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STANDAR ASUHAN KEPERAWATAN (SAK) STANDAR ASUHAN KEPERAWATAN (SAK) ASUHAN KEP

ASUHAN KEPERAWERAWAATATAN KLIEN N KLIEN DENGAN HEMDENGAN HEMODIALISISODIALISIS

Di buat Oleh : Di buat Oleh : TIM HEMODIALISA TIM HEMODIALISA RUMAH SAKIT BALI ROYAL RUMAH SAKIT BALI ROYAL

DENPASAR, OKTOBER 201 DENPASAR, OKTOBER 201

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DAFTAR ISI DAFTAR ISI

D

Daa!!ttaa" " ii##i i $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ ii Se

Se%a%a&u&u" " SiSi"i"ih$h$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ iiii Ka

Kata ta PePe'('(a'a'tata"$"$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)))) iiiiii Bab I PENDAHULUAN

Bab I PENDAHULUAN A

A)) LaLatata" Be" Belala%%a'a'( $( $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ i*i* B

B)) TTuu+u+uaa' Pe' Pe''uulili##a' $a' $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$))  Bab II Tinjauan Teori

Bab II Tinjauan Teori II KKOONNSSEEP P DDAASSAAR  R  

A)

A) DeDe!i!i'i'i#i $$#i $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)$) 11 B)

B) EtiEti-l--l-(i $$(i $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)$$))))) 11 .)

.) PatPat-!i-!i#i-#i-l-(l-(i i $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 11 D)

D) /e'/e'i#  +i#  +e'ie'i# $$# $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 22 E)

E) TTaa''a aa a' e' e+a+ala $$la $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)$))) 22 3

3)) PePe'a'atatalala%#%#a'a'aa Maa Meei# $i# $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)))) 44 )

) K-5K-5&li&li%a#%a#i $$$i $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)) 44 II

II ASASUHUHAN AN KEKEPEPERARAWWAATTAANN A)

A) Pe'Pe'(%(%a+ia+ia' $$$a' $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)))) 44 B)

B) DiaDia('('-#e -#e %e%e&e"&e"a6aa6ata' ta' $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)$$))) 77 .)

.) ReRe'8'8a'a'a a atatau au I'I'tete"*"*e"e"e'e'#i #i $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)$))) 99 Bab III PENUTUP

Bab III PENUTUP A)

A) KeKe#i#i5&5&ulula' a' $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$)) 1212 B)

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DAFTAR PUSTAKA

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SEKAPUR SIRIH

Me'(haa&i &e"#ai'(a' a' te"bu%a'a &a#a" beba# #eba(ai &e'(a"uh e"a (l-bali#a#i a'( i5uilai #e+a% tahu' 2004, 5e5be"i%a' i5&li%a#i a'( 8u%u& lua# ala5 bia'( &e"u5ah#a%ita' a' %e#ehatab, te"5a#u% %e&e"a6ata') Pelaa'a' %e&e"a6ata' #aat i'i tia%  ha'a i tu'tut be"5utu ti'((i teta&i +u(a a&at 5e'+a6ab ta'ta'(a' ;a5a' a' tu'tuta' 5a#a"a%at #e5a%i' ti'((i)

U'tu% itu, %ita #e5ua &e"lu be"be'ah i"i a' 5e'ia&%a' i"i 5e'(i%uti &e"%e5ba'(a' a'( aa, te"5a#u% 5e'ia&%a' #e5ua #ta'a"  #ta'a" &"a%te% #e#uai &"-!e#i 5a#i'(  5a#i'(, te"5a#u% #ta'a" &"a%te% u'tu% &"-!e#i %e&e"a6ata', a(a" %ita a&at 5e5be"i%a' &elaa'a' a'( be"5utu #e#uai #ta'a" &"-!e#i) Bu%a' tia% 5u'(%i', #aat i'i be"ba(ai tu'tua' a'( be"5ua"a %e  &e'(aila' be"#u5be" a"i ti'a%a' &e"a6at a'( tia% #e#uai e'(a' #ta'a" &"-!e#i %e&e"a6ata') Me'(hi'a"i hal i'i, 5a%a %a5i

5e'(ha"a&%a' a(a" e'(a' #ta'a"  #ta'a" &"a%te% a'( telah i#ia&%a' -leh %-5ite %e&e"a6ata' &a"a &e"a6at i Ru5ah Sa%it Bali R-al i'i e6a a&at 5e5atuhi'a)

Ru5ah #a%it bali "-al a'( 5e5&u'ai *i#i a#uha5 %e&e"a6ata' a'( be"5utu a' &"-!e##i-'al #a'(at 5e'u%u'( u&aa &iha%  %e&e"a6ata' ala5 5e'i'(%at%a' &e'(etahua' a' %ete"a5&ila' %e&e"a6at' #ehi'((a a&at 5e5be"i%a' a#uha' %e&e"a6ata' #e#uai #ta'a") Salah #atu'a aalah Sta'a" A#uha' Ke&e"a6ata' i'i, #eba(ai &e-5a' ba(i &a"a &e"a6at ala5 5e5be"i%a' A#uha' Ke&e"a6ata')

Ka5i 5e'(ha"a& a(a" #ta'a" i'i a&at i(u'a%a' e'(a' bai%, a' a&abila 5a#ih aa %e%u"a'(a' i 5a#a e&a' %ita a%a' 5e5&e"bai%i'a be"#a5a  #a5a)

De'&a#a" , O%t-be" 201

D") Ha"#a

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KATA PENGANTAR Om Swastiastu

 Atas asung kerta wara nugraha Ida Sang Hyang Widi Wasa,  Tuha' Ya'( Maha E#a, bu%u Sta'a" A#uha' Ke&e"a6ata' He5-iali#a a'( 5e"u&a%a' &e-5a' ala5 5e5be"i%a' A#uha' Ke&e"a6ata' i Bali R-al H-#&ital a&at %a5i &e"#e5bah%a' #eba(ai #alah #atu 6u+u %-5it5e' %e&e"a6ata' Bali R-al H-#&ital ala5 5e5'e"i%a' &elaa'a'a a'( be"5utu)

Sei"i'( ala5 &e"%"5ba'(a' il5u &e'(etahua' a' te%'-l-(i a'( #a'(at' &e#at, 5a%a ti'(%at &e'(etahua' a' #-8ial e%-'-5i 5a#a"a%at a%a' 5e'(ala5i &e"%e5ba'(a' a' &e'i'(%at%a') De'(a' e5i%ia', %ebutuha' a' tu'tuta' 5a#a"a%at a%a'  &elaa'a' %e#ehata' a'( be"%6alita#, te"%i'i a' u'((ul a%a' 5e'(ala5i &e'i'(%ata' &ula)

Ata# a#a" te"#ebut, 5a%a K-5ite Ke&e"a6ata' 5e'u#u' Sta'a" A#uha Ke&e"a6ata' He5-iali#aa'( i"a'(%u5 a"i  be"ba(ai lite"atu"e a' 'a"a#u5be") Bu%u i'i i(u'a%a' #eba(ai &e-5a' ala5 5e5be"i%a' a#uha' %e&e"a6ata' #ehi'((a &elaa'a'

%e#ehata' ab( ibe"i%a' #e#uai e'(a' #ta'a" &"-!"e#i a'( be"la%u)

Bu%u i'i 5a#ih &e"lu &ee5&u"'aa' i#e#uai%a' e'(a' &e"e%e5ba'(a' il5u &e'(etahua' &e'(etahua' a' teh'-l-(i #e"ta  &elaa'a' i Bali R-al H-#&ital) Oleh %a"e'a itu, iha"a&%a' aa'a 5a#u%a', %"iti%, a' #a"a' a'( 5e5ba'(u' (u'a  &e'e5&u"'aa' &aa &e'e"bita' be"i%ut'a, #ehi'((a a&at be"%6alita# &elaa'a' %e&e"a6ata' i Bali R-al H-#&ital)

Om Shanti, Shanti, Shanti Om.

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BAB I PENDAHULUAN A La!ar Be"a#an$

Se+a% &aa tahu' 1<90 he5-iali#a ite"a&%a' #eba(ai #uatu te"a&i &e'((a'ti (i'+al &aa &a#ie' (a(al (i'+al a%ut a' (a(al (i'+al te"5i'al)He5-iali#a 5e"u&a%a' te"a&i &e'((a'ti a'( be"ti'a% #eba(ai (i'+al buata' =a"ti!i8ial %i'e atau ial;e">)Bia#a'a i I'-'e#ia he5-iali#a ila%u%a' 2 %ali #e5i'((u)Setia& %ali he5-iali#a ibutuh%a' 6a%tu #ela5a %u"a'( lebih 7 +a5) Di bebe"a&a &u#at ial#i# lai''a aa a'( ila%u%a' he5-iali#a 4 %ali #e5i'((u e'(a' la5a ial#i#   +a5)

