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    Diabetic Ulcer

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    mucfhsin
    This document discusses diabetic foot ulcers, including their complexities and management. It notes that foot ulcers in diabetes often progress from ulcer to infection to deep infection and bone infection if not properly treated. It also provides statistics on the prevalence of foot ulcers and lower extremity amputations among people with diabetes. The document outlines best practices for assessment, treatment, and prevention of diabetic foot ulcers.

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    Diabetic Ulcer

    Uploaded by

    mucfhsin
    65 views56 pages
    This document discusses diabetic foot ulcers, including their complexities and management. It notes that foot ulcers in diabetes often progress from ulcer to infection to deep infection and bone infection if not properly treated. It also provides statistics on the prevalence of foot ulcers and lower extremity amputations among people with diabetes. The document outlines best practices for assessment, treatment, and prevention of diabetic foot ulcers.

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    This document discusses diabetic foot ulcers, including their complexities and management. It notes that foot ulcers in diabetes often progress from ulcer to infection to deep infection and bone infection if not properly treated. It also provides statistics on the prevalence of foot ulcers and lower extremity amputations among people with diabetes. The document outlines best practices for assessment, treatment, and prevention of diabetic foot ulcers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    65 views56 pages

    Diabetic Ulcer

    Uploaded by

    mucfhsin
    This document discusses diabetic foot ulcers, including their complexities and management. It notes that foot ulcers in diabetes often progress from ulcer to infection to deep infection and bone infection if not properly treated. It also provides statistics on the prevalence of foot ulcers and lower extremity amputations among people with diabetes. The document outlines best practices for assessment, treatment, and prevention of diabetic foot ulcers.

    Copyright:

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    of 56

    DIABETIC ULCER

    COMPLEXITIES AND MANAGEMENT

    W ocare Center 2018


    TUJUAN PEMBELAJARAN

    TPU TPK
    Peserta mampu melakukan Peserta mampu memahami
    Asuhan Keperawatan Luka
    Asuhan Keperawatan Luka Diabetes:
    KRONIK.
    •  Pengkajian

    •  Analisa Data

    •  Pemeriksaan Penunjang

    •  Implementasi Senam kaki


    dengan koran

    •  Pemetaan kaki dan pemilihan


    alas kaki yang benar
    Calculated

    711.954 DATA LUKA


    Menurut Data Kementrian
    Kesehatan Tahun 2015, angka
    kejadian luka sangat tinggi
    dan diperkirakan terus
    meningkat jumlahnya setiap
    tahun
    *jumlah penduduk Indonesia: 262 juta jiwa;
    Penderita DIABETES (6,9%): 18 juta jiwa;
    Dengan Luka (30%); 5,4 juta jiwa
    66.000 5.423.400
    *Jumlah kanker: (1,4%): 3,68 juta jiwa;
    Penderita KANKER USUS (1,8%): 66 ribu jiwa

    *Jumlah kasus luka tekan diambil dari data


    STROKE: 2,1 juta jiwa; dengan kejadian
    Pressure Injury (33,3%): 711 ribu jiwa
    FAKTA

    Hanya 0,06%
    yang telah di
    tangani oleh
    WOCARE
    DIABETIC FACTS ( IDF 2017 )

    The natural history of a diabetic foot ulcer In most developed


    without medical intervention usually progresses countries, the annual
    from ulcer to infected ulcer to deep infected incidence of foot
    ulcer to osteomyelitis (bone infection) and ends
    in amputation or death. ulceration amongst
    people with
    56% of ulcers become infected and diabetes is about
    1 in 5 of these will require some 2%. In these countries,
    level of amputation. diabetes is the most
    common cause of non-
    Additionally, it has been estimated that 15% of traumatic amputation;
    diabetic foot ulcers result in lower extremity
    amputations and 85% of diabetic patients who approximately 1% of
    undergo lower extremity amputations had an people with diabetes
    ulcer prior to amputation. suffer a lower-limb
    amputation
    The 5-year relative mortality after
    diabetic foot ulcer is 48%, This is
    clearly higher than most cancers
    (breast, lymphoma, etc.).
    IDF, 2017
    DEFINISI
    Luka : gangguan integritas kulit,
    Penyebab : simple/kompleks /
    multi faktor

    Penyebab luka kaki:


    Venous Insufiensi,
    gangguan Arterial dan
    NEUROPHATY
    ULCER
    Neuropati ulcer – hilangnya sensasi
    proteksi (biasa terkait dgn
    Diabetes)
    CHRONIC WOUND
    VASKULAR STATUS ?
    NUTRITIONAL STATUS ?
    GLYCEMIC CONTROL ?
    DEBRIDMENT ?

