Askep Lansia Menjelang Ajal

ASKEP LANSIA MENJELANG AJAL

Objectives n

n n n

Renungan

Objectives n

n n n

Proses ajal pada lansia Sikap terhadap kematian pada lansia Respon fisik, psikis dan spiritual Strategi keperawatan pada lansia menjelang ajal

ASKEP LANSIA MENJELANG AJAL n

n

n

n

Apa yang saudara fikirkan ketika melihat lansia? Usia berapa yang saudara harapkan saat menjelang ajal? Dalam kondisi yang bagaimana yang saudara harapkan saat menjelang ajal? Siapa yang saudara harapkan hadir saat menjelang ajal?

Persepsi kematian n

n

n n

Diperoleh dari pengalaman kematian orang lain Tidak selalu dipengaruhi oleh kematangan perkembangan Kecenderungan akan menyangkal kematian Kebudayaan mempengaruhi persepsi seseorang terhadap kematian

Arti Kematian Pada Lansia n

n

Positif: suatu perjalanan; teman yang melepaskan dari rasa nyeri dan penderitaan; menuju hidup yang kekal Negatif: pelarian dari situasi yang tidak dapat diatasi “the great destroyer” yang menyebabkan kelemahan; hukuman; perpisahan.

Perilaku Lansia Menghadapi Kematian n

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Khawatir menjadi beban, penderitaan, dan penggunaan tehnologi yang memperpanjang kehidupan Tingkat kekhawatiran lansia yang sakit dan dirawat di rumah sakit lebih rendah dari mereka yang menunggu giliran masuk ke rumah sakit Yang menjadi perhatian adalah dimana, bagaimana kematian itu terjadi, dan kehidupan setelah kematian

Dying n

n

Is a personal and private event and involves physical, psychological, behavioral, social and spiritual problems as the client moves between remission and a further decline in health status. Accumulative losses and physical and psychological decline leave the client feeling lonely and isolated.

Symptom of Dying Process n n n n n

n n

Decreased Appetite Lethargy Cardiovascular changes Respiratory changes Musculoskeletal system changes Gastrointestinal system changes Mental status changes

Decreased Appetite n n n n n

First sign Food refusal Anorexia Choked on food and liquids Unable to swallow (1-4 days before death)

Cardiovascular Changes n n n n n

n

Rapid heart rate Irregular rhythms/ arrhythmias Diaphoretic Skin feels cool Mucosa often become deeply cyanotic The decreased of cardiac out put

Respiratory Changes n n n

n

n

Pulmonary Congestion Pulmonary secretion (Pneumonia) Breath sounds: diminished, irregular, rapid, audible Carbondioxide levels increase Period of irregular respiration/ apnea/ dyspnea

Gastrointestinal & Musculoskeletal system changes Musculoskeletal Absent of in all muscle Gastrointestinal n Weakness bowel soundsgroup n Rectal sphincter relaxes n Fecal incontinence

Psychological symptom n n n n n

n

Confusion Sadness and depression Anxiety and agitation Insomnia Stress grieving

Spiritual concerns n

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Patient who are dying often ask what their life means, who they really are, why the illness has affected them, and what will happen to them when they are die. Some feel guilty of worry that their behavior caused their illness Unresolved spiritual distress can lead to despair and hopelessness

n

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Dying patients do not always need to hope for a cure; instead they can hope for having time to reconcile with loved ones, sharing time with family, finishing a personally important project, or making peace with god or higher power. When spiritual distress is relieved, patients can die more peacefully

n

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They need to find meaning and purpose in their lives. Belief in an afterlife and possible reunion with loved ones and comfort patients and family members.

Environment setting n

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The setting should be peaceful, quiet, and physically comfortable. Stains or tubes are covered, and odors are masked In some patients near death, noisy breathing develops because of bronchial congestion or palatal relaxation Family member are encouraged to touch the patient as well as talk with the patients

Care of dying patient n

n

n

Helping a patient and family find comfort with meaning in the experience of dying is important The nurse should preserve and enhance the dignity of the dying patient by allowing the patient and the family members to maintain control and participate in end-of-life care whenever possible Caregivers team must also prevent and relieve distress as effective as possible

Pengkajian klien n

n n

Fisik: perubahan CV, gastro, perkemihan, persyarafan, persepsi sensori, integritas kulit Psikososial: proses kehilangan Spiritual:kebutuhan akan cinta dan perhatian

Pengkajian keluarga n n n

Pengetahuan akan kondisi klien Observasi perilaku Kaji respon patologi keluarga

Strategi intervensi n n n n n

n

Intervensi lebih sering Membutuhkan waktu dan kesabaran Keterampilan terpeutik Life review Dukungan psikologis bagi caregiver social support

The process of death The moment of death death is recognized when respiration and cardiac action cease. The pupils of the eyes become fixed and dilated and the skin on the face and extremities become cool to touch. n

The process of death n

Rigor mortis n n

n

Stiffening of the body Begins 2-4 hours after death.

Algor mortis n n

Post-morterm cooling The internal body temperature begins to fall at approximately 1ºC per hour

The process of death n

Post-mortem decomposition Discoloration of the skin n As the red blood cells break down, hemoglobin is released and stains the vessel walls and surrounding tissues. n The skin appears mottled, bruised or both. n

n

Post-mortem digestion n

The tissue soften and then are liquefied because of fermentation.

The process of death n

Post-mortem digestion n

The tissue soften and then are liquefied because of fermentation.

Kesimpulan n n

Dying is a part of life, just as birth is Nurses are called on to provide emotional support to patients and families, teaching and utilizing coping strategies, because dying and death occur mostly in facilities where care is provided by nurses