Askep CHF Dila Fkep Unand

BAB I PENDAHULUAN 1.1 Latar belakang

Dalam Dalam kehidu kehidupan pan sehari sehari hari hari sering sering kita kita menjum menjumpai pai berbaga berbagaii macam macam penyaki penyakitt yang yang membahayakan kehidupan manusia, penyakit yang salah satu yang sering kita jumpai yaitu  penyakit yang berhubungan dengan jantung manusia. Penyakit yang cukup berbahaya bagi manusia yaitu salah satunya penyakit gagal jantung yang merupakan gagalnya fungsi jantung untuk memompakan darah keseluruh tubuh, penyakit ini sering kita temui pada anak – anak, gagal jantung harus segera ditangani karena apabila tidak cepat untuk ditangani maka akan  berakibat fatal bagi orang tersebut. Sistem kardiovaskuler merupakan sistem yang memberi fasilitas proses pengangkutan  berbagai substansi dari, dan ke sel – sel tubuh. Sistem ini terdiri dari organ penggerak yang disebut jantung, dan sistem saluran yang terdiri dari arteri yang mengalirkan darah dari jantung, dan vena yag mengalirkan darah menuju jantung. Gagal jantung adalah suatu keadaan dimana jantung tidak mampu lagi memompakan darah secukupnya dalam memenuhi memenuhi kebutuhan kebutuhan sirkulasi sirkulasi untuk metabolism metabolismee jaringan jaringan tubuh, sedangkan tekanan pengisian ke dalam jantung masih cukup tinggi. 1.2 Rumusan masalah •

Apa pengertian dari Gagal Jantung ?

•

Bagaimana anatomi dan fisiologi dari kardiovaskular ?

•

Apa saja etiologi dari Gagal Jantung ?

•

Bagaimana klasifikasi dari Gagal jantung ?

•

Apa manifestasi klinik dari gagal jantung ?

•

Bagaimana patofisiologi nya ?

        1

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•

Bagaimana komplikasi dari gagal jantung ?

1.3 Tujuan •

Untuk mengetahui pengertian dari gagal jantung

•

Untuk mengetahui anatomi da fisiologi dari jantung

•

Memahami etiologi dari gagal jantung

•

Untuk mengetahui klasifikasi dari gagal jantung

•

Memahami manifestasi dari gagal jantung

•

Untuk memahami patofisiologi dari gagal jantung

•

Mengetahui komplikasi dari gagal jantung

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BAB II LAPORAN PENDAHULUAN

2.1 LANDAS LANDASAN AN TEORIT TEORITIS IS PENYAKI PENYAKIT T 2 .1 .1

Definisi CHF CHF adal adalah ah keti ketida dak k mamp mampua uan n jant jantun ung g untuk untuk memo memomp mpaa dara darah h kese keselu luru ruh h tubu tubuh h

(ebbersole, hess, 1998). CHF merupakan penyebab tersering lansia dirawat di RS (miller, 1997). Sekitar 3000  penduduk amerika serikat menderita CHF. Pada umumnya CHF di derita lansia yang berusia 50 tahun. Angka kejadiannya akan terus bertambah setiap tahun pada lansia yang berusia di atas 50 tahun (aranow et, 1998 ). Menurut penelitian, sebagian besar lansia yang didiagnosa CHF tidak  dapat hidup lebih dari 5 tahun (ebbersole, hess, 1998). Gagal Gagal

jantun jantung g adalah adalah suatu keadaan keadaan ketika ketika jantung jantung tidak tidak mampu mempertah mempertahanka ankan n

sirkulasi yang cukup bagi kebutuhan tubuh meskipun pengisian darah pada vena normal. Namun, definisi lain menyatakan bahwa gagal jantung bukanlah penyakit yang terbatas pada suatu organ mela melain inkan kan suat suatu u sind sindro rom m klin klinis is akiba akibatt kela kelain inan an jant jantung ung yang yang dita ditand ndai ai deng dengan an resp respon on hemodinamik, renal, neural dan hormonal (muttaqin, 2009) Salah satu definisi lain yang diajukan mengenai gagal jantung adalah suatu keadaan  patofisiologis berupa kelainan ke lainan fungsi jantung. Kelainan ini mengakibatkan jantung tidak mampu memomp memompaa darah darah untuk untuk memenuh memenuhii kebutu kebutuhan han metabol metabolism ismee jaring jaringan/ an/ jantun jantung g hanya hanya mampu mampu memompa darah jika disertai peninggian volume diastolic secara abnormal (masnjoe, 2000) Para Para ahli ahli kese keseha hata tan n yang yang lain lainpun pun meng mengaj ajuk ukan an defi defini nisi si yang yang kurang kurang lebi lebih h sama sama

