stroke askep

7/21/2019 Stroke Askep

1/45

ASUHAN

KEPERAWATANPADA STROKE

Oleh: Mugi Hartoyo

3/2/15 1ASKEP KRITIS STROKE


2/45

STROKE Dikeal !g "#g $ere#ro %a"&ular A&&i'et

($%A)

A'alah i"tilah utuk *e!ela"ka "eraga

akut 'e+i"it ,er"ara+a yg #erlag"ug"ela*a le#ih 'ari 2- !a* 'a 'i"e#a#ka

oleh gaggua alira 'arah ke otak.

3/2/15ASKEP KRITIS STROKE 2


3/45

STROKE Meurut HO "troke 'i'e+ii"ika "#g

gaggua +ug"ioal otak yag ter!a'i "e&ara

*e'a'ak 'ega ta'a klii" +okal atau

glo#al yag ter!a'i le#ih 'ari 2- !a* (ke&ualiaki#at ,e*#e'aha atau ke*atia) ta,a

ta'a0ta'a ,eye#a# o a"kuler

ter*a"uk 'i 'ala*ya ta'a2 ,er'araha "u#

ara&hoi' ,er'araha itra "ere#rali"ke*ik atau i+ark "ere#ral.



4/45

KLASIFIKASI STROKE

1. Stroke i"ke*ik

405 'r "e*ua "troke2. Stroke he*orrhagi&agka *ortalita"ya

le#ih tiggi 'i#a'ig i"ke*ik (3603 :

012).

3/2/15ASKEP KRITIS STROKE -


5/45



6/45

1. STROKE ISKEMIK Diha"ilka 'ari kuragya alira 'arah otak

aki#at oklu"i/"u*#ata ,e*#uluh 'arah.

Oklu"i #i"a 'i"e#a#ka oleh tro*#u" atau

e*#oli. Stroke i"ke*ik ',t !g 'i"e#a#ka oleh

hi,o,er,u"i aki#at hi,ote"i.

Se#agia #e"ar "troke tro*#u" 'i"e#a#ka

oleh aku*ula"i ,lak athero"klero"i" ,a'alu*e ,e*#uluh 'arah khu"u"ya yg

#er&a#ag 'ua atau #er#etuk

#eloka/kura.



7/45

1. STROKE ISKEMIK ...

LANJUTAN Plak athero"klero"i" ,alig "erig ter!a'i

,a'a ,er&a#aga arteri karoti" arteri otak

tegah 'a 'e,a 'a arteri erte#ra.

8aktor re"iko tertiggi "troke i"ke*ik a'alahhipertensi.

8aktor re"iko lai: 'ia#ete" ,eigkata

li,i' 'arah ,eyakit arteri karoti"

*egko"u*"i alkohol 'a ,erokok.



8/45

ETIOLOGI STROKE ISKEMIK Stroke e*#olik ter!a'i ketika e*#olu" 'ari

!atug atau !alur "irkula"i yg le#ih

re'ah/'i"tal 'a ter"agkut ,',e*#uluh

ke&il yg *eye#a#ka hilagya "u,lai'arah.

Se'ikitya 34 "troke i"ke*ik #erhu#uga

'g +eo*ea kar'ioe*#olik.

3/2/15ASKEP KRITIS STROKE


9/45

ETIOLOGI STROKE ISKEMIK Peyakit katu, !atug 3 kali *eigkatka

re"iko "troke.

8aktor re"iko lai *eli,uti atrial +i#rila"i

i+ark *yo&ar' aeuri"*a a"kuler 'akar'io*yo,ati.

Athero"klero"i" aorta a"e'e !g ',t

*eye#a#ka "troke e*#olik.



10/45

PATOFISIOLOGI STROKE ISKEMIK Ketika alira 'arah otak #erkurag aka

*eye#a#ka i!uri i"ke*ik ter!a'i i+ark

otak yag 'iikuti i!uri "ara+ yg irreer"i#le

(ti'ak 'a,at 'iru#ah). Tika i+ark ter!a'i !ariga otak yg terkea

*e!a'i *eluak 'a *e!a'i &air.

Riayat tra"iet i"&he*i& atta&k" (TIA)

e,i"o'e "igkat ge!ala eurologi 'aReer"i#le i"&he*i& eurologi& 'e+i&it (RI;D)

yg #erakhir kurag 'r 2- !a* *eru,aka

,erigata #aha "troke *ugki ter!a'i.



11/45

PATOFISIOLOGI STROKE ISKEMIK I"ke*ik *eyeluruh ter!a'i ketika hi,ote"i

#erat atau &ar'io,ul*oary arre"t

*e*,egaruhi turuya alira 'arah

"e*etara ,a'a "e*ua area 'i otak. E'e*a otak #" ter!a'i ,' ,a"ie 'g "troke

i"ke*ik 'a ',t *eye#a#ka hi,erte"i

itra kraial.

