Scribd
Upload
4 views4 pages

Tangkapan Layar 2025-01-30 Pada 13.04.45

Asthma is a chronic obstructive airway disease characterized by bronchial spasms and hyperreactivity, which can be triggered by extrinsic (allergens) or intrinsic (non-specific factors) causes. The pathophysiology involves airway obstruction due to muscle contractions, swelling, and mucus production, leading to symptoms such as shortness of breath and wheezing. Nursing care focuses on effective airway clearance, breathing patterns, and gas exchange, with interventions tailored to improve patient outcomes.

Uploaded by

Nur Annizah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
4 views4 pages

Tangkapan Layar 2025-01-30 Pada 13.04.45

Asthma is a chronic obstructive airway disease characterized by bronchial spasms and hyperreactivity, which can be triggered by extrinsic (allergens) or intrinsic (non-specific factors) causes. The pathophysiology involves airway obstruction due to muscle contractions, swelling, and mucus production, leading to symptoms such as shortness of breath and wheezing. Nursing care focuses on effective airway clearance, breathing patterns, and gas exchange, with interventions tailored to improve patient outcomes.

Uploaded by

Nur Annizah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

A.

Definitions
Asthma is a disease of the airway that can not be recovered due t
obronchial spasms that occur due to various causes (Hudak& Gallo, 199
7).
Asthma is an obstructive airway disease intermittent, reversible
where the trachea and bronchi are hyperactive
respond to stimulation in certain(Smeltzer, Suzanne, 2002)
B. Etiology
The etiology of asthma can be divided into 3, (according
to Andra SaferiWijaya &Yessie Marisa.2013) explained that
1. Extrinsic asthma / allergy
Asthma caused by allergen known since his time there has been
such children readapt protein
allergy pollen, fuzz, animal and dust may be asetiological factors tow
ard the diseases currently.
2. Asthma intrinsic / idiopathic
Asthma that is not found obvious precipitating factors, but their
nonspecific factors such as: flu, physical exercise or emotional often
triggerasthma attacks. Asthma often appears
/ develops after the age of 40 after suffering from a sinus
infection / branch tracheobronchial.
3. Asthma mix
Asthma happens / Thimbu because as component of extrinsic
and intrinsic factors that has correlated with the accured of asthma.

C. Pathophysiology
Asthma is reversible diffuse airway obstruction caused by
one or more of the following factors.
1. The contractions of the muscles that surround the bronchi constrict the
airway.
2. Swelling of the membrane lining the bronchi.
3. Charging bronchi by mucus Kenta
In addition, the bronchial muscles and enlarged glands. Sputum
that isthick, are produced and alveoli become hyperinflammatory with
air trapped inthe lungs. The resulting antibody (IgE) then attacked the
mast cells in thelungs. Repeated exposure to an antigen
results in antigen binding

with antibodies causes the release of the products of mast cells


(mediators) such as histamine, bradykinin, and prostaglandins
as well as anaphylaxis fromsuptamin that react slowly.
The release of these mediators affect smooth muscle
and glands airwaycauses bronchospasm, swelling of the mucous membr
anes and the formation of mucus very much
Autonomic nervous system affects the lungs,
bronchial muscle tone pagalregulated by nerve impulses through the sy
mpathetic system. In idiopathic asthma / non-allergenic, when the
nerve endings in the airway is stimulated by factors such as: infections,
exercise, cold air, smoke, emotions and pollutants.Increasing the
amount of acetylcholine released.
The release of this asetilkolin directly cause bronchikonstrik
si alsostimulates the formation of chemical mediators.
In a severe asthma attack that has been accompanied
by toxemia, the body will hold hyperventilation to provide for O2. This
hyperventilation will cause excessive spending and further CO2 CO2
result in arterial blood pressure (pa CO2) decreases causing respiratory
alkalosis (increased blood pH). When
more severe asthma attacks, many alveolar covered by mucus that did n
otparticipate at all in gas exchange. Now the ventilation is not sufficient
anymore, hypoxemia gain weight, respiratory muscles work to gain
weight and increased CO2 production with decreased alveolar
ventilation causes retention of CO2 in
the blood (hypercapnia) and respiratory acidosis (pH decreases).This sta
ge we are familiar with respiratory failure.
Hypothermia prolonged will lead to metabolic
acidosis and pulmonaryvascular network construction and subsequent e
dit circulatory causes bloodvessels to larger units without going

through a good gas exchange. Edit this also results hipercapnia so that w
illmake things worse.

