CHAPTER I

INTRODUCTION

1.1 Background

Kidney hydronephrosis is swelling of the kidney due to back pressure due to the flow of
urine is blocked. Under normal circumstances, urine flows from the kidneys with very
rendah.Jika pressure flow of urine is blocked, the urine will flow back into the small tubes in the
kidney (tubulusrenalis) and into the central area of the urine collection (renal pelvis) . This will
cause the kidneys to swell and press akhinyarapuh.Pada kidney tissue, pressure persistent
hydronephrosis and severe renal tissue damage so that the kidneys gradually lose
fungsinya.Pelebaran prolonged renal pelvis can inhibit rhythmic muscle contractions that
normally drain the water to the urinary bladder. Fibrous tissue and muscle tissue replaces normal
position on the wall of the ureter, causing permanent damage. Hydronephrosis many occur
during pregnancy due to enlarged uterus pressing ureter. Hormonal changes will exacerbate this
situation by reducing the contractions of the ureter that normally drain the urine into the bladder.

Hydronephrosis would end if the pregnancy berakhir.Oleh therefore to overcome and to

prevent complications arising from hydronephrosis specific management needs to be done,
namely to identify and correct the cause of obstruction, to deal with the infection, and to
maintain and protect renal function.

1.2 Problem Formulation

a) What is the sense of hydronephrosis?

b) How is the epidemiology of hydronephrosis?
c) What are the etiology of hydronephrosis?
d) What are the signs and symptoms of hydronephrosis?
e) How the pathophysiology of hydronephrosis?
f) What are the complications and prognosis of hydronephrosis?
g) How does the management and treatment of hydronephrosis?
h) What are the investigation of hydronephrosis?
1.3 Purpose

a) to determine the meaning of hydronephrosis

b) to determine the epidemiology of hydronephrosis
c) to determine the etiology of hydronephrosis
d) to know the signs and symptoms of hydronephrosis
e) to determine the pathophysiology of hydronephrosis
f) to determine the complications and prognosis of hydronephrosis
g) to determine the management and treatment of hydronephrosis
h) to determine the investigation of hydronephrosis?

1.4 Benefits

This paper we make to fulfill the task subjects and to increase knowledge about the
disease and hydronephrosis to determine appropriate nursing care in patients with
hydronephrosis.
 CHAPTER II

REFERENCES

2.1 Definition

Pelvic dilatation of the ureterhydronephrosis is generated by outflow obstruction of urine

by stones or layout artery abnormalities that suppress the enlarged pelvis and ureter so that there
is progressive destruction of kidney tissue (Gibson, 2003). Hydronephrosis is the enlargement of
the kidneys due to back pressure on the kidneys as urine flow is blocked. Hydronephrosis is
obstruction of the urinary tract proximal to the bladder resulting in accumulation of fluid
pressure in the renal pelvis and ureter as well as atrophy of the renal parenchyma (Price, 2001).

Under normal circumstances, urine flows from the kidneys with very rendah.Jika
pressure flow of urine is blocked, the urine will flow back into the small tubes in the kidney
(renal tubules) and into the central area of the urine collection (renal pelvis ).

This will cause the kidneys to swell and press the kidney tissues are fragile. Is ultimately,
pressure persistent hydronephrosis and severe renal tissue damage so that the kidneys gradually
lose function.

