Hasil Pencarian  ::  Simpan CSV :: Kembali

Hasil Pencarian

Ditemukan 119712 dokumen yang sesuai dengan query
cover
Nany Budiman
Tata laksana nutrisi pada pasien Acute Decompensated Heart Failure dengan berbagai faktor risiko = Nutritional management in Acute Decompensated Heart Failure with various risk factors
"[Pendahuluan: Acute decompensated heart failure (ADHF) adalah penyebab
utama rawat inap di RS karena morbiditas dan mortalitasnya yang tinggi.
Perubahan metabolisme, pengaruh kongesti sistemik pada gastrointestinal, dan
efek samping terapi medikamentosa ADHF menyebabkan pasien ADHF rentan
mengalami malnutrisi. Perbedaan faktor risiko ADHF juga mempengaruhi tata
laksana nutrisi. Tata laksana nutrisi yang adekuat sesuai dengan faktor risiko dan
kondisi klinis dibutuhkan untuk mencegah malnutrisi, menurunkan morbiditas dan
mortalitas.
Presentasi Kasus: Pasien dalam serial kasus ini adalah dua perempuan dan dua
laki-laki berusia 32–62 tahun dengan ADHF dan berbagai faktor risiko. Pasien
pertama dengan diabetes melitus tipe 2, pasien kedua dengan dilated
cardiomyopathy, pasien ketiga dengan hipertensi, sedangkan pasien keempat
dengan stenosis aorta. Target kebutuhan energi keempat pasien adalah sebesar
130–140% kebutuhan energi basal yang dihitung dengan Harris-Benedict. Target
pemberian protein sebesar 0,8–1,4 g/kg BB/hari, kebutuhan lemak 25% dari
energi total dengan komposisi lemak sesuai therapeutic lifestyle changes.
Kebutuhan natrium 2400 mg/hari dengan restriksi cairan rata-rata sebesar 1500
mL/hari. Pemberian mikronutrien dan nutrien spesifik berupa vitamin B
kompleks, C, B12, asam folat, seng, dan omega 3 disesuaikan dengan kondisi
pasien.
Hasil: Pada keempat pasien didapatkan perbaikan kondisi klinis dan kapasitas
fungsional.
Kesimpulan: Tata laksana nutrisi yang adekuat pada pasien ADHF sesuai dengan faktor risiko dan kondisi klinis dibutuhkan untuk perbaikan outcome, menurunkan morbiditas dan mortalitas., Background: Acute decompensated heart failure (ADHF) is a leading cause for
hospitalization due to its high morbidity and mortality. Metabolic changes,
congestion effects on gastrointestinal, and side effects of therapy result in
increased risk of malnutrition in ADHF patients. Various risk factors and clinical
status also have great impact on nutritional management. An adequate nutritional
management based on risk factor and clinical status is required to prevent
malnutrition, reduce morbidity and mortality.
Case Presentation: Two female and two male patients were included in this case
series, aged 31–60 years old, and diagnosed as ADHF with various risk factors.
The risk factor of ADHF for first patient was diabetes mellitus type 2, the second
patient was dilated cardiomyopathy, the third patient was hypertension, and the
fourth patient was aortic stenosis. Total energy requirement was 130–140% of
estimated basal energy requirement. Target of protein was 0.8–1.4 g/kg BW/day.
Fat requirement was 25% of total energy with composition based on therapeutic
lifestyle changes. Sodium intake was 2400 mg/day with fluid restriction averaged
to 1500 mL/day. Micronutrient and specific nutrient supplementation such as
vitamin B complex, C, B12, folic acid, zinc, and omega 3 were provided to
patients based on clinical status.
Result: There was improvement of clinical status and functional capacity in all
patients.
Conclusion: An adequate nutritional management in ADHF patients based on risk factor and clinical status leads to better outcome and reduction of morbidity and mortality. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Linda Arintawati
Tata laksana Nutrisi pada Pasien Gagal Jantung Dekompensasi Akut karena Infark Miokard Lama = Nutrition management in patients with acute decompensated heart failure due to old myocardial infarction
"ABSTRAK
Latar Belakang: Prevalensi gagal jantung semakin meningkat per tahun, 60-70% disebabkan penyakit jantung koroner (PJK). Beberapa faktor risiko penyebab gagal jantung yaitu DM, hipertensi, obesitas, sindrom metabolik, dan aterosklerosis. Patofisologi gagal jantung sangat kompleks dan melibatkan banyak sistem, terjadi hipermetabolisme yang dapat menyebabkan penurunan
berat badan dan memicu terjadinya malnutrisi. Keadaan gagal jantung dekompensasi akut karena infark miokard lama membutuhkan penanganan segera di RS untuk menghindari komplikasi lebih lanjut.
