NURSING CARE IN CRONIC

KIDNEYS DISEASE (CKD)

Group 5

1. ASRI WULANDARI 4. FRUISKA VALENTIN F 7. NILUH PUTU E

2. BAGAS PANDU P 5. GILANG YUANGGA M 8. SINDHI MAIPURI
3. DIMAS PANDU D 6. LISTYA APRILIA O 9. YOANITA PUTRI
Definition of nursing process

The nursing process is dynamic, adaptable to individual needs and

society requirements and maintains an unaltered main objective, i.e.
achieving a better state of health for the individual, family and
community.
Cronic Kidney Diseases (CKD)
1. Definition
Chronic kidney failure is an irreversible disease due to kidney damage due to diabetes
mellitus, hypertension, glomerulonephritis, HIV infection, polycystic kidney disease, or
ischemic nephropathy (Digiulio Etall, 2014, p. 397)
2. Etiology
a. Infections such as chronic pyelonephritis (urinary tract infections), glomerulonephritis
(inflammatory disease).
b. Hypertensive vascular diseases
c. Congenital and hereditary disorders such as polycystic kidney disease
d. Metabolic diseases such as DM (Diabetes Mellitus)
e. Toxic nephropathy such as analgesic abuse, lead nephropathy
f. Urinary stones that cause hidrolityasis
Clinical Manifestations

▪ Nausea and vomiting ▪ Swelling in the legs

▪ Decreased appetite ▪ Permanent itching
▪ The body feels weak ▪ Chest pain (if there is fluid
retention)
▪ Sleep disturbance
▪ Hard to breathe
▪ Changes in the amount of urine
▪ Increased blood pressure
▪ Change in mental status
▪ Muscle disorders
Complication

▪ Anemia ▪ A buildup of fluid around the

lungs (pleural effusion)
▪ Stomach or intestinal bleeding
▪ Complications of the heart and
▪ Muscle, bone and joint pain blood vessels (Congestive heart
▪ Changes in blood sugar failure, coronary artery disease,
high blood pressure, pericarditis,
▪ Damage to the nerves of the feet stroke
and hands (peripheral
neuropathy)
▪ Dementia
Supporting Investigation

▪ Laboratory examination (blood laboratory)

▪ Urine Test: Color, PH, BJ, turbidity, volume, glucose, protein,
sediment, SDM, ketone, SDP, TKK / CCT
▪ ECG examination
▪ Ultrasound examination
▪ Radiology Examination
 NURSING CONCEPT
A. Assessment
1. Activity and rest 11. Neurosensori
2. Fatigue, weakness, malaise, sleep disorders, muscle weakness 12. Pain / Comfort
and tone, decreased ROM
13. Breathing
3. Circulation
14. Security
4. History of long or severe hypertension
15. Itchy skin
5. Ego Integrity
16. Sexuality
6. Stress factors
17. Decreased libido, amenorrhea, infertility
7. Eliminasi
18. Social Interaction
8. Decreased frequency of urine
19. Unable to work, unable to carry out roles as usual
9. Food / Liquid

10. Increased BB due to edema, decreased BB due to malnutrition

DIAGNOSE

1. Excess fluid in the body is related to unbalance intake and outflow

characterized by edema extremity
2. Ineffective breath pattern associated with a buildup of fluid in the
lungs characterize by shortness of breath
3. Activity intolerance is related to oxygen supply imbalance
Nursing Intervention

no Diagnose NOC NIC

1 Excess fluid in the body is related to After taking nursing action for 2x24 hours, its expected - Maintaining the electrolyte balance
unbalance intake and outflow that excess fluid volume can be overcome with the 1. Assessment of the electrolyte status: - serum level of
characterized by edema extremity expected results: electrolytes - daily changes in body weight
1. intake and outtake balance 2. indication of fluid intake and loss
2. electrolyte balance 3. Identification of persistent skin fold or edema
the patients is not edema 4. monitoring blood pressure, pulse, respiration rate.
5. Identifying fluid intake: - medication, food, IV (drips),
fluids administered per os.
6. Nurses will explain the patient and his carers about the
importance of food and fluid restrictions.
no Diagnose NOC NIC
2 Ineffective breath pattern associated After the 1x24-hour nursing care for adequate breathing respiratory Monitoring
with a buildup of fluid in the lungs patterns. 1. Monitor the average - average, depth, rhythm and
characterize by shortness of breath Criteria Results: respiration effort
NOC: Respiratory Status 2. Record the chest movement, observe the symmetry, the use
 Increased ventilation and adequate oxygenation of additional muscle, supraclavicular and intercostal
 Free of signs of respiratory distress muscle retraction
 Clean breath sounds, no cyanosis and dyspnea 3. Monitor breathing patterns: bradipena, takipenia,
(capable of removing sputum, able to breathe Kussmaul, hyperventilation, Cheyne Stokes
easily, no pursed lips) 4. Auscultation of breath sounds, noting areas of decreased /
Vital signs within normal range absence of ventilation and additional sound
oxygen Therapy
1. Auscultation of breath sounds, record their crakles
2. Teach the patient breath
3. Adjust the position as comfortable as possible
4. Restrict to move
Collaboration of oxygen
no Diagnose NOC NIC
3 Activity intolerance is related to After taking nursing actions for 2x24 hours, clients can energy management
oxygen supply imbalance perform daily life activities independently with the 1. observation of the patient's level of fatigue after activity
expected outcome criteria: 2. help the patient identify the choice of activities to be
1. oxygen saturation when on the move can be carried out
controlled 3. encourage the patient to choose activities that build
2. respiratory rate when active within normal limits resilience
4. monitor the patient's oxygen response
5. collaborate with family to monitor patient activity