Jumat, 06 Mei 2011
CHAPTER I
INTRODUCTION
A. Background
Based Nursing Workshop 1983 in Ali (2002:12), nursing is a professional service which is an integral part of health care based on nursing science and troubleshooting, service-shaped bio - psycho - social - spiritual thoroughly addressed to individuals, groups, and society, both healthy andpain that covers the entire process of human life. Nursing services, are provided as a result of physical and mental weakness, lack of knowledge, and lack of willingness to carry out activities of daily living - day. Activities carried out in an effort to improve health, disease prevention, healing, recovery and health maintenance with an emphasis on primary health care efforts (PHC) in accordance with the authority, responsibility, and ethical codes of professional nursing.
According to Law - Law of RI. No. 23 of 1992 on Health Nurses are those who have the ability and authority to act on the basis of nursing science has, which is obtained through treatment education (Ali, 2002:12).
Mission of Indonesia's health development plans reduce morbidity and maternal and neonatal mortality through strengthening health systems to ensure access to effective interventions based on scientific evidence that quality, empowering women, families communities through activities that promote maternal and newborn health and ensure that internal and maternal promoted and preserved as a national priority development programs.
Congenital heart disease or congenital heart disease is a set of structural malformations of heart or major blood vessel that has been there since birth. Complex congenital heart disease found mainly in infants and children. If no surgery, most will die in infancy. If the congenital heart disease found in adults, this suggests that these patients were able through natural selection, or has undergone surgery early in childhood.(Www.google.com)
Our hope is that this paper can be optimally utilized by all human health in an effort to provide professional nursing practice and to help reduce maternal and neonatal mortality.
Background Based on the description above, then the problem can be raised is "How to implement the Nursing Child With a Case of patent ductus arteriosus (PDA)? ".
C. Goal Writing 1. General Purpose
To provide a basic overview on how to establish Nursing Children With Case "patent ductus arteriosus (PDA)"
2. Specific Objectivesa. Students gain knowledge about the definition, pathophysiology, etiology, clinical manifestations, complications of cases of "patent ductus arteriosus (PDA)"
b. Students are able to carry out assessment of the status of nursing "patent ductus arteriosus (PDA)"c. Students are able to define the problem of nursing assessment data conducted
d. Students are able to make nursing care plan based on diagnoses that occurred on the client e. Students are able to perform actions based on nursing care nursing definedf. Students are able to evaluate nursing actions that have been implemented based on the criteria established
g. Students are able to document nursing care in a systematic and continuousD. Benefits of Writing
1. As input to the nurse in caring for pediatric patients with cases of "patent ductus arteriosus (PDA)"
2. To increase nursing knowledge, especially students with cases of "patent ductus arteriosus (PDA)"
3. As one of the experiences in conducting Nursing Children with cases of "patent ductus arteriosus (PDA)"
4. Can be used as one of the scientific contribution to the presentation of the next report.
CHAPTER II
THEORETICAL REVIEW
1. Definition Patent ductus arteriosus (PDA) is a ductus arteriosus that remains open after birth. This disorder is 7% of all congenital heart disease. Often found in premature infants, incidence increases with decreasing gestation (Betz & Sowden. 2002: 375)
Patent ductus arteriosus (PDA) is fixed to the opening of the ductus arteriosus after birth, which causes blood dialirkannya directly from the aorta (higher pressure) into the pulmonary artery (lower pressure). (Betz & Sowden, 2002; 375)
Patent ductus arteriosus (PDA) or patent ductus arteriosus (DAP) is a congenital heart abnormality (congenital) where there is no closure (patency) ductus arteriosus which connects the aorta and large pulmonary blood vessels after 2 months post-birth babies Source :http://kumpulanmaterikeperawatan.blogspot.com
Patent ductus arteriosus is the failure to close the ductus arteriosus (the artery that connects the aorta and pulmonary artery) in the first week of life, which causes the flow of blood from the aorta of high pressure to low pressure pulmonary artery. (Suriadi, Rita Yuliani. 2001; 235)
2. Etiology
The cause of congenital heart disease can not be known for certain, but there are several factors that allegedly have an influence on increasing the incidence of congenital heart disease:
1. Prenatal factors: Mother suffering from infectious diseases: Rubella. • Mother alcoholism. • maternal age over 40 years. • The mother suffered from Diabetes Mellitus (DM) who require insulin. • Mother drank a sedative drug or herbal medicine. 2. Genetic factors: • Children born before suffering from congenital heart disease. • Father / Mother suffered from congenital heart disease. • chromosomal abnormalities such as Down Syndrome. • Born with congenital abnormalities of the other. (Textbook Cardiovascular Nursing, Center for Cardiovascular Health National Harapan Kita, 2001; 109)3. Pathophysiology
Ductus arteriosus is a blood vessel connecting the pulmonary blood flow to systemic blood flow during pregnancy (fetus). This relationship (shunt) is needed because of fetal respiratory system has not worked on during pregnancy. Blood flow through the fetus will be mixed with clean blood flow from the mother (via the umbilical vein) and then get into the right atrium and then pumped by the right ventricle back into the systemic flow through the ductus arteriosus. Normally the ductus arteriosus originating from the main pulmonary artery (left pulmonary artery) and ends at the superior part of the descending aorta, ± 2-10 mm distal from the left subclavian artery branches.
