Terminal Care

Terminal Care( Perawatan Terminal )Malisyah Septawati,SKep.,Ns

Terminal CareYaitu perawatan untuk membantu meringankan penderitaan secara fisik ataupun psikologis pada pasien yang tidak dapat disembuhkan atau dalam tahap terminal ( sakaratul maut )Pada penyakit yg belum/tidak dapat disembuhkan dan belum/tidak ada obatnya, kematian tidak dapat dihindari dalam waktu yang bervariasi ( stuart&Sudeen, 1995 )

Terminal CarePenyakit dg stadium lanjut, penyakit utama tidak dpt diobati, bersifat progresif,pengobatan yg diberikan hanya bersifat menghilangkan gejala dan keluhan,memperbaiki kualitas hidup ( tim medis RS Kanker Darmais, 1996 )

Dying ( Sakaratul Maut )Tahap Dying DENIAL - Menyangkal - Terhadap kenyataan mengisolasi diriANGER - Ekspresi kemarahan dan permusuhan - Sikap menyalahkan takdir

Cont..Dying ( Sakaratul Maut )3. BERGAINING - tawar menawar - Hope and want4. DEPRESSION - periode berkabung before death - More crying - No talk

Cont..Dying ( Sakaratul Maut )

5. ACCEPTANCE - pasien relaxs and peace - pasien menantikan tibanya kematian dan mempersiapkan diri menghadapi kematian

Tanda Klinis DYINGSAAT MENDEKATI KEMATIAN - Hilangnya tonus otot gerakan tubuh mulai menurun, penurunan aktivitas GI, Relaksasi otot wajah, sulit berbicara, sulit menelan dan perlahan kehilangan efek muntah

ContTanda Klinis DYING - sirkulasi melemah : sensasi melemah, ekstremitas sianosis, kulit, akral, ujung hidung, ujung telinga teraba dingin. - Perubahan VS Hipotensi, pernafasan irreguler dan melalui mulut, nadi lemah dan lambat.

ContTanda Klinis DYINGKegagalan sensori Blurred ( pandangan kabur & berkabut ) Kegagalan indera penghidu dan perasa.- Tingkat kesadaran bervariasi

2. DEKAT KEMATIAN Dilatasi pupi, tidak bisa bergerak,refleks menghilang, nadi naik kmdn turun, Respirasi Cheyne stokes ( satu satu ), sura nafas stridor dan terdengar kasar, hipotensi

3. KEMATIAN - henti nafas, nadi dan TD - Hilang respon thd stimulus eksternal - Pergerakan otot tidak ada - Enchepalogram ( garis otak ) datar, aktivitas listrik otak terhenti

Problems with terminal carePhysical Problems - Pain - Change of skin - Constipation - Anorexia / Nausea - Alopesia - Weakness of muscle, ect

Cont..Problems with terminal care2. Physicology Problems - High of depend on - Loss of control - Loss of productivities - Disturb in comunication

ContProblems with terminal care3. Social Problems - social isolation - menarik diri

4. Spiritual Problems - Hopelessness - Planning Before dying

Nursing Care PlanAssesment - Knowledge about diagnosa deseases, plan of treatment (medicine) and follow up care - Coping management - Physic and emotional support - Respon of diagnosis

- Responsiblelity of family about diseases - Condition of physic and level of power ( fisik & tk energi ) - Hemodinamic, liquids and nutritional status.

Nursing Diagnosis & InterventionAnxiety r.t Ca diagnosis, change of health conditions and medical intervention.

Intervention : - giving the health education, answer the question, adequate information and explain procedure treatment - Giving motivation to the Patient

- Increased of hopeless - Exploration coping management and giving adaptive coping mecanism - Giving pt to talk about the feel (sadness) and angry

2. Antisipatory of loss r.t change of status ( antisipasi kehilangan b.d perub status peran ) Intervention : - Giving motivation to express the feeling losses - Disscus of coping strategy in the past experince - Giving the privacy, besides in patient, and support emotional - Increased self esteem patient

3. Cronic pain r.t operating effect, radical teraphy and chemoteraphy

Intervention ; - asesment of pain, intensity, duration and objective pain. - giving health education about causa of pain - evaluation effect of pain - Explain to the pt to continuing drug and prevent pain - Doing a pain management

4. Risk infection r.t imunosupressi Intervention : - Monitor sign infection - Prevent pain standart - Cultur microorrganism

5. Imbalance nutrition : less r.t radiasi effect, chemotheraphy, weakness, distress emotional6. Fatique r.t physical and phycology distress 7. Impaired body image r.t performance8. Impaired of integrity skinr.t radiasi effect, chemotherapy, immobility, decrease of nutrition

EVALUATIONPatient can adopt adaptif coping mecanismControl painIntake liquids and adequate nutritionPatient should be partisipation in carring without weakness and fatique