DEFENISI is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

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BY. NUR ASNAH SITOHANG,S.Kep.Ns.M.Kep BY. NUR ASNAH SITOHANG,S.Kep.Ns.M.Kep

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DEFENISI DEFENISI

is a progressive is a progressive

disease that makes disease that makes it hard to breathe.

it hard to breathe.

"Progressive" means

"Progressive" means the disease gets

the disease gets worse over time.

worse over time.

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To understand COPD, it helps To understand COPD, it helps to understand

to understand how the lungs how the lungs work

work. The air that you breathe . The air that you breathe goes down your windpipe into goes down your windpipe into tubes in your lungs called

tubes in your lungs called bronchial tubes, or airways.

bronchial tubes, or airways.

The airways are shaped like an The airways are shaped like an upside

upside--down tree with many down tree with many upside

upside--down tree with many down tree with many branches. At the end of the branches. At the end of the branches are tiny air sacs branches are tiny air sacs called alveoli

called alveoli

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The airways and air sacs are elastic. The airways and air sacs are elastic.

When you breathe in, each air sac fills up When you breathe in, each air sac fills up with air like a small balloon. When you

with air like a small balloon. When you breathe out, the air sac deflates and the breathe out, the air sac deflates and the breathe out, the air sac deflates and the breathe out, the air sac deflates and the air goes out.

air goes out.

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In COPD, less air flows in and out of the In COPD, less air flows in and out of the airways because of one or more of the airways because of one or more of the following:

following:

The airways and air sacs lose their elastic The airways and air sacs lose their elastic quality.

quality.

The walls between many of the air sacs The walls between many of the air sacs

The walls between many of the air sacs The walls between many of the air sacs are destroyed.

are destroyed.

The walls of the airways become thick and The walls of the airways become thick and inflamed (swollen).

inflamed (swollen).

The airways make more mucus than The airways make more mucus than usual, which tends to clog the airways.

usual, which tends to clog the airways.

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In the United States, the term "COPD" includes In the United States, the term "COPD" includes two main conditions

two main conditions——emphysemaemphysema and chronic and chronic obstructive bronchitis.

obstructive bronchitis.

In emphysema, the walls between many of the In emphysema, the walls between many of the In emphysema, the walls between many of the In emphysema, the walls between many of the air sacs are damaged, causing them to lose their air sacs are damaged, causing them to lose their shape and become floppy. This damage also

shape and become floppy. This damage also can destroy the walls of the air sacs, leading to can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny fewer and larger air sacs instead of many tiny ones.

ones.

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In chronic obstructive bronchitis, the lining In chronic obstructive bronchitis, the lining of the airways is constantly irritated and

of the airways is constantly irritated and

inflamed. This causes the lining to thicken.

Lots of thick mucus forms in the airways, Lots of thick mucus forms in the airways, making it hard to breathe.

making it hard to breathe.

Most people who have COPD have both Most people who have COPD have both emphysema and chronic obstructive

emphysema and chronic obstructive

bronchitis. Thus, the general term "COPD"

is more accurate.

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COPD is a major cause of disability, and COPD is a major cause of disability, and it's the fourth leading cause of death in the it's the fourth leading cause of death in the United States. More than 12 million people United States. More than 12 million people are currently diagnosed with COPD. An

are currently diagnosed with COPD. An additional 12 million likely have the

additional 12 million likely have the disease and don't even know it.

disease and don't even know it.

COPD develops slowly. Symptoms often COPD develops slowly. Symptoms often

COPD develops slowly. Symptoms often COPD develops slowly. Symptoms often worsen over time and can limit your ability worsen over time and can limit your ability to do routine activities. Severe COPD may to do routine activities. Severe COPD may prevent you from doing even basic

prevent you from doing even basic

activities like walking, cooking, or taking activities like walking, cooking, or taking care of yourself.

care of yourself.

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Most of the time, COPD is diagnosed in Most of the time, COPD is diagnosed in middle

middle--aged or older people. The disease aged or older people. The disease isn't passed from person to person

isn't passed from person to person——you you can't catch it from someone else.

can't catch it from someone else.

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Other Names for COPD Other Names for COPD

Chronic obstructive airway disease Chronic obstructive airway disease

Chronic obstructive bronchitis Chronic obstructive bronchitis

Chronic obstructive lung disease Chronic obstructive lung disease Emphysema

Emphysema

EmphysemaEmphysema

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What Causes COPD?

Most cases of COPD develop after Most cases of COPD develop after long

long--term exposure to lung irritants that term exposure to lung irritants that damage the lungs and the airways.

damage the lungs and the airways.

