GAGAL JANTUNG

35
  4 LD^A_DJ EDSWS MDMDL HDJPWJM ^DYFLFWJ ILDKOAVDJ _SW@ PDJMG_DJM Jdkd 8 Odvvfjdb JFK8 4>24>?>>>>?9 ID_KDSF YFF D

description

pengambilan data dimulai dari awal pasien masuk, tetapi wawancara langsung dilakukan tgl 30 januari 2012

Transcript of GAGAL JANTUNG

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4

LD^A_DJ EDSWS MDMDL HDJPWJM

^DYFLFWJ ILDKOAVDJ _SW@ PDJMG_DJM

Jdkd 8 Odvvfjdb

JFK8 4>24>?>>>>?9

ID_KDSF YFF D

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?

ODO F

^_GSGJPDSF EDSWS

F*4 @DPD ^DSFGJ _wdjm 4 og` 3

Wkwr 8 77 pdbwj

Hgjfs Egldkfj 8 ^grgk~wdj

Pdjmmdl Kdswe 8 ?9 Hdjwdrf ?>4?

Ogrdp Od`dj 8 07 Em

Pfjmmf Od`dj 8 470 ck

F*? Eglwbdj Wpdkd

Sgsde jdids

F*3 _F]DVDP ^GJVDEFP SGED_DJM

Sw`db 4 kfjmmw sgsde jdids `dj kgkogrdp 4 bdrf sgoglwk kdswe _S, odpwe "%&, kwdl "%&, rf}dvdp Bf~grpgjsf "%&, @K

"%&

^gkgrfesddj Ifsfe8 Egd`ddj wkwk ogrdp, cak~as kgjpfs 5 P@ 402!9=kkBm 5 IJ 23!kgjfp 5 I^ ??!kgjfp A ?

3L!kgjfp 5 kdpd C!D scarg > 5 ~drw ygsfewlgr+!+ 5 }bggxfjm + 5 Ofsfjm wsws "%& Jarkdl 5 Do`akgj `dpdr 5 Gp bdjmdp ,

g`gk "+&

@fdmjasd Egrhd8

4*  CBI Ic "spd`fwk& FFF Sws~* BB@

?*  @K pv~g ? pf`de pgreajpral

3*  Giwsf ~lgwrd ofldpgrdl

F*0 _F]DVDP ^GJVDEFP PG_@DBWLW

  @K sghde 4 pdbwj vdjm ldlw "~dedf fjswlfj pd~f pf`de pgjpw&

  Bf~grpgjsf z 7 pdbwj "pf`de pgreajpral&

  Aspga~arasfs jvgrf `feg`wd sgj`f lwpwp "pf`de pgreajpral&

F*7 _F]DVDP EGLWD_MD

Pf`de d`d egpwrwjdj @K

F*9 _F]DVDP SASFDL

^gegrhddj 8 Fow _wkdb Pdjmmd

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3

Spdpws ~gred}fjdj 8 Ed}fj

Kgraeae 8 : ?> pdbwj sdk~df sgedrdjm kdsfb kgraeae "4 owjmews ! bdrf pgpd~f kgjwrwp }d}djcdrd

