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PERNAPASAN
FUNGSI PERNAPASAN
Figure 10.1
Organs in the Respiratory System
STRUCTURE FUNCTION
Figure 10.2
Upper Respiratory Tract
Functions
Figure 10.3
Lower Respiratory Tract
Functions:
Larynx: maintains an open airway, routes food
and air appropriately, assists in sound production
Trachea: transports air to and from lungs
Figure 10.8A
Respiratory Cycle
Figure 10.9
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
TERMINOLOGI
TERMINOLOGI
TERMINOLOGI
TERMINOLOGI
DYSPNEA
1. KARAKTERISTIK → APAKAH DYSPNE
KRONIS , AKUT ?. APAKAH TERJADI TIBA-
TIBA ATAU BERTAHAP ?. APAKAH
MENGGUNAKAN 1 ATAU LEBIH BANTAL
SAAT TIDUR ?. APAKAH DYSPNEA
PROGRESIF REKUREN ATAU
PAROKSIMAL ?. BERJALAN BERAPA JAUH
TIMBUL SESAK NAPAS.
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
DYSPNEA
2. FAKTOR YG BERHUBUNGAN; APAKAH
BATUK BERHUBUNGAN DENGAN
DYSPNEA, APAKAH BATUK PRODUKTIF ?,
APAKAH AKTIVITAS MENCETUSKAN
DYSPNEA ?, APAKAH BERTAMBAH
PARAH BILA KAGET ?. APAKAH
DIPENGARUHI OLEH WAKTU HARI DAN
CUACA ?, APAKAH TERJADI SAAT
ISTIRAHAT ATAU LATIHAN ?, ADAKAH
DEMAM, MENGGIGIL, BERKERINGAT
MALAM, & PERUBAHAN BERAT BADAN.
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
DYSPNEA
3. RIWAYAT →APAKAH RIWAYAT
KELUARGA DAN PASIEN MENDERITA
PENYAKIT PARU KRONIS ?, APAKAH ADA
RIWAYAT MEROKOK ?
4. KEMAKNAAN → DYSPNEA MENDADAK
DAPAT MEMBERI INDIKASI EMBOLI
PARU, PNEUMOTHORAKS, INFARK
MYOKARD, GAGAL VENTRIKEL AKUT,
ATAU GAGAL NAPAS AKUT.
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
DYSPNEA
4. PADA PASIEN POST OP ATAU PASIEN
POSTPARTUM DYSPNEA DAPAT
MEMBERI INDIKASI EMBOLUS PARU
ATAU EDEMA.
5. ORTHOPNEA DAPAT MEMBERI INDIKASI
PENYAKIT JANTUNG ATAU PPOM. JIKA
DYSPNEA BERHUBUNGAN DENGAN
WHEEZING PERLU DIPERTIMBANGKAN
ASTHMA ATAU PPOM.
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
CHEST PAIN (NYERI DADA)
1. KARAKTERISTIK NYERI DADA APAKAH
TAJAM, TUMPUL, MENUSUK ?, APAKAH
INTERMITEN ATAU PERSISTEN ?,
APAKAH TERLOKALISIR ATAU
MENYEBAR ?, JIKA MENYEBAR KEMANA
?, BAGAIMANA INTENSITAS NYERINYA ?
2. FAKTOR YG BERHUBUNGAN → APAKAH
NYERI BERHUBUNGAN DENGAN
INSPIRASI DAN EKSPIRASI ?, APAKAH
TERLIHAT FAKTOR YG MENCETUSKAN
NYERI ?
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
CHEST PAIN (NYERI DADA)
3. RIWAYAT → APAKAH ADA RIWAYAT MEROKOK
ATAU TERPAPAR LINGKUNGAN ?, APAKAH
NYERI PERNAH DIALAMI SEBELUMNYA ?, APA
PENYEBABNYA DULU ?, APAKAH PERNAH
TERDIAGNOSA PENYAKIT JANTUNG ATAU
PARU ?
4. KEMAKNAAN → NYERI DADA BERHUBUNGAN
DENGAN PENYEBAB PARU BIASANYA
DIRASAKAN PADA SISI DIMANA MUNCULNYA
FATOLOGIS. NYERI PERSISTEN DAPAT
MEMBERI INDIKASI KARSINOMA PARU, NYERI
MENUSUK TAJAM BIASANYA DARI AREA
PLEURA
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
BATUK (COUGHT)
1. KARAKTERISTIK →APAKAH BATUK
KERING ?, HACKING, SPT ALAT MUSIK
ATAU WHEEZING ? APAKAH KUAT ATAU
LEMAH ?.
