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CLINICAL SCIENCE SESSIONpulmonary rehabilitation
Disusun oleh:
Muthia Arsil Buntaram
Preceptor:dr ! Satryo "aspodo# Sp$%&
BAGIAN REHABILITASI MEDIKPROGRAM PENDIDIKAN PROFESI DOKTER
FAKULTAS KEDOKTERAN UNISBARUMAH SAKIT MUHAMMADIYAH
2016
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&espirasi'transport(
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ANATOMI PARU-PARU
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)entilasi men*a+a suatu perbedaante,anan antara al-eolar +as dandarah -ena sehin++a pertu,aran +asantara darah dan al-eolar ter*adimelalui di.usi
Sistem sir,ulasi mempersiap,an
transport o,si+en antara paru dan*arin+an
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/u*uan dari pernapasan adalah untu,menyedia,an o,si+en ba+i *arin+andan membuan+ ,arbondio,sida
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0 peristi1a .un+sional
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d!"#$a%&!"#p'!a%
#"(a(u)
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'a a +"% a't"r&a%tu%& pada)
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Ga%&&ua% r"'pra'
Suatu ,ondisiyan+
mence+ah
transportyan+ ade,uat
dari
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a%&&ua% +"% a'r"'tr!t,
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2an++uan restri,ti.
2an++uan restri,ti. di,ara,terisasi,an olehsuatu penin+,atan ,ebutuhan ener+iuntu, melemah,an elastic recoil paru3paru
atau stru,tur dada pada saat pemberian-entilasi
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Penya,it yan+ menimbul,an +an++uanrestri,ti.
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2an++uan Obstru,si
Penya,it obstru,si dapatmenyebab,an penurunan te,anano,si+en arteri dan retensi dari
,arbondio,sida# contohnya pada saatada lesi di tra,ea
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Dia+nosti,
Spirometri
ITAL.APA.ITY
FOR.ED ITAL.APA.ITY /
IN 1 SE.
MAIMALBREATHING.APA.ITY
Obstructi-e Menurun 4 567 Menurun
&estricti-e Menurun 567 atau lebih Normal atau
sedi,it menurun
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Compliance
Nilai dimana pen+emban+an paru untu, setiapunit dapat menin+,at,an te,anantranspulmoner
Dia+ram compliance paru adalah dia+ram yan+
men+hubun+,an perubahan -olume paruden+an perubahan te,anan transpulmoner'daya elastis paru(
Daya elastis paru :3 daya elastis *arin+an paru itu sendiri
3 daya elastis yan+ disebab,an oleh te+an+anpermu,aan cairan yan+ membatasi dindin+ba+ian dalam al-eoli dan ruan+ udara parulainnya
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P8LMONA&9&E!ABILI/A/ION
DE%INI/ION:
IS A COMP&E!ENSI)E /EAM
APP&OAC! /!A/ P&O)IDES PA/IEN/S"I/! /!E ABILI/9 /O ADAP/ /O/!EI& C!&ONIC L8N2 DISEASE I/INCL8DES:
MEDICAL MANA2EMEN/
/&AININ2 IN COPIN2 S$ILLS
EE&CISE &ECONDI/IONIN2
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/!E 2ENE&AL 2OALS O%P8LMONA&9 &E!ABILI/A/ION
/O S/ABILI;E O& POSSIBL9 &E)E&SE BO/!/!E P!9SICAL AND PS9C!OPA/!OLO2ICAL
ASPEC/S O% /!E P8LMONA&9 DISEASE
/O !ELP /!E PA/IEN/ &E/8&N /O /!E
!I2!ES/ POSSIBLE %8NC/IONAL CAPACI/9DESPI/E /!E P8LMONA&9 DISEASE
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/!E SPECI%IC 2OALS O%P8LMONA&9 &E!ABILI/A/ION
/O S8PPO&/< IMP&O)E CA&DIOP8LMONA&9 %8NC/IONS AS"ELL AS P&E)EN/ AND /&EA/ COMPLICA/IONS
%OS/E& COMPLIANCE "I/! MEDICAL &E2IMENS
&ED8CE /!E N8MBE& O% EACE&BA/IONS# EME&2ENC9
&OOM )ISI/S# AND !OSPI/ALI;A/IONS ED8CA/E /!E PA/IEN/ /O CON%&ON/ /!E DISEASE
&EALIS/ICALL9
P&EPA&E /!E PA/IEN/ /O /A$E &ESPONSIBILI/9 %O& !IS O&!E& &E!ABILI/A/ION AND "ELL BEIN2
OP/IMI;E PS9C!OSOCIAL %8NC/IONIN2 AND COPIN2MEC!ANISMS
&E/8&N /!E PA/IEN/ /O A MO&E AC/I)E# P&OD8C/I)E#AND EMO/IONALL9 SA/IS%9IN2 LI%E
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/!E BENE%I/S O% /!EP8LMONA&9 &E!ABILI/A/ION
&ED8C/ION IN /!E A)E&A2EN8MBE& O% !OSPI/ALI;A/ION DA9SPE& 9EA&
S8B=EC/I)E IMP&O)EMEN/ INS9MP/OMS AND >8ALI/9 O% LI%E
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DASAR UNTUKLATIHANPERNAFASAN DAN
TERAPI FISIK DADA
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U%tu! &a%&&ua% r"'tr3t+"
$elemahan otot dapat dibantu
oleh latihan otot respirasiMisalnya pada pen+obatan?brosis atau s,lerosis dari chest
cage dan musculaturedan e.e,hilan+nya complience.
