2.

2 Basic Concepts of Asthma According Syaifuddin, (2014) anatomy and respiratory physiology
respiratory system can be classified as follows:

1. Anatomy of the respiratory system

a. Nose

It is the first air channel, has two holes (rice cavity), separated by the nasal septum (septum rice). Inside
there are feathers that are useful for filtering the air, the dust that enters the nose (Syaifuddin, 2014

2.2.1 Anatomy and physiology

b.Sinus paranasalis

The paranasal sinuses of the cavity within the skull are located near the nose and the eye. There are four
sinuses: frontal sinus, etmoidalis, sphenoidalis, and maxillary (Brunner and Suddarth, 2014

c. Faring

Faring or throat is the cavity that connects between the nose and oral cavity to the larynx. The pharynx
is divided into three areas, namely the nasopharynx, oropharynx and hypopharynx (Brunner and
Suddarth, 2015)

d. Faring

Faring or throat is the cavity that connects between the nose and oral cavity to the larynx. The pharynx
is divided into three areas, namely the nasopharynx, oropharynx and hypopharynx (Brunner and
Suddarth, 2015)

e. Trachea

The trachea or windpipe is a continuation of the larynx formed by 16-20 rings consisting of horse-shaped
bones shaped like a horse's hooves. Inside is covered by a fluffy lender membrane called ciliated cells
(Syaifuddin, 2015)

f. Bronkus

The bronchus is a continuation of the trachea located at the height of the thoracic vertebrae IV and V.
The bronchus has the same structure as the trachea and is located towards the lungs (Syaifuddin, 2015).

2. Respiratory system physiology

Breathing is the process of entering the air into and out of the lungs. The process of breathing begins by
entering the air into the lung cavity to be circulated into the circulation and removal of waste substances
(CO2) from the circulation to the exit of the body through the lungs....
a. Ventilation

Ventilation is the process of air movement in and out of lungs. The ventilation consists of two stages:
inspiration and expiration

b. Diffusion gas diffusion is a process in which oxygen and carbon dioxide exchanges occur at the
udarah-blood meeting place.

C Transportation of gas

The third part of the respiratory process is the transport of gas (oxygen and carbon dioxide) from the
lungs to the body's circulation (Syaifuddin, 2014).

2.2.2 Definition of Asthma

Asthma itself comes from the word asthma. This word is derived from the Greek that has the
meaning of difficult breathing, asthma is known because of the symptoms of shortness of breath,
coughing and wheezing caused by narrowing of the airways. Or in other words asthma is a peradagan or
swelling of the airway that causes the production of excessive viscous fluid ( Prasetyo, 2010). Asthma is
an intermittent obstructive airway disease, a reversivel in which trakia and bronchi respond in a
hyperactive way to certain stimuli. (Smeltzer, 2002: 611)

Asthma is a reversible airway obstruction, occurring when the bronchus is inflamed and hyperresponsive
(Reeves, 2001: 48). Asthma is a chronic inflammatory disease of the airways caused by hyperresponsive
reactions of immune cells such as mast sets, eosinophils, and T-lymphocytes to certain stimuli and cause
symptoms of dyspnea, whizzing, and cough due to reversible and recurrent episodic airway obstruction (
Brunner and Suddarth, 2001).

According to Prasetyo (2010) Asthma, wheezing or wheezing are some of the common names we use to
patients who suffer from asthma diseases not infectious diseases, but genetic factors have a big role
here. Respiratory tract asthma sufferers are very sensetif and provide a very excessive response if
experiencing stimuli or ganguan.Salusan respiratory interaction with a way to narrow and block the
incoming air.

