LAPORAN PENDAHULUAN REUMATHIC HEART DISEASE DI RUANG ICCU RSD dr. SOEBANDI JEMBER
DISUSUN OLEH : EKO PRAYUGO SAPUTRO (14.401.11.029)
AKADEMI KESEHATAN RUSTIDA PROGRAM PROGR AM STUDI STUD I DIII KEPERAW KEPERAWATAN KRIKILAN – GLENMORE – BANYUWANGI BANYUWANGI 2013 – 2014
BAB I PENDAHULUAN
A. Latar Bea!a"#
Pe"$a!%t &a"t'"# re'at%! (PR) a*aa+ ,aa+ ,at' !-%!a,% $a"# e/a+a$a!a" *ar% *ea re'at%!.Pe"$a!%t &a"t'"# re'at%! a*aa+ ,e/'a+ !-"*%,% *%a"a ter&a*% !er',a!a" era"e" *ar% !at'!at' &a"t'"# $a"# *%,e/a/!a" -e+ *ea re'at%!. Kat'!at' &a"t'"# ter,e/'t r',a! !are"a r-,e, er&aa"a" e"$a!%t $a"# *%'a% *e"#a" %"e!,% te"##-r-!a" $a"# *%,e/a/!a" -e+ /a!ter% Stret--', 3 +e-%t%', t%e A (-"t-+: Stret--', $-#e"e,) /a!ter% $a"# /%,a e"$e/a/!a" *ea re'at%!. Se/a"$a! !'ra"# e/%+ 59 6 a,%e" *e"#a" *ea re'at%! a!'t /%,a ter&a*% !ea%"a" a*a &a"t'"# 'a% *ar% #a"##'a" !at' #a#a &a"t'"# er%!ar*%t%, (ra*a"# ,ea't &a"t'"#) /a+!a" !eat%a".De"#a" e"$a!%t &a"t'"# re'at%! $a"# !r-"%! a*a a,%e" /%,a ter&a*% ,te"-,%, !at' (#a"##'a" !at') e/e,ara" atr%' (r'a"# &a"t'"#) ar%t%a (#a"##'a" %raa &a"t'"#) *a" #a"##'a" '"#,% 7e"tr%!e (r'a"# &a"t'"#).Pe"$a!%t &a"t'# re'at%! a,%+ e"&a*% e"$e/a/ ,te"-,%, !at' %tra *a" e"##a"t%a" !at' a*a -ra"# *e8a,a *% Aer%!a Ser%!at. RHD ter*aat *%,e'r'+ *'"%a. Le/%+ *ar% 100.000 !a,', /ar' *ea reat%! *%*%a#"-,a ,et%a ta+'""$a !+',',"$a a*a !e--! a"a! ',%a 1 ta+'". ;e"*er'"# ter&a"#!%t a*a *aera+ *e"#a" '*ara *%"#%" e/a/ %"#!'"#a" $a"# !-"*%,% !e/er,%+a" *a" #%<%"$a !'ra"# ea*a%.See"tara *%"e#ara a&' %",%*e" e"$a!%t %"% 'a% e"'r'" !are"a t%"#!at ere!-"-%a" e/%+ /a%! *a" 'a$a e"e#a+a" e"$a!%t e/%+ ,e'r"a. Dar% *ata = r'a+ ,a!%t *% I"*-"e,%a ta+'" 19=519= e"'"&'!a" !a,', RHD ratarata 544 > *ar% ,e'r'+ &'a+ e"*er%ta $a"# *%ra8at.Seara Na,%-"a -rta%ta, a!%/at RHD '!' t%"##% *a" %"% er'a!a" e"$e/a/ !eat%a" 'taa e"$a!%t &a"t'"# ,e/e' ',%a 40 ta+'".
B. R'',a" ?a,aa+ 1. Aa *e%"%,% R+e'at% Heart D%,ea,e@ 2. Aa et%--#% R+e'at% Heart D%,ea,e@ 3. Ba#a%a"a eer%!,aa" D%a#"-,t%! Pe"'"&a"#R+e'at% Heart D%,ea,e@ 4. Aa !-%!a,% R+e'at% Heart D%,ea,e@ 5. Ba#a%a"a r-#"-,%, R+e'at% Heart D%,ea,e@ 6. Ba#a%a"a !a,%%!a,% R+e'at% Heart D%,ea,e@ 7. Ba#a%a"a a"%e,ta,% !%"%! R+e'at% Heart D%,ea,e@ 8. Ba#a%a"a e"ataa!,a"aa" R+e'at% Heart D%,ea,e@ 9. Ba#a%a"a at-%,%--#% ,e!a%#', a,!e a*a a,%e" R+e'at% Heart D%,ea,e@
C. T'&'a"
1. T'&'a" U'
D%+ara!a" a+a,%,8a *aat e"#eta+'% *a" ea+a% /a%! !-",e e"$a!%t RHD a''" !-",e !eera8ata" a*a !%e" *e"#a" Re'at-%* Heart D%,ea,e( RHD ). 2. T'&'a" K+',',
A#ar e/aa e"#eta+'%: 1) De%"%,% R+e'at% Heart D%,ea,e 2) Et%--#% R+e'at% Heart D%,ea,e 3) Peer%!,aa" D%a#"-,t%! Pe"'"&a"#R+e'at% Heart D%,ea,e 4) K-%!a,% R+e'at% Heart D%,ea,e 5) Pr-#"-,%, R+e'at% Heart D%,ea,e 6) Ka,%%!a,% R+e'at% Heart D%,ea,e 7) ?a"%e,ta,% !%"%! R+e'at% Heart D%,ea,e 8) Pe"ataa!,a"aa" R+e'at% Heart D%,ea,e 9) Pat-%,%--#% ,e!a%#', a,!e a*a a,%e" R+e'at% Heart D%,ea,e.