2.2 Etiology

Hydronephrosis generally occurs due to blockage of the ureteropelvic connection (the

connection between the ureter and renal pelvis), namely:

a. Structural abnormalities, for example, if the entry of the ureter into the pelvis high
renalisterlalu

b. Windings in the kidney due to ureteropelvic connection shifted down

c. Stone in the renal pelvis

d. Emphasis on the ureter by fibrous tissue, arteries or veins letaknyaabnormal, and

tumors.
 Hydronephrosis can also occur due to blockage under sambunganureteropelvik or
because backflow of urine from the bladder:

a. Stone in the ureter

b. Tumors in or near the ureter

c. Narrowing of the ureter caused by congenital defects, injury, infection, surgery

penyinaranatau therapy

d. Abnormalities in the muscles or nerves in the bladder or ureter

e. The formation of fibrous tissue in or around the ureter due to surgery, x-rays or drugs
(especially metisergid)

f. Ureterokel (protrusion of the lower end of the ureter into the bladder)

g. Cancer of the bladder, cervix, uterus, prostate or organ panggullainnya

h. Blockage that prevents the flow of urine from the bladder to uretraakibat prostate
enlargement, inflammation or cancer

i. Backflow of urine from the bladder due to a congenital defect or injury

j. Severe urinary tract infection, which for a time menghalangikontraksiureter.

Sometimes hydronephrosis occurs during pregnancy due to enlargement of the

ureterrahimmenekan. Hormonal changes will exacerbate this situation karenamengurangi normal
contractions of the ureter to drain urine kandungkemih. Hydronephrosis ends when the
pregnancy ends, although the renal pelvis and ureter afterward may remain somewhat widened.

Dilation of the renal pelvis and can further hinder rhythmic muscle contractions that
normally drain the urine into the bladder. Fibrous tissue and will menggantikankedudukan
normal muscle tissue in the walls of the ureter, causing kerusakanyang settled.
2.3 Signs and symptoms

Patients may be asymptomatic if the onset is gradual. Acute obstruction can cause pain
and draped waist. If there is an infection will occurdysuria, chills, fever and tenderness and
pyuria. Hematuria and pyuria may also exist.

If both kidneys in contact with the signs and symptoms of chronic renal failure will arise,
such as:

a. Hypertension (due to fluid retention and sodium)

b. Congestive heart failure

c. Pericarditis (due to irritation by toxic uremi)

d. Pruritis (itchy skin)

e. Uremic granules (urea crystals on the skin)

f. Anorexia, nausea, vomiting, hiccups

g. Decreased concentration, muscle twitching and spasms

h. Amenorrhea, testicular atrophy. (Smeltzer and Bare, 2002)

2.4 Pathophysiology

Obstruction in the normal flow of urine causes the urine to flow back, thus increasing the
pressure on the kidneys. If the obstruction occurs in the urethra or bladder, back pressure will
affect both kidneys, but if the obstruction occurs in one of the ureter due to stone or stiffness then
only one kidney who rusak.Obstruksi partial or intermittent may be caused by renal stones that
form in the cup kidney but got into the ureter and block it. Obstruction can be caused by a tumor
pressing ureter or file scarring caused by the abscess or inflammation near the ureter and pinning
the channel. Disturbance can be as a result of an abnormal form at the base of the ureter or
kidney position is wrong, which led to the ureter twisting or rigid. In older men, the most
common cause is obstruction of the urethra at the door of the bladder due to an enlarged prostate.
 Hydronephrosis can also occur in pregnancy due to enlargement uterus.Adanya
accumulation of urine in the kidneys will cause distention trophy cup and Calix kidney. At this
time renal atrophy occurs. When one kidney is damaged gradually, the other kidney will
gradually enlarged (compensatory hypertrophy), ultimately impaired renal function
(danBareSmeltzer, 2002).

2.5 Complications and Prognosis

If hydronephrosis remains untreated, the increased pressure in the kidneys could reduce
the ability of the kidneys to filter the blood, removing waste products and making urine, and
regulate electrolytes in the body. Hydronephrosis biased cause kidney infections
(pyelonephrosis) renal failure, sepsis, and in some cases, loss of renal function or death. Kidney
function will begin to decline soon with the onset of hydronephrosis but reversible if it does not
resolve the swelling. Kidney usually heal well even if there is no obstacle lasts up to 6 weeks.