He5-iali#a 5e"u&a%a' #alah #atu te"a&i !aal (i'+al e'(a' tu+ua' u'tu% 5e'(elua"%a' ;at  ;at 5etab-li#5e &"-tei' a' %-"e%#i (a'((ua' %e#ei5ba'(a' ai" a' ele%t"-lit a'ta"a %-5&a"te5e' a"ah &a#ie' e'(a' %-5&a"te5e' la"uta' ia#ilat 5elalui 5e5b"a'e #e5i&e"5eabel a'( be"#i!at #eba(ai &e'((a'ti (i'+al)He5-iali#i# #e"i'( i#ebut &aa -"a'( a6a' #eba(ai te"a&i 8u8i a"ah) He5-iali#a te"bu%ti a&at be"5a'!aat ala5 5e5&e"&a'+a'( u#ia a' 5e'i'(%at%a' %ualita# hiu&  &e'e"ita (a(al (i'+al te"5i'al) Dala5 #uatu &"-#e# he5-iali#i#, a"ah &e'e"ita i&-5&a -leh 5e#i' %eala5 %-5&a"te5e' a"ah &aa ial;e") Dial;e" 5e'(a'u'( "ibua' #e"at atau !ibe" #i'teti# a'( be"luba'( %e8il ite'(ah'a)Da"ah 5e'(ali" i ala5 luba'( #e"at #ea'(%a' 8ai"a' iali#i# aitu iali#at 5e'(ali" ilua" #e"at) Di'i'( #e"at be"ti'a% #eba(ai 5e5b"a' #e5i&e"5eabel te5&at te"+ai'a &"-#e# ult"a!ilt"a#i) Ult"a!ilt"a#i te"+ai e'(a' 8a"a 5e'i'(%at%a' te%a'a' hi"-#tati%  5eli'ta#i 5e5b"a' ial;e" e'(a' 8a"a 5e'e"a&%a' te%a'a' 'e(ati! %e ala5 %-5&a"te5e' iali#at a'( 5e'ebab%a' ai"  a' ;at?;at te"la"ut be"&i'ah a"i a"ah %e ala5 8ai"a' iali#at) Hal i'i a&at be"5a'!aat u'tu% 5e'e-t %elebiha' 8ai"a' tubuh a' #a5&ah?#a5&ah #i#a ha#il 5etab-li%)He5-iali#i# i I'-'e#ia i5ulai &aa tahu' 1<@0 a' #a5&ai #e%a"a'( i'i telah ila%#a'a%a' &aa ba'a% "u5ah #a%it "u+u%a')U5u5'a i&e"(u'a%a' (i'+al a'( %-5&a"te5e' a"ah'a aalah %a&ile" #ela&ut #e5i&e"5eabel =h-ll-6 !ib"e %i'e>)Kualita# hiu& a'( i&e"-leh 8u%u& bai% a' &a'+a'( u5u" te"ti'((i #a5&ai #e%a"a'( aalah 1 tahu'

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' Tujuan uu

Me5be"i &e-5a' te"tuli# ba(i &e"a6at ala5 5e5be"i%a' a#uha' %e&e"a6ata' &"-!e##i-'al #e#uai #ta'a"   Tujuan #*u&u&

a) Me'a5bah &e'(etahua' &e"a6at te'ta'( a#uha' %e&e"a6ata' &aa &a#ie' a'( 5e'+ala'i he5-iali#a, a'( 5e"u&a%a' 5-el %-'#e& a'( a%a' i&a%ai u'tu% %e&e"a6ata')

 b) Me'a5bah &e'(etahua' &e"a6at te'ta'( &"-#e# %e&e"a6ata', a'( 5e"u&a%a' %-'#e& a'( ha"u# i&a%ai ala5 5e5be"i%a' a#uha' %e&e"a6ata')

8) Me'a5bah %ete"a5&ila' &e"a6at ala5 5e5be"i%a' a#uha' %e&e"a6ata' &"-!e##i-'al, #e#uai e'(a' #ta'a" a#uha' %e&e"a6ata' a' &"i'#i&  &"i'#i& &"-#e# %e&e"a6ata')

Bab II

TIN+AUAN TEORITIS

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A) De!i'i#i

He5-iali#a be"a#al a"i %ata he5- a' iali#a)He5- aalah a"ah #ea'(%a' iali#a aalah &e5i#aha' atau !ilt"a#i)Paa  &"i'#i&'a he5-iali#a 5e'e5&at%a' a"ah be"a5&i'(a' e'(a' 8ai"a' iali#at atau &e'8u8i a'( i&i#ah%a' -leh #uatu 5e5b"a' atau #ela&ut #e5i &e"5eabel)Me5b"a' i'i a&at ilalui -leh ai" a' ;at te"te'tu atau ;at #a5&ah) P"-#e# i'i i#ebut ial#i# aitu &"-#e# be"&i'ah'a ai" atau ;at, baha' 5elalui 5e5b"a' #e5i &e"5eable)

Me'u"ut P"i8e a' il#-' =1<<7> iali#i# aalah #uatu &"-#e# i5a'a #-lut a' ai" 5e'(ala5i i!u#i #e8a"a &a#i! 5elalui #uatu 5e5b"a' be"&-"i a"i %-5&a"te5e' a"ah 5e'u+u %-5&a"te5e' iali#at) He5-iali#i# a' iali#i# &e"it-'eal 5e"u&a%a' ua te%'i% uta5a a'( i(u'a%a' ala5 iali#i#) P"i'#i& a#a" %eua te%'i% te"#ebut #a5a aitu i!u#i #-lut a' ai" a"i &la#5a %e la"uta' iali#at #eba(ai "e#&-' te"haa& &e"beaa' %-'#e't"a#i atau te%a'a' te"te'tu) Me'u"ut Ti#he" a' il8- =1<<@> he5-iali#i# ie!i'i#i%a' #eba(ai &e"(e"a%a' la"uta' a' ai" a"i a"ah &a#ie' 5ele6ati 5e5b"a' #e5i&e"5eabel =iali;e"> %e ala5 iali#at) Diali;e" +u(a a&at i&e"(u'a%a' u'tu% 5e5i'ah%a' #eba(ia' be#a" *-lu5e 8ai"a') Pe5i'aha' i'i ila%u%a' 5elalui ult"a!ilt"a#i i5a'a te%a'a' hi"-#tati% 5e'ebab%a' ali"a' a'( be#a" a"i ai" &la#5a =e'(a' &e"ba'i'(a' #ei%it la"uta'> 5elalui 5e5b"a') De'(a' 5e5&e"be#a" +ala' 5a#u% &aa *a#%ule", a'ti%-a(ula#i a' &"-u%#i iali;e" a'( a&at i&e"8aa a' e!i#ie', he5-iali#i# telah 5e'+ai 5et-e a'( -5i'a' ala5 &e'(-bata' &e'a%it (i'+al a%ut a' %"-'i% i A5e"i%a Se"i%at =Ti#he" C il8-, 1<<@>)

He5-iali#i# 5e5e"lu%a' #ebuah 5e#i' iali#i# a' #ebuah !ilte" %hu#u# a'( i'a5a%a' iali;e" =#uatu 5e5b"a' #e5i&e"5eabel> a'( i(u'a%a' u'tu% 5e5be"#ih%a' a"ah, a"ah i%elua"%a' a"i tubuh &e'e"ita a' be"ea" ala5 #ebuah 5e#i' i lua" tubuh) He5-iali#i# 5e5e"lu%a' +ala' 5a#u% %e ali"a' a"ah, 5a%a ibuat #uatu hubu'(a' buata' a'ta"a a"te"i a' *e'a =!i#tula a"te"i-*e'-#a> 5elalui &e5beaha' =NK3, 2009>)

B) Tu+ua'

Me'u"ut Ha*e'# a' Te""a =2007>, tu+ua' a"i he5-iali#i# a'ta"a lai' : :

1) Me'((a'ti%a' !u'(#i (i'+al ala5 !u'(#i e%#%"e#i, aitu 5e5bua'( #i#a?#i#a 5etab-li#5e ala5 tubuh, #e&e"ti u"eu5, %"eati'i', a' #i#a 5etab-li#5e a'( lai')

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2) Me'((a'ti%a' !u'(#i (i'+al ala5 5e'(elua"%a' 8ai"a' tubuh a'( #eha"u#'a i%elua"%a' #eba(ai u"i'e #aat (i'+al #ehat)

4) Me'i'(%at%a' %ualita# hiu& &a#ie' a'( 5e'e"ita &e'u"u'a' !u'(#i (i'+al) ) Me'((a'ti%a' !u'(#i (i'+al #a5bil 5e'u'((u &"-("a5 &e'(-bata' a'( lai')

.) I'i%a#i

He5-iali#a #eba(ai te"a&i &e'a%it (i'+al e'?#ta(e i(u'a%a' lebih a"i 400)000 -"a'( i A5e"i%a Se"i%at)Sta'a"i#a#i te"a&i i'i i5ulai &aa tahu' 1<@4 -leh bebe"a&a ahli #e&e"ti K-l!!, Me""ill, S"ib'e" a' S8h"ei'e")Te"a&i i'i +u(a 5e5&e"ti5ba'(%a' #e(i &e'ii%a', &e%e"+aa', a' %-'i#i %e#ehata' &a#ie')Keba'a%a' ahli (i'+al 5e'(a5bil %e&utu#a' te"a&i be"a#a"%a' %e#ehata' &e'e"ita a'( te"u# ii%uti e'(a' 8e"5at #eba(ai &e'e"ita "a6at +ala')Pe'(-bata' bia#a'a i5ulai a&abila &e'e"ita #uah tia% #a'((u& la(i be%e"+a &u"'a 6a%tu, 5e'e"ita 'eu"-&ati &e"i!e" atau 5e5&e"lihat%a' (e+ala %li'i# lai''a) Pe'e"ita tia% b-leh ibia"%a' te"u# 5e'e"u# be"ba"i'( ite5&at tiu" atau #a%it be"at #a5&ai %e(iata' #eha"i?ha"i tia% ila%u%a' la(i)=1>

 Klasifikasi Penyakit Ginjal Kronik 

S!a,iu Fun$&i Ginja" Laju Fi"!ra&i G"oeru"u& (L-eni!-'./0)

Ri#i%-5e'i'(%at

 N-"5al  <0, te"a&at !a%t-"

"i#i%-Staiu5 1  N-"5al atau 5e'i'(%at  <0, te"a&at %e"u#a%a' (i'+al, &"-tei'u"ia 5e'eta&, %elai'a' #ei5e' u"i', %elai'a' %i5ia a"ah a' u"i', %elai'a' &aa &e5e"i%#aa' "ai-l-(i)

