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Wednesday 19 December 2012

HEART FAILURE


HEART FAILURE (HEART FAILURE)

A. Understanding.
A failure of the heart to pump blood to meet the body's needs (Purnawan Junadi, 1982).
Congestive heart failure is a failure of pumping (in which the cardiac output is not sufficient for metabolic body), this may occur as a result of the end of heart problems, blood vessel or the capacity of the oxygen carried in the blood that cause the heart can not meet the need of oxygen to the organ erbagai (Ni Luh Gede Yasmin, 1993).

B. Incident
Heart failure can be experienced by every person of every age. For example, neonates with congenital heart disease or adults with heart disease and atherosclerosis, middle age and older often heart failure (Ni Luh Gede Yasmin, 1993) ..

C. Pathophysiology
Normal heart to respond to increased metabolic needs using a variety of compensatory mechanisms to maintain cardiac output. These may include: the sympathetic nervous system responses to baro receptors or chemoreceptors, tightening and widening of the heart muscle to match your volume increases, vasokonstyrinksi renal artery and activation of renin-angiotensin system and the response to serum-serum sodium and fluid reabsorption regulation of ADH.
Failure of compensatory mechanisms brought forward by the volume of blood in circulation pumped to oppose increase in vascular resisitensi by tightening the heart. Memperpendeka time heart rate and coronary artery ventricular filling, decreased cardiac output lead to a decrease in myocardial oxygenation.
Increased pressure due to dilation of blood vessel walls causing an increase tunutan oxygen and cardiac enlargement (hypertrophy), especially in ischemic heart or damage, which led to the failure of the pumping mechanism

Kegaglan heart failure can be expressed as the left or right side of the heart. Failure on one side of the heart may lead to a failure on the other side and the clinical manifestations are often reveals total pumping failure. Clinical manifestations of right heart failure are: edema, venous distention, ascites, weight loss, nocturia, anorexia, increased right atrial pressure, peripheral venous pressure.
Clinical manifestations of left-sided heart failure are: dyspnea on effort, orthopnea, cyanosis, batuuk, bloody sputum, weakness, increased pulmonary capillary pressure, increased left atrial pressure.
D. Mechanisms of hypertension increases the risk of
When most diastolic pressure readings remain at or above 90 mmHg after 6-12 months without drug therapy, that person is considered hypertension and additional risk for coronary heart disease.
Simply put in say an increase in blood pressure and arteriosclerosis thus accelerating atherosclerosis and occlusive vascular rupture occurred about 20 years earlier than those with normotensive. Most of the mechanisms involved in the increase in blood pressure mengkibatkan structural changes in the blood vessels, but the pressure in some way involved. Consequently, the higher the blood pressure, the greater the amount of vascular damage.

E. Nursing Care In Clients With Heart Failure
1. Assessment
a. Activity and rest
Weakness, fatigue, inability to sleep (maybe in getting Tachycardia and dyspnea at rest or on exertion).

b. Circulation
Have a history of IMA, coronary heart disease, CHF, high blood pressure, diabetes mellitus.
Blood pressure may be normal or elevated, the pulse may be normal or delayed capilary refill time, dysrhythmias.
Heart sound, extra heart sounds S3 or S4 may reflect the occurrence of heart failure / ventricular lose kontraktilitasnya.
Murmur if there is a result of muscular insufisensi valve papillary or non-functioning.
Heart rate may increase or decrease repetition (or bradi tachy cardia).
Or irregular heart rhythms may also normal.
Edema: jugular venous distension, edema anasarka, crackles may also arise with heart failure.
Skin color may pale in both lips and nails.
c. Elimination
Bowel sounds may be increased or even normal.
d. Nutrition
Nausea, loss of appetite, decreased skin turgor, sweating, vomiting and weight change.
e. Personal hygiene
Dyspnea or chest pain or chest palpitations when doing activities.
f. Neoru sensory
Severe headache, Changes mentation.
g. Comfort
Onset of chest pain suddenly unrelieved by rest or nitroglycerin.
Location chest pain front substerbnal may spread to the arms, jaw and face.
Characteristics of the pain can be said as the severe pain that ever experienced. As a result of the pain may be in getting a grinning face, body pustur changes, crying, decreased eye contact, changes in heart rhythm, ECG, blood pressure, respiration and skin color and level of consciousness.
h. Respiration
Dyspnea with or without activity, productive cough, smokers with a history of chronic respiratory disease. On examination may get an increase in respiration, pallor or cyanosis, breath sounds or wheezes crakcles or vesicular well. Sputum clear or too pink / pink tinged.
i. Social Interaction
Stress, difficulties in adapting to stressors, uncontrolled emotions.
j. Knowledge
History in the family is suffering from heart disease, diabetes, stroke, hypertension, smokers.
k. Diagnostic studies
ECG showed: a ST elevation is a sign dri ischemia, T wave inversion or loss which is a sign of injury, and Q waves reflect necrosis.
Enzymes and isoenzym at heart: CPK-MB increased in 4-12 hours, and reached a peak at 24 hours. Increased AST within 6-12 hours and peaks at 36 hours.
Electrolytes: imbalance that allows the reduction in cardiac conduction, and cardiac contractility as hypo or hyperkalemia.
Whole blood cell: leukocytosis may occur on the next day after the attack.
Blood gas analysis: Indicates the occurrence of hypoxia or chronic lung disease or acute.
Cholesterol or trigliseid: may have increased resulting in arteriosclerosis.
Chest X-ray: may be normal or there cardiomegali, CHF, or ventricular aneurysm.
Echocardiogram: Probably should be done in order to describe the function or capacity of each chamber of the heart.
Exercise stress test: Demonstrate the ability of the heart to adapt to the stress / activity.

