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PELATIHAN PERAWATAN PALIATIF PADA STROKE

PELATIHAN PERAWATAN PALIATIF PADA STROKE<br>https://drive.google.com/drive/folders/1-fwcwBSm3MUjgNcyb99D8mEAdNc4KeGQ?usp=sharing

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PELATIHAN PERAWATAN PALIATIF PADA STROKE

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  1. PERAWATAN PALIATIF DAN MASA AKHIR KEHIDUPAN PADA PASIEN STROKE dr. IkaSyamsul Huda MZ, MPH, SpPD Ketua Tim PerawatanPaliatif RSUP dr. Kariadi Semarang

  2. Butterflies are known as a symbol of transformation, hope, life, and spirit. https://www.facebook.com/NHPCO/posts/butterflies-are-known-as-a-symbol-of-transformation-hope-life-and-spirit-hospice/10155750819413907/

  3. WHODefinition of Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. http://www.who.int/cancer/palliative/definition/en/

  4. Quality of Life (QoL) • Kualitashidup (QoL) didefinisikansebagaipersepsiindividutentangposisimerekadalamkehidupandalamkonteksbudaya dan sistemnilai di mana merekahidup dan dalamkaitannyadengantujuan, harapan, standar, dan kekhawatiranmereka. • Iniadalahkonsepluas yang dipengaruhisecarakompleks oleh kesehatanfisikseseorang, keadaanpsikologis, tingkatkemandirian, hubungansosial, dan hubunganmerekadenganciri-cirimenonjoldarilingkunganmereka.

  5. PALLIATIVE CARE IS REQUIRED FOR A WIDE RANGE OF DISEASES http://www.who.int/en/news-room/fact-sheets/detail/palliative-care

  6. Dame Mary Cicely Saunders TOTAL PAIN Total pain recognises pain as being physical, psychological, social and spiritual. INTERDISCIPLINARY TEAMWORK IN PALLIATIVE CARE Hospice care movement Dame Mary Cicely Saunders(22 Juni 1918 - 14 Juli 2005)

  7. PALLIATIVE Palliare(Bahasa Latin) = to cloak, cover jubah, mantel dr. Balfour Mount Born 14 April 1939 Urological surgeon Father of Canada's palliative care movement

  8. TOTAL PAIN

  9. What ISN’T Palliative Care • Palliative Care IS NOT only for actively/imminently dying patients • Palliative Care IS NOT doing nothing • Palliative is never futile • Palliative Care DOES NOT start when curative treatment stops; it is simultaneous along the continuum of care • Palliative Care DOES NOT convince patients to stop treatment • Palliative Care DOES NOT take the place of care by the patient’s personal physician • Palliative Care IS NOT Hospice Care

  10. LINTASAN SAKIT ILLNESS TRAJECTORY Department of Health, Western Australia. Palliative Care Model of Care. Perth: WA Cancer & Palliative Care Network, Department of Health, Western Australian; 2008.

  11. https://csupalliativecare.org/wp-content/uploads/Five-Trajectories-eBook-02.21.2018.pdfhttps://csupalliativecare.org/wp-content/uploads/Five-Trajectories-eBook-02.21.2018.pdf

  12. THE END OF LIFE

  13. People are ‘approaching the end of life’ if they are likely to die within the next 12 months. People “at the end of life” people who are imminently dying and might be in the last few hours or days of life. https://www.dyingmatters.org/sites/default/files/user/10Questions.pdf

  14. Bear in mind that even doctors with long experience tend to over-estimate prognosis.

  15. MODEL PERAWATAN PALIATIF http://www.jpalliativecare.com/articles/2010/16/3/images/IndianJPalliatCare_2010_16_3_107_73639_f1.jpg

  16. INTEGRASI PERAWATAN PALIATIF PALLIATIVE CARE KERJASAMA TIM

  17. TIM PERAWATAN PALIATIF RUMAH SAKIT • Dokter • Perawat • Fisioterapis • Rohaniawan • Pekerjasosial • Farmasis • … Multidisipliner Kolaborasi Koordinatif

  18. Seven principles of the Palliative Care Program: People with a life-threatening illness and their carers and families have information about options for their future care and are actively involved in those decisions in the way that they wish Carers of people with a life-threatening illness are supported by health and community care providers People with a life-threatening illness and their carers and families have care that is underpinned by the palliative approach Source: Stroke care strategy for Victoria https://www2.health.vic.gov.au/Api/downloadmedia/%7B012C7C05-3760-49A2-A19D-391DA710D5A7%7D

  19. Seven principles of the Palliative Care Program: People with a life-threatening illness and their carers and families have access to specialist palliative care services when required People with a life-threatening illness and their carers and families have treatment and care that is coordinated and integrated across all settings People with a life-threatening illness and their carers and families have access to quality services and skilled staff to meet their needs People with a life-threatening illness and their carers and families are supported by their communities. Source: Stroke care strategy for Victoria https://www2.health.vic.gov.au/Api/downloadmedia/%7B012C7C05-3760-49A2-A19D-391DA710D5A7%7D

  20. PALLIATIVE CARE

  21. PROVIDING A PALLIATIVE APPROACH TO CARE

  22. Identify if the patient would benefit from palliative care earlier in their illness trajectory Three triggers that suggest that patients could benefit from a palliative care approach: The Surprise Question: ‘Would you be surprised if the patient were to die in the next year?’ General indicators of decline: deterioration, advanced disease, decreased response to treatment, choice for no further disease modifying treatment. Specific clinical indicatorsrelated to certain conditions.

