Asuhan Keperawatan Post Craniotomy Evakuasi Intracerebral Hemorrhage (ICH) di Intensive Care Unit: Studi Kasus
DOI:
https://doi.org/10.32583/jgd.v6i1.2143Keywords:
kraniotomi, perdarahan intraseberal (PIS), stroke hemoragikAbstract
Pasien dengan post craniotomy di intensive care unit (ICU) atas indikasi adanya perdarahan intraserebral (intracerebral hemorrhage) dalam substansi otak dan membutuhkan pemantauan intensive untuk mengevakuasi perdarahan melalui pemasangan drain di kepala. Penulisan artikel ini bertujuan untuk menyampaikan asuhan keperawatan pada pasien Post Craniotomy Evakuasi Intracerebral Hemorrhage (ICH) et causa Stroke Hemoragik di Intensive Care Unit. Metode yang digunakan adalah studi kasus deskriptif pada Tn. M melalui pendekatan proses keperawatan dengan memaparkan fakta, membandingkannya dengan teori, dan disajikan dalam pembahasan. Analisis dilakukan melalui narasi hasil pengkajian, implementasi, dan evaluasi. Masalah keperawatan yang muncul pasien yaitu penurunan kapasitas adaptif intrakranial, gangguan penyapihan ventilator, risiko ketidakseimbangan cairan dan risiko aspirasi. Intervensi yang telah dilakukan berupa manajemen peningkatan intrakranial, penyapihan ventilasi mekanik, manajemen cairan dan pencegahan aspirasi. Hasil evaluasi didapatkan kesadaran somnolen, pasien mengalami penurunan kondisi di tandai dengan reintubasi, kapasitas adaptif intrakranial menurun, penyapihan ventilator menurun dan keseimbangan cairan menurun.
References
Ackley, B. J., Ladwig, G. B., Msn, R. N., & Makic, M. B. F. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
Almohammedi, R. M., AlMutairi, H., AlHoussien, R. O., et al. (2020). Brainstem hemorrhage is uncommon and is associated with high morbidity, mortality, and prolonged hospitalization. Saudi Journal of Neurology, 27(4), 240-245. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015522/
American Association of Neurological Surgeons. (2021). Craniotomy. Available from: https://www.aans.org/en/Patients/Neurosurgical-Conditions-andTreatments/ Craniotomy
American Stroke Association. (2021). Hemorrhagic Stroke. Available from: https://www.heart.org/en/health-topics/stroke/types-of-stroke/hemorrhagic-strokes
Amri, A. (2017). Implementing early management in severe traumatic brain injury. Critical Care Nursing Journal, 10(2), 61-65.
Bahrami, A., Keyhanifard, F., & Afzali, M. (2022). The Role of CT Scan in the Diagnosis and Management of Intracranial Hemorrhage. Journal of Clinical and Diagnostic Research, 16(1), 1-5.
Bal’afif, F., Alfandy, T. N., Wardhana, D. W., & Anindhita, P. (2022). Pengaruh Terapi Hipertonik Nacl 3% Dan Mannitol 20% Terhadap Keparahan Edema Serebral Pada Cedera Otak Traumatik Moderat Diffus. Jurnal Medika Udayana, 11(10).
Bispo, M. A. (2016). Aspiration Pneumonia: Overview of Risk Factors and Management. The American Journal of Medicine, 129(11), 1167.e9-1167.e14.
Blackwood, B., Alderdice, F., Burns, K. E., Cardwell, C. R., Lavery, G., O'Halloran, P. (2017). Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in critically ill paediatric patients. Cochrane Database of Systematic Reviews, (1), CD009082.
Branson, R. D., Gomaa, D., & Rodriguez, D. (2015). Role of the ventilator in the prevention of aspiration. Respiratory Care, 60(6), 855-870.)
