*Alit Suwandewi *University of Muhammadiyah Banjarmasin, South Kalimantan Indonesia

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1 THE EFFECT OF GIVING OXYGENATION WITH SIMPLE OXYGEN MASK AND THE POSITION 30 OF HEAD TOWARD TO CHANGE OF CONSCIOUSNESS LEVELS OF MODERATE HEAD INJURY PATIENTS IN BANJARMASIN ULIN GENERAL HOSPITAL *Alit Suwandewi *University of Muhammadiyah Banjarmasin, South Kalimantan Indonesia ABSTRACT Head injury is directly or indirectly mechanical injuries that resulted wound in the scalp, skull fracture, tear the lining of the brain, and brain damage, and neurological disorders. The basic method for brain protection of head injury patients are freeing the airway and giving adequate oxygenation. Giving oxygenation with simple oxygen mask and position 30 of head are the appropriate action for the moderate head injury classification to launch the cerebral oxygen perfusion and to increase consciousness level. The purpose of this research were to determine the GCS before and after giving oxygenation with simple oxygen mask the and position 30 of head and to analyze the effect of giving oxygenation with simple oxygen mask and position 30 of head to change the levels of consciousness of moderate head injury patients. This research was an quasi experimental study with 30 respondents. The test were used Wilcoxon Test. The results showed that there was an effect of giving oxygenation with simple oxygen mask and position 30 of head toward to change the level of consciousness of moderate head injury patients. GCS average value before was 17,92 and GCS average after value was 14,09 with p value was This is applicative research, so it s need to reflikatif and develop to improve the quality and monitoring of emergency nursing services. Keywords : Simple Oxygen Mask, Position 30 of the Head Levels of Consciousness GCS, Moderate Head Injury I. Introduction A preliminary examination of a patient with a head injury is that the Glasgow coma scale (GCS) is a standardized assessment system used to assess the level of consciousness in patients with impaired consciousness. GCS is a numerical calculation of cognitive, behavioral, and neurological functions. GCS is a standard instrument that can be used to measure the level of awareness of head trauma patients, is one component Which is used as a treatment reference, the basis of general clinical decision-making for patients (Ricard Coton & Michelle 2010). The brain is an organ that is vital to all activities and functions of the body, because in the brain there are various control centers such as physical control, intellectual, emotional, social, and skills. Although the brain is in a closed space and is protected by strong bones but can also be experienced damage. One of the causes of brain damage is the occurrence of trauma or head injury that can lead to damage to the brain structure, so its function can also be disrupted (Black & Hawks, 2009). The brain's oxygen balance is influenced by cerebrospinal blood flow of 15-20% of cardiac output (Black & Hawks,

2 2009). Brain protection is a series of actions performed to prevent or reduce damage to brain cells caused by ischemic state. Brain ischemia is a hemodynamic disorder that will cause a decrease in cerebral blood flow to a level that will cause irreversible brain damage. The basic method of passing brain protection is by freeing the airway and adequate oxygenation (Simon M, Andrew B, Mark CB, 2006). The results of Noor khalilati (2014) study that proper administration of oxygen in head injured patients is by using ordinary masks, as it is more effective in increasing oxygen saturation compared with nasal cannula. According to Summers et al. (2009) to maximize oxygenation requires higher head elevation as it facilitates increased cerebral blood flow, where in the 30º head position there is an increase in cerebral blood flow (CBF). The primary goal of head injury management is to optimize recovery from primary head injury and prevent secondary head injury caused by ischemic brain (Tisdal M, 2008). Management of a good head injury should be initiated from the scene, during transportation, at the emergency department, until difinitive therapy. Proper and proper management will affect patient outcomes. The results of preliminary study conducted by the author on February 2, 2015 in the IGD room Ulin Regional General Hospital Banjarmasin, there is no SOP (Standard Operating Procedure) about handling head injury patients. But the hospital has provided a policy stating that the competent officer to perform or use life saving tools in the ER is one of the paramedics who have been trained and certified to use the tool such as oxygen delivery and position on Head injured patients. It is not yet known whether oxygen delivery through simple masks and 30º head positions provided by nurses can show a change in the level of consciousness in patients with moderate head injury. II. Method This study was an Quasi-Experimental research that is a method that test the hypothesis in the form of causal relationship through manipulation (treatment, intervention, treatment) independent variable, then test the changes caused by the manipulation earlier. The research design used is Pretest-Postest control design. Respondent's measurement begins with pre test, after given treatment / intervention is done back or post test (Ircham, 2013). In this study the intervention was done once that first intervention was done by measuring GCS first, after that was given oxygen through the usual mask and head position 30 then GCS was measured again after 24 hours. A. Instrument The instruments in this study are GCS assessment guides 1. Response open Eyes (Eye Or E), 2. Response Best Motoric (Motoric Or M) 3. Response Verbal Best (Verbal or V) and observation forms, oxygen with a simple mask 6 Liter speed and position of t he head 30º The research was conducted at ICU of Ulin General Hospital Banjarmasin in June 2015 until July The population in this study were all patients whose with moderate head injury. Samples were taken by purposive sampling sample teqhnique were 30 respondents with criteria are: 1. Patients with a moderate head injury diagnosis with GCS 9-12, 2.Patients with SpO2 were less than normal (<95%)

