Stroke (Encephalitis/Meningitis)

Trauma kepala
Trauma medulla spinalis
Zahid Fikri, M.Kep
email: zahfik@gmail.com
Phone number: +6283831420702
STROKE
 Stroke
• …is defined as sudden onset of neurological
dysfunction resulting from abnormality in
cerebral circulation (ischemic or hemorrhagic
lesions in the brain).
• A stroke is when blood flow to a part of your
brain is stopped either by a blockage or the
rupture of a blood vessel (Ellis, 2016)
 Epidemiology
• CVA is the third leading cause of death in the
U.S.
• And the most common cause of adult
disability
• October 2012 - April 2013, Ischemic stroke
accounted for the majority of cases (67.1%)
and hemorrhagic was 32.9%  Indonesia
• incidence increases dramatically with age
• only 20% of CVAs occur in individuals under
the age 65
• incidence has declined steadily over the past
30 years (USA), past 18 years (Indonesia)
 Causes
• A stroke occurs when the blood supply to your
brain is interrupted or reduced oxygen and
nutrients ↓  brain cells to die.
• A stroke may be caused by a blocked artery
(ischemic stroke) or the leaking or bursting of
a blood vessel (hemorrhagic stroke). Some
people may experience only a temporary
disruption of blood flow to their brain
(transient ischemic attack, or TIA).
 CVA Categories
• Etiologic
– thrombosis, embolus, hemorrhage
• Management
– transient ischemic attack (TIA), minor stroke,
major stroke, etc
• Anatomic
– specific vascular area
 Thrombus vs. Embolus
• Thrombus originates in the body part that is
damaged (i.e. cerebral artery)
• Embolus had to travel to get to the body part
that is damaged
 Etiologic Categories: Ischemic
• Lack of blood flow & oxygen to the brain
• Can be caused by
– (1) Cerebral thrombosis: blood clot (thrombus)
within the cerebral arteries or their branches
• lead to ischemia with resulting infarction (tissue death)
– (2) Cerebral embolus: bits of matter (thrombi, fat,
air) that travel through the bloodstream to the
cerebral arteries where they produce an occlusion
and infarction
• associated with CV disease
 Etiologic Categories:
Hemorrhagic
• Hemorrhage: abnormal bleeding due to a
ruptured vessel. Tissue death results from
both ischemic and mechanical injury.
– intracerebral hemorrhage, subarachnoid
hemorrhage
 Risk Factors for Stroke
• Hypertension
• Heart disease
• Diabetes
Signs & Symptoms
 Beyond F.A.S.T. – Other
Symptoms You Should Know
 Transient Ischemic Attack (TIA)
• often labeled “mini-stroke”
• more accurately characterized as a “warning
stroke”
• Should be taken very seriously
 Stroke Syndromes
• Anterior Cerebral Artery Syndrome
– contralateral weakness and sensory loss, primarily
in LE’s
– aphasia
– Incontinence
– May have significant memory deficits, loss of
behavioral inhibition
– May see neglect, aphasia, apraxia & agraphia
• Middle Cerebral Artery Occlusion
– most common
– contralateral sensory loss and weakness in face and
UE, less in LE
– Spastic hemiparesis
– homonymous hemianopsia
– Perceptual deficits: unilateral neglect, apraxia, and
spatial disorganization
– Wernicke’s aphasia in dominant hemisphere
– Flat affect in right hemisphere
– Impaired body schema
• The term Body Scheme refers to a postural
model of the body, including the relationship
of body parts to each other and the
relationship of the body to the environment
• Unilateral neglect, somatoagnosia, finger
agnosia, anosognosia
 Find the meaning of..
• Unilateral neglect..?
• Somatoagnosia..?
• Finger agnosia..?
• Anosognosia..?
