PANDUAN MANAJEMEN NYERI RS. MITRA SEHAT MEDIKA PANDAAN NDAAN TAHUN TAHUN 2014
RS MITRA MI TRA SEHAT MEDIKA PANDAAN
JL RAYA BY PASS NO.6 PANDAAN
JL RAYA BY PASS NO.6 PANDAAN
DAFTAR ISI
Halaman Judul........................................ Judul............................................................... ................................................................ ......................................... ... Da!"a# I$............................................. I$.................................................................... .............................................. ..................................... ......................... ........... L%m&a# P%n'%$a(an.................. P%n'%$a(an......................................... .............................................. .......................................................... ................................... I. DE)INISI....................................... DE)INISI.............................................................. .............................................. .............................................. ...........................1 ....1 II. RUAN* LIN*KUP.................................... LIN*KUP........................................................... ..........................................................2 ...................................2 III. TAT TATA LAKSANA................................ LAKSANA....................................................... ................................................................4 .........................................4 +.1. MANAJEMEN NYERI AKUT.................................. AKUT.......................................................................... ........................................ 4 +.2. MANAJEMEN NYERI KRONIK.......................................... KRONIK................................................................. ............................1, .....1, +.+. MANAJEMEN NYERI PADA KELOMPOK USIA LANJUT -*ERIAT -*ERIATRI............................................. RI.................................................................... .............................................. ....................................++ .............++ I/. DOKUMENTASI.... DOKUMENTASI........................... .............................................. .............................................. ...............................................+ ........................+ RE)ERENSI................................ RE)ERENSI....................................................... .............................................. ....................................................... ................................ +
LEMBAR PENGESAHAN
PENGESAHAN DOKUMEN RS. MITRA SEHAT MEDIKA PANDAAN NAMA
KETERANGAN
D#. R'a"u$ T#a3"5S.An.
P%m&ua" D7um%n
D#. Imanu%l E7a Tan"au"#a
Au"(#8%d P%#$n
D#. A#(3nda PA5S.K)R.5MARS.
D#%7"u# RS. MITRA SEHAT MEDIKA PANDAAN
TANDA TANGAN
TANGGAL
I. DEFINISI
N9%# m%#ua7an %#a$aan "da7 n9aman5&a7 #n'an mauun &%#a" 9an' (an9a daa" d#a$a7an l%( nd:du "%#$%&u" "ana daa" d#a$a7an l%( #an' lan5m%n;a7u la 7#5a7"!"a$ $%$%#an' $%;a#a lan'$un'5dan %#u&a(an (du $%$%#an'.N9%# m%#ua7an "anda dan '%ala %n"n' 9an' daa" m%nunu77an "%la( "%#adn9a 'an''uan !$l';al5 M%nu#u" &%&%#aa "7( a"au $um&%#<
IASP 1== -In"%#na"nal !# "(% S"ud9 ! Pann9%# adala(>Sua"u %n'alaman $%n$#7 dan %m$nal 9an' "da7 m%n9%nan'7an59an' &%#7a"an d%n'an 7%#u$a7an a#n'an 9an' n9a"a a"au 9an' &%#"%n$ un"u7 m%nm&ul7an 7%#u$a7an a#n'an>da# d%!n$ "%#$%&u" daa" d $mul7an &a(3a n9%# &%#$!a" $u&9%7"! dmana nd:du m%m%laa# aa "u n9%#5m%lalau %n'alaman 9an' lan'$un' &%#(u&un'an d%n'an lu7a -nu#59an' dmula da# a3al ma$a 7%(duann9a.
S"%#n&a;( -1=6 m%n'a"a7an n9%# $%&a'a ?7n$% 9an' a&$"#a7 ? 9an' m%#uu7 ada $%n$a$ #&ad "%n"an' $a7"5$ua"u $"mulu$ &%#&a(a9a 9an' m%n''am&a#7an a7an "%#adn9a 7%#u$a7an a#n'an5$ua"u la #%$n un"u7 m%lndun' #'an$m da# &a(a9a.
M;@a!!%# -1== m%n'a"a7an n9%# $%&a'a %n%la$an #&ad "%n"an' n9%# 7%"7a da m%n'a"a7an "%n"an' n9%# ?aaun 9an' d 7a"a7an "%n"an' n9%# dan d manaun 7%"7a da m%n'a"a7an5(al "u ada.