The walls of the ductus arteriosus mainly consists of layers of smooth muscle (tunica media) is composed spiral. Among the smooth muscle cells contained elastin fibers that form a berfragmen layer, in contrast to the aorta which has a thick layer of elastin and arranged meetings (unfragmented). Smooth muscle cells in the ductus arteriosus is sensitive to vasodilator prostaglandins and vasoconstrictor mediators (pO2). After childbirth circulation and physiological changes that began soon after elimination of the placenta from the newborn. The change in pressure, circulation and increased pO2 will cause the closure of the ductus arteriosus spontaneously within 2 weeks. Persistent ductus arteriosus (PDA) will lead to Gout (shunt) LR which then can cause pulmonary hypertension and cyanosis. The amount of Gout (shunt) is determined by the diameter, length of PDA and pulmonary vascular resistance (PVR).
1. Do not cause symptoms when a small PDA. Signs of CHF appear on a large PDA.
2. Continuous murmur (machinery) degrees 1 to 4 / 6 clearly audible on the left infraklavikula ULSB or area which is a typical marker of this disorder.Rumble apical sounds great on your PDA.
3. Weak peripheral pulses and pulse width 4. CHF and recurrent pulmonary infections often occur in large PDAs. 5. Spontaneous closure of PDA is not going to happen to the baby term.6. There will be pulmonary hypertension and PVOD when PDAs are left without closure action.
7. Cyanosis which occurred on PDA with PVOD known as differential cyanosis because of the lower limb only the blue while the upper extremities remained normal. (Suriadi, Rita Yuliani, 2001; 236)5. Complication a. Endocarditis b. Obstruction of pulmonary blood vessels c. CHF (congestive heart failure) d. Hepatomegaly (rare in premature infants) e. Necrotizing enterocolitis f. Concomitant pulmonary disorders (eg respiratory distress syndrome or dysplasia bronkkopulmoner) g. Gastrointestinal bleeding (GI), decreased platelet count h. Hyperkalemia (decreased urine output). i. Arrhythmia j. Failure to thrive (Suriadi, Rita Yuliani, 2001; 236) 6. Medical Treatment
a. Conservative Treatment: fluid restriction, and provision of drugs: furosemide (Lasix) is supplied with fluid restriction to increase diuresis and reduce the effects of cardiovascular overload, giving indomethacin (prostaglandin inhibitor) to facilitate the closure of the ductus, a prophylactic antibiotic to prevent bacterial endocarditis.
b. Surgery: The cutting or fastening the duct.
c. Non-surgical: Closure by means of closing done at the time of cardiac catheterization.
(Suriadi, Rita Yuliani, 2001; 236)7. Diagnostic Examination
a. ECG abnormalities similar to the VSD. In the small PDA-being can occur LVH or normal. CVH when a large PDA. Or when it has occurred PVOD RVH. varies according to severity, on a small PDA no abnormalities, left ventricular hypertrophy in a larger PDA.
b. Chest radiograph abnormalities also resembles VSD. In a normal heart shadow small PDA. PDA medium-high and an increase occurred kardiomegali PVM. PVOD presence will result in a normal heart size with enlarged MPA and increased corakan vaskulerisasi hilum.
c. Through the examination ekho 2-D and Doppler can be visualized and the amount of PDA shunt. Angiography examination is usually not necessary unless there is suspicion PVOD.
d. Ekhokardiografi the ratio of left atrial tehadap base of the aorta more than 1,3:1 in term infants or more than 1.0 in infants praterm (caused by increased left atrial volume as a result of the shunt left to right).
e. Cardiac catheterization is only performed to further evaluate the results of Doppler ECHO or questionable or if there is suspicion of any additional defects.
