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 b’kaitan dg peny. Bronko pulmoner
PATOGENITAS

 BELUM JELAS
 Dasar gejala asma
 Imflamasi
 Respon saluran nafas b’lebih
1. Asma sbg peny. Imflamsi

Respon imflamasi
 Kalor→ panas
 Rubor → kemerahan
 Tumor → bengkak, eksudasi plasma
 Dolor → nyeri
 Fungsio laesa → fungsi t’gnggu
 Infiltrasi sel” radang
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 t’jadi
 Mekanisme neurologis pe respon sal nafas
 Ggn intrinsik otot polos sal nafas & hypertropi otot
polos pd sal nafas b’peran pd HSN
 Obstruksi sal nafas
TRIGGERS
Patofisiologi

 Obstruksi jln nafas mrp kan kombinasi antara

 spasme otot bronkhus
 Sumbatan mukus
 Edema
 Imflamasi dinding bronkhus
 Obstruksi b’tambah berat pd expirasi krn sal
nafas menyempit pd fase tsb→ udara distal
t’jebak tdk dpt diekspirasi
Lanjutan patofisiologi…..

 Klien b’nafas dg vol udara yg tinggi, m’dekati

TLC, b’tujuan agar sal nafas tetap t’buka →
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 b’lebih →
alkalosis respiratorik
 Pd asma yg lebih berat banyak sal nafas &
alveoli t’tutup oleh mukus m’akibatkan ggn
p’tukaran gas → hypoksemia
Penyempitan sal nafas m’akibatkan :
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 m’buruk pd awal
minggu & m’baik 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. M’cegah 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, 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.
 Gradually increase activity.
 Use supplemental oxygen therapy.