Staiu5 2 Pe'u"u'a' "i'(a' 90?< Staiu5 4 Pe'u"u'u'a' #ea'( 40?7< Staiu5  Pe'u"u'a' be"at 17?2<

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Staiu5 7 a(al i'+al F17 Tabel 1.Kla#i!i%a#i Pe'a%it i'+al K"-'i% 

Me'u"ut %-'#e'#u# Pe"hi5&u'a' Ne!"-l-(i I'-'e#ia =PERNE3RI> =2004> #e8a"a ieal #e5ua &a#ie' e'(a' La+u 3ilt"a#i l-5e"-lu# =L3> %u"a'( a"i 17 5LG5e'it, L3 %u"a'( a"i 10 5LG5e'it e'(a' (e+ala u"e5ia atau 5al'ut"i#i a' L3 %u"a'( a"i 7 5LG5e'it 6alau&u' ta'&a (e+ala a&at 5e'+ala'i iali#i#) Selai' i'i%a#i te"#ebut +u(a i#ebut%a' aa'a i'i%a#i %hu#u# aitu a&abila te"a&at %-5&li%a#i a%ut #e&e"ti -ee5 &a"u, hi&e"%ale5ia, a#i-#i# 5etab-li% be"ula'(, a' 'e!"-&ati% iabeti%)=,7,1>

Thi#e" a' il8- 5e'ebut%a' bah6a he5-iali#a bia#a'a i5ulai %eti%a be"#iha' %"eati'i' 5e'u"u' iba6ah 10 5LG5e'it, i'i #eba'i'( e'(a' %aa" %"eati'i' #e"u5 10 5(GL) Pa#ie' a'( te"a&at (e+ala?(e+ala u"e5ia a' #e8a"a 5e'tal a&at 5e5bahaa%a' i"i'a +u(a ia'+u"%a' ila%u%a' he5-iali#a)=1@>

E"e#!i1 Heo,ia"i&a 2ITO Heo,ia"i&a Si'"-5 u"e5ia Hi&e"%ale5ia

HT #ulit i%-'t"-l Ee5a &a"u

O*e"l-a 8ai"a' G .H3 A#i-#i# 5etab-li% be"at Pe"#ia&a' &"e-&e"a#i O*e"-#i# -bat

Oli(-u"ia  a'u"ia 4?7 ha"i Pe"i%a"iti# G e!u#i &e"i%a" P"-!ila%#i# i'i :

K"eati'i'  ?12 5( BUN 100  124 '(

K-5a

Tabel 2) I'i%a#i He5-iali#a

Paa u5u5a i'i%a#i a"i te"a&i he5-iali#a &aa (a(al (i'+al %"-'i# aalah la+u !ilt"a#i (l-5e"ulu# = L3 > #uah %u"a'( a"i F 17 5LG5e'it, #ehi'((a iali#i# ia'((a& ba"u &e"lu i5ulai bila i+u5&ai &e5e"i%#aa' ta'a a' (e+ala #e"ta  &e5e"i%#aa' lab-"at-"iu5, #eba(ai be"i%ut :

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Pe'e"ita a&at 5e'(ala5i (a'((ua' %e#aa"a')Aa'a (a'((ua' a#i-#i# 5etab-li% a' atau (e+ala #i'"-5 u"e5ia #e&e"ti 5ual, 5u'tah a' a'-"e%#ia) Ta'a  ta'a -*e"l-a 8ai"a' #e&e"ti ee5, #e#a% 'a&a# a%ibat ee5a &a"u, #e"ta aa'a (a'((ua' +a'tu'() Pe'e"ita +u(a a&at 5e'(eluh%a' #ulit %e'8i'( =a'u"ia> lebih a"i 7 ha"i)

 b) Pe5e"i%#aa' Lab-"at-"iu5 ite5u%a'

• K"eati'i' #e"u5   5(GL • U"eu5 a"ah  200 GL • Hi&e"%ale5i

•  &H a"ah F @,1

D) K-'t"a i'i%a#i

Me'u"ut Thi#e" a' il8-, %-'t"a i'i%a#i a"i he5-iali#a aalah hi&-te'#i a'( tia% "e#&-'#i! te"haa& &"e#-", &e'a%it #taiu5 te"5i'al, a' #i'"-5 -ta% -"(a'i%)Sea'(%a' 5e'u"ut PERNE3RI %-'t"a i'i%a#i a"i he5-iali#a aalah tia%  ia&at%a' a%#e# *a#%ule" &aa he5-iali#a, a%#e# *a#%ule" #ulit, i'#tabilita# he5-i'a5i% a' %-a(ula#i) K-'t"a i'i%a#i he5-iali#a a'( lai' ia'ta"a'a aalah &e'a%it al;hei5e", e5e'#ia 5ulti i'!a"%, #i'"-5 he&at-"e'al, #i"-#i# hati la'+ut e'(a' e'#e!al-&ati a' %e(a'a#a' la'+ut)=1>

E) P"-#e# he5-iali#a

Me#i' he5-iali#i# a'( i(u'a%a' u'tu% ti'a%a' he5-iali#i# be"!u'(#i 5e5&e"#ia&%a' 8ai"a' iali#at, 5e'(ali"%a' iali#at a' ali"a' a"ah 5ele6ati #uatu 5e5b"a' #e5i&e"5eabel, a' 5e5a'tau !u'(#i'a te"5a#u% iali#at a' #i"%uit a"ah %-"&-"eal) Pe5be"ia' he&a"i' 5ele'(%a&i a'ti%-a(ula#i #i#te5i%) Da"ah a' iali#at iali"%a' &aa #i#i a'( be"la6a'a' u'tu%  5e5&e"-leh e!i#ie'#i 5a%#i5al a"i &e5i'aha' la"uta') K-5&-#i#i iali#at, %a"a%te"i#ti% a' u%u"a' 5e5b"a' ala5 alat iali#i#, a' %e8e&ata' ali"a' a"ah a' la"uta' 5e5&e'(a"uhi &e5i'aha' la"uta' =Ti#he" C il8-, 1<<@>) Dala5 &"-#e# he5-iali#i# i&e"lu%a' #uatu 5e#i' he5-iali#i# a' #uatu #a"i'(a' #eba(ai (i'+al ti"ua' a'( i#ebut iali;e", a'(

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i(u'a%a' u'tu% 5e'a"i'( a' 5e5be"#ih%a' a"ah a"i u"eu5, %"eati'i' a' ;at?;at #i#a 5etab-li#5e a'( tia% i&e"lu%a' -leh tubuh) U'tu% 5ela%#a'a%a' he5-iali#i# i&e"lu%a' a%#e# *a#%ule" #eba(ai te5&at #u&lai a"i a"ah a'( a%a' 5a#u% %e ala5 5e#i' he5-iali#i# =NK3, 2009>) A%#e# *a#%ula" #a'(at &e'ti'( &aa &"-#eu" he5-iali#i# e'(a' tu+ua' u'tu%  5e'(hubu'(%a' #i"%uit a"ah &a#ie' e'(a' 5e5b"a' iali;e") Aa&u' +e'i# a"i a%#e# *a#%ule" te"#ebut aalah :

' A#&e& 3a&#u"ar &een!ara

Met-a i'i 5elalui &e5buluh a"ah *e'a aitu !e5-"al a' *e'a +u(ula"i# i'te"'a) Ke"u(ia' 5et-a i'i &a#ie' %u"a'( 'a5a', 4 %ali tu#u%a' *e'a !e5-"al &e" 5i'((u, tia% b-leh be"(e"a% #ela5a 7 +a5 #e#i iali#i#, 5u'(%i' &e"a"aha'  bila #alah #a#a"a' tu#u%a' =a"te"i !e5-"ali#>) Ke'ala te%'i% a%#e# *e'a !e5-"al te"uta5a &a#ie' e'(a' ee5a a'a#a"%a

a' %eaaa' a"u"at 5ei%)A%#e# *a#%ula" 5elalui *e'a +u(ula"i# i'te"'a e'(a' 5e'((u'a%a'  silasti twin atheter  atau dou!le lumen atheter  5e"u&a%a' 5et-a 8u%u& 5e5ua#%a' a' 'a5a' u'tu% &a#ie')Met-a i'i a&at i(u'a%a' u'tu% bebe"a&a 5i'((u #a5&ai !i#tula A #ta'a" #ia& u'tu% i&a%ai &"-#eu" he5-iali#i#)

 A#&e& 3a&#u"ar %eranen

a> 3i#tula a"te"i-*e'-#a =A> #ta'a" 

Beli'( H) S"ib'e" %%)&e"ta5a %ali 5e'((u'a%a' a%#e# *a#%ule" &e"5a'e' be'tu% ete"'al a"te"i-*e'-u# =A> #hu't) Kele5aha' te%'i% i'i #e"i'( 5e'i5bul%a' 5a#alahJ #e&e"ti i'!e%#i, "u&tu" a%ibat t"au5a, #e"i'( 5e'(a'((u %ehiu&a' #eha"i?ha"i).i5i'- a' B"e#8ia =1<99> 5e'(a'+u"%a' te%'i% ba"u aitu internal arterio"enous  =A>  shunt ) Paa #aat i'i telah te"8a&ai %e#e&a%ata' u'i*e"#al bah6a  su!utaneous arterio"enous radioe#hali fistula

5e"u&a%a' 5et-a &iliha' &e"ta5a u'tu% a%#e# *a#%ula")  b> Met-e alte"'ati! 

(15)

Paa &a#ie' u#ia la'+ut te"uta5a i#e"tai iabete# %e(a(ala' !i#tula A #e"i'( i+u5&ai #etelah be"tahu'?tahu' 5e'+ala'i he5-iali#i# "e(ule") Ke(a(ala' !i#tula i'i 5u'(%i' i#ebab%a' &"-#e# ate"-#%le"-#i#) Ma%a i&e"lu%a' te%'i% lai', aitu autogenous atau allogenous "ein grafts a' #rostheti.

