Asuhan keperawatan myocard infark (MCI)* *) Disiapkan oleh :Johanna.R.Kawonal,BSc,Dipl.Nsg.Admin.CV.RN, PSIK-UKSW Salatiga,Juni 2012.

Asuhan MCI… Kompetensi Setelah menyelesaikan topik ini mahasiswa mampu : Memahami terjadinya MCI Memahami management asuhan keperawatan pasien dengan MCI.

Pokok bahasan/bahan kajian Introduksi The development of atheroslcerosis Coronary artery dieseases (CAD/PJK) Collaborative care for ACS/MI Management keperawatan Kesimpulan Sumber rujukan.

INTRODUKSI Study from selected countries in Europe and USA and Asia ie Rusia is the highest precentage,death rates/100.000-men aged 34-74 (1966) ( beberapa hasil studi dibeberapa negara di Eropa,USA & Asia merupakan pembunuh nomor satu,misalnya Rusia dengan prosentasi tertinggi,berumur antara 34-74 tahun.)

introduksi cont’… Obesity in children tends to increase,(ESPGHAN.2011),(Quack Seng Hock/NUH-Singapore, (Kompas,Friday 4 March 2011) Basic Health Research Indonesia(2010)obesity among children are increased 14% compared to 2007 in some provinces in Indonesia(Kompas, Friday. 4 March 2011)

introduksi cont’… House hold survey ,MOH (SKRT) Indonesia Mortality rates caused by generative diseases increasingly:15.4% (1980),48,5% (2001).Cardiovascular diseases: 9.1%(1986)and 26,4(2001) and 11th caused of death 1973 and continously increase to the 3rd caused of death and 1st killer since 1992,1995 and 2001.Obesity and hypertension and hyperglycemia and hypercholesterolemia are tend to increase for male and female (http://typtcat.com RANP 2006-2010)

The development of artherioslerosis

Risk Factors

The Heart Structure & functions Struktur dan fungsi jantung ( REVIEW )

Nutrisi ibu hamil sangat esensial & kelainan jantung bawaan The uniqueness of the heart The heart has formed at the 3th week of gestation (pembuahan) 2. It started to beat at 22th days 3. The formation of left and right atrium/ventricles at the 7th week Nutrisi ibu hamil sangat esensial & kelainan jantung bawaan

Base Ventricles Apex

Pulmonal Circulation System

Systemic Circulation System

Capillary Circulation System

Coronary artery diseases ( CAD)/PJK * Acute Coronary Syndrom (ACS) * Myocardial Infarction (MI)

Acute coronary syndrome (ACS) Acute Coronary Syndrome (ACS): is a term used to reflect the relationship among the pathophysiology, diagnosis, prognosis, and interventions of serious manifestations of coronary artery diseases (CAD). Manifestations include unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-segment-elevation myocardial infarction (STEMI)

Acs cont’… Pathophysiology ACS-occurs when stable coronary artery atherosclerotic plaque ruptures, exposing the intima to blood and stimulating platelets aggregation, and local vasoconstriction with thrombus— manifest as UA or a STEMI ( ST-ELEVATION MYOCARD INFARCTION) Total occluded by a thrombus—manifest as a STEMI

Acs cont’… Unstable Angina:-ischemia associated with thrombus formation and vasoconstriction. Chest pain occurs at rest, or has a worsening pattern Myocardial infarction:-as a result of sustained ischemia, causing irreversible myocardial cell death (necrocis). Contractile function of heart stop in the necrotic area & most involve some portion of the left ventricle.

Clinical manifestations Unstable angina (UA): -unpredictable - easily provoked by minimal or no exertion - fatigue - shortness of breath - indigestions - anxiety

Diaphoresis and constrictions peripheral blood vessel Clinical manifestations cont’…. Nausea,vomiting Diaphoresis and constrictions peripheral blood vessel Skin ashned Clummy and cool and fever and BP raised HR elevated initially

Myocadial infarction Chest pain: Severe, immobilizing and persistent not relieved by rest or NTG administration PQRST assessment of Angina: P- Precipitating events Q- Quality of pain R- Radiation pain S- Severity of pain T- Timing

The Evolution of Infarction

characteristics cont’… Heaviness, pressure, burning, crushing, tightness or constriction Common locations are: Epigastric, substernal or retrosternal, radiate to the neck, jaw and arm or the back; it may occur while active, rest, asleep, awake, commomly early morning hours. Clinical Nursing skills assessment

mci cont’… Complications Dysrhytmias— VF a common cause of sudden death Heart failure (HF)- diminish pumping power Cardiogenic shock- inadequate O2 and nutrients to the tissues—reguires aggressive management.

