THE RELATIONSHIP BETWEEN INITIAL HANDLING AND BREADTH NEUROLOGICAL DAMAGE TO STROKE PATIENTS

ABSTRACT


INTRODUCTION
Stroke has a high mortality and disability rate.Stroke is the main cause of physical disability in productive age and old age.In developed countries stroke is the number one cause of patient admission to hospital, with a proportion of deaths of 20% in the first 28 days of treatment.According to the World Stroke Organization that 1 in 6 people in the world will experience a stroke in their entire life, while the American Health Association (AHA) data states that every 40 seconds there is 1 new case of stroke with a prevalence of 795,000 new or recurrent stroke patients occurring every year and approximately every 4 minutes there is 1 stroke patient dying (Mutiarasari, 2019).
Stroke is an acute focal and global brain functional disorder due to obstruction of blood flow to the brain due to bleeding or blockage, with symptoms and signs according to the part of the brain affected, which can be completely cured, cured with a disability, or death (Yuanita et al., 2015).Stroke or brain attack is a clinical syndrome whose initial onset is sudden, progressive, rapid, in the form of focal and or global neurological deficits, which lasts 24 hours or more or directly gives rise to death, and is caused solely by non-traumatic cerebral circulatory disorders (Khairunnisa et al., 2014).
According to Smeltzer and Bare (2008), stroke is an abnormality in the functioning of the central nervous system (CNS) caused by impaired normalization of blood flow to the brain.The World Health Organization (WHO) determines that stroke is a clinical syndrome with symptoms in the form of focal or global brain function disorders that can cause death or abnormalities that persist for more than 24 hours, with no other cause except vascular disorders (Ginting et al., 2015).
Stroke is a sudden (acute) neurological emergency due to occlusion or hypoperfusion of the blood vessels of the brain, so that if it is not resolved immediately, cell death will occur within a few minutes, then cause neurological deficits and cause disability or death (Amila et al., 2019).
According to dr.Scientia Inukirana, there are several types of stroke.Ischemic Stroke (Non-Hemorrhagic) is the most common type of stroke, which is about 85% is an ischemic stroke, in which blood flow to the brain is blocked by blood clots or fat deposits called thrombus in the lining of blood vessels (Honestdocs.com, 2019).Ischemic stroke occurs as a result of thrombus or blood clots clogging blood vessels in the brain.Non-hemorrhagic stroke is twice as risky to occur in people with a history of diabetes mellitus due to an unhealthy diet, and lack of physical activity that causes high blood sugar so that the body has difficulty producing insulin and if it lasts a long time it can cause the walls of blood vessels to the brain to become thick so that blood flow is blocked (Krisnawati & Anggiat, 2021).Acute ischemic stroke associated with basilar artery occlusion is known to be associated with high rates of death and disability.Acute ischemic stroke associated with basilar artery occlusion is known to be associated with high rates of death and disability (Ghozy et al., 2022).
Hemorrhagic Stroke occurs as a result of rupture of blood vessels in the brain.Because it breaks, the blood will accumulate and compress the surrounding brain tissue.Hemorrhagic stroke or bleeding occurs as a result of rupture of blood vessels in the brain.Meanwhile, Transient Ischemic Attack (TIA) is a "warning of stroke" or "mini-stroke" or mild stroke resulting in no permanent damage.TIA is an event where the blood supply decreases suddenly in less than five minutes and is temporary.Recognizing and treating TIA immediately may be able to reduce the risk of severe stroke.
According to Feigin in Anggriani et al. (2018), the symptoms of stroke can be physical, psychological, and behavioral.The most characteristic physical symptoms are paralysis, weakness, loss of sensation on the face, arms or legs on one side of the body, difficulty speaking, difficulty swallowing and partial loss of vision on one side.A person is said to have a stroke if any or any combination of the above symptoms lasts for 24 hours or more.The treatment of stroke patients, especially new patients, should be done quickly and precisely.The certainty of determining the type of stroke pathology early is very important for the administration of appropriate drugs to prevent more fatal impacts (Arifianto et al., 2014).
Quoted from Otcdigest.com(2017), the cure or severity of disability is determined by the speed of treatment.There is a "golden period" in which brain cell damage can be minimized, that is, help is carried out a maximum of 4-5 hours after a stroke occurs.According to dr.Farhan in Satria (2021), the Golden time period it is the best time to deal with stroke.If people can achieve this time then the results are better, compared to when treated (or taken to the doctor) after a day, two days, or even after a week of being taken to the hospital, it is too late.
Based on the description above, stroke patients need quick treatment if it is too late, it will be fatal.So researchers are interested in conducting a study with the title "The Relationship Between Initial Treatment and the Extent of Neurological Damage to Stroke Patients."This is a variant of the study conducted by Batubara and Tat (2016), in which they conducted it in Kupang General Hospital while the current research took place in Citra Husada Hospital, Karawang, West Java, Indonesia.

METHOD
The research design chosen in this study is quantitative with a cross sectional approach.This approach is used to measure and observe both variables, namely independent variables and dependent variables at the same time, which is carried out to determine the relationship between the initial treatment of stroke at home and the extent of neurological damage in stroke patients.Cross-sectional design is a research design with the collection of data on more than one case or variable and carried out in one specific time (Anwar, 2020).
Population Sampling was carried out using non probability sampling techniques, a type of total sampling.This technique is also called the non-random sampling technique, which is random research sampling (Supardi, 1993).This research was conducted at Citra Sari Husada Hospital, Karawang.In this study, it used a data collection instrument in the form of a questionnaire.The questionnaire was prepared based on guidelines from the AHA and a validity test was carried out on 30 respondents and only questions whose r-count value > 0.5 were included in the study.
The independent variable in this study is the initial treatment of stroke at home, which is an action that is carried out from the moment the attack occurs until the patient is taken to a health facility.Meanwhile, the dependent variables are neurological damage that occurs and is the result of the researcher's study in the form of motor disorders (paralysis, balance disorders, difficulty forming words, unable to speak, stiff), sensory disorders (loss of taste, visual disturbances, numbness), orientation disorders (time, place, people) and impaired perception and headache & level of consciousness.All this neorological damage is made in 2 categories namely yes and no.Based on the table above, it shows the data of respondents who accompanied the data collection based on gender, occupation, and education categories.Family members who attended the hospital were 9 people or 30% men, and as many as 21 people or 70% women.The respondents' jobs were 3 people or 10% civil servants, as many as 2 people or 6% retired civil servants, as many as 5 people or 17% farmers, as many as 8 people or 27% private, and as many as 12 people or 40% housewife.

