PART I

PRELIMINARY

A. Background

One trigger asthma attacks is the client's psychological condition unstable included

anxiety. This is often overlooked by the client so that the frequency of recurrence

becoming more frequent and clients fall in a worse situation. This condition is a chain

that is difficult to determine which is the cause and which is effect. Circumstances cause

or worsen anxiety attacks, asthma attacks can cause great anxiety on the client asthma

when anxiety makes things worse (Cris Sinclair, 1990: 106). Crowded conditions can

cause anxiety for clients to feel the threat of death (Barbara C. Long, 1996: 512).

Lowering the level of anxiety on the client both during an attack of asthma or when

there is no attack is very important. For as has been described above, the circle on the

causes and consequences of anxiety should be disconnected. Thus, it means deciding one

trigger asthma and disconnected state of anxiety caused by asthma. So can shorten attacks

and reduce the frequency of relapse.

In the UK around 2.5 million people who need treatment Bronchial asthma and

routine surveillance, 10% of children and 7% of adults (A Crockett, 1997). In the United

States an estimated 9.5 million people suffer from asthma. In Germany nine million

inhabitants. Anxious associated with breathing difficulty are reported as diagnoses are

often handled (50% - 74%) (Carpenito, 2000: 128). This is a number that is large enough

to get attention from nurses in treating clients in a comprehensive asthma bio psycho

social and spiritual. In East Java, according to research by Muhammad Amin (2000)

reported there were 13.5% of 6144 respondents showed symptoms of asthma.

B. Research Objectives

1. General Purpose

Being able to know the concept of medical and nursing concepts in clients with

asthma brongkial.

2. Special Purpose

a. Students are able to understand medical concepts bronchial asthma.

b. Students are able to understand the concept of nursing care to clients with medical

diangnosa bronchial asthma

 CHAPTER II

REVIEW OF THEORY

A. Basic Concept Asthma

1. Understanding

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 spontaneously or as a result of treatment (Soeparman, 1990 quoted

from The American Thoracic Society, 1962).

According to Sylvia Anderson (1995: 149) asthma is a clinical condition

characterized by reversible bronchial constriction period, separated by a period in

which the ventilation airway to various stimuli.

Asthma is a chronic inflammatory airways involving eosinophils, mast cells,

neutrophils, lymphocytes and macrophages are characterized by wheezing, shortness

of breath recurrence-recurrence, cough, chest felt pressured to recover with or without

treatment (Cris Sinclair, 1990: 94).

Samsuridjal and Bharata Widjaja (1994) describes asthma is a disease of

inflammation (swelling) of the airways to stimuli or bronchial hyper reactions. The

nature of inflammation in asthma is typical of the signs of airway inflammation

accompanied infliltrasi eosinophils.

Asthma is a condition of disturbance / damage to the bronchi marked with

reversible bronchospasm (spasm and kontriksi long in the airway) (Joyce M. Black,

1996: 504).
 According to Crockett (1997) Bronchial asthma is defined as a disease of the

respiratory system that includes inflammation of the airways with reversible

bronchospasm symptoms.

2. Asthma Classification Based on Etiology

a. Bronchial Asthma Atopic mode (Extrinsic)

Asthma arises because someone atopy by exposure to allergens. Allergens that

enter the body through the respiratory tract, skin, gastrointestinal tract and others

will be caught by macrophages that work as antigen presenting cells (APC). Once

the allergen is processed within APC cells, and then by the cell, allergens

presented to Th cells. APC cells through the release of interleukin I (II-1) activate

Th cells. Through the release of Interleukin 2 (II-2) by the activated Th cells, the

B cells proliferate be given a signal to the cell plasthma and form IgE.

IgE is formed will be bound by the existing mast cells in tissues and basophils

are present in the circulation. This is possible because the two are on the surface

of cells have receptors for IgE. Eosinophils, macrophages and platelets also have

receptors for IgE but with a weak affinity. People who already have the mast cells

and basophils by IgE on the surface are not yet showing symptoms. The person is

considered a new desentisisasi or become vulnerable

When people who are already vulnerable was exposed two times or more with

the same allergen, allergens that enter the body will be bound by the existing IgE

on the surface mastofit and basophils. The bond will cause influk Ca ++ into the

cell and changes in the cells that degrade cAMP levels.