Metode: Laporan serial kasus ini memaparkan empat kasus pasien gagal jantung dekompensasi akut karena infark miokard lama, berusia antara 41 hingga 70 tahun, dan tiga diantaranya dengan riwayat DM tipe II. Semua pasien memerlukan dukungan nutrisi, tiga pasien memiliki status gizi obesitas dan satu pasien berat badan normal. Masalah berkaitan erat pada nutrisi keempat pasien adalah hipoalbuminemia, gangguan elektrolit, gangguan fungsi ginjal, gangguan fungsi hati, keseimbangan cairan, serta defisiensi mikronutrien. Perhitungan kebutuhan energi basal (KEB) dihitung berdasarkan rumus Harris Benedict dengan faktor stres sesuai kondisi klinis dan penyakit penyerta. Komposisi makronutrien diberikan menurut
rekomendasi Therapeutic Lifestyle Changes (TLC) dan American Heart Association (AHA), pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien. Pemberian suplementasi mikronutrien juga diberikan
kepada keempat pasien. Pemantauan pasien meliputi keluhan subyektif, hemodinamik, analisis toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan dan kapasitas fungsional.
Hasil: pemantauan selama di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, perbaikan kadar elektrolit dan peningkatan kapasitas fungsional.
Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien gagal jantung dekompensasi akut karena infark miokard lama.
ABSTRACT
Background: The prevalence of heart failure increase annually, 60-70% due to coronary heart disease (CHD). Some of the risk factors associated with heart failure are diabetes, hypertension, obesity, metabolic syndrome, and atherosclerosis. The phatophysiology of heart failure is very complex and involves many systems. The occurance of hypermetabolism can lead to weight loss and triger malnutrition. The state of acute decompensated heart failure due to old myocardial infarction require immediate treatment in hospital to avoid further complications.
Methods: This series of case report describes four cases of patients with acute myocardial heart failure, due to old infarction, aged between 41 to 70 years old, and three of them with a history of type 2 diabetes melitus. All patients required nutritional support, three patients had nutritional status of obese and one patient was normal in weight. The problems which closely linked to all nutrition of the four patients were hypoalbuminemia, electrolyte disturbances, impaired renal function, impaired liver function, fluid inbalance, and micronutrient deficiencies. Basal Energy Requirement was calculated using Harris Benedict formula with stress factors corresponding clinical condition and comorbidities. Macronutrients composition was given according to the recommendation of the Therapeutic Lifestyle Changes (TLC) and the American Heart Association (AHA), while the provision of proteins was
tailored with the kidney function of each patient. Micronutrients supplementation was also given to four patients. Patient monitoring parameters included subjective complaints, hemodynamic, analysis tolerance
of intake, laboratory tests, anthropometric, fluid balance and functional capacity.
Results: During the monitoring period in the hospital four patients showed clinical improvement, increased tolerance of intake, improved electrolyte levels and increased functional capacity.
Conclusion:Adequate medical nutrition therapy can improve the clinical condition of patients with acute decompensated heart failure due to old myocardial infarction."
2016
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Ahmad Pandu Pratama
Faktor-faktor prognostik resistensi diuretik pada pasien dengan gagal jantung dekompensasi akut = Factors peedicting diuretic resistance in patients with acute decompensated heart failure
"Latar belakang: Gagal Jantung Dekompensasi Akut (GJDA) merupakan penyebab utama terjadinya kematian dan kesakitan di dunia. Angka kematian dalam perawatan di dunia adalah sebesar 3-4%, sementara di Indonesia sebesar 11,2% berdasarkan Indonesian Registry of Heart Failure. Tatalaksana menggunakan diuretik loop telah dibuktikan efektif dalam meredakan kongesti, namun penggunaan secara terus menerus dapat menyebabkan terjadinya komplikasi berupa resistensi diuretik. Resistensi diuretik terjadi pada 20-35% pasien dengan GJDA dan telah diketahui sebagai prediktor independen terhadap terjadinya perburukan luaran klinis, kematian segera paska perawatan dan kejadian rawat ulang.
Tujuan: Mengetahui faktor-faktor yang mempengaruhi terjadinya resistensi diuretik pada pasien GJDA brdasarkan penyakit yang mendasari, komorbid, tanda vital, fraksi ejeksi ventrikel kiri dan laboratorium.
Metode: Studi kohort retrospektif dilakukan pada 535 pasien yang dirawat dengan GJDA selama periode Januari-Desember 2019. Resistensi diuretik didefinisikan sebagai respon diuresis kurang dari 1400ml dalam 24jam pertama setelah pemberian 40mg furosemide intravena (atau setara).
Hasil: Resistensi diuretik terjadi pada 68% pasien. Prediktor independen terhadap terjadinya resistensi diuretik yang diperoleh dari analisa regresi logistik multivariat adalah: riwayat DM (p = 0.013), riwayat penggunaan diuretik loop iv > 6 hari (p = 0.002), dosis diuretik loop oral > 80mg/hari (p = 0.006), FEVKi ≤ 49% (p = 0.002), BUN ≥ 21 mg/dL (p < 0.001) dan klorida serum < 98mmol/L (p < 0.001). Sebagai tambahan, sebuah sistem skoring telah dibuat berdasarkan model akhir tersebut.
