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

5/30/2013

askep stroke@wanti.doc

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Preface Stroke is the #1 cause of serious. The incidence of stroke is higher for males than for females. About 1/3 have mild impairments. This means that every year more than 750. another 1/3 are moderately impaired and the remaining 1/3 are severely impaired.000 women and 105. Stroke is the third leading cause of death after heart disease and cancer.000 men under 45 years of age For people over 55. 4 million Americans are living with the effects of stroke.doc 3 5/30/2013 . Women account for 43% of the strokes that occur each year but they account for 62% of stroke deaths. Every 45 seconds someone in the U. four out of every five American families will be touched by stroke. askep stroke@wanti. will experience a stroke.000 Americans have a new or recurrent stroke. especially in the under 65 age group. long-term adult disability in the United States. Over the course of a lifetime. stroke affects 120. Nearly 30% of those who suffer a stroke are under the age of 65.000 people each year.7 Each year.S. It kills nearly 160. the incidence of stroke more than doubles in each successive decade.

they are also twice as likely to die from a stroke.Among women over age 45. Women over age 30 who smoke and take high-estrogen oral contraceptives have a stroke risk 22 times higher than average. Hypertension is a major contributing factor for up to 70% of strokes. a recent survey showed that 97% could not identify a single stroke symptom. Not only are AfricanAmericans twice as likely as Caucasians to have a stroke.doc 4 and 3/4 of older individuals with stroke have persisting impairments and disabilities. are at increased risk for stroke. Among adults age 50 and over.S. especially those who have high blood pressure. People with diabetes. . Women with diabetes are at greater risk than men. Stroke incidence among African Americans is almost double that of white Americans. but they also suffer more extensive physical impairments that last longer than those of other racial groups in the U. Approximately one third of younger individuals with stroke 5/30/2013 askep stroke@wanti. Only 1% could name stroke as a leading cause of death. African-Americans not only have a higher incidence of strokes than Caucasians and Hispanics. stroke is more common than heart attack.

yang secara tiba tiba daerah otak tidak menerima darah karena arteri yang memperdarahi daerah tersebut tersumbat. 5/30/2013 askep stroke@wanti.STROKE??? A stroke is sometimes called a brain attack. putus atau pecah. 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.doc 5 . 1997) Stroke digunakan untuk menamakan sindrome hemiparese atau hemiparalisis akibat lesi vascular.

Chinese. or myocardial infarction 5/30/2013 askep stroke@wanti. and prior transient ischemic attack. some Hispanic Americans. stroke. and Japanese populations).doc 6 .RISK FACTORS Nonmodifiable risk factors for stroke include advancing: age. ethnicity or race (increased stroke risk noted for Blacks. heredity or family history.

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.doc 7 . 5/30/2013 askep stroke@wanti.

5 mil bungkus saraf . Jeffrey Saver (direktur Stroke Center UCLA):  Setiap keterlambatan satu menit: 1.doc 8 5/30/2013 .Time is brain Jaringan Otak akan mulai mati bila tidak mendapat aliran darah selama 4 menit.hilang 7.hilang 14 juta serabut saraf . Menurut Dr.9 juta sel otak .hilang  Setiap keterlambatan 12 menit – sebesar biji polong akan hilang askep stroke@wanti.

Macam-macam stroke 5/30/2013 askep stroke@wanti.doc 9 .

5/30/2013 askep stroke@wanti.Etiologi ischemic stroke — is too little blood in the brain.doc 10 . hemorrhagic stroke — is too much blood within the skull.

doc 11 .Etiologi ―heart-stroke‖ 5/30/2013 askep stroke@wanti.

doc 12 .Patofisiologi Stroke iskemik (non hemoragik) 5/30/2013 askep stroke@wanti.

Patfis Stroke Hemoragik 5/30/2013 askep stroke@wanti.doc 13 .

5/30/2013 askep stroke@wanti. if it goes to one side or the other. . (Coherently) (i. It is sunny out today? R *Ask him or her to RAISE BOTH ARMS.doc 14 . T *Ask the person to TALK.Sign and symptom Tanda dan gejala stroke tergantung area otak yang terkena serangan RECOGNIZING A STROKE: Remember the "3" steps.e. NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out their tongue . . to SPEAK A SIMPLE SENTENCE. if the tongue is 'crooked'. S *Ask the individual to SMILE. that is also an indication of a stroke.

doc 15 .Area Otak 5/30/2013 askep stroke@wanti.

doc 16 .Rantai Pengobatan Stroke (stroke chain survival and recovery) Detectiondeteksi dini Dispatchkomunikasi Deliverypengiriman DoorTriase Dataevaluasi Decision  terapi Drug therapy  pengobatan 5/30/2013 askep stroke@wanti.

ASUHAN KEPERAWATAN .

doc 18 . perawatan stroke harus bersifat:  Spesifik  multidisiplin 5/30/2013 askep stroke@wanti.Perawatan Stroke Paradigma lama: ―wait and see‖  keterlambatan penanganan  angka keberhasilan penanganan stroke << Saat ini.

doc 19 .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 5/30/2013 askep stroke@wanti.

d kelemahan fisik/motorik 5. Gangguan perfusi jaringan otak b. iskemi otak 7. gangguan sensorik motorik 6. Gangguan mobilitas fisik b.d.DIAGNOSA KEPERAWATAN Masalah yang muncul sangat tergantung pada area yang terkena dan kondisi klien Diagnosa yang mungkin muncul: 1. kurangnya pengetahuan tentang penyakit dan perawatannya 20 .d edema cerebral 3. Cemas b. Konstipasi b. gangguan vascular cerebral: perdarahan cerebral 2. Gangguan komunikasi verbal b/d ketidakmampuan untuk berbicara 5/30/2013 askep stroke@wanti.d.doc 8.d parsial paralisis 4.d. Gangguan Persepsi sensori (spesifik/umum) b/d perubahan penerimaan sensori. Nyeri b. Self care deficit b.

doc 21 . Fase Akut: Pertahankan fungsi vital: jalan nafas. yaitu 1. pernafasan. Post fase akut Pencegahan spatik paralisis dengan antispasmodik Program fisiotherapi  latihan ROM Penangan masalah psikososial 5/30/2013 askep stroke@wanti. oksigenisasi dan sirkulasi Reperfusi dengan trombolitik atau vasodilation Pencegahan peningkatan TIK Mengurangi edema cerebral dengan diuretik 2.Implementasi PENATALAKSANAAN stroke secara umum terbagi dalam 2 fase.

Discharge Planning 1. 6. 2. 3. 9. 5/30/2013 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 askep stroke@wanti. 5. 4. 8. 7.doc 22 .

2. 5. 4. Diet sehat stroke.doc 23 5/30/2013 . 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 askep stroke@wanti.Lanjut DP 1. 3.

doc 24 .Alhamdulillah…. Terima kasih Semoga bermanfaat 5/30/2013 askep stroke@wanti.