 CAMP levels declining it will cause cell degranulation. In the process of

degranulation of these cells were first issued is a mediator who is already

contained in granules (preformed) in the cytoplasm which has the properties of

biological, ie histamine, Eosinophil chemotactic factor-A (ECF-A), Neutrophil

chemotactic factor (NCF), trypase and quinine. Immediate effects by obstruction

by the mediator is histamine.

Hiperreaktifitas bronchus is bronchi easily shrink (constrict) when exposed to

the substance / factor with low levels that most people do not cause any reaction,

such as allergens (inhalant, kontaktan), pollution, cigarette smoke / kitchen, odors

sharp and the other either in the form of irritant and non-irritant. Today has been

known that bronchial hyper rektifitas caused by chronic bronchial inflammation.

Inflammatory cells, especially eosinophils are found in large quantities in the

liquid rinse bronchus Bronchial asthma patients as eosinophilic chronic

bronchitis. Hyper reactivity associated with severe degree of disease. At the clinic

the hiperreaktifitas bronchi can be demonstrated with the use methacholine

provocation test or histamine.

Based on the things mentioned above is currently considered to be clinically

disease asthma as a disease that is reversible bronchospasm, is patofisiologik as a

bronchial hyper reactions and pathological as an inflammation of the airways.

Bronchial asthma patients in mucosal edema and walls, inflammatory cell

infiltration mainly of eosinophils and the release of ciliary cells that cause

vibrations of cilia and mucus on it so that one of the defense of the respiratory
 tract does not function anymore. Also found in patients with asthma Bronchial

blockage of the airways by mucus, especially in the branches of the bronchus

As a result of bronchospasm, mucosal edema and mucus hypersecretion walls

of the bronchi and the narrowing of bronchi and the ramifications that will cause

tightness, wheezing (wheezing) and a productive cough.

The existence of both physical and psychological stressors will lead to a state

of stress that will stimulate the HPA axis. HPA axis are aroused will increase

adeno corticotropic hormone (ACTH) and cortisol levels in the blood. Increased

cortisol in the blood will suppress immunoglobulin A (IgA). IgA decrease in the

ability to cause lysis of inflammatory cells decreased the response by the body as

a form of inflammation of the bronchi, causing Bronchial asthma.

b. Bronchial Asthma Atopic Non mode (Intrinsic)

Non allergenic asthma (intrinsic asthma) occurred not because of exposure to

allergens, but due to multiple factors such as the originator of upper respiratory

tract infections, exercise or strenuous physical activities, as well as mental stress

or psychological stress. Asthma attacks are caused by autonomic nervous

disorders, especially disorders of the sympathetic nerve is adrenergic blockade

beta and alpha adrenergic hiperreaktifitas. Under normal circumstances the beta

adrenergic activity is more dominant than the adrenergic alpha. In most

asthmatics alpha adrenergic activity unexpectedly increased the lead

bronkhokonstriksi, causing shortness of breath.

Beta adrenergic receptor is estimated that the enzyme present in the cell

membrane known as the adenyl-cyclase and is also called the second messengner.
 When this receptor is stimulated, then the adenyl-cyclase enzyme is activated and

will catalyze ATP in the cells become 3'5 'cyclic AMP. cAMP then will cause

dilation of bronchial smooth muscles, inhibiting the release of mediators from

mast cells / basophils and inhibit the secretion of mucous glands. As a result of

the blockade of beta adrenergic receptor alpha adrenergic receptor function is

more dominant resulting in a bronchus, causing shortness of breath. This is known

as the theory of beta adrenergic blockade. (Baratawidjaja, 1990).

c. Bronchial Asthma Mixed (Mixed)

In this type of complaint is exacerbated both by intrinsic factors or extrinsic.