Tam$u# -200 n9%# d d%!n$7an $%&a'a $ua"u 7%adaan 9an' m%m%n'a#u( $%$%#an' dan %7$$"%n$n9a d 7%"a(u &la $%$%#an' %#na( m%n'alamn9a. Pada "a(un 1===5"(% /%"%#an$ H%al"( Admn$"#a$n m%n'%lua#7an
7%&a7an un"u7 m%ma$u77an n9%# $%&a'a "anda :"al 7% lma5ad %#a3a" "da7 (an9a m%n'7a $u(u "u&u(5nad5"%7anan da#a(5dan #%$#a$ "%"a u'a (a#u$ m%n'7a "%n"an' n9%#. Saa" n "%la( d a7u &a(3a mana%m%n n9%# m%#ua7an 7mn%n %n"n' dalam %#a3a"an a$%n.
1
II. RUANG LINGKUP.
Ruan' ln'7u %la9anan n9%# 9a"u $%mua a$%n d%n'an 7nd$ n9%# 9an' m%m&u"u(7an %la9anan mana%m%n n9%#5 %n'&a"an dan &$%#:a$ n9%#. Pada "a(un 1=65 T(% Na$nal In$""u"%$ ! H%al"( @n$%n$u$ @n!%#%n;% n Pan m%n'7a"%'#7an n9%# m%nad 2 "% 9a"u < 1. N9%# A7u"5 m%#ua7an (a$l da# nu# a;u"5%n9a7" dan %m&%da(an. Nyeri akut adala( n9%# d%n'an n$%" $%'%#a dan du#a$ 9an' "%#&a"a$5
m%ml7 (u&un'an "%m#al dan 7au$al d%n'an adan9a ;%d%#a a"au %n9a7". 2. N9%# K#n7 <
Non keganaan d (u&un'7an d%n'an 7%#u$a7an a#n'an 9an' dalam
ma$a %n9%m&u(an a"au "da7 #'#%$!
Keganaan adala( n9%# 9an' d (u&un'7an d%n'an 7an7%# a"au
#$%$ %n9a7" lan 9an' #'#%$!.
Nyeri kronik adala( n9%# 9an' &%#"a(an un"u7 %#d% 3a7"u 9an'
lama. N9%# 7#n7 adala( n9%# 9an' "%#u$ ada m%$7un "%la( "%#ad #$%$ %n9%m&u(an dan $%#n' $%7al "da7 d7%"a(u %n9%&a& 9an' a$"
2
Karakteristiknyeriakutdankronis Karakterist ik Nyeri Akut
Nyeri Kronis Sangat diinginkan
Ketergantunganterha dap obat
Komponen psikologis
Tidakbiasa
Sering
Seringmerupakanmasal ah
Umumnyatidakada
utama
Penyebab organik Kontribusi lingkungan dan keluarga Insomnia Tujuan pengobatan Depresi
sering kecil
Seringkalitidakada
Signifkan
jarang
Sering
kesembuhan
ungsionalisasi
jarang
sering
Lidya SHLV 7/6/2012
+
III. TATA LAKSANA !.".
MANA#EMEN N$ERI AKUT
1. N9%# a7u" m%#ua7an n9%# 9an' "%#ad 6 mn''u. 2. La7u7an a$%$m%n n9%#< mula da# anamn%$$ (n''a %m%#7$aan %nunan'. +. T%n"u7an m%7an$m% n9%#< a. Nyeri o%atik&
. Da7&a"7an
adan9a
7%#u$a7an
a#n'an
9an'
m%n9%&a&7an %l%a$an 8a" 7ma da# $%l 9an' ;%d%#a dan m%m%da$ n!lama$ dan n9%# m%lalu n$$%"# 7ul". . Ka#a7"%#$"7< n$%" ;%a"5 "%#l7al$a$ d%n'an &a75 dan n9%# &%#$!a" "aam5 m%nu$u75 a"au $%%#" d"7am. . @n"(< n9%# a7&a" la$%#a$5 sprain5 !#a7"u#5 d$l7a$.
'. Nyeri (i)era*&
. N$$%"# :$;%#al l%&( $%"7" d&andn'7an $ma";5 $%(n''a 7a "%#$"mula$ a7an m%nm&ul7an n9%# 9an' 7u#an' &$a dl7al$a$5 &%#$!a" d!u$5 "umul5 $%%#" d"%7an &%nda &%#a". . P%n9%&a&<
$7%mCn%7#$$5
n!lama$5
%#%'an'an
l'am%n"5 $a$m% "" l$5 d$"%n$ #'an &%#n''a C lum%n. . Ba$an9a d$%#"a d%n'an '%ala "nm5 $%%#" mual5 mun"a(5 ("%n$5 &#ad7a#da5 &%#7%#n'a".
