Asuhan Keperawatan Pada Klien dengan Stroke

Oleh:

Wantiyah

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Kompetensi dasar:

Mahasiswa mampu:

1. Menjelaskan konsep dasar stroke

2. Menjelaskan proses keperawatan pada klien stroke

3. Menerapkan asuhan keperawatan pada klien yang mengalami stroke

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Preface Stroke is the #1 cause of serious, long-term adult disability in the United States.Stroke is the third leading cause of death after heart disease and cancer. It kills nearly 160,000 people each year. Every 45 seconds someone in the U.S. will experience a stroke. This means that every year more than 750,000 Americans have a new or recurrent stroke.Over the course of a lifetime, four out of every five American families will be touched by stroke.4 million Americans are living with the effects of stroke. About 1/3 have mild impairments, another 1/3 are moderately impaired and the remaining 1/3 are severely impaired.Nearly 30% of those who suffer a stroke are under the age of 65.7  Each year, stroke affects 120,000 women and 105,000 men under 45 years of age For people over 55, the incidence of stroke more than doubles in each successive decade.The incidence of stroke is higher for males than for females, especially in the under 65 age group. Women account for 43% of the strokes that occur each year but  they account for 62% of stroke deaths.

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Among women over age 45, stroke is more common than heart attack.Women over age 30 who smoke and take high-estrogen oral contraceptives have a stroke risk 22 times higher than average.Stroke incidence among African Americans is almost double that of white Americans.African-Americans not only have a higher incidence of strokes than Caucasians and Hispanics, but they also suffer more extensive physical impairments that last longer than those of other racial groups in the U.S. Not only are African-Americans twice as likely as Caucasians to have a stroke, they are also twice as likely to die from a stroke.People with diabetes, especially those who have high blood pressure, are at increased risk for stroke. Women with diabetes are at greater risk than men.Hypertension is a major contributing factor for up to 70% of strokes. Among adults age 50 and over, a recent survey showed that 97% could not identify a single stroke symptom. Only 1% could name stroke as a leading cause of death.Approximately one third of younger individuals with stroke and 3/4 of older individuals with stroke have persisting impairments and disabilities.

It has been estimated that 33% of stroke survivors need help caring for themselves. 20% need help walking. 70% cannot return to their previous jobs.5 51% are unable to return to any type of work after stroke.6Approximately 1/3 of all stroke survivors will have another stroke within five years.7 About 14% will have another within one year.8

Stroke costs the U.S. $30 billion dollars annually in medical expenses and lost productivity.9

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STROKE???A stroke is sometimes called a brain attack, cerebrovascular accident (CVA)Stroke secara umum merupakan defisit neurologis yang mempunyai serangan mendadak dan berlangsung 24 jam sebagai akibat dari terganggunya pembuluh darah otak (hudak dan Gallo, 1997)Stroke digunakan untuk menamakan sindrome hemiparese atau hemiparalisis akibat lesi vascular, yang secara tiba tiba daerah otak tidak menerima darah karena arteri yang memperdarahi daerah tersebut tersumbat, putus atau pecah.

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RISK FACTORS

Nonmodifiable risk factors for stroke include advancing: age, heredity or

family history, ethnicity or race (increased stroke risk noted for Blacks, some Hispanic Americans, Chinese, and Japanese populations), and prior transient ischemic attack, stroke, or myocardial infarction

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Modifying these risk factors:• hypertension• cigarette smoking• diabetes mellitus• atherosclerosis (particularly carotidartery disease)• atrial fibrillation• coronary artery disease• heart failure• sickle cell disease• dyslipidemia• a diet high in cholesterol andsaturated and trans fats• physical inactivity• obesity.

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Time is brain

Jaringan Otak akan mulai mati bila tidak mendapat aliran darah selama 4 menit.