2. FAKTOR YG BERHUBUNGAN → APAKAH
BATUK PRODUKTIF ? BAGAIMANA
KONSTITENSINYA, BAU, JUMLAH DAN
WARNA SPUTUM ? APAKAH TERDAPAT
WAKTU KHUSUS TIMBULNYA BATUK ?
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
BATUK (COUGHT)
2. FAKTOR YG BERHUBUNGAN → APAKAH
ONSETNYA MENDADAK ATAU
BERTAHAP? APAKAH BERHUBUNGAN
DENGAN MAKANAN
3. RIWAYAT → APAKAH TERDAPAT
PAPARAN LINGKUNGAN DAN
PEKERJAAN (DEBU, GAS) ?. APAKAH
ADA RIWAYAT MEROKOK ? APAKAH ADA
TERDIAGNOSIS PENYAKIT ?
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
BATUK (COUGHT)
4. KEMAKNAAN → BATUK KERING,
BATUK IRITASI MENUNJUKAN
INFEKSI VIRUS . BATUK MALAM
HARI HARUS DIWASPADAI GAGAL
JANTUNG KIRI ATAU ASTHMA .
BATUK PAGI HARI DENGAN
SPUTUM MUNGKIN BRONKHITIS.
PNEUMONIA BAKTERI SPUTUM
COKLAT KUNING TUA (BERKARAT)
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
BATUK (COUGHT)
4. KEMAKNAAN → SPUTUM PINK
BERBUSA INDIKASI EDEMA PARU,
BATUK BERHUBUNGAN DENGAN
MAKAN KEMUNGKINAN ASPIRASI
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
HEMOPTYSIS
1. KARAKTERISTIK → APAKAH DARAH DARI
PARU, APAKAH DARI SISTEM
PENCERNAAN (HEMATEMESIS) ATAU
JALAN NAPAS ATAS (EPITAKSIS) ?.
APAKAH MERAH MENYALA DAN
BERBUSA, BERAPA BANYAKNYA
2. FAKTOR YG BERHUBUNGAN (APAKAH
ONSET BERHUBUNGAN DGN AKTIVITAS,
APAKAH ONSET MENDADAK, HILANG
TIMBUL, TERUS MENERUS ?
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
HEMOPTYSIS
2. FAKTOR YG BERHUBUNGAN
(APAKAH ADA SENSASI GATAL DI
TENGGOROKAN, RASA ASIN,
PANAS, SENSASI GELEMBUNG
DIDADA SEBELUM PERDARAHAN ?)
3. RIWAYAT ( APAKAH ADA TRAUMA
DADA TERKINI, ATAU TERAFI DADA
(CHEST PERCUSSION)
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
DATA SUBJEKTIF PENGKAJIAN
HEMOPTYSIS
4. KEMAKNAAN (HEMOPTYSIS DAPAT
BERHUBUNGAN DENGAN INFEKSI
PARU, KARSINOMA PARU,
KELAINAN JANTUNG DAN PEMB
DARAH, ARTERI ATAU VENA PARU
ATAU EMBOLI DAN INFARK
PEMERIKSAAN FISIK
Equipment Needed
• A Stethoscope
• A Peak Flow Meter
Surface markings of the lobes of the lung:
(a) anterior, (b) posterior, (c) right lateral and (d) left lateral.
(UL, upper lobe; ML, middle lobe; LL, lower lobe).
ul
ll Ul
ml
a
ul
ml
ll
b ll
Position/Lighting/Draping
• Position –
• patient should sit upright on the examination table.
• The patient's hands should remain at their sides.
• When the back is examined the patient is usually asked
to move their arms forward( hug themself position )so
that the scapulae are not in the way of examining the
upper lung fields.
• Lighting - adjusted so that it is ideal.
• Draping - the chest should be fully exposed. Exposure
time should be minimized.
The basic steps of the examination
Percussion over the anterior chest. Direct percussion of the clavicles for
disease in the lung apices
Palpation
• Tactile fremitus
is vibration felt by palpation. Place your open palms against the
upper portion of the anterior chest, making sure that the
fingers do not touch the chest. Ask the patient to repeat the
phrase “ninety-nine” or another resonant phrase while you
systematically move your palms over the chest from the
central airways to each lung’s periphery.You should feel
vibration of equally intensity on both sides of the chest.
