ASUHAN KEPERAWATAN PPOMDefinisiPeny

ASUHAN KEPERAWATAN PPOM
Definisi
Penyakit Paru Obstruktif Kronik ( PPOK ) atau Penyakit Paru Obstruktif Menahun (PPOM) merupakan satu kelompok penyakit paru yang mengakibatkan obstruksi yang menahun dan persisten dari jalan nafas di dalam paru. Termasuk dalam kelompok ini yaitu : bronchitis menahun, emfisema paru, beberapa bentuk dari pada asma, bronkiektasis, dan lain lain. Walaupun masing masing penyakit mempunyai karalteristik tersendiri tetapi sering secara klinik, radiologic dan fisiologik terdapat “overlapping” satu sama lain hingga diagnosis pasti daripada salah satu penyakit sukar ditetapkan. Secara fungsional semuanya akan mengakibatkan peningkatan tahanan saluran nafas (“airways resistance”).
Berdasarkan Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006, PPOM dibagi atas 4 derajat:
PPOM Ringan: biasanya tanpa gejala, faal paru VEP1/KVP < 70%
PPOM Sedang: VEP1/KVP < 70%, atau 50% =< VEP1 < 80% prediksi
PPOM Berat: VEP1/KVP < 70%, atau 30%=

Hasil (Inggris) 1:

NURSING CARE of PPOM

definition of chronic obstructive pulmonary disease (COPD) or Chronically obstructive pulmonary disease (PPOM) is a group of illnesses that result in an obstruction and persistent from the chronically breath in his lungs. Included in this group are: chronical pulmonary emphysema, bronchitis, some forms of asthma, bronkiektasis, and others. Although the each disease has its own karalteristik but often clinically, radiologic and there were "overlapping" deserve each other until the diagnosis is definite rather than one the disease difficult to set. Functionally everything will lead to increased respiratory tract resistance ("airways resistance")
Based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006, PPOM divided into 4 degrees:
PPOM Light: typically without symptoms, pulmonary faal VEP1/KVP < 70%
PPOM Are: VEP1/KVP < 70%, or 50% = < VEP1 < 80% predicted
PPOM weight: VEP1/KVP < 70%, or 30% = < VEP1 < 50% prediction
PPOM very heavy: KVP/VEP1 < VEP1 < 70% or 30% or 50% are accompanied VEP1 < failed breath Chronicle

EtiologyA wide range of diseases that can cause pulmonary obstruction disease chronical as follows:


pulmonary Emphysema Emphysema is a definition, i.e. a change anatomik anatomik pulmonary melebarnya is characterized by abnormal distal parts of the bronchial Airways terminalis, accompanied by damage to the walls of alveoli. According to this definition, so if the abnormality is found in the form of widening air spaces (alveoli) without commensurate destruction network then this State is actually not including emphysema, but rather simply as "overinflation". Emphysema causes air flow on the septal.

Chronicle Bronchitis Bronchitis is a respiratory disease in which the mucous membrane channels bronchial lung inflamed. When an irritated membrane swells and grows thicker, this causes a narrowing of the bronchi, resulting in coughing attacks are accompanied by phlegm and shortness of breath.
bronkiale
Asthma Asthma is a disease that is characterized by its branches trakeobronkial hypersensitivity against different types of stimuli. This condition manifests as narrowing channels of periodic breathing and reversible due to bronchospasm.
Bronkiektasis
Bronkiektasis bronkiolus and bronchial dilation is Chronicle which may be caused by a variety of conditions, including infections of the lungs and bronchial obstruction, aspiration of foreign matter, flooded, or objects from the upper respiratory tract, and pressure on tumor, the berdilatasi blood vessels and lymph node enlargement.


Risk Factors Risk Factors that can be modified:

smoking habit On heavy smokers the possibility to contract the PPOM become higher. Smoking, which can cause paralysis of the vibrating membrane fleece lenders bronchus mucous drainage so distracted. A collection of mucus is a good medium for bacterial growth.
Environmental pollution
individuals who live in the city is likely to be exposed to higher than PPOM individuals who lived in the village, because of the air pollution in the city is higher than in the village, air pollution is caused by industry-industry, motor vehicles, etc..

a risk Factor cannot be modified increasing age:

gender a recurring bronchial Infection

Allergic or hypersensitive on bronchial

Where there is a genetic Factor alfa-2 protease inhibitor are low (an inhibitor of alpha-2 protease)

Race Deficiency of Alpha-1 Antitrypsin Deficiency in anti oxidants


Work miners working in a dusty environment will more easily exposed PPOM.



