Asuhan Keperawatan Asma Bronkhial

REPORT INTRODUCTION

A. Definition

Bronchial asthma is intermittent obstructive airway disease, reversible hyperactivity where trakheobronkhial responds to certain stimuli.

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

There are some things that are a bronchial asthma attacks:

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

Allergens can be divided into three types, namely:

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.

5. Exercise / heavy physical activity

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. Disorders of ventilation in the form of hypoventilation

2. ventilation perfusion imbalance where ventilation is not equivalent to the distribution of pulmonary blood circulation

3. Impaired gas diffusion at the level of the alveoli

These three factors will result in:

1. Hypoxaemia

2. hypercapnia

3. Respiratory acidosis at a very advanced stage

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

Various complications that may arise are:

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.

3. Hypoxaemia body is deprived of oxygen

4. pneumothorax is the presence of air in the pleural cavity causing the lung collapse.
 5. Emphysema is a disease whose primary symptom is narrowing (obstruction) airway because of the air sacs in the lungs ballooned in excess and suffered extensive
damage.

G. Management

The general principle of treatment of bronchial asthma are:

1. Eliminate airway obstruction immediately

2. Identify and avoid factors that can trigger asthma attacks

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

Treatment of bronchial asthma is divided into two, namely:

1) Treatment of non-pharmacologic

a. provide counseling

b. Avoiding precipitating factors

c. Giving fluids

d. Physiotherapy

e. Give O₂ if necessary

2) Treatment of pharmacologic

- Bronchodilators: drugs that dilate the airways. Divided into two groups:

a. Sympathomimetic / andrenergik (adrenaline and ephedrine)

Drug name: Orsiprenalin (Alupent), fenoterol (berotec), terbutaline (bricasma).

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

a. Past medical history

- Assess personal or family history of lung disease earlier

- Assess correcting a history of allergy or sensitivity to substances / environmental factors

b. Activity

- The inability to perform activities because of difficulty breathing

- A decrease in ability / improvement needs bentuan perform daily activities

- Sleep in a seated position high

c. Respiratory

- Dyspnea at rest or in response to activity or exercise

- Breath worsened when the client lying on his back in bed

- Using breathing apparatus, eg elevating the shoulders, spread his nose.

- The presence of wheezing breath sounds

- There is a recurrent cough

d. Circulation

- An increase in blood pressure

- An increase in the frequency of heart

- The color of the skin or mucous membranes normal / gray / cyanosis

e. ego integrity

- Anxiety

- Fear

- Sensitive stimuli

- Restless

f. nutritional intake

- The inability to eat due to respiratory distress

- Weight loss due to anorexia

g. social relations

- Limitations of physical mobility

- It's hard to talk or speak haltingly

- The existence of dependency on others

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.

- If there are complications, then there is a picture on pulmonary infiltrates

- It can also cause local atelectasis picture

- In case of pneumonia mediastinum, pneutoraks, and pneumopericardium, it can be seen form radiolucent picture of the lungs.

b. Examination of the skin test

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

1. Ineffective airway clearance related to accumulation of secretions.

a. Objective: airway re-effective

b. Expected outcomes:

• can demonstrate effective cough

• can declare a strategy to reduce the viscosity of secretions

c. Intervention

1) Auscultation of breath sounds, record their breath sounds, eg; wheezing, krekels, crackles.

R: some degree of bronchospasm occurs obstruction in the airway

2) Assess / monitor respiratory frequency.

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.

R: clod elevation makes it easier to breathe

4) Push / aids abdominal breathing exercises / lip

R: give patients a way to remedy and resolve dyspnea memgontrol

5) Observation of cough characteristics eg settling, hacking cough, wet

R; short cough, moist secretions usually come out with a cough

6) Perform suctioning
 R: to lift off the road respiratory ssekret

7) Koaborasi with doter

R: for drug delivery

2. Ineffective breathing pattern b / d decreased ability to breathe.

a. Objective: patient breathing pattern becomes effective

b. Expected outcomes:

• Chest no disturbance development

• Breathing becomes normal 18-24 x / min

c. Intervention

1) Monitor frequency, rhythm and depth of breathing

R: dyspnea and an increase in employment of breath, respiratory depth varies throughout

