ASKEP LANSIA MENJELANG AJAL

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KEILMUAN KOMUNITAS
FAKULTAS ILMU KEPERAWATAN
UNIVERSITAS INDONESIA
tanggal upload : 28 April 2009

Objectives
n
n
n
n

Proses ajal pada lansia

Sikap terhadap kematian pada lansia
Respon fisik, psikis dan spiritual
Strategi keperawatan pada lansia menjelang
ajal

ASKEP LANSIA MENJELANG AJAL

n

Apa yang saudara fikirkan ketika melihat

lansia?
Usia berapa yang saudara harapkan saat
menjelang ajal?
Dalam kondisi yang bagaimana yang saudara
harapkan saat menjelang ajal?
Siapa yang saudara harapkan hadir saat
menjelang ajal?

Persepsi kematian
n

n
n

Diperoleh dari pengalaman kematian orang

lain
Tidak selalu dipengaruhi oleh kematangan
perkembangan
Kecenderungan akan menyangkal kematian
Kebudayaan mempengaruhi persepsi
seseorang terhadap kematian

Arti Kematian Pada Lansia

n

Positif: suatu perjalanan; teman yang

melepaskan dari rasa nyeri dan penderitaan;
menuju hidup yang kekal
Negatif: pelarian dari situasi yang tidak dapat
diatasi the great destroyer yang
menyebabkan kelemahan; hukuman;
perpisahan.

Perilaku Lansia Menghadapi

Kematian
n

Khawatir menjadi beban, penderitaan, dan

penggunaan tehnologi yang memperpanjang
kehidupan
Tingkat kekhawatiran lansia yang sakit dan
dirawat di rumah sakit lebih rendah dari
mereka yang menunggu giliran masuk ke
rumah sakit
Yang menjadi perhatian adalah dimana,
bagaimana kematian itu terjadi, dan
kehidupan setelah kematian

Dying
n

Is a personal and private event and

involves physical, psychological,
behavioral, social and spiritual problems
as the client moves between remission
and a further decline in health status.
Accumulative losses and physical and
psychological decline leave the client
feeling lonely and isolated.

Symptom of Dying Process

n
n
n
n
n
n
n

Decreased Appetite
Lethargy
Cardiovascular changes
Respiratory changes
Musculoskeletal system changes
Gastrointestinal system changes
Mental status changes

Decreased Appetite
n
n
n
n
n

First sign
Food refusal
Anorexia
Choked on food and liquids
Unable to swallow (1-4 days before
death)

Cardiovascular Changes
n
n
n
n
n
n

Rapid heart rate

Irregular rhythms/ arrhythmias
Diaphoretic
Skin feels cool
Mucosa often become deeply cyanotic
The decreased of cardiac out put

Respiratory Changes
n
n
n

n
n

Pulmonary Congestion
Pulmonary secretion (Pneumonia)
Breath sounds: diminished, irregular,
rapid, audible
Carbondioxide levels increase
Period of irregular respiration/ apnea/
dyspnea

Gastrointestinal & Musculoskeletal

system changes
n
n
n

Musculoskeletal
Gastrointestinal
Absent of bowel
Weakness
in all muscle
soundsgroup
Rectal sphincter relaxes
Fecal incontinence

Psychological symptom
n
n
n
n
n
n

Confusion
Sadness and depression
Anxiety and agitation
Insomnia
Stress
grieving

Spiritual concerns
n

Patient who are dying often ask what their life

means, who they really are, why the illness
has affected them, and what will happen to
them when they are die.
Some feel guilty of worry that their behavior
caused their illness
Unresolved spiritual distress can lead to
despair and hopelessness

Dying patients do not always need to hope

for a cure; instead they can hope for having
time to reconcile with loved ones, sharing
time with family, finishing a personally
important project, or making peace with god
or higher power.
When spiritual distress is relieved, patients
can die more peacefully

They need to find meaning and purpose

in their lives.
Belief in an afterlife and possible
reunion with loved ones and comfort
patients and family members.

Environment setting
n

The setting should be peaceful, quiet, and

physically comfortable. Stains or tubes are
covered, and odors are masked
In some patients near death, noisy breathing
develops because of bronchial congestion or
palatal relaxation
Family member are encouraged to touch the
patient as well as talk with the patients

Care of dying patient

n

Helping a patient and family find comfort with

meaning in the experience of dying is
important
The nurse should preserve and enhance the
dignity of the dying patient by allowing the
patient and the family members to maintain
control and participate in end-of-life care
whenever possible
Caregivers team must also prevent and
relieve distress as effective as possible

Pengkajian klien
n

n
n

Fisik: perubahan CV, gastro,

perkemihan, persyarafan, persepsi
sensori, integritas kulit
Psikososial: proses kehilangan
Spiritual:kebutuhan akan cinta dan
perhatian

Pengkajian keluarga
n
n
n

Pengetahuan akan kondisi klien

Observasi perilaku
Kaji respon patologi keluarga

Strategi intervensi
n
n
n
n
n
n

Intervensi lebih sering

Membutuhkan waktu dan kesabaran
Keterampilan terpeutik
Life review
Dukungan psikologis bagi caregiver
social support

The process of death

The moment of death
death is recognized when respiration
and cardiac action cease. The pupils of
the eyes become fixed and dilated and
the skin on the face and extremities
become cool to touch.
n

The process of death

n

Rigor mortis
n
n

Stiffening of the body

Begins 2-4 hours after death.

Algor mortis
n
n

Post-morterm cooling
The internal body temperature begins to
fall at approximately 1C per hour

The process of death

n

Post-mortem decomposition
Discoloration of the skin
n As the red blood cells break down,
hemoglobin is released and stains the
vessel walls and surrounding tissues.
n The skin appears mottled, bruised or both.
n

Post-mortem digestion
n

The tissue soften and then are liquefied

because of fermentation.

The process of death

n

Post-mortem digestion
n

The tissue soften and then are liquefied

because of fermentation.

Kesimpulan
n
n

Dying is a part of life, just as birth is

Nurses are called on to provide emotional
support to patients and families, teaching and
utilizing coping strategies, because dying and
death occur mostly in facilities where care is
provided by nurses