Aritmia-ppt
-
Upload
yus-rendra -
Category
Healthcare
-
view
355 -
download
3
Transcript of Aritmia-ppt
![Page 1: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/1.jpg)
ASUHAN KEPERAWATAN CARDIAC ARRYTMIA
Yus Rendra,Amd.Kep.
![Page 2: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/2.jpg)
Definisi• Devisiasi dari Irama Sinus Normal ( Normal Sinus Rhytm )• Gangguan Pembentukan Impuls• Gangguan Sistem Konduksi
![Page 3: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/3.jpg)
Batasan• Aritmia Gangguan pembentukan atau penghantaran
impuls• Irama sinus normal suatu irama jantung dengan
pemacu di SA Node dengan frekuensi 60-100 x/menit
![Page 4: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/4.jpg)
SISTEM KONDUKSI NORMAL
S A NODE
A V NODE
BUNDLE OF HIS
RIGH BUNDLE BRANCH LEFT
PURKINJE FIBRE
![Page 5: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/5.jpg)
![Page 6: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/6.jpg)
![Page 7: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/7.jpg)
![Page 8: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/8.jpg)
IRAMA SINUS NORMAL
Irama teraturFrekwensi (HR) : 60 – 100 x / menitP : QRS = 1 : 1Interval dan bentuk normal
![Page 9: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/9.jpg)
Etiologi• Sering tidak dapat ditentukan• Semua penyakit jantung dapat menyebabkan aritmia
![Page 10: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/10.jpg)
ETIOLOGI• Pada jantung normal
• Takut, cemas, gelisah, exercise• Demam, nyeri, anemia, dehidrasi• Hipersensitif vagal• Infeksi: bronchitis, pemonia, hepatitis• Hormon thyroid: hyper / hypo• Obat-obatan: digitalis, anti aritmia, anti depresan.• Tindakan: endoskopi, bronkoskopi• Ggn elektrolit, asam basa
![Page 11: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/11.jpg)
…ETIOLOGI…• Jantung abnormal
• Penyakit katup jantung• PJK, angina pectoris, akut infark• Miokarditis,myopathi,miokarditis• Penyakit jantung bawaan• Gagal jantung• Manipulasi pada jantung. Mis: punksi pericard, kateterisasi jantung,
operasi jantung• Proses degenerasi, kalsifikasi,fibros
![Page 12: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/12.jpg)
Pembagian
• Gangguan pembentukan impuls• Gangguan pembentukan impuls di sinus• Gangguan pembentukan impuls di atria• Gangguan impuls di penghubung AV• Gangguan pembentukan impuls di ventrikel
• Gangguan penghantaran impuls• Block sinus – atrial• Block atrial – ventrikuler• Block intra ventrikuler
![Page 13: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/13.jpg)
Aritmia yang memerlukan tindakan EMERGENSI
• TDS < 90 mmHg dengan tanda-tanda hipoperfusi• Nyeri dada, sesak nafas, pre syncope, syncope• Gagal jantung
![Page 14: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/14.jpg)
Derajat kegawatan aritmia tergantung :
• Jenis aritmia• Frekuensi ventrikel > 160x/m• Frekuensi ventrikel < 40 x/m• Fibrilasi ventrikel
• Kelainan dasar jantung miokard yang jelek akan memperburuk bila disertai aritmia (IMA, miokarditis, kardiomiopati, gagal jantung)
• Kelainan diluar jantung yang dapat menambah kegawatan aritmia (gangguan elektrolit, asam-basa, anemia, demam)
![Page 15: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/15.jpg)
Pembagian Aritmia secara Klinis• Taki aritmia• Bradi aritmia• Bradi-takhiaritmia
![Page 16: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/16.jpg)
Tujuan Pengobatan
1. Konversi menjadi irama sinus
2. Mengendalikan frekuensi ventrikel yang optimal (60-100 x/m)
3. Mengatasi etiologi
![Page 17: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/17.jpg)
Algoritme AritmiaKeluhan :
• nyeri dada, sesak, berdebar, syncope
• Kesadaran menurun
• Hipotensi / syok
Curiga aritmia
Aritmia jantung gawat
EKG, hemodinamik
Cardiac Arrest BradiaritmiaTakiaritmia
•Henti kardiopulmoner
•Fibrilasi ventrikel
Sinus Bradikardi Blok AV Asistole
QRS lebar QRS sempit
Reguler Ireguler Reguler Ireguler
1. VT
2. SVT + RBBB / LBBB
1. AF + WPW
2. Torsade depointes
1. Sinus takikardi
2. Atrial flutter
3. TSVT (PAT)
1. AF
2. TAM
![Page 18: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/18.jpg)
![Page 19: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/19.jpg)
![Page 20: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/20.jpg)
PATOFISIOLOGI
ABNORMAL MYOCARDIUM – UNSTABLE (HYPOXIA)
↓ATPGangguan pompa ion
Disfungsi Elektrofisiologi Sel
ARITMIA
![Page 21: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/21.jpg)
![Page 22: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/22.jpg)
KOMPLIKASI ARHYTMIA• Gagal jantung• Emboli• Syncope• Ischemia• Sudden death• Cardiac arrest
![Page 23: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/23.jpg)
SUPRA VENTRIKULAR TAKIKARDI (SVT)• Keluhan: berdebar kuat cepat, sesak, chest discomfort,
pusing.• Karakteristik EKG SVT:
• Irama : Teratur• Rate : 150 – 250 X/Menit• Gel. P : sukar dilihat• P-R interval : tak dapat di hitung• QRS interval : normal
![Page 24: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/24.jpg)
![Page 25: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/25.jpg)
S V T
BERDEBAR ↓DIASTOLIC FILLING TIME
CEMAS ↓ L V DIASTOLIC VOLUME
KURANG PENGETAHUAN ↓ ↓CARDIAC OUTPUT
![Page 26: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/26.jpg)
WOC
CEMAS ↓ CARDIAC OUTPUT
Vagal Manuever
Support Emosional
Manipulasi Lingkungan
Pendidikan Kesehatan
![Page 27: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/27.jpg)
↓CARDIAC OUTPUT
↑Residu LV ↓ Perfusi ↓ Perfusi ↓Perfusi
otak myocard perifer
Kongesti- Pusing Chest Pain Akral dingin
paru ↓ kesadaran Iskemia
VT/VF
Sesak Pot. trauma ↓ ↓ C O Kelemahan
![Page 28: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/28.jpg)
MASALAH KEPERAWATAN :
• Kecemasan• Gangguan rasa nyaman
• Penurunan cardiac output
• Penurunan perfusi organ
• Potensial trauma• Intoleransi aktivitas• Bersihan jalan nafas inefektif
• Pertukaran gas inefektif
• Kurang pengetahuan
![Page 29: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/29.jpg)
Intervensi Keperawatan Pada SVT• Berikan oksigen• Tanda-tanda vital, rekam EKG interpretasi segera
• Hubungi dokter • Pasang IV line• Kaji tanda & gejala serius• Pertimbangkan vagal manuever• Kolaborasi pemberian terapi (algoritma/ manajemen SVT)
• Dokumentasikan
![Page 30: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/30.jpg)
VAGAL MANEUVER• Metode non invasive merangsang parasimpatis
cholinergic/vagal efek pada jantung :• ↓ kecepatan pacu SA node, automatisasi, excitability• Memperlambat konduksi yang melewati AV node• Hasilnya : ↓ heart rate, ↓ cardiac output, ↓ tekanan darah.• Efek : nausea, bronkhospasme, berkeringat, pingsan,
hypersalivasi.
![Page 31: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/31.jpg)
VENTRIKULAR TAKIKARDI (VT)• Keluhan: berdebar, chest pain, pingsan• Karakteristik EKG SVT:
• Irama : Teratur • Rate : 150 – 250 x/menit• Gel. P : selalu tak kelihatan• P-R interval : tak dapat di ukur• QRS interval : lebar > 0,12 DETIK
![Page 32: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/32.jpg)
![Page 33: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/33.jpg)
VT
Berdebar ↓ Diastolic filling time
Cemas ↓ LV diastolic volume
Kurang pengetahuan
Kurang pengetahuan ↓ ↓ cardiac output
![Page 34: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/34.jpg)
CEMAS ↓ CARDIAC OUTPUT
Vagal Manuever
Support Emosional
Manipulasi Lingkungan
Pendidikan Kesehatan
![Page 35: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/35.jpg)
↓CARDIAC OUTPUT
↑Residu LV ↓ Perfusi ↓ Perfusi ↓Perfusi
otak myocard perifer
Kongesti- Pusing Chest Pain Akral dingin
paru ↓ kesadaran Iskemia
VT/VF
Sesak Pot. trauma ↓ ↓ C O Kelemahan
![Page 36: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/36.jpg)
MASALAH KEPERAWATAN :
• Kecemasan• Gangguan rasa nyaman
• Penurunan cardiac output
• Penurunan perfusi organ
• Penurunan kesadaran
• Potensial trauma• Intoleransi aktivitas• Bersihan jalan nafas inefektif
• Pertukaran gas inefektif
• Kurang pengetahuan
![Page 37: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/37.jpg)
VENTRIKULAR FIBRILASI (VF)• Tanda gejala: chest pain, akral dingin, unresponsiveness,
apnoe, pulseless.• Karakteristik EKG SVT:• Irama : tidak teratur • Rate : tidak dapat dihitung• Gel. P : tidak kelihatan• P-R interval : tidak dapat di ukur• QRS interval : tidak teratur, garis
isoelektris bergelombang
![Page 38: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/38.jpg)
![Page 39: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/39.jpg)
W O C
V F
↓ ↓ Cardiac output /
no cardiac output
↓ ↓ Perfusi jaringan / organ
![Page 40: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/40.jpg)
↓ ↓ Cardiac output / no cardiac output
↓Perfusi ↓ Perfusi ↓ Perfusi Otak myocard perifer
Unresponsive Chest pain Akral dingin
Cemas/ketakutan Loss control organkeluarga (pangkal lidah jatuh)
![Page 41: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/41.jpg)
MASALAH KEPERAWATAN
• Penurunan curah jantung
• Penurunan perfusi organ
• Kehilangan kesadaran
• Bersihan jalan nafas inefektif
• Pertukaran gas inefektif
• Potensial trauma• Kecemasan / ketakutan keluarga
• Kurang pengetahuan
![Page 42: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/42.jpg)
INTERVENSI KEPERAWATAN PADA V F• Analisa monitor EKG• Lakukan precordial thump / shock defibrilasi • Segera nilai CAB• Segera mulai C P R• Hubungi dokter • Kaji tanda & gejala serius• Kolaborasi pemberian therapi (algoritma VF)• Dokumentasikan
![Page 43: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/43.jpg)
![Page 44: Aritmia-ppt](https://reader030.fdocument.pub/reader030/viewer/2022013123/5a647a867f8b9a52568b4747/html5/thumbnails/44.jpg)