ACUTE RENAL FAILURE

DEFINITION :

Acute kidney failure happens when your kidneys suddenly lose the ability to
eliminate excess salts, fluids, and waste materials from the blood. This elimination is the
core of your kidneys’ main function. Body fluids can rise to dangerous levels when kidneys
lose their filtering ability. The condition will also cause electrolytes and waste material to
accumulate in your body, which can also be life-threatening.

Acute kidney failure is also called acute kidney injury or acute renal failure. It’s
common in people who are already in the hospital. It may develop rapidly over a few hours.
It can also develop over a few days to weeks. People who are critically ill and need intensive
care have the highest risk of developing acute kidney failure.

Acute kidney failure can be life-threatening and requires intensive treatment.

However, it may be reversible. If you’re in good health otherwise, recovery is possible.

Gagal ginjal akut terjadi ketika ginjal Anda tiba-tiba kehilangan

kemampuan untuk menghilangkan kelebihan garam, cairan, dan bahan limbah
dari darah. Penghapusan ini adalah inti dari fungsi utama ginjal Anda. Cairan
tubuh bisa naik ke tingkat berbahaya saat ginjal kehilangan kemampuan
menyaringnya. Kondisi ini juga akan menyebabkan elektrolit dan material
limbah menumpuk di tubuh Anda, yang juga bisa mengancam nyawa.

Gagal ginjal akut juga disebut gagal ginjal akut atau gagal ginjal akut.
Ini biasa terjadi pada orang-orang yang sudah berada di rumah sakit. Mungkin
berkembang dengan cepat selama beberapa jam. Hal ini juga dapat
berkembang dalam beberapa hari sampai beberapa minggu. Orang yang sakit
kritis dan membutuhkan perawatan intensif memiliki risiko tertinggi terkena
gagal ginjal akut.

Gagal ginjal akut bisa mengancam jiwa dan membutuhkan perawatan

intensif. Namun, mungkin reversibel. Jika Anda dalam keadaan sehat, jika
tidak, pemulihan mungkin dilakukan.
CAUSE OF ACUTE RENAL FAILURE :

What are the causes of acute kidney failure?

Acute kidney failure can occur for many reasons. Among the most common reasons
are:
1. acute tubular necrosis (ATN)
2. severe or sudden dehydration
3. toxic kidney injury from poisons or certain medications
4. autoimmune kidney diseases, such as acute nephritic syndrome and
interstitial nephritis
5. urinary tract obstruction

Reduced blood flow can damage your kidneys. The following conditions can lead to
decreased blood flow to your kidneys:
1. low blood pressure
2. burns
3. dehydration
4. hemorrhage
5. injury
6. septic shock
7. serious illness
8. surgery
Apa penyebab gagal ginjal akut?
Gagal ginjal akut bisa terjadi karena berbagai alasan. Salah satu alasan yang
paling umum adalah:
1. nekrosis tubular akut (ATN)
2. dehidrasi parah atau mendadak
3. Cedera ginjal beracun dari racun atau obat tertentu
4. Penyakit ginjal autoimun, seperti sindrom nefritis akut dan nefritis
interstisial
5. obstruksi saluran kemih
Mengurangi aliran darah bisa merusak ginjal Anda. Kondisi berikut dapat
menyebabkan penurunan aliran darah ke ginjal Anda:
1. tekanan darah rendah
2. luka bakar
3. dehidrasi
4. pendarahan
5. cedera
6. syok septik
7. Penyakit serius
8. operasi
Gangguan tertentu dapat menyebabkan pembekuan di dalam pembuluh darah
ginjal Anda, dan ini dapat menyebabkan gagal ginjal akut. Kondisi ini meliputi:

1. sindrom uremik hemolitik

2. idiopatik thrombocytopenic thrombotic purpura (ITTP)
3. hipertensi ganas
4. reaksi transfusi
5. skleroderma
6. Beberapa infeksi, seperti septikemia dan pielonefritis akut, bisa
langsung melukai ginjal Anda.