3 B. Data Analysis III. Independent sample t-test, because the data distribution is not normal then the requirement using t-test test is not met then use alternative test Wilcoxon Test with significancelevel α = 0,05 to see difference in group, If result obtained <α then Ho Rejected means there is an effect of simple mask oxygen delivery and a 30 head position on the change of GCS awareness level. Results Characteristics of Respondents Table 1. Distribution of Respondents gender and Age Characteristics Amount 1 Gender a. Man 20 b. Women Age a. <=32 Years 17 b. >32 Years Percentage(%) 66,7 33,3 56,7 43,3 Normality Test of GCS Value Before And After Simplified Oxygen Mask And Head Position 30 Based on Test of Normality Shapiro-Wilk Table 2. Normality test analysis based on Shapiro-Wilk test of normality GCS values before and after simple oxygen mask administration and head position 30 Variables Kolmogorov-Smirnov Shapiro-Wilk GCS Before 0,000 0,000 GCS After 0,001 0,002 GCS Awareness Value Before Simple Mask Giving Simple And Head Position 30 In Medium Head Injury Patients Table 3. Distribution of GCS awareness level values before simple oxygen mask administration with 30º head position Results before delivery Simple oxygen mask With a head position of 30 F % Level Awareness

4 % 30 GCS Awareness Value After Simple Mask Giving Oxygen And Head Position 30 In Medium Headache Patients Table 4. Distribution of GCS awareness levels after simple oxygen mask administration and 30º head position Level Awareness Results after simple oxygen mask administration With a head position of 30 Up Fixed Down f % f % F % Effect of GCS Values Before and After Giving Simple Oxygen Mask Table 5. Results of GCS value analysis before and after oxygen administration of simple mask and head position 30 Variables Mean Rank P value GCS Before ,009 GCS After ,009 IV. Discussion The results of this study obtained the youngest respondent age is 11 years and the oldest 68 years, whereas for the sex of respondents in this study at most is male gender. GCS difference value with age category of less than or equal to 32 years difference of GCS value with total difference of 15 or 50% while distribution of respondent with age category over 32 years difference of GCS value with total difference of 9 or 30%. Evan (1996) in Nasution (2010) which mentions the distribution of head injury cases in men twice as often as women. Other studies also mention the same thing

