dm kota malang 4 juni 3(1)

7/26/2019 DM Kota Malang 4 Juni 3(1)

1/130

DAN ERAN STATEGIS

AN ERAN STATEGIS

ERAWAT DLM

ERAWAT DLM

MENINGKATKAN KUALITAS

ENINGKATKAN KUALITAS

ELAYANAN ASIEN DM

ELAYANAN ASIEN DM

By: Nursalam


2/130

CURRICULUM VITAE

Name : Prof. Dr. Nursalam, M.Nurs (Hons) 081339650000

Aress : !l. "e#u$%& 'eal '%mur 6 *ura+aya 60111

-ma%l : nursalamf/#.una%r.a.%

H2H, D4A'N:1. Doctor, Model of Nursing Care for HIV-AIDS, Postgraduate Programme,

Airlangga Uniersit!, "##$

". Honours Master of Nursing,, Uniersit! of %ollongong, Ne& Sout'

%ales, Australia, 1(()

*. +SN Master of Nursing Course&or/, Uni. %ollongong, NS%, Australia,1((0

. Di2loma III in Nursing, Sutoma Sura3a!a 1(44

2AN*A'N AND 7"N2 PN* :1. 5ecturer and nurse in Di2loma III in Nursing, Anest'esia, Ministr! of Healt', 6I Sura3a!a 1(44 7 1(()/

". 5ecturer in Sc'ool of Nursing, 8acult! of Medicine 9 8acult! of Nursing, Airlangga Uniersit! since 1((4/

*. Vice, Head, Sc'ool of Nursing, 8acult! of Medicine, UA 1(((7 "##4/

. Vice Head, PPNI :ducatin ;raining, :ast


3/130

nursalam -"##0

OutlinesOutlines

1.

ENGANTAR

2.

ISU SEJALAN DGN UU NO 38 & 36/201

3. IM LIKASI T!D RAKTIK / ELAYANAN

.

RAKTIK KE ERAWATAN MANDIRI

". IM LEMENTASI ASU!AN KE ERAWATAN

ADA DMT2


4/130

ISSUE MEAISSUE MEA


5/130

@U6I@U5UM-N:6S-NU6SA5AM

1

ISSUE AEC (MEA)

1(909"#1*


6/130

e%onal n$er-oernmen$al

ran%;a$%on (A)

10 mem+ers

0m%ll%on #eo#le (ro?$&1.5@)


7/130

WhyWhy MEAMEA??

1. Menu?u Pasar 3e3as, mem2eruat anggotaAS:AN 'arus men?adian 2asar !ang 3ai.

". Mem3angun industri unggulan AS:AN untu

mere3ut 2asar dunia.*. Mem3utian e dunia 3a'&a ada euatan

eonomi regional 3aru di a&asan ASIA

. Meregulasi 2asar 3arang dan 2asar ?asa !angmenguntungan anggota AS:AN

$. Mem2eruat anggota AS:AN t'd serangan6egional lain

)


8/130

Neo$%a$%onsNeo$%a$%ons

*$ru$ure of Heal$&*$ru$ure of Heal$&

*er%es %n A*AN*er%es %n A*AN

CCCA(Trade in Goods)

CCI(Investment)

CCS(Coordinating Committee of

Services)

Healthcare Services

Sectoral Working Group(HSSWG)

Logistics and TransportServices SWG

Business Services SWG

AJCCM AJCCD AJCCNA AS:AN


9/130

B!' B!'

MAMA N N4*N2 **N N4*N2 **

(


10/130

Kerangka Kerjasama Jasa Kesehatan dKerangka Kerjasama Jasa Kesehatan dlmlm

MEAMEAMODE AKSES PASAR PERAKUA! !ASIO!A

M"de # Tidak ada Tidak ada

M"de $Tidak ada Tidak ada

M"de % Di wilayah Indonesia Timur (Kecuali

Makasar & Manado) usaha patungan

dgn penyertaan modal asing sampai

dengan 70% Di Medan & !ura"aya

sampai dengan #$%

!e"agaimana dise"ut dalam Komitmen orisontal dan

Ketentuan mum'roesional kesehatan wai" merupakan warga negaraIndonesia

M"de & *asa+asa keperawatan ,

a -ai" disediakan oleh pihak+pihak

dgn iin keperawata yg dikeluarkan

Kemenkes & .'

