Cecep E. Kosasih, SKp., MNS

PENGERTIANSuatu kondisi dimana jantung tidak mampu

memompakan darah secukupnya dalam memenuhi kebutuhan sirkulasi tubuh untuk keperluan metabolisme jaringan tubuh pd keadaan tertentu .

Menyebabkan curah jantung menurun dan gagal sirkulasi & faal tubuh

Penyebab Disfungsi miokardBeban tekanan berlebihan sistolic overloadBeban volum berlebihan- diastolic overloadPeningkatan kebutuhan metabolik – demand

overloadGangguan pengisian.

Sindroma gagal jantungGagal jantung kiriGagal jantung kanan Gagal jantung kongestif

Gagal jantung kiriGangguan fungsi pompa ventrikel kiri

curah jantung kiri turun tekanan akhir diastolik dalam ventrikel kiri dan volum akhirr diastolik dalam ventrikel kiri meningkat bendungan pada atrium kiri, meningkatnya tekan pada atrium kiri bendungan terjadi pada vena pulmonalis, tekanan meningkat bendungan paru (edem paru), tekanan wedge pulmonal meningkat beban sistolik pada ventrikel kanan.

Gejala klinisBadan lemahCepat lelahBerdebarSesakBatukAnoreksiaKeringat dingin

Penyebab Stenosis aortaInfark miokard

Gagal jantung kananGangguan fungsi pompa ventrikel kanan

curah jantung kanan turun & tekanan akhir diastolik ventrikel kanan meningkat bendungan pada atrium kanan dan tekanan dalam atrium kanan meningkat bendungan pada vena sistemik (vena kava) & tek meningkat hambatan arus balik vena dan bendungan sistemik.

Gagal jantung

Aliran darah turun

Vasokonstriksi ginjal

Filtrasi glomerulus turun

Reabsorpsi Na+ dan H2O (pd tubuli proximal)

Retensi ginjal Na+ dan H2O

Volume plasma meningkat

Transudasi cairan Edema

Sekresi ADH meningkat

Reabsorpsi Na+ pada tubuli distal meningkat

Sekresi renin meningkat

Sekresi aldosteron meningkat

Absorpsi H2O pada tubuli distal meningkat

Gejala klinisEdema tumit dan tungkai

bawahHati membesar, lunak dan

nyeri tekanBendungan vena perifer (vena

jugularis)Ggn gastrointestinal (perut

kembung, anoreksia, nausea)AsitesBb meningkat

Gagal jantung kongestifBila terdapat gagal jantung kiri dan kanan

dalam waktu bersamaanDitandai dengan bendungan pada paru dan

sistemik

Gejala klinisPembesaran jantungTerdengan bunyi jantung 3Sering dimulai dari gagal jantung kiriCurah jantung turun

Treatment Preparat digitalis (inotropik positif dan

kronotropif negatif): digoksin; oral 0,5-2 mg 4-6 dosis/24 jam, 0,5 mg 2x sehari. IV; 0,75-1 mg dalam 4 dosis/24 jam. Cedilanid: IV 1,2-1,6 mg/24 jam

Angiotensin-Converting Enzyme Inhibitors.Beta-BlockersCalcium Channel BlockersDiuretik: furosemid, spironolactone

(Aldactone)Mengurangi beban hemodinamis jantung

dengan memperbaiki preload dan afterload dengan obat vasodilator: nitrogliserin(Isosorbide Dinitrate), Hydralazine dan

OksigenIstirahat baringNUTRITIONAL THERAPY: rendah sodium

(≤2 to 3 g/day)

Diagnosa keperawatanPerubahan cardiak outputKurang pengetahuanIntoleransi aktifitasTidak efektifnya pola nafasPerubahan volume cairan

Activity intolerance (or risk for activity intolerance) related to imbalance between oxygen supply and demand because of decreased CO

Excess fluid volume related to excess fluid or sodium intake and retention of fluid

Anxiety related to breathlessness and restlessness from inadequate oxygenation

Powerlessness related to inability to perform role responsibilities because of chronic illness and hospitalizations

Noncompliance related to lack of knowledge

PROMOTING ACTIVITY TOLERANCELatihan secara teratur terjadwal3-5 menit 1-4x/hari

Sebelum latihanBegin with a few minutes of warm-up activities.Avoid performing physical activities outside in

extreme hot, cold, or humid weather.Ensure that you are able to talk during the physical

activity; if you are unable to do so, decrease the intensity of activity.

Wait 2 hours after eating a meal before performing the physical activity.

Stop the activity if severe shortness of breath, pain, or dizziness develops.

End with cool-down activities and a cool-down period.

MANAGING FLUID VOLUMEPemberian diuretikmonitors the patient’s fluid status closely

—auscultating the lungs, monitoring daily body weights, assisting the patient to adhere to a low-

sodium diet by reading food labels and avoiding high-sodium foods such as canned, processed, and convenience foods

Monitoring Intake and output

CONTROLLING ANXIETYPemberian oksigenthe nurse takes steps to promote physical

comfort and psychological support. a family member’s presence provides

reassurance. the nurse should speak in a slow, calm, and

confident manner and maintain eye contact. the nurse should also state specific, brief

directions for an activity.

the nurse can begin teaching ways to control anxiety and to avoid anxiety-provoking situations.

The nurse explains how to use relaxation techniques and assists the patient to identify factors that contribute to anxiety.

Lack of sleep may increase anxiety, misinformation, lack of information, or poor nutritional status.

Promoting physical comfort, providing accurate information, and teaching the patient to perform relaxation techniques and to avoid anxiety triggering situations may relax the patient

MINIMIZING POWERLESSNESSTaking time to listen actively to patients often

encourages them to express their concerns and ask questions.

providing the patient with decision-making opportunities,

review hospital policies and standards that tend to promote powerlessness and advocate for their elimination or change (eg, limited visiting hours, prohibition of food from home, required wearing of hospital gowns).