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LAPISANLAPISAN KULIT
Epidermis
Dermis
Hypodermis
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FISIOLOGI KULIT
Pelindung terhadap substansi
berbahaya
Fungsi thermoregulasi (berkeringat,
evaporasi, radiasi)
Sensasi (nyeri, sentuhan, panas-dingin) Eksresi dan absorbsi
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LUKA
(GLOBAL WOUND ACADEMY) :
A WOUND IS GENERALLY DEFINED AS
PATHOLOGICAL STATE IN WICH TISSUE ARE
SEPARATED FROM EACH OTHER /ORDESTROYED
UMUM :
TERPUTUSNYA
KONTINUITAS/KETERSAMBUNGAN KULIT
KARENA SUATU SEBAB.
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TYPE OF WOUND
Estimated healing time (waktu penyembuhan).
Aetiology (penyebab).
Depth of the wound (kedalaman luka).
Condition of the wound (kondisi luka).
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WOUND TYPE
HEALING TIME PREDICTABLE
(WAKTU PENYEMBUHAN)
AKUT: SESUAI TAHAPAN & WAKTU PENYEMBUHAN
KRONIK: KEGAGALAN DALAM TAHAPAN & WAKTU
PENYEMBUHAN
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JENIS LUKAETIOLOGI
ULCERATIF
TRAUMATIC
SURGICAL
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Arterial
DiabeticVenous
Aetiology - Ulcers
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Superficial burn
from an electric fire
Minor laceration
during pre-operative
shaving
Aetiology - Minor Trauma
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Aetiology - Major Trauma
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Aetiology - Surgery
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JENIS LUKA
DEPTH
SHALLOW/SUPERFISIAL WOUND (EPIDERMIS)
PARTIAL THICKNESS (EPIDERMIS-DERMIS)
FULL THICKNESS (SAMPAI FASIA)
DEPTH (SAMPAI OTOT)
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ShallowPenetrating Epidermis and Basement Membrane
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Partial ThicknessEpidermis \ Some Dermis
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Full ThicknessEpidermis \ Dermis
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CavityEpidermis / Dermis / Underlying Structures
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Infected
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NecroticYellow, wet slough Black, dry eschar
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Exuding
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PROSES PENYEMBUHAN
LUKA Bioseluler
Biokimia
Respons vaskuler Saling
Aktivitas seluler terkait
Bahan kimia
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TAHAP PENYEMBUHAN LUKA
1. Fase Haemostasis :perdarahan, kons tr iksi vasku lar,
c lott ing , platelet agregasi
Segera setelah inju ry
2. Fase Inf lamasi :
vasodilastasi vaskular,
phagocytos is ,mulai d i lepaskan
faktor pertumbuhan
2-3 hari setelah in jur y 1 m inggu
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TAHAP PENYEMBUHAN LUKA
3. Fase Prol i feras i :
Migrasi f ib rob last, Sintesa colagen,
angiogenesis, prol i ferasi sel,
granu lasi, epitel isasi
Hari 3 m inggu ke 2
4. Fase Maturasi dan remodel l ing :
pematangan jar ingan baru
21 hari setelah inju ry
GRANULASI
EPITELISASI
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Primary intention
healing
Secondaryintention healing
(luka kronik)
Tertiary intention
healing (skngraft)
Types of Surgical Healing
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Luka sembuh
Pengertian :
Terciptanya kontinuitas lapisan kulit serta
adanya kekuatan jar. parut yang mampumelakukan fungsi / aktifitas yang normal
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Faktor-Faktor Yang Mempengaruhi
Penyembuhan Luka
Penyembuhan luka proses yg kompleks
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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
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KONSEP MODERN
MANAJEMEN PERAWATAN
LUKA KRONIK
MOIST WOUND HEALING
WOUND BED PREPARATION
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Konsep modern
Dimulai 45 tahun y.l (1961)
Konsep dasar :
perawatan berbasis suasanalembab
MOIST WOUND HEALING
Dr. George Winter
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Dr. Winter
Science of wound
healing
Smith & Nephew
Polymer filmTechnology
The First Advanced Dressing
1971
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Dr. George Winter
Healing of Skin Wounds andthe Influence of Dressings on
the Repair Process
Published Nature journal
1971
MOIST WOUND HEALING
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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)
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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
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Dr Mary Dyson
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Dr. Mary Dyson
(1987)
Conclusion :
Wound in which a moist environtment has beenmaintained .heal more rapidly and in a more orderly
manner than do dry wounds, both epidermal and
dermal repair being accelerated.