" arus menadi "agian / su"ordinat

asa rumah sakit

c ntuk melanutkan perawatan di

rumah setelah perawatan !

d telah menerapkan audit mutu dari

Kemenkes

e 'erawat harus mempunyairekomendasi se"agai pelatih dari

Kemenkes & memiliki sertiikasi dari

.' & Kemenkes

'roesional 'erawat 1sing,

a dii2inkan hanya se"agai pelatih/ konsultan dan tidak

dapat mem"erikan asa+asa keperawatan secara

langsung kepada pasien

" harus memilik i2in keperawatan yang masih "erlaku

yang dikeluarkan oleh Kemenkes dan .'

c diwai"kan untuk melakukan alih teknologi3 ilmu

keperawatan dan kemampuan proesional kepada

perawat Indonesia

d wai" memiliki pendampingan sekurang+kurangnya 4

perawat -5I selama masa tugasnya

e' dii(inkan hanya untuk )ekerja selama $

tahun dan d*t di*er*anjang' lancar "er"ahasa Indonesia "aik lisan dan tertulis dalam

pekeraannya

1#


11/130

" D#$%'( #) *+, ASEAN

D#$%'( #) *+, ASEAN

N-(' C#$$#'

-(' C#$$#'

C#, C#$,*,',(

#, C#$,*,',(

1. $&% an eal Pra$%e

. Profess%onal Nurs%n Pra$%e3. eaes&%# C Manaemen$


12/130

Ean sua&Ean sua&C &arusC &arus%la/u/an%la/u/an

6egulasi SDM @ese'atan uat UU Prati

@edoteran, UU Pendidian @edoteran, UU ;enaga

@ese'atan, UU @e2era&atan/

6egulasi tentang ;enaga @ese'atan Asing !ang3eer?a di Indonesia Permenes No. 0) ta'un "#1$/

"ons%l 'enaa "ese&a$an nones%a

Areditasi 6S !ang suda' diaui internasional

Pendidian elas dunia

1"


13/130

MPMN'A'N

A*AN MA on Nurs%n *er%es

1*


14/130

MPMAN'A'N

A*AN MA on Nurs%n *er%es

1


15/130

ole m#o?ermen$ole m#o?ermen$::

1$


16/130

N4* 2* ' A (MA)N4* 2* ' A (MA)

Mula% ar% masa #en%%/an sam#a%

masa /erFa

10


17/130

i+ensing E,tensi"n and anguagei+ensing E,tensi"n and anguage

oun$ry %ense #er%oGe$ens%on anuae

Mala!sia 1 !ear :nglis'

nones%a 5 year, 5 re%$ Ba&asa

M!anmar ;em2orar! :nglis'

P'ili22ine* !ears :nglis'

Singa2ore 1 !ear :nglis'

;'ailand $ !ear, $# credit 5ocal

+runei 1 !ear, *# credit 1 Mala!, :nglis'

ao oal

am+o%a oal

%e$nam oal


18/130

'* I HA'H A'*'* I HA'H A'*

14


19/130

Re-uirement ."r "/erseasRe-uirement ."r "/erseas

nursesnursesoun$ry a$eory ua$%on %ensuream om#e$enyassessmen$

Mala!sia 6N Di2, +N, 2ost3asic

no no

nones%a N l%n%al *#Gaane

Na$%onalam

Am%n C f%$$o #ra$%e

M!anmar 6N Di2, +N MNMC eam Sill2erformance

P'ili22ine 6N +N Bes No

Singa2ore 6N Di2, +N Bes 0 mont's

;'ailand 6N ualifiedNursingsc'ool

Bes In 2rocess

+runei 6N Di2, +N No No

No data for 5ao PD6, Cam3odia and Vietnam !et


20/130

IMPIKASI 01D PRAK0IK 2IMPIKASI 01D PRAK0IK 2

PEA3A!A!PEA3A!A!

44 No: 38G01< "PA7A'AN

(BAB )


21/130

nursalam -"##0

1.As#e/ $%/

;eori :ti@ode :tiAas :ti

.As#e/ Hu/um

UU @e2. *4 ;a'un "#1UU @es *0 ;a'un "#1@:P M:N@:S No. 149"#1#

1)9"#1*

%' R"le 4I5! 6 PP!I7#'PRAK0IK E0IK8 E9A8 PEKA :UDA3A

$'ASU1A! DA! MA!AJEME! KEP

%'PE!9EM:A!9A! PRO;ESIO!AISME

A ASPEK MORAA ASPEK MORA


22/130

Doingno harm

Doinggoo

!espect

"orautonom#

Holisticinclusio

n o"patient"amil#

Communal$orkattitue

%ollo$inginstitutional rules& regulations

'irtuouscharacter

ro"ession

alcompetence

Socialresponsiilit#

*+uit#

A' ASPEK MORAA' ASPEK MORA

Values

2referencesnursalam-"#1

: ASPEK: ASPEK E0IKE0IK KEPERAWA0A!KEPERAWA0A!


23/130

nursalam-"#1

:' ASPEK:' ASPEK E0IKE0IK KEPERAWA0A!KEPERAWA0A!

J


24/130

nursalam -"##0

SUMBER MASALA! ETIK

UMBER MASALA! ETIK

1. Dasar-asar moral ma/%n memuar

. Dasar C sen% aama ma/%n men%#%s

3. Per/em+anan P'" y men%n/a$


25/130

1/ Prati @e2era&atan dilasanaan di 8asilitas Pela!anan

@ese'atan dan tem2at lainn!a sesuai lien sasarann!a.

