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Endokarditis Myokarditis
Perikarditis Rheumatic Heart
FeverBy.Septiana Fathonah, S.Kep., Ns
Keperawatan Medika Bedah !
"kper Notokusumo #o$yakarta
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Rheumatic %ever adaah suatu penyakit in&amasi akut yan$diaki'atkan oeh in%eksi streptococcus β hemoytic $roup " padaten$$orokan (%arin$itis), tetapi tanpa disertai in%eksi ain atau tidakada in%eksi streptococcus di tempat ain seperti di kuit.
Mani%estasi kinis RH*+
e-aa permuaan (Mode of Onset)
a. ika hanya mani%estasi carditis+ onsetnya tersem'unyi den$anmaaise dan %ati$ue pro$resi% ke /HF, nyeri a'domen karena distensi
hepar akut, dispnea, edema peri%er dan raes pumoner (mani%estasiam'at)
'. ika -u$a disertai pericarditis+ nyeri prekordia akut, kardiaktamponade dapat ter-adi den$an pusus parado0 dan syncope (aki'atpenurunan airan 'aik vena pada -antun$ kanan), serta arthra$ia.
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Manifestasi Klinis menurut Jones (1982)
Mayor Minor
/arditis Fever
Poiarthritis "rthra$ia
/horea Pernah men$aami $a$a$in-a
Erythema mar$inatum 1E* tin$$i
Nodu Su'cutaneous /2Reactive Protein3/RP (4)
1eukositosis
!nterva PR meman-an$
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*ia$nosis RH* ditetapkan 'erdasarkandidapatkannya ha2ha se'a$ai 'erikut+
a. *ua mani%estasi mayor'. 5 mani%estasi mayor dan dua
mani%estasi minor
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PER!K"R*!6!SM#7/"R*!6!S
EN*7/"R*!6!S
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PENER6!"N
Perikarditis adaah peradan$an pericardparieta, visera atau keduanya
Myocarditis adaah peradan$an otot -antun$3miocard
Endocarditis adaah peradan$an endocardyan$ mencakup katup -antun$ (mitra 89:dan aorta)
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MYOCARDITI
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!"DOKARDITI
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!TIO#O$I
%eri&ar'istis in%eksi virus, 'akteri, uremia, trauma,sindrom pasca in%ark miocard, idiopatic, sindrompasca pericardiotomi, neopasma atau penyakitkoa$en
Myoar'itis demam reumatic akut (acut reumatic%ever), in%eksi virus, 'akteri, riketsia, -amur, danparasit.
!n'o&ar'itis streptococcus β hemoitic $roup ",staphyococcus aureus, streptococcus viridian,streptococcus %ecais, candida, asper$ius dan 'asi
E. /oi.
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TA"DA DA" $!JA#A%!RIKARDITI
"yeri 'a'a se*erti 'itusu& terutama +ila +er,era&- na*as'alam. +er&uran, +ila 'u'u& a,a& mem+un,&u&
/rition ru+*ositif "yeri 'a'a su+sternal-*arasternal. men0alar &e +au-leer 'an
len,an &iri
Distensi 3ena 0u,ularis 4e*atome,ali !'ema e&stremitas +a5a esa&l nafas. 'enyut 0antun, menin,&at
6unyi 0antun, lema atau normal !5art7s si,n (*er&usi *e&a& 'i +a5a an,ulus s&a*ula &iri +ila
a'a efusi)
Ront,en tora&s+ayan,an 0antun, mem+esar Iso enym ar'iamenin,&at %ola !K$ T ele3asi *a'a area yan, rusa& (strain) tan*a 'ii&uti
*eru+aan 'i area resi*ro&al
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TA"DA DA" $!JA#AMYOCARDITI
Da'a terasa +erat 'an sesa& nafas Demam. 'enyut 0antun,
menin,&at-ta&i&ar'i Anore&sia $allo*7s. +unyi 0antun, lema
Tan'a;tan'a ,a,al 0antun, &anan
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6"N*" *"N E"1" EN*7K"R*!6!S
4i*er*ire&sia 'an men,,i,il Clubbing fngers Ptechiae *a'a mu&osa ten,,oro&. 'i retina mata (Rot7s
*ot) 'an &ulit 'a'a Anemis-*uat
Splinter Hemorrhagic (em+oli 'i +a5a &u&u 'en,an +entu&linier)
Mur;mur-+isin, 0antun, (&arena &erusa&an &atu* 0antun,) Osler’s Nodes (no'ul &emeraan. mera mu'a atau
&e+iruan) 'i +a,ian 'alam 0ari. otot tenar 'an i*otenar yan,
terasa nyeri Janeway Lession (no'ul &emeraan. mera mu'a atau
&e+iruan)'i +a,ian 'alam 0ari. otot tenar 'an i*otenarnamun ti'a& terasa nyeri
Tan'a 'an ,e0ala ,a,al 0antun, &anan (e*atome,ali. e'ema'an 'istensi 3ena 0u,ularis)
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O#!R7"OD!
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%#I"T!R
4!MORR4A$IC
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JAN!A"LSS#ON
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%!"$KAJIA"
Ri5ayat Ke*era5atan
a Ri5ayat infe&si+ "on s*esi:& *er&em+an,an setela trauma tora&s.
