c4ca4238a0b923820dcc509a6f75849b-Panduan Geriatri Fix
July 3, 2019 | Author: gareth | Category: N/A
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iii
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KATA PENGANTAR
Indonesia menempatkan para lanjut usia (lansia) pada posisi yang dihormati, bukan saja karena nilai-nilai budaya yang hidup dan berkembang
di
masyarakat,
tetapi
tergolongdalamkelompokyang
rentan.
berupa
dan
pemberian
fasilitas
juga
karena
Penghormatan
pelayanan
tersebut
khusus
lansia dapat
dalamrangka
perlindungan dan pemenuhan hak-hak mereka sebagaimana diatur dalamPasal8 UU Nomor 39 Tahun 1999. Salah satu wujudnyaadalah tersedianya fasilitas danpelayanan khusus di rumah sakitberupa kursi roda, lift khusus, toilet, jalan/akses bagi lansia yang bertongkat, tangga, fasilitas lain, dan layanan khusus berupa “Pelayanan Geriatri”. Geriatri”. Buku Panduan Pelayanan Geriatri RSUD Pesanggrahan ini diharapkan dapat bermanfaat dalam rangka perlindungan dan pemenuhan hak-hak para lansia. Kami tidak mungkin lepas dari khilaf dan salah, untuk itu kritik dan saran sangat kami harapkan untuk penyempurnaan buku ini.
Jakarta, Januari 2019
Penyusun
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DAFTAR ISI
HALAMAN JUDUL ..................................................................................... i SK DIREKTUR TENTANG PEMBERLAKUAN BUKU PANDUAN
PELAYANAN GERIATRI...........................................................................
ii
KATA PENGANTAR ................................................................................ iv
DAFTAR ISI ..................................... ......................................................... ........................................ ...................................... ..................
v
PENDAHULUAN ................................. ............................................................ ..................................... ..........
1
BAB I.
A. LATAR BELAKANG ............................................................ 1 B. TUJUAN.............................................................................. 1 C. PENGERTIAN ....................................................................
2
BAB II. II.
RUANG LINGKUP ..................................... ......................................................... ............................... ...........
4
BAB III.
TATALAKSANA ................................... ....................................................... .................................... ................
5
A. PELAYANAN GERIATRI ....................................................
4
1. Batasan Pelayanan ............................................ ...................................................... .......... 4 2. Alur 2. Alur Pelayanan Pelayanan Geriatri ............................. ................................................ ................... 5 B. Pelayanan Geriatri di RSUD Pesanggrahan Pesanggrahan 1. Jenis Pelayanan Geriatri .............................................. .............................................. 6 ........................ .................... .................... .................... ............ 2. Assesment Geriatri ..............
9
............... 9 3. Yang perlu Mendapatkan Pelayanan Geriatri ...............
4. Prinsip-Prinsip Pelayanan Geriatri .............................. 10 5. Kriteria Pelayanan Lansia........................................... 10 6. Tata Laksana Assesment Lansia ........................ ....... 10 7. Tujuan Assesment Usia Lanjut ................. .................. .............. .... 10 8. Proses Assesment Usia Lanjut ................................... 11 C. GERIATRIC GIANTS ..................... ........................ ........... 11 1. Sindroma Serebral ..................................................... 11 2. Konfusio dan Dimentia ............................................... 12 3. Gangguan Otonom ..................................................... 13
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6. Kelainan pada Tulang Belakang ............................................ 16 7. Dekubitus .......................................................................................... 16 BAB IV.