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2.1.2 Etiologi •

Kelainan otot jantung Gagal Gagal jant jantun ung g pali paling ng seri sering ng terj terjad adii pada pada pende penderi rita ta kelai kelainan nan otot otot jant jantun ung g

akan akan

menur menurunk unkan an kont kontra rakt ktil ilit itas as jant jantung ung.. Kondi Kondisi si peny penyeba ebab b kela kelain inan an fung fungsi si otot otot ini ini adal adalah ah aterosklerosis koroner, hipertensi arterial, dan penyakit ot ot degeneratif atau inflamasi. •

Aterosklerosis koroner  Menyebabkan disfungsi miokardium karena terganggunya alirandarah ke otot jantung.

Terjadi hipoksia dan asidosis karena penumpuka asam laktat. Infark miokardium biasanya tanda terjadinya gagal jantung. •

Hipertensi sistemik atau pulmonal (peningkatan afterload) Mening Meningkat katkan kan beban beban kerja kerja jantun jantung g sehing sehingga ga mengaki mengakibat batkan kan hipert hipertrop ropii serabut serabut otot otot

 jantung (hipertropi miokard). Sebenarnya hipertropi miokard termasuk mekanisme kompensasi karena meningkatkan kontraktilitas jantung. Tetapi hipertropi otot jantung ini tidak berfungsi normal sehingga terjadi gagal jantung. •

Peradangan dan penyakit miokardium degeneratif  Berhubungan dengan gagal jantung Kondisi ini secara langsung merusak serabut jantung,

menyebabkan kontraktilitas menurun. •

Penyakit jantung lain Penyakit jantung yang sebenarnya tidak mempengaruhi jantung secara langsung, seperti:

gangguan aliran darah melalui jantung (ex: stenosiskatup semiluner), ketidakmampua jantung mengis mengisii darah darah (ex: (ex: tampona tamponade de perika perikardi rdium, um, perika perikardi rditas taskon konstr strikt iktif, if, stenos stenosis is katup katup AV), AV),  pengosongan jantung abnormal (ex: insufisiensi katup AV), peningkatan mendadak afterload

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Mening Meningkat katnya nya laju laju metabol metabolism ismee (ex: (ex: demam, demam, tiroto tirotoksi ksikos kosis) is),, hipoks hipoksia ia dan anemia anemia memer memerlu lukan kan peni pening ngkat katan an cura curah h jant jantun ung g untu untuk k meme memenuh nuhii kebut kebutuh uhan an oksi oksige gen n sist sistem emik ik.. (respiratorius&metabolik) & abnormalitas elektrolit dapat menurunkan kontraktilitas jantung. Disritmia jantung dapat terjadi secara sendirinya atau sekunder akibat gagal jantung menurunkan efisiensi keseluruhan fungsi jantung. •

Gangguan pengisian / hambatan input Hambat Hambatan an pada pengis pengisian ian ventri ventrikel kel karena karena ganggua gangguan n aliran aliran darah darah masuk masuk kedalam kedalam

ventrikel/ pada aliran balik vena atau venous return akan mengakibatkan pengeluaran/output ventrikel berkurang dan curah jantung menurun.

2.1.3 2.1.3 •

Manife Manifesta stasi si klinik klinik// tand tandaa dan dan gejala gejala Gagal jantung kiri, Gagal Gagal jantun jantung g kiri kiri menyeba menyebabka bkan n pengum pengumpul pulan an cairan cairan di dalam dalam paru-pa paru-paru ru (edema (edema

 pulmoner), yang menyebabkan sesak nafas yang hebat. Pada awalnya sesak nafas hanya dirasakan dirasakan saat seseorang melakukan aktivitas, aktivitas, tetapi tetapi sejalan sejalan dengan memburuknya memburuknya penyakit penyakit maka sesak nafas juga akan timbul pada saat penderita tidak melakukan aktivitas. Sedangkan tanda tanda lain lainny nyaa adal adalah ah cepa cepatt leti letih h (fat (fatig igue) ue),, gelis gelisah ah/c /cem emas as (anx (anxit ity) y),, deta detak k jant jantun ung g cepa cepatt (tachycardia), batuk-batuk serta irama degub jantung tidak teratur (Arrhythmia). Manifestasi klinisnya : Dispnea : dapat dapat terjad terjadii akibat akibat penimb penimbunan unan cairan cairan dalam dalam alveol alveolii yang mengga mengganggu nggu  Dispnea  pertukaran gas dapat terjadi saat istirahat atau dicetuskan oleh gerakan yang minimal/ sedang Ortopne pneaa  Orto