2. Nursing diagnosis and plan of action
a. Impaired sense of comfort pain associated with tissue ischemia heart
Purpose:
After nursing actions in the hope that the client is able to show a decrease in chest pain, showed a drop in pressure and how to relax.
Plan:
1. Monitor and assess the characteristics and location of pain.
2. Monitor vital signs (blood pressure, pulse, respiration, consciousness).
3. Instruct the patient to immediately report instances of chest pain.
4. Create an atmosphere of calm and comfortable environment.
5. Teach and encourage the patient to do relaxation techniques.
6. Collaboration in:
- Provision of oxygen.
- Medications (beta blockers, anti-angina, analgesics)
7. Measure vital signs before and after treatment with narkosa.
b. Activity intolerance related to imbalance between oxygen supply and demand, and the presence of necrotic tissue in myocardial ischemia.
Objective: after doing action menunnjukan client care increased ability to perform activities (blood pressure, pulse, rhythm within normal limits) the absence of angina.
Plan:
1. Record the heart rhythm, blood pressure and pulse before, during and after activity.
2. Instruct the patient to have more rest first.
3. Instruct patients not to "ngeden" during defecation.
4. Explain to patients about the stages of activities that may be performed by the patient.
5. Patients show signs of activity fisiki that exceed the limit.

c. The risk of a decline in cardiac output associated with changes in the rate, rhythm, cardiac conduction, the decrease preload or increased SVR, miocardial infarction.
Goal: no decline in cardiac output during nursing actions undertaken.
Plan:
1. Perform blood pressure measurements (compare arms standing, sitting and lying down if possible).
2. Assess the quality of the pulse.
3. Note the development of the S3 and S4.
4. Auscultation breath sounds.
5. Stay with the patient at the time of the activity.
6. Serve food that is easy to digest and reduce the consumption of kafeine.
7. Collaboration in: examination of serial ECG, thorax photo, provision of medicines anti dysrhythmias.

d. The risk of decreased tissue perfusion associated with decreased blood pressure, hypovolemia.
Purpose: for the action of nursing is not a decline in tissue perfusion.
Plan:
1. Assess the change of consciousness.
2. Inspection of the pale, cyanosis, cold skin and decreased peripheral pulse quality.
3. Kaji Homans sign (pain in calf on dorsoflextion), erythema, edema.
4. Assess respiration (rhythm, and effort into breathing).
5. Assess the function of the gastrointestinal (bowel sounds, abdominal distension, constipasi).
6. Monitor intake and output.
7. Collaboration in: Examination ABG, BUN, serum ceratinin and electrolytes.

e. The risk of excess fluid imbalances associated with decreased organ perfusion (renal), increased sodium retention, decreased plasma protein.
Goal: avoid excess fluid in the body the client during the treatment.
Plan:
1. Auscultation of breath flare (examine the crackless).
2. Jugular vein distension Kaji, increased occurrence of edema.
3. Measure intake and output (fluid balance).
4. Assess body weight every day.
5. Najurkan the patient to consume a maximum of 2000 total liquids cc/24 hours.
6. Serve a meal with a low-salt diet.
7. Collaboration in the provision deuritika.

REFERENCES

Barbara C long. (1996). Medical Surgical Nursing. Pajajaran Bandung.

Carpenito J.L. (1997). Nursing Diagnosis. J.B Lippincott. Philadelpia.

Carpenito J.L. (1998.). Handbook of Nursing Diagnosis. Edition 8 EGC. Jakarta.

Doengoes, Marylin E. (2000). Nursing Care Plans and Documentation. Issue 3 EGC. Jakarta.

Hudack & Galo. (1996). Critical Care. Holistic Approach. VI edition, volume I EGC. Jakarta.

Junadi, Purnawan. (1982). Capita Selekta Medicine. Media Aesculapius University of Indonesia. Jakarta.

Kaplan, Norman M. (1991). Prevention of Coronary Heart Disease. EGC Jakarta.

Lewis T. (1993). Disease of the Heart. Macmillan. New York.

Marini L. Paul. (1991). ICU Book. Lea & Febriger. Philadelpia.

Morris D. C. et.al, The Recognation and Treatment of Myocardial Infarction and It'sComplication.

Health Manpower Education Center. (1993). Nursing Process System In Patients With Impaired Krdiovaskuler. Department of Health. Jakarta.

Tabrani. (1998). Emergency Agenda. Pembina Science. Bandung.

(1994). Guidelines for Diagnosis and Treatment of Heart Disease Studies. Airlangga University Faculty of Medicine & dr Soetomo

1 comment:

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