"/ Prati @e2era&atan se3agaimana dimasud 2ada a!at 1/

terdiria. #ra/$%/ /e#era?a$an man%r%, an

+. #ra/$%/ /e#era?a$an % fas%l%$as #elayanan

/ese&a$an

*/ Prati @e2era&atan se3agaimana dimasud 2ada a!at 1/

'arus didasaran 2ada ode eti 2rofesi, standar

2ela!anan ....

PRAK0IK KEPERAWA0A!PRAK0IK KEPERAWA0A!

UU $>#& 4:A: =78 *s'UU $>#& 4:A: =78 *s' $$

PRAK0IK KEPPRAK0IK KEP


26/130

1/ Dalam men!elenggaraan Prati @e2era&atan,Pera?a$ +er$uas se+aa%:

a. Pem+er% Asu&an "e#era?a$an

3. Penyulu&an an /onselor +a% /l%ean

c. Pengelola 2ela!anan e2era&atan

d. Peneliti e2era&atan

e. Pelasana tugas 3erdasaran 2elim2a'an

&e&enang, danf. Pelasana tugas dalam eadaan eter3atasan

tertentu

PRAK0IK KEPPRAK0IK KEP

UU $>#&8 *s'UU $>#&8 *s' $@$@

PRAK0IK KEP UU $>#&PRAK0IK KEP UU $>#&


27/130

a. melauan 2enga?ian e2era&atan secara 'olistiE

3. meneta2an diagnosis e2era&atanE

c. merencanaan tindaan e2era&atanE

d. melasanaan tindaan e2era&atanE

e. mengealuasi 'asil tindaan e2era&atanf. melauan ru?uanE

g. mem3erian tindaan 2d eadaan ga&at darurat sesuai dengan

om2etensi

'. Mem3erian onsultasi e2era&atan dan 3erola3orasi dengan doteri. melauan 2en!ulu'an ese'atan dan onseling , dan

?. Melauan 2enatalasanaan 2em3erian o3at sesuai dengan rese2

tenaga medis atau o3at 3e3as dan o3at 3e3as ter3atas.

PRAK0IK KEP' UU $>#&PRAK0IK KEP' UU $>#&

Ps' %>Ps' %> WEWE!A!9WEWE!A!9

PRAK0IK KEP UU $>#& *sPRAK0IK KEP UU $>#& *s %%


28/130

a. Perl%nunan &u/um K. Pra/$%/ sesua%

s$anar

+. Mem#erole& %nformas% y len/a# C FuFur ..

. Mem#erole& %m+alan Fasa seara man%r% K.

. Menola/ #erm%n$aan /l%en G #%&a/ la%n y

+er$en$anan n s$anar #rofes%

e. Mem#erole& fas%l%$as /erFa sesua% s$anar

PRAK0IK KEP' UU $>#&8 *sPRAK0IK KEP' UU $>#&8 *s %%

1AK1AK

PRAK0IK KEP UU $>#& *s &>PRAK0IK KEP UU $>#& *s &>


29/130

a. Melenga2i sarana 2rasarana sesuai standar 2ela!anan F.3. Mem3eri 2ela!anan e2era&atan sesuai standar 2rofesi..

c. Meng'ormati 'a lien F.

d.Meru?u asus !g tida da2at ditangani F

e. Mera'asiaan segala sesuatu !g dieta'ui F

f. Mendooumentasian Ase2

g. Mem3erian informasi !g lenga2, ?u?ur, ?elas F.

'. Melasanaan tindaan 2elim2a'an dari tim F.

i. Melasanaan 2enugasan 'usus !g diteta2an 2emerinta'

PRAK0IK KEP' UU $>#&8 *s &>PRAK0IK KEP' UU $>#&8 *s &>

KEWAJI:A!KEWAJI:A!


30/130


31/130

KOA:ORASIKOA:ORASI

*u#er%or 2oal (4nul): Ean D%/ %$

H7L


32/130

*"

*u#er%or 2oal (4nul): Ean, D%/, %$.

(=ual%$y C #a$%en$ safe$y)

*u#er%or

omm%$men$

*u#er%or

es#ons%+%l%$y

% s %on

M%ss%on G alue

+Fe$%e

ole

%&$

Aoun$a+%l%$y

% s/

ela$%ons&%#

eula$%on

+l%a$%on

Nurse Heal$& Profess%on

D%/man A

H7L


33/130

**

:uild < 0


34/130

Inter*r".essi"nal 5"lla)"rati"nInter*r".essi"nal 5"lla)"rati"n Provide leadership for the Enhancing Interdisciplinary

Collaboration in caring initiative

Determine how to enable health professionals towork together in

an effective and efficient way for the benefit of individuals andfamilies

Interprofessional collaboration refers to the positiveinteraction of two or more health professionals, who bring

their unique skills and knowledge, to assistpatients/clients and families with their health decisions (CAO, !""#$


35/130

Inter*r".essi"nal

5"lla)"rati"n Is voluntary

Requires parity among professionals

Based on mutual goals Depends on shared responsibility for

participation and decision making

hare resources

hare accountability for outcome


36/130

Whats the g"al?Whats the g"al?