Kesimpulan: Kejadian resistensi diuretik dapat diprediksi berdasarkan karakteristik pasien, parameter klinis dan laboratorium. Sistem skoring baru dapat memprediksi kejadian resistensi diuretik pada pasien gagal jantung dekompensasi akut yang menjalani rawat inap.
Background: Acute Decompensated Heart failure (ADHF) is a leading cause of mortality and morbidity in the world. In-hospital mortality rate is 3-4%, while in Indonesia it is 11.2% based on the Indonesian Heart Failure Registry. The management of using loop diuretics has proven effective in relieving congestion yet continuous utilization could lead to the development of diuretic resistance. Diuretic resistance occurs in 20-35% of patients with ADHF and has been shown to be an independent predictor of worsening clinical outcomes, immediate post-treatment death and re-admission events.
Objective: to identify factors that influence the occurrence of diuretic resistance in ADHF patients based on the underlying disease, comorbidities, vital signs, left ventricular ejection fraction and laboratory.
Methods: A cohort retrospective study was conducted on 535 patients treated with ADHF from January-December 2019. Diuretic resistance was defined as a diuresis response of less than 1400ml in the first 24 hours after administration of 40mg of intravenous furosemide (or equivalent).
Results: Diuretic resistance occurs in 68% of patients. Independent predictors obtained from multivariate logistic regression analysis were: history of DM (p = 0.013), history of using iv loop diuretics > 6 days (p = 0.002), oral loop diuretic dose > 80mg/day (p = 0.006), LVEF ≤ 49% (p = 0.002), BUN ≥ 21 mg/dL (p < 0.001)and serum chloride <98mmol/L (p <0.001). In addition, a scoring system has been made from the final model.
Conclusion: Diuretic resistance could be predicted using patient's characteristics, clinical parameters and laboratory findings. A new scoring system could predict diuretic resistance among patients hospitalized with acute decompensated heart failure. "
Depok: Fakultas Kedokteran Universitas Indonesia, 2020
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Destia Anggraini Rahmawati
Analisis Asuhan Keperawatan Pasien Acute Decompensated Heart Failure pada Congestive Hearth Failure With Reduced Ejection Fraction Dengan Penerapan Ankle Pumping Exercise = Analysis of Nursing Care for Acute Decompensated Heart Failure in Congestive Heart Failure With Reduced Ejection Fraction With the Application of Ankle Pumping Exercise
"ADHF (Acute decompensated heart failure) merupakan suatu kondisi gagal jantung dengan perubahan mendadak pada jantung untuk berkontraksi, sehingga mengancam nyawa dan dapat menyebabkan edema paru. Gagal jantung dapat dikategorikan menurut nilai ejeksi fraksi, salah satunya heart failure with reduce ejection fracktion (HFrEF) dengan nilai EF ≤40%. Tanda klinis ADHF salah satunya edema pada tungkai. Hal ini terjadi karena kegagalan LV untuk berkontraksi sehingga menyebabkan aliran balik dengan penumpukan cairan diparu, kemudian kembali ke RV dan keluar melalui atrium kanan ke seluruh tubuh, salah satunya ke tungkai. Intervensi yang dilakukan untuk mengatasi edema tungkai yaitu ankle pumping exercise. Intervensi ini dilakukan selama 3 hari dengan frekuensi 10 kali/jam, kemudian dievaluasi selama 6 jam dengan metode pitting edema. Hasil intervensi menunjukkan terdapat perubahan derajat edema tungkai dari +3/+3 menjadi +1/+2. Hasil karya ilmiah ini diharapkan menjadi salah satu alternatif intervensi untuk mengurangi edema tungkai.
ADHF (Acute decompensated heart failure) is a condition of heart failure with sudden changes in the heart to contract, so it is life threatening and can cause pulmonary edema. Heart failure can be categorized according to the value of the ejection fraction, one of which is heart failure with reduced ejection fracture (HFrEF) with an EF value of ≤40%. One of the clinical signs of ADHF is edema in the legs. This occurs due to the failure of the LV to contract causing backflow with a buildup of fluid in the lungs, then back into the RV and out through the right atrium to the rest of the body, including the legs. The intervention to treat leg edema is ankle pumping exercise. This intervention was carried out for 3 days with a frequency of 10 times/hour, then evaluated for 6 hours using the pitting edema. The results of the intervention showed that there was a change in the degree of leg edema from +3/+3 to +1/+2. The results of this scientific work are expected to be an alternative intervention to reduce leg edema."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2022
PR-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Carolina Paolin Kanaga
Terapi nutrisi pasien gagal jantung kongestif dengan berbagai faktor risiko dan gangguan elektrolit = Nutritional therapy in congestive heart failure patients with various risk factors and electrolyte disorders
"Latar Belakang: Gagal jantung kongestif merupakan penyakit tahap akhir yang disebabkan oleh multifaktor. Pada gagal jantung kongestif terjadi perubahan metabolisme dan perubahan neurohormonal, yang dapat menyebabkan asupan tidak adekuat. Selain itu, akibat obat-obatan yang sering digunakan, terjadi gangguan elektrolit. Terapi nutrisi sejak dini, dapat mendukung proses penyembuhan pasien dan mencegah terjadinya malnutrisi.
