NURSING CARE OF PATIENT UNDERGOING

NEUROLOGICAL INTERVENTION IN CATHLAB

R. ISNAWAN RISQI R, NERS, M.KEP

 Implementas
Pengkajian Diagnosa Intervensi Evaluasi
i
PENGKAJIAN

▪ RIWAYAT PASIEN
▪ Riwayat penyakit saat ini : fokus pada masalah utama/ primer
▪ Riwayat penyakit dahulu : comorbid, dan risk for procedures related
complication
▪ PEMERIKSAAN FISIK
▪ Pemeriksaan neurologis: baseline GCS, pupil, kekuatan otot
▪ Pemeriksaan neurologis khusus : N. Cranialis, NIHSS
▪ DIAGNOSTIC STUDIES
▪ CT/CTA/MRI
▪ EKG
▪ LAB : DPL, UR/CR, GDS, PT/APTT, penyaring infeksi
MASALAH KEPERAWATAN

▪ RISIKO PERDARAHAN
▪ RISIKO PENURUNAN PERFUSI SERBRAL
▪ CEMAS
▪ RISIKO/AKTUAL PENURUNAN CURAH JANTUNG
INTERVENSI : NURSING GOAL

▪ PATIENT SAFETY
▪ PASIEN ADAPTIF
▪ HEMODINAMIK STABIL SESUAI TARGET
TERAPEUTIK
▪ PENANGANAN KOMPLIKASI INTRA DAN PASCA
PROSEDUR
 CPP = MAP - TIK

60 – 70 90-120
mmHg mmHg
 INTERVENSI: MANAJEMEN KOMPLIKASI

Ashutosh P. Jadhav. Stroke. Care of the Post-Thrombectomy Patient, Volume: 49,

Issue: 11, Pages: 2801-2807, DOI: (10.1161/STROKEAHA.118.021640)
 Key Issues in Patients Undergoing Endovascular
Stroke Treatment (EVT)
Stroke inherent Critically Ill
Direct Secondary
condition encounter
• Hiperglikemia • Stress ulcers • Volume overload • Konversi
• Disregulasi • Pressure Ulcer • Arteriotomy site perdarahan
temperatur • Peripheral complication • Edema
• Aritmia venous • Perforasi malignan
• Instabilitas thrombosis vaskular
hemodinamik • Vasospasme
• Aspirasi • Device retention
• Gagal nafas • Reoklusi
• infeksi Vaskular

KEY MANAGEMENT DECISION :

TEKANAN DARAH, TARGET GLUKOSA, KESEIMBANGAN CAIRAN, MEDIKASI (ANTIPLATELET, ANTICOAGULAN,
ANTIEPILEPTIC)
CONTRAST ALLERGY

▪ PRETREAT : 50 mg IV diphenhydramine dan 200 mg IV

methylprednisolone
▪ Oksigen supplement
▪ IV epinephrine, dipenhydrmanin (H1 antagonist), hydrocortisone,
ranitidine (H2 antagonist)
▪ Resusitasi cairan dan epinephrine
▪ Intubasi (jika terjadi edema laring)
Access-site hematoma and pseudoaneurysm

▪ Establish hemostasis,
▪ reestablish arterial flow,
▪ vascular repair,
▪ initiate blood transfusion,
▪ thrombin injection, or
▪ direct surgical repair of symptomatic pseudoaneurysms, watchful
waiting (if stable)
VESSEL VASOSPASM

▪ Remove catheter/device,
▪ infusion of calcium channel blocker (5–10 mg of intra-arterial
verapamil,
▪ 2.5 mg of intra-arterial nicardipine),
▪ balloon angioplasty (if severe)
VESSEL PERFORATION

▪ Turunkan TDS < 140 mmHg

▪ Reverese coagulopathies  transfuse platelet sesuai indikasi
▪ Post procedural CT untuk mengevaluasi perdarahan, edema, atau
hidrosefalus
▪ Perdarahan intraventricular massive  pertimbangkan EVD
▪ Perdarahan intraparenkim  pertimbangkan kraniotomi evakuasi
hematom, atau kraniektomi dekompresif
BLOOD PRESSURE cONTROL

▪ Jika reperfusi telah tercapai

▪ target TDS <140-160 mmHg

▪ Jika reperfusi belum tercapai 

▪ permissive hypertension TDS <180-220
mmHg
 GLUCOSE CONTROL

▪NORMOGLYCEMIA : <180 mg/dL

TEMPERATURE CONTROL

▪EUTHERMIA
EVALUASI

▪ NEUROLOGICAL CHECKS
▪ GROIN ACCESS SITE
▪ HEMATOMA
▪ PULSES
▪ PERFUSION
▪ NEUROLOGOCAL AND VITAL SIGNS CHECKS:
▪ Setiap 15 menit pada 2 JAM PERTAMA
▪ Setiap 30 menit pada 6 JAM BERIKUTNYA
▪ Setiap jam pada 16 JAM BERIKUTNYA