(kes (kesul ulit itan an bern bernap apas as saat saat berba berbari ring) ng),, bias biasan anya ya digun digunak akan an banta bantall untu untuk  k 

mengurangi sesak nafas  Proksimal nocturnal dispneu (PND)

Sesak napas tiba-tiba pada malam hari disertai batuk, hal ini terjadi bila pasien

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 Kegelisahan dan kecemasan

Akibat Akibat ganggua gangguan n oksige oksigenas nasii jaring jaringan, an, stress stress karena karena kesuli kesulitan tan bernapa bernapass dan  pengetahuan bahwa jantung siap berfungsi dengan baik .  Batuk 

Bisa Bisa keri kering ng dan dan tida tidak k produ produkt ktif if tapi tapi yang yang seri sering ng batuk batuk basa basah/ h/ batu batuk k yang yang sputumnya berbusa dalam jumlah banyak, yang kadang disertai bercak darah  Bunyi jantung s3 dan s4  Mudah lelah

Akibat Akibat curah curah jantun jantung g yang yang kurang kurang mengham menghambat bat jaring jaringan an di sirku sirkulas lasii normal normal oksige oksigen n menuru menurunkan nkan pembuan pembuangan gan sisa sisa hasil hasil katabol katabolism isme, e, mening meningkat katkan kan energy energy utk   bernapas, insomnia akibat distress pernapasan dan batuk.

•

Gagal jantung kanan Gagal Gagal jantun jantung g sebela sebelah h kanan kanan cender cenderung ung mengaki mengakibat batkan kan pengump pengumpula ulan n darah darah yang

mengal mengalir ir ke bagian bagian kanan kanan jantun jantung. g. Sehing Sehingga ga hal ini menyeb menyebabka abkan n pembeng pembengkaka kakan n di kaki, kaki,  pergelangan kaki, tungkai, perut (ascites) dan hati (hepatomegaly). Tanda lainnya adalah mual, munt muntah ah,, kelet keletih ihan an,, detak detak jant jantung ung cepa cepatt sert sertaa seri sering ng buang buang air air keci kecill (uri (urin) n) dima dimala lam m hari hari (Nocturia). Manifestasi klinisnya:  Edema ektrimitas bawah

Dimulai pada kaki dan tumut kemudian bertambah keatas tungkai dan paha dan akhirnya kegenitalia eksternal dan tubuh bagian bawah begitu juga dengan tangan. Pitting edema adalah edema edema yang tetap cekung bahkan setelah setelah penekanan penekanan ringan dengan ujung ujung  jari  Peningkatan berat-badan  Hepatomegali : pembesaran hepar dan nyeri tekan pada kuadran kanan atas abdomen

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 Anoreksia dan mual

Hilang nafsu makan akibat pembesaran vena dan stasis vena di dalam rongga abdomen   Nokturia : rasa ingin BAK pada malam hari  Lemah : karena penurunan curah jantung, gangguan sirkulasi dan pembuangan produk 

sampah katabolisme yang tidak adekuat dari jaringan 

Peningkatan HR 

 Distensi venajugularis  Murmur 

2.1.4 2.1.4

Pemeri Pemeriksa ksaan an penunj penunjang ang dan diagno diagnosti sticc Menu Menuru rutt Doen Doengo goes es (200 (2000) 0) peme pemeri riks ksaa aan n penu penunj njan ang g yang yang dapa dapatt dila dilakuk kukan an untu untuk  k 

menegakkan diagnosa CHF, yaitu : a. Elek Elektr trok okar ardi diog ogra ram m (EK (EKG) G) Hipertropi Hipertropi atrial atrial atau ventrikule ventrikuler, r, penyimpangan penyimpangan aksis, aksis, iskemia, iskemia, disritmi disritmia, a, takikardi, takikardi, fibrasis atrial.  b. Scan jantung Tindakan penyuntikan fraksi dan memperkirakan gerakan dinding.