This narrowing or obstruction usually results in one or a combination of various symptoms starting and
coughing, shortness of breath, shortness of breath, wheezing, to breath that "tinkles" (Hadibroto et al
2006)

2.2.3 Classification of Asthma

According to Sudoyo (2006: 245), it is very difficult to distinguish one type of asthma with another.
Asthma in differentiation, allergic asthma (extrinsic) and non-alergic (intrinsic). Allergic asthma is
particularly pronounced in childhood, its mechanism of attack through type I allergic reactions to
allergens. While asthma is said to be intrinsic if asthma is not found signs of hypersensitivity to allergens.
2.2.4 Etiology

According to Muwarni (2009: 5-6), the etiology of asthma is as follows: Extrinsic: Allergen factors are
inhalation of ingredients, dust, animal fur, plants etc.Ingestan: through food / medicine, for example sea
fish / fresh fish, eggs and drugs.

Intrinsic: Non-allergen factors are usually not clear of allergic factors. There is usually inflammation.

Psychological: Psychology: in people who are angry, in people who are a lot of trouble. Genetics:
Heredity: less clear, occurs to her suffering family.

Meanwhile, according to Suyono (2004: 22), the etiology of asthma is not known with certainty, but
various studies have shown that the basic symptoms of asthma is inflammation and exaggerated airway
responses.

2.2.5 Pathophysiology

According to Suyono (2004: 22-23), the pathophysiology of asthma is as follows: Airway obstruction in
asthma is a combination of bronchial muscle spasm, mucus, edema and inflammation of the bronchial
wall, obstruction increases in weight during expiration as the physiologic airways narrow in phase the.
This results in distal air where the occurrence, trapped obstruction, can not be expired. Next there is an
increase in residual volume, functional residual capacity (KRF) and the patient will breathe at high
volume near the total lung capacity (DTL). This hyperinflation state aims to keep the airway open and
gas exchange running smoothly.

Airway constriction may occur in large, medium or small airways. Symptoms of wheezing suddenly there
is a narrowing in the large airway, whereas in the small airways, symptoms of cough and tightness are
more dominant than wheezing.

Airway constriction is not evenly distributed throughout the lung. There are areas that lack ventilation
so that blood capillaries through the blood experience hypoxemia. To overcome the lack of oxygen the
body to do hyperventilasi, kinda oxygen needs are met. But as a result CO2 expenditure becomes
excessive so that PaCO2 decreases and then causes respiratory senseosis. In more severe asthma
attacks, the respiratory tract and alveolus are covered by mucus, so no longer possible gas exchange.
This causes hypoxemia and respiratory muscle work to gain weight and an increase in CO2 production.
Increased CO2 production accompanied by decreased alveolar ventilation leads to CO2 retention
(hypercapnia) and respiratory acidosis or respiratory failure. Prolonged hypoxemia causes metabolic
acidosis and pulmonary vascular constriction which then leads to simulation of the circulation of blood
without going through a good gas exchange unit, which consequently worsens hypercapnia. Thus
narrowing of the airways in asthma will cause the following things:
2.2.7 Clinical Manifestations

According to Corwin (2009: 567-568), the clinical manifestations of asthma are:

1. Meaningful Dipsneas

2. Cough especially at night

3. Respiratory superficial and fast

4. Wheezing may be heard in auscultation of the lung. Usually wheezing is heard only during expiration,
unless the patient's condition is severe

5. Increased breathing effort, characterized by chest retraction, accompanied by bad condition, breath
nostrils

6. Anxiety associated with inability to get enough air

7. Air is trapped due to airflow obstruction, especially seen during expiration in asthmatic patients

8. Among asmatic attacks, individuals are usually asymptomatic but in examination of pulmonary
function changes, it may be seen

2.2.8 Investigations

According to Asih and Effendy (2004: 97-98), diagnostic tests performed on asthma patients are as
follows:

1. Chest x-rays: Normal findings during remission period

2. Pulmonary function tests: Done to determine whether the functional obsnormalities are obstructive
or restrictive, to estimate the extent of dysfunction and to evaluate therapeutic effects, eg
bronchondilator

3. Inspiration capacity: Rising

4. Residual volume increase

5. Sputum: Cultures to determine the presence of infection, identify pathogens, cytologic examinations,
to improve underlying malignancy or allergic disorders