2) Elevate the head and help reposition

R: high dududk enables lung expansion and ease breathing

3) Observe the pattern of coughing and secretions character

R: menegtahui keribg or wet cough as well as the color of the secretions

4) Give the patient practice deep breathing or coughing effective

R: may increase secretions in which there is an interruption in breathing inconveniences ventilation sitambah

5) Provide additional O2

R: maximize breathing and lower the breath work

6) Auxiliary chest physiotherapy

 R: facilitate efforts to breathe preformance and improve draenase secret

3. Damage to gas exchange associated with CO2 retention,

a. Objective: gas exchange to be effective

b. Results Criteria: Shows improvement vertilasi and adequate tissue oxygen within the range

c. Intervention:

1) Assess TTV

R: TD changes occur with the severity of hypoxemia and acidosis

2) Assess the level of consciousness / mental changes

R: systemic hypoxemia can be demonstrated first by the restless and sensitive excitatory

3) Observation of cyanosis

R: systemic Menunjukkanhipoksemia

4) Elevate the head of the bed within their patients' needs

R: improving chest expansion and make breathing easier

5) Keep an eye on BGA (blood gas analysis)

R: to determine the oxygen saturation in the blood

6) Give O2 sesui indication

R: maximizing the dosage of oxygen for gas exchange

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
Text Box: Activation of the immune response

PATHWAY

bronchospasm

NURSING CARE
Sample case

Ny. H age of 29 years, the Islamic religion, ethnic Javanese, occupation housewife. Residential address Jl. Kerinci 39 Sumbersari, Jember. admission On March 3, 2015 Client
hospitalized for shortness of breath and cough with phlegm that was felt during the first weeks. This happens when a client complaint tightness and coughing during early riser
and increased when on the move.

The assessment results obtained client clients complain tightness, productive cough with thick white sputum, and clients feel crowded reduced after fumigation (nebulizer).
Clients look worried. Clients admitted no appetite. Clients are also said to have a history of asthma since childhood and clients say that there is one family member who had a
history of asthma, namely his mother.

Physical examination of the client is obtained: symmetrical chest cavity, chest wall retractions (+), tactile fremitus symmetrical between left and right, audible wheezing breath
sounds clients, Resonant to percussion of the chest wall, and a thick white sputum. From the observation results showed: the level of awareness: compost mentis, and the
results of TTV: TD = 130/70 mmHg, RR = 36x / min, HR = 76x / minute, temperature = 37o C.

Results of laboratory examination showed: Hb = 15.5 g%, leukocytes = 17,000 / mm3, platelets 260,000 / mm3, Ht = 47vol%. Clients now getting therapy: IVFD RL 20 tts / i,
Pulmicort, Ventolin, Bisolvon and O2 with nasal cannula 2 L. In the investigation of X-ray chest / thorax, lungs results obtained in the normal range

1. Assessment

Client identity

1. Name: Ny. H

2. Age: 29 years

3. Gender: Female

4. Religion: Islam

5. tribe / nation: Java

6. Education: High School

7. Occupation: Housewife
8. Status: Married

9. Address: Earth Tamalanrea Permai

Person in charge :

1. Name: Mr. J

2. Age: 30 years

3. Occupation: Private

4. Address: Earth Tamalanrea Permai

5. Relationships with clients: Husband

2. Main Complaint

Clients complained of chest tightness and coughing.

3. History of Nursing Now

Clients come to the hospital at 14:00 pm for one client said last week suffering from tightness, cough, colds, fever accompanied by thick white phlegm.

4. Formerly Nursing History

Clients say that suffered from asthma since childhood, the client never admitted to hospital in Jember Lung Hospital in August 2012 because of tightness for 2 weeks. Clients
say is undergoing a therapeutic treatment that is given doctor. Clients said Asma would arise when cold, due to dust and smell the pungent odor.

5. Family Health History

 Clients say that the client's mother also suffered from the same disease with the client.

