NURSING CARE CHILDREN WITH BRONCHIAL ASTHMA

A.    DEFINITIONS

Bronchial asthma is intermittent obstructive airway disease, reversible where the hyperactive trakheobronkhial respond to certain stimuli.

Bronchial asthma is a disease characterized by increased responsiveness of the trachea and bronchi to various stimuli with the narrowing of the airway manifestations are broad and rank can change either spontaneously or result from the treatment.

2. ETIOLOGI

There are some things that are predisposing factors and precipitation onset bronchial asthma attacks.

   1.   Factors Predisposing

   - Genetics

Derived is allergic talent although the decline is not known how. Patients with allergic diseases usually have close relatives who also suffer from allergic diseases. Because of the talent this allergy, the patient very susceptible to bronchial asthma if exposed to trigger factors.

   

   2.    Factors Precipitation

   - Allergens

Allergens can be divided into three types, namely:

   a) inhalants, 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 medicine

c) Kontaktan, which enter through skin contact. Example: jewelry, metal, and watches.

3. Pathophysiology

Asthma is characterized by spastic contraction of smooth muscle that causes difficulty breathing bronkhiolus. A common cause is bronkhiolus hypersensitivity to foreign substances in the air. Reactions that occur in allergic type of asthma is thought to occur in a way: a person is allergic IgE antibodies to abnormal forms of allergic reactions. In asthma, the antibody is particularly attached to mast cells in interstitial lung contained a closely related bronkhiolus and small bronchi. When a person inhaling the allergen antibody IgE people increases, allergen reacting with antibodies that have terlekat on mast cells and cause these cells secrete a variety of substances, including histamine, slow reacting substance of anaphylaxis (which is a leukotriene), eosinophilic chemotactic factor, and bradykinin. The combined effect of all these factors will result in local edema and small bronkhiolus wall is thick mucus secretions 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 lungs during forced expiration bronkhiolus pressing the outside. Bronkhiolus already partially blocked the subsequent blockage is a result of external pressure that causes severe obstruction ekspirasi.pada especially for people with asthma can usually be done properly and adequately inspiration but only occasionally do the expiration. This causes dyspnea. Functional residual capacity and residual lung volume to be greatly increased during an asthma attack due to trouble getting expiratory air from the lungs. It can lead in barrel chest.

4. CLINICAL

In patients who were free of clinical symptoms of the attack was not found, but at the time of the attack the patient was breathing fast and deep, restless, sitting with prop forward, and without a respirator muscles working hard. Classic symptoms: shortness of breath, wheezing (wheezing), coughing, and in some patients there who feel pain in the chest. In more severe asthma attack, the more symptoms, such as: silent chest, cyanosis, impaired consciousness, hyperinflation of the chest, tachycardia, and rapid-shallow breathing. Asthma attacks often occur at night.

    v Treatment

Treatment of bronchial asthma divided into two, namely:

1). Non-pharmacologic treatment

a. Providing counseling

b. Avoiding trigger factors

c. Fluid

d. Physiotherapy

e. Give O2 if necessary

         2). Pharmacologic treatment

-   Bronchodilators: medicines that dilate the airways. Divided into 2 groups:

a. Sympathomimetic / andrenergik (adrenaline and ephedrine)

Drug name: Orsiprenalin (Alupent), fenoterol (berotec), terbutaline (bricasma).

b. Santin (theophylline)

Nama obat: Aminofilin (Amicam supp), Aminofilin (Euphilin Retard), Teofilin (Amilex)

Patients with gastric disease should exercise caution when taking this medicine.

- Kromalin

Kromalin not a bronchodilator but it is but an asthma preventer medication. Kromalin usually given together anti-asthma drug to another and a new effect seen after 1 month usage.

-   Ketolifen

Possessed i preventive effect against asthma as kromalin. Usually given dose of 1 mg 2 times / day. The advantage of this drug is that it can be administered orally.

5. ASTHMA ATTACK PREVENTION IN CHILDREN 

    1)       Avoid trigger

How to avoid the various trigger attacks in asthma needs to be known and taught in the family is often a precipitating factor is house dust. To avoid the triggers for house dust recommended by striving for a child's bedroom:

- Bed linen, curtains, blankets washed at least 2 weeks. Bed sheets and pillowcases more often. Better not use carpet in the bedroom or children's playground. Do not keep animals.

- To avoid the causes of food when not know for sure, it is better not to eat chocolate, peanuts or foods containing ice, and foods containing dyes.

- Avoid contact with influenza patients, avoid the kids were in the moderate weather changes, such as being overcast.

  

    2)       physical activity

Children with asthma should not banned from playing or exercising. but the sport needs to be regulated because it is a necessity for the development of the child. The setting is done by:

- Adding tolerance gradually, avoiding abrupt acceleration motion

- When you start to cough, just take a break, drink some water and after no cough, activity continued.

- Sometimes some children before making activities need to take medication or inhaling aerosol first.