Peran Perawat dalam Assessment Pengenalan Dini untuk Meningkatkan Outcome Pasien Stroke di Instalasi Gawat Darurat

Dewi Rachmawati
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Abstract


Stroke penyakit kegawat daruratan medis yang sangat tergantung waktu dalam penanganannya. Assessment menentukan diagnosis stroke adalah kunci pokok manajemen stroke. Tujuan literature ini mengatahui bagaimana peran perawat dalam assessment untuk meningkatkan outcome pasien stroke. Metode literature review adalah mengumpulkan dan analisa artikel tentang assessment, diagnosis dan manajemen stroke di IGD. Sumber literatur dari text book, artikel elektronik seperti ScienceDirect, PubMed, Cochrane Library dengan kriteria dipublikasi periode 2000-2016, pencarian menggunakan kata kunci”recognition, assessment, stroke, emergency”. Hasil penelusuran didapatkan 21 artikel tentang pengkajian/pengenalan gejala, diagnosis dan menajemen stroke, hanya 7 artikel yang memenuhi kriteria inklusi. Literatur review menunjukkan bahwa aktivasi protokol manajemen stroke segera dilakukan dengan pertama kali menentukan tipe atau diagnosis stroke pasien. Penentuan diagnosis penting untuk dilakukan sebagai dasar memberikan terapi. Penentuannya biasanya menggunakan CT-Scan untuk membedakan stroke akut atau gejala mirip stroke. Tidak semua rumah sakit tersedia CT-Scan sehingga sebagai alternatif dapat menggunakan ROSIER scale dengan sensitifitas 93% dan nilai prediksi positif 90% membedakan stroke akut dan bukan stroke. Terdapat 7 aitem penilaian yaitu kehilangan kesadaran atau sinkop, aktivitas kejang, kelemahan otot wajah/asimetris, kelemahan anggota gerak atas/asimetris, kelemahan anggota gerak bawah/asimetris, kesulitan bicara, gangguan lapang pandang. Total skor antara -2 sampai +5. Apabila pasien mendapat skor 1 atau lebih terdiagnosis stroke dan skor ≤ 0 maka bukan stroke kecuali skor total 0. ROSIER merupakan skala diagnosis simple, sensitif, spesifik dan cocok digunakan saat triage di IGD. Penggunaannya juga sangat cepat dan mudah sehingga semakin cepat identifikasi pasien stroke untuk mendapatkan tindakan yang dapat menurunkan angka kematian dan kecacatan.


Keywords


Instalasi Gawat Darurat; Outcome; Assessment; Perawat

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References


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DOI: 10.26699/jnk.v6i2.ART.p163-171


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