Suatu (i'+al buata' atau iali;e" te"i"i a"i 5e5b"a' #e5i&e"5eabel a'( te"i"i a"i ua ba(ia', ba(ia' u'tu% a"ah a'  ba(ia' lai' u'tu% iali#at) Da"ah 5e'(ali" a"i a"ah a'( be"la6a'a' e'(a' a"ah a"ah atau&u' ala5 a"ah a'( #a5a e'(a'

a"ah ali"a' a"ah) Diali;e" 5e"u&a%a' #ebuah hollow fi!er  atau a#illary diali$er  a'( te"i"i a"i "ibua' #e"abut %a&ile" halu# a'( te"#u#u' &a"a"el) Da"ah 5e'(ali" 5elalui ba(ia' te'(ah tabu'(?tabu'( %e8il i'i a' 8ai"a' iali#at 5e5ba#ahi ba(ia' lua"'a) Diali;e" i'i #a'(at %e8il a' %-5&a% %a"e'a 5e5ili%i &e"5u%aa' a'( lua# a%ibat aa'a ba'a% tabu'( %a&ile"  =P"i8e C il#-', 1<<7>)

(16)

Sela'+ut'a P"i8e a' il#-' =1<<7> +u(a 5e'ebut%a' bah6a #uatu #i#te5 iali#i# te"i"i a"i ua #i"%uit, #atu u'tu% a"ah a' #atu la(i u'tu% 8ai"a' iali#i#) Da"ah 5e'(ali" a"i &a#ie' 5elalui tabu'( &la#ti% =+alu" a"te"iGbl-- li'e>, 5elalui iali;e"  hollow fi!er   a' %e5bali %e &a#ie' 5elalui +alu" *e'a) .ai"a' iali#i# 5e5be'tu% #alu"a' %eua) Ai" %"a' i!ilt"a#i a' iha'(at%a' #a5&ai #e#uai e'(a' #uhu tubuh, %e5uia' i8a5&u" e'(a' %-'#e't"at e'(a' &e"a'ta"aa' &-5&a &e'(atu"  #ehi'((a te"be'tu% iali#at atau ba% 8ai"a' iali#i#) Diali#at %e5uia' i5a#u%a' %e ala5 iali;e", i5a'a 8ai"a' a%a' 5e'(ali" i lua" #e"abut be"-'((a #ebelu5 %elua" 5elalui "ai'a#e) Ke#ei5ba'(a' a'ta"a a"ah a' iali#at te"+ai #e&a'+a'( 5e5b"a' #e5i&e"5eabel a"i iali;e" 5elalui &"-#e# i!u#i, -#5-#i#, a' ult"a!ilt"a#i) Ult"a!ilt"a#i te"uta5a i8a&ai e'(a' 5e5buat &e"beaa' te%a'a' hi"-#tati% a'ta"a a"ah e'(a' iali#at) Pe"beaaa' te%a'a' hi"-#tati% a&at i8a&ai e'(a' 5e'i'(%at%a' te%a'a' &-#iti! i ala5 %-5&a"te5e' a"ah iali;e" aitu e'(a' 5e'i'(%at%a' "e#i#te'#i te"haa& ali"a'

(17)

*e'a, atau e'(a' 5e'i5bul%a' e!e% *a%u5 ala5 "ua'( iali#at e'(a' 5e5ai'%a' &e'(atu" te%a'a' 'e(ati!) Pe"beaaa' te%a'a' hi"-#tati% i a'ta"a 5e5b"a' iali#i# +u(a 5e'i'(%at%a' %e8e&ata' i!u#i #-lut) Si"%uit a"ah &aa #i#te5 iali#i# ile'(%a&i e'(a' la"uta' (a"a5 atau Na.l 0,< , #ebelu5 ihubu'(%a' e'(a' #i"%ula#i &e'e"ita) Te%a'a' a"ah &a#ie' 5u'(%i' 8u%u& u'tu% 5e'(ali"%a' a"ah 5elalui #i"%uit e%#t"a%-"&-"eal =i lua" tubuh>, atau 5u'(%i' +u(a 5e5e"lu%a'  &-5&a a"ah u'tu% 5e5ba'tu ali"a' e'(a' %uik !lood  =B> =#e%ita" 200 #a5&ai 00 5lG5e'it> 5e"u&a%a' ali"a' %e8e&ata'

a'( bai%) He&a"i' #e8a"a te"u#?5e'e"u# i5a#u%%a' &aa +alu" a"te"i 5elalui i'!u# la5bat u'tu% 5e'8e(ah &e5be%ua' a"ah) Pe"a'(%a& be%ua' a"ah atau (ele5bu'( ua"a ala5 +alu" *e'a a%a' 5e'(hala'(i ua"a atau be%ua' a"ah %e5bali %e ala5 ali"a' a"ah &a#ie') U'tu% 5e'+a5i' %ea5a'a' &a#ie', 5a%a iali;e" 5-e"' ile'(%a&i e'(a' 5-'it-"?5-'it-"  a'( 5e5ili%i ala"5 u'tu% be"ba(ai &a"a5ete" =P"i8e C il#-', 1<<7>) Me'u"ut Pe"'e!"i =2004> 6a%tu atau la5a'a he5-iali#i# i#e#uai%a' e'(a' %ebutuha' i'i*iu) Tia& he5-iali#i# ila%u%a' 7 +a5 e'(a' !"e%ue'#i 2 %ali #e5i'((u) He5-iali#i# ieal'a ila%u%a' 1017 +a5G5i'((u e'(a' B 200400 5lG5e'it) Sea'(%a' 5e'u"ut .-"6i' =2000> he5-iali#i# 5e5e"lu%a' 6a%tu 4  7 +a5 a' ila%u%a' 4 %ali #e5i'((u) Paa a%hi" i'te"*al 24 ha"i i a'ta"a he5-iali#i#, %e#ei5ba'(a' (a"a5, ai", a' &H #uah tia% '-"5al la(i) He5-iali#i# i%ut be"&e"a' 5e'ebab%a' a'e5ia %a"e'a #eba(ia' #el a"ah 5e"ah "u#a% ala5 &"-#e# he5-iali#i#) P"i8e a' il#-' 5e'+ela#%a' bah6a iali#at &aa #uhu tubuh a%a' 5e'i'(%at%a' %e8e&ata' i!u#i, teta&i #uhu a'( te"lalu ti'((i 5e'ebab%a' he5-li#i# #el?#el a"ah 5e"ah #ehi'((a a&at 5e'ebab%a' &a#ie' 5e'i'((al) R-be%a' &aa 5e5b"a' iali;e" a'( 5e'(a%ibat%a' %eb-8-"a' %e8il atau 5a#i! a&at iete%#i -leh !-t-#el &aa ali"a' %elua" iali#at) He5-iali#a "u5ata' bia#a'a ila%u%a' ti(a %ali #e5i'((u, a' la5a

(18)

 &e'(-bata' be"%i#a" a"i  #a5&ai 9 +a5, te"(a'tu'( a"i +e'i# #i#te5 iali#at a'( i(u'a%a' a' %eaaa' &a#ie')=17>) Aa&u' %-5&-#i#i a"i .ai"a' ial#i# aalah 8ai"a' a'( i(u'a%a' &aa &"-#e# he5-iali#a, te"i"i a"i 8a5&u"a' ai" a' ele%t"-lit a'( 5e5&u'ai %-'#e't"a#i ha5&i" #a5a e'(a' #e"u5 '-"5al a' 5e5&u'ai te%a'a' -#5-ti8 a'( #a5a e'(a' a"ah) 3u'(#i 8ai"a' ial#i# aalah 5e'(elua"%a' a' 5e'a5&u'( 8ai"a' #e"ta #i#a?#i#a 5etab-li#5e a"i tubuh, #e"ta 5e'8e(ah %ehila'(a' ;at?;at *ital a"i tubuh #ela5a iali#a) K-5&-#i#i iali#at iatu" #ee5i%ia' "u&a #ehi'((a 5e'e%ati %-5&-#i#i i-' a"ah '-"5al, a' #ei%it i5-i!i%a#i a(a" a&at 5e5&e"bai%i (a'((ua' 8ai"a' a' ele%t"-lit a'( #e"i'( 5e'e"tai (a(al (i'+al)U"ea, %"eati'i', a#a5 u"at a' !-#!at a&at be"i!u#i e'(a' 5uah a"i a"ah %e ala5 iali#at %a"e'a u'#u"?u'#u" i'i tia% te"a&at ala5 iali#at) Ke"u(ia' 8ai"a' a#etat aalah be"#i!at a#a5 #ehi'((a a&at 5e'i5bul%a' #ua#a'a a#a5 i ala5 a"ah a'( a%a' be"5a'i!e#ta#i #eba(ai *a#-ilata#i) a#-ilata#i a%ibat 8ai"a' a#etat a%a' 5e'(u"a'(i %e5a5&ua' *a#-%-'#t"i%#i &e5buluh a"ah a'( a%a' i&e"lu%a' tubuh u'tu% 5e5&e"bai%i (a'((ua' he5-i'a5i% a'( te"+ai #ela5a he5-iali#i#) Keu'tu'(a' 8ai"a' bi%a"b-'at aalah a&at 5e5be"i%a' bi%a"b-'at %e ala5 a"ah a'( a%a' 5e'et"al%a' a#i-#i# a'( bia#a te"a&at &aa &a#ie' (a(al (i'+al te"5i'al a' tia% 5e'i5bul%a' *a#-ilata#i) =17>

