Kuliah Klarifikasi Nursing Care AIDS

7/27/2019 Kuliah Klarifikasi Nursing Care AIDS

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Kuliah KlarifikasiNursing Care of Patients withHIV/AIDS

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


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Anatomic of The Immune System


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Physiology of The Immune System


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Understanding The Immune System


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HIV Antibody Tests

Enzyme-linked immunosorbent assay (ELISA)

test

Western blot testComplete Blood Cell Count/Lymphocyte Count

CD4+ (410 - 1590 sel/ul)

CD8+ (190 - 1140 sel/ul)

Viral Load Testing

100.000 copies/mlhigh risk for AIDS

Laboratory Testing & Diagnostic


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Five Goals of ART

Decrease the amount of virus in theblood.

Support and help the immune system.

Improve quality of life.

Reduce HIV-related illness and death.

Possibly reduce transmission of HIV to

others.


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Nucleoside (and nucleotide) reversetranscriptase inhibitors (NRTIs):

NTRIs inhibit the transcription (change) of

viral RNA into DNA, thereby interfering withviral replication.

Non-nucleoside reverse transcriptase

inhibitors (NNRTIs):

NNRTIs also inhibit the transcription of viralRNA into DNA, but they are chemically

different than NRTIs.


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Protease inhibitors (PIs):

PIs block protease, an enzyme that HIV

requires for replication.

Fusion inhibitors:

Fusion inhibitors disrupt the interaction

between the HIV virus and the cell surface,

preventing the fusion of the HIV virus to the

cell.

These drugs are not widely available and

cannot be taken by mouth.


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ARV drugs


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Medications for HIV Infection

Medication Class Action

Nonnucleoside reversetranscriptase inhibitors

(NNRTIs)

Block active site of HIV reversetranscriptase

Nucleoside/Nucleotide

Reverse

Transcriptase Inhibitors(NRTIs)

Inhibit production of reverse transcriptase

and viral replication

Protease Inhibitors (PIs) Bind to active site of HIV protease enzyme,

which cuts reproduced HIV strands.Interrupt

formation of mature viral particles and

reduceviral replication. Rapid resistance

development if not taken as directed

Fusion Inhibitors Blocks HIV-1 fusion with the CD4+cell

membrane to prevent cell entry


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Cairan

Estimasi rata-rata tubuh orang dewasa akankehilangan 2.5 L cairan per harinya :

Sekitar 1.5 L cairan tubuh keluar melalui urin,

500 ml melalui keluarnya keringat, 400 ml keluar dalam bentuk uap air melalui

proses respirasi (pernafasan) dan

100 ml keluar bersama dengan feces (tinja).

Sehingga berdasarkan estimasi ini, konsumsi

antara 8-10 gelas (1 gelas 240 ml)


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Macro Mineral

Kalsium (Ca)

Fosfor (P)

Magnesium (Mg)

Sulfur (S) Kalium (K)

Klorida (Cl)

Natrium (Na)


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Micro Mineral

Kromium (Cr)

Tembaga (Cu)

Fluoride (F)

Yodium (I) Besi (Fe)

Mangan (Mn)

Silisium (Si) Seng (Zn))


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Natrium (Na)

Minimum kebutuhan untuk orangdewasa berkisar antara 1.3-1.6 gr/hari

(ekivalen dengan 3.3-4.0 gr

NaCl/hari). konsentrasi berkisar antara 135-145

mmol/L. Io


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Kalium (K)

Konsentrasi antara 3.5-5.0 mmol /L.

Kebutuhan minimum kalium

diperkirakan sebesar 782 mg/hari

Konsentrasi total kalium di dalamtubuh diperkirakan sebanyak 2g/kg

berat badan. Nam


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Klorida (Cl)

Dalam jaringan tubuh diperkirakansebanyak 1.1 g/ Kg berat badan

Konsentrasi antara 98-106 mmol / L


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The Cycle of Malnutrition & Infection

in the context of HIV/AIDS

I l i Eff t f S ifi


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Immunologic Effects of Specific

Micronutrient Deficiences


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Body Mass Indeks

BMI =


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Kategori BMI

Kurus Kekurangan BB Berat < 17

Kekurangan BB

Ringan

17 18,4

Normal 18,5 - 25

Gemuk Kelebihan BB Ringan > 25 - 27

Kelebihan BB Berat > 27


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Cara Menghitung Kebutuhan

Kalori BB Idaman x Keb. Kalori BB IdamanAktivitas Ringan Sedang Berat

Gemuk 25 30 35

Normal 30 35 40

Kurus 35 40 40 - 50


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Nursing Diagnosis

Risk for infection related to decreasedimmune function

Impaired gas exchange related to respiratory

infection Acute or chronic pain related to neuropathy,

cancer, infection, or dyspnea

Fatigue related to HIV infection and/or side

effects of treatments


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Diarrhea

DEFINITION: Passage of loose, unformed stools

Related factors Infectious processes,medications

SubjectiveAbdominal pain

Urgency, cramping

Objective

Hyperactive bowel sounds

At least three loose liquid stools per day


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DESIRED OUTCOMES/EVALUATION

CRITERIA

Client Will (Include Specific Time Frame)

Reestablish and maintain normal pattern of

bowel functioning.

