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Terminal Care

( Perawatan Terminal )
Malisyah Septawati,SKep.,Ns

Terminal Care
Yaitu perawatan untuk membantu meringankan
penderitaan secara fisik ataupun psikologis
pada pasien yang tidak dapat disembuhkan
atau dalam tahap terminal ( sakaratul maut )
Pada penyakit yg belum/tidak dapat
disembuhkan dan belum/tidak ada obatnya,
kematian tidak dapat dihindari dalam waktu
yang bervariasi ( stuart&Sudeen, 1995 )

Terminal Care

Penyakit dg stadium lanjut, penyakit


utama tidak dpt diobati, bersifat
progresif,pengobatan yg diberikan hanya
bersifat menghilangkan gejala dan
keluhan,memperbaiki kualitas hidup
( tim medis RS Kanker Darmais, 1996 )

Dying ( Sakaratul Maut )


Tahap Dying
1.
DENIAL
- Menyangkal
- Terhadap kenyataan mengisolasi diri
2.
ANGER
- Ekspresi kemarahan dan permusuhan
- Sikap menyalahkan takdir

Cont..Dying ( Sakaratul
Maut )

3. BERGAINING
- tawar menawar
- Hope and want
4. DEPRESSION
- periode berkabung before death
- More crying
- No talk

Cont..Dying ( Sakaratul Maut )

5. ACCEPTANCE
- pasien relaxs and peace
- pasien menantikan tibanya kematian
dan mempersiapkan diri menghadapi
kematian

Tanda Klinis DYING


1.

SAAT MENDEKATI KEMATIAN


- Hilangnya tonus otot
gerakan tubuh mulai menurun,
penurunan aktivitas GI, Relaksasi otot
wajah, sulit berbicara, sulit menelan dan
perlahan kehilangan efek muntah

ContTanda Klinis DYING

- sirkulasi melemah :
sensasi melemah, ekstremitas sianosis,
kulit, akral, ujung hidung, ujung telinga
teraba dingin.
- Perubahan VS
Hipotensi, pernafasan irreguler dan
melalui mulut, nadi lemah dan lambat.

ContTanda Klinis DYING

Kegagalan sensori
Blurred ( pandangan kabur &
berkabut )
Kegagalan indera penghidu dan
perasa.
- Tingkat kesadaran bervariasi
-

2. DEKAT KEMATIAN
Dilatasi pupi, tidak bisa
bergerak,refleks menghilang, nadi
naik kmdn turun, Respirasi Cheyne
stokes
( satu satu ), sura nafas stridor dan
terdengar kasar, hipotensi

3. KEMATIAN
- henti nafas, nadi dan TD
- Hilang respon thd stimulus eksternal
- Pergerakan otot tidak ada
- Enchepalogram ( garis otak ) datar,
aktivitas listrik otak terhenti

Problems with terminal care


1.

Physical Problems
- Pain
- Change of skin
- Constipation
- Anorexia / Nausea
- Alopesia
- Weakness of muscle, ect

Cont..Problems with terminal care

2. Physicology Problems
- High of depend on
- Loss of control
- Loss of productivities
- Disturb in comunication

ContProblems with terminal


care

3. Social Problems
- social isolation
- menarik diri
4. Spiritual Problems
- Hopelessness
- Planning Before dying

Nursing Care Plan


1.

Assesment
- Knowledge about diagnosa deseases, plan
of treatment (medicine) and follow up care
- Coping management
- Physic and emotional support
- Respon of diagnosis

- Responsiblelity of family about diseases


- Condition of physic and level of power
( fisik & tk energi )
- Hemodinamic, liquids and nutritional
status.

Nursing Diagnosis &


Intervention
1.

Anxiety r.t Ca diagnosis, change of health


conditions and medical intervention.
Intervention :
- giving the health education, answer
the question, adequate information
and explain procedure treatment
- Giving motivation to the Patient

- Increased of hopeless
- Exploration coping management and
giving adaptive coping mecanism
- Giving pt to talk about the feel
(sadness) and angry

2. Antisipatory of loss r.t change of status


( antisipasi kehilangan b.d perub status peran )

Intervention :
- Giving motivation to express the
feeling losses
- Disscus of coping strategy in the past
experince
- Giving the privacy, besides in patient, and
support emotional
- Increased self esteem patient

3. Cronic pain r.t operating effect, radical teraphy and


chemoteraphy
Intervention ;
- asesment of pain, intensity, duration and
objective pain.
- giving health education about causa of
pain
- evaluation effect of pain
- Explain to the pt to continuing drug and prevent
pain
- Doing a pain management

4. Risk infection r.t imunosupressi


Intervention :
- Monitor sign infection
- Prevent pain standart
- Cultur microorrganism

5. Imbalance nutrition : less r.t radiasi effect,


chemotheraphy, weakness, distress
emotional
6. Fatique r.t physical and phycology
distress
7. Impaired body image r.t performance
8. Impaired of integrity skinr.t radiasi effect,
chemotherapy, immobility, decrease of
nutrition

EVALUATION
1.

2.
3.
4.

Patient can adopt adaptif coping


mecanism
Control pain
Intake liquids and adequate nutrition
Patient should be partisipation in
carring without weakness and fatique