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ASUHAN KEPERAWATAN PADA KLIEN YANG

MENGALAMI GANGGUAN SISTEM
HEMATOPOETIK DAN IMMUNITAS
Kusman Ibrahim, PhD. Kusman Ibrahim, PhD. Kusman Ibrahim, PhD. Kusman Ibrahim, PhD.
BAGIAN KEPERAWATAN KLINIK
FAKULTAS ILMU KEPERAWATAN
UNIVERSITAS PADJADJARAN
Blood (7-10%BW, 5-6 L:
Plasma (55%)
Cells (40-45%)
Cells:
RBCs (Erythrocyte)
WBCs (Leukocyte)
Platelets (Thrombocyte)
Hematology system Hematology system
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Blood Development
Pathophysiology of Hematology Pathophysiology of Hematology
System System
Most hematologic diseases reflect a defect in
the hematopoietic, hemostatic, or RES
systems.
The defect can be quantitative (eg, increased
or decreased production of cells), qualitative
(eg, the cells that are produced are defective
in their normal functional capacity), or both.
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Anemia Anemia
Anemia is a symptom of
an underlying condition,
such as loss of blood
components, inadequate
elements, or lack
of required nutrients for
the formation of blood
cells, that results in
decreased oxygen-
carrying capacity of the
blood.
Anemia Anemia
Types of anemia: Types of anemia:
Iron deficiency (ID), the result of inadequate (ID), the result of inadequate
absorption or excessive loss of iron; absorption or excessive loss of iron;
Pernicious (PA), the result of a lack of Pernicious (PA), the result of a lack of
the the intrinsic factor essential for the absorption intrinsic factor essential for the absorption
of vitamin B of vitamin B12 12; ;
Aplastic Aplastic, due to failure of bone marrow; , due to failure of bone marrow;
Hemolytic, due Hemolytic, due to red blood cell (RBC) to red blood cell (RBC)
destruction destruction
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Anemia Anemia
TYPE CAUSE
Sickle Cell
Disease
Autosomal recessive inheritance of two defective
genes for hemoglobin synthesis
G6PD
Deficiency
X-linked recessive inherited deficiency of the enzyme
glucose-6-phosphate dehydrogenase
Autoimmune
Hemolytic
Abnormal immune function; immune reactive cells
fail to recognize own blood cells as self cells
Iron
Deficiency
Inadequate iron intake (iron deficient diet, chronic
alcoholism, malabsorption syndromes, partial
gastrectomy);
Or rapid metabolic activity (pregnancy, adolescence,
infection)
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Anemia Anemia
TYPE CAUSE
Vitamin B
12
Deficiency
Dietary deficiency
Failure to absorb vitamin B
12
from intestinal tract
(partial gastrectomy, pernicious anemia)
Folic Acid
Deficiency
Dietary deficiency
Malabsorption syndromes
Drugs (Oral contraceptives, anticonvulsants,
methotrexate)
Aplastic Anemia
Exposure to myelotoxic agents
(radiation, benzene, chloromycetin, alkylating
agents, anti-metabolities, sulfonamides, insecticides)
Viral Infections [unproven]
(Epstein-Barr virus, hepatitis B, cytomegalovirus)
NURSING PRIORITIES
1. Enhance tissue perfusion
2. Provide nutritional/fluid needs
3. Prevent complications
4. Provide information about disease
process, prognosis, and treatment
regimen
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Primary Nursing Diagnosis Primary Nursing Diagnosis
Imbalanced Nutrition, Less than Body Imbalanced Nutrition, Less than Body
Requirements Requirements related to related to Failure to ingest or Failure to ingest or
inability to digest food/absorb nutrients inability to digest food/absorb nutrients
necessary for formation of normal RBCs necessary for formation of normal RBCs
possibly evidenced by possibly evidenced by Weight loss/weight Weight loss/weight
below normal for age, height, and below normal for age, height, and
build; build; Decreased triceps skin Decreased triceps skin--fold fold
measurement; measurement; Changes in gums, oral mucous Changes in gums, oral mucous
membranes; and membranes; and Decreased tolerance for Decreased tolerance for
activity, weakness, and loss of muscle tone activity, weakness, and loss of muscle tone
Desired Outcomes Desired Outcomes
1. Demonstrate progressive weight gain or
stable weight, with normalization of
laboratory values.
