Asuhan Keperawatan Gawat Darurat dengan Masalah Perfusi Jaringan Serebral Tidak Efektif pada Klien Cerebrovascular Accident (CVA) Bleeding di RS Siti Khodijah Sepanjang Sidoarjo

Cerebrovascular Accident (CVA) Bleeding merupakan kondisi kegawatdaruratan neurologis yang dapat menyebabkan perdarahan intrakranial, edema serebral, peningkatan tekanan intrakranial dan juga penurunan kesadaran. Kondisi tersebut dapat menyebabkan gangguan perfusi jaringan serebral sehingga memerlukan pemantauan dan penatalaksanaan keperawatan secara sistematis. Penelitian ini bertujuan untuk menggambarkan pelaksanaan asuhan keperawatan gawat darurat pada klien CVA Bleeding dengan masalah perfusi jaringan serebral tidak efektif di RS Siti Khodijah Sepanjang Sidoarjo. Metode yang digunakan adalah deskriptif dengan pendekatan studi kasus. Subjek studi terdiri dari dua pasien, yaitu Ny. H berusia 78 tahun dan Ny. S berusia 70 tahun. Pengumpulan data dilakukan melalui wawancara, observasi, pemeriksaan fisik, dokumentasi dan pemeriksaan penunjang. Proses keperawatan meliputi pengkajian, diagnosis, intervensi, implementasi dan evaluasi. Hasil pengkajian menunjukkan kedua pasien mengalami penurunan kesadaran. Ny. H memiliki GCS E2V1M4, sedangkan Ny. S memiliki GCS E1V1M1 dan mengalami koma. Pemeriksaan CT-Scan menunjukkan ICH lobus parietalis sinistra sekitar 18 cc disertai IVH pada Ny. H, sedangkan Ny. S mengalami ICH berukuran sekitar 3,7 x 4,3 x 4,9 cm disertai edema perifokal. Intervensi difokuskan pada manajemen peningkatan tekanan intrakranial, pemantauan status neurologis dan hemodinamik, pemberian posisi head up 30 derajat, pencegahan kejang, pemantauan intake dan Output, serta kolaborasi terapi. Setelah dilakukan asuhan keperawatan selama tiga hari pada masing-masing pasien, masalah perfusi jaringan serebral tidak efektif belum sepenuhnya teratasi sehingga intervensi dilanjutkan oleh perawat ruangan. Hasil menunjukkan pentingnya pemantauan GCS dan status hemodinamik secara berkelanjutan pada pasien CVA Bleeding. Pemantauan tersebut menjadi dasar evaluasi perubahan kondisi neurologis dan respons pasien terhadap intervensi keperawatan yang diberikan selama perawatan.

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Cerebrovascular Accident (CVA) Bleeding is a neurological emergency that can lead to intracranial hemorrhage, cerebral edema, increased intracranial pressure, and decreased consciousness. This condition can cause impaired cerebral tissue perfusion, necessitating systematic nursing monitoring and management. This study aimed to describe the delivery of emergency nursing care for clients with CVA Bleeding experiencing ineffective cerebral tissue perfusion at RS (hospital) Siti Khodijah Sepanjang, Sidoarjo. A descriptive method with a case study approach was employed. The study subjects consisted of two patients: Mrs. H (78 years old) and Mrs. S (70 years old). Data collection involved interviews, observations, physical examinations, documentation reviews, and diagnostic tests. The nursing process encompassed assessment, diagnosis, intervention, implementation, and evaluation. Assessment results indicated that both patients experienced decreased consciousness. Mrs. H had a Glasgow Coma Scale (GCS) score of E2V1M4, while Mrs. S had a GCS score of E1V1M1 and was in a coma. CT scans revealed an approximately 18 cc left parietal lobe intracerebral hemorrhage (ICH) accompanied by intraventricular hemorrhage (IVH) in Mrs. H, whereas Mrs. S presented with an ICH measuring approximately 3.7 x 4.3 x 4.9 cm accompanied by perifocal edema. Interventions focused on managing increased intracranial pressure, monitoring neurological and hemodynamic status, maintaining a 30-degree head-up position, preventing seizures, monitoring fluid intake and output, and collaborating on therapeutic regimens. After three days of nursing care for each patient, the issue of ineffective cerebral tissue perfusion had not been fully resolved; consequently, interventions were continued by the ward nurses. The results highlight the importance of continuous monitoring of GCS and hemodynamic status in patients with CVA bleeding. Such monitoring serves as the basis for evaluating changes in neurological condition and the patient's response to nursing interventions administered during care.