Minggu, 26 Agustus 2012

NURSING CARE IN PATIENTS WITH CARDIOMYOPATHY

I'll post about nursing hostile cardiomyopathy patients.
Please be listened to, and do not forget to comment ...


Cardiomyopathy is a myocardial disease that attacks the heart muscle (myocardial) and the cause is unknown.This disease can be found in all types of male and female, in all age groups.Division:1. Congestive Cardiomyopathy / Dilatatif.Congestive cardiomyopathy is a primary myocardial disease or idiopathic characterized by dilatation of the cavities of the heart and congestive heart failure. The beginning of a slow, progressive symptoms of heart trouble being within a few months. aetiology:• Not known.• Anything to do with;o Use alkhohol excessive.o Gravidarum and puerperium.o Systemic Hypertension.o Virus infection.o autoimmune disorders.o Influence of physical substances and chemicals. Symptoms:• Suck kongestive especially left heart.• Tired and weak.• It can be accompanied by signs of systemic and pulmonary emboli.
2. Hypertrophic cardiomyopathy.Hypertrophic cardiomyopathy is ventricular hypertrophy without heart disease or other systemic ventricular hypertrophy can cause this. Characterized by thickening (hypertrophic) of the left ventricle, which septal thickening interventrikularis more striking.
 Etiology• Not known.• Anticipated related reasons:o Genetic, family, inheritance.o Abnormalities in the coronary arteries. Symptoms:• Dyspnoe, Angina pectoris.• Tired, palpitations, sincope.
3. Kardimiopati restrictive.Characterized by a disturbance in diastolic function, ventricular wall is very rigid and impede ventricular filling. Etiology:• Not known.• Often found at: haemochromatosis, glycogen deposition, Endomyocardial, fibrosis, eosinophilia. Symptoms:• Weak, shortness of breath, heart trouble right, signs and symptoms of systemic; haemochromatosis.
Kompliasi / complications:Syncope, heart failure, arrhythmias, and thrombosis.
Assessment:Type I: The heart can be enlarged once, heart sounds to 3 and 4 can be heard.
Type II: mild heart enlargement. In the frowsy palpable systolic and strong vibrations. 4th heart sound is usually heard. Noisy systolic hardened on Valsalva action.
Type III: Enlargement of the heart is. heart murmurs to 3 and 4.Regurgitation  mitralis or trikuspidalis.
Investigations; Photo Thorax, on kardiomiopathi dilatatif be obtained cardiomegaly and pulmonary edema. EKG, would seem "Left Ventricle hypertropi" on the type of cardiomyopathy hypertropi .. Ekocardiografi; visible dilatation, thickening of the heart.
Treatment / management:Type I: There is no specific treatment, because the clinical manifestations of heart failure, treatment of heart failure, as well as giving anticoagulants to prevent thrombosis.
Type II: Because clinical manifeatasi beta blockers such as arrhythmias. Left ventricular outflow tract obstruction, septal penebalahan partial / resection.
Type III: Because the clinical manifestations such as heart failure; treatment of heart failure, arrhythmia drugs. Surgical resection endokard thickened.
Data persistem that may arise (we identikkan with congestive heart failure) where the principal problem is the weakness of the heart that causes decreased cardiac output. Activity / rest: Maybe we'll get the data: insomnia, weakness / tiredness decreased, chest pain on exertion, shortness of breath at rest, mental status changes, fatigue, changes in activity as a vital sign. Cirkulasi: a history of hypertension, IMA, IMK, rhythm; dysrhythmias, edema, increased PVJ, cardiac surgery, endocarditis, anemia, SLE, septic shock, the use of beta-blocker drugs. Elimination: drop pattern, nocturia, dark color urine, constipation, diarrhea. food / liquids: anorexia, nausea, vomiting, weight gain is striking, extremitas swelling down, use deuretika, salt diet, abdominal distention, edema anasarca, local, pitting udema. Diets high in salt, processed foods (processed), fat, protein sugar. Personal hygiene: hygiene impairment, fatigue, decreased self care. Convenient / pain: Chest pain, withdrawn behaviors to protect themselves, edgy, nervous, muscle pain, abdominal pain up, fear, irritability. Respiratory: shortness of breath, sleep half sitting, use lots of pillows, cough with no sputum, breath Crekles, Ronky (+), history of chronic lung disease, use breathing aids. Neuro Sensory: weakness, dizziness, fainting, disorientation, behavioral changes, irritability. Social interactions: decreased participation in social activities.