Kehamilan juga bisa menyebabkan komplikasi yang membahayakan ginjal,

termasuk plasenta previa dan abrupsi plasenta.
RISK FACTOR OF ARF

The chances of acquiring acute kidney failure are greater if you’re an older person or
if you have any of the following long-term health problems:

1. kidney disease
2. liver disease
3. diabetes, especially if it’s not well controlled
4. high blood pressure
5. heart failure
6. morbid obesity

If you’re ill or being treated in a hospital’s intensive care unit, you’re at an extremely
high risk for acute kidney failure. Being the recipient of heart surgery, abdominal
surgery, or a bone marrow transplant can also increase your risk.

Kemungkinan untuk mendapatkan gagal ginjal akut lebih besar jika Anda
adalah orang yang lebih tua atau jika Anda memiliki masalah kesehatan jangka
panjang berikut ini:

1. penyakit ginjal
2. penyakit hati
3. diabetes, terutama jika tidak terkontrol dengan baik
4. tekanan darah tinggi
5. gagal jantung
6. obesitas morbid

Jika Anda sakit atau dirawat di unit perawatan intensif di rumah sakit, Anda
berisiko tinggi mengalami gagal ginjal akut. Sebagai penerima operasi jantung,
operasi perut, atau transplantasi sumsum tulang juga bisa meningkatkan
risiko Anda.
SYMPTOMS

The symptoms of acute kidney failure include:

1. bloody stools
2. breath odor
3. slow, sluggish movements
4. generalized swelling or fluid retention
5. fatigue
6. pain between ribs and hips
7. hand tremor
8. bruising easily
9. changes in mental status or mood, especially in older adults
10. decreased appetite
11. decreased sensation, especially in your hands or feet
12. prolonged bleeding
13. seizures
14. nausea
15. vomiting
16. high blood pressure
17. a metallic taste in your mouth

Gejala gagal ginjal akut meliputi:

1. tinja berdarah
2. Bau nafas
Gerakan lambat dan lamban
4. pembengkakan umum atau retensi cairan
5. kelelahan
6. Rasa sakit antara tulang rusuk dan pinggul
7. getaran tangan
8. memar dengan mudah
9. Perubahan status mental atau mood, terutama pada orang dewasa
yang lebih tua
10. nafsu makan menurun
11. Sensasi menurun, terutama di tangan atau kaki Anda
12. perdarahan berkepanjangan
13. kejang
14. mual
15. muntah
16. Tekanan darah tinggi
17. Rasa logam di mulut Anda
DIAGNOSIS
If you have acute kidney failure, you may have generalized swelling. The swelling is
due to fluid retention.

Using a stethoscope, your doctor may hear crackling in the lungs. These sounds can
signal fluid retention.

Results of laboratory tests may also show abnormal values, which are new and
different from baseline levels. Some of these tests include:

1. blood urea nitrogen (BUN)

2. serum potassium
3. serum sodium
4. estimated glomerular filtration rate (eGFR)
5. urinalysis
6. creatinine clearance
7. serum creatinine
8. An ultrasound is the preferred method for diagnosing acute kidney failure.
However, abdominal X-ray, abdominal CT scan, and abdominal MRI can help
your doctor determine if there’s a blockage in your urinary tract.

Certain blood tests may also reveal underlying causes of acute kidney failure.

Jika Anda mengalami gagal ginjal akut, Anda mungkin mengalami

pembengkakan secara umum. Pembengkakan ini disebabkan oleh retensi
cairan.
Dengan menggunakan stetoskop, dokter Anda mungkin akan mendengar
suara keras di paru-paru. Suara ini bisa memberi sinyal retensi cairan.

