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ASKEP HIPERVOLEMIA

ASKEP HIPERVOLEMIA. Hipervolemia. Adl penambahan volume CES t er j a d i j i k a terdapat : stimulus kronis pd g in j a l u/ menahan Na & air fgs g in j a l abnormal dg penurunan Na & air kelebihan pemberian cairan IV perpindahan cairan intertisial ke plasma

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ASKEP HIPERVOLEMIA

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  1. ASKEP HIPERVOLEMIA

  2. Hipervolemia • Adlpenambahan volume CES • terjadi jikaterdapat: • stimulus kronis pd ginjal u/ menahan Na & air • fgs ginjal abnormaldg penurunan Na & air • kelebihanpemberiancairan IV • perpindahancairanintertisialke plasma • dptmenyebabkangagal jantung danodempulmonal, khususnyaps dg disfungsicardiovaskuler

  3. Mekanisme kompensasi hipervolemia • Pelepasanpeptidanatreuretik atrium (PNA)=> hormonygdilepaskan atrium jantung sbgresponthdpeningkatantek atrium, berlawanan dg sistemrenin-angiotensin-aldosteron. Cara kerjanya: • peningkatanekskresi Na & air o/ gjl • penurunansintesisrenindanaldosteron • penurunanpelepasan ADH • vasodilatasi

  4. pengkajian • Tanda & gjl: sesaknafas • pengkajianfisik: • odem • peningkatanBB • peningkatanTD (menurunsaatgagal jantung) • nadikuat • asites

  5. Pemeriksaanfisik: • distensivena leher • kulitlembab • takikardi • iramagallop • pengukuranhemodinamik: • peningkatan CVP (N : 8 – 12)

  6. Riwdanfaktorresiko: • retensiNa & air: ggljtg, sirosis, sindromanefrotik, kelebihanpemberianglukokortikosteroid • fgsgjlabormal: gglgjlakut a/ kronis dg oliguri • kelebihanpemberiancairan IV • perpindahancairanintertisialke plasma: remobilisasicairanstlhpengoblukabakar, kelebihanpemberianlarhipertonik (manitol) a/ laronkotikkoloid (albumin)

  7. Px/ diagnostik • Hematokrit; menurun • BUN: meningkat pd gglgjl • GDA: hipoksemia(penurunan PaO2) & alkalosis (peningkatan PH &penurunan PaCO2) pd adanyaodempulmonal • Na urine: meningkatbilaginjal berupayamengekskresikankelebihan Na

  8. BJ urin: menurunbilagjlberupaya u/ ekskresikankelebihan volume. • Foto Rontgen dada: kongestivaskulerpulmonal

  9. Makananber Na tinggi Air dagingseledri kejubuahkering makanankaleng MSG mustard buahzaitun asinandaging salad dansauskue(krekers,kripik kecap

  10. Penatalaksanaan kolaboratif • Tujuan therapi adl: mengatasi msl pencetus dan mengembalikan CES normal - pembatasan Na dan air - deuretik - dialisis a/ hemofiltrasi arteriovena kontinu:pd ggl gjl

  11. Diagnossakeperawatan • Kelebihanvolcairanb.dkelebihan input dan Na a/ g3 mekanismepengaturan Hasilygdiharapkan:psnormovolemik

  12. Kerusakanpertukaran gas b.dperubahanmembranalveokapilerskunderthdkongestivaskulerpulmonalygtjd pd pertambahan CES • Hasilygdiharapkan: psmpypertukaran gas adekuat

  13. Restithdkerusakanintegritaskulitdanjaringanb.dodemskunderthdkelebihankelebihanvolcairanRestithdkerusakanintegritaskulitdanjaringanb.dodemskunderthdkelebihankelebihanvolcairan Hasilygdiharapkan: kulitpsbebasdreritema, lukadanulserasi

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