BAB II PE?BAHASAN
A. DEENISI
Pe"$a!%t &a"t'"# reat%! (PR) ata' *aa /a+a,a e*%,"$a r+e'at% +eart *%,ea,e (RHD) a*aa+ ,'at' !-"*%,% *%a"a ter&a*% !er',a!a" a*a !at' &a"t'"# $a"# /%,a /er'a e"$e%ta" ata' !e/--ra" ter'taa !at' %tra ,e/a#a% a!%/at a*a"$a #e&aa ,%,a *ar% *ea reat%!. Dea reat%! er'a!a" ,'at' e"$a!%t ,%,te%! $a"# *aat /er,%at a!'t ,'/a!'t !r-"%! ata' '%"a" *a" *aat ter&a*% ,etea+ %"e!,% Stret--', /eta +e-$t%', #r-' A a*a ,a'ra" er"aa,a" /a#%a" ata,. Dea re'at%! a!'t *%ta"*a% -e+ *ea /er!ea"&a"#a" &a"t'"# /er*e/ar !era, !a*a"# eat ea+. P'"a! %",%*e" *ea reat%! ter*aat a*a !e--! ',%a 1 ta+'" e"$a!%t %"% &ara"# *%&'a% a*a a"a! *%/a8a+ ',%a 4 ta+'" *a" e"*'*'! *% ata, 0 ta+'". R+e'at% e7er a*aa+ ,'at' e"$a!%t %"aa,% a!'t $a"# *%a!%/at!a" -e+ %"e!,% ,tret--', 3 +e-$t% #r-' A a*a te"##-r-!a" (ar%"#%t%,) teta% ta"a *%,erta% %"e!,% a%" ata' t%*a! a*a %"e!,% ,tret--', *% teat a%" ,eert% *% !'%t. Kara!ter%,t%! r+e'at% e7er e"*er'"# /er'a"# (re'rre"e) (U*&%a"t% 2010). R+e'at% e7er ter*%r% ata, /e/eraa a"%e,ta,% !%"%, 1) art+r%t%, (a%"# ,er%"#) 2) ar*%t%, (a%"# ,er%',) 5) +-rea (a%"# &ara"# *a" t%*a! /er!a%ta") 4) ,'/'ta"e-', "-*'e ) er$t+ea ar#%"at' (U*&%a"t% 2010). Se,e-ra"# $a"# e"#aa% *ea reat%! aa/%a t%*a! *%ta"#a"% ,eara a*e!'at ?a!a ,a"#at '"#!%" ,e!a% e"#aa% ,era"#a" e"$a!%t &a"t'"# reat%!. I"e!,% -e+ !'a" Stret--', Beta He-$t%', #r-' A $a"# e"$e/a/!a" ,e,e-ra"# e"#aa% *ea reat%! *%a"a *%a8a% ter&a*%"$a era*a"#a" a*a ,a'ra" te"##-r-!a" *%!are"a!a" e"ataa!,a"aa" *a" e"#-/ata""$a $a"# !'ra"# terara+ e"$e/a/!a" ra'"t-C%" *ar% !'a" %"% e"$e/ar ea'% ,%r!'a,% *ara+ *a" e"#a!%/at!a" era*a"#a" !at' &a"t'"#. A!%/at"$a *a'"*a'" !at' e"#aa% ere"#!eta" ,e+%"##a e"$e%t ata' e"e/a *a" e"#!er't ,e+%"##a !aa' e"'t' t%*a! ,e'r"a a#% *a" ter&a*% !e/--ra".
B. ETIOLOGI
Pe"$e/a/ ter&a*%"$a e"$a!%t &a"t'"# re'at%! *%er!%ra!a" a*aa+ rea!,% a't-%'" (!e!e/aa" t'/'+) $a"# *%,e/a/!a" -e+ *ea re'at%!. I"e!,% ,tret--', 3 +e-%t%!', #r' A a*a te"##-r-! ,ea' e"*a+''% ter&a*%"$a *ea re'at%! /a%! *ea re'at%! ,era"#a" ertaa a''" *ea re'at%! ,era"#a" 'a"#.
a!t-ra!t-r re*%,-,%,% ter&a*%"$a e"$a!%t &a"t'"# reat%! R+e'at% Heart De,ea,e ter*aat a*a *%r% %"*%7%*' %t' ,e"*%r% *a" &'#a a!t-r %"#!'"#a". a!t-r *ar% I"*%7%*' *%a"tara"$a $a%t' : 1. a!t-r #e"et%!
A*a"$a a"t%#e" %-,%t a"',%a ( HLA ) $a"# t%"##%. HLA ter+a*a *ea reat%! e"'"&'!a" +'/'"#a" *e"#a" a-a"t%#e" ,e B ,e,%%! *%!e"a *e"#a" a"t%/-*% -"-!-"a *e"#a" ,tat', re'at%!',. 2. U'r
U'r a#a!"$a er'a!a" a!t-r re*%,-,%,% tere"t%"# a*a t%/'"$a *ea re'at%! e"$a!%t &a"t'"# re'at%!. Pe"$a!%t %"% a%"# ,er%"# e"#e"a% a"a! ''r a"tara 1 ta+'" *e"#a" '"a! ,e!%tar ''r = ta+'". T%*a! /%a,a *%te'!a" a*a a"a! a"tara ''r 5 ta+'" *a" ,a"#at &ara"# ,e/e' a"a! /er''r 5 ta+'" ata' ,etea+ 20 ta+'". D%,tr%/',% ''r %"% *%!ata!a" ,e,'a% *e"#a" %",%*e", %"e!,% ,tret--', a*a a"a! ',%a ,e!-a+. Teta% ?ar!-8%t< e"e'!a" /a+8a e"*er%ta %"e!,% ,tret--', a*aa+ ere!a $a"# /er''r 2 ta+'". 3. Kea*aa" #%<% *a" a%"a%"
Kea*aa" #%<% ,erta a*a"$a e"$a!%te"$a!%t a%" /e' *aat *%te"t'!a" aa!a+ er'a!a" a!t-r re*%,-,%,% '"t'! t%/'"$a *ea re'at%!. 4. G--"#a" et"%! *a" ra,
Data *% Aer%!a Utara e"'"&'!!a" /a+8a ,era"#a" ertaa a''" 'a"# *ea re'at%! e/%+ ,er%"# *%*aat!a" a*a -ra"# !'%t +%ta *%/a"*%"# *e"#a" -ra"# !'%t 't%+. Teta% *ata %"% +ar', *%"%a% +at%+at% ,e/a/ '"#!%" /er/a#a% a!t-r %"#!'"#a" $a"# /er/e*a a*a !e*'a #--"#a" ter,e/'t %!'t /erera" ata' /a+!a" er'a!a" ,e/a/ $a"# ,e/e"ar"$a. 5. e"%, !ea%"
Dea re'at%! ,er%"# *%*aat!a" a*a a"a! 8a"%ta *%/a"*%"#!a" *e"#a" a"a! a!% a!%. Teta% *ata $a"# e/%+ /e,ar e"'"&'!!a" t%*a! a*a er/e*aa" &e"%, !ea%" e,!%'" a"%e,ta,% terte"t' '"#!%" e/%+ ,er%"# *%te'!a" a*a ,at' &e"%, !ea%". 6. Rea!,% a't-%'"
Dar% e"e%t%a" *%te'!a" a*a"$a !e,aaa" a"tara -%,a!ar%*a /a#%a" *%"*%"# ,e ,tret-!-!', /eta +e-%t%!', #r-' A *e"#a" #%!-r-te%" *aa !at'/ '"#!%" %"% e"*'!'"# ter&a*%"$a %-!ar*%t%, *a" 7a7'%t%, a*a re'at%! e7er.
