Care Bundles for Chronic Kidney Disease (CKD) Patients with Hypervolemia: Case Reports
Keywords:
CKD, ESRD, Hypervolemia, Care Bundles, Fluid
Abstract
The rising prevalence of Chronic Kidney Disease (CKD) highlights its significance as a global health concern requiring comprehensive management. CKD is characterized by a progressive, irreversible decline in renal function, leading to fluid and electrolyte imbalances. One such complication is hypevolemia, which can result in serious health consequences. Our case reports evaluates the effectiveness of implementing care bundles that incorporated both independent and collaborative nursing intervention. Data collection was conducted through observation, interviews, physical examinations, and supporting data. The subjects were two stage V CKD patients with hypervolemia at Umar Wirahadikusumah Hospital in Sumedang, West Java. Over a five-day period, interventions included patient education, fluid restriction, proper positioning, breathing relaxation techniques, and collaborative treatments such as administration of diuretics, antihypertensives, hemodialysis, and ascitic fluid paracentesis.The implementation of care bundles resulted in improved clinical outcomes, including stabilized blood pressure (120–130/70–80 mmHg), decreasing abdominal circumference (6–15%), reducing dyspnea (respiratory rate 20–25 breaths/min), and increasing oxygen saturation (98–99%). Nurses play a key role as caregivers and coordinators in delivering both independent and collaborative interventions. Through an interdiciplinary approach, the implementation of care bundles has proven effective in achieving optimal care goals and improving patient health outcomes.
References
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Mehrotra, R., Devuyst, O., Davies, S. J., & Johnson, D. W. (2016). The current state of peritoneal dialysis. Journal of the American Society of Nephrology, 27(11), 3238-3252. https://doi.org/10.1681/ASN.2016010112
Muhsinin, S. Z., Musniati, M., Zulfa, E., & Yanti, N. W. M. (2022). Perbedaan efektivitas posisi Fowler dengan posisi Semifowler untuk mengurangi sesak nafas. Jurnal Ilmu Kesehatan dan Farmasi, 10(2), 47–50. https://doi.org/10.51673/jikf.v10i2.1391
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Prasetya, D. W., Rahmawati, F., & Nugroho, T. (2019). Pengaruh tindakan punksi asites terhadap perubahan lingkar perut pada pasien dengan asites masif. Jurnal Ilmu Kesehatan, 11(1), 45–51.
Putranto, T., Murhayati, A., & Saelan. (2022). Pengaruh pemberian posisi Semi Fowler 45° terhadap frekuensi nafas pada pasien gagal ginjal kronik di wilayah kerja Puskesmas Sidoharjo Sragen (Undergraduate thesis, Universitas Kusuma Husada Surakarta). Universitas Kusuma Husada Institutional Repository. Retrieved from http://eprints.ukh.ac.id/id/eprint/2610
Rahman, T. S., Dwiningsih, S. U., & Indriyawati, N. (2021). Nursing care to meet fluid and electrolyte needs of chronic kidney disease patient. Jendela Nursing Journal, 5(1), 48–63. https://doi.org/10.31983/jnj.v5i1.6954
Sari, L., Purwanti, O. S., Ns, M. K., & Kep, N. S. (2016). Upaya mencegah kelebihan volume cairan Pada pasien chronic kidney disease Dirsud dr. soehadi prijonegoro (Doctoral dissertation, Universitas Muhammadiyah Surakarta).
Sari, Y. K., Sari, E. A., & Pratiwi, S. H. (2023). Hipervolemia dan keletihan pada pasien chronic kidney disease stage 5: Sebuah studi kasus. MAHESA: Malahayati Health Student Journal, 3(9), 2605–2618. https://doi.org/10.33024/mahesa.v3i9.10878
Safitri, L. N. (2019). Asuhan keperawatan pada Ny. H dengan Chronic Kidney Disease (CKD) dalam pemenuhan kebutuhan cairan (Diploma thesis, STIKes Kusuma Husada Surakarta). Universitas Kusuma Husada Surakarta Institutional Repository. Retrieved from http://eprints.ukh.ac.id/id/eprint/39/
Saraswati, N. L. G. I., Antari, N. L. Y. S., & Suwartini, N. L. G. (2019). Hubungan dukungan keluarga dengan kepatuhan pembatasan cairan pada pasien chronic kidney disease yang menjalani hemodialisa. Jurnal Ilmu Kesehatan Bhakti Husada: Health Sciences Journal, 10(1), 45–53. https://doi.org/10.34305/jikbh.v10i1.84
