2. Manajemen Stroke.docx

A. Tata laksana umum: 1. Tata laksana umum di ruang gawat darurat  Stabilisasi jalan napas dan pernapasan. Beri oksigen ketika saturasi <95%. Pasang endotracheal tube ketika pasien mengalami hipoksia, syok, dan berisiko mengalami aspirasi.  Stabilisasi hemodinamik -> cairan kristaloid/koloid intravena, kontrol tekanan darah (sistolik <140 mmHg)  Pengendalian tekanan intrakranial -> elevasi kepala 20o-30o, posisi pasien jangan meneka vena jugular, hindari pemberian cairan hipotonik, osmoterapi menggunakan manitol atau furosemide, dll.  Pengendalian kejang -> diazepam  Pengendalian suhu tubuh 2. Tata laksana umum di ruang rawat  Jaga euvolemi dengan pemberian cairan isotonik (30ml/kgBB/hari)  Jaga keseimbangan elektrolit dan asam-basa  Nutrisi enteral paling lambat diberikan dalam 48 jam. Apabila terdapat gangguan menelan dan penurunan kesadaran, makanan diberikan melalui NGT. Kebutuhan kalori: 25-30 kkal/kgBB/hari.  Mobilisasi dan cegah komplikasi imobilisasi lama (aspirasi, malnutrisi, pneumonia, DVT, emboli paru, ulkus decubitus, kontraktur, komplikasi ortopedi, dll)  Antibiotic, analgetik, anti-emetik diberikan atas indikasi  Pemasangan kateter urin B. Tata laksana khusus: 1. Stroke iskemik  Kontrol tekanan darah dan gula darah  Trombolisis pada stroke akut -> recombinant tissue plasminogen activator pada pasien dengan presentasi stroke antara 3-4,5 jam  Antitrombosit ->aspirin atau klopidogrel 2. Stroke hemoragik  Tata laksana perdarahan intrakranial -> pemberian vitamin K atau plasma segar beku apabila terdapat gangguan koagulasi; pencegahan tromboemboli vena dengan stoking elastis; heparin subkutan dapat diberikan apabila perdarahan telah berhenti sebagai pencegahan tromboemboli vena.  Kontrol tekanan darah dan gula darah  Pemberian antiepilepsi apabila terdapat kejang  Indikasi operasi evakuasi bekuan darah secepatnya: perdarahan serebelum dengan perburukan neurologis, adanya kompresi batang otak, hidrosefalus akibat obstruksi ventrikel. C. Biopsychosocial aspect -> family support berupa: 1. Dukungan informasional Keluarga memberi nasihat, saran, petunjuk & memberi info kepada pasien tentang stroke & bagaimana penanganannya

2. Dukungan emosional Menjaga hubungan emosional meliputi dukungan yang diwujudkan dalam bentuk afeksi, adanya kepercayaan, perhatian, dan mendegarkan atau didengarkan saat mengeluarkan perasaannya 3. Dukungan instrumental Sumber pertolongan praktis dan konkrit, diantaranya keteraturan dalam menjalani terapi, kesehatan penderita dalam hal kebutuhan makan dan minum, istirahat, dan terhindarnya penderita dari kelelahan. 4. Dukungan penghargaan Memberikan penghargaan dan perhatian saat pasien menjalani rehabilitasi. D. Non-farmakologi = lifestyle modification (nutritional management, physical activity, checkup and control regularly), rehabilitasi, home care.  Healthy food habits can help you reduce three risk factors for stroke — poor cholesterol levels, high blood pressure and excess weight. Diets high in saturated fat and trans fat can raise blood cholesterol levels. Diets high in sodium can contribute to increased blood pressure, and high-calorie diets can contribute to obesity. A diet with five or more servings of fruits and vegetables per day may reduce the risk of stroke.  The American Heart Association/American Stroke Association offers these recommendations for a healthy diet: o Eat a diet rich in vegetables and fruits. o Choose whole-grain, high-fiber foods. (*beras merah memiliki kandungan serat yang lebih tinggi dan kalori yang lebih rendah daripada berah putih) o Eat fish at least twice a week. o Limit saturated fat and trans fat. Avoiding partially hydrogenated oils will reduce trans fats. o Choose lean meats (daging rendah lemak) and poultry, and prepare them without using saturated or trans fats. Hal tersebut untuk membatasi asupan kolestrol. o Select low-fat dairy products. o Kurangi drinks and foods with added sugars. The AHA recommends that no more than half of your discretionary calories should come from added sugars. For most American women, the discretionary calorie allowance is no more than 100 calories and no more than 150 calories for men. o Choose and prepare foods with little salt (sodium). The AHA recommends consuming less than 1500 mg of sodium a day. o Kurangi/batasi konsumsi alkohol. Limit yourself to one drink per day if you’re a non-pregnant woman or two drinks if you’re a man.  Some stroke survivors (post-stroke patients) have a loss of appetite. For others, eating may be difficult due to swallowing problems or limited hand or arm movement. To make eating a little easier again, try these steps: o Choose healthy foods with stronger flavors, such as broiled fish and citrus fruits. Also, spices add flavor to food and serve as a good substitute for salt. o Choose colorful, visually appealing foods, such as salmon, carrots and dark green vegetables.

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Cut foods into small pieces to make them easier to chew. Pick softer, easier-to-chew foods, such as yogurt, bananas, whole-grain hot cereals and low sodium soups. If you have trouble swallowing, talk to your speech therapist or doctor. This condition can be treated. If weakness in arms or hands is a problem, you might try adaptive eating utensils. Some types of flatware (sendok, garpu,pisau makan) have thicker handles that are easier to hold, and “rocker knives” make it possible to cut food using one hand.