NURSING CARE CLIEN WITH ASTHMA
MEDICAL CONCEPTS ASTHMA
I. DEFINITIONS
Asthma is a disease caused by the increased response of the trachea and bronchi to various stimuli are marked by narrowing of bronchial secretions or bronkhiolus and excess – excess of glands – glands in the bronchus mucosa
II. Aetiology
1. Extrinsic Factors
Asthma is caused by a hypersensitivity reaction caused by IgE reacts to antigens contained in the air (antigen – inhalation), such as house dust, pollen – pollen and animal fur
2. Intrinsic Factor
• Infection:
- The virus that causes influenza is the virus, respiratory syncytial virus (RSV)
- Bacteria, such as pertussis and streptokokkus
- Mushrooms, such as Aspergillus
• weather:
changes in air pressure, air temperature, wind and humidity associated with the acceleration
• irritant chemicals, perfumes, cigarette smoke, air pollutants
• Emotional: fear, anxiety and tension
• Excessive activity, such as running
III. Pathology
Asthma is a lung disease with typical cirri of the airways is very easy to react to stimulation series of very young or the originator of the manifestations of an asthma attack. Acquired disorders are:
1. Bronchial muscle to contract (there narrowing)
2. Bronchial mucous membrane udema
3. Production of more mucus, sticky and thick, thus causing all three channels into a narrow hole bronchus and children will be able to cough and even shortness of breath. The attack itself may be lost or missing, with the help of drugs.
In the early stages of the attack looks pale mucosa, there were edema and increased secretions. Lumen narrowing due to bronchial spasm. Visible blood vessels congestion, infiltration of eosinophils cells in a secret location within the airway lumen. If attacks occur often or chronic and long will be seen deskuamasi (peeling) epithelium, bosal hyaline membrane thickening, hyperplasia elastin fibers, as well as hyperplasia and bronchial muscle hypertrophy. In severe attacks of asthma or to have chronic bronchial obstruction by thick mucus.
In asthma arising imunologik reaction, the reaction of antigen – antibody caused the release of chemical mediators that can cause this pathological abnormalities. Chemical mediators are:
a. Histamine
- Contraction of smooth muscle
- Dilatation of capillaries and veins contraction, resulting in edema
- Increased secretion of glandular dimukosa bronchus, bronkhoilus, mukosaa, nose and eyes
b. Bradikinin
- Bronchus smooth muscle contraction
- Increasing the permeability of blood vessels
- Vasodepressor (drop in blood pressure)
- Increased secretion of sweat and salivary glands
c. Prostaglandin
- Bronkokostriksi (especially prostaglandin F)
IV. Clinical manifestations
1. Wheezing
2. With long expiratory dyspnea, use of accessory muscles of respiration
3. nostril breathing
4. dry cough (not productive) because the secret thick and narrow the airway lumen
5. diaphoresis
6. cyanosis
7. abdominal pain due to involvement of the abdominal muscles in breathing
8. anxiety, and decreased levels of labile kesadarn
9. intolerant of activities: eating, playing, walking, even talking
V. STADIUM ASTHMA
1. Stage I
Time of the bronchial wall edema, proksisimal cough, irritation and dry cough. Sputum that is thick and collect foreign materials that stimulate coughing
2. Stage II
Increased bronchial secretions and coughing with a lot of clear sputum and frothy. At this stage the child will begin to feel shortness of breath trying to breathe more deeply. Lengthwise and expiratory wheezing sound. Additional breathing muscles look works. There is retracted sternal supra, epigastrium and may also broke ribs. Children prefer to sit down and bowed, his hands pressed to the edge of the bed or chair. Children looked nervous, pale, sianosisi around the mouth, the thorax forward and more round and move slowly on your breathing. In younger children, tend to occur abdominal breathing, retracted supra-sternal and intercostal.
3. Stage III
Obstruction or spasm of the bronchial heavier, very little air flow so that the sound barely audible sigh.
This stage is very dangerous because it is frequently thought to have improved. As well as suppressed cough. Shallow breathing, irregular and sudden respiratory rate rises.
