Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
1) Contour, Confek, no depressed sternum
2) Antero posterior diameter greater than the diameter of the transverse
3) structural abnormality Thorax
4) Contour symmetrical chest
5) Leather Thorax; Warm, dry, pale or not, the uneven distribution of color
6) Respiratory rate and rhythm for one minute.
1) The temperature of the skin
2) Premitus: fibrasi chest
3) Development of the chest
2) Broncho vesicular
3) Hyper ventilation
6) The location and changes in breathing and when incurred.
Nursing Diagnosis Asthma - Nursing Intervention and Rational for Asthma
Nursing Diagnosis Asthma
Ineffective airway clearance related to the accumulation of mucus.
Less congested, coughing was reduced, the client can issue a sputum, wheezing reduced / lost, vital signs within normal limits, a good general state.
Nursing Intervention and Rational for Asthma
a. Auscultation of breath sounds, record the presence of breath sounds, such as: wheezing, ronkhi.
Rationale: Some degree of bronchial spasms occur with airway obstruction. Faint breath sounds with expiratory wheezing (empysema), there is no breathing function (severe asthma).
b. Review / monitor the frequency of recorded respiratory inspiration and expiration ratio.
Rational: Tachypnea is usually present in some degree and can be found at the reception during strest / presence of acute infectious process. Respiratory frequency can be slowed down and elongated than the expiration of inspiration.
c. Assess the patient to a safe position, such as: elevation head is not sitting on the backrest.
Rational: Elevation head is not easier for respiratory function by using gravity.
d. Observation of the characteristic cough, persistent, hacking cough, wet. Auxiliary measures to improve the effectiveness of cough effort.
Rational: cough may persist but are not effective, especially on elderly clients, acute pain / weakness.
e. Give warm water.
Rational: the use of warm fluids can decrease bronchial spasms.
f. Collaboration drugs as indicated.
Spiriva bronchodilator 1 × 1 (inhalation).
Rational: Freeing spasm of the airway, wheezing and mucus production.