.ai"a' ial#i# 5e'(a'u'( 5a8a5?5a8a5 (a"a5, ele%t"-lit a' atau ;at a'ta"a lai' 1) Na.l G S-iu5 .hl-"ie

 Nat"iu5 5e"u&a%a' ete"5i'a' uta5a -#5-lalita# iali#at) K-'#e't"a#i 'at"iu5 ala5 iali#at &ali'( #ei%it ha"u# #a5a e'(a' &la#5a u'tu% 5e'8e(ah %ehila'(a' 'at"iu5 a%ibat &"-#e# i!u#i) Diali#at hi&-'at"e5i a&at 5e'ebab%a' e&i#-e hi&-te'#i, #a%it %e&ala a' %"a5 -t-t)Paa u5u5'a %-'#e't"a#i 'at"iu5 ala5 iali#at #e%ita" 10 55-lGL #uah 8u%u& u'tu% ele5i'a#i 8ai"a' #eba'a% 4? L ta'&a e!e% #a5&i'()

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K-'#e't"a#i %aliu5 ala5 iali#at 2 5EGL, i(u'a%a' u'tu% 5e'(elua"%a' "ete'#i %aliu5 #ela5a &e"i-e a'ta"  he5-iali#i# a' #ela5a &"-#eu" he5-iali#i# ?7 +a5) K-'#e't"a#i %aliu5 a&at iti'(%at%a' #a5&ai 4? 5EGL #e#uai %ebutuha', %hu#u#'a hi&-%ale5ia &aa a%hi" #e#i he5-iali#i# u'tu% 5e'8e(ah 8a"ia8 a""ht5ia te"uta5a  &a#ie' u#ia la'+ut)

4) M(8l2 G Ma('e#iu5 .hl-"ie

Hi&e"5a('e#e5ia a%ut a&at 5e'ebab%a' (a'((ua' %-'u%#i at"i-*e't"i%ula" a' i't"a*e't"i%ula", a' e&"e#i #i#te5 #a"a!)Hi&e"5a('e#e5ia %"-'i% 5e5&u'ai &e"a'a' &aa &at-(e'e#i# -#te-i#t"-!i "e'al a' %al#i!i%a#i +a"i'(a' i%at) Re%-5e'a#i %-'#e't"a#i 5a('e#iu5 ala5 %-'#e't"at iali#at 0,7?0,@7 55-lGL =1,17 5EGL>)

) Kal#iu5

K-'#e't"a#i %al#iu5 ala5 iali#at ha"u# 8u%u& ti'((i u'tu% 5e'8e(ah %e#ei5ba'(a' 'e(ati! #ela5a he5-iali#a) K-'#e't"a#i %al#iu5 ala5 iali#at 4,27  4,7 5EGL)

7) A#etat

P"e#i&ita#i bi%a"b-'at 5u'(%i' ia&at%a' %a"e'a %ebe"aaa' i-' %al#iu5 a' 5a('e#iu5)U&aa u'tu% 5e'8e(ah  &"e#i&ita#i bi%a"b-'at i&e"lu%a' #ub#itu#i #u5be" #-iu5 a#etat #eba(ai #alah #atu &iliha' alte"'ati!) Paa &a#ie'

he5-iali#i# 5ai5u5 a8etate utili;ati-' "ate i&e"%i"a%a' 4,0  4,7 55-lG%(G+a5) Bila i(u'a%a' hi(h?e!!i8ie'8 ial;e", %e8e&ata' &e"(e"#e"a' a#etat a"i iali#at 5u'(%i' 5elebihi %e5a5&ua' 5etab-li#5e he&a" #ehi'((a 5e'ebab%a' hi&e"a#etate5ia)P"e#e'ta#i %li'i% hi&e"a#etate5ia 5eli&uti hi&-te'#i, %"a5 -t-t, #a%it %e&ala, 5ual a' 5u'tah)

9) Bi%a"b-'at

Bi%a"b-'at 5e"u&a%a' ;at &e'((a'ti a'( &e'ti'( ala5 8ai"a' iali#i#, %a"e'a lebih !i#i-l-(i# u'tu% %-"e%#i a#i-#i# 5etab-li% iba'i'(%a' e'(a' iali#at a#etat)Be"bea e'(a' iali#at a#etat, %-'#e't"a#i bi%a"b-'at a"ah a' &H 5e'i'(%at ("aual #ela5a &"-#eu" he5-iali#a a' %e'ai%a' &a#8a he5-iali#i# a&at ihi'a"i #ehi'((a &a#ie' beba# a"i (e+ala)Re%-5e'a#i %-'#e't"a#i bi%a"b-'at ala5 8ai"a' iali#i# 29?49 55-lGL)

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K-'#e't"a#i a'i-' %l-"ia #a5a e'(a' %-'#e't"a#i t-tal %ati-' =te"uta5a 'at"iu5> 5i'u5 %-'#e't"a#i a#etat atau a'i-'  bi%a"b-'at u'tu% 5e5&e"taha'%a' ele8t"-8he5i8al 'eut"alit a"i 8ai"a' iali#i#) Re%-5e'a#i %-'#e't"a#i %l-"ia

ala5 iali#at be"*a"ia#i a'ta"a 107 a' 120 5EGL) ) lu%-#a

He5-iali#i# 5e'((u'a%a' iali#at beba# (lu%-#a =(lu8-#e !"ee ial#ate>) Se+u5lah (lu%-#a a%a' be"(e#e" a"i a"ah %e %-5&a"te5e' iali#at i&e"%i"a%a' 27?40 ( #etia& %ali &"-#eu" he5-iali#a) Kehila'(a' (lu%-#a #ela5a &"-#eu"  he5-iali#i# 5u'(%i' 5e'ebab%a' ial#i# a##-8iate #5&t-5# #e&e"ti #a%it %e&ala, 5ual,a' 5u'tah &a#8a he5-iali#a) Bila &"-#eu" he5-iali#i# 5e'((u'a%a' iali#at ta'&a (lu%-#a tubuh a%a' %ehila'(a' a5i'-a8i 8u%u& ti'((i aitu 10 ("a5 &e" #e#i he5-iali#i#) Kehila'(a' a5i'-a8i ibata#i ha'a #e%itat 1?4 ("a5 &e" #e#i he5-iali#i#  bila 5e'((u'a%a' 8ai"a' iali#i# 5e'(a'u'( (lu%-#a)A5i'-a8i 6a#ti'( be"#a5a e'(a' &e'i'(%ata' %atab-li#5e  &"-tei' a&at 5e"a'(#a'( %ehila'(a' (lu%-#a %e %-5&a"te5e' iali#at, a' 5u'(%i' ii%uti %e#ei5ba'(a' 'e(ati!   &"-tei') Re%-5e'a#i %-'#e't"a#i (lu%-#a ala5 8ai"a' iali#i# a'ta"a 1?2 ("a5GL u'tu% &a#ie' 'e!"-&ati iabeti% a'

u#ia la'+ut) Dial#at bi%a"b-'at a'Gatau iali#at 5e'(a'u'( (lu%-#a iu(a 5e"u&a%a' 5eia #ubu" u'tu%   &e"tu5buha' ba%te"i a' &e5be'tu%a' e'-t-%#i', 5e"u&a%a' "e#i%- ti'((i ial#ate 8-'ta5i'ati-')Te%'i% i#i'!e%#i

%etat i#e"tai &e5eliha"aa' 5e#i' he5-iali#i# a' #i"%uit 6ate" t"eat5e't #a'(at &e'ti'()lu%-#a ala5 %-'#e't"a#i a'( "e'ah ita5bah%a' %e ala5 iali#at u'tu% 5e'8e(ah i!u#i (lu%-#a %e ala5 iali#at a'( a&at 5e'ebab%a' %ehila'(a' %al-"i a' hi&-(li%e5ia)Paa he5-iali#a tia% ibutuh%a' (lu%-#a ala5 %-'#e't"a#i a'( ti'((i, %a"e'a  &e5bua'(a' 8ai"a' a&at i8a&ai e'(a' 5e5buat &e"beaa' te%a'a' hi"-#tati% a'ta"a a"ah e'(a' iali#at)

3) Ma'a(e5e't &a#ie' he5-iali#a 1) Se&i *eo,ia"i&i& %er!aa

Du"a#i he5-iali#i# &e"ta5a ha"u# #i'(%at =2 atau 4 +a5> u'tu% 5e'8e(ah &e'u"u'a' "a#ti# %-'#e't"a#i u"ea #e"u5 a' #i'"-5 i#euilib"iu5)

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a. &asular onnetion

I'#e"#i +a"u5 a"te"ial ha"u# lebih i#tal a"i i'#e"#i *e'-#a u'tu% 5e'8e(ah "e#i"%ula#i a"ah)  b) He&a"i'i#a#i

Paa &"-#e# iali#i# te"+ai ali"a' a"ah i lua" tubuh) Paa %eaaa' i'i a%a' te"+ai a%ti*a#i #i#te5 %-a(ula#i a"ah e'(a' a%ibat ti5bul'a be%ua' a"ah) Ka"e'a itu &aa iali#i# i&e"lu%a' &e5be"ia' he&a"i' #ela5a iali#i#  be"la'(#u'()Aa ti(a te%'i% &e5be"ia' he&a"i', aitu te%'i% he&a"i' "uti', he&a"i' 5i'i5al, a' beba# he&a"i')

Paa te%'i% he&a"i' "uti', te%'i% a'( #e"i'( i(u'a%a' #eha"i?ha"i, he&a"i' ibe"i%a' e'(a' 8a"a b-lu# ii%uti e'(a' 8-'ti'-u# i'!u#i-') Paa %eaaa' i5a'a "e#i%- &e"a"aha' #ea'( atau be"at i(u'a%a' te%'i% he&a"i' 5i'i5al a' te%'i% beba# he&a"i').-'t-h bebe"a&a %eaaa' "i#i%- &e"a"aha' be"at 5i#al'a &aa &a#ie' e'(a'  &e"a"aha' i't"a#e"eb"al, t"-5b-#it-&e'ia, %-a(ul-&ati, a' &a#8a-&e"a#i e'(a' &e"a"aha')