+e'a tora&s atau *emasan,an &atu* +uatan. ra'iasi.infar& mio&ar' 'an &erusa&an &atu*
Ri5ayat tera*i *er intra3ena 'alam 0an,&a *an0an,
' Ri5ayat en'o&ar'itis &arena *enyala,unaan o+at *erintra3ena (misalnya nar&oti&a)
e %eru+aan stru&trur 0antun,&atu*. se*tum. 'u&tus.oartatio aorta 'an lain;lain a&i+at en'o&ar'itis
f Men,elu nyeri 'a'a se*erti 'itusu&. saat +ernafas
'alam 'an &eluan nyeri +er&uran, +ila &lien 'u'u&atau mem+un,&u&
, Ri5ayat &elelaan. *enurunan +erat +a'an. 'is*nea.*al*itasi. 'emam. men,,i,il. nyeri *un,,un,. +atu&'an artral,ia
$e0ala ma&in mem+uru& +ila 'i'a*at&an *a'a &lien
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tu'i Dia,nosti&a
a Kar'ia iso enyme (terutama C%K 'an CK M6)menin,&at
+ !K$ is&emia (,elom+an, T in3ersi). &ete,an,an ataustrain (se,men T ele3assi. ,elom+an, mun,&inmunul ) &erusa&an mio&ar'. eart +lo&. 'an 'isritmia.!K$ *eri&ar'itis se,men T ele3asi 'an ,elom+an, T'atar atau in3ersi 'alam. ,elom+an, ti'a& munul. 'anam*litu'o R ren'a
Monitor !K$men,e3aluasi fre&uensi 'an ti*e 'isritmia
' Kultur 'ara untu& men,&a0i etiolo,i infe&si 'an
sensiti:tas anti+ioti& e Kea'aan &elelaan 'alam 5a&tu 1;< min,,u
f Ront,en tora&s menilai &ar'iome,ali (ar'io tora= ratio;CRT) 'an in:ltrat *a'a *aru
, Anti tre*tolysin O Titer (ATO) menilai or,anisme*enye+a+ 'an men,esam*in,&an 'ia,nosis *enya&itsistemi& lu*us erytematous(#!). Reumati fe3er.*enya&it ile Cell
C reati3e *rotein *ositife
i 4itun, sel 'ara len,&a* 'an 'iferensial menilai *rosesinfe&si &ronis atau a&ut. anemia &arena &erusa&an
eritrosit. s*lenome,ali !oar'io ram menilai i ertro: mioar' 'isfun si
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%!M!RIKAA"/IIK
Di'a*at&an tan'a ,e0ala ,a,al 0antun, &on,estif.&ete,an,an 'an in0uri mioar'
!3aluasi +unyi 0antun,. *eriar'ial frition ru+. irama,allo*s
Munulnya atau *eru+aan murmur atau +isin, 0antun, *lenome,ali. ematuria. *teie. ,an,,uan neurolo,i.
terutama 'alam ron,,a mulut. leer 'an +a,iane&stremitas 'istal ('iuri,ai a'anya em+oli)
Rot7s s*ot *a'a mata. Osler7s no'es 'i u0un, 0ari.s*linter aemorara,i *a'a 0ari. Jane5ay7s lesion *a'a
tela*a& tan,an 'an &a&i 4i*er*ire&sia 'an men,,i,il.tam*a& &elelaan 'an
merasa ti'a& nyaman. serta le+i su&a 'u'u& atau a,a&mem+un,&u&
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DIA$"OI DA" I"T!R?!"I K!%!RA@ATA"
%eru+aan *erfusi 0arin,an +eru+un,an 'en,an
&erusa&an otot 0antun, se&un'er tera'a* *roses*era'an,an- inamasi
Data *enun0an, esa& nafas. +a'an *anas. &e'in,inan. e*etlela. *usin,. mual. nyeri 'a'a. *al*itasi-+er'e+ar;'e+ar
O+0e&tifte&anan 'ara menurun. MA% a+normal. ta&i&ar'ia.
'enyut lema. suu menin,&at. 'is*nea. 6J1 'an atau 6J2lema. 'isritmia. *ulsus *ara'o&s. 'istensi 3ena 0u,ularis(J?%B m42O). *uat. sianosis. a&ral 'in,in. men,,i,il.'emam. *ola !K$ (T ele3asi;strain. 3oltase R ren'a. #?4atau R?4). isoenim &ar'ia menin,&at. nilai nalisis ,as 'araa+normal. leu&ositosis 'an C reati3e *rotein *ositif
Tu0uanmenin,&at&an *erfusi 0arin,an 'an mene,a &erusa&anotot 0antun, (infe&si ti'a& +er&em+an,)
Kriteria 4asil
u+0e&tifKeluan (*a'a 'ata *enun0an,) ilan, atau +er&uran,
O+0e&tif"ilai analisa ,as 'ara normal. *ola !K$ T isoele&tris.
3oltase R normal. a=is ;2 'era0at sam*ai 'en,an E11'era0at. iso enim &ar'ia 'an tan'a 3ital 'alam +atas normalF
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!N6ER;ENS!
http://var/www/apps/conversion/tmp/scratch_5/INTERVENSI.docxhttp://var/www/apps/conversion/tmp/scratch_5/INTERVENSI.docx
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*"F6"R P'0ianti 21 Ke*era5atan Kar'io3as&ular %ener+italem+a Me'i&a Ja&arta
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Trima&asi
SEK!"N 6ER!M"K"S!H