Asuhan Keperawatan Penurunan Kapasitas Adaptif Intrakranial (TBI) dengan Terapi Suction dan Ventilator di RSUD Bangil Kabupaten Pasuruan

Abstract

ABSTRAK Pendahuluan : Traumatic Brain Injury (TBI) merupakan kondisi kegawatdaruratan neurologis yang dapat meningkatkan tekanan intrakranial sehingga memicu cedera otak sekunder yang meningkatkan risiko kematian. Penelitian ini bertujuan menganalisis penerapan asuhan keperawatan pada masalah keperawatan penurunan kapasitas adaptif intrakranial melalui terapi suction dan penggunaan ventilator di ICU RSUD Bangil. Deskripsi Kasus : Metode penelitian menggunakan studi kasus pada seorang pasien lansia berinisial Ny. J usia 65 tahun yang mengalami cedera kepala akibat jatuh hingga menimbulkan dugaan hematoma subdural yang meluas ke area subarachnoid. Hasil CT-scan menunjukkan adanya Subarachnoid Hemorrhage (SAH), Intraventricular Hemorrhage (IVH), dan hydrocephalus communicans. Pada pengkajian awal, pasien mengalami penurunan kesadaran dengan GCS 2x2, ICP 18 mmHg, tekanan darah 140/93 mmHg, menggunakan ventilator mode SIMV, serta terpasang External Ventricular Drainage (EVD). Intervensi keperawatan meliputi pemantauan ICP, tanda vital, analisis gas darah, keseimbangan cairan, tindakan suction, pengaturan ventilator untuk mempertahankan PaCO₂ normal, posisi semi Fowler dengan head up 30°, serta kolaborasi pemberian manitol dan sedasi. Setelah intervensi dilakukan, ICP menurun menjadi 15 mmHg dan saturasi oksigen meningkat hingga 99%. Namun, kondisi neurologis pasien terus memburuk akibat luasnya kerusakan otak disertai gangguan koagulasi sehingga pasien meninggal pada hari keempat penelitian. Kesimpulan : Terapi suction dan ventilator mampu mempertahankan oksigenasi serta kestabilan tekanan intrakranial (ICP), tetapi belum mampu mempertahankan kehidupan pasien akibat perdarahan ulang yang disertai gangguan system koagulasi.

ABSTRACT Introduction : Traumatic Brain Injury (TBI) is a neurological emergency that can increase intracranial pressure, thereby triggering secondary brain injury and increasing the risk of death. This study aims to examine the implementation of nursing care for the problem of decreased intracranial adaptive capacity through suctioning and the use of ventilators in the ICU at Bangil Regional General Hospital. Case Description : The research method employed a case study of an elderly patient, Mrs. J, aged 65, who sustained a head injury from a fall, leading to a suspected subdural hematoma extending into the subarachnoid space. CT scan results revealed subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), and communicating hydrocephalus. At the initial assessment, the patient exhibited impaired consciousness with a GCS of 2x2, ICP of 18 mmHg, blood pressure of 140/93 mmHg, was on SIMV ventilator mode, and had an external ventricular drainage (EVD) tube in place. Nursing interventions included monitoring ICP, vital signs, and blood gas analysis; managing fluid balance; performing suctioning; adjusting the ventilator to maintain normal PaCO₂; positioning the patient in a semi-Fowler’s position with the head elevated 30°; and collaborating on the administration of mannitol and sedation. Following these interventions, ICP decreased to 15 mmHg and oxygen saturation increased to 99%. However, the patient’s neurological condition continued to deteriorate due to extensive brain damage accompanied by coagulation disorders, resulting in the patient’s death on the fourth day of the study. Conclusion : Suction and ventilator therapy were able to maintain oxygenation and intracranial pressure (ICP) stability, but were unable to sustain the patient’s life due to the severity of the brain injury and the resulting complications.