Nursing Diagnosis
1. Decrease in cardiac output associated with myocardial muscle damage.2. Activity intolerance related to decreased cardiac output.3. Lack of knowledge related to lack of information.4. Impaired gas exchange associated with congestive polmunal.
Nursing Plan
Diagnosis No. 1.Goal: Reduce the burden of heart.Criteria: Vital sign within normal limits, free from the symptoms of heart failure, decreased dyspnoe.
RATIONAL INTERVENTION.1. Auscultation apical pulse, assess the frequency, heart rhythm.2. Record heart sounds, peripheral pulse palpation, blood pressure monitor.3. Assess against pale skin, and cyanosis.
4. Provide supplemental oxygen as indicated.5. Elevate the legs, avoid skin pressure on the knee.6. Berikaan medications as insruksi / collaboration.: Deuretika, Morphin, Vasodilators 1. This condition tachikardia.
2. Decrease in cardiac output appears on the pulse, and blood tekakan.3. Perfusion impairment ferifer pale, cyanosis because kongseti vein.4. Increase dosage to myocardial oxygen.5. Lowering Static vein, and the incidence of thrombus.6. Lowers preload, afterload.
Diagnosis Number 2Objective: Patients can perform their daily activities.Criteria: Can participate in activities, to meet its own needs, vital sign during normal activity.
RATIONAL INTERVENTION.1. Check the vital sign before and immediately after exercise.2. Record cardiopolmunal response to the activity.
3. Assess the cause of the weakness.
4. Evaluation of increased activity intolerance.5. Provide assistance in activities, activities interspersed with rest.
6. Collaboration heart rehabilitasii program / activity. 1. Orthostatic hypotension can occur because of the activity.2. The decrease infarction to improve secuncum during activity.3. Weakness may occur due to the effects of the drug.4. excess activity increases heart decompensasi.5. Activity without affecting myocardial stress / excessive oxygen demand.6. Increased activity bertahab avoid excessive cardiac work.
Diagnosis No. 3.Objective: Patients and family know Congestive heart failure recurrence prevention.Criteria: patients and family therapy program obeyed, can mention signs and symptoms for rapid intervention, changing lifestyle can cause stress.
RATIONAL INTERVENTION.1. Discuss the differences in normal cardiac function and cardiac abnormalities.2. Strengthen rational treatment.
3. Discuss the importance of being seaktiv possible, without becoming exhausted and rest between activities.4. Discuss the importance of sodium restriction, provide a list sodium content in common foods that should be limited.5. Dskusikan medication, purpose and side effects, give verbal and written instructions.6. Instruct the patient to eat food according to the diet provided. 1. Pengatahuan improve adherence to treatment programs.
2. Pemahanan about drugs can help control symptoms.3. Excessive physical activity can continue to be a weakness of the heart.
4. Dietary sodium influx above 3 g / day deuretik effect.

5. Understanding patients can prevent complications.
6. Blood money set excessively restricting sodium.
Diagnosis No. 4.Objective: Gas exchange and the patient can adequately free of seams.Criteria: Patients are not claustrophobic, GDA values ​​within normal limits.
RATIONAL INTERVENTION.1. Auscultation of breath sounds, record breath sounds, crackles, wheezing,2. Instruct the patient to cough effectively and breathe deeply.3. Encourage frequent position changes / every 2-3 hours.4. Maintain bed rest with the head of the bed 20-30 degrees, semi-Fowler position and chock hand with a pillow.5. GDA monitored serially.
6. Provide supplemental oxygen as indicated.
7. Give medication as indicated. Deuretika: Furosemide, bronchodilators. Aminophilin, 1. Indications of pulmonary congestion / accumulation of secretions.2. Clearing the airway and, facilitate the flow of oxygen.3. Prevent atelectasis and pneumonia.4. Lowering oxygen consumption, increased maximal lung expansion.
5. Hypoxemia may become heavy during pulmonary edema.6. Increasing the concentration of alveolar oxygen, preventing hipoxemia network.7. Lowering alveolr congestion, improve gas exchange,
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.

Thank you and hopefully useful...

Tidak ada komentar:

Posting Komentar