Kuliah Klarifikasi Nursing Care of Patients with HIV/AIDS

Kuswantoro Rusca Putra, S.Kp.,M.Kep

Anatomic of The Immune System

Physiology of The Immune System

Understanding The Immune System

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000 copies/ml  low risk for AIDS • 10.000 copies/ml high risk for AIDS  .000 copies/ml  the risk double • > 100.Laboratory Testing & Diagnostic HIV Antibody Tests  Enzyme-linked immunosorbent assay (ELISA) test  Western blot test  Complete Blood Cell Count/Lymphocyte Count  CD4+ (410 .1590 sel/ul)  CD8+ (190 .000 – 100.1140 sel/ul)  Viral Load Testing • <10.

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Reduce HIV-related illness and death. Possibly reduce transmission of HIV to others. Support and help the immune system. . Improve quality of life.Five Goals of ART      Decrease the amount of virus in the blood.

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but they are chemically different than NRTIs.Nucleoside (and nucleotide) reverse transcriptase inhibitors (NRTIs): NTRIs inhibit the transcription (change) of viral RNA into DNA. . Non-nucleoside reverse transcriptase inhibitors (NNRTIs): NNRTIs also inhibit the transcription of viral RNA into DNA. thereby interfering with viral replication.

Fusion inhibitors:  Fusion inhibitors disrupt the interaction between the HIV virus and the cell surface.  These drugs are not widely available and cannot be taken by mouth. preventing the fusion of the HIV virus to the cell.Protease inhibitors (PIs):  PIs block protease. an enzyme that HIV requires for replication. .

ARV drugs .

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Interrupt formation of mature viral particles and reduce viral replication.Medications for HIV Infection Medication Class Nonnucleoside reverse transcriptase inhibitors (NNRTIs) Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) Protease Inhibitors (PIs) Action Block active site of HIV reverse transcriptase Inhibit production of reverse transcriptase and viral replication Bind to active site of HIV protease enzyme. Rapid resistance development if not taken as directed Blocks HIV-1 fusion with the CD4+cell membrane to prevent cell entry Fusion Inhibitors . which cuts reproduced HIV strands.

 400 ml keluar dalam bentuk uap air melalui proses respirasi (pernafasan) dan  100 ml keluar bersama dengan feces (tinja).5 L cairan tubuh keluar melalui urin.5 L cairan per harinya :  Sekitar 1.  500 ml melalui keluarnya keringat.Cairan Estimasi rata-rata tubuh orang dewasa akan kehilangan 2. Sehingga berdasarkan estimasi ini. konsumsi antara 8-10 gelas (1 gelas •240 ml) .

Macro Mineral        Kalsium (Ca) Fosfor (P) Magnesium (Mg) Sulfur (S) Kalium (K) Klorida (Cl) Natrium (Na) .

Micro Mineral         Kromium (Cr) Tembaga (Cu) Fluoride (F) Yodium (I) Besi (Fe) Mangan (Mn) Silisium (Si) Seng (Zn)) .

konsentrasi berkisar antara 135145 mmol/L. Io .6 gr/hari (ekivalen dengan 3.3-1.0 gr NaCl/hari).3-4.Natrium (Na) Minimum kebutuhan untuk orang dewasa berkisar antara 1.

0 mmol /L. Nam .5-5. Kebutuhan minimum kalium diperkirakan sebesar 782 mg/hari Konsentrasi total kalium di dalam tubuh diperkirakan sebanyak 2g/kg berat badan.Kalium (K) Konsentrasi antara 3.

1 g/ Kg berat badan Konsentrasi antara 98-106 mmol / L .Klorida (Cl) Dalam jaringan tubuh diperkirakan sebanyak 1.

The Cycle of Malnutrition & Infection in the context of HIV/AIDS .

Immunologic Effects of Specific Micronutrient Deficiences .

Body Mass Indeks BMI = .

27 > 27 Normal Gemuk Kelebihan BB Ringan Kelebihan BB Berat .Kurus Kategori Kekurangan BB Berat Kekurangan BB Ringan BMI < 17 17 – 18.4 18.5 .25 > 25 .

Kalori Berat BB Idaman x Sedang BB Gemuk Cara Menghitung Kebutuhan Kalori Idaman 25 30 35 30 35 40 35 40 40 .Aktivitas Ringan Keb.50 Normal Kurus .

cancer. infection. or dyspnea Fatigue related to HIV infection and/or side effects of treatments .Nursing Diagnosis     Risk for infection related to decreased immune function Impaired gas exchange related to respiratory infection Acute or chronic pain related to neuropathy.

Diarrhea DEFINITION: Passage of loose. medications Subjective Abdominal pain Urgency. cramping Objective  Hyperactive bowel sounds  At least three loose liquid stools per day . unformed stools Related factors Infectious processes.