Examine the posterior thorax in a similar manner. The
fremitus should be felt more strongly in the upper chest with
little or no fremitus being felt in the lower chest
Tactile Fremitus
Tactile Fremitus
– Mediate
• Pleximeter: distal inter-phalangeal joint of left middle
finger
• Plexor: right middle finger tip
– Immediate
– Order
• Up to down, anterior to posterior
Percussion
Rational
• To determine if
underlying tissue is
filled with air or solid
material
Procedure
• Pt sitting
• Tap starting at shoulder
• compare rt to lf
Percussion: results
• Resonance – drum like
– Normal
• Hyper-resonance
– Too much air
– Emphysema
• Flatness / dull
– Fluid or solid
– Pleural effusion
– Pneumonia
– Tumor
2. Affected factors
– Thickness of thoracic wall
– Calcification of costal cartilage
– Hydrothorax
– Containing gas in alveoli
– Alveolar tension
– Alveolar elasticity
3. Classification
– Resonance
• Normal
– Hyperresonance
• Emphysema
– Tympany
• Cavity or pneumothorax
– Dullness
• Hydrothorax, atelectasis
– Flatness
• Massive Hydrothorax
4. Normal sound
3) Prolonged expiration
• Bronchitis
• Asthma
• emphysema
4) Cogwheel breath sound
• TB
• Pneumonia
5) Coarse breath sound
• Early stage of bronchitis or pneumonia
Abnormal bronchial breath
sound
(tubular breath sound)
• (moist) Crackles
• Rhonchi (wheezes)
Mechanism
During inspiration, air flow passes thin
secretion in the airway to rupture the
bubbles, or to open the collapse of
bronchioli due to adhesion by secretion.
Characteristics of crackles
1. Adventitious sound
2. Intermittent
3. Appeared in phase of inspiration or early
expiration
4. Constant in site
5. Unchanged in character
6. Medium and fine crackles exist
meantime
7. Less or disappeared after cough
Classification of crackles
• According to intensity of the sound
1. Loud moist crackles
2. Slight moist crackles
• According to diameter of the airway crackles appeared
1. Coarse: trachea, main bronchi, or cavity
• Bronchiectasis, pulmo. edema, TB, lung abscess,
coma
2. Medium: bronchi
• bronchitis, pneumonia
3. Fine: bronchioli
• pneumonia
4. Crepitus:
• Bronchiolitis, alveolitis, early pneumonia (pulmo.
Congestion), elder subject, pat. bed rest for long
Site of crackles
1. Local: local lesion
– Pneumonia, TB, bronchiectasis
2. Both bases
– Pulmo. edema, bronchopneumonia,
chronic bronchitis
3. Full fields
– Acute pulmo. edema, severe
bronchopneumonia, chronic bronchitis with
severe infection
Rhonchi (wheezes)
Mechanism
The turbulent flow is formed in trachea, bronchi or
bronchioli due to airway narrow or incomplete
obstruction.
Causes
– Congestion
– Secretion
– Spasma
– Tumor
– Foreign subject
– Compression
Characteristics of rhonchi
1. Adventitious sound
2. High pitch
3. Dominance in phase of expiration
4. Variable intensity of character or site
5. Wheezing
Classification of rhonchi
1. Sibilant (高调)
– Bonchioli, bronchi
2. Sonorous (低调)
– Trachea, main bronchi
Site of rhonchi
1. Both fields
– Asthma
– Chronic bronchitis
– Acute left heart failure
2. Local site
– Tumor
– Endobronchial TB
Pleural friction rub
1. Cellulose exudation in pleurisy (rough pleura)
2. Area of auscultation
– Anterolateral thoracic wall (maximal shifting area of lung)
3. Friction rub disappeared if holding breath
4. Friction rub appeared both breath and heart beat:
mediastinal pleurisy
5. Causes
– Tuberculous pleurisy
– Pulmo. embolism
– Uremia
– Pleural mesothelioma
Vocal resonance
• Bronchophony (支气管语音)
– Consolidation
• Pectoriloqny (胸语音)
– Massive consolidation
• Egophony (羊语音)
– Upper area of hydrothorax
• Whispered (耳语音)
– Consolidation
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
TES DIAGNOSTIK
1. ABGs (ARTERRIAL BLOOD GAS
ANALYSIS
2. PEMERIKSAAN SPUTUM
3. ANALYSIS CAIRAN PLEURA
4. CHEST X-RAY
5. COMPUTERIZED AXIAL TOMOGRAPHY
(CAT, CT)
6. MAGNETIC RESONANCE IMAGING (MRI)
7. PULMONARY ANGIOGRAPHY
PENGKAJIAN ASKEP SISTEM
PERNAPASAN
TES DIAGNOSTIK
8. VENTILATION-PERFUSION (V/Q)
SCAN
9. BRONCHOSCOPY
10.LUNG BIOPSY
11.PULMONARY FUNCTION TESTS
(PFTs)
12.PULSE OXIMETRY
13.CAPNOGRAPHY