8) A%ti*ita# &a#ie'

Pa#ie' a&at be"a%ti*ita# #e&e"ti 5e5ba8a, 5e'-'t-', a' lai'?lai')Na5u' #ebai%'a ibata#i) ) Pe'(a6a#a' %li'i% #ela5a #e#i he5-iali#i#

Te%a'a' a"ah, e'ut 'ai, te%a'a' &aa bl-- li'e a' iali#at a' ult"a!ilt"ati-' "ate ha"u# #elalu i8atat, be"at  baa' &"e a' &a#8a he5-iali#i#)

) K-5&li%a#i he5-iali#i#

1) K-5&li%a#i i't"aialiti% 

a) 3i"#t u#e #'"-5e

Rea%#i a'a!ila%ti% te"haa& iali#at a"i 8u&"-&ha'e %a"e'a aa'a a%i*a#i #i#te5 %-5&le5e' alte"'ati!  a' te"&a+a' -leh elli'e -ie) Rea%#i a'a!ila%ti% te"haa& 5e5b"a' iali#i# &-la8"l-'it"ile &aa  &a#ie' a'( 5e'a&at &e'(-bata' A.E i'hibit-")

 b) K-5&li%a#i teh'i% 

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Ua"a 5a#u% #i"%uit a"ah E5b-li ua"a

Diali#at hi&-t-'i% He5-li#i# 5a#i!  

Diali#at hi&e"t-'i% Hi&e"'at"e5ia, hau#, #a%it %e&ala,  be'u'(a' &a"u a' %e+a'(

Diali#at -*e"heate He5-li#i# a' &e5be%ua' a"ah Pe"tu%a"a' bi%a"b-'at e'(a'

%-'#e't"a#i a8i

Al%al-#i# hebat

Di#%-'e%#i tabu'( a"ah Pe"a"aha', %-la&#e 8) K-5&li%a#i te"%ait he5-iali#i#

a> Hi&-te'#i te"%ait he5-iali#i#

Eti-l-(i &ali'( #e"i'( be"hubu'(a' e'(a' &e'u"u'a' *-lu5e &la#5a, %e(a(ala' e!e%  *a#-%-'t"i%#i, a' !a%t-" +a'tu'( te"uta5a &aa &a#ie' 'e!"-&ati iabeti% a' u#ia la'+ut) Ma'a+e5e' hi&-te'#i i#e"tai %"a5 -t-t : ult"a!ilt"ati-' "ate a' bl-- !l-6 "ate i%u"a'(i, &a#ie'  &-#i#i t"e'ele'be"(, be"i%a' i'!u# (a"a5 !i#i-l-(i# 100?700 5l, atau (a"a5 hi&e"t-'i# #eba'a% 10?

20 5l ala5 6a%tu 4?7 5e'it)

 b> K"a5 -t-t

K"a5 -t-t =beti#> i#ebab%a' &e'u"u'a' *-lu5e .ES a%ibat &e'i'(%ata' ult"a!iltati-' "ate atau %-'#e't"a#i Na ala5 %-'#e't"at tia% ae%uat)Pe5be"ia' (a"a5 !i#i-l-(i# atau hi&e"t-'i# 5e"u&a%a' te"a&i &iliha' &e"ta5a)

8> Mual, 5u'tah a' #a%it %e&ala

Tia% +a"a'( 5e"u&a%a' #alah #atu &"e#e'ta#i %li'i% i#euilib"iu5 #'"-5e)

> Sa%it aa

Ha"u# i8u"i(ai #eba(ai %e(a6at a"u"ata' a'( be"hubu'(a' e'(a' a'(i'a, i'!a"% 5i-%a", atau  &e"i%a"iti#, atau be"hubu'(a' e'(a' he5-li#i# a%ut atau "ea%#i a'a!ila%t-i)

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e> atal

Eti-l-(i e&-#it %"i#tal %al#iu5?!-#!-" =hi&e"&a"ati"-ii#5e>, %ulit %e"i'(, ale"(i te"haa& -bat =he&a"i'>, a' &ele&a#a' hi#ta5i') Te"a&i %au#al a' #i5&t-5ati# =i&he'h"a5i'e, %et-ti!e'>)

!> 3eb"i#

Be"hubu'(a' e'(a' "ea%#i &i"-(e' atau i'!e%#i 5i%"--"(a'i#5e)

2) K-5&li%a#i i'te"ialiti% 

K-5&li%a#i #ela5a &e"i-e a'ta" he5-iali#i# lebih #e"i'( be"hubu'(a' e'(a' (a'((ua' %e#ei5ba'(a' ai" a' ele%t"-lit ='at"iu5 a' %aliu5>) P"e#e'ta#i %li'i% e'(a' be'u'(a' &a"u a%ut, a#i-#i#, a' hi&e"%ale5ia, 5e"u&a%a' %eaaa' a"u"at 5ei% 5e5e"lu%a' te"a&i he5-iali#i# a%ut)=17>

4) K-5&li%a#i &aa a"te"i-*e'-#a

Bebe"a&a %-5&li%a#i a'( a&at te"+ai a'ta"a lai' : #te'-#i#, 8l-tti'(, i'!e%#i =l-%al 5au&u' #i#te5i%>, ali"a' a"ah  be"lebiha' ="e#i%- hi(h?-ut&ut !ailu"e>, i#%e5ia i#tal, a'eu"i#5a *e'-#a ilata#i, &e"a"aha' a%ibat "u&tu" a'eu"i#5a,

ee5a le'(a' atau tu'(%ai a%ibat #te'-#i# *e'a #e't"ali#, a' he5at-5a l-8al H) Pe5a'taua' e*alua#i +a'(%a &a'+a'(

Setia& &a#ie' ba"u ila%u%a' &e'ilaia' a'( 5eli&uti &e5e"i%#aa' !i#i% le'(%a& a' &e'u'+a'( #eba(ai be"i%ut : =1>

• Da"ah &e"i!e" le'(%a&

• Ele%t"-lit a"ah =Na, K, .l, .a, P>

• HB#A(

• A'ti H., HI • 3-t- aa

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Bila tia% aa i'i%a#i %hu#u#, 5a%a ila%u%a' &e5e"i%#aa' #e#uai +a6al be"i%ut i'i

•  Na, K, .a, P, U"eu5 =tia& 4 bula'> • SI, TIB., 3e""iti'

• HB#A(, A'ti H., a'ali#a (a# a"ah, EK =tia& 9 bula'> • E%-%a"i-("a!i =tia& 4 tahu'>

Pe5e"i%#aa' %hu#u# a'( a&at ila%u%a' aalah :

• M( =%hu#u# u'tu% a"it5ia> a' PTH tia& tahu'

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II PASIEN GAGAL GIN+AL DENGAN HEMODIALISA A DEFINISI

a(al (i'+al aitu (i'+al %ehila'(a' %e5a5&ua''a u'tu% 5e5&e"taha'%a' *-lu5e a' %-5&-#i#i 8ai"a' tubuh ala5 %eaaa' a#u&a' 5a%a'a' '-"5al) a(al (i'+al %"-'i% 5e"u&a%a' &e"%e5ba'(a' (a(al (i'+al a'( &"-("e#i! a' la5bat = bia#a'a  be"la'(#u'( #e8a"a bebe"a&a tahu'>, #ebali%'a (a(al (i'+al a%ut a%a' te"+ai ala5 bebe"a&a ha"i atau 5i'((u)

= P"i8eCil#-',2009>) a(al (i'+al %"-'i% aalah %e"u#a%a' (i'+al a'( te"+ai #ela5a lebih a"i 4 bula') Dia('-#i# &e'a%it (i'+al %"-'i% ite(a%%a' +i%a 'ilai la+u !ilt"a#i (l-5e"ulu# %u"a'( a"i 90 5lG5e'itG1,@45, #e&e"ti &aa tabel be"i%ut:

Bata#a' &e'a%it (i'+al %"-'i% 

Ke"u#a%a' (i'+al  4 bula', aitu %elai'a' #t"u%tu" atau !u'(#i (i'+al, e'(a' atau ta'&a &e'u"u'a' la+u !ilt"a#i (l-5e"ulu# be"a#a"%a':

Kelai'a' &at-l-(i%

Peta'a %e"u#a%a' (i'+al #e&e"ti &"-tei'u"ia atau %elai'a' &aa &e5e"i%#aa'  &e'8it"aa'

La+u !ilt"a#i (l-5e"ulu# F 90 5lG5e'itG1,@45 #ela5a  4 bula' e'(a' atau ta'&a %e"u#a%a' (i'+al

=P"i8e, S)A) C il#-', 2004>

Paa &a#ie' e'(a' &e'a%it (i'+al %"-'i%, %la#i!i%a#i #taiu5 ite'tu%a' -leh 'ilai la+u !ilt"a#i (l-5e"ulu#, aitu #taiu5 a'( lebih ti'((i 5e'u'+u%%a' 'ilai la+u !ilt"a#i (l-5e"ulu# a'( lebih "e'ah) U'tu% 5e'a&at%a' 3R %ita ha"u# 5e'(u%u"  %-'#e't"a#i'a ala5 #a5&el &la#5a =P>, %-'#e't"a#i'a ala5 #a5&el u"i'e=U>, a' *-lu5e u"i' ala5 &e"i-e te"te'tu =>  be"a#a"%a' a'(%a te"#ebut, &e"#a5aa' u'tu% 3R =ala5 5l &e" 5e'it>, a&at iu"ai%a' #e&e"ti ala5 &e"#a5aa':

