Tatik Dwi Wahyuni
Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, UGM

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PENGARUH PENGELOLAAN PENGOBATAN TERHADAP KEPATUHAN MINUM OBAT PADA PASIEN HEMODIALISIS DENGAN HIPERTENSI: STUDI KASUS Regina Nathalia Serafina; Tatik Dwi Wahyuni; Anggi Lukman Wicaksana
Jurnal Persatuan Perawat Nasional Indonesia (JPPNI) Vol 7, No 1 (2022)
Publisher : Persatuan Perawat Nasional Indonesia (JPPNI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32419/jppni.v7i1.299

Abstract

ABSTRAKHipertensi menjadi kondisi penyulit terbanyak pada pasien yang menjalani hemodialisis. Namun, sering dijumpai ketidakpatuhan dalam pengobatan.  Tujuan penelitian: Menggambarkan upaya pengelolaan pengobatan berdasarkan evidence-based practice dengan cara menguji coba intervensi pengelolaan pengobatan terhadap tingkat kepatuhan minum obat pasien hemodialis.  Keluhan utama pasien: Penelitian ini menggunakan pendekatan studi kasus. Tn. S, 25 tahun, rutin menjalani hemodialisis dua kali/minggu, sering mengalami sakit kepala, penglihatan kabur, serta diketahui tidak menjalani pengobatan sesuai anjuran.  Pasien terdiagnosis gagal ginjal kronis (GGK) stadium V e.c hipertensi sejak tahun 2017. Sejak saat itu pasien rutin melakukan hemodialisis dua kali seminggu di unit Hemodialisis RSUP Dr. Sardjito, Yogyakarta.  Secara umum, terdapat penurunan fungsi ginjal dan penurunan indikator hematologi.  Hasil: Data rekaman medis Tn. S dicatat dalam lembar pencatatan, termasuk penggunaan Morisky medication adherence scale (MMAS-8) untuk kepatuhan pengobatan.  Pengukuran tekanan darah dan indikator hemodialisis dilakukan pemantauan secara berkala. Upaya pengelolaan obat dilakukan dengan mengatur obat sesuai jadwal, memantau konsumsi obat harian, serta mengirimkan SMS pengingat dan motivasi kepada pasien untuk meminum obat tepat waktu selama dua minggu. Setelah dilakukan intervensi, terjadi peningkatan skor MMAS-8 (pre = 4,5, post = 5,75). Rerata tekanan darah selama dilakukan intervensi menjadi terkontrol, terutama prehemodialisis (M = 148/91 mmHg).  Upaya pengelolaan pengobatan yang dilakukan menunjukkan hasil yang baik sejalan dengan temuan evidence based practice. Pasien juga merasa puas dan berkenan melakukannya secara mandiri. Kesimpulan: Terdapat peningkatan tingkat kepatuhan minum obat pasien dan terkendalinya tekanan darah pasien. Intervensi yang dilakukan dapat digunakan sebagai acuan perawat dalam mengelola pasien hemodialisis dengan masalah ketidakpatuhan minum obat.Kata Kunci: kepatuhan minum obat, hipertensi, hemodialisis, pengobatan, polifarmasi Effect of Medication Management on Medication Adherence in Hemodialysis Patients with Hypertension: A Case Study ABSTRACTHypertension is the most common complicating condition in patients undergoing hemodialysis. However, medication non-adherence is often found. Objective: To describe medication management efforts based on evidence-based practice by testing medication interventions on the level of medication adherence in hemodialysis patients. Main complaints of the patient: This research employed a case study approach. Mr. S, 25 years old, underwent hemodialysis twice a week, had frequent headaches and blurred vision, and was known not to have received medication as recommended. The patient was diagnosed with stage 5 chronic kidney disease (CKD) e.c hypertension in 2017. Since then, the patient had routinely undergone hemodialysis twice a week at the Hemodialysis unit of Dr. Sardjito Hospital, Yogyakarta. In general, there was a decrease in renal function and a decrease in hematological indicators. Results: Medical record data of Mr. S was recorded in the logs, including the Morisky medication adherence scale (MMAS-8) for medication adherence. Blood pressure and hemodialysis indicators were monitored periodically. Medication was managed by scheduling medicine, combining daily medicine, and sending reminders and motivational SMS to the patient to take medicine on time for two weeks. After the intervention, there was an increase in the MMAS-8 score (pre = 4.5, post = 5.75). The mean blood pressure during the intervention was controlled, especially during prehemodialysis (M = 148/91 mmHg). The medication management indicated good results in line with evidence-based practice findings. Patients also felt satisfied and happy to do it independently. Conclusion: There is an increase in the patient's medication adherence level, and the patient's blood pressure is well controlled. The interventions can be used as a reference for nurses in managing hemodialysis patients with the problem of medication non-adherence.Keywords: medication adherence, hypertension, hemodialysis, medication, polypharmacy
EDUKASI PEMANTAUAN CAIRAN PADA PASIEN GAGAL GINJAL KRONIS DENGAN ANURIA 8 TAHUN: STUDI KASUS Rohmah Puriana Khusna; Tatik Dwi Wahyuni; Anggi Lukman Wicaksana
Jurnal Persatuan Perawat Nasional Indonesia (JPPNI) Vol 7, No 3 (2022)
Publisher : Persatuan Perawat Nasional Indonesia (JPPNI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32419/jppni.v7i3.403

