Penatalaksanaan Fisioterapi pada Pneumonia.
Definisi
Pneumonia merupakan suatu kondisi infeksi saluran pernapasan akut yang umum terjadi dan menginfeksi bagian alveoli dan bronchial distal dari paru-paru. Pneumonia merupakan masalah kesehatan utama dengan tingkat morbiditas yang tinggi dan mortalitas jangka pendek dan jangka panjang pada semua kelompok usia di dunia.(1) Berdasarkan data dari 2019 Global Burden of Diseases (GBD), infeksi saluran napas bawah termasuk pneumonia dan bronchitis terjadi pada 489 juta orang di seluruh dunia. Anak-anak dibawah usia 5 tahun dan orang dewasa usia diatas 70 tahun adalah populasi yang paling sering mengalami pneumonia. Pneumonia secara umum dibagi menjadi dua, yaitu:(1,2)
1. Community-Acquired Pneumonia (CAP)
Merupakan infeksi paru-paru akut yang mengenai alveolus dan terjadi pada pasien tanpa adanya kontaminasi dari pelayanan kesehatan. CAP mempengaruhi pasien dari segala usia di seluruh spektrum kesehatan, dengan organisme tertentu memiliki kecenderungan untuk subkelompok pasien tertentu. Patogen umum penyebab terjadinya CAP adalah:(2)
- Rhinovirus
- Virus influenza
- Streptococcus pneumoniae
- Mycoplasma pneumoniae
- Staphylococcus aureus
- Legtonella pneumoniae
- Haemophilus influenzae
- Chamydophila pneumoniae
- Moraxella catarrhalls
2. Hospital-Acquired Pneumonia (HAP)
Hospital-acquired pneumonia (HAP) didefinisikan sebagai infeksi yang terjadi setelah minimal 48 jam mendapat pelayanan kesehatan atau dirawat di rumah sakit. Ventilation-acquired pneumonia (VAP) merupakan subkategori dari HAP dna terjadi pada pasien yang menerima tindakan ventilasi mekanis.(3) Patogen umum penyebab terjadinya HAP: (1)
- Staphylococcus aureus (termasuk methicillin-susceptible S.aureus (MSSA) dan methicillin-resistant S. aureus (MRSA)
- Enterobacterales
- Non-fermenting gram-negative bacilli (contohnya, Pseudomonas aeruginosa)
- Acinetobacter spp
Terdapat beberapa faktor risiko dari pneumonia yang meningkat bersamaan dengan usia dan adanya komorbiditas, seperti :(3)
- Chronic obstructive pulmonary disease (COPD)
- Bronkiektasis
- Penyakit jantung dan ginjal
- Epilepsi
- Dementia
- Stroke
Faktor risiko yang berhubungan dengan gaya hidup adalah : (3)
- Smoke
- Alkohol
- Malnutrisi kronis
- Kebersihan gigi dan mulut yang kurang baik
Patofisiologi Pneumonia
Sebagian besar kasus pneumonia disebabkan oleh mikroorganisme seperti bakteri dan virus (Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, dan Legtonella pneumoniae)(1) yang berpindah dari nasofaring ke saluran pernapasan bagian bawah. Bakteri memasuki nasofaring setelah keluar dari individu yang terjangkit. Patogen dapat menyebar antar individu melalui kontak langsung atau tidak langsung (droplet dan aerosol).
Keberhasilan transmisi dipengaruhi oleh kondisi lingkungan, berkumpulnya orang dan faktor lainnya. Perlekatan patogen pada epitel saluran napas bagian atas merupakan langkah pertama yang penting dalam kolonisasi dan infeksi selanjutnya. Saat memasuki nasofaring, bakteri keluar dari mukus dan menempel pada epitel menggunakan berbagai strategi untuk menghindari pembersihan inang seperti meniru sel inang atau molekul yang berbeda secara antigen (yaitu, molekul yang meniru struktur molekul inang atau dapat memvariasikan antigennya untuk menghindari pengenalan oleh sel imun inang).(1) Mikroorganisme masuk ke saluran udara bagian bawah melalui inhalasi atau dengan penyemaian pleura dari darah. Infeksi terjadi ketika pertahanan individu (imun) terganggu dan/atau telah terpapar mikroorganisme yang sangat virulen atau inokulum besar. Beberapa faktor dapat memfasilitasi transisi dari kolonisasi ke infeksi adalah infeksi virus sebelumnya dan penyakit paru-paru kronis, hilangnya integritas penghalang dan gangguan imun karena interaksi kompleks antara struktur anatomi, mikroorganisme (dan faktor virulensinya) dan sistem imun individu.(1)
Dikatakan pneumonia ketika terjadinya infeksi alveolus ketika sistem imun tubuh tidak mampu membersihkan patogen dari saluran napas bagian bawah dan alveolus. Faktor inflamasi lokal dan sitokin menyebabkan kerusakan tambahan pada parenkim paru dan menyebabkan peradangan sistemik, yang menyebabkan gejala sekunder seperti demam, menggigil, dan kelelahan.
