Nursing Care for Mrs. R with Urinary System Disorders: Chronic Kidney Disease in the Inpatient Room of Royal Prima Hospital Medan in 2026
Abstract
Background: Chronic Kidney Disease (CKD) is a progressive and irreversible impaired kidney function, causing various health problems such as urinary elimination disorders, hypervolemia, electrolyte imbalance, and an increased risk of infection. Patients with late-stage CKD generally require hemodialysis therapy to maintain body function and prevent further complications.
Objective: To describe the implementation of nursing care in patients with urinary system disorders due to Chronic Kidney Disease undergoing hemodialysis therapy.
Methods: Case studies with a nursing process approach that includes assessment, nursing diagnosis, planning, implementation, and evaluation. The subject of the study is Mrs. R, a stage V CKD patient who is undergoing treatment in the inpatient room of Royal Prima Medan Hospital in 2026. Data was obtained through interviews, observations, physical examinations, and medical record documentation studies.
Results: The results of the study showed that the patient had severe oliguria (±100 ml/24 hours), edema in both legs, hypertension, increased urea and creatinine levels, and electrolyte balance disorders. Established nursing diagnoses include urinary elimination disorders, hypervolemia, risk of electrolyte imbalance, and risk of infection. The implementation of nursing was carried out for three days through monitoring fluid status, urine elimination, electrolyte balance, infection prevention, fluid restriction education, low-potassium diet, and hemodialysis therapy collaboration. Evaluation showed that there was an improvement in the patient's condition characterized by reduced edema, more stable blood pressure, decreased potassium levels, and no signs of infection in hemodialysis vascular access.
Conclusion: Comprehensive nursing care for CKD patients undergoing hemodialysis is able to help control fluid and electrolyte balance, reduce symptoms of hypervolemia, improve patient understanding of the disease, and prevent complications during treatment.
References
Aisara, S. (2015). Research Article Clinical Overview of Patients with Chronic Kidney Disease. 7(1), 42–50.
AL-MUQSITH. (n.d.). Urinary System.
Alwiyah, F., Rudiyanto, W., Anggraini, D. I., Windarti, I., Medicine, F., Lampung, U., Histology, B., Medicine, F., Lampung, U., Skin, B., Medicine, F., Lampung, U., Anatomy, B. P., Medicine, F., & Lampung,
U. (2024). Anatomy and Physiology of the Kidney: Literature Review Anatomy and Physiology of the Kidney. 14, 285–289.
Anggraini, D., Clinic, B. P., Medicine, F., & Baiturrahmah, U. (2022). CLINICAL ASPECTS AND LABORATORY EXAMINATION OF CHRONIC KIDNEY. 9(2).
Arisanti et al., 2025. (n.d.). Indonesian Health Scientific Journal. 10(1).
Armiyati, Y., Hadisaputro, S., Chasani, S., & Sujianto, U. (2021). Improving Quality of Life in Hemodialysis Patients With Intradialysis Hypertension Using " SEHAT " Nursing Interventions. Sec. 18.
https://doi.org/10.26714/mki.4.3.2021.208-217 Astari et al., 2023. (2023). 1,2,3,4. 5, 3520–3526.
c. (2019).
Celal, M. (2021). Characteristics of Chronic Kidney Disease Patients Who Undergo Hemodialysis Rina Tampake, Asih Dwi Shafira Doho Poltekkes Ministry of Health Palu. 1(2), 39–43.
Dewi, R., & Mustofa, A. (2021). Reduction in the intensity of thirst in patients with chronic kidney disease who undergo hemodialysis by smoking ice cubes.
Diwyami, N. P. (2024). Jln . Swakarsa III No. 10 -13 GrisakKekalikMataram -NTB
. Tlp/Fax . ( 0370 ) 638760 Analysis of Factors Affecting the Implementation of Discharge Planning in Space. 10(1), 92–101.
Djamil, M., Juwita, D. A., Rachmaini, F., & Abdillah, R. (2022). Drugs Related
Problems (DRPs) in Patients with Chronic Kidney Disease (CKD) at RSUP. 184–189. https://doi.org/10.25077/jsfk.9.sup.184-189.2022
Farhana, C., Mohtar, A., & Dhiandani, E. (2021). Hemoglobin Levels in Chronic Kidney Failure Patients After Undergoing Hemodialysis. 5(2).
G, W. (2015). Renal Physiology Control of Urinary Drainage and Voiding. Sec. 10. https://doi.org/10.2215/CJN.04520413
Ginting, D. S., Indriani, R., Andera, N. A., Sendra, E., Rini, D. S., Setiyorini, E., Juwariah, T., Kusumaningrum, V., & Sulupadang, P. (n.d.). Physiological Anatomy of the Human Body.
Halimah, N., Alhidayat, N. S., & Handayani, D. E. (2022). Garuda Pelamonia J with reduced CAPD every year (USRDS, 2018). 4(1).
Hioda, P. A., Sumaraw, L., & Toar, J. M. (2024). The Relationship between Dri Care Management and the Quality of Life of Chronic Kidney Disease Patients Undergoing Hemodialysis at Siloam Manado Hospital. 2(1), 73–79.
Ibrahim & Syamsuddin, 2023. (2023). Analysis of Nursing Care for Reducing Cardiac Volume in Congestive Heart Failure Patients (CHF). 1(3).
Imayani, S. (2022). ELDERLY URINARY ELIMINATION DISORDER IN HAMLET VILLAGE OF RAHMAH. 1.
Irene, I., Yemina, L., & Maria, S. (2022). Quality of Life of Patients with Chronic Kidney Disease with Hemodialysis Therapy at PGI Cikini Hospital. 3(1), 1–6.