6. Physical Examination

General examination

The general state: the client looks crowded

a. Awareness: compost mentis

b. Blood pressure: 130/70 mmHg

c. Frequency of breath: 36x / min

d. Nadi: 76x / min

e. Temperature: 37o C

7. The head-to-toe physical examination

1. Head

Eyes: ananemis conjunctiva, sclera anikterik, clear lens, pupil isokor, direct light reflex + / +

2. Thorax

lung

- Inspection: chest movement symmetrical right and left

- Palpation: tactile fremitus symmetrical right and left, retraction of the chest wall (+)

- Auscultation: breath sounds audible wheezing client

Heart

- Inspection: iktus apex invisible

- Palpation: iktus cordis palpable at ICS V

- Auscultation: heart sounds normal, additional sound (-)

3. Abdomen

• Inspections: convex abdomen, ascites (-)

• palpation: tenderness (-), rebound (-), the liver was not palpable

• Percussion: timpani

• Auscultation: bowel sounds normal

4. Extremities

Superior: edema (-)

Cyanosis (-)

Akral cold (-)

Skin turgor: normal

• Diagnostic

1. Results of Laboratory Tests

Ny.H examination results obtained the following results.

• Sputum thick white

• Hb = 15.5 g%

• Leukocyte = 17,000 / mm3

• Platelets 260,000 / mm3

• Ht = 47vol%

8. Data classification
DS:

1. The patient complained of shortness of breath and cough with phlegm that was felt during the first weeks.

2. The patient said he was anxious for their secret buildup

DO:

Physical examination:

a. wheezing audible breath sounds client

b. white sputum viscous

c. level of consciousness: compost mentish

d. TTV: RR = 36x / menitBersihan airway is not efektifBronkopasme à dyspnea, wheezing, coughing sputumRZ203 March 2015

therapeutic Treatment

Initial therapy, namely:

1. Provide oxygen pernasal

2. The beta 2 adrenergic antagonists (mg salbutamol or terbutaline fenetoral 2.5 mg or 10 mg). Inhalation of nebulized and the administration can be repeated every 20 minutes
to 1 hour. Beta 2-adrenergic antagonist can subcutan or intravenous salbutamol at a dose of 0.25 mg in 5% dextrose solution

3. Aminophilin intravenous 5-6 mg per kg, if already using this drug in the previous 12 hours then simply given half doses.

4. corticosteroid hydrocortisone 100-200 mg intravenously if there is no immediate response or the attack is very berat25

5. Bronchodilators, to overcome airway obstruction, including the class of beta adrenergic and anti-cholinergic.

9. Nursing diagnoses

1. Ineffective airway clearance related to accumulation of secretions

2. Ineffective breathing pattern associated with a decreased ability to breathe

3. Damage to gas exchange associated with CO2 retention,

4. Lack of knowledge related to treatment regumen (Doenges, 2003)

10. Intervention

1. Ineffective airway clearance related to accumulation of secretions.

a. Objective: airway re-effective

b. Expected outcomes:

• can demonstrate effective cough

• can declare a strategy to reduce the viscosity of secretions

c. Intervention

1) Auscultation of breath sounds, record their breath sounds, eg; wheezing, krekels, crackles.

R: some degree of bronchospasm occurs obstruction in the airway

2) Assess / monitor respiratory frequency.

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.

R: clod elevation makes it easier to breathe

4) Push / aids abdominal breathing exercises / lip

R: give patients a way to remedy and resolve dyspnea memgontrol

5) Observation of cough characteristics eg settling, hacking cough, wet

R; short cough, moist secretions usually come out with a cough

6) Perform suctioning
 R: to lift off the road respiratory ssekret

7) Koaborasi with doter

R: for drug delivery

2. Ineffective breathing pattern b / d decreased ability to breathe.

a. Objective: patient breathing pattern becomes effective

b. Expected outcomes:

• Chest no disturbance development

• Breathing becomes normal 18-24 x / min

c. Intervention

1) Monitor frequency, rhythm and depth of breathing

R: dyspnea and an increase in employment of breath, respiratory depth varies throughout

2) Elevate the head and help reposition

R: high dududk enables lung expansion and ease breathing

3) Observe the pattern of coughing and secretions character

R: menegtahui keribg or wet cough as well as the color of the secretions

4) Give the patient practice deep breathing or coughing effective

R: may increase secretions in which there is an interruption in breathing inconveniences ventilation sitambah

