Konsep Penanganan Luka

Zaqqi Ubaidillah
 Pendahuluan

 Luka adalah suatu keadaan putusnya kontinuitas

jaringan yang disebabkan oleh berbagai hal.

 Kondisi ini disusul dengan proses penyembuhan luka

yang berlangsung sangat kompleks melalui berbagai
fase.

 Luka menjadi masalah → luka kronik,

therapy-resistant & berbahaya bagi
pasien
 Pendahuluan
 Perawatan luka: mengawal proses penyembuhan luka
agar dapat berlangsung dengan baik  Perawat harus
memiliki pengetahuan yang baik tentang perawatan
luka dan patologinya

 Goal dari perawatan luka terkini adalah penderita

sembuh dari lukanya dan dapat kembali menjadi orang
yang produktif serta hidupnya berarti (Kresner et al,
2001)

 Program penatalaksanaan luka yang komprehensif 

penting
 Klasifikasi Luka

1. Luka Akut
Luka baru yang terjadi mendadak dan
penyembuhan luka sesuai dengan waktu yang
diperkirakan (Moreau, 2003)

2. Luka Kronik
Luka yang mengalami kegagalan dalam proses
penyembuhan, yang biasanya disebabkan oleh
masalah multifaktor dari penderita (eksogen
atau endogen)
epidermis.jpg

Review kulit
Extent of Tissue
Involvement

Partial Thickness
Extent of Tissue
Involvement

Full Thickness
 Manajemen vs Perawatan Luka

 Manajemen luka adalah pemberian asuhan secara

komprehensif dan holistik pada pasien khususnya
tentang segala sesuatu yang mempengaruhi
proses penyembuhan luka pasien tersebut.

 Perawatan luka adalah pemberian perawatan

langsung dan fokus pada area luka.
 Luka Akut

 Luka Insisi

 Kontusio

 Laserasi

 Puncture wounds

 Avulsion wounds

 Luka Bakar
gr1_lrg.jpg

Proses Penyembuhan Luka

 Type of Acute Wound Closure

 Primary Closure

 Delayed primary closure

 Secondary or spontaneous closure

 Factors In The Repair of The
Acute Wound

• interactions among cytokines, growth factors, blood and the

extracellular matrix
• Cytokine stimulating the production of components of the
basement membrane, preventing dehydration, increasing
inflammation and the formation of granulation tissue.
• Local factors which includes hypothermia, pain, infection,
radiation and tissue oxygen tension directly influence the
characteristics of the wound
• systemic factors are the overall health or disease state of the
individual that affect individual’s ability to heal
• In addition to these factors, poor nutrition, age and protein,
vitamins and mineral deficiency
 Dressing Selection

 Pemilihan balutan untuk luka akut ditentukan oleh

apakah luka tertutup secara primer atau
dibiarkan terbuka
 Primary Closure  sterile dressing for 24 to 48
hours
 Penggantian balutan setelah > 48 jam, tergantung
kondisi luka & tujuan treatment
 Untuk luka yang dibiarkan terbuka  treatment
with a moist dressing
 Jenis balutan lain dapat dipilih, tergantung kondisi
luka  gunakan secara tepat!
 Dressing Selection

 Gunakan teknik aseptik saat mengganti insisi

bedah

 Frekuensi penggantian balutan tergantung pada

jumlah drainage, kondisi penyembuhan luka, dan
jenis balutan yang digunakan. Beberapa produk
dapat bertahan 3 – 7 hari.
 Karakteristik wound dressing ideal

a) provide or maintain moist environment

b) enhance epidermal migration
c) promote angiogenesis and connective tissue
synthesis
d) allow gas exchange between wounded tissue
and environment
e) maintain appropriate tissue temperature to
improve the blood flow to the wound bed and
enhances epidermal migration
f) provide protection against bacterial infection
 Karakteristik wound dressing ideal

g) should be non-adherent to the wound and

easy to remove after healing
h) must provide debridement action to enhance
leucocytes migration and support the
accumulation of enzyme and
i) must be sterile, non-toxic and non-allergic.
 Infection

 Spreading erythema of the skin around the incision line

 Local pain
 Local oedema
 Heat
 Pyrexia
 Increased exudates / suppuration
 Abscess formation
 Cellulitis
 Loss of function of a limb
 Dehiscence

Wound dehiscence is a surgical complication in which a wound

ruptures along a surgical incision
 Evisceration

extrusion of viscera outside the body, especially through a

surgical incision
 SINUS

A track to the body

surface from an
abscess or some
material which has
an irritant effect
and becomes a
focus for infection
e.g sutures, fibres
from gauze
dressings
 FISTULA

Abnormal track connecting

one viscus with another
viscus, or connecting a viscus
with a body surface
 Luka Kronik