Kusuma, I. Y., Putri, B. A., Kurniasih, K. I., Nugroho, G. A., & Nurkholis, F. (2026). Cost Analysis of Haemodialysis in Chronic Kidney Disease : The Role of Patient Characteristics in a Regional Indonesian Hospital. 192–198. https://doi.org/10.25077/jsfk.12.3.192-198.2025
Kusumajaya, H., & Faizal, K. M. (2023). Journal of Nursing Practice and Education. 3(2), 118–126.
Limpeleh, H. (2013). CUBITI IN HEMODIALYSIS PATIENTS AT PROF. KANDOU HOSPITAL FOR THE PERIOD OF JANUARY 2013 – DECEMBER 2013. 3–8.
Mahesvara, I. B. G. D. E. A., Putu, W., Yasa, S., & Ngurah, A. A. N. (2020). Udayana Medical Journal. 9(7), 1–7.
Meydina, W., & Rustiawati, E. (2024). Management of Urinary Elimination in Post
Operative Turp Patients with Impaired Urinary Elimination Management in Postoperative Turp Patients with Urinary Elimination Disorder. 1(2), 73–78.
Misdiyanti, D., Sumarsih, T., Djalil, A., Sarjana, K. P., & Muhammadiyah, U. (2022). The 15. 189–199.
Nilasari, P., Tutik, R., Hariyati, S., Ode, L., & Rahman, A. (2022). Relationship of Nursing Management Functions with Missed Nursing Care : A Cross-Sectional Study. 25(June), 103–111. https://doi.org/10.7454/jki.v25i2.850
Nindi et al., 2025. (2025). CERVIX WITH PAIN PROBLEMS USING SLOW. 6, 17727–17739.
Prastiwi, F. (2021). Factors Associated with Fatigue in Chronic Kidney Disease Patients Undergoing Hemodialysis : A Systematic Review Factors Associated with Fatigue in Chronic Kidney Failure Patients Undergoing Hemodialysis : A Systematic Review. 31(4), 260–268.
Psychosocial, F., & On, D. A. N. K. (2024). CORRELATION BETWEEN HEMODIALYSIS HISTORY , PSYCHOSOCIAL , COGNITIVE , AND FATIGUE FACTORS IN CKD PATIENTS UNDERGOING HEMODIALYSIS. 6(April), 8–12.
Rahman & Putri, 2022. (2023). Rahman & Putri, 2022. Rahmawati, et al., 2022. (n.d.). No Title.
Regina, V. (2024). Self-Care Management in Chronic Disease Patients with an Educational Approach in the Jasmine Hemodialysis Room of the Hospital. Prof. Dr. . R . Self-Care Management in Chronic Disease Patients with Educational Approach in Melati Hemodialysis Room RSUP . Prof. Dr. . R . D . pp. 2, 48–55.
Rsi, R. A. (n.d.). Case Study of Nursing Care for Urinary Elimination Disorders in Mrs. K with Duct Infection. pp. 2(03), 91–94.
Sabillah & Jamil, 2023. (n.d.). ANALYSIS OF NURSING CARE WITH RESPIRATORY SYSTEM DISORDERS: PULMONARY TUBERCULOSIS WITH PURSED LIPS BREATHING EXERCISES AND POSITIONS. 1–7.
Saputra & Mauny, 2024). (2022). META-ANALYSIS STUDY OF HYPERTENSION AND
DIABETES MELLITUS AS A RISK FACTOR. 11(9), 49–53. Saraswati et al., 2021. (n.d.). 70357-205-196287-1-10-20210204 (1).pdf. Siahaan & Astuti, 2022). (n.d.). 70357-205-196287-1-10-20210204.pdf.
Sinaga, 2021. (n.d.). No Title.
Sucipto, A., Rahil, N. H., & Yogyakarta, U. R. (2019). COMPARATIVE STUDY OF HEMODYNAMIC STATUS OF CHRONIC GINAL FAILURE PATIENTS THAT HAVE HEMODIALYSIS. 9(2).
Utami, M., & Kamaluddin, R. (2024). Analysis of the concept of justice in nursing care for patients with acute kidney failure. 5(01), 56–62. https://doi.org/10.34305/jnpe.v5i1.1420
Virona, L. (2025). Introduction. 16(1), 20–28.
Widia, F., Indraswari, M. T., & Rahardjo, H. E. (2023). Characteristics of neurogenic lower urinary tract dysfunction patients at Cipto Mangunkusumo Hospital. Medical Journal of Indonesia, 31–37. https://doi.org/10.13181/mji.oa.236605
William. (n.d.). A Review of the Physiological Literature on the Balance of Fluids and Hormones at Play. d(6), 69–73.
Yuliyanti, H., Yemina, L., & Gamayana, Y. (2022). Case Study of Nursing Care in Patients with Chronic Kidney Disease with Nursing Problems of Skin Integrity Disorders. 3(2), 47–52.
Scott, N. G. (2026). Analysis of Nursing Care in Patients with Respiratory System Disorders Due to Pneumonia with the Application of Chest Physiotherapy Intervention on Changes in Oxygen Saturation in the ICU Room of RSU Holistic Purwakarta. 2(1).
Black, J. M., & Hawks, J. H. (2020). Medical-Surgical Nursing: Clinical Management for Positive Outcomes. Elsevier.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Wolters Kluwer.
Potter, P. A., & Perry, A. G. (2017). Fundamentals of Nursing. Elsevier.
Smeltzer, S. C., Bare, B. G. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Wolters Kluwer.
Copyright (c) 2026 Rodi Saputra Buulolo
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