Hasil tes laboratorium juga dapat menunjukkan nilai abnormal, yang baru dan
berbeda dari tingkat awal. Beberapa tes ini meliputi:

1. nitrogen urea darah (BUN)

2. kalium serum
3. natrium serum
4. perkiraan laju filtrasi glomerulus (eGFR)
5. urinalisis
6. klirens kreatinin
7. kreatinin serum
8. USG adalah metode yang lebih disukai untuk mendiagnosis gagal ginjal
akut. Namun, rontgen perut, CT scan abdomen, dan MRI perut dapat
membantu dokter Anda menentukan apakah ada penyumbatan di saluran
kemih Anda.

Tes darah tertentu mungkin juga mengungkapkan penyebab gagal ginjal akut.
NURSING DIAGNOSE

1. Excess Fluid Volume

2. Risk for Decreased Cardiac Output
3. Risk for Imbalanced Nutrition: Less Than Body Requirements
4. Risk for Infection
5. Risk for Deficient Fluid Volume
6. Deficient Knowledge
7. Other Possible Nursing Care Plans
MANAGEMENT AND TREATMENT

Your treatment will depend on the cause of your acute kidney failure. The goal is to
restore normal kidney function. Preventing fluids and wastes from building up in your
body while your kidneys recover is important. In the majority of cases, a kidney
specialist called a “nephrologist” makes an evaluation.

Diet

Your doctor will restrict your diet and the amount of liquids you eat and drink. This
will reduce the buildup of toxins that the kidneys would normally eliminate. A diet
high in carbohydrates and low in protein, salt, and potassium is usually
recommended.

Medications

Your doctor may prescribe antibiotics to treat or prevent any infections that occur at
the same time. Diuretics may help your kidneys eliminate fluid. Calcium and insulin
can help you avoid dangerous increases in your blood potassium levels.

Dialysis

You may need dialysis, but it’s not always necessary, and it will likely only be
temporary. Dialysis involves diverting blood out of your body into a machine that
filters out waste. The clean blood then returns to your body. If your potassium levels
are dangerously high, dialysis can save your life.

Dialysis is necessary if there are changes in your mental status or if you stop
urinating. You may also need dialysis if you develop pericarditis or inflammation of
the heart. Dialysis can help eliminate nitrogen waste products from your body.
Pengobatan Anda akan tergantung pada penyebab gagal ginjal akut Anda.
Tujuannya adalah mengembalikan fungsi ginjal normal. Mencegah cairan dan
limbah dari bangunan di tubuh Anda sementara pemulihan ginjal Anda
penting. Pada sebagian besar kasus, spesialis ginjal yang disebut
"nephrologist" melakukan evaluasi.

Diet
Dokter Anda akan membatasi diet Anda dan jumlah cairan yang Anda makan
dan minum. Ini akan mengurangi penumpukan racun yang biasanya akan
dihilangkan ginjal. Diet tinggi karbohidrat dan rendah protein, garam, dan
kalium biasanya dianjurkan.

Obat-obatan
Dokter Anda mungkin meresepkan antibiotik untuk mengobati atau mencegah
infeksi yang terjadi pada waktu bersamaan. Diuretik dapat membantu ginjal
Anda menghilangkan cairan. Kalsium dan insulin dapat membantu Anda
menghindari peningkatan kadar kalium darah yang berbahaya.

Dialisis
Anda mungkin memerlukan dialisis, tapi itu tidak selalu diperlukan, dan
kemungkinan hanya bersifat sementara. Dialisis melibatkan pengalihan darah
keluar dari tubuh Anda ke mesin yang menyaring limbah. Darah bersih
kemudian kembali ke tubuh Anda. Jika kadar potassium Anda sangat tinggi,
dialisis dapat menyelamatkan hidup Anda.

