Nama

: EVELIN APRILIANTY

NPM

: 220110090040

Makul

: KARDIOVASKULER

ASKEP KLIEN DG RHD

PENGKAJIAN

KELUHAN UTAMA: Kriteria mayor dan kriteria minor

RIWAYAT PENYAKIT SEKARANG

RIWAYAT PENYAKIT DAHULU

RIWAYAT PENYAKIT KELUARGA: srg lebih dr satu anggota kelg, kembar monosigot,
antigen HLA tertentu pd klien

RIWAYAT PSIKOSOSIAL SPIRITUAL

PEM FISIK

KARDITIS

POLIARTHRITIS MIGRANS

KHOREA: lemah otot, gerakan tdk tkendali, ggn emosi

Nodul subkutan: jrg pd dewasa

ERITEMA MARGINATUM: Rash di tbh, jrg pd dewasa

DIAGNOSA KEPERAWATAN
INTERVENSI

BED REST

ADEQUATE NUTRISI

PERSONAL HYEGIENE

SLEEPING

MOBILITYdeep greathing, leg exercise, wheelchair use

KOLABORASI

BENZATIN PENISILIN im

SALISILAT OR PREDNISON

DIURETIK

KHORPROMAZIN: Khorea

PATOFISIOLOGI PERADANGAN PADA JANTUNG

INFLAMMATION AND INFECTION IN THE HEART

RHEUMATIC FEVER

IS AN ACUTE SYSTEMIC INFLAMMATORY CONDITION THAT APPEARS

TO RESULT FROM AN ABNORMAL IMMUNE REACTION OCCURING A FEW
WEEKS AFTER AN UNTREATED INFECTION, USUALLY CAUSED BY
CERTAIN STRAINS OF GROUP A BETAHEMOLYTIC STREPTOCOCCUS

INVOLVES THE HEART AND OTHER PARTS SUCH AS JOINTS AND SKIN

USUALLY OCCURS IN CHILDREN 5-15 YEARS

THE INFECTION COMMONLY

APPEARS AS AN UPPER RESPIRATORY

INFECTION, TONSILITIS, PHARYNGITIS, OR STREP THROAT.

ANTIBODIES TO THE STREPTOCOCCUS ORGANISM FORM AS USUAL AND

THEN REACT WITH CONNECTIVE TISSUE (COLLAGEN) IN THE SKIN,
JOINTS, BRAIN, AND HEART CAUSING INFLAMMATION.

DURING THE ACUTE STAGE, THE INFLAMMATION IN THE HEART MAY

INVOLVE ONE OR MORE LAYERS OF THE HEART:

1. PERICARDITIS..OUTER LAYERMAY INCLUDE EFFUSION

2. MYOCARDITISHEART MUSCLEASCHOFF BODIES, MAY INTERFERE

WITH CONDUCTION

3. ENDOCARDITIS..VALVESBECOME EDEMATOUS AND VERRUCAE

FORM

PANCARDITIS

OTHER SITES OF INFLAMMATION IN PATIENTS WITH RHEUMATIC FEVER

INCLUDE:

THE LARGE JOINTS, PARTICULARLY IN THE LEGS, WHICH MAY BE

INVOLVED WITH SYNOVITIS IN A MIGRATORY POLYARTHRITIS

THE SKIN..RED MACULES OR POPULES THAT ENLARGE AND HAVE

WHITE CENTERS

THE WRISTS, ELBOWS, KNEES, OR ANKLES

BASAL NUCLEI IN THE BRAINCAUSING INVOLUNTARY JERKY

MOVEMENT OF THE FACE, ARMS, AND LEGS.

