Pengelolaan Masalah Pernapasan pada Pasien dengan Heart Decompensation di IGD RSA Universitas Gadjah Mada: Case Report

https://doi.org/10.22146/jkkk.77411

Noviya Ayuningtyas(1*), Hersinta Retno Martani(2), Setyawan Setyawan(3)

(1) Universitas Gadjah mada
(2) Departemen Keperawatan Dasar dan Emergensi, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(3) Instalasi Gawat Darurat, Rumah Sakit Akademik Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


Background: Heart decompensation is a heart failure exacerbation caused by the body’s decompensated mechanism. Uncontrolled hypertension is one of the risk factors for heart decompensation that worse the decompensated mechanism in the presence of target organ damage (TOD). Patient with heart decompensation also suffers dyspnea, ortopnea, and paroxysmal nocturnal dyspnea (PND).
Objective: To describe the management of breathing problem in patient with heart decompensation in emergency department (ED).
Case: A 39-year-old woman came to ED with severe shortness of breath that has been felt since this week and has gotten worse for past few days. Her condition was as follow saturation 94%, RR 45x/ minutes, HR 153x/minutes, BP 200/125mmHg.
Result: Breathing problem management in this patient was helped by oxygen therapy, positioning, mucolytic, bronchodilator, antibiotic, and corticosteroid. Breathing problem was improved after administering the therapy based on effort, frequency, depth in breathing, and oxygen saturation. In addition to breathing problem, circulation problem was also managed comprehensively and had shown improved outcome.
Conclusion: Administration of therapy in the ED in heart decompensation patient with breathing problem has improved with increased saturation, reducted shortness of breath, and expelled excess fluid.

ABSTRAK

Latar belakang: Heart decompensation merupakan faktor yang memperparah kondisi gagal jantung kronis yang disebabkan oleh mekanisme dekompensasi tubuh. Hipertensi tidak terkontrol merupakan salah satu faktor risiko heart decompensation yang dapat memperburuk mekanisme dekompensasi dengan adanya target organ damage (TOD). Pasien dengan heart decompensation juga disertai masalah pernapasan seperti dyspnea, ortopnea, dan paroxysmal nocturnal dyspnea (PND).
Tujuan: Mendeskripsikan pengelolaan masalah pernapasan pasien heart decompensation di instalasi gawat darurat (IGD).
Laporan kasus: Pasien wanita, berusia 39 tahun, datang ke IGD dengan keluhan sesak napas berat yang dirasakan sejak seminggu ini dan memberat dalam beberapa hari ini. Saturasi 94%, RR 45x/ menit, nadi 153x/menit, TD 200/125mmHg.
Hasil: Penatalaksanaan masalah pernapasan pada pasien dengan pemberian terapi oksigen, positioning, mukolitik, bronkodilator, antibiotik, dan kortikosteroid. Masalah pernapasan pada pasien mengalami perbaikan setelah pemberian terapi tersebut. Hal ini dilihat berdasarkan usaha, frekuensi, kedalaman bernapas, dan saturasi oksigen. Selain masalah pernapasan, masalah sirkulasi pada pasien juga dikelola secara komprehensif dan menunjukkan outcome yang membaik.
Simpulan: Pemberian terapi di IGD pada pasien heart decompensation dengan masalah pernapasan mengalami perbaikan dengan peningkatan saturasi, sesak napas berkurang, cairan berlebih dapat dikeluarkan.


