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

5. systolic blood pressure rises and continues to rise with age. Kidney damage for equal or more than 3 months. Diabetes – most common cause of chronic kidney disease worldwide. Autoimmune disease Systemic infection Urinary stones or lower urinary tract obstruction Exposure to certain toxic drugs – cyclosporins and othe immunosuppressive agents and corticosteriods . Beginning at around age 50. 6.Chronic Kidney Disease could be known if the following criteria has met: 1. GFR <60 mL/min/1. with or without kidney damage Stages of Chronic Kidney Disease This is according to National Kidney Foundation Stage 1 Description GFR (mL/min/1. with or without decreased GFR 2.73m2 for greater than or equal 3 months. as defined by structural or functional abnormalities of the kidney. 4. 3.73m2 ) 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. obesity is an 2. additional factor for diabetes Hypertension – systolic hypertension is of particular concern.

loss of appetite 5. blood urea nitrogen. fatigue 3. Administer prescribe medications ( ion exchange resin. folic acid supplements) 4. Peritoneal dialysis 2. Urinalysis reveal that casts found in urine are helpful in determining the type of kidney disease 2. headaches 9. weight loss 4. itching 10.Diagnostic Evaluation: 1. Computed tomography and magnetic resonance imaging demonstrate vessel disorders 5. Signs and symptoms: 1. usually of the lower extremities 2. change is sleep pattern 8. 3. Ultrasonography can detect a tumor or hydronephrosis 4. Kidney arteriography and venography can show damage to kidney vasculature 6. Blood analyses may include levels of createnine. erythropoietin. swelling. nausea or vomiting 6. serum electrolytes and pH 3. Proper assessment for risk factors that might cause a rapid decline 2. a change in urination (change in volume and frequency) 7. 5. Maintain strict fluid control . adverse effects and the possible or actual loss of job and income Medical Management: 1. Cardiovascular disease – hypertension may also contribute to the development and 2. Encourage self-management such a blood pressure monitoring and glucose monitoring 3. Proteinuria screening – persistent proteinuria is usually the first indicator of kidney damage. difficulties in memory and concentration Complications: 1. a hormone that stimulates production of red blood cells Bone disease – disorders of calcium and phosphorus metabolism may develop early Malnutrition – alteration of the body’s 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. increase the risk of stroke Anemia – when kidneys are damaged there is a decrease in erythropoietine. antibiotics. Kidney Transplantation Nursing Management: 1. 4. Hemodialysis 3. alkalizing agents.

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

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