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

DEFENISIDEFENISI

�� is a progressive is a progressive

disease that makes disease that makes

it hard to breathe. it hard to breathe.

"Progressive" means "Progressive" means "Progressive" means "Progressive" means

the disease gets the disease gets

worse over time. worse over time.

�� To understand COPD, it helps To understand COPD, it helps

to understand to understand how the lungs how the lungs

workwork. 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

upsideupside--down tree with many down tree with many upsideupside--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

�� 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.

�� 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.

�� In the United States, the term "COPD" includes In the United States, the term "COPD" includes

two main conditionstwo 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.

�� 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. 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.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" bronchitis. Thus, the general term "COPD" is more accurate.is more accurate.

�� 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.

�� Most of the time, COPD is diagnosed in Most of the time, COPD is diagnosed in middlemiddle--aged or older people. The disease aged or older people. The disease isn't passed from person to personisn't passed from person to person——you you can't catch it from someone else.can't catch it from someone else.can't catch it from someone else.can't catch it from someone else.

Other Names for COPDOther 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

EmphysemaEmphysema�� EmphysemaEmphysema

What Causes COPD?What Causes COPD?

�� Most cases of COPD develop after Most cases of COPD develop after longlong--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 smokeSecondhand smoke——that is, smoke in that is, smoke in the air from other people smokingthe 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.

�� In rare cases, a genetic condition In rare cases, a genetic condition called called alphaalpha--1 antitrypsin deficiency1 antitrypsin deficiencymay 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 alphahave 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 quicklyCOPD can worsen very quickly

Who Is At Risk for COPD? 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. 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

What Are the Signs and What Are the Signs and Symptoms of COPD?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

How Is COPD Diagnosed?How Is COPD Diagnosed?

�� Lung Function Test :spirometryLung Function Test :spirometry

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

�� 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 presentfailure are present

How Is COPD Treated?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.complications.

The goals of COPD treatmentThe 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

Stage of COPD and their treatmentStage of COPD and their treatmentStage Stage characteristicscharacteristics RecommendedRecommended

treatmenttreatment

allall oo avoidance ofavoidance of

risk factorrisk factor

oo influenza facinfluenza fac

0: at risk0: at risk •• chronic symptomschronic symptoms

••Exposure to risk factorExposure to risk factor

••Normal spyrometryNormal spyrometry

Short acting Short acting

bronchodilatorbronchodilator

when neededwhen needed

1.Mild COPD1.Mild COPD --FEV1/FVC FEV1/FVC

<70%<70%

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

predictedpredicted

--short acting short acting

bronchodilator bronchodilator

when neededwhen needed

predictedpredicted

--With or without With or without

symptomsymptom

2. Moderate 2. Moderate

COPDCOPD

II AII A

-- FEV1/FVC FEV1/FVC

<70%<70%

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

predictedpredicted

Regular Regular

treatmen with treatmen with

one/more one/more

bronchodilatorbronchodilator

--RehabilitationRehabilitation

Inhaled Inhaled

IIBIIB

-- FEV1/FVC FEV1/FVC

<70%<70%

-- 30% 30%

FEV,<50% FEV,<50%

predictedpredicted

With or without With or without

--Regular Regular

treatmen with treatmen with

one/more one/more

bronchodilatorbronchodilator

--RehabilitationRehabilitation

--Inhaled Inhaled

glucocorticosterglucocorticoster--With or without With or without

symptomsymptom

glucocorticosterglucocorticoster

oid if significant oid if significant

symptom & lung symptom & lung

function function

respon/if respon/if

repeated repeated

exacerbationexacerbation

III. Severe III. Severe

COPDCOPD

-- FEV1/FVC FEV1/FVC

<70%<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

complicationscomplications

-- rehabilitationrehabilitation

-- long term O2 long term O2 failure or right failure or right

heart filureheart filure

-- long term O2 long term O2

therapy if therapy if

respiratory respiratory

failurefailure

-- consider consider

surgical surgical

treatmenttreatment

The 2001 GOLD gudelines for The 2001 GOLD gudelines for

diagnosis,management & diagnosis,management &

prevention COPDprevention COPD

�� Nonpharmacological therapy :Nonpharmacological therapy :

1.1. Exercise trainingExercise training

2.2. Nutritional counselingNutritional counseling2.2. Nutritional counselingNutritional counseling

3.3. EducationEducation

�� Pharmacilogical therapy ;Pharmacilogical therapy ;

1.1. BronchodilatorsBronchodilators

2.2. GlucocorticoidsGlucocorticoids

Other pharmacological agentsOther pharmacological agents3.3. Other pharmacological agentsOther pharmacological agents

4.4. O2 therapyO2 therapy

5.5. Surgical therapySurgical therapy

How Can COPD Be Prevented? 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.

Living With COPDLiving 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 emergenciesPrepare for emergencies�� Prepare for emergenciesPrepare for emergencies

PengkajianPengkajian

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

�� Apakah aktivitas meningkatkan Apakah aktivitas meningkatkan dispnea?dispnea?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?

�� 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 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?

Data tambahan yang dikumpulkan Data tambahan yang dikumpulkan

melalui observasi dan pemeriksaanmelalui 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?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?

�� 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?Kegelisahan?

�� Palpasi:Palpasi:

Palpasi pengurangan pengembangan Palpasi pengurangan pengembangan dada?dada?

Adakah fremitus taktil menurun?Adakah fremitus taktil menurun?Adakah fremitus taktil menurun?Adakah fremitus taktil menurun?

�� Perkusi:Perkusi:

Adakah hiperesonansi pada perkusi?Adakah hiperesonansi pada perkusi?

Diafragma bergerak hanya sedikit?Diafragma bergerak hanya sedikit?

�� Auskultasi:Auskultasi:

Adakah suara wheezing yang nyaring?Adakah suara wheezing yang nyaring?

Adakah suara ronkhi?Adakah suara ronkhi?

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

Diagnosa KeperawatanDiagnosa 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.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.

�� 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.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.

�� 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.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.

Masalah kolaboratif/Potensial Masalah kolaboratif/Potensial

komplikasi yang dapat terjadi komplikasi yang dapat terjadi

�� Gagal/insufisiensi pernapasanGagal/insufisiensi pernapasan

�� HipoksemiaHipoksemia

�� AtelektasisAtelektasis

PneumoniaPneumonia�� PneumoniaPneumonia

�� PneumotoraksPneumotoraks

�� Hipertensi paruHipertensi paru

�� Gagal jantung kananGagal jantung kanan