Gagal Jantung Kongestif

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Bismillahirrahmanirahim, . Alexander Graham Bell

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

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).

The Donkey Analogy

Gangguan fungsi ventrikel membatasi

kemampuan pasien untuk melakukan aktivitas sehari-hari

Pathway Gagal Jantung

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. Batuk c. Mudah lelah, d. Kegelisahan atau kecemasan

Gagal jantung Kanan : a. Kongestif jaringan perifer dan visceral b. Oedema ekstremitas bawah (oedema dependen), biasanya oedema pitting, penambahan BB c. Hepatomegali dan nyeri tekan pada kuadran kanan atas abdomen d. Anoreksia dan mual e. Nokturia f. kelemahan

Nursing Process
Congestive Heart Failure

Batasan Karakteristik
Perubahan Frekuensi / Irama
Perubahan Preload meliputi :
a. b.

jantung meliputi :
a. Aritmia b. Bradikardia c. Perubahan EKG

Edema Penurunan tekanan vena sentral (sentral venous pressure, CVP) Penurunantekanan baji arteri paru (pulmonary artery wedge pressure, PAWP) Keletihan Peningkatan CVP Peningkatan PAWP Distensi vena jugular

c.

d. Palpitasi
e. Takikardia

d. e. f. g.

h.
i.

Murmur
Kenaikan berat badan

 Perubahan Afterload a. b. c. d. e. f. g. h. i. j. k.

Kulit lembab Dipsnea Penurunan nadi perifer Penurunan resistansi vascular paru (pulmonary vascular resistance, PVR) Penurunan resistansi vascular sistemik (systemic vascular resistance , SVR) Peningkatan PVR Peningkatan SVR Oliguria Pengisian ulang kapiler memanjang Perubahan warna kulit Variasi pada pembacaan tekanan darah

 a. b. c. d. e. f. g. h. i. j. a. b.

Perubahan kontraktilitas Crackle Batuk Penurunan fraksi ejeksi Penurunan left ventricular stroke work index (LVSWI) Penurunan stroke volume index (SVI)

Penurunan indeks jantung

Ortopnea Dipsnea paroksismal nocturnal Bunyi S3 Bunyi S4 Perilaku / Emosi Ansietas Gelisah

 Faktor yang Berhubungan

a. Perubahan frekuensi jantung

b. Perubahan irama c. Perubahan volume sekuncup d. Perubahan afterload e. Perubahan kontraktilitas

f. Perubahan preload

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

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 mentation Interaksi 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.

Kenyamanan Timbulnya 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. Respirasi Dispnea 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

Studi diagnostik ECG 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.

 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

Intervensi + Rasional

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.

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 nurse Learn to recognize your symptoms Learn to recognize any changes in your symptoms Find out which of your symptoms relate to heart failure Think about what you normally do when you get these

symptoms Know what works and why Know when to seek help Think about problem that stop you managing your symptom; for example lack of knowledge, physical ability or resource

HEART FAILURE EDUCATION

Interventions to Decrease Re-admissions & Improve QOL

Regular Checkups Medication Compliance Diet & Weight

Communication with Nurse and/or Doctor Symptom Management

Exercise

Medication Compliance
Write out a list of what pills you take and how often you take them Have a fixed routine for taking your pills Dont stop taking any pills without medical advice, even if you fell better Never take a double dose If you cant remember whether you have taken your pills, wait until the next time they are due Tell your pharmacist or doctor if you belive a pll is giving you a problem Always check with your doctor before taking any over the counter medicines Keep your medicine out of reach of children

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

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 )

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

Congestive Heart Failure Plan of Care

Care: Problem 1: Potential for inability to care for self related to weakness and decreased mobility Intervention Asses patients ability to bathe and dress self Assist with activities of daily living as needed for personal care Teach importance of rest when bathing and dressing Goal Patient will have increased strength to bathe and dress self Patient will have assistance as needed for personal care Patient will verbalize and demonstrate the importance of rest when bathing and dressing

Problem 2: Potential for decreased social interaction secondary to fear, anxiety, and trust Intervention Identify cause(s) of stress/anxiety Provide comfort and support Encourage open communication Identify strengths Goal Patient will verbalize stress and anxiety issues and have decrease fear Patient will feel comfort and support during care Patient will communicate openly Patient will verbalize strengths in ability to care for self

Cure Problem 1: Activity intolerance secondary to decrease cardiac output and weakness Intervention Assess vital signs Monitor respiratory status Encourage rest periods during activity Assess need for oxygen and stress importance of compliance of oxygen use Goal Pulse, blood pressure and respiratory rate with be within patients limit Respiratory effort, oxygen saturation with be within patients normal limit Patient rest during activity and verbalizes importance of rest

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 change Goal 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

Core: Problem 1: Ineffective coping secondary to disease process Intervention Assess patients image of body/health changes Identify patients strengths in caring for self Assess patients ability to care for self Goal Patient will understand and begin to accept changes related to disease process Patient will verbalize strengths and weakness Patient will have care needed to promote optimal health

Problem 2: Potential for non-compliance secondary to knowledge deficit and low self esteem Intervention Assess patients knowledge of disease process, treatment and medication schedule Assess patients feelings of ability to care for self Promote patients strengths and self esteem Goal 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.