the pathophysiology of Pneumonia Increased muchus
Muchus overload occurs due to:
Dysplasia mucus-producing cells in the bronchus.
Cilia that line the bronchus suffered paralysis or dysfunction as well as meta plasia due to irritation caused by respiratory air.
This change causes disruption of system mukosiliaris and cause a buildup of escalator muchus large amounts of thick, hard breath expelled from the channel. As a result of bronkiolus can be narrowed and clogged phase so as to make ekspirasi longer than a normal state. Muchus buildup will be the media propagate microorganism causing infection. The infection causes a purulent feses muchosa, then arise causing inflammation and edema and swelling of tissues.
The Alveoli are adjacent to the bronkiolus can become damaged and forming fibrosis, resulting in changes in alveolar macrophage function which was instrumental in destroying the foreign particles including bacteria. Bronchial constriction occurs as a result of further changes that occur in the fibrotik airway. In due course it may happen that the irreversible lung changes, likely lead to emphysema and oedema Formation.
bronkiektasis
the Alveoli are where oxygen from the air taken by blood through him, and carbon dioxide in the blood is ejected into the alveoli to exhaled out. The Alveoli normally have very thin walls that allow the exchange of air, and liquids are usually kept away from the alveoli except wall-dindig lost his integrity.
The presence of infection-an infection, trauma, severe lung injuries, ingesting toxins, infections-infections of the lungs, smoking, cocaine or radiation in the lungs may cause edema. Kidney failure and the inability to remove fluid from the body can cause a buildup of fluid in the blood vessels, resulting in pulmonary edema.
Pulmonary edema occurs when the alveoli are filled with excess fluid that oozes out of the blood vessels in the lung instead of air. This can cause problems with the gas exchange (oxygen and carbon dioxide), resulting in difficulty breathing and a bad blood pengoksigenan.

Contraction bronki
occurs due to allergic reactions, this caused IgE antibodies bind to the allergen causes cell mast degranulasi. This causes Degranulasi terlepasnya histamine which resulted in:
Smooth muscle constricting bronchialis.
stimulates the formation of mucus and increase the permeability of the capillaries

. Emphysema Emphysema is a disorder where
occur damage to the walls of the alveoli which will cause permanent overdistensi air space. Air travel will be disrupted as a result of this change. Difficulty during ekspirasi on emphysema is the result of the destruction of the wall (septum) between the alveoli, airway collapse partially, and lose elasticity to constrict or recoil. At the time of the alveoli and septum of collapsing, the air will be stuck between the space aveolus (called blebs) parenkim and between the lungs (called bullae). This process will lead to an increase in ventilatory on "dead space" or areas that do not experience the gas exchange of blood or breath Work.
increased due to the occurrence of kekurang function of lung tissue to make the exchange of O2 and CO2. Emphysema is also causing destruction of the lung capillaries, decrease in perfusion occurs then the O2 and a decrease in ventilation. Emphysema is still considered normal if appropriate with age, but if this occurs on younger patients usually associated with chronic bronchitis and Asthma
.
smokes some individuals with asthma experience a poor immune response to their environment. The resulting antibodies (IgE) then attacked the mast cells in the lung. Re-Pemajanan of antigen binding antigens with antibodies resulted in, causing the release of products of mast cells (called mediators) such as histamine, prostaglandins, and baradikinin as well as the substance of anaphylaxis reacts slow (SRS-A). This mediator release in pulmonary tissue affects smooth muscles and glands, airway, causing bronchospasm, swelling of the mucous membrane, and formation of mucus that is very much.
clinic Manifestations (signs and symptoms)

Bronchitic
Cough berdahak (dahaknya can be reddish-colored)
shortness of breath when doing sports or mild activity
Often suffer from respiratory infections (e.g. flu)
Tired
Swelling ankles, feet and limbs left and right
face, the Palm of the hand or reddish colored mucous membrane of the cheeks appear rosy

Ill head


Dispnea Emphysema
Takipnea
inspection: barrel chest muscle, use breathing apparatus
Percussion: hiperresonan, decreased fremitus in the entire field of lung sound Auscultation breath:
krekles, ronchi, extension ekspirasi
Hipoksemia
Hiperkapnia


BB Loss Anorexia Weakness Asthma Cough





Hypoxia DispneaFlutter

Widening pulse pressure Sweats




Hipoxemia Complications Hipoxemia is defined as a decrease in the value of PaO2 less than 55 mmHg, with Oxygen Saturation values < 85%. At first the client will experience mood changes, loss of concentration and forgetfulness. On the advanced stage of cyanosis occurs.