(Betz & Sowden, 2002; 377)CHAPTER III ADOPTION OF CHILDREN IN CASES OF NURSING patent ductus arteriosus (PDA)
A. ASSESSMENT
1. Activity / rest
Symptoms: Weakness, fatigue. Dizziness, a sense of pulsing. Sleep disorders.
Signs: Tachycardia, interference with the TD. Dyspnea
2. Circulation
Symptoms: History trigger conditions, eg rheumatic fever, hypertension, conditions
congenital (atrial-septal damage.) History of heart murmur, palpitations.Cough with or without sputum production
Signs: Systolic BP decreased. Pulse pressure: constriction (SA); area (IA). Carotid pulse: slow with a small pulse volume (SA); dam with visible arterial pulsation (IA). Apical pulse: PMI kauat and is located in the bottom right and left (IM); strong lateral displacement (IA). Murmur: systolic murmur in the area pulmonik (IP). Renadah sound, diastolic murmur noise (SM).Sitolik murmurs sounded good at the musty (MR). Systolic murmur heard best at the base to spread to the neck (SA).
3. Ego Integrity
Symptoms: Signs of anxiety, restlessness example, pale, sweaty, the focus narrowed, trembling.
4. Food / fluid
Symptoms: Dysphagia (chronic IM). Changes in body weight. Usage deuretik
Signs: Edema public. Hepatomegaly and ascites. Warmth, redness and skin
moist. Breathing hard and noisy with the sounds krekles and wheezing.
5. Neurosensori
Symptoms: Dizziness / fainted due to excessive activity
6. Pain / comfort
Symptoms: Chest pain, angina. Nion chest pain of angina / non-typical
7. Respiratory
Symptoms: Dispnae. Cough settle
Signs: Takipnae. Mengih breath sounds. Many sputum and blood spots
(Pulmonary edema).
8. Security
Symptoms: The process of infection, chemotherapy radiation. The existence of the tooth perawatn
Signs: Dental care / mouth
B. Nursing Diagnosis
1. Rainfall decrease heart b.d heart malformations.
2. Bd activity intolerance imbalance between oxygen consumption by
body and supply oxygen to the cells.
3. Bd anxiety situations (hospital care / lack of family)
4. Lack of family knowledge about the condition, treatment needs bd less exposed to information about diseases PDAs.
C. INTERVENTION AND RATIONAL
Nursing Diagnosis 1: Rainfall Decrease heart malformations heart bd
Intervention:
1) Monitor BP, apical pulse, peripheral pulse
2) Monitor the cardiac rhythm as indicated
3) Encourage bed rest with head of bed elevated 45 degrees
4) Assist with activities as indicated.
Rational:
1) clinical indicator of cardiac output keadekuatan. Monitoring allows early detection of dekomensasi.
2) Distrimia common in clients with valve disease. Distrimia most common atrium, with regard to increased atrial pressure and volume.
3) Lowering blood volume kemabali to the heart, which allows oxygenation, reduce dyspnea and heart strain.
4) To re-activity gradually to prevent coercion of cardiac reserve.
Nursing Diagnosis 2: Intolerance bd activity imbalance between oxygen consumption by the body and supply oxygen to the cells.
Intervention:
1) Assess the client's tolerance of activity using the following parameters: pulse frequency 20 / min above the resting frequency: note the increase in BP, dyspnea or chest pain: severe fatigue and weakness, sweating, dizziness or fainting.
2) Assess the readiness to increase the activity of samples decreased weakness or fatigue, TD stable / pulse frequency,
3) Notice of activity and self care.
4) Encourage advance self-care activities or tolerance.
Rational:
1) Parameters client shows the physiological response to stress and activity indicators of the degree of influence over the activity or heart
2) physiological stability at rest is important to advance the level of individual activity
3) Consumption of O2 miokardia during various activities to increase the amount of O2 available.
4) Progress of activity gradually to prevent sudden increase in heart work.
Nursing Diagnosis 3: Anxiety bd critical situations (hospital care / lack of family)
Intervention:
1) Identify the perception that the show treatment by the situation.