    APPROPRIATE
    DRESSING ?
    APPROPRIATE OFF
    LOADING ?
    RESOLUTION OF
    INFECTION ?
    Karakteristik luka diabet
    •  Perubahan kondisi kulit
    •  Kedalaman luka bervariasi
    •  Exudat jumlah bervariasi
    •  Edema
    •  Kulit sekitar hangat
    •  Infeksi
    •  Reflek berkurang/kurang sensitif
    •  Gangguan saat berjalan
    •  Periperal pulse teraba
    •  Capilary refill normal
    •  Lokasi biasanya terdapat pada :
    tumit, jari, plantar, phalangeal,
    metatarsal
    Simple Think for DFU
    PRE - ULCER
    ASUHAN 1. WOUND
    KEPERAWATAN ASSESMEN
    T

    6.
    EVALUATI 2.
    ON -
    Monitor &
    NURSING
    Review DIAGNOS
    Your IS
    Progress
    WOUND
    MANAGEME
    NT
    5.
    3.
    IMPLEME
    NURSING
    NTATION
    GOAL
    AND
    CRITERIA
    DOCUME
    S
    NTATION

    4.
    NURSIN
    G PLAN
    PENGKAJIAN
    WOUND MANAGEMENT DIAGNOSTIK

    •  HEAD TO TOE : •  LABORATORIUM :


    KURATIF HEMATOLOGI RUTIN,
    PROTEIN TOTAL
    ATAU ALBUMIN, ELEKTROLIT
    PALIATIF
    •  GULA DARAH
    •  WOUND
    •  LOKASI, LUAS, STAGE •  KULTUR INFEKSI
    •  INFEKSI atau
    KONTAMINASI •  ABPI = USG DOPLER
    •  SUDAH BERAPA LAMA
    •  PENYEBAB LUKA •  X – RAY : OSTEOMYLITIS
    •  BALUTAN SEBELUMNYA
    PEMERIKSAAN BENTUK KAKI :
    FOOT DEFORMITIES
    Pes Covus : Flat foot

    Hammer toes : Claw toes


    FOOT SCREENING
    •  SENSATION (NEUROLOGIC)
    •  Sensation vibration
    •  Temperature
    •  SWME : Semmes Weinstein (10g)
    Monofilament Examination

    •  PULSES (VASCULAR)
    •  Doppler ABPI

    •  FOOT DEFORMITIES
    •  SELF ASSESSMENT
    Pemeriksaan pada kaki

    INSPEKSI / OBSERVASI

    status vaskuler; tanda


    iskemik, kulit pada bagian
    dorsum kaki dan jari-jari,
    pucat, dependent rubor atau
    reaksi hiperemi, kulit tampak
    mengkilat, atrofi, pada
    umumnya adanya luka pada
    bagian superficial.
    Inspeksi adanya maserasi,
    fisura, kalus, area yang
    tertekan, dan deformitas
    Pemeriksaan pada kaki

    Palpasi= femoral, popliteal, dorsal pedis

    Nadi = posterior tibia

    Suhu = perabaan dingin atau hangat


    Pemeriksaan pada kaki
    Pemeriksaan sensori= vibration, monofilaments test, test suhu.
    FOOT RISK CLASSIFICATION SYSTEM,
    Driver et al 2005

    Sensation (-)
    Pulses (-)
    Foot deformities (-) / (+) HIGH RISK

    Sensation (+)
    Pulses (+)
    Foot deformities (+)

    MODERATE
    LOW RISK
    RISK
    Sensation (+)
    Pulses (+)
    Foot deformities (-)
    SOP. PERAWATAN LUKA DIABETIC

    •  Perawatan luka optimal 12 minggu


    •  2 - 4 minggu : WBP
    •  3 minggu : support proliferasi
    •  2 minggu : support epitelisasi
    •  3 minggu : Perbaikan sistemik

    •  Kontrol gula darah ( > 200 konsultasi untuk


    pemberian insulin )

    •  Agresive treatment untuk kontrol infeksi :


    KULTUR dan pemberian AB dan Cilostazol

    •  Support Nutrisi : Pemberian protein


    ( COLAGEN )
    •  Kontrol edema
    •  Pemakaian alas kaki orthopedic
    •  Bed rest / aktivitas sesuai kondisi pasien
    •  Adjunctive treatment
    •  Edukasi
    CHRONIC WOUND : HOLISTIC APPROACH