2.6 Management and Treatment

2.6.1 Treatment

The goal is to activate and fix the cause darihidronefrosis (obstruction, infection) and to
maintain and melindungifungsiginjal.Untuk reduce urinary obstruction will be routed through the
action nefrostomiatau other types dissertation. Infection treated with anti-microbial agent for
sisaurin in Calix will cause infection and pyelonephritis.

The patient is prepared for surgery raised obstructive lesions (stones, tumors, ureteral
obstruction). If one of the main functions of the kidneys were badly damaged and destroyed it
nephrectomy (kidney removal) can be performed (Smeltzer and Bare, 2002)

2.6.2 Treatment

A. acute hydronephrosis

1. If you have decreased kidney function, persistent infections or severe pain, the urine collected
immediately above the blockage removed (usually through a needle inserted through the skin)
2. In the event of a total blockage, there is a serious infection or stone, it can be installed catheter
in the renal pelvis for a while

B. chronic hydronephrosis

1. Overcome by treating the causes and reduce the blockage of urine

2 ureters were narrowed or abnormal can be removed surgically and the edges are connected
back

3 Do surgery to free the ureter from fibrous tissue.

If the connection of the ureter and bladder clogged, then surgery to remove the ureter and
reconnect on a different side of the bladder

4 If the urethra is blocked, then the treatment includes:

a. Hormonal therapy for prostate cancer

b. surgery

c. urethral dilation with dilators

2.7 Examination

Checks that can be performed are:

1 The presence of a mass in the area between the ribs and hip bones, especially if the
kidney was enlarged

.2. Ultrasound, gives an overview of the kidneys, ureters and bladder

3 intravenous urography, could indicate the flow of urine through the kidneys

4. Cystoscopy, bladder can see directly

5. Laboratory

Blood tests can show the presence of urea levels because the kidneys are not able to
remove waste products.
 CHAPTER III

Nursing Care

3.1 Assessment
a. Age: adults
    Gender: Men elderly and pregnant women
b. Main complaints
 flank pain during urination
c. Disease History Now

complaints depends periods of illness, pain during urination, flank pain.Dysuria,

patients say when urinating urine out slightly, patient face look grimace, patient says
the body felt warm,redness face and patient says no appetite

d. Past history of disease

kidney stones, tumors, prostate enlargement, or congenital abnormalities.

e. Family History : -

f. Physical Examination :

B1: Normal breathing is 16-20x / min

B2: here was a increase in blood pressure (hypertension)., BP: >120/80 mm Hg, T:>
37,5oC, P:> 60-100x/min.

B3: flank pain.

B4: Dysuria, Decrease in frequency, oliguric, Anuri, urine discoloration.

B5: Weight loss due to malnutrition, anorexia, nausea, vomiting.

B6: malaise.
3.2 DiagnosaKeperawatan
3.2.1 Analisa Data

No. D a t a P r o b l e m E t i o l o g i
1 . DS : patient said Flank pain during urination A c u t e P a i n Acute Obstruction
DO :
patient face look grimace
P: obstruction
Q : pain feels like punctured-
pin
R : Pelvic
S: 3
T : when urination
blood pressure BP: >120/80
mm Hg, T:> 37,5oC, P:> 60-
100x/min.

2. DS: patients say when urinating urine out slightly Changes in the pattern of urinary elimination narrowing of the ureter / urethra
DO: Decrease in frequency,
oliguric, Anuri,
urine discoloration
3. DS : patien says the body felt warm, Hypertermi infection process

DO :redness face,

BP: >120/80 mm Hg,

T:> 37,5oC, P:> 60-100x/min.

