1 / 41

“Always Do Everything for Every Patient Forever.”

“Always Do Everything for Every Patient Forever.”. Principles of Non-Pharmacologic Treatment.

davis-king
Download Presentation

“Always Do Everything for Every Patient Forever.”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “Always Do Everything for Every Patient Forever.”

  2. Principles of Non-Pharmacologic Treatment

  3. “ Medicineswill be well used when the doctor understands their nature, what man is, what life isand what constitution and health are.Know these well and you will know their opposites; you will then know well how to devise a remedy." Leonardo da Vinci

  4. A Knowledge Of The Specific Element In Disease Is The Key Of Medicine. Armand Trousseau 1810–1867 (French physician) (Clinical Medicine Vol. I, Introduction)

  5. MUST KNOW! • Normal Body Structure & Functions • Pathophysiologic principles • Methods of therapy appropriate to each diseases • Evaluation of the diseases to which the system is prey • Based on the most recent evidence  evidence-based medicine • Cooperate with the Law of Nature

  6. PURPOSE Non pharmacological treatment in medicine are aimed to…. • Increase health status (Individual, Family & Society)  Self reliance • Control Risk Factors • Diseases Management & Control • Increase Quality of Life • Life Completion  death & dying

  7. Asclepiades 1st century bcGreek-born Roman physicianAttributed To cure safely, swiftly and pleasantly.

  8. Non-Pharmacologic Tx • Treatment WO Drugs &/ Chemical Substance (herbs/herbalism & naturopathy), &/ combination of chemical subtance (jamu/unani/ homeopathy) & body substance e.g. transplant (cell or organ), blood, imunoglobulin, etc • Divided into • Preventive (prevent diseases)  increase health, control risk factors • Curative (treat disease) • Rehabilitative (post disease incidents)

  9. Principles • Based on Primum non nocere • Done Separately, in sequence &/ simultaneusly when treating a patient • Depend on disease • What is necessary for patient clinical condition

  10. Sylvius (François De La Bois) 8th century(French Professor of Anatomy, Paris)Praxeos medicae idia nova (1671) The aim of treatment must be to maintain the energies of the organism to drive away the illness, to remove the causes and to mitigate the symptoms.

  11. PREVENTION Preventive medicine   incidence & prevalence Component of Prevention: • Body Protection  Injury • Vaccination prevent Infectious diseases • Screening programs  risk factors  deg. disease • Chemoprevention farmacoTx before disease occur e.g. lipid lowering drugs in preatherosklerosis • Counseling  Individual, family & society  life style Types of prevention • Primary  promotive • Secondary  detect & treated early • Tertiary  prevent fx loss/death, ↑ quality of live

  12. RISK FACTORS CONTROL • Factors involve in disease/s development • Not Modifiable Risk Factors • Age, Sex, Race • Family history  genetics • Immune system  immunity • Modifiable Risk Factors • Smoking, Drugs & Alcohol • Weight & Diet • Physical environment & risk prevention • Social environment (stress, mental health & social setting) • Vaccination

  13. Patients may recover in spite of drugs or because of them. J. H. Gaddum 1900–1968 British professor of physiology Pharmacology by D. R. Laurence, Churchill Livingstone, Edinburgh (1973), Frontispiece

  14. MANAGEMENT W.O DRUGS • Information & education to patient/s, family & society • Life style changes • Eating & drinking (nutrition/dietary treatment) • Smoking cessation • Daily routine (Sleep & Wake Cycle) • Physical stress (Work load & activity) • Exercises & physical fitness

  15. Continued….. • Enviromental changes • Emotional stress  Individual Coping mechanism • Support groub • Family counseling & treatment • Social Function & changes • Economy • Public Health & Epidemiology  diseases incidence, prevalence & mode of transfer

  16. Continued….. Radiologic tx  Radiotherapy  Cancer Patient Care  nursing skills Alternative Medicine Acupuncture Mind-Body Technique Meditation, Relaxation, Guided Imaginary, Hypnotherapy, Biofeedback Body-based therapy  Chiropractic, massage, rolfing, reflexiology, postural reeducation, Osteopathy Energy Therapies  Bioelectromagnetic based therapy, reiki, therapetic touch.

  17. REHABILITATION Temperature mediated  Heat  Superficial (hot packs, warm water, etc), deep (Short Wave Diatermy & Long Wave Diatermy), Cold  Superficial cold (ice packs, etyl chloride, cold water), deep cold is rarely use Electrical simulation  Transcutaneus Electrical Simulation Traction & Massage Physical Therapy  Exercise  ROM, Muscle Strengthening, coordination, ambulatory, general conditioning Tilt table & tranfer training

  18. C I E • Comunication • Good dr-patient relationship, family & society relation • Information • Information on the disease for patients (family & society if allowed by the patients) • Education • Education (to patients, family & society in written & oral methods)

  19. Francis Weld Peabody 1881–1927US pathologist, haematologist, and authorThe Care of the Patient The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal.