Tanda dan Gejala Pneumonia
Tanda dan gejalan dari pneumonia adalah:(2)
- Batuk berdahak
- Dyspnea
- Nyeri dada
- Fever
- Hypoxemia
- Fatigue
- Nyeri perut
- Headache
Penderita pneumonia juga mungkin mengalami gejala yang tidak berhubungan dengan saluran pernapasan, seperti:(3)
- Malaise
- Myalgia
- Bingung
- Diare
Dalam menegakan diagnosis pneumonia, tdak bisa dilakukan hanya dengan menilai tanda dan gejalanya saja. Dibutuhkan hasil radiographic untuk mengonfirmasi apakan pasien benar-benar mengalami pneumonia.
Pemeriksaan Fisioterapi Pneumonia
Pemeriksaan fisioterapi pneumonia yang dapat dilakukan diantaranya :
1. Inspeksi
Inspeksi adalah pemeriksan yang dilakukan dengan cara melihat pasien tanpa memberikan intervensi apapun. Yang perlu diperhatikan:
- Adanya dyspnea (pemendekan napas).
- Takipnea.
- Adanya penggunaan otot bantu napas.
- Adanya retraksi (pada suprasternal, subcostal, subternal, dan intercostal).
- Nasal faring.
- Adanya cyanosis.
- Stridor.
- Perubahan dalam status mental, seperti agitasi, kebingungan, gangguan orientasi, dan kemampuan untuk mengikuti perintah.
- Ekspresi wajah.
- Postur tubuh pasien.
- Bentuk dada pasien.
- Posisi trakea (midline atau berdeviasi ke salah satu sisi).
- Kesimetrisan dada saat bernapas.
- Gerakan tambahan saat bernapas.
- Pola napas pasien. Kecepatan napas normal pada orang dewasa adalah 12 – 20 kali/menit, pada anak-anak 15 – 25 kali/menit, balita 20-40 kali/menit, dan bayi 30-60 kali/menit.
- Adanya batuk. Karakteristik batuk pasien, produksi dahak, lingkup gerak sendi pasien, dan mobilitas pasien.
2. Auskultasi
Auskultasi adalah pemeriksaan paru-paru untuk mendengar suara paru-paru pasien menggunakan stetoskop. Hal-hal yang perlu diperhatikan pada auskultasi adalah suara jantung dan suara napas. Auskultasi dilakukan pada kedua sisi tubuh.
3. Palpasi
Palpasi adalah pemeriksaan dengan cara memegang anggota tubuh pasien dengan tangan dan merasakan perubahan yang ada pada tubuh pasien.Hal-hal yang perlu diperhatikan pada palpasi adalah deviasi trakea, pola napas utama pasien, aktivitas otot pernapasan, pergerakan dinding dada, nyeri sentuh, fremitus, dan denyut nadi pasien.
4. Perkusi
Pada pemeriksaan perkusi, terapis akan mengetahui adanya abnormalitas pada paru-paru dalam hubungannya dengan perubahan densitas paru-paru. Pemeriksan ini dilakukan dengan cara mengetuk dada menggunakan jari tangan. Dalam pemeriksaan ini, hal yang harus diperhatikan adalah suara yang dihasilkan dari ketukan jari.
Baca Juga : Penanganan Fisioterapi pada Tuberculosis Paru
Reference
- Torres, A., Cilloniz, C., Niederman, M. S., Menéndez, R., Chalmers, J. D., Wunderink, R. G., & van der Poll, T. (2021). Pneumonia. Nature reviews. Disease primers, 7(1), 25. https://doi.org/10.1038s41572-021-00259-0
- Rider, A. C., & Frazee, B. W. (2018). Community-Acquired Pneumonia. Emergency medicine clinics of North America, 36(4), 665–683. https://doi.org/10.1016/j.emc.2018.07.001
- Lanks, C. W., Musani, A. I., & Hsia, D. W. (2019). Community-acquired Pneumonia and Hospital-acquired Pneumonia. The Medical clinics of North America, 103(3), 487–501. https://doi.org/10.1016/j.mcna.2018.12.008
- MLA (7th ed.) Watchie, Joanne. Cardiopulmonary Physical Therapy: A Clinical Manual. Philadelphia: W.B. Saunders, 1995.
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