Sabtu, 14 Mei 2011
Nursing Children with Bronchial Asthma
A. Definition
Bronchial asthma is intermittent obstructive airway disease, reversible where the hyperactive trakheobronkhial respond to certain stimuli.
Bronchial asthma is a disease characterized by the increased response of the trachea and bronchi to various rangsangandengan manifestation of airway narrowing and the degree to which widely varies either spontaneously or result from treatment.
B. Etiology
There are some things that are predisposing factors and the precipitation onset bronchial asthma attacks.
1. Predisposition factor
- Genetic
Derived is not known, although an allergic talent how to downgrade.Patients with allergic diseases usually have close relatives who also suffer from allergic diseases. Because of the talent of this allergy, the patient is susceptible to bronchial asthma when exposed to trigger factors.
2. Precipitation Factor
- Allergens
Allergens can be divided into 3 types, namely:
a) inhaled, entering through the respiratory tract. Examples: dust, animal dander, pollen, mold spores, bacteria, and pollution.
b) Ingestan, which enter through the mouth. Example: food and drugs
c) Kontaktan, who entered through contact with skin. Example: jewelry, metals, and watches.
- Changes in weather
Humid weather and cold mountain air often affect asthma. Sometimes the attacks associated with the seasons, such as the rainy season, dry season, the season of interest. This is related to the direction of the wind, pollen, and dust.
- Stress
Stress / emotional disturbances can trigger asthma and aggravate existing asthma attack. Patients are given the motivation to solve personal problems because if the stress has not yet addressed the symptoms of asthma can be treated.
- Sports / heavy physical activity
Most patients will get the attack Juka perform physical activity or sport that fast berat.lari easiest cause asthma attacks.
C. Classification
Based on the cause, bronchial asthma can be classified into 3 types, namely:
1. Extrinsic (allergic)
Marked by an allergic reaction caused by factors specific trigger, such as dust, pollen, animal dander, drugs (antibiotics and aspirin), and mold spores. Extrinsic asthma is often associated with the presence of a genetic predisposition to allergies.
2. Intrinsic (non-allergic)
Characterized by non-allergic reaction penctus react to non-specific or unknown, such as cold air or can also be caused by respiratory infections and emotion. 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.
3. Combined asthma
The most common form of asthma. Asthma has a shape characteristic of allergic and non-allergic.
D. Pathophysiology
Asthma is characterized by spastic contraction of smooth muscle bronkhiolus causing difficult breathing. A common cause is hypersensitivity bronkhiolus against foreign objects in the air.Reactions that occur in the type of allergic asthma is thought to occur in a way: someone allergic àmembentuk à abnormal number of IgE antibodies of allergic reactions. In asthma, these antibodies attached to mast cells mainly located in interstitial lung is closely related to bronkhiolus and small bronchi. If someone inhaled allergens, the IgE antibody that person increases, the allergen reacts with antibodies that have been attached to the mast cells and causes these cells to release various substances, including histamine, slow reacting substance of anaphylaxis (which is the leukotrienes), eosinophilic kemotaktik factor, and bradykinin. The combined effect of all these factors will result in local edema on small bronkhiolus wall and a thick mucus secretion in the lumen bronkhiolus and smooth muscle spasm bronkhiolus causing airway resistance becomes greatly increased.
In asthma, bronkhiolus diameter decreases during expiration than during inspiration because of increased pressure in the lung during forced expiratory bronkhiolus pressing the outside. Bronkhiolus already partially blocked the subsequent blockage is a result of external pressures that cause obstruction, especially during ekspirasi.pada severe asthma can usually be done properly and adequately inspiration, but only occasionally do the expiration. This leads to dyspnea. Functional residual capacity and residual lung volume to be greatly increased during an asthma attack due to difficulty in expiratory air out of lungs. This in can cause barrel chest.
E. Clinical Manifestation
Usually in patients who were free of clinical symptoms of the attack is not found, but at the time of the attack sufferers seem to breathe fast and deep, restless, sitting with a prop forward, and without a respirator muscles work hard. Classical symptoms: shortness of breath, wheezing (wheezing), coughing, and in some patients there who feel pain in the chest. In more severe asthma attacks, symptoms that occur more and more, including: silent chest, cyanosis, impaired consciousness, chest hyperinflation, tachycardia, and rapid-shallow breathing. Asthma attacks often occur at night.