4 . DS : patient says no appetite Impaired nutrition less than body requirements nausea and vomiting
DO : Weight loss due to
malnutrition, anorexia,
nausea, vomiting,malaise
N0. N u r s i n g D i a g n o s e Purpose / Criteria Results I n t e r v e n t i o n R a s i o n a l

1 . Acute Pain related withAcute Obstruction characterized by patient said low back pain during urination, patient face look grimace Acute pain can be resolved after the act of nursing for 3 x 24 hours with expected outcomes:  Explain to patients nursing actions to be performed and its  By allowing the patient to understand the situation explanation and cooperative to
purpose. nursing actions
P: obstruction  patient cooperative
 with drinking water can
 patient did not
Q : pain feels like punctured-pin  suggest patient to help remove the stone from
complain of pain
drink plenty of water the renal pelvis
R : Pelvic  patient face not
grimacing
S: 5-8  give patients a  comfortable position can
 Reduced pain scale
T : when urination comfortable position reduce perceived pain
 Normall vital signs
BP: >120/80 mm Hg, T:> 37,5oC  collaborate with

, P:> 60-100x/min. doctor to give

analgesic  reduce perceived pain
patient
 observation patient
face

 ask to patient about  can know the pain is

pain felt resolved or not
 to determine the success of
  observation Vital intervention
Signs
 normall vital signs an
indicator of the body's
condition stable
hemodynamic

2 . Changes in the pat ern of urinary elimination related with nar owing of the ureter/urethra characterized by patients say when urinating urine out slightly, Decrease in frequency, oliguric, Anuri, Changes in the pat ern of urinary elimination can be resolved after the act of nursing for 3 x 24 hours with expected outcomes:
 Explain to patients
 patient cooperative  By allowing the patient to
nursing actions to be
 patient can understand the situation
performed and its
urination explanation and
purpose
 No frequency cooperative to nursing
 suggest patient to
 No Oliguri actions
drink plenty of water
 No Anuri  with drinking water can
help the patient to urinate
 palpation for
and and assist the passage
suprapubic
of stone
distention
 distension in the
suprapubic area is an
indicator of the
 collaboration with
accumulation of urine in
doctor to surgery
the bladder
 can help speed up the
 healing process

3 . Hypertermi related with infection proces characterized by patien says the body felt warm, rednes face, blood pres ure BP: >120/80 mm Hg, T:> 37,5oC, P:> 60-100x/min. Hypertermican be resolved after the act of nursing for 3 x 24 hours with expected outcomes:

 patient cooperative  Explain to patients  By allowing the patient to

 patient did not nursing actions to be understand the situation
complain of heat performed and its explanation and
 body felt warm purpose cooperative to nursing

 not the patient's actions

face reddis  modification of the  can reduce fever through

 Vital signs normall patient's the process of evaporation

environment  can reduce fever of patient
 instruct the patient to  fever can decrease the
use thin clothes perceived
 apply warm
compresses in  can send a set point in the
patients hypothalamus so that the
 collaboration with pain is reduced
physicians in the
provision of  red face is an indicator of
antipyretic the fever is not resolved
  observation of the
patient's face  normall vital signs an
indicator of the body's
condition stable
 observation vital hemodynamic
signs

4 . Impaired nutrition les than body requirementrelataed with nausea and vomiting characterized bypatient says no ap etite, Weight los due to malnutrition, anorexia, nausea, Impaired nutrition les than body requirement can be resolved after the act of nursing for 3 x 24 hours with expected outcomes:
v o m i t in g , m a la i s e
 patient cooperative  Explain to patients  By allowing the patient to
 patients have nursing actions to be understand the situation
appetite performed and its explanation and
 No anorexia purpose cooperative to nursing

 No nausea actions

 No vomiting  give patients to eat  Minimizing anorexia and

 weight gain little but often nausea

 Supervise px lab,  Indicator nutritional needs
example BUN, are met
serum albumin,
sodium, potassium
 antidiuretic drug
collaboration and  Relieve nausea, vomiting,
roborantia increase oral intake
  collaboration with a
nutritionist for a diet
of patients
 BB Weigh every day
 ask about the desire
to eat
 can help meet the
nutritional needs of the
patient
 BB is an indicator of the
success of intervention
 can determine the patient's
desire to eat