SIGNS AND SYMPTOMS RHD

LOW GRADE FEVER

LEUKOCYTOSIS

MALAISE

ANOREXIA

FATIGUE

TACHYCARDIA, EVEN AT REST

HEART MUJR MURS INDICATE THE SITE OF INFLAMMATION

EPISTAXIS & ABDOMINAL PAIN MAY BE PRESENT

ACUTE HEART FAILURE MAY DEVELOP FROM ARRYTHMIA

PERICARDITIS

NYERI PRECORDIAL

NYERI PERIKARDITIS BERKURANG DG DUDUK TEGAK DAN

MEMBUNGKUK KE DEPAN

FRICTION RUBgesekan pericard

EFUSI PERIKARDIUMsuara jtg lbh lemah

TAMPONADE JANTUNG

NADI PARADOKSAL

EKGElevasi ST segmen..tanpa perub QRS

Efusi pericardium

Impuls apeks jantung dpt hilang atau atau kadang teraba

Fluoroskopi memperlihatkan denyut ventrikel berkurang

Perkusi pekak
TANDA EWART

TAMPONADE JANTUNG

PENGUMPULAN CAIRAN INTRAPERICARDIUM

MENYEBABKN OBSTRUKSI SERIUS THD MASUKNYA DARAH KE KE2 ATRIUM

BS MENIMBLK TAMPONADE

250 CC-1000 CC

MYOCARDITIS
ENDOKARDITIS

NON INFEKTIF

INFEKTIF

MANIFESTASI KLINIS

KELAINAN VASKULER

RUPTUR KATUP

PENGKAJIAN KARDIOVASKULER

MASALAH KEPERAWATAN

1. PENURUNAN CURAH JANTUNG

ETIOLOGI

: vasokonstriksi,gangguan kontraktilitas,peningkatan after load

RIWAYAT PENYAKIT :
Pernah / sedang mengalami penyakit jantung : hypertensi, decompensasi cordis,aterosklerosis,
angina pectoris, hypertensi,MCI,anginapectoris,cardiac effusion,aritmia, gagal ginjal
Perokok
Pecandu alkohol
Hereditas
Toksisitas digitalis
Pola makan
Pola aktivitas

PEMERIKSAAN FISIK

DO :
1. INSPEKSI : lemah,JVP meningkat, odem ekstremitas, sianosis
2. PALPASI : nadi melemah & lambat, akral dingin,laterisasi PMI
3. PERKUSI :pelebaran batas jantung
4. AUSKULTASI : murmur,S3/S4,ronchi
5. Keadaan umum : rasa lelah,vital sign: TD turun,bradikardi,dispnea

DS :
1. Mengeluh sesak,mudah capek
2. Mual
3. Nyeri dada
4. Palpitasi

PEMERIKSAAN DIAGNOSTIK
1. Rontgen : kardiomegali
2. EKG : ST elevasi
3. LAB : CKMB meningkat,troponin meningkat,SGOT/SGPT meningkat,BUN
meningkat,trigliserida meningkat

Masalah Keperawatan = Gangguan Perfusi Jantung b.d. gangguan sirkulasi, penurunan Cardiac
Output

Riwayat : PJK, merokok, DM, Dislipidemia, Riwayat inflamasi jantung, kelainan katup dan
emboli plaque atherosclerosis.

PEMERIKSAAN FISIK

DS : keluhan chest pain menjalar ke lengan kiri, bahu dan penggung.

Palpitasi.

DO :

Inspeksi :tampak memegang daerah dada, keringat banyak/diaphoresis, gelisah, dan RR

meningkat.

Palpasi : tachicardia, Td menurun

Pemeriksaan Diagnostik
Pd DK Intoleransi Aktivitas

Laboratorium darah: Hb, Ht

Tredmill

Valsalva manuever

2. GANGGUAN RASA NYAMAN NYERI bd. PENURUNAN SUPPLAI O2

RIW. KEPERAWATAN

RIWAYAT KETURUNAN DG PENY. ARTERI KORONER, HIPERTENSI, DM

RIW. PENGGUNAAN KONTRASEPSI ORAL PD WANITA

RIW. OBESITAS

KEBIASAAN MEROKOK

KEBIASAAN OLAH RAGA

RIW. NYERI DADA TYANG PERNAH DIALAMI

RIW. RESPON THD STRES

PEMERIKSAAN FISIK
PEM. DIAGNOSTIK

ANALISA GAS DARAH

EKG

ENZIM CK-CKMB

TROPONIN T

PEMERIKSAAN HB, HT, LED

KOLESTEROL, LDL, HDL