Hipervolemia dan Keletihan pada Pasien Chronic Kidney Disease Stage 5: Sebuah Studi Kasus

Yuyun Kartika Sari, Eka Afrima Sari, Sri Hartati Pratiwi

Sari


ABSTRACT

 

Chronic kidney disease leads to a progressive decline in kidney function. A decrease in kidney function leads to water and sodium retention, which subsequently causes hypervolemia. Mr. N came with complaints of shortness of breath to the hospital; the patient has undergone hemodialysis five times. In the process of examination, the presence of peripheral edema, pulmonary edema, and shortness of breath was found to be characterized by rapid and shallow breathing. According to the case, there was a problem of hypervolemia and fatigue in Mr. N. The aim of this study is to explore the application of nursing care in patients with chronic kidney disease stage 5 with hyperbolemia and fatigue. The method used is a case study descriptive of nursing care provision systematically starting from the examination, determination of diagnosis, planning, implementation, and evaluation of nurse care. The course was carried out for three days in a collaborative and independent manner. General interventions performed include hypervolemia management consisting of fluid restriction; edema and jugular venous pressure monitoring; interdialytic weight gain calculation; fluid intake and output control; monitoring of urea and creatinine levels; as well as co-administration of furosemide and hemodialysis. General interventions to overcome fatigue performed by giving semi-fowler positions; deep breathing relaxation; oxygen therapy; transfusion packed red cells, and relaxation foot massage. After the evaluation results were obtained for the problem of hypervolemia showed a decrease in the level of edema in the leg from degree 2 to degree 1, decreased jugular venous pressure, reduced blood pressure, interdialytic weight gain of 3.2%, improvement in the values of urea and creatinine, and a glomerular filtration rate post-hemodialysis of 8.28 ml/min/1.73 m2. As for the problem of fatigue, fatigue decreased from a score of 35 to 29, sickness decreased from a scale of 4 to 3, and breathing frequency was within the normal boundaries, so it can be concluded that the problems of nursing hyperbolemia and fatigue are partially overcome.

 

Keywords: Chronic Kidney Disease, Hypervolemia, Fatigue

 

 

ABSTRAK

 

Chronic Kidney Disease mengakibatkan penurunan fungsi ginjal secara progresif. Penurunan fungsi ginjal mengakibatkan retensi air dan natrium yang selanjutnya menimbulkan hipervolemia. Tn.N datang dengan keluhan sesak nafas ke RS, pasien telah menjalani hemodialisis sebanyak 5 kali. Pada proses pengkajian ditemukan adanya edema perifer, edema paru, serta sesak nafas yang ditandai pernafasan cepat dan dangkal. Berdasarkan kasus ditemukan adanya masalah hipervolemia dan keletihan pada Tn.N. Tujuan penelitian ini untuk mengekplorasi penerapan asuhan keperawatan pada pasien chronic kidney disease stage 5 dengan masalah keperawatan hipervolemia dan keletihan. Metode yang digunakan yaitu dengan studi kasus deskriptif pemberian asuhan keperawatan secara sistematis diawali dari pengkajian, penentuan diagnosa, perencanaan, implementasi, dan evaluasi keperawatan. Intervensi dilakukan selama 3 hari secara kolaborasi dan mandiri. Intervensi generalis dilakukan meliputi manajemen hipervolemia yang terdiri atas pembatasan cairan, pemantauan edema dan jugular venous pressure, perhitungan interdialytic weight gain, pemantauan intake dan output cairan, pemantauan kadar ureum dan kreatinin, serta kolaborasi pemberian furosemide, dan tindakan hemodialisis. Adapun intervensi generalis untuk mengatasi keletihan dilakukan dengan pemberian posisi semi fowler, relaksasi nafas dalam, terapi oksigen, transfusi packed red cells, dan relaksasi pijat kaki. Setelah dilakukan evaluasi didapatkan hasil untuk masalah hipervolemia, terdapat penurunan tingkat edema pada kaki dari derajat 2 menjadi derajat 1, penurunan jugular venous pressure, penurunan tekanan darah, interdialytic weight gain 3,2%, perbaikan pada nilai ureum dan kreatinin dengan glomerular filtration rate post-hemodialisis 8,28 ml/min/1,73m2. Adapun untuk masalah keletihan, kelelahan berkurang dari skor 35 menjadi 29, sesak berkurang dari skala 4 menjadi 3, frekuensi nafas dalam batas normal, sehingga dapat disimpulkan masalah keperawatan hipervolemia dan keletihan teratasi sebagian.

