Askep Penyakit Jantung Koroner Iskemia

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{\phpg\posx4200\pvpg\posy1600\absw4595\absh319 \li-5\ri-15 \expndtw-14 \dn0 \up0
\f10 \fs26 CORONARY ARTERY DESEASE/CAD \par}
\f10 \fs26 (= PENYAKIT JANTUNG KORONER/PJK = PENYAKIT JANTUNG ISKEMIA) \par}
\f10 \fs22 By. HASRAT JAYA ZILIWU, S.Kep \par}
{\phpg\posx2120\pvpg\posy3040\absw8963\absh249 \li-5\ri-15 \expndtw0 \dn0 \up0 \
f20 \fs22 Secara anatomis jantung mendapatkan supply nutrisi melalui arteri koro
ner yang beredar di \par}
f20 \fs22 seluruh otot-otot jantung (miocard). Bila terjadi obstruksi/bendungan
atau aterosklerosis, \par}
f20 \fs22 maka supply nutrisi ke miocard akan menjadi terganggu menyebabkan keti
dakadekuatnya \par}
\f20 \fs22 fungsi jantung sebagai pompa. \par}
f20 \fs22 Penyebab dari penyakit jantung koroner belum secara jelas diketahui, n
amum diduga ada \par}
\f20 \fs22 kaitannya dengan proses ateroskelerosis yang akan menyebabkan iskemia
miocard. \par}
\f20 \fs22 Faktor-faktor resiko timbulnya ateroskelerosis adalah : \par}
f20 \fs22 1. Non-modifiable : herediter/keturunan, sex/jenis kelamin, umur \par}

f20 \fs22 2. Midifiable : merokok, hipertensi, hiperlipidemia, obesitas, diabete
s melitus, gout, \par}
\f20 \fs22 kontrasepsi oral dan pola hidup \par}
f20 \fs22 Penyebab-penyebab lain dari Coronary Artery Desease adalah spasme, kel
ainan kongenital, \par}
\f20 \fs22 trombosis, emboli, trauma, peradangan, kompresi eksternal seperti tum
or. \par}
\f20 \fs22 Penyakit jantung koroner terdiri dari : \par}
f20 \fs22 1. Agina Pectoris \par}
f20 \fs22 2. Infark miokard \par}
\f10 \fs22 ANGINA PEKTORIS \par}
\f20 \fs22 Angina pectoris adalah suatu sindrom klinis berupa serangan sakit/nye
ri dada yang khas yaitu \par}
\f20 \fs22 seperti ditekan atau terasa berat di dada yang sering kali menjalar k
e lengan kiri. Hal ini biasa \par}
\f20 \fs22 timbul saat klien melakukan aktifitas dan segera hilang saat aktifita
s dihentikan. \par}
{\phpg\posx2120\pvpg\posy10064\absw8962\absh249 \li-5\ri-15 \expndtw1 \dn0 \up0
\f20 \fs22 Angina pectoris adalah nyeri dada atau ketidaknyamanan yang disebabka
n oleh iskemia \par}
\f20 \fs22 miokard, yang merupakan akibat dari ketidakseimbangan antara supply d
an kebutuhan \par}
\f20 \fs22 oksigen miokard (meskipun demikian angina pektoris dapat terjadi pada
klien dengan arteri \par}
\f20 \fs22 koroner normal). \par}
{\phpg\posx2120\pvpg\posy11411\absw790\absh203 \li-5\ri-15 \expndtw-9 \b \dn0 \u
p0 \f20 \fs22 Etiologi \par}
\f20 \fs22 Angina pektoris berkaitan dengan penyakit jantung koroner ateroskeler
otik (faktor pencetus) \par}
\f20 \fs22 yang mengakibatkan ketidakseimbangan oksigen demand dengan oksigen ya
ng dibutuhkan \par}
\f20 \fs22 miokard, tetapi dalam beberapa kasus dapat merupakan kelanjutan dari
stenosis aorta berat, \par}
\f20 \fs22 insufisiensi atau hipertrofi kardiomiopati tanpa/disertai obstruksi,
aortitis sifilitika, \par}
\f20 \fs22 peningkatan kebutuhan metabolik (seperti hipertiroidisme atau pasca p
engobatan tiroid), \par}
\f20 \fs22 anemia yang jelas, takikardi paroksismal dengan frekwensi ventrikular
cepat, emboli atau \par}