Keywords


heart decompensation; hipertensi darurat; pengelolaan pernapasan

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References

  1. WHO. International Statistical Classification of Diseases and Related Health Problems, 10th Revision ICD-10 : Tabular List. World Health Organization [Internet]. 2016; 1: 332–45 [cited 2022 July 31]. Available from: http:// www.who.int/classifications/icd/icdonlineversions/en/
  2. Alley WD SM. Hypertensive Emergency. National Central Biotechnology Information Statpearls [Internet]. 2021 [cited 2022 August 1]. Available from: www.ncbi.nlm.nih.gov.
  3. World Health Organization. Cardiovascular Diseases [Internet]. World Health Organization. 2022 [cited 2022 July 30]. Available from: www.who.int.
  4. Center for Disease Control and Prevention. High Blood Pressure [Internet]. Center for Disease Control and Prevention. 2021 [cited 2022 July 29]. Available from:www.cdc.gov.
  5. American Heart Association. What is Heart Failure? [Internet]. American Heart Association. 2017 [cited 2022 July 18]. Available from: www.heart.org.
  6. Bozkurt B, Hershberger RE, Butler J, Grady KL, Heidenreich PA, Isler ML, Kirklin JK, Weintraub WS. 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure). Circulation Cardiovascular Quality Outcomes. 2021; 14(4): e000102. DOI: https://doi.org/10.1161/hcq.0000000000000102.
  7. Njoroge JN, Teerlink JR. Pathophysiology and Therapeutic Approaches to Acute Decompensated Heart Failure. Circulation Research. 2021; 128(10): 1468–86. DOI: https://doi.org/10.1161/CIRCRESAHA.121.318186.
  8. Farmakis D, Parissis J, Lekakis J, Filippatos G. Acute heart failure: Epidemiology, Risk Factors, and Prevention. Revista Española de Cardiología. 2015; 68(3): 245–8. DOI: https://doi.org/10.1016/j.rec.2014.11.004.
  9. Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, Herridge M, Randolph AG, Calfee CS. Acute Respiratory Distress Syndrome. Disease Primers. 2019(5):18. DOI: https://doi.org/10.1038/s41572- 019-0069-0.
  10. Nurkhalis N & Adista RJ. Manifestasi Klinis dan Tatalaksana Gagal Jantung. Jurnal Kedokteran Nanggroe Medika. 2020; 3(3): 36-46. DOI: https://doi.org/10.35324/jknamed.v3i3.106.
  11. Sarraf M, Masoumi A, Schrier RW. Cadiorenal Sydnrome in Acute Decompensated Heart Failure. Clinical Journal of The American Society of Nephrology. 2009; 4(12): 2013-26. DOI: https://doi.org/10.2215/ cjn.03150509.
  12. American Heart Association. 2022 AHA/ACC/HFSA Guideline for The Management of Heart Failure: A Report of The American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(18): e895–e1032. DOI: https://doi.org/10.1161/CIR.0000000000001063.
  13. Hafen, B. B., & Sharma, S. Oxygen Saturation. [Internet]. In N. C. Information, STATPEARLS. National Library of Medicine. 2021. [cited 2022 August 1]. Available from: www.ncbi.nlm.nih.gov.
  14. American Nurses Association. No Title. In: Nursing Fundamentals [Internet]. Pressbooks; 2021.[cited 2022 August 1] Available from: https://wtcs.pressbooks.pub/nursingfundamentals/
  15. Ernstmeyer & Christman. Basic Concept of Oxygenation. [Internet]. 2022 [cited 2022 august 3]. Available from: med.libretexts.org.
  16. Chanif C, Prastika D. Position of Fowler and Semi-fowler to Reduce of Shortness of Breath (Dyspnea) Level While Undergoing Nebulizer Therapy. South East Asia Nurs Res. 2019;1(1):14.
  17. Saab H, Aboeed A. Ipratropium. National Central Biotechnology Information Statpearls [Internet]. 2021. [cited 2022 July 19]. Available from: www.ncbi.nlm.nih.gov.
  18. World Health Organization. Pneumonia [Internet]. World Health Organization. 2021 [cited 2022 Jul 31]. Available from: www.who.int.
  19. America Thoracic Society. Diagnosis and Treatment of Adults with Community-acquired Pneumonia: An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. 2019; 200(7): e45-e67. DOI: https://doi.org/10.1164/rccm.201908-1581ST.
  20. Chang CC, Cheng AC, Chang AB. Over-The-Counter (Otc) Medications to Reduce Cough as an Adjunct to Antibiotics for Acute Pneumonia in Children and Adults. Cochrane Database Systematic Review. 2014; (3). DOI: https://doi.org/10.1002/14651858.cd006088.pub4.
  21. Mehta J, Rolta R, Mehta BB, Kaushik N, Choi EH, Kaushik NK. Role of Dexamethasone and Methylprednisolone Corticosteroids in Coronavirus Disease 2019 Hospitalized Patients: A Review. Frontiers Microbiology. 2022 Feb 15;13:813358. DOI: https://doi.org/10.3389/fmicb.2022.813358.
  22. American Heart Association. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension [Internet]. American Heart Association. 2018 [cited 2022 Jul 31]. Available from: www.heart.org.
  23. Loftus NW, Bowden T. Acute Decompensated Heart Failure: A Study of Nursing Care. Br J Card Nurs. 2020;15(3):1–12. DOI: https://doi.org/10.12968/bjca.2019.0127.
  24. Khashayar, Farzam; John RR. Premature Ventricular Contraction. National Central Biotechnology Information Statpearls [Internet]. 2022. [cited 2022 July 19] Available from: https://www.ncbi.nlm.nih.gov/books/NBK532991/
  25. Badan Pengawas Obat dan Makanan. Sistem Kardiovaskuler: Antiplatelet [Internet]. Badan Pengawas Obat dan Makanan. 2015 [cited 2022 Aug 1]. Available from: http://pionas.pom.go.id.
  26. Rumah Sakit Akademik Universitas Gadjah Mada. Klaster Penyakit Dalam dan Metabolisme Klaster Jantung Terpadu Klaster Ginjal Terpadu. Standar Pelayanan. Jilid 3. Yogyakarta: RS Akademik UGM.



DOI: https://doi.org/10.22146/jkkk.77411

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