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Asuhan Keperawatan Pada Klien dengan Stroke

Oleh: Wantiyah

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. askep stroke@wanti.doc 3

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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 AfricanAmericans 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 5/30/2013 askep stroke@wanti.doc 4 and 3/4 of older individuals with stroke have persisting impairments and disabilities.

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 carotid artery disease) atrial fibrillation coronary artery disease heart failure sickle cell disease dyslipidemia a diet high in cholesterol and saturated 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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Patofisiologi
Stroke iskemik (non hemoragik)

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Patfis Stroke Hemoragik

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Sign and symptom


Tanda 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


(stroke

chain survival and recovery)

Detectiondeteksi dini Dispatchkomunikasi Deliverypengiriman DoorTriase Dataevaluasi Decision terapi Drug therapy pengobatan
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ASUHAN KEPERAWATAN

Perawatan Stroke
Paradigma lama: wait and see keterlambatan penanganan angka keberhasilan penanganan stroke << Saat ini, perawatan stroke harus bersifat:
Spesifik multidisiplin

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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 KEPERAWATAN
Masalah yang muncul sangat tergantung pada area yang terkena dan kondisi klien Diagnosa 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 paralisis 4. Gangguan mobilitas fisik b.d kelemahan fisik/motorik 5. Konstipasi b.d. gangguan sensorik motorik 6. Gangguan Persepsi sensori (spesifik/umum) b/d perubahan penerimaan sensori, iskemi otak 7. Gangguan komunikasi verbal b/d ketidakmampuan untuk berbicara 5/30/2013 askep stroke@wanti.doc 8. Cemas b.d. kurangnya pengetahuan tentang penyakit dan perawatannya

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Implementasi
PENATALAKSANAAN stroke secara umum terbagi dalam 2 fase, yaitu 1. Fase Akut: Pertahankan fungsi vital: jalan nafas, pernafasan, oksigenisasi dan sirkulasi Reperfusi dengan trombolitik atau vasodilation Pencegahan peningkatan TIK Mengurangi edema cerebral dengan diuretik 2. Post fase akut Pencegahan spatik paralisis dengan antispasmodik Program fisiotherapi latihan ROM Penangan masalah psikososial
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Discharge Planning
1. 2. 3. 4. 5. 6. 7. 8. 9.
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Stroke Prevention: Kontrol TD (hipertensi) Turunkan kolesterol: kurangi intake lemak (Saturated fat) Hindari merokok Kontrol DM Jaga keseimbangan BB OR teratur Kelola stress Hindari alkohol Hindari minum sembarang obat
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Lanjut DP
1. 2. 3. 4. 5. Diet sehat stroke, meliputi konsumsi: buah dan sayuran yang mengandung kalium, folat dan antioksidan Serat Calsium Produk kacang-kacangan (kedelai) Makanan yang mengandung omega 3 Latihan ROM pasif/aktifK Mekanisme Koping
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Alhamdulillah.
Terima kasih Semoga bermanfaat

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