6. ECG: Right axis irregularities, allergic waves

Meanwhile, according to Mansjoer (2005: 481), diagnostic tests performed on asthma patients are:

a. History: A history of disease characterized by the above 3 clinical symptoms and causal factors
b. Physical examination

1. Patients usually appear emaciated with barrel-shaped chest (increased chest anteroposterior
diameter)

2. The tactile fremitus is reduced or absent

3. Hypersonor chest percussion, liver shrinkage smaller, lower liver lung limit, reduced heart loss

4. The breath sound decreases with elongated expiration

a. Radiological examination

1) Chest X-ray of chronic bronchitis shows tubular shadow in the form of parallel shadow lines coming
out of the hilum toward the lung apex and increasing pulmonary scalp

2) In pulmonary emphysema, the piston image indicates an over-inflation with a low and flat diaphragm,
pulmonary vascular sequelae and the addition of a distal profile

b. Examination of lung function

c. Blood gas examination

d. ECG Check

e. Blood laboratory examination: white blood cell counts

2.2.9 Management

According Mansjoer, et al, (2005: 477); Asih and Efendy, (2004: 100), management performed on
asthma patients are:

A. Medical

The goal of asthma therapy is

1. Heal and control asthma symptoms

2. Prevent recurrence

3. Seek lung function as normal as possible and maintain it

4. Strives for daily activities at normal levels

5. Avoiding the side effects of asthma medication

6. Prevent irreversible airway obstruction

B. Including antiaxic drugs are:

1) Bronchocondylator: B2 agonist, methylxanthine, anticholinergic

2) Anti-inflammatory: corticosteroids, sodium chromatin.

C. Nursing

1. Improving airway hygiene

2. Provide emotional support and prevent anxiety

3. Facilitate learning

2.2.10 Complications

According to Mansjoer et al (2005: 477), complications from asthma include pneumothorax,

pneumomediastinum and subcutaneous emphysema, atelectasis, allergic bronchopulmonary
aspergillosis, respiratory failure, bronchitis, and rib fracture.

2.2.10 Complications

According to Mansjoer et al (2005: 477), complications from asthma include pneumothorax,

pneumomediastinum and subcutaneous emphysema, atelectasis, allergic bronchopulmonary
aspergillosis, respiratory failure, bronchitis, and rib fracture.

2.3. Nursing Care Concept

a. Airway clearance is ineffective in association with (Nanda, 2007-2008: 51):

1) Family inability to recognize family health problems.

2) The inability of the family to make the right health action decisions.

3) The inability of the family to care for sick family members.

4) Family inability to modify the environment.

5) Family inability to take advantage of existing health care facilities.

Definition: Inability to clean secretions or obstruction of the respiratory tract to maintain airway
hygiene.

Rational: May need to treat or prevent hypoxia. If breathing or oxygenation is inadequate, ventilate as
needed.

General Objectives: Maintain the patient's airway, with a clear and clear breath sound Special purpose :

1) The family is able to find out family health problems

Intervention:
a) Assess family knowledge about airway clearance is ineffective.

Rationale: Providing family advice on ineffective airway clearance.

b) Explain the process of ineffective airway clearance.

Rational: ineffective airway can decrease oxygen input.

c) Auscultation of breath sounds, note the existence of wheezing, ronhi, krekels.

Rational: some degree of bronchial spasm occurs with airway obstruction and may or may not be
manifested as adventitious breath sounds, eg spreading, wet crackles (bronchitis) dim breath sounds
with wheezing expiratory (emphysema) or absence of breath sounds.

d) Provide health counseling with strengthening of essentials in care to address ineffective clearance of
airway clearance.

Rational: several ways to overcome and control dyspnea and lower air traps.

2) The family is able to make the right decision

Intervention:

a) Assess the level of family knowledge about the importance of making the right decision to address
ineffective airway clearance.

