Penerapan Clinical Pathways dalam Asuhan Keperawatan Berbasis Evidence-Based Practice pada Pasien Chronic Kidney Disease Stage V: Studi Kasus

ABSTRACT Chronic kidney disease (CKD) stage V is frequently accompanied by fluid overload, metabolic disorders, anemia, and respiratory complaints, requiring structured nursing care based on clinical pathways and evidence-based practice. Purpose: This case study aimed to describe the implementation of clinical pathways in evidence-based nursing care for a patient with CKD stage V and diabetes mellitus, focusing on nursing diagnoses, interventions, implementation, and evaluation. Method: A descriptive case study was conducted using nursing care documentation of one adult patient. Data were analyzed by clustering subjective and objective findings, determining nursing diagnoses based on the Indonesian Nursing Diagnosis Standards, setting outcomes based on the Indonesian Nursing Outcome Standards, selecting interventions based on the Indonesian Nursing Intervention Standards, and integrating current clinical guidelines and hemodialysis evidence. Result: Three priority nursing diagnoses were identified: hypervolemia, unstable blood glucose level, and ineffective breathing pattern. The clinical pathway guided fluid balance monitoring, daily body weight assessment, interdialytic weight gain evaluation, fluid restriction education, glucose monitoring, diabetes self-management education, semi-Fowler positioning, respiratory monitoring, effective coughing exercises, and titrated oxygen therapy. Evaluation showed that respiratory status was maintained, fluid overload and glucose instability required continued monitoring, and patient-family education became a key component of care continuity. Conclusion: Clinical pathways combined with evidence-based practice strengthen clinical reasoning, standardize nursing actions, and support more measurable nursing evaluation in CKD stage V care. Keywords: Chronic Kidney Disease, Clinical Pathway, Evidence-Based Practice, Hypervolemia, Nursing Care, Case Study. ABSTRAK Chronic kidney disease (CKD) atau penyakit ginjal kronik stage V sering disertai kelebihan cairan, gangguan metabolik, anemia, dan keluhan respirasi sehingga memerlukan asuhan keperawatan yang terstruktur berdasarkan clinical pathways dan evidence-based practice (EBP) atau praktik berbasis bukti. Tujuan: Studi kasus ini bertujuan menggambarkan penerapan clinical pathways dalam asuhan keperawatan berbasis evidence-based practice pada pasien CKD stage V dengan diabetes mellitus (kencing manis), terutama pada penetapan diagnosa, intervensi, implementasi, dan evaluasi keperawatan. Metode Penelitian: Penelitian menggunakan desain studi kasus deskriptif berdasarkan dokumentasi asuhan keperawatan pada satu pasien dewasa. Data dianalisis melalui pengelompokan data subjektif dan objektif, penetapan diagnosa berdasarkan Standar Diagnosis Keperawatan Indonesia (SDKI), penentuan luaran berdasarkan Standar Luaran Keperawatan Indonesia (SLKI), pemilihan intervensi berdasarkan Standar Intervensi Keperawatan Indonesia (SIKI), serta integrasi pedoman klinis dan bukti ilmiah hemodialisis (cuci darah) terkini. Hasil: Tiga diagnosa prioritas yang ditemukan adalah hipervolemia, ketidakstabilan kadar glukosa darah, dan pola napas tidak efektif. Clinical pathway mengarahkan pemantauan keseimbangan cairan, penimbangan berat badan harian, evaluasi interdialytic weight gain (IDWG) atau peningkatan berat badan antara dua sesi dialisis, edukasi pembatasan cairan, pemantauan glukosa darah, edukasi pengelolaan diabetes, posisi semi-Fowler, pemantauan respirasi, latihan batuk efektif, dan terapi oksigen yang dititrasi. Evaluasi menunjukkan status respirasi terpantau stabil, masalah kelebihan cairan dan glukosa masih membutuhkan pemantauan lanjutan, serta edukasi pasien dan keluarga menjadi komponen penting keberlanjutan asuhan. Kesimpulan: Clinical pathways yang dipadukan dengan EBP memperkuat penalaran klinis, menstandarkan tindakan keperawatan, dan mendukung evaluasi asuhan yang lebih terukur pada pasien CKD stage V. Kata Kunci: Chronic Kidney Disease, Clinical Pathway, Evidence-Based Practice, Hipervolemia, Asuhan Keperawatan, Studi Kasus.