2) Monitor the physical response, tachikardi example, repetitive movements, anxiety
3) Provide comfort measures example, bath, rubbing his back, a change of position
4) Involve the people closest to the plan of care and encourage maximum participation in treatment plan
Rational:
1) Tools to define the scope of the problem and intervention options
2) Assist Kien determine appropriate degrees anxious heart status.
3) Use of premises in rhythm evaluation of verbal and non verbal responses Helping to redirect attention and increase relaxation, improve coping skills.
4) involvement will help focus the attention of clients in a positive sense and provide a sense of control.
Nursing Diagnosis 4: Lack of family knowledge about the condition, treatment needs bd less exposed to information about diseases PDAs.
Intervention:
1) Explain the rationale of treatment, dosage, side effects and the importance of taking medication as prescribed examples of diuretics, vasodilators
2) Instruct the client to drink daily diuretic
3) Discuss Kien need to balance activity and rest
Rational:
1) Can enhance cooperation with drug therapy and prevent the termination of his own medicine and drug interactions merugiakan
2) Scheduling to minimize nighttime urination or disrupt sleep
3) Program activities are consistently and accurately gradual best to minimize the conditions and weaknesses and prevent the excess of work which can increase the burden or decompensated heart.
E. EVALUATION
Nursing Diagnosis 1: Rainfall Decrease cardiac malformations bd
heart
Expected results:
1. Showed a decrease dyspnea, chest pain
2. Participate in activities that reduce the heart's workload
Nursing Diagnosis 2: Intolerance bd activity imbalance between oxygen consumption by the body and supply oxygen to the cells.
Expected results:
1. Show measurable improvement in activity tolerance
2. Identify factors that affect tolerance and activity decline with negative effects
Nursing Diagnosis 3: Anxiety bd critical situations (hospital care / lack of family)
Expected results:
1. Normal states of consciousness / composmentis, feeling calm, anxiety no longer exists
2. Reported reduction / control
3. Shows relaxation
Nursing Diagnosis 4: Lack of knowledge about conditions, treatment needs bd less exposed to information about diseases PDAs.
Expected results:
1. Expressing understanding of the disease process, treatment programs and potential
complication
2. Identify the behavior or lifestyle changes to prevent complications
3. Recognizing the need for cooperation and to follow treatment.
CHAPTER VI
CLOSING
A. Conclusion
Based on the above discussion it can be deduced:
a. Students know and are able to explain about the definition, pathophysiology, etiology, clinical manifestations, complications of cases of "patent ductus arteriosus (PDA)"
b. Students may carry out the assessment status of nursing "patent ductus arteriosus (PDA)"
c. Students can define the problem of nursing assessment data conducted
d. Students can create a nursing care plan based on diagnoses that occurred on the client
e. Students can perform actions based on nursing care nursing defined
f. Students can evaluate nursing actions that have been implemented based on the criteria established
g. Students can document nursing care in a systematic and continuous
B. Suggestion
Based on the above conclusion, it is recommended:
1. It is expected that the students especially for nursing students to understand, understand and can explain tenatang disease patent ductus arteriosus (PDA) both on understanding, pathophysiology, etiology, clinical manifestations, and prevention and the implementation of nursing care.
2. Students are expected to dig back more about the disease process patent ductus arteriosus (PDA). And knowledge gained can be applicable in public life.
3. Pregnant women should avoid consuming alcohol, drugs or herbal tranquilizers.
4. Nurses are able to explain to pregnant women that the disease patent ductus arteriosus (PDA) could be caused by genetic factors / heredity.
5. In an effort to decrease the number of patients with patent ductus arteriosus (PDA) is expected to team health and nursing students to further improve health education to communities about the disease patent ductus arteriosus (PDA).
REFERENCES
Ali.Z. 2002. Fundamentals of Professional Nursing
Anonymous. 2001. Cardiovascular nursing textbook. New York: Center for Health National Heart And Blood Vessels Harapan Kita.
Betz., Sowden., 2002, Pediatric Nursing, Issue 3, EGC, Jakarta.
Suriadi, Rita Yuliani. 2001, Plan for Medical Surgical Nursing, Volume 3, EGC, Jakarta.
http://www. google.com.id. Access dated October 13, 2009
www.pediatrik.com / scientific / nursing care of patent ductus arteriosus.Access dated October 13, 2009
Source :http://kumpulanmaterikeperawatan.blogspot.com
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