Repository Poltekkes Kemenkes Palangka Raya

Nabila, Nasyiatun (2026) Asuhan keperawatan pada pasien stroke hemoragik di Ruang SC RSUD Ulin Banjarmasin. Karya Tulis Ilmiah thesis, Poltekkes Kemenkes Palangka Raya.

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Abstract

Latar Belakang : Stroke hemoragik merupakan kegawatdaruratan neurologis akibat pecahnya pembuluh darah di otak yang dapat menyebabkan penurunan kesadaran, kelumpuhan, hingga kematian. WHO (2023) mencatat stroke sebagai penyebab kematian kedua terbesar di dunia, dengan prevalensi stroke di Indonesia sebesar 10,9 per 1.000 penduduk. Di Ruang Stroke Center RSUD Ulin Banjarmasin tahun 2025 terdapat 74 pasien stroke hemoragik, sehingga diperlukan asuhan keperawatan yang sistematis berdasarkan SDKI, SIKI, dan SLKI. Tujuan : Mendeskripsikan asuhan keperawatan pada pasien stroke hemoragik di Ruang SC RSUD Ulin Banjarmasin meliputi pengkajian, diagnosis, intervensi, implementasi, dan evaluasi berdasarkan SDKI, SIKI, dan SLKI. Metode : Studi kasus deskriptif pada satu pasien laki-laki usia 66 tahun dengan stroke hemoragik post kraniotomi yang dirawat pada 12–14 April 2026. Pengumpulan data dilakukan melalui wawancara, observasi, pemeriksaan fisik, dan studi dokumentasi rekam medis. Hasil : Pengkajian menemukan penurunan kesadaran (GCS 9), hipertensi (175/110 mmHg), hemiparesis dextra (kekuatan otot 2/2), afasia, serta edema serebral pada CT scan. Diagnosis yang ditegakkan adalah Penurunan Kapasitas Adaptif Intrakranial (D.0066), Gangguan Mobilitas Fisik (D.0054), dan Risiko Aspirasi (D.0024). Intervensi meliputi pemantauan tekanan intrakranial, dukungan mobilisasi, dan latihan ROM. Implementasi dilakukan konsisten selama 3 hari berupa monitoring TTV dan GCS, posisi head up 30°, ROM pasif, alih baring tiap 2 jam, dan edukasi keluarga. Evaluasi menunjukkan perbaikan sebagian: GCS meningkat dari 9 menjadi 10, tekanan darah turun menjadi 160/100 mmHg, kekuatan otot ekstremitas kanan meningkat dari skala 2 menjadi skala 3, SpO2 membaik menjadi 98%, serta tidak ditemukan aspirasi, dekubitus, maupun kontraktur. Kesimpulan : Asuhan keperawatan berbasis SDKI, SIKI, dan SLKI menunjukkan kesesuaian yang baik dengan standar dan menghasilkan perbaikan klinis yang bermakna meskipun masalah belum sepenuhnya teratasi dalam 3 hari. Intervensi perlu dilanjutkan dengan pemantauan neurologis yang lebih ketat dan peningkatan frekuensi latihan ROM. Kata Kunci : stroke hemoragik, asuhan keperawatan, SDKI, SIKI, SLKI Background: Hemorrhagic stroke is a neurological emergency caused by the rupture of blood vessels in the brain, which can lead to decreased consciousness, paralysis, and death. WHO (2023) recorded stroke as the second leading cause of death worldwide, with a stroke prevalence of 10.9 per 1,000 population in Indonesia. In the Stroke Center Ward of RSUD Ulin Banjarmasin in 2025, there were 74 hemorrhagic stroke patients, highlighting the need for systematic nursing care based on SDKI, SIKI, and SLKI standards Objective: To describe nursing care for hemorrhagic stroke patients in the SC Ward of RSUD Ulin Banjarmasin, covering assessment, diagnosis, intervention, implementation, and evaluation based on SDKI, SIKI, and SLKI. Method: A descriptive case study of a 66-year-old male patient with post-craniotomy hemorrhagic stroke admitted from April 12–14, 2026. Data were collected through interviews, observation, physical examination, and medical record documentation. Results: Assessment revealed decreased consciousness (GCS 9), hypertension (175/110 mmHg), right-sided hemiparesis (muscle strength 2/2), aphasia, and cerebral edema on CT scan. Nursing diagnoses established were Decreased Intracranial Adaptive Capacity (D.0066), Impaired Physical Mobility (D.0054), and Risk for Aspiration (D.0024). Interventions included intracranial pressure monitoring, mobility support, and range of motion (ROM) exercises. Implementation was carried out consistently over 3 days, comprising vital sign and GCS monitoring, head-up 30° positioning, passive ROM exercises, repositioning every 2 hours, and family education. Evaluation showed partial improvement: GCS increased from 9 to 10, blood pressure decreased to 160/100 mmHg, right-side muscle strength improved from 2 to 3, SpO₂ improved to 98%, and no signs of aspiration, pressure ulcers, or contractures were found. Conclusion: Nursing care based on SDKI, SIKI, and SLKI demonstrated good conformity with standards and produced meaningful clinical improvement, although problems were not fully resolved within 3 days. Interventions should be continued with closer neurological monitoring and increased frequency of ROM exercises. Keywords: hemorrhagic stroke, nursing care, SDKI, SIKI, SLKI

Item Type:	Laporan Tugas Akhir / Karya Tulis Ilmiah / Laporan Praktek Asuhan Kebidanan (stase 9) / Skripsi / Tesis / Disertasi (Karya Tulis Ilmiah)
Uncontrolled Keywords:	stroke hemoragik, asuhan keperawatan, SDKI, SIKI, SLKI
Subjects:	11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111008 Nursing Practical 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111009 Nursing Research 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing
Divisions:	Jurusan Keperawatan > Program Studi Diploma III Keperawatan
Depositing User:	Mahasiswa D3 Keperawatan
Date Deposited:	04 Aug 2026 04:19
Last Modified:	04 Aug 2026 04:19
URI:	http://repo.polkesraya.ac.id/id/eprint/3790

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