Hendra Kurnia Rakhma, S.Kep.

, Ns

Pokok Bahasan
Definisi Etiologi Patofisiologi Penatalaksanaan medis dan keperawatan

Definisi
Acute Lung Injury (ALI) Sindrom inflamasi paru akut dg pean permeabilitas vascular, ditandai dg: Bilateral diffuse pulmonary infiltrate on chest radiograph 200 mmHg < PaO2 / FiO2 < 300 mmHg, irrespective of the level of PEEP No clinical evidence of elevated left atrial pressure, atau Pulmonary capillary wedge pressure (PCWP) < 18 mmHg

Definisi
Acute Respiratory Distress Syndrome (ARDS) Sindrom inflamasi paru akut dg pean permeabilitas vascular, ditandai dg: Bilateral diffuse pulmonary infiltrate on chest radiograph PaO2 / FiO2 < 200 mmHg, irrespective of the level of PEEP No clinical evidence of elevated left atrial pressure, atau Pulmonary capillary wedge pressure (PCWP) < 18 mmHg

Radiograph

Bilateral widespread infiltrate Normal Thorax

Penyebab ARDS
Direct Lung Injury (Pulmonary ARDS)
Aspiration or other chemical pneumonitis Infectious pneumonia Trauma: lung contusion, penetrating chest injury Near drowning Fat embolism

Distant Injury (Non pulmonary ARDS)

Inflammation; sepsis syndrome Multiple trauma Shock, hypoperfusion Acute pancreatitis

Web of Causation
Direct Lung Injury Distant Lung Injury Pean aliran darah ke paru Merangsang platelet teragregasi Melepaskan serotonin, bradikinin& histamin Menginflamasi dan merusak membran alveloli Mean permeabilitas kapiler Cairan pindah ke ruang interstitial Dlm jangka wkt lama menjadi Fibrosis Takipnea Dyspnea takikardi

Pola nafas inefektif

Protein & cairan banyak keluar ke interstitial Pe an tekanan osmotik interstitial Merusak surfaktan & mean produksi surfaktan di alveoli Penumpukan secret PO2 me PCO2 me Kerusakan pertukaran gas Bersihan jalan nafas inefektif Alveoli kolaps hypoxaemia Asidosis metabolik Mental confusion Odem paru Kelebihan volume cairan

Tanda dan Gejala ARDS

O2 sangat susah masuk ke sirkulasi darah krn alveoli terisi cairan. Alveoli menjadi collapse
Sesak dan nafas cepat Nafas dangkal Tekanan darah me HR me Perubahan status kesadaran atau susah berkonsentrasi

Hasil Lab: non-spesifik

Hypoxaemia Elevated alveolar-arterial oxygen gradient

Prinsip Penatalaksanaan

Treat the primary problem ! Physiologic support

Of the lungs Other organs Lungs Sepsis Other

Avoid complications

Disease modifier

Adequate Oxygenation

Better Q relative to V

Pulmonary vasodilator Increase cardiac output (fluid/other) PEEP Inverse ratio ventilation Recruitment manuvers Patient position Dry lungs are happy lungs

Better V relative to Q

Fluid management overall

Asuhan Keperawatan Klien dgn ARDS

Pengkajian

Keluhan Utama

Sesak napas Inhalasi racun (rokok, kimia corrosive) Aspirasi cairan (gastric, tenggelam, hydrocarbon, ethylene glycol) Shock (traumatic, hemorrhagic, bacterial, pneumonia septic) Drug overdose (heroin, methadone barbiturat) Trauma kepala, thorax

Riwayat Penyakit Sekarang

Pemeriksaan Fisik

B1 breath: dyspnea, takipnea (RR me), shallow breath B2 blood: hipotensi, takikardia B3 brain: susah bekonsentrasi, pean kesadaran B4 bladder: B5 bowel: B6 bone: -

Diagnosa Keperawatan

Pola nafas inefektif b.d pean compliance paru Kerusakan pertukaran gas b.d kolaps alveoli Bersihan jalan nafas inefektif b.d penumpukan secret sekunder akibat kolaps alveoli Kelebihan volume cairan b.d odem paru

Pola nafas inefektif

Tujuan

Pola nafas menjadi efektif selama masa perawatan Tidak ada tanda distress napas:

Kriteria Hasil

RR= 12 20 x/mnt, flaring nostril (-), tracheal tug (-), intrekking (-)

Intervensi

Posisi semi fowler atau slide head up 30-45 Bebaskan jalan napas dengan kepala posisi ekstensi Bantu pernafasan dengan oksigen (intubasi dan ventilasi jika diperlukan) Pertahankan istirahat klien

Kerusakan pertukaran gas

Tujuan

Masalah kerusakan pertukaran gas teratasi selama masa perawatan SpO2 98-100% Analisa gas darah:

Kriteria Hasil

PaO2 80 100 mmHg PaCO2 35 45 mmHg pH 7,35 7,45

Intervensi

Kolaborasi pemberian diuretik (furosemid / lasix) Monitor evaluasi BGA, pulse oxymeter, foto thorax