GIBBS REFLECTIVE

MEDICAL SURGICAL NURSING

SECOND WEEK IN ELANG 1 PUTRA ROOM, KARIADI HOSPITAL,
SEMARANG

CREATED BY :
FAJAR OKTAVIAN RAHARJO
P1337420922080

NERS PROFESSIONAL STUDY PROGRAM

NURSING DEPARTMENT
POLTEKKES KEMENKES SEMARANG
2022
DESCRIPTION

I am currently undergoing clinical nursing practice in the Nursing profession at the Medical
Surgical Nursing station at the Elang 1 Putra Building. In the first week of October 3 to October
8 I took a case of the cardiovascular system on a client with Congestive Heart Failure.
FEELING

Congestive heart failure occurs when the heart muscle cannot pump blood strong enough
throughout the body. This health problem used to be nicknamed the silent killer because it can
appear without symptoms for a long period of time until finally causing the patient to die.

But now researchers have come to the conclusion that congestive heart failure does not mean a
death sentence for patients. Many people with mild to moderate heart failure can live long and
normal lives with the help of medications and treatments.

Here are some facts about heart failure found in research:

 Heart failure means that the pumping function of the heart cannot meet the body's basic
needs
 This disease can appear with other diseases
 Symptoms vary from one patient to another
 This disease is progressive or can get worse over time
 Many patients feel tired and short of breath

Patients with congestive heart failure can be classified into four categories based on their ability
to carry out activities of daily living:

I: no mobility problem
II: there are only minor mobility issues
III: have limitations for certain activities
IV: unable to complete activities without feeling extreme discomfort

EVALUATION

Congestive heart failure occurs due to heart muscle problems caused by various factors. Among
them:

Coronary artery disease : the flow of oxygenated blood to the heart is blocked due to plaque
buildup in the arteries, hardening of the arteries, or tearing of the inner lining of the arteries.
Heart attack : occurs when a coronary artery suddenly becomes blocked and blood cannot flow
to the heart completely. As a result, the heart muscle becomes permanently damaged and muscle
cells can die, while normal muscle cells are forced to work harder.

Cardiomyopathy : This disease refers to damage and swelling of the heart muscle that is not
triggered by problems with blood flow or coronary arteries.

Congenital heart disease : heart defects that occur during pregnancy due to problems with fetal
development.

Diabetes : high blood sugar levels

Hypertension : high blood pressure

Obesity : overweight

Arrhythmia : abnormal heart rhythm

Unhealthy lifestyle : for example smoking, using narcotics, eating unhealthy foods, rarely
exercising

ANALYSIS

The tests needed to diagnose heart failure include:

Blood test : to determine cholesterol levels and red blood cell levels

Cardiac catheterization : the use of a small, long tube-shaped device called a catheter that is
inserted into an artery and directed into the heart to determine the condition of the heart. X-rays
and contrast fluid are also needed to get a better view of the heart and blood vessels.

X-rays : X-ray scans can show the size of the heart and whether there is a buildup of fluid in the
area of the heart and lungs.

Echocardiogram : the use of sound wave technology to determine how well the pumping
function of the heart is at the same time checking blood flow.

Measurement of ejection fraction: ejection fraction is a measure of how much blood is pumped
out of the heart in each beat. It can be measured using an echocardiogram, magnetic resonance
imaging (MRI), or multigated acquisition (MUGA) imaging. Normal EF is 55-70 percent.
Electrocardiogram : to record the electrical activity of the heart using electrodes connected to
an electrocardiograph monitoring machine.

In my managed patient with Congestive Heart Failure, several supporting examinations have
been carried out including:

1. ECG (30 September 2022 RSDK)

Rhythmic sinus, HR : 84x/minute
2. Radiology Thorax Photo (30 September 2022 RSDK)
Cor : Cardiomegaly LV, LA
Pulmo: The vascular pattern appears to increase, Spots appear in the lower field of the right
lung
3. Echocardiography (25 May 2021 RSI Sultan Agung)
-LA, LV, LVH dilatation eccentric
-LV thrombus 1x1 cm, minimal pericardial effusion
-Global hypokinetic, LVEF 26% Teich
-E/A 1.7, E/e 29
-TAPSE 18mm
-MR mild, TR mild
4. Percutaneous Angiography Coronary (7 August 2021 RSI Sultan Agung)
-RCA: 70-80% proximal stenosis, mild CTO, bridging collaterals (+)
-LM: short, stenosis 60-70% distal
-LAD : CTO distal-proximal, got collateral from LCX
-LCX: Stenosis 70-80% proximal

CONCLUSION

There are several symptoms that indicate a person has congestive heart failure. An
examination at a heart hospital can confirm these symptoms. However, symptoms in the early
stages may not affect general health conditions. There are at least three levels of symptoms that
appear according to their severity.

Early stage

 Swollen feet
 Easy to feel tired, especially after doing physical activities
 Significantly increased weight
 Frequent urge to urinate, especially at night
Intermediate stage

 Irregular heartbeat
 Cough due to swelling of the lungs
 Shortness of breath
 Shortness of breath because the lungs are filled with fluid
 Difficult to move the body because of fatigue

Advanced stage

 Pain in the chest, this could indicate a heart attack

 Blue skin, a sign of lack of oxygen
 Breath fast and short
 Faint

My chronological history of the disease I manage is: Mr. P was admitted to the RSDK hospital
September 30, 2022 complaining of shortness of breath that was getting worse day by day, the
most congested and severe in the last 1 week accompanied by swollen legs since the last 1
month, chest pain (-), pounding (-), DOE (+), PND (+), OP (+). Mr. P said that the shortness of
breath appears when walking 10 meters or taking a shower feels breathless. Mr. P also finds it
difficult to sleep, sleeping at home with 2-3 pillows sometimes sleeping sitting up. Mr. P
discontinued routine hypertension medication himself since last 1 month, history of previous
heart attack (-) Mr. P a history of cardiac catheterization in 2021 at the Sultan Agung Hospital,
Semarang, it is recommended to install a heart ring but does not want to.

Physical Examination of My Managed Patients with Congestive Heart Failure:

 Neck

There is an increase in the jugular venous pressure of 5+3 cm

 Chest Breathing

Inspection: Symmetrical shape

Palpation: Focal fremitus normal left and right
Percussion : Sonor
Auscultation: Vesicular, minimal smooth wet rhonchi +/+ at the lung bases,

 Heart
 Inspection: ictus cordis does not appear intercostal to IV-V, in the mid clavicle a little 2 cm
medial left
Palpation: ictus cordis palpable at the fifth intercostal area, in the mid clavicle, slightly 2 cm
medial left
Percussion: absolute dim sound is heard throughout the heart field
Auscultation: S1-S2 regular sound, murmur (-), gallop (-)

 Lower extremities: warm acral, leg edema (+/+) pitting edema 2 cm

ACTION PLAN

Medications for congestive heart failure may be given, depending on the severity of the
patient's condition. Doctors may also need to perform other medical procedures to help increase
the patient's chances of recovery. Types of drugs intended for patients with heart failure include:

ACE inhibitors (angiotensin converting enzyme inhibitors) : to lower blood pressure

Digoxin : useful for strengthening the heart muscle

Beta blockers (beta blockers): relieve the work of the heart by blocking certain hormones

Diuretics : remove excess fluid from the body

Other procedures include repair or replacement of heart valves, bypass surgery to treat blockages
in arteries, insertion of a defibrillator to restore the heart's rhythm, and heart transplants.