    SIMPLE MIND MAPPING – WOCARE,2013


    STANDART
    PROTOCOL

    WOUND
    HEALING
    PROCESS
    ADJUNCTIVE
    TRETMENT
    IMPLEMENTASI
    CLEANSING
    PENCUCIAN LUKA
    MECHANICAL: ULTRASOUND cleansing

    24
    MECHANICAL : INFRA RED THERAPY

    • MICROMASSAGE
    • EXERCISING

    25
    PHARMACEUTICAL : OXYGEN ( ozonizes )

    26
    MECHANICAL : ELECTRICAL
    STIMULATION

    27
    Off Loading: TOTAL CONTACT CASTING

    28
    How to
    dress
    infected
    wound
    How to dress
    CASE REPPORT

    Therapeutic Footwear,
    with custom made
    insoles to
    accommodate for any
    formed deformity, to be
    used thereafter.
    CASE : DIABETIC FOOT ULCER HEALED 7 WEEKS
    Case Study : DFU HEALD 2 MONTH
    CASE STUDY : DFU HEALD 3 WEEK
    CASE STUDY : DFU COMPLECATED GAS GANGREN
    HEALD 3 MONTH

    COURTESSY BY IKRAM WOUND CARE MAJENE


    CASE STUDY: DFU HEALD 2 MONTH

    COURTESSY BY IKRAM WOUND CARE MAJENE


    CASE STUDY: DFU HEALD 12 DAYS

    COURTESSY BY IKRAM WOUND CARE MAJENE


    CASE: DFU HEALED 6 WEEKS
    HEALED 6
    WEEKS
    HEALED
    8 WEEKS
    HEALED
    5 WEEKS
    Patient
    education

    about management
    plan and prevention of
    complications
    associated with Charcot
    Neuro-osteoparthropathy.

    Periodic examination is
    required if ulceration or
    deformity occurs and
    should be managed
    accordingly.
    UPAYA PENCEGAHAN

    KAMPANYE STOP AMPUTASI – CEGAH SEJAK


    DINI - LUKA KAKI DIABETES
    THE GOLDENS CARE

    •  Periksa kaki setiap hari


    •  SENAM KAKI

    •  Beri perlindungan EXTRA


    •  PERAWATAN KUKU KAKI
    atau DIABETIC FOOT SPA
    •  MEMAKAI ALAS KAKI
    •  MENGGUNAKAN KAOS
    KAKI DAN SEPATU YANG
    TEPAT
    •  PERIKSA GULA DARAH
    •  STOP MEROKOK
    SELF ASSESSMENT

    Skin lesion check with


    mirror : Xerosis, Challus or
    chorn (hyperkeratotic)

    Between toes

    Pulse

    Inside your shoes


    SENAM KAKI : KORAN
    SENAM KAKI : KARET
    FOOT WEAR EVALUATION

    •  Foot map with size

    •  Kind of shoes

    •  Pressure are
    Mapping your foot

    •  Make your own shoes size

    •  Minimize complications
    Practice : Steps for foot
    mapping
    SEPATU YANG BAIK

    Alas kaki yang lembut dan tebal berfungsi Untuk melindungi


    kaki neurophaty dari terinjak benda tajam. Bentuknya lebar
    sehingga terhindar dari gesekan sepatu yang sempit.
    DIABETIC FOOT SPA :
    PERAWATAN KAKI, POTONG
    KUKU DAN PEMIJATAN KAKI
    LEBIH BAIK MERAWAT KAKI SEBELUM
    TERLAMBAT
    Summary

    PENTING UPAYA PENCEGAHAN


    PERAWATAN LUKA DIABETES : KURATIF
    ATAU PALIATIF

    ADJUNCTIVE TREATMENT MORE EFFECTIVE


    WHEN WE FOUND THE DIFFICULTIES OF
    WOUNDS SUCH AS DIABETIC FOOT ULCER

    THIS ARE THE MODALITIES OF WOUND


    HEALING PROCESS
    Successful treatment

    Pengkajian secara holistik


    sangat memfasilitasi perawat
    dalam melakukan perawatan
    luka.

    Pendokumentasian
    dilakukan untuk memfasilitasi
    komunikasi antar perawat,
    meningkatkan pelayanan yang baik
    dan profesionalisme, serta memenuhi
    standart legal.
    References

    •  Bryant, R (2016). Acute and Chronic Wounds. (3nd ed.).


    St Louis : Mosby Year Book

    •  Carvile, K. (2012). Wound Care Manual. (6th ed.). Perth,


    WA : Silver Chain Foundation.

    •  Doughty, Beckley D, McNichol, Lauwerie L (2016).


    Wound, Ostomy and Continence Nurse Society core
    curriculum. Wound management. Philaedelphia :
    Wolters Kluwe

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