E'e*a ter!a'i aki#at hilagya +ug"i or*al*eta#oli"*e "el 'a *e&a,ai ,u&akya ,'

hari ke 3 < 5 *eru,aka ,eye#a#

ke*atia ,a'a *iggu ,erta*a.



12/45

PATOFISIOLOGI STROKE ISKEMIK Per'araha ,a'a 'aerah le"i "troke 'a

"eraga ke!ag ("ei=ure) *eru,aka

ko*,lika"i eurologi" akut 'r "troke i"ke*ik.

Agka ke*atia ,a'a 24 hari ,erta*a"etelah "eraga "troke i"ke*ik #erki"ar 0

34.



13/45

PENGKAJIAN & DIAGNOSIS:

>e!ala karakteri"tik "troke i"ke*ik *eru,aka"eraga ti#a0ti#a ta'a0ta'a eurologi"

+okal #erlag"ug le#ih 'ari 2- !a*.

Peega"a 'iago"a "troke i"ke*ik *eru,aka

lagkah aal "aat ealua"i terha'a, ,a"ie. Me*#e'akaya 'g ,er'araha itrakraial

"agat ,etig/ital.

$T S&a o kotra" *r,k ,e*erik"aa

'iago"tik aal yg ,alig ,etig. MRI aka *e*,erlihatka i+ark !ariga

&ere#ral yg yata



14/45

PENGKAJIAN & DIAGNOSIS: LANJUTAN

Kr hu#uga yg kuat atara "troke i"ke*ik

akut 'g ,eyakit !atug *aka ,erlu 'ilakukaEK> 120lea' Rotge thora? 'a *oitor

!atug teru"0*eeru" utk *e'etek"i

etiologi kar'iak atau ko'i"i yg #erkaita.

E&ho&ar'iogra,hy @a#orat: +ug"i he*atologi elektrolit 'a gula

'arah +ug"i real 'a hati.

>A 'ilakuka #ila &uriga hi,ok"ia

EE>#ila *u&ul "eraga ke!ag/"ei=ure

@u*#al ,ug"i !ika "u",e&k ,er'araha

"u#ara&hoi'.

3/2/15ASKEP KRITIS STROKE 1-


15/45

PENGKAJIAN :

GEJALA STROKE ISKEMIK AKUT

He*i"+er kiri ('o*ia) ge!ala yg *u&ul:

A,ha"ia he*i,are"e kaa hilag "e"ori

"i"i kaa keru"aka la,ag ,a'ag *atakaa gaggua ,eta+"ira ,a'aga

"e#elah kaa 'y"arthria (ti'ak "e*,ura

*egu&a,ka kata0kata) ke"ulita

*e*#a&a *euli" atau *eghitug.



16/45


He*i"+er kaa (o'o*ia) ge!ala yg

*u&ul:

>aggua ,a'ag *ata kiri keru"aka

la,ag ,a'ag "e#elah kiri he*i,are"e kirihilag "e"ori "e#elah kiri ,eta+"ira

,a'aga kiri tergaggu ke*atia "ti*uli

"i"i kiri 'y"arthria 'i"orieta"i te*,at.



17/45


atag otak/"ere#elu* (otak ke&il)/he*i"+er

#elakag ge!ala yg *u&ul:

Hilag "e"ori *au,u *otorik ,a'a kee*,at

aggota gerak gait atak"ia (gagguakoor'ia"i gerak kaki) 'y"arthria y"tag*u"

(gerak #olak0#alik #ola *ata yg &e,at)

a*e"ia gaggua la,ag ,a'ag ke'ua

"i"i.



18/45


He*i"+er "u#&ortikal ke&il atau #atag otak

("troke *otorik *uri) ge!ala yg *u&ul:

Kele*aha a!ah 'a aggota gerak ,a'a

"atu "i"i tu#uh ta,a a#or*alita" +ug"iotak yg le#ih tiggi "e"a"i *au,u

,a'aga.



19/45



("troke "e"ori *uri) ge!ala yg *u&ul:

Peuruaa "e"a"i a!ah 'a aggota

gerak ,a'a "atu "i"i tu#uh ta,akelaia/a#or*alita" +ug"i otak yg le#ih

tiggi +ug"i *otorik *au,u ,a'aga.



20/45



("troke "e"ori *uri) ge!ala yg *u&ul:

Peurua "e"a"i ,a'a a!ah 'a aggota

gerak ,a'a "atu "i"i tu#uh ta,aa#or*alita" +ug"i otak yg le#ih tiggi

"e"a"i *au,u ,a'aga.



