A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. It can be caused by a blockage (ischemic stroke) or bleeding (hemorrhagic stroke). Risk factors include hypertension, diabetes, atrial fibrillation, smoking, obesity, previous stroke or transient ischemic attack (TIA). Diagnosis involves assessing signs and symptoms followed by brain imaging such as CT scan or MRI. Treatment depends on whether the stroke is ischemic or hemorrhagic and may involve clot-busting drugs, surgery, or managing risk factors to prevent future strokes. Lifestyle changes like quitting smoking, diet, exercise, and medication can help prevent primary

1. NURSING CARE OF STROKE
Dwi Kartika Rukmi
kartikarukmi@ymail.com

2. STROKE PREVALENCE

3. DEFINITION OF STROKE
■ A stroke is caused by the interruption of the blood
supply to the brain, usually because a blood vessel
bursts or is blocked by a clot. This cuts off the supply
of oxygen and nutrients, causing damage to the brain
tissue (WHO, 2016).
■ TIA (Transient Ischaemic Attack) is defined as signs
and symptoms of stroke which resolve within 24
hours with no evidence of infarction on imaging
(RCP, 2012 ).
■ Stroke is different from transient ischaemic attack
(TIA) as its symptoms last longer than 24 hours and it
carries an increased risk of mortality; diagnosis is
supported by evidence of focal infarction or
haemorrhage on imaging. (Puthenpurakal & Crussell,
2017)

4. STROKE DESCRIPTION

8. RISK RELATIVE FACTORS
(Mac Walter &Shirley,2003; Dundas et al,2011)
Modifiable Non Modifiable
•Hipertensi (2,3)
•Diabetes mellitus (2-3)
•Atrial fibrilasi (5)
•Smoking (2)
•Alkohol 30 units/minggu (2,5-4)
•Inaktivitas fisik (0,3-0,5)
•Obesitas (1-2)
•Hyperhomocystenaemia (5-7)
•Malnutrisi (2)
•Serum albumin <42g/l (0,6)
•Usia perdekade (2,2)
•Laki laki (1,4)
•Ischaemic heart attack (2,5)
•Social class (1,6-3,5)
•Peripheral vascular disease (2)
•Previous stroke (9-15)
•Previous TIA (7)
•Ischaemic heart attack (2,5)
•Gagal jantung (2,5-4,4)
•Riwayat keluarga (1,4-2)
•Etnis (masih dalam penelitian)

9. ISCHAEMIC STROKE
PATHOPHYSIOLOGY

10. HEMORRAGHIC STROKE
PATHOPHYSIOLOGY
Stroke Hemorraghic
Haemorrhage
Rupture vessel
Chronically raised
blood
Affect the small
penetrating end-vessel
Degenerative changes
vessel
(Durdas et al,2011; Liebeskind,2015)

11. CLASSIFICATION SYSTEM OF
STROKE
(Simposium Nasional Update Stroke,2016)
Berdasarkan perjalanan klinisnya
■ TIA (Transient Ischemic Attack): gangguan peredaran darah
otak dengan defisit neurologis yang membanik dalam waktu
kurang dari 24 jam
■ RIND (Reversible Ischemic Neurological Deficit): gangguan
peredaran darah otak dengan defisit neurologis yang membaik
lebih dari 24 jam
■ Stroke in evolution: defisit neurologis pada pasien stroke yang
terus berkembang dimana gangguan yang mucul semakin berat
dan memburuk
■ Stroke complete: terjadi defisit neurologis yang menetap dan
permanen pada pasien stroke

12. CLASSIFICATION SYSTEM OF
STROKE
(Bamford et al,1991;Dundas et al,2011)
■ TAC – Total anterior circulation stroke
■ LAC – Lacunar Stroke
■ PAC – Partial anterior circulation stroke
■ POC – Posterior circulation stroke
An Additional code is added as the last letter
■ S – Syndrom: uncertain pathogenesis prior to imaging
■ I – Infarct (ex: TACI)
■ H – Haemorrhage (ex: TACH)

14. CLINICAL SIGNS AND SYMPTOMS
(Puthenpurakal & Crussell, 2017)
■ Clinical features of stroke depend on the
location and extent of brain damage
■ Setiap pasien dapat menunjukkan tanda
dan gejala yang berbeda
■ Perlu pengkajian teliti
■ Tanda dan gejala pada stroke iskemik
maupun hemoragik tidaklah berbeda jauh
à urgent untuk dilakukan brain imaging
segera

17. CLINICAL SIGNS AND SYMPTOMS
(Dundass et al,2011)

19. DIAGNOSIS OF STROKE

20. Score ≥ 1 suggest as stroke, less than 1 is stroke unlikely but not excluded

21. DIAGNOSTIC TEST
■ Patients with suspected acute stroke should receive brain
imaging urgently and no later than one hour after arrival at
hospital.
■ Computed tomography (CT) and magnetic resonance
imaging (MRI) are the two main approaches used for brain
imaging studies in the hospital setting
■ CT can provide static images whereas MRI can deliver
static or dynamic cerebral vascular images results rich in
diagnostic information.
■ MRI is more detail and less radiation than CT scan.
Radiation in CT is higher than MRI.
■ CT scan is preferable because of a lack of MRI equipment,
patients’ fears of the MRI procedure, its high cost, and
contraindications linked to the presence of ferromagnetic
and other metallic substances in patients’ bodies.