2. Experience no signs of malnutrition
3. Demonstrate behaviors, lifestyle changes
to regain and/or maintain appropriate
weight.
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Nursing Intervention Nursing Intervention
1. Review nutritional history, including food
preferences.
2. Observe and record patients food intake.
3. Weigh periodically as appropriate (e.g., weekly)
4. Recommend small, frequent meals and/or
between-meal nourishment.
5. Suggest bland diet, low in roughage, avoiding hot,
spicy, or very acidic foods as indicated
6. Have patient record and report occurrence of
nausea/ vomiting, flatus, and other related
symptoms such as irritability or impaired memory.
Nursing Intervention Nursing Intervention
6. Encourage/assist with good oral hygiene; before and
after meals, use soft-bristled toothbrush for gentle
brushing. Provide dilute, alcohol-free mouthwash if oral
mucosa is ulcerated.
7. Consult with dietitian.
8. Monitor laboratory studies, e.g., Hb/Hct, blood
urea nitrogen (BUN), prealbumin/albumin, protein,
transferrin, serum iron, vitamin B12, folic acid, TIBC,
serum electrolytes.
9. Administer medications as indicated, e.g.: Vitamin and
mineral supplements, e.g., cyanocobalamin (vitamin
B12), folic acid (Folvite), ascorbic acid (vitamin C).
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Acute Leukemia
Definition:
a malignant disease of the blood-forming organs,
results when white blood cell (WBC) precursors
proliferate in the bone marrow and lymphatic
tissues. The cells eventually spread to the
peripheral blood and all body tissues.
Leukemia is considered acute when it has a rapid
onset and progression and when, if it is left
untreated, it leads to 100% mortality within days or
months.
Two major forms of acute leukemia: Two major forms of acute leukemia:
-- Lymphocytic leukemia Lymphocytic leukemia
-- Non Non--lymphocytic leukemia lymphocytic leukemia
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Risk Factors Risk Factors
Overexposure to radiation even years before the
development of the disease, particularly if the exposure is
prolonged, is a major risk factor.
Exposure to certain chemicals (benzene), medications
(alkylating agents used to treat other cancers in
particular), and viruses.
Genetic abnormalities such as Down syndrome, albinism,
and congenital immunodeficiency syndrome. People who
have been treated with chemotherapeutic agents for
other forms of cancer have an increased risk for
developing AML. Such cases generally develop within 9
years of chemotherapy..
Nursing care plan: Assessment and
Physical Examination
Risk factors
Occupation
Symptoms: a sudden onset of high fever,
abnormal bleeding (increased bruising, bleeding
after minor trauma, nosebleeds, bleeding gums,
petechiae, and prolonged menses), increased
fatigue and malaise, weight loss, palpitations,
night sweats, and chills.
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Primary Nursing Diagnosis
Risk for infection related to decreased
primary and secondary responses
Nursing Intervention and Treatment Nursing Intervention and Treatment
Four phases:
Induction, intense course of chemotherapy until
complete remission 1 month
Consolidation, modified course of chemotherapy
to eradicate any remaining disease
Continuation or maintenance, may continue for
more than a year, the patient receives small
doses of chemotherapy every 3 to 4 weeks.
Treatment of (CNS) leukemia
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Nursing Intervention and Treatment Nursing Intervention and Treatment
Transfusions with blood component therapy to
control infection and prevent bleeding and
anemia
Bone marrow transplantation (BMT)
Peripheral blood stem cell transplant (SCT) or
peripheral blood progenitor cell transplant.
Multiple pheresis, or removal of cells from the
blood, provides the stem cells from the patient for
transplantation
Radiation treatment is sometimes used to treat
leukemic cells in the brain, spinal cord, or
testicles
Nursing Intervention and Treatment Nursing Intervention and Treatment
Focus on providing comfort and support, Focus on providing comfort and support,
managing complications, and providing patient managing complications, and providing patient
education education
Provide mouth care to lessen the discomfort from Provide mouth care to lessen the discomfort from
oral lesions. Support the patients efforts to oral lesions. Support the patients efforts to
maintain grooming and a positive body image maintain grooming and a positive body image
Protect the patient from injury and infection Protect the patient from injury and infection
Work with the patient, significant others, and Work with the patient, significant others, and
chaplain to help the patient plan for a terminal chaplain to help the patient plan for a terminal
illness and achieve a compassionate death. illness and achieve a compassionate death.