Ulcers
Pressure
Traumatic wound
Surgical Wound
Neoplasmatic Wound

Leg Ulcer
Arterial
Venous
Neuropathic
 Apa Yang Membuat Luka menjadi
Kronik

Underlying Pathology

Prolonged Inflammatory Phase

Low levels of Growth Factors

Host condition

Denervation
Prinsip-Prinsip Manajemen Luka

1. Mengontrol atau menghilangkan faktor-faktor

penyebab

2. Memberikan support sistemik untuk

mengurangi kofaktor yang ada dan
berpotensial

3. Menjaga keadaan fisiologis lokal di area sekitar

luka (kelembapan, temperatur normal,
keseimbangan bakteri, pH)
 Dressing Selection

 Sebelum memilih balutan  Wound Bed

Preparation

 Principle of Wound Bed Preparation  TIME

 Tissue-remove non-viable & restore wound base

Infection-treat microbial burden
Moisture-maintain moisture balance
Edge-advance wound edge & fill dead space
 Factors Influencing Dressing
Selection
Wound type • Superficial
• Full thickness
• Cavity
• • Necrotic
Wound description
• Sloughy
• Granulating
• Epithelialising
Wound characteristics • Dry
• Moist
• Heavily exuding
• Malodorous
• Excessively painful
• Difficult to dress
• Liable to bleed easily
Bacterial profile • Sterile
• Colonised
• Infected and potential source of serious
cross infection
 Characteristics and Uses of Wound-Dressing Materials
Category Description Applications

All hydrogel dressings are

Hydrogel dressings are glycerine or
indicated for the dry to
waterbased dressings that are
minimally wounds with or
Hydrogel primarily and uniquely designated to
without a clean granular wound
hydrate the wound
base

Films dressing are indicated as

a primary dressing for (1)
Transparant film dressings are
prophylaxis on high risk intact
polyurethane sheets coated on one
Transparant Film side with an acrylic, hypoallergenic
skin, (2) superficial wounds
with minimal or no exudate and
adhesive
(3) eschar covered wounds
when autolysis is indicated
Hydrocolloid Hydrocolloid dressings are made of Hydrocolloid dressings are useful
microgranular suspension of natural or for minimal to moderate exudate in
synthetic polymers, such as gelatin or partial & full thickness wound
pectin, in an adhesive matrix. The
granules change from a semihydrated
state to a gel as the wound exudate is
absorbed.
 Category Description
Foam Polyurethane foam has absorptive
capacity
Alginate Alginate dressings are made of
seaweed extract contains guluronic
and mannuronic acids that provide
tensile strength and calcium and
sodium alginates, which confer an
absorptive capacity. Some can leave
fibers in the wound if they are not
thoroughly irrigated. These dressings
are secured with secondary coverage
Debriding Agents Various products provide some
chemical or enzymatic debridement
Applications
These dressings are useful for
moderate to heavy exudate
wounds with or without a clean
granulate wound bed
Alginate are indicated for
moderate to heavily exudative
wounds with or without dept
and with or without a clean
granular wound bed
Debriding agents are useful for
necrotic wounds as an adjunct
to surgical debridement.
 Applications Description
Wound Filler Wound filler are available in
hydrated forms , dry forms,
or other forms
Antimicrobial Dressing Topical antifungal and
antibiotic agents available as
ointment, impregnated
gauzes, pads, island dressing
and gels
Category
Wound fillers are used to fill
dead space as well as to
absorb exudate and are
indicated for shallow
wounds with minimal to
moderate exudate
To provide a sustained
release of a long-lasting
antimicrobal action in
combination with
maintaince of a physiological
environment for healing.
Partial & full thickness
wounds, odorous wounds
with minimal to heavy
exudates, highly
contaminated & infected
wounds
 Continuum of dressing selection with
changing exudate & depth

Least-------------------------------------------------------------------- Most
Absorptive Absorptive
Hydrogel Transparant Hydrocolloids Wound Foams Alginates

Film Filler

Shallow ----------------------------------------------------------------------- Wounds

Wounds Transparent Hydrocolloids Wound Foams Algynates Impregnated with
Depth
Films Filler Gauze & tunnels
 Necrotic/sloughy Local Infeksi/ Granulasi Epitelisasi
tissue Critical
Kolonisasi
Wound Bed

Objective of Mengangkat Clean up & Support Protection of

Treatment Jaringan Nekrotik reduce bacterial granulation & newly formed
barden tissue growth tissue

Treatment
Suggestion
Eksudat Banyak Alginate Silver Foam
Hydrocapillary Silver Alginate
foam Hydrofobic
Eksudat Sedang Hydrogel + Silver foam Foam
Alginate Foam Silver Alginate Alginate

Eksudat Sedikit Hydrocolloid Silver Hydrocolloid Thin hydrocolloid

Hydrogel hydrocolloid Film
Silver wound
TERIMA KASIH