ENGLISH REPORT

NURSING MANAGEMENT OF PATIENT WITH

ASTHMA BRONCIAL

DESTI DWI SAGITYA

P07120112013
REGULER II A

POLTEKKES KEMENKES MATARAM

2014

Nursing Management of Patient with Asthma Bronchial

Asthma bronchial is an intermittent obstructive airway disease and
reversible tracheal bronkhi which are hyperactive respond to specific stimulation.
(Smeltzer Suzanne: 2001).
D.J. a 10 years old female had a medical history of asthma. She suffered
from asthma since 2 years ago.
According (Smeltzer Suzanne: 2001), the nursing focus of asthma is
airway exemption, because asthma is a respiratory disease characterized by
obstruction of smooth muscle spasm acute bronkhiolus, which causes airflow
obstruction and decreased alveolar ventilation.
Pathophysiology
Asthma is characterized by spastic contraction of bronchial smooth muscle
that causes difficulty in breathing. A common cause is a hypersensitivity
bronkhioulus against foreign substances in the air. Reactions that occur on the
type of allergic asthma is thought to occur in the following manner: When a
person inhales an allergen, the IgE antibodies of that person increases, allergens
react with antibodies that have the fixed on mast cells and cause these cells to
secrete a variety of substances, including histamine, slow reacting substance of
anaphylaxis (which is leukotrient), eosinophilic chemotactic factor and
bradykinin. Histamine is produced to cause bronchial smooth muscle contraction.
(Brunner and Suddart, 2002).
If histamine exaggerates response, the asthmatic spasm may arise because
histamine also stimulates the formation of mucus and increases the capillary
permeability, It also causes to congestion and swelling of the intestinal lung space,
thus causing respiratory arrest be greatly increased. Besides, exercise can also act
as an irritant, due to the flow of air in and out of the lungs in a big number and
fast. This aerial has not got humidification, warming, or the cleaning of dust
particles that can trigger asthma adequate.

In asthma, the diameter of bronkhiolus becomes less and less during

expiration than during inspiration. Therefore the patient with asthma can breathe
normally but has great difficulty in expiration. It causes dyspnea, or "air hunger".
Functional residual lung capacities and volumes of the lungs during an asthma
attack are increasing greatly because of the difficulty to remove the air from the
lungs. After a long period of time, the chest cage becomes permanently enlarged,
thus causing a "barrel chest". (Brunner and Suddart, 2002).
History
D.J., a 10 years old female, had a medical history of asthma. Before that,
D.J previously had been hospitalized because of the same illness suffered as today
so she was hospitalized twice before this. D.J. said she began to have difficulty in
breathing since yesterday. Then at 8 pm her mother took D.J. to the emergency
unit of Patut Patuh Patju Hospital. The condition of D.J. got better, so her mother
took her home. The next morning at 7 am D.J. had difficulty in breathing again so
her mother had to take her to the emergency unit of Patut Patuh Patju Hospital
again. She then was hospitalized. If her asthma relapsed, she usually gets
fumigation therapy or better known as the nebulizer. She gets nebulizer twice a
day.
Nursing Physical Assessment
The patient's temperature is 370 Celsius, the pulse was 88 times per minute, the
respiration was 30 times per minute, and blood pressure was 100/80 mmHg. The
patient complained of tightness when breathing, cough with phlegm, chest pain
and the pain that she felt was on 4 in the scale 1-10. The head to toes examination
showed: there are no lesions on the head, face, neck, upper extremities, and lower
extremities. No tenderness (apa maksudnya nyeri???) in the face, neck, piston,
abdomen, upper extremities and lower extremities. Her hair looked greasy. Her
nails looked clean. no tenderness. contained breathing cuping nose. there is a
breathing muscle. Ronchi audible breath sounds and wheezing. The patient ate 3

times a day with a share of third runs. The patient was never bathed when
hospitalized; she was simply wiped with warm water by her mother.
Related treatments
The general principle treatment of asthma broncial are : eliminating airway
obstruction immediately, recognizing and avoiding factors that can trigger asthma
attacks and provide information to patients or their families about
asthma. The treatments that was given to the patient were : infuse RL: D5 20 tpm,
nebulizer with combiven 2 times in a day, oxygen nasal canul 2 liters/minute via
nasal cannula, Aminophilin bolus of 5 mg / kg bw, Dexamatason intravenous
mg/6jam 10-20 and antibiotic.
Nursing Care Plan
Nursing diagnosis for D.J. is ineffective airway clearance related to the
increase production of secretions. Airway obstruction is characterized by
difficulty that the patient is having when breathing, coughing with sputum, ronchi
and wheezing sound, respiration 30 times per minute, blood pressure of 100/70,
temperature of 370 Celsius, and pulse of 88 times per minute.
The objectives of the nursing actions performed for the diagnosis of
airway clearance is effective airway clearance.
The nursing interventions for ineffective airway clearance (according to Doenges,
2000) are:
1.
2.
3.
4.

Observing breath sounds / wheezing presence auscultation, Ronchi.

Observing secretion / secret: the amount, color, consistency, smell.
Teaching deep breath relaxation techniques and effective cough.
Performing suction mucus and caution when patients are not able to

5.
6.
7.

remove the mucus itself.

Instructing the patient to drink frequently and drink warm water.
Collaborating with the doctor in the nebulizer.
Collaborating with physicians regarding the therapy /
bronchodilators.

drug

Recommendation
The patient should avoid trigger factors that can cause asthma relapse such as
avoiding dust, stress, fatigue, and others. The patient should also regularly take
medication in order to control her asthma. Asthma medications should not only be
consumed when an asthma attack, but it is also used to prevent asthma relapse.

REFERENCE

Brunner&Suddart(2002)BukuAjarKeperawatanMedikalBedah,Jakarta:EGC.
Doenges, M. E., Moorhouse, M. F. & Geissler, A. C. (2000) Rencana Asuhan
Keperawatan,Jakarta:EGC
Mansjoer,arif.1999. kapita
aesculapis: Jakarta

selekta

kedokteran

edisi

3.media

Notes:
1. Tulisan merah: saya tdk paham dgn maksudmu. Tlg dijelaskan lebih detil!
2. Tulisan hijau: saya mencoba mengubah gaya bahasamu tanpa bermaksud
merubah maknanya. Tlg di cross check!
3. Mana referencenya??

PENJELASAN
Allergens react with antibodies that have the fixed on mast cells
Maksudnya

: alergen bereaksi dengan antibodi yang melekat pada sel mast.

It also causes to congestion and swelling of the intestinal lung space, thus causing
respiratory arrest be greatly increased
Maksudnya

: maka juga akan terjadi kongesti dan pembengkakan ruang

intestinum paru, sehingga menyebabkan tahanan saluran napas menjadi sangat

meningkat.
This aerial has not got humidification, warming, or the cleaning of dust particles
that can trigger asthma adequate.
Maksudnya

: Udara ini belum mendapat perlembaban (humidifikasi),

penghangatan, atau pembersihan dari partikel-partikel debu secara adekuat

sehingga dapat mencetuskan asma.
No tenderness.
Maksudnya

: nyeri tekan

No tenderness. contained breathing cuping nose ( lobe nose? thats right? ), there
is a breathing muscle.
Maksudnya

: tidak ada nyeri tekan, terdapat pernapasan cuping hidung.

Terdapat otot bantu napas.

The patient ate 3 times a day with a share of third runs.

Maksudnya

: pasien makan 3 kali sehari dengan posri 1/3 habis.

a big number
Terimakasih untuk masukkan