Decreased Cardiac Output and Impaired Skin Integrity - NCP Chronic Kidney Disease

Nursing Care Plan for Chronic Kidney Disease

Chronic Kidney Disease (CKD) / CRF is a kidney disorder that is progressive and irreversible in which the ability of the body fails to maintain metabolism and fluid and electrolyte balance, causing uremia (retention of urea and other nitrogen garbage in the blood).

Causes of Chronic Kidney Diseas

CKD / CRF may be caused by systemic diseases are as follows:

1. DM.
2. Chronic Glomerulonefrtitis.
3. Pyelonephritis.
4. Toxic agents.
5. Uncontrolled hypertension.
6. Urinalysis tract obstruction.
7. Vascular disorders.
8. Infection.

Clinical manifestations of Chronic Kidney Disease

1. Cardiovascular system: includes hypertension (due to fluid retention and sodium from activation of the renin-angiotensin-aldosterone system), congestive heart failure and pulmonary edema (due to excess fluid) and pericarditis (due to irritation of the pericardial layers by uremic toxins).
2. Integrumenurum system: severe itching (pruritus). Granules is a penunpukkan uremic urine crystals in the skin, hair thin and rough.
3. Gastrointestinal System: anorexia, nausea, vomiting.
4. Neurovascular system: changes in the level of consciousness, inability to concentrate, and muscle spasms kedura.
5. Pulmonary System: krekels, sputun thick, deep breath and kusmaul.
6. Reproductive system: amenorrhea, testicular atrifi.

Nursing Diagnosis : Decreased Cardiac Output related to increased cardiac load

Goal: Decrease in cardiac output does not occur

Expected outcomes : maintain cardiac output and blood pressure with evidence of cardiac frequency in the normal range, strong peripheral pulses and capillary refill time is equal to.

Intervention:
1. Auscultation of heart and lungs.
R /: The presence of an irregular heart rate tachycardia.

2. Assess for hypertension.
R /: Hypertension may occur due to interference with the system of the renin-angiotensin-aldosterone system (caused by renal dysfunction).

3. Investigate complaints of chest pain, note the location, severity (0-10 scale).
R /: HT and CRF can cause pain.

4. Assess the level of activity, response to activity.
R /: Fatigue can also accompany CRF anemia.



Nursing Diagnosis : Impaired Skin Integrity related to pruritis

Goal : Skin integrity can be maintained

Expected outcomes :
Maintaining intact skin.
Shows the behavior / technique to prevent skin damage.

Intervention :
1. Inspection of the skin to change color, turgor, vascular, note any redness.
R / : Indicates areas poor circulation or damage that may lead to the formation of pressure sores / infections.

2. Monitor fluid intake and hydration of the skin and mucous membranes.
R / : Detecting the presence of dehydration or overhydration affecting circulation and tissue integrity

3. Inspection of the area depends on the edema.
R / : Tissue edema is more likely to be damaged / torn.

4. Change positions as often as possible.
R / : Lowering pressure on edema, poorly perfused tissue to reduce ischemia.

5. Give skin care.
R / : Reduce drying, skin tears.

6. Maintain a dry linen.
R / : Lowering dermal irritation and the risk of skin damage.

7. Instruct the patient to use a damp and cold compresses to put pressure on the area pruritis.
R / : Eliminate the discomfort and reduce the risk for injury.

8. Encourage wear loose cotton clothes.
R / : Prevent direct dermal irritation and improve skin moisture evaporation.

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