CHRONIC KIDNEY DISEASE

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
(ml/mnt)
72 x cr

Wanita: x 0.85
Etiology of ESRD
DM
39%
Hypertension + large vessel D 28
GN, primary or secondary 13
Hereditary cystic % congenital D 4
Interstitial nephritis & Pyelonephritis 4
Neoplasm / tumor 2
Miscellaneous 3
Missing 3
 Sign and Symptoms
General GI
Fatigue & malaise Anorexia
Edema Nausea/vomiting
Musculoskeletal
Osteodistrofi Skin
Cardiac Pruritis
Heart failure Pallor
Pericarditis Neurological
CAD 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 : 10-18 mg/day
Fosfor : 5-10mg/day Magnesium : 200-
300mg/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

Ask the clients about his/her energy level,

Renal/urologic disorder
PHYSICAL ASSESSMENT/CLINICAL
MANIFESTATIONS
yawning
PHSYCHOSOCIAL ASSESSMENT
X-ray
NURSING PROBLEMS

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
 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

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
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
ContinuousAmbulatoryPeritonealDialysis(CAPD)=DialisisPeritonealMandiriBerkesinambungan.
CAPDtidakmembutuhkanmesinkhusussepertipadaAPD.

PemasanganKateteruntukDialisisPeritoneal
SebelummelakukanDialisisperitoneal,perludibuataksessebagaitempatkeluarmasuknyacairandialisat
(cairankhususuntukdialisis)daridankedalamronggaperut(peritoneum).Aksesiniberupakateteryang
ditanamdidalamronggaperutdenganpembedahan.Posisikateteryaitusedikitdibawahpusar.Lokasi
dimanasebagiankatetermunculdaridalamperutdisebutexitsite.
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.