SKRIPSI PENGARUH EDUKASI TERHADAP KEPATUHAN INTAKE CAIRAN PASIEN PENYAKIT GINJAL KRONIK (PGK) ON HEMODIALISIS PENELITIAN PRA-EKSPERIMENTAL

ADLN - PERPUSTAKAAN UNIVERSITAS AIRLANGGA

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PENGARUH EDUKASI TERHADAP KEPATUHAN INTAKE CAIRAN PASIEN PENYAKIT GINJAL KRONIK (PGK) ON HEMODIALISIS

PENELITIAN PRA-EKSPERIMENTAL

Oleh: Desak Putu Kuniawati 131311123032

PROGRAM STUDI PENDIDIKAN NERS FAKULTAS KEPERAWATAN UNIVERSITAS AIRLANGGA SURABAYA 2015

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PENGARUH EDUKASI TERHADAP KEPATUHAN INTAKE CAIRAN PASIEN PENYAKIT GINJAL KRONIK (PGK) ON HEMODIALISIS PENELITIAN PRA-EKSPERIMENTAL Untuk Memperoleh Gelar Sarjana Keperawatan (S.Kep) Dalam Program Studi Pendidikan Ners Pada Program Studi Pendidikan Nurs Fakultas Keperawatan UNAIR

Oleh: Desak Putu Kuniawati 131311123032

PROGRAM STUDI PENDIDIKAN NERS FAKULTAS KEPERAWATAN UNIVERSITAS AIRLANGGA SURABAYA 2015

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UCAPAN TERIMA KASIH Segala puji syukur penulis panjatkan atas segala rahmat dari Tuhan Yang Maha Esa, sehinggapeneliti dapat menyelesaikan penyusunan skripsi ini dengan judul “PENGARUH EDUKASI TERHADAP KEPATUHAN INTAKE CAIRAN

PASIEN

PENYAKIT

GINJAL

KRONIK

(PGK)

ON

HEMODIALISIS” Penulis menyadari bahwa dalam penyusunan skripsi ini tidak akan selesai tanpa bantuan dari berbagai pihak yang telah memberikan dukungan, bimbingan serta arahan baik moril maupun materiil. Untuk itu, ucapan terima kasih yang sebesar-besarnya disampaikan kepada yang terhormat : 1. Ibu Ika Yuni Widyawati, M.Kep,,Ns.,Sp.Kep.MB.selaku Dosen Pembimbing Utama yang telah banyak memberikan bimbingan, masukan dan saran serta motivasi dengan penuh kesabaran sehingga skripsi ini dapat terselesaikan dengan baik. 2. Ibu Herdina Mariyanti,S.Kep.,Ns.,M.Kep, selaku Dosen Pembimbing Pendamping yang memberikan bimbingan, masukan dan saran sehingga skripsi ini dapat terselesaikan dengan baik. 3. Bapak Abu Bakar,M.Kep.,Ns.,Sp.Kep.MBselaku Dosen Penguji dalam Sidang skripsi

yang telah

banyak

memberikan

masukan

dan

saran

demi

kesempurnaan skripsi ini. 4. Ibu Ninuk Dian Kurniawati,S.Kep.,Ns.,MANP, selaku Dosen Penguji pertama dalam Sidang proposal yang telah banyak memberikan masukan dan saran. 5. Seluruh responden yang telah bersedia berpartisipasi dalam penelitian ini. 6. Seluruh dosen dan para staf Fakultas Keperawatan Universitas Airlangga Surabaya yang telah membantu proses belajar peneliti selama pendidikan. 7. Seluruh staf administrasi Fakultas Keperawatan Universitas Airlangga. 8. Pak Hendy yang telah berbaik hati mencarikan sumber referensi bagi penelitian dan menunggu kami pulang meskipun jam kerja telah berakhir. 9. Dr. Widodo Sp.PDD,KGH selaku dokter pembimbing klinik yang banyak membentu dalam memfasilitasi saat penelitian

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10. Keluarga tercinta, suami dan ke tiga anak-anakku yang selalumemberikan motivasi, semangat dan doa. 11. Rekan-rekan mahasiswa Fakultas Keperawatan Universitas Airlangga Surabaya yang telah memberi dukungan dalam menyusun proposal ini. 12. Teman-teman RSUD dr Soetomo Khususnya Unit HD dan Unit HD GRAHA AMERTA yang selalu memberikan dukungan moral dan spiritual. 13. Semua pihak yang telah membantu dalam penyusunan skripsi ini. Penulis menyadari sepenuhnya bahwa skripsi ini masih jauh dari kesempurnaan, sehingga penulis sangatmengharapkan kritik dan saran dari pembaca. .