Menurut Dr. Jeffrey Saver (direktur Stroke Center UCLA): Setiap keterlambatan satu menit:

1.9 juta sel otak - hilang

14 juta serabut saraf - hilang

7.5 mil bungkus saraf - hilang Setiap keterlambatan 12 menit – sebesar biji

polong akan hilang

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Macam-macam stroke

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Etiologi

ischemic stroke — is too little blood in the brain.hemorrhagic stroke — is too much blood within the skull.

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Etiologi“heart-stroke”

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PatofisiologiStroke iskemik

(non hemoragik)

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Patfis Stroke Hemoragik

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Sign and symptomTanda dan gejala stroke tergantung area otak yang terkena serangan RECOGNIZING A STROKE: Remember the "3" steps.

S *Ask the individual to SMILE. T *Ask the person to TALK, to SPEAK A SIMPLE SENTENCE. (Coherently) (i.e. . . It is sunny out today?R *Ask him or her to RAISE BOTH ARMS.

NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue . if the tongue is 'crooked', if it goes to one side or the other, that is also an indication of a stroke.

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Area Otak

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Rantai Pengobatan Stroke

Detectiondeteksi dini

Dispatchkomunikasi

Deliverypengiriman

DoorTriase

Dataevaluasi

Decision terapi

Drug therapy pengobatan

(stroke chain survival and recovery)

ASUHAN KEPERAWATAN

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Perawatan Stroke

Paradigma lama: “wait and see” keterlambatan penanganan angka keberhasilan penanganan stroke <<

Saat ini, perawatan stroke harus bersifat:Spesifikmultidisiplin

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PENGKAJIAN KEPERAWATAN UTAMA

Mengkaji dan monitor tanda vital

Mengkaji dan Monitor tingkat kesadaran

Mengkaji fungsi eliminasi

Mengkaji adanya gerakan involunter

Mengkaji kemampuan ADLs

Mengkaji kemampuan gerakan-otot

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DIAGNOSA KEPERAWATANMasalah yang muncul sangat tergantung pada area yang terkena dan kondisi klienDiagnosa yang mungkin muncul:

1. Nyeri b.d. gangguan vascular cerebral: perdarahan cerebral

2. Gangguan perfusi jaringan otak b.d edema cerebral

3. Self care deficit b.d parsial paralisis4. Gangguan mobilitas fisik b.d kelemahan

fisik/motorik5. Konstipasi b.d. gangguan sensorik motorik6. Gangguan Persepsi sensori (spesifik/umum) b/d

perubahan penerimaan sensori, iskemi otak7. Gangguan komunikasi verbal b/d

ketidakmampuan untuk berbicara8. Cemas b.d. kurangnya pengetahuan tentang

penyakit dan perawatannya

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ImplementasiPENATALAKSANAAN stroke secara umum terbagi

dalam 2 fase, yaitu1. Fase Akut:

Pertahankan fungsi vital: jalan nafas, pernafasan, oksigenisasi dan sirkulasiReperfusi dengan trombolitik atau vasodilationPencegahan peningkatan TIKMengurangi edema cerebral dengan diuretik

2. Post fase akutPencegahan spatik paralisis dengan antispasmodikProgram fisiotherapi latihan ROMPenangan masalah psikososial

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Discharge PlanningStroke Prevention:

1. Kontrol TD (hipertensi)2. Turunkan kolesterol: kurangi intake lemak

(Saturated fat)3. Hindari merokok4. Kontrol DM5. Jaga keseimbangan BB6. OR teratur7. Kelola stress8. Hindari alkohol9. Hindari minum sembarang obat

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Lanjut DP

Diet sehat stroke, meliputi konsumsi:

1. buah dan sayuran yang mengandung kalium, folat dan antioksidan

2. Serat

3. Calsium

4. Produk kacang-kacangan (kedelai)

5. Makanan yang mengandung omega 3

Latihan ROM pasif/aktifK

Mekanisme Koping

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Alhamdulillah….

Terima kasih

Semoga bermanfaat