perawatan kaki diabetes -bpjs 2015-fabiola
TRANSCRIPT
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Simple Diabetes Foot Care
PERAWATAN KAKI DIABETES
Fabiola M.S Adam
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Slide 3
WHY FOOT CARE IS IMPORTANT TO DIABETESMANAGEMENT
Have 15 4!"ld #i$#e% %i&'"! le$a()*+a+i",+#a, ,",dia-e+i.
Have a 15 /li!e +i(e %i&' "!devel")i,$!""+ *l.e%
Eve%0 3&e.",d& al"e% li(- l"&+.a*&ed -0dia-e+e&
520ea%&*vival %a+ea!+e% (a"%a()*+a+i", 5 /
5/ "! dia-e+e&2%ela+ed a()*+a+i",& a%e#a))e,i,$ i, )a+ie,+& i+# !""+ *l.e%&
Ea%l0 de+e.+i", .a, )%eve,+ 425 / l"e% li(-a()*+a+i",
Frykberg et al. J Foot Ankle Surg, 2000. IDF, International Working Group on Diabetic Foot 2007
Dia-e+i. Pa+ie,+&
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Slide 4
5 CORNERSTONES OF DIABETES FOOT CAREMANAGEMENT
67 Ide,+i!i.a+i", "!%i&' !a.+"%&
17 F""+ e8a(i,a+i",%e$*la%l0
37 Ed*.a+i",9)a+ie,+&: )%"vide%&
a,d !a(il0;
47 T%ea+(e,+ -e!"%e
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Slide 5
RISK FACTORS FOR DIABETIC FOOT "i,+ M"-ili+0
Ne)#%")a+#0
A$e
D*%a+i", "! Dia-e+e&
?i&*al A.*i+0
P%evi"*&
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Slide @
CA
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Slide
PATHWAY TO DIABETIC FOOT
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Slide
PERIPHERA= NE
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Slide
Ne*%")a+#i.
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Slide 1
?ASC
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Slide 11
PATHOPHYSIO=OGY OF DIABETIC FOOT
Dia-e+e& Melli+*&
Ne*%")a+#0 T%a*(a ?a&.*la% Di&ea&e
MOTOR
"ea#ness$trophy
%ighPlantarPressure
Deformity
$bnormaltress
Callus&ormation
S+%*.+*%alDe!"%(i+0
C#ei%"a%+#%")a+#0
I()ai%ed Re&)",&e+" I,!e.+i",
Dia-e+i. F""+
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Slide 13
NE
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Slide 15
C=INICA= C=ASSIFICATION OF DIABETICFOOT 9EDMOND;
Grade 1Grade 1 Grade 2Grade 2 Grade 3Grade 3 Grade 4Grade 4 Grade 5Grade 5 Grade 6Grade 6
Normalfoot, no
risk factorsof
neuropathy,ischemia,deformitie
s
No activeulcers,
have 1risk
factors:neuropathy, ischemia,deformities, callus
andswelling,
naildeformitie
s
Skinbreakdown
; surre,blitser,
ulcersually inplantarsurface
!ootdevelop
infections,"ischarge
purulent,cellulitis,neuropathy and orischemia
#issuenecrosiswith or
with out
intakefoot,neuropath
y,ischemia,neuroische
mi,
infection
nsalvageable foot,
need ma$oramputatio
n,e%tensivenecrosis,destroyed
foot,severe
infection
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WAGNER-MEGGITWO
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DIA/ETE 122T E3AMINATI2NDIA/ETE 122T E3AMINATI2N
PatientPatient
4istory4istory
GrossGross
Assess-Assess-
mentment
5ascular5ascular
E%aminationE%amination
creenin&creenin&
forfor
neuropatyneuropaty
Derma-Derma-
tolo&ictolo&ic
E%aminationE%amination
Nail Defor-Nail Defor-
matiesmaties
6 TEP 12R A 72MPETE DIA/ETE 122T E3AMINATI2N6 TEP 12R A 72MPETE DIA/ETE 122T E3AMINATI2N
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Slide 1
FIRST 4 STEPS IN THE ASSESSMENT
A&&e&&(e,+ Si$,i!i.a,+ Fi,di,$
Pa+ie,+Hi&+"%0
2 P%evi"*& !""+ *l.e%a+i",2 P%evi"*& a()*+a+i",
2 Dia-e+i. 1 0ea%&2 A1. /
2 I()ai%ed vi&i",
2 Ne*%")a+#i. &0()+"(&2 Cla*di.a+i"
G%"&&I,&)e.+i",
2 Ha((e% +"e&2 Cla +"e&
2 Hal*8 val$*&
2 C"%,: .all*&: .all*& i+# *l.e%: -*,i",2 P%"(i,e,+ (e+a+a%&al #ead
De%(a+"l"$i.
