Instalasi Farmasi

RSU Dr Soetomo

 Kasus

penyakit yang belum dapat disem

buhkan semakin meningkat jumlahnya baik
pada pasien dewasa maupun anak;
Penyakit2 tsb :
kanker, penyakit degeneratif, penyakit paru
obstruktif kronis, cystic fibrosis,
stroke,
Parkinson, gagal jantung/heart failure,
penyakit genetika dan
penyakit infeksi seperti HIV/AIDS
yang memerlukan perawatan paliatif,

Meningkatkan kualitas pelayanan kesehatan

kuratif dan rehabilitatif juga diperlukan
perawatan Paliatif bagi pasien dengan
stadium terminal;

Masyarakat menganggap perawatan paliatif

hanya untuk pasien dalam kondisi terminal
yang akan segera meninggal.

Namun konsep baru perawatan paliatif

menekankan
pentingnya
integrasi
perawatan paliatif lebih dini agar masalah
fisik, psikososial dan spiritual dapat diatasi
dengan baik

Rumah sakit memberikan perawatan paliatif

masih terbatas terdapat di 5 (lima) ibu kota
propinsi
yaitu
Jakarta,
Yogyakarta,
Surabaya, Denpasar dan Makassar.

Ditinjau dari besarnya kebutuhan dari

pasien, jumlah dokter yang mampu
memberikan pelayanan perawatan paliatif
juga masih terbatas.

Dengan pertimbangan tsb diatas perlu

Kebijakan Perawatan Paliatif.
Adanya KepMenkes RI NOMOR : 812 / Menkes/ SK/ VII /

2007, tentang Perawatan Paliatif

1.

2.

3.

4.

Perawatan paliatif yang bermutu dapat

dilaksanakan di RSDS
Dapat
di
susun
pedoman-pedoman
pelaksanaan /juklak perawatan paliatif.
Tersedianya tenaga medis , farmasi dan
non medis yang terlatih.
Tersedianya sarana dan prasarana yang
diperlukan.

Perawatan paliatif adalah pendekatan

yang bertujuan memperbaiki kualitas hidup
pasien dan Keluarga yang menghadapi
masalah
yang
berhubungan
dengan
penyakit yang dapat mengancam jiwa,
melalui pencegahan dan peniadaan melalui
identifikasi dini dan penilaian yang tertib
serta penanganan nyeri dan masalahmasalah lain, fisik, psikososial dan spiritual
(sumber referensi WHO, 2002).

Palliative care is care which aims to

ameliorate the effects of progressive,
advanced disease, or terminal illness and
improve the quality of life of the patient, his
or her partner, family and friends.
Palliative care is generally provided to
people of all ages whose condition has
progressed beyond the stage where
curative treatment is effective and cure is
attainable, or to those who choose not to
pursue curative treatment.

Kualitas hidup pasien

adalah keadaan pasien yang dipersepsikan
terhadap keadaan pasien sesuai konteks
budaya dan sistem nilai yang dianutnya,
termasuk tujuan hidup, harapan, dan
niatnya.

Dimensi kualitas hidup (Jennifer

J. Clinch, Deborah Dudgeeon
dan Harvey Schipper)/(1999),:

a. Gejala fisik
b. Kemampuan fungsional
(aktivitas)
c. Kesejahteraan keluarga
d. Spiritual
e. Fungsi sosial

f.

Kepuasan
terhadap
pengobatan
(termasuk masalah keuangan)
g. Orientasi masa depan
h. Kehidupan seksual, termasuk gambaran
terhadap diri sendiri
i. Fungsi dalam bekerja

Palliative home care

adalah pelayanan perawatan paliatif yang
dilakukan di rumah pasien, oleh tenaga
paliatif dan atau keluarga atas bimbingan/
pengawasan tenaga paliatif.

Prevention and relief of symptoms

Attention to emotional and spiritual needs
Care for the patient and family as a unit
Sensitive communication, goal setting and
advance planning
Interdisciplinary care
Services
appropriate to the various
settings in which people die

When you are facing a serious illness, you

need relief.
Relief from pain.
Relief
from other symptoms, such as
fatigue, nausea, loss of appetite and
shortness of breath.
Relief from stress.

 Be

Pharmacists better to understand the

patients condition and choices for care.
Pharmacists need to improve the ability to
tolerate medical treatments.
And, Pharmacists need to be able to carry
on with everyday the patients life.

A program designed to provide palliative

care when life expectancy is six months or
less
Covered by Medicare and Medicaid

Covered by private insurance plans with

enhanced home care benefits
The
term hospice applies to care
administered towards the end of life,
hospice care is also palliative

1. Jenis kegiatan perawatan paliatif

meliputi :
Penatalaksanaan nyeri (Relief pain)
Penatalaksanaan keluhan fisik lain.
Asuhan keperawatan
Dukungan psikologis
Dukungan sosial.

Opioid Safety in Patients With Renal or

Hepatic Dysfunction

..\PALIATIVE CARE DES 2010\Opioids-RenalHepatic-Dysfunction.pdf

..\PALIATIVE CARE DES 2010\who-living-withhivaids.pdf

(..........Lanjutan):

Dukungan kultural dan spiritual

Dukungan persiapan dan selama
masa dukacita (bereavement).
2. Perawatan paliatif dilakukan melalui rawat
inap, rawat jalan, dan kunjungan/rawat
rumah.

