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Cecep E. Kosasih, SKp.

, MNS

PENGERTIAN
Suatu kondisi dimana jantung tidak mampu

memompakan darah secukupnya dalam memenuhi kebutuhan sirkulasi tubuh untuk keperluan metabolisme jaringan tubuh pd keadaan tertentu . Menyebabkan curah jantung menurun dan gagal sirkulasi & faal tubuh

Penyebab
Disfungsi miokard
Beban tekanan berlebihan sistolic overload Beban volum berlebihan- diastolic overload

Peningkatan kebutuhan metabolik demand overload


Gangguan pengisian.

Sindroma gagal jantung


Gagal jantung kiri
Gagal jantung kanan Gagal jantung kongestif

Gagal jantung kiri


Gangguan fungsi pompa ventrikel kiri curah jantung kiri turun tekanan akhir diastolik dalam ventrikel kiri dan volum akhirr diastolik dalam ventrikel kiri meningkat bendungan pada atrium kiri, meningkatnya tekan pada atrium kiri bendungan terjadi pada vena pulmonalis, tekanan meningkat bendungan paru (edem paru), tekanan wedge pulmonal meningkat beban sistolik pada ventrikel kanan.

Gejala klinis
Badan lemah
Cepat lelah Berdebar Sesak Batuk Anoreksia Keringat dingin

Penyebab
Stenosis aorta
Infark miokard

Gagal jantung kanan


Gangguan fungsi pompa ventrikel kanan curah

jantung kanan turun & tekanan akhir diastolik ventrikel kanan meningkat bendungan pada atrium kanan dan tekanan dalam atrium kanan meningkat bendungan pada vena sistemik (vena kava) & tek meningkat hambatan arus balik vena dan bendungan sistemik.

Gagal jantung

Aliran darah turun

Sekresi renin meningkat

Vasokonstriksi ginjal Sekresi ADH meningkat Filtrasi glomerulus turun

Sekresi aldosteron meningkat Reabsorpsi Na+ dan H2O (pd tubuli proximal) Reabsorpsi Na+ pada tubuli distal meningkat Retensi ginjal Na+ dan H2O Volume plasma meningkat Transudasi cairan Absorpsi H2O pada tubuli distal meningkat

Edema

Gejala klinis
Edema tumit dan tungkai bawah

Hati membesar, lunak dan nyeri


tekan Bendungan vena perifer (vena jugularis) Ggn gastrointestinal (perut kembung, anoreksia, nausea) Asites Bb meningkat

Gagal jantung kongestif


Bila terdapat gagal jantung kiri dan kanan dalam

waktu bersamaan Ditandai dengan bendungan pada paru dan sistemik

Gejala klinis
Pembesaran jantung
Terdengan bunyi jantung 3 Sering dimulai dari gagal jantung kiri Curah jantung turun

Treatment
Preparat digitalis (inotropik positif dan kronotropif negatif): digoksin; oral 0,5-2 mg 4-6 dosis/24 jam, 0,5 mg 2x sehari. IV; 0,75-1 mg dalam 4 dosis/24 jam. Cedilanid: IV 1,2-1,6 mg/24 jam Angiotensin-Converting Enzyme Inhibitors. Beta-Blockers Calcium Channel Blockers Diuretik: furosemid, spironolactone (Aldactone) Mengurangi beban hemodinamis jantung dengan memperbaiki preload dan afterload dengan obat vasodilator: nitrogliserin(Isosorbide Dinitrate), Hydralazine dan

Oksigen Istirahat baring NUTRITIONAL THERAPY: rendah sodium (2 to 3

g/day)

Diagnosa keperawatan
Perubahan cardiak output
Kurang pengetahuan Intoleransi aktifitas Tidak efektifnya pola nafas Perubahan volume cairan

Activity intolerance (or risk for activity intolerance) related

to imbalance between oxygen supply and demand because of decreased CO Excess fluid volume related to excess fluid or sodium intake and retention of fluid Anxiety related to breathlessness and restlessness from inadequate oxygenation Powerlessness related to inability to perform role responsibilities because of chronic illness and hospitalizations Noncompliance related to lack of knowledge

PROMOTING ACTIVITY TOLERANCE


Latihan secara teratur terjadwal
3-5 menit 1-4x/hari

Sebelum latihan
Begin with a few minutes of warm-up activities.
Avoid performing physical activities outside in extreme

hot, cold, or humid weather. Ensure that you are able to talk during the physical activity; if you are unable to do so, decrease the intensity of activity. Wait 2 hours after eating a meal before performing the physical activity. Stop the activity if severe shortness of breath, pain, or dizziness develops. End with cool-down activities and a cool-down period.

MANAGING FLUID VOLUME


Pemberian diuretik
monitors the patients fluid status closely auscultating the lungs, monitoring daily body weights, assisting the patient to adhere to a low-sodium diet by reading food labels and avoiding highsodium foods such as canned, processed, and convenience foods Monitoring Intake and output

CONTROLLING ANXIETY
Pemberian oksigen
the nurse takes steps to promote physical comfort and psychological support. a family members presence provides reassurance. the nurse should speak in a slow, calm, and confident manner and maintain eye contact. the nurse should also state specific, brief directions for an activity.

the nurse can begin teaching ways to control anxiety and to

avoid anxiety-provoking situations. The nurse explains how to use relaxation techniques and assists the patient to identify factors that contribute to anxiety. Lack of sleep may increase anxiety, misinformation, lack of information, or poor nutritional status. Promoting physical comfort, providing accurate information, and teaching the patient to perform relaxation techniques and to avoid anxiety triggering situations may relax the patient

MINIMIZING POWERLESSNESS
Taking time to listen actively to patients often

encourages them to express their concerns and ask questions. providing the patient with decision-making opportunities, review hospital policies and standards that tend to promote powerlessness and advocate for their elimination or change (eg, limited visiting hours, prohibition of food from home, required wearing of hospital gowns).

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