Kasus: Dalam serial kasus ini terdapat empat kasus pasien gagal jantung kongestif dengan berbagai faktor risiko, diantaranya obesitas, diabetes melitus, hipertensi, dan acute on chronic kidney disease. Pada awal pemeriksaan didapatkan asupan pasien yang kurang dari kebutuhan, kadar glukosa darah yang tidak terkontrol, gangguan elektrolit dan penurunan kapasitas fungsional. Terapi nutrisi diberikan sesuai dengan klinis, hasil laboratorium, dan asupan terakhir masing-masing pasien.
Hasil: Tiga pasien mencapai kebutuhan energi total dan satu pasien mencapai 85 kebutuhan energi total, kadar glukosa darah terkontrol, terdapat perbaikan kapasitas fungsional pada semua pasien.
Kesimpulan: Terapi nutrisi yang adekuat dan sesuai dengan kondisi pasien gagal jantung dapat mendukung perbaikan klinis pasien, perbaikan kadar glukosa darah, perbaikan kapasitas fungsional, sehingga dapat mempercepat lama rawat di rumah sakit dan mencegah terjadinya malnutrisi.
Background: Congestive heart failure is an end stage disease caused by a multifactor. In congestive heart failure changes in metabolism and neurohormonal changes, which can cause inadequate intake. In addition, due to frequently used drugs, electrolyte disorders occur. Early nutrition therapy, can support the process of healing the patient and prevent the occurrence of malnutrition.
Case: In this case series there are four cases of patients with congestive heart failure with various risk factors, including obesity, diabetes mellitus, hypertension, and acute on chronic kidney disease. At the beginning of the examination was obtained less patient intake of the need, uncontrolled blood glucose levels, electrolyte disorders and decreased functional capacity. Nutritional therapy is given in accordance with clinical, laboratory outcomes, and the patient's final intake.
Result: Three patients achieved total energy requirements and one patient achieved 85 of total energy requirements, controlled blood glucose levels, and improved functional capacity in all patients.
Conclusion: Adequate nutritional therapy appropriate to the condition of patients with heart failure can support patient clinical improvement, improvement of blood glucose levels, functional capacity improvement, so as to accelerate hospital stay and prevent malnutrition."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Herlina Escana
Analisis asuhan keperawatan pada pasien acute decompensated heart failure dan intervensi pembatasan serta pemantauan cairan = Analysis of Nursing Care in Patient Acute Decompensated Heart Failure and Intervention of Fluid Restriction and Monitoring
"Pembatasan cairan sebagai salah satu intervensi pada pasien gagal jantung masih menjadi kontroversi terkait manfaat yang diperoleh. Karya ilmiah ini merupakan studi kasus yang dilakukan selama lima hari terhadap pasien gagal jantung akut dekompensasi di salah satu Rumah Sakit di Jakarta. Studi kasus ini bertujuan untuk mengetahui efektifitas pembatasan dan pemantauan cairan pada pasien gagal jantung yang mengalami kongesti. Hasil yang didapat yaitu terjadi penurunan berat badan, lingkar perut, klinis kongesti dan persepsi rasa haus setelah dilakukan pembatasan dan pemantauan cairan. Karya ilmiah ini menyarankan bahwa pembatasan cairan perlu dilakukan pada pasien gagal jantung yang mengalami kongesti untuk mengurangi beban kerja jantung dan pemantauan cairan juga perlu dilakukan untuk meningkatkan kemampuan pasien dalam perawatan mandiri guna mencegah kejadian rawat inap berulang sehingga dapat terjadi peningkatan kualitas hidup pasien gagal jantung di area perkotaan.