Respiratory Acidosis Occurs as a result of an increase in the value of PaCO2 (hiperkapnia). Marks that appear include: headaches, fatique, lethargi, of dizzines, tachipnea.

Respiratory Infection acute respiratory infections are caused due to the increased production of mucus-secreting smooth muscle stimulation, increased bronchial mucosa and edema. The limited air flow will increase the incidence of dyspnea and breath work.

Especially heart failure kor-pulmonal (right heart failure due to pulmonary disease), should be observed especially in clients with severe dyspnea. This complication is often associated with chronic bronchitis, but clients with severe emphysema can also experience this issue.
makes Cardiac Dysrhythmia
Arising as a result of other hipoxemia, heart disease, effects of medications or acidosis respiratory Status Asmatikus.

is the major complications associated with bronchial asthma. The disease is very severe, potentially life-threatening and often not berespon against the usual given therapi. The use of auxiliary respiratory muscles and neck veins often look distensi.
Pe Examination

Hasil (Inggris) 2:

Nursing care PPOM
definition of
Chronic Obstructive Pulmonary Disease (COPD) or Chronic Obstructive Pulmonary Disease (PPOM) is a group of lung diseases that result in chronic and persistent obstruction of the airways in the lungs. Included in this group are: chronic bronchitis, pulmonary emphysema, some forms of asthma, bronchiectasis, and others. Although each disease has its own karalteristik but often in clinical, radiologic, and physiologic there are "overlapping" each other until a definite diagnosis than either disease is difficult to determine. Functionally, everything will lead to an increase in respiratory arrest ("airways resistance").
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006, PPOM divided into 4 degrees:
PPOM Lightweight: usually without symptoms, pulmonary function VEP1/KVP <70%
PPOM Medium: VEP1/KVP <70%, or 50% = <VEP1 <80% predicted
PPOM Weight: VEP1/KVP <70%, or 30% =PPOM Very Weight: VEP1/KVP <70% or VEP1 <30% or VEP1 <50% with chronic respiratory failure
etiology
variety of diseases that can cause chronic obstructive pulmonary disease, among others:
Emphysema Pulmonary Emphysema is an anatomic definition, which is an anatomic changes in pulmonary which is characterized by abnormal widening of the distal part of the bronchial airways terminal, which is accompanied by destruction of alveolar walls. In accordance with the definition, then if found to be abnormal dilation of the air spaces (alveoli) without the presence of tissue destruction that these circumstances do not actually include emphysema, but only as "overinflation". Emphysema causes a defect in the air flow. Bronchitis Chronic Bronchitis is a respiratory disease in which the mucous membranes of the bronchial channels inflamed lung. As the irritated membrane swells and grows thicker, it causes constriction of the bronchi, resulting in coughing attacks were accompanied by phlegm and shortness of breath. bronkiale Asthma Asthma is a disease characterized by hypersensitivity tracheobronchial branches to various types of stimuli. This condition manifests as airway constriction channels due to periodic and reversible bronchospasm. Bronchiectasis Bronchiectasis is a chronic dilatation of the bronchi and bronchioles that may be caused by various conditions, including pulmonary infection and bronchial obstruction, foreign body aspiration, vomit, or objects of channel upper respiratory, and pressure on the tumor, blood vessels were dilated and enlarged lymph nodes. Factor Risk Factor modifiable risk: Smoking Habits In heavy smokers is likely to have contracted PPOM be higher. Smoking, which can lead to paralysis bronchial mucus membranes vibrating bristles that impaired mucus drainage. The set of mucus is a good medium for bacterial growth. environmental pollution Individuals who live in the city is likely to hit PPOM higher than in individuals who live in the village, because of air pollution in the city is higher than in the villages, air pollution can be caused by industry -industry, motor vehicles, etc.. risk factor that can not be modified: Increasing age Gender recurrent bronchial infections Allergy and hypersensitivity in bronchial genetic factor alpha-2 Where there is a low protease inhibitor (alpha-2 protease inhibitors) Ras deficiency of alpha- 1 antitrypsin deficiency of anti-oxidants work mine workers who work in dusty environments will be more susceptible to PPOM. Pathophysiology of Bronchitis Improvement Muchus excessive Muchus result from dysplasia mucus-producing cells in the bronchus. cilia lining the bronchi suffered paralysis or dysfunction as well as meta-plasia due to irritation caused by breathing air. these changes cause the escalator system and cause a buildup Muchus mukosiliaris thick, large amounts of which is difficult to remove from the respiratory tract. As a result of the bronchioles may become narrowed and clogged thus making the expiratory phase longer than normal. Stacking Muchus will be a hotbed of media microorganism causing the infection. Infection causes muchosa become purulent, then arise and cause inflammation and swelling