By I made Rantiasa, SKp

ASTHMA
Pendahuluan

Definisi
Asthma is penyakit paru dg karakteristik
Obstruksi sal nafas yg reversible
Implamasi sal nafas
Pe respon sal nafas thd bbg rangsang
PREVALENSI

Dipengaruhi oleh banyak faktor

Umur
Jenis kelamin
Status atopi
Keturunan
lingkungan
KLASIFIKASI

Asma extrinsik atopik

Asma extrinsik non atopik
Asma Kriptogenik
Asma kegiatan jasmani
Asma yg bkaitan dg peny. Bronko pulmoner
PATOGENITAS

BELUM JELAS
Dasar gejala asma
Imflamasi
Respon saluran nafas blebih
1. Asma sbg peny. Imflamsi

Respon imflamasi
Kalor panas
Rubor kemerahan
Tumor bengkak, eksudasi plasma
Dolor nyeri
Fungsio laesa fungsi tgnggu
Infiltrasi sel radang
 ALLERGEN
diolah

APC ( allergen presenting cells ) Saraf

Jalur non allergik

otonom
SEL
T helper PLASMA
HSN
IgE
Jalur allergik
SITOKIN Sel radang
Mastosit Mediator infeksi
Makrofag Histamin
Sel efitel Prostaglandin
Eosinofil Leukotrin
neutrofil bradikinin
Permeabilitas ddg vasculer me
Edema sal nafas
Infiltrasi sel radang HSN
Sekresi mukus
What Is Happening During
an Asthma Attack in the Lungs?
2. Hypereaktivitas sal nafas

Kongenital
Peka thd debu, zat kimia, histamin, fisis, allergen
spesifik
Di dapat karena
Imflamasi sal nafas kerusakan sel epitel bronkhus
kontriksi mudah tjadi
Mekanisme neurologis pe respon sal nafas
Ggn intrinsik otot polos sal nafas & hypertropi otot
polos pd sal nafas bperan pd HSN
Obstruksi sal nafas
TRIGGERS
Patofisiologi

Obstruksi jln nafas mrp kan kombinasi antara

spasme otot bronkhus
Sumbatan mukus
Edema
Imflamasi dinding bronkhus
Obstruksi btambah berat pd expirasi krn sal
nafas menyempit pd fase tsb udara distal
tjebak tdk dpt diekspirasi
Lanjutan patofisiologi..

Klien bnafas dg vol udara yg tinggi, mdekati

TLC, btujuan agar sal nafas tetap tbuka
diperlukan otot bantu nafas
Konstriksi sal nafas dpt tjd pd sal yg besar,
sedang maupun kecil
Mengi/whezing penyempitan pd sal nafas
yg besar
Gejala batuk & sesak penyempitan pd sal
nafas kecil
 Penyempitan sal nafas tdk merata diseluruh
bgn paru, shg daerah tsb mjd hypoksemia
pe PaO2
Unt memenuhi kebuthan O2 klien melakukan
hyperventilasi pengeluaran CO2 blebih
alkalosis respiratorik
Pd asma yg lebih berat banyak sal nafas &
alveoli ttutup oleh mukus makibatkan ggn
ptukaran gas hypoksemia
Penyempitan sal nafas makibatkan :
1. ggn ventilasi hypoventilasi
2. Ketidak seimbangan ventilasi perfusi dimana
distribusi ventilasi tdk sesuai dg sirkulasi
darah paru
3. Gangguan difusi gas di alveoli
Hal tsb berakibat
Hypoksemia, hyperkapnia, asidosis respiratorik
Gejala klinis

Batuk
Mengi
Sesak nafas
Pilek & bersin pd asma allergik
Batuk tanpa sekret mjd batuk purulen
Asma allergik sering berhubungan dg
pemajanan allergen
Asma akibat kerja biasanya mburuk pd awal
minggu & mbaik pd akhir mggu
Faktor pencetus pd asma

Infeksi virus sal nafas influenza

Pemajanan thd allergen, tungau, debu
rumah, bulu binatang
Pemajanan thd iritan asap rokok, minyak
wangi
Kegiatan jasmani lari
Lanjutan faktor pencetus

Expresi emosional takut, marah ,frustrasi

Lingk kerja : uap zat kimia
Polusi udara : asap rokok
Pemeriksaan fisik

Ekspirasi memanjang
Mengi
Hyperinflasi dada
Pernafasan cepat
cyanosis
Pemeriksaan penunjang

Spirometri sebelum & sesudah pemberian

bronkhodilator
Pemeriksaan sputum dominan eosinofil
Foto dada
Pemeriksaan AGD
Pengobatan

Prinsip pengobatan
1. Mencegah ikatan allergen IgE
Menghindari allergen, tampak mudah tapi
sukar dilakukan
2. Mcegah pelepasan mediator
Natrium kromolin mencegah spasme
bronkhus yg dicetuskan allergen
Lanjutan pengobatan

3. Melebarkan sal nafas dg bronkhodilator

Simpatomimetik
Asma akut salbutamol, fenoterol diberikan
inhalasi
Efinefrin sub cutan , unt anak & dewasa muda
Aminophilin sewaktu serangan akut
Kortikosteroid
4. Mengurangi respon dg meredam imflamasi
sal nafas natrium kromolin, kortikosteroid
Treatment of Asthma

Global Initiative for Asthma (GINA) 6-point plan

Educate patients to develop a partnership in asthma
management
Assess and monitor asthma severity with symptom
reports and measures of lung function as much as
possible
Avoid exposure to risk factors
Establish medication plans for chronic management
in children and adults
Establish individual plans for managing
exacerbations
Provide regular follow-up care
Impaired Gas Exchange

Interventions for chronic obstructive

pulmonary disease:
Airway management
Monitoring client at least every 2 hours
Oxygen therapy
Energy management
Ineffective Breathing Pattern
Interventions for the chronic obstructive
pulmonary disease client:
Assessment of client
Assessment of respiratory infection
Pulmonary rehabilitation therapy
Specific breathing techniques
Positioning to help alleviate dyspnea
Exercise conditioning
Energy conservation
 Ineffective Airway Clearance
Assessment of breath sounds before and after
interventions
Interventions for compromised breathing:
Careful use of drugs
Controlled coughing
Suctioning
Hydration via beverage and humidifier
Postural drainage in sitting position when possible
Tracheostomy
Imbalanced Nutrition

Interventions to achieve and maintain body

weight:
Prevent protein-calorie malnutrition through
dietary consultation.
Monitor weight, skin condition, and serum
prealbumin levels.
Address food intolerance, nausea, early satiety,
loss of appetite, and meal-related dyspnea
Anxiety

Interventions for increased anxiety:

Important to have client understand that
anxiety will worsen symptoms
Plan ways to deal with anxiety
Activity Intolerance

Interventions to increase activity level:

Encourage client to pace activities and promote
self-care.
Do not rush through morning activities.
Gradually increase activity.
Use supplemental oxygen therapy.