Im2roing t'e =ual%$y an safe$y of

care for 2atient and t'eir families in

t'e 'os2ital setting

UAI03UAI03 C PSC PS


37/130

*)

UAI03UAI03C PSC PS

PRI!5IPES


38/130

I!0ERPRO;ESSIO!AI!0ERPRO;ESSIO!A

PA0IE!0


39/130

The 5ature o 6olla"orationThe 5ature o 6olla"oration


40/130

O)sta+les t" Inter*r".essi"nal

5"lla)"rati"n

tructure of the !ealth Care ystem

tructure of the Education ystem

!ealth Care and Education Professionals

"or#ing in eparate ystems


41/130

Mo%fy nea$%e a$$%$ues C #ere#$%onsCar2enter, 1(($/

emey fa%lures %n $rus$ C ommun%a$%on +e$?een #rofess%onsCar2enter, 1(($/

e%nfore olla+ora$%e om#e$ene+arr, 1((4/

*eure olla+ora$%on im2lement 2olicies De2artment of Healt', "##1/

im2roe serices %ilcoc and Headric, "###/

effect c'ange :ngel, "###/

o#e ?%$& #ro+lems $&a$ eee $&e a#a%$y of any one

#rofess%onCasto


42/130

Com2leit! of care 6ising e2ectations

Professional 2roliferation

Students &ant to no&

Communit! 3ased care ;eam&or

Inter2rofessional conflict

Ne& models of 2ractice

5egislation redefinition of 2rofessional roles :ffectieness of inter2rofessional 2ractice

-hy Interproessional ducation8-hy Interproessional ducation8


43/130


44/130

PERA! S0RA0E9ISPERA! S0RA0E9IS

DM ME!I!9KA0KA!DM ME!I!9KA0KA!

KUAI0AS ASKEPKUAI0AS ASKEPPASIE! DMPASIE! DM

ISSUES H'' ualityISSUES H'' uality < PA0IE!0< PA0IE!0


45/130

SA;E03SA;E03 FS


46/130

(BA PA*N '4 *AEA G *A4DAA)

KONSE DASAR ASU!ANONSE DASAR ASU!AN

ATIENT

ATIENT

7CENTRED

ENTRED

CARE

ARE

& ATIENT SAETY

& ATIENT SAETY

B IS9

nursalam-"#1

!ursing Res*"nsi)ilities!ursing Res*"nsi)ilitiesinin Patient


47/130

5entered A**r"a+hes5entered A**r"a+hes 4;aye A)dellah74;aye A)dellah7ffe$%e ommun%a$%on3et&een 2atient and

caregier. Information is accurate, timel! and

a22ro2riate.

Do eery$&%n #oss%+le to alleiate 2atients 2ain

and mae t'em feel comforta3le.

%e 2roide emo$%onal su##or$ and alleiate fears

and aniet!.

%e %nole fam%ly an fr%ens in eer! 2'ase of

our 2atients care.

%e ensure a smoo$& $rans%$%on an on$%nu%$y

from one focus of care to anot'er.

%e guarantee eer! mem3er of our communit! 'as

aess $o our are(BP!* G #oor G eneral)

nursalam-"#1


48/130

MA!A9EME!0MA!A9EME!06 DM0$6 DM0$

1. Nu$r%$%onal

. er%se

3. Mon%$or%n


49/130

nursalam-"#1

E=IDE!5E :ASEDE=IDE!5E :ASED

PRA50I5E 6DM0$PRA50I5E 6DM0$

;"rming A 9""d uesti"nsB;"rming A 9""d uesti"nsB


50/130

nursalam-MASA5AH

gg

E=IDE!5E :ASED


51/130

P '

Consider=J ender

J AgeJ Diagnosticcategor!J In

2atient9out2atient

Consider=J Dose lo& or

'ig'/J Ho& to definedoseJ Platelet t!2ea2'eresis,&'ole 3loodderied/

J Pro2'!lacticand9ort'era2eutic

Consider=J Standard

dose or no2lateletsJ Platelet t!2ea2'eresis ort'era2eutic/J Pro2'!lacticand9or

t'era2eutic

Consider=J Mor3idit! or

mortalit!J +leeding &'atseerit!/J Post transfusion

2latelet countJ Corrected countincrement

J +lood 2roductuse

Consider=J Ho& freGuentl! to

assess anddocument 3leedingJ Platelet countincrement at 1 'ourersus " 'oursJ Duration of follo&u2i.e., for a

s2ecified 2eriodafter eac'transfusion or fortotal duration of

2lateletde2endenc!