Analysis of Nursing Care in Patient Acute Decompensated Heart Failure and Intervention of Fluid Restriction and Monitoring. Fluid restriction is one of heart failure nursing intervention still controversy regarding the benefits of these interventions. This scientific paper is a case study conducted for five days on acute decompensated heart failure patients in a hospital in Jakarta. This case study aims to determine the effectiveness of fluid restriction and monitoring in congestive heart failure patients. The results showed there a decrease in body weight, abdominal circumference, clinical congestion and perception of thirst after restriction and monitoring of fluids. This scientific paper suggests that fluid restriction needs to be applied in heart failure patients who have congestion to reduce cardiac workload and fluid monitoring also needs to be done to improve the ability of patients in self-care to prevent rehospitalizations so there is an enhancement quality of life in heart failure patients in urban society"
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2019
PR-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Paskariatne Probo Dewi Yamin
Hubungan malnutrisi yang diukur dengan Nutritional Risk Index terhadap perburukan fungsi ginjal pada pasien gagal jantung dekompensasi akut = Association between malnutrition as assessed with Nutritional Risk Index with worsening renal function in patients admitted with acute decompensated heart failure
"[ABSTRAK
Latar Belakang. Malnutrisi merupakan salah satu masalah kesehatan utama yang banyak dijumpai terutama di negara berkembang. Malnutrisi pada pasien gagal jantung diketahui berhubungan dengan luaran klinis yang lebih buruk, meliputi peningkatan lama perawatan, readmisi dan mortalitas. Pada pasien gagal jantung dekompensasi akut (GJDA), perburukan fungsi ginjal (PFG) selama perawatan diduga merupakan komorbid yang memberikan dampak luaran klinis yang lebih buruk tersebut. Namun sampai saat ini belum diketahui bagaimana hubungan antara status malnutrisi dengan terjadinya PFG pada pasien GJDA. Oleh karena itu, penelitian ini bertujuan untuk mengetahui hubungan antara status malnutrisi dengan terjadinya PFG pada pasien GJDA, sekaligus untuk menilai besarnya pengaruh malnutrisi terhadap luaran klinis tersebut.
Metode. Studi kohort prospektif dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Kejadian PFG didefinisikan sebagai peningkatan nilai kreatinin > 0,3 mg/dL atau > 25% dibandingkan kreatinin saat masuk rawat. Karakteristik dasar, pemeriksaan klinis awal, status antropometri dan data laboratorium diambil pada saat admisi. Pasien dibagi berdasarkan nilai NRI menjadi kelompok malnutrisi (NRI < 97,5) dan tidak malnutrisi (NRI > 97,5). Kemudian pemeriksaan serial kreatinin dilakukan dengan interval setiap 3 hari selama pasien menjalani perawatan di RS. Data kemudian diolah dengan analisis bivariat dan multivariat untuk mengetahui hubungan antara malnutrisi dengan PFG, lama perawatan, dan mortalitas.
Hasil Penelitian. Sebanyak 265 pasien GJDA diikutsertakan dalam penelitian ini, dengan proporsi kelompok malnutrisi sebesar 50,2%. Pada kelompok malnutrisi PFG terjadi pada 31,6% pasien, sedangkan pada kelompok tidak malnutrisi sebesar 26,5% pasien. Tidak didapatkan hubungan yang bermakna antara malnutrisi dengan kejadian PFG, namun terdapat kecenderungan peningkatan risiko PFG pada pasien GJDA yang disertai malnutrisi (OR 1,279; 95%IK 0,751-2,178; p=0,364). Malnutrisi ditemukan memiliki pengaruh yang signifikan terhadap tingginya lama rawat (HR 6,254; 95%IK 4,614-8,477; p<0,001) serta kematian pada pasien GJDA.
Kesimpulan. Penelitian prospektif ini tidak menemukan hubungan yang bermakna antara malnutrisi dengan PFG, namun didapatkan kecenderungan bahwa malnutrisi akan semakin meningkatkan risiko terjadinya PFG pada pasien GJDA. Pada pasien GJDA di RSJPDHK ditemukan proporsi malnutrisi yang sangat besar, dan malnutrisi pada kelompok ini memberikan kontribusi yang signifikan terhadap tingginya lama perawatan serta kematian.
ABSTRACT
Background. Malnutrition is the leading cause of disease burden especially in developing countries. Malnutrition in heart failure patients is associated with longer length of stay (LOS), higher readmission and mortality rates. Worsening renal function (WRF) has also been shown to contribute to the worsened outcomes in patients with acute decompensated heart failure (ADHF) patients. It is not known, however, whether malnutrition contributed to the worse outcomes in ADHF patient through the WRF. Accordingly, this study sought to investigate the association between malnutrition and WRF in ADHF patients.
Methods. A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita (NCCHK) to all patients admitted with ADHF. WRF was defined as the occurrence, at any time during the hospitalization, of > 0,3 mg/dL or > 25% increase in serum creatinine from admission. Baseline and clinical characteristics, anthropometry status, and laboratory data were collected during hospital admission. Subjects were divided based on NRI into malnutrition (NRI < 97,5) and no malnutrition group (NRI > 97,5). Serial serum creatinine was evaluated within 3 days interval during hospitalization. Statistical analysis was done using bivariate and multivariate analysis to determine the association between malnutrition with WRF, LOS and mortality rates.
