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Gagal Jantung Kongestif
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Gagal Jantung Kongestif ok

Nov 08, 2014

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Page 1: Gagal Jantung Kongestif ok

Gagal Jantung Kongestif

Page 2: Gagal Jantung Kongestif ok

Kata Penyemangat Sebelum Memulai Presentasi

Bismillahirrahmanirahim, .

Alexander Graham Bell

“ Konsentrasikan pikiran Anda pada sesuatu yang Anda lakukan Karena sinar matahari juga tidak dapat membakar sebelum difokuskan ”

^_^

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Definisi Gagal Jantung

Suatu kegagalan jantung dalam memompa darah untuk memenuhi kebutuhan tubuh (Purnawan Junadi, 1982).

Kegagalan jantung kongestif adalah suatu kegagalan pemompaan (di mana cardiac output tidak mencukupi kebutuhan metabolik tubuh), hal ini mungkin terjadi sebagai akibat akhir dari gangguan jantung, pembuluh darah atau kapasitas oksigen yang terbawa dalam darah yang mengakibatkan jantung tidak dapat mencukupi kebutuhan oksigen pada berbagai organ (Ni Luh Gede Yasmin, 1993).

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The Donkey Analogy

Gangguan fungsi ventrikel membatasi kemampuan pasien untuk melakukan aktivitas sehari-hari

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Pathway Gagal Jantung

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Gagal Jantung Kiri :Kongesti paru menonjol pada gagal ventrikel kiri karena ventrikel kiri tak mampu memompa darah yang datang dari paru. Manifestasi klinis yang terjadi yaitu :

a. Dispnea,b. Batukc. Mudah lelah,d. Kegelisahan atau kecemasan

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Gagal jantung Kanan :

a. Kongestif jaringan perifer dan visceralb. Oedema ekstremitas bawah (oedema dependen), biasanya oedema pitting, penambahan BBc. Hepatomegali dan nyeri tekan pada kuadran kanan atas abdomend. Anoreksia dan muale. Nokturiaf. kelemahan

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Nursing Process

Congestive Heart Failure

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Batasan Karakteristik

Perubahan Frekuensi / Irama

jantung meliputi :

a. Aritmia

b. Bradikardia

c. Perubahan EKG

d. Palpitasi

e. Takikardia

Perubahan Preload meliputi :

a. Edema

b. Penurunan tekanan vena sentral (sentral venous

pressure, CVP)

c. Penurunantekanan baji arteri paru (pulmonary

artery wedge pressure, PAWP)

d. Keletihan

e. Peningkatan CVP

f. Peningkatan PAWP

g. Distensi vena jugular

h. Murmur

i. Kenaikan berat badan

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Perubahan Afterload

a. Kulit lembab

b. Dipsnea

c. Penurunan nadi perifer

d. Penurunan resistansi vascular paru (pulmonary vascular resistance, PVR)

e. Penurunan resistansi vascular sistemik (systemic vascular resistance , SVR)

f. Peningkatan PVR

g. Peningkatan SVR

h. Oliguria

i. Pengisian ulang kapiler memanjang

j. Perubahan warna kulit

k. Variasi pada pembacaan tekanan darah

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Perubahan kontraktilitas

a. Crackle

b. Batuk

c. Penurunan fraksi ejeksi

d. Penurunan left ventricular stroke work index (LVSWI)

e. Penurunan stroke volume index (SVI)

f. Penurunan indeks jantung

g. Ortopnea

h. Dipsnea paroksismal nocturnal

i. Bunyi S3

j. Bunyi S4

Perilaku / Emosi

a. Ansietas

b. Gelisah

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Faktor yang Berhubungan

a. Perubahan frekuensi jantung

b. Perubahan irama

c. Perubahan volume sekuncup

d. Perubahan afterload

e. Perubahan kontraktilitas

f. Perubahan preload

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Pengkajian

Aktivitas dan istirahat Kelemahan, kelelahan, ketidakmampuan untuk tidur (mungkin di dapatkan

