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2 Basic Concepts of Asthma According Syaifuddin, (2014) anatomy and respiratory physiology
respiratory system can be classified as follows:
a. Nose
It is the first air channel, has two holes (rice cavity), separated by the nasal septum (septum rice). Inside
there are feathers that are useful for filtering the air, the dust that enters the nose (Syaifuddin, 2014
b.Sinus paranasalis
The paranasal sinuses of the cavity within the skull are located near the nose and the eye. There are four
sinuses: frontal sinus, etmoidalis, sphenoidalis, and maxillary (Brunner and Suddarth, 2014
c. Faring
Faring or throat is the cavity that connects between the nose and oral cavity to the larynx. The pharynx
is divided into three areas, namely the nasopharynx, oropharynx and hypopharynx (Brunner and
Suddarth, 2015)
d. Faring
Faring or throat is the cavity that connects between the nose and oral cavity to the larynx. The pharynx
is divided into three areas, namely the nasopharynx, oropharynx and hypopharynx (Brunner and
Suddarth, 2015)
e. Trachea
The trachea or windpipe is a continuation of the larynx formed by 16-20 rings consisting of horse-shaped
bones shaped like a horse's hooves. Inside is covered by a fluffy lender membrane called ciliated cells
(Syaifuddin, 2015)
f. Bronkus
The bronchus is a continuation of the trachea located at the height of the thoracic vertebrae IV and V.
The bronchus has the same structure as the trachea and is located towards the lungs (Syaifuddin, 2015).
Breathing is the process of entering the air into and out of the lungs. The process of breathing begins by
entering the air into the lung cavity to be circulated into the circulation and removal of waste substances
(CO2) from the circulation to the exit of the body through the lungs....
a. Ventilation
Ventilation is the process of air movement in and out of lungs. The ventilation consists of two stages:
inspiration and expiration
b. Diffusion gas diffusion is a process in which oxygen and carbon dioxide exchanges occur at the
udarah-blood meeting place.
C Transportation of gas
The third part of the respiratory process is the transport of gas (oxygen and carbon dioxide) from the
lungs to the body's circulation (Syaifuddin, 2014).
Asthma itself comes from the word asthma. This word is derived from the Greek that has the
meaning of difficult breathing, asthma is known because of the symptoms of shortness of breath,
coughing and wheezing caused by narrowing of the airways. Or in other words asthma is a peradagan or
swelling of the airway that causes the production of excessive viscous fluid ( Prasetyo, 2010). Asthma is
an intermittent obstructive airway disease, a reversivel in which trakia and bronchi respond in a
hyperactive way to certain stimuli. (Smeltzer, 2002: 611)
Asthma is a reversible airway obstruction, occurring when the bronchus is inflamed and hyperresponsive
(Reeves, 2001: 48). Asthma is a chronic inflammatory disease of the airways caused by hyperresponsive
reactions of immune cells such as mast sets, eosinophils, and T-lymphocytes to certain stimuli and cause
symptoms of dyspnea, whizzing, and cough due to reversible and recurrent episodic airway obstruction (
Brunner and Suddarth, 2001).
According to Prasetyo (2010) Asthma, wheezing or wheezing are some of the common names we use to
patients who suffer from asthma diseases not infectious diseases, but genetic factors have a big role
here. Respiratory tract asthma sufferers are very sensetif and provide a very excessive response if
experiencing stimuli or ganguan.Salusan respiratory interaction with a way to narrow and block the
incoming air.
This narrowing or obstruction usually results in one or a combination of various symptoms starting and
coughing, shortness of breath, shortness of breath, wheezing, to breath that "tinkles" (Hadibroto et al
2006)
According to Sudoyo (2006: 245), it is very difficult to distinguish one type of asthma with another.
Asthma in differentiation, allergic asthma (extrinsic) and non-alergic (intrinsic). Allergic asthma is
particularly pronounced in childhood, its mechanism of attack through type I allergic reactions to
allergens. While asthma is said to be intrinsic if asthma is not found signs of hypersensitivity to allergens.
2.2.4 Etiology
According to Muwarni (2009: 5-6), the etiology of asthma is as follows: Extrinsic: Allergen factors are
inhalation of ingredients, dust, animal fur, plants etc.Ingestan: through food / medicine, for example sea
fish / fresh fish, eggs and drugs.
Intrinsic: Non-allergen factors are usually not clear of allergic factors. There is usually inflammation.
Psychological: Psychology: in people who are angry, in people who are a lot of trouble. Genetics:
Heredity: less clear, occurs to her suffering family.