Results. Two hundred and sixty-five ADHF patients were included in this cohort study. Of those subjects, 50,2% were on malnutrition group. WRF occured in 31,6% patients of malnutrition group and 26,5% patients of no malnutrition group. Although there was an increased probability of WRF occurence in ADHF patients with malnutrition (OR 1,279; 95%CI 0,751-2,178; p=0,364), but this increased probability was not statistically significant. Malnutrition was found significantly prolonged the LOS (HR 6,254; 95%CI 4,614-8,477; p<0,001) and increased mortality rates in ADHF patients.
Conclusion. This prospective study demonstrated there was no significant association between malnutrition and WRF, but there was an increased probability of WRF occurrences in ADHF patients with malnutrition. Nevertheless, we found high burden of malnutrition in ADHF patients in NCCHK, and this burden contributed significantly to longer LOS and higher mortality rates in this population., Background. Malnutrition is the leading cause of disease burden especially in developing countries. Malnutrition in heart failure patients is associated with longer length of stay (LOS), higher readmission and mortality rates. Worsening renal function (WRF) has also been shown to contribute to the worsened outcomes in patients with acute decompensated heart failure (ADHF) patients. It is not known, however, whether malnutrition contributed to the worse outcomes in ADHF patient through the WRF. Accordingly, this study sought to investigate the association between malnutrition and WRF in ADHF patients.
Methods. A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita (NCCHK) to all patients admitted with ADHF. WRF was defined as the occurrence, at any time during the hospitalization, of > 0,3 mg/dL or > 25% increase in serum creatinine from admission. Baseline and clinical characteristics, anthropometry status, and laboratory data were collected during hospital admission. Subjects were divided based on NRI into malnutrition (NRI < 97,5) and no malnutrition group (NRI > 97,5). Serial serum creatinine was evaluated within 3 days interval during hospitalization. Statistical analysis was done using bivariate and multivariate analysis to determine the association between malnutrition with WRF, LOS and mortality rates.
Results. Two hundred and sixty-five ADHF patients were included in this cohort study. Of those subjects, 50,2% were on malnutrition group. WRF occured in 31,6% patients of malnutrition group and 26,5% patients of no malnutrition group. Although there was an increased probability of WRF occurence in ADHF patients with malnutrition (OR 1,279; 95%CI 0,751-2,178; p=0,364), but this increased probability was not statistically significant. Malnutrition was found significantly prolonged the LOS (HR 6,254; 95%CI 4,614-8,477; p<0,001) and increased mortality rates in ADHF patients.
Conclusion. This prospective study demonstrated there was no significant association between malnutrition and WRF, but there was an increased probability of WRF occurrences in ADHF patients with malnutrition. Nevertheless, we found high burden of malnutrition in ADHF patients in NCCHK, and this burden contributed significantly to longer LOS and higher mortality rates in this population.]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Sarah Sabillah
Analisis Asuhan Keperawatan pada Pasien Acute Decompensated Heart Failure Dengan Penerapan Ankle Pumping Exercise Untuk Mengurangi Edema Tungkai = Analysis of Nursing Care for Acute Decompensated Heart Failure Patients Using Ankle Pumping Exercise to Reduce Leg Edema
"Acute Decompensated Heart Failure (ADHF) merupakan kondisi klinis terjadinya perburukan gagal jantung secara tiba-tiba yang terjadi pada pasien dengan riwayat gagal jantung kronik. Kondisi gagal jantung dapat dilakukan pemeriksaan ekokardiografi untuk menilai kontraktilitas jantung, fungsi katup, pembesaran jantung, dan nilai fraksi ejeksi. Gagal jantung dengan penurunan nilai ejeksi fraksi EF <40% dan jantung mengalami disfungsi sistolik pada ventrikel kiri. Penurunan pemompaan darah oleh ventrikel kiri akan menyebabkan perubahan hemodinamik kapiler sehingga mendorong kebocoran dari kompartemen vaskular ke interstitium serta retensi air dan garam oleh sehingga menghasilkan akumulasi cairan di ekstremitas atau edema tungkai. Intervensi yang dilakukan untuk mengatasi edema tungkai adalah dengan ankle pumping exercise yang terdiri dari gerakan plantar fleksi dan dorsofleksi. Intervensi ini dilakukan selama 5 hari dengan frekuensi 10x/jam dengan interval 4 detik pada masing-masing gerakan, kemudian dievaluasi setelah 6 jam dengan metode pitting edema, Hasil intervensi menunjukkan adanya perubahan derajat tungkai dari +2/+2 menjadi 0/0 (tidak ada edema). Hasil karya ilmiah ini diharapkan menjadi salah satu intervensi alternatif untuk mengurangi edema tungkai.
