Perawatan Kaki Diabetes -Bpjs 2015-Fabiola

7/24/2019 Perawatan Kaki Diabetes -Bpjs 2015-Fabiola

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Simple Diabetes Foot Care

PERAWATAN KAKI DIABETES

Fabiola M.S Adam


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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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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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PATHWAY TO DIABETIC FOOT


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PERIPHERA= NE


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Slide

Ne*%")a+#i.


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Slide 1

?ASC


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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""+


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Slide 13

NE


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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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=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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MONOFI=AMEN TEST

T


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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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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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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 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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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

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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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INFECTION CONTRO=3

17 Need a$$%e&&ive +#e%a)067


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Slide 4

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?ASC


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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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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""+

Perawatan Kaki Diabetes -Bpjs 2015-Fabiola

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