4
). Nyeri neuro+atik&
. B%#a$al da# ;%d%#a a#n'an $a#a! . S!a" n9%#< #a$a "%#&a7a#5 n9%# m%nala#5 7%$%mu"an5 aldna -n9%# $aa" d$%n"u(5 (%#al'%$a. . *%ala n9%# &a$an9a dalam ada &a'an d$"al da# "%ma" ;%d%#a -$%m%n"a#a ada n9%# n$$%"!5 n9%# dalam ada "%ma" ;%d%#an9a :. Ba$an9a dd%#"a l%( a$%n d%n'an da&%"%$5 multiple sclerosis5 (%#na$ d$7u$5 AIDS5 a$%n 9an' m%nalan 7%m"%#a C #ad"%#a.
4. Ta"ala7$ana $%$ua m%7an$m% n9%#n9a. a. )a#ma7l'< gunakan Step-Ladder WHO . OAINS %!%7"! un"u7 n9%# #n'an$%dan'5 d %!%7"! un"u7 n9%# $%dan'&%#a". . Mulala( d%n'an %m&%#an OAINS C d l%ma( -lan'7a( 1 dan 2 dn%'an %m&%#an n"%#m"%n - pro re nata#n d 7ua" 9an' d$%$ua7an d%n'an 7%&u"u(an a$%n. . J7a lan'7a( 1 dan 2 7u#an' %!%7"! C n9%# m%nad $%dan' &%#a"5 daa" d"n'7a"7an m%nad *angka, ! -'an" d%n'an d 7ua" dan #n anal'%$7 dalam 7u#un 3a7"u 24 am $%"%la( lan'7a( 1. :. P%n''unaan d (a#u$ d""#a$. Od $"anda# 9an' $%#n' d'una7an adala( m#!n5 7d%n. :. J7a a$%n m%ml7 7n"#and7a$ a&$lu" OAINS5 daa" d&%#7an d #n'an. :. J7a !a$% n9%# a7u" a$%n "%la( "%#l%3a"5 la7u7an %n'u#an'an d$$ $%;a#a &%#"a(a •
In"#a:%na< an"7n:ul$an5 7%"amn%5 OAINS5 d
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R%7"al
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Su&7u"an< d5 an%$"%$ l7al
8
3-Step WHO Analgesic Ladder FK%"%#an'an< •
patch !%n"an9l "da7 &l%( d'una7an un"u7 n9%# a7u" 7a#%na "da7 $%$ua nd7a$ dan n$%" 7%#an9a lama.
•
Un"u7 n9%# 7#n7< %#"m&an'7an %m&%#an "%#a anal'%$7 adu:an" -m$aln9a am"#"ln5 'a&a%n"n.
FI$"la(< •
NSAID< non-steroidal anti-inflammatory drug
•
SCR< slow release
•
PRN< 3(%n #%Gu#%d
6
:. B%#7u" adala( al'#"ma %m&%#an d n"%#m"%n -#n n"#a:%na un"u7 n9%# a7u"5 d%n'an $9a#a"< •
Han9a d'una7an l%( $"a! 9an' "%la( m%ndaa" n$"#u7$
•
Tda7 $%$ua un"u7 %m&%#an anal'%$7 $%;a#a #u"n d #uan' #a3a" na &a$a
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E!%7 un;a7 da# d$$ n"#a:%na daa" "%#ad $%lama 1, m%n" $%(n''a $%mua a$%n (a#u$ d&$%#:a$ d%n'an 7%"a" $%lama !a$% n.
A*gorit%a Pe%'erian O+ioi- Inter%iten Intra(ena untuk Nyeri Akut
Aa7a( a$%n $%dan'C&%#a"
n9%# "da7
O&$%#:a$ #u"n
9a "da7 •
Saa"d$$"%la(d&%#7an5la7u7an Aa7a(d#%$%7andI/ Mn"aun"u7d#%$%7an mn"# $%"a,m%n"$%lama mnmal20m%n".
*una7an$u"10ml Am&l10m'm#!n$ul!a" dan;amu#d%n'anNa@l 05=(n''a10ml-1m'C ml
Tun''u(n''a+0m%n"da# %m&%#and$$"%#a7(#$%&%lum m%n'ulan'$7lu$.
