Terminal Care

Terminal CareTerminal Care( Perawatan ( Perawatan Terminal )Terminal )

Tri Amin Lestari,SKep.,NsTri Amin Lestari,SKep.,Ns

Terminal CareTerminal Care

Yaitu perawatan untuk membantu Yaitu perawatan untuk membantu meringankan penderitaan secara fisik meringankan penderitaan secara fisik ataupun psikologis pada pasien yang tidak ataupun psikologis pada pasien yang tidak dapat disembuhkan atau dalam tahap dapat disembuhkan atau dalam tahap terminal ( sakaratul maut )terminal ( sakaratul maut )

Pada penyakit yg belum/tidak dapat Pada penyakit yg belum/tidak dapat disembuhkan dan belum/tidak ada disembuhkan dan belum/tidak ada obatnya, kematian tidak dapat dihindari obatnya, kematian tidak dapat dihindari dalam waktu yang bervariasi dalam waktu yang bervariasi ( stuart&Sudeen, 1995 )( stuart&Sudeen, 1995 )

Terminal CareTerminal Care

Penyakit dg stadium lanjut, penyakit Penyakit dg stadium lanjut, penyakit utama tidak dpt diobati, bersifat utama tidak dpt diobati, bersifat progresif,pengobatan yg diberikan progresif,pengobatan yg diberikan hanya bersifat menghilangkan gejala hanya bersifat menghilangkan gejala dan keluhan,memperbaiki kualitas dan keluhan,memperbaiki kualitas hidup hidup

( tim medis RS Kanker Darmais, ( tim medis RS Kanker Darmais, 1996 )1996 )

Dying ( Sakaratul Maut )Dying ( Sakaratul Maut )

Tahap Dying Tahap Dying

1.1. DENIALDENIAL

- Menyangkal- Menyangkal

- Terhadap kenyataan mengisolasi diri- Terhadap kenyataan mengisolasi diri

2.2. ANGERANGER

- Ekspresi kemarahan dan - Ekspresi kemarahan dan permusuhanpermusuhan

- Sikap menyalahkan takdir- Sikap menyalahkan takdir

Cont………..Dying ( Sakaratul Cont………..Dying ( Sakaratul Maut )Maut )

3. 3. BERGAININGBERGAINING

- tawar menawar- tawar menawar

- “Hope and want”- “Hope and want”

4. DEPRESSION4. DEPRESSION

- periode berkabung - periode berkabung before death before death

- More crying- More crying

- No talk- No talk

Cont………..Dying ( Sakaratul Maut )Cont………..Dying ( Sakaratul Maut )

5. 5. ACCEPTANCEACCEPTANCE

- pasien - pasien relaxs and peacerelaxs and peace

- - pasien menantikan tibanya kematian pasien menantikan tibanya kematian dan mempersiapkan diri dan mempersiapkan diri menghadapi kematianmenghadapi kematian

Tanda Klinis DYINGTanda Klinis DYING

1.1. SAAT MENDEKATI KEMATIANSAAT MENDEKATI KEMATIAN

- Hilangnya tonus otot- Hilangnya tonus otot

gerakan tubuh mulai menurun, gerakan tubuh mulai menurun, penurunan aktivitas GI, Relaksasi penurunan aktivitas GI, Relaksasi otot wajah, sulit berbicara, sulit otot wajah, sulit berbicara, sulit menelan dan perlahan kehilangan menelan dan perlahan kehilangan efek muntahefek muntah

Cont…Tanda Klinis DYINGCont…Tanda Klinis DYING

- - sirkulasi melemah :sirkulasi melemah :

sensasi melemah, ekstremitas sensasi melemah, ekstremitas sianosis, kulit, akral, ujung hidung, sianosis, kulit, akral, ujung hidung, ujung telinga teraba dingin.ujung telinga teraba dingin.

- Perubahan VS- Perubahan VS

Hipotensi, pernafasan irreguler dan Hipotensi, pernafasan irreguler dan melalui mulut, nadi lemah dan melalui mulut, nadi lemah dan lambat.lambat.

Cont…Tanda Klinis DYINGCont…Tanda Klinis DYING

- Kegagalan sensoriKegagalan sensori

Blurred ( pandangan kabur & Blurred ( pandangan kabur & berkabut )berkabut )

Kegagalan indera penghidu Kegagalan indera penghidu dan perasa.dan perasa.