3R =5lG5'it> U=5(G5l>=5lG5't> P=5(G5l>

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Kla#i!i%a#i te"#ebut 5e5ba(i &e'a%it (i'+al %"-'i% ala5 li5a #taiu5) Staiu5 1 aalah %e"u#a%a' (i'+al e'(a' !u'(#i (i'+al a'( 5a#ih '-"5al, #taiu5 2 %e"u#a%a' (i'+al e'(a' &e'u"u'a' !u'(#i (i'+al a'( "i'(a', #taiu5 4 %e"u#a%a' (i'+al e'(a' &e'u"u'a' a'( #ea'( !u'(#i (i'+al, #taiu5  %e"u#a%a' (i'+al e'(a' &e'u"u'a' be"at !u'(#i (i'+al, a' #taiu5 7 aalah (a(al (i'+al =P"i8e, S)A) C il#-', 2004>)

La+u !ilt"a#i (l-5e"ulu# =L3> a' #taiu5 &e'a%it (i'+al %"-'i% 

Staiu5 De#%"i&#i L3 =5LG5e'itG1)@4 5>

0 Ri#i%- 5e'i'(%at  <0 e'(a' !a%t-"

"i#i%-1 Ke"u#a%a' (i'+al i#e"tai L3  '-"5al atau 5e'i'((i

 <0

2 Pe'u"u'a' "i'(a' L3 90?<

4 Pe'u"u'a' 5-e"at L3 40?7<

 Pe'u"u'a' be"at L3 17?2<

7 a(al (i'+al F 17 atau iali#i#

B ETIOLOGI

Kla#i!i%a#i &e'ebab (a(al (i'+al %"-'i%

Kla#i!i%a#i &e'a%it Pe'a%it

Pe'a%it i'!e%#i tubulu# i'te"te#tial Piel-'e!"iti# %"-'i% atau "e!lu% 'e!"-&ati Pe'a%it &e"aa'(a' (l-5e"ul-'e!"iti#

Pe'a%it *a#%ule" hi&e"te'#i! Ne!"-#%e"-#i# be'i('a  Ne!"-#le"-#i# 5ali('a

Ste'-#i# "e'ali#

a'((ua' +a"i'(a' i%at Lu&u# e"ite5atu#u# #i#te5i%   P-lia"te"iti# '--#a

a'(ua' %-(e'ital a' he"iite" Pe'a%it (i'+al &-li%i#ti%  A#i-#i# t-bulu# (i'+al

Pe'a%it 5etab-li8 Diabete# 5ilitu#

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Hi&e"&a"ati"-ii#5e A5il--i-#i#

 Ne!"-&ati t-%#i% Pe'alah(u'aa' a'al(eti8

 Ne!"-&ati ti5ah

 Ne!"-&ati -b#tu%ti! T"a%tu# u"i'a"iu# ba(ia' ata#: batu, 'e-&la#5a, !ib"-#i# "et"-&e"it-'eal T"a%tu# u"i'a"iu# ba(ia' ba6ah : hi&e"t"-!i &"-#tat, #tu%tu" u"ete", a'-5al 8-'(e'ital, lehe" *e#i%a u"i'a"ia, a' u"et"a)

A5o!eia Pra Rena" (%enurunan 1un$&i $inja") 1) De&le#i *-lu5e 8ai"a' e%#t"a#el =E.3> ab#-lute

a) Pe"a"aha' : -&e"a#i be#a", t"au5aQ, t"au5a &a#8a&a"tu5  b) Diu"ei#i be"lebiha'

8) Kehila'(a' 8ai"a' a"i (a#t"-i'te#ti'al a'( be"at J 5u'tah, ia"e

) Kehila'(a' 8ai"a' a"i "ua'( %eti(a J lu%a ba%a"Q, &e"it-'iti#, &"a'%"eatiti#) 2) Pe'u"u'a' *-lu5e #i"%ula#i a"te"i a'( e!e%ti!

a) Pe'u"u'a' 8u"ah +a'tu'( J i'!a"% 5i-%a"iu5, i#"it5ia, (a(al +a'tu'( %-('eti!, ta5&-'e +a'tu'(, e5b-li  &a"u)

 b) a#-ilata#i a"te"i-l e!e"e' : &e'(ha5bat e';i5 &e'(%-'*e"#i a'(i-te'#i', 5i#al 8a&t-&"il) 8) Obat *a#-%-'t"i%#i : -bat  -bat al!a  a"e'e"e'i% =5i#al '-"e&i'e&"i'> a'(i-te'#i' II ) Si'"-5a he&at-"e'al

4) Pe"ubaha' he5-i'a5i% (i'+al &"i5e"  a) Ste'-#i# a"te"i (i'+al, e5b-li, th"-5bu#  b) Th"-5b-#i# *e'a "e'ali# bilate"al ) Ob#tu%#i *a#%ule" (i'+al bilate"al

A5o!eia Pa&#a Rena" (ob&!u#&i &a"uran #ei*) 1) Ob#t"u%#i u"et"a : %atub u"et"a, #ti%tu" u"et"a

2) Ob#t"u%#i ali"a' %elua" %a'u'( %e5ih : hi&e"t"-&i &"-#tatQ, %a"#i'-'a 4) Ob#t"u%#i bilate"al =u'ilate"al +i%a #aat (i'+al be"!u'(#i>

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 b) E%#t"a u"te" = %-5&"e#i> J !ib"-#i# "et"-&e"it-'eal, 'e-&la#5a %a'u'( %e5ih, &"-#tat, atau #e"*i% li(a#i beah a'( tia% i#e'(a+a atau 8ie"a

) Ka'u'( %e5ih 'eu"-(e'i%  Ga$a" Ginja" A#u! In!rin&i#

1) Ne%"-#i# Tubula" A%ut

a) Pa#%a i#%e5i%, #-8% , #e&#i#, beah +a'tu'( te"bu%a, beah a-"ta, =#e5ua &e'ebab a;-te5ia &"a "e'al  be"at>

 b) Ne!"-t-%#i#

1> Ne!"-&t-%#i# e%#-(e'

a> A'tib- : a5i'-(li%-#ia, a5!-te"i#i#' B

 b> Meia %-'t"a# te"i-i'a#i =te"uta5a &aa &e'e"ita iabete#> 8> L-(a5 be"at : #i#&lati' bi%l-"ia 5e"%u"i, a"#e'

> Si#%l-#&-"i' : ta%"-li5u#

e> Pela"ut : %a"b-' tet"a%l-"ia, etile'e (li%-l, 5etha'-l 2> Ne!"-t-%i' e'-(e'

a> Pi(5e' i't"a tubula" : he5-(l-bi', 5i-(l-buli'  b> P"-tei' i't"a t-bula" : 5el-5a 5ulti&le

8> K"i#tal i't"a tubula" : a#a5 u"at

2) Pe'a%it a#%ule" atau (l-5e"-"u# (i'+al &"i5e" 

a) l-5e"ul-'e&h"iti# &"-("e#i! 8e&at atau &a#8a t"e&t-%-%u# a%ut  b) Hi&e"te'#i 5ali('a

8) Se"a'(a' a%ut &aa (a(al (i'+al %"-'i# a'( te"%ait &e5bata#a' (a"a5 atau ai"  4) Ne!"iti# tubulu# i'te"te#tial a%ut

a) Ale"(i : beta  la8ta5 =&e'e#ili', #e!al-#&-"i', #ul!-'a5ie>  b) I'!e%#i =5i#al &iel-'e!"iti#>

= Ni8  N-8, 2014 > 2 PATOFISIOLOGI

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Paa K te"+ai &e'u"u'a' !u'(#i "e'al a'( 5e'(a%ibat%a' &"-u% a%hi" 5etab-li#5e &"-tei' tia% a&at ie%#%"e#i%a' %e ala5 u"i'e #ehi'((a te"ti5bu' iala5 a"ah a'( i#ebut u"e5ia) U"e5ia a&at 5e5&e'(a"uhi #etia& #i#te5 tubuh) Da' #e5a%i' ba'a% ti5bu'a' &"-u% #a5&ah u"e5ia 5a%a (e+ala a'( iti5bul%a' #e5a%i' be"at)

Pe'u"u'a' la+u !ilt"a#i (l-5e"ulu# =3R> 5e'(a%ibat%a' %li"e'# %"eati'i' a%a' 5e'u"u' #ehi'((a %"eati'i' a%a' 5e'i'(%at) Kaa" 'it"-(e' u"ea a"ah =BUN> bia#a'a +u(a 5e'i'(%at) i'+al +u(a tia% 5a5&u 5e'(%-'#e't"a#i%a' atau 5e'(e'8e"%a' u"i'e #e8a"a '-"5al a' #e"i'( te"+ai "ete'#i 'at"iu5 a' 8ai"a', 5e'i'(%at%a' "e#i%- te"+ai'a ee5a, (a(al +a'tu'( %-'(e#ti!, a' hi&e"te'#i) Hi&e"te'#i +u(a a&at te"+ai a%ibat a%ti*a#i #i#te5 "e''i' a'(i-te'#i' al-#te"-')

