PENATALAKSANAAN REHABILITASI

MEDIK PADA PPOK

Dr. RETNO SETIANING, SpKFR

 PENDAHULUAN

PPOK ( Penyakit Paru Obstruktif Kronik)/

COPD( Chronic Obstructive Pulmonary Disease)
merupakan gangguan paru yang sering terjadi &
dapat menurunkan kualitas hidup
Tidak bisa sembuh, sehingga penatalaksanaan
seharusnya difokuskan pada peningkatan status
fungsional dan kualitas hidup penyandang PPOK
 PENDAHULUAN
Merokok adalah faktor risiko utama
Faktor risiko lain : perokok pasif, polusi udara, polusi
industri di tempat kerja,riwayat infeksi masa anak2
Survey American Lung Society :
51 % pasien PPOK terbatas kemampuan kerjanya,
70 % mengalami keterbatasan aktivitas fisik, 56 %
terbatas dalam kegiatan rumah tangga, 53%
terbatas dalam aktivitas sosial, 50 % terganggu
tidurnya, 46% terbatas dalam kegiatan keluarga
 PPOK ?
Penyakit paru obstruktif yang
terminologinya merujuk pada 2
kasus : bronkitis kronik &
emfisema
Gangguannya irreversible &
progresif
Karakteristik PPOK :
1.Peningkatan retensi sekresi
paru
2.Penyempitan & obstruksi
jalan nafas
 Bronkitis Kronik
Inflamasi pada bronkus yang menyebabkan iritasi dan
batuk produktif sekurang nya 3 bulan yang
berlangsung 2 th berturutan

Perubahan patologis yang sering terjadi :

1. Bertambahnya sel goblet yg memproduksi mukus
pada cabang bronkus
2. Penurunan sel epitel bersilia yang menggerakkan
mukus
3. Penyempitan jalan udara karena radang menahun
ditambah peningkatan mukus kongesti & batuk
sesak napas
 Emfisema

Emfisema adalah kondisi yang ditandai

dengan destruksi gradual dari alveoli,
tempat dimana terjadi pertukaran antara
oksigen dari udara dg karbondioksida dari
darah
Kerusakan alveoli terjadi secara ireversibel
dan berakibat jumlah alveoli yang bekerja
untuk pertukaran oksigen makin sedikit
7 Keys Priorities COPD Guideline

Diagnosis
Smoking cessation
Inhaled therapy
Pulmonary rehabilitation
Non invasive ventilation
Exacerbations
Multidisciplinary working
 Definition of Pulmonary
Rehabilitation
Pulmonary rehabilitation is a multidisciplinary
program of care for patients with chronic
respiratory impairment that is individually
tailored and design to optimize physical and
social performance and autonomy (ATS 1999)
Typical program : physical training, disease
education, nutritional, psychological &
behavioral intervention
 International Classification of
Functioning, Disability and Health
(ICF)
health condition disorder or
disease

Body function and

Participation
body structure activity

Environment factor Personal factor

 Domain Relevant to Pulmonary
Rehabilitation in Patients With Dyspnea
Domain Example
Pathophysiology Obstructive airway disease
Impairment Breathless, cough, sputum

Disability : Limited exercise tolerance;

Functional limitation requires O2 for activity daily of
life; weakness
Disability Cannot do constructive work, loss
of recreation

Handicap: Cannot find employment difficulty

Societal limitation; with health; life; architectural
barriers
 Outline of the physiatric history
and examination
Psychiatric history Psychiatric
-Chief complaint examination
-History of present -Functional examination
problem -Musculosceletal
-Functional history examination
-Psychosocial history -Neurological examination
-Medications/alergy -General medical
-Diet examination
-Past medical/ surgical
history Summary
-Family history Problem list
-Review of system Management plan
Goals
 Outcome assessment
Dyspnea assessment
- Borg category scales
Laboratory test of exercise performance
-Incremental of exercise testing
Fields test
-Self pace 6 minute walking distance
(6 MWD)
Health related quality of life
-St. Georges Respiratory
Questionare (SGRQ)
 Proper Candidat

Any patients with symptomatic,

stable chronic lung diseases who is
disabled either the underlying
diseases or by related therapy or
complications, is a candidate for
pulmonary rehabilitation
 Konservasi Energi
Adalah penyelesaian tugas dengan
cara yang sehat dan efisien.
Dengan melalukan strategi
konservasi energi dapat
melakukan aktivitas sehari-hari yang
sebelumnya sulit dilakukan
kualitas hidup lebih baik
The Four Ps of
Energy
Conservation :
Planning
Pacing
Prioritize
Positioning
PLANNING
Organize yourself, your home and your working
environment
List daily and weekly activities
Utilize your mental energy before you expend your
physical energy: Think about what you are about to
do, what items you will need, and plan your trip
between any two points to eliminate any
unnecessary trips
Put items you frequently use in a convenient place
Keep duplicates of frequently used items in several
convenient locations, for example keep a pair of
scissors both upstairs and downstairs to save steps
Consider using a bag, basket or rolling utility care
to carry things in one trip.
In the kitchen, use the counter to slide things to
Pacing
Space difficult and
strenuous chores evenly
throughout the week
Allow plenty of time for rest
and relaxation
Do difficulty chores at your
best time of the day when you
have the most energy
Allow for flexibility and
leisure in your routine: It is
better to feel well and be able
to participate in family life
than to feel tired and sore
with all of your chores done?
Prioritize
Can I change my role
with my family, friends
and community to
something that is
satisfying but more
realistic?
Are there some tasks
that would be better for
someone else to do?
Eliminate
unnecessary tasks
Positioning
Good posture will save
you energy
Sit when possible: make
sure your work surface is an
appropriate height
Use a shower seat and
hand held shower head to
sit and rest in the shower
Use long-handled assistive
devices to reduce bending
such as a long handled
sponge to clean up small
spills on the floor
 AKTIVITAS SEKSUAL
1. Komunikasi terbuka dg pasangan
2. Dilakukan saat simptom minimal ( misal 20 menit
stlh semprot bronkodilator)
3. Hindari melakukan saat merasa lelah, dalam
infeksi paru, setelah makan banyak
4. Lakukan dengan perlahan, dengan metode
relaksasi
5. Dengan posisi yang paling menguntungkan
 AKTIVITAS SEKSUAL
6. Mengekspresikan perasaan dengan berbagai
cara
7. Bila tergantung oksigen, dapat menggunakan
nasal prong selama aktivitas seksual
8. Berciuman sebaiknya dihindari, bila
mengganggu pernapasan
9. Membangun kepercayaan diri
Matur
Nuwun
 PRINSIP PENGELOLAAN
PPOK
Fase akut :
- mengatasi sesak napas
- membantu ekspektorasi dahak
- mencegah sindroma dekondisi

Medikamentosa, posisioning,
relaksasi,ankle pumping, ROM exc,
chest tx, mobilisasi dini ( bila
sesak)
 Fase Pemulihan
Mengurangi frek eksaserbasi,
memperbaiki pola napas,
meningkatkan toleransi latihan,
meningkatkan kemampuan AKS

Edukasi, Program latihan

 Fase Lanjut
Mencegah eksaserbasi,
mempertahankan kapasitas
fungsional, mempertahankan
kapasitas AKS

Edukasi , Latihan rekondisi (3-5X

perminggu), 30 menit, intensitas
sesuai uji latih
Skala Borg