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PAPER OF ASTHMA CASE STUDYCompiled to Fulfill Adult Nursing Task Oxigenation Module

Created by : Sitha R. Amanatunnisa Destya D. Pangestika Mitsalina Maulida Hafidz Safina Aprillia G2B 009 031 G2B 009 044 G2B 009 050 G2B 009 059

Class A092

NURSING SCIENCE PROGRAM FACULTY OF MEDICINE DIPONEGORO UNIVERSITY OCTOBER, 2010

1st CHAPTER PREFACE

A. Background Asthma is a worldwide health problem, both in developed and in developing countries. In addition, asthma is a disease known in the community. This is different about a century ago, for asthma disease was first discovered and is still relatively rare. In the 1970s, more and more asthma sufferers are found, this disease can be deadly even for reasons that are unclear. In the United States for example, if heart disease and cancer are still occupying the top position in the list of diseases spreading death, the lung disease is now ranked third. And among the categories of lung diseases are fatal, chronic asthma, including one of them. WHOs data (World Health Organization) indicates the number of asthma sufferers in Indonesia ranges from 3-8 percent, or 6-16 million of the 200 million population. Another survey from various hospitals showed the number of asthma sufferers in some provinces, namely Bali (2.4 percent), East Java (7 percent), Jakarta for the children (16.5 percent), Malang for children (22 percent) , East Jakarta for adults (18.3 percent), and Central Jakarta (7 percent). Asthma is a chronic airway inflammatory disease involving various immune cells, especially mast cells, epithelial cells, and the increased response of the airways (bronchial hipereaktivitas) to various stimulants. Asthma can be mild and do not interfere with the activity, but can be settled and not disturbs daily activities and even activities reduce the quality of life. But unfortunately, not all aspects of the pathophysiology of asthma as a whole is understood to arise from the opinions of some doctors and the public that asthma is a disease that is simple and easily treated, assuming that management is the main thing is particularly bronchodilator drugs. Then show habits of physicians and patients to overcome the symptoms of asthma are particularly against the symptoms of shortness of breath and wheezing with drug use and instead of managing asthma in full.

B. The Goals This paper has eleven points to pass the goal of learning objective, namely: 1. Students can find out the definition of asthma. 2. Students can find a variety of causes of asthma. 3. Students can find out all kinds of asthma. 4. Students can find out stages of asthma. 5. Students can find out three reactions in the pathology of asthma. 6. Students can learn how to forced expiratory. 7. Students can find pictures of X-Ray lungs 8. Students can learn the tools used in the investigation of asthma. 9. Students can learn the process of bronchial provocation test. 10. Students can find a variety of asthma medications. 11. Students can learn how to diagnose asthma and nursing interventions.

2 nd CHAPTER LITERATURE REVIEW

A. Definition and types of Asthma Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. Asthma is divided into two categories, namely : 1. Extrinsic or allergies Marked by allergic reactions caused by factors specific trigger, such as dust, animals, influenza virus, pneumonia,Mycoplasma, food, cigarettes and drugs. 2. Non allergic Characterized by non-allergic reaction which reacts to triggers that are not specific or unknown, such as cold air or can also be caused by respiratory infections , emotion, exercise, and environmental pollution. Asthma attacks became more severe and often in line with the passage of time and can develop into chronic bronchitis and emphysema. Some patients will experience asthma combined.

B. How a proper forced expiratory test is to be performed. The function of proper force expiratory test is to know how the condition of respiratory system then it identified how long someone can not breath and how much the carbon dioxide volume of force respiration process. This way is suitable for identifying asthma patient and reducing the symptom of asthma. A kind of proper forced expiratory test is the buteyko method. The Buteyko method has five steps, they are : a. Sit, relax, breathing regularly during 30 second b. Inpiration and expiration as usuall c. Close your nostril and start a stopwatch

d. Dont breath until you feel oxigenation needs then breath maximally e. See the stopwatch. How long you didnt breath. It is you control pause time. After we have done the buteyko method, we analysize how long we can not breath. These are the result of proper forced expiratory test :

Control pause time Less than 10 second 10 25 second 30 40 second More than 60 second

