MANAJEMEN KEPERAWATAN PADA PASIEN ACS

DATA KEJADIAN SERANGAN JANTUNG Heart Disease and Stroke Statistics—2010 Update.A Report From the American Heart Association Setiap 25 detik ada 1 orang mengalami penyakit jantung koroner Setiap menit ada 1 kematian yg disebabkan penyakit jantung koroner WHO, 2011 Prediksi thn 2030, 23,6 juta penduduk dunia akan meninggal karena jantung koroner. Peningkatan jumlah kematian terbesar akan terjadi di wilayah Asia Tenggara Di Indonesia penyakit jantung koroner menjadi urutan 1, penyebab kematian Angka kematian sakit jantung di Indonesia 7,6 juta per tahun 325 kasus meninggal sebelum tiba di RS Data Medika Record RSPJHK Angka kejadian & kematian Tahun 2012 2723 kasus ACS , angka kematian :102 0rang Tahun 2013, 2956 kasus ACS, angka kematian : 127 orang Data Kegawatan ACS di ruang rawat inap paska rawat intensif Tahun 2013 31 orang Tahun 2014 16 0rang

DATA KUNJUNGAN PASIEN 10 KASUS TERBESAR INSTALASI GAWAT DARURAT RSJPDHK JULI – SEPTEMBER 2016 EMERGENCY DEPARTMENT- NCCHK

Gejala Utama Serangan Jantung Pengkajian Nyeri dan Rasa Tidak Nyaman (discomfort) OPQRST : GAMBARAN SEKUMPULAN GEJALA NYERI DADA SAKIT DADA : Mulai timbulnya sakit dada (sakit, nyeri, rasa tertimpa beban, terbakar) dibelakang tulang dada, bisa menjalar ke punggung, bahu, rahang atau lengan disertai Rasa lemah, berkeringat dingin, rasa cemas dan bahkan bisa pingsan ), Lamanya > 20 menit

Apa yang harus kami kerjakan ???

Cardiac Markers Are used in the Diagnosis + risk stratification + triage and management of patients with chest pain and suspected acut coronary syndrome The cardiac troponin is central to the definition of AMI In STEMI patients – cardiac markers are not necessary for the diagnosis

Emerging Markers Investigations into emerging cardiac markers are focusing on increasing diagnostic sensitivity and specificity and on improving prognostic capability 1. B – type natriuretic peptide 2. C – reactive protein 3. Myeloperoxidase 4. Ischemia modified albumin

Prognostic Value of troponin An elevated troponin level can identify patients at high risk for adverse cardiac events Data from a meta- analysis indicated that an elevated troponin level in patients with and without ST – segmen elevation is associated with increased cardiac mortality rate CK-MB level were not predictive of adverse cardiac events and had no prognostic value

NURSING MANAGEMENT PERFORM INDEPENDENT AND COLLABORATIVE ACTIVITIES THAT LIMIT INFARCT SIZE MANAGE CHEST PAIN/DISCOMFORT DETECT AND PREVENT COMPLICATIONS PROMOTE OPTIMAL SHORT AND LONG- TERM RECOVERY PROVIDE ONGOING EDUCATION AND SUPPORT FOR THE PATIENT AND FAMILY

Prehospital ECG acquisition and interpretation Key issues with major changes in the 2015 Guidelines Update recommendations for ACS include the following: Prehospital ECG acquisition and interpretation Choosing a reperfusion strategy when prehospital fibrinolysis is available Choosing a reperfusion strategy at a non–PCI-capable hospital Troponin to identify patients who can be safely discharged from the emergency department Interventions that may or may not be of benefit if given before hospital arrival

Prehospital ECG acquisition and interpretation 2015 (New): Prehospital 12-lead ECG should be acquired early for patients with possible ACS. 2015 (New): Trained nonphysicians may perform ECG interpretation to determine whether or not the tracing shows evidence of STEMI. 2015 (Updated): Computer-assisted ECG interpretation may be used in conjunction with interpretation by a physician or trained provider to recognize STEMI. 2015 (Updated): Prehospital notification of the receiving hospital and/or prehospital activation of the catheterization laboratory should occur for all patients with a STEMI identified on prehospital ECG.

Choosing a reperfusion strategy when prehospital fibrinolysis is available 2015 (New): Where prehospital fibrinolysis is available as part of the STEMI system of care and direct transport to a PCI center is available, prehospital triage and transport directly to a PCI center may be preferred because it results in a small relative decrease in the incidence of intracranial hemorrhage. There is, however, no evidence of mortality benefit of one therapy over the other In adult patients presenting with STEMI in the emergency department of a non–PCI-capable hospital, we recommend immediate transfer without fibrinolysis from the initial facility to a PCI center, instead of immediate fibrinolysis at the initial hospital with transfer only for ischemia-driven PCI.

TERIMA KASIH