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