EMERGENCY PROCCES

CEREBRO VASCULER ACCIDENT

AND CORONARY HEART DISEASE

Ika Rahmawati, S.Kep.Ns, M.Kep, CWCCA, CHtN

 Curiculum Vitae

Nama : Ika Rahmawati, S.Kep.Ns, M.Kep, CWCCA, CHtN

No. HP : 081334680625
Email : ika_rahma23@yahoo.com
Rumah : Jl. Misbahul Munir 14A Kediri
Kantor : Jl. K.H Wachid Hasyim 65 Kediri

Riwayat Pendidikan :
Lulus SPK Karya Husada Pare : 2003
Lulus Poltekes Malang Program Studi Keperawatan Blitar : 2005
Lulus PSIK Universitas Brawijaya Malang : 2009
Lulus Magister Keperawatan Universitas Brawijaya Malang : 2013
Riwayat Pekerjaan

Sebelumnya :
Sekretaris Program Studi S1 Keperawatan IIK Bhakti
Wiyata Kediri : 2009
Ketua Program Studi S1 Keperawatan IIK Bhakti Wiyata
Kediri : 2010
Wakil Dekan III FIK IIK Bhakti Wiyata Kediri : 2013

Saat ini :
Wakil Dekan I FIK IIK Bhakti Wiyata Kediri
Bendahara PPNI Komisariat Pendidikan Kota Kediri
CEREBRO VASCULER ACCIDENT
 What is a stroke?

Penyakit yg disebabkan kelainan pembuluh

darah otak yg menyebabkan ggn suplai darah
ke otak, dgn gejala penyakit dtg tiba2, dan dpt
sembuh lengkap atau sebagian, menetap atau
bahkan kematian.
A stroke is similar to a heart attack, but it
occurs in the brain.
Sudden blockage of oxygen and nutrients to
brain causing death to brain cells.
Mortality
Stroke is the number 3 cause of death in the
US.
In 2001,strokes killed 163,538 people, as
reported by National Center for Health
Statistics.
Every 45 seconds some one in America has a
stroke.
Every 3 minutes someone dies of stroke.
In Indonesia, about 800-1000 case of stroke
every year

6
CVA
Thrombosis

Proses Aterosklerosis
Embolism

Emboli A. Karotis /
Jantung
 Manifestasi klinis

TIA (Transient Ischemic Attack)

- Sakit kepala mendadak, pusing, bingung, gelisah,
penglihatan kabur, kehilangan keseimbangan, rasa
baal/ kesemutan pada sisi tubuh
- < 24 jam sembuh
SIE (Stroke In Evolution)
- Semua gejala di atas, kelemahan tangan & kaki,
bicara tidak jelas
- > 24 jam sampai beberapa minggu
CSI (Completed Stroke Ischemic)
Semua gejala di atas, koma, parese tangan & kaki,
hilang kemampuan bicara, Gg menelan, (-) kontrol
BAK & BAB
Ischemic
Is caused by the buildup of fatty deposits or plaque in
blood-vessels in the brain.
A blood clot may break away from plaque in some
other part of the body and travel to the brain, where it
stops blood flow and kills brain cells.
About 80% of strokes are Ischemic.
Thrombotic

Occurs during rest, progresses slowly over 1-2

day period (stroke in evolution)
50 % of strokes are this type
Embolic

May begin from thrombus in left side of heart

Occurs sudenly and causes immediate deficit
Hemorrhagic
A hemorrhagic stroke is uncontrolled bleeding in
the brain or an interruption of the normal flow of
blood within the brain.
The uncontrolled bleeding floods and kills brain
cells.
Can be caused by an aneurysm
About 20% of strokes are hemorrhagic.
Intracerebral

Occurs suddenly with activity

Sometimes preceded by headache
Related to aneurysm, trauma
Subarachnoid

Bleeding beneath the dura

Causes symptoms of coma, focal neuro deficit
 Risk Factors

Controllable
Obesity
High blood pressure
DM Uncontrollable
Dehidrasi Age
High cholesterol Sex
Arterial fibrillations Race
Smoking Genetics
Physical inactivity Prior medical history
Warning Signs
Sudden numbness or Sudden loss of vision,
weakness in the face, particularly in one eye
arm or leg. or double vision.

Sudden temporary loss Sudden severe

of speech or trouble headache and loss of
understanding speech. balance.
Common Stroke Patterns
Left Hemisphere Stroke
Aphasia : ekspresif (- bicara tp mengerti),
reseptif (+ bicara tp tdk mengerti)
Right hemiparesis
Right visual field defect
Apraxia (menggunakan objek tdk tepat)
Dysarthria, disfagia
Difficulty reading, writing, or calculating
Common Stroke Patterns
Right Hemisphere Stroke
Left hemiparesis

Left visual field defect

Spatial disorientation

Proprioresepsi (-): respon ttg posisi

bagian tubuh
Common Stroke Patterns
Pure Motor (small subcortical hemisphere)
Weakness of face and limbs on one side of the
body without abnormalities of higher brain
function, sensation, or vision

Pure Sensory (small subcortical hemisphere)

Decreased sensation of face and limbs on one side
of the body without abnormalities of higher brain
function, motor function, or vision
Tests for the Emergent Evaluation
of the Patient with Acute Ischemic
Stroke
CT scan
Angiografi
EEG
Electrocardiogram
Chest x-ray
Hematologic studies
Serum electrolytes
Blood glucose
Lumbal fungsi
Pada pungsi lumbal
keluar cairan
serebrospinalis
bercampur darah
Cerebral infarct

