ppt heart failure fix

8/12/2019 PPT Heart Failure Fix

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MUHAMMAD MUSTAFA

SRN 011022 D3 KI

BANJARMASIN MUHAMMADIYAH HEALTH COLLEGE

INTERNATIONAL CLASS OF NURSING DIPLOMA PROGRAM

BANJARMASIN, 2014

•

NURSING CARE ON Mr. A

WITH MEDICAL DIAGNOSIS HEART FAILURE

IN ALAMANDA WARD OF ULIN GENERAL HOSPITAL BANJARMASIN



• Heart failure is a major health problem, where the prevalence ofheart failure in developing countries is quite high and isincreasing. Half of patients diagnosed with heart failure stillhave hope to live for 5 years but approximately 250,000 patients

died because of heart failure either directly or indirectly everyyear, and that number has increased 6 times in the last 40 years.

• In Banjarmasin Ulin General Hospital, from the calculation beginning of 2013 until December 2013, it was found the total of350 patients with heart failure diagnose, from total of 664

patients with heart disease.

BACKGROUND



DEFINITIONAccording to Muttaqin (2009), heart failure

is a condition when the heart is unable to maintain

adequate circulation to meet the body's needs,

although the normal venous filling.

ETIOLOGY

According to Kasron (2012), the etiology of heart

failure include :

• Abnormalities of the heart muscle.

• Coronary Atherosclerosis Myocardium resulting in

dysfunction due to disruption of blood flow to the heartmuscle to hypoxia and acidosis (due to lactic acid buildup).

• Myocardial infarction (death of heart cells).

• Systemic hypertension / pulmonary. Increase the workload

of the heart and in turn lead to hypertrophy of the heart

muscle fibers.

• Inflammation and myocardium disease.

• Heart disease.

• Systemic factors such as hypoxia and anemia who can

reduce oxygen supply to the heart.



PATHOPHYSIOLOGY

According to Kasron (2012), the function of the

heart as a pump is indicated by its ability to meet

adequate blood supply to all parts of the body, eitherat rest or while experiencing physiological stress.



SIGN AND SYMPTOM

According to Muttaqin (2009), signs and symptoms of heart

failure include:

• Increased intravascular volume (picture dominant)

• Ortopnuea is breathlessness on lying

• Dipsnea on effort (DOE) is Dipsnea when doing activities

• Paroxymal noctural dipsnea (PND) is a sudden shortness of

breath at night with a cough

• Palpitations, cold skin

•Hurry tired

• Cough

• Increased insistence on pulmonary venous (pulmonary edema)

is characterized by coughing and shortness of breath

• Increased insistence on systemic venous as seen in the general

peripheral edema and weight gain



TREATMENT

According to Muttaqin (2009 : 103-104),

physiological responses in heart failure provide therationale for action. Target management of heart

failure are:

• To reduce the heart’s work

• To increase cardiac output and myocardialcontractility

• To reduce salt and water retention

• Oxygen Therapy

• Therapy of vasodilator and nitrate coronary• Diuretic Therapy

• Digitalis Therapy

• Positive Inotropic

• Sedatives Therapy



DIAGNOSTIC

EXAMINATION

According to Muttaqin (2009 :

100-102), Diagnostic

Examination for heart failure :

• Echocardiography

• Chest X-ray

• Electrocardiography

COMPLICATION

• Kidney damage

• Heart valve problems

• Liver damage

• Heart attack and stroke



NURSING CARE ASSESSMENT

Client’s identity Name : Mr. A

Gender : Male

Age : 47 years old

Address : Kelayan B

Religion : Islam

Medical Diagnose : Heart failure

Date of entry : May 12th, 2014

Date of assessment : May 15th, 2014



Assessment Main complaint of the client when assessment on May 15th, 2014:

• the client said that he had felt breathless

• he had felt weak doing more activity

•he had no appetite during the hospitalized

Mr. A

1. Difficult to Breath

2. Weak

3. No appetite

treated in the Alamanda Ward

May 12th, 2014

THE CLIENT



•History of previous diseaseThe client said that he was ever hospitalized inhospital in same ward with heart failure too. The clientsaid that he had heart failure since 6 months ago andthe client said that this is for 9 times when he took

medication in hospital in same ward. The client saidthat he had no history of hypertension, diabetic andcontagious disease. The client said that he had nohistory of allergic.