21/45

KONTRA LATERAL



22/45

MANAJEMEN MEDIS Tera,i tro*#olytik rt0PA / ati koagula

"e&ara itraea 'ala* 3 !a* *u&ulya

ge!ala "eraga "troke i"ke*ik (utuk u"ia

le#ih 'ari 1 tahu) *eguragi ke!a'ia

'ee, ei thro*#o"i" 'a e*#oli ,ul*oal.



23/45

STROKE HEMORAGIK:

PERDARAHAN SUBARACHNOID A'alah ,er'araha ,a'a ruag "u#ara&hoi'

'i"e#a#ka oleh ,e&ahya aneurisma"ere#ri

atau *al+or*a"i arterioeou" (A%M).

8aktor re"ikoya: hi,erte"i *erokokalkohol 'a ,e*akaia "ti*ulat.

Hi,erte"i *eru,aka *eru,aka +aktor

re"iko ,alig uta*a.



24/45

ANEURISMA



25/45

ETIOLOGI PERDARAHAN

SUBARACHNOID Ru,tur aeuri"*a5

*eye#a#ka ,er'araha

"u#ara&hoi'.

Pe&ahya aeuri"*a #ia"ayater!a'i "ela*a 'eka'e ke 5 atau

7 kehi'u,a.

A%M (Arterioeou"

Mal+or*atio) *eye#a#kaB14 ,er'araha "u#ara&hoi'.



26/45

KLASIFIKASI PERDARAHAN

SUBARACHNOID >ra'e I: a"i*,to*atik atau "akit ke,ala riga

C kaku leher riga

>ra'e II: "akit ke,ala "e'ag "a*,ai ,arah

kaku leher ti'ak a'a 'e+i"it eurologi "elai

"ara+ kraial ,al"y.

>ra'e III: *egatuk #igug 'e+i"it +okal

riga

>ra'e I%: "tu,or (gaggua ke"a'ara)

he*i,are"i" "e'ag0#erat *ugki kekakua

'e"ere#ra"i aal gaggua egetatie.

>ra'e %: ko*a 'ala* kekakua 'e"ere#ra"i

,ea*,ila "e,erti *au *ati.



27/45

PENGKAJIAN

Karakteri"tik ,er'araha "u#ara&oi':

"eraga yeri ti#a0ti#a yg *eru,aka "akit

ke,ala ,alig he#at.

Hilag ke"a'ara "e&ara ti#a0ti#a Mual *utah

De+i"it eurologi" +okal

Sti++ e&k/kaku tegkuk/leher



28/45

DIAGNOSIS $T S&a

@u*#al ,ug"i

MRI

Agiogra,hy utuk *egetahui loka"iaeuri"*a yg ru,tur utk ,er"ia,a o,era"i.



29/45

MANAGEMEN MEDIS Maa!e*e !ala a+a"

atua etilator

Pe*#e'aha 'g &li,,ig/,e!e,ita aeuri"*a

Pe*#e'aha ek"i"i A%M E*#oli"a"i :itere"i #aru 'g tekik

eurora'iologi



30/45

KOMPLIKASI PERDARAHAN

SUBARACHNOID %a"o",a"*e "ere#ral

Hy,oatre*i

Hi'ro"e,alu" aki#at ter"u*#atya illi

ara&hoi' oleh 'arah.



31/45

PERDARAHAN INTRA KRANIAL

(ICH) I$H *eru"ak !ariga otak *eye#a#ka

e'e*a "ere#rral C *eigkatka tekaa

itrakraial.

Peye#a# ,er'araha itra "ere#ri ,alig

,etig a'alah hi,erte"i.

Peye#a# lai a'alah tera,i atikoagula atau

tro*#olitik ,eyalahguaa o#at ,er'araha

,' !ariga otak yg *egala*i i+ark atau

tu*or.

Per'araha itra"ere#ral #i"a ter!a'i "etelah

,a"ie *eghetika ,ego#ata hi,erte"i 2 $S - atau kurag ,e*#e'aha

ti'ak *eu!ukka ha"il yg le#ih #aik.



35/45

MANAJEMEN KEPERAWATAN Melakuka ,egka!ia yg teru" *eeru"

Pegaa"a terha'a, ko*,lika"i



36/45

MANAJEMEN KEPERAWATAN

Melakuka ,egka!ia yg teru" *eeru"

Tu!uaya utk *egeali "e'ii *ugki

ke*u'ura eurologi" atau he*o'ia*ik.

Pegka!ia *eli,uti ta'a0ta'a eurologi"'a ta'a0ta'a ital. Alat oto*ati"

oia"ie ,egukur tekaa 'arah 'a

,ul"e o?i*eter "agat *e*#atu.

Sei=ure 'ii'eti+ika"i 'a 'itrit*e "egera*ugki.



37/45

MANAJEMEN KEPERAWATAN ...

