ST-ELEVASI MIOCARD INFARK DAN KETOASIDOSIS DIABETIKUM : SEBUAH STUDI KASUS DENGAN PENDEKATAN PROSES KEPERAWATAN

Ismail Fahmi; Musaddad Kamal; Hermin Esti Dianingtyas

doi:10.47522/jmk.v4i2.143

Authors

Ismail Fahmi Poltekkes kemenkes jambi
Musaddad Kamal Universitas Faletehan
Hermin Esti Dianingtyas Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita Jakarta

DOI:

https://doi.org/10.47522/jmk.v4i2.143

Keywords:

Nursing management, Ketoasidosis diabetikum, STEMI, Nursing care

Abstract

Pendahuluan: Ketoasidosis diabetikum (KAD) diabetikum diketahui memiliki hubungan dengan prognosis ST Elevation Miocardial Infact (STEMI). Peningkatan kejadian gagal jantung, shock hingga terjadinya kematian. Perawat memiliki peran penting kolaboratif dalam penanganan kejadian tersebut. Penelitian ini bertujuan untuk menggambarkan manajemen asuhan keperawatan pada pasien STEMI dengan KAD.

Metode: Pendekatan studi kasus digunakan dalam penelitian ini, dimana kami mempersembahkan penerapan asuhan keperawatan pada pasien laki-laki usia 42 tahun STEMI disertai ketoasidosis diabetikum di ruang gawat darurat.

Hasil: Pada studi kasus ini pasien masuk unit gawat darurat dengan keluhan nyeri dada khas dan kondisi hiperglikemia. Hasil pemeriksaan penunjang pasien didiagnosis mengalami STEMI ekstensif anterior onset 3 jam dan KAD, diagnosis keperawatan pada pasien tersebut adalah nyeri akut (NANDA: 00132) dan defisit volume cairan (NANDA 00027), intevensi yang digunakan Manajemen nyeri dengan aktivitas tindakan tatalaksana STEMI dan manajemen cairan dengan aktivitas tindakan tatalaksana cairan KAD sesuai dengan evidence based practice. Evaluasi hasil tindakan keperawatan, nyeri masih terajdi dan defisit volume cairan tidak terjadi.

Kesimpulan: STEMI dan KAD merupakan dua kasus gawatdarurat yang memerlukan penanganan yang tepat, manajemen keperawatan dengan pendekatan interpersonal kolaborasi dan berbasis evidence based practice pada pasien pada kasus tersebut dapat meningkatkan outcome yang baik bagi pasien.

References

Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., Levine, G. N., Liebson, P. R., Mukherjee, D., Peterson, E. D., Sabatine, M. S., Smalling, R. W., & Zieman, S. J. (2014). 2014 AHA/acc guideline for the management of patients with Non-ST-Elevation acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 64(24), e139–e228. https://doi.org/10.1016/j.jacc.2014.09.017

Bandyopadhyay, D., Devanabanda, A. R., Tummala, R., Chakraborty, S., Hajra, A., Amgai, B., Akhtar, T., Jain, V., & Ghosh, R. K. (2019). Effect of diabetic ketoacidosis on the outcomes of ST-elevation myocardial infarction: An analysis of national inpatient sample. IJC Heart and Vasculature, 24, 100384. https://doi.org/10.1016/j.ijcha.2019.100384

Chiha, M., Njeim, M., & Chedrawy, E. G. (2012). Diabetes and coronary heart disease: A risk factor for the global epidemic. International Journal of Hypertension, 2012. https://doi.org/10.1155/2012/697240

Frangogiannis, N. G. (2015). Pathophysiology of myocardial infarction. Comprehensive Physiology, 5(4), 1841–1875. https://doi.org/10.1002/cphy.c150006

Gabriel-costa, D. (2018). SC.

Gosmanov, A. R., Gosmanova, E. O., & Dillard-Cannon, E. (2014). Management of adult diabetic ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 255–264. https://doi.org/10.2147/DMSO.S50516

Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., Hindricks, G., Kastrati, A., Lenzen, M. J., Prescott, E., Roffi, M., Valgimigli, M., Varenhorst, C., Vranckx, P., Widimský, P., … Gale, C. P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119–177. https://doi.org/10.1093/eurheartj/ehx393

Issa, M., Alqahtani, F., Berzingi, C., Al-Hajji, M., Busu, T., & Alkhouli, M. (2018). Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction. Diabetology and Metabolic Syndrome, 10(1), 1–8. https://doi.org/10.1186/s13098-018-0357-y

Issa, M., Alqahtani, F., Ziada, K. M., Stanazai, Q., Aljohani, S., Berzingi, C., Giordano, J., & Alkhouli, M. (2018). Incidence and Outcomes of Non-ST Elevation Myocardial Infarction in Patients Hospitalized with Decompensated Diabetes. American Journal of Cardiology, 122(8), 1297–1302. https://doi.org/10.1016/j.amjcard.2018.07.004

Kreider, K. E. (2018). Updates in the Management of Diabetic Ketoacidosis. Journal for Nurse Practitioners, 14(8), 591–597. https://doi.org/10.1016/j.nurpra.2018.06.013

Mechanic, O. J., Gavin, M., Grossman, S. A., & Ziegler, K. (2022). Acute Myocardial Infarction (Nursing). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK568759/

NANDA International. (2018). Nursing diagnoses: definitions and classification 2018-2020.

PERKI. (2015). Pedoman tatalaksana sindrom koroner akut. Pedoman Tatalaksan Sindrome Koroner Akut, 88. https://doi.org/10.1093/eurheartj/ehn416

Pk, W., Whelton, P. K., Carey, R. M., Aronow, W. S., Ovbiagele, B., Casey, D. E., Smith, S. C., Collins, K. J., Spencer, C. C., Himmelfarb, C. D., Stafford, R. S., Depalma, S. M., Taler, S. J., Gidding, S., Thomas, R. J., Jamerson, K. A., Williams, K. A., Jones, D. W., Williamson, J. D., … Mauri, L. (2017). 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults A Report of the American College of Cardiology / American Heart Association T. In Journal of American College of Cardiology. https://doi.org/10.1161/HYP.0000000000000065/-/DC1.The

Planer, D., Witzenbichler, B., Guagliumi, G., Peruga, J. Z., Brodie, B. R., Xu, K., Fahy, M., Mehran, R., & Stone, G. W. (2013). Impact of hyperglycemia in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: The HORIZONS-AMI trial. International Journal of Cardiology, 167(6), 2572–2579. https://doi.org/10.1016/j.ijcard.2012.06.054

Rosenson, R. S., Brewer, H. B., Ansell, B. J., Barter, P., Chapman, M. J., Heinecke, J. W., Kontush, A., Tall, A. R., & Webb, N. R. (2016). Dysfunctional HDL and atherosclerotic cardiovascular disease. Nature Reviews Cardiology, 13(1), 48–60. https://doi.org/10.1038/nrcardio.2015.124

Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., & White, H. D. (2012). Third universal definition of myocardial infarction. Journal of the American College of Cardiology, 60(16), 1581–1598. https://doi.org/10.1016/j.jacc.2012.08.001

White, K., Macfarlane, H., Hoffmann, B., Sirvas-Brown, H., Hines, K., Rolley, J. X., & Graham, S. (2018). Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice. Heart Lung and Circulation, 27(5), 535–551. https://doi.org/10.1016/j.hlc.2017.10.022