Nursing Care for Patients with Leptospirosis Receiving Hemodialysis : a Study of Two Cases

Abstract

Background : Leptospirosis It is a disease caused by bacterial infection that causes pathology and symptoms in many systems, especially the kidney system. Causes acute kidney failure with shock and respiratory failure. Which is both quick and timely hemodialysis treatment the renal function can recover as close to normal as possible

Objective: To comparison nursing diagnosis nursing action plan evaluation outcome of nursing and development the nursing protocol for Leptospirosis received hemodialysis.

Result: The two patients with leptospirosis had similar signs and symptoms, namely high fever and yellow eyes. They were chief complaint are severe sepsis and acute kidney failure. The first case study had a history of exposure to the Leto virus for less than 1 week, presenting with abdominal distension, 1 black stool, and body aches. The doctor diagnosed severe leptospirosis with acute kidney injury. Post receiving information on treatment guidelines they relative agreed to receive treatment by hemodialysis immediately. While on hemodialysis, there were no serious complications. After 1 session of dialysis, the patient's condition improved progressively. On the 4^th day of admission to the hospital, kidney function improved. The doctor returned the referral to the community hospital for antibiotics after stopping hemodialysis and removing the catheter from the intravenous line, as he still had a fever. This is different from the second case study, which had a history of exposure to the Leto virus for more than 1 week, had a high fever, and had a severe infection called Weil's syndrome combined with shock, causing a poor prognosis due to pathology in the lungs and liver. The patient refused to receive information on treatment guidelines after refusing intubation and hemodialysis for serve acute kidney injury due to fear of treatment as a result, on the 2^nd day of admission to the hospital respiratory failure occurred doctor was intubated and put on a ventilator. Transferred case to MICU to receive treatment via hemodialysis. Although no serious complications were found during hemodialysis but still need to follow up to evaluate the symptoms, signs, results of laboratory tests and I/O, but still found that the kidney function results have not improved. Therefore, hemodialysis must be set again. After 2 times of dialysis, the kidney function results tend to improve. But still need to follow the result’s renal function. Refer back to the community hospital for continue antibiotics and make an appointment to follow up on renal function on May 16, 2022. Renal function was found to be better. Remove the catheter from the right femoral double lumen.

A significant physical issue was encountered in the first case study, which involved a Leptospirosis infection, acute kidney injury, and an electrolyte imbalance. Chief complaint with abdominal distension, 1 black stool, and body aches. During hemodialysis treatment, no serious complications were found. Relatives and patients are worried about illness after receiving medical treatment information and understand and cooperate well in treatment. As for the second patient, he had been exposed to the virus for a longer time. Therefore, causing a more severe infection. In addition to having a high fever the eyes are yellow. There was also a state of shock, anemia, thrombocytopenia and labored breathing. Because patients and relatives are afraid of treatment, they refuse treatment at first. until the symptoms worsen Need urgent treatment and care for treatment and hemodialysis using hemodialysis machines in the medical intensive care unit by monitoring and monitoring for infection Respiratory failure, shock, electrolyte imbalance, anemia, monitoring to prevent complications during and after hemodialysis. The duration of treatment and recovery of kidney function is longer than case study number 1.

Keywords: Leptospirosis, Acute kidney injury, Hemodialysis