Broderick, J. P., Brott, T., Tomsick, T., Miller, R., & Huster, G. (2020). Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. Journal of Neurosurgery, 78(2), 188–191. https://doi.org/10.3171/jns.1993.78.2.0188
Fithrah, B. A., Oetoro, B. J., Umar, N., & Saleh, S. C. (2016). Perdarahan Berulang Pascakraniotomi pada Pasien Cedera Kepala Ringan Recurrent Post Craniotomy Hemorrhage in Patient with Mild Head Injury. Jurnal Neuroanastesi Indonesia, 5(3), 173–179.
Greenberg MS (edt). 2010. Handbook of Neurosurgery (7th ed). New York: Thieme.
Hallett, D. J., Modi, P., & Levy, P. D. (2016). Evaluation and Management of Hypervolemia in Acutely Ill Patients. Frontiers in Medicine, 3(3).
Hart, J. L., Dupaix, J., Rusa, S., Kane, A., & Volpi, J. (2016). Aspiration prevention in critically ill patients: A nursing review. Dimensions of Critical Care Nursing, 35(4), 204-211.)
Hart, M. K., Dupaix, J. P., Rusa, L., Kane, T., & Volpi, S. (2016). Strategies for reducing the risk of aspiration in the emergency department. Advanced Emergency Nursing Journal, 38(2), 89-100.)
Hemphill III, J. C., Greenberg, S. M., Anderson, C. S., Becker, K., Bendok, B. R., Cushman, M., ... & Rosand, J. (2015). Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 46(7), 2032-2060.
Kementerian Kesehatan Republik Indonesia. (2020). Profil Kesehatan Indonesia. Jakarta.
Kim, J. S., & Kang, S. (2016). Use of diuretics in neurocritical care. Journal of Clinical Neurology (Seoul, Korea), 12(2), 135-146
NICE medical technology guidance. Ambu aScope2 for use in unexpected difficult airways. (2015). Available from http://guidance.nice.org.ukmtg
Nyoman, I. G. (2016). Faktor Risiko dan Manifestasi Klinis Perdarahan Intraserebral. Jurnal Kedokteran Brawijaya, 29(2), 89-94.
PPNI. (2017a). Standar Diagnosis Keperawatan Indonesia. Definisi dan Indikator Diagnostik (Edisi 1). Jakarta: DPP PPNI.
PPNI. (2017b). Standar Intervensi Keperawatan Indonesia. Definisi dan Tindakan Keperawatan (Edisi 1). Jakarta: DPP PPNI.
Rajashekar, D & Liang., JW 2023, 'Intracerebral Hemorrhage'. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553103#:~:text=Intracerebralhemorrhage (ICH)%2Ca,morbidity andmortality%5B1%5D.
Rebecca, S.M., Himendra, W., & Nazaruddin, U. 2014. Penalaksanaan Anestesi dengan TIVA Propofol-Dexmedetomidine-Fentanyl untuk Operasi Meningioma rontalis Sinistra. Jurnal Neuroanestesi Indonesia. 3(3): 149-156
Rudini, D. 2018. Efektifitas Antara Alat Ukur Coma Recovery Scale-Revised (Crs-R), Full Outline Unresponsiveness (Four) Score, dan Glasgow Coma Scale (Gcs) dalam Menilai Tingkat Kesadaran Pasien di Unit Perawatan Intensif RSUD Raden Mattaher Jambi. Jurnal Imiah Imu Terapan Universitas Jambi, 2(1), 68-74
Sekiguchi, H., & Schenck, L. A. (2021). Mechanical Ventilation Liberation. In StatPearls [Internet]. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560543/
Silva, L.C.R., Tonelis, I.S., Oliveira, R.C.C., Lemos, P.L., Matos, S. S., & Chianca, T.C.M. (2020). Clinical study of dysfunctional ventilatory weaning response in critically ill patiens. Revista Latino-Americana de Enfermagem, 28, 1 – 13. doi:10.1590/15188345.3522.3334
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2020). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Wolters Kluwer.
Wilson, B. A., Shannon, M. T., & Shields, D. (2021). Pearson Nurse's Drug Guide 2022. Pearson.
World Health Organization. (2021). Guideline for The Pharmacological Treatment of Hypertension in Adul