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Dapat Dapat menu menunj njuk ukkan kan pembe pembesa sara ran n jant jantung ung,, bayan bayanga gan n menc mencer ermi minka nkan n dila dilata tasi si atau atau hipertropi bilik, atau perubahan dalam pembuluh darah abnormal. f. Enzim hepar  Meningkat dalam gagal atau kongesti hepar. g. Elektrolit Mungkin berubah karena perpindahan cairan atau penurunan fungsi ginjal, terapi diuretik. h. Oks Oksimet imetrri nadi nadi Saturasi O2 mungkin rendah terutama jika gagal jantung kongesif akut menjadi kronis. i. Anal Analis isis is Gul Gulaa Dara Darah h (AGD (AGD)) Gagal ventrikel kiri ditandai dengan alkaliosis respiratori ringan atau hipoksemia dengan  peningkatan PCO2 akhir.  j.

Blood Ureum Nitrogen (BUN) dan kreatinin Peningka Peningkatan tan BUN mengaki mengakibat batkan kan penurun penurunan an fungsi fungsi ginjal ginjal,, pening peningkat katan an BUN dan kreatinin mengakibatkan indikasi gagal jantung.

k. Peme Pemeri riks ksaa aan n tiroi tiroid d Peningkatan aktifitas tiroid menunjukkan hiperaktifitas tiroid sebagai pre pencetus gagal

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Pemberian oksigen sangat dibutuhkan karena pemenuhan oksigen akan mengurangi kebutuhan miokardium dan membantu memenuhi kebutuhan oksigen tubuh  Terapi nitrat dan vasodilator 

ObatObat- obat obat vasoak vasoaktif tif digunak digunakan an untuk untuk mengur mengurang angii impada impadansi nsi tekana tekanan n terhada terhadap p  penyemburan darah oleh ventrikel, obat ini memperbaharui pengosongan ventrikel dan peningkatan kapasitas vena sehingga tekanan pada ventrike kiri dapat diturunkan  ACE inhibitor   Obat digitalis 

meningkatkan kekuatan kontraksi jantung dan memperlambat frekuensi  jantung



efek: peningkatan curah jantung dengan memperkuat tenaga konstraksi ventrikel, penurunan tekanan vena dan volume darah, menurunkan ukuran  jantung, peningkatan diueresis, memperlambat kecepatan ventrikel pada keadaandisritmia supraventrikuler 



Digitalis Digitalis dosis lengkap diberikan pada penderita penderita gagal jantung berat.Jika berat.Jika tidak, diberikan sebagian. Dosis pemeliharaan setiap hari.



Menga engattasi asi

kead keadaa aan n

miksidema, dan aritmia.  b. Pelaksanann keperawatan

yang yang

reve reverrsibe sibell,

terma ermasu suk k

tirot rotoks oksikos kosis, is,

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 syok kardiogenik : stadium dari gagal jantung kiri, kongestof akibat penurunan

curah jantung dan pefusi jaringan yang tidak adekuat ke organ vital (jantung, otak   jantung)  Episode trombosimbolik 

Trombu Trombuss terbent terbentuk uk

karena karena imobi imobilit litas as pasien pasien dan ganggua gangguan n sirkul sirkulasi asi dengan

aktivitas trombus dapat menyumbat pembuluh darah.  Efusi perikardial dan tamponde jantung

Masuknya cairan ke kantung perikardium cairan dapat meregangkan peri kardium sampai ukuran maksimal aliran balik vena ke jantung himponade jantung  COP menurun dan aliran Episode Episode tromboembol tromboembolik, ik, akibat peningkatan peningkatan aktivitas aktivitas mebilitas mebilitas lama, trombus terlepas dan dapat terbawa keotak, ginjal, usus dan paru namun yang sering adalah emboli paru  Kerusakan / kegagalan ginjal : gagal jantung dapat mengurangi aliran darah ke

ginjal ginjal yang akhirny akhirnyaa dapat dapat menyeb menyebabka abkan n gagal gagal ginjal ginjal jika jika tidak tidak ditang ditangani ani.. Keru Kerusa saka kan n ginj ginjal al dari dari gaga gagall jant jantun ung g dapa dapatt memb membut utuh uhka kan n dial dialis isis is untu untuk  k   pengobatan  Kerusakan hati : gagal jantung menyebabakan penumpukan cairan yang membuat

tekanan pada hati meningkat akibatnya jaringan parut yang abnormal sehingga

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A. LANDASAN LANDASAN TEORITIS TEORITIS ASUHAN KEPERAWATA KEPERAWATAN N 1. a.

 b.