F. Complication
The various complications that may arise are:
1. Status asmatikus is any severe asthma attack, or who later become heavy and do not respond (refractory) or aminophylline injection of adrenaline and can be classified on the status asmatikus. Patients should be treated with intensive therapy.
2. Atelectasis is a contraction of part or all of the lung due to blockage of the airways (bronchi and bronchioles) or due to very shallow breathing.
3. Hypoxemia is the body lacks oxygen
4. Pneumothorax is the presence of air in the pleural cavity causing collapse of the lung.
5. Emphysema is a disease whose primary symptom is a narrowing (obstruction) due to respiratory air sacs in the lungs ballooned to excess and suffered extensive damage.
G. Management
General principles of treatment of bronchial asthma are:
1. Eliminates airway obstruction immediately
2. Know and avoid the factors that can trigger asthma attacks
3. Provide information to patients or their families about asthma.Includes treatment and history of the disease so that patients understand the purpose of treatment provided and the cooperation with the treating physician or nurse.
- Treatment
Treatment of bronchial asthma is divided into 2, namely:
1) non-pharmacologic treatment
a. Provide counseling
b. Avoiding trigger factors
c. Fluid
d. Physiotherapy
e. Give O ₂ if necessary
2) pharmacologic treatment
- Bronchodilators: drugs that dilate the airways. Divided into 2 groups:
a. Sympathomimetic / andrenergik (adrenaline and ephedrine)
Name of medicine: Orsiprenalin (Alupent), fenoterol (berotec), terbutaline (bricasma).
b. Santin (theophylline)
Name of medicine: Aminofilin (Amicam supp), Aminofilin (Euphilin Retard), Theophylline (Amilex)
Patients with gastric disease should be careful when taking this medicine.
- Kromalin
Kromalin not bronchodilators but it is but it is a preventive medicine asthma attack. Kromalin usually given together with other anti-asthma drugs and the effect was only seen after the use of 1 month.
- Ketolifen
Prevention of asthma has an effect like kromalin. Usually given a dose of 2 times 1 mg / day. The advantage of this drug is that it can be administered orally.
H. Prevention of Asthma Attacks in Children
1. Avoiding triggers
How to avoid trigger attacks in asthma need to know and be taught in their families who are often the trigger is the house dust. To avoid triggers for house dust are encouraged to seek the child's bedroom:
- Linen, curtains, blankets washed at least 2 weeks. Bed sheets and pillowcases more often. Better not to use carpet in the bedroom or a children's playground. Do not keep animals.
- To avoid the causes of food when it is not know for sure, better not eat chocolate, peanuts or foods containing ice, and foods that contain dyes.
- Avoid contact with people with influenza, avoid the child is in what is going on weather changes, such as being cloudy.
2. Physical Activity
Children with asthma should not prohibited from playing or exercising.but the sport should be regulated because it is a requirement for development of the child. Setting is done by:
- Adding tolerance gradually, avoiding sudden acceleration motion
- When you start to cough, rest for a while, drinking water and after not coughing, activity continued.
- Sometimes a child before doing the activities need to take medication or inhaling aerosol first.
I. Nursing
1. Assessment
a. Past medical history
- Assess your personal or family history of previous lung disease
- Review the history of corrections allergy or sensitivity to substances / environmental factors
b. Activity
- The inability to perform activities due to breathlessness
- The decline in the ability / improvement needs bentuan perform daily activities
- Sleep in a sitting position high
c. Respiratory
- Dyspnea at rest or in response to activity or exercise
- Breath worse when the client lying on his back in bed
- Using a ventilator, for example raising the shoulders, widen the nose.
- The sound of wheezing breath
- The recurrent coughing
d. Circulation
- There is an increasing blood pressure
- There is an increasing frequency of heart
- The color of skin or mucous membranes normal / gray / cyanosis
e. Ego integrity
- Anxiety
- Fear
- Sensitive stimulation
- Fidget
f. Nutrition
- Inability to eat due to respiratory distress
- Weight loss due to anorexia
g. Social relations
- Limited physical mobility
- Difficult to talk or stammering
- The existence of dependence on others
Examination Support
a. Radiological examination
Radiological picture of asthma in general normal. At the time of the attack showed a picture of hyperinflation of the lungs that is radiolucent intercostalis cavity increases and smelting, and the diaphragm is decreased. However, if there are complications, the disorder is acquired is as follows:
- When accompanied with bronchitis, so spots will increase in the hilum
- If there are complications of emphysema (COPD), then the picture will radiolucent increasing.
