AMPUTASI BUKAN PILIHAN

MANAJEMEN LUKA DIABETES ADALAH SOLUSINYA

 Ns. Edy Mulyadi. M. Kep. RN. WOC(ET)N.CHTN
Magister of Nursing, Registerd Nurse, Wound Ostomy Continance
(Enterostomal Therapys)Nurse , Certfied Hypnotharapi Nursing,
edWcare clinik, Sekolah Tinggi Ilmu Kesehatan Cut Nyak Dhien Langsa-Aceh,
embollu_ns@yahoo.co.id
 every

7 seconds
diabetes
someone dies from
= 4,6 mio deaths
 every
20 seconds
someone is amputated
 FAKTA
Hanya 0,06% yang
telah di tangani oleh
WOCARE
The Stairway to amputation
 Complications of Diabetic Foot Ulcers

 DFUs that persist more than 4 weeks have 5-fold higher risk of infection.1
 Development of an infection in a foot ulcer increases the risk for hospitalization 55.7 times and the
risk for amputation 155 times.1
 “Infected neuropathic ulcerations are the leading cause of diabetes-related partial foot amputations
at the Phoenix Indian Medical Center.”2
 Foot ulceration is a significant risk factor for lower-extremity amputation in Native American Indians. 3

Diabetes Neuropathy Foot Ulcer Infection

Amputation

1. Lavery et al. Risk Factors for Foot Infections in Individuals With Diabetes. Diabetes Care. 2006;29:1288-93.
2. Dannels E. Neuropathic foot ulcer prevention in diabetic American Indians with hallux limitus. J Am Podiatr Med Assoc. 1989;79:447-50.
3. Mayfield et al. A foot risk classification system to predict diabetic amputation in Pima Indians. Diabetes Care. 1996;19:704-9.
 The Impact of Amputation
 Not being able to
work as usual
 Body Image
Disturbance
 Suicide
Amputations are a serious predictor of death…
 CHRONIC WOUND

• IS FAILED TO PROGRESS OR RESPOND TO TREATMENT OVER THE NORMAL

EXPECTED OF HEALING TIME FRAME (4 WEEKS) AND BECOME “STUCK” IN THE INFLAMATORY PHASE .
Clinical Guidelines (Nursing)- Royal Children hospital Melbourne
• GENERALLY WOUND DOESN’T START TO HEAL WITHIN 4 WEEKS OR HASN’T HEALED
WITHIN 8 WEEKS
• IS MEAN DELAY WOUND HEALING PROCESS
• THIS IS A SPECIAL CONDITION THAT WE HAVE TO DEAL WITH DIFFICULTIES OF INTERNAL
AND EXTERNAL PROBLEMS

•
AND WE MUST TREAT THE WOUND WITH AN EVIDENCE BASE
PRACTICES
CHRONIC WOUND
• VASKULAR STATUS ?
• NUTRITIONAL STATUS ?
• GLYCEMIC CONTROL ?
• DEBRIDMENT ?

• APPROPRIATE
DRESSING ?
• APPROPRIATE OFF LOADING ?
• RESOLUTION OF
INFECTION ?
BEST
PRACTICE
Balai ASKEP edwcare
Proud to be beneficial for them
Proud to be beneficial for them
OVERVIEW UPDATE

• UNDERSTANDING WOUND HEALING

1 PROCESS

• UNDERSTANDING MOISTURE
2 BALANCE CONCEPT

• UNDERSTANDING WOUND BED

3 PREPARATION
Dr. George Winter

“Healing of Skin Wounds and the

Influence of Dressings on the Repair
Process”

Published ‘Nature’ journal 1971

Case problem : INFECTION

High
Exudate

Normal
Exudate
Case problem :
NON-
INFECTed
 1. WOUND
ASSESMEN
T

6.
EVALUATI 2.
ON - NURSING
Monitor & DIAGNOS
Review Your IS
Progress

WOUND
MANAGEME
NT
5.
IMPLEMEN
3. NURSING
TATION
GOAL
AND
CRITERIAS
DOCUMEN
TATION

4.
NURSIN
G PLAN
 ASSESMENT

 HOLISTIK ASSESMENT
 Wound assessment
 Location
 Stage
 Wound base
 Type of tissue
 Dimention
 Exudates
 Odor
 Wound edge
 Periwound skin
 sign of infection
 wound pain
Plan GUIDELINES

SYSTEMIC
(ANTIBIOTI
EVIDEN C)
CE BASE NUTRITION
DRESSIN AL DIET
G

(AUTOLYSI WOUN ADJUNCTIV

S) D E
DEBRIDME HEALIN TREATMEN
NT T
G
 Multidisciplinary Intervention: PCC
PERAWAT

FISIOTERAPI
DOKTER

PASIEN
ANALIS
APOTEKER

LAINYA AHLI GIZI

 TIME FOR HEALING

MATURATION
Projects Worked On HEALED 80%

PHASE
2 WEEKS

PROLIFERATION
PHASE
3 - 6 WEEKS
WOUND BED
PREPARATION 2 – 4
WEEKS

Time Spent ON 12 WEEKS

2009.
EVIDENCE PRACTISE BASE ON WINNERS SCALE THAT ADOPTED FROM BETES JANSEN SCALE
wound Care Update

Modern wound care

Evidence based on wound management

Old wound care

Traditional wound care
WOUND MANAGEMENT:DRESSING

CONVENTIONAL DRESSING EVIDENCE BASE DRESSING

 DRESSING PROCESS

AUTOLYSIS
MEMPERTAHANKAN DEBRIDMENT :
MEMBUANG
MEMPERC
KELEMBABA JARINGAN EPAT PROSES
N / MOISTURE MATI, BENDA ASING PENYEMBUHN
BALANCE YANG TIDAK LUKA
DIBUTUHKAN TUBUH

4. ABSORB EKSUDATE
5. KONTROL INFEKSI
6. COST EFFECTIVE
 Adjunct Therapies & Dressing

 NPWT Dry • Hydrogel, hydrocoloid,

transparant film
Exudate
 Electrotherapy&
Therapeutic Ultrasound Minimal • Gauze, Hydrogel, hydrocoloid,
calcium alginate
 Electromagnetic Therapy Exudate
Moderate • Ca.alginate, foam
JBI Pressure Ulcers, Management of pressure tissue
damage, Best Practice, 2006 Exudate
Heavy • Foam, hydrofiber
Exudate
IMPLEMEnTATION
CLEANSING
 ULTRASOUND cleansing

Dok. Wocare clinic 32

INFRA RED THERAPY

•MICROMASSAGE
•EXERCISING

33
OXYGEN: ozonizes

34
MECHANICAL : ELECTRICAL STIMULATION

35
Off Loading: TOTAL CONTACT CASTING

36
How to dress
infected wound
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 standar
legal.
Disease patterns In Indonesia

At this time Indonesian experience

exchange infectious diseases to non

infectious such us Diabetes Millitus
But amputation is not achoice
 How to campaign
Promotive and preventive
effort for diabetics
 How to campaign
Wound care training
for nurses
 How to campaign
Wound care services
with moist
wound healing
Good wound care will
provide exeptional result
What do you think???? Should
amputation
Wound care in Edwcare Clinic
Wound care in Edwcare Clinic
Wound care in Edwcare Clinic
Wound care in Edwcare Clinic
 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
Warm Regards,

(Thank you)