a!t-ra!t-r *ar% %"#!'"#a" %t' ,e"*%r% : A. Kea*aa" ,-,%a e!-"-% $a"# /'r'!
?'"#!%" %"% er'a!a" a!t-r %"#!'"#a" $a"# tere"t%"# ,e/a#a% re*%,-,%,% '"t'! ter&a*%"$a *ea reat%!. I",%*e", *ea re'at%! *% "e#ara"e#ara $a"# ,'*a+ a&' &ea, e"'r'" ,e/e' era a"t%/%-t%! tera,'! *aa !ea*aa" ,-,%a e!-"-% $a"# /'r'! ,a"%ta,% %"#!'"#a" $a"# /'r'! r'a+r'a+ *e"#a" e"#+'"% a*at re"*a+"$a e"*%*%!a" ,e+%"##a e"#ert%a" '"t'! ,e#era e"#-/at% a"a! $a"# e"*er%ta ,a!%t ,a"#at !'ra"# e"*aata" $a"# re"*a+ ,e+%"##a /%a$a '"t'! era8ata" !e,e+ata" !'ra"# *a" a%"a%". Se'a +a %"% er'a!a" a!t-ra!t-r $a"# e'*a+!a" t%/'"$a *ea re'at%!. B. ;'aa
Per'/a+a" 'aa $a"# e"*a*a! ,er%"# e"#a!%/at!a" %",%*e", %"e!,% ,a'ra" "aa, /a#%a" ata, e"%"#!at ,e+%"##a %",%*e", *ea re'at%! &'#a e"%"#!at. C. I!% *a" #e-#ra%
Dea re'at%! er'a!a" e"$a!%t !-,--%t. Pe"$a!%t ter/a"$a! *%*aat!a" *%*aera+ $a"# /er%!% ,e*a"# teta% *ata a!+%ra!+%r %"% e"'"&'!!a" /a+8a *aera+ tr-%, '" e'"$a% %",%*e", $a"# t%"##% e/%+ t%"##% *ar% $a"# *%*'#a ,e'a. D%*aera+ $a"# eta!"$a a#a! t%"##% a#a!"$a a"#!a !e&a*%a" *ea reat%! e/%+ t%"##% *ar%a*a *%*atara" re"*a+.
;.
PATOISIOLOGI
?e"'r't +%-te,a Kaa" *!! (2004) *a" a/r%,!%e (2010) ter&a*%"$a &a"t'"# reat%! *%,e/a/!a" a"#,'"# -e+ *ea reat%! ,'at' e"$a!%t ,%,te%! $a"# *%,e/a/!a" -e+ %"e!,% ,tret-!-!', #r' A. *ea reat%! ee"#ar'+% ,e'a er,e"*%a" e"$e/a/!a" -%artr%t%,. a"t'"# er'a!a" -r#a" ,a,ara" *a" er'a!a" /a#%a" $a"# !er',a!a""$a a%"# ,er%',. Ker',a!a" &a"t'"# *a" e,% ,e"*% /'!a" a!%/at %"e!,% art%"$a &ar%"#a" ter,e/'t t%*a! e"#aa% %"e!,% ata' ,eara a"#,'"# *%r',a! -e+ -r#a"%, ter,e/'t "a'" +a %"% er'a!a" e"-e"a ,e",%t%7%ta, ata' rea!,% $a"# ter&a*% ,e/a#a% re,-" ter+a*a ,tret-!-!', +e-%t%!',. Le'!-,%t *ara+ a!a" tert%/'" a*a &ar%"#a" $a"# ter!e"a *a" e/e"t'! "-*' $a"# !e'*%a" a!a" *%#a"t% *e"#a" &ar%"#a" ar't. ?%-!ar*%' te"t' ,a&a ter%/at *aa r-,e, %"aa,% %"% art%"$a /er!e/a"#a+ %-!ar*%t%, reat%! $a"# ,ee"tara eea+!a" te"a#a !-"tra!,% &a"t'"#. De%!%a" 'a er%ar*%' &'#a ter%/at art%"$a &'#a ter&a*% er%ar*%t%, reat%! ,eaa er&aa"a" a!'t e"$a!%t. K-%!a,% %-!ar*%a *a" er%ar*%a /%a,a"$a ta"a e"%"##a!a" #e&aa ,%,a $a"# ,er%',. Na'" ,e/a%!"$a e"*-!ar*%t%, reat%! e"#a!%/at!a" ee! ,a%"# !eaata" era"e". E"*-!ar*%t%, reat%! ,eara a"at-%, *%a"%e,ta,%!a" *e"#a" a*a"$a t'/'+a" !e% $a"# tra",ara" $a"# e"$er'a% a"%! *e"#a" '!'ra" ,e/e,ar !eaa &ar' e"t' ter,','" *aa *ereta" ,ea"&a"# te% /%a+ !at'. ?a"%a"%! !e% %t' t%*a! taa! /er/a+a$a *a" *aat e"#+%a"# ta"a er',a! /%a+ !at' "a'" $a"# e/%+ ,er%"# ere!a e"%/'!a" ee! ,er%',. ?ere!a e"&a*% a8a ter&a*%"$a ,'at' r-,e, $a"# ,eara /erta+a
e"e/a!a" /%a+/%a+ !at' e"$e/a/!a" e"&a*% ee"*e! *a" e"e/a *%,/a"*%"# $a"# "-ra ,e+%"##a t%*a! *aat e"'t' *e"#a" ,e'r"a. Ter&a*%a+ !e/--ra" ,'at' !ea*aa" $a"# *%,e/'t re#'r#%ta,% !at'. Teat $a"# a%"# ,er%"# e"#aa% re#'r#%ta,% !at' a*aa+ !at' %tra.