Infeksi Tumor, Batu, Jaringan Penyakit (BPH)

Fibrosa

Reaksi Peradangan
Bakterimia / Viremia Obstruksi Menyumbat Aliran Urine

Fagositosis Penekanan Pada Saraf Perifer Aliran Urine Statis di Ureter Urine Yang Keluar Sedikit

Interleukin I Mengeluarkan Substansi Hidroureter Gangguan Pola

Bradikinin Eliminasi Urine
Terjadi Refluks Urine ke Pelvis Ginjal
Merangsang
asam arakidonat Thalamus
Hidronefrosis
Cortex Cerebri
Meningkatakan Set
Point di Hipotalamus Terjadi Interpretasi Nyeri Kerusakan Glomerulus PK : GGK

Permeabilitas Glomerulus Kegagalan Filtrasi

Menggigil Nyeri Akut atau
Kronis Protein Uria Pe BUN dan Creatinin
HIPERTERMI
Protein dalam darah Azotemia Toksik Ureum di Kulit

Hipoalbumine Penumpukan Ureum

Pe Tekanan Osmolitik Pruritis Perubahan Warna Kulit

Ekstravasasi Cairan MK: Kerusakan

Integritas Kulit
Edema

Toksik Ureum di Toksik Merangsang Vagus dan Syaraf

Kelebihan Volume Cairan
Usus Ureum di liur Fernikus di Diagfragma

Penumpukan Mengganggu Respon Kesemutan Pada Burning feet

Metabolisme Terganggu
Ureum Di mulut Lengkung Refleks Ekstremitas syndrom
Mulut bau Penutupan Glotis
Hiperperistaltik Merangsang Hipolateral Stomatitis Urine pada Saat respirasi Mati Rasa Rest Less Leg
 CHAPTER IV

CLOSING

4.1 Conclusion

Hydronephrosis is obstruction of urinary flow proximal to the bladder can lead to

accumulation of fluid pressure in the kidney and ureterpelviks which can lead to great absorption
in the renal parenchyma. If this happens obstruction in the ureter or bladder, back pressure will
affect both kidneys but if the obstruction occurs in one ureter due to stone or stiffness then only
one kidney is damaged. Therefore, to overcome the problems caused by hydronephrosis need for
problem solving through the nursing process. The goal of treatment of hydronephrosis is to
activate and fix the cause of hydronephrosis (obstruction, infection) and to maintain and protect
kidney function. To reduce the obstruction of urine is diverted through nephrostomy action or
other type of dissertation.

4.2 Suggestions

Patients should avoid causing hydronephrosis. In addition, the family must also be
berperanaktif to cure the patient and capable of exercising self-care to the patient after the nurse
memgajarkan way of self-care at home.
 REFERENCES

Doenges, Marilynn E. 1990.  Rencana Asuhan  Keperawatan. Jakarta: EGC

Doenges, Marilyn E, dkk. 1999.Rencana Asuhan Keperawatan :Pedoman untuk Perencanaan dan

Pendokumentasian Perawatan Pasien. AlihBahasa,

I Made Kariasa, N Made Sumarwati. Editor edisibahasa Indonesia, Monica Ester, Yasminasih.
Ed.3.Jakarta : EGC.

Gibson, John. 2003. Fisiologi&Anatomi Modern untukPerawat. Jakarta: EGC.

Smaltzer, Suzanne C & Brenda G Bare. Buku Ajar Medikal Bedah edisi 8. Jakarta: EGC

Price,sylvia,A,1995, patofisiologikonsepklinisproses-prosespenyakit. Alihbahasa:peteranugerah.
Edisi 4, jakarta:EGC
RN, swearingen.2001. keperawataanmedikalbedahedisi 2. Jakarta: EGC
Robins, stanley L,2001. Patofisiologi II edisi 4.Jakarta:EGC