am#le ues$%on

ues$%on: n aul$s ?%$& a %anos%s of au$e myelo+las$% leu/em%a ?&o are ree%%n#ro#&yla$% #la$ele$ $ransfus%ons, oes $&e $ransfus%on of a &%& #la$ele$ ose (e=u%alen$ $o 1?&ole +loo er%e #la$ele$ #rou$s), resul$ %n fe?er ays ?%$& +lee%n ur%n $&e #er%o of$&rom+oy$o#en%a (7H 2rae O ), om#are $o a s$anar ose #la$ele$ $ransfus%on(e=u%alen$ $o 6?&ole +loo er%e #la$ele$s) L

ues$%on: n aul$s ?%$& a %anos%s of au$e myelo+las$% leu/em%a ?&o are ree%%n2ro2'!lactic

2latelet transfusions, does t'e transfusion of a 'ig' 2latelet dose eGuialent to 1" &'ole 3lood deried

2latelet 2roducts/, result in fe&er da!s &it' 3leeding during t'e 2eriod of t'rom3oc!to2enia %HK


52/130

2 2 / ! g g 2 ! 2

rade > "/, com2ared to a standard dose 2latelet transfusion eGuialent to 0 &'ole 3lood deried

2latelets/ L

P - aul$s ?%$& a %anos%s

of au$e myelo+las$%

leu/em%a ?&o are

ree%%n #ro#&yla$%

#la$ele$ $ransfus%ons

I ays ?%$& +lee%n

%HK rade > "/

I s$anar ose #la$ele$

transfusion eGuialent

to 0 &'ole 3lood

deried 2latelets/

- $ransfus%on of a &%&

#la$ele$ ose (e=u%alen$ $o

1 ?&ole +loo er%e

#la$ele$ #rou$s)

' I a%ly +lee%n

assessment during t'e

2eriod oft'rom3oc!to2enia


53/130

C,-N-CA, A.HWA/ 0 contoh ($or)

Sama engan care path$a#2 care map2 critical path$a#2

integrate care path$a#s2 multi isciplinar# path$a#s o"

care2 path$a#s o" care2 collaorative care path$a#s3

Merupakan langkah secara etailsapa #g harusilakukan lm konisi klinis #ang ter4ai paa pasien2

merupakan rencana kegiatan a# to a# ari mana4emen

pasien

Menggunakan penekatan multiisiplin karena itu apat

igunakan "ormat #ang sama untuk setiap pemeri

asuhan5 pela#anan35U%I "1 A2ril "#1


54/130


55/130


56/130


57/130


58/130


59/130

##


60/130

##

!U0RI0IO!!U0RI0IO!


61/130

Dietary ManagementDietary Management6 %J6 %J

Car3o'!drate $-0$ total dail! calories

Protein-1$-"# total dail! calories

8atsless t'an *# total calories, saturated fats

onl! 1# of total calories 8i3erlo&ers c'olesterolE solublelegumes, oats,

fruits Insoluble&'ole grain 3reads, cereals andsome egeta3les. +ot' increase satiet!. Slo&ing

a3sor2tion time seems to lo&er gl!cemic inde.Consistent, &ell-3alanced small meals seeral

times 2er da!

:c'ange s!stem or counting car3o'!drates

$$

EER5ISESEER5ISES


62/130

EER5ISESEER5ISES

E,er+ise and Dia)etesE,er+ise and Dia)etes


63/130

E,er+ise and Dia)etesE,er+ise and Dia)etes

:ercise increases u2tae of glucose 3!

muscles and im2roes utiliation, alters

li2id leels, increases HD5 and decreases

; and ;C' colesterol

If on insulin, eat 1$g snac 3efore 3eginning

C'ec +S 3efore, during and aftereercising if t'e eercise is 2rolonged

i d Di " t i d Di " t


64/130

9ercise and Dia"etes9ercise and Dia"etes

Aoid trauma to t'e feet

Aoid 2ounding actiities t'at could cause

itreous 'emorr'ageCaution if CAD

+aseline stress test ma! 3e indicated

es2eciall! in t'ose older t'an *# and &it' "or more ris factors for CAD/

%%


65/130

9U5OSE MO!I0ORI!99U5OSE MO!I0ORI!9

9l it i9l +"se m"nit"ring


66/130

9lu+"se m"nit"ring9lu+"se m"nit"ring

Patients on insulin s'ould c'ec sugars "-times 2er da!

Not on insulin, t&o or t'ree times 2er &eeaccording to tet/

S'ould c'ec 3efore meals and " 'ours aftermeals

Parameters from 2'!sician er! im2ortant

6ontinuous glucose6ontinuous glucose


67/130

gg

monitoringmonitoringSu3cutaneous sensor in a3domen

Do&nload data G)"'

:aluates trends and efficac! of treatmentoer "' 2eriod

"1$6"1$6 :; #:; #


68/130

"1$6"1$6+ :;3#+ :;3#

Measures 3lood leels oer "-* mont's 2er

tet/

Hig' leels of glucose &ill attac' to'emoglo3in

Hel2s to ensure t'at t'e 2atients glucometer

is accurate

KetonesKetones


69/130

KetonesKetones

C'ec in 2regnanc!

During illness

If +S O"#

&&

I!SUI!I!SUI!