D. ?ANIESTASI KLINIS
Pe"*er%ta ''"$a e"#aa% ,e,a! "aa, $a"# *%,e/a/!a" &a"t'"#"$a ,'*a+ e"#aa% #a"##'a" "$er% ,e"*% $a"# /er%"*a+ %"*a+ /era! !eera+a" *% !'%t $a"# /er/ata, #era!a" ta"#a" $a"# ta! /erat'ra" *a" ta! ter!e"*a% (!-rea) ata' /e"&-a" !e%!e% *%/a8a+ !'%t. Sea%" %t' ta"*a $a"# &'#a t'r't e"$erta%"$a a*aa+ "$er% er't !e+%a"#a" /erat /a*a" eat ea+ *a" te"t' ,a&a *ea. Dea re'at%! er'a!a" !''a" ,e&'a+ #e&aa *a" ta"*a !%"%!. Dea re'at%! er'a!a" e"$a!%t a*a /a"$a! ,%,te e"#e"a% ter'taa &a"t'"# ,e"*% -ta! *a" &ar%"#a" !'%t. Ta"*a *a" #e&aa a!'t *ea re'at%! /er7ar%a,% ter#a"t'"# -r#a" $a"# ter%/at *a" *era&at !eter%/ata""$a. B%a,a"$a #e&aa#e&aa %"% /era"#,'"# ,at' ,aa% e"a %"##' ,etea+ %"e!,% -e+ Stret--',. Ge&aa !%"%, a*a e"$a!%t &a"t'"# re'at%! /%,a /er'a #e&aa !ar*%a! (&a"t'"#) *a" "-" !ar*%a!. Ge&aa"$a a"tara a%": 1. ?a"%e,ta,% !ar*%a! *ar% *ea re'at%! a) (%"e!,% *a" era*a"#a" &a"t'"#) a*aa+ !-%!a,% a%"# ,er%', *a" !e*'a
a%"# '' *ar% *ea re'at%! (,e!%tar 0 6). Pa*a !a,',!a,', $a"# e/%+ a"&'t a,%e" *aat e"#e'+ ,e,a! "aa, *a*a tera,a t%*a! "$aa" "$er% *a*a e*ea (/e"#!a!) /at'! ata' -rt-"e' (,e,a! ,aat /er/ar%"#) b) Pa*a eer%!,aa" %,%! !ar*%t%, (era*a"#a" a*a &a"t'"#) ''"$a *%*ete!,%
*e"#a" *%te'!a""$a /%,%"# &a"t'"# (#a"##'a" /'"$% &a"t'"#) ata' ta!%!ar*%a (&a"t'"# /er*eta! F 100Ce"%t) *%'ar ter&a*%"$a *ea c) ?a"%e,ta,% !ar*%a! a%" a*aa+ #a#a &a"t'"# !-"#e,t% *a" er%!ar*%t%, (ra*a"#
,ea't &a"t'"#) d) Pa,%e" *e"#a" *%a#"-,%, *ea re'at%! a!'t +ar', *%!-"tr- ,e,er%"# '"#!%"
!are"a r-#re,%%ta, e"$a!%t"$a e) ?'r'r (/%,%"# &a"t'"#) /ar' ata' er'/a+a" /'"$% 'r'r. ?'r'r $a"#
*%*e"#ar a*a *ea re'at%! a!'t /%a,a"$a *%,e/a/!a" -e+ %",'%,%e",% !at' (#a"##'a" !at'). f)
Ga#a &a"t'"# !-"#e,t% Ga#a &a"t'"# *aat ter&a*% ,e!'"*er a!%/at %",'%,%e",% !at' $a"# /erat ata' %-!ar*%t%, (ra*a"# a*a ,e -t-t &a"t'"#)
g) Per%!ar*%t%,
2. Ge&aa '' "-" !ar*%a! *a" a"%e,ta,% a%" *ar% *ea reat%! a!'t a"tara a%":
a) P-%artr%t%, (era*a"#a" a*a /a"$a! ,e"*%) a*aa+ #e&aa '' *a" er'a!a"
a"%e,ta,% a8a *ar% *ea re'at%! (0 6). U'"$a artr%t%, (ra*a"# ,e"*%) *%'a% a*a ,e"*%,e"*% /e,ar *% e!,tre%ta, /a8a+ ('t't *a" e"#!e) a' /er%#ra,% !e ,e"*%,e"*% /e,ar a%" *% e!,tre%ta, ata, ata' /a8a+ (,%!' *a" er#ea"#a" ta"#a"). Se"*% $a"# ter!e"a a!a" tera,a ,a!%t /e"#!a! tera,a +a"#at er%te *a" er#era!a" ter/ata,. Be"#!a! *a" '"a! a*a er,e"*%a" "$er% $a"# /er%"*a+%"*a+. a-'*, art+r%t%, (r-"% -,t r+e'at% e7er art+r-at+$) $a%t' *e-r%ta, &ar% ta"#a" *a" !a!% /er'a '"ar *e7%a,% e!,% ,e"*% etaar-aa"#ea +%ere!,te",% ,e"*% r-!,%a %"teraa"#ea. Ge&aa artr%t%, e"aa% '"a!"$a a*a 8a!t' 12 24 &a *a" /erta+a" *aa 8a!t' 2 +ar% (&ara"# ter&a*% e/%+ *ar% 5 %"##') *a" /ere,-" ,a"#at /a%! *e"#a" e/er%a" a,%r%". P-%artr%t%, e/%+ '' *%&'a% a*a rea&a *a" -ra"# *e8a,a '*a *%/a"*%"#!a" a*a a"a!a"a!. b) K+-rea S$*e"+a !+-rea %"-r ata' St. Ja"e *a"e e"#e"a% +a%r 16