Surabaya, 06 Pebruari 2015

Penulis

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ABSTRACT EFFECT of EDUCATION on PATIENT COMPLIANCE FLUID INTAKE CHRONIC KIDNEY DISEASE (CKD) on HEMODIALYSIS Pre-experimental in Hemodyalisis Unit, RSUD dr. Soetomo

By : Desak Putu Kuniawati Abstract Introduction: One of the causes of death in patients with chronic kidney disease on hemodialysis was due to the problem of uncontrolled fluid intake. The prevalence at Dr. Soetomo ireported hospital as much as 80% increase weight more than 6%. Nursing education in fluid restriction was expected to improve adherence to fluid intake, and therefore contributes to the achievement of the ideal IDGW was less than 2%. Method: The design in this study was pre-experiment. The population in the study were all patients with chronic kidney disease undergoing hemodialysis. The samples obtained were 28 respondents who met to the inclusion and exclusion criteria. Sampling using purposive sampling technique. The independent variabel was education. The dependent variabel was Inter Dialitic Weight Gain, Qb and systolic blood pressure. Body weight was observered before and after hemodialysis. Blood pressure was observered during hemodialysis. Data were analyzed using Wilcoxon Signed Rank test with significant level of p=0.005. Result: The results showed that IDWG (p=0.157),Qb (p=0.007) and systolic blood pressure (p=0.021). IDWG patients did not undergo significant changes before and after education. Qb and systolic blood pressure of patients experiencing significant changes before and after education. Nursing educations provides significant effect on the patient's fluid intake compliance with indicator Qb and systolic blood pressure. Discussion: Nursing educations would provide significant effect on compliance if supported by many factors such as family support advocates, social support and motivation of the patients. The provision of education should be carried out continuously and sustainably to obtain optimal results in patients undergoing regular hemodialysis , especially in terms of compliance with hemodialysis therapy and fluid therapy regimen , in order to achieve adequate dialysis. In a subsequent study can be developed not only limited to the provision of education to the patient but also involve the patient's family . Keywords: Compliance, fluid intake, CRF, HD, IDWG, Qb, and a decrease in systolic.

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DAFTAR ISI Halaman HALAMAN JUDUL .............................................................................................. i HALAMAN PRASYARAT GELAR .................................................................... ii LEMBAR PERNYATAAN .................................................................................... iii LEMBAR PERSETUJUAN ................................................................................... iv LEMBAR PENETAPAN PANITIA PENGUJI ..................................................... v UCAPAN TERIMA KASIH................................................................................... vi ABSTRACT .............................................................................................................. viii DAFTAR ISI ........................................................................................................... ix DAFTAR TABEL ................................................................................................... xii DAFTAR GAMBAR .............................................................................................. xiii DAFTAR LAMPIRAN ........................................................................................... xiv DAFTAR SINGKATAN DAN ISTILAH .............................................................. xv BAB 1 PENDAHULUAN ..................................................................................... 1.1 Latar Belakang ...................................................................................... 1.2 Identifikasi Masalah .............................................................................. 1.3 Rumusan Masalah ................................................................................. 1.4 Tujuan Penelitian 1.4.1 Tujuan umum ............................................................................ 1.4.2 Tujuan khusus ........................................................................... 1.5 Manfaat Penelitian 1.5.1 Manfaat teoritis ......................................................................... 1.5.2 Manfaat praktis .........................................................................

1 1 5 6

BAB 2 TINJAUAN PUSTAKA ............................................................................. 2.1 Penyakit Ginjal Kronik ......................................................................... 2.1.1 Pengertian penyakit ginjal kronik ............................................. 2.1.2 Stadium penyakit ginjal kronik ................................................. 2.1.3 Etiologi ...................................................................................... 2.1.4 Patofisiologi .............................................................................. 2.1.5 Komplikasi ................................................................................ 2.1.6 Penatalaksanaan penyakit ginjal kronik .................................... 2.2 Hemodialisis ......................................................................................... 2.2.1 Pengertian ................................................................................. 2.2.2 Indikasi hemodialisis ................................................................ 2.2.3 Tujuan hemodialisis .................................................................. 2.2.4 Prinsip dasar hemodialisis......................................................... 2.2.5 Komplikasi hemodialisis ........................................................... 2.3 Konsep Interdialtytic Weight Gain (IDWG)......................................... 2.3.1 Pengertian IDWG...................................................................... 2.3.2 Klasifikasi IDWG ..................................................................... 2.3.3 Komplikasi IDWG ....................................................................