Verbalize understanding of causative factorsand rationale for treatment regimen.

Demonstrate appropriate behavior to assist

with resolution of causative factors (e.g.,

proper food preparation or avoidance ofirritating foods).


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risk for deficient Fluid VolumeDEFINITION: At risk for experiencing vascular, cellular, or intracellular

dehydration

RISK FACTORS

Excessive losses through normal

routes (e.g., diarrhea)


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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, moist mucous

membranes, good skin turgor, and prompt

capillary refill


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Client/Caregiver Will (Include Specific TimeFrame)

Identify individual risk factors and appropriate

interventions.

Demonstrate behaviors or lifestyle changes to

prevent development offluid volume deficit.


CRITERIA


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risk for Electrolyte ImbalanceDEFINITION: At risk for change in serum electrolyte levels that may

compromise health.

RISK FACTORS

Fluid imbalance (e.g., dehydration,

water intoxication); diarrhea; vomiting


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CRITERIA

Client Will (Include Specific Time Frame) Display laboratory results within normal

range for individual.

Be free of complications resulting fromelectrolyte imbalance.

Identify individual risks and engage in

appropriate behaviors or lifestyle changes

to prevent or reduce frequency ofelectrolyte imbalances.

imbalanced Nutrition: less than body


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imbalanced Nutrition: less than body

requirementsDEFINITION: Intake of nutrients insufficient to meet metabolic

needs

RELATED FACTORS

Inability to ingest or digest food; inability to

absorb nutrients


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SubjectiveReported food intake less than RDAs

(recommended daily allowances); lack of

food Lack of interest in food; aversion to

eating; reported altered taste sensation;

perceived inability to digest food


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Objective Loss of weight with adequate food intake

Hyperactive bowel sounds; diarrhea

Poor muscle tone


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Objective [Abnormal laboratory studies (e.g., decreased

albumin, total proteins; iron deficiency;

electrolyte imbalances)]


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CRITERIA

Client Will (Include Specific Time Frame) Demonstrate progressive weight gain

toward goal.

Display normalization of laboratory valuesand be free of signs of malnutrition

Verbalize understanding of causative

factors when known and necessary

interventions. Demonstrate behaviors, lifestyle changes to

regain or maintain appropriate weight.


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risk for InfectionDEFINITION: At increased risk for being invaded by pathogenic

organisms

RISK FACTORS Inadequate primary defenses (broken skin,

traumatized tissue, decrease in ciliary

action,stasis of body fluids, change in pH

secretions, altered peristalsis)

Inadequate secondary defenses (e.g.,

decreased hemoglobin, leukopenia,

suppressed inflammatory response) Inadequate acquired immunity;

immunosuppression


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Client Will (Include Specific Time Frame) Verbalize understanding of individual

causative or risk factor(s).

Identify interventions to prevent or reducerisk of infection.

Demonstrate techniques, lifestyle changes

to promote safe environment.


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FatigueDEFINITION: An overwhelming sustained sense of exhaustion and

decreased capacity for physical and mental work at usual level

SubjectiveVerbalization of an unremitting or overwhelming

lack of energy; inability to maintain usual

routines or level of physical activity

Perceived need for additional energy to

accomplish routine tasks; increase in rest

requirements

Tired; inability to restore energy even after sleep

Feelings of guilt for not keeping up with

responsibilities

Increase in physical complaints


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Objective Lethargic; listless; drowsy; lack of

energy

Decreased performance,


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Client Will (Include Specific Time Frame) Report improved sense of energy.

Identify basis of fatigue and individual areas

of control. Perform activities of daily living (ADLs) and

participate in desired activities at level of

ability.

Participate in recommended treatmentprogram.


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Activity IntoleranceDEFINITION: Insufficient physiological or psychological energy to endure or

complete required or desired daily activities

SubjectiveVerbal report of fatigue, weakness

Exertional discomfort, dyspnea

[Verbalizes no desire for and/or lack of interest inactivity]

Objective

Abnormal heart rate or blood pressure responseto activity

Electrocardiographic changes reflecting

arrhythmias or ischemia [Pallor, cyanosis]


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Client Will (Include Specific Time Frame) Identify negative factors affecting activity

tolerance and eliminate or reduce their effects

when possible.

Use identified techniques to enhance activity

tolerance.

Participate in necessary/desired activities.

Report measurable increase in activity tolerance. Demonstrate a decrease in physiological signs of

intolerance (e.g., pulse, respirations, and blood

pressure remain within clients usual range).

ne ec ve am y erapeu c eg men


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y p gManagementDEFINITION: 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;

Kuliah Klarifikasi Nursing Care AIDS

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