Shi, Y., Xiong, J., Chen, Y., Deng, J., Peng, H., Zhao, J., & He, J. (2018). The effectiveness of multidisciplinary care models for patients with chronic kidney disease: A systematic review and meta analysis. International Urology and Nephrology, 50(2), 301–312. https://doi.org/10.1007/s11255-017-1679-7
Siskawati, R. H. S. (2022). Pengaruh edukasi terhadap kepatuhan pasien CKD dalam pembatasan intake cairan di ruang haemodialisa di Rumah Sakit Aminah Tangerang. Jurnal Ilmiah Keperawatan IMELDA, 8(1), 5–11. https://doi.org/10.52943/jikeperawatan.v8i1.667
Think Kidneys. (2020). Acute Kidney Injury – Fluid balance monitoring for nurses. NHS. Retrieved from https://www.thinkkidneys.nhs.uk
Yusman, F. A., Dewi, R. T. K., Mashuri, Y. A., Nurhayatun, E., & Giani, M. T. (2020). Factor related to the incidence of ascites in chronic kidney disease patients undergoing hemodialysis at RSUD Dr Moewardi Surakarta: A cross sectional study. Jurnal Penyakit Dalam Indonesia, 7(3), 5. https://doi.org/10.7454/jpdi.v7i3.420
Al-Zakhari, R., Alataby, H., Freg, G., Moussa, J., Mossayebi, E., & Ebrahimi, F. (2020). A Real Neglected Problem With a Grave Prognosis: Nephrogenic Ascites. Journal of medical cases, 11(1), 26–29. https://doi.org/10.14740/jmc3413
Ammirati, A. L. (2020). Chronic kidney disease. Revista da Associação Médica Brasileira, 66(Suppl 1), s03–s09. https://doi.org/10.1590/1806-9282.66.s1.3
Angraini, F., & Putri, A. F. (2016). Pemantauan intake output cairan pada pasien gagal ginjal kronik dapat mencegah overload cairan. Jurnal Keperawatan Indonesia, 19(3), 152–160. https://doi.org/10.7454/jki.v19i3.475
Anindita, C. (2024). Asuhan Keperawatan Pada Pasien CKD Dengan Hipervolemia Melalui Pemberian Terapi Furosemide Diruang Icu Rumah Sakit Umum Daerah Pasar Rebo (Doctoral dissertation, Universitas Mohammad Husni Thamrin).
Barakat, M. I., & Zaidi, S. R. (2023). Paracentesis. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK435998/
Direktorat Jenderal Pelayanan Kesehatan. (2022). Asites: Gejala dan Penanganannya. Kementerian Kesehatan Republik Indonesia. Retrieved from https://yankes.kemkes.go.id/view_artikel/1553/asites
Evans, M., Lewis, R. D., Morgan, A. R., Whyte, M. B., Hanif, W., Bain, S. C., Davies, S., Dashora, U., Yousef, Z., Patel, D. C., & Strain, W. D. (2022). A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Advances in therapy, 39(1), 33–43. https://doi.org/10.1007/s12325-021-01927-z
Haksara, E., & Rahmanti, A. (2021). Pengaruh dosis hemodialisis terhadap kejadian ascites pada pasien gagal ginjal kronis yang menjalani hemodialisis di RST Dr. Soedjono Magelang: Effect of hemodialysis dose on ascites event in chronic renal failure patients treating hemodialysis in RST Dr. Soedjono Magelang. Jurnal Keperawatan Sisthana, 6(2), 48–53. https://doi.org/10.55606/sisthana.v6i2.77
Huxel, C., Raja, A., & Ollivierre-Lawrence, M. D. (2023). Loop diuretics. In StatPearls. StatPearls Publishing. Retrieved from.
https://www.ncbi.nlm.nih.gov/books/NBK538206/
Jiamjariyapon, T., Ingsathit, A., Pongpirul, K., Vipattawat, K., Kanchanakorn, S., Saetie, A., Kanistanon, D., Wongprompitak, P., Leesmidt, V., Watcharasaksilp, W., Wang, W., Chandraker, A. K., & Tungsanga, K. (2017). Effectiveness of integrated care on delaying progression of stage 3–4 chronic kidney disease in rural communities of Thailand (ESCORT study): A cluster randomized controlled trial. BMC Nephrology, 18(1), 83. https://doi.org/10.1186/s12882-016-0414-4
Kemenkes R.I. 2020. Ginjal Kronis Direktorat P2PTM. Available At: http://www.p2ptm.kemkes.go.id/kegiatan-p2ptm/subdit-penyakit-jantung-dan-pembuluhdarah
Kemenkes. Situasi Penyakit Ginjal Kronik. Pusat Data dan Informasi Kemenkes RI.2019
Khan, Y. H., Sarriff, A., Adnan, A. S., Khan, A. H., & Mallhi, T. H. (2016). Chronic kidney disease, fluid overload and diuretics: A complicated triangle. PLOS ONE, 11(7), e0159335. https://doi.org/10.1371/journal.pone.0159335
Kusuma, A. H. (2022). Hubungan lama menjalani hemodialisis dengan kualitas hidup pasien gagal ginjal kronik di ruang hemodialisa RSUD Merauke. Jurnal Ilmiah Obsgin: Jurnal Ilmiah Ilmu Kebidanan & Kandungan, 14(4), 156–163. https://doi.org/10.36089/job.v14i4.909