8 8 8 8 9 9 11 11 12 13 13 14 14 17 18 18 19 19

6 6 6 7

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2.4 Konsep Asupan Cairan.......................................................................... 2.5 Konsep Kepatuhan ................................................................................ 2.5.1 Pengertian kepatuhan ................................................................ 2.5.2 Faktor yang mempengaruhi kepatuhan ..................................... 2.5.3 Mengurangi Ketidakpatuhan ..................................................... 2.6 Indikator Kepatuhan.............................................................................. 2.6.1 Interdialytic Weight Gain (IDWG) ........................................... 2.6.2 Quick of Blood (Qb) .................................................................. 2.6.3 Hipotensi Intradialitik ............................................................... 2.6.4 Hipertensi Intradialitik .............................................................. 2.7 Konsep Edukasi .................................................................................... 2.7.1 Pengertian Edukasi .................................................................... 2.7.2 Tujuan Edukasi ......................................................................... 2.7.3 Tempat Penyelenggaraan Edukasi ............................................ 2.7.4 Sasaran Edukasi ........................................................................ 2.7.5 Metode Edukasi ........................................................................ 2.8 Metode Penyuluhan .............................................................................. 2.9 Orisinalitas (Keaslian) Penelitian .........................................................

19 20 20 21 21 22 22 23 24 25 25 25 26 27 27 27 29 31

BAB 3 KERANGKA KONSEPTUAL DAN HIPOTESIS PENELITIAN ............ 36 3.1 Kerangka Konseptual ........................................................................... 36 3.2 Hipotesis Penelitian ............................................................................. 39 BAB 4 METODE PENELITIAN ........................................................................... 4.1 Desain Penelitian .................................................................................. 4.2 Populasi, Sampel dan Sampling ............................................................ 4.2.1 Populasi ..................................................................................... 4.2.2 Sampel....................................................................................... 4.2.3 Sampling ................................................................................... 4.3 Variabel dan Definisi Operasional ........................................................ 4.3.1 Variabel ..................................................................................... 4.3.2 Definisi operasional .................................................................. 4.4 Instrumen Penelitian ............................................................................. 4.4.1 Instrumen edukasi ..................................................................... 4.4.2 Instrumen asupan cairan............................................................ 4.4.3 Instrumen capaian Qb ............................................................... 4.4.4 Instrumen hipotensi ................................................................... 4.5 Tempat Penelitian ................................................................................. 4.6 Waktu Penelitian ................................................................................... 4.7 Prosedur Pengumpulan Data ................................................................. 4.8 Analisis Data ......................................................................................... 4.9 Kerangka Operasional ........................................................................... 4.10 Etika Penelitian ................................................................................... 4.10.1 Informed consent ....................................................................... 4.10.2 Privacy ...................................................................................... 4.10.3 Anonimity .................................................................................. 4.10.4 Confidentiality........................................................................... 4.11 Keterbatasan ........................................................................................

40 40 41 41 41 42 43 43 44 47 47 47 48 48 49 49 51 52 53 53 53 54 54 54 55

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BAB 5 HASIL DAN PEMBAHASAN PENELITIAN .......................................... 5.1 Hasil Penelitian ..................................................................................... 5.1.1 Gambaran umum lokasi penelitian .......................................... 5.1.2 Data khusus ............................................................................... 5.2 Pembahasan........................................................................................... 5.2.1 Analisa hubungan edukasi terhadap kepatuhan intake cairan dengan IDWG ........................................................................... 5.2.2 Analisa hubungan edukasi dengan kepatuhan intake cairan dengan Qb ................................................................................ 5.2.3 Analisa hubungan edukasi kepatuhan intake cairan dengan tekanan darah (hipotensi) ..........................................................