In the United States, the most common In the United States, the most common irritant that causes COPD is cigarette irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of smoke. Pipe, cigar, and other types of smoke. Pipe, cigar, and other types of smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, tobacco smoke also can cause COPD, especially if the smoke is inhaled.

especially if the smoke is inhaled.

Secondhand smoke

Secondhand smoke——that is, smoke in that is, smoke in the air from other people smoking

the air from other people smoking——also also can irritate the lungs and contribute to can irritate the lungs and contribute to COPD.

COPD.

Breathing in air pollution and chemical Breathing in air pollution and chemical fumes or dust from the environment or fumes or dust from the environment or workplace also can contribute to COPD.

workplace also can contribute to COPD.

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In rare cases, a genetic condition In rare cases, a genetic condition called

called alphaalpha--1 antitrypsin deficiency1 antitrypsin deficiency may play a role in causing COPD.

may play a role in causing COPD.

People who have this condition People who have this condition have low levels of alpha

have low levels of alpha--1 1 antitrypsin (AAT)

antitrypsin (AAT)——a protein made a protein made antitrypsin (AAT)

antitrypsin (AAT)——a protein made a protein made in the liver.

in the liver.

Having a low level of the AAT Having a low level of the AAT protein can lead to lung damage protein can lead to lung damage and COPD if you're exposed to and COPD if you're exposed to

smoke or other lung irritants. If you smoke or other lung irritants. If you have this condition and smoke,

have this condition and smoke, COPD can worsen very quickly COPD can worsen very quickly

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Who Is At Risk for COPD?

The main risk factor for COPD is smoking The main risk factor for COPD is smoking

People who have a family history of COPD People who have a family history of COPD are more likely to get the disease if they

are more likely to get the disease if they smoke.

smoke.

LongLong--term exposure to other lung irritants term exposure to other lung irritants also is a risk factor for COPD

also is a risk factor for COPD

a genetic condition a genetic condition

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What Are the Signs and What Are the Signs and

Symptoms of COPD?

The signs and symptoms of COPD include: The signs and symptoms of COPD include:

An ongoing cough or a cough that produces An ongoing cough or a cough that produces

large amounts of mucus (often called "smoker's large amounts of mucus (often called "smoker's cough")

cough") cough") cough")

Shortness of breath, especially with physical Shortness of breath, especially with physical activity

activity

Wheezing (a whistling or squeaky sound when Wheezing (a whistling or squeaky sound when you breathe)

you breathe)

Chest tightnessChest tightness

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How Is COPD Diagnosed?

Lung Function Test :spirometryLung Function Test :spirometry

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A A chest x raychest x ray or or chest computed chest computed tomography (CT) scan

tomography (CT) scan

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Arterial blood gases : should be performed Arterial blood gases : should be performed in all patients with an FEV1 less than 40%

in all patients with an FEV1 less than 40%

predicted or when clinical signs of predicted or when clinical signs of respiratory failure/ rigth

respiratory failure/ rigth ––sided heart sided heart respiratory failure/ rigth

respiratory failure/ rigth ––sided heart sided heart failure are present

failure are present

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How Is COPD Treated?

Quitting smoking Quitting smoking

Other treatments for Other treatments for COPD may include COPD may include medicines, vaccines, medicines, vaccines, medicines, vaccines, medicines, vaccines, pulmonary

pulmonary

rehabilitation (rehab), rehabilitation (rehab), oxygen therapy,

oxygen therapy, surgery, and

surgery, and managing managing

complications.

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The goals of COPD treatment The goals of COPD treatment

Relieve your symptoms Relieve your symptoms

Slow the progress of the disease Slow the progress of the disease

Improve your exercise tolerance (your Improve your exercise tolerance (your ability to stay active)

ability to stay active) ability to stay active) ability to stay active)

Prevent and treat complicationsPrevent and treat complications

Improve your overall health Improve your overall health

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Stage of COPD and their treatment Stage of COPD and their treatment