e"*er%ta *ea re'at%!. ?a"%e,ta,% %"% e"er%"!a" !eter%/ata" ,%,te ,$ara ,e"tra a*a r-,e, ra*a"#. Pe"*er%ta *e"#a" !+-rea %"% *ata"# *e"#a" #era!a"#era!a" $a"# t%*a! ter!--r*%"a,% *a" t%*a! /ert'&'a" *a" e-,% a/%. ?a"%e,ta,% %"% e/%+ "$ata /%a e"*er%ta /a"#'" *a" *aa !ea*aa" ,tre,. Pe"*er%ta taa! ,ea' #'#' *a" ,er%"#!a% e"$er%"#a%. B%ara"$a terta+a" ta+a" *a" ee*a!e*a!. K--r*%"a,% -t-t-t-t +a', ,'!ar. T'%,a" ta"#a""$a &ee! *a" *%ta"*a% -e+ -reta" !e ata, $a"# t%*a! a"ta *e"#a" #ar%, $a"# ra#' ra#'. Pa*a ,aat '"a! #e&aa"$a t'%,a""$a t%*a! *aat *%/aa ,aa ,e!a%. c) Er%t+ea ar#%"at' er'a!a" r'a $a"# !+a, '"t'! *ea re'at%! *a"
&ara"# *%te'!a" a*a e"$a!%t a%". Kare"a !e!+a,a""$a ta"*a %"% *%a,'!!a" *aa a"%e,ta,% %"-r. Kea%"a" %"% /er'a r'a t%*a! #ata a!'er *e"#a" te% er%t+ea (!eera+a") $a"# e"&aar *ar% /a#%a" ,at' !e /a#%a" a%" e"#e%%"#% !'%t $a"# taa! "-ra ter&a*% a*a 6 e"*er%ta. Ga"##'a" %"% /er*%aeter 2 *a" a%"# ,er%"# *%te'!a" a*a /ata"# t'/'+ *a" t'"#!a% /a#%a" ata, t%*a! e%/at!a" '!a. Er%t+ea %"% t%/' ,e8a!t'8a!t' ,eaa ,a!%t e,!%'" $a"# ter,er%"# a*aa+ a*a ,ta*%' a8a *a" /%a,a"$a ter&a*% +a"$a a*a e"*er%ta *ea re'at%! *e"#a" !ar*%t%,. d) N-*' ,'/!'ta". re!'e",% a"%e,ta,% %"% e"'r'" ,e&a! /e/eraa *e!a*e
tera!+%r *a" !%"% +a"$a *%te'!a" a*a e"*er%ta e"$a!%t &a"t'"# re'at%! !+r-"%!. re!'e",%"$a !'ra"# *ar% 6 "a'" a*a e"&a"#!%ta" *% Uta+ "-*'', ,'/!'ta" *%te'!a" a*a ,aa% 106 e"*er%ta. N-*'', (/e"&-a") %"% /%a,a"$a tereta! a*a er'!aa" ,e"*% ter'taa r'a, &ar% 't't *a" er,e"*%a" !a!%. Ka*a"#!a*a"## "-*'', %"% *%te'!a" a*a !'%t !eaa *a" *% ata, t'a"# /ea!a"#. U!'ra""$a /er7ar%a,% *ar% 0 ,aa% *e"#a" 2 ,erta t%*a! "$er% *a" *aat *%#era!!a" ,eara /e/a, /%a,a"$a !e% *a" e"#+%a"# e/%+ eat. K'%t $a"# e"'t'% t%*a! 'at ata' era*a"#. N-*'', %"% '"' +a"$a ,e,'*a+ /e/eraa %"##' ,a!%t *a" !e/a"$a!a" +a"$a *%te'!a" a*a e"*er%ta *e"#a" !ar*%t%,. e) ?a"%e,ta,% a%" *ar% *ea re'at%! a"tara a%" "$er% er't e%,ta!,%,
(%%,a") *ea *e"#a" ,'+' *% ata, 59 ; *e"#a" -a $a"# t%*a!
!ara!ter%,t%! "e'-"%a re'at%! $a"# #e&aa"$a %r% *e"#a" "e'-"%a !are"a %"e!,%. f)
Tr-/-e/-% (,'/ata" *% e/''+ *ara+) /%,a ter&a*% ,e/a#a% !-%!a,% *ar% ,te"-,%, %tra (#a"##'a" !at').
g) A"e%a +e-%t%! !ar*%a! /%,a ter&a*% a!%/at ea+"$a ,e *ara+ era+ !are"a
/er#e,e!a" *e"#a" !at' $a"# ter%"e!,%. Pe"%"#!ata" e"#+a"'ra" tr-/-,%t /%,a &'#a ter&a*%. h) Ar%t%a atr%' (#a"##'a" %raa &a"t'"#) /%a,a"$a ter&a*% !are"a e/e,ara"
atr%' !%r% !are"a #a"##'a" a*a !at' %tra.
