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CHRONIC KIDNEY DISEASE DIANA IR. EDUCATIONAL OBJECTIVE  Define Chronic Kidney Disease  Identify risk factors for progression and co-morbid conditions.

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Presentasi berjudul: "CHRONIC KIDNEY DISEASE DIANA IR. EDUCATIONAL OBJECTIVE  Define Chronic Kidney Disease  Identify risk factors for progression and co-morbid conditions."— Transcript presentasi:

1 CHRONIC KIDNEY DISEASE DIANA IR

2 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

3 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)

4  CRF = CKD (chronic kidney disease)  Is irreversible loss of renal function  Classification : StateGFR (ml/mn/1.73m2) 1normal + persistent proteinuria persistent proteinuria <15 or renal replacement therapy Persistent at least for 3 months ESRD : advanced CRF requiring dialysis or transplantation

5 ♂ : (140 – umur) x BB (ml/mnt) ☺ 72 x cr Wanita: ♂ x 0.85

6

7 Etiology of ESRD  DM 39%  Hypertension + large vessel D28  GN, primary or secondary13  Hereditary cystic % congenital D4  Interstitial nephritis & Pyelonephritis4  Neoplasm / tumor2  Miscellaneous3  Missing3

8 Sign and Symptoms  General  Fatigue & malaise  Edema  Musculoskeletal  Osteodistrofi  Cardiac  Heart failure  Pericarditis  CAD  GI  Anorexia  Nausea/vomiting  Skin  Pruritis  Pallor  Neurological  MS changes  Seizures

9

10  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 : mg/day  Kalium : 40-70meq/day Besi : mg/day  Fosfor : 5-10mg/day Magnesium : mg/day

11  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,

12  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

13 NURSING MANAGEMENT Family history of renal disease,DM,HT Drug use Ask about the presence of nausea, vomiting, anorexia Discuss the client’s urine elimination in detail Age & Gender Renal/urologic disorder Ask the client’s about his/her energy level, fatique, weakness ASSESSMENT TORYHIS

14 PHYSICAL ASSESSMENT/CLINICAL MANIFESTATIONS

15 yawningUremic fetor tachypnea, kussmaul respiration fever, coughing, crackles Respiratory Manifestations

16 PHSYCHOSOCIAL ASSESSMENT 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

17 LABORATORY ASSESSMENT BUN ↑ Imbalanced Electrolytes Hb ↓ ( DPL )

18 X-raybone x-ray CT scanUSG RADIOGRAPHIC ASSESSMENT

19 1. Imbalanced nutrition less than body requirements r/t inability to ingest 2. Excess fluid volume r/t inability of kidney 3. Decreased CO 4. Risk for infection 5. Risk for injury 6. Anxiety 7. Impaired skin integrity

20 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

21  Expected outcomes : Maintain adequate nutrition. Following parameters : Food intake, W/H ratio, muscle tone, laboratory value (albumin, Hb, Ht ) 1. Complete the nutritional assessment 2. Instruct client and family about prescribed diet 3. Collaboration with dietitian 4. Monitor lab value

22 RENAL REPLACEMENT THERAPIES  HEMODIALYSIS  Lebih bersih ( advantages )  Hemorrhage  Air embolus  Hemodynamic instability (contraindication)  Vascular access route  Complex  Restrict diet

23 HEMODIALYSIS

24 RENAL REPLACEMENT THERAPIES  PERITONEAL DIALYSIS  Easy access ( advantages )  Protein loss ( complication )  Peritonitis  Peritoneal fibrosis (contraindication)  Recent abdominal surgery  Simple  More flexible diet

25 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”.

26 PERITONEAL DIALYSIS  Cairan dialisat mengandung dekstrosa (gula) yang memiliki kemampuan untuk menarik kelebihan air, proses penarikan air ke dalam cairan dialisat ini disebut Ultrafiltrasi.

27 TERIMA KASIH

28  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 : 36 0 C, RR : 30x/mnt.BB : 60 kg.Hasil lab : Ur : 289Mgr%,Cr : 16,4,Hb : 7,4 gr/Dl. Th/ : CaCO 3, Asam folat 1x3,lasix 2x2 amp,captopril 2x25 mg.


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