Onset 6 Hours

Infarct
Infarct
Ischaemic
Ischaemic
penumbra
penumbra

24 Hours
Infarct
Ischaemic
penumbra
(O2, glukosa, blood
flow adekuat)
Assesment data
Right CVA- brain damage on right, symptoms on the
left
Left sided hemiplegia

Difficully in perception and activities (apraksia)

Confusion and lack of insight (intelektual

menurun)
Left CVA- brain damage on the left, symptoms on the
right
Right sided hemiplegia

Communication problems (aphasia)

Expressive, receptive, global

Cautious and slowed behaviors
Assesment data

Symptoms occurring with either right or

left sided CVA
Dysarthria- motor difficulty with muscles of
tongue, lips, face
Dysphagia
Visual field difficulty
Elimination problems (spastic bowel and
bladder
Nursing care for clients in Ineffective airway
acute phase clearance
Management airway

Nursing Care
Impaired tissue perfusion
Impaired Physical mobility related to flaccidity
on side of body
Turn 2 hours

Passive ROM

Aktif Rom (px sadar, TD normal, peny.

Jantung -)
Correct positioning in bed
Nursing care for clients in
rehabilitative phase of CVA

Risk for aspiration related to dysphagia

Assess swallowing reflex before
feeding- feed on unaffected side of
mouth
High fowlers position

Semi-solid food

Remain upright 30 minutes after meal

CORONARY HEARTH
DISEASE
 52%

13%
17%
.4% 4% 6% 7%
.5%

Coronary Heart Disease Stroke

Heart Failure High Blood Pressure
Diseases of the Arteries Congenital Cardiovascular
Defects
Other
Rheumatic Fever/
Rheumatic Heart Disease

Percentage breakdown of deaths from cardiovascular diseases

(United States : 2004)
Source: NCHS and NHLBI.
Development of Atherosclerotic Plaques

Fatty streak
Normal

Lipid-rich plaque

Foam cells

Fibrous cap

Lipid core
Thrombus

Penyempitan arteri koroner

Stable Unstable Disrupted Plaque
Plaque
 Proses Aterosklerosis yang
Progresif
Plaque Angina Tak
Athero- rupture/ Stabil }ACS
Fatty Fibrous sclerotic fissure &
Normal streak plaque plaque thrombosis MI

Ischemic
stroke/TIA

Critical leg
ischemia
Keluhan klinis (-)
Angina Stabil Kematian
Intermittent claudication Akibat Kardiovaskular

Bertambahnya Umur
ACS, acute coronary syndrome; TIA, transient ischemic attack
Common Blood Vessel Disorders
 Controllable
Risk factors

High blood pressure (hypertension)

High blood cholesterol
Smoking
Obesity
Physical inactivity
Diabetes
Stress
Risk Factors

Gender
Heredity
Age
Uncontrollable

Deteksi dini, Kenali Faktor Resiko !!!

Major Risk Factors :
The Big Three

Hypertension
High cholesterol All three increase risk
factor eight times
Cigarette smoking

AND. we should add LACK OF EXERCISE

Estimated 10-Year CHD Risk in
55-Year-Old Adults According to Levels of Various Risk Factors
Framingham Heart Study

40 37
Estimated 10-Year Rate (%)

35
30 25 27
25 20 Men
20
13 Women
15
8
10 5 5
5
0
A B C D

A B C D
Blood Pressure (mm Hg) 120/80 140/90 140/90 140/90
Total Cholesterol (mg/dL) 200 240 240 240
HDL Cholesterol (mg/dL) 50 50 40 40
Diabetes No No Yes Yes
Cigarettes No No No Yes
mm Hg = millimeters of mercury
mg/dL = milligrams per deciliter of blood
 Symptoms of CHD

Chest pain (angina)

Shortness of breath
Heaviness, tightness, pain,
burning, pressure or squeezing
Behind the breastbone or

in the arms, neck, or jaws

Pain may vary
Perhaps no pain
Mati Mendadak
 Diagnosis of CHD

Electrocardiogram (EKG)
Stress test
Nuclear scanning
Coronary angiography
Treatment for CHD

Lifestyle changes
Medication
Surgery
Lifestyle Changes

Change of habits
Low fat diet
Lower weight
Increase exercise
Stop smoking
 Medication and Surgery
Menghilangkan
keluhan nyeri dada
Stabilisasi tekanan darah

Mengurangi perluasan
kematian otot jantung
Pembukaan sumbatan
bekuan darah pada
pembuluh koroner (reperfusi)

Obat-obatan
Angioplasti koroner dgn balon (PTCA)
Bila keduanya tidak mungkin beda pintas koroner
(CABG)
Tindakan reperfusi yang cepat

- Meminimalkan kerusakan otot jantung

- Memelihara fungsi pompa jantung
Reperfusi optimal : dilakukan dalam 4-6 jam
dari serangan jantung

Jumlah sisa otot jantung yg masih sehat

- Penentu utama kualitas hidup

- Memperpanjang harapan hidup pasca serangan
 KESIMPULAN
Penanganan CVA yang cepat, tepat, dan akurat
akan meminimalkan kecacatan yang
ditimbulkan karena CVA masih merupakan salah
satu pemicu kematian tertinggi di Indonesia.
Pengelolaan CHD dapat dicegah dengan
melakukan pola hidup sehat dan menghindari
faktor resiko. Semakin cepat dilakukan tindakan
reperfusi maka hasil akan lebih baik.
Orang-orang pilihan dari pada kamu adalah siapa yang umurnya lebih panjang
dan budi pekertinya lebih bagus
(Hadist : Riwayat Ahmad dan Al Bazar)

Sekian dan terima kasih