70/130

I!SUI!I!SUI!

Insulin thera*yInsulin thera*y


71/130

*y*y

6a2id actinglis2ro Humalog/ and insulin

as2art Noolog/ onset 1$, 2ea 0#-(# and

last from "- 'ours

S'ort actingregular. Knset is *#-0#, 2ea

in "-*' and last for -0 'ours. 6egular

insulin is onl! ind for IV use.

Insulin TherapyInsulin Therapy


72/130

Insulin TherapyInsulin Therapy

Intermediate insulinsNPH or 5ente. Knset

*-', 2ea -1" 'ours and lst 10-"# 'ours.

Names include Humulin N, Noolin N,

Humulin 5, Noolin 5

5ong actingHumulin Ultralente. Knset 0-

4', 2ea 1"-10 ' and lasts "#-*#'.

Pealess insulins= determir and glargine

Methods o Insulin Deli


73/130

Methods o Insulin Deli


74/130

!"rmal Insulin Meta)"lism!"rmal Insulin Meta)"lism

as$%n s$a$e

7 oun$er-reula$ory &ormones (es#e%ally

luaon) s$%mula$e lyoen luose

7&en luose unaa%la+le ur%n fas$%n

s$a$e

7 %#olys%s (fa$ +rea/o?n)

7 Pro$eolys%s (am%no a% +rea/o?n)

A'D H M'AB*M

Insulin


75/130

lucose Utiliation

l!cogenol!sis

H!2ergl!cemia

lucosuria osmotic diuresis/

Pol!uriaQ

and electrol!te im3alance/

Pol!di2siaQ

Q Hallmar s!m2toms of dia3etes

A'D P'N M'AB*M


76/130

Insulin

Protein Cata3olism

luconeogenesis

amino acids glucose/

H!2ergl!cemia

%eig't 5oss and 8atigue

A'D P'N M'AB*M


77/130

Insulin

Protein Cata3olism

luconeogenesis

amino acids glucose/

H!2ergl!cemia

%eig't 5oss and 8atigue

EDU5A0IO!EDU5A0IO!


78/130

EDU5A0IO!EDU5A0IO!

0ea+hing Plan0ea+hing Plan


79/130

0ea+hing Plan0ea+hing Plan

:ducation is critical

Sim2le 2at'o2'!siolog!

;reatment modalities

6ecognition, treatment and 2reention ofacute com2lications

%'en to call t'e doctor

8oot care, e!e care, general '!giene, risfactor management

Patient edu+ati"n 4.""t +are7Patient edu+ati"n 4.""t +are7 'a/e are of your %a+e$es


80/130

'a/e are of your %a+e$es

5"nt'5"nt' ns#e$ your fee$ eery ay


81/130

# y y y

7as& your fee$ eery ay

5"nt'5"nt' "ee# $&e s/%n sof$ C smoo$&


82/130

"ee# $&e s/%n sof$ C smoo$&

5"nt'5"nt' *moo$& orns an


83/130

alluses en$ly

'r%m your $oena%ls ea&

?ee/ or ?&en neee

5"nt'5"nt' 7ear s&oes an so/s a$


84/130

7ea s oes a so s a$

all $%mes

Pro$e$ your fee$ from

&o$ an ool

"ee# $&e +loo flo?%n

$o your fee$

&e/ ?%$& your &eal$&

are #ro%er.

Teaching patients toTeaching patients to

d i i t i lid i i t i li


85/130

administer insulinadminister insulin Storing insulin ma! not refrigerate if used &it'in

one mont'/. Prefilled s!ringes s'ould 3e storedstanding u2.

S!ringesConcentrations of insulin

Miing insulins

Do not rotate area to area, use same anatomic area

No need to as2irate

MA!A9EME!0MA!A9EME!0


86/130

5OMPI5A0IO!5OMPI5A0IO!

1cute 6omplications o1cute 6omplications o

Dia"etesDia"etes


87/130

Dia"etesDia"etes

1. H!2ogl!cemia$#-0# or less

". D@A

*. HHNS

aa ypoglycemiaypoglycemia


88/130

yp g yyp g y

ause +y $oo mu& %nsul%n or oral

aen$s, $oo l%$$le foo or eess%e #&ys%al

a$%%$y

*ure %n e#%ne#&r%ne an nore#%ne#&r%ne

resul$s %n s?ea$%n, $remors, $a&yar%a,

#al#%$a$%ons, nerousness an &uner

ypoglycemiaypoglycemia


89/130

yp g yyp g y

CNS effectsina3ilit! to concentrate,

'eadac'e, lig't'eadedness, confusion,

memor! 2ro3lems, slurred s2eec',

incoordination, dou3le ision, seiures and

een loss of consciousness.

ypoglycemic unawarenessypoglycemic unawareness


90/130

yp g yy g y

6elated to autonomic neuro2at'!

%ill not e2erience t'e s!m2at'etic surge

&it' s&eating, s'ainess, HA, etc.