- If there are complications, then there is a picture of pulmonary infiltrates
- It can also cause local atelectasis picture
- In the event of pneumonia mediastinum, pneutoraks, and pneumoperikardium, it can be seen form the picture of radiolucent lungs.
b. Examination of skin tests
Conducted to find factors allergies with various allergens that can cause a positive reaction in asthma.
c. Electrocardiographic
Electrocardiographic picture during an attack can be divided into 3 parts and adapted to the image that occurs in pulmonary emphysema, namely:
- Changes in the axis of the heart, usually occurs right axis deviation and clock wise rotation
- There are signs of heart muscle hypertrophy, the presence of RBB (Right Bundle Branch Block)
- The signs of hypoxemia, the presence of sinus tachycardia, SVES, and Ves or the occurrence of negative ST segment depression.
d. Lung Scanning
Can be seen that the redistribution of air during an asthma attack is not comprehensive in the lungs.
e. Spirometry
To show the existence of reversible airway obstruction. Spirometry examination tdak just important to make the diagnosis but it is also important to assess the weight of obstruction and treatment effects.
2. Nursing Diagnosis
1) ineffective airway clearance bd bronchospasm
Objective: To maintain a patent airway with clean and clear sound
Intervention:
- Auscultation of breath sounds, record the sound of breath, ex: wheezing
- Assess / monitor respiratory frequency, record the ratio of inspiration / expiration
- Write down the degree of dyspnea, anxiety, respiratory distress, use of drugs
- Place klie in a comfortable position. Example: elevating the head of TT, sitting on the back of the TT
- Maintain a minimum of environmental pollution. Examples: dust, smoke, etc.
- Increase fluid intake up to 3,000 ml / day according to tolerance of the heart, providing warm water.
- Collaboration with the doctor for medication as indicated.
2) Impaired gas exchange of oxygen supply disruption bd
Objective: To improve ventilation and adequate tissue oxygen
Intervention:
- Review / watch regular clients skin condition and mucous membranes
- Monitor vital signs and cardiac rhythm
- Collaboration:. Provide supplemental oxygen in accordance with an indication of the results of AGDA and client tolerance
- Cyanosis may indicate the severity of peripheral or central hypoxemia
- Impairment of vibration vibration suspected clotting fluid / air
- Tachycardia, dysrhythmias, and changes in blood pressure can show the effects of systemic hypoxemia.
3) Anxious parents and children who experienced child bd disease
Objective: To reduce anxiety in parents and children
Interventions for parents:
- Give ketanangan in older people
- Provide a sense of comfort
- Encourage the family to provide understanding and information (Waley & Wong, 1989)
- Encourage families to engage in child care
- Consultation with a medical team to determine the condition of her child.
Intervention for children:
- Construct a trusting relationship
- Reduce parting with their parents
- Encourage to express his feelings
- Involve children in play
- Prepare children to deal with new experiences, for example: pprosedur action
- Provide a sense of comfort
- Encourage families to provide information understanding (Waley & Wong, 1989).
4) High risk families are not effective Hollow bd unmet psychosocial needs of parents
Purpose: return effective family coping
Intervention:
- Create relationships with parents who encourage them to express difficulty
- Provide information to parents about child development
- Provide guidance in anticipation of the growth and development
- Emphasize the importance of support systems
- Encourage parents to provide time as needed
- Help parents to refer to specialist
- Inform parents about the services available in the community.
J. Bibliography
- Cecily Betz, Linda A Sowden. 2002. Pediatric Nursing Handbook.EGC: Jakarta.
- Capernito, Lynda J. 2000. Applications of Nursing Diagnosis in Clinical Practice. EGC: Jakarta.
- Ngastiyah. 1997. Child Care Hospital. EGC: Jakarta.
- Dorland Medical Dictionary. 29.EGC Edition: Jakarta.
Langganan:
Posting Komentar (Atom)
1 komentar:
Hi! I know this is kinda off topic but I'd figured I'd ask.
Would you be interested in exchanging links or maybe guest writing
a blog article or vice-versa? My blog discusses a lot of the same
topics as yours and I feel we could greatly benefit from each other.
If you might be interested feel free to send me an e-mail.
I look forward to hearing from you! Wonderful blog by the way!
Also visit my web-site advokatska tarifa
Posting Komentar