E8a(i,a+i",
2 D%0 &'i,
2 A-&e,.e "! #ai%2 Yell" "% e%0+#e(a+"*& &.ale
2
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Slide 1
=AST 6 STEPS IN THE ASSESSMENT
A&&e&&(e,+ Te&+ Si$,i!i.a,+Fi,di,$
S.%ee,i,$ !"%
Ne*%")a+#0
2 Se((e&2Wei,&+ei,
(","!ila(e, 1 $%a(
=a.' "! )e%.e)+i", a+
",e "% ("%e &ide
2 T*,i,$ !"%' 16H Ne$a+ive "! vi-%a+i",)e%.e)+i",
2 Bi"+#e&i"(e+e%?i-%a+i", )e%.e)+i",
?i-%a+i", )e%.e)+i",+#%e"ld 65 v"l+
?a&.*la%
E8a(i,a+i",
! Pal)a+i", "! d"%&ali&
)edi& a,d +i-iali&)"&+e%i"% a%+e%0
! A,'le B%a.#ial I,de8! C"l"% d"))le%
De.%ea&e "% a-&e,+
)*l&e ABI 7 .",&i&+e,+
i+# PAD
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Slide 6
MONOFI=AMEN TEST
T
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Slide 61
PA=PATION OF ARTERIES
5A7)2PAT48 7REENING
Ca)illa%0 %e!ill 6 &e.
A7 D"%&ali& )edi&
A7 Ti-iali& )"&+e%i"%
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Slide 66
ANK=E BRACHIA= INDE
ABI
-./0
1/2 3 ./0
41/2
41/5
I,+e%)%e+a+i",
6igid or calcified (essels or both
Normal 7or calcified8
Ischemia
e(ere ischemia
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Slide 63
RISK C=ASSIFICATION BASED ON FOOT ASSESSMENT
S."%e Ca+e$"%0 Ri&' P%"!ile C#e.'2*)F%eJ*e,.0
=" Ri&'
P*l&a+i", ADP a,d ATP $""d N" de!"%(i+ie& 9#a((e% +"e: .la
+"e&: #al*8 val$*&: )%"(i,e,+
(e+a+a%&al #ead;
O,.e a 0ea%
1 I,.%ea&ed Ri&'
P*l&a+i", ADP a,d ATP $""d A,d"% de!"%(i+ie& 9#a((e% +"e:
.la +"e&: #al*8 val$*&: )%"(i,e,+(e+a+a%&al #ead;
O,.e eve%0 @
(",+#&
6 Hi$# Ri&'
ABI : "% ADP ATP ,"+
)al)a-le De!"%(i+ie& 9 #a((e% +"e: .la
+"e&: #al*8 val$*&: : )%"(i,e,+
(e+a+a%&al #ead
O,.e eve%0 3
(",+#&
3 ?e%0 Hi$# Ri&'