• History of family diseaseThe client said that there were no family members

had the disease like the client had now, from thefamilies there were not having heart disease,hypertension, and diabetic.

Assessment



Focus Data

• The client said that

he had felt

breathless


he had felt weakdoing more activity


he had no appetite

during the

hospitalized

•

INSPECTION

• The client looked breathless

• The client looked weak

• The client looked just lied down on his bed

• The client looked using oxygen 3 liters

• The client’s consciousness level was

ompos mentis

• Body weight of the client is 46 kg

• Ideal body weight of the client is

56,7 kg – 69,3 kg

SUBJECTIVE DATA OBJECTIVE DATA



Cont…

• Skin turgor was back less than 2 second

• Conjunctives were anemic

• Mocusa of the client looked dry

• The client looked had no appetite

• The client just ate 3 – 4 spoons

• Respiration 32 times a minutes

• There was no ictus cordis

• Activity scale was 2 (the client needs help)

• The client looked helped by family in activity• Muscle scale :

4444 4444

4444 4444



Cont…

• Laboratory result of blood test on May 12th, 2014, hematology, hemoglobin

12.6 g/dl, erythrocyte 4.15 million/dl, hematocryte 38.7 vol%, RDW-CV 18.8

%

• Laboratory result of blood test on May 12th, 2014, fat and heart physiology,

LDH 580 U/I, CKMB 26 U/I• Laboratory result of blood test on May 12th, 2014, hepar, SGOT 47 U/I, SGPT

51 U/I

• Laboratory result of blood test on May 12th, 2014, kidney, urea 52 mg/dl

• Laboratory result of blood test on May 12th, 2014, electrolyte, potassium 3.3

mmol/I, chloride 100.6 mmol/I

• Chest x-ray results on May 12th, 2014 shows cardiomegaly 60,37 %

enlargement of heart

• ECG results on May 12th, 2014 : Regular heart rhythm, Heart rate 98 times a

minutes



Cont…

AUSCULTATION

• Thorax : Breath sound was vesicular, there was no wheezing and ronchi sounds.

Heart Sound S1 S2 regular

• Abdominal : Bowel sound heard normal with frequency 12 times a minute

• Blood pressure 100/80 mmHgPERCUSSION

• Thorax : resonant sounds on all area of lungs

• Abdominal : thympani sounds, heard dull sound

PALPATION

• Pulse was 94 times a minute• CRT back less than 2 seconds

• Tactile premitus was symmetric between right and left chest

• It was not found mass in abdominal

• There was no pain pressure in abdominal

• Ictus cordis was not palpable



1. Impaired gas exchange related to inadequatecardiac pump.

2. Imbalanced of nutrition: less than bodyrequirement related to inadequate intake ofnutrients.

3. Activity intolerance related to imbalance

between oxygen supply to tissues secondarywith cardiac output decrease (generalweakness).

Nursing Diagnosis



CONCLUSION

1. In the result of the assessment on May 15th to May 20th , 2014 there are three

nursing diagnosis

– Impaired gas exchange related to inadequate cardiac pump.

– Imbalanced of nutrition: less than body requirement related to inadequate

intake of nutrients . – Activity intolerance related to imbalance between oxygen supply to tissue

secondary with cardiac output decrease (general weakness).

2. In the Nursing implementation based on the plan done in May

15th to May 20th, 2014. In the nursing evaluation, the problemcould only be half solved because of limited time and the client

went home.



By:

Muhammad Mustafa

ppt heart failure fix

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