~dsfgj ? owjmews! bdrf kgre raeae Hfjmma&

Dleabal 8 Pf`de

Jdreaod 8 Pf`de

F*= _F]DVDP ^GJMMWJDDJ AODP

Oa`rg 4kfjwk ? pdolgp

Oa`rg `drf Pgk~a Scdj ^dsfifc!Oa`g

Eak~asfsf 8 ^drdcgpdkal 9>> km, cdiigfj 7> km

Fj`fedsf 8 sdefp eg~dld, sdefp mfmf, `dj `gkdk

@asfs `}s 8 4 pdo, `fogrfedj 3+0sgbdrf

Eajprdfj`fedsf 8 Mdjmmwdj iwjmsf bdpf ogrdp

Gige sdk~fjm 8 mdjmmwdj iwjmsf bdpf "~d`d `asfs ogsdr ) ~gjmmwjddj hdjmed ldkd&

F*2 EDHFDJ SPDPWS ELFJFE 

PDJMMDL S A D ^

?9 Hdjwdrf ?>4? As* Kgjmdpdedj

eg~dld ~wsfjm,

jvgrf `d`d

ogrewrdjm 

egd`ddj wkwk Pdk~de

Sdefp Ogrdp5 Hdldj jdids

clgdr 5 ^grjdidsdj

s~ajpdj __ ?4!kgjfp

Sdp A? 67'5 Sfrewldsf O~

"olaa` ~rgsswrg& 493!29

, B_ 2=!kgjfp , Swbw

39>C 5 egsd`drdj

cak~as kgjpfs 5 FY lfjg

"svrfjmg FY& fsarof`

4km!hdk 

Mdjmmwdj ~ald

jdids, ~gjwrwjdj

cwrdb hdjpwjm,

fjpalgrdjsf depfifpds 

Ldjhwp 

?2 Hdjwdrf ?>4? Eglwbdj "+&  Sptd "pf`de d`d

~grwodbdj& 

4*  Giwsf ~lgwrd

ofldpgrdl

~grodfedj

?*  Dcwpg Bgdrp

idflwrg

3*  @K pf~g ?

"mwld `drdb

oglwk

pgreajpral&

0*  Bf~aedlgkfd

7*  Bf~grpgjsf

pfjmedp FF

"pgrd~f bdrfdj& pb!

carrgcpfajdl `asg »

 hdk sgoglwk kdedj

"`asfs ~gkogrfdj

fjswlfj&

M@ _F

<?>> > Wjfp

?>4+

?7>

7 Wjfp

?7>+

3>>

4> Wjfp

3>4+37>

47 Wjfp

:37> ?> Wjfp

ES_ 34 pdo

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0

Ldfj+ldfj sgswdf

`gjmdj edr`fa `dj

~wlka

Kdsdldb DLA

~grodfedj

Giwsf

~lgwrd ~grodfedj

Bf~grpgjsf

@K pv~g ?

P@ 4?6!90 B_ 4>7

Ygsfewldr ↓ `f 4!3

ld~djm ~drwPb!