5) Provide additional O2

R: maximize breathing and lower the breath work

6) Auxiliary chest physiotherapy

R: facilitate efforts to breathe preformance and increase secretions draenase

3. Damage to gas exchange associated with CO2 retention,

a. Objective: gas exchange to be effective

b. Results Criteria: Shows improvement vertilasi and adequate tissue oxygen within the range

c. Intervention:

1) Assess TTV

R: TD changes occur with the severity of hypoxemia and acidosis

2) Assess the level of consciousness / mental changes

R: systemic hypoxemia can be demonstrated first by the restless and sensitive excitatory

3) Observation of cyanosis

R: systemic Menunjukkanhipoksemia

4) Elevate the head of the bed within their patients' needs

R: improving chest expansion and make breathing easier

5) Keep an eye on BGA (blood gas analysis)

R: to determine the oxygen saturation in the blood

6) Give O2 sesui indication

R: maximizing the dosage of oxygen for gas exchange

LAPORAN PENDAHULUAN
 ASMA

A. Pengertian

Asma bronchial adalah penyakit jalan nafas obstruktif intermitten, reversibel dimana trakheobronkhial berespon secara hiperaktif terhadap stimuli tertentu.

Asma bronchial adalah suatu penyakit dengan ciri meningkatnya respon trachea dan bronkhus terhadap berbagai rangsangan dengan manifestasi adanya penyempitan jalan
nafas yang luas dan derajatnya dapat berubah-ubah baik secara spontan maupun hasil dari pengobatan. (The American Thoracic Society, 1962).

B. Etiologi

Ada beberapa hal yang merupakan faktor timbulnya serangan asma bronkhial:

1. Genetik

Yang diturunkan adalah bakat alergi meskipun belum diketahui bagaimana cara penurunannya. Penderita dengan penyakit alergi biasanya mempunyai keluarga dekat yang juga
menderita penyakit alergi. Karena adanya bakat alergi ini, penderita sangat mudah terkena penyakit asma bronkhial jika terpapar dengan faktor pencetus.

2. Alergen

Alergen dapat dibagi menjadi 3 jenis, yaitu:

a. Inhalan, yang masuk melalui saluran pernapasan. Contoh: debu, bulu binatang, serbuk bunga, spora jamur, bakteri, dan polusi.

b. Ingestan, yang masuk melalui mulut. Contoh: makanan dan obat-obatan

c. Kontaktan, yang masuk melalui kontak dengan kulit. Contoh: perhiasan, logam, dan jam tangan.

3. Perubahan cuaca

Cuaca lembab dan hawa pegunungan yang dingin sering mempengaruhi asma. Kadang-kadang serangan berhubungan dengan musim, seperti musim hujan, musim kemarau,
musim bunga. Hal ini berhubungan dengan arah angin, serbuk bunga, dan debu.

4. Stress
Stress/gangguan emosi dapat menjadi pencetus asma dan memperberat serangan asmayang sudah ada. Penderita diberikan motivasi untuk menyelesaikan masalah pribadinya
karena jika stressnya belum diatasi maka gejala asmanya belum bisa diobati.

5. Olah raga/aktivitas jasmani yang berat

Sebagian besar penderita akan mendapat serangan jika melakukan aktivitas jasmani atau olahraga yang berat. Lari cepat paling mudah menimbulkan serangan asma.

C. Klasifikasi

Berdasarkan penyebabnya, asma bronkhial dapat diklasifikasikan menjadi 3 tipe, yaitu:

1. Ekstrinsik (alergik)

Ditandai dengan reaksi alergi yang disebabkan oleh faktor-faktor pencetus yang spesifik, seperti debu, serbuk bunga, bulu binatang, obat-obatan (antibiotik dan aspirin), dan
spora jamur. Asma ekstrinsik sering dihubungkan dengan adanya suatu predisposisi genetik terhadap alergi.

2. Intrinsik (non alergik)

Ditandai dengan adanya reaksi non alergi yang bereaksi terhadap pencetus yang tidak spesifik atau tidak diketahui, seperti udara dingin atau bisa juga disebabkan oleh adanya
infeksi saluran pernafasan dan emosi. Serangan asma ini menjadi lebih berat dan sering sejalan dengan berlalunya waktu dan dapat berkembang menjadi bronkhitis kronis dan
emfisema. Beberapa pasien akan mengalami asma gabungan.

