LAPORAN PENDAHULUAN

ASUHAN KEPERAWATAN PADA KLIEN

GAGAL GINJAL KRONIK
Disusun Oleh:
Sri Mulyani
04/1822671/EIK/0439
PROGRAM STUDI ILMU KEPERAWATAN
FAKULTAS KEDOKTERAN UGM
YOGYAKARTA
2006
GAGAL GINJAL KRONIK
A P!n"!r#ian
Gagal ginjal kronik eru!akan gangguan "ungsi ginjal #ang
!rogresi" $an irre%ersi&le' #ang en#e&a&kan kea!uan (u&uh gagal
un(uk e!er(ahankan e(a&olise $an kesei&angan )airan au!un
elek(roli(' sehingga (i&ul gejala ureia *re(ensi urea $an sa!ah ni(rogen
lain $ala $arah+,
$ E#i%l%"i&'!ny!(a(
Gagal ginjal kronik (erja$i se(elah &er&agai a)a !en#aki( #ang
erusak ne"ron ginjal, -e&agian &esar eru!akan !en#aki( !arenki
ginjal $i"us $an &ila(eral,
1, In"eksi : !ielone"ri(is kronik
2, .en#aki( !era$angan : gloerulone"ri(is
3, .en#aki( %askuler hi!er(ensi" : ne"rosklerosis &enigna
ne"rosklerosis aligna
s(enosis ar(eri renalis
4, Gangguan jaringan !en#a&ung : -/E
.oli ar(eri(is no$osa
-klerosis sis(eik !rogresi"
0, Gangguan )ongeni(al $an here$i(er: .en#aki( ginjal !olikis(ik
1si$osis (u&uler ginjal
6, .en#aki( e(a&oli) : D2' Gou(' 3i!er!ara(iroi$ise'
1iloi$osis
7, 4e"ro!a(i o&s(ruk(i" : !en#alahgunaan analge(ik
ne"ro!a(i (i&ale
8, 4e"ro!a(i o&s(ruk(i" : Sal K!)i* (a"ian a#a+,
Kalkuli' neo!lasa' "i&rosis'
ne(ro!eri(oneal
Sal K!)i* (a"ian (a-a*,
3i!er(ro"i !ros(a(e' s(rik(ur ure(ra'
anoali )ongeni(al !a$a leher
kan$ung keih $an ure(ra
. Pa#%/i+i%l%"i
.erjalanan uu GGK elalui 3 s(a$iu:
1 S#a0iu) I : .enurunan )a$angan ginjal
5Krea(inin seru $an ka$ar 674 noral
51si!(oa(ik
58es &e&an kerja !a$a ginjal: !eeka(an keih' (es G9:
2 S#a0iu) II : Insu"isiensi ginjal
5Ka$ar 674 eningka( *(ergan(ung !a$a ka$ar !ro(ein $ala $ie(+
5Ka$ar krea(inin seru eningka(
54ok(uria $an !oliuri *karena kegagalan !eeka(an+
1$a 3 $eraja( insu"isiensi ginjal:
a, :ingan
40; 5 80; "ungsi ginjal $ala kea$aan noral
&, -e$ang
10; 5 40; "ungsi ginjal noral
), Kon$isi &era(
2; 5 20; "ungsi ginjal noral
3 S#a0iu) III, gagal ginjal s(a$iu akhir a(au ureia
5ka$ar ureu $an krea(inin sanga( eningka(
5ginjal su$ah (i$ak $a!a( enjaga hoeos(asis )airan $an elek(roli(
5air keih/urin isooso(is $engan !lasa' $engan 6< 1'010
Pa#%/i+i%l%"i u)u) GGK
3i!o(esis 6ri)ker *hi!o(esis ne"ron #ang u(uh+
=6ila ne"ron (erserang !en#aki( aka seluruh uni(n#a akan han)ur'
naun sisa ne"ron #ang asih u(uh (e(a! &ekerja noral>
<ulah ne"ron (urun se)ara !rogresi"
?
Ginjal elakukan a$a!(asi *ko!ensasi+
5sisa ne"ron engalai hi!er(ro!i
5!eningka(an ke)e!a(an "il(rasi' &e&an solu(e $an rea&sor&si
(u&ulus $ala (ia! ne"ron' eski!un G9: un(uk seluruh assa ne"ron
enurun $i &a@ah noral
?
Kehilangan )airan $an elek(roli( $!( $i!er(ahankan
?
<k 70; assa ne"ron han)ur
Ke)e!a(an "il(rasi $an &e&a& solu(e &agi (ia! ne"ron eningka(
?
Kesei&angan gloerulus $an (u&ulus (i$ak $a!a( $i!er(ahankan
?
9leksi&ili(as !roses ekskresi A kon%ersi solu(e Aair ?
-e$iki( !eru&ahan !a$a $ii( engaki&a(kan kesei&angan (erganggu
?
3ilangn#a kea!uan eeka(kan/engen)erkan keih
6< 1'010 a(au 2'80 Osl *B konsen(rasi !lasa+
?
!oliuri' nok(uria
ne"ron (i$ak $a!a( lagi engko!ensasi $gn (e!a(
(erha$a! kele&ihan $an kekurangan 4a a(au air
8oksik 7reik
Gagal ginjal (aha! akhir
?
?G9:
Krea(inin C .ro$, 2e(, .ro(, 8er(i&un C !hos!ha(e seru
Dala $arah ? kalsiu seru
-ekresi !ara(horon

