asuhan keperawatan acute respiratory distress syndrome (ards)
DESCRIPTION
Mata Kuliah:Keperawatan KritisTRANSCRIPT
Hendra Kurnia Rakhma, S.Kep., Ns
Pokok Bahasan
Definisi Etiologi Patofisiologi Penatalaksanaan medis dan
keperawatan
Definisi
Acute Lung Injury (ALI)Sindrom inflamasi paru akut dg pe↑an
permeabilitas vascular, ditandai dg: Bilateral diffuse pulmonary infiltrate on chest
radiograph 200 mmHg < PaO2 / FiO2 < 300 mmHg,
irrespective of the level of PEEP No clinical evidence of elevated left atrial
pressure, atau Pulmonary capillary wedge pressure (PCWP) <
18 mmHg
Definisi
Acute Respiratory Distress Syndrome (ARDS)Sindrom inflamasi paru akut dg pe↑an
permeabilitas vascular, ditandai dg: Bilateral diffuse pulmonary infiltrate on chest
radiograph PaO2 / FiO2 < 200 mmHg, irrespective of the
level of PEEP No clinical evidence of elevated left atrial
pressure, atau Pulmonary capillary wedge pressure (PCWP) <
18 mmHg
Normal Thorax
Bilateral widespread infiltrate
Radiograph
PenyebabPenyebab ARDSARDS
Direct Lung Injury (Pulmonary ARDS)Aspiration or other chemical pneumonitisInfectious pneumoniaTrauma: lung contusion, penetrating chest injuryNear drowningFat embolism
Distant Injury (Non pulmonary ARDS)Inflammation; sepsis syndromeMultiple traumaShock, hypoperfusionAcute pancreatitis
Direct Lung Injury Distant Lung Injury
Web of Causation
Melepaskan serotonin, bradikinin& histamin
Pe↓an aliran darah ke paru
Merangsang platelet teragregasi
Menginflamasi dan merusak membran alveloli
Me↑an permeabilitas kapiler
Cairan pindah ke ruang interstitial
TakipneaDyspneatakikardi
Pola nafas inefektif
Dlm jangka wkt lama menjadi
Fibrosis
Protein & cairan banyak keluar ke interstitial
Odem paruPe ↑ an tekanan osmotik interstitial
Alveoli kolaps
Kerusakan pertukaran gas
Bersihan jalan nafas inefektif
Merusak surfaktan & me↓an produksi surfaktan di alveoli
Kelebihan volume cairan
hypoxaemia
Asidosis metabolik
Mental confusion
Penumpukan secretPO2 me↓
PCO2 me↑
Tanda dan Gejala ARDSO2 sangat susah masuk ke sirkulasi darah
krn alveoli terisi cairan. Alveoli menjadi collapse› Sesak dan nafas cepat› Nafas dangkal› Tekanan darah me↓› HR me↑› Perubahan status kesadaran atau susah
berkonsentrasiHasil Lab: non-spesifikHypoxaemiaElevated alveolar-arterial oxygen gradient
Prinsip Penatalaksanaan Treat the primary problem ! Physiologic support Of the lungs Other organs
Avoid complications Lungs Sepsis Other
Disease modifier
Adequate Oxygenation Better Q relative to V Pulmonary vasodilator Increase cardiac output (fluid/other)
Better V relative to Q PEEP Inverse ratio ventilation Recruitment manuvers Patient position
Fluid management overall Dry lungs are happy lungs
Asuhan Keperawatan Klien dgn ARDS
Pengkajian Keluhan Utama
Sesak napas Riwayat Penyakit Sekarang
Inhalasi racun (rokok, kimia corrosive) Aspirasi cairan (gastric, tenggelam, hydrocarbon,
ethylene glycol) Shock (traumatic, hemorrhagic, bacterial, pneumonia
septic) Drug overdose (heroin, methadone barbiturat) Trauma kepala, thorax
Pemeriksaan Fisik
B1 breath: dyspnea, takipnea (RR me↑), shallow breath
B2 blood: hipotensi, takikardia B3 brain: susah bekonsentrasi, pe↓an
kesadaran B4 bladder: - B5 bowel: - B6 bone: -
Diagnosa Keperawatan
Pola nafas inefektif b.d pe↓an compliance paru
Kerusakan pertukaran gas b.d kolaps alveoli Bersihan jalan nafas inefektif b.d
penumpukan secret sekunder akibat kolaps alveoli
Kelebihan volume cairan b.d odem paru
Pola nafas inefektif Tujuan Pola nafas menjadi efektif selama masa
perawatan Kriteria Hasil Tidak ada tanda distress napas:
RR= 12 – 20 x/mnt, flaring nostril (-), tracheal tug (-), intrekking (-)
Intervensi Posisi semi fowler atau slide head up 30-45° Bebaskan jalan napas dengan kepala posisi
ekstensi Bantu pernafasan dengan oksigen (intubasi dan
ventilasi jika diperlukan) Pertahankan istirahat klien
Kerusakan pertukaran gas Tujuan Masalah kerusakan pertukaran gas teratasi
selama masa perawatan Kriteria Hasil SpO2 98-100% Analisa gas darah:
PaO2 80 – 100 mmHg PaCO2 35 – 45 mmHg pH 7,35 – 7,45
Intervensi Kolaborasi pemberian diuretik (furosemid / lasix) Monitor evaluasi BGA, pulse oxymeter, foto thorax