RESULT AND DISCUSSION
Then the education of respondents as many as 2 people or 7% did not finish elementary school, as many as 9 people or 30% graduated from elementary school, as many as 3 people or 10% of junior high school graduates, as many as 9 people or 30% of high school graduates, and as many as 7 people or 23% of college graduates.Table 2 shows stroke patient data based on gender, occupation, and education categories.There were 30 stroke patients in the hospital with 16 people or 53% men, and as many as 14 people or 47% women.The work of patients is 5 people or 16% of civil servants, as many as 2 people or 7% of retired civil servants, as many as 4 people or 13% of farmers, as many as 5 people or 17% private, and as many as 14 people or 47% housewives.The education of patients as many as 2 people or 6% did not finish elementary school, as many as 10 people or 32% graduated from elementary school, as many as 4 people or 11% of junior high school graduates, as many as 7 people or 22% of high school graduates, and as many as 9 people or 29% of college graduates.Table 3 shows the relationship between respondents and patients, namely 15 people or 50% wives/husbands, as many as 10 people or 32.5% children/daughters-in-law, and as many as 5 people or 16.5% who are siblings.Table 5 shows the stroke characteristics suffered by patients with stroke types classified based on CT-Scan results.The most common type of stroke is non-hemoragic stroke by 83% Based on the table above, it can be seen that the handling at home is not good at 17 people or 57%, and 13 people or 43% are good.Meanwhile, the patient's medical treatment received medical treatment after 3 hours as many as 19 people or 63%.The most sign of neurological damage experienced by patients is a 60% sense of baal.The patient did not have 77% visual impairment, but felt confused 57%; dizziness 80%, having balance disturbances 83%, stiffness 80%, loss of taste 67%, field of view disturbances 37%, difficulty forming words 53%.The patient could not speak 70%, headache 87%, but did not have a perceptual disorder 77%, and did not have a 93% orientation disorder.Left paralysis is the most 30%.Patients in compos mentis awareness level 87%.Table 8 above shows the relationship of early stroke management with neurological damage.The initial treatment of stroke was related to the stiffness experienced by respondents with a p value (0.042) < α (0.05).The initial treatment of stroke is not related to numbness, visual impairment, dizziness, confusion, balance disturbance, headache, paralysis, loss of taste, impaired field of view, difficulty forming words, unable to speak, impaired perception, impaired orientation and level of consciousness.This is evidenced by a p value greater than 0.05.
There are several risk factors that can facilitate the occurrence of stroke attacks, such as old age, gender (male), low birth weight, hereditary (familial) factors, race (ethnicity), indeed unavoidable or altered (non modifiable risk factor).While other risk factors may still be avoided, treated or corrected (modifiable risk factors) (M.K. Indonesia, 2017).
According to K. K. Indonesia (2013), the early detection of acute stroke attacks, it is carried out using the assessment tool "Immediately to the hospital" which is an asymmetrical smile, movements of limbs that are weakened or cannot be moved suddenly, sounds that are pelo, hoarse, or even disappear, numbness, myopic/visual impairment, and staggering/vertigo/spinning dizziness.
Prevention of stroke according to Handayani et al. (2019) what can be done at home is by exercising regularly, controlling blood pressure and sugar and checking health regularly, avoiding stress, stopping smoking, inet low salt and fat, increasing vegetable and fruit foods, regular control when suffering from chronic diseases such as high blood pressure (hypertension), diabetes (Diabetes Mellitus), high cholesterol, heart disease, and taking medications regularly according to doctor's instructions.

CONCLUSION
Based on the results of the study, it can be concluded that the initial treatment carried out at home by the family is not related to the neurological damage of stroke patients.The initial treatment of stroke was only related to the stiffness experienced by respondents with a p-value (0.042) < α (0.05).Meanwhile, the initial treatment of stroke is not related to feeling bad, visual impairment, dizziness, confusion, balance disturbance, headache, paralysis, loss of taste, impaired

Table 1 .
Characteristics of the patient's family

Table 2 .
Characteristics of Stroke Patients

Table 3 .
Respondents' Relationship with Patients

Table 4 .
Patient's Disease History and Habits

Table 5 .
Types of Strokes According to CT-Scan

Table 6 .
Handling Early Stroke and Hours of Medical Treatment

Table 7 .
Signs of Neurological Damage Experienced by Patients

stiff Paralysis The Relationship Between Initial Handling and Breadth Neurological Damage to Stroke Patients 2632
| I n d o n e s i a n J o u r n a l o f M u l t i d i s c i p l i n a r y S c i e n c e , 2 ( 6 ) , M a r c h , 2023

Table 8 .
The Relationship between Early Treatment of Stroke and Neurological Damage

The Relationship Between Initial Handling and Breadth Neurological Damage to Stroke Patients 2633
| I n d o n e s i a n J o u r n a l o f M u l t i d i s c i p l i n a r y S c i e n c e , 2 ( 6 ) , M a r c h , 2023