(Luka yang diperlakukan tetap dalam kondisilembabLEBIH CEPAT SEMBUH daripada luka dalam
kondisi kering.
Membandingkan konsep moist wound healing dan Drywound healing pada dermal wound
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A NEW concept
Wound Bed Preparation
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Dr. Vincent Falanga,MD, FACP
The wound must be
prepared within the basetissue and the
environment primed in
order to ensure thehealing process can
progress in a timely
fashion
WOUND BED PREPARATION
WOUND BED PREPARATION
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R. GarySibbald, Md, Frcpc
Debridement, bacterial
balance and moist
interactive healingmust all
be optimised as integral
parts of preparing the
wound bed.
WOUND BED PREPARATION
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T.I.M.E
T - TISSUE VIABILITY
I - INFLAMATION/INFECTION
M - MOISTURE IMBALANCE
E - EDGE OF THE WOUND
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Tissue Viability
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Tissue Viability
Viable Tissue -- Bright Red (granulating), Pink
(epithelialising)
Non Viable Tissue -- Black (necrotic), Yellow
(slough)
Removing -- Debridement
Debridement -- Surgically, Enzymatic,
Autolytic, Mechanic.
Product -- Intrasite Gel
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WOUND MANAGEMENT
T - TISSUE VIABILITY
LIHAT KONDISI JARINGAN
Viable/Baik (merah
cerah, pink)
Non Viable/Tidak
Baik (Kuning, Hitam)
Debridement
INTRASITE GEL
(Autolisys Debridement)
INTRASITE GEL
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Inflamation And Infection
Mikroorganismeyg merugikan Infeksi danmenghambat
penyembuhan luka
Sign -- Redness, exudate, odour, Inflamation,
tenderness, bleed easily
Use topikal antiseptic or antimicrobial
Product -- Acticoat
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WOUND MANAGEMENT
I - INFLAMATION/INFECTION
LIHAT TANDA INFEKSI
ADATIDAK
ADA
-ACTICOATLangsung
absorbance
dressing
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Moisture and Exudate
Management
Suasana lembab paling ideal dalam
penyembuhan luka
Kaji exudate level
Use Absorbence Dressing
Product :
Allevyn
Allevyn Plus Cavity
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WOUND MANAGEMENT
M - MOISTURE IMBALANCE
LIHAT TINGKAT/LEVEL EKSUDAT
Gunakan Absorbance Dressing
Eksudate
Ringan
Eksudate
sedang
Eksudate
produktif/banyak
MELOLIN MELOLIN/ALLEVYN ALLEVYN
HIDROCELULLAR
FOAM
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Edge Of The Wound
Luka menutup dari tepi dan dasar luka
Gangguan di tepi luka Oedema, Infeksi,
Callus dll) akan menghambat penyembuhan
luka
Evaluasi Luka PENTING
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WOUND MANAGEMENT
E - EDGE OF THE WOUND
LIHAT TEPI DAN DASAR LUKA
Adakah oedema, callus,
Cavity/Undermaining ?