24. MANAGEMENT OF ACUTE ISCHEMIC
STROKE
STROKE
THERAPY

30. MANAGEMENT OF ACUTE
HEMORRAGHE STROKE
■ Needs urgent specialist assessment
and monitoring
■ When level of consciousness
deteriorates, patient should be sent for
urgent repeat brain imaging
■ Determine the underlying cause of ICH,
and gives appropriate treatment (eg.
Anticoagulant vs. PCC or Vit K).

31. ■ If BP >150 mmHg six hours after ICH
diagnosed, patient should be given with
hypertensive control.
■ Target is under 140 mmHg for at least 7 days.
■ However, the following circumstances may
preclude BP control:
1. Glasgow Coma Scale score ≤5
2. The haematoma is very large and death is
expected
3. A structural cause for the haematoma has
been identified
4. Immediate surgery to evacuate the
haematoma is planned.

32. MECHANICAL CLOT RETRIEVAL
■ Carotid endarterectomy ■ Carotid Angioplasty

33. DECOMPRESSIVE CRANIECTOMY

34. MANAGEMENT OF TRANSIENT
ISCHEMIC ATTACK
■ Assess immediately include an exploration of the possible
causes of the TIA (one of which is AF) and appropriate
treatment should then be initiated.
■ If haemorrhage is a possibility, brain imaging should be
performed to check whether or not there is bleeding
■ If ischaemic is a possibility, brain imaging no need for cost
effectiveness
■ Give aspirin 300mg immediately (or within 24 hrs), and
clopidogrel 75mg once daily for maintenance antiplatelet
therapy.
■ Statin therapy is also recommended (Simvastatin 40mg ).
■ Educate patient and family about signs and symptoms of stroke

35. PRIMARY STROKE
PREVENTION
■ https://qrisk.org/three/index.php to calculate stroke
risk
■ Patients with hypertension should be treated with
medication to maintain blood pressure of
<140/90mmHg (150/90mmHg for those over the age
of 80).
■ Stop smoking
■ Physical activity can reduce the risk of stroke by up to
30%
■ Healthy and balanced diet

36. ■ Control blood glucose and use statin to reduce stroke
risk in people with type two diabetes
■ Control blood cholesterol, total cholesterol
concentration of more than 9.0mmol/l (or a non high
density lipoprotein cholesterol con- centration of more
than 7.5mmol/l) should be offered a specialist
appointment for an assessment.
■ Alcohol rule: neither men nor women should drink
more than 14 units per week and should abstain from
alcohol for at least two or three days a week
■ The use of aspirin, with its potential gastric side-
effects, as general principle is not recommended in
primary stroke prevention

37. SECONDARY STROKE
PREVENTION
■ Carotid artery assessment
■ Blood pressure management
■ Lipid modification : high intensity
statin
■ Lifestyle management

38. STROKE PREVENTION
AFTER A TIA
Low risk refer to primary prevention, high risk to secondary prevention

39. HEALTH PROMOTION IN NURSING
PRACTICE

40. REFERENSI
■ Dundas,J ., Bennett,B;Slark,J. 2011. Management of Patients with Stroke and Transient Ischaemic Attack .
Neuroscience Nursing Evidence-Based Practice. United Kingdom: Wiley Blackwell
■ Warlow C , Dennis M , van Gijn J et al. ( 2008 ) Stroke: Apractical guide to management . ( 3 rd
edition ). Oxford : Blackwell Publishing .
■ MacWalter RS , Shirley CP ( 2003 ) Managing Strokes and TIAs in Practice . London : Royal
Society of Medicine Press Ltd .
■ Bamford J , Sandercock P , Dennis M et al . ( 1991 ) Classification and natural history of clinically
identifiable subtypes of cerebral infarction . Lancet 22 337 ( 8756 ): 1521 – 1526 .
■ Brodal P ( 2004 ) The Central Nervous System: Structure and function . ( 3 rdedition ). Oxford : Oxford
University Press .
■ National Audit Office ( 2005 ) Reducing Brain Damage: Faster access to better stroke care . London :
The Stationery Office .
■ Simposium Nasional Update Stroke.2014.Manajemen perawatan cedera servikal dan serebrovaskuler.
HIPENI Yogyakarta.
■ Murphy J , Cameron L ( 2005 ) Talking Mats: A resource To enhance communication . Stirling :
University of Stirling .
■ Corcoran N, McCullagh L (2018) Stroke 5: health promotion for primary stroke prevention. Nursing Times
[online]; 115: 3, 53-56
■ Puthenpurakal A, Crussell J (2017) Stroke 1: de nition, burden, risk factors and diagnosis. Nursing Times
[online]; 113: 11, 43-47.
■ Jones P, Jones D (2017) Stroke 2: primary and secondary prevention strategies. Nursing Times [online];
113: 12, 42-46
■ Barclay J, Jones D (2018) Stroke 4: immediate treatment of acute stroke and TIA. Nursing Times [online];
114: 2, 51-54.