• Vertebral-Basilar Artery occlusion
– Loss of consciousness
– Hemiplegia or tetraplegia
– Headache, dizziness, ataxia
– cranial nerve involvement
– locked in syndrome
• inability to speak
• alert
• vertical eye movement intact
• Posterior Cerebral Artery occlusion
– contralateral sensory loss
– thalamic pain syndrome
– memory deficit
– homonymous hemianopsia
– visual agnosia
– cortical blindness
• Lacunar Infarct
– deep region of the
brain
– common in diabetes
and hypertension
– results in a cystic cavity
after the infarct
– sensory loss
– ataxia
– dysarthria
 Diagnostic test
• Physical examination
– Your doctor will ask you or a family member what
symptoms, personal and family history of heart
disease, transient ischemic attack or stroke, and
check blood pressure
• Blood tests
– how fast your blood clots, blood sugar is
abnormally high or low, whether critical blood
chemicals are out of balance, or have an infection.
• Computerized tomography (CT) scan.
– create a detailed image of your brain show a
hemorrhage, tumor, stroke and other conditions. Doctors
may inject a dye into your bloodstream to view your blood
vessels in your neck and brain in greater detail
(computerized tomography angiography).
• Magnetic resonance imaging (MRI).
– create a detailed view of your brain  can detect brain
tissue damaged by an ischemic stroke and brain
hemorrhages. Your doctor may inject a dye into a blood
vessel to view the arteries and veins and highlight blood
flow (magnetic resonance angiography, or magnetic
resonance venography).
• Carotid ultrasound.
– In this test, sound waves create detailed images of the
inside of the carotid arteries in your neck  shows buildup
of fatty deposits (plaques) and blood flow in your carotid
arteries.
• Cerebral angiogram.
– In this test, your doctor inserts a thin, flexible tube
(catheter) through a small incision, usually in your groin,
and guides it through your major arteries and into your
carotid or vertebral artery. Then your doctor injects a dye
into your blood vessels to make them visible under X-ray
imaging. This procedure gives a detailed view of arteries in
your brain and neck.
• Echocardiogram.
– An echocardiogram uses sound waves to create
detailed images of your heart. An echocardiogram
can find a source of clots in your heart that may
have traveled from your heart to your brain and
caused your stroke.
 Stroke Prevention
• Anticoagulants/Antiplatelets
– Antiplatelet agents such as aspirin and
anticoagulants, such as warfarin, interfere with
the blood's ability to clot and can play an
important role in preventing stroke.
• Antihypertensives
• Additionally, when arteries show plaque
buildup or blockage, medical procedures may
be needed. Such as:
– Carotid Endarterectomy
• Carotid endarterectomy, also called carotid artery
surgery, is a procedure in which blood vessel blockage
(fatty plaque) is surgically removed from the carotid
artery.
• Angioplasty/Stents
– Doctors sometimes use balloon angioplasty and
implantable steel screens called stents to treat
cardiovascular disease and help open up the
blocked blood vessel.
 Ischemic Stroke Treatment
• tPA (tissue plasminogen activator), the Gold
Standard
– tPA, also known as IV rtPA, given through an IV in
the arm  dissolving the clot and improving
blood flow to the part of the brain being deprived
of blood flow.  within 3 hours (and up to 4.5
hours in certain eligible patients),  improve the
chances of recovering from a stroke.
 • A significant number of stroke victims don’t get to the hospital
in time for tPA treatment; this is why it’s so important to
identify a stroke immediately.
• Endovascular Procedures
– called mechanical thrombectomy, strongly
recommended, in which trained doctors try removing
a large blood clot by sending a wired-caged device
called a stent retriever, to the site of the blocked
blood vessel in the brain. The procedure should be
done within six hours of acute stroke symptoms,
and only after a patient receives tPA.
 Hemorrhagic Stroke Treatment
• Endovascular Procedures
– Endovascular procedures may be used to treat
certain hemorrhagic strokes similar to the way the
procedure is used for treating an ischemic stroke.