Pengkajian Identitas klien  Nama :

Pekerjaan :

Usia :

Agama :

Jenis kelamin:

No. RM :

Alamat :

Tanggal masuk :

Riwayat kesehatan  Riwayat kesehatan dahulu

Apakah Apakah pasien pasien memil memiliki iki riwaya riwayatt faktor faktor-fa -fakto ktorr penyeba penyebab b sepert sepertii hipert hipertens ensi, i,  penyakit katup, penyakit jantung bawaan, infark miokard, gagal ginjal, bedah jantung, endokar endokardit ditis, is, SLE, SLE, anemia anemia,, syok syok septi septik, k, kelain kelainan an pada otot otot jantun jantung, g, ateros ateroskle kleros rosis is koroner, paradangan dan penyakit miokardium, degeneratif atau tidak 

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 beberapa bantal, TD rendah, tekanan nadi sempit, takikardi, disritmia, adanya bunyi  jantung S3 dan S4, mur-mur sistolik dan diastolik, sianosis.  Riwayat kesehatan keluarga

Adanya riwayat penyakit jantung pada keluarga atau penyakit komplikasi lain yang dialami pasien sama dengan keluarga c.

Pemeriksaan fisik    Kepala

I

: perh perhat atik ikan an kea keada daan an ram rambu but, t, ada adaka kah h rukt ruktur ur,, adak adakah ah keb kebir iruu-bi biru ruan an,, kuli kulitt kepa kepala la dan anamnesa rambut mudah dicabut / tidak 

P

: raba apakah ada edema dan nyeri.

 Mata

I

: liha lihatt kesi kesi et is

ta kir kirii dan k

, pal bra, bra, mint mintak akllie

buka buka d

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I

: li lihat hat kes kesim imet etrrisan san hi hidung dung,, per periiksa ksa ada adany nyaa dar darah ah,, sek sekrret. et.

P

: palp palpas asii tula tulang ng hidu hidung ng,, apak apakah ah ada ada beng bengka kak, k, edem edema, a, nyer nyeri, i, fra frakt ktur ur,, dan pal palpa pasi si sinus.

 Mulut

I

: lih lihat at bib bibir ir apa apaka kah h ada ada sian sianos osis is dan dan baga bagaim iman anaa muko mukosa sany nya, a, sel selan anju jutn tnya ya gig gigii dan dan gusi, apakah ada caries, lidah periksa lidah dan sensasi rasa.

P

: pal palpa pasi si bagi bagian an bibi bibirr dan dan lida lidah h apa apaka kah h ada ada beng bengka kak k dan dan nyer nyeri. i.

 Leher 

I

: am amati ati ben benttuk leher eher apak apakah ah ada ada pem pembe bessaran aran kele kelenj njar ar tiro tiroiid,

P

: pal palpa pasi si kelen kelenja jarr get getah ah benin bening, g, palp palpas asii kel kelen enja jarr tir tiroi oid, d, palpa palpasi si juga juga JVP. JVP.

 Dada

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Per

: leta letakk kkan an tanga tangan n kiri kiri mulai mulai dari dari daer daerah ah terj terjauh auh dan dan lakuk lakukan an penge pengetu tuka kan n dengan tangan kanan serta dengarkan perubahan bunyi yang dihasilkan.

A

: apak apakah ah ada ada bun bunyi yi jan janttung ung S3 dan dan S4. S4. Deng Dengar arka kan n iram iramaa dan dan frek frekue uens nsii  jantung.

 Abdomen

I

: apa apaka kah h ada ada kuli kulitt yang yang ber berwa warrna keb kebiiruan uan pada pada abd abdom omen en,, amat amatii apak apakah ah ada pembesaran pada perut.

A

: dengarkan bising usus.

Per Per

: perk perkus usii denga dengan n membag membagii empat empat ruan ruang g abdom abdomen en lalu lalu tent tentuk ukan an posi posisi si dan dan ukuran hati, lambung, ginjal, apendiks.

