Asuhan Keperawatan pada

anak dengan gangguan sistem

cardiovaskular

Erwin Wicaksono, SKep.Ns

Struktur
Jantung
 CHD/ PJB
Kelainan struktur yang didapat sejak lahir

Insiden :
- 8/1000 kelahiran (1%)
- 35.000 px lahir dengan CHD/tahun
- Bayi dengan CHD akan meningkatkan
resiko kehamilan yang sama berikutnya
 Penyebab
❖ Kelainan kromosom
❖Mutasi gen
❖Infeksi Rubella
❖Lingkungan
❖Keturunan
 CHD classification
Asianotik Sianotik

Pulmonary Pulmonary Mixed blood

Obstruction to
Blood flow Blood flow flow
blood flow
from ventricles Transposition of
great arteries

ASD Tetralogy of Total anomalous

Coarctation of
VSD Fallot pulmonary
Aorta
PDA venous return
Tricuspid
Aortic stenosis
atresia Trunctus
Pulmonic arteriosus
stenosis
Hypoplastic left
heart syndrome
Manifestasi klinis pada bayi
o Dispneu
o Sulit bernafas (WOB meningkat)
o HR > 200x/mnt
o Infeksi sal pernafasan berulang kali
o BB tidak bertambah
o Murmur
o Sianosis
o Stridor
Manifestasi klinis pada Anak
o Dispneu
o Gangguan pertumbuhan fisik
o Penurunan aktifitas fisik
o Infeksi sal nafas berulang kali
o Murmur
o Sianosis
o Squat/jongkok
o Clubbing finger
o TD meningkat
 Komplikasi CHD
1. Gagal jantung kongestif
2. Henti jantung
3. Aritmia
4. Endokarditis
5. Hipertensi
6. Hipertensi pulmonal
7. Trombo emboli
8. Abses otak
 Pemeriksaan penunjang
1) Pemeriksaan dasar :
❖ Anamnesa dan pemeriksaan fisik
❖ EKG
❖ Foto thorax
❖ Lab : BGA, serum elektrolit, Gula darah
 Pemeriksaan penunjang
2) Pemeriksaan lanjutan :
❖ Echocardiografi
❖Kateterisasi jantung
❖Angiografi
 Tatalaksana
• Terapi simptomatik
• Penanganan gagal jantung
• Pencegahan komplikasi
• Observasi hasil pemeriksaan penunjang
• Kateterisasi jantung
• Pembedahan
 ASUHAN KEPERAWATAN
Assesment:
• Riwayat keluarga
• Usia
• Pertumbuhan dan perkembangan
• Pola aktifitas/ prilaku
• Vital sign
• Sign and symptom
• Pemeriksaan fisik ( warna, IPPA thorax)
• General function of body system
Assesment:
Impaired myocardial function
 Sweating
 Tachycardia
 Decreased urinary output


Nursing Care of CHD
Fatique, Anorexia
Weakness, pale, cold ekstremity
 Weak peripheral pulse
 Decreased Blood Pressure
 Gallop Rhytm
 Cardiomegaly
2. Pulmonary Congestion
▪ Tachypnea
▪ Dyspnea
▪ Wheezing
▪ Flaring nares
▪ Exercise intolerance
▪ Cough
▪ Cyanosis
▪ Grunting
▪ Orthopnea
3. Systemic Venous Congestion
▪ Weight gain
▪ Hepatomegaly
▪ Peripheral edema, especially periorbital
▪ Ascites
▪ Neck vein distention
Nursing Problems
1. Decreased cardiac output
2. Ineffective breathing pattern
3. Impaired gas exchanged
4. Activity intolerance
5. Imbalanced Nutrition: less than body
requirement
6. Risk for infection
7. Altered Growth and Development
8. Altered family processes
9. Risk for fluid imbalance
 Planning
1. Child will exhibit improved cardiac output
2. Child will experience decreased cardiac
demands
3. Child will exhibit improved respiratory function
4. Child will maintain adequate nutritional status
5. Child will exhibit no evidence of fluid excess
6. Child and family will receive adequate support
and education
 Implementation
1. Assist in measures to improve cardiac function
▪ Administer digoxin and angiotensin- ACE
inhibitors as ordered
▪ Check dosage
▪ Count apical pulse
▪ Recognize sign of drug toxicity
▪ Asses diuresis, cardial and respiratory system
2. Decreased cardiac demands
▪ Providing a neutral thermal environtment to
prevent cold stress
▪ Treating any existing infection
▪ Reducing the effort of breathing (semi fowler
position)
▪ Using medication to sedate an irritable child
▪ Providing rest and decreasing enviromental
stimuli
3. Reduce respiratory distress
▪ Place in inclined posture of 35-45 degress
▪ Administer hunidified oxygen
▪ Asses respiratory rate, ease of respiration,
color and oxygen saturation
▪ Place newborn in incubator
▪ Keep infant warm
4. Maintain nutritional status
▪ Feed small volume at frequent intervals
(every 2-3 hours)
▪ Implement gavage feeding if infant
becomes fatigue before taking an
adequate amount
▪ Check intake-output
5. Assist in measure to promote fluid loss

▪ Record fluid intake-output

▪ Monitor body weight
▪ Asses for evidence of edema
▪ Maintain fluid restriction, if ordered
▪ Provide skin care for children with edema
▪ Change position
6. Family receive adequate support
Teach family:
▪ Medication admistration and side/toxic effect
▪ Sign and symtomps of congestif heart failure
▪ Feeding technique and nutritional requirement
▪ Positioning
▪ Need for rest
▪ Growth and development consideration