- Tingkat kesadaran bervariasi- Tingkat kesadaran bervariasi

2. 2. DEKAT KEMATIANDEKAT KEMATIAN

Dilatasi pupi, tidak bisa Dilatasi pupi, tidak bisa bergerak,refleks menghilang, nadi bergerak,refleks menghilang, nadi naik kmdn turun, Respirasi Cheyne naik kmdn turun, Respirasi Cheyne stokes stokes

( satu satu ), sura nafas stridor dan ( satu satu ), sura nafas stridor dan terdengar kasar, hipotensiterdengar kasar, hipotensi

33. KEMATIAN. KEMATIAN

- henti nafas, nadi dan TD- henti nafas, nadi dan TD

- Hilang respon thd stimulus - Hilang respon thd stimulus eksternaleksternal

- Pergerakan otot tidak ada- Pergerakan otot tidak ada

- Enchepalogram ( garis otak ) - Enchepalogram ( garis otak ) datar, datar,

aktivitas listrik otak terhentiaktivitas listrik otak terhenti

Problems with terminal Problems with terminal carecare

1.1. Physical ProblemsPhysical Problems

- Pain- Pain

- Change of skin- Change of skin

- Constipation- Constipation

- Anorexia / Nausea- Anorexia / Nausea

- Alopesia- Alopesia

- Weakness of muscle, - Weakness of muscle, ectect

Cont…..Problems with terminal careCont…..Problems with terminal care

2.2. Physicology ProblemsPhysicology Problems

- High of depend on- High of depend on

- Loss of control- Loss of control

- Loss of productivities- Loss of productivities

- Disturb in comunication- Disturb in comunication

Cont…Problems with terminal Cont…Problems with terminal carecare

3. 3. Social ProblemsSocial Problems

- social isolation- social isolation

- menarik diri- menarik diri

4. Spiritual Problems4. Spiritual Problems

- Hopelessness- Hopelessness

- Planning Before dying - Planning Before dying

Nursing Care PlanNursing Care Plan

1.1. AssesmentAssesment

- Knowledge of K about diagnosa - Knowledge of K about diagnosa deseases, plan of treatment (medicine) deseases, plan of treatment (medicine) and follow up careand follow up care

- Coping management- Coping management

- Physic and emotional support- Physic and emotional support

- Respon of diagnosis- Respon of diagnosis

- - Responsiblelity of family about Responsiblelity of family about diseasesdiseases

- Condition of physic and level of power - Condition of physic and level of power

( fisik & tk energi )( fisik & tk energi )

- Hemodinamic, liquids and nutritional - Hemodinamic, liquids and nutritional

status.status.

Nursing Diagnosis & Nursing Diagnosis & InterventionIntervention

1.1. Anxiety r.t Ca diagnosis, change of Anxiety r.t Ca diagnosis, change of health conditions and medical health conditions and medical intervention.intervention.

Intervention :Intervention :

- giving the health education, answer - giving the health education, answer

the question, adequate information the question, adequate information

and explain procedure treatmentand explain procedure treatment

- Giving motivation to the Patient - Giving motivation to the Patient

- - Increased of hopelessIncreased of hopeless

- Exploration coping management - Exploration coping management and and

giving adaptive coping mecanismgiving adaptive coping mecanism

- Giving pt to talk about the feel - Giving pt to talk about the feel

(sadness) and angry(sadness) and angry

2. 2. Antisipatory of loss r.t change of statusAntisipatory of loss r.t change of status ( antisipasi kehilangan b.d perub status peran )( antisipasi kehilangan b.d perub status peran )

Intervention :Intervention : - - Giving motivation to express the Giving motivation to express the feeling lossesfeeling losses - Disscus of coping strategy in the past - Disscus of coping strategy in the past experince experince - Giving the privacy, besides in patient, and - Giving the privacy, besides in patient, and support emotionalsupport emotional - Increased self esteem patient- Increased self esteem patient

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

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

4. 4. Risk infection r.t Risk infection r.t imunosupressiimunosupressi

Intervention : Intervention :

- Monitor sign infection- Monitor sign infection

- Prevent pain standart- Prevent pain standart

- Cultur microorrganism- Cultur microorrganism

5. 5. Imbalance nutrition : less r.t radiasi effect, Imbalance nutrition : less r.t radiasi effect,

chemotheraphy, weakness, distress chemotheraphy, weakness, distress

emotionalemotional

6. Fatique r.t physical and phycology 6. Fatique r.t physical and phycology

distress distress

7. Impaired body image r.t performance7. Impaired body image r.t performance

8. Impaired of integrity skinr.t radiasi effect, 8. Impaired of integrity skinr.t radiasi effect, chemotherapy, immobility, decrease of chemotherapy, immobility, decrease of nutritionnutrition

EVALUATIONEVALUATION

1.1. Patient can adopt adaptif coping Patient can adopt adaptif coping mecanismmecanism

2.2. Control painControl pain

3.3. Intake liquids and adequate Intake liquids and adequate nutritionnutrition

4.4. Patient should be partisipation in Patient should be partisipation in carring without weakness and carring without weakness and fatiquefatique

Thanks for your Thanks for your attentions………..attentions………..

good luck and God blessing good luck and God blessing youyou

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