LANJUTAN


Pa"ie "troke haru" 'i*oitor terha'a,:

1. Ta'a0ta'a ,er'araha

2. %a"o",a"*e3. PTIK

. Ko*,lika"i lai 'ari "troke *eli,uti: a",ira"i

*alutri"i ,eu*oia tro*#o"i" ea 'ala*

e*#oli"*e ,ul*oal tukak la*#ug/,re""ureul&er" kotraktur 'a a#or*alita" "e'i

keru"aka he*i"+er yg 'o*ia *a"alah

i&ara #aha"a 'a a#"trak.



38/45

MANAJEMEN KEPERAWATAN ...

LANJUTAN


Keru"aka he*i"+er yg o'o*ia

ago"ia (kehilaga 'aya keal) a,rak"ia

(kehilaag ke*a*,ua yg telah 'i,eroleh"e#elu*ya ketera*,ila) gaggua la,ag

,a'ag.



39/45

PERDARAHAN DAN VASOSPASME I'ika"i ,erta*a a"o",a"*e a'l *u&ulya 'e+i"it eurologi"

+okal yg #aru atau 'e+i"it eurologi" glo#al/*eyeluruh.

Kea",a'aa haru" 'ilakuka utk *e&egah "tre" atau

ketegaga yg #er,ote"i *eye#a#ka ,er'araha ulag

*eli,uti: kotrol tekaa 'arah #e' re"t ligkuga yg

teag 'a gela, 'a ,eluak +e"e". Aalgetik a "e'ati+

'i,akai utk *eguragi yeri 'a ke&e*a"a.

Re"trai ek"tre*ita" 'a,at *eye#a#ka ketegaga "hg haru"

'ihi'ari

agia ke,ala te*,at ti'ur 'ielea"ika 35 < -5 'era!at Dee, ei tro*#o"i" ,re&autio haru" 'ilakuka

Pa"ie haru" "elalu teag

Pa"ie 'ia!arka utk *eghi'ari aktiita" yg *eye#a#ka

al"ala *auer



40/45

PENINGKATAN TEKANAN INTRA

KRANIAL I'ikator yg ,alig "e"iti+ a'alah ,eru#aha

tigkat ke"a'ara

I'ikator lai: ukura ,u,il ti'ak "a*a

,eurua re",o ,u,il terha'a, &ahayayeri ke,ala o*itu" yg ,royektil

,eru#aha ,ola a+a" $u"hig" tria'

(#ra'ikar'i "i"tolik hi,erte"io 'a

#ra'i,ea) ,a,ile'e*a #erkuragyare+lek" #rai"te* 'a ek"te"i a#or*al

(,o"tur 'e"ere#ra"i) atau +lek"i (,o"tur

'ekortika"i).

3/2/15ASKEP KRITIS STROKE -4


41/45

DIAGNOSA KEPERAWATAN Ie+ekti+ ,er+u"i !ariga otak #.'.

Peurua alira 'arah otak

Ie+ekti+ ,er+u"i !ariga otak #.'.

Per'araha ;yeri akut #.'. Tra"*i"i 'a ,er"e,"i

kutaeu" i"&eral *u"kular atau i*,ul"

i"ke*ik.

>aggua ko*uika"i er#al #.'.i!uri ,u"ati&ara 'i otak

>aggua *eela #.'.keru"aka

euro*u"kular +atigue



42/45

DIAGNOSA KEPERAWATAN Re"iko a",ira"i

Re"iko i+ek"i



43/45

MANAJEMEN KOLABORASI

(PERAWAT-MEDIS) e'aka ,eye#a# "troke (5 ,eye#a#)

I*,le*eta"ika trit*e #erkaita 'g

,eye#a# ,er'araha: i"ke*ik (tro*#olitik

'a kotrol TD) ,er'araha "u#ara&hoi'(o,era"i &li,,ig aeuri"*a atau A%M

e*#oli"a"i) ,er'araha itra &ere#ral

(kotrol TD)

Protek"i airay erika #atua etilator !ika 'i,erluka

Pe*erik"aa "ara+ teru"0*eeru"



44/45

MANAJEMEN KOLABORASI

(PERAWAT-MEDIS) ... LANJUTAN Pertahaka ,egaa"a terha'a,

ko*,lika"i: e'e*a "ere#ri i"ke*i

"ere#ri/a"o",a"*e re#lee'ig gaggua

*eela 'e+i"it eurologi".

erika keya*aa 'a 'ukuga e*o"i

Re&aaka 'a i*,le*eta"ika ,rogra*

reha#ilita"i yg "e"uai

E'uka"i ,a"ie 'a keluaraga (,etigya*iu* o#at AD@ tekik reha#ilita"i 'a"ar

'll.)

3/2/15ASKEP KRITIS STROKE --


45/45

SELESAI

stroke askep

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