Meanwhile, according to Suyono (2004: 22), the etiology of asthma is not known with certainty, but
various studies have shown that the basic symptoms of asthma is inflammation and exaggerated airway
responses.
2.2.5 Pathophysiology
According to Suyono (2004: 22-23), the pathophysiology of asthma is as follows: Airway obstruction in
asthma is a combination of bronchial muscle spasm, mucus, edema and inflammation of the bronchial
wall, obstruction increases in weight during expiration as the physiologic airways narrow in phase the.
This results in distal air where the occurrence, trapped obstruction, can not be expired. Next there is an
increase in residual volume, functional residual capacity (KRF) and the patient will breathe at high
volume near the total lung capacity (DTL). This hyperinflation state aims to keep the airway open and
gas exchange running smoothly.
Airway constriction may occur in large, medium or small airways. Symptoms of wheezing suddenly there
is a narrowing in the large airway, whereas in the small airways, symptoms of cough and tightness are
more dominant than wheezing.
Airway constriction is not evenly distributed throughout the lung. There are areas that lack ventilation
so that blood capillaries through the blood experience hypoxemia. To overcome the lack of oxygen the
body to do hyperventilasi, kinda oxygen needs are met. But as a result CO2 expenditure becomes
excessive so that PaCO2 decreases and then causes respiratory senseosis. In more severe asthma
attacks, the respiratory tract and alveolus are covered by mucus, so no longer possible gas exchange.
This causes hypoxemia and respiratory muscle work to gain weight and an increase in CO2 production.
Increased CO2 production accompanied by decreased alveolar ventilation leads to CO2 retention
(hypercapnia) and respiratory acidosis or respiratory failure. Prolonged hypoxemia causes metabolic
acidosis and pulmonary vascular constriction which then leads to simulation of the circulation of blood
without going through a good gas exchange unit, which consequently worsens hypercapnia. Thus
narrowing of the airways in asthma will cause the following things:
2.2.7 Clinical Manifestations
1. Meaningful Dipsneas
4. Wheezing may be heard in auscultation of the lung. Usually wheezing is heard only during expiration,
unless the patient's condition is severe
5. Increased breathing effort, characterized by chest retraction, accompanied by bad condition, breath
nostrils
7. Air is trapped due to airflow obstruction, especially seen during expiration in asthmatic patients
8. Among asmatic attacks, individuals are usually asymptomatic but in examination of pulmonary
function changes, it may be seen
2.2.8 Investigations
According to Asih and Effendy (2004: 97-98), diagnostic tests performed on asthma patients are as
follows:
2. Pulmonary function tests: Done to determine whether the functional obsnormalities are obstructive
or restrictive, to estimate the extent of dysfunction and to evaluate therapeutic effects, eg
bronchondilator
5. Sputum: Cultures to determine the presence of infection, identify pathogens, cytologic examinations,
to improve underlying malignancy or allergic disorders
Meanwhile, according to Mansjoer (2005: 481), diagnostic tests performed on asthma patients are:
a. History: A history of disease characterized by the above 3 clinical symptoms and causal factors
b. Physical examination
1. Patients usually appear emaciated with barrel-shaped chest (increased chest anteroposterior
diameter)
3. Hypersonor chest percussion, liver shrinkage smaller, lower liver lung limit, reduced heart loss
a. Radiological examination
1) Chest X-ray of chronic bronchitis shows tubular shadow in the form of parallel shadow lines coming
out of the hilum toward the lung apex and increasing pulmonary scalp
2) In pulmonary emphysema, the piston image indicates an over-inflation with a low and flat diaphragm,
pulmonary vascular sequelae and the addition of a distal profile
d. ECG Check
2.2.9 Management
According Mansjoer, et al, (2005: 477); Asih and Efendy, (2004: 100), management performed on
asthma patients are:
A. Medical
2. Prevent recurrence
C. Nursing
3. Facilitate learning
2.2.10 Complications
2.2.10 Complications
2) The inability of the family to make the right health action decisions.
Definition: Inability to clean secretions or obstruction of the respiratory tract to maintain airway
hygiene.
Rational: May need to treat or prevent hypoxia. If breathing or oxygenation is inadequate, ventilate as
needed.
General Objectives: Maintain the patient's airway, with a clear and clear breath sound Special purpose :
Intervention:
a) Assess family knowledge about airway clearance is ineffective.