?a"%e,ta,% K%"%! e"'r't -"e, (19=2) ?a$-r
?%"-r
1. ;ar*%t%,
1. e7er
2. P-%art+r%t%,
2. Art+ra#%a
5. ;+-rea
5. Per"a+ e"#aa% #a#a #%"&a
4. Er$t+ea ar#%"at'
4. LED t%"##%
. N-*' S'/'ta"e-',
. ;Reat%7e Pr-te%";RP () . Le'!-,%t-,%, . I"ter7a PR ea"&a"#
E. PEN;EGAHAN
%!a !%ta %+at *%ata, /a+8a e"$a!%t &a"t'"# reat%! ,a"#at '"#!%" ter&a*% *e"#a" a*a"$a !e&a*%a" a8a $a%t' *ea reat%! (DR). Pe"e#a+a" $a"# ter/a%! a*aa+ /a#a%a"a 'a$a !%ta &a"#a" ,aa% e"#aa% *ea reat%! (DR) (ter,era"# %"e!,% !'a" Stret--', /eta +e-$t%',). A*a /e/eraa a!t-r $a"# *aat e"*'!'"# ,e,e-ra"# ter,era"# !'a" ter,e/'t *%a"tara"$a a!t-r %"#!'"#a" ,eert% !-"*%,% !e+%*'a" $a"# &ee! !-"*%,% t%"##a $a"# /er*e,a!a" *a" a!,e, !e,e+ata" $a"# !'ra"# er'a!a" *eter%"a" $a"# ,%#"%%!a" *aa *%,tr%/',% e"$a!%t %"%. Jar%a,% 'aa &'#a e'"$a% era" $a"# /e,ar *aa ter&a*%"$a %"e!,% ,tret-!-!!', '"t'! ter&a*% DR. Se,e-ra"# $a"# ter%"e!,% !'a" Stret--', /eta +e-$t%', *a" e"#aa% *ea reat%! +ar', *%/er%!a" t+era$ $a"# a!,%a *e"#a" a"t%/%-t%!"$a. Ha %"% '"t'! e"#+%"*ar!a" !e'"#!%"a" ,era"#a" !e*'a !a%"$a ata' /a+!a" e"$e/a/!a" Pe"$a!%t a"t'"# Reat%!. F. Peer%!,aa" D%a#"-,t%!
1. Peer%!,aa" *ara+ a) LED t%"##% ,e!a% b) Le!-,%t-,%, c) N%a% +e-#-/%" *aat re"*a+ 2. Peer%!,aa" /a!ter%--#% a) B%a!a" +a', te"##-r-!a" '"t'! e/'!t%!a" a*a"$a ,tret--',. b) Peer%!,aa" ,er--#%. D%'!'r t%ter ASTO a,t%,tret-!%"a,e a"t% +$a'r-"%*a,e. 3. Peer%!,aa" ra*%--#%
Ee!tr-!ar*-%#ra% *a" e!-!ar*%-#ra% '"t'! e"%a% a*a"$a !ea%"a" &a"t'"#. 4. EKG a) I",'%,%e",% ?%tra (I?): +%ertr-% atr%' *a" 7e"tr%!e !%r% ,%"', ta!%!ar*%a
!-"tra!,% atr%' reat're %/ra,% atr%' b) Pr-a (?JP): a/"-raa, #e-/a"# c) Ste"-,%, ?%tra (S?) :e/e,ara" atr%' !%r% +%ertr-% 7e"tr%!e !a"a"
*e%a,% a!,%, !a"a" er'/a+a" #e-/a"# ST *ee! !-"*'!,% ( /-! AJ *era&at I /-! a/a"# /er!a, !%r%) d) I",'%,%e",% A-rt%! (IA) :+%ertr-% 7e"tr%!e !%r% a*a %/r%a,% atr%'/%a #a#a
!-"#e,t% /erat e) Ste"-,%, Tr%!',%* (ST) : +%ertr-% atr%' !a"a" +%ertr-% 7e"tr%!e !%r%
!a"a" %/r%a,% atr%' I",'%,%e",% Tr%!',%* (IT) : +%ertr-% 7e"tr%!e *a" atr%' !a"a" %/r%a,% atr%' f)
g) Ste"-,%, P'-"%! (SP) : +%ertr-% 7e"tr%!e atr%' !a"a" *e7%,%a,% a!,e,
!a"a" %/r%a,% atr%' h) I",'%,%e",% P'-"a%! (IP) : *%ata,% 7e"tr%!e !a"a" *a" atr%' !a"a"
.
PENATALAKSANAAN Pe"ataa!,a"aa" *ea re'at%! a!t% ata' rea!t%7a,% !e/a% *%a"tara"$a a*aa+ 1. T%ra+ /ar%"# *a" -/%%,a,% (!e/a% !ea!t%7%ta, "-ra) ,eara /erta+a 2. Pe/era"ta,a" ter+a*a !'a" ,tret-!-!!', *e"#a" e/er%a" a"t%/%-t%
e"%,%%" ata' er%tr-%,%". U"t'! r-%a!,%, ata' e"e#a+a" *aat *%/er%!a" a"t%/%-t% e"%,%%" /e"
a*a *ea re'at%! ta"a !ar*%t%, (era*a"#a" a*a &a"t'"#)
Kare"a *ea reat%! /er+'/'"#a" erat *e"#a" ra*a"# Stret--', /eta +e-$t%', #r' A a!a e/era"ta,a" *a" e"e#a+a" *%t'&'!a" a*a ra*a"# ter,e/'t. I"% *aat /er'a : a. Era*%!a,% !'a" Stret--', /eta+e-$t%', #r' A
Pe"#-/ata" a*e!'at +ar', *%'a% ,eeat"$a a*a DR *a" *%a"&'t!a" *e"#a" e"e#a+a". Er$t+r-$%" *%/er%!a" !ea*a ere!a $a"# aer#% ter+a*a e"%%%". b. O/at a"t% reat%!