of tissue edema. alveoli adjacent to the bronchioles can be broken and formed fibrosis, resulting in changes in the function of alveolar macrophages play an important role in destroying foreign particles including bacteria. Further bronchial constriction occurs as a result of fibrotic changes that occur in the airway. In time perhaps irreversible changes in the lungs, possibly leading to emphysema and bronchiectasis. Formation of edema The alveoli are where oxygen from the air through which the blood was taken by, and carbon dioxide in the blood released into the alveoli to be exhaled. Normal alveoli have very thin walls that allow the air exchange, and fluids are usually kept out of the alveoli unless these walls lose their integrity-dindig. presence of severe infections, trauma, lung injury, inhalation of toxins, lung infections, smoking cocaine, or radiation to the lungs can cause edema. Renal failure and the inability to remove fluid from the body can cause a buildup of fluid in the blood vessels, resulting in pulmonary edema. Pulmonary edema occurs when the alveoli are filled with excess fluid that seeps out of the blood vessels in the lungs instead of air. This can cause problems with gas exchange (oxygen and carbon dioxide), resulting in difficulty breathing and blood pengoksigenan bad. bronchi contraction occurred because of an allergic reaction, this causes the IgE antibodies bind to the allergen causes mast cell degranulation. This causes the release of histamine degranulation that result: smooth muscle constriction bronchialis. Stimulate the formation of mucus and increase capillary permeability. Emphysema Emphysema is a disorder in which there is damage to the alveolar wall which will cause permanent overdistention air space. Air travel will be disrupted as a result of this change. Difficulty during expiration in emphysema is a result of the destruction of the wall (septum) between the alveoli, airway collapse in part, to shrivel and lose elasticity or recoil. At the time of the alveoli and septal collapse, the air will be suspended between aveolus space (called blebs) and between the lung parenchyma (called bullae). This process will lead to an increase in ventilatory the "dead space" or areas that do not undergo gas exchange or blood. Employment increased respiratory function due to the lack of lung tissue for O2 and CO2 exchange. Emphysema also cause destruction of lung capillaries, further decreased perfusion and decreased O2 ventilation. Emphysema is still considered normal according to age, but if it occurs in younger patients is usually associated with chronic bronchitis and smoking. Asthma Some people with asthma have a poor immune response to their environment. The resulting antibody (IgE) and then attack the mast cells in the lung. Repeated exposure to the antigen results in antigen-antibody binding, causing the release of the products of mast cells (called mediators) such as histamine, baradikinin, and prostaglandins as well as anaphylaxis of slow reacting substance (SRS-A). The release of these mediators in the lung tissue and glands affect the smooth muscle of the airway, causing bronchospasm, swelling of the mucous membrane, and the formation of mucus that very much. clinical manifestations (signs and symptoms) bronchitic cough up phlegm (sputum can be colored red) Shortness of breath when exercising or light activity often suffer from respiratory infections (eg influenza) Tired Swollen ankles, feet and legs left and right face, palms or reddish mucous membrane looks rosy cheeks Headache Emphysema Dyspnea Tachypnea Inspection: barrel chest, use of accessory muscles Percussion : hiperresonan, decreased fremitus in all areas of pulmonary auscultation breath sounds: krekles, Ronchi, extension of expiration Hypoxemia hypercapnia Anorexia Weight loss Weakness Asthma Cough Dyspnea Hypoxia Tachycardia Sweating Widening pulse pressure Complications Hipoxemia Hipoxemia defined as a decrease in PaO 2 values ​​less than 55 mmHg, with a saturation value Oxygen <85%. At first the client will experience changes in mood, decreased concentration and forgetfulness. In advanced stages arise cyanosis. Respiratory acidosis arises as a result of the increase in the value of PaCO2 (hypercapnia). Signs that arise include: headache, fatigue, lethargi, dizzines, tachipnea. Respiratory Infections Acute respiratory infection caused by an increase in mucus production, increased bronchial smooth muscle stimulation and mucosal edema. Lack of air flow will increase the work of breath and the onset of dyspnea. Cardiac failure Especially cor-pulmonale (right heart failure due to pulmonary disease), should be observed especially in clients with severe dyspnea. These complications often associated with chronic bronchitis, but clients with severe emphysema can also experience this problem. Cardiac dysrhythmias arise as a result of hipoxemia, other heart disease, drug effects or respiratory acidosis. status asthmaticus is a major complication associated with bronchial asthma. This disease is very severe, potentially life-threatening and often do not respond to usual therapy given. The use of a respirator muscles and distended neck veins are often visible. Examination Pe