DOKUMENTASI ............................................................................................. 19
DAFTAR PUSTAKA ...................................................... .................................................... 20
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BAB I PENDAHULUAN
A. LATAR BELAKANG Indonesia menempatkan para lanjut usia (lansia) pada posisi yang dihormati, bukan saja karena nilai -nilai budaya yang hidup dan berkembang
di
masyarakat,
tergolongdalamkelompokyang dapat
berupa
pemberian
tetapi
rentan. fasilitas
juga
karena
Penghormatan dan
pelayanan
lansia tersebut khusus
dalamrangka perlindungan dan pemenuhan hak-hak mereka sebagaimana diatur dalam Pasal8 UU Nomor 39 Tahun 1999. Salah satu wujudnya adalah tersedianya fasilitas dan pelayanan khusus di rumah sakit berupa kursi roda, lift khusus, toilet, jalan/akses bagi lansia yang bertongkat, tangga, fasilitas lain, dan layanan khusus berupa “Pelayanan Geriatri”. Geriatri”. Data menunjukkan, jumlah lansia di Indonesia, baik itu di pedesaan maupun di perkotaan terus meningkat. Berdasarkan jenis kelaminnya, jumlah lansia perempuan ± 9,5 juta lebih banyak dibanding lansia laki-laki ± 8,2 juta.Penyebabnya adalah angka harapan hidup perempuan lebih tinggi jika dibanding dengan angka harapan hidup laki-laki. Keberhasilan
pembangunan
di
bidang
kependudukan,
pendidikan, kesehatan, dan program-program terkait, berdampak pada menurunnya angka kelahiran dan meningkatnya usia harapan hidup. Peningkatan usia lanjut sering disertai dengan meningkatnya berbagai penyakit dan ketidakmampuan (disability ( disability ), ), sehingga diperlukan perawatan dan pengobatan dengan waktu yang cukup lama, sedangkan fasilitas dan pelayanan kesehatan bagi lansia di rumah sakit masih sangat kurang.
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B. TUJUAN Panduan Pelayanan Geriatri disusun agar adastandar pelayanan kesehatan bagi lansia yang populasinya sudah semakin meningkat, yaitu : 1. Mempertahankan derajat kesehatan para lansiapada taraf yang setinggi-tingginya, sehingga terhindar dari penyakit atau gangguan kesehatan; 2. Memelihara kesehatan kesehatan melalui aktivitas fisik dan mental; 3. Merangsang para petugas kesehatan kesehatan (dokter, perawat) untuk dapat mengenal dan menegakkan diagnosa yang tepat dan dini, bila dijumpai suatu kelainan; 4. Mencari upaya semaksimal mungkin, agar para lansia yang menderita
penyakit
atau
gangguan
kesehatan,
dapat
mempertahankan kebebasan yang maksimal tanpa perlu suatu pertolongan (memelihara kemandirian secara maksimal); 5. Bila para lansia sudah sampai stadium terminal/penyakit atau gangguan kesehatan sudah tidak dapat disembuhkan, ilmu ini mengajarkan untuk tetap memberikan bantuan yang simpatik dan perawatan dengan penuh pengertian, (dalam akhir hidupnya memberikan bantuan moril dan perhatian yang maksimal, sehingga kematiannya berlangsung dengan tenang); 6. Memberdayakan kemandirian penderita dalam waktu lama dan mencegah disabilitas-handicap disabilitas-handicap diwaktu mendatang. Sifat dari
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2. Pasien Geriatri:orang tua berusia diatas 60 tahun yang memiliki penyakit lebih dari 2 (dua)/majemuk/multipatologi akibat gangguan fungsi jasmani dan rohani, dan atau kondisi sosial yang bermasalah. 3. Konsep/pengertian secara secara bertingkat dari mundurnya kemandirian kemandirian lansia yaitu : a. Hambatan
(impairment )
adalah
setiap
kehilangan
atau
kelainan,baik psikologik,fisiologik,maupun struktur atau fungsi anatomik; b. Disabilitas adalah semua restriksi atau kekurangan dalam kemampuan untuk melakukan kegiatan yang dianggap dapat dilakukan oleh orang normal. c. Handicap adalah ketidakmampuan seseorang sebagai akibat impairment /disabilitas /disabilitas
