Nursing Care for Patients with Hemorargic Stroke Related to Decubitus Prevention in General Ward of Parepare Hospital

In Indonesia, almost 25% of stroke sufferers are affected by decubitus. Tarrirohan’s research results, et al. (2010) in Alfi Lailatus Zahro Maskun (Wibowo A Dodik et al. 2019). Stroke is the main factor causing serious disability, of which 1530% are hemorrhagic strokes, especially intra cerebral hemorrhage. The condition will lead to a decrease in muscle strength which is a factor related to mobility barrier nursing problems. (Maghfiroh Ervi 2018) But the number of people with stroke under the age of 45 also continues to grow. The World Health Organization predicts that deaths from stroke will increase along with deaths from heart disease and cancer by approximately 6 million in 2010 to 8 million in 2030 (American Heart Association 2018) [1].

A hemorrhagic stroke is a hemorrhage into the brain tissue or subarachnoid hemorrhage, that is, a narrow space between the surface of the brain and the layer of tissue that covers the brain. This stroke is the deadliest type of stroke and constitutes a small part of the overall stroke, which is 10-15% for intra cerebrum in redness and about 5% for subarachnoid hemorrhage (Greece, Amber 2020). Decubitus is the damage or death of skin tissue until the tissue under the skin can even penetrate the muscles until it hits the bone due to continuous suppression of an area which results in disruption of local blood circulation. Decubitus is a chronic wound that occurs in an area that is under pressure on patients who are unable to move in bed or unable to carry out activities independently (Azwar Agoes et al. 2018) [2].

Decubitus is the damage or death of skin tissue until the tissue under the skin can even penetrate the muscles until it hits the bone due to continuous suppression of an area which results in disruption of local blood circulation. Decubitus is a chronic wound that occurs in an area that is under pressure on patients who are unable to move in bed or unable to carry out activities independently (Azwar Agoes et al 2018). Decubitus wounds are cellular necrosis that tends to occur due to prolonged compression of the soft tissues between bone protrusions and dense surfaces, the cause of which is often due to immobility (Faridah 2013). Decubitus is the damage or death of the skin to the tissues under the skin, even penetrating the muscles until it hits the bone due to continuous suppression of an area resulting in disruption of local air circulation. If this lasts for a long time, it can lead to blood flow insufficiency, anoxia or tissue ischemia which can result in death (Huda 2019).

The place where the case study was taken was carried out in the treatment room of A Makkasau Parepare Hospital. The implementation of the study was carried out in April-June 2022. The application of the changes position used was 2 stroke case patients with priority nursing problems of physical mobility barriers by applying positioning every 2 hours with regular bed rest. In this case study, which is used to make it easier for researchers to collect data, includes interviews, observations, documentation and actions for giving the right tilt and left tilt positions to activity patterns. The interview method is carried out to find out the main complaints, the history of the main complaints, and the daily history of the patient’s habits. This is proven in the physical examination which is used as a support for complaints submitted by patients. Observation, for the risk of decubitus injuries, researchers used observation sheets using Norton scores. Documentation is the patient’s personal data which includes name, age, gender, medical record number, and so on. The act of giving a right tilt position on the left side uses an SOP given to the patient’s family to be done every two hours a day [3].

After nursing action for 3 days, it is the act of applying a position every 2 hours with regular bed rest to prevent decubitus. Patient Mrs”M” said she had applied virgin care. Observation is carried out every 3 days, namely by conducting an examination and assessment of the risk of pressure sores experienced by patients. Observation in each patient is carried out up to 3 days of treatment. The area observed is the decomposed area of the bones-the protruding bones, namely the back of the head, sacrum, back, heel and trochanter. The results of observation in patient 1 Mrs”M” on day 3 after the application of positioning every 2 hours obtained were 16 (less likely to occur) and on day 6 the Norton score obtained was 18 (less likely to occur) and no signs of pressure sores were found. Then the results of the observation in patient 2 Mr”H” on day 3 after observation with regular bed rest the Norton score obtained was 11 (likely to occur) and on day 3.

