ (enurunan ting#at #e"a&aran+ "a#it #e(ala+ tinitu"+ mual+ muntu'+ #e*ang &an &i"ritmia%.

2.

Pantau te#anan &ara' tia( *am &an # la, ra"i ,ila a&a (ening#atan TD "i"t le I1AB &an &ia"t le I >B mm Hg 9.

untu# men*aga a&e#uatn)a (er!u"i *arringan. P "i"i ti&ur )ang ren&a' men*aga "u(la) &ara' )ang 4u#u( #e &aera' 4ere,ral

.. 9.

Ka*i #ee!e#ti!an ,at anti 'i(erten"i Perta'an#an TT &alam ( "i"i ren&a'

@.

Peru,a'an integrita" #ulit ,.&. im ,ili"a"i+ uremia+ #era(u'an #a(iler &an e&ema. Tu*uan 3 Klien ti&a# menun*u#an a&an)a (eru,a'an integrita" #ulit "elama men*alani (era7atan. Ren4ana Ra"i nal
1. Menganti"i(a"i a&an)a #eru"a#an #ulit "e'ingga &a(at &i,eri#an (enangan &ini. 2+.. Kulit )ang #ering &an ,er"i' ti&a# mu&a' ter*a&i irita"i &an mengurangi me&ia (ertum,u'an #uman. 9. L ti n &a(at melentur#an #ulit "e'ingga ti&a# mu&a' (e4a'8ru"a#. @.Sa,un )ang #era" &a(at menim,ul#an #e#eringan #ulit &an "a,un )ang #a"ar &a(at mengg re" #ulit. untu# ti&a# A. #ulit. 0+C.Am,ula"i &an (eru,a'an ( "i"i mening#at#an "ir#ula"i &an men4ega' (ene#anan (a&a "atu "i"i. 1B. 11. 12. 19. Li(atan menim,ul#an tte#anan (a&a #ulit. Sir#ula"i )ang ter'am,at memu&a'#an ter*a&in)a #eru"a#an #ulit.. Ela"ti"ita" #ulit &aera' e&ema "angat #urang "e'ingga mu&a' ru"a# Nutri"i )ang a&e#uat mening#at#an (erta'anan #ulit Menggaru# menim,ul#an #eru"a#an

1. 2. .. 9.

Ka*i #ulit &ari #emera'an+ #eru"a#an+ memar+ turg r &an "u'u. <aga #ulit teta( #ering &an ,er"i' 1er"i'#an ; #ering#an &aera' (erineal "etela' &e!i#a"i Ra7at #ulit &engan mengguna#an l ti n untu# men4ega' #e#eringan untu# &aera' (ruritu".

@. A. 0. C. >. 1B. 11. 12. 1.. 19.

Hin&ari (enggunaan "a,un )ang #era" &an #a"ar (a&a #ulit #lien In"tru#"i#an #lien menggaru# &aera' (ruritu". An*ur#an am,ula"i "emam(u #lien. 1antu #lien untu# mengu,a' ( "i"i "etia( 2 *am *i#a #lien tira' ,aring. Perta'an#an linen ,e,a" li(atan 1eri (elin&ung (a&a tumit &an "i#u. Le(a"#an (a#aian+ (er'ia"an )ang &a(at men)e,a,#an "ir#ula"i ter'am,at. Tangani area e&ema &engan 'ati /'ati. 1eri#an "unti#an &engan 'ati/'ati . Pertta'an#an nutri"i a&e#uat.

DAFTAR PUSTAKA Tu4#er Mrrtin+ at al. $1>>C% + Stan&ar Pera7atan Pa"ien+ J Pr "e" Ke(era7atan+ Diagn "a+ &an e-alua"i J+ EG5+ <a#arta. L ng 1ar,ara 5.+$1>C>%+ E""ential ! Me&i4al/Surgi#al Nur"ing a Nur"ing Pr 4e"" A((r a4'+ T'e 5G M ",) 5 m(an) St L ui"+ USA. <una&i Purnaman+ at al + $1>>0% Ka(ita Sele#ta Ke& #teran + Me&ia Ae"#ula(iu"+ <a#arta.