Studi Kasus: Penerapan General Initial Management Terhadap Kriteria Hasil Masalah Nyeri Akut Pada Pasien Acute Coronary Syndrome di Instalasi Gawat Darurat RSUD Cibabat Kota Cimahi

Sari

ABSTRACT

The incidence of ACS in the emergency room of Cibabat Hospital, Cimahi City in 2023 was quite high, reaching 1,056 people. The appropriat handling carried out by nurses in the emergency room is to apply general initial management (MONA) as a measure to help reduce pain and risk of death within the first 2 hours of an attack. The purpose of this study was to determine the description of the application of general initial management in nursing care for ACS patients in the Emergency Room of Cibabat Hospital, Cimahi City. This study used descriptive case report or case study methodology. The research subjects were patients with a diagnosis of ACS STEMI, patients with acute pain nursing problems, patients fully conscious with a compos mentis level of consciousness. The results of the assessment of left chest pain, pain did not decrease, pain like stabbing, pain radiating to the back and left arm, pain scale 6, pain lasted ≥20 minutes, echg picture of sinus bradycardia and ST segment elevation in leads II, III, and aVF, troponin I 40000 ng/L. General initial management was applied, positioning, nasal cannula oxygen 4L/min, aspirin (arixtra 2.5 cc 1x1 sc), and nitrates were not given because the patient did not meet the requirements, namely systolic ≤90 mmHg and pulse ≤60x/min, after being evaluated 1 hours the pain scale was reduced to 3. The author concludes that the application of general initial management (MONA) can reduce pain in ACS in the first 1 hours. Based on this study, it is recommended for nurses to improve the accuracy of the implementation of general initial management to reduce acute pain in ACS patients..

Keywords: General Initial Management, Acute Pain, Acute Coronary Syndrome, Nursing Care

ABSTRAK

Angka kejadian ACS di IGD RSUD Cibabat Kota Cimahi pada tahun 2023 cukup tinggi yaitu mencapai 1.056 orang. Penanganan yang tepat dilakukan perawat di IGD dengan melakukan penerapan general initial management (MONA) sebagai tindakan untuk membantu mengurangi rasa sakit dan risiko kematian dalam 2 jam pertama serangan. Tujuan penelitian ini guna memahami gambaran penerapan general initial management dalam asuhan keperawatan pada pasien ACS di IGD RSUD Cibabat Kota Cimahi. Penelitian ini menggunakan metodologi deskriptif case report atau studi kasus. Subjek penelitian adalah pasien dengan diagnosa ACS STEMI, pasien dengan masalah keperawatan nyeri akut, pasien sadar penuh dengan tingkat kesadaran compos mentis. Hasil pengkajian nyeri dada sebelah kiri, nyeri tidak berkurang, nyeri seperti tertusuk-tusuk, nyeri menjalar ke punggung dan lengan kiri, skala nyeri 6, nyeri berlangsung ≥20 menit, gambaran EKG sinus bradikardia dan ST segmen elevasi pada lead II, III, dan aVF, troponin I 40000 ng/L. Dilakukan penerapan general initial management pemberian posisi, pemberian oksigen nasal kanul 4L/menit, aspirin (arixtra 2,5 cc 1x1 sc), dan nitrat tidak diberikan karena pasien tidak memenuhi syarat yaitu sistolik ≤90 mmHg dan nadi ≤60x/menit, setelah dievaluasi 1 jam skala nyeri berkurang menjadi 3. Penulis menarik kesimpulan penerapan general initial management (MONA) dapat menurunkan nyeri pada ACS di 1 jam pertama. Berdasarkan penelitian ini disarankan bagi perawat untuk meningkatkan ketepatan implementasi general initial management untuk mengurangi nyeri akut pada pasien ACS.

Kata Kunci: General Initial Management, Nyeri Akut, Acute Coronary Syndrome, Asuhan Keperawatan