Stage

Stage characteristicscharacteristics RecommendedRecommended treatment

treatment all

all ^o^o avoidance ofavoidance of

risk factor risk factor

o

o influenza facinfluenza fac

0: at risk

0: at risk ^•• chronic symptomschronic symptoms

••Exposure to risk factorExposure to risk factor

••Normal spyrometryNormal spyrometry

Short acting Short acting bronchodilator bronchodilator when needed when needed

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1.Mild COPD

1.Mild COPD ^--FEV1/FVC FEV1/FVC

<70%

--FEV,>80% FEV,>80%

predicted predicted

--short acting short acting bronchodilator bronchodilator when needed when needed predicted

predicted

--With or without With or without symptom

symptom 2. Moderate

2. Moderate COPD

COPD

II A II A

-- FEV1/FVC FEV1/FVC

<70%

--FEV,<80% FEV,<80%

predicted predicted

Regular Regular

treatmen with treatmen with one/more

one/more

bronchodilator bronchodilator

--RehabilitationRehabilitation Inhaled

Inhaled

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IIB IIB

<70%

-- 30% 30%

FEV,<50%

predicted predicted

With or without With or without

--Regular Regular

treatmen with treatmen with one/more

one/more

bronchodilator bronchodilator

--RehabilitationRehabilitation

--Inhaled Inhaled

glucocorticoster glucocorticoster

--With or without With or without symptom

symptom

glucocorticoster glucocorticoster oid if significant oid if significant symptom & lung symptom & lung function

function respon/if respon/if repeated repeated

exacerbation exacerbation

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III. Severe III. Severe COPD

COPD

<70%

-- 30% 30%

FEV,predicted FEV,predicted or presence of or presence of respiratory

respiratory

failure or right failure or right

--Idem stage II + Idem stage II +

;;

-- treatment of treatment of complications complications

-- rehabilitationrehabilitation

-- long term O2 long term O2 failure or right

failure or right heart filure

heart filure

-- long term O2 long term O2 therapy if

therapy if respiratory respiratory failure

failure

-- consider consider surgical surgical treatment treatment

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The 2001 GOLD gudelines for The 2001 GOLD gudelines for

diagnosis,management &

prevention COPD prevention COPD

Nonpharmacological therapy :Nonpharmacological therapy :

1.

1. Exercise trainingExercise training

2.

2. Nutritional counselingNutritional counseling

2.

2. Nutritional counselingNutritional counseling

3.

3. EducationEducation

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Pharmacilogical therapy ;Pharmacilogical therapy ;

1.

1. BronchodilatorsBronchodilators

2.

2. GlucocorticoidsGlucocorticoids

Other pharmacological agents Other pharmacological agents

3.

3. Other pharmacological agentsOther pharmacological agents

4.

4. O2 therapyO2 therapy

5.

5. Surgical therapySurgical therapy

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How Can COPD Be Prevented?

you can take steps to prevent you can take steps to prevent

complications and slow the progress of the complications and slow the progress of the disease.

disease.

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Living With COPD Living With COPD

Avoid lung irritantsAvoid lung irritants

Get ongoing careGet ongoing care

Manage the disease and its symptomsManage the disease and its symptoms Prepare for emergencies

Prepare for emergencies

Prepare for emergenciesPrepare for emergencies

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Pengkajian Pengkajian

Sudah berapa lama pasien mengalami Sudah berapa lama pasien mengalami kesulitan pernapasan?

kesulitan pernapasan?

Apakah aktivitas meningkatkan Apakah aktivitas meningkatkan dispnea?

dispnea?

Berapa jauh batasan pasien terhadap Berapa jauh batasan pasien terhadap toleransi aktivitas?

toleransi aktivitas?

Kapan pasien mengeluh paling letih Kapan pasien mengeluh paling letih dan sesak napas?

dan sesak napas?

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Apakah kebiasaan makan dan tidur Apakah kebiasaan makan dan tidur terpengaruh?

terpengaruh?

Riwayat merokok?Riwayat merokok?

Obat yang dipakai setiap hari?Obat yang dipakai setiap hari?

Obat yang dipakai pada serangan akut?Obat yang dipakai pada serangan akut?

Apa yang diketahui pasien tentang Apa yang diketahui pasien tentang kondisi dan penyakitnya?

kondisi dan penyakitnya?

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Data tambahan yang dikumpulkan Data tambahan yang dikumpulkan melalui observasi dan pemeriksaan melalui observasi dan pemeriksaan

Frekuensi nadi dan pernapasan pasien?Frekuensi nadi dan pernapasan pasien?

Apakah pernapasan sama tanpa upaya?Apakah pernapasan sama tanpa upaya?

Apakah ada kontraksi ototApakah ada kontraksi otot--otot abdomen otot abdomen selama inspirasi?

selama inspirasi?

Apakah ada penggunaan ototApakah ada penggunaan otot--otot otot aksesori pernapasan selama

aksesori pernapasan selama pernapasan?

pernapasan?

Barrel chest?Barrel chest?