sehingga
membatasinya
untuk
melaksanakan peranan hidup secara normal (berhubungan erat dengan usia,jenis kelamin, dan faktor-faktor sosial budaya); 4. Asesmen Geriatri adalah suatu proses pendekatan multidisiplin untuk menilai aspek medik, fungsional, psikososial, dan ekonomi penderita usia lanjut dalam rangka menyusun program pengobatan dan pemeliharaan kesehatan yang rasional. 5. Tim Geriatri adalah suatu tim multidisipliner yang bekerja secara multidisipliner, interdisiplin untuk menangani masalah kesehatan usia lanjut.Tim ini minimal terdiri atas dokter geriatris atau
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BAB II RUANG LINGKUP
Ruang Lingkup Pelayanan Geriatri di RSUD Pesanggrahan meliputi : 1. Dokter Spesialis Penyakit Dalam 2. Dokter Spesialis Penyakit Bedah 3. Dokter Spesialis penyakit Mata 4. Dokter Spesialis Penyakit Syaraf 5. Dokter Spesialis Penyakit THT 6. Dokter Spesialis Penyakit Mata 7. Dokter Spesialis Obsgyn 8. Instalasi Rawat Jalan 9. Fisioterapi
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BAB III TATALAKSANA
A. PELAYANAN GERIATRI 1. Batasan Pelayanan Pelayanan Geriatri adalah pelayanan kesehatan usia lanjut dengan pendekatan interdisiplin yang mencakup aspek medik promotif, preventif, kuratif dan rehabilitatif serta aspek sosial dan psikologik pada pasien usia lanjut. Pelayanan Geriatri Sederhana adalah suatu bentuk pelayanan geriatri yang mempunyai kegiatan hanya berupa pelayanan poliklinik. Pelayanan tersebut diberikan oleh Tim Geriatri yang minimal terdiri dari : -
Dokter Umum yang telah mendapat pelatihan geriatri;
-
Perawat yang telah mendapat pelatihan geriatri;
-
Tim Rehabilitasi Medik, minimal fisioterapis.
2. Alur Pelayanan Geriatri a. Bagan Alur Pelayanan Geriatri Geriatri di Rumah Sakit Sakit Kelas D; D;
IGD
POLIKLINIK
IRJ
POLI GERIATRI
DOKTER PRAKTEK
PUSKESMAS
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B. Pelayanan Pasien Pasien Geriatri di RSUD Pesanggrahan Pesanggrahan 1. Jenis Pelayanan Geriatri a. Tingkat pelayanan geriatric di RSUD Pesanggrahan adalah tingkat sederhana disertai dengan pelayanan kesehatan warga lanjut usia di masyarakat berbasis rumah sakit
b. Alur pelayanan geriatric di RSUD Pesaggrahan yang yang digunakan adalah alur pelayanan sederhana c. Jenis pelayanan -
Rawat jalan geriatric Tempat ini memberikan jasa pengadaan asesmen, tindakan kuratif sederhana dan konsultasi bagi penderita rawat jalan, baik
dari
masyarakat,
puskesmas,
maupun
antar
poliklinik.Tenaga minimal yang dibutuhkan adalah dokter umum/internis yang telah mendapat kursus geriatri atau dokter spesialis geriatri/geriatrism, seorang perawat, dan seorang petugas sosial medik -
Rawat inap RSUD Pesanggrahan belum memiliki ruang rawat inap khusus pasien geriatric, sehingga pasien-pasien geriatric yang perlu dirawat, akan dirawat di ruang rawat inap umum sesuai dengan sarana dan prasarana yang dimiliki oleh RSUD Pesanggrahan
-
Rehabilitasi Medik
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penting dalam pelayanan lansia dan harus dilaksanakan secepat mugkin sejakpasien masuk sampai pulang sesuai kebutuhannya. Untuk memulai program rehabilitasi medik pada lansia,tenaga l ansia,tenaga profesional harus mengetahui kondisi lansia saat itu juga,baik penyakit yang menyertai maupun kemampuan fungsional yang mampu dilakukan.Banyak instrument untuk menilai kemampuan seorang lansia,salah satu diantaranya adalah Index Katz yang cukup sederhana dan mudah diterapkan untuk menilai kemampuan fungsional AKS (Aktivitas Kehidupan Sehari-hari) dan juga untuk meramalkan prognosis dari berbagai macam penyakit pada golongan lansia. Adapun aktivitas yang dinilai adalah : 1) Bathing -
Mandiri : memerlukan bantuan hanya pada satu bagian tubuh atau dapat melakukan sendiri secara menyeluruh.