Pe'u"u'a' 3R +u(a 5e'(a%ibat%a' &e'i'(%ata' %aa" !-#!at #e"u5 #ehi'((a te"+ai &e'u"u'a' %aa" %al#iu5 #e"u5) Pe'u"u'a' %aa" %al#iu5 5e'ebab%a' #e%"e#i %aa" &ha"ath-"5-', te"+ai "e#&-' ab'-"5al #ehi'((a %al#iu5 ala5 tula'( 5e'u"u' 5e'ebab%a' &e'a%it tula'( a' %al#i!i%a#i 5eta#ta#i%) Di#a5&i'( itu &e'a%it tula'( +u(a i#ebab%a'  &e'u"u'a' &"-u%#i 5etab-lit a%ti! *ita5i' D =1,27 ehi"-%-le%al#i!e"-l>) Pat-(e'e#i# (a(al (i'+al %"-'i% aitu #e5a%i'  bu"u% a' "u#a%'a 'e!"-'  'e!"-' a'( i#e"tai be"%u"a'('a !u'(#i (i'+al, %eti%a %e"u#a%a' (i'+al be"la'+ut a' +u5lah 'e!"-' be"%u"a'(, 5a%a %e8e&ata' !ilt"a#i a' beba' #-lute ba(i 'e!"-' e5i%ia' ti'((i hi'((a %e#ei5ba'(a' (l-5e"-lu# tubulu# =%e#ei5ba'(a' a'ta" &e'i'(%ata' !ilt"a#i a' &e'i'(%ata' "eab#-"&#i -leh tubulu#> tia% a&at i&e"taha'%a' la(i) 3le%#ibilita# bai% &aa &"-#e# %-'*e"#i=&e"ubaha'> #-lute a' ai" 5e'+ai %u"a'() Reab#-"b#i %aliu5 a'( 5e"u&a%a' #alah #atu !u'(#i (i'+al +u(a 5e'(ala5i (a'((ua' i5a'a #eha"u#'a 70 %aliu5 i"eab#-"b#i i tubulu# &a"-%#i5al,

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0 i &a"# a#e'e'# tebal a' #i#a'a i ba(ia' a%hi" 'e!"-' u%tu# &e'(u5&ul i 5eulla) Ka"e'a %e"u#a%a' (i'+al  &aa &a#ie' K hal i'i 5e'+ai i'i%a#i u'tu% ila%u%a''a he5-iali#a &aa &a#ie' K)

Ke"u#a%a' (i'+al bi#a i#ebab%a' -leh iabete# 5elitu# aitu &aa iabete# 5elitu# te"+ai &e'i'(%ata' %-'#e't"a#i (ula a"ah #ehi'((a (i'+al tia% a&at 5e'e"a& #e5ua a' +i%a %eaaa' i'i te"u# be"la'+ut, 5a%a a%a' be"%u"a'('a !u'(#i 'e!"-' a' te"+ai %e"u#a%a' &aa 'e!"-' te"#ebut) Sehi'((a (lu%-#a 5u'8ul i u"i' a' 5e'ebab%a' (lu%-#u"ia #e"ta a&at 5e'i'(%at%a' &e'(elua"a' 8ai"a' a' ele%t"-lit) I'i 5e'(a%ibat%a' &aa &a#ie' a%a' te"+ai &-liu"i =ba'a%  %e'8i'(>, &-lii&#i =ba'a% 5i'u5>, a' tu"(-" %ulit 5e'u"u')

Selai' itu %e"u#a%a' (i'+al +u(a a&at i#ebab%a' -leh (l-5e"ul-'e!"iti# %"-'i# =&e"aa'(a' &aa (l-5e"ulu#> aitu a'tib-i =I(> a&at iete%#i &aa %a&ile" (l-5e"ula" a' te"+ai "ea%#i a'ti(e'?a'tib-i #ehi'((a te"be'tu% a("e(at 5-le%ul, a("e(at 5-le%ul te"#ebut iea"%a' %e #elu"uh tubuh a' aa bebe"a&a a'( te"&e"a'(%a& i (l-5e"ulu# 5e'ebab%a' "e#&-' i'!la5a#i, +i%a %e+aia' i'i be"ula'( a%a' 5e'(a%ibat%a' u%u"a' (i'+al be"%u"a'( #e&e"li5a a"i u%u"a' '-"5al, "e#&-' i'!la5a#i +u(a 5e'ebab%a' %-"te%# 5e'(e8il 5e'+ai la&i#a' a'( tebal'a 155?255) I'i 5e'(a%ibat%a' be"%a# +a"i'(a' &a"ut 5e"u#a% #i#a %-"te%# a' &e"5u%aa' (i'+al 5e'+ai %a#a" a' i"e(ule" #ehi'((a (l-5e"uli a' tubulu# 5e'+ai +a"i'(a' &a"ut #e"ta te"+ai %e"u#a%a' (l-5e"ulu# a'( &a"ah #ehi'((a "e#&-' (i'+al a'( #e#uai te"haa& 5a#u%a' 8ai"a' a' ele%t"-lit tia% te"+ai #e"ta te"+ai "ete'#i 8ai"a' a' 'at"iu5 a'( a%a' 5e'ebab%a' -ee5) Ke"u#a%a' (l-5e"ulu# a'( &a"ah +u(a 5e'ebab%a' u"e5ia a' a'e5ia)

 Ne!"-&ati t-%#i% +u(a 5e'ebab%a' %e"u#a%a' &aa (i'+al a'( ia%ibat%a' %a"e'a &e'u"u'a' !u'(#i !ilt"a#i a' 5e'ebab%a' %e"u#a%a' 'e!"-' #ehi'((a a&at +u(a 5e'ebab%a' %e"u#a%a' (l-5e"ulu# a'( &a"ah) Pe'ebab %e"u#a%a'

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(i'+al a'( lai' aitu 'e!"-&ati -b#t"u%ti! =batu #alu"a' %e5ih>, i'!e%#i #alu"a' %e5ih a' (a'((ua' &aa +a"i'(a'  &e'a5bu'()

Pa#ie' +u(a 5uah te"%e'a i'!e%#i #e&e"ti i'!e%#i #alu"a' %e5ih, i'!e%#i #alu"a' 'a&a#, 5au&u' i'!e%#i #alu"a' 8e"'a) /u(a a%a' te"+ai (a'((ua' %e#ei5ba'(a' ai" #e&e"ti hi&- atau hi&e"*-le5ia, (a'((ua' %e#ei5ba'(a' ele%t"-lit a'ta"a lai' 'at"iu5 a' %aliu5) Paa 3R iba6ah 17 a%a' te"+ai (e+ala a' %-5&li%a#i a'( lebih #e"iu#, a' &a#ie' #uah 5e5e"lu%a' te"a&i &e'((a'ti (i'+al =renal re#laement thera#y> a'ta"a lai' iali#i# atau t"a'#&la'ta#i (i'+al) Paa %eaaa' i'i &a#ie' i%ata%a' #a5&ai &aa #taiu5 (a(al (i'+al =S-e&a"5a', 2001>)

D Mani1e&!a&i #"ini# 

' Ga$a" $inja" #roni#   Ga$a" $inja" a#u!

III ASUHAN KEPERAWATAN A) PENKA/IAN

Keluha' uta5a &aa &a#ie' he5-iali#i# e'(a' K aalah : a) Si'"-5 u"e5ia

 b) Mual, 5u'tah, &e"a"aha' (a#t"-i'te#ti'al) 8) Pu#i'(, 'a!a# %u#5aul, %-5a)

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) Pe"i%a"iti#, 8a"ia8 a"it5ia) e) Ee5a, (a(al +a'tu'(, ee5a &a"u !) Hi&e"te'#i

Ma'i!e#ta#i %li'i% :

a) Kulit : %ulit %e%u'i'(a', &u8at, %e"i'( a' be"#i#i%, &"u"itu# atau (atal?(atal  b) Ku%u J %u%u ti&i# a' "a&uh)

8) Ra5but : %e"i'( a' "a&uh

) O"al J halit-#i#G!a%t-" u"e5i8, &e"a"aha' (u#i

e) La5bu'( J 5ual, 5u'tah, a'-"e%#ia, (a#t"iti# ul#e"a#i) !) Pul5-'a" J u"e5i8 lu'( atau &'eu5-'ia

() A#a5 ba#a J a#i-#i# 5etab-li% 

h) Neu"-l-(i% J letih, #a%it %e&ala, (a'((ua' tiu", (a'((ua' -t-t : &e(al i) He5at-l-(i : &e"a"aha')

B) DIANOSA KEPERAATAN

a> a'((ua' &e"tu%a"a' (a# be"hubu'(a' e'(a' &e'u5&u%a' 8ai"a' i &a"u =-*e"l-a>

 b> Kelebiha' *-lu5e 8ai"a' be"hubu'(a' e'(a' a#u&a' 5a%a'a' ti'((i 'at"iu5 ="ete'#i 'at"iu5>)

8> Ku"a'( &e'(etahua' te'ta'( &e'a%it be"hubu'(a' e'(a' %u"a'('a i'!-"5a#i :&e'a%it a' %ebutuha' u'tu% ili#i#) > Pe"ubaha' 'ut"i#i %u"a'( a"i %ebutuha' tubuh be"hubu'(a' e'(a' (a'((ua' I =u"e5ia>, &e5bata#a' iet, hila'(a

 &"-tei' #ela5a iali#i#

e> Ri#i%- ti'((i u'tu% 8ee"a: a'( be"hubu'(a' e'(a' a%#e# *a#%ula" a' %-5&li%a#i #e%u'e" te"haa& &e'u#u%a' a'  &e5eliha"aa' a%#e# *a#8ula" 

!> Ri#i%- ti'((i %e%u"a'(a' *-lu5e 8ai"a': a'( be"hubu'(a' e'(a' %ehila'(a' a"ah atau he&a"i'i#a#i a'( tia% te&at #ela5a ial#i#

(> Ri#%- ti'((i t"a'#5i#i i'!e%#i a'( be"hubu'(a' e'(a' %-'ta% #e"i'( e'(a' a"ah a' i'i*iu e'(a' "i#i%- ti'((i he&atiti# B)

h> Ri#i%- &e"a"aha' be"hubu'(a' e'(a' &e5a%aia' he&a"i') i> PK: U"e5ia

Gambar

Tabel 2) I'i%a#i He5-iali#a

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