Tachycardia dan dispnea pada saat beristirahat atau pada saat beraktivitas). Sirkulasi Mempunyai riwayat IMA, Penyakit jantung koroner, CHF, Tekanan darah

tinggi, diabetes melitus. Tekanan darah mungkin normal atau meningkat, nadi mungkin normal atau

terlambatnya capilary refill time, disritmia. Suara jantung , suara jantung tambahan S3 atau S4 mungkin mencerminkan

terjadinya kegagalan jantung/ ventrikel kehilangan kontraktilitasnya. Murmur jika ada merupakan akibat dari insufisensi katub atau muskulus

papilaris yang tidak berfungsi. Heart rate mungkin meningkat atau menglami penurunan (tachy atau bradi

cardia). Irama jantung mungkin ireguler atau juga normal. Edema: Jugular vena distension, odema anasarka, crackles mungkin juga

timbul dengan gagal jantung. Warna kulit mungkin pucat baik di bibir dan di kuku

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Eliminasi Bising usus mungkin meningkat atau juga normal.Nutrisi Mual, kehilangan nafsu makan, penurunan turgor kulit, berkeringat

banyak, muntah dan perubahan berat badan.Hygiene perseorangan Dispnea atau nyeri dada atau dada berdebar-debar pada saat melakukan

aktivitas. Neoru sensori Nyeri kepala yang hebat, Changes mentationInteraksi sosial Stress, kesulitan dalam beradaptasi dengan stresor, emosi yang tak

terkontrol.Pengetahuan Riwayat di dalam keluarga ada yang menderita penyakit jantung,

diabetes, stroke, hipertensi, perokok.

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KenyamananTimbulnya nyeri dada yang tiba-tiba yang tidak hilang

dengan beristirahat atau dengan nitrogliserin.Lokasi nyeri dada bagian depan substerbnal yang

mungkin menyebar sampai ke lengan, rahang dan wajah.

RespirasiDispnea dengan atau tanpa aktivitas, batuk produktif,

riwayat perokok dengan penyakit pernafasan kronis. Pada pemeriksaan mungkin di dapatkan peningkatan respirasi, pucat atau cyanosis, suara nafas crakcles atau wheezes atau juga vesikuler. Sputum jernih atau juga merah muda/ pink tinged

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Studi diagnostikECG menunjukan: adanya S-T elevasi yang

merupakan tanda dri iskemi, gelombang T inversi atau hilang yang merupakan tanda dari injuri, dan gelombang Q yang mencerminkan adanya nekrosis.

Enzym dan isoenzym pada jantung: CPK-MB meningkat dalam 4-12 jam, dan mencapai puncak pada 24 jam. Peningkatan SGOT dalam 6-12 jam dan mencapai puncak pada 36 jam.

Elektrolit: ketidakseimbangan yang memungkinkan terjadinya penurunan konduksi jantung dan kontraktilitas jantung seperti hipo atau hiperkalemia.

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Analisa gas darah: Menunjukan terjadinya hipoksia atau proses penyakit paru yang kronis atau akut.

Kolesterol atau trigliseid: mungkin mengalami peningkatan yang mengakibatkan terjadinya arteriosklerosis.

Chest X ray: mungkin normal atau adanya cardiomegali, CHF, atau aneurisma ventrikuler.

Echocardiogram: Mungkin harus di lakukan guna menggambarkan fungsi atau kapasitas masing-masing ruang pada jantung.

Exercise stress test: Menunjukan kemampuan jantung beradaptasi terhadap suatu stress/ aktivitas

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Intervensi + Rasional

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Discharge Planning

Components of effective discharge planning should include: Family and team meetings Care plans Pre-discharge needs assessment Caregiver training Post-discharge follow-up Information and education Liaison with community resources Review of patient and caregiver psychological

and support needs.