  20. CASE EXAMPLE AX : ID : Ny. A, 45 th, BB: 85kg, TB:165 cm, BMI: 32,32. Sekretaris PMA. Jl. MTH 193, Mlg KU : “Nyeri Dada, terasa terbakar.” RPS: Nyeri dada dirasakan 7 hari yang lalu, memberat dengan aktifitas, menghilang dengan istirahat. Nyeri dada dirasakan di daerah ulu hati, menjalar ke lengan kiri kadang ke rahang. BAB & BAK dbN. Riwayat trauma (-), Riwayat alergi (-), dan Riwayat operasi (-). Ayah & ibunya meninggal o.k hipertensi. Ny. A sering minum kopi, sering bergadang, sering stress karena pekerjaan dan jarang berolahraga. Ia tidak pernah minum alkohol, jamu, dan hanya minum obat2 yang diresepkan dokter. RPD: Hipertensi (150/90 tertinggi 170/100, tidak minum obat HT khusus

  21. Continued… PMX FISIK • KU : Sadar, dapat duduk tegak, memegangi dada o.k. nyeri • VS : T: 160/95 mmHg; N: 100 x/min, reg; RR 20x/min; Tax 37°C • Kulit : Rash (-), Kuku baik, clubbing (-) cyanosis (-) • Kepala: Ukuran normal, jejas/trauma (-) Mata : Visus O.D & O.S t.a.a. Telinga: Luar t.a.a. Kanal paten, membrana tymphani t.a.a. Mulut : Mukosa pink; gigi baik, pharynx t.a.a • Leher : Supple, pembesaran tyroid (-), Pembesaran KGB (-) • Thorax : Symmetric, Diameter AP normal Paru : Inspeksi & perkusi Normal. Suara vesikuler paru normal, wheezing (-), rhonchi (-) Jantung: JVP + 2 cm, Denyut karotis regular, tanpa bruits S1, S2 tunggal; S3-S4 N. Gallop – Bising - • Abdomen: Flat, Supple, Hepar/Lien ttb. Bising usus N ↑ • Extremitas sup : Edema - / - , motorik +5/+5, sensorik N/N • Extremitas Inf : Edema - / - , motorik +5/+5, sensorik N/N

  22. QUESTIONS • What is your most likely diagnosis? • What is the best “prescribed” non pharmacological treatment for this patient?

  23. JAWAB: 1. Wdx. Angina Pectoris Unstable + Hipertensi esensial Tx u/ Angina : ISDN 2 x 5mg, Aspirin 1 x 80 – 160 mg Tx u/Hipertensi : Anti Hipertensi (β Blocker/CCB/ACEI/ARB). Masalah kesehatan lain: • Hipertensi • Overweight • Sedentary life style/kurang olahraga • Stress pekerjaan tinggi 2. Mrs. A. Non Pharmacological Tx? Lets Follow These Procedures… Shall We?

  24. Isaac Judaeus c. ad 850 - 950(Baghdad physician)Attributed Most illnesses are cured without the physician’s help through the aid of Nature. If you can cure the patient by dietary means, do not turn to drugs.

  25. DIETARY/NUTRITION TREATMENT • Balance diet  calories (40kal/kgBB in male & 35 in female with normal condition, add/substract 5/kgBB in weight for gain/loss weight diet), types of food. • Consist of Macronutrients  fat, carbs, protein, & fiber • Micronutrients +  vit., minerals, trace elements • Serving  Portions & Methods • Food/drink to avoid &/ consumed • Weight loss diet  High-prot-low carbs diet, low-fat diet, High-fiber diet, fruit diet, atkins diet, liquid diet, food-combining & food cycling diet • Weight Gain diet  gradual high calories diet

  26. Mrs A. Dietary/Nutrition Tx • Diet  35 kal x BB Ideal (70kg) = 2450 kal/hari • Jenis  Weight loss diet high-protein-low carbs diet, low-fat diet, High-Fiber diet • Micro nutrients  Buah, sayur & susu, rendah garam (tanpa garam) • Serving  dibagi dalam 3 x makan, 2 x snack. • Food/drink to avoid : Nangka, Tewel, Santan, minyak goreng kelapa sawit, Jerohan, daging “serat putih/ tetelan”, ikan asin, makanan kaleng • Food/drink to consumed : Apel, pisang, mentimun, protein nabati dll

  27. EXERCISE • Daily work IS NOT ALWAYS exercise • Exercise  Physical activity performed repeatedly to achieve & maintain fitness • Fitness  capacity to performed physical activity • Regular Exercise  Part of Prevention & Disease management • Exercise Intensity  hard/soft exercise depend on condition. ↑ 20% in HR or 75%-80% from max human HR (220) with heavy breathing, & profuse sweating = HARD intensity exercise • Prevent injury  Warming up, stretching, choose the rite exercise, wear protective measures, cooling down • Types of Exercise  Aerobic (Jumping, Running, biking, swimming, skating) & Non Aerobic (Weight lift)

  28. Continued… • Duration  short or long periods  few min then grew longer (30 – 60 min) • Frequency  Every 2 days or 3 – 4 x a week depend on Px condition • Prescribe exercise for the patient above