8u&uh ($k &eres!on $gn 4

Kalsiu $i (ulang ?
2e(,ak(i" %i(
D?
.eru&,!a (ulang/os(eo$is(ro"i ginjal

D Tan0a 0an G!1ala
1, Kelainan 3eo!oesis' $iani"es(asikan $engan aneia
a, :e(ensi (oksik ureia D heolisis sel eri(rosi(' ulserasi ukosa
sal,)erna' gangguan !e&ekuan' asa hi$u! eri(rosi( een$ek'
&iliru&uin seru eningka(/noral' uji )o&Es nega(i%e $an julah
re(ikulosi( noral,
&, De"isiensi horone eri(ro!oe(in
Ginjal su&er E-9 *Eri(ro!oe(i) -(iula(ing 9a)(or+ D $e", 3
eri(ro!oe(in DDe!resi susu (ulang D susu (ulang (i$ak
a!u &ereaksi (erha$a! !roses heolisis/!er$arahan D aneia
norokro norosi(er,
2, Kelainan -aluran )erna
a, 2ual' un(ah' hi)(h)u!
$iko!ensasi oleh "lora noral usus D aonia *433+ D
iri(asi/rangsang ukosa la&ung $an usus
&, -(oa(i(is ureia
2ukosa kering' lesi ulserasi luas' karena sekresi )airan sali%a
&an#ak engan$ung urea $an kurang enjaga ke&ersihan ulu(,
), .ankrea(i(is
6erhu&ungan $engan gangguan ekskresi enFi a#lase
3, Kelainan a(a
4, Kelainan kuli(
a, Ga(al
8eru(aa !a$a klien $gn $ialisis ru(in karena:
5(oksik ureia #ang kurang (er$ialisis
5!eningka(an ka$ar kaliu !hos!hor
5alergi &ahan5&ahan $ala !roses 3D
&, Kering &ersisik
Karena ureu eningka( eni&ulkan !eni&unan kris(al urea $i
&a@ah kuli(
),Kuli( u$ah ear
0, 4euro!sikia(ri
6, Kelainan sela!u( serosa
7, 4eurologi D kejang o(o(
8, Kar$ioegali
E P!)!ri2+aan P!nun1an"
1,/a&ora(oriu
a, .eeriksaan !enurunan "ungsi ginjal
5ureu krea(inin
5asa ura( seru
&, I$en(i"ikasi e(iologi gagal ginjal
5analisis urin ru(in
5ikro&iologi urin
5kiia $arah
5elek(roli(
5iuno$iagnosis
), I$en(i"ikasi !erjalanan !en#aki(
5!rogresi"i(as !enurunan "ungsi ginjal
ureu krea(inin' klearens krea(inin (es(
GG8 B *140 H uur + I 66 *kg+
72 I krea(inin seru
@ani(a B 0'80
!ria B 0'80 I GG8
5heo!oesis : 3&' (ro&osi(' "i&rinogen' "a)(or !e&ekuan
5elek(roli(
5en$okrin : .83 $an 83'84
5!eeriksaan lain: in"ark iokar$
2, Diagnos(ik
a, E(iologi GGK $an (erinal
59o(o !olos a&$oen
57-G
54e"ro(ogra
5.ielogra"i re(rogra$e
5.ielogra"i an(egra$e
5i)(ua(ing G#s(o 7rogra!h# *2G7+
&, Diagnosis !e&uruk "ungsi ginjal
5re(ogra
57-G
F Mana"!)!n #!ra'i
GGK
8era!i konser%a(i"
.en#aki( ginjal (erinal