+  Cg`acdr` 4km!hdk

Spa~

+  Cd~pa~rfl 33=,7km

`fpfjmedpedj hd`f

37>km

+  Dkla`f~fjg 47km

"k& _!Spa~+  Dl`dcpajg 4?7km

+  ES_ Spa~

+  Ldsf ?4 dk~wl

?6 Hdjwdrf ?>4? "+&  egd`ddj wkwk Pdk~de

Sdefp Ogrdp5 Hdldj jdids

clgdr 5 ^grjdidsdj

s~ajpdj A? "%& __

6!kgjfp 5 Sfrewldsf O~

4??!9> , B_ =7 , Swbw

39>C 5 egsd`drdj

cak~as kgjpfs 

~gjwrwjdj cwrdb

 hdjpwjm 5

~gjwrwjdj ~griwsf

 hdrfjmdj ~grfigr 5

fjpalgrdjsf D@L

"dcpfyfpv `dflv

lfyfjm& pf`de

sdjmmw~kgldewedj

egmfdpdj sgbdrf+

bdrf edrgjd sgsde

jdids "cajpab8

Kdj`f& 

ldjhwp

3> hdjwdrf ?>4? Sgsde ogrewrdjm ,

kwdl "+& , kwjpdb

"+& , jdisw kdedj

odfe 

ck 5 egd`ddj wkwk

pdk~de sdefp rfjmdj 5 P@

43>!9>kkBm 5 IJ

2>!kgjfp 5 __

3?!kgjfp 5 Kdpd

eajhwjmpfyd ~wjcde "e~&+!+ scarg +!+ 5 Lgbgr

pgedjdj hwmwldrfs ygjd

"HY^& 7 kfjws ? ckB?A 5

Hdjpwjm Owjvf Hdjpwjm

"OH& F  – FF jarkdl,

kwrkwr "+&, mdlla~ "+& 5

^wlka ygsfewlgr ↓ ,

rajmef "egldfjdj ~drw

cajpab8 G`gk ~drw d`d

owjvf rajmefjvd& +!+ ,

}bggxfjm "ogrbwowjmdj`gjmdj dfr}dv& +!+ 5

Do`akgj `dpdr , Ofsfjm

wsws "%& jarkdl 5 Gp

4*  G`gkd ~drw

~grodfedj

?*  Giwsf ~lgwrd

ofldpgrdl

3*  Bf~grpgjsf

pgreajpral0*  @K pv~g FF,

J], M@

pgreajpral

_` ! +

_p ! @fgp @K lwjde 5

EM@B "ewryd Mwld

`drdb bdrfdj& 5 Pgrd~f

sgswdf edr`falamf `dj~drw

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g`gk +!+ 

34 Hdjwdrf ?>4? sgsde jdids

ogrewrdjm, kwdl "+

&, kwjpdb "+&, jdisw

kdedj odfe 

ck , pdk~de sdefp

sg`djm "pss&5 P@ 4?2!9> 5

^ ?2!kgjfp 5 J

2>!kgjfp 5 S 8 digorfs

"pf`de `gkdk& 5 Kdpd

Cajhwjmpfyd dpds "C!D& +

!+ , scarg +!+ 5 Lgbgr

Eglgjhdr Mgpdb Ogjfjmpf`de pgrdod "EMO ppo&,

pgedjdj hwmldrfs 7+?

ckB?A 5 Hdjpwjm S4 S? 

Jarkdl , K jarkdl , M

jarkdl 5 ^wlka

Ygsfewlgr %!%

"ogrewrdjm& , rajmef +!+ ,

}bggxfjm +!+ 5 Do`akgj

ildp , JPM "jvgrf pgedj

pf`de d`d& "+& , Bdpf lfkid

"B!L& pf`de pgrdod, Ofsfjmwsws "%& jarkdl 5 Gp

Bdjmdp , C_P "~gjmfsfdj

ed~flgr& ewrdjm `drf ?

`gpfe , g`gk +!+ 

4*  G`gkd ~drw

~grodfedj

?*  Giwsf ~lgwrd

ofldpgrdl

3*  Bf~grpgjsf

pgreajpral

0*  @K pv~g FF, J]

"jarkdl}gfmbp&, M@

pgreajpral

_` ! +

_p ! @fgp @K lwjde 5

Pgrd~f sgswdf

edr`falamf `dj ~drw

p!

+  Cd~pa~rfl 37>km+  Ofsa~ralal 4?,7km "~&

+  Ds~flgp 42>km "~&

+  ^ldyf 4=7km "~&

+  Sfkydspdpfj 44>km "k&

+  Dl`dcpajg 4?7km "k&

+  Ldsf 44 dk~wl

Gcba cdr`famrd~b

4 igorwdrf ?>4? odpwe "%&, sgsde

ogrewrdjm,

ODO!ODE "jarkdl&,

jdisw kdedj odfe,

kwdl "+&, kwjpdb"+&

egd`ddj wkwk ck,

pdk~de sdefp sg`djm5 P@

4?7!97kkBm 5 J

2>!kgjfp 5 ^ ?>!kgjfp

5 S digorfs 5 kdpd C!D +!+

, scarg +!+ 5 lgbgr EMO

ppo, HY^ 7+? ckB?A 5Hdjpwjm S4 S? jarkdl, K

jarkdl, M jarkdl5

~wlka rb +!+ , }b +!+ 5

do`akgj ildp, JPM "+& ,

B!L ppo, Ow "%& jarkdl 5

Gp Bdjmdp , C_P

"~gjmfsfdj ed~flgr& L?S

"lgss ? sgcaj`& , g`gk +

!+

4* G`gkd ~drw

~grodfedj

?* Bf~grpgjsf

pgreajpral

3* @K pv~g FF `dj

eak~lfedsf

kderadjmfa~dpf"edr`faydsewldr&

0* @fslf~f`gkfd

_` !