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Nursing Intervention and Treatment Nursing Intervention and Treatment
Nursing care plan discharge and home health care
guidelines
Health education
Explain the proper administration and potential
side effects of any medications
Encourage the patient to eat a diet high in
calories and protein and to drink at least 2000 mL
of fluids per day
Urge the patient to maintain a realistic but
positive attitude.
KONSEP DASAR SISTEM IMMUN
PENGERTIAN
SEMUA MEKANISME DIDALAM TUBUH YG DIPERGUNAKAN UNTUK
MEMPERTAHANKAN KEUTUHAN TUBUH SERTA MELINDUNGI TUBUH DARI
BERBAGAI BAHAYA
SISTEM IMMUN NONSPESIFIK
DAPAT MENGENAL BENDA ASING WALAUPUN SEBELUMNYA BELUM
PERNAH TERPAPAR BENDA ASING TERSEBUT
SISTEM IMMUN SPESIFIK
MEMERLUKAN PEMAPARAN DG BENDA ASING TERLEBIH DAHULU UNTUK
DAPAT BEREAKSI
ANTIGEN
ZAT YG MAMPU MERANGSANG TIMBULNYA RESPON KEKEBALAN
(SELULER, HUMORAL)
ANTIBODI
ANTIBODI (IMUNOGLOBULIN) MRP MOLEKUL GLIKOPROTEIN YG MEMILIKI
SPESIFIKASI DAN AKTIVITAS BIOLOGIS KETIKA BERAKSI DG ANTIGEN
TERTENTU
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ANATOMI DAN FISIOLOGI
LYMPHOID:
GENERATIVE LYMPHOID ORGAN THYMUS, SUM-SUM TULANG
PERIPHERALORGAN KELENJAR LYMPH, SPLEEN, TONSIL, LIVER
KEL. THYMUS
LETAK; CAVUM MEDIASTINUM, SEBELAH DEPAN ATAS JANTUNG
BERAT; 40 GR
FUNGSI; PEMATANGAN LYMPHOCYTES T (SEL T)
SUM-SUM TULANG
FUNGSI; PEMATANGAN LIMPHOSIT B
DEWASA SUM-SUM TULSNG SKTIF TERUTAMA RUSUH, STERNUM,
PELVIS, TENGKORSK, FEMUR, HUMERUS
KELENJAR LYMPH
TERDAPAT 500 LYMPH NODES DLM TUBUH
BERISI; LIMFOSIT, PLASMA SEL, MAKROFAG, GRANULOSIT, SEDIKIT
ERITROSIT
FUNGSI; MENYARING BENDA ASING, SBG TEMPAT BERKUMPULNYA
SEL-SEL AKTIF DAN ANTIGEN PRODUKSI ANTIBODI
LIMPHA (SPLEEN) FUNGSI HOMEOSTASIS
LIVER SEL KUPFFER
TONSIL DAN PEYERS PATCHES
TONSIL TERLETAK DI OROPHARING
TONSIL BERISI LIMFOSIT & MAKROFAG, SEL MEMORY
PEYERS PATCHES KEL LYMPH DI USUS HALUS
RESPON IMMUN NONSPESIFIK
PERTAHANAN FISIK (KULIT, MEMBRAN MUKOSA, SILIA)
PERTAHANAN KIMIA (ASAM LAMBUNG, SEKRESIKEL SABASEA ASAM
LAKTAT, LYSOZYME)
INTERFERON
INFLAMASI
PHAGOCYTOSIS
INTERFERON:
SUATU PROTEIN YG DIPRODUKSI OLEH MAKROFAG ATAU LYMPHOSIT SBG
RESPON THD INFEKSI VIRUS
TEMPAT PRODUKSI UTAMA INTERFERON; LYMPHOSIT, LYMPHA, HATI, PARU
INFLAMASI
SUATU RESPON KOMPLEKS NONSPESIFIK YG TERJADI KETIKA JARINGAN
MENGALAMI CEDERA OLEH BERBAGAI SEBAB BAIK FISIK, KIMIA,
MIKROORGANISME, TOXIN, ANOXIA
PHAGOSITOSIS
SUATU PROSES MENCERNA SUATU PARTIKEL OLEH SUATU SEL PHAGOSIT
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RESPON IMMUN SPESIFIK
HUMORAL
SELULER
KOMPLEMEN
HUMORAL
SEL B MEMPERODUKSI ANTIBODI; Ig G, Ig A, Ig M