The meaning of forced expiratory time Someone has respitory system disorder He/she should be more attention to check up Good respiratory system It is en excellent respiratory system and its so healthy

From that test, we can know the difference between forced expiratory volume and vital capacity. Forced expiratory volume in one second (FEV 1.0) is the volume of air that can expiratoried during the first second expiratory vital capacity in the determination. Then, Peak flow is the patient's maximum speed of expiration, or also called peak expiratory flow rate (PEFR or PEF) and normally value is 250/250. Whereas vital Capacity (VC) is maximum volume of air that can be spent during a one-time breathing after maximum inspiration. Vital capacity is usually about 80% of the total lung capacity (4800 ml). Vital capacity (VC). This is the amount of air (in liters) moved out of the lung during normal breathing. The patient is instructed to breathe in and out normally to attain full expiration.

C. Pathophisiology of asthma These are three primary pathologic reactions: a. The bronchi muscles do vasoconstriction (stricture of bronchi muscle). Because the duct of air is too narrow, so the airs have difficulty to out from the body. It can make wheezing voice, because the duct and air have friction.

b. In bronchi, there is some of mucosa. If the mucosa is too much, it can make edema so the airway is disturbed. The air will get difficulty to out from the body in bronchi area, because there is edema. So, the person who has this condition will be feeling congested. In edema bronchi, there is much substance like histamine, leukotrien, and serotonin. c. The third is cough effect. In gland of bronchial, there are so much mucosa fluids. Because the mucosa fluids is abnormal, it can make hyper secrets. This condition make production of mucosa has abnormal, so the cilia difficult to move. It can make cough as effect of body from the abnormal mucosa production. A person who has allergy have ability to make much antibody Ig E in big volume. This antibody can make allergy reaction if the reaction with specification of antigen. In asthma, this antibody patch in mast cell which the location in lung interstitial that is have relation with bronchial and small bronchi. If the person inhale allergen so the antibody of Ig E will be increase, allergen will reaction with antibody in mast cell. This condition can make mast cell will be releasing many substance like histamine, anafilaksis (acute allergy reaction) that is slow reaction (leukotrient), and bradikinin. The merger effect from all of this factors will be releasing local edema in small bronchias wall and mucus secretion in bronchial lumen and spasm of bronchial artless muscle so it can make person will get difficulty in breath. D. Recognize chest x-ray changes seen with asthma

the normal lungs

the asthma lungs

In t

pi t

above shows a pi t e torax in normal circumstances. In the er and expanded. This is caused by

state of asthma torax look bi

inflammation resulting in swelling. And the white shadows in the asthma lungs are the mucus and the eudema. Beside that the asthma patient has chest deformity become a barrel chest. And it is the barrel chest picture :

The chest is bigger because there are so many carbon dioxide.

E. Recogni e the signs and symptoms of asthma To evaluate signs : a. Chest deformity Functional residual capacity and residual lung volume to be greatly increased during an asthma attack due to difficulties expiratory air out of lungs. This can cause the barrel chest. b. Cyanosis Cyanosis effects is a blue color of the skin and nails may occur from lack of oxygen. c. Chest and stomach pain Those happened because the abdomen and thoraxs muscle involve during respiration process.

To evaluate symptoms : a. Cough In uncomplicated asthma, cough is only noticeable when the attack subsided and coughing helps remove accumulated secretions. b. Dyspnea Breathing felt tight and difficult. Functionally, an asthmatic airway to act as if the neural beta-adrenergiknya (which helps maintain the airway to remain patent) is not competent. c. Orthopnea Difficulty breathing in a state of supine d. Phlegm (sputum) production Bronchial gland hipersecret e. Wheezing Turbulence of air currents and vibrations bronchial mucus resulting in an audible wheezing sound during an asthma attack, but the physical signs are also seen prominently in obstructive airway problems. In symptomatic asthma, breathing faster than normal (although this is likely to increase resistance to air flow) due to constriction or spasm of bronchial muscle.

The causes of asthma a. Children at Risk Children can have asthma easily because their immune still low and sensitive. b. Allergies Allergies because of various allergens. Allergens can be divided in three kinds, they are : Inhalan, that enter into respiratory systems (dust, bactery, and polluti