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Asuhan Keperawatan Angina Pectoris

Asuhan Keperawatan Angina PectorisAsuhan Keperawatan Angina Pectoris


DIAGNOSA KEPERAWATAN YANG MUNGKIN MUNCUL
  1. Nyeri akut berhubungan dengan iskemik miokard.
  2. Intoleransi aktifitas berhubungan dengan berkurangnya curah jantung.
  3. Ansietas berhubungan dengan rasa takut akan ancaman kematian yang tiba-tiba.
  4. Kurang pengetahuan (kebutuhan belajar) mengenai kodisi, kebutuhan pengobatan berhubungan dengan kurangnya informasi.

FOKUS INTERVENSI
  1. Nyeri akut berhubungan dengan iskemik miokard.

    Intervensi :
    • Kaji gambaran dan faktor-faktor yang memperburuk nyeri.
    • Letakkan klien pada istirahat total selama episode angina (24-30 jam pertama) dengan posisi semi fowler.
    • Observasi tanda vital tiap 5 menit setiap serangan angina.
    • Ciptakanlingkunan yang tenang, batasi pengunjung bila perlu.
    • Berikan makanan lembut dan biarkan klien istirahat 1 jam setelah makan.
    • Tinggal dengan klien yang mengalami nyeri atau tampak cemas.
    • Ajarkan tehnik distraksi dan relaksasi.
    • Kolaborasi pengobatan.


  2. Intoleransi aktifitas berhubungan dengan kurangnya curah jantung.

    Intervensi :
    • Pertahankan tirah baring pada posisi yang nyaman.
    • Berikan periode istirahat adekuat, bantu dalam pemenuhan aktifitas perawatan diri sesuai indikasi.
    • Catat warna kulit dan kualittas nadi.
    • Tingkatkan katifitas klien secara teratur.
    • Pantau EKG dengan sering.


  3. Ansietas berhubungan dengan rasa takut akan ancaman kematian yang tiba-tiba.

    Intervensi :
    • Jelaskan semua prosedur tindakan.
    • Tingkatkan ekspresi perasaan dan takut.
    • Dorong keluarga dan teman utnuk menganggap klien seperti sebelumnya.
    • Beritahu klien program medis yang telah dibuat untuk menurunkan/membatasi serangan akan datang dan meningkatkan stabilitas jantung.
    • Kolaborasi.


  4. Kurang pengetahuan (kebutuhan belajar) mengenai kodisi, kebutuhan pengobatan berhubungan dengan kurangnya informasi.

    Intervensi :
    • Tekankan perlunya mencegah serangan angina.
    • Dorong untuk menghindari faktor/situasi yang sebagai pencetus episode angina.
    • Kaji pentingnya kontrol berat badan, menghentikan kebiasaan merokok, perubahan diet dan olah raga.
    • Tunjukkan/ dorong klien untuk memantau nadi sendiri selama aktifitas, hindari tegangan.
    • Diskusikan langkah yang diambil bila terjadi serangan angina.
    • Dorong klien untuk mengikuti program yang telah ditentukan.


DAFTAR PUSTAKA


Corwin, Elizabeth, Buku Saku Patofisiologi, Jakarta, EGC, 2000.

Chung, EK, Penuntun Praktis Penyakit Kardiovaskuler, Jakarta, EGC, 1996

Doenges, Marylinn E, Rencana Asuhan Keperawatan, Jakarta, EGC, 1998

Engram, Barbara, Rencana Asuhan Keperawatan Medikal Bedah volume 2, Jakarta, EGC, 1998

Long, C, Barbara, Perawatan Medikal Bedah 2, Bandung, IAPK, 1996

Noer, Sjaifoellah, Buku Ajar Ilmu Penyakit Dalam, Jakarta, FKUI, 1996

Price, Sylvia Anderson, Patofisiologi Buku I Jakarta, EGC, 1994

……., Dasar-dasar Keperawatan Kardiotorasik (Kumpulan Bahan Kuliah edisi ketiga),Jakarta : RS Jantung Harapan Kita, 1993.

Tucker, Susan Martin, Standar Perawatan Pasien Volume I, Jakarta, EGC, 1998

Underwood, J C E, Pathologi Volume 1 , Jakarta, EGC, 1999
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