Studi Kasus: Status Pernafasan Pada Pasien Myasthenia Gravis di Ruang Azalea RSUP Dr. Hasan Sadikin Bandung

Abstract

Myasthenia gravis (MG) merupakan penyakit autoimun kronis yang dimediasi oleh antibodi terhadap acetylcholin receptor (AChR)  pada membran postsynaptic dari tautan otot saraf. Hilangnya situs AchR mengakibatkan kelemahan pada otot rangka yang berhubungan dengan pernafasan serta pergerakan ekstrimitas. Sebanyak 15 % – 20 % pasien dengan MG setidaknya mengalami satu kali myasthenic crisis. Myasthenic crisis  merupakan keadaan darurat medis yang terjadi akibat kelemahan otot-otot pernafasan sehingga pasien mengalami penurunan status pernafasan. Tujuan : untuk mengetahui gambaran karakteristik dan menganalisis status pernafasan pasien MG. Metode : penelitian dekriptif dengan pendekatan observasi studi kasus. Teknik pengambilan sampel menggunakan  consecutive sampling. Pengumpulan data dan pengkajian menggunakan form pengkajian asuhan keperawatan RSHS dan lembar observasi status pernafasan nursing intervention clasification. Hasil  :  karakteristik  pasien dalam studi ini adalah pasien MG dengan riwayat gagal nafas,  jenis kelamin perempuan, dengan klasifikasi klinis MG IIb dan IIIb. Hasil Kedua pasien mengalami keluhan kesulitan bernafass namun saat diobservasi pasien kedua mengalami dua kali gagal nafas karena melakukan aktivitas seperti berbicara lama, mengedan, dan tertawa berlebih yang mengakibatkan kelemahan pada otot-otot pernafasan sehingga terjadi peningkatan frekuensi pernafasan dan penurunan saturasi oksigen. Simpulan  :  edukasi yang tepat mengenai aktivitas serta observasi status pernafasan secara berkala dibutuhkan pasien MG agar dapat mengontrol dan mencegah terjadinya gagal nafas yang dapat menyebabkan kematian.  Case Study: Respiratory Status of Patients Myasthenia Gravis at Azalea Room Hasan Sadikin Bandung Hospital. Myasthenia gravis (MG) is a chronic autoimmune disease that is mediated by antibodies to the acetylcholine receptor (AChR) in the post-synapses membrane of the neural muscle tissues. Loss of the AchR site results in weakness in skeletal muscle associated with breathing and limb movements. A total of 15%-20% of patients with MG have suffered a one-time crisis. The Myasthenic crisis is a medical emergency that occurs due to the weakness of the respiratory muscles so that the patient experiences decrease in respiratory status. Objective: to determine the characteristics and analyze the respiratory status of MG patients. Method: Descriptive research with an observation approach to case studies. The sampling technique uses consecutive sampling. Data collection and assessment used the RSHS nursing care assessment form and an observation sheet about the classification status of nursing interventions. Results : The characteristics of the patients in this study were MG patients with a history of respiratory failure, female sex, with clinical classification of MG IIb and IIIb. Both patients had a history of respiratory failure but when observed the second patient experienced two symptoms of respiratory failure due to activities such as prolonged talking, straining, and excessive laughter which resulted in weakness in the respiratory muscles which resulted in an increase in respiratory frequency and decreased oxygen saturation.  Conclusion: proper education about the activity and observation of respiratory status regularly is needed by MG patients to be able to control and prevent respiratory failure which can cause death.