NURSING CARE OF

BRONCHIAL ASTHMA

Intan Rahmi, Amd.Kep

 Definition

Bronchial asthma is intermittent

obstructive airway disease,
reversible hyperactivity
where trakheobronkhial
responds to certain stimuli.
 ETIOLOGY
There are some things that are a bronchial asthma attacks:
1. Genetic
Patients with allergic diseases usually have close relatives who also suffer from allergic
diseases. Because of the talent of this allergy, patients are susceptible to bronchial
asthma if exposed to precipitating factors.
2. Allergens
Allergens can be divided into three types, namely:
a. Inhalant, entering through the respiratory tract. Example: dust, anima dander, pollen,
mold spores, bacteria and pollution.
b. Ingestan, which enter through the mouth. Examples: food and medicine
c. Kontaktan, entering through contact with the skin. Example: jewelry, metal, and
watches.
3. Changes in weather
The weather was damp and cold mountain air often affects asthma.
4. Stress
Stress / emotional disorders can trigger asthma attacks and aggravate existing asma.
5. Exercise / heavy physical activity
Most people will come under attack if doing physical activity or strenuous exercise
 CLASSIFICATION
Based on the cause, bronchial asthma can be classified into three
types, namely:

1. Extrinsic (allergic)
Characterized by an allergic reaction caused by trigger
factors that are specific, such as dust, pollen, animal
dander, drugs (antibiotics and aspirin), and fungal spores.
2. Intrinsic (non-allergic)
Characterized by non-allergic reaction that reacts to the
originator of non-specific or unknown, such as cold air or
it could be caused by respiratory infections and emotion.
3. Asthma combined
The most common form of asthma. Asthma is has the
characteristics of a shape allergic and non-allergic.
 Pathophysiology
Airway obstruction in asthma is a combination of bronchial muscle spasm, mucus
plugs, edema and inflammation of the walls of bronkus.obstruksi gain weight
during expiration because physiologically airway narrowing in this tersebut.Hal
phase resulted in a distal obstruction of air can not be trapped in
ekspirasi.Keadaan hyperinflation is intended that the airways remain open and
running lancar.Penyempitan gas exchange respiratory tract may occur either in the
airways that is large, medium, or wheezing kecil.Gejala indicate a narrowing in the
large airways, while the small airways and cough symptoms shortness
mengi.Penyempitan dominant over the airways in asthma will lead to the following
matters:
1. Disorders of ventilation in the form of hypoventilation.
2. ventilation perfusion imbalance where ventilation is not equivalent to the
distribution of pulmonary blood circulation.
3. Impaired gas diffusion at the level of the alveoli
These three factors will result in:
1. Hypoxaemia
2. Hypercapnia
3. Respiratory acidosis at a very advanced stage
 Clinical
Manifestations
Usually in patients who were free of clinical symptoms of the attack was not found, but at
the time of the attack sufferers seem breathing fast and deep, restless, sitting with prop
forward, and without a respirator muscles work hard.
The classical symptoms:
1. shortness of breath
2. wheezing (wheezing)
3. Coughing
4. And in some people who feel pain in the chest
In more severe asthma attacks, symptoms there are, among others:
1. silent chest
2. Cyanosis
3. disturbance of consciousness
4. chest hyperinflation
5. Tachycardia
6. and rapid shallow breathing
7. Asthma attacks often occur at night.
 Complications

Various complications that may arise are:

