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    Stroke Ebn PDF

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    Rifdha Rifdha
    The document discusses nursing interventions in stroke care delivery based on evidence-based practice. It outlines the key roles of nurses in being part of a multidisciplinary team, interacting frequently with patients and caregivers, and implementing best practices and interventions according to patient responses. Examples discussed include preventing stroke, complications, and recurrent strokes through cultivating evidence-based practices, standards like SOPs, and goals of care such as preventing secondary brain injury and maintaining hemodynamic stability. Assessment, monitoring of vital signs, screening for dysphagia, early mobilization and management of issues like aphasia are also covered.

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    Stroke Ebn PDF

    Uploaded by

    Rifdha Rifdha
    15 views21 pages
    The document discusses nursing interventions in stroke care delivery based on evidence-based practice. It outlines the key roles of nurses in being part of a multidisciplinary team, interacting frequently with patients and caregivers, and implementing best practices and interventions according to patient responses. Examples discussed include preventing stroke, complications, and recurrent strokes through cultivating evidence-based practices, standards like SOPs, and goals of care such as preventing secondary brain injury and maintaining hemodynamic stability. Assessment, monitoring of vital signs, screening for dysphagia, early mobilization and management of issues like aphasia are also covered.

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    The document discusses nursing interventions in stroke care delivery based on evidence-based practice. It outlines the key roles of nurses in being part of a multidisciplinary team, interacting frequently with patients and caregivers, and implementing best practices and interventions according to patient responses. Examples discussed include preventing stroke, complications, and recurrent strokes through cultivating evidence-based practices, standards like SOPs, and goals of care such as preventing secondary brain injury and maintaining hemodynamic stability. Assessment, monitoring of vital signs, screening for dysphagia, early mobilization and management of issues like aphasia are also covered.

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    15 views21 pages

    Stroke Ebn PDF

    Uploaded by

    Rifdha Rifdha
    The document discusses nursing interventions in stroke care delivery based on evidence-based practice. It outlines the key roles of nurses in being part of a multidisciplinary team, interacting frequently with patients and caregivers, and implementing best practices and interventions according to patient responses. Examples discussed include preventing stroke, complications, and recurrent strokes through cultivating evidence-based practices, standards like SOPs, and goals of care such as preventing secondary brain injury and maintaining hemodynamic stability. Assessment, monitoring of vital signs, screening for dysphagia, early mobilization and management of issues like aphasia are also covered.

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    of 21

    Nursing Interventions in stroke

    care delivery : Evidence-based


    Nursing Practice

    Rosyidah Arafat

    Schwamm et al. Circulation. 2010 epub April 6


    Peran Perawat dalam Pelayanan Stroke

    • Bagian Inti dari TIM Multidisplin


    • Lebih banyak berinteraksi dgn pasien &
    caregiver
    • Memberikan intervensi keperawatan yg
    dibutuhkan sesuai dgn respon pasien.
    • Mengimplementasikan praktik
    terbaik bd bukti/fakta.
    • Berkontribusi mencegah terjadinya
    stroke, komplikasi & stroke berulang.

    Schwamm et al. Circulation. 2010 epub April 6


    CONT’

    Membudayakan
    EBP

    Hasil yg Standar
    terbaik Praktik Kep. JCI
    bagi pasien (mis : SOP)

    Schwamm et al. Circulation. 2010 epub April 6


    Schwamm et al.

    Schwamm et al. Circulation. 2010 epub April 6


    Schwamm et al.

    Schwamm et al. Circulation. 2010 epub April 6


    Tujuan Perawatan Stroke

    Mencegah cedera otak sekunder

    Mempertahankan jalan napas

    Mempertahankan stabilitas hemodinamik

    Mencegah terjadinya komplikasi

    Meningkatkan kemampuan fungsional

    Schwamm et al. Circulation. 2010 epub April 6


    Schwamm et al.

    Schwamm et al. Circulation. 2010 epub April 6


    Schwamm et al.