 

Kata Kunci: Chronic Kidney Disease, Hipervolemia, Keletihan


Teks Lengkap:

Download Artikel

Referensi


Almutary, H., Bonner, A., & Douglas, C. (2013). Symptom burden in chronic kidney disease: A review of recent literature. Journal of Renal Care, 39(3), 140–150. https://doi.org/10.1111/j.1755-6686.2013.12022.x

Alvionita, Ayu, W. D., & Masruhim, M. A. (2016). Pengaruh Penggunaan Asam Folat Terhadap Kadar Hemoglobin Pasien Penyakit Ginjal Kronik Yang Menjalani. J. Trop. Pharm. Chem. 2016, 3(3), 179–184.

Angraini, F., & Putri, A. F. (2016). Pemantauan intake output cairan pada pasien gagal ginjal kronik dapat mencegah overload cairan. Jurnal Keperawatan Indonesia, 19(3), 152–160.

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic Kidney Disease Diagnosis and Management: A Review. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745

Gregg, L. P., Bossola, M., Ostrosky-Frid, M., & Hedayati, S. S. (2021). Fatigue in CKD: Epidemiology, Pathophysiology, and Treatment. Clinical Journal of the American Society of Nephrology : CJASN, 16(9), 1445–1455. https://doi.org/10.2215/CJN.19891220

Guo, Q., Yi, C., Li, J., Wu, X., Yang, X., & Yu, X. (2013). Prevalence and risk factors of fluid overload in Southern Chinese continuous ambulatory peritoneal dialysis patients. PloS One, 8(1), e53294.https://doi.org/10.1371/journal.pone.0053294

Habibzadeh, H., Wosoi Dalavan, O., Alilu, L., Wardle, J., Khalkhali, H., & Nozad, A. (2020). Effects of Foot Massage on Severity of Fatigue and Quality of Life in Hemodialysis Patients: A Randomized Controlled Trial. International Journal of Community Based Nursing and Midwifery, 8(2), 92–102. https://doi.org/10.30476/IJCBNM.2020.81662.0

Hansen, B. (2021). Fluid Overload. Frontiers in Veterinary Science, 8, 668688. https://doi.org/10.3389/fvets.2021.668688

Haryanti, I. A. P., & Nisa, K. (2015). Terapi Konservatif dan Terapi Pengganti Ginjal sebagai Penatalaksanaan pada Gagal Ginjal Kronik. Majority, 4, 49–54.

Hasanah, U., & Livina. (2021). Slow Deep Breathing Berpengaruh Terhadap Fatigue Pada pasien Dengan Gagal Ginjal Kronik Yang Menjalani Hemodialisis. Jurnal Ilmiah Permas: Jurnal Ilmiah STIKes Kendal, 11(1), 1–8.

Heriansyah, Humaedi, A., & Widada. (2019). Gambaran ureum dan kreatinin pada pasien gagal ginjal kronis di RSUD Karawang. Binawan Student Journal, 1(1), 8–14.

Hidayah, I. (2018). Peningkatan Kadar Asam Laktat Dalam Darah Sesudah Bekerja. The Indonesian Journal of Occupational Safety and Health, 7(2), 131. https://doi.org/10.20473/ijosh.v7i2.2018.131-141

Ju, A., Strippoli, G. F. M., Craig, J. C., Tong, A., Saglimbene, V. M., & Unruh, M. L. (2018). Interventions for fatigue in people with chronic kidney disease requiring dialysis. In The Cochrane Database of Systematic Reviews (Vol. 2018, Issue 8). https://doi.org/10.1002/14651858.CD013074

KDIGO. (2020). Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. In Kidney international (Vol. 98, Issue 4S, pp. S1–S115). https://doi.org/10.1016/j.kint.2020.06.019

Kemenkes RI. (2018). Peran pemerintah dalam pencegahan dan pengendalian gangguan ginjal. In Penyakit Tropik di Indonesia.

Kemenkes RI. (2022). Sepuluh Obat Anti Hipertensi. https://yankes.kemkes.go.id/view_artikel/1994/sepuluh-obatantihipertensi#:~:text=Obat antihipertensi ini bekerja dengan cara menghambat kerja hormon norepinefrin,darah dan menurunkan tekanan darah.