9a
D7"%#mun'7n%#luun"u7 m%#%$%7and$$ulan'an
ATA
B%#7anla&%lada$u"
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Sa7anNa@ l *una7an$u"10ml Am&l100m'%"dndan ;amu#d%n'anNa@l05=
Ya5"%"a "%la( d&%#7an d$$""al
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9a T%7ananIda#a(I$$"2l 7 100mmH' F
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2ml J7a$7#n9%#46<&%#7an1 ml
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Keterangan& Skor nyeri& 0 "da7 n9%#
01atatan&
Skor e-ai& 0 $ada# %nu(
• $% da$ #n'an5 7adan' m%n'an"u75
1+ n9%# #n'an 1 muda( n9%# 46 $%dan' d&an'un7an $%da$ $%dan'5 $%#n' $%;a#a 7n$"an 2 m%n'an"u75 10 n9%# &%#a" muda( d&an'un7an $%da$ &%#a"5 $mnl%n5 $u7a# + d&an'un7an =
=
J7a "%7anan da#a( $$"l7 100mmH'< (a#u$la( dalam #%n"an' +0 "%7anan da#a( $$"l7 n#mal a$%n -7a d7%"a(u5 a"au ;a#la( $a#anC&an"uan.
S "du# n#mal *una7an "a&%l &a"&a"an an"%m%"; -7a d%#lu7an T%#u$7an %n''unaan OAINS I/ 7a d#%$%7an &%#$ama d%n'an d. (iii. Mana2e%en e3ek a%+ing& •
o+ioi−
Mual dan mun"a(< an"%m%";
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Kn$"a$< &%#7an $"mulan" &uan' a# &%$a#5 (nda# la7$a"! 9an' m%n'andun' $%#a" 7a#%na daa" m%n9%&a&7an #du7$ 'a$7%m&un' 7#am %#u".
−
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*a"al< %#"m&an'7an un"u7 m%n''an" d %n$ lan5 daa" u'a m%n''una7an an"($"amn. M7lnu$< %#"m&an'7an un"u7 m%n''an" d5 a"au &%#7an &%n8da8%n%
un"u7
m%n'a"a$ m7lnu$. −
D%#%$
%#naa$an
a7&a" d<
&%#7an
nal7$n -;amu# 054m' nal7$n d%n'an Na@l 05= $%(n''a ""al :lum% m%n;aa 10ml. B%#7an 0502 m' -05,ml &lu$ $%"a m%n" (n''a 7%;%a"an %#naa$an m%nn'7a". Daa" dulan' 7a a$%n m%ndaa" "%#a d an'7a anan'. •
OAINS< −
−
*an''uan 'a$"#n"%$"nal< &%#7an PPI (proton pump inhibitor) P%#da#a(an
a7&a"
d$!un'$
la"%l%"<
%#"m&an'7an un"u7 m%n''an" OAINS 9an' "da7 m%ml7 %!%7 "%#(ada a'#%'a$ la"%l%".
&. P%m&%da(an< n%7$ %du#al5 $u#a$nal5 n!l"#a$ an%$"%$ l7al d "%ma" n9%#.
10
;. Nn!a#ma7l'< . Ola( #a'a . Im&l$a$ . Pa" :. R%la7$a$ :. S"mula$ $a#a! "#an$7u"an %l%7"#7
,. )ll3u C a$%$m%n ulan' a. A$%$m%n ulan' $%&a7n9a dla7u7an d%n'an n"%#:al 9an' "%#a"u#. &. Panduan umum< . P%m&%#an a#%n"%#al< +0 m%n" . P%m&%#an #al< 60 m%n" . In"%#:%n$ nn!a#ma7l'< +060 m%n".
6. P%n;%'a(an a. Edu7a$ a$%n< . B%#7an n!#ma$ m%n'%na 7nd$ dan %n9a7" a$%n5 $%#"a "a"ala7$anan9a. . D$7u$7an "uuan da# mana%m%n n9%# dan man!aa"n9a un"u7 a$%n . B%#"a(u7an &a(3a a$%n daa" m%n'u&un' "m m%d$ 7a m%ml7
%#"an9aan
C
n'n
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m%n'%na
7nd$n9a. :. Pa$%n
dan
7%lua#'a
7u"
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dalam
m%n9u$un
mana%m%n n9%# -"%#ma$u7 %nad3alan m%d7a$5 %ml(an anal'%$75 dan ad3al ;n"#l. &. K%a"u(an a$%n dalam m%nalan mana%m%n n9%# d%n'an &a7
. M%d7a$ $aa" a$%n ulan' a. Pa$%n dulan'7an $%'%#a $%"%la( n9%# daa" "%#a"a$ dan daa" &%#a7":"a$ $%%#" &a$a C n#mal. &. P%ml(an m%d7a$ anal'%$7 &%#'an"un' ada 7nd$ a$%n.
