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REPORT INTRODUCTION
A. Definition
Bronchial asthma is a disease characterized by increased responsiveness of the trachea and bronchi to
various stimuli with the narrowing of the airway manifestations broad and rank can change either
spontaneously or result from the treatment. (The American Thoracic Society, 1962).
B. Etiology
1. Genetic
Derived is not yet known although the allergy talent how to slide. Patients with allergic diseases
usually have close relatives who also suffer from allergic diseases. Because of the talent of this allergy,
patients are susceptible to bronchial asthma if exposed to precipitating factors.
2. Allergens
a. Inhalant, entering through the respiratory tract. Example: dust, anima dander, pollen, mold
spores, bacteria and pollution.
b. Ingestan, which enter through the mouth. Examples: food and medicine
c. Kontaktan, entering through contact with the skin. Example: jewelry, metal, and watches.
3. Changes in weather
The weather was damp and cold mountain air often affects asthma. Sometimes the
attacks associated with the season, as the rainy season, dry season, the season of flowers. This is related
to the wind direction, pollen, and dust.
4. Stress
Stress / emotional disorders can trigger asthma attacks and aggravate existing asmayang.
Patients are given the motivation to resolve his personal problems because if the stress is not addressed
then the asthma symptoms can not be treated.
Most people will come under attack if doing physical activity or strenuous exercise.
Scamper easiest cause asthma attacks.
C. Classification
Based on the cause, bronchial asthma can be classified into three types, namely:
1. Extrinsic (allergic)
Characterized by an allergic reaction caused by trigger factors that are specific, such as dust, pollen,
animal dander, drugs (antibiotics and aspirin), and fungal spores. Extrinsic asthma is often associated
with the presence of a genetic predisposition to allergies.
2. Intrinsic (non-allergic)
Characterized by non-allergic reaction that reacts to the originator of non-specific or unknown, such
as cold air or it could be caused by respiratory infections and emotion. An asthma attack is becoming
more severe and frequent with the passage of time and can develop into chronic bronchitis and
emphysema. Some patients will experience asthma combined.
3. Asthma combined
The most common form of asthma. Asthma is has the characteristics of a shape allergic and non-
allergic.
D. Pathophysiology
Airway obstruction in asthma is a combination of bronchial muscle spasm, mucus plugs, edema and
inflammation of the walls of bronkus.obstruksi gain weight during expiration because physiologically
airway narrowing in this tersebut.Hal phase resulted in a distal obstruction of air can not be trapped in
ekspirasi.Keadaan hyperinflation is intended that the airways remain open and running
lancar.Penyempitan gas exchange respiratory tract may occur either in the airways that is large,
medium, or wheezing kecil.Gejala indicate a narrowing in the large airways, while the small airways and
cough symptoms shortness mengi.Penyempitan dominant over the airways in asthma will lead to the
following matters:
1. Hypoxaemia
2. hypercapnia
E. Clinical Manifestations
Usually in patients who were free of clinical symptoms of the attack was not found, but at the
time of the attack sufferers seem breathing fast and deep, restless, sitting with prop forward, and
without a respirator muscles work hard. The classical symptoms: shortness of breath, wheezing
(wheezing), coughing, and in some people who feel pain in the chest. In more severe asthma attacks,
symptoms there are, among others: silent chest, cyanosis, disturbance of consciousness, chest
hyperinflation, tachycardia, and rapid shallow breathing. Asthma attacks often occur at night.
F. Complications
1. Status asthmaticus is a severe asthma attack or any later became heavy and does not provide a
response (refractory) or aminophylline injection of adrenaline and can be classified in status
asthmaticus. Patients should be treated with intensive therapy.
2. atelectasis is shrinkage of part or all of the lung caused by a blockage of the airways (bronchi
and bronchioles) or due to very shallow breathing.
4. pneumothorax is the presence of air in the pleural cavity causing the lung collapse.
G. Management
3. Provide information to patients or their families about asthma. Includes the treatment and course of
the disease so that patients understand the purpose of the treatment given and work with your doctor
or nurse who cared for.
- Treatment
1) Treatment of non-pharmacologic
a. provide counseling
c. Giving fluids
d. Physiotherapy
e. Give O₂ if necessary
2) Treatment of pharmacologic
- Bronchodilators: drugs that dilate the airways. Divided into two groups:
b. Santin (theophylline)
Drug name: Aminofilin (Amicam supp), Aminofilin (Euphilin Retard), Theophylline (Amilex)
Patients with gastric disease should be careful when taking this medicine.
- Kromalin
Kromalin not a bronchodilator but it is but it is a preventive medicine asthma attacks. Kromalin usually
given together anti-asthma drug to another and a new effect is seen after one month usage.
- Ketolifen
Possessed a preventive effect against asthma as kromalin. Usually the dose 2 times 1 mg / day. The
advantage of this drug is that it can be administered orally.
BASIC CONCEPT OF NURSING
1. Assessment
b. Activity
c. Respiratory
d. Circulation
e. ego integrity
- Anxiety
- Fear
- Sensitive stimuli
- Restless
f. nutritional intake
g. social relations
2. Supporting investigation
a. radiological examination
Radiology picture in asthma is generally normal. At the time of the attack showed a picture
hyperinflation of the lungs that is radiolucent increases and smelting intercostalis cavity, as well as the
diaphragm downward. However, if there are complications, the disorder is obtained as follows:
- When accompanied by bronchitis, then the patches in the hilum will increase
- If there are complications of emphysema (COPD), then the picture will be growing radiolucent.
Done to find the allergy factor with various allergens that can cause a positive reaction in asthma.
c. electrocardiography
Electrocardiographic picture that occurred during an attack can be divided into 3 parts and adapted to
the image that occurs in pulmonary emphysema, namely:
1. Changes in cardiac axis, usually occurs right axis deviation and a clock wise rotation
2. There are signs of hypertrophy of the heart muscle, namely the presence of RBB (Right Bundle Branch
Block)
3. The signs of hypoxemia, namely the presence of sinus tachycardia, SVES, and VES occurrence of ST
segment depression or negative.
d. Lung scanning
It can be seen that the redistribution of air during an asthma attack is not exhaustive of the lungs.
e. spirometry
To indicate the presence of reversible airway obstruction. A critical examination tdak spirometry for
diagnosis but it is also important to assess the weight of the obstruction and the therapeutic effect.
3. Intervention
b. Expected outcomes:
c. Intervention
1) Auscultation of breath sounds, record their breath sounds, eg; wheezing, krekels, crackles.
R: tachypnea normally exist in some degree and can be found at the reception or during stress
3) Assess the patient to a comfortable position eg: raising the head of the bed, sitting on the back of
the bed.
6) Perform suctioning
b. Expected outcomes:
c. Intervention
5) Provide additional O2
b. Results Criteria: Shows improvement vertilasi and adequate tissue oxygen within the range
c. Intervention:
1) Assess TTV
R: systemic hypoxemia can be demonstrated first by the restless and sensitive excitatory
3) Observation of cyanosis
R: systemic Menunjukkanhipoksemia
4.Implementatuion
In respect of the action or implementation is the implementation of the intervention by the nurse
and the client for the purpose of kebutuhn clients optimally and clearly the actions undertaken.