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INTRODUCTION
1.1. Background
Currently, many new diseases of the respiratory tract and causes vary, there are
caused by viruses, bacteria, and so forth. With this phenomenon should be of concern
to us all. One of the diseases of the respiratory tract is pneumonia. Pneumonia disease
most often affects older people (seniors) and those with chronic diseases as a result of
damage to the immune system (immune), but pneumonia also can attack the ablebodied young people. Currently the world's disease Pneumonia has been reported to
be among the major disease of childhood and is a serious disease that meragut the
lives of thousands of older people each year. (Jeremy, et al, 2007, p 76-78)
Pneumonia disease prevention the focus of the program P2ISPA (Communicable
Disease Acute Respiratory Infection). The program is underway to terms Pneumonia
known to the public, to facilitate outreach activities and disseminate information
about pneumonia prevention. P2ISPA program classifies people into 2 age groups:
Age under 2 months (Serious and Not Pneumonia Pneumonia) Age 2 months to less
than 5 years (2 months - Pneumonia, Pneumonia Pneumonia weight and not).
Classification of Non-pneumonia include cough five groups of people who do not
show symptoms of increased frequency of breath and did not show any withdrawal of
the chest wall into the bottom. ARI pneumonia beyond include: cough-cold normal
(common cold), pharyngitis, tonsillitis and otitis. Pharyngitis, tonsillitis and otitis,
excluding
diseases
covered
in
this
program.
Pneumonia is a health problem in the world because of the high death rate, not only
in developing countries but also in developed countries like the U.S., Canada and
European countries. In the U.S. for example, there are two million to three million
cases of pneumonia per year with the average number of deaths of 45,000 people (SA
Price, 2005, p 804-814)
CHAPTER
II
LITERATURE REVIEW
2.1. Basic Concepts Theory Pneumonia
2.1.1. Definition
Pneumonia is an acute respiratory infection on the bottom of the lung parenchyma.
According to anatomical, pneumonia in children can be divided into lobar
pneumonia, pneumonia and bronchopneumonia interstiasialis (Arif Mansjoer, 2001, p
446).
Pneumonia is an inflammatory process of the lung parenchyma is usually caused by
infectious agents. Pneumonia is an infectious disease that often results in death.
Pneumonia caused by radiation therapy, chemicals and aspirations. Pneumonia can
accompany radiation radiation therapy for breast and lung cancer, usually six weeks
or more after treatment is completed. Pneoumalitiis chemical or pneumonia occurring
after becoming kerosene or gas inhalation irritant. If a portion of a lobe or substasial
famous with this disease called lobar pneumonia (Jeremy, et al, 2007, p 76-78).
Pneumonia is an acute inflammation of the lung parenchyma that usually comes from
an infection. (S. A. FRICE. 2005, p 804)
2.1.2. Classification
Three classifications of pneumonia.
1. Based on the clinical and epidemiological:
a. Pneumonia local community (community-acquired pneumonia).
b. Nosocomial pneumonia, (hospital-acquired pneumonia /
nosocomial
pneumonia).
c. Aspiration pneumonia.
d. Pneumonia in immunocompromised patients.(Jeremy, et al, 2007, p 76-78)
Can occur at any age. Bacterial pneumonia is often termed pneumonia germs.
The types of pneumonia can affect anyone, from infants to those who have
elderly. The alcoholics, mentally retarded patients, postoperative patients,
people suffering from other respiratory diseases or viral infections are those
which have a low immune system and become very susceptible to the disease.
At the time of the body's defenses decreased, for example due to illness, old
age, and malnutrition, pneumonia bacteria will quickly multiply and damage
the lungs. If there is an infection, some tissue from the lung lobe, or entire
lobe, even most of the five lobes of the lung (three in the right lung and two in
the left lung) become filled with liquid. Of lung tissue, the infection spreads
quickly throughout the body via the blood circulation. Pneumococcal bacteria
are bacteria that are the most common cause of bacterial pneumonia as such.
Usually the symptoms of bacterial pneumonia was preceded by a mild
respiratory infection a week earlier. For example, due to a viral infection
(influenza). Viral infections of the respiratory tract can lead to pneumonia
caused by mucus (fluid / mucus) containing pneumococci can be sucked into
the
lungs
(Soeparman,
et
al,
1998,
697).
bacterial superinfection occurs is thick mucus discharge and green or dark red
(SA Price, 2005, p 804-814)
3.Based on the predilection of infection:
a. Lobar pneumonia, pneumonia that occurs in one lobe (large branches of the
bronchial tree) either right or left.
b. pneumonia bronchopneumonia.
Pneumonia is an infection characterized patches on various parts of the lung.
Can be right or left caused by viruses or bacteria, and often occurs in infants
or the elderly. In patients with pneumonia, lung air bag filled with pus and
other fluids. Thus, the function of the lungs, which absorb the clean air
(oxygen) and release the dirty air to be disrupted. As a result, the body suffers
from a lack of oxygen to all its consequences, for example, be more easily
infected by other bacteria (super infection) and so on. If this is the case, of
course the added difficulty healing. The cause disease in a wide range of
conditions and thus had an infection that can occur throughout the body. (S.