Acute decompensated heart failure (ADHF) is a clinical condition of sudden worsening of heart failure that occurs in patients with a history of chronic heart failure. In conditions of heart failure, echocardiography can be performed to assess heart contractility, valve function, heart enlargement and ejection fraction values. Heart failure with a decrease in ejection fraction EF <40% and the heart experiences systolic dysfunction in the left ventricle. Decreased blood pumping by the left ventricle will cause changes in capillary hemodynamics, thereby encouraging leakage from the vascular compartment into the interstitium as well as water and salt retention thereby resulting in fluid accumulation in the extremities or leg edema. The intervention carried out to overcome leg edema is ankle pumping exercise which consists of plantar flexion and dorsiflexion movements. This intervention was carried out for 5 days with a frequency of 10x/hour with an interval of 4 seconds for each movement, then evaluated after 6 hours using the pitting edema method. The results of the intervention showed a change in leg grade from +2/+2 to 0/0 (no there is edema). It is hoped that the results of this scientific work will become an alternative intervention to reduce leg edema."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2024
PR-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Azlan Sain
Faktor klinis dan metabolik sebagai prediktor readmisi 30-hari pada pasien gagal jantung dekompensasi akut dengan penurunan fraksi ejeksi dan diabetes melitus tipe-2 = Clinical and metabolic factors as predictors of 30-day-readmission in patients with acute decompensated heart failure with reduced ejection fraction and type-2 diabetes mellitus
"Latar belakang: Pasien gagal jantung dengan penurunan fraksi ejeksi memiliki angka readmisi yang lebih tinggi dibandingkan dengan fraksi ejeksi normal, dan angka readmisi paling tinggi pada 30-hari pertama pascakeluar admisi sebelumnya. Sekitar 30% pasien dengan gagal jantung juga mengalami Diabetes Melitus (DM) Tipe-2. Sejauh ini, belum ada prediktor kejadian readmisi dalam 30-hari pada pasien dengan populasi tersebut di RSJPDHK, khususnya prediktor dari sisi klinis dan metabolik.
Tujuan: Mengetahui prediktor klinis dan metabolik terhadap kejadian readmisi dalam 30-hari pada pasien Gagal Jantung Dekompensasi Akut (GJDA) dengan penurunan fraksi ejeksi dan DM tipe-2.
Metode: Studi dilakukan secara kohort retrospektif, data diambil dari rekam medis berdasarkan admisi pasien yang memenuhi kriteria inklusi antara Januari 2016-Januari 2021. Luaran klinis terbagi menjadi kelompok readmisi dan kelompok non-readmisi. Luaran klinis yang dinilai adalah kejadian readmisi akibat perburukan kondisi gagal jantung pada 30-hari pascaadmisi terakhir di RSJPDHK. Dilakukan analisis multivariat untuk menentukan prediktor yang bermakna menentukan readmisi dalam 30-hari
Hasil: Dari total 747 subjek penelitian, 179 subjek termasuk ke dalam kelompok readmisi, dan 568 subjek termasuk ke dalam kelompok non-readmisi (angka readmisi 24%). Analisis regresi logistik multivariat menunjukkan bahwa faktor-faktor yang berhubungan dengan kejadian readmisi dalam 30-hari adalah: irama fibrilasi atrium (OR 2.616; 95% IK: 1.604-4.267; p 0.000), serta denyut jantung saat pulang rawat (OR 1.022; 95% IK: 1.005-1.039; p 0.010). Kadar gula darah post-prandial < 140 mg/dL menjadi prediktor protektif untuk kejadian readmisi dalam 30-hari (OR 0.528; 95% IK: 0.348-0.802; p 0.003).
Kesimpulan: Dua faktor klinis yaitu irama fibrilasi atrium dan denyut jantung saat akhir masa rawat menjadi prediktor readmisi yang bermakna terhadap kejadian readmisi dalam 30-hari akibat perburukan kondisi gagal jantung, sedangkan kadar gula darah post-prandial < 140 mg/dL menjadi faktor protektif untuk kejadian readmisi 30-hari pada populasi pasien gagal jantung dengan penurunan fraksi ejeksi dan DM tipe-2.
Background: Patients Heart Failure with reduced Ejection Fraction (HFrEF) had higher readmission rates than normal ejection fractions, and readmission rates were highest in the first 30-days post-admission. About 30% of patients with heart failure also have Type-2 Diabetes Mellitus (DM). So far, there is no predictors for the incidence of 30-days readmission in patients with this kind of population in National Cardiovascular Centre Harapan Kita (NCCHK).
Objective: To determine the clinical and metabolic predictors of 30-days readmission in patients with Acute Decompensated Heart Failure (ADHF) with reduced ejection fraction and type-2 DM.
Methods: The study was conducted in a retrospective-cohort, data were taken from medical records based on admissions of patients who met the inclusion criteria between January 2016-January 2021. The clinical outcomes were divided into readmission and non-readmission groups. The clinical outcome assessed was the incidence of readmission due to worsening of the condition of heart failure at 30-days after the last admission at NCCHK. Multivariate analysis was performed to determine significant predictors for 30-day readmission.