Abstract

ABSTRAKPembatasan cairan sangat penting bagi pasien gagal ginjal kronis (GGK). Banyak pasien tidak mengetahui pentingnya pemantauan cairan berkala dan enggan membatasi cairan yang dikonsumsi. Tujuan penelitian: Untuk mengujicobakan edukasi pemantauan cairan berbasis bukti pada pasien GGK dengan anuria 8 tahun. Penelitian ini menggunakan pendekatan studi kasus dalam mengimplementasikan edukasi pemantauan cairan.Keluhan utama pasien: Ny. S sering melaporkan kenaikan berat badan > 4 kg prehemodialisis, terdapat asites, dan edema perifer. Tidak dilaporkan adanya sesak napas, tetapi pasien sering lelah dan pusing. Diberikan edukasi pemantauan cairan, penggunaan buku monitoring cairan, dan pendampingan selama 10 hari. Pasien didorong menuliskan hasil asupan dan haluaran harian. Hasil: Setelah pemberian intervensi, terjadi penurunan kenaikan berat badan prehemodialisis (6,7 kg menjadi 4 kg), ultrafiltration rate (4.500 ml menjadi 2.800 ml), Kt/v (2,08 menjadi 1,46), dan QB (230 menjadi 150). Kesimpulan: Edukasi pemantauan cairan berbasis bukti mampu membantu menurunkan kenaikan berat badan sebelum hemodialisis dan jumlah volume tarikan saat dialisis. Dengan demikian, penting bagi pasien untuk mendapatkan edukasi dan intervensi yang tepat dari tenaga kesehatan, khususnya perawat selama menjalani hemodialisis.Kata kunci: anuria, asupan cairan, gagal ginjal kronis, ketidakpatuhan, pemantauan cairan Fluid Monitoring Education in Patient with Chronic Kidney Disease Suffering from 8-Year Anuria: A Case Study ABSTRACTFluid restriction is crucial for patients with chronic kidney disease (CKD). Lots of patients are unaware of the importance of regular fluid monitoring and reluctant to restrict the fluid intake. Objective: To pilot an evidence-based fluid monitoring education in patients with CKD suffering from 8-year anuria. This research applied a case study design to implement the fluid monitoring education. Patient's chief complaint: Mrs. S regularly reported > 4 kg weight gain at pre-hemodialysis; experienced ascites and peripheral edema. No shortness of breath was reported, but the patient complained fatigue and dizzy. The patient received education on fluid monitoring, using fluid monitoring book, and assistance for 10 days. In her daily basis, patient was encouraged to record the amount of intake and output results. Results: After the intervention, there was a decrease in pre-hemodialysis weight gain (from 6,7 kg to 4 kg), ultrafiltration rate (from 4.500 ml to 2.800 ml), Kt/v (from 2.08 to 1.46), and QB (from 230 to 150). Conclusion: Evidence-based fluid monitoring education can assist to reduce pre-hemodialysis weight gain and the ultrafiltration rate during dialysis. Therefore, patients with CKD facing from 8-year anuria need to receive proper education and intervention from healthcare workers, especially nurses, while undergoing hemodialysis.Keywords: anuria, fluid intake, chronic kidney disease, non-adherence, fluid monitoring