Nursing Diagnosis Frequently Enforced by Nurse to Clients with Ischemic Stroke

Authors

  • Nita Arisanti Yulanda Universitas Tanjungpura
  • Kharisma Aji Martadi
  • Anggelisa Larasati
  • Ikbal Fradianto

DOI:

https://doi.org/10.33755/jkk.v8i3.406

Keywords:

Nursing Diagnosis, NANDA, Ischemic Stroke

Abstract

Aims : This study is to find out the most diagnoses in stroke patients so that they can arrange appropriate interventions.

Design: This study is a retrospective study using the descriptive anaysis.

Methods :. The population of this study were all medical records of patients with stroke in 2018 - 2019 in Installation of Tanjungpura University Hospital. The study sample was selected using a purposive sampling method with inclusion criteria, namely patients with ischemic stroke, active patients undergoing outpatient care. The number of samples used was 100 medical record documents of stroke patients. The method of data collection is carried out by checklist instrument.

Results : The results of the study were 6 nursing diagnoses that were often enforced by nurses in ischemic stroke patients, namely nursing diagnoses of . Impaired physical mobility ( 59 %), acute pain ( 24%), activity intolerance ( 7%), risk for ineffective cerebral tissue perfusion (5%), impaired verbal communication (3%) and impaired skin integrity (2%). However, of the 6 diagnoses, there were 2 nursing diagnoses written that were not in accordance with the labels on the 2015-2017 NANDA, however namely impaired skin integrity (100%) and impaired verbal communication (46%).

Conclusions : It is recommended to increase the socialization of nursing diagnoses so that nurses write a diagnosis according to the diagnosis label used as a reference for writing documentation.

References

Liebeskind DS, Cotsonis GA, Saver JL, Lynn MJ, Turan TN, Cloft HJ, et al. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol. 2011 Jun;69(6):963–74.

American Heart Association I. Explaining Stroke. American Stroke Association (ASA). 2013.

Feigin VL, Krishnamurthi R V., Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology. 2015;45(3):161–76.

Development Heath Research and Agency Ministry of the Republic of Indonesia. Basic Health Research (Riskesdas). 2013.

Malhotra K, Liebeskind DS. Collaterals in ischemic stroke. Brain Hemorrhages. 2020 Mar;1(1):6–12.

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med. 2015 Mar;372(11):1019–30.

Liu L, Ding J, Leng X, Pu Y, Huang L-A, Xu A, et al. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke Vasc Neurol. 2018 Sep;3(3):117–30.

Sari SH, Agianto A, Wahid A. Batasan Karakteristik Dan Faktor Yang Berhubungan (Etiologi) Diagnosa Keperawatan: Hambatan Mobilitas Fisik Pada Pasien Stroke. Dunia Keperawatan. J Keperawatan dan Kesehat Masy. 2015;3(1):12–21.

Siokal B. Analisis Kesesuaian Penggunaan Diagnosis Keperawatan, Tujuan dan Intervensi Dengan Nanda, Noc dan Nic Pada Pasien Stroke di RSUD Syekh Yusuf Gowa. Muslim Community Heal. 2021;2(3).

Suwarto T, Yulisetyaningrum. Analisis Kesesuaian Penggunaan Diagnosa Keperawatan, Tujuan Dan Intervensi Dengan Nanda, Noc Dan Nic. In: The 4th Univesity Research Coloquium. 2016.

Indonesian Ministry of Health. InfoDatin: Situation of Indonesian Nursing Personnel. Jakarta: Data and Information Center; 2017.

Félix ND de C, Ramos N de M, Nascimento MNR, Moreira TMM, Oliveira CJ de. Nursing diagnoses from ICNP® for people with metabolic syndrome. Rev Bras Enferm. 2018;71(suppl 1):467–74.

Carpenito L, J M. Nursing Diagnoses Application to Clinical Practice. 13th ed. Philadelphia: Lippincot Williams & Wilkins; 2010.

Nurjannah. ISDA Intan’s Screening Diagnoses Assessment. Yogyakarta: Mocomedia; 2010.

Herdman TH. NANDA International Nursing Diagnoses. 11th ed. Jakarta: EGC; 2017.

Yasmara D. Medical-surgical nursing care plan: Nanda-1 diagnosis 2015-2017 NIC intervention results NOC. Jakarta: Medical Books; 2016.

Irdawati. Motion Exercises to Balance Stroke Patients. Kesmas. 2012;7(2):134–41.

Pradana AA. The relationship between the type of stroke and the length of stay in the hospital. Yogyakarta: University of Muhammadiyah Yogyakarta; 2016.

Rahmi U. The Effect of Structured Discharge Planning on the Quality of Life of Schemic Stroke Patients at AL Ihsan Hospital and Al Islam Hospital Bandung. University of Indonesia; 2011.

Ginsberg L. Lecture Notes Neurology. Jakarta: Erlangga; 2008.

Cisler JM, Bush K, Scott Steele J, Lenow JK, Smitherman S, Kilts CD. Brain and behavioral evidence for altered social learning mechanisms among women with assault-related posttraumatic stress disorder. J Psychiatr Res. 2015 Apr;63:75–83.

Sheerwood, Lauralee. Human Physiology. Jakarta: EGC; 2001.

Ignatavicius, D. & Workman L. Medical-Surgical Nursing: Patient-Centered Collaborative Care. Missouri: Saunders Elseviers; 2010.

Carpenito L, J M. Nursing Diagnoses Application to Clinical Practice. Lippincot Williams & Wilkins, editor. Philadelphia; 2013.

Nurjannah I, Siwi SM. Guidelines for analysis on measuring interrater reliability of nursing outcome classification. Int J Res Med Sci. 2017 Mar;5(4):1169.

Downloads

Published

2022-11-02

How to Cite

Yulanda, N. A. ., Martadi, K. A. ., Larasati, A. ., & Fradianto, I. . (2022). Nursing Diagnosis Frequently Enforced by Nurse to Clients with Ischemic Stroke . Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 8(3). https://doi.org/10.33755/jkk.v8i3.406