Rational: the knowledge to decide the right decision to overcome airway clearance is not effective.

b) Explain how to make the right decision to overcome the ineffectiveness of airway clearance.

Rational: explain to the patient some ways to overcome the ineffectiveness of the airway and lower the
air trap.

c) Teach you how to make the right decision in overcoming airway clearance problems.

Rational: teaching the patient some ways of making the right decision can decrease the degree of airway
clearance.

d) Discuss what are the obstacles in making decisions.

Rational: Deliberation on the patient can help in making the right decision. 3) The family is able to
provide care to sick family members.

Intervention:

a) Explain how to care for sick family members.

Rational: respiratory dysfunction is a variable that depends on the stage stage stage of chronic processes
other than acute processes that cause hospitalization, eg infection, allergic reactions.
b) Explain the importance of care for sick family members.

Rational: the originator in the care of a sick family member is the originator of the type of respiratory
allergic reaction that can trigger acute episodes.

c) Teach how to care for sick family members.

Rational: giving families some ways to cope and control or how care can control dyspnea.

d) Teach effective cough.

Rationale: mobilize secretions to clear the airway and help prevent respiratory complications.

4) The family is able to modify the healthy house.

Intervention:

a) Assess family level knowledge on how to modify healthy homes.

Rational: knowledge to modify a healthy environment can improve health status.

b) Explain the importance of healthy homes

Rational: making a healthy home in principle does not have to be expensive.

c) Teach modify healthy homes.

Rationale: teaching in modifying a healthy environment can reduce the spread of disease.

d) Maintain adequate moisture inspiration air.

Rational: maintaining air can lower air traps.

5) Families are able to utilize existing health services.

Intervention:

a) Assess family knowledge about airway clearance is ineffective.

Rational: Knowing about the level of family knowledge about airway clearance

b) Explain about losses if not utilizing existing health facilities.

Rational: give consideration based on benefits.

c) Describe the benefits of existing health facilities.

Rational: give consideration based on benefits.

d) Teach to utilize health facilities as optimal as possible.

Rational: utilize for the benefit of health.

a. Ineffective breathing patterns are associated with (Nanda, 2007-2008: 68).

1) Family inability to recognize family health problems

2) The inability of the family to make the right health action decisions

3) The inability of the family to care for sick family members

4) Family inability to modify the environment

5) Family inability to take advantage of existing health care facilities

Definition: Ineffective breathing patterns are inadequate inspiratory or inadequate air exchanges

General Objectives: Maintain an effective breath pattern

Special purpose : 1) The family is able to recognize family health problems

Intervention:

a) Assess family knowledge of ineffective breathing patterns

b) Explain the process of the ineffective breathing pattern.

c) Auscultation of breath sounds, note the presence of allergens, ronchi, wheezing and krekels.

d) Give health education by strengthening the important things in care to know the ineffectiveness of
the pattern of the breath.

2) The family is able to make the right health action decisions

Intervention:

a) Assess family's level of knowledge about the importance of making the right decision to know the
pattern of the breath is not effective

b) Explain about how to make the right decision to know the ineffectiveness of the breath pattern

c) Teach you how to make the right decision to overcome the problem of the breath pattern is not
effective

d) Discuss what are the obstacles in making decisions.

3) The family is able to provide care to members who are sick

Intervention:

a) Explain how to care for sick family members

b) Explain how to care for sick family members

c) Teach how to care for sick family members

d) Teach inner breathing techniques and semi-fowler position

4) The family is able to modify the healthy house

Intervention:

a) Assess family level knowledge on how to modify healthy homes

b) Explain the importance of healthy homes

c) Teach modify healthy homes

d) Maintain adequate moisture inspiration air

5) The family is able to utilize the existing health facilities

Intervention:

a) Encourage families to use existing health facilities / the nearest

b) Assess the level of family knowledge in utilizing health facilities

c) Explain about the benefits of health facilities.

b. Impaired fulfillment of nutritional needs less than body needs related to (Doenges, et al., 2000: 159):

1) Family inability to recognize family health problems.