11
. B%#7u" adala( al'#"ma a$%$m%n dan mana%m%n n9%# a7u"< Pasien Mengeluh yeri
!namnesis dan Pemeriksaan "isik !sesmen yeri
!pakah #tiologi nyeri bersifat re&ersibel '
$a
Tidak !pakah nyeri berlangsung + , minggu' Tidak
$a
Prioritas utama % Identifkasi dan atasi etiologi nyeri () *ihat manajemen nyeri kronik -) Pertimbangkan untu k merujuk ke spesialis yang sesuai
Tentukan mekanisme nyeri .pasien dapat mengalami + ( jenis nyeri/
Nyeri Somatic yeri bersifat tajam0 menusuk0 terlokalisir0
Nyeri Viseral yeri bersiat dius seperti ditekan benda
seperti ditikam
berat0 nyeri tumpul
Nyeri Neuropatik yeri bersifat menjalar0 rasa terbakar0 kesemutan0 tidak spesifk
12
A*gorit%a
Mana2e%en
Nyeri
4
Akut
Nyeri/o%ati)/ Cold%pac ks
K#"7$"%#d An%$"%$l7al -";alCn!l"#a $ OAINS Od S"mula$"a7"l
Nyeri/(iera*/ K#"7$"%#d An%$"%$l7aln"#a$nal OAINS Od
Nyeri/neuro+atik/ An"7n:ul$an
K#"7$"%#d Bl7n%u#n OAINS Od An"d%#%$an"#$7l7 -am"#"ln
Pl(al"%#na"!"%#a 9an'lann9a "da7 L(a"mana%m%n 9a n9%#7#n7. P%#"m&an'7an Aa7a(n9%# un"u7 m%#uu77% 6mn''u $%$al$ 9an' $%$ua
•
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• • • • •
Pen)ega,an// Edu7a$a$%n T%#a!a#ma7l' Kn$ul"a$-7a%#lu P#$%du#%m&%da(an Nn!a#ma7l'
"da7 Anal'%$7ad%7ua" 9a
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"da7
n9%# ‟
9a E!%7$amn' %n'&a"an %!%7$amn' "da7 )ll3uC nlaulan'
Mana%m%n
1+
!.5.
MANA#EMEN N$ERI KRONIK
() La7u7an ae%en nyeri <
a. anamn%$$
dan %m%#7$aan
!$7 -7a#a7"%#$"7 n9%#5 #3a9a"
mana%m%n n9%# $%&%lumn9a &. %m%#7$aan %nunan'< #adl' ;. a$%$m%n !un'$nal< . nla a7":"a$ (du da$a# -ADL5 d%n"!7a$ 7%;a;a"an C d$a&l"a$ . &ua"la( "uuan !un'$nal $%$!7 dan #%n;ana %#a3a"an a$%n . nla %!%7"!"a$ #%n;ana %#a3a"an dan mana%m%n %n'&a"an
-) "%n"u7an %ekani%e nyeri <
a. mana%m%n &%#'an"un' ada %n$ C 7la$!7a$ n9%#n9a. &. Pa$%n $%#n' m%n'alam 1 %n$ n9%#. ;. T%#&a' m%nad 4 %n$< i. Nyeri neuro+atik& •
d$%&a&7an
l%(
7%#u$a7an
C
d$!un'$
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)&#m9al'a< 'a"al5 7a7u5 dan n9%# 9an' d!u$ ada mu$;ul$7%l%"al -&a(u5 %7$"#%m"a$5 n9%# &%#lan'$un' $%lama +&ulan
ii) Nyeri otot< "%#$%#n' adala( n9%# m!a$al •
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DOKUMENTASI.
S%mua a$%n dla7u7an %n'7aan 9an' 7m#%(%n$! "%n"an' n9%#5 "%#ma$u7
l7a$57a#a7"%#$"75n$%"Cdu#a$5!#%7u%n$57ual"a$5n"%n$"a$5a"au
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