Khan, Y. H., Sarriff, A., Adnan, A. S., Khan, A. H., & Mallhi, T. H. (2016). Chronic Kidney Disease, Fluid Overload and Diuretics: A Complicated Triangle. PloS One, 11(7), e0159335. https://doi.org/10.1371/journal.pone.0159335

Kopač, M. (2021). Evaluation of Hypervolemia in Children. Journal of Pediatric Intensive Care, 10(1), 4–13. https://doi.org/10.1055/s-0040-1714703

Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7–11. https://doi.org/10.1016/j.kisu.2021.11.003

Kurniawan, A., Kristinawati, B., & Widayati, N. (2019). Aplikasi Foot Massage untuk Menstabilkan Hemodinamik di Ruang Intensive Care Unit Rumah Sakit Umum Pusat dr . Soeradji Tirtonegoro Klaten. University Research Colloqium, 10, 510–515. http://repository.urecol.org/index.php/proceeding/article/view/684/667

Lazarus, E. R., Deva Amirtharaj, A., Jacob, D., Chandrababu, R., & Isac, C. (2020). The effects of an olive-oil massage on hemodialysis patients suffering from fatigue at a hemodialysis unit in southern India - a randomized controlled trial. Journal of Complementary & Integrative Medicine, 18(2), 397403.https://doi.org/10.1515/jcim-2019-0338

Lewis, S. L., Dirksen, S. R., & Bucher, L. (2014). Study Guide for Medical-Surgical Nursing: Assessment and Management of Clinical Problems. In Elsevier Health Sciences. (Ninth Edit). Elsevier Inc. https://books.google.com/books?id=4VcMBAAAQBAJ&pgis=1

Lukela, J. R., Harrison, R. Van, Jimbo, M., Mahallati, A., Saran, R., & Sy, A. Z. (2019). Management of Chronic Kidney Disease Key points. UMHS Chronic Kidney Disease Guideline,.https://www.med.umich.edu/1info/FHP/practiceguides/kidney/CKD.pdf

Meriyani, H., Sartikawati, N. K. A., & Putra, I. M. A. S. (2020). Pengaruh Penggunaan Antianemia Terhadap Kadar Hemoglobin Pasien Gagal Ginjal Kronik. Jurnal Ilmiah Medicamento, 5(2), 105–110. https://doi.org/10.36733/medicamento.v5i2.665

Natashia, D., Irawati, D., & Hidayat, F. (2020). Fatigue Dan Kualitas Hidup Pada Pasien Gagal Ginjal Kronis Dengan Terapi Hemodialisa. Jurnal Keperawatan Muhammadiyah, 5(2), 209–218. https://doi.org/10.30651/jkm.v5i2.6540

Noble, D. J., & Hochman, S. (2019). Hypothesis: Pulmonary Afferent Activity Patterns During Slow, Deep Breathing Contribute to the Neural Induction of Physiological Relaxation. Frontiers in Physiology, 10, 1176. https://doi.org/10.3389/fphys.2019.01176

Novak, J. E., & Ellison, D. H. (2022). Diuretics in States of Volume Overload: Core Curriculum 2022. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation, 80(2), 264–276. https://doi.org/10.1053/j.ajkd.2021.09.029

Patil, V. P., & Salunke, B. G. (2020). Fluid Overload and Acute Kidney Injury. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(Suppl 3), S94–S97. https://doi.org/10.5005/jp-journals-10071-23401

PERNEFRI. (2018). Report of Indonesian Renal Registry. https://www.indonesianrenalregistry.org/data/IRR 2018.pdf

Pertiwi, R. A., & Prihati, D. R. (2020). Penerapan Slow Deep Breathing Untuk Menurunkan Keletihan Pada Pasien Gagal Ginjal Kronik. Jurnal Manajemen Asuhan Keperawatan, 4(1), 14–19. https://doi.org/10.33655/mak.v4i1.77

POKJA SDKI DPP PPNI. (2017). Standar Diagnosis Keperawatan Indonesia: Definisi dan Indikator Diagnostik, Edisi 1. DPP PPNI.

