Diagnosis & Manajemen Keperawatan terkait Cardiovaskular Responses Sri Setiyarini Subag. KGD

Bagan alur mrumuskan diagnosa Kep. Pengkajian: Pengumpulan data Identifikasi defining characteristic Related factors Terintegrasi dng riwayat, bukti-bukti lain atau chart Diagnosa cek kesesuaiannya dng definisi diagnosa (NANDA , Hal 297)

Cardiovaskular Responses (NANDA 2012 – 2014) Domain 4: activity/rest Production, Converasation, expenditure or balance of energy resources Class 4: cardiovaskular/respiratory responses Cardiopulmonary mechanism that support activity/rest

Diagnosa Keperawatan (NANDA Decrease cardiac Output (00029) Activity Intolerance (00092) Risk for Activity Intolerance (00094) Ineffective Peripheral Perfusion (00204) Risk for Ineffective peripheral perfussion Ineffective breathing pattern

Diagnosa keperawatan Risk for Decreased cardiac Tissue perfusion (00200) Risk for Ineffective Cerebral Tissue Perfusion (00201) Risk for Ineffective Gastrointestinal Perfusion (002002) Risk for Ineffective Renal Perfusion (00203) Impaired spontaneous ventilation Dysfunctional ventilatory weaning Response

7 Diagnosis Decrease Cardiac Output (CO) Definition Inadequate blood pumped by the heart to meet the metabolic demands of the body

Cardiac Output Determination Cardiac Output (C0) is the volume of blood that is pumped out of the heart per minute. (Normal= 4-8 liters/minute) CO = Heart Rate X Stroke Volum e (CO=HR X SV)

EFFECT OF VARIOUS CONDITIONS ON CARDIAC OUTPUT.

Interaksi antar komponen-komponen yang mengatur CO dan tekanan atrial. Tanda panah tebal menandakan PENINGKATAN Tanda panah putus-putus menandakan PENURUNAN CO Afterload kontraktilitas Preload Pemendekan serat miokard Arterial Pressure Heart Rate Heart Rate Sroke volume Ukuran ventrikel kiri Resistensi perifer Resistensi perifer

STROKE VOLUME - volume of blood ejected as he ventricles contract with each heart beat During systole = 70ml - 90 ml / PRELOAD - degree of tension on the muscle when it begins to contract CARDIAC OUTPUT - the quantity of blood pumped into the aorta each minute by the heart AFTERLOAD - load against which the muscle exerts its contractile force - pressure in the artery leading from the ventricle

Related Factors Altered preload Altered afterload Altered contractility Altered heart rate, Altered rhythm Altered Stroke Volume

Penyakit/kondisi yg menurunkan CO Umumnya: myocardial infarction, Hypertension valvular heart disease, congenital heart disease, cardiomyopathy, pulmonary disease, arrhythmias, drug effects, fluid overload, decreased fluid volume, electrolyte imbalance.

Diagnosis Lainnya ( mendahului atau lanjutan) Ineffective Peripheral Tissue Perfusion (00204) Activity Intolerance (00092) Risk for Activity Intolerance (00094) Risk for Ineffective Cerebral Tissue Perfusion (00201) Risk for Ineffective Gastrointestinal Perfusion (002002) Risk for Ineffective Renal Perfusion (00203) Risk for Shock (00205)

CO Arterial Pressure Resistensi perifer Resistensi perifer MAP= Tekanan Rata-rata Arterial (mean arterial pressure) MAP= Tekanan Rata-rata Arterial (mean arterial pressure) As blood is pumped out of the left ventricle into the arteries, pressure is generated MAP = (CO × SVR) + CVP Karena CVP umumnya dengan nilai /mendekati 0 mmHg, maka persamaan tersebut dapat disederhanakan menjadi: MAP approx = CO × SVR MAP = 1 sistolik + 2 Diastolik 3 atau

MAP menggambarkan TEKANAN PERFUSI ke ORGAN-ORGAN tubuh MAP normal = 70 – 105 mmHg

MAP MAP > 60 mmhg, cukup untuk menjaga perfusi organ. Jika MAP turun secara bermakna dan dalam waktu cukup lama, aliran darah ke organ-organ akan berkurang dan dapat berlanjut menjadi iskemi Blood Flow to the Organs Matches Body Requirements Active organs such as the liver, brain and kidney have high blood flows at rest – About 25% of the cardiac output goes to the kidney Composition of the blood is continuously regulated by the kidney – Gastrointestinal tract & liver get another 25% – Muscle circulation at rest is about 20% of cardiac output – Brain needs about 15% of the cardiac output

Low blood pressure results in inadequate perfusion Brain Heart - (70 % coronary artery perfusion occurs during diastole) (Diastolic pressure < 50 mmHg compromises perfusion of heart) Kidneys BP = CO × PVR (peripheral vascular resistance ) Atau BP ∝ CO/r 4 (resistensi pembuluh drh kecil)

Diagnosis : Ineffective Peripheral Tissue Perfusion (00204) Definition: decrease in blood circulation to the periphery that may compromise health Def Charac & related Fact; see NANDA 2009 – 2010 Diagnosis: Activity Intolerance (00092) Definition: insufficient physiological or psychological energy to endure or complete required or desired daily avtivities Def Charac & related Fact; see NANDA 2009 – 2010 Diagnosis: Risk for Decreased cardiac Tissue perfusion (00200) Definition: risk for a decrease in cardiac (coronary) circulation

Diagnosis: Risk for Ineffective Renal Perfusion (00203) Definision: at risk for a decrease in circulation to the kidney that may compromise health Diagnosis: Risk for Ineffective Cerebral Tissue Perfusion (00201) Definition: risk for a decrease in cerebral tissue circulation Diagnosis: Risk for Ineffective Gastrointestinal Perfusion (002002) Definition: at risk for a decrease in gastrointestinal circulation Diagnosis: Risk For Bleeding (00206) Definition: at risk for a decrease in blood volume that may compromise health Risk for Activity Intolerance (00094)

22 Left CHF/Pulmonary Congestion

Cardiac Pump Effectiveness Circulatory Status Tissue Perfusion: Abdominal Organs Tissue Perfusion: Peripheral Vital Signs Status NOC Outcomes (Nursing Outcomes Classification) Suggested NOC Labels

CONTOH: Outcomes Cardiac Pump Effectiveness Definisi: Keadekuatan volume darah yang dipompakan dari ventrikel kiri untuk mendukung tekanan perfusi sistemik

Cardiac Care: Acute Hamodinamyc Circulatory Care Shock management: Cardiac NIC Interventions (Nursing Interventions Classification) Mayor intervensi

Suggested Intervention  Manajemen asam basa  Monitoring asam-basa  Manajemen airway  Cardiac care: rehabilitasi  Cardiac precaution  Code management  Manajemen elektrolit  Monitoring elektrolit  Manajemen cairan/elektrolit  Manajemen cairan  Monitoring cairan  Monitoring hemodinamik invasif  Pemberian obat-obatan  Manajemen obat-obatan  Manajemen Pacemeker temporer  Monitoring tanda vital

Intervensi pilihan (optional) Mengurangi perdarahan Transfusi produk-produk darah Manajemen disaritmia Monitoring elektronik fetus: antepartum Manajemen energi Pemasangan intravena (IV) Terapi IV

. Intervensi pilihan (optional) Pasien mendapat proteksi yang tepat Plebotomi- sampel darah arteri Plebotomi- kanulasi IV Plebotomi- pengambilan sampel darah vena Resusitasi Resusitasi: neonatus Resusitasi: fetus

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