“always do everything for every patient forever.”
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“Always Do Everything for Every Patient Forever.”. Principles of Non-Pharmacologic Treatment. - PowerPoint PPT PresentationTRANSCRIPT
“ Medicines will be well used when the doctor understands their
nature, what man is, what life is and 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
A Knowledge Of The Specific Element In Disease
Is The Key Of Medicine.
Armand Trousseau 1810–1867(French physician)
(Clinical Medicine Vol. I, Introduction)
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
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
Asclepiades 1st century bcGreek-born Roman physician
Attributed
To cure safely, swiftly and pleasantly.
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)
Based on Primum non nocere Done Separately, in sequence &/
simultaneusly when treating a patient Depend on disease What is necessary for patient clinical
condition
Principles
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.
PREVENTIONPreventive medicine incidence & prevalenceComponent of Prevention:1. Body Protection Injury2. Vaccination prevent Infectious diseases3. Screening programs risk factors deg. disease4. Chemoprevention farmacoTx before disease
occur e.g. lipid lowering drugs in preatherosklerosis5. Counseling Individual, family & society life styleTypes of prevention1. Primary promotive2. Secondary detect & treated early 3. Tertiary prevent fx loss/death, ↑ quality of live
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
Patients may recover
in spite of drugs or
because of them.
J. H. Gaddum 1900–1968British professor of physiology
Pharmacology by D. R. Laurence, Churchill Livingstone, Edinburgh (1973), Frontispiece
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
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
Continued…..
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.
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
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)
Francis Weld Peabody 1881–1927US pathologist, haematologist, and author
The Care of the Patient
The treatment of a disease may be entirely impersonal;
the care of a patient must be completely personal.
CASE EXAMPLEAX : ID : Ny. A, 45 th, BB: 85kg, TB:165 cm, BMI: 32,32. Sekretaris PMA. Jl. MTH 193, MlgKU : “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
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
QUESTIONS
1. What is your most likely diagnosis?
2. What is the best “prescribed” non pharmacological treatment for this patient?
JAWAB:1. Wdx. Angina Pectoris Unstable + Hipertensi esensial Tx u/ Angina : ISDN 2 x 5mg, Aspirin 1 x 80 – 160
mgTx 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?
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.
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
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
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)
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
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
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.
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
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
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
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
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
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.
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.
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
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