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Nursing Management for Chronic Kidney Disease

Chronic Kidney Disease

Chronic Kidney Disease or end stage renal disease (ESRD) is a progressive renal dysfunction and irreversible failure where the body's ability to maintain metabolism and fluid and electrolyte balance, causing uremia (retention of urea and other nitrogen waste in the blood). (Brunner & Suddarth, 2001; 1448).


Causes
  • Infections such as chronic pyelonephritis, glomerulonephritis.
  • Hypertensive vascular disease, for example, benign nephrosclerosis, malignant nephrosclerosis, renal artery stenosis.
  • Connective tissue disorders such as systemic lupus erythematosus, polyarteritis nodosa, progressive systemic sclerosis.
  • Congenital and hereditary disorders such as polycystic kidney disease, renal tubular acidosis.
  • Metabolic diseases such as; DM, gout, hyperparathyroidism, amyloidosis.
  • Toxic nephropathy, for example; analgesic abuse, lead nephropathy.
  • Obstructive nephropathy for example; upper urinary tract: calculi neoplasms, fibrosis netroperitoneal. Lower urinary tract: prostatic hypertrophy, urethral stricture, congenital anomalies of the neck of the bladder and urethra.
  • Urinary tract stones are caused hidrolityasis.


Clinical manifestations

Clinical manifestations according Suyono (2001) are as follows:
a. Cardiovascular disorders.
Hypertension, chest pain, and shortness of breath due to pericarditis, pericardial effusion and heart failure due to fluid retention, heart rhythm disturbances and edema.

b. Pulmonary disorders
Shallow breathing, Kussmaul breathing, cough with thick sputum and ripple, crackling noises.

c. gastrointestinal disorders
Anorexia, nausea, and fomitus related to protein metabolism in the gut, bleeding in the gastrointestinal tract, ulceration and bleeding mouth, ammonia breath odor.

d. Musculoskeletal disorders.
Resiles leg syndrome (sore on his leg that has always driven), burning feet syndrome (tingling and burning, especially on the soles of the feet), tremor, myopathy (weakness and limb muscle hypertrophy).

e. Integumentary Disorders.
Skin pale due to anemia and yellowish due to accumulation urokrom, itching caused by toxic, thin and brittle nails.

f. Endocrine disorders.
Sexual Disorders: fertility libido, and erectile decrease, menstrual disorder and amenorrhea. Glucose metabolic disorders, metabolic disorders of fat and vitamin D.

g. Disorders of fluid electrolyte and acid-base balance.
Usually the retention of salt and water but can also occur sodium loss and dehydration, acidosis, hyperkalemia, hypomagnesemia, hypocalcemia.

h. Hematology system.
Anemia caused by decreased production of erythropoietin, so that stimulation of erythropoiesis in the bone marrow is reduced,
hemolysis due to decreased life span of erythrocytes in uremia toxic atmosphere, can also malfunction thrombosis and thrombocytopenia.


Test and Diagnostics

In providing nursing services primarily intervention is necessary investigations required either medically or collaboration include:

1 laboratory examination of blood
  • Hematology: hemoglobin, hematocrit, erythrocytes, leukocytes, platelets.
  • RFT (renal function test): urea and creatinine
  • LFT (liver function test)
  • Electrolytes: Chloride, potassium, calcium
  • Coagulation studies: PTT, PTTK
  • BGA
2 Urine
  • Urine routine
  • Urine specific: ketone bodies, rock crystal analysis.

3. Cardiovascular examination
  • ECG
  • ECO
4. Radiodiagnostic
  • Abdominal ultrasound.
  • Abdominal CT scan.
  • BNO / IVP, FPA.
  • Renogram.
  • RPG (retio pyelography).

NURSING MANAGEMENT

Nursing management in patients with CKD is divided into three, namely:

a) Conservative
  • Laboratory examination of blood and urine.
  • Observation of fluid balance.
  • Observation of edema.
  • Limit fluid intake.

b) Dialysis
  • Peritoneal dialysis: usually done in cases of emergency. While dialysis can be done anywhere that is not acute CAPD (Continues Peritonial Ambulatory Dialysis)
  • Hemodialysis: dialysis That is done through invasive action in the vein by using a machine. At first hemodiliasis performed through the femoral region, but to simplify it done:
  • AV fistula: combining veins and arteries.
  • Double lumen: directly in the heart area (vascularization to the heart).

c) Operations
  • Stone retrieval.
  • Kidney transplant.

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