\f20 \fs22 spasme koroner. \par}
{\phpg\posx2120\pvpg\posy15038\absw4221\absh101 \li-5\ri-15 \expndtw-1 \i \dn0 \
up0 \f20 \fs11 Creted by Hasrat ; D:\\PROFIL WEBSITE\\ASKEP\\Askep Kardiovaskule
r\\Askep PJK.doc \par}
{\phpg\posx10023\pvpg\posy14914\absw236\absh249 \li-5\ri-15 \expndtw-26 \dn0 \up
0 \f20 \fs22 16 \par}
\sect\sectd\sbkpage\margtsxn1460\pard
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}}}
}}\margt1600\margb120\margr1540\margl2000
p0 \f20 \fs22 Patofisiologi \par}
f20 \fs22 Penimbunan lemak (lipid) dan jaringan fibrous pada dinding arteri koro
ner mengakibatkan \par}
f20 \fs22 penyempitan pembuluh darah koroner sehingga terjadi obstruksi/hambatan
aliran darah \par}
f20 \fs22 miokard. Keadaan ini menimbulkan ketidakseimbangan kebutuhan oksigen o
tot jantung \par}
\f20 \fs22 dengan supply oksigen ke otot jantung. \par}
p0 \f20 \fs22 Manifestasi klinis \par}
f20 \fs22 Perasaan seperti diikat atau ditekan yang bermula dari tengah dada yan
g secara bertahap \par}
\f20 \fs22 menyebar ke rahang bawah, permukaan dalam tangan kiri dan permukaan u
lnar jari manis dan \par}
f20 \fs22 jari kelingking kiri. Secara garis besar, ciri khas tanda dan gejala t
erjadinya angina pektoris \par}
\f20 \fs22 dapat dilihat dari letaknya (daerah yang terasa sakit), kualitas saki
t, hubungan timbulnya sakit \par}
f20 \fs22 dengan aktifitas dan lama serangan. Sakit biasanya timbul di daerah st
ernal, substernal atau \par}
f20 \fs22 dada sebelah kiri dan menjalar ke lengan kiri. Kualitas sakit yang tim
bul beragam, dapat \par}
f20 \fs22 seperti ditekan benda berat, dijepit atau terasa panas. Sakit dada bia
sanya timbul saat \par}
f20 \fs22 melakukan aktifitas dan hilang saat berhenti, dengan lama serangan ber
langsung antara 1 - 5 \par}
\f20 \fs22 menit. \par}
p0 \f20 \fs22 Perbedaan Pola Angina \par}
{\phpg\posx2323\pvpg\posy6477\absw760\absh152 \li-5\ri-15 \expndtw-6 \b \dn0 \up
0 \f20 \fs16 Observasi \par}
p0 \f20 \fs15 NYERI DADA \par}
{\phpg\posx2120\pvpg\posy7139\absw524\absh166 \li-5\ri-15 \expndtw-6 \dn0 \up0 \
f20 \fs15 Kualitas \par}
f20 \fs15 Lokasi \par}
f20 \fs15 penyebaran \par}
\f20 \fs15 dan \par}
p0 \f20 \fs16 Angina pektoris stabil \par}
p0 \f20 \fs16 Angina varian \par}
p0 \f20 \fs16 Angina pektoris tak stabil \par}
f20 \fs15 Sakit, tajam, kesemutan atau rasa \par}
\f20 \fs15 terbakar/tertekan \par}
f20 \fs15 Substernal dengan penyebaran ke \par}
\f20 \fs15 bahu kiri, bagian dalam bawah dari \par}
f20 \fs15 lengan kiri atau kedua lengan, \par}
f20 \fs15 leher, rahang dan skapula mungkin \par}
f20 \fs15 merupakan tempat penyebaran \par}
f20 \fs15 tambahan \par}
f20 \fs15 Awitan secara klasik berkaitan \par}
f20 \fs15 dengan latihan atau aktifitas yang \par}
f20 \fs15 meningkatkan kebutuhan oksigen \par}

