(Clinical Mentoring) Wound Care , Sabtu, 12 April 2014

8/17/2019 (Clinical Mentoring) Wound Care , Sabtu, 12 April 2014

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WOUND

CARE

dr. H.N.Nazar, SpB, FINACS, Trauma (K),MHKes


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Acute Wound Chronic Wound

Defnitio

n

!!urred in "ast #$%

&ee's

resent or "on*er t+an % &ee's.

Caused - endo*enous me!+anismsre"ated to a predisposin* !onditionor ris' a!tor (diaetes, oesit-,smo'in*, AIDS, !+emot+erap-)&+i!+ eentua""- !ompromisesderma" and epiderma" tissue

stru!tures

/0amp"e Sur*i!a" &ounds, ites,urns, arasions,traumati! &ounds.

1e*2oot u"!ers and pressure sores 3"i'e- rom as!u"ar insu4!ien!- orneuropat+-


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KerusakanJaringan

External = Trauma

nternal = n!eksi" #en$akit


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ato*en en-ea


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%enurut tingkat Kontaminasi terhada& luka 5

6. C"ean 7ounds (1u'a ersi+), "u'a eda+ ta' terine'si -an* mana tida'ter8adi proses peradan*an

:. C"ean$!ontamined 7ounds (1u'a ersi+ter'ontaminasi), "u'a pemeda+an dimana sa"uran respirasi,pen!ernaan, *enita" atau per'emi+an da"am 'ondisiter'ontro", 'ontaminasi tida' se"a"u ter8adi.

;. Contamined 7ounds (1u'a ter'ontaminasi),termasu' "u'a teru'a, "u'a a'iat 'e!e"a'aan dan

operasi den*an 'ontaminasi dari sa"uran !erna


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'ase #en$em(uhan )uka


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%ekanisme#en$em(uhan)uka

6. rimar- Intention:. Se!ondar-

Intention;. Tertiar- Intention


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Fa'tor -an* Berpen*aru+da"am en-emu+an 1u'a


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*+ #enilaian Keadaan Umum #asiendan Keadaan )uka

,+ Wound Cleansing- E.#)ORE"

RR/ATON AND DE0RDE%ENT1+ Dressing2+ #ro3ide a moist 4not 5et6 5ound

(ed

7+ Consider Other To&ical Agent8+ %anage #ain9+ Ensure Ade:uate Ox$gen"

Nutrition

;+ Treat n!ection

%anagement


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eni"aian 1u'a


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Tanda )uka Terin!eksi


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%anagement

Wound Cleansing- E.#)ORE"RR/ATON AND DE0RDE%ENT

The goal of wound cleansing is to:• Remove visible debris and devitalised tissue• Remove dressing residue

• Remove excessive or dry crusting exudates


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%anagement

Principles:• Cleansing should be performed in a way that minimises

trauma to the wound

• Wounds are best cleansed with sterile isotonic saline orwater

• Skin and wound cleansers should have a neutral p and be

non!toxic

• "void alkaline soap on intact skin as the skin p is altered#resistance to bacteria decreases• Antiseptics are not routinely recommended for cleansing

and should only be used sparingly for infected wounds


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Deridement

• Te'ni' Deridement 1u'a5

*+ De(ridement Autolisis

:. Deridement Me'anis

;. Deridement Kimia&i

#. Deridement Bio"o*is


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Deridement


6. Deridement Auto"isis

,+ De(ridement %ekanis




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Deridement




1+ De(ridement Kimia5i



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Deridement





2+ De(ridement 0iologis


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1u'a Ba'ar


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Dressin*

• A&a" mun!u"n-amodern dressin*

se'itar ta+un 6• Saat ini suda+ ada

"ei+ dari ;?>> 8enis a"utan


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Memi"i+ a"utan +arus

mempertiman*'an5

• @um"a+ e'sudat

• 7arna dasar "u'a

• Berapa "ama a"utan di+arap'an dapaterta+an


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Tu8uan emi"i+an Ba"utan

• Memuan* 8arin*an mati, enda asin*

• Memunu+ mi'roa

• Men*+indari ter8adi ine'si

• Memperta+an'an 'e"emaan

• Memper!epat proses pen-emu+an "u'a

• N-aman di*una'an

• Steri"

• Cost ee!tie


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@enis$8enis a"utan

• auze 2 'assa• Transparant f"m

• H-dro*e"• Ca"sium a"*inat• H-dro!e""u"osa• o"-uret+ane oam

• Si"er 2 A*• Sa" zin!


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auze 2 Kassa

• rimar- 2se!ondar- dressin*

• Me'ani'a"

deridement


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H-dro*e"

• Memantu prosesauto"-sis

• Di*una'an pada"u'a d*n &arnadasar 'unin*2+itam

• Berentu' *e"



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Ca"!ium A"*inate

• Ba+an dasar darirumput "aut

• Berua+ men8adi *e"sete"a+ men-erap

!airan

• Mampu men-erap!airan sedan* $ an-a'

• ntu' "u'a d*n &arna

dasar mera+ danmuda+ erdara+

• Ka"tostat, !urasor


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H-dro!e""u"osa

• Teruat darise"u"osa

• Da-a serap san*attin**i me"ei+ida-a serapa"*inate

• Tida' muda+ 'o-a'


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H-dro!o""oid

• Men*andun* CMC

• Memperta+an'an'e"emaan "u'a

• Me"indun*i "u'a daritrauma

• Men-erap sedi'ite'sudat

•ntu' "u'a &arnadasar mera+2pin'

• Duoderm, !omee",suprasor


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Transparant Fi"m

• Berentu'"emaran p"asti'

tipis• 7aterproo• as permea"e• Se!ondar- dressin*

• psite, te*aderm


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Foam

• Mampu men-erape'sudat an-a'


• Bai' di*una'an tu''ontro"+-per*ranu"asi

• ntu' "u'a &arnadasar mera+

• A""e-n, Cutimedsi"te!, Bitain

!omee"


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H-drooi'

• Men*andun* DAAC(Dia"'-!aramoi"!"oride)

• Non asoren, non

ad+esie• ntu' "u'a

ere'sudatsedan*$an-a'

• ntu' "u'a ine'si• er"u a"utan

se'under


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Si"er Dressin*

• /e'ti pada 'asusine'si

• A!ti!oat, Aua!e"

si"er, d""


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Ein! Sa"

• Memper!epat prosespen-emu+an "u'a

• Memperta+an'an 'e"emaan"u'a

• Berun*si support auto"isisderidemen

• Men*uran*i n-eri saat *antia"utan

• @i'a di !ampur d*nmetronidazo" dapatmen*uran*i au pada "u'a

• Bai' di*una'an ut' "u'a &arna

dasar mera+, 'unin*, +itam


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7assa"amN. Nazar

(Clinical Mentoring) Wound Care , Sabtu, 12 April 2014

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