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Nursing Management for Chronic Kidney Disease

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

Clinical Manifestations of Chronic Kidney Disease

Clinical manifestations according Suyono (2001) is 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 ripples, the sound crackles.

c. Gastrointestinal disorders
Anorexia, nausea, and fomitus associated with protein metabolism in the intestine, gastrointestinal tract bleeding, ulceration and bleeding mouth, ammonia breath odor.

d. Musculoskeletal disorders
Restless legs syndrome (RLS) (pains in the legs so that it always moved), burning feet syndrome (tingling and burning, especially on the soles of the feet), tremor, myopathy (weakness and hypertrophy of the muscles of the extremities).

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

f. Endocrine disorders
Sexual disorders: decreased fertility and erection, 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. hematological System
Anemia is caused by reduced production eritopoetin, so that the stimulus eritopoesis in reduced bone marrow, hemolysis due to reduced life span of erythrocytes in uremia toxic atmosphere, can also malfunction thrombosis and thrombocytopenia.

Nursing Management for CKD is divided into three, namely:

1. Conservative
  • Laboratory examination of blood and urine.
  • Observation of fluid balance.
  • Observe for edema.
  • Limit fluid intake.
2. Dialysis
  • Peritoneal dialysis: usually done in cases of emergency. While dialysis can be done anywhere that is not acute CAPD (Continuous Ambulatory Peritoneal Dialysis).
  • Hemodialysis: Namely; dialysis is performed via invasive action in the vein by using a machine. At first hemodiliasis performed through the femoral region, but to simplify it done: arteriovenous fistula: venous and arterial combine, Double lumen: directly on the heart area (vascularity to the heart).
3. Operation
  • Stone retrieval
  • Kidney transplant