Ba%! -rt-%,ter-%* a''" ,a%,%at *%!eta+'% ,e/a#a% -/at $a"# /er#'"a '"t'! e"#'ra"#%e"#+%a"#!a" #e&aa#e&aa ra*a"# a!'t a*a DR c. D%et
?a!a"a" $a"# '!' !a-r% r-te%" *a" 7%ta%". d. I,t%ra+at
I,t%ra+at *%a"&'r!a" ,aa% ta"*ata"*a %"aa,% +%a"# *a" /e"t'! &a"t'"# e"#e% a*a !a,',!a,', !ar*%-e#a%. B%a,a"$a 14 +ar% a*a !a,', DR %"', ar*%t%,. Pa*a !a,', ', ar*%t%, aa %,t%ra+at ratarata 5 %"##' 5 /'a" ter#a"t'"# a*a /erat r%"#a""$a !ea%"a" $a"# a*a ,erta !ea&'a" er&aa"a" e"$a!%t. e. O/at-/at La%"
D%/er%!a" ,e,'a% *e"#a" !e/'t'+a". Pa*a !a,', *e"#a" *e!-e",a,% !-r*%, *%/er%!a" *%#%ta%, *%'ret%!a *a" ,e*at%7e. B%a a*a +-rea *%/er%!a" ar#at% *a" a%"a%".
H.
KO?PLIKASI
K-%!a,% $a"# ,er%"# ter&a*% a*a Pe"$a!%t a"t'"# Re'at%! (PR) *%a"tara"$a a*aa+ #a#a &a"t'"# a"!ar*%t%, (%"e!,% *a" era*a"#a" *% ,e'r'+ /a#%a" &a"t'"#) "e'-"%t%, re'at%! (%"e!,% ar') e/-% ata' ,'/ata" a*a ar' !ea%"a" !at' &a"t'"# *a" %"ar! (!eat%a" ,e &a"t'"#). A. De!-e",a,% ;-r*%,
Per%,t%8a *e!-e",a,% -r*%, a*a /a$% *a" a"a! e"##a/ar!a" ter*aat"$a ,%"*r-a !%"%! a!%/at $-ar*%' t%*a! a' ee"'+% !eer'a" eta/-% tera,'! ert'/'+a". Kea*aa" %"% t%/' !are"a !er&a -t-t &a"t'"# $a"# /ere/%+a" /%a,a"$a !are"a !ea%"a" ,tr'!t'r &a"t'"# !ea%"a" -t-t &a"t'"# ,e"*%r% ,eert% r-,e, %"aa,% ata' #a/'"#a" !e*'a a!t-r ter,e/'t. Pa*a ''"$a a$a+ &a"t'"# a*a a"a! *%-/at% ,eara !a,%! $a%t' *e"#a" *%#%ta%, *a" -/at-/at *%'ret%!a. T'&'a"
e"#-/ata" %aa+ e"#+%a"#!a" #e&aa (,%t-at%!) *a" $a"# a%"# e"t%"# e"#-/at% e"$a!%t r%er. B. Per%ar*%t%,
Pera*a"#a" a*a er%ar* 7%,era%, *a" ar%eta%, $a"# /er7ar%a,% *ar% rea!,% ra*a"# $a"# r%"#a" ,aa% tert%/'"""$a a%ra" *aa a7' er%ar*.
BAB III KONSEP ASUHAN KEPERAMATAN
A. PENGKAIAN 1.
A!t%7%ta,%,tra+at
Ge&aa
: Keea+a" !eea+a".
Ta"*a
: Ta!%!ar*%a e"'r'"a" TD *%,"ea *e"#a" a!t%7%ta,.
2.
S%r!'a,%
Ge&aa : R%8a$at e"$a!%t &a"t'"# !-"#e"%ta I? /e*a+ &a"t'"#. Pa%ta,% &at'+ %"#,a". Ta"*a : Ta!%!ar*%a *%,r%t%a er%"*a+a" TI? !%r% *a" %"er%-r r%t%-" r'/ 'r'r e*ea ete!%e +e-ra#% ,%"ter. 3.
E%%"a,%
Ge&aa
: R%8a$at e"$a!%t #%"&a e"'r'"a" re!'e",%&'a+ 'r%"e.
Ta"*a
: Ur%"e e!at #ea.
4.
N$er%!et%*a!"$aa"a"
Ge&aa : N$er% a*a *a*a a"ter%-r $a"# *%er/erat -e+ %",%ra,% /at'! #era!a" e"ea" /er/ar%"# "$er% *a*a'"##'"# ,e"*%. Ta"*a 5.
Ge&aa
: Per%a!' *%,tra!,% %,: #e%,a+. Per"aa,a" : *%,"ea /at'! e"eta ata' "-!t'r"a (,'t' '"#!%"t%*a! r-*'!t%).
Ta"*a : ta!%"ea /'"$% "aa, a*7e"t%,%', (!re!e, *a" e"#%) ,'t' /a"$a! *a" /er/era! *ara+ (e*ea '-"a). 6.
Keaa"a"
Ge&aa
: R%8a$at %"e!,% 7%r', /a!ter% &a'r e"'r'"a" ,%,te %'".
Ta"*a
: Dea.