  23. Tool https://www.spict.org.uk/

  24. NATIONAL INSTITUTES OF HEALTH STROKE SCALE (NIHSS)

  25. ICD-10 Version:2019 https://icd.who.int/browse10/2019/en#/Z51.5

  26. Contoh: • Nontraumatic intracerebral hemorrhage, unspecified • Hemiplegia, unspecified • Hypertension grade 2 • Sepsis due to Staphylococcus aureus • Paliative Care I61.9 G81.9 I10 A41.0 Z51.5

  27. Assess the person’s current and future needs and preferences across all domains of care. Screening Tools • Palliative Performance Scale (PPSv2) • Edmonton Symptom Assessment System (ESAS-r) https://www.ontariopalliativecarenetwork.ca/en/node/31896

  28. www.victoriahospice.org/sites/default/files/pps_english.pdf

  29. PAIN TIREDNESS DROWSINESS NAUSEA LACK OF APPETITE SHORTNESS OF BREATH DEPRESSION ANXIETY WELLBEING OTHER PROBLEM

  30. 11 SYMPTOMS Pain Anorexia Nausea and vomiting Constipation Diarrhoea Dyspnea Fatigue Delirium Depression Anxiety Respiratory tract secretions

  31. Goals of palliative care of stroke • Manage stroke symptoms through medicines and other treatments • Counsel patient and his family on what to expect from disease and treatment • Support the patient for the best quality of life • Improve of quality of life for both patient and his family

  32. Family Meeting INFORMATION BREAKING BAD NEWS FAMILY SUPPORT ADVANCED CARE PLANNING

  33. BREAKING BAD NEWS • PersiapkandanRencanakan • CariTahuApa yang PasiendanKeluargaTahudanIngintahu • DukunganEmosi (Support Mental PasiendanKeluarga) • MembuatRekomendasi • Resolusikonflik

  34. Providing good psychosocial care comes down to good communication skills, both verbal and non‑verbal.

  35. DNR Do-not-resuscitate DNI Do-not-intubate

  36. All people admitted to hospital with Acute stroke should receive: • Swallow screen • modification of diet or institution of NG feeding as appropriate within 48 hours • Hydration Status: Maintain euvolemia. • Assessment of continence • Evaluation of pressure risk • Early mobilisation where appropriate • Occupational therapy and seating assessment • Multidisciplinary assessment and discussion • Assessment of mood • Information meeting with relatives and patient • Source: • https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/stroke-unit-management-care-bundle.pdf

  37. SPIRITUAL CARE Every patient record should demonstrate a record of the patient’s faith tradition (religious affiliation or belief system) or its absence. https://www.nwcscnsenate.nhs.uk/files/4914/0742/3855/Spirituality_Guidelines_-June_2014_FINAL.pdf

  38. MENAHAN DAN MENGHENTIKAN TERAPI MEDIK (TO WITHHOLD AND WITHDRAW = CURING VERSUS CARING) Sesuaiprinsipperawatanpaliatif, tujuanterapipadapasien stadium terminal adalahuntukmencapaikondisinyamandanmeninggalsecarabermartabat. Sehinggaterapi yang diberikanbertujuanuntukmemperpanjangproseskematianharusdihentikandanterapi yang tidaksesuaidengantujuandiatastidakmungkindiberikan.

  39. Anticipatory Medicines ‘Just in Case’ medicines • Pain • Shortness of breath • Sickness/Nausea • Secretions in the throat • Restlessness/agitation

  40. Infus dan InjeksiSubkutan

  41. WITHHOLD & WITHDRAW Tidakmemberikan dan Menghentikan Obat-obatan, Tindakan dan Pemeriksaanmungkinperludipertimbanganuntuktidakdiberikan, dan yang sudahdiberikantidakdiberikanlagi.

  42. When Death Nears: • Sleeping • Loss of Interest in Food and Fluids • Coolness • Changes in Skin Color • Rattling Sounds in the Lungs and Throat • Bladder and Bowel Changes • Disorientation and Restlessness • Surge of Energy • Breathing Pattern Changes

  43. MOTTLED SKIN Mottled skin occurs before death and is a strong indicator that death is imminent.

  44. deprescribing

  45. Palliative sedation In medicine, specifically in end-of-life care, palliative sedation (also known as terminal sedation, continuous deep sedation, or sedation for intractable distress in the dying/of a dying patient) is the palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying patient's life, From Wikipedia

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