3. Factors Triggers Asthma Attacks bronchiale

Factors that can cause asthma attacks bronchiale or commonly referred to as

trigger factors are:

a. Allergens

Allergens are sat-specific substance when smoked or eaten can cause

asthma attacks, such as house dust, house dust mites (Dermatophagoides

pteronissynus) mold spores, cat's skin flakes, fur, some seafood and so on.

b. Respiratory infections

Respiratory infections, mainly by viruses such as influenza is one of the

trigger factors that most often lead to Bronchial asthma. An estimated two-

thirds of adult asthma sufferers asthmanya attack caused by respiratory tract

infections (Sundaru, 1991).

c. pressure soul
 Mental stress do not cause asthma, but as the originator of asthma, because

a lot of people who receive mental pressure but did not become Bronchial

asthma sufferers. These factors contributed to trigger asthma attacks,

especially in the somewhat unstable personality. It is more prevalent in

women and children (Yunus, 1994).

d. Exercise / strenuous physical activities

Most people with asthma Bronchial asthma attack will get when doing

sport or physical activity is excessive. Run fast and easiest cycling cause

asthma attacks. Asthma attacks because of physical activity (Exercise induced

asthma / EIA) occurs after exercise or physical activity is quite heavy and

infrequent attacks occur several hours after exercise.

e. Drugs

Some Bronchial asthma patients are sensitive or allergic to certain drugs

such as penicillin, salicylates, beta blockers, codeine, and so on.

f. Air pollution

Asthma patients are very sensitive to dusty air, smoke from factories /

vehicles, smoke, smoke containing combustion products and fotokemikal

oxide, as well as a sharp odor.

g. Work environment

An estimated 2-15% of patients with bronchial asthma Triggers are

working environment (Sundaru, 1991).

h. Impact Generated by Bronchial Asthma

The impact of the Bronchial asthma is:

1) Physical

2) Respiratory System

Respiratory system include:

a. Increased respiratory rate, labored breathing, shortening the period

of inspiration, lengthening expiratory

b. The use of accessory respiratory muscles (retractions sternum,

shoulder appointment time to breathe).

c. Respiratory nostril.

d. Wheeze is heard without a stethoscope.

e. Coughing hard, dry, and finally productive cough.

f. Lung function impairment in FEV1.

3). Cardiovascular System

a. tachycardia

b. Tensions rise

c. Pulsus paradoxus (decreasing blood pressure) to 10 mmHg at the

time of inspiration).

d. cyanosis

e. diaphoresis

f. Dehydration

4). Psychological
 a. Increased anxiety (anxiety): fear of death, fear of suffering, panic,

anxiety.

b. The expression of anger, sadness, do not trust the other person, not a

concern.

C. The expression is not hopeless, helplessness.

5). Social

a. Fear of interacting with others.

b. communication disorders

c. inappropiate dress

d. Hostility toward others

6). Haematology

a. Increased eosinophils> 250 / mm3

b. Decrease in lymphocytes and white blood cell component to another.

c. Decrease Immunoglobulin A (IgA)

 CHAPTER III

CASE REVIEW

Date of assessment: 12-07-2016

Hours: 8:00 pm

A. Identity Patients:

Name : An. A

RM : 763 915

Age : 4 years old 7 months

Gender : Male

Job :-

Religion : Islam

Sign RS Date : 12-07-2016

Reason Sign RS : An. A Sign hospital with complaints of shortness

B. Survey of primary and resuscitation

1. ARWAY

a. The state of the airway

Look :

The level of consciousness : Composmentis

Respiratory : 40x / I, Dyspnea

efforts to breathe : There is an attempt to breathe due to the amount of

sputum in the airways.

Listen :

Breath sounds : Wehzing

 b. nursing problems

Ineffectiveness airway clearance

c. Intervention or implementation

Nursing Diagnosis / The nursing plan

Problem Collaboration Objectives and Criteria Intervention

Results

Airway Clearance NOC:

ineffectiveness After the act of nursing ▪ Positioning the patient to maximize ventilation.

associated with airway for 1x24 hours. the ▪ Assess client's vital signs

obstruction: excessive patient demonstrate the ▪ Reviewing rate, rhythm, depth and difficulty

mucus. effectiveness of airway breathing..