Hi&+"%0 "! *l.e% "% a()*+a+i",
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Slide 65
PRE?ENTION OF DIABETES FOOT
DOC#e.' 0"*% !ee+ eve%0da0
Ala0& ea% !""+ea%
C#e.' 0"*% !""+ea% -e!"%e
ea%i,$ +#e(
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Slide 6@
MANAGEMENT OF FOOT
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Slide 6
W"*,d C",+%"l1
17 I,.i&i",: d%ai,a$e:de-%ide(e,+ a,d,e.%"+"(0
67 Ma,a$e(e,+ "!i,!e.+i",& i, +i&&*ea,d -",e
37 E8*da+e Ma,a$e(e,+47 Kee) .",+%"l "!
)%"li!e%a+i", )#a&e
a,d i,!e.+i",&
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Slide 6
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Slide 6
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Slide 3
S#a%) de-%ide(e,+"*ld -e .a%%ied "*+ -0e8)e%ie,.ed)%a.+i+i",e%& i+#&)e.iali&+ +%ai,i,$
SHARP DEBRIDEMENT
G"ld &+a,da%d +e.#,iJ*e !"%+i&&*e (a,a$e(e,+17 &.al)el:67 &.i&&"%&:37 a,d"% !"%.e)&
Be,e!i+&
17Re("ve& ,e.%"+i. +i&&*e a,d.all*&67Red*.e )%e&&*%e37All"& !*ll i,&)e.+i",& "! +#e*,de%l0i,$ +i&&*e&
47Hel)& d%ai,a$e "! )*&&e.%e+i",&57O)+i(i&e +#e e!!e.+ive,e&& "!+")i.al )%e)a%a+i",&@7S+i(*la+e& #eali,$
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Slide 31
De-%ide(e,+"*ld%e("ved alldevi+ali&ed+i&&*e: .all*&add !"%ei$,-"die&d", +" via-le-leedi,$ +i&&*e
Slide 36
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W"*,d D%e&&i,$
9 T%a,&)a%e,+ !il( i,)a+ie,+ : d%0 "% (i,i(ale8*da+i,$ "*,d 9CI i,!e.+ed "*,d&: #eav0e8*da+e: "ve% -",0 )%"(i,e,.e;
Slide 36
Slide 33
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W"*,d d%e&&i,$
Slide 33
9 H0d%"."ll"id&a+e%)%""! : -a%%ie% +")%"+e.+ !%"( -a.+e%ia "%!%i.+i",7 I,di.a+i", l"2("de%a+e e8*da+i,$"*,d&7 CI #eav0 !l*ida,d )"&&i-le &i,*&+%a.'i,$ "% i,!e.+i",
Slide 34
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W"*,d d%e&&i,$
Slide 34
9 F"a(& #i$#l0 a-&"%-e,+: !le8i-le: )%"+e.+"*,d& *) +" da0&7 I,di.a+i", l"2#eav0e8*da+i,$ "*,d&7 CI d%0 "*,d&
Slide 35
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W"*,d d%e&&i,$
A-&"%)+ive .avi+0 "*,d !ille%& Al$i,a+e .al.i*(d%e&&i,$: #i$#l0 a-&"%-e,+7 S+i(*la+e $%a,*la+i",+i&&*e !"%(a+i", 7 F"% )%"+#%"(-"+i. ."a$*la+i",a,d )la+ele+ a.+iva+i", +" )%"vide $""d
#ae("&+a&i& +" &+") -leedi,$ a!+e% &*%$e%0
Slide 35
Slide 3@
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W"*,d d%e&&i,$
Slide 3@
9 C"lla$e,& ."&+& #i$#7 Ca, )%"("+e& #ae("&+a&i&a,d .#e("+a&i&7 I,di.a+ed !"% .lea, "*,d& a,d,"+ .",+ai,(i,a+ed7
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W"*,d d%e&&i,$
A,+i(i.%"-ial& #eavil0 a,d .",+a(i,a+ed "*,d& 7Red*.e -a.+e%ial ."*,+& a,d .",+%"l -a.+e%ia i,+#e "*,d
Slide 3
Slid 3
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Slide 3
Me+a-"li. C",+%"l6
17 H0)e%$l0.e(ia! "ill inhibit process of ,ound reco(ery! Inhibit gro,th factor: collagen synthesis and! fibroblast acti(ities67 H0)e%al-*(i,e(i37 H0)e%+e,&i",47 De.%ea&e "! #ea%+ a,d 'id,e0 !*,.+i",57 D0&li)ide(ia@7 A,e(ia7 O+#e% di&ea&e& .a*&ed -0 dia-e+e&
Slide 3
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Slide 3
INFECTION CONTRO=3
17 Need a$$%e&&ive +#e%a)067
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Slide 4
Slide 46
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Slide 46
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Slide 43
?ASC
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Slide 44
MECHANIC CONTRO=5
17 P%i,.i)leRed*.e &+%e&& ", +#e "*,d
O!! l"adi,$ Mi$#+ -e -ed %e&+
N",2ei$#+ -ea%i,$
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CONC=
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Slide 4
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KAS
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Slide 4
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9 17 A)a dia$,"&i& da%i )a&ie, +e%&e-*+
9 67 Pe(e%i'&aa, a)a 0a,$ dia,*%'a,
9 37 Te%a)i 0a,$ di-e%i'a,
DM +) 6 *,.",+%"lled
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Ka&*& 6
9 Se"%a,$ a,i+a *&ia @ +a#*,: '",+%"l 'e 'li,i'de,$a, %ia0a+ DM &ea' 3 +a#*, 0a,$ lal*: "-a+Me+!"%(i, 5 ($ 1221 de,$a, %a&a '%a( )ada'a'i7 Pada )e(e%i'&aa, !i&i& dida)a+'a, TD
15 ((H$: IMT 6:3 '$.( Fi&i& lai, ,"%(al,a(*, )ada &'%i,i,$ 'a'i dida)a+'a, l*'a )ada)la,+a% )edi&: dia(e+e% 6:5 .(: )*& 92;: %a&a ,0e%i92;
9 Pe(e%i'&aa, GDS 665 ($d=: '% 1: : SGPT 1
Slide 51
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Slide 56
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9 17 A)a dia$,"&i& da%i )a&ie, +e%&e-*+
9 67 Pe(e%i'&aa, a)a 0a,$ dia,*%'a,
9 37 Te%a)i 0a,$ di-e%i'a,
DM +) 6CKD HT
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Slide 54
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PATHOPHYSIO=OGY OF DIABETIC FOOT
Dia-e+e& Melli+*&
Ne*%")a+#0 T%a*(a ?a&.*la% Di&ea&e
MOTOR
"ea#ness$trophy
%ighPlantarPressure
Deformity
$bnormaltress
Callus&ormation
S+%*.+*%alDe!"%(i+0
C#ei%"a%+#%")a+#0
I()ai%ed Re&)",&e+" I,!e.+i",
Dia-e+i. F""+