f20 \fs15 miokard, mis. Latihan fisik, \par}
\f20 \fs15 mengangkat berat, stress emosional \par}
\f20 \fs15 dan suhu dingin \par}
\f20 \fs15 3 - 15 menit, berkurang dengan \par}
\f20 \fs15 istirahat, menghentikan aktifitas \par}
\f20 \fs15 penyebab nyeri, menggunakan \par}
\f20 \fs15 tablet nitrogliserin sublingual \par}
\f20 \fs15 Selama serangan angina : dispnea, \par}
\f20 \fs15 ansietas, diaforesis, kulit dingin \par}
\f20 \fs15 lembab \par}
\f20 \fs15 Normal selama periode tidak ada \par}
\f20 \fs15 gejala, selama serangan angina \par}
\f20 \fs15 frekwensi jantung meningkat, \par}
\f20 \fs15 pulsus berubah-ubah dan temuan \par}
\f20 \fs15 abnormal \par}
\f20 \fs15 bersifat \par}
\f20 \fs15 sementara \par}
\f20 \fs15 merupakan tonjolan prekordial dan \par}
\f20 \fs15 gallop ventrikel atau atrium. \par}
\f20 \fs15 Sama dengan angina pektoris stabil \par}
f20 \fs15 Sama dengan angina pektoris stabil, \par}
\f20 \fs15 tetapi mungkin lebih berat \par}
f20 \fs15 Faktor-faktor \par}
f20 \fs15 pencetus \par}
f20 \fs15 Awitan istirahat ; nyeri siklik, sering \par}
f20 \fs15 terjadi selama tidur (paling umum \par}
f20 \fs15 pagi hari) \par}
f20 \fs15 Nyeri dapat disebabkan sedikit \par}

\f20 \fs15 aktifitas biasa ; dapat terjadi pada saat \par}
f20 \fs15 istirahat \par}
\f20 \fs15 Durasi dan faktor \par}
\f20 \fs15 pereda \par}
\f20 \fs15 Secara khas nyeri meningkat dengan \par}
\f20 \fs15 cepat cenderung berakhir lebih lama \par}
\f20 \fs15 dibandingkan angina dan reda dengan \par}
\f20 \fs15 latihan \par}
\f20 \fs15 Lama dan biasanya tidak secara cepat \par}
\f20 \fs15 berkurang dengan istirahat atau \par}
\f20 \fs15 menggunakan nitrogliserin \par}
\f20 \fs15 Sama dengan angina pektoris stabil, \par}
\f20 \fs15 tetapi gejala mungkin menonjol dan \par}
\f20 \fs15 menetap, \par}
\f20 \fs15 mungkin \par}
\f20 \fs15 berhubungan \par}
\f20 \fs15 dengan mual \par}
\f20 \fs15 Sama dengan angina pektoris stabil, \par}
\f20 \fs15 tetapi dapat juga menunjukkan nadi \par}
\f20 \fs15 ireguler, hipotensi dan disfungsi \par}
\f20 \fs15 ventrikel kiri \par}
\f20 \fs15 Tanda dan gejala \par}
\f20 \fs15 yang berhubungan \par}
{\phpg\posx2120\pvpg\posy11675\absw1184\absh135 \li-5\ri-15 \expndtw-5 \b \dn0 \
up0 \f20 \fs15 PEMERIKSAAN \par}
p0 \f20 \fs15 FISIK \par}
up0 \f20 \fs22 Komplikasi \par}
\f20 \fs22 Komplikasi utama dari angina (stable) adalah unstable angina, infark
miocard, aritmia, gagal \par}

\f20 \fs22 jantung dan sudden death (mati tiba-tiba). \par}
0 \f20 \fs22 17 \par}
\sect\sectd\sbkpage\margtsxn1520\pard
{\shp
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108067204fb03012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}}}
}}\margt1600\margb120\margr1540\margl2120
p0 \f20 \fs22 Diagnosa klinis \par}
f20 \fs22 Dengan EKG didapatkan depresi segmen ST lebih dari 1 mm pada waktu mel
akukan \par}
f20 \fs22 latihan/aktifitas dan biasanya disertai sakit dada mirip seperti saat
serangan angina. \par}
f20 \fs22 Pemeriksaan enzim jantung seperti CPK-MB dan LDH. Pada pemeriksaan rad
ionukleid \par}
\f20 \fs22 didapatkan gambaran pengumpulan darah dengan technetium 99m angiograf
i koroner. \par}
p0 \f20 \fs22 Penatalaksanaan \par}
f20 \fs22 1. Pengobatan terhadap serangan akut \par}
f20 \fs22 Berupa pemberian Nitrogliserin sublingual tablet yang merupakan obat p
ilihan yang \par}
\f20 \fs22 bekerja sekitar 1 - 2 menit dan dapat diulang dengan interval 3 - 5 m
enit. \par}
f20 \fs22 2. Pencegahan serangan lanjutan \par}
\f20 \fs22 Long-acting nitrate, yaitu dengan pemberian ISDN 3 x 10-40 mg oral \p
ar}