Dialisis 3D $i :-' :uah' G1.D
8rans!lan(asi ginjal
P!na#ala2+anaan 2%n+!r3a#i/
.enga(uran $ie( !ro(ein' kaliu' na(riu' )airan
T!ra'i +i)'#%)a#i2
-u!leen alkali' (rans"use' o&a(5o&a( lo)alAsis(eik' an(i hi!er(ensi
T!ra'i '!n""an#i
3D' G1.D' (rans!lan(asi
F K%)'li2a+i
53i!er(ensi
5hi!erkaleia
5aneia
5asi$osis e(a&oli)
5os(eo$is(ro!i ginjal
5se!sis
5neuro!a(i !eri"er
5hi!erureia
G Kla+i/i2a+i GGK a#au .KD 4.r%ni5 Ki0n!y Di+!a+!6 ,
S#a"! G(ran 2!ru+a2an "in1al GFR 4)l&)in&789: )
2
6
1 4oral a(au ele%a(e$ G9: J 90
2 2il$ $e)rease in G9: 60589
3 2o$era(e $e)rease in G9: 30509
4 -e%ere $e)rease in G9: 10529
0 :eKuires $ial#sis L 10
H Dia"n%+a 2!'!ra-a#an yan" +!rin" )un5ul
1, In(oleransi ak(i%i(as &,$ kele(ihan/keleahan' aneia' re(ensi !ro$uk
sa!ah $an !rose$ur $ial#sis.
2, Kele&ihan %olue )airan
3, Ke(i$aksei&angan nu(risi kurang $ari ke&u(uhan (u&uh &,$ in(ake
akanan #ang ina$ekua( *ual' un(ah' anoreksia $ll+,
4, .ola na"as (i$ak e"ek(i" &,$ e$ea !aru' asi$osis e(a&oli)'
!neuoni(is' !erikar$i(is,
0, Kurang !enge(ahuan (en(ang !en#aki( $an )ara !era@a(an &,$
kurangn#a in"orasi keseha(an,
6, .K -e!sis
7, Gangguan !er(ukaran gas
8, .enurunan )ar$ia) ou(!u( &,$ !eru&ahan !reloa$' a"(erloa$ $an se!sis
9, :esiko (erha$a! $isuse s#n$ro
DAFTAR PUSTAKA
6runner A -u$$ar(h' 2002' Buku Ajar Keperawatan Medikal Bedah' e$isi 8
%olue 2' EGG' <akar(a
6ongar$' 9re$eri)' -, -ue' $arr#l, M' 1994' Current Critical, Care Diagnosis and
Treatment, "irs( E$i(ion' .araoun( .u&lishing 6ussiness an$
Grou!' /os 1ngeles
2)Gloske#' 1996' Nursing Interventions Classiication !NIC"' 2os&#' 7-1
:al!h A :osen&erg' 2003' Nursing Diagnoses# Deinition $ Classiication %&&'(
%&&)' .hila$el!hia 7-1
.ri)e' -#l%ia 1 an$ Nillson' /orraine 2' 1996' *atoisiologi# Konsep Klinis
*roses(*roses pen+akit, E$isi e!a(' EGG' <akar(a
@@@, 7s, Else%ierheal(h,)o' 2004' 4ursing Diagnosis: or guide to *alnning
care' "i"(h E$i(ion