2) The inability of the family to make the right health action decisions.

3) The inability of the family to care for sick family members.

4) Family inability to modify the environment.

5) Family inability to take advantage of existing health care facilities.

Definition: Insufficient intake of body metabolic needs

Rational: Energy storage decreases metabolic demand in the liver and promotes cellular regeneration.

General Purpose: Shows weight gain in the normal direction.

Special purpose :

1) The family is able to know the health problems.

Intervention:

a) Assess family's level of knowledge in providing proper nutrition.

Rational: Knowing the level of family knowledge in terms of nutrition fulfillment.

b) Explain the factors that cause the lack of nutrition in the patient.

Rational: in order to prevent.

c) Explain the importance of proper nutrition.

Rational: as a consideration for the family.

d) Evaluate the ability to process and prepare food.

Rational: to know the extent of family ability in the practice of providing food.

2) The family is able to make the right decision.

Intervention:

a) Assess family's level of knowledge in making decisions in proper nutrition.

Rational: adequate nutrition is essential for the recovery of patients.

b) Explain the importance of appropriate decision making in the proper nutrition.

Rational: as a consideration for the family.

c) Teach the family to make decisions in the proper nutrition.

Rational: in order for the family to determine the exact action.

3) The family is able to provide care to sick family members.

Intervention:

a) Assess family's level of knowledge in providing care to family members with nutritional disorders that
lack the essence of body needs.
Rational: provide information about the family in relation to the basic needs of calories or plans within

meet the nutrients and can help increase appetite.

b) Suggest to serve warm and appetizing foods.

Rationale: the provision and nutritional support is based on estimates of calorie and protein
requirements.

c) Help in determining proper nutrition.

Rational: help patients take action.

d) Teach the family to provide food with small portions but often.

Rational: prevent nausea vomiting.

e) Avoid gas-generating foods and contain carbonates.

Rational: to reduce the risk of increased intestinal peristaltic.

4) The family is able to modify the healthy house.

Intervention:

a) Assess family knowledge in modifying a healthy home.

Rationale: modifying a healthy environment can improve health status.

b) Explain about the benefits of a healthy home.

Rational: a healthy environment can create a healthy life.

c) Help in modifying a healthy home.

Rational: creating a healthy home can improve health status to prevent the occurrence of disease.

5) The family is able to utilize the existing health facilities.

Intervention:

a) Assess family knowledge about the utilization of health facilities.

Rational: Knowing the level of family knowledge about the utilization of health facilities.

b) Describe the benefits of existing health facilities.

Rational: to give consideration to the family.

c) Explain about the loss if not utilizing the existing health facilities.
Rational: to give consideration to the family.

c. Lack of knowledge is related to family inability to deal with disease problems (Carpenito, 2002: 158).

Definition: Lack of knowledge is a condition in which individuals experience a lack of congnitive and
psychomotor knowledge.

General Purpose: The family is able to make efforts to prevent the recurrence of asthma.

Special purpose:

1) The family is able to recognize health problems

Intervention:

a) Assess family knowledge about asthma.

b) Explain to the family about asthma.

c) Explain about the process of the occurrence of asthma.

d) Explain to the family how to prevent the recurrence of asthma.

Rational: provide basic knowledge where the patient or family can get to know about the illness.

2) The family is able to make the right health action decisions.

Intervention:

a) Discuss alternative actions available to prevent more severe conditions.

b) Assist the family in taking action.

c) Give praise from the discussion on the correct answer.

d) Explain how to make the right decision.

Rational: provides basic knowledge where the family can make informed decisions.

3) The family is able to provide care to sick family members.

Intervention:

a) Assess the level of family ability in providing care to families with asthma.

b) Explain to the family how to care for asthma patients.

c) Help the family in caring for sick family members.

d) Encourage the family to assist the patient's activities.

e) Encourage the family to have adequate rest.