\f20 \fs22 Beta blocker seperti Propanolol, Metoprolol, Nadolol, Atenol dan Pind
olol \par}
\f20 \fs22 Kalsium antagonis seperti Verapamil, Diltiazem, Nifedipin, Nikardipin
, atau Isradipin \par}
f20 \fs22 3. Tindakan invasif : Percutaneus transluminal coronary angiplasty (PT
CA), Laser coronary \par}
\f20 \fs22 angioplasty, Coronary artery bypass grafting(CABG) \par}
f20 \fs22 4. Olahraga disesuaikan \par}
\f10 \fs22 Asuhan Keperawatan Klien dengan Angina Pektoris \par}
p0 \f20 \fs22 Pengkajian \par}
\f20 \fs22 Sakit/nyeri dada \par}
f20 \fs22 dengan karakteristik sakit ringan sampai sakit berat ; dengan kualitas
\par}
f20 \fs22 nyeri tajam, kesemutan, tekanan atau rasa terbakar ; digambarkan klien
seperti berat, \par}
\f20 \fs22 terpelintir, rasa terbakar atau sesak pada dada ; dengan durasi berak
hir 5 sampai 30 menit. \par}
\f20 \fs22 Identifikasi faktor-faktor pencetus \par}
f20 \fs22 stress emosi atau fisik, pemajanan terhadap suhu \par}
\f20 \fs22 eksterm seperti dingin, makan terlalu banyak \par}
f20 \fs22 Identifikasi faktor-faktor yang meringankan \par}
f20 \fs22 penghilangan faktor pencetus, \par}
\f20 \fs22 menggunakan tablet Nitrogliserin \par}
f20 \fs22 Identifikasi tanda dan gejala yang berhubungan \par}
f20 \fs22 diaforesis, sakit kepala, berdebar- \par}
\f20 \fs22 debar, sesak nafas \par}
\f20 \fs22 Identifikasi timbulnya ansietas, tidak dapat mencerna/disfagia, kulit
pucat, sesak nafas \par}
\f20 \fs22 Monitoring takikardi, pulsus alternans, gallop atrium dan atau ventri
kel (S\dn4 \fs15 3\dn0 \fs22 , S\dn4 \fs15 4\dn0 \fs22 ) \par}
up0 \f20 \fs22 Diagnosa keperawatan \par}
\f20 \fs22 1. Nyeri dada berhubungan dengan ketidakseimbangan supply dan kebutuh
an oksigen \par}
\f20 \fs22 miokard. \par}
\f20 \fs22 Rencana tindakan : \par}

\f20 \fs22 o Pertahankan istirahat selama episode nyeri \par}
\f20 \fs22 o Kaji nyeri : lokasi, durasi, penyebaran dan awitan gejala baru \par
}
\f20 \fs22 o Berikan oksigen sesuai indikasi \par}
\f20 \fs22 o Monitor EKG selama fase nyeri angina \par}
\f20 \fs22 o Pantau TD dan nadi apikal selama episode nyeri \par}
\f20 \fs22 o Berikan obat sesuai indikasi ; kaji dan laporkan respon yang timbul
\par}
\f20 \fs22 o Pertahankan diet sesuai pesanan ; jika nyeri dada terjadi selama ma
kan, anjurkan \par}
\f20 \fs22 makanan kecil lebih dari 2 atau 3 makanan besar \par}
0 \f20 \fs22 18 \par}
}

Askep Penyakit Jantung Koroner Iskemia

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Askep Penyakit Jantung Koroner Iskemia

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{\rtf \ansi\ansicpg1252\deff0

{\fonttbl{\f11\fswiss\fcharset0 Arial Narrow;}{\f10\fswiss\fcharset0 Arial;}{\f1

f20 \fs22 1. Non-modifiable : herediter/keturunan, sex/jenis kelamin, umur \par}

{\phpg\posx2120\pvpg\posy13180\absw1553\absh249 \li-5\ri-15 \expndtw-5 \dn0 \up0

f20 \fs15 meningkatkan kebutuhan oksigen \par}

f20 \fs15 Nyeri dapat disebabkan sedikit \par}

{\phpg\posx2120\pvpg\posy13817\absw3964\absh249 \li-5\ri-15 \expndtw-3 \dn0 \up0

{\phpg\posx2798\pvpg\posy4723\absw7091\absh249 \li-5\ri-15 \expndtw-2 \dn0 \up0

\f20 \fs22 Rencana tindakan : \par}

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