Lbm 5 RESPIRASI

STEP 1

 Pulse lips breathing : position to breath like wistling,

stance to inhale slowly, close lips like want to wistle,
 Retraction: chest pull to inside while inspiration
 FEV1: forced expiration volume in 1 second
 Barrel chest: condition of chest that diamater of latero lateral more short than antero
posterior

STEP 2

1. What is the relation between the patient smoker and his job with his illness?
2. What are the composition of cigarette?
3. Why dispnea in patient continue in 1 week with plegn sputum?
4. Why is there barrel chest in physical examination?
5. What are causes the retraction of chest muscle?
6. Why is there pulse lips breathing in the physical examination?
7. Why the doctor consider smoking eventhough he has stop smoking more than 5 years?
8. What are treatments for this diagnosis?
9. How the interpretation from spirometer examination?
10. What are the differential diagnosis and diagnosis of the scenario?
11. How is the patogenesis of the scenario?
12. What are the risk factor of this scenario?
13. What are the etiology of this scenario?
14. What are the clinical manifestation of this scenario?

STEP 3

1. What is the relation between the patient smoker and his job with his illness?
The patient is smoker and his job, is inhale toxic and polutan induce on going inflamation
with acumulation of neutrofil , macrophage and limfosit in the lung. If the stanger object
inhale to the lang, its physiology mechanism to protect out body.
The composition of smoke can cause the inflamation, the endotel change from
respiration epitel to squamous kompleks, the silia gone, so the mucus can’t out.

2. What are the composition of cigarette?

Nikotin,
tar,
CO the one of the gas no smell was produce of the burn of carcoal substance, thei gas is
toxic, increase the blood bring the oxygen,
hydrogen cianida make evaporation,
NO,
alkaloid nicotin fo the taste of cigarrete
 type of cigarrete:
1. White cigarrete: tar and nicotine lower, with filter
2. Kretek cigarrete: tar and nicotine middle, without filter
3. Cigar: high tar and nicotine
4. Electronic cigarrete;

Classification of smoker

 Mild: smoker can consume 1-10 cigarrete of a day

 Severe: 11-20 cigarrete a day
 More severe : >20 a day
 Intermiten smoker: from time to time
 Social smoker: when they go out

3. Why dispnea in patient continue in 1 week with plegn sputum?

The cigarrete has the content of nicotin, can make inflamation in the bronchus and make
hiperplasia and hipertropy mucus gland  and secretion increase make phlegn
sputum make obstruction and destroy alveolus  air flow breathing decrease 
dispnea

4. Why is there barrel chest in physical examination?

Nikotin, neutrofil will arise  neutrofil enter alveolar in the alveolus, neutrofil produce
neutrofil elastase cause defec of 1 alfa anyitripsin(elastic recoil)  dilatation, co will
accumulate in lung  barrel chest  difficult to expiration

5. What are causes the retraction of chest muscle?

Sign of increase use of difficulty breathing, as breathing become difficult, area of the
chest where retraction can be seen increase
Classification:
Mild : cause the retraction of subcosta and sub sternal
Moderate: same area with mild but the is intercosta reaction
Severe: retraction same area with mild and the retaraction of the neck, supraclavicular
and suprasternal

6. Why is there pulse lips breathing in the physical examination?

The patien to compensate for the lack of oxygen in the lung , pulse lips breathing
improve yhe air sack in the lung and ventilation then release trap air in the lung.
Decrease the work of breathing keep the air ways open for longer period.

7. Why the doctor consider smoking eventhough he has stop smoking more than 5 years?
If the patient smoking, the coplication after years
Because his work
Smoke control the body
8. How the interpretation from spirometer examination?
FVC for measure of FEV1 is a volume of air can expiration during first 1 second to kvow
vital capacity, the result FVC decrease , if FVC decrease the diagnosis is abnormality
obstructive.

9. What are the differential diagnosis and diagnosis of the scenario?

COPD
Pasca tuberculosis obstructive syndrome
Asthma
Bronkiektasis

10. What are the etiology of this scenario?

Smoking
Free radical
Occupation
Congenital desease; decrease od 1 alfa antitripsin

11. How is the patogenesis of the scenario?

The patient is smoker and his job, is inhale toxic and polutan induce on going inflamation
with acumulation of neutrofil , macrophage and limfosit in the lung. If the stanger object
inhale to the lang, its physiology mechanism to protect out body.
The composition of smoke can cause the inflamation, the endotel change from
respiration epitel to squamous kompleks, the silia gone, so the mucus can’t out.

12. What are the clinical manifestation of this scenario?

Cough
Barrel chest
Dispnea
Wheezing
Pneumonia attack
Bronchitis attack
PPOK has phase
1. Asimptomatic
2. Has a sign cough for long time, dispnea defort, wheezing, percution hipersonor,
expiration longer, wet ronchi
3. Same with phase before but decrease appetite, weight loss,
4. Same with phase before but hiperkapnia, easy angry and somnolen

13. What are the risk factor of this scenario?

Smoker
Inhahe air polution
Hiperreaktiv bronchus
History of lower respiratory infection
Defisiensi antitripsin alfa 1
 14. What are treatments for this diagnosis?

Inhalation anticolinergic: beta 2 agonis, bronchodilator, aseptilistain 600mg a day for 6 month

Corticosteroid: prednisolon or metil prednisolon 30-40 mg a day for 2 weeks

STEP 4

symptom

Fev 1
sign

copd patophysiology

Risk factor

classification
etiology

STEP 6