CURRICULUM VITAE

Nama Lulu Lusyana, SKp, SpKV

Pendidikan S1 Kep UI (2009)

Sertifikasi Ners Spesialis KV
Pengalaman Intensif Cardiovascular Care Unit (1984- 2012)
Pelatihan Kardiologi Dasar
Kardiologi Lanjutan (Post Basic Course)
CCU Course ( St Vincents Hosp Australia )
CCU Course (Thailand)
Organisasi Profesi Sekjen PP INKAVIN (2006 sd 2011)
Ketua PP INKAVIN ( 2016 sd 2021)
email lulusyamsudin @gmail.com
inkavinpusat@yahoo.com
Pekerjaan Kasie Rawat Jalan RSJPDHK
NURSING MANAGEMENT AND
HOME CARE PATIENT HEART
FAILURE

LULU LUSYANA
6 Juli 2018
 PENDAHULUAN
• Gagal jantung merupakan masalah kesehatan yang
progresif dengan angka mortalitas dan morbiditas
yang tinggi di negara maju maupun negara
berkembang termasuk Indonesia
• Prevalensi ggl jantung di AS sebanyak 5,7 juta orang
dan diperkirakan akan terus meningkat
• Rehospitalisasi meningkat
 Etiology and Pathophysiology
Primary risk factors
Impaired cardiac function
 Coronary artery disease (CAD)
 Advancing age
Contributing risk factors 
Increased cardiac workload
 Hypertension
 Diabetes
 Tobacco use
 Obesity
 High serum cholesterol
 Valvular heart disease
 Hypervolemia
Symptoms of Heart Failure
 Tujuan Pengobatan Gagal jantung
Prognosis Menurunkan mortalitas

Morbiditas Meringankan gejala dan tanda

Memperbaiki kualitas hidup
Menghilangkan edema dan retensi cairan
Meningkatkan kapasitas aktifitas fisik
Mengurangi kelelahan dan sesak nafas
Mengurangi kebutuhan rawat inap
Menyediakan perawatan akhir hayat
Pencegahan Timbulnya kerusakan miokard
Perburukan kerusakan miokard
Remodelling miokard
Timbul kembali gejala dan akumulasi cairan
Rawat inap

ESC Guidelines for the diagnosis and treatment of acute

and
chronic heart failure 20081
 TATALAKSANA NON-FARMAKOLOGI

 Manajemen perawatan mandiri mempunyai peran dalam

keberhasilan pengobatan gagal jantung dan dapat memberi
dampak bermakna perbaikan gejala gagal jantung,
kapasitas fungsional, kualitas hidup,morbiditas dan
prognosis.
 Manajemen perawatan mandiri dapat didefnisikan sebagai
tindakan-tindakan yang bertujuan untuk menjaga stabilitas
fisik, menghindari perilaku yang dapat memperburuk
kondisi dan mendeteksi gejala awal perburukan gagal
jantung (pedoman tatalaksanan gagal jantung PERKI)
TATALAKSANA NON-FARMAKOLOGI
• Ketaatan pasien berobat  Menurunkan
mortalitas dan morbiditas
• Pemantauan berat badan mandiri jika
terdapat kenaikan berat badan > 2 kg dalam 3 hari
segera menghubungi dokter/klinik gagal jantung
• Asupan cairan Restriksi cairan 1,5 - 2 lt/hr
dipertimbangkan terutama pada pasien dengan
gejala berat yang disertai hiponatremia
• Pengurangan berat badan
 Tata Laksana Farmakologi
Pemberian ACEI direkomendasikan, bagi semua pasien dengan
EF ≤ 40%, untuk menurunkan risiko hospitalisasi akibat gagal
jantung dan kematian dini

Pemberian penyekat β, setelah pemberian ACEI atau ARB pada

semua pasien dengan EF ≤ 40% untuk menurunkan risiko
hosipitalisasi akibat gagal jantung dan kematian prematur
Digoksin  Pemberiannya dapat dipertimbangkan untuk menurunkan
risiko
hospitalisasi pada pasien dengan EF ≤ 45% yang intoleran
terhadap penyekat beta

Disadur dari ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure 2012
 Nonpharmacologic theraphy
Intraaortic balloon pump (IABP) therapy
Left Ventricular assist devices (LVADs)
Transplantasi Jantung
Incidence is expected  by 50% in next 25 years
Mortality & Morbidity 
ALOS 
Hospitalization

What is being
done?
 Multidisciplinary
Management of Heart Failure

Care provider,Konsultan
Patients Centered Care
Edukator,promotor

Cardiologist HF Clinic

Nursing
In hospital patient Out patient

Dietician

Physiotherapist Nursing
home care
Social services
 Impact of a chronic disease such as
Heart Failure
Rehospitalization

Medication
Quality of
Compliance
Life

Communication Functional
with Nurse and/or
Doctor Status

Dependence
Multidisciplinary approach to heart failure
management

Improve quality of life

Relief of symptoms
Reduced emergent care
 ↓ ALOS
Prevent progression of LV dysfunction
Reduce hospitalization and morbidity
Reduce mortality
↓Sudden death
 Nursing Management
Nursing diagnoses
ACTIVITY INTOLERANCE
DECREASED CARDIAC OUTPUT
FLUID VOLUME EXCESS
IMPAIRED GAS EXCHANGE
ANXIETY
DEFICIENT KNOWLEDGE
 Decreased cardiac output
• Plan frequent rest periods
• Monitor VS and O2 sat at rest and during activity
• Take apical pulse
• Review lab results and hemodynamic monitoring results
• Fluid restriction- keep accurate Intake and Output
• Elevate legs when sitting
• Teach relaxation and ROM exercises
Activity Intolerance
Provide O2 as needed
Practice deep Fluid Volume Excess
 Give diuretics and
breathing exercises
provide BSC
Teach energy saving  Teach side effects of
techniques meds
Prevent interruptions  Teach fluid restriction
at night  Teach low sodium diet
Monitor progression  Monitor I and O and
of activity daily weights
 Position in semi or high
fowlers
 Listen to Breath Sound
frequently
Acute Care Management HF
• Nursing Assessment of HF
Manifestations:
– SOB, DOE, PND, orthopnea, dry cough or hemoptysis
– Crackles, weight gain, edema, liver enlarges, oliguria, JV
Distention
– Fatigue, anorexia
– <SBP, >DBP, HR, S3 gallop rhythm