P

: palp palpas asii posi posisi or organgan-or orga gan n dal dalam abdo abdome men, n, palp palpas asii apaka apakah h ada ada nyer nyeri,  penegangan abnormal atau massa.

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Kaji status kesehatan, status promosi dan praktek pencegahan kesehatan,  persepsi pengobatan atau perawatan. Biasanya pasien tidak tahu tanda-tanda dan gejala penyakitnya, sehingga terlambat pergi berobat. Klien telah mengalami gejala penyakit gagal jantung sejak 3 tahun yang lalu, tapi selama ini klien hanya berobat secara tradisional.

-

Pola 2. Nutrisi dan Metabolisme Kaji Kaji pola pola makan, makan, keseim keseimban bangan gan cairan cairan tubuh tubuh dan elektr elektroli olit, t, kesuli kesulitan tan menelan, diet khusus, BB, postur tubuh, tinggi badan. Klien mengalami penurunan nafsu makan dan penurunan berat badan karena memikirkan penyakit yang dideritanya.

-

Pola 3. Eliminasi Kaji BAB dengan jumlah feses, warna feses dan khas, BAK dengan jumlah urine, warna urine dengan kejernihan. Biasanya tidak mengalami gangguan.

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Kaji perasaan harga diri, sikap tentang dirinya, identitas diri, dan pola emosional. Klien biasanya mengalami peningkatan rasa kekhawatiran tentang penyakit yang dideritanya serta pada pasien juga akan mengalami harga diri rendah.

-

Pola 8. Hubungan dan Peran Kaji hubungan dengan orang lain dan keluarga. Kaji peran kelurga dan peran sosial, kepuasan dan ketidakpuasan dengan peran, persepsi terhadap peran yang terbesar dalam hidup. Klien biasanya akan mengalami gangguan peran hubungan karena pasien merasa tidak percaya diri lagi.

-

Pola 9. Seksual dan Reproduksi Kaji Kaji kepuas kepuasan an atau atau ketida ketidakpu kpuasa asan n dengan dengan seks, seks, pola pola reprod reproduks uksi, i, dan menstruasi. Dalam hal ini pola seksual pasien tidak terkaji.

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2.2 LAPORAN KASUS

2.2.1Pengkajian A. Data Data Klin Klinis is

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Jenis kelamin

: Perempuan

Agama

: Islam

Pekerjaan

: Ibu rumah tangga

Alamat

: Jl. Banjir Kanal No.8, Parak Kopi

Status

: Menikah

Hub dg klien

: Istri

2.2.2Asuhan Keperawatan

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seorang perokok aktif yang bisa menghabiskan 2 bungkus rokok dalam sehari. Dan klien sudah mulai berhenti merokok saat ini.

•

Riwayat Penyakit Keluarga Ibu dari klien adalah penderita DM tipe 1.

B. Peme Pemeri riks ksaa aan n 1. Peme Pemeri riks ksaa aan n Fisi Fisik  k 

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K +

: 5,2 mmHg

N : 3,5-5 mEq/L

Ca+

: 0,41 mmHg

N : 4,5-5,5 mEq/L

Ureum

: 89 mg/dl

N : 10 – 50 Mg/dl

Kreatinin

: 6,0 mg/dl

N : 0,9 – 1,3 Mg/dl

(tanggal 28 oktober 2012) Hemoglobin

: 9,7 gr%

N : 13,0 – 18,0 gr/ dl

Ht

: 29 %

N : 40 – 50 %

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Tidak ada sekret dan nyeri

d. Mulut Bibir tidak sianosis Gigi mengalami caries

e. Leher   Tidak ada pembesaran kelenjar getah bening

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Palpasi

i

: H/L tdk teraba

Ekstremitas

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4. Pola Pola akt aktiv ivit itas as dan dan Lati Latiha han n Klien sulit beraktifitas karena sesak nafas yang dialami mengakibatkan energi

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9. Pola Pola Seks Seksual ualita itass dan dan Reprod Reproduks uksii Tidak dikaji.

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 penyediaan oksigen ke otak , menyebabkan korban kehilangan kesadaran dan berhenti  bernafas dengan tiba-tiba. Terdapat tiga aspek penting dalam menanggulangi gagal jantung yaitu pengobatan terhadap penyakit yang mendasari dan pengobatan terhadap faktor pencetus . Termasuk 

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Rencana Asuhan Keperawatan Medikal Bedah Volume 2. Barbara Engran.1998. Jakarta: EGC