B. DIAGNOSA KEPERAMATAN YANG ?UNGKIN ?UN;UL 1. Pe"'r'"a" 'ra+ &a"t'"# /* a*a"$a #a"##'a" a*a e"'t'a" a*a !at' %tra
( ,te"-,%, !at' ) 2. Per',% &ar%"#a" er%er t%*a! ee!t% /er+'/'"#a" *e"#a" e"'r'"a" eta/-%,e ter'taa er%er a!%/at 7a,-!-",tr%!,% e/''+ *ara+ 3. N$er% a!'t /er+'/'"#a" *e"#a" era*a"#a" a*a e/ra" ,%"-7%a
4. H%erter%a /er+'/'"#a" *e"#a" Pera*a"#a" a*a e/ra" ,%"-7%a *a" era*a"#a"
!at' &a"t'"# 5. Ket%*a!,e%/a"#a" "'tr%,% !'ra"# *ar% !e/'t'+a" t'/'+ /er+'/'"#a" *e"#a" e"%"#!ata" a,a a/'"# a!%/at !-e",a,% ,%,te ,ara ,%at%,. 6. I"t-era",% a!t%7%ta, /er+'/'"#a" *e"#a" !eea+a" -t-t t%ra+ /ar%"# ata' %-/%%,a,% 7. S$"*r-e !'ra"# era8ata" *%r% /er+'/'"#a" Ga"##'a" ',!'-,!eeta P-tart+r%t%,art+a#%a *a" t+era% /e* re,t . 8. Ker',a!a" %"te#r%ta, !'%t /e+'/'"#a" *e"#a" era*a"#a" a*a !'%t *a" &ar%"#a" ,'/'ta". 9. Re,%!- !er',a!a" ert'!ara" #a, /er+'/'"#a" *e"#a" e"''!a" *ara+ *%ar' a!%/at e"#%,%a" atr%' $a"# e"%"#!at 10. Re,%!- %*era /er+'/'"#a" *e"#a" Gera!a" %"7-'"ter%rr%#'aer eat *a" !eea+a" -t-t!+-rea C. REN;ANA TINDAKAN KEPERAMATAN 1. Penurunan curah jantung b/d adanya gangguan pada penutupan katup mitral ( stenosis katup ) T'&'a": Setea+ *%/er%!a" a,'+a" !eera8ata"e"'r'"a" 'ra+ &a"t'"# *aat *%%"%a!a". Kr%ter%a +a,%: ?e"'"&'!!a" ta"*ata"*a 7%ta *aa /ata, $a"# *aat *%ter%a (*%,r%t%a ter!-"tr- ata' +%a"#) *a" /e/a, #e&aa #a#a &a"t'"# (%, : araeter +e-*%"a%! *aa /ata, "-ra +a'ara" 'r%"e a*e!'at). ?ea-r!a" e"'r'"a" e%,-*e *%,"eaa"#%"a. I!'t ,erta *aa a!$%7%ta, $a"# e"#'ra"#% /e/a" !er&a &a"t'"#. I"ter7e",% *a" ra,%-"a: I!"r#"
%$R&$%'&(
a. Ka&% re!'e",% "a*% RR TD 1) ?e-"%t-r
,eara terat'r ,et%a 4 &a.
b. Ka&% er'/a+a" 8ar"a !'%t 2)
ter+a*a ,%a"-,%, *a" 'at.
c. Bata,%
a!t%%ta,
,eara3)
a*e!'at.
4) d. Ber%!a" !-"*%,% ,%!--#%,
%"#!'"#a" $a"# te"a"#.
5)
a*a"$a er'/a+a" ,%r!'a,% &a"t'"# ,e*%"% '"#!%" *a" ter&a*%"$a ta!%!ar*%a*%,r%t%a ,e/a#a% !-e",a,% e"%"#!at!a" 'ra+ &a"t'"# P'at e"'"&'!!a" a*a"$a e"'r'"a" er',% er%er ter+a*a t%*a! a*e!'at"$a 'ra+ &a"t'"#. S%a"-,%, ter&a*% ,e/a#a% a!%/at a*a"$a -/,tr'!,% a%ra" *ara+ a*a 7e"tr%!e. I,t%ra+at ea*a% *%er'!a" '"t'! eer/a%!% e%,%e",% !-"tra!,% &a"t'"# *a" e"'r'"!a" !-,',% O2 *a" !er&a /ere/%+a". Stre, e-,% e"#+a,%!a" 7a,-!-"tr%!,% $a"# e"%"#!at!a" TD *a" e"%"#!at!a" !er&a &a"t'"#. ?e"%"#!at!a" ,e*%aa" -!,%#e" '"t'! '"#,% %-!ar* *a" e"e#a+ +%-!,%a.
e. K-a/-ra,% '"t'! e/er%a"6) D%/er%!a"
-!,%#e" K-a/-ra,% '"t'! e/er%a" *%#%ta%, f.
'"t'! e"%"#!at!a" !-"tra!t%%ta, %-!ar* *a" e"'r'"!a" /e/a" !er&a &a"t'"#.
2. Per',%
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DATAR PUSTAKA
U*&%a"t% Ma&a" '"%. 2010. Keera8ata" Kar*%-7a,!'er. a!arta: Sae/a ?e*%!a
Art+'r ;. G'$t-" a"* -+" E. Ha ( 199) Buku Ajar Fisiologi Kedokteran Edisi 9 Pe"er/%t B'!' Ke*-!tera" EG; a!arta ?ar$%" E. D-e"#-e, ?ar$ ra"e, ?--r+-',e A%e ;. Ge%,,er (2000) encana Asuhan Kepera!atan" Pedoman #ntuk Perencanaan dan Pendokumentasian Pera!atan Pasien Edisi $ Pe"er%/%t B'!' Ke*-!tera" EG; a!arta Ne,-" (1995) %lmu Kesehatan Anak" &e'tbook o Pediatrics Edisi * B'!' !e*-!tera" EG; a!arta. S'"-t- Prata"' (1990) Penyakit +antung ematik, ?a!aa+ T%*a! *%'/%!a,%!a" S'ra/a$a S$7%a A. Pr%e (199) Patoisiologi" Konsep Klinis Proses - Proses Penyakit Edisi . B'!' !e*-!tera" EG; a!arta. M-"# a"* M+ae$, (199) linical 0anual o Pediatrics 1ursing . th Edit%-" ?-,/$Year B--! St.L-'%, ?%,,-'r%. He"%*!! (2001) Buku Ajar kepera!atan Kardio2asculer Edisi Haraa" K%ta a!arta S'**art+ /r'""er ( 2002). Buku Ajar kepera!atan 0edikal Bedah 34l * Edisi 5 EG; a!arta.