• Surgical Treatment
– surgical treatment may be done to stop the
bleeding. If the bleed is caused by a ruptured
aneurysm (swelling of the vessel that breaks), a
metal clip may be placed surgically at the base of
the aneurysm to secure it.
Meningitis
 Definition
• Meningitis
– Inflammation of the meninges; abnormal WBC in
CSF
• Encephalitis
– Inflammation of the brain
• Meningoencephalitis
– Inflammation of the brain accompanied by
meningitis
 Etiology
• Viral infections are the most common cause of
meningitis, followed by bacterial infections
and, rarely, fungal infections.
– Viruses such as herpes simplex virus, HIV, mumps,
West Nile virus and others also can cause viral
meningitis
• Bacterial meningitis
– Streptococcus pneumoniae (pneumococcus). This
bacterium is the most common cause of bacterial
meningitis in infants, young children and adults in
the United States. It more commonly causes
pneumonia or ear or sinus infections. A vaccine
can help prevent this infection.
– Neisseria meningitidis (meningococcus) 
commonly cause an upper respiratory infection
but can cause meningococcal meningitis when
they enter the bloodstream, highly contagious
infection  teenagers and young adults, local
epidemics in college dormitories, boarding schools
and military bases. A vaccine can help prevent
infection.
– Haemophilus influenzae (haemophilus) was
once the leading cause of bacterial meningitis in
children. But new Hib vaccines have greatly
reduced the number of cases of this type of
meningitis.
– Listeria monocytogenes (listeria). These bacteria
can be found in unpasteurized cheeses, hot dogs
and luncheo
 Fungal meningitis
• Fungal meningitis isn't contagious from person
to person.
• Cryptococcal meningitis is a common fungal
form of the disease that affects people with
immune deficiencies, such as AIDS.
• It's life-threatening if not treated with an
antifungal medication.
 Other meningitis causes
• Meningitis can also result from noninfectious
causes, such as chemical reactions, drug
allergies, some types of cancer and
inflammatory diseases such as sarcoidosis.
 Risk factors
• Skipping vaccinations.
– Risk rises for anyone who hasn't completed the
recommended childhood or adult vaccination
schedule.
• Age.
– Most cases of viral meningitis occur in children
younger than age 5. Bacterial meningitis is
common in those under age 20.
• Living in a community setting.
– College students living in dormitories, personnel
on military bases, and children in boarding schools
and child care facilities are at greater risk of
meningococcal meningitis. This is probably
because the bacterium is spread by the
respiratory route, and spreads quickly through
large groups.
• Pregnancy.
– Pregnancy increases the risk of listeriosis — an infection
caused by listeria bacteria, which also may cause
meningitis. Listeriosis increases the risk of miscarriage,
stillbirth and premature delivery.
• Compromised immune system.
– AIDS, alcoholism, diabetes, use of immunosuppressant
drugs and other factors that affect your immune system
also make you more susceptible to meningitis. Having your
spleen removed also increases your risk, and patients
without a spleen should get vaccinated to minimize that
risk.
 Symptoms
• Sudden high fever, Stiff neck
• Severe headache that seems different than
normal, Headache with nausea or vomiting
• Confusion or difficulty concentrating
• Seizures, Sleepiness or difficulty waking
• Sensitivity to light, No appetite or thirst
• Skin rash (sometimes, such as in
meningococcal meningitis)
 Signs in newborns
• High fever, Constant crying
• Excessive sleepiness or irritability
• Inactivity or sluggishness, Poor feeding
• A bulge in the soft spot on top of a baby's
head (fontanel)
• Stiffness in a baby's body and neck
 When to see a doctor
• Fever, Severe, unrelenting headache
• Confusion, Vomiting, Stiff neck
• Bacterial meningitis is serious, and can be fatal
within days without prompt antibiotic
treatment.
• Delayed treatment increases the risk of
permanent brain damage or death.