3. Asma gabungan

Bentuk asma yang paling umum. Asma ini mempunyai karakteristik dari bentuk alergik dan non-alergik.

D. Patofisiologi

Obstruksi saluran napas pada asma merupakan kombinasi spasme otot bronkus, sumbat mukus,edema dan inflamasi dinding bronkus.obstruksi bertambah berat selama
ekspirasi karena secara fisiologis saluran napas menyempit pada fase tersebut.Hal ini mengakibatkan udara distal tempat terjadinya obstruksi terjebak tidak bisa di
ekspirasi.Keadaan hiperinflasi ini bertujuan agar saluran napas tetap terbuka dan pertukaran gas berjalan lancar.Penyempitan saluran napas dapat terjadi baik pada saluran
napas yang besar,sedang,maupun kecil.Gejala mengi menandakan ada penyempitan di saluran napas besar,sedangkan pada saluran napas yang kecil gejala batuk dan sesak
lebih dominan dibanding mengi.Penyempitan saluran napas pada asma akan menimbulkan hal-hal sebagai berikut:

1. Gangguan ventilasi berupa hipoventilasi

2. Ketidakseimbangan ventilasi perfusi dimana distribusi ventilasi tidak setara dengan sirkulasi darah paru

3. Gangguan difusi gas di tingkat alveoli

Ketiga faktor tersebut akan mengakibatkan:

1. Hipoksemia

2. Hiperkapnia

3. Asidosis respiratorik pada tahap yang sangat lanjut

E. Manifestasi Klinis

Biasanya pada penderita yang sedang bebas serangan tidak ditemukan gejala klinis, tapi pada saat serangan penderita tampak bernafas cepat dan dalam, gelisah, duduk dengan
menyangga ke depan, serta tanpa otot-otot bantu pernafasan bekerja dengan keras. Gejala klasik: sesak nafas, mengi (wheezing), batuk, dan pada sebagian penderita ada yang
merasa nyeri di dada. Pada serangan asma yang lebih berat, gejala yang timbul makin banyak, antara lain: silent chest, sianosis, gangguan kesadaran, hiperinflasi dada, takikardi,
dan pernafasan cepat-dangkal. Serangan asma sering terjadi pada malam hari.

F. Komplikasi

Berbagai komplikasi yang mungkin timbul adalah:

1. Status asmatikus adalah setiap serangan asma berat atau yang kemudian menjadi berat dan tidak memberikan respon (refrakter) adrenalin dan atau aminofilin suntikan
dapat digolongkan pada status asmatikus. Penderita harus dirawat dengan terapi yang intensif.

2. Atelektasis adalah pengerutan sebagian atau seluruh paru-paru akibat penyumbatan saluran udara (bronkus maupun bronkiolus) atau akibat pernafasan yang sangat
dangkal.

3. Hipoksemia adalah tubuh kekurangan oksigen

4. Pneumotoraks adalah terdapatnya udara pada rongga pleura yang menyebabkan kolapsnya paru.

5. Emfisema adalah penyakit yang gejala utamanya adalah penyempitan (obstruksi) saluran nafas karena kantung udara di paru menggelembung secara berlebihan dan
mengalami kerusakan yang luas.
G. Penatalaksanaan

Prinsip umum pengobatan asma bronkhial adalah:

1. Menghilangkan obstruksi jalan nafas dengan segera

2. Mengenal dan menghindari faktor-faktor yang dapat mencetuskan serangan asma

3. Memberikan penerangan kepada penderita atau keluarganya mengenai penyakit asma. Meliputi pengobatan dan perjalanan penyakitnya sehingga penderita
mengerti tujuan pengobatan yang diberikan dan bekerjasama dengan dokter atau perawat yang merawat.