  29. Mrs A. EXERCISE RECEPY • Tipe  Low impact Aerobic (biking, swimming, fast walking, senam pernafasan, senam taichi dll) & Non Aerobic (angkat beban boleh, asal ringan ) • Intensitas  Soft exercise (o.k. obese dg low physical fitness & HT) s.d tercapai HR maksimal 20% dari Normal (100 – 120x/min) • Durasi & frekuensi  pendek dulu (20 min/x 3 x seminggu) s.d. 40 min/kali 2 hari sekali. Dimulai dari yang ringan, sebentar  perlahan2 meningkat seiring peningkatan kemampuan fisik • Upaya pencegahan “injury” o.k. olahraga  Pemantauan keluhan Pemanasan, memakai pelindung & cooling down

  30. C. Jeff Miller 1874–1936US gynaecologistSurgery, Gynaecology and Obstetrics 52: 488 (1931) Body and soul cannot be separated for purposes of treatment, for they are one and indivisible. Sick minds must be healed as well as sick bodies.

  31. SLEEP & WAKE CYCLE • BODY FUCTION HAVE CIRCARDIAN CYCLE • Daily routine  Wake time & sleep time • Sleep intensity  deep & undisturbed sleep  enough REM (dream state, give fresh feeling) & good Non REM sleep (non-dream state, muscle resting) • Duration  at least 5 – 8 hours in normal, increase in bedridden individual • Frequency  Daily • Wake cycle  Not more than 19 hours • Prescribe routine cycle for the patient above

  32. Mrs. A SLEEP & WAKE CYCLE • Kebiasaan  Tidur -jaga yg teratur dalam 1 atau 2 sesi. • Intensitas tidur nyenyak > baik, teratur jam-jam tertentu. • Durasi/frekuensi  min 5 jam maks 8 jam/hari • Jaga  Tidak lebih dari 18 jam

  33. SUBSTANCE CONSUMPTION • Drugs  Drugs with addiction side effects • Nicotine Tobbacco & smoke • Cafein  Coffee, tea, coke • Food additives • Food preservatives • Alcohol & its derivatives  beer, vodca etc • Trans Fatty Acids  fried fast food • High calori, high fat, high salt diet • Others  Toxic substance, depend on condition • Prescribe substance/food avoidance for the patient above

  34. Mrs. A. SUBSTANCE CONSUMPTION • Drugs  sesuai dg resep dokter • Cafein  m-<< minum kopi, teh ringan, coke tdk boleh, minuman berkafein lain tidak boleh. • Food additives & preservatives : Sebaiknya makan dr bahan segar (natural homemade food) krn pengawet dan bahan tambahan makanan biasanya mengandung natrium. • Alcohol & its derivatives  Pertahankan tidak konsumsi alkohol/turunannya • Trans Fatty Acids  dilarang, tidak menggunakan minyak goreng shg masakan dibakar, dipanggang atau direbus/dikukus

  35. ENVIRONMENT CHANGES • INDIVIDUAL • Emotional stress  Coping mechanism  positive thinking & attitude • Personality  open mind & attitude  ppl Support &/ suppport groub • Personal problem/s • Job & work (salary & economy) • FAMILY • Family counseling & treatment • Building Family support groub • Economy • SOCIETY • Social Function & changes  person’s task & role in society • Prevent diseases incidence & prevalence by preventing mode of transfer  e.g avian flu • Economy

  36. Mrs. A ENVIRONMENTAL CHANGES • INDIVIDUAL  Stress emosi +, Kepribadian, Masalah individual, masalah kerja DLL  jika ada diperbaiki, bila perlu konsultasi dg psikolog/psikiater atau bergabung dg Support groub (spt AA (alcoholic anonymous), Fight Fat (obese ppl), QS (quit smoking), Gerakan Anti Narkoba • FAMILY  jika ada masalah keluarga  Family counseling dg psikolog/psikiater/bergabung dg support groub • SOCIETY  perubahan fungsi sosial bila diperlukan  ganti pekerjaan, pensiun dini. Pertimbangkan posisi Ny. A. dalam komunitas.

  37. Sir Thomas Browne 1605‒82(English physician, writer and rhetorician)Religio Medici ii, Sect. II (1643) We all labour against our own cure, for death is the cure of all diseases.

  38. DEATH & DYING • NOT PART OF A TREATMENT • BUT a Completion of live • Making health care choise  doctor, system care, treatment option, organ donation • Financial concern • Legal & ethical concern (advance directives/will/wasiat & suicide/euthanasia) • Coming to term with death  when it is near & when it is occur individual & family

  39. Mrs. A DEATH & DYING • Mungkin belum perlu untuk kasus ini karena tidak ada perubahan jantung yang bermakna, prognosis relatif baik  angka kematian kecil tapi angka kesakitan tinggi (dapat menjadi serangan jantung). • Penting dipertimbangkan dalam upaya penentuan terapi operatif B/P  dokter, RS pilihan, opsi pilihan dll • Pertimbangan dalam hal/masalah keuangan  Asuransi, biaya sendiri, dibiayai perusahaan, loan/pinjaman dll

  40. TERIMA KASIH

More Related