Disease

Management
Penyaji: Ivan Veriswan
Diambil dari Handbook of Adolescent Medicine and Health Promotion
Pembimbing:
dr. Hendriani Selina, SpA(K), MARS
dr. Fitri Hartanto, SpA(K)
dr. Farid Agung Rahmadi, Msi.Med, SpA

 Adolescents with chronic handicapping conditions (CHC) or

developmental disabilities (DD) should participate in decision
making regarding their care
If limitations prevent participation in the same manner as other
teens and young adults, then physical and social
accommodations must be made.
Chronic medical conditions (CMC) such as asthma, diabetes,
eating disorders, constipation, and chronic pain, interfere with
the lives and lifestyles of adolescents and young adults,
sometimes to the extent that they can become physically and
emotionally handicapping conditions.

OVERVIEW

 Adolescent compliance with medical regimens and advice

requires the patient to feel that the physician really cares about
him or her.
The use of complimentary and alternative medicine (CAM) and
dietary supplements among adolescents are increasing and
remain largely unregulated.
Common supplements among adolescents include zinc,
echinacea, weight loss supplements and creatine
Clinicians must include CAM and dietary supplements in the
medical history and evaluate incompatibilities with concurrent
treatment plans and prescription medications.

Medical Compliance
and Self-Management

Reynold Bean [Bean, 1992]

Know who you are identify strengths and weaknesses.
Take a look at what makes you feel good and bad about
yourself.
Identify people in your life who are builders and who are
blockers.
Identify things in your life that are builders and that are
blockers.
Explore what you know and have learned about yourself.

Self-Esteem and
Compliance

A Person with Low Self-Esteem

Avoids situations that stimulate fear or anxiety.
Demeans their own talents.
Feels unliked and unwanted.
Is overly influenced by others.
Becomes easily frustrated.
Feels powerless.
Is often incapable of managing their chronic disease.

Health Decision Making Process

Determine if there is a decision to be made; describe it out
loud.
Examine the choices.
Collect information and identify other influences on the
decision.
Investigate the consequences of choices.
Decide which action is responsible, optimal and most
appropriate.
Evaluate the results of the decision.

Decision Making and

Goal Setting

Realistic Health Goals

Definable
Desirable
Attainable
Appropriate
Motivational
Measurable

 When adolescents suffer from low self-esteem, they may

have difficulty in setting and attaining goals
They learned that the greater the number of protective
factors existing in their lives, the more likely they were to
develop resiliency [ODougherty, 1983; Rutter, 1980;
Werner, 1992].
Resiliency is the ability to adapt to changes and
transitions, and/or deal with difficult problems and
situations in a positive way

Resiliency

How to Build Resiliency

Build on the adolescents cognitive, social, goal-oriented,
physical, and civic competencies.
Promote a positive environment by setting high
achievable standards for all youths.
Provide accurate, factual information from which patients
can draw conclusions about the benefits and dangers of
behaviors.
Encourage strong ties to the family and community.

Techniques for Optimal Effectiveness of Management of Chronic Medical

Conditions
Create agreements with the adolescent on the nature and extent of the chronic
condition.
Determine the adolescents attitude towards the condition, his or her level of
knowledge regarding the condition, and motivation to co-manage the condition.
Reinforce healthy behaviors and health choices that improve the condition.
Determine with the adolescent a concrete, personalized course of management.
Encourage the adolescent to commit to this plan, and provide positive
reinforcement when success is achieved.
Enlist family members to be supportive and collaborate with proper management
when appropriate.
Arrange follow-up contacts on a regular basis

 Specific Issues: Asthma, Diabetes, Eating Disorders

 The prevalence of overweight children aged 611 years more than

doubled from 1980 to 2000, and overweight adolescents aged 1219
more than tripled, increasing from 5% to 18%.
For the first 10 years of the 21st century, as of 2010, approximately 5%
of adolescents are obese, and as many as 25% are overweight.
Type 2 diabetes, high blood pressure, high cholesterol and asthma have
become increasingly prevalent among adolescents as rates of
overweight and obesity rise. It has been said that, due to obesity, this
generation of adolescents may not outlive their parents.
Adolescence appears to be a crucial period when overweight and
obesity can occur. In males, abdominal fat is deposited; in females, the
percentage of body fat increases

Obesity and Overweight

 Under-eating disorders may be the third most common

chronic condition in adolescents (after obesity and asthma).
Bulimia nervosa is more common than anorexia nervosa,
which can occur in up to 5% of adolescent females. Over 90%
of all eating disorders occur in adolescent females. Cultural,
social, and environmental factors, as well as psychological
factors in both the adolescent and the family, contribute to the
development of eating disorders [Pathy, 2008].
Anorexia nervosa is the unwillingness to keep body weight at
or above the mini- mal normal weight for age.

Anorexia and Bulimia

 Some adolescents die from the effects of chronic

illnesses.
Emotional and psychological regression is common
during illness. Legally, few terminally-ill adolescents
who have not yet reached adulthood can make medical
deci- sions such as discontinuing medical interventions
optimal decision-making and communication between
the dying adolescent, his or her family, and his or her
medical team

The Dying Adolescent

Penyakit Kronik

Kepatuhan medis
dan manajemen
diri

Kepercayaan diri

Kepatuhan

Pengambilan
keputusan dan
Menetapkan
Tujuan Akhir

Proses
pembuatan
keputusan

Bagan Penyakit Kronis

pada Remaja

Ketahanan

Terimakasih mohon
asupan