Treatment or hypoglycemiaTreatment or hypoglycemia

+. D%a+e$% "e$oa%os%s (D"A)


91/130

yp g y+. D%a+e$% "e$oa%os%s (D"A)

Dia"etic KetoacidosisDia"etic Ketoacidosis


92/130

Clinical features are=

1. H!2ergl!cemia". De'!dration and electrol!te loss

*. acidosis

DK1DK1


93/130

;'ree main causes= illness, undiagnosed and

untreated and decreased insulin

Kt'er causes= 2atient error, intentional

si22ing of insulin

'resentation o DK1'resentation o DK1


94/130

* Ps

Krt'ostatic '!2otension

@etosisI s9s

Acetone 3reat'

'!2erentilation

Diagnostic =indings o DK1Diagnostic =indings o DK1


95/130

+S 3et&een *##-4##

Acidosis

:lectrol!te a3normalities:leated +UN, creatinine and 'ct r9t

de'!dration

Medical Management o DK1Medical Management o DK1


96/130

6e'!drate &it' normal saline, t'en follo&&it' .$ NaCl t'en D$.$NS or ot'er/

6estore electrol!tes

:Cs

Hourl! 3lood sugars

IV insulin

Aoid 3icar3onate as can affect serum @

5ursing Management5ursing Management


97/130

Am%n%s$er flu%s

nsul%n

Preen$ flu% oerloa

*$r%$ C

ollo? ly$es

2 mon%$or%n

%$al s%nsMon%$or #a$%en$ res#onses $o $rea$men$s


. Hy#erlyem% Hy#erosmolar

Non/e$o$% *ynrome


98/130

Non/e$o$% *ynrome

yperglycemic yperosmolaryperglycemic yperosmolar

5onketotic !yndrome5onketotic !yndrome


99/130

5onketotic !yndrome5onketotic !yndrome

Predominated 3! '!2erosmolarit! and

'!2ergl!cemia

Minimal etosis

Ksmotic diuresis

l!cosuria and increased osmolarit!

Kccurs oer time+lood sugar is usuall! oer 0##

dd5ursing Management o5ursing Management o

5!5!


100/130

5!5!Monitor neurologicall!

Monitor :C

Monitor ital signs

5a3sHourl! 3lood glucose monitoring

Insulin IV

Cautious correction of '!2ergl!cemia to aoidcere3ral edema


N2 'M MPA'N*


101/130

DAB'*

>ong term complications o>ong term complications o

Dia"etesDia"etes


102/130

Dia"etesDia"etesIncreasing num3ers of deat's from

cardioascular and renal com2lications

6enal microascular/ disease is more

common in t!2e 1 dia3etics

Cardioascular disease macroascular/

com2lications are more common in t!2e "

dia3etics

$)$)Dia"etic ?ascular DiseasesDia"etic ?ascular Diseases


103/130

C'ronic '!2ergl!cemia causes irreersi3le

structural c'anges in t'e 3asement mem3ranes

of essels. 6esult is t'icening and organ

damage.lucose toicit! affects cellular integrit!

C'ronic isc'emia in microcirculator!

3rancesOOcause connectie tissue '!2oia andmicroisc'emia

Dia"etic ?ascular DiseasesDia"etic ?ascular Diseases


104/130

U2 to "1 of dia3etics 'ae retino2at'! at

time of diagnosis

Macro


105/130

Coronar! arter! disease

Cere3roascular disease

Peri2'eral arterial disease

Management oManagement o

Macro


106/130

Modif!9reduce ris factors

Meds for '!2ertension and '!2erli2idemia

Smoing cessation

Control of 3lood sugars &'ic' &ill 'el2

reduce ;

Micro


107/130

Dia3etic retino2at'!-leading cause of 3lindness int'ose "#-)

+lood essel c'anges&orst case scenario,2roliferatie retino2at'!. Also an increasedincidence of cataracts and glaucoma in dia3etics.

Need regular e!e eams

Control +P, control +S and cessation of smoing

can 'el2

Micro


108/130

Accounts for $# of 2atients &it' :S6D

:arliest clinical sign of ne2'ro2at'! is

microalbuminuria.

%arrants freGuent 2eriodic monitoring for

microal3uminuriaif eceeds *#mg9"' on

t&o consecutie random urines, need "'

urine sam2le

4)4) 5ephropathy5ephropathy


109/130

Dia3etes causes '!2ertension in renal

essels &'ic' cause leaing glomeruli,

de2osits in narro& essels, scarring and

ascular damage

Micro


110/130

p p yMedical management= control +P AC: or

A6+/

; of U;Is

Aoid ne2'rotoic agents, contrast d!es

5o& sodium diet

5o& 2rotein diet;ig't gl!cemic control

5ephropathy5ephropathy


111/130

Ma! reGuire dial!sis

Ma! 'ae co-eistent retino2at'!