Rational: some degree of bronchial spasm occurs with airway obstruction and may or may not be
manifested as adventitious breath sounds, eg spreading, wet crackles (bronchitis) dim breath sounds
with wheezing expiratory (emphysema) or absence of breath sounds.
d) Provide health counseling with strengthening of essentials in care to address ineffective clearance of
airway clearance.
Rational: several ways to overcome and control dyspnea and lower air traps.
Intervention:
a) Assess the level of family knowledge about the importance of making the right decision to address
ineffective airway clearance.
Rational: the knowledge to decide the right decision to overcome airway clearance is not effective.
b) Explain how to make the right decision to overcome the ineffectiveness of airway clearance.
Rational: explain to the patient some ways to overcome the ineffectiveness of the airway and lower the
air trap.
c) Teach you how to make the right decision in overcoming airway clearance problems.
Rational: teaching the patient some ways of making the right decision can decrease the degree of airway
clearance.
Rational: Deliberation on the patient can help in making the right decision. 3) The family is able to
provide care to sick family members.
Intervention:
Rational: respiratory dysfunction is a variable that depends on the stage stage stage of chronic processes
other than acute processes that cause hospitalization, eg infection, allergic reactions.
b) Explain the importance of care for sick family members.
Rational: the originator in the care of a sick family member is the originator of the type of respiratory
allergic reaction that can trigger acute episodes.
Rational: giving families some ways to cope and control or how care can control dyspnea.
Rationale: mobilize secretions to clear the airway and help prevent respiratory complications.
Intervention:
Rationale: teaching in modifying a healthy environment can reduce the spread of disease.
Intervention:
Rational: Knowing about the level of family knowledge about airway clearance
2) The inability of the family to make the right health action decisions
Definition: Ineffective breathing patterns are inadequate inspiratory or inadequate air exchanges
Intervention:
c) Auscultation of breath sounds, note the presence of allergens, ronchi, wheezing and krekels.
d) Give health education by strengthening the important things in care to know the ineffectiveness of
the pattern of the breath.
Intervention:
a) Assess family's level of knowledge about the importance of making the right decision to know the
pattern of the breath is not effective
b) Explain about how to make the right decision to know the ineffectiveness of the breath pattern
c) Teach you how to make the right decision to overcome the problem of the breath pattern is not
effective
Intervention:
Intervention:
b. Impaired fulfillment of nutritional needs less than body needs related to (Doenges, et al., 2000: 159):
2) The inability of the family to make the right health action decisions.
Special purpose :
Intervention:
b) Explain the factors that cause the lack of nutrition in the patient.
Rational: to know the extent of family ability in the practice of providing food.
Intervention:
Intervention:
a) Assess family's level of knowledge in providing care to family members with nutritional disorders that
lack the essence of body needs.
Rational: provide information about the family in relation to the basic needs of calories or plans within
Rationale: the provision and nutritional support is based on estimates of calorie and protein
requirements.
d) Teach the family to provide food with small portions but often.
Intervention:
Rational: creating a healthy home can improve health status to prevent the occurrence of disease.
Intervention:
Rational: Knowing the level of family knowledge about the utilization of health facilities.
c) Explain about the loss if not utilizing the existing health facilities.
Rational: to give consideration to the family.
c. Lack of knowledge is related to family inability to deal with disease problems (Carpenito, 2002: 158).
Definition: Lack of knowledge is a condition in which individuals experience a lack of congnitive and
psychomotor knowledge.
General Purpose: The family is able to make efforts to prevent the recurrence of asthma.
Special purpose:
Intervention:
Rational: provide basic knowledge where the patient or family can get to know about the illness.
Intervention:
Rational: provides basic knowledge where the family can make informed decisions.
Intervention:
a) Assess the level of family ability in providing care to families with asthma.
Intervention:
Intervention:
c) Tell the family about the benefits of existing health care facilities.
Rational: motivating patients and families to make the most of the available health facilities.
d. The high risk of infec- tion is related to: (Doenges, et al., 2000: 160).
2) The inability of the family to make the right health action decisions.
Special purpose :
Intervention:
b) Explain the importance of hand washing techniques before and after meals.
Rational: prevent the occurrence of germs into the body through food.
Intervention:
b) Explain about the risks of not taking immediate action to deal with the infection.
c) Explain about the risks of not making the appropriate decision to deal with the problem of infection.
Intervention:
Rational: knowing the family's ability to recognize the early signs of infectious diseases.
Rational: the temperature or more to be used depends on the identification of the pathogen when the
infection occurs.
Intervention:
b) Explain about the importance of healthy homes that avoid pathogenic organisms.
Intervention:
Rational: for families to know how to take advantage of existing health facilities.