D. Clinical Manifestations
Subjective Data
1. The patient complained of shortness of breath
2. The patient complained of cough slimy
3. The patient complains of difficulty secretions out
4. The patient complains of chest pain

Objective Data
1. RR: 30x / m
2. The patient is claustrophobic
3. Breath sounds wheezing
4. Clients appear to be breathing fast and deep
5. The client seems restless

E. Nursing Diagnosis
1. Ineffective airway clearance related to accumulation of
secretions
2. Ineffective breathing pattern associated with a decreased
ability to breathe
3. Damage to gas exchange associated with CO2 retention

F. Nursing Care Plan


1. Nursing Diagnosis: Ineffective airway clearance associated
with buildup secret
Objective: airway re-effective

75
Expected outcomes:
● can demonstrate effective cough
● can declare a strategy to reduce the viscosity of secretions
Intervention
a. Auscultation of breath sounds, record their breath sounds, eg; wheezing,krek
els, crackles.
R: some degree of bronchospasm occurs obstruction in the airway
b. Assess / monitor respiratory frequency

R: tachypnea normally exist in some degree and can be found at


the reception or during stress
c. 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
d. Push / aids abdominal breathing exercises / lip

R: give patients a way to remedy and resolve dyspnea memgontrol


e. Observation cough characteristics eg settling, hacking cough, wet
R; short cough, moist secretions usually come out with a cough
f. Perform suctioning

R: to lift off the road respiratory sekret


g. collaboration with physicians R: for drug delivery

75

2. Ineffective breathing pattern b / d decreased ability to breathe. Objective:pati


ent breathing pattern becomes effective
Expected outcomes:
● Chest no disturbance development
● Breathing becomes normal 18-24 x / min Intervention
a. Monitor frequency, rhythm and depth of breathing

R: dyspnea and an increase in employment of breath, respiratory


depth varies throughout
b. Elevate the head and help reposition

R: high dududk enables lung expansion and ease breathing


c. Observations pattern of coughing and secret characters
R: menegtahuikeribg or wet cough as well as the color
of the secretions
d. Give the patient practice deep breathing or coughing
effective
R: may increase secretions in which there is an interruption in
breathing inconveniences ventilationsitambah
e. Provide supplemental O2

R: maximize breathing and lower the breath work


f. chest physiotherapy
R: facilitate efforts to breathe performance and increase
secretions drainase

3. Damage to gas exchange associated with CO2 retention,


Objective: gas exchange to be effective
Results Criteria: Shows improvement ventilasi and adequate tissue ox
ygen within the range intervention:
a. observation of vital signs

R: TD changes occur with the severity of hypoxemia and acidosis


b. Assess the level of awareness / mental changes
R: systemic hypoxemia can be demonstrated first by the
restless and sensitive excitatory
c. Observation of cyanosis
R: systemic Menunjukkan Hipoksemia
d. Elevate the head of the bed within their patients’
needs R: improving chestexpansion and make breathing easier
e. Give O2 sesui indication

R: maximizing the dosage of oxygen to exchange g

G. Nursing Implementation
In accordance with the implementation of the intervention, the
nurses should apply the nursing care plan that have been formulated to
meet thepatient’s needs.

H. Nursing Evaluation
Evaluation is focused on the nursing care plan that have been done
to meet the patient’s needs and what are the
patient’s responses on it and relatedto their expected outcome. For exam
ple the patient could be performed as follow:

You might also like