Professional Documents
Culture Documents
Courses: Organisasi:
Stroke Care (Perth, 1995) Ketua PP HIPENI
Multiple Schlerosis (Singp, Perth) Pengurus Kolegium KMB
Clinical Training ( Japan, 2015) Pengurus Kongres Perawat bedah Sarah asia
Epilepsy Manag (Thailand, 2019)
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Asuhan Keperawatan Pasien Stroke
Pre & Intra Hospital
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GLOBAL BURDEN OF STROKE
3rd leading cause of death in the USA and 2nd leading cause of
death worldwide.
More than 795.000 new cases and 200.000 recurrent cases of
stroke occur each year in the USA (AHA 2016)
Stroke kills about 140,000 Americans each year—that's 1 out of
every 20 deaths. Someone in the United States has a stroke every
40 seconds. Every 4 minutes, someone dies of stroke.
Major cause of long-term disability.
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Latar Belakang
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STROKE is
A BRAIN ATTACK!!!
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Sebaran RS yang telah menyediakan fasilitas Terapi Trombolisis
(Angels Indonesia, 2021)
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MASA
PANDEMI
??
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Data Pasien di Ruang Isolasi
RS Pusat Otak Nasional per 12 Mei 2020
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Faktor risiko stroke
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KLASIFIKASI
Iskemik (Infak) Perdarahan
Patologi: perdarahan,
penyumbatan/ iskemik
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MANIFESTASI KLINIS STROKE:
tergantung lokasi dan luas lesi
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STROKE IS A BRAIN ATTACK
Kedaruratan medik
Intervensi dini dpt mengurangi “sequel”
Penanganan yg komprehensif dan terkoordinir dari tim stroke.
Starting with pre-hospital and emergency department care
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Stroke Care Management
❖ Hyperacute phase
❖ Acute Phase
❖ Subacute phase (recovery)
❖ Chronic phase/ adaptation/rehabilitation
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In hyper acute stroke care….
Time is of the utmost importance
“therapeutic window”
Perlu keterlibatan pasien, klg & tim kes
Stroke management protocols: well known,
rehearsed
(trained),easy to follow, should be in place.
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A stroke “Chain of survival”
Detection
Dispatch
Delivery
Door
Data
Decision
Drug
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Detection:
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25 Kampanye informasi publik
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STROKE is
A BRAIN ATTACK!!!
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Dispatch & Delivery
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Covid 19 screening
Obtain time of onset
Time the pt was last seen to be a
normal.
The presence of seizure/ trauma
The pt’s health history
the pt’s medication therapy
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En route…EMS personal should
Elevate HOB 15-30 degree
Check Oxygen saturation
ABCDE
Provide Oxygen 2 L/ mnt
FAST IV line…. Isotonic fluids
Neurological deficit Check blood sugar level
Special intervention Correction if hyperg/
hypoglicemic
NPO/ NBM
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DOOR – Emergency Room
Covid 19 screening
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ACUTE STROKE FAST TRACK
Onset > 24 jam Onset <4,5 jam Onset 4,5 – 24 jam Suspect Sirkulasi Posterior/ Arteri Vertebrobasiler
CT Scan Otak non kontras - CT Scan Otak non kontras + CTA Stenosis arteri basiler Oklusi arteri
- CTP atau MRI & MRA basiler
Perdarahan Iskemik
CTA + CTP
Lihat PPK Stroke Lihat PPK Stroke
Ada stenosis arteri berat
Tidak ada stenosis arteri/
oklusi arteri besar
Hubungi dr Neurointervensi & dr Pertimbangkan tindakan endovasculer/
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Lihat PPK StrokeMulyatsih_2021 Anestesi Mechanical Thrombectomy
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Emergency Dept Evaluation
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Stroke / Brain Attack Team
Nursing
Neurology Glucose & electrolytes
Complete blood cell • CT Scan
Neurosurgery
count • MRI
Radiology
PT/ aPTT • MRA
Pharmacy
Cardiac enzyme • CTA
Clinical laboratory ABG • DSA
Hemostasis
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Phycical examination
Be strategic & directed Level of
toward: consciousness
ABC’s Visual function
Vital signs: especially BP Motor function
Tanda SAH: kaku kuduk, Sensation &
nyeri kepala neglect
Neurologic examination Cerebellar function
language
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Decision
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DRUG……General Management
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Hyperakut phase…..Thrombolitic
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Blood pressure management
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Neurological Intervention
• DSA
• Mechanical Thrombectomy
• Coiling
• Ballooning
• Stanting
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Acute Phase.. Stroke Unit
Seizure Prophylaxis
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Hoist
• Promoting partnerships
between the cared-for
person, the family and
staff has been
recognised as a
strategy for improving
nursing quality (Brown
et al. 2011).
Metode????
• Pertimbangkan:
❖ I hear and I forget
❖ I see and I remember
❖ I do and I understand
Gymnasium
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Terima Kasih
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