Lethal Dysrhytmias

Pemeriksaan diagnostik Patients’s history of pain Risk factors Health history ECG Serum cardiac markers Coronary angiography Exercise stress testing Echocardiogram

Collaborative care An IV lines 02 percannula 2-4 l/m Mo Continous EKG monitoring Vital Signs freguently taken Drugs: aspirin, heparin, antidysrhthmic Percutaneous coronary interventions (PTCI) or reperfusion therapy or fibirinolytic (thrombolytic) therapy Coronary Artery bypass surgery (CABG)/Robotic Minimal invasive & laser Stem cell therapy—need deep ethicslegal assessment

Nursing care management Goals Nursing diagnoses Nursing interventions Patient and family teaching Advanced clinical nursing practice

Management asuhan keperawatan Tujuan Mengurangi rasa nyeri Melindungi otot jantung Tritmen yang tepat Efektif koping terkait ansietas Berpartisipasi dalam rehabilitasi Mengurangi faktor resiko.

management cont’… Diagnosa keperawatan 1, nyeri akut 2. Tidak efektif perfktif usi jaringan 3.Ansietas 4.Tidak toleransi pada aktifitas 5.Tidak efektif manegemnt terapeutik.

Intervensi keperawatan management cont’…. Intervensi keperawatan Prioritas fase awal mengakaji dan mengurangi rasa nyeri.

Intervensi cont’… Pemantauan fisiologik Promosi istirahat &kenyamanan Mengurangi stress & ansietas Memahami reaksi emosional & perilaku Ketepatan management mengurangi kebutuhan O2 myokard & tindakan mencegah imobilisasi.

Memberikan NTG & Mo sulfate intervensi cont’.. Memberikan NTG & Mo sulfate Menginterpretasikan EKG  kaji status jantung & identifikasi aritmia & tritmen. Monitor TTV, I/O-shift,fisikal asesment untuk mendeteksi deviasi parameter dasar,bujyi jabtung & paru,inspeksi bukti awal HF.

intervensi cont’…. Mengkaji status oksigenasi,memperhatiakan area pemberian O2,rencana asuhan &tindakan terapeutik menjamin kecukupan istirahat,bebas interupsi. Ansietas dalam berbagai tingkatan,Ns mengidentifikasi sumbernya ,keluarga diperbolehkan berada disamping klien & Ns secara reguler mencek pasien,kaji ledih jauh agar pasien menerima kenyataan.

intervensi cont’… Pendidikan klien & keluarga Pendidikan cont’… Penk.kes  lebih awal sejak dirawat sampai di komunitas/rumah. Rehabilitasi jantung : pemeliharaan status berfungsi optimal dalam 6 area: ( fisiologik,psikologik,mental emosional & vokasional) Tujuan Memberikan perangkat sesuai dengan kebutuhan untuk kberhasilan rehabilitasi. pedoman antisipasi mencakup menyiapkan pasien/keluarga dalam proses pemulihan & rehabilitasi:

intervensi cont’…. pendidikan cont’… pendidikan cont’… Mempelajari apa harapan selama tritmen & pemulihan. Pencapaian pasien untuk mengontrol kehidupannya. Pasien harus diajarkan parameter tentang latihan & bagaimana mencek kecepatan HR. Ajarkan HR minimum pada setiap aktifitas,jika tidak mencapai diluar kecepatan atau tidak kembali normal saat istirahat dalam beberapa menit. Pasien diinstrusikan berhenti latihan,jika terjadi dyspneu atau chest pain (nyeri dada).

Pedoman pendidikan bagi pasien & keluarga : pendidikan cont’… Pedoman pendidikan bagi pasien & keluarga : Ns harus mengajarkan pada pasien & keluarga hal2 sbb: Anatomi & fisiologi jantung & pembuluh darah Penyebab & efek atherosclerosis. hospitalisasi singkat,penekanan pada “ listen to what the body is saying “. “ sexual counselling” -bagi pasien & partner,mis diberikan bacaan sumber.

4). Tanda & gejala awal ,MI & kenapa hal ini terjadi Pendidikan cont’… 4). Tanda & gejala awal ,MI & kenapa hal ini terjadi 5). Penyembuhan setelah serangan MI 6). Modifikasi & identifikasi faktor resiko 7).Rasional uji diagnostik & tritmen ( EKG,pemeriksaan darah,angiography/kateterisasi,echocardiogram,dll. 8). Kembali bekerja & aktifitas fisik & seksual. 3). Pengertian istilah2 ( CAD,MI/MCI, Angina pectoris,chest pain/nyeri dada,sudden cardiac death, gagal jantung/HF)

10). Pentingnya pemahaman secara bertahap & penuh. pendidikan cont’…. Kesimpulan CAD/PJK kini menjadi pembunuh nomor satu terutama dinegara2 maju. Berbagai faktor resiko penyebab & patofisiologi terjadinya CAD/PJK. Ns harus memahami tanda & gejala PJK & memberikan asuhan keperawatan secara kolaboratif selama di RS. Pasien & keluarga harus disiapkan &diberikan pendidikan sebelum pulang. **JO/PSIK/UKSW/2012** 9). Tindakan2 untuk meningkatkan pemulihan & kesehatan. 10). Pentingnya pemahaman secara bertahap & penuh.

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