@idne! trans2lantationsuccess no& )$-

4# for $ !ears

Pancreas trans2lantation ma! also 3e

2erformed at time of idne! trans2lantation

5europathies5europathies


112/130

rou2 of diseases t'at affect all t!2es of

neres.

Includes 2eri2'eral, autonomic and s2inal

neres.

Prealence increases &it' duration of t'e

disease and degree of gl!cemic control



113/130

Ca2illar! 3asement mem3rane t'icening

and ca2illar! closure ma! 3e 2resent.

Ma! 3e dem!elination of t'e neres, nere

conduction is disru2ted.

;&o most common t!2es of neuro2at'! are=

sensorimotor 2ol!neuro2at'! and autonomic

neuro2at'!.

'eripheral neuropathy'eripheral neuropathy


114/130

Manifestations=2arest'esias, 3urning

sensations, num3ness, decrease in

2ro2rioce2tion.

C'arcot foot can result from a3normal

&eig't distri3ution on ?oints secondar! to

lac of 2ro2rioce2tion

Management o 'eripheralManagement o 'eripheral



115/130

Pain management in t'e form of ;CAs,

Dilantin, ;egretol, Neurontin, meilitene,

and ;:NS. C!m3alta 'as 3een

recommended. Also, t'e drug 5!rica2rega3alin/

1utonomic 5europathies1utonomic 5europathies


116/130

Cardiac, gastrointestinal and renal s!stems

Cardiacm!ocardial isc'emia ma! 3e 2ainless

Idela!ed gastric em2t!ing &it' earl! satiet!,

nausea, 3loating, diarr'ea or consti2ationUrinar! retentiondecreased sensation of 3ladder,

neurogenic 3ladder

1utonomic neuropathy@1utonomic neuropathy@

hypoglycemia unawarenesshypoglycemia unawareness


117/130

No longer feel s'ainess, s&eating,

nerousness and 2al2itations associated &it'

'!2ogl!cemia

;'e ina3ilit! to detect &arning signs of'!2ogl!cemia can 2lace t'e 2atient at er!

'ig' ris

1utonomic neuropathy+1utonomic neuropathy+

sudomotor neuropathysudomotor neuropathy


118/130

Patient &ill 'ae a decrease or a3sence of

s&eating of t'e etremities &it'

com2ensator! increase in u22er 3od!

s&eating.

1utonomic neuropathy@1utonomic neuropathy@

se9ual dysunctionse9ual dysunction


119/130

Decreased li3ido in &omen

Anorgasmia

:D in men

U;I and aginitis

6etrograde e?aculations

Management o neuropathiesManagement o neuropathies


120/130

:arl! detection, 2eriodic f9u on 2atients&it' cardiac disease

Monitor +P freGuentl! for s9s ort'ostatic

'!2otension5o& fat diet, freGuent small meals, close +S

monitoring and use of 2roineticmedications

Meticulous sin care

A)A) =oot and >eg 'ro"lems=oot and >eg 'ro"lems


121/130

Sensor! loss

Sudomotor neuro2at'! leads to dr!,

cracing feet

PADso 2oor &ound 'ealing9gangrene

5o&ered resistance to infection

Management o =oot and >egManagement o =oot and >eg

'ro"lems'ro"lems


122/130

;eac'ing 2atient foot care-ins2ect feet and s'oesdail!

:amine feet eer! time goes to doctor

See 2odiatrist at least annuall!

Closed toe s'oes

;rimming toenails

ood foot '!giene

Glycemic control is the key to preventingcomplications

5O!5USIO!5O!5USIO!

K: KEMAUAN


123/130

U: USA!A /UANG

W: WAKTU

A: ALAT ;SARANA

T: TENAGA KUALITAS

&

KUANTITAS5

A P I

A =AKTUALITAS

P =PRODUKTIFITAS

I =INOVATIF

AA!E0WORKI!9 C I!0ER5O!!E50I!9!E0WORKI!9 C I!0ER5O!!E50I!9


124/130

We are n"thing ith"ut "thers8 s" needWe are n"thing ith"ut "thers8 s" need"thersL"thersL

::SE; RE;ORMSE; RE;ORM


125/130

55

;I910I!9 SPIRI0;I910I!9 SPIRI0


126/130

#091910 1"0

'DA" ADA "MNAN2AN, 'ANPA

MM4A

'DA" ADA "*4"**AN, 'ANPA


127/130

Eou on$ &ae $o +e rea$ $o e$ s$ar$e,

+u$ you &ae $o e$ s$ar$e $o +e rea$

--------- es Bro?n ----------

MNBA

'DA" ADA "DDHAN, 'ANPA

MA4 BA!A


128/130


129/130

Ma/%n oo on$r%+u$%ons

$o Pa$%en$ safe$!

*4*'AN 4A'E

AND PD4''E

(MMB

A-P-)

Bu%l%n s/%lls anom#e$eny

of nurses

1"(mtrla91*#)"#1#

T!ANK!ANKYOU & GOODYOU & GOOD

LUCK

UCK


130/130

dm kota malang 4 juni 3(1)

Documents