After conducting research on nursing care in stroke patients with the application of providing a good position to prevent the occurrence of decubitus in the Andi makkasau parepare hospital with a total of 2 respondents, namely Mrs”M” and Mr”H”, it was concluded that the nursing actions given were able to overcome the risk of decubitus. In the management of nursing care carried out for 6 days in stroke sufferers in preventing the occurrence of decubitus, this does not result in skin damage to the protruding bone area, namely giving a 2-hour position. The administration of this non-pharmacological therapy can be done to stroke sufferers so that decubitus does not occur. Then the results of observations in patient 2 Mrs”M” on day 3 after observation with regular bed rest the Norton score obtained was 11 (probability of occurring) and on day 6 the Norton score obtained was 13 (less likely to occur) and found erythema or redness on the back where when pressed with the finger the sign of erythema or old redness returned again. The results of the study that the author conducted for 6 days at Andi Makkasau Parepare Hospital can be concluded that giving a good position with the application of the right oblique left oblique position in stroke patients to prevent the occurrence of decubitus has proven to be effective as evidenced by an increase in the Norton assessment score in Mrs”M” patients from a score of 16 to 18, which is a small probability of decubitus. Then in Mr”M” patients who only observed regular bed rest, the Norton assessment score obtained from 11 to 13 was likely to occur and found erythema or redness in the back where when pressed with the finger the sign of erythema or redness long returned again.

This is in accordance with research conducted by Dwi Kriwnawati (2022) on the effect of position changes on the incidence of decubitus in bed rest patients in the room of the Mardi Rahayu Kudus hospital with a large sample of 32 respondents. Nursing interventions are carried out by providing a bedtime transfer program every 2 hours to patients with a decrease in consciousness. Researchers found that obediently shifting interventions every 2 hours were very effective in preventing the incidence of decubitus compared to not being given bed position interventions. Another study was conducted by Umi faridah (2019) on the effect of oblique position on decubitus in stroke patients at Soewondo Starch Hospital which was carried out on 16 patients. The intervention carried out is the administration of an inclined position aimed at reducing the decubitus chastisement experienced by the patient during one week of observation. The results of the study obtained the final observation of the control group who experienced degree 1 decubitus as many as 6 respondents (35.3%), degree 2 decubitus as many as 10 respondents (58.8%) and degree 3 decubitus as many as 1 respondent (5.9%).

i. 1, in patients who were intervened, the application of positioning every 2 hours was less likely to occur decubitus as evidenced by an increase in the Norton assessment score in Mrs”M” patients from a score of 16 to 18, namely there was less chance of decubitus. There are no signs of decubitus in patients 1 Mrs”M”.
ii. Whereas in Mr”H” patients with regular bed rest, the possibility of decubitus with a Norton assessment score obtained from 11 to 13 is likely to occur and signs of decubitus are found, namely erythema or redness in the back where when pressed with the fingers the sign of erythema or old redness returns again.
iii. It is proven that the research conducted by the author on nursing care in stroke patients with the application of good positioning to prevent the occurrence of decubitus in the hospital Andi makkasau parepare by applying positioning every 2 hours is more effective in preventing the occurrence of decubitus in stroke patients who experience physical mobility barriers.

i. It is hoped that nurses can apply nursing care to stroke patients by applying good positioning to prevent decubitus.
ii. It is hoped that the nurse can teach the client and the client’s family about the prevention of decubitus.
iii. Understand and understand the benefits of giving a position every 2 hours for stroke patients both individually, family and community.

1. Gracewati Maylina (2019) Application of the use of anti-decubitus mattresses to overcome damage to the integrity of the skin in stroke patients. Diss Final Project, University of Muhammadiyah Magelang, Indonesia.
2. https://scholar.google.co.id/scholar?hl=id&as_sdt=0%2C5&q=Jurnal+dekubitus&btnG=#d=gs_qabs&t=1655426213072&u=%23p%3DJmfNQLn1Q8wJ
3. https://scholar.google.co.id/scholar?hl=id&as_sdt=0%2C5&q=Jurnal+dekubitus&btnG=#d=gs_qabs&t=1655426092081&u=%23p%3DGazPy75oqT0J