    Schwamm et al. Circulation. 2010 epub April 6


    Assesment

    Evaluasi Gejala & klinik stroke akut (AHA/ASA, Kelas 1 level evidence B)
    - Anamnesis
    - Pemeriksaan fisik
    - Pemeriksaan Status Neurologis dan skala stroke (NIHSS)

    Schwamm et al. Circulation. 2010 epub April 6


    Schwamm et al. Circulation. 2010 epub April 6
    Temperatur

    - 20 sd 50 % pasien stroke mengalami peningkatan suhu tubuh (demam)


    pada 24 jam pertama.
    - Monitor suhu tubuh tiap 4- 6 jam pertama dalam 72 jam pertama.
    (Kelas 1, level evidence A)
    - Jika suhu > 37,5 derajat maka perlu dilakukan intervensi sesegera
    mungkin : anti piretik atau intervensi menurunkan suhu tubuh. (Kelas 1,
    level C)

    Schwamm et al. Circulation. 2010 epub April 6


    Glukosa

    - Pemeriksaan glukosa darah secara rutin setiap 1-6 jam


    dalam 72 jam pertama (Kelas 1, level evidence A)
    -Peningkatan glukosa > 10 mmol/l : insulin
    - Penggunaan larutan dextrose tidak direkomendasikan
    (Kelas 1, level evidence B)

    Schwamm et al. Circulation. 2010 epub April 6


    Feeding & screening disfagia

    - Semua pasien stroke harus dilakukan


    screening disfagia sebelum diberikan
    makan, minum dan obat oral.
    - Screening disfagia harus dilakukan
    sesegera mungkin paling tidak dalam
    24 jam 1 saat masuk RS.

    Schwamm et al. Circulation. 2010 epub April 6


    CON’T
    -

    - Gag Reflkes tidak bisa dijadikan dasar sebagai pengganti screening disfagia
    - Instrumen screening disfagia dgn sensitifitas & spesifisitas 100 % Massey
    Bedside Swallowing Screen .

    Schwamm et al. Circulation. 2010 epub April 6


    Terapi Oksigen

    - Hipoksia merupakan masalah utama pada pasien stroke


    - Pasien dengan saturasi O2 < 95 % harus diberikan O2
    secara rutin.
    -Pemberian 02 rutin untuk maintenance tidak
    direkomendasikan
    (Kelas 1, level evidence C)

    Schwamm et al. Circulation. 2010 epub April 6


    Pemberian Posisi

    -Elevasi kepala 30 derajat


    -Posisi telentang jika tidak berisiko
    peningkatan TIK.
    -Posisi miring 30 derajat tiap 2
    jam.

    (Kelas 1 level evidence B)

    Schwamm et al. Circulation. 2010 epub April 6


    Mobilisasi Dini

    -Mobilisasi dini direkomendasikan untuk mencegah aspirasi,


    DVT & Ulkus Dekubitus
    -Mobilisasi dini dapat meningkatkan status fungsional pasien
    stroke
    (Kelas IV, level GCP)

    Schwamm et al. Circulation. 2010 epub April 6


    Manajemen Afasia

    Identifikasi Afasia
    Intervensi Afasia :
    Speech Language Therapy
    Augmentative Alternative
    Task Spesific
    Computer Based

    Schwamm et al. Circulation. 2010 epub April 6


    - 5 – 61 % pasien stroke mengalami PSD
    - Identifikasi PSD
    - Pemberian informasi, terapi life review, peningkatan motivasi,
    latihan fisik, dan asuhan spiritual dapat menurunkan PSD.
    - Program manajemen non farmakologik dapat membantu
    mengatasi PSD.
    (Kelas 1, level evidence B)
    Schwamm et al. Circulation. 2010 epub April 6
    DAFTAR PUSTAKA

    Theofanidish D, Gibbon B. Nursing interventions in stroke care delivery : An evidence based clinical review. Journal of vascular
    nursing, 2016 : 144 -151

    Summers D, Leonard A, Wenworth D, et al. 2009. Comprehensive overview of nursing and interdiciplinary care of the acut e
    ischemic stroke patient : A Scientifict statement from the American Heart Association . Stroke, 2009 : 40 : 2911-44.

    Granito M , Gabitz D. Update on Stroke : The latest guidelines . Nurse Practice, 2008 : 39-46.

    Middleton S, McElduff P, Ward J, et al. Implementation of evidence-based treatment protocols to manage fever,
    hyperglycaemia, and swallowing dysfunction in acute stroke : a cluster CRT. The Lancet , 2011 : 1699-706.

    PERDOSSI. Guidelines stroke 2011.

    Cross S. Stroke Care : a Nursing Perspective. Nursing Standard, 2008 ; 22: 23-47.

    Schwamm et al.

    Schwamm et al. Circulation. 2010 epub April 6


    Questions?

    Schwamm et al. Circulation. 2010 epub April 6

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