1. Status asthmaticus is a severe asthma attack or any
later became heavy and does not provide a response
(refractory) or aminophylline injection of adrenaline
and can be classified in status asthmaticus. Patients
should be treated with intensive therapy.
2. atelectasis is shrinkage of part or all of the lung
caused by a blockage of the airways (bronchi and
bronchioles) or due to very shallow breathing.
3. Hypoxaemia body is deprived of oxygen.
4. pneumothorax is the presence of air in the pleural
cavity causing the lung collapse.
5. Emphysema is a disease whose primary symptom is
narrowing (obstruction) airway because of the air
sacs in the lungs ballooned in excess and suffered
extensive damage.
 Management
The general principle of treatment of bronchial asthma are:
1. Eliminate airway obstruction immediately.
2. Identify and avoid factors that can trigger asthma attacks.
3. Provide information to patients or their families about asthma.
- Treatment
Treatment of bronchial asthma is divided into two, namely:
1) Treatment of non-pharmacologic
a. provide counseling
b. Avoiding precipitating factors
c. Giving fluids
d. Physiotherapy
e. Give O₂ if necessary
2) Treatment of pharmacologic
- Bronchodilators: drugs that dilate the airways. Divided into two groups:
a. Sympathomimetic / andrenergik (adrenaline and ephedrine)
Drug name: Orsiprenalin (Alupent), fenoterol (berotec), terbutaline (bricasma).
b. Santin (theophylline)
Drug name: Aminofilin (Amicam supp), Aminofilin (Euphilin Retard), Theophylline (Amilex)
Patients with gastric disease should be careful when taking this medicine.
- Kromalin
Kromalin not a bronchodilator but it is but it is a preventive medicine asthma attacks. Kromalin usually given together
anti-asthma drug to another and a new effect is seen after one month usage.
- Ketolifen
Possessed a preventive effect against asthma as kromalin. Usually the dose 2 times 1 mg / day. The advantage of this
drug is that it can be administered orally.
BASIC CONCEPT OF NURSING
1. Assessment
a. Past medical history
- Assess personal or family history of
lung disease earlier
- Assess correcting a history of allergy
or sensitivity to substances /
environmental factors
b. Activity
- The inability to perform activities
because of difficulty breathing
- A decrease in ability / improvement
needs bentuan perform daily activities
- Sleep in a seated position high
c. Respiratory
- Dyspnea at rest or in response to
activity or exercise
- Breath worsened when the client
lying on his back in bed
- Using breathing apparatus, eg
elevating the shoulders, spread his
nose.
- The presence of wheezing breath
sounds
- There is a recurrent cough
 d. Circulation
 - An increase in blood pressure
 - An increase in the frequency of
heart
 - The color of the skin or
mucous membranes normal /
gray / cyanosis
 e. ego integrity
 - Anxiety
 - Fear
 - Sensitive stimuli
 - Restless
 f. nutritional intake
 - The inability to eat due to
respiratory distress
 - Weight loss due to anorexia
 g. social relations
 - Limitations of physical mobility
 - It's hard to talk or speak
haltingly
 - The existence of dependency
on others
2. Supporting investigation
a. radiological examination
Radiology picture in asthma is generally
normal. At the time of the attack showed a
picture hyperinflation of the lungs that is
radiolucent increases and smelting
intercostalis cavity, as well as the diaphragm
downward. However, if there are
complications, the disorder is obtained as
follows:
- When accompanied by bronchitis, then the
patches in the hilum will increase
- If there are complications of emphysema
(COPD), then the picture will be growing
radiolucent.
- If there are complications, then there is a
picture on pulmonary infiltrates
- It can also cause local atelectasis picture
- In case of pneumonia mediastinum,
pneutoraks, and pneumopericardium, it can
be seen form radiolucent picture of the
lungs.
b. Examination of the skin test
Done to find the allergy factor with various
allergens that can cause a positive reaction
in asthma.
c. electrocardiography
Electrocardiographic picture that occurred
during an attack can be divided into 3 parts
and adapted to the image that occurs in
pulmonary emphysema, namely:
1. Changes in cardiac axis, usually occurs
right axis deviation and a clock wise
rotation
2. There are signs of hypertrophy of the heart
muscle, namely the presence of RBB (Right
Bundle Branch Block)
3. The signs of hypoxemia, namely the presence
of sinus tachycardia, SVES, and VES
occurrence of ST segment depression or
negative.
d. Lung scanning
It can be seen that the redistribution of air
during an asthma attack is not exhaustive of
the lungs.
e. spirometry
To indicate the presence of reversible airway
obstruction. A critical examination tdak
spirometry for diagnosis but it is also
important to assess the weight of the
obstruction and the therapeutic effect.
3. Intervention
1. Ineffective airway clearance related to accumulation of secretions.
a. Objective: airway re-effective
b. Expected outcomes:
• can demonstrate effective cough
• can declare a strategy to reduce the viscosity of secretions
c. Intervention
1) Auscultation of breath sounds, record their breath sounds, eg; wheezing, krekels,
crackles.
R: some degree of bronchospasm occurs obstruction in the airway
2) Assess / monitor respiratory frequency.
R: tachypnea normally exist in some degree and can be found at the reception or during
stress
3) Assess the patient to a comfortable position eg: raising the head of the bed, sitting on the
back of the bed.
R: clod elevation makes it easier to breathe
4) Push / aids abdominal breathing exercises / lip
R: give patients a way to remedy and resolve dyspnea memgontrol
5) Observation of cough characteristics eg settling, hacking cough, wet
R; short cough, moist secretions usually come out with a cough
6) Perform suctioning
R: to lift off the road respiratory ssekret
2. Ineffective breathing pattern b / d decreased ability to breathe.
a. Objective: patient breathing pattern becomes effective
b. Expected outcomes:
• Chest no disturbance development
• Breathing becomes normal 18-24 x / min
c. Intervention
1) Monitor frequency, rhythm and depth of breathing
R: dyspnea and an increase in employment of breath, respiratory
depth varies throughout
2) Elevate the head and help reposition
R: high dududk enables lung expansion and ease breathing
3) Observe the pattern of coughing and secretions character
R: menegtahui keribg or wet cough as well as the color of the
secretions
4) Give the patient practice deep breathing or coughing effective
R: may increase secretions in which there is an interruption in
breathing inconveniences ventilation sitambah
5) Provide additional O2
R: maximize breathing and lower the breath work
6) Auxiliary chest physiotherapy
R: facilitate efforts to breathe preformance and improve draenase secret
3. Damage to gas exchange associated with CO2 retention,
a. Objective: gas exchange to be effective
b. Results Criteria: Shows improvement vertilasi and adequate
tissue oxygen within the range
c. Intervention:
1) Assess TTV
R: TD changes occur with the severity of hypoxemia and
acidosis
2) Assess the level of consciousness / mental changes
R: systemic hypoxemia can be demonstrated first by the
restless and sensitive excitatory
3) Observation of cyanosis
R: systemic Menunjukkanhipoksemia
4) Elevate the head of the bed within their patients' needs
R: improving chest expansion and make breathing easier
5) Keep an eye on BGA (blood gas analysis)
R: to determine the oxygen saturation in the blood
6) Give O2 sesui indication
R: maximizing the dosage of oxygen for gas exchange
4.Implementatuion
In respect of the action or
implementation is the implementation of
the intervention by the nurse and the
client for the purpose of kebutuhn clients
optimally and clearly the actions
undertaken.