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Muskhab Eko Riyadi

S.Kep., Ns., M.Kep., CWCS

Carsinoma Bronkogenik

Faktor resiko
More than 85% of lung cancers are caused by the
inhalation of carcinogenic chemicals, most commonly
cigarette smoke
Polusi udara > kendaraan bermotor dsb.
Bahaya industri > abses , uranium
Status gizi > vit A
Genetik

Manifestasi
Batuk
Hemoptysis
Wheezing
Dyspneu
Nyeri dada
Anoreksia
Penurunan berat badan

Diagnosis
Radiologi > chest x-ray
Bronkoskopi > biopsi
Sitologi > sputum

Medical management
In general, treatment may involve :
surgery
radiation therapy > mengurangi ukuran tumor
chemotherapy > mengganggu pola pertumbuhan
tumor
or a combination of these

Masalah Keperawatan
Anxiety
Activity intolerance
Impaired gas exchange

Intervensi Keperawatan
Monitor respiratory status, looking at rate, effort, use of

accessory muscles, and skin color; auscultate breath


sounds.
Monitor pain and administer analgesics appropriately.
Monitor vital signs for changes, elevated pulse, elevated
respiration, change in BP, and elevated temperature, which
may signal infection.
Monitor pulse oximetery for decrease in oxygenation levels.
Assist patient with turning, coughing, and deep-breathing
exercises.
Place patient in semi-Fowlers position to ease respiratory
effort.
Explain to the patient:
- The importance of taking rest periods.

Chronic Obstructive Pulmonary


Disease (COPD)
Chronic obstructive pulmonary disease
is a group of pulmonary disorders
characterized by difficulty exhaling
because of airways that are narrowed or
blocked by inflammation and mucus.

COPD

COPD > Astma, Bronchitis, Emfisema


Bronkitis kronik > gangguan klinis yang ditandai oleh
pembentukan mukus yang berlebihan dalam bronkus
> batuk kronik > 3 bln setahun > 2 thn
Emfisema > perubahan anatomis parenkim paru >
pembesaran/kerusakan alveoli
Asma > hipersensitivitas cabang trakeobronkial
terhadap rangsangan > penyempitan jalan nafas

Asma

Emfisema

Bronchitis
Normal bronkus

Bronchitis

COPD > Astma, Emfisema, Bronchitis

Signs and Symptoms


Cough
Chronic sputum production
Dyspneau that occurs every day
Activity intolerance
Crackles, wheezes
Barrel chest > kehilangan elastisitas paru >
kecenderungan dinding dada untuk mengembang
Use of accessory muscles

Barrel Chest

Diagnostic Test
Chest x-ray examination
CT scan
Arterial blood gas analysis
Sputum analysis
Spirometry

Penatalaksanaan
Smoking cessation
Bronchodilators
Corticosteroids, expectorants
Supplemental oxygen
Breathing exercises
Chest physiotherapy
Pulmonary rehabilitation

Masalah Keperawatan
Impaired gas exchange
Ineffective airway clearance

Impaired gas exchange

Ineffective Airway Clearance related to bronchoconstriction,


increased mucus production, and ineffective cough

Expected Outcome: Client will maintain a patent airway and


adequate airway clearance
Auscultate breath sounds at least every 8 hours
Encourage client to cough and clear secretions; suction as

needed
Perform postural drainage with percussion and vibration
twice a day as indicated
Observe for dyspnea, restlessness, increased anxiety, or use
of accessory muscles
Increase fluid intake to 3 L/day if not contraindicated

Cont .
Instruct client in early signs of infection: increased
sputum production, changes in sputum color and
consistency, fever, increased coughing, and increased
dyspnea
Administer bronchodilators by nebulizer as indicated
Teach and encourage the use of diaphragmatic and
pursed-lip breathing.

Impaired Gas Exchange related to loss of lung tissue elasticity, and


atelectasis
Expected Outcome: Client will maintain optimal gas
exchange.

Promote more effective breathing patterns

through optimal positioning, pursed-lip breathing,


and use of abdominal muscles
Administer oxygen as prescribed
Monitor level of consciousness and mental status
Monitor results of ABGs and pulse oximetry

Referensi
Williams, Linda S., Hopper, Paula D. (2007).
Understanding Medical Surgical Nursing 3th Edition.
Davis Company. Philadelphia
Smeltzer, Suzanne C., Bare, Brenda G. (1996). Brunner &
Suddarth Textbook of Medical Surgical Nursing.
Philadelphia
Tymbi, Barbara K., Smith, Nancy E. (2010). Introductory
Medical Surgical Nursing. Lippincott Williams
&Wilkins. Philadelphia

TERIMA KASIH

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