asuhan keperawatan inke

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Transcript of asuhan keperawatan inke

ASUHAN KEPERAWATAN GAWAT DARURAT PADA KLIEN NY. HL DENGAN DIAGNOSIS INFARK MIOKARDNama: Ny HLJenis keamin: !e"em!#anUm#": $% &a'#nA(ama: isamS#k#)*an(sa: *+aan( m+n(+n,+#-)In,+nesiaPen,i,ikan: SDPeke".aan: IRTAama&: /#ya&T().am MRS: %0 J#ni 01%23 Jam 14.52Tan((a !en(ka.ian: %0 .#ni 01%23 Jam 14.52Dia(n+sis me,is: In6a"k Mi+ka", A7#&I,en&i&as kienPenan((#n( .a-a*Nama:Tn AJenis keamin: Laki8akiUm#": 52 &a'#nA(ama: isamS#k#)*an(sa: *+aan( m+n(+n,+#-)In,+nesiaPen,i,ikan: SDPeke".aan: TaniAama&: /#ya&A. Kel Utama : nye"i ,a,a se*ea' ki"i9 sesak9 m#a m#n&a' isi 7ai"an : ;9 /. Riwayat Peny Saat Ini : Kien ,i*a-a ke UGD RSUPR/ ,en(an ke#'an nye"i s& *e"ak&iBA*,+menIns!eksi :Ti,ak kem*#n(9 A#sk#&asi : /isin( #s#s a,a n+"maPa!asi : &i,ak a,a nye"i &ekanEks&"emi&as a&as8 Kanan : Pen(e"akan *aik9 &e"!asan( ICFD RL 01 &e&es ) meni&9 &i,ak a,a *en(kak9 &i,ak me"a'.8 Ki"i : Pe"(e"akan *aik%:B Eks&"emi&as *a-a'8 Ki"i :&i,ak a,a +,em8 Kanan : &i,ak a,a +,emPeme"iksaan Pen#n.an(!eme"iksaan a*+"a&+"i#m Tan((a %> 8 = D 01%1 Niai N+"maPeme"iksaan ,a"a'H* %590 E F%:8%$(),B GF%08%5(),Be#k+si& >. 011 mm: 2.111 D %1. 111 mm: T"+m*+si& 05:.111 %21.111 D 511.111Oksi(en 085 i&e")mI?6, NS 01 &!mRani&i,in 0;% i?On,ansen&"+n %;% i?Is,n 2 m( s#*in(#aAs!i"in 41 m( !e" +"aSan(+*i+n %;% &a* !e" +"aOme!"aH+e 0;% !e" +"aTe"a!i%. Nye"i ak#& *e"'#*#n(an ,en(an iskemia mi+ka", aki*a& s#m*a&an a"&e"i k+"+ne"0. Sesak *e"'#*#n(an ,en(an k#"an(nya s#!ai +ksi(en ke +&+& .ann(:. N#&"isi k#"an( ,a"i ke*#'an *#' *e"'#*#n(an ,en(an an+"eksia9ss m#a8m#n&a'Dia(n+sis ke!e"a-a&an! "iagnsis keperawatan#u$uan Inter%ensi Implementasie%aluasi% Nye"i ak#& *), iskemia mi+ka", aki*a& s#m*a&an a"&e"i k+"+ne". Di &an,ai ,en(an :DS : kien men(a&akan nye"i ,a,aDO : kien &am!ak nye"i ,an -a.a' &am!ak me"in&i'Daam -ak I 01 meni& ,i'a"a!kan nye"i akan *e"k#"an( ) 'ian( %.Pan&a# skaa nye"i F+kasi9 ka"ak&e"is&ik9 ,#"asi ,an in&ensi&as nye"iB0. /e"ikan in(k#na(an yan( &enan( ,an nyaman:. /an meak#kan &eknik "eaksasi5. An.#"kan #nk men(#"an(i ak&i