- Pengobatan

Pengobatan pada asma bronkhial terbagi 2, yaitu:

1) Pengobatan non farmakologik

a. Memberikan penyuluhan

b. Menghindari faktor pencetus

c. Pemberian cairan

d. Fisioterapi

e. Beri O₂ bila perlu

2) Pengobatan farmakologik

- Bronkodilator: obat yang melebarkan saluran nafas. Terbagi dalam 2 golongan:

a. Simpatomimetik/andrenergik (adrenalin dan efedrin)

Nama obat: Orsiprenalin (Alupent), fenoterol (berotec), terbutalin (bricasma).

b. Santin (teofilin)

Nama obat: Aminofilin (Amicam supp), Aminofilin (Euphilin Retard), Teofilin (Amilex)
Penderita dengan penyakit lambung sebaiknya berhati-hati bila minum obat ini.

- Kromalin

Kromalin bukan bronkodilator tetapi merupakan tetapi merupakan obat pencegah serangan asma. Kromalin biasanya diberikan bersama-sama obat anti asma yang lain dan
efeknya baru terlihat setelah pemakaian 1 bulan.

- Ketolifen

Mempunya efek pencegahan terhadap asma seperti kromalin. Biasanya diberikan dosis 2 kali 1 mg/hari. Keuntungan obat ini adalah dapat diberikan secara oral.

KONSEP DASAR ASUHAN KEPERAWATAN

1. Pengkajian

a. Riwayat kesehatan masa lalu

- Kaji riwayat pribadi atau keluarga tentang penyakit paru sebelumnya

- Kaji riwayat reksi alergi atau sensitivitas terhadap zat/faktor lingkungan

b. Aktivitas

- Ketidakmampuan melakukan aktivitas karena sulit bernafas

- Adanya penurunan kemampuan/peningkatan kebutuhan bentuan melakukan aktivitas sehari-hari

- Tidur dalam posisi duduk tinggi

c. Pernapasan

- Dispnea pada saat istirahat atau respon terhadap aktivitas atau latihan

- Napas memburuk ketika klien berbaring telentang di tempat tidur

- Menggunakan alat bantu pernapasan, misal meninggikan bahu, melebarkan hidung.

- Adanya bunyi napas mengi

- Adanya batuk berulang

d. Sirkulasi

- Adanya peningkatan tekanan darah

- Adanya peningkatan frekuensi jantung

- Warna kulit atau membran mukosa normal/abu-abu/sianosis

e. Integritas ego

- Ansietas

- Ketakutan

- Peka rangsangan

- Gelisah
f. Asupan nutrisi

- Ketidakmampuan untuk makan karena distress pernapasan

- Penurunan berat badan karena anoreksia

g. Hubungan sosial

- Keterbatasan mobilitas fisik

- Susah bicara atau bicara terbata-bata

- Adanya ketergantungan pada orang lain

2. Pemeriksaan Penunjang

a. Pemeriksaan radiologi

Gambaran radiologi pada asma pada umumnya normal. Pada waktu serangan menunjukkan gambaran hiperinflasi pada paru-paru yakni radiolusen yang bertambah dan
peleburan rongga intercostalis, serta diafragma yang menurun. Akan tetapi bila terdapat komplikasi, maka kelainan yang didapat adalah sebagai berikut:

- Bila disertai dengan bronkhitis, maka bercak-bercak di hilus akan bertambah

- Bila terdapat komplikasi empisema (COPD), maka gambaran radiolusen akan semakin bertambah.

- Bila terdapat komplikasi, maka terdapat gambaran infiltrat pada paru

- Dapat pula menimbulkan gambaran atelektasis lokal

- Bila terjadi pneumonia mediastinum, pneutoraks, dan pneumoperikardium, maka dapat dilihat bentuk gambaran radiolusen pada paru-paru.

b. Pemeriksaan tes kulit

Dilakukan untuk mencari faktor alergi dengan berbagai alergen yang dapat menimbulkan reaksi yang positif pada asma.

c. Elektrokardiografi

Gambaran elektrokardiografi yang terjadi selama serangan dapat dibagi menjadi 3 bagian dan disesuaikan dengan gambaran yang terjadi pada empisema paru, yaitu:

- Perubahan aksis jantung, pada umumnya terjadi right axis deviasi dan clock wise rotation

- Terdapat tanda-tanda hipertropi otot jantung, yakni terdapatnya RBB (Right Bundle branch Block)

- Tanda-tanda hipoksemia, yaitu terdapatnya sinus takikardia, SVES, dan VES atau terjadinya depresi segmen ST negatif.

d. Scanning Paru

Dapat diketahui bahwa redistribusi udara selama serangan asma tidak menyeluruh pada paru-paru.

e. Spirometri

Untuk menunjukkan adanya obstruksi jalan napas reversibel. Pemeriksaan spirometri tdak saja penting untuk menegakkan diagnosis tetapi juga penting untuk menilai berat
obstruksi dan efek pengobatan.