-
Tergantung : memerlukan bantuan mandi lebih dari satu
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-
Tergantung : tidak dapat melakukan sendiri/dengan bantuan.
5) Continence -
Mandiri : dapat mengontrol buang air besar dan kecil.
-
Tergantung : tidak dapat mengontrol sebagian atau seluruhnya dengan bantuan manual atau kateter.
6) Feeding -
Mandiri : mengambil makanan dari piring atau yang yang lainnya dan memasukkan ke dalam mulut (tidak termasuk kemampuan memotong daging daging dan menyiapkan makanan seperti mengoleskan mentega pada roti).
-
Tergantung : memerlukan bantuan bantuan untuk makan atau tidak dapat makan sendiri secara parenteral.
Dari kemampuan melaksanakan 6 (enam) aktivitas dasar tersebut di atas,kemudian diklasifikasikan menjadi 7 (tujuh) tahapan yangdisebut sesuai dengan aktivitas yang dikerjakan
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7) Index Katz G : tergantung pada orang lain untuk 6 enam) aktivitas.
2. Assesment Geriatri Assesment Geriatri adalah suatu proses pendekatan multidisiplin untuk menilai aspek medik,fungsional,psikososial dan ekonomi penderita usia lanjut dalam rangka menyusun program pengobatan dan pemeliharaan kesehatan yang rasional. Asesmen ini bersifat tidak
sekedar
multi-disiplin
tetapi
juga
interdisiplin
dengan
koordinasi serasi antar disiplin dan lintas pelayanan kesehatan.
3. Yang mendapatkan pelayanan pelayanan geriatric -
Menderita lebih dari satu penyakit kronis atau degeneratif dengan atau tanpadisertai penyakit akut;
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-
Team work (koordinasi); work (koordinasi); Melibatkan keluarga dalam pelaksanaannya
5. Kriteria pelayanan lansia -
Komprehensif: adanya adanya dukungan dukungan finansial finansial yang adekuat, perawatan sehari-hari, pelayanan kesehatan yang memadai, pendidikan kesehatan, perawatan keluarga, kebutuhan rekreasi dan aktifitas fisik dan pelayanan transportas;
-
Adanya kerjasama/terkoordinasi lintas program/sektoral;
-
Mudah dijangkau; Memperhatikan kualitas pelayanan
6. Tatalaksana pelayanan lansia Assesment Lansia adalah adalah suatu rangkaian kegiatan kegiatan proses keperawatan yang: -
Ditujukan kepada usia lanjut;
-
Meliputi kegiatan pengkajian, dengan memperhatikan kebutuhan fisik, psikologis, sosial dan spiritual;
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c. Untuk mengetahui mengetahui sumber daya sosial sosial ekonomi dan lingkungan lingkungan yang dapat digunakan untuk penatalaksanaan penderita tersebut.
8. Proses assessment lansia sesuai yang yang dilampirkan pada panduan ini
C. GERIATRIC GIANTS Penampilan suatu penyakit pada usia lanjut sering berbeda dengan usia muda. Harus dapat dibedakan, apakah kelainan yang terjadi berkenaan dengan bertambahnya usia atau memang ada suatu proses patologi sebagai penyebabnya. Beberapa problema klinik dari penyakit pada lansia yang sering dijumpai disebut “GERIATRIC GIANTS”, GIANTS”, yang terdiri dari : 1. Sindroma Serebral; Dengan adanya kelainan anatomis pembuluh darah arteri pada
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b. Gangguan persepsi,antara lain ilusi,delusi,halusinasi, ilusi,delusi,halusinasi, dan mis intrepretasi; c. Terganggunya siklus bangun bangun tidur tidur dengan terjadinya insomnia, tetapi siang hari tertidur; d. Aktivitas spikomotor meningkat atau menurun; e. Disorientasi waktu,tempat, dan orang; f.