VI. COMPLICATIONS
1. Status asmatikus
2. Chronic bronchitis, bronkhiolus
3. Ateletaksis: lobari segmental bronchus because of obstruction by the lenders
4. Pneumo thoracic
Work of breathing increases, increased O2 requirements. People acid is unable to meet the needs of a very high O2 required to breathe against bronkhiolus spasms, swelling bronkhiolus, and ukus m thick. Situation may cause ioni magnitude pneumothoraks due to ventilation teklanan
5. Death
VII. DIAGNOSTIC EXAMINATION
1. Disease history or physical examination
2. Chest X-ray
3. Examination of lung function: decreased tidal volume, vital capacity, eosinophils are increased in blood and sputum
4. Examination allergies (radioallergosorbent test; RAST)
5. Blood gas analysis – pH initially increased, PaCO2 and Pao2 falls (mild Respiratory alkalosis due to hyperventilation); then decreased pH, Pao2 decreased and increased PaCO2 (respiratory acidosis)
VIII. Management
1. Prevention of allergy exposure
2. Acute attacks with oxygen nasal or face mask
3. Parenteral fluid therapy
4. Appropriate medication therapy program
- Beta 2-agonist to reduce bronkospasme, bronchial smooth muscle mendilatasi
• Albuterol (proventil, Ventolin)
• Tarbutalin
• Epinephrine
• Metaprotenol
- Metilsantin, such as aminophylline and theophylline have the effect bronkodilatasi
- Anticholinergics, such as atropine metilnitrat or bronchodilator effect of fluoxetine has a very good
- Corticosteroids given IV (hydrocortisone), orally (mednison), inhalation (dexamethasone)
NURSING CARE CONCEPT
I. ASSESSMENT
1. History of asthma or allergies and asthma attacks before, allergies and respiratory problems
2. Review knowledge of children and parents about the disease and treatment
3. Psychosocial History: trigger factor, stress, exercise, habits and routines, previous treatment
4. Physical examination
a. Respiratory
- Short Breath
- Wheezing
- Retraction
- Tachypnoea
- Dry cough
- Ronkhi
b. Cardiovascular
- Tachycardia
c. Neurologic
- Fatigue
- Anxiety
- Difficulty sleeping
d. Musculoskeletal
- Intolerans activities
e. Integumentary
- Cyanosis
- Pale
f. Psychosocial
- No cooperative during treatment
5. Kaji hydration status
- Status of mucous membrane
- Skin turgor
- Urine output
II. Diagnosis
1. Disruption of gas exchange, ineffective airway clearance bd bronkospasme and mucosal udema
2. Fatigue b.d. hypoxia and increased work of breathing
3. Changes in nutritional status is less than the needs of bd GI distress
4. Risk of fluid volume deficiency b.d. pernapsan increased and decreased oral intake
5. Anxiety b.d. hospitalisasi and respiratory distress
6. Changes b.d. family process Chronic conditions
7. Lack of knowledge b.d. disease process and treatment]
III. INTERVENTION
1. Disruption of gas exchange, ineffective airway clearance bd bronkospasme and mucosal udema
Destination:
- The child will show marked improvement in gas exchange:
o no wheezing and retracted
o cough decreased
o reddish color
- Child does not show 95%?acid base imbalance disorder characterized by oxygen saturation
Intervention:
a. Kaji RR, auscultation of breath sounds
P/: as a source of data pewrubahan before and after treatment
b. Give high Fowler’s position or semi-Fowler
P /; develop lung expansion
c. Encourage your child to practice a deep breath and cough effectively
P /: to help clean mucus from the p [aru and breath in improving oxygenation
d. Apply suction if necessary
P /: help out secret which can not be issued by the children themselves
e. Do physiotherapy
P /: help pengeluaransekresi, lung expansion menmingkatkan
f. Provide oxygen according to the program
P /: improve oxygenation and reduce the secretion
g. Monitor expenditures peningkatn sputum
P /: as an indication of a failure on the lung
h. Give appropriate indications bronchodilator
P /: breathing muscles are relaxed and steroids to reduce inflammation
2. Fatigue b.d. hypoxia and increased work of breathing
Goal: Children demonstrate marked reduction in fatigue iritabel not, can participate and increase capacity in activities
Intervention:
a. sign – a sign of hypoxia / hypercapnea; fatigue, agitation, increased HR, increased RR
P /: early detection to prevent hypoxia can prevent further fatigue
b. Avoid frequent intervention is not important which can make the child tired, give adequate rest
P /: Get plenty of rest can reduce stress and enhance comfort
c. Ask parents to always accompany the child
P /: Reducing fear and anxiety
d. Provide adequate rest and sleep from 8 to 10 hours each night
P /: adequate rest and sleep enough to reduce fatigue and increase resistance to infection
e. Teach stress management techniques
P /: Bronkospasme may be due to emotional and stress
3. Changes in nutritional status is less than the needs of bd GI distress
Goal: Children will show a decrease GI distress characterized by:
Decrease nausea and vomiting, the improvement of nutrition / intake
Intervention:
a. Give small portions but often 5 to 6 times a day with food that he liked
P /: small but frequent meals provide the energy needed, the stomach is not too full, thus providing the opportunity for absorption of food. Food mendporong children preferred to eat and increase the intake
b. Give soft foods, low fat, use color
P /: spicy foods high in fat and can increase the GI distress that it is difficult to digest
c. Instruct to avoid foods that cause allergies
P /: It can cause acute attacks in children are sensitive
4. Risk of fluid volume deficiency b.d. pernapsan increased and decreased oral intake
Destination:
Children can maintain adequate hydration characterized by elastic skin turgor, moist mucous membranes, fluid intake according to age and weight, urine output: 1-2 ml / kg/d
Intervention:
a. skin turgor, monitor urine output every 4 hours
P /: to know the level of hydration and fluid needs
b. Maintain appropriate indication of parenteral therapy and monitor the excess fluid
P /: excess fluid can cause udema pulmonar
c. After the acute phase, and parents encourage children to drink 3-8 glasses / day, depending on age and weight children
P /: children need enough fluids to maintain hydration and acid base balance to prevent shock
5. Anxiety b.d. hospitalisasi and respiratory distress
Destination:
Decreased anxiety, marked by the child calm and able to express their feelings
Intervention:
a. Teach relaxation techniques; exercise deep breath, guided imagination
P /: diverting attention during episodes of asthma can reduce fear and anxiety
b. Provide play therapy as an indication
P /: play therapy can reduce the effects of hospitalisasi and anxiety
c. Informed about the care, treatment and condition of the child
P /: reducing fear and losing control of himself
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