chronic kidney disease

CHRONIC KIDNEY DISEASE
DIANA IR
EDUCATIONAL OBJECTIVE
Define Chronic Kidney Disease
 Identify risk factors for progression and
co-morbid conditions
 Discuss how early intervention improves
outcomes during CKD progression
 Review measurements of kidney disease
 Nursing Diagnosis and Intervention

CKD
Is the progressive loss of renal function over
months to years, advancement of the disease
can sometimes be slowed, but it is ultimately
irreversible and terminates in end-stage renal
disease( Black 1999).
 Hilangnya kemampuan ginjal untuk
mempertahankan volume dan komposis cairan
tubuh dalam keadaan asupan diet normal (
Price 1999)

Chronic Renal Failure

CRF = CKD (chronic kidney disease)


Is irreversible loss of renal function
Classification :
 State
GFR (ml/mn/1.73m2)
1
normal + persistent proteinuria
2
60-89 + persistent proteinuria
3
30-59
4
15-29
5
<15 or renal replacement therapy

Persistent at least for 3 months

ESRD : advanced CRF requiring dialysis or transplantation
Menghitung GFR
♂:
(140 – umur) x BB
72 x cr
Wanita: ♂ x 0.85
(ml/mnt)☺
Etiology of ESRD








DM
39%
Hypertension + large vessel D
GN, primary or secondary
Hereditary cystic % congenital D
Interstitial nephritis & Pyelonephritis
Neoplasm / tumor
Miscellaneous
Missing
28
13
4
4
2
3
3
Sign and Symptoms

General
 Fatigue

& malaise
 Anorexia
 Edema

 Nausea/vomiting
Musculoskeletal
 Osteodistrofi

GI

Skin
Cardiac
 Pruritis
 Heart
 Pallor
failure
 Pericarditis
 CAD

Neurological
 MS
changes
 Seizures
Management of Clinical Problems

Nutrition
Protein : 0,6 – 0,75 gr/Kg/ day
Kalori : 35 kal / Kg/ day
Lemak : 30 – 40%
KH
: 50 – 60%
Mineral

Garam : 2-3 gr/day
Kalsium :1400-1600 mg/day

Kalium : 40-70meq/day
Besi
Fosfor
Magnesium : 200-300mg/day






: 5-10mg/day
: 10-18 mg/day
Management of Clinical Problems




Control blood pressure to protect the kidney from
the damage that hypertension produces.
The use of ACE inhibitors appears to slow the
progression of CKD to ESRD
DM should be controlled especially those with proteinuria
Risk Factors for Progression of CKD : proteinuria ( the
higher the poor the prognosis), +HT, black DM,
dyslipidemia, others : smoking, > excretion IGG, IGM, B-2
& alfa-1 microglobulin,
Management of Clinical Problems






Others : stop smoking, discourage the use of NSAID,
aminoglycosides, radiocontrast agents
Correction of fluid imbalance
Prevention of hyperkalemia
Treatment of acidosis
Prevention if anemia
Aviodence and treatment of infection
NURSING MANAGEMENT
• Discuss the client’s urine
elimination in detail
• Age & Gender
• Renal/urologic disorder
• Ask the client’s about
his/her energy level,
fatique, weakness
• Drug use
• Ask about the presence
of nausea, vomiting,
anorexia
ASSE
SSMENT
HIS
TORY
• Family history
of renal
disease,DM,HT
PHYSICAL ASSESSMENT/CLINICAL
MANIFESTATIONS
yawning
Uremic fetor
Respiratory
Manifestations
tachypnea, kussmaul
respiration
fever, coughing,
crackles
Ask about the client’s
understanding the
diagnosis and what the
treatments means to him
or her (e.g. drugs, diet,
dialysis)
Assess for anxiety
and for the coping
styles used by the
client’s or family
members
PHSYCHOSOCIAL
ASSESSMENT
Imbalanced
Electrolytes
BUN ↑
Hb ↓( DPL )
LABORATORY
ASSESSMENT
X-ray
bone x-ray
RADIOGRAPHIC
ASSESSMENT
CT scan
USG
NURSING PROBLEMS
1.
2.
3.
4.
5.
6.
7.
Imbalanced nutrition less than body requirements
r/t inability to ingest
Excess fluid volume r/t inability of kidney
Decreased CO
Risk for infection
Risk for injury
Anxiety
Impaired skin integrity
Nursing Implementation

Health promotion
 Identify individuals at risk for CKD
 History of renal disease
 Hypertension
 Diabetes mellitus
 Repeated urinary tract infection
 Regular checkups and changes in urinary
appearance, frequency and volume should be
reported
Planning & Intervention

1.
2.
3.
4.
Expected outcomes : Maintain adequate nutrition .
Following parameters : Food intake, W/H ratio,
muscle tone, laboratory value (albumin, Hb, Ht )
Complete the nutritional assessment
Instruct client and family about prescribed diet
Collaboration with dietitian
Monitor lab value
RENAL REPLACEMENT THERAPIES








HEMODIALYSIS
Lebih bersih ( advantages )
Hemorrhage
Air embolus
Hemodynamic instability (contraindication)
Vascular access route
Complex
Restrict diet
HEMODIALYSIS
RENAL REPLACEMENT THERAPIES








PERITONEAL DIALYSIS
Easy access ( advantages )
Protein loss ( complication )
Peritonitis
Peritoneal fibrosis (contraindication)
Recent abdominal surgery
Simple
More flexible diet
PERITONEAL DIALYSIS
Continuous Ambulatory Peritoneal Dialysis (CAPD) = Dialisis Peritoneal Mandiri Berkesinambungan.
CAPD tidak membutuhkan mesin khusus seperti pada APD.
Pemasangan Kateter untuk Dialisis Peritoneal
Sebelum melakukan Dialisis peritoneal, perlu dibuat akses sebagai tempat keluar masuknya cairan dialisat
(cairan khusus untuk dialisis) dari dan ke dalam rongga perut (peritoneum). Akses ini berupa kateter yang
“ditanam” di dalam rongga perut dengan pembedahan. Posisi kateter yaitu sedikit di bawah pusar. Lokasi
dimana sebagian kateter muncul dari dalam perut disebut “exit site”.
PERITONEAL DIALYSIS

Cairan dialisat mengandung dekstrosa (gula) yang
memiliki kemampuan untuk menarik kelebihan air,
proses penarikan air ke dalam cairan dialisat ini
disebut Ultrafiltrasi.
TERIMA KASIH

Tn H usia 68 tahun mengeluh nafas terasa sesak,
edema pada ekstremitas bawah. Menurut keluarga,
pasien memiliki riwayat sakit gula yang tidak terkontrol
dan riwayat hipertensi sejak 10 tahun yang lalu. Pasien
pernah dioperasi prostat 2 tahun yang lalu, saat ini
keluhan berkemih tidak ada masalah,hanya jumlah urin
yang dikeluarkan semakin sedikit(±150cc/hr). Hasil
pemeriksaan fisik.Pasien tampak pucat, konjungtiva
anemis,Tampak asites, BB: 70kg, TB: 170 cm. TD :
150/90mmHg, Nd : 104x/mnt, SH : 360C, RR :
30x/mnt.BB : 60 kg.Hasil lab : Ur : 289Mgr%,Cr : 16,4,Hb
: 7,4 gr/Dl. Th/ : CaCO3, Asam folat 1x3,lasix 2x2
amp,captopril 2x25 mg.