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WOUND
MANAGEMENT
Hypodermis
FISIOLOGI KULIT
Pelindung terhadap substansi
berbahaya
Fungsi thermoregulasi (berkeringat,
evaporasi, radiasi)
Sensasi (nyeri, sentuhan, panas-dingin)
Eksresi dan absorbsi
PT. ENSEVAL MEDIKA PRIMA
LUKA
(GLOBAL WOUND ACADEMY) :
A WOUND IS GENERALLY DEFINED AS
PATHOLOGICAL STATE IN WICH TISSUE ARE
SEPARATED FROM EACH OTHER /OR
DESTROYED
UMUM :
TERPUTUSNYA
KONTINUITAS/KETERSAMBUNGAN KULIT
KARENA SUATU SEBAB.
PT. ENSEVAL MEDIKA PRIMA
TYPE OF WOUND
Estimated healing time (waktu penyembuhan).
Aetiology (penyebab).
Depth of the wound (kedalaman luka).
Condition of the wound (kondisi luka).
WOUND TYPE
HEALING TIME PREDICTABLE
(WAKTU PENYEMBUHAN)
AKUT : SESUAI TAHAPAN & WAKTU PENYEMBUHAN
KRONIK : KEGAGALAN DALAM TAHAPAN & WAKTU
PENYEMBUHAN
JENIS LUKA
ETIOLOGI
ULCERATIF
TRAUMATIC
SURGICAL
Aetiology - Ulcers
Arterial
Venous
Diabetic
Superficial burn
from an electric fire
Aetiology - Surgery
JENIS LUKA
DEPTH
Shallow
Penetrating Epidermis and Basement Membrane
Partial Thickness
Epidermis \ Some Dermis
Full Thickness
Epidermis \ Dermis
Cavity
Epidermis / Dermis / Underlying Structures
JENIS LUKA
KONDISI
INFEKSI
NECROTIC
EXUDATING
Infected
Necrotic
Yellow, wet slough
Exuding
PROSES PENYEMBUHAN
LUKA
Bio seluler
Bio kimia
Respons vaskuler
Aktivitas seluler
Bahan kimia
Saling
terkait
2. Fase Inflamasi :
vasodilastasi vaskular,
phagocytosis,mulai dilepaskan
faktor pertumbuhan
2-3 hari setelah injury 1 minggu
PT. ENSEVAL MEDIKA PRIMA
WARNA JARINGAN
1. Jaringan baik (Viable tissue)
a. Merah cerah
Granulasi
b. Merah muda/pink
Epitelisasi
2. Jaringan tidak baik (Non Viable Tissue)
a. Kuning
Slough
b. Hitam
Eschar
Luka sembuh
Pengertian :
Terciptanya kontinuitas lapisan kulit serta
adanya kekuatan jar. parut yang mampu
melakukan fungsi / aktifitas yang normal
proses yg kompleks
1.
Faktor Internal
1. Usia
2. Status Nutrisi
3. Oksigenasi dan Perfusi Jaringan (vaskulasrisasi)
4. Status Imunologi
5. Penyakit Penyerta
2.