AdaTidak Ada
ALLEVYN PLUS CAVITY
VISITRAK
Patient Assesment
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Patient Assesment
Treat Cause Wound Diagnosis Addres Patient Concerns
Prepare Wound Bed
Exudate
Management
Cellular
Dysfungtion
Biochemical
Balance
Management
Of Necrosis
Bacterial
Balance
Antimikrobial
therapy
Debridement Absorptive
products
Grafts Wound Healing
factors
Bio-enginered
products
Moist Wound
Healing
Healing wound
Overal
evaluation
Wound bed
preparation
Prepared wound
Conventional
And/or advanced
therapy
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LANGKAH PERAWATAN
ASSESMENT
PENCUCIAN DAN DEBRIDEMANG
PEMILIHAN TOPIKAL THERAPI
KULTUR LUKA
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PENGKAJIAN
Usia
Medikasi
Penyakit penyerta Nutrisi
Hambatan lokal
(TIME), warnadasar luka
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PENCUCIAN LUKA
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PENCUCIAN LUKA
Tujuan:
1. Meningkatkan, memperbaiki danmempercepat proses penyembuhan luka.
2. Menghindari terjadinya infeksi.
3. Membuang jaringan nekrosis dan sisabalutan.
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Cairan Pencuci Luka
Paling mudah dicari NaCl 0,9 %
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DEBRIDEMANG
Debridement /
Debridemang :
Membuang jaringan
nekrosis dar ipermukaan luka
Necrosis:Kematian sel yang
disebabkan oleh penurunan
proses enzymatic tubuh
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T j d i ilih b l t
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Tujuan dari pemilihan balutan
membuang jaringan mati, benda asing dan partikel
balutan dapat mengontrol kejadian infeksi /melindungi luka dari trauma dan invasi bakteri
mampu mempertahankan kelembaban,
mempercepat proses penyembuhan luka,
absorbs cairan luka
nyaman digunakan,
steril dan
cost effective.
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Sebelum Memilih Balutan,
Pertimbangkan ..
Frekuensi mengganti balutan Jumlah eksudat
Ada tidaknya goa / undermining / cavity
Orang yang akan mengganti balutan
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Wound Dressings
Untuk pertamakalinyabalutan yangmempertahankankelembaban
digunakan pada tahun1970s
Saat ini lebih dari3500 jenis balutan ada
di dunia
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Melolin-Gauzes / kasa
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Melolin Gauzes / kasa
Primary dressing / balutanyang menempel di luka
Secondary dressing / balutanpenutup
Mengisi jaringan matiberongga
Cleansing material Mechanical debridement
Carrier for medication
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HydrogelsJenis topical therap
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Hydrogels Jenis topical therapyyang dapat membantu
proses peluruhan
jaringan nekrotik olehtubuh sendiri ( support
autolisis debridement ).
Partial or full thicknesswounds, minor burns (
radiasi / ekspose panas )
Conformable No residue in wounds
INTRASITE GEL
Foams-Allevyn
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Foams Allevyn
Hydrophylicpolyurethane
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 controlhypergranulation tissue
Ab b d ill All
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Absorbent Wound Fillers-Allevyn
Cavity
Various compositions as gels,
strands, beads, foam pillows
Varying levels of absorption
Useful with deep cavity
wounds
Can absorb while at the sametime promoting moist wound
healing
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Other Surgical Techniques
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Other Surgical Techniques
Skin Graft
Muscle
Flap
Drainage
Tube
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Complications Infection
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Complications - Infection
Typically ~10% surgical wound infectionrate
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Complications - Dehiscence
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Complications - Dehiscence
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Fistula & Sinus
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Fistula & Sinus
Fistula - organ to organ
- organ to skin
Sinus - blind sac to skin
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Incisional Hernia
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Incisional Hernia
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Non-sensitising
Good adhesion Sterile
Low Cost
Non-flammable &non-toxic
Post-Operative Dressing criteria
- High MVP
Non-adherent
Absorbent
Waterproof
Bacterial Barrier
Conformable
Professor Scales Criteria:
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PERAWATAN LUKA AKUT
Prinsip STERIL
Cairan pencuci luka : antiseptik (iodine atau NaCl 0,9 %)
Gunakan balutan yang ideal (sesuai dengan kriteria)
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M i l
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Materials
Wound cleansing pack
Gloves
Cleansing solution
Dressings
Dressing retention device
Clean work area
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Preparing the patient
Wash hands Position patient
Loosen retention devices
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Preparation of equipment
P ti f k
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Preparation of work area
P i f h d
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Preparation of the wound
Wound Cleansing
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Wound Cleansing
Dressing the wound
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Dressing the wound
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Final Stage