3. Diagnosa Keperawatan

1. Ketidakefektifan bersihan jalan napas berhubungan dengan penumpukan sekret.

a. Tujuan: jalan nafas kembali efektif

b. Kriteria hasil:

dapat mendemontrasikan batuk efektif

dapat menyatakan strategi untuk menurunkan kekentalan sekret

c. Intervensi
1) Auskultasi bunyi nafas, catat adanya bunyi nafas, mis; mengi, krekels, ronki.

R: beberapa derajat spasme bronkus terjadi sumbatan di jalan nafas

2) Kaji/pantau frekuensi pernafasan.

R: takipnea biasanya ada pada beberapa derajat dan dapat di temukan pada penerimaan atau selama stres

3) Kaji pasien untuk posisi yang nyaman mis : peninggian kepala tempat tidur, duduk pada sandaran tempat tidur.

R: peninggian kepal memudahkan untuk bernafas

4) Dorong/bantu latihan nafas abdomen/bibir

R: memberikan cara kepada pasien untk memgontrol dan mengatasi dispnea

5) Observasi karakteristik batuk mis : menetap, batuk pendek, basah

R; batuk pendek, basah biasanya sekret ikut keluar bersama batuk

6) Lakukan tindakan suction

R: untuk mengangkat ssekret dari jalan pernafasan

7) Koaborasi dengan doter

R: untuk pemberian obat

2. Ketidakefektifan pola napas b/d penurunan kemampuan bernapas.

a. Tujuan: pola nafas pasien menjadi efektif

b. Kriteria hasil:

Dada tidak ada gangguan pengembangan

Pernafasan menjadi normal 18-24 x/menit

c. Intervensi
1) Monitor frekuensi, irama dan kedalaman pernafasan

R: dispnea dan terjadi peningkatan kerja nafas, kedalaman pernafasan bervariasai

2) Tinggikan kepala dan bantu mengubah posisi

R: dududk tinggi memungkinkan ekspansi paru dan memudahkan pernafasan

3) Observasi pola batuk dan karakter sekret

R: menegtahui batuk keribg atau basah serta warna dari sekret itu

4) Berikan pasien latihan nafas dalam atau batuk efektif

R: dapat meningkatkan sekret di mana ada gangguan ventilasi sitambah ketidaknyamana bernafas

5) Berikan O2 tambahan

R: memaksimalkan bernafas dan menurunkan kerja nafas

6) Bantu fisioterapi dada

R: memudahkan upaya bernafas dalm dan meningkatkan draenase secret

3. Kerusakan pertukaran gas yang berhubungan dengan retensi CO2,

a. Tujuan: pertukaran gas menjadi efektif

b. Kriteria Hasil: Menunjukkan perbaikan vertilasi dan oksigen jaringan adekuat dalam rentang

c. Intervensi:

1) Kaji TTV

R: perubahan TD terjadi dengan beratnya hipoksemia dan asidosis

2) Kaji tingkat kesadaran/ perubahan mental

R: hipoksemia sistemik dapat ditunjukkan pertama kali oleh gelisah dan peka rangsang
3) Observasi adanya sianosis

R: Menunjukkanhipoksemia sistemik

4) Tinggikan kepala tempat tidur sesui kebutuhan pasien

R: meningkatkan ekspansi dada serta membuat mudah bernafas

5) Awasi BGA (blood gas analysis)

R: untuk mengetahui saturasi oksigen dalam darah

6) Berikan O2 sesui indikasi

R: memaksimalkan sediaan oksigen untuk pertukaran gas

4. Implementasi

Sehubungan tindakan atau implementasi merupakan pelaksanaan dari intervensi oleh perawat dan klien dengan tujuan untuk kebutuhn klien secara optimal dan jelas
tindakan yang di lakukan.