Gangguan memori.
Dimentia adalah suatu sindroma klinik yang meliputi hilangnya fungsi intelektual dan ingatan/memori sedemikian berat sehingga menyebabkan disfungsi hidup sehari-hari. Secara garis besar, dementia pada usia lanjut dapat dikategorikan
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Daftar Pertanyaan 10. Hitung mundur 3-3, dimulai dari 20
Penilaian Bila penderita sekolah lebih dari SMA kesalahan yang diperbolehkan -1 dari atas.
Dari : Folstein,1990 Folstein,1990 3. Gangguan Otonom Beberapa hal yang dikatakan sebagai penyebab seringnya gangguan syaraf otonom pada usia lanjut adalah : -
Dengan meningkatnya usia, terdapat terdapat beberapa beberapa perubahan pada neurotransmisi pada ganglion otonom, berupa penurunan asetil kolin terutama disebabkan oleh penurunan enzim utama, yaitu kolin asetilase.Hal ini cenderung menurunkan fungsi
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-
Penurunan visus dan pendengaran;
-
Perubahan neuro muskuler, gaya berjalan, dan reflek postural karena proses menua.
b. Faktor Ekstrinsik -
Obat-obatan yang diminum;
-
Alat-alat bantu berjalan;
-
Lingkungan yang tidak mendukung (berbahaya).
a. Kecelakaan : merupakan penyebab jatuh yang yang utama; b. Nyeri kepala dan atau vertigo; c. Hipotensi orthostatic;
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a. Aktivitas; -
Sebagian besar besar jatuh terjadi pada saat lansia melakukan melakukan aktivitas biasa seperti berjalan, naik atau turun tangga, dan mengganti posisi.
b. Lingkungan; -
Sekitar 70% lansia jatuh di rumah, 10% terjadi di tangga, dengan kejadian jatuh saat turun tangga lebih banyak dibandingkan saat naik tangga.
c. Penyakit Akut. Pencegahan Jatuh : Ada 3 usaha pokok untuk untuk pencegahan ini,antara ini,antara lain :
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Dekubitus adalah kerusakan/kematian kulit sampai jaringan di bawah
kulit,
bahkan
menembus
otot
sampai
mengenai
tulangakibat adanya penekanan pada suatu area secara terus menerus, sehingga mengakibatkan gangguan sirkulasi darah setempat. Area yang biasa terjadi dekubitus adalah tempat di atas tonjolan tulang dan tidak dilindungi cukup dengan lemak subkutan, misalnya : daerah sakrum, daerah trokanter mayor dan spina ischiadica superior anterior, daerah tumit dan siku. Karakteristik penampilan klinis dari dekubitus dapat dibagi sebagai berikut:
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-
Penyakit-penyakit neurologik;
-
Keadaan hidrasi/cairan tubuh perlu dinilai dengan
cermat. b. Faktor Ekstrinsik. -
Kebersihan tempat tidur;
-
Alat-alat tenun yang kusut dan kotor;
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perdarahan.Setelah jaringan nekrotik dibuang dan luka bersih,penyembuhan luka secara alami dapat diharapkan. Beberapa usaha mempercepat antara lain dengan memberikan oksigenasi pada daerah luka,tindakan dengan ultrasono untuk membuka sumbatan-sumbatan pembuluh darah dan sampai
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BAB IV DOKUMENTASI
1. Asesmen Medis Geriatri 2. SPO Pelayanan Pasien Geriatri
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DAFTAR PUSTAKA
Allender, J.A., & Spradley. B.W.(2005). Community health nursing promoting and protecting the public health. (6 th ed), ed), Philadelphia: Lippincott Williams & Wilkins
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