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Bentu, latihannya berupalatihan -olunter untu,
penin+,atan -entilasisehin++a ter*adi
penin+,atan a,ti-itas ototuntu, mela,u,an -entilasi
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U%tu! Ga%&&ua% 4$'tru3t+" Adanya ?,sasi dari dada pada posisi
yan+ lebih besar dari normal den+an
penin+,atan functional residualcapacity dan residual volume.
$ondisi tersebut menyebab,andia.ra+manya men*adi @at# otot
inspirasi ,uran+ dapat di +una,an
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3 /erapinya den+an rela,sasi ototabdominal selama inspirasi dan,ontra,si pada otot abdominal
selama e,spirasi3 Bentu, latihan *u+a dapat
den+an berna.as dan+,al
melalui mulut# *u+a dapatdila,u,an den+an berna.aspende, dan dalam
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8nder -entilation
8nder -entilationmenyebab,an respiratori
asidosis dimana COmenin+,at O *umlahnyasedi,it
/erlihat adanya sianosis danpenurunan capilary beds
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/erapinya den+an pemberiante,anan positi. pada *alan udaraselama inspirasi den+an
men++una,an intermiten positivepressure breathing inspirationmachine 'IPPB( selama 6 menit
ditambah den+an pemberianbron,odilator# de,on+estan danmu,oliti, ,e tra,tus respiratorius
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Pada pasien den+an +an++uanobstru,si paru tida, ada usaha
otot untu, mela,u,an-entilasi#sehin++a otot a,sesoristerutama pada leher
ber,ontra,si untu, men+an+,atdada dan *u+a ter*adi ,ontra,siotot abdominal secara simultan
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Chest In*ury
Contoh: pneumothora
/erapi pilihan den+an ?,sasi
tulan+ rusu, IPPB di+una,an seba+ai
treatment pilihan pada chestin*ury den+an under-entilation
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8ntu, men+eluar,an se,retdan benda asin+ di dalamhidun+ perlu diberi,an
,elembaban den+anmen++una,an air sampaiden+an 7 pada suhu tubuh#
/u*uannya untu, mencapai,elembaban yan+ relati.dila,u,an selama menit
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/erapi ?si, untu,mensupport -entilasiden+an cara ,onstra,si
dia.ra+ma pada inspirasidan otot abdominal pada
e,spirasi untu,pen+an+,atan dia.ra+ma
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TERAPI FISIKDADA
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/erapi ?si, dada adalah apli,asi darimetode ?si, pada pera1atanrespiratory dari pasien den+anpenya,it paru Dila,u,an selama
menit /reatmentnya meliputi :
Instru,si untu, rela,sasi dan latihan
perna.asan Mela,u,an postural draina+e
Per,usi dan -ibrasi a+ar ter*adi batu,
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/erapi ini diindi,asi,an pada pasien
den+an COPD yan+ bermani.estasi seba+ai asma# bron,itis#
em?sema# bron,ie,tasis dan cystic ?brosis
Post opersai bedah abdomen atas# tora,s# dan
sistem ,ardio-as,ular Pasien yan+ ter+antun+ pada -entilator
Pasien den+an penya,it neuromus,ular danhilan+nya re@e,s batu, sehin++a tida, mampu
untu, se,resi mu,us /erapi ?si, dada memerlu,an pera1atan
secara intensi.
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POSTURAL DRAINAGE
Di+una,an untu, pasien
yan+ sulit batu, Posisi terlentan+ Leta,an
,epala pasien lebihrendah dari posisi ,a,ipasien se,itar 36
Posisi ini di+una,an untu,drainase basal se+men
Posisi telun+,up den+anposisi ,epala lebih rendah
dari ,a,i untu, drainaseposterior basal se+men
Posisi mirin+ ,anan danmirin+ ,iri untu, drainaselobus ,anan ,iri dan
bron,us
i i
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Pursed lips breathing
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+$rat4%
/e,ni, :
Na.as dalam# tahanbeberapa deti,# -ibrasidiberi,an saat e,spirasi
Satu session latihan#
henda,nya diberi,ansetelah 6 F G na.as dalam
Setelah tinda,an -ibrasidapat dila,u,an postural
draina+e
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PE&C8SSION
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/erapi untu, pasien yan+ a,ut
/erapi ?si, dada dila,u,an
seserin+ mun+,in yaitu setiap *am dalam sampai 0 ,alisehari atau sesuai perintah
do,ter
&outine Chest Physical
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&outine Chest Physical/herapy
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Mist Inhalation
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IPPB
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Chest Physical Therapy
menit
S R A!$
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S't"# R"'pra' A!$at
Ga%&&ua% S't"#
Mu'!u(4'!"("ta(
I i t I ti
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Inspiratory Incenti-eSpirometry
Sustained maimalinspiration 'SMI(
A component o.
bronchial hy+ienetherapy
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Electrophrenic Stimulation
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Electrophrenic Stimulation
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TERIMA KASIH
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