Terapi Paliatif
Operative
Radiotherapy
Chemotherapy
Physiotherapy
Psychotherapy
Complimentary

Pelayanan Obat pasien Paliatif dengan

Tindakan :
Operative (GBPT)
Radiotherapy (GDC)
Chemotherapy (POSA, OBGYN, BEDAH, ANAK,
MEDIK)

Physiotherapy

(Rehab Medik)
Psychotherapy (Syaraf)
Complimentary (POTI)

Protap Pengkajian Resep ISO2010.doc

Nama pasien Mrs. X (39 tahun)

Dx
: Ca Cervix stad III B
Terapi symptom : Relief Nyeri
R/Codifam
Codein
Amitrip

Lower part of the uterus

Connects the body of
the uterus to the vagina
(birth canal)

Source: American Cancer Society

The central cause of cervical cancer is

human papillomavirus or HPV:
HPV is transmitted through sexual
contact
The HPV detected today could have been
acquired years ago
There are many different types of HPV
that can infect the cervix, vagina and
vulva
Low-risk types may cause genital warts
High-risk types may cause precancer and
cancer of the cervix

Most women who are infected with HPV

will never have any symptoms

Delay onset of sexual activity or remain

abstinent
Know your sexual partner
Do not smoke
Maintain a healthy diet and lifestyle
Practice safe sex. Condoms decrease
the chance of HPV exposure.
If eligible, consider getting the vaccine
that prevents most cervical cancers.
Get your Pap test and HPV testing as
recommended by your health care
provider.

Abnormal bleeding
Between periods
With intercourse
After menopause

Unusual vaginal discharge

Other symptoms
Leg pain
Pelvic pain
Bleeding from the rectum or bladder

Some women have no symptoms

Women who have ever had sex

Women who have had more than one

partner

Women whose partner (s) has had more

than one sexual partner

Women who have had a sexuallytransmitted disease

Vaginal bleeding

Menstrual bleeding is longer and heavier than usual

Bleeding after menopause or increased vaginal

discharge

Bleeding following intercourse or pelvic exam

Pain during intercourse

Source: American Cancer Society

Human papillomavirus infection (HPV) Primary factor

HPV 16, HPV 18, HPV 31, HPV 33, HPV 45
50% are caused by HPV 16 AND 18
Sexual behavior
Smoking
HIV infection
Chlamydia infection
Diet
Oral contraceptives
Multiple pregnancies
Low socioeconomic status
Diethylstilbestrol (DES)
Family history

Source: American Cancer Society

Surgery

Preinvasive cervical cancer

Cryosurgery
Laser surgery
Conization
Invasive cervical cancer
Simple hysterectomy
Removal of the body of the uterus and cervix.
Radical hysterectomy and pelvic lymph node dissection
Removal of entire uterus, surrounding tissue, upper part of the
vagina, and lymph nodes from the cervix.

Radiation

Chemotherapy
Paliative Care

Source: American Cancer Society

Brain
Lymph nodes
Skin
Liver

Bone

Pleura
Lung

Hormone receptor status

Any Estrogen Receptor (ER) or Progesterone

Receptor (PR) expression indicates possible
response to hormonal therapy
1% or more cells positive or ER or PR by
immunohistochemistry

Her2/neu (ErbB-2) overexpression

High overexpression of Her2/neu indicates

possible responder to trastuzumab therapy

ER/PR/Her2 negative patients:

chemotherapy
Paliative Care

Generally considered incurable

For most patients, primary goal should be
palliation
First recurrences are always biopsied to
confirm diagnosis

Confirm ER/PR status and Her2/neu status

Hormonal therapy for indolent disease

Single agent chemotherapy for
aggressive/symptomatic disease or
disease not responsive to hormonal
therapy
Polyagent chemotherapy for visceral crisis
or disease requiring rapid response

Metastatic
Metastatic Breast
Breast Cancer
Cancer

Limited
Limited metastases
metastases (bone
(bone && soft
soft tissue)
tissue)
Positive
Positive hormone
hormone receptors
receptors
Hormone
Hormone responsive
responsive
Disease-free
Disease-free interval
interval 22 years
years

Hormonal
Hormonal Therapy
Therapy
Response
Response

No
No response
response

Extensive
Extensive metastases
metastases or
or visceral
visceral crisis
crisis
Negative
Negative hormone
hormone receptors
receptors
No
No response
response to
to hormones
hormones

Chemotherapy
Chemotherapy

No
Progression of
of disease
disease
No progression
progression Progression

IfIf disease
disease progresses,
progresses, second-line
second-line hormonal
hormonal therapy
therapy

Second-line
Second-line chemotherapy
chemotherapy

Fundus
Round ligament
Tube
Fibroid

Ovary

Fimbria

Benign serous
cystadenoma

6,810 grams, 20 cm X 40 cm

Palliative+Care+Inform.pdf

TERIMA KASIH