Faktor Eksternal
Pengobatan
Radiasi
Stress Psikologis
Trauma Jaringan
Infeksi
KONSEP MODERN
MANAJEMEN PERAWATAN
LUKA KRONIK
MOIST WOUND HEALING
WOUND BED PREPARATION
CONCLUSION
Covering a wound with a water-vapor proof film, had
a profound effect on the pattern of healing, orientating
the migrating epidermis over the original wound
surface instead of through the dermis
(Menutup luka dengan suatu transparant film yang
dapat menahan uap air, mempunyai efek pertumbuhan
jaringan pada luka)
S. Randolph May
(1984)
Penelitian terhadap OPSITE FILM pada superfisial &
partial thickness wound :
- Bacterial barrier
- Gas permeability
- Moisture pavour and water proof
- Maintain Temperature
Conclusion :
Memperkuat teori dari Dr. George Winter
PT. ENSEVAL MEDIKA PRIMA
A NEW concept
Wound Bed Preparation
2. EXCESS CHRONIC
EXUDATE
3. BACTERIAL
IMBALANCE
T.I.M.E
T
I
M
E
- TISSUE VIABILITY
- INFLAMATION/INFECTION
- MOISTURE IMBALANCE
- EDGE OF THE WOUND
Tissue Viability
Viable Tissue -- Bright Red (granulating), Pink
(epithelialising)
Non Viable Tissue -- Black (necrotic), Yellow
(slough)
Removing -- Debridement
WOUND MANAGEMENT
T - TISSUE VIABILITY
LIHAT KONDISI JARINGAN
Viable/Baik (merah
cerah, pink)
INTRASITE GEL
Non Viable/Tidak
Baik (Kuning, Hitam)
Debridement
INTRASITE GEL
(Autolisys Debridement)
Infeksi dan
menghambat
penyembuhan luka
Product -- Acticoat
WOUND MANAGEMENT
I
- INFLAMATION/INFECTION
LIHAT TANDA INFEKSI
TIDAK
ADA
ADA
-ACTICOAT
Langsung
absorbance
dressing
Product :
Allevyn
Allevyn Plus Cavity
WOUND MANAGEMENT
M - MOISTURE IMBALANCE
LIHAT TINGKAT/LEVEL EKSUDAT
Gunakan Absorbance Dressing
Eksudate
Ringan
Eksudate
sedang
MELOLIN
MELOLIN/ALLEVYN
Eksudate
produktif/banyak
ALLEVYN
HIDROCELULLAR
FOAM
Evaluasi Luka
PENTING
WOUND MANAGEMENT
E - EDGE OF THE WOUND
LIHAT TEPI DAN DASAR LUKA
Ada
ALLEVYN PLUS CAVITY
VISITRAK
Patient Assesment
Overal
evaluation
Treat Cause
Wound Diagnosis
Wound bed
preparation
Bacterial
Balance
Management
Exudate
Cellular
Biochemical
Of Necrosis
Management
Dysfungtion
Balance
Antimikrobial
therapy
Debridement
Absorptive
products
Prepared wound
Conventional
And/or advanced
therapy
Grafts
Wound Healing
factors
Bio-enginered
products
Healing wound
Moist Wound
Healing
LANGKAH PERAWATAN
ASSESMENT
PENCUCIAN DAN DEBRIDEMANG
PEMILIHAN TOPIKAL THERAPI
KULTUR LUKA
PENGKAJIAN
Usia
Medikasi
Penyakit penyerta
Nutrisi
Hambatan lokal
(TIME), warna
dasar luka
PENCUCIAN LUKA
Tujuan:
3.
NaCl 0,9 %
DEBRIDEMANG
Necrosis:
Kematian sel yang
disebabkan oleh penurunan
proses enzymatic tubuh
Debridement /
Debridemang :
Membuang jaringan
nekrosis dari
permukaan luka
Wound Dressings
Untuk pertamakalinya
balutan yang
mempertahankan
kelembaban
digunakan pada tahun
1970s
Saat ini lebih dari
3500 jenis balutan ada
di dunia
Melolin-Gauzes / kasa
Primary dressing / balutan
yang menempel di luka
Secondary dressing / balutan
penutup
Mengisi jaringan mati
berongga
Cleansing material
Mechanical debridement
Carrier for medication
Transparent Films-Opsite
Polyurethane or copolyester composition
Waterproof and gas
permeable
Superficial wounds dg
jumlah eksudat minimal
Promote autolysis
debridemang pada
jaringan nekrotik
Permit evaluation of
wound progress
Can tear healthy skin if
improperly removed
Occlusion may reduce
pain
Hydrogels
Foams-Allevyn
Hydrophylic
polyurethane
No residue or breakdown
Highly absorbent,
conformable
With or without adhesive
borders
Partial & full thickness
wounds
Safe to use with clinical
infected wounds
May help to control
hypergranulation tissue
Closure Techniques
Skin Graft
Drainage
Tube
Complications - Infection
Typically ~10% surgical wound infection
rate
Complications - Haematoma
Complications - Dehiscence
Incisional Hernia
- High MVP
Non-sensitising
Non-adherent
Good adhesion
Absorbent
Sterile
Waterproof
Low Cost
Bacterial Barrier
Non-flammable &
non-toxic
Conformable
PT. ENSEVAL PUTERA MEGATRADING
Materials
Preparation of equipment
Wound Cleansing
Final Stage