Dialisis diperlukan jika terjadi perubahan status mental Anda atau jika Anda
berhenti buang air kecil. Anda mungkin juga memerlukan dialisis jika Anda
mengalami perikarditis atau pembengkakan jantung. Dialisis dapat membantu
menghilangkan produk limbah nitrogen dari tubuh Anda.
LAB PROCEDURES

If your signs and symptoms suggest that you have acute kidney failure, your doctor
may recommend certain tests and procedures to verify your diagnosis. These may
include:

 Urine output measurements. The amount of urine you excrete in a day may
help your doctor determine the cause of your kidney failure.
 Urine tests. Analyzing a sample of your urine, a procedure called urinalysis,
may reveal abnormalities that suggest kidney failure.
 Blood tests. A sample of your blood may reveal rapidly rising levels of urea
and creatinine — two substances used to measure kidney function.
 Imaging tests. Imaging tests such as ultrasound and computerized
tomography may be used to help your doctor see your kidneys.
 Removing a sample of kidney tissue for testing. In some situations, your
doctor may recommend a kidney biopsy to remove a small sample of kidney
tissue for lab testing. Your doctor inserts a needle through your skin and into
your kidney to remove the sample.

Jika tanda dan gejala Anda menunjukkan bahwa Anda mengalami gagal ginjal akut, dokter
Anda mungkin merekomendasikan beberapa tes dan prosedur untuk memverifikasi
diagnosis Anda. Ini mungkin termasuk

1. Pengukuran output urin. Jumlah urin yang Anda buang dalam sehari dapat
membantu dokter menentukan penyebab gagal ginjal Anda.
2. Tes urin Menganalisis sampel urin Anda, prosedur yang disebut urinalisis, dapat
mengungkapkan kelainan yang menunjukkan kegagalan ginjal.
3. Tes darah. Sampel darah Anda dapat menunjukkan tingkat urea dan kreatinin
yang meningkat pesat - dua zat yang digunakan untuk mengukur fungsi ginjal.
4. Tes pencitraan. Tes pencitraan seperti ultrasound dan tomografi terkomputerisasi
dapat digunakan untuk membantu dokter Anda melihat ginjal Anda.
5. Melepaskan sampel jaringan ginjal untuk pengujian. Dalam beberapa situasi,
dokter Anda mungkin merekomendasikan biopsi ginjal untuk mengeluarkan
sampel kecil dari jaringan ginjal untuk pengujian laboratorium. Dokter Anda
memasukkan jarum ke kulit Anda dan masuk ke ginjal untuk membuang sampel.
COMPLICATION

Some of the complications of acute kidney failure include:

1. chronic kidney failure

2. heart damage
3. nervous system damage
4. end-stage renal failure
5. high blood pressure

PREVENTION
Preventing and treating illnesses that can lead to acute kidney failure is the best
method for avoiding the disease. According to the Mayo Clinic, having a healthy
lifestyle that includes regular physical activity and a sensible diet can help to prevent
kidney failure. Work with your doctor to manage existing medical conditions that
could lead to acute kidney failure.
Treating the underlying cause of your kidney failure

Treatment for acute kidney failure involves identifying the illness or injury that
originally damaged your kidneys. Your treatment options depend on what's causing
your kidney failure.

Treating complications until your kidneys recover

Your doctor will also work to prevent complications and allow your kidneys time to
heal. Treatments that help prevent complications include:

 Treatments to balance the amount of fluids in your blood. If your acute

kidney failure is caused by a lack of fluids in your blood, your doctor may
recommend intravenous (IV) fluids. In other cases, acute kidney failure may
cause you to have too much fluid, leading to swelling in your arms and legs.
In these cases, your doctor may recommend medications (diuretics) to cause
your body to expel extra fluids.
 Medications to control blood potassium. If your kidneys aren't properly
filtering potassium from your blood, your doctor may prescribe calcium,
glucose or sodium polystyrene sulfonate (Kayexalate, Kionex) to prevent the
accumulation of high levels of potassium in your blood. Too much potassium
in the blood can cause dangerous irregular heartbeats (arrhythmias) and
muscle weakness.
 Medications to restore blood calcium levels. If the levels of calcium in your
blood drop too low, your doctor may recommend an infusion of calcium.
 Dialysis to remove toxins from your blood. If toxins build up in your blood,
you may need temporary hemodialysis — often referred to simply as dialysis
— to help remove toxins and excess fluids from your body while your
kidneys heal. Dialysis may also help remove excess potassium from your
body. During dialysis, a machine pumps blood out of your body through an
artificial kidney (dialyzer) that filters out waste. The blood is then returned to
your body.
Assessment:

