Studi Kasus Identifikasi Status Neurologis pada Pasien Lansia Post Op Craniotomy di Rumah Sakit Srinagarind Khon Kaen University Thailand

Latar Belakang: Lansia merupakan kelompok yang rentan mengalami gangguan neurologis dan memiliki risiko tinggi mengalami komplikasi setelah tindakan craniotomy. Pasien pasca operasi craniotomy memerlukan pemantauan status neurologis secara komprehensif untuk mendeteksi secara dini perubahan kondisi yang dapat mengarah pada komplikasi, seperti peningkatan tekanan intrakranial, edema serebri, maupun gangguan perfusi serebral. Tujuan: Mengidentifikasi status neurologis pada pasien lansia pasca operasi craniotomy di Rumah Sakit Srinagarind Khon Kaen University, Thailand. Metode: Penelitian ini menggunakan desain deskriptif observasional dengan pendekatan studi kasus (case study) pada satu pasien lansia pasca operasi craniotomy. Pengumpulan data dilakukan melalui observasi langsung, dokumentasi rekam medis, dan pengkajian neurologis secara serial menggunakan Glasgow Coma Scale (GCS), pemeriksaan ukuran dan reaksi pupil terhadap cahaya, serta penilaian kekuatan motorik. Hasil: Pada hari pertama pasca operasi, pasien menunjukkan GCS 13 (E3V4M6), pupil isokor 3 mm dengan refleks cahaya positif bilateral, kelemahan ekstremitas kiri, dan kesulitan berbicara. Hari kedua terjadi penurunan status neurologis dengan GCS menjadi 10 (E3V1M6) disertai rasa kantuk, pupil 3 mm pada mata kanan dan 2 mm pada mata kiri yang masih reaktif terhadap cahaya, sedangkan kekuatan motorik tetap. Setelah mendapatkan penatalaksanaan, kondisi neurologis membaik dengan GCS kembali menjadi 13 (E3V4M6) pada hari kelima dan mencapai GCS normal 15 (E4V5M6) pada hari ke-17 hingga hari ke-21. Meskipun demikian, kelemahan motorik ekstremitas kiri masih ditemukan selama masa observasi. Kesimpulan: Identifikasi status neurologis secara serial menggunakan Glasgow Coma Scale, pemeriksaan pupil, dan penilaian kekuatan motorik mampu mendeteksi perubahan kondisi neurologis secara dini pada pasien lansia pasca operasi craniotomy. Pemantauan neurologis yang berkesinambungan berperan penting dalam mengevaluasi perkembangan pasien, mendukung pengambilan keputusan klinis, serta meningkatkan keselamatan dan kualitas asuhan keperawatan.

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Background: The elderly are a group that is vulnerable to neurological disorders and has a high risk of complications after craniotomy. Post-craniotomy patients require comprehensive neurological monitoring to detect early changes in conditions that can lead to complications, such as increased intracranial pressure, cerebral edema, and impaired cerebral perfusion. Objective: To identify the neurological status of elderly patients after craniotomy surgery at Srinagarind Hospital Khon Kaen University, Thailand. Methods: This study used a descriptive observational design with a case study approach in one elderly patient after craniotomy surgery. Data collection was carried out through direct observation, medical record documentation, and serial neurological assessments using the Glasgow Coma Scale (GCS), examination of pupil size and reaction to light, and assessment of motor strength. Results: On the first postoperative day, the patient showed a GCS of 13 (E3V4M6), isochoric pupils of 3 mm with bilateral positive light reflexes, left extremity weakness, and difficulty speaking. On the second day, neurological status decreased, with a GCS score of 10 (E3V1M6), accompanied by drowsiness, a pupil size of 3 mm in the right eye and 2 mm in the left eye that was still reactive to light, while motor strength remained unchanged. After receiving treatment, the neurological condition improved, with the GCS returning to 13 (E3V4M6) on the fifth day and reaching a normal GCS of 15 (E4V5M6) on days 17 to 21. However, motor weakness of the left extremity was still found during the observation period. Conclusion: Serial neurological status identification using the Glasgow Coma Scale, pupil examination, and motor strength assessment can detect early changes in neurological conditions in elderly patients after craniotomy surgery. Continuous neurological monitoring plays a crucial role in evaluating patient progress, supporting clinical decision-making, and improving the safety and quality of nursing care.