Diagnostic Tests
– CXR-fluid and heart enlargement
– ECG
– Echo-enlargement, valvular function, condition of great vessels
– ABGs, O2 sat
– Liver enzymes, BUN, creatinine
Nursing Management HF in acute care
• To improve CO and gas x-change
– Assessment of heart, lungs, tissue perfusion, edema,
VS, ECG, labs, I&O, daily wts
– Administer and monitor med tx, diet, fluid restriction
– Balance rest and activity; Fowler’s, O2
– Monitor for complications: acute PE, dysrhythmias,
multisystem failure
– Provide emotional support
– Pt and family education: meds, rest and activity, diet,
fluid status
– Assist device IABP,CPAP mask,mechanical
ventilator or CRT may be as indicated
Nursing Monitoring HF in Acute Care

• Invasive hemodynamic monitoring

• Rhythm disturbance (VT,VF etc…)
• Respons pt to assist device (IABP.CPAP
mask,mechanical ventilator, Cardiac Resynchronize
Th/CRT)
• I/O monitoring (diuretic treatment)
• Drugs (side effect,toxicity,potential interaction):
inotropic
 Ward Management
• Continue standard heart failure medications
• Monitor of biochemistry and haematology profiles.
• weight monitoring, before breakfast & after voiding. Same scales if
possible.
• Daily intake / output chart
• Salt restriction
• Mobilisation
• Multidisciplinary team involvement
• Preparation for discharge
• Self Care Management (Taking medications ,monitoring for
signs/symptoms,measuring & monitoring daily weights
I&O,dietary /salt restriction
• Early Warning System (NEWSS)
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

24
PATIENT TEACHING
 PATIENT TEACHING
• Menimbang BB setiap hari  ajarkan pasien menimbang
BB setiap hari dan mencatatnya  penambahan BB 2-3
Kg dalam seminggu harus segera dikonsultasiakn
dengan dokter atau klinik
• Mengurangi asupan garam  Jumlah garam perhari
sekitar 1500-2000 mg/hari(satu sendok garam
mengandung 2300 mg)
• Membatasi asupan cairan  kebutuhan 25 cc/ kg/hari
• Aktifitas dan olah raga
 Interventions to Decrease
Re-admissions & Improve QOL(quality of Life)
Regular
Checkupps
Medication Diet &
Compliance Weight

Communication Exercise
with Nurse
and/or Doctor

Symptom
Management
 What is palliative
care?

• The active total care of patient whose diseases is not

responsive to curative treatment. Control of pain and other
problems, physical, psychosocial and spiritual ”
(WHO)

• Good quality palliative care can be delivered by many

practitioners
Nursing Role Palliative Care
 Increasing shortness of breath (managing breathlessness)
 Managing pain
 Managing fatique
 Managing cough,nausea and vomiting
 Managing pain
 Managing oedem
 Managing cardiac cachexia(poor appetite,lose
weight,acites),constipation.
 ↑mobility
 Managing depression
Out Patient Management
Home-Based Care (WHO )
Home-Based
 Care kesehatan
Penyediaan layanan (WHO ) oleh caregiver formal
 dan
The informal
provisiondiofrumah
healthdalam rangka
services untuk and informal
by formal
mempromosikan, memulihkan
caregivers in the home in orderdan mempertahankan
to promote, restore and
secara
maintainmaksimal
a person’s , merasa
maximal nyaman
level offungsi danfunction
comfort,
kesehatan
and health menuju
towardskematian yang
a dignified bermartabat.
death.

 Home
Home care
care services
services diklasifikasikan
can be classified dalam preventive,
into preventive,
promotive,
promotive, therapeutic,
therapeutic, rehabilitative,
rehabilitative, long-term
long-term
maintenance
maintenance danand palliative care categories.
 Fokus utama dari perawatan di rumah adalah untuk
mendidik pasien dan keluarga mereka untuk menjadi
mandiri dengan HF
 Home Care Heart Failure
• Comprehensive
• Interdisciplinary team: Nurse, Social Worker,
Physician, Therapist, Dietitian
• Delivered in the home
• Education patient
• Risk factor modification
• Complex, chronic, progressive disease
• Improve quality of life
• Reduces hospital days
 Heart Failure Clinic
• Heart Failure Clinic helps patient with:
Education and support
Managing symptoms of heart failure
Assistance with risk factor modification, such as
decreasing cholesterol, decreasing blood pressure,
and improving diet
Managing medications
Self management
Conclusions !!!! SUCCESS
• Heart failure is a chronic , progressive disease that is
characterized by frequent hospital admissions and high
mortality rates. ↑cost
• Some evidence that a multidiciplinary management program can
↓readmission rate and LOS↓
• Good quality palliative care can be delivered by many practitioners
• Effective home care monitoring of heart failure pt will ↓the incidence
of readmission,↑pt the quality of life and lower of costs of health care

Thank you…………………………………………..