1. Oliguric-anuric phase: urine volume less than 400 ml per 24 hours; increased in
serum creatinine, urea, uric acid, organic acids, potassium, and magnesium; lasts 3
to 5 days in infants and children, 10 to 14 days in adolescents and adults.
2. Diuretic phase: begins when urine output exceeds 500 ml per 24 hours, end when
BUN and creatinine levels stop rising; length is availabe.
3. Recovery phase: asymptomatic; last several months to 1 year; some scar tissue may
remain.
4. In prerenal disease: decreased tissue turgor, dryness of mucous membranes,
weight loss, flat neck veins, hypotension, tachycardia.
5. In postrenal disease: difficulty in voiding, changes in urine flow.
6. In Intrarenal disease: presentation varies; usually have edema, may have fever, skin
rash.
7. Nausea, vomiting, diarrhea, and lethargy may also occur.

Diagnostic Evaluation:

1. Urinalysis shows proteinuria, hematuria, casts. Urine chemistry distinguishes various

forms of ARF(prerenal, postrenal, intrarenal).
2. Serum creatinine and BUN levels are elevated; arterial blood gas (ABG) levels, serum
electrolytes may be abnormal.
3. Renal ultrasonography estimates renal size and rules out treatable obstructive
uropathy.

Primary Nursing Diagnosis

 Fluid volume deficit related to excessive urinary output,vomiting,hemorrhage

Other Diagnoses that may occur in Nursing Care Plans For Acute Renal Failure

 Ineffective tissue perfusion (renal)

 Excess fluid volume
 Risk for infection

Therapeutic and Pharmacologic Interventions:

1. Surgical relief of obstruction may be necessary.

2. Correction of underlying fluid excesses or deficits.
3. Correction and control of biochemical imbalances.
4. Restoration and maintenance of blood pressure through I.V. fluids and
vasopressors.
5. Maintenance of adequate nutrition: Low protein diet with supplemental amino
acids and vitamins.
 6. Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement
therapy for patients with progressive azotemia and other life-threatening
complications.

Nursing Interventions:

1. Monitor 24-hour urine volume to follow clinical course of the disease.

2. Monitor BUN, creatinine, and electrolyte.
3. Monitor ABG levels as necessary to evaluate acid-base balance.
4. Weigh the patient to provide an index of fluid balance.
5. Measure blood pressure at various times during the day with patients in supine,
sitting, and standing positions.
6. Adjust fluid intake to avoid volume overload and dehydration.
7. Watch for cardiac dysrhythmias and heart failure from hyperkalemia, electrolyte
imbalance, or fluid overload. Have resuscitation equipment available in case of
cardiac arrest.
8. Watch for urinary tract infection, and remove bladder catheter as soon as possible.
9. Employ intensive pulmonary hygiene because incidence of pulmonary edema and
infection is high.
10. Provide meticulous wound care.
11. Offer high-carbohydrate feedings because carbohydrates have a greater protein-
sparing power and provide additional calories.
12. Institute seizure precautions. Provide padded side rails and have airway and suction
equipment at the bedside.
13. Encourage and assist the patient to turn and move because drowsiness and lethargy
may reduce activity.
14. Explain that the patient may experience residual defects in kidney function for a
long time after acute illness.
15. Encourage the patient to report routine urinalysis and follow-up examinations.
16. Recommend resuming activity gradually because muscle weakness will be present
from excessive catabolism.