A. Price, 2005, p 804-814)
2.1.3. Etiology
The cause of pneumonia is Streptococcus pneumoniae and Haemophilus
influenzae. In infants and young children found Staphylococcus aureus as a cause
of severe pneumonia, and very profesif with high mortality. (Arif Mansjoer, et al,
p 466)
1. Bacteria: stapilokokus, streplokokus, aeruginosa, eneterobacter
2. Virus: influenza virus, adenovirus
3. Micoplasma pneumonia
2.1.4. Pathophysiology
Most of pneumonia acquired through aspiration of infective particles. There are
several mechanisms that normally protect the lungs from infection. Infectious
particles filtered in the nose, or trapped and cleared by mucus and ciliated
epithelium in the airways. When a particle can reach the lungs, the particles will
5
to
bacterial
pathogens
infect
the
lower
respiratory
tract.
This bacterium is an organism which can normally colonizes the upper respiratory
tract or the bacteria are transmitted from one person to another through airborne
droplet spread. Sometimes bacterial and viral pneumonia (eg varisella, measles,
rubella, CMV, Epstein-Barr virus, herpes simplex virus) can occur through either
hematogenous spread from a localized source or bacteremia / viremia generalized.
After reaching the lung parenchyma, the bacteria causing an acute inflammatory
response that includes fluid exudation, fibrin deposits, and infiltration of
polymorphonuclear leukocytes in alveolar macrophages followed infitrasi.
Exudative fluid in the alveoli causing typical lobar consolidation on chest X-ray.
Viruses, mycoplasma, and chlamydia cause inflammation with a predominance of
mononuclear infiltrates in the submucosal and interstitial structure. This causes
the release of epithelial cells into the airway, as occurs in bronchiolitis (SA Price,
2005, p 804-814).
2. GDA / pulse oksimetris: abnormal may occur, depending on the extent of lung
involved and the existing lung disease.
3. Examination grams / culture, sputum and blood: to be taken biosi needle
aspiration transtrakea, bronkoskofi fiberobtik or pulmonary opening biosi to
overcome penyebeb organisms. More than one organis there: bekteri
common diplococcos include pneumonia, stapilococcos, Aures A.-hemolik
strepcoccos, hemophlus influenza: CMV. Note: exit sekutum can not identify
all the organisms present. Blood cultures may indicate bacteremia semtara
4. JDL: leokositosis usually exist, although low white blood cells occurs in viral
infections, immune stress conditions such as AIDS, enabling the development
of bacterial pneumonia.
5. Serologic tests: eg, viral titer or legionella, cold agglutinins. assist in
differentiating the diagnosis of specific organisms.
6. Examination of lung function: the volume may decrease (congestion and
alveolar collapse); airway pressure may be increased and complaints. Seepage
may occur (hypoxemia)
7. Electrolytes: Sodium and Chloride may be low
8. Bilirubin: Perhaps increased.
9. Percutaneous aspiration / biopsy of lung tissue open: to declare the network
and the typical intra-nuclear cytoplasmic involvement (CMP; kareteristik
engineered cells (rubella).(Marlyn E. Dongoes, 1999 ASKEP, Page 164-174)
2.1.8. Management
1. Oxygen 1-2 L / min
2. IVFD (Intra Venous Fluid Drug) / (drug administration through intravenous)
dextrose 10%: 0.9% NaCl = 3: 1, + KCL 10 mEq / 500 ml of fluid. The
amount of fluid according to body weight, temperature rise, and hydration
3.
status.
If shortness is not too great, it can begin with a gradual entral food through a
in
or
provide:
days
giving
draniase
chronic
pulmonary
(PPOM)
increases
patient's
3. Individuals who smoke noisy, smoke because they disrupt both mukosiliari
and macrophage activity. Preventive Tindaka: ajurkan individuals to quit
smoking.
4. Every patient who diperbolehakan passively lying in bed in a long time that
are relatively immobile and shallow breathing at risk of bronchopneumonia.
Done had preventive: frequently change positions.
5. Individuals who are depressed cough reflex (because of medication, or the
circumstances that weaken the weak respiratory muscles), has been aspiring
for foreign objects into the lungs over a period of unconscious (head injury,
anesthesia), or have their swallowing mechanism is abnormal who almost
certainly
suffered
bronchopneumonia.
Preventive
action:
penghisan
10
REFERENCES
Arief Mansjoer. , 2001. Capita Selecta Medicine Volume 1. EGC: Jakarta.
Brenda G Bare, Suzan C. Smeltzer Medical Surgical Nursing 8th Edition, Vol. 1,
EGC,
Jakarta.
Doenges, Marilynn, E. et al. , 1999. Plans Nursing 3rd Edition. EGC, Jakarta
Jeremy, et al. , 2005. Respiratory System at a Glance, 2nd Edition. Grants: Jakarta
2,
Issue
4.
EGC:
Jakarta.
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