DESIRED OUTCOMES/EVALUATION CRITERIA Client Will (Include Specific Time Frame) Reestablish and maintain normal pattern of bowel functioning. Verbalize understanding of causative factors and rationale for treatment regimen.. Demonstrate appropriate behavior to assist with resolution of causative factors (e. proper food preparation or avoidance of irritating foods).g. .

.risk for Volume deficient Fluid DEFINITION: At risk for experiencing vascular. or intracellular dehydration RISK FACTORS  Excessive losses through normal routes (e. diarrhea) . cellular.g.

moist mucous membranes. and prompt capillary refill .DESIRED OUTCOMES/EVALUATION CRITERIA Client Will (Include Specific Time Frame) • Maintain fluid volume at a functional level as evidenced by individually adequate urinary output with normal specific gravity. stable vital signs. good skin turgor.

.  Demonstrate behaviors or lifestyle changes to prevent development of fluid volume deficit.DESIRED OUTCOMES/EVALUATION CRITERIA Client/Caregiver Will (Include Specific Time Frame)  Identify individual risk factors and appropriate interventions.

vomiting . diarrhea.. RISK FACTORS Fluid imbalance (e.g. water intoxication).risk for Electrolyte Imbalance DEFINITION: At risk for change in serum electrolyte levels that may compromise health. dehydration.

 Identify individual risks and engage in appropriate behaviors or lifestyle changes to prevent or reduce frequency of electrolyte imbalances.DESIRED OUTCOMES/EVALUATION CRITERIA Client Will (Include Specific Time Frame)  Display laboratory results within normal range for individual.  Be free of complications resulting from electrolyte imbalance. .

imbalanced Nutrition: less than body requirements RELATED FACTORS Inability to ingest or digest inability to absorb nutrients DEFINITION: Intake of nutrients insufficient to meet metabolic needs food. .

perceived inability to digest food .Subjective Reported food intake less than RDAs (recommended daily allowances). lack of food Lack of interest in food. reported altered taste sensation. aversion to eating.

diarrhea Poor muscle tone .Objective Loss of weight with adequate food intake Hyperactive bowel sounds.

electrolyte imbalances)] . decreased albumin.Objective [Abnormal laboratory studies (e. iron deficiency.g. total proteins..

 Display normalization of laboratory values and be free of signs of malnutrition  Verbalize understanding of causative factors when known and necessary interventions.DESIRED OUTCOMES/EVALUATION CRITERIA Client Will (Include Specific Time Frame)  Demonstrate progressive weight gain toward goal. .  Demonstrate behaviors. lifestyle changes to regain or maintain appropriate weight.

suppressed inflammatory response)  Inadequate acquired immunity. leukopenia. immunosuppression . traumatized tissue.stasis of body fluids.g. decrease in ciliary action. change in pH secretions..risk for Infection DEFINITION: At increased risk for being invaded by pathogenic organisms RISK FACTORS  Inadequate primary defenses (broken skin. decreased hemoglobin. altered peristalsis)  Inadequate secondary defenses (e.

Client Will (Include Specific Time Frame)  Verbalize understanding of individual causative or risk factor(s). lifestyle changes to promote safe environment. .  Identify interventions to prevent or reduce risk of infection.  Demonstrate techniques.

inability to restore energy even after sleep Feelings of guilt for not keeping up with responsibilities Increase in physical complaints . inability to maintain usual routines or level of physical activity Perceived need for additional energy to accomplish routine tasks. increase in rest requirements Tired.Fatigue DEFINITION: An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level Subjective Verbalization of an unremitting or overwhelming lack of energy.

drowsy. .Objective Lethargic. listless. lack of energy Decreased performance.

Perform activities of daily living (ADLs) and participate in desired activities at level of ability. Participate in recommended treatment program. . Identify basis of fatigue and individual areas of control.Client Will (Include Specific Time Frame) Report improved sense of energy.

cyanosis] .Activity Intolerance DEFINITION: Insufficient physiological or psychological energy to endure or complete required or desired daily activities Subjective Verbal report of fatigue. dyspnea [Verbalizes no desire for and/or lack of interest in activity] Objective Abnormal heart rate or blood pressure response to activity Electrocardiographic changes reflecting arrhythmias or ischemia [Pallor. weakness Exertional discomfort.

pulse.  Participate in necessary/desired activities. .  Demonstrate a decrease in physiological signs of intolerance (e. and blood pressure remain within client’s usual range).Client Will (Include Specific Time Frame)  Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible.g.  Report measurable increase in activity tolerance. respirations.  Use identified techniques to enhance activity tolerance..

ineffective family Therapeutic Regimen Management DEFINITION: Pattern of regulating and integrating into family processes a programfor treatment of illness and the sequelae of illness that is unsatisfactory for meeting specific health goals Subjective  Verbalizes difficulty with therapeutic regimen  Verbalizes desire to manage the illness Objective  Inappropriate family activities for meeting health goals  Acceleration of illness symptoms of a family member  Failure to take action to reduce risk factors. lack of attention to illness .