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Improving Self-Management of HF

Education for patients to notify health care provider of signs and symptoms of worsening heart failure : pain in jaw, neck, or chest increased SOB increased fatigue dizziness of syncope swelling in feet, ankles, legs, or abdomen Palpitations/ tachycardia weight gain decreased exercise capacity

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When self managing your symptoms….British foundation, 2010

Always talk to your doctor or nurseLearn to recognize your symptomsLearn to recognize any changes in your symptomsFind out which of your symptoms relate to heart failureThink about what you normally do when you get these

symptomsKnow what works and whyKnow when to seek helpThink about problem that stop you managing your

symptom; for example lack of knowledge, physical ability

or resource

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HEART FAILURE EDUCATION

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Communication with Nurse

and/or Doctor

Diet &

Weight

Symptom

Management

Exercise

Regular

Checkups

Medication

Compliance

Interventions to Decrease Re-admissions & Improve QOL

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Medication Compliance

Write out a list of what pills you take and how often you take themHave a fixed routine for taking your pillsDon’t stop taking any pills without medical advice, even if you fell betterNever take a double doseIf you can’t remember whether you have taken your pills, wait until the next time they are dueTell your pharmacist or doctor if you belive a pll is giving you a problemAlways check with your doctor before taking any over the counter medicinesKeep your medicine out of reach of children

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Healthy heart diet British foundation, 2010

At least 5 portion of fruit and vegetables

every day

2 or more portion of fish every week

Less salt ( < 5 grams a day)

Less saturated fats

Lots of wholegrain foods

Small amounts of nuts and seeds

Not too much sugar

Small, regular meal

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Weight gain

Have you noticed a sudden weight gain ?

Tell your doctor if you have a weight gain of more than 6 pounds ( about 2,5 kilos over 3 days )

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Weighing yourself

Get yourself some reliable weighing scales

Try always to use the same weighing scales in the

same place

Weigh yourself regularly

Weigh yourself first thing in the morning

Weigh before eating or drinking , before breakfast

Go to toilet before you weigh

Weigh, wearing the same clothes

keep daily weight chart

If to see the doctor take your weight chart

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Congestive Heart Failure Plan of Care

Care:Problem 1: Potential for inability to care for self related to

weakness and decreased mobilityInterventionAsses patient’s ability to bathe and dress selfAssist with activities of daily living as needed for personal

careTeach importance of rest when bathing and dressingGoalPatient will have increased strength to bathe and dress selfPatient will have assistance as needed for personal carePatient will verbalize and demonstrate the importance of rest

when bathing and dressing

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Problem 2: Potential for decreased social interaction secondary to fear, anxiety, and trust

InterventionIdentify cause(s) of stress/anxietyProvide comfort and supportEncourage open communicationIdentify strengthsGoalPatient will verbalize stress and anxiety issues and have

decrease fearPatient will feel comfort and support during carePatient will communicate openlyPatient will verbalize strengths in ability to care for self

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CureProblem 1: Activity intolerance secondary to decrease cardiac

output and weaknessIntervention Assess vital signs Monitor respiratory status Encourage rest periods during activity Assess need for oxygen and stress importance of compliance of

oxygen useGoal Pulse, blood pressure and respiratory rate with be within patient’s

limit Respiratory effort, oxygen saturation with be within patient’s

normal limit Patient rest during activity and verbalizes importance of rest

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Problem 2: Fluid volume excess secondary to decreased circulatory status/cardiac output

Intervention Teach patient to monitor daily weight, pulse, edema and

respiratory effort Teach patient medication protocol and importance of medication

compliance Teach importance of diet compliance Teach importance of notifying the physician of status changeGoal Patient will verbalize the importance of monitoring weight, pulse,

edema, and respiratory effort Patient will verbalize medication schedule and importance of

compliance Patient will verbalize importance of diet compliance Patient will verbalize the importance of notifying the physician

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Core:Problem 1: Ineffective coping secondary to disease

processInterventionAssess patient’s image of body/health changesIdentify patient’s strengths in caring for selfAssess patients ability to care for selfGoalPatient will understand and begin to accept changes

related to disease processPatient will verbalize strengths and weaknessPatient will have care needed to promote optimal health

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Problem 2: Potential for non-compliance secondary to knowledge deficit and low self esteem

Intervention Assess patient’s knowledge of disease process, treatment and

medication schedule Assess patients feelings of ability to care for self Promote patient’s strengths and self esteemGoal Patient will understand disease process, treatment and

medication schedule Patient will verbalize feeling of ability to care for self and assist

in discharge planning of disease process Patient will increased self esteem in ability to care for self and

disease management.

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Thank you, . .