5 that most 74% of cases of head injury are male (Suparnadi, 2002 in Nasution, 2010). The large number of men in the event of a head injury is closely related to the mobilization of more frequent individuals. After a simple mask oxygen delivery and a 30 head position an increase in GCS value is mean 10 to mean 11.07, Sastrodiningrat (2006) GCS is a strong predictor of prognosis. In the Jannet et al study reported 82% of patients with GCS score of 11 or more, within 24 hours after injury had good outcome or moderately disabled and only 12% died or got severe disability. Outcomes will progressively decrease if the initial GCS score decreases. The main focus of management of patients with head injury is to prevent secondary brain injury. Giving oxygenation and maintaining good blood pressure and adequate for adequate brain perfusion is paramount and especially to prevent and limit the occurrence of secondary brain injury that will ultimately improve the patient's final outcome. This is in accordance with what is described by Patria (2012) that in patients head injury should be given oxygen therapy by using a mask or reservoir mask with a concentration of 40-80% oxygen. Hypoxia is inadequate tissue oxygenation at the tissue level, this condition occurs due to oxygen delivery deficiency or the use of oxygen diular (Potter and Perry, 2005). Oxygenation is the most basic basic human need. The presence of oxygen is one component of gas and vital elements in metabolic processes and to maintain the viability of all body cells (Sulistyo, 2010). Basic human needs according to the theory of Maslow's Hierarchy is a theory that nurses can use to understand the relationship between basic human needs while providing care. Physiological needs are essential for survival, one of which is the need for oxygenation (Potter and Perry 2005). Christopher B, et.al (2012) they concluded that oxygenation of brain tissue is closely related to some outcome parameters and patient prognosis. Application of intervention therapy to keep oxygenation of brain tissue above a certain threshold can Improve mortality and neurological outcome in head injury patients. Head elevation based on physiological responses is a change in position to increase blood flow to the brain and prevent the occurrence of increased ICT. Some clinical nurses perform bedrest acts with head elevation of no more than 30, rationally preventing increased risk of decreased cerebral perfusion pressure and may further worsen cerebral ischemia if vasospasm is present (Anne et al., 2005). V. Conclusion There is effect of oxygen delivery through simple mask and head position 30 to change of consciousness level with p value 0,009 with average GCS value before oxygen delivery intervention through simple mask and head position 30 that is 10 with standard deviation 1,145 and mean of GCS value after done The oxygen delivery intervention through a simple mask and a 30 head position is with a standard deviation of References [1] Anne, et. Al.(2005). Head Down; Flat Positioning 5

6 Improves Blood Flow Velocity in Acut Ischemic Stroke. Journal of American Academy of Neurology. [2] Black.J.M & Hawks. J. H. (2009). Medical- Surgical Nursing : Clinical Management For Positive Outcome. (7 th edition), St Louis, Elsivier Saunders. [3] Christopher B, Karl L, Berk O, Andreas W, and Oliver W. (2012). Brain Tissue Oxygen Monitoring and Hyperoxic Treatment in Patients with Traumatic Brain Injury. In: Journal of Neurotrauma. Mary Ann Liebert; 2012.p [4] Nasution. E.S.(2010). Karakteristik Cedera Kepala Akibat Kecelakaan Lalu Lintas. diakses tanggal 20 Juni [5] Noor Khalilati. (2014). Efektivitas Pemberian Oksigen Melalui Masker Biasa Dibandingkan Dengan Nasal Kanul Dengan Mengukur Saturasi Oksigen (SpO2) Pada Pasien Cedera Kepala Ringan Dan Sedang Di Ruang IGD RSUD Ulin Banjarmasin. Tesis. [6] Patria. (2012). Aplikasi Klinis Terapi Oksigen. EGC. Jakarta. [11] Sulistyo Andarmoyo. (2012). Kebutuhan Dasar Manusia (Oksigenasi). Konsep, Proses dan Praktik Keperawatan. Graha Ilmu. Yogyakarta. [12] Summers,et.al.(2009).Comprehensive overview of Nursing and Interdisciplinary Care of Acute Ischemic Stroke Patient. A Scientific Statement From the American Heart Association full.Diakses pada 26 Agustus 2014 [7] Potter dan Perry.(2005). Buku Ajar Fundamental Keperawatan. Penerbit Buku Kedokteran.EGC. Jakarta. [8] Ricard, et.al.(2010). Journal assessing the Neurological Status of Patients with Head Injuries. [9] Sastrodiningrat AG.(2006). Memahami fakta-fakta pada perdarahan subdural akut. Majalah Kedokteran Nusantara. [10] Simon M, Andrew B, Mark CB. (2006). IntensiveCare, 2nd ed, Elsievier Churcill Livingstone. 6

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