CHAPTER 1

INTRODUCTION

1.1 Background

Heart is an organ in the human body which is included in the circulation

structure. Heart acts as a basic pump which pumps blood to deliver materials
necessary metabolic tissues throughout the body and transporting the remains
to be removed from the body's metabolism. Heart is a complex structure
composed of fibrous tissue, muscles and tissue heart's electrical conduction.
The main function of the heart is to pump blood. It can be done when the heart
muscle's ability to pump well enough, valve systems, and pumping rhythm was
good , if found abnormalities in any of the above, it will affect the pumping
efficiency and enables it will cause heart failure (Muttaqin, 2012).

Heart failure is expected to continue to increase, in USA and EU 44% of heart

failure patiens who were hospitalised in Europe will be rehospitalised at least
once within 12 months of discharge .Heart failure is associated with high
morbidity and mortality rates. The in hospital mean length of stay is mortality
rate is 4.1% . The complex, progressive nature of heart failure often result in
adverse outcomes, the most costly being hospital read missions (Lewis, 2011).
According to "Global Status Report on Noncommunicable
Diseases"Data(WHO, 2014)Cardiovascular disease is the highest cause of
death,Ie by 37% of total mortality. While in Indonesia ,heart failure disease is
one of the leading causes of death. Prevalence by Nationwide reached 7.2%.

We should not underestimate the disease of heart failure, because heart failure
if not treated quickly, and get treatment since the appearance of symptoms, it
will be deadly.

Based on data from Ulin General Hospital Banjarmasin in the Intensive

Cardiac Care Unit room in 2014 (January-December) clients with heart failure
were 162, in 2015 (January-December) there were 94 people, in 2016
(January-December) there were 276

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people, In 2017 (January-December) there were 76 people .When the students

did nursing clinical practice at the ICCU room on 17 April there were 7 client
who experienced heart failure .

The consequences of this disease of heart failure rapidly affect the shortage of
blood supply, causing cell death due to lack of oxygen carried in the blood
itself. The lack of oxygen supply to the brain (Cerebral Hypoxia), causes a
person to lose consciousness and stop breathing suddenly which can result in
the worst state of death.

Heart failure is a medical illness that if left untreated will result in the death
within minutes. The first major treatment for heart failure is cardiopulmonary
resuscitation. Heart failure can be acute, after a heart attack or it can also occur
slowly. Heart failure can be indicated by shortness of breathing, waking up at
hight breath, swollen feet, and frequent urination during night.

Patients with heart failure should be given treatment because Patients with
heart disorders require a rehabilitation program.Comprehensive to restore
physical ability after assault as well ,Prevent re-attacks. The rehabilitation
program includes Lifestyle changes that include dietary regulation, stress
management,physical training. Basically a rehabilitation program for people
with disorders The heart aims to:optimize the physical capacity of the body,
giving Counseling patients and families in preventing worsening, Helping the
patient to return to physical activity as before have heart problems (Wonder et
al., 2011).

The writer chose Mr. S with Medical Diagnosis Heart Failure because Mr. S
has complication that make patient need to meet her daily need. Writer chose
Banjarmasin Ulin General Hospital because Banjarmasin Ulin general
Hospital is the biggest hospital that has higher prevalence of heart failure
every year, almost half of the number of suffer cardiac disease were
hospitalized in Banjarmasin Ulin General Hospital suffering heart failure, do
nursing care that can include biological, psychological, social and spiritual
with nursing knowledge. From this nursing care ,the client is expected to
reach optimal health and also can reach productive life and also nurse can get
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more knowledge about the different in giving nursing care directly to the
patient in hospital with heart failure patient and analyze the case throughout
several theories.

1.2 Purpose

1.2.1 General Purpose

The general purpose of writing this paper is to know the description of

nursing care of patients with medical diagnosis of heart failure in real
practice in the field with a nursing process approach that includes
assessment through documentation.

1.2.2 Special Purpose

The specific purpose of doing nursing care through biological,

psychological, social, cultural, and spiritual is as follows :

1.2.2.1 Assessing data regarding clients with Heart Failure in Intensive

Cardiac Care Unit Ulin General Hospital Banjarmasin.

1.2.2.2 Determining the nursing diagnoses that appear in clients with

Heart Failure in Intensive Cardiac Care Unit Ulin General
Hospital Banjarmasin.

1.2.2.3 Determining the intervention of action on nursing clients with

Heart Failure in Intensive Cardiac Care Unit Ulin General
Hospital Banjarmasin.

1.2.2.4 Doing implementation in accordance with a plan of action on

clients with Heart Failure in Intensive Cardiac Care Unit Ulin
General Hospital Banjarmasin.

1.2.2.5 Evaluating the results of nursing care of patients with heart

failure in Intensive Cardiac Care Unit Ulin General Hospital
Banjarmasin.
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1.2.2.6 Making documentation all of the process about heart failure

in Intensive Cardiac Care Unit Ulin General Hospital
Banjarmasin.

1.3 Benefit

1.3.1 Patient :

Improving health and preventing disease complications and

prevention, so that heart failure does not happen again.

1.3.2 Families :

To keep relations of cooperation, members motivation, comply

with treatment and care programs, as well as improving family
knowledge about Heart Failure.

1.3.3 Nurse :

To increase knowledge of nursing care the client who suffered

delusions so that service quality can be improved.

1.3.4 Nursing institutions and the world health

This case study can be a source of data, information, or reference

material for the student of health education.
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1.4 Scientific Method of Nursing Care

Scieantific method used in the writing of the present paper is a case

study approach by exploring the treatment process to get all the data
that supports bothe subjective data and objective data . The nursing
process approach includes the assessment , formulation of nursing
diagnosis ,nursing plans, which was implemented according to the
existing plans in order, to evaluate the care provided .

1.5 The Systematic of Writing

1.5.1 Chapter 1 introduction consists of background , general
purpose, specific purpose , scientific method of nursing care ,
systematic of writitng , and benefits

1.5.2 Chapter 2 about theoritical background of the heart failure that

includes anatomy and physiology , definition , etiology ,
clinical manifestion ,pathofisiology , phatway , diagnostic
examination , treatment , prognosis , complications , nursing
care plan , nursing diagnosis , intervention , and evaluation .

1.5.3 Chapter 3 nursing care report connsists of assesment , data

analysis, nursing diagnosis , intervention , implemention , and
evaluation of nursing .

1.5.4 Chapter 4 closing that contains of Conclusion and

Recommendation.