56 56 56 57 59 59 63 66

BAB 6 SIMPULAN DAN SARAN ........................................................................ 67 6.1 Simpulan ............................................................................................... 67 6.2 Saran ..................................................................................................... 67 DAFTAR PUSTAKA ............................................................................................. 69 LAMPIRAN ............................................................................................................ 73

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DAFTAR TABEL Halaman

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Tabel 2.1

Katagori LFG pada Penyakit Ginjal Kronis (KDIGO 2013) ...................................................................................................... 8

Tabel 2.2

Komplikasi Penyakit Ginjal Kronis (KDOQI 2002) .............................. 11

Tabel 2.3

Stadium Penyakit Ginjal Kronis serta Clinical Action Plane (KDOQI 2002) ............................................................................. 12

Tabel 2.4

Komplikasi Akut Hemodialisis (Bieber & Himmelfarb 2013) ...................................................................................................... 17

Tabel 2.5

Komplikasi Kronis Hemodialisis (Bieber & Himmelfarb 2013) .................................................................................. 18

Tabel 2.6

Keaslian Penulisan ................................................................................ 31

Tabel 4.1

Desain Penelitian Pengaruh Edukasi terhadap Kepatuhan Intake Cairan Pasien PGK on HD ....................................... 40

Tabel 4.2

Definisi Operasional Penelitian ............................................................. 45

Tabel 5.1

Tabulasi IDWG Sebelum dan Sesudah Pelaksanaan Edukasi terhadap Kepatuhan Intake Cairan pada Pasien PGK on HD pada Januari 2015 .............................................................. 57

Tabel 5.2

Tabulasi QB Sebelum dan Sesudah Pelaksanaan Edukasi terhadap Kepatuhan Intake Cairan pada Pasien PGK on HD pada Januari 2015 .............................................................. 58

Tabel 5.3

Tabulasi Penurunan Tekanan Darah Sistolik Sebelum dan Sesudah Pelaksanaan Edukasi terhadap Kepatuhan Intake Cairan pada Pasien PGK on HD pada Januari 2015........................................................................................................ 58


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DAFTAR GAMBAR Halaman

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Gambar 1.1

Identifikasi Masalah Pengaruh Edukasi terhadap Kepatuhan Intake Cairan Pasien PGK on HD ....................................... 5

Gambar 2.1

Hemodialisis (Human Body Disease 2009) ........................................... 8

Gambar 2.2

Mekanisme Disfusi (Biology corner 2001) ............................................ 15

Gambar 2.3

Mekanisme Ultrafiltrasi (Greenchen 2010) ........................................... 15

Gambar 3.1

Kerangka Konseptual Pengaruh Edukasi terhadap Kepatuhan Intake Cairan Pasien PGK on HD ....................................... 36

Gambar 4.1

Kerangka Operasional Penelitian Pengaruh Edukasi terhadap Kepatuhan Intake Cairan Pasien PGK on HD......................... 53


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DAFTAR LAMPIRAN

Lampiran 1 Lampiran 2 Lampiran 3 Lampiran 4 Lampiran 5 Lampiran 6 Lampiran 7 Lampiran 8 Lampiran 9 Lampiran 10 Lampiran 11 Lampiran 12 Lampiran 13 Lampiran 14

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Halaman Surat Permohonan Fasilitas Pengambilan Data Penelitian dari Fakultas .......................................................................... 73 Surat Permohonan Ijin Penelitian dari Litbang ..................... 74 Surat Lolos Uji Etik. ............................................................. 75 Surat Selesai Penelitian ......................................................... 76 Lembar Penjelasan Penelitian ............................................... 77 Lembar Persetujuaan Menjadi Responden Penelitian........... 78 Satuan Acara Penyuluhan ..................................................... 79 Data Demografi dan Rumus IDWG ..................................... 80 Lembar Observasi ................................................................. 87 Tabulasi Sebelum Edukasi .................................................... 89 Tabulasi Setelah Edukasi ...................................................... 90 Hasil Uji Wilcoxon………………………………………… 91 Leaflet 1 ................................................................................ 92 Leaflet 2 ................................................................................ 93


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DAFTAR SINGKATAN DAN ISTILAH

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HD

: Hemodialisis

IDWG

: Interdyalitic Weight Gains

IWL

: Insensible Water Losses

KDIGO

: Kidney Disease Improving Global Outcomes

KDOQI

: Kidney Disease Outcomes Quality Initiative

LFG

: Laju Filtrasi Glomerulus

NKF/KDOQI

: National Kidney Foundation/Kidney Disease Outcomes Quality Initiative

PGK

: Penyakit Ginjal Kronis

Qb

: Quick of Blood

TGF

: Transforming Groowth Factors

TKK

: Total Klirens Kreatinin

TMP

: Trans Membran Pressure

UF

: Ultrafiltrasi


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SKRIPSI PENGARUH EDUKASI TERHADAP KEPATUHAN INTAKE CAIRAN PASIEN PENYAKIT GINJAL KRONIK (PGK) ON HEMODIALISIS PENELITIAN PRA-EKSPERIMENTAL

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