Rational: family can provide optimal care possible.

4) The family is able to modify the environment

Intervention:

a) Assess family knowledge in managing the environment.

b) Explain to the family how to organize a healthy environment.

c) Teach the family to organize a healthy environment.

d) Explain about a healthy home.

e) Help the family in modifying the home environment.

Rational: the environment affects the health of the occupants.

5) The family is able to utilize health service facilities.

Intervention:

a) Assess family knowledge on how to use health facilities.

b) Explain to the family how to use the health facility.

c) Tell the family about the benefits of existing health care facilities.

d) Encourage families to use health facilities.

e) Explain the losses if not using health facilities.

Rational: motivating patients and families to make the most of the available health facilities.

d. The high risk of infec- tion is related to: (Doenges, et al., 2000: 160).

1) Family inability to recognize family health problems.

2) The inability of the family to make the right health action decisions.

3) The inability of the family to care for sick family members.

4) Family inability to modify the environment.

5) Family inability to take advantage of existing health care facilities.

Definition: Increased risk to be invaded by pathogenic organisms

Rational: Restrict the source of infection, which can cause sepsis in patients.

General Objectives: Identify interventions to prevent or reduce infection.

Special purpose :

1) The family is able to know the health problems.

Intervention:

a) Assess family knowledge about respiratory infections.

Rational: prevent the spread of pathogens.

b) Explain the importance of hand washing techniques before and after meals.

Rational: prevent the occurrence of germs into the body through food.

c) Explain about risk factors related to infection.

Rational: prevent infection.

d) Assess family knowledge of signs and symptoms of infection.

Rational: done to identify the causative organism and signs of infection.

e) Keep an eye on body temperature.

Rational: fever may occur due to infection or dehydration.

2) The family is able to make the right decision.

Intervention:

a) Discuss on how to prevent infection.

Rational: to invite family to give opinion.

b) Explain about the risks of not taking immediate action to deal with the infection.

Rational: to overcome or control the increase of disease.

c) Explain about the risks of not making the appropriate decision to deal with the problem of infection.

Rational: handle the process of spreading the infection appropriately.

d) Teach you how to make informed decisions about infection.

Rationale: lowering exposure to ppotential infectious diseases.

3) The family is able to provide care to sick family members.

Intervention:

a) Assess family's level of knowledge about signs and symptoms of infection.

Rational: knowing the family's ability to recognize the early signs of infectious diseases.

b) Explain the causes, risks, and strengths of transmission from infection.

Rational: the temperature or more to be used depends on the identification of the pathogen when the
infection occurs.

c) Push the balance between activity and rest.

Rational: help improve body resistance and avoid disease.

d) Teach how to prevent infection.

Rational: prevent the spread of infection.

e) Teach you how to wash your hands properly.

Rational: reduce the risk of infection.

4) The family is able to modify a healthy home environment.

Intervention:

a) Assess family natural knowledge modify healthy homes.

Rational: as the basis for making subsequent interventions.

b) Explain about the importance of healthy homes that avoid pathogenic organisms.

Rational: motivate the family to always keep the house clean.

c) Encourage the house to be clean.

Rational: motivate the family to always keep the house clean.

d) Teach on how to modify a healthy home.

Rational: giving knowledge to the family.

e) Encourage families to open house ventilation.

Rational: clean air from microorganisms.

5) able to utilize existing health facilities.

Intervention:

a) Family Assess family level knowledge in utilizing health facilities.

Rational: measuring family knowledge in terms of utilizing existing health facilities.

b) Explain how to use health facilities.

Rational: for families to know how to take advantage of existing health facilities.

c) Explain about the benefits of health facilities.

Rationale: changing lifestyles in trust using health facilities.

d) Explain the losses if not using the health facility well.

Rational: to give consideration to the family.

e) Encourage families to utilize health facilities as well as possible.

Rational: improving health status.s