 Diagnosis
• Your family doctor or pediatrician can
diagnose meningitis based on a medical
history, a physical exam and certain diagnostic
tests. During the exam, your doctor may check
for signs of infection around the head, ears,
throat and the skin along the spine.
• You or your child may undergo the following
diagnostic tests:
• Blood cultures.
– A sample may also be placed on a slide and stained
(Gram's stain), then studied under a microscope for
bacteria.
• Imaging.
– scans of the head may show swelling or inflammation.
X-rays or CT scans of the chest or sinuses may also
show infection in other areas that may be associated
with meningitis.
• Spinal tap (lumbar puncture).
– In people with meningitis, the CSF often shows a
low sugar (glucose) level along with an increased
white blood cell count and increased protein.
• If your doctor suspects viral meningitis, he or
she may order a DNA-based test known as a
polymerase chain reaction (PCR) amplification
or a test to check for antibodies against
certain viruses to determine the specific cause
and determine proper treatment.
 Treatment
• The treatment depends on the type of
meningitis you or your child has.
• Bacterial meningitis
– Acute bacterial meningitis must be treated
immediately with intravenous antibiotics and,
more recently, corticosteroids. This helps to
ensure recovery and reduce the risk of
complications, such as brain swelling and seizures.
• Viral meningitis
– Antibiotics can't cure viral meningitis, and most cases
improve on their own in several weeks. Treatment of
mild cases of viral meningitis usually includes:
• Bed rest
• Plenty of fluids
• Over-the-counter pain medications to help reduce fever and
relieve body aches
– Your doctor may prescribe corticosteroids to reduce
swelling in the brain, and an anticonvulsant
medication to control seizures. If a herpes virus
caused your meningitis, an antiviral medication is
available.
• Other types of meningitis
– If the cause of your meningitis is unclear, your
doctor may start antiviral and antibiotic treatment
while the cause is determined
 Tugas
• Membuat Askep
– Stroke:
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC NIC
(2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC NIC
(2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC NIC
(2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC NIC
(2 mhs)
• Tugas dikumpulkan paling akhir 24 Februari 2017
 Tugas
• Membuat Askep
– Meningitis/ encephalitis:
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• Tugas dikumpulkan paling akhir 24 Feb 2017
• Membuat Askep
– Trauma Kepala:
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• Tugas dikumpulkan paling akhir 24 Feb 2017
• Membuat Askep
– Trauma medulla spinal:
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• 1 masalah keperawatan, 1 diagnosa keperawatan, NOC
NIC (2 mhs)
• Tugas dikumpulkan paling akhir 24 Feb 2017
 Tugas
• Mencari literature Trauma Kepala
– Definisi (2 mhs)
– Etiologi (2 mhs)
– Epidemiologi (2 mhs)
– Klasifikasi (2 mhs)
– Manifestasi klinis (2 mhs)
– Pemeriksaan diagnostik (2 mhs)
– Pathway (3 mhs)
– Treatment/ penatalaksanaan (2 mhs)
• Tugas dikumpulkan paling akhir 24 Feb 2017
 Tugas
• Mencari literature Trauma medulla spinal
– Definisi (2 mhs)
– Etiologi (2 mhs)
– Epidemiologi (2 mhs)
– Klasifikasi (2 mhs)
– Manifestasi klinis (2 mhs)
– Pemeriksaan diagnostik (2 mhs)
– Pathway (3 mhs)
– Treatment/ penatalaksanaan (2 mhs)
• Tugas dikumpulkan paling akhir 24 Feb 2017
 Tugas
• Mencari jurnal penelitian penatalaksanaan
keperawatan terbaru
– Stroke/ CVA (4 mhs)
– Meningitis/ encephalitis (4 mhs)
– Trauma kepala (4 mhs)
– Trauma medulla spinal (4 mhs)
• Dikumpulkan paling akhir tgl 3 Maret 2017
SEMANGAT BELAJAR