DS: evidenced by outcomes: ▪ Assessing the sura additional breath

- Clients say ❖ clean breath sounds, ▪ Reviewing breathing patterns

claustrophobic no cyanosis and ▪ Collaboration of nebulizer therapy

DO: dyspnea ▪ Collaboration of O2

- The assessment ❖ Indicates that a patent

results obtained: airway (the client does

TD: 90/60 mmHg, not feel suffocated,

P: 40 x / I, breathing rhythm,

N: 98x / i respiratory frequency

S: 36.80C, in the range of

BB: 23 kg, normal, no abnormal

 TB: 111cm breath sounds)

- Client was restless ❖ O2 Saturation within

- Auscultation of breath normal limits

sounds: wheezing

- Visible green sputum

viscous

2. BREATHING

a. respiratory function

Look:

Respiratory frequency : 40x / i, There retraction breath auxiliary muscles, and the

walls are symmetrical torax

Listen:

Breath sounds : wezing

b. nursing problems

Ineffectiveness of breathing patterns

c. Intervention or implementation

Nursing The nursing plan

Diagnosis / Objectives and Criteria Intervention

Problem Results
 Collaboration

Breath pattern NOC: NIC:

of After the act of nursing ❖ Assessment of vital signs

ineffectiveness for 1x24 hours breathing ❖ Assess breathing pattern and oxygenation
related to: patterns of patients
status
fatigue showed effectiveness,
❖ Assess breath sounds, noting the additional
DS: evidenced by outcomes:
sound
- Clients say ❖clean breath sounds, no
❖ Assess the signs of hypoventilation
claustrophobi cyanosis and dyspnea

c ❖Indicates that a patent

- DO: airway (the client does

- The not feel suffocated,

assessment breathing rhythm,

results respiratory frequency in

obtained TV: the range of normal, no

TD: 90/60 abnormal breath

mmHg, sounds)

P: 40x / I, ❖Signs Vital signs within

N: 98x / i normal range (blood

S: 36.80C, pressure, pulse,

BB: 23 kg, respiration)

TB: 111cm

- The client
looks using

accessory

muscles of

breath.

3. CIRCULATION

a. circulatory state

Look:

Composmentis awareness level, no bleeding, capillary refill> 3 seconds.

Feel:

Akral peripheral warm.

b. nursing problems

c. Intervention or implementation

d. Evaluation

4. Disability

GCS 15 (verbal: m6, motor: 5, and the eye: 4), the reaction of the pupil miosis

5 EXPOSURE

No signs of hyperthermia or hypothermia.

C. Secondary Assessment

1. Medical history first

 Klein mother said her son had a history of asthma

2. Health history now

Mother clients tell a history of asthma in misery to the present day.

3. Family health history

Mother said the father and keluarnga client of his father had a history of asthma

D. History and mechanism of trauma

Mom client said he had no history of trauma

E. Physical examination

1. Head

Visible scalp clean clients, eyes appear symmetrical, retraction pupil miosis,

glasses (-0.25), telingga appears clean, normal auditory, olfactory function in kedaan

good, clean mouth, no stomatitis, no lesih in the facial area.

2. Neck

No enlarged glands tiroit (T1), no bone pain.

3. Chest / thoracic

Lung –paru : No chest retraction, breast shape is symmetrical, there is no

scarring in the chest ekitar, wising respiratory sounds, respiratory frequency 40x /

i.
 Heart : Heart border on in intracosta II, take heart border in intrakosta V,

medicalivucularis linea left boundary of the left and right boundary line

parasikularis dextra, no complaints of chest pain, heart sounds BJ 1 and BJ2.

Abdomen : No tenderness in the abdomen, there is no scar tissue around

the abdomen, abdominal convex shape, peristaltic intestinal 12.

4. Therapy

Ventolin 2.5 mg + NaCl 2.5 ml

F. Analia Data

no Data nursing problems

1 S: Airway clearance ineffectiveness.

1. The client's father said Ana (Nanda 406)

Shortness Definition : The inability to clean secretion or

O: obstruction of the airway to maintain

1. Physical examination found no airway clearance.

additional breath sounds Code : 00031

(wheezing), TD: 90/60 mmHg, Domain 11 : Safety / protection

P: 40x / I, S: 36.80C, BB: 23 Class 2 : Physical injury

kg, Height: 111cm

2. Visible green Scutum issuing

clients.
NURSING DIAGNOSES

a. Ineffective Airway Clearance related to airway obstruction: excessive mucus.