Palliative Care

 

Rahmanu Reztaputra 0906508415

 

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Quality of Life(QoL) diartikan sebagai persepsi individu terhadap posisinya di kehidupan dalam konteks budaya dan nilai yang berlaku di tempat mereka tinggal dan berkaitan dengan tujuan, ekspektasi, standart, dan pertimbangan.(WHO)1 individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns  concerns 

 

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Paliative care didefinisikan sebagai pendekatan untuk meningkatkan QoL QoL pasien  pasien dan keluarganya dalam menghadapi masalah yang berkaitan dengan penyakit yang mengancam  jiwa melalui  jiwa  melalui pencegahan dan mengurangi penderitaan dengan cara asesmen dan tatalaksana nyeri serta masalah termasuk fisik, psikososial, dan lainnya, spiritual(WHO) spiritual (WHO)1

 

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Perawatan akhir hidup1,2

 

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Dahlin for C et.al. Clinical Practice Guideline for Quallity Paliative Care. Pittsburg: national Consensus Project Paliative Care. 2nd ed. 2009.p.1-50

 

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International Human Right to Health from the International Covenant on Economic, Social and Cultural Rights (ICESCR) Article 12.1 (1966):: “right (1966) “right of everyone to the enjoyment of the highest attainable standard of physical and ”.   mentalhealth”. mentalhealth

 

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Pengontrolan nyeri dan gejala, distres psikologis, masalah spiritual, dan kebutuhan praktis di asses dalam pelayanan yang kontinuum Keluarga dan pasien memperoleh perkembangan informasi dengan cara yang memperhatikan budaya dan sosial sehingga dapat menentukan pilihan terapi yang realistik

 

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Koordinasi yang baik antar petugas dan pemberi layanan medis

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Baik pasienkematian dan keluarga menjalani pasiendipersiapkan untuk

 

1. 2.

Structure and processes of care Physical aspects of care

3. Psychosocial and psychiatric aspects of care 4. Social aspects of care 5. Spiritual, religious, and existential aspects of care 6. Cultural aspects of care 7. Care of the imminently dying patient 8. Ethical and legal aspects of care

 

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provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; process; intends neither to hasten or postpone death; death;  integrates the psychological and spiritual aspects of patient care;  offers a support system to help patient’s live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement;

 

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uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; will enhance quality of life, life, and may also positively influence the course of illness; illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such asthose chemotherapy or radiation therapy, and includes investigations needed to better understand and manage distressing clinical complications

 

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Penyakit kronik yang sudah diakui akan mendapatkan manfaat bila perawatan paliatif dilakukan Penyakit yang mengancam nyawa

 

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Alzheimer’s and other dementias, cancer, cardiovascular diseases (excluding sudden deaths), cirrhosis of the liver,pulmonary diseases, chronic obstructive diabetes, HIV/AIDS, kidney failure, multiple sclerosis, Parkinson’s disease,  disease,  rheumatoid arthritis, drug-resistant tuberculosis (TB)

 

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cancer, cardiovascular diseases, cirrhosis of the liver, congenital anomalies (excluding heart abnormalities),

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blood and immune disorders, HIV/AIDS, meningitis, kidney diseases, neurological disorders and neonatal conditions

 

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It has been widely advocated that palliative care should be delivered on the basis of need, not diagnosis or prognosis Tidak ada batasan waktu atau prognostik Dimulai sejak tegaknya diagnosis

 

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Mulai dari petugas medis primer sampai tersier

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Petugas non medis Interdisiplin

 

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Tidak terbatas pada suatu tempat perawatan tertentu

 

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Step ladder WHO 1986 Dibagi tiga tingkat nyeri:3 

Ringan  Sedang  Berat Berdasarkan skor VAS

 

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Non narcotic –  • Acetaminophen 650mg q4h or

• ASA 650mg q4h or • Ibuprofen 400mg q4h or • other NSAIDs • + Adjuvants* 

 

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Add Opioid for Moderate Pain –  • Acetaminophen 325mg + codeine 30mg q4h (Tylenol #3) or • Acetaminophen 325mg + codeine 60mg q4h (Tylenol #4) or • Acetaminophen 325/500mg + oxycodone 5mg q4h (Percocet / Roxicet) • + Adjuvants* 

 

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Start strong oral opioid –  • Morphine 5 10mg q4h titrate to pain

• Dilaudid 1 4 mg q4h titrate to pain • MS Contin or other long acting 30 60mg q8 12 h • Fentanyl5 25ųg/ plus Morphine Sulphate mg. q hour 2 • + Adjuvants 

 

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NSAID Anticonvulsan Antidepresan trisiklik

 

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Tujuannya QoL Makna makanan  

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Fisik Comfort/nurture Tradisi Psikologis sosialisasi

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Oral feeding Oral suplementation Enteral parenteral

 

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Connor SR, Bernedo MCS(ed). Global Atlas of Paliative Care at End of Life. Worldwide Paliative Care Alliance.2014. p.1-100 Dahlin et.al. Clinical Guideline QuallityCPaliative Care.Practice Pittsburg: nationalfor Consensus Project for Paliative Care. 2nd ed. 2009.p.1-50 Anonim. WHO Pain Ladder with Pain Management Guidelines. Kein-Smith L. Nutrition Management in Palliative Care. ESPEN Congress Cannes. 2003.diakses 2003.diakses dari: http://www.espen.org/presfile/PalliativeKentSmith.pdf   KentSmith.pdf