Apakah tampak sianosis?Apakah tampak sianosis?

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Apakah ada batuk?Apakah ada batuk?

Apakah ada edema perifer?Apakah ada edema perifer?

Apakah vena leher tampak membesar?Apakah vena leher tampak membesar?

Apa warna, jumlah dan konsistensi Apa warna, jumlah dan konsistensi

Apa warna, jumlah dan konsistensi Apa warna, jumlah dan konsistensi sputum pasien?

sputum pasien?

Bagaimana status sensorium pasien?Bagaimana status sensorium pasien?

Apakah terdapat peningkatan stupor? Apakah terdapat peningkatan stupor?

Kegelisahan?

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Palpasi:Palpasi:

Palpasi pengurangan pengembangan Palpasi pengurangan pengembangan dada?

dada?

Adakah fremitus taktil menurun?

Perkusi:Perkusi:

Adakah hiperesonansi pada perkusi?

Diafragma bergerak hanya sedikit?

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Auskultasi:Auskultasi:

Adakah suara wheezing yang nyaring?

Adakah suara ronkhi?

Vokal fremitus nomal atau menurun Vokal fremitus nomal atau menurun Vokal fremitus nomal atau menurun Vokal fremitus nomal atau menurun

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Diagnosa Keperawatan Diagnosa Keperawatan

Bersihan jalan napas tidak efektif berhubungan Bersihan jalan napas tidak efektif berhubungan

dengan bronkokontriksi, peningkatan produksi sputum, dengan bronkokontriksi, peningkatan produksi sputum, batuk tidak efektif, kelelahan/berkurangnya tenaga dan batuk tidak efektif, kelelahan/berkurangnya tenaga dan infeksi bronkopulmonal.

infeksi bronkopulmonal.

Pola napas tidak efektif berhubungan dengan napas Pola napas tidak efektif berhubungan dengan napas pendek, mucus, bronkokontriksi dan iritan jalan napas.

pendek, mucus, bronkokontriksi dan iritan jalan napas.

Gangguan pertukaran gas berhubungan dengan Gangguan pertukaran gas berhubungan dengan ketidaksamaan ventilasi perfusi

ketidaksamaan ventilasi perfusi

Intoleransi aktivitas berhubungan dengan Intoleransi aktivitas berhubungan dengan

ketidakseimbangan antara suplai dengan kebutuhan ketidakseimbangan antara suplai dengan kebutuhan oksigen.

oksigen.

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Risiko perubahan nutrisi kurang dari Risiko perubahan nutrisi kurang dari

kebutuhan tubuh berhubungan dengan kebutuhan tubuh berhubungan dengan anoreksia.

anoreksia.

Ganggua pola tidur berhubungan dengan Ganggua pola tidur berhubungan dengan ketidaknyamanan, pengaturan posisi.

ketidaknyamanan, pengaturan posisi.

Kurang perawatan diri berhubungan dengan Kurang perawatan diri berhubungan dengan keletihan sekunder akibat peningkatan upaya keletihan sekunder akibat peningkatan upaya pernapasan dan insufisiensi ventilasi dan

pernapasan dan insufisiensi ventilasi dan oksigenasi.

oksigenasi.

Ansietas berhubungan dengan ancaman Ansietas berhubungan dengan ancaman terhadap konsep diri, ancaman terhadap terhadap konsep diri, ancaman terhadap kematian, keperluan yang tidak terpenuhi.

kematian, keperluan yang tidak terpenuhi.

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individu tidak efektif berhubungan individu tidak efektif berhubungan

dengan kurang sosialisasi, ansietas, dengan kurang sosialisasi, ansietas, depresi, tingkat aktivitas rendah dan depresi, tingkat aktivitas rendah dan ketidakmampuan untuk bekerja.

ketidakmampuan untuk bekerja.

Kurang pengetahuan berhubungan Kurang pengetahuan berhubungan dengan kurangnya informasi, tidak dengan kurangnya informasi, tidak mengetahui sumber informasi.

mengetahui sumber informasi.

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Masalah kolaboratif/Potensial Masalah kolaboratif/Potensial komplikasi yang dapat terjadi komplikasi yang dapat terjadi

Gagal/insufisiensi pernapasanGagal/insufisiensi pernapasan

HipoksemiaHipoksemia

AtelektasisAtelektasis Pneumonia Pneumonia

PneumoniaPneumonia

PneumotoraksPneumotoraks

Hipertensi paruHipertensi paru

Gagal jantung kananGagal jantung kanan

(43)