Pralisa, K., Dewi, D. A. K., & Ilmiawan, M. I. (2021). Gambaran etiologi penyakit ginjal kronik stadium V pada pasien rawat inap di RSUD Dokter Soedarso Pontianak tahun 2017-2018. Jurnal Cerebellum, 6(3), 59. https://doi.org/10.26418/jc.v6i3.45308

Putrantu, T., Murhayati, A., & Saelan. (2021). Pengaruh Pemberian Posisi Semi Fowler 45 Terhadap Frekuensi Nafas Pada Pasien Gagal Ginjal Kronik Di Wilayah Kerja Puskesmas Sidoharjo Sragen. Universitas Kusuma Husada Surakarta.

Riyanto, W. (2011). Hubungan antara penambahan berat badan di antara dua waktu hemodialisis (interdialysis weight gain = IDWG) terhadap kualitas hidup pasien penyakit ginjal kronik yang menjalani terapi hemodialisis di Unit Hemodialisa IP2K Rumah Sakit Umum Pusat Fatmawati J. Universitas Indonesia.

Sari, D. S. I., Nistiandani, A., Siswoyo, & Umayanah. (2023). An Application of Semi-Fowler Positioning to Overcome Nursing Problems Ineffective Breath Patterns in Clients with Chronic Kidney Disease: a Case Study. Jurnal Kegawatdaruratan Medis Indonesia, 2(1), 109–114. https://doi.org/10.58545/jkmi.v2i1.71

Sepdianto, T. C., Suprajitno, S., & Usmiati, E. (2017). Penambahan Berat Badan antara Dua Waktu Hemodialisa pada Pasien Gagal Ginjal Kronik yang Menjalani Hemodialisa di RSD Mardi Waluyo Kota Blitar. Jurnal Ners Dan Kebidanan (Journal of Ners and Midwifery), 4(1), 064–069.https://doi.org/10.26699/jnk.v4i1.art.p064-069

Setiati, IAlwi, Sudoyo, Simadibrata, Setiyohadi, & Syam. (2014). Buku ajar ilmu penyakit dalam jilid I (Edisi ke 6). Interna Publishing.

Sharaf, A. (2016). The impact of educational interventions on hemodialysis patients’ adherence to fluid and sodium restrictions. IOSR Journal of Nursing and Health Science, 5(3), 50–60. https://doi.org/10.9790/7388-0603025060

Sitoresmi, H., Masyitha Irwan, A., Sjattar, E. L., & Usman, S. (2020). The effect of foot massage in lowering intradialytic blood pressure at Hemodialysis Unit in Indonesian Hospital. Clinical Epidemiology and Global Health, 8(4), 1272–1276.https://doi.org/10.1016/j.cegh.2020.04.026

Smeltzer, S. C. (2013). Keperawatan Medikal - Bedah Brunner & Suddart Edisi 12 (12th ed.). EGC.

Sulaiman, S. S. (2019). Application of nursing care in patients with fluid and electrolyte needs in hemodialisa room, labuang baji makassar’s hospital. Journal of Health, Education and Literacy, 2(1), 52–60. https://doi.org/10.31605/j-healt.v2i1.475

Sutinah, & Azhari, R. (2020). The effects of relaxation breathing on fatigue in patients with chronic kidney disease undergoing hemodialysis. Malahayati International Journal of Nursing and Health Science, 03(1), 15–21. https://doi.org/https://doi.org/10.33024/minh.v3i1.2335

Tovazzi, M. E., & Mazzoni, V. (2012). Personal paths of fluid restriction in patients on hemodialysis. Nephrology Nursing Journal : Journal of the American Nephrology Nurses’ Association, 39(3), 207–215.

Vaidya, S. R., & Aeddula, N. R. (2022). Chronic Renal Failure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK535404/

Yun Jufan, A., Adiyanto, B., & Reza Arifin, A. (2020). Manajemen dan Stabilisasi Pasien dengan Edema Paru Akut. Jurnal Komplikasi Anestesi, 7, 61–73.

Yuniarti, W. (2021). Anemia Pada Pasien Gagal Ginjal Kronik. Journal Health And Science ; Gorontalo Journal Health & Science Community, 5, 1–5.




DOI: https://doi.org/10.33024/mahesa.v3i9.10878

Refbacks

  • Saat ini tidak ada refbacks.


Publisher: Universitas Malahayati Lampung


Creative Commons License
Semua artikel dapat digunakan dibawah lisensi Creative Commons Attribution-ShareAlike 4.0 International License


kostenlose besucherzähler