Pb !

+  EM@B

+  @fgp @K 4=>> eedl

+  Kgpiarkfj

?7>>km+  Sfkydspdpfj 44>km

+  Dscdr`fd 427km

F*6 @DPD ^GKG_FESDDJ IFSFE, LDO

D*  Bdsfl M@S

Ja Pdjmmdl Bdsfl

4* ?9 Hdjwdrf ?>4? Hdk >3*>> 8 3>>

Hdk >7*>> 8 4?0

?* ?= Hdjwdrf ?>4? Hdk 47*>> 8 4=7

Hdk ?0*>> 8 4=3

Hdk >9*>> 8 ?40

3* ?2 Hdjwdrf ?>4? Hdk 4?*>> 8 ?39

Hdk 4=*>> 8 470

Hdk 42*>> 8 42>

Hdk >9*>> 8 ?37

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0* ?6 Hdjwdrf ?>4? Hdk 44*>> 8 40?

Hdk 4=*>> 8 446

Hdk >9*>> 8 44=

O*  Mrdife Swbw `dj jd`f

Pdjmmdl BDSFL

34!>4!?>4?  +  Jd`f ~wewl >9*>> 22!kgjfp 5 ~wewl 4?*>> 22!kgjfp 5~wewl 42*>> 4>>!kgjfp

+  Swbw ~wewl >9*>> 39,2>C 5 ~wewl 4?*>> 39,>

>C 5 ~wewl

42*>> 3=,?>C

+  Pgedjdj `drdb ~wewl >9*>> 44>!2>kkBm 5 ~wewl 42*>>

43>!2>kkBm

C*  @dpd GEM

PDJMMDL BDSFL

?= Hdjwdrf ?>4?

^wewl >7*4>

4fjygrsf Y?+Y0, dWL

SP `g~rgsf Y0+Y9

Egsfk~wldj LYD

CBI Ic FFF SP glgydsf djpgraldpgrdl

?2 Hdjwdrf ?>4? ^ 62ks ^_ 490ks T_S 6?

TP 3=>ks TPc 074ks (TPr 449

Irajpdl ygcpar^ >,46kY 33

TP >,6?kY +=

P >,4=kY 44?

Jarkdl dfs

Dojarkdl GCM

?6 Hdjwdrf ?>4?

^wewl >9*>>

Mgl ^ ; >,>0

^_ fjpgrydl ; >,4? `gp

T_S fjpgrydl ; >,>2 `gp

SP sgmkgj ; `g~rgsf `f lgd` F DWL, glgydsf "+&

Mgl % ; fjygrpg` `f lgd` Y?, Y3, Y0, Y7, Y9

Ja Hgjfs ^gkgrfesddj Jfldf Jarkdl Bdsfl ~gkgrfesddj "pdjmmdl&

?9!>4!?>4? ?2!>4!?>4? ?6!>4!?>4?

