Bronchial asthma nursing care

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 activit
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
a. Bronchodilators: drugs that dilate the airways. Divided into two groups:
1. Sympathomimetic / andrenergik (adrenaline and ephedrine)
Drug name: Orsiprenalin (Alupent), fenoterol (berotec), terbutaline
(bricasma).
2. Santin (theophylline)
Drug name: Aminofilin (Amicam supp), Aminofilin (Euphilin Retard),
Theophylline (Amilex) Patients with gastric disease should be careful when
taking this medicine.
b. 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.
c. 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
1) Assess personal or family history of lung disease earlier
2) Assess correcting a history of allergy or sensitivity to substances /
environmental factors
b. Activity
1) The inability to perform activities because of difficulty breathing
2) A decrease in ability / improvement needs bentuan perform daily activities
3) Sleep in a seated position high
c. Respiratory
1) Dyspnea at rest or in response to activity or exercise
2) Breath worsened when the client lying on his back in bed
3) Using breathing apparatus, eg elevating the shoulders, spread his nose.
4) The presence of wheezing breath sounds
5) There is a recurrent cough
d. Circulation
1) An increase in blood pressure
2) An increase in the frequency of heart
3) The color of the skin or mucous membranes normal / gray / cyanosis
e. Ego integrity
1) Anxiety
2) Fear
3) Sensitive stimuli
4) Restless
f. Nutritional intake
1) The inability to eat due to respiratory distress
2) Weight loss due to anorexia
g. Social relations
1. Limitations of physical mobility
2. It's hard to talk or speak haltingly
3. 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:
1) When accompanied by bronchitis, then the patches in the hilum will increase
2) If there are complications of emphysema (COPD), then the picture will be
growing radiolucent.
3) If there are complications, then there is a picture on pulmonary infiltrates
4) It can also cause local atelectasis picture
5) 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) 2. There are signs of hypertrophy of the heart muscle, namely the presence of
RBB (Right Bundle Branch Block)
3) 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
a. Ineffective airway clearance related to accumulation of secretions.
1) Objective: airway re-effective
2) Expected outcomes:
 can demonstrate effective cough
 can declare a strategy to reduce the viscosity of secretions
3) Intervention
a. Auscultation of breath sounds, record their breath sounds, eg; wheezing,
krekels, crackles.
R: some degree of bronchospasm occurs obstruction in the airway
b. Assess / monitor respiratory frequency.
R: tachypnea normally exist in some degree and can be found at the reception
or during stress
c. 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
d. Push / aids abdominal breathing exercises / lip
R: give patients a way to remedy and resolve dyspnea memgontrol
e. Observation of cough characteristics eg settling, hacking cough, wet
R; short cough, moist secretions usually come out with a cough
f. Perform suctioning
R: to lift off the road respiratory ssekret
g. Koaborasi with doter
R: for drug delivery
b. Ineffective breathing pattern b / d decreased ability to breathe.
1) Objective: patient breathing pattern becomes effective
2) Expected outcomes:
- Chest no disturbance development
- Breathing becomes normal 18-24 x / min
3) Intervention
a. Monitor frequency, rhythm and depth of breathing
R: dyspnea and an increase in employment of breath, respiratory depth varies
throughout
 b. Elevate the head and help reposition
R: high dududk enables lung expansion and ease breathing
c. Observe the pattern of coughing and secretions character
R: menegtahui keribg or wet cough as well as the color of the secretions
d. Give the patient practice deep breathing or coughing effective
R: may increase secretions in which there is an interruption in breathing
inconveniences ventilation sitambah
e. Provide additional O2
R: maximize breathing and lower the breath work
f. Auxiliary chest physiotherapy
R: facilitate efforts to breathe preformance and improve draenase secret
c. Damage to gas exchange associated with CO2 retention,
1) Objective: gas exchange to be effective
2) Results Criteria: Shows improvement vertilasi and adequate tissue oxygen within
the range
3) Intervention:
a. Assess TTV
R: TD changes occur with the severity of hypoxemia and acidosis
b. Assess the level of consciousness / mental changes
R: systemic hypoxemia can be demonstrated first by the restless and sensitive
excitatory
c. Observation of cyanosis
R: systemic Menunjukkanhipoksemia
d. Elevate the head of the bed within their patients' needs
R: improving chest expansion and make breathing easier
e. Keep an eye on BGA (blood gas analysis)
R: to determine the oxygen saturation in the blood
f. 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 undertake