Documentation Guidelines

 Physical findings:Urinary output and description of urine, fluid balance, vital signs,
findings related to original disease process or insult,presence of pain or
pruritus,mental status,GI status, and skin integrity
 Condition of peritoneal or vascular access sites
 Nutrition: Response to dietary or fluid restrictions, tolerance to food, maintenance
of body weight
 Complications:Cardiovascular,integumentary infection
Discharge and Home Healthcare Guidelines

All patients with ARF need an understanding of renal function,signs and symptoms
of renal failure ,and how to monitor their own renal function. Patients who have
recovered viable renal function still need to be monitored by a nephrologist for at
least a year. Teach the patient that she or he may be more susceptible to infection than
previously. Advise daily weight checks. Emphasize rest to prevent overexertion.
Teach the patient or significant others about all medications, including dosage,
potential side effects, and drug interactions. Explain that the patient should tell the
healthcare professional about the medications if the patient needs treatment such as
dental work or if a new medication is added. Explain that ongoing medical
assessment is required to check renal function. Explain all dietary and fluid
restrictions. Note if the restrictions are life-long or temporary.

Patients who have not recovered viable renal function need to understand that their
condition may persist and even become chronic. If chronic renal failure is suspected,
further outpatient treatment and monitoring are needed. Discuss with significant
others the lifestyle changes that may be required with chronic renal failure.

PENGKAJIAN
1. Oliguric-anuric phase: volume urin kurang dari 400 ml per 24 jam;
peningkatan kreatinin serum, urea, asam urat, asam organik, potasium,
dan magnesium; berlangsung 3 sampai 5 hari pada bayi dan anak-anak,
10 sampai 14 hari pada remaja dan orang dewasa.
2. Fase diuretik: dimulai saat keluaran urin melebihi 500 ml per 24 jam,
berakhir saat kadar BUN dan kreatinin berhenti naik; panjang tersedia.
3. Fase pemulihan: asimtomatik; beberapa bulan terakhir sampai 1 tahun;
beberapa jaringan parut mungkin tertinggal.
4. Pada penyakit prerenal: turgor jaringan menurun, kekeringan selaput
lendir, penurunan berat badan, vena leher datar, hipotensi, takikardia.
5. Pada penyakit postrenal: sulit buang air kecil, perubahan arus urin
6. Pada penyakit Intrarenal: presentasi bervariasi; Biasanya memiliki
edema, mungkin sudah demam, ruam kulit.
7. Mual, muntah, diare, dan kelesuan juga bisa terjadi.
Evaluasi Diagnostik:
1. Urinalisis menunjukkan proteinuria, hematuria, gips. Kimia urin
membedakan berbagai bentuk ARF (prerenal, postrenal, intrarenal).
2. Tingkat kreatinin dan BUN serum meningkat; kadar gas arterial
(ABG), elektrolit serum mungkin tidak normal
3. Ultrasonografi ginjal memperkirakan ukuran ginjal dan
menyingkirkan uropati obstruktif yang dapat diobati.
Diagnosis Keperawatan Primer
1. Defisit volume cairan terkait dengan keluaran kencing yang berlebihan,
muntah, pendarahan
Diagnosis lain yang mungkin terjadi pada Rencana Perawatan Perawat untuk
Gagal Ginjal Akut

Perfusi jaringan tidak efektif (ginjal)

Kelebihan volume cairan
Risiko infeksi

Intervensi Terapeutik dan Farmakologis:

1. Pembedahan pembedahan mungkin diperlukan.
2. Koreksi kelebihan cairan atau defisit cairan
3. Koreksi dan pengendalian ketidakseimbangan biokimia
4. Restorasi dan pemeliharaan tekanan darah melalui I.V. cairan dan
vasopressor.
5. Pemeliharaan nutrisi yang adekuat: Diet rendah protein dengan
suplemen asam amino dan vitamin.
6. Inisiasi hemodialisis, dialisis peritoneal, atau terapi penggantian ginjal
kontinu untuk pasien dengan azotemia progresif dan komplikasi yang
mengancam jiwa lainnya.
Intervensi Keperawatan:
1. Pantau volume urin 24 jam untuk mengikuti perjalanan klinis penyakit
ini.
2. Pantau BUN, kreatinin, dan elektrolit.
3. Pantau kadar ABG yang diperlukan untuk mengevaluasi keseimbangan
asam-basa.
4. Timbang pasien untuk memberikan indeks keseimbangan cairan.
5. Ukur tekanan darah pada berbagai waktu di siang hari dengan pasien
dalam posisi terlentang, duduk, dan berdiri.
6. Sesuaikan asupan cairan untuk menghindari kelebihan volume dan
dehidrasi.
7. Perhatikan disritmia jantung dan gagal jantung dari hiperkalemia,
ketidakseimbangan elektrolit, atau kelebihan cairan. Memiliki peralatan
resusitasi yang tersedia jika terjadi serangan jantung
8. Perhatikan infeksi saluran kencing, dan buang kateter kandung kemih
sesegera mungkin.
9. Mempekerjakan kebersihan paru secara intensif karena timbulnya
edema paru dan infeksi yang tinggi.
10. Berikan perawatan luka yang cermat.
11. Tawarkan makanan berkarbohidrat tinggi karena karbohidrat memiliki
kekuatan hemat protein yang lebih besar dan memberi kalori tambahan.
12. Tindakan pencegahan kejang di Institute. Sediakan rel samping empuk
dan memiliki peralatan jalan napas dan hisap di samping tempat tidur.
13. Dorong dan bantu pasien untuk berbalik dan bergerak karena kantuk
dan lesu dapat mengurangi aktivitas.
14. Jelaskan bahwa pasien mungkin mengalami cacat sisa dalam fungsi
ginjal untuk waktu yang lama setelah penyakit akut.
15. Dorong pasien untuk melaporkan urinalisis rutin dan pemeriksaan
lanjutan.
16. Sarankan melanjutkan aktivitas secara bertahap karena kelemahan otot
akan hadir dari katabolisme yang berlebihan.

Pedoman Dokumentasi

Temuan fisik: Keluaran urin dan deskripsi urin, keseimbangan cairan,

tanda vital, temuan yang berkaitan dengan proses atau penghinaan
penyakit asli, adanya rasa sakit atau pruritus, status mental, status GI,
dan integritas kulit.
Kondisi situs akses peritoneal atau vaskular
Nutrisi: Respon terhadap pembatasan diet atau cairan, toleransi
terhadap makanan, pemeliharaan berat badan
Komplikasi: Kardiovaskular, infeksi integumen

Discharge dan Home Healthcare Guidelines

Semua pasien dengan ARF memerlukan pemahaman tentang fungsi

ginjal, tanda dan gejala gagal ginjal, dan bagaimana memantau fungsi
ginjal mereka sendiri. Pasien yang telah pulih kembali fungsi ginjal
masih perlu dipantau oleh seorang nephrologist setidaknya selama
satu tahun. Ajarkan pasien bahwa dia atau dia mungkin lebih rentan
terhadap infeksi daripada sebelumnya. Beritahu pemeriksaan berat
badan harian. Tekankan istirahat untuk mencegah ekspresinya berlebih.
Ajarkan pasien atau orang penting lainnya tentang semua obat,
termasuk dosis, efek samping potensial, dan interaksi obat. Jelaskan
bahwa pasien harus memberi tahu profesional kesehatan tentang obat
jika pasien memerlukan perawatan seperti perawatan gigi atau jika obat
baru ditambahkan. Jelaskan bahwa penilaian medis yang sedang
berlangsung diperlukan untuk memeriksa fungsi ginjal. Jelaskan semua
batasan diet dan cairan. Perhatikan jika pembatasan itu seumur hidup
atau sementara.