Lestari, S., & Widyaningsih, R. (2021). Efektivitas tindakan paracentesis terhadap penurunan keluhan dan lingkar perut pada pasien dengan asites. Jurnal Keperawatan Klinis dan Komunitas, 7(2), 120–127. https://doi.org/10.33024/jkm.v7i2.3824
García-Maset, R., Bover, J., Segura de la Morena, J., Sánchez, A., Goicoechea, M., Galcerán, J. M., Macía, M., Pascual, J., Prats, D., & Cases, A. (2022). Information and consensus document for the detection and management of chronic kidney disease. Nefrología, 42, 233–264. https://doi.org/10.1016/j.nefroe.2022.07.003
Mehrotra, R., Devuyst, O., Davies, S. J., & Johnson, D. W. (2016). The current state of peritoneal dialysis. Journal of the American Society of Nephrology, 27(11), 3238-3252. https://doi.org/10.1681/ASN.2016010112
Muhsinin, S. Z., Musniati, M., Zulfa, E., & Yanti, N. W. M. (2022). Perbedaan efektivitas posisi Fowler dengan posisi Semifowler untuk mengurangi sesak nafas. Jurnal Ilmu Kesehatan dan Farmasi, 10(2), 47–50. https://doi.org/10.51673/jikf.v10i2.1391
National Kidney Foundation. (2022). Managing complications in advanced CKD. https://www.kidney.org
Prasetya, D. W., Rahmawati, F., & Nugroho, T. (2019). Pengaruh tindakan punksi asites terhadap perubahan lingkar perut pada pasien dengan asites masif. Jurnal Ilmu Kesehatan, 11(1), 45–51.
Putranto, T., Murhayati, A., & Saelan. (2022). Pengaruh pemberian posisi Semi Fowler 45° terhadap frekuensi nafas pada pasien gagal ginjal kronik di wilayah kerja Puskesmas Sidoharjo Sragen (Undergraduate thesis, Universitas Kusuma Husada Surakarta). Universitas Kusuma Husada Institutional Repository. Retrieved from http://eprints.ukh.ac.id/id/eprint/2610
Rahman, T. S., Dwiningsih, S. U., & Indriyawati, N. (2021). Nursing care to meet fluid and electrolyte needs of chronic kidney disease patient. Jendela Nursing Journal, 5(1), 48–63. https://doi.org/10.31983/jnj.v5i1.6954
Sari, L., Purwanti, O. S., Ns, M. K., & Kep, N. S. (2016). Upaya mencegah kelebihan volume cairan Pada pasien chronic kidney disease Dirsud dr. soehadi prijonegoro (Doctoral dissertation, Universitas Muhammadiyah Surakarta).
Sari, Y. K., Sari, E. A., & Pratiwi, S. H. (2023). Hipervolemia dan keletihan pada pasien chronic kidney disease stage 5: Sebuah studi kasus. MAHESA: Malahayati Health Student Journal, 3(9), 2605–2618. https://doi.org/10.33024/mahesa.v3i9.10878
Safitri, L. N. (2019). Asuhan keperawatan pada Ny. H dengan Chronic Kidney Disease (CKD) dalam pemenuhan kebutuhan cairan (Diploma thesis, STIKes Kusuma Husada Surakarta). Universitas Kusuma Husada Surakarta Institutional Repository. Retrieved from http://eprints.ukh.ac.id/id/eprint/39/
Saraswati, N. L. G. I., Antari, N. L. Y. S., & Suwartini, N. L. G. (2019). Hubungan dukungan keluarga dengan kepatuhan pembatasan cairan pada pasien chronic kidney disease yang menjalani hemodialisa. Jurnal Ilmu Kesehatan Bhakti Husada: Health Sciences Journal, 10(1), 45–53. https://doi.org/10.34305/jikbh.v10i1.84
Shi, Y., Xiong, J., Chen, Y., Deng, J., Peng, H., Zhao, J., & He, J. (2018). The effectiveness of multidisciplinary care models for patients with chronic kidney disease: A systematic review and meta analysis. International Urology and Nephrology, 50(2), 301–312. https://doi.org/10.1007/s11255-017-1679-7
Siskawati, R. H. S. (2022). Pengaruh edukasi terhadap kepatuhan pasien CKD dalam pembatasan intake cairan di ruang haemodialisa di Rumah Sakit Aminah Tangerang. Jurnal Ilmiah Keperawatan IMELDA, 8(1), 5–11. https://doi.org/10.52943/jikeperawatan.v8i1.667
Think Kidneys. (2020). Acute Kidney Injury – Fluid balance monitoring for nurses. NHS. Retrieved from https://www.thinkkidneys.nhs.uk
Yusman, F. A., Dewi, R. T. K., Mashuri, Y. A., Nurhayatun, E., & Giani, M. T. (2020). Factor related to the incidence of ascites in chronic kidney disease patients undergoing hemodialysis at RSUD Dr Moewardi Surakarta: A cross sectional study. Jurnal Penyakit Dalam Indonesia, 7(3), 5. https://doi.org/10.7454/jpdi.v7i3.420
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2025-12-01
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