Result: Of the total 747 research subjects, 179 subjects were included in the readmission group, and 568 subjects included in the non-readmission group (readmission rate 24%). Multivariate logistic regression analysis showed that the factors associated at 30-days readmission were: atrial fibrillation rhythm (OR 2.616; 95% CI: 1.604-4,267; p 0.000), heart rate at discharge (OR 1.022; 95% CI: 1.005-1.039; p 0.010). Post-prandial blood glucose level < 140 mg/dL was a protective predictor for 30-day readmission (OR 0.528; 95% CI: 0.348-0.802; p 0.003).
Conclusions: Two clinical factors, namely atrial fibrillation and heart rate at the end of hospitalization, were significant predictors of readmission in 30 days due to worsening of heart failure, while postprandial blood sugar levels < 140 mg/dL were protective factors for 30-days readmission in population of heart failure with reduced ejection fraction and type-2 DM."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Wiji Lestari
Tata laksana nutrisi pada gagal jantung kongestif = Nutritional management in congestive heart failure
"Malnutrisi merupakan salah satu masalah penting yang sering terjadi pada pasien dengan penyakit gagal jantung kronik. Perubahan neurohormonal dan reaksi inflamasi yang terjadi menyebabkan serangkaian perubahan metabolisme. Kondisi ini jika tidak diimbangi asupan nutrisi yang adekuat akan terjadi kaheksia kardiak. Adanya kaheksia kardiak terbukti meningkatkan morbiditas dan mortalitas. Laporan serial kasus ini memaparkan empat kasus pasien gagal jantung kongestif dengan etiologi penyakit jantung hipertensi disertai berbagai kondisi penyerta. Semua pasien telah mengalami kaheksia kardiak sehingga memerlukan dukungan nutrisi selama perawatan.
Masalah yang turut menyertai dan berkaitan erat dengan nutrisi pada keempat pasien adalah infeksi, anemia, hipoalbuminemia, gangguan fungsi ginjal, gangguan fungsi hati, keseimbangan cairan dan elektrolit serta defisiensi mikronutrien tertentu serta nutrien spesifik. Penentuan kebutuhan energi total dihitung berdasarkan rumus Harris Benedict disesuaikan dengan faktor stres tergantung beratnya kasus dan kondisi penyerta. Pemberian protein disesuaikan dengan fungsi ginjal pada masing-masing pasien. Restriksi cairan dan natrium disesuaikan dengan keadaan retensi cairan, keadaan hiponatremia dan respon terhadap diuretik yang diberikan. Pemberian mikronutrien tertentu dan nutrien spesifik belum sepenuhnya dapat dilaksanakan pada keempat kasus.
Monitoring dan evaluasi yang diberikan meliputi klinis, antropometri terutama perubahan berat badan akibat retensi cairan, toleransi asupan, keseimbangan cairan dan kapasitas fungsional. Selama pemantauan didapatkan peningkatan asupan nutrisi dengan toleransi yang baik disertai dengan perbaikan klinis, kapasitas fungsional dan kondisi metabolik. Tata laksana penyakit primer yang adekuat disertai dukungan nutrisi yang optimal menghasilkan outcome yang baik selama perawatan. Perlu penatalaksanaan nutrisi berkelanjutan untuk mempertahankan status nutrisi, membantu mengontrol progresifitas penyakit dan mengendalikan komplikasi.
Malnutrition is the one of the most important problem which is frequently occurred in chronic heart disease patients. Neurohormonal changes and inflammatory reactions which developed will cascading metabolism shifts. If this condition is not followed by adequately nutrition intake, patients will have cardiac cachexia. The present of cardiac cachexia is evidenced in increasing the morbidity and mortality. This case series described four congestive heart failure patients which caused by hypertensive heart disease with various morbid conditions. All of the patients had cardiac cachexia and require nutritional support during the inward.
Several problems accompany and strongly relate with nutritional aspect in this cese series were infection, anemia, hypoalbuminemia, renal dysfunction, hepatic dysfunction, water and electrolyte imbalance, and specific micronutrient and nutrient deficiency. Total energy needs based on Harris Benedict formula and stress factors depend on case severity and other morbid conditions. Protein requirement adjusted to renal function for every patient. Water and sodium restriction adjusted to water retention, hyponatremia, and given diuretic responses conditions. Specific micronutrient and nutrient were not fully maintained in those four cases.
Monitoring and evaluation of this case series including clinical, antropometry especially weight changes due to water resistance, tolerance of intake, water balance and functional capacity conditions. During follow up, the improvement of nutrition intake and tolerance were developed as good as improving clinical, functional capacity, and metabolic condition. Adequate treatment for primary disease accompanied by optimal nutritional support resulted great outcome during inward. Further nutritional support are required to maintain nutritional status, help controlling disease progression, and control complications."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
<<   1 2 3 4 5 6 7 8 9 10   >>