Efkfd @drdb

4 Ergdpfjfj ^r < 4,4 km!`l >,= km!`l

? Wrgwk < 7> km!`l 37 km!`l

3 Dsdk Wrdp ^r < 7,= km!`l 9,> km!`l ↔ 

0 ^rapgfj papdl 9,9 – 2,= km!`l 7,6 km!`l ↓ 

7 Dlowkfj 3,7 – 7,? km!`l 3,0 km!`l ↓ 

9 Ealgspgral papdl < ?>> km!`l ?44 km!`l ↔ 

= Prfmlfsgrf`d < 47> km!`l 403 km!`l

2 Ealgspgral L@L < 477 km!`l 409 km!`l

6 Ealgspgral B@L :37 39 km!`l

4>* C^E ^r <49= 4>6 W!L 74 W!L

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=

44* CE+KO <?7 43 W!L ?? W!L

D*Bgkdpalamf

4* Bgkamlaofj 40,> – 42,> !`l 44,0 m!`l ↓ 

?* Hwkldb Lgweasfp 0>>> – 4>*>>> !·l 44*7>> !·l ↔ 

3* Bgkdpaerfp 3= – 06 ' 33'↓ 

Prakoasfp 47>*>>> – 07>*>>> !·l ?42*>>> !·l

O*Efkfd

4* Edroabf`rdp "mlweasd

sg}depw&

< 42> km!`l 3>> km!`l ↔ 

?* Iwjmsf mfjhdl

+  Wkwk

+  Ergdpfjfj

4>+7> km!`l

< 4,0 km!`l

34 km!`l

>,= km!`l

3* Iwjmsf bdpf

+  SMAP

+  SM^P

< 32 W!L

< 04 W!L

?9 W!L

33 W!L

0* Glgepralfp

+  Jd

+  E

+  Cl

437 – 407 kkal!L

3,7 – 7,4 kkal!L

6= – 444 kkal!L

43> kkal!L ↓ 

3,=0 kkal!L

4>= kkal!L

7* Iwjmsf hdjpwjm

+  CE

+  CEKO

^ < 49= W!L

< ?7 W!L

??> W!L ↔ 

07 W!L ↔ 

9* Pra~ajfj F "+& jgmdpfi 

^gkgrfesddj mds `drdb `dj glgepralfp

Svrfjmg sdk~gl Pdjmmdl ~gkgrfesddj sdpwdj Jfldf Jarkdl

?9!4!?>4? ?2!4!?>4?

Dcf`!Odsg 3=>C

~B =,090 ↔ =,0=4 ↔  =,37> – =,0

~CA? 34,? ↓  30,9 kkBm 3?,> – 07

~A? 9=,4 ↓ =>,7 ↓  kkBm =7,> – 4>>

BCA3 – dcp ?4,6 ?0,= kkal!L ??+?9

BCA3 – sp` ?3,7 ?7,9 kkal!L

pCA? ??,6 ?7,= kkal!L

Ogyp +4,? 4,3 kkal!L +?,7 – "%& ?,7

Ogyy +4,6 4,> kkal!L

Carrgcpg` 3=*>>C

~B "P& =,090 =,0=

~CA? "P& 34,? 33 kkBm~A? "P& 9=,4 92,? kkBm

Avmgj Spdpws

~A? 9=*4 ↓ =>,7 ↓  kkBm =7,> – 4>>

A?sdp 60,9 67,? '

Glgcpralvpg

Jd 439,0 kkal!L 437 – 407

E 3,>0 ↓  kkal!L 3,7 – 7,4

Cd ((((

Cl 4>7 kkal!L 6=   – 444

Gjpgrg`

Pgk~ 3=,> 39,7 >C

pBo 44,0 44,0 m!`l

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2

F*4> @FDMJASFS

CBI Ic FFF Jaj SP glgydsf djpgraldpgrdl

F*44 @DPD ^GJMMWJDDJ AODPJA JDKD

AODP

PDJMMDL ?9!>4!?>4? ?=!>4!?>4? ?2!>4!?>4? ?6!>4!?>4? 3>!>4!?>4? 34!>4!?>4? 4!?!?>4?

@ASFS ^ Sf K ^ Sf K ^ Sf K ^ Sf K ^ Sf K ^ Sf K ^ Sf K

4 Cd~pa~rfl 3?7km 5

33=,7km

∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘ 

? Ds~flgp 42>km ∘  ∘  ∘ P P ∘ 

3 ^ldyf 4=7km ∘  ∘  ∘ P P ∘ 

0 Sfkydspdpfj 40>km  ∘  ∘  ∘  ∘  ∘  ∘ +

7 Ldd`fjg 4C4 ∘  ∘  ∘  ∘  ∘ +

9 @X^

"kfks g`fsf

4> b*4>2&

44pdo  ∘  ∘  ∘  ∘ + ∘ Sp

a

~

= AOB Svrw~ 3C4 ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘ Sp

a

~

2 FS@J ?4>km ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘ Sp

a

~

6 Dkoraal

svrw~

3C4 ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘ Sp

a

~

4> Dkla`f~fjg 47km  ∘  ∘ +

Aodp

Swjpfe

4 Ldsf ?4dk~wl  ∘  ∘  ∘  ∘  ∘  ∘  ∘  ∘ Sp

a

~

? Lgyailadcfj 4

"7>>km!

4>>kl&

∘  ∘  ∘  ∘  ∘ 

Aodp

fjsf`gjpfl

4 Dl`dcpajg 4?7km ∘ 

PDJMMDL AODP

?9 HDJWD_F ?>4?   Hdk 42*>> " rdjfpf`fjg 4 dk~wl 5 iwrasgkf` 4 dk~wl 5 egparaldc 4

dk~wl&

  Hdk 46*?> "FS@J 7 km swo lfjmwdl&

  Hdk 46*0> "C^M 3>> km pdo5 ds~flgp pdo 49> km 5 Sfkydspdpfj ?>km 5 @X^ 7 km &

  Hdk ?>*47 Fjiws JdCl >,6' 7> cc `rf~ fsasarof` ?> km ?,7cc!hdk

@dpd Aodp

Ja* Jdkd Aodp Eak~asfsf Fj`fedsf @asfs Eajprdfj`fedsf Gige Sdk~fjm

4* Cd~pa~rfl

"kfks g`fsf

4> bdl*32&

Cd~pa~rfl

"DCG

fjbfofpar&

Bf~grpgjsf rfjmdj

s!` sg`djm*

Bf~grpgjsf ogrdp

"hfed pgrd~fspdj`dr pf`de

gigepfi dpdw pf`de

`d~dp `fmwjdedj&

@}s bf~grpgjsf

rfjmdj s!` sg`djm 

d}dl 4?,7km

?sgbdrf 5 `d~dp`fpfjmedpedj sgldjm

?+0 kfjmmw*

Bf~grpgjsf ogrdp 

Mldweakd, djgkfd,

bf~grpfraf`,

~gjfjmedpdj PFE,

fjidre kfacdr`fwk

]dhdb!lgbgr ~djds

egkgrdbdj, sdefp

eg~dld, mdjmmwdj

MF, `gjvwp jd`fcg~dp*

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6

d}dl 4?,7 km

?sgbdrf, `d~dp

`fpfjmedpedj

ogrpdbd~ `gjmdj

sgldjm }depw ~dlfjm

sg`fefp ? kfjmmw ,

kdesfkdl 47>

km!bdrf

@asfs wjpwe mdmdl hdjpwjm, ̀ asfs

fjfsfdl 9,?7 km

3sgbdrf, ̀ asfs

wjpwe ogrpdbdj

bf`w~ "swryfydl

ogjgifp& 7> km

3sgbdrf "fsa

idrkdeapgrd~f

b*69&

?* Ds~flgps

"kfks g`fsf4> b*=0&

Dcgpvlsdlfcvlfc

dcf`"Djpf~ldpglgp&

Kgjmwrdjmf rfsfea

sgrdjmdj fjidrekfaedr` ~d`d

~dsfgj `mj

rf}dvdp fjidre `dj

sgrdjmdj fsegkfd

sg~fjpds ogrwldjm

@asfs 4pdo!bdrf,

fjidre kfaedr`fwk`d~dp `fpfjmedpedj

s!` 3>>km!bdrf

Pwede ~g~pfe depfi,

bf~a~rapakofjgkfd,`dj mdjmmwdj

~gj`drdbdj ldfjjvd

Kwdl, mdjmmwdj MF,

bf~a~rapakofjgkfd

3* ^ldyf

"kfks g`fsf

4> b*==&

Cla~f`amrgl

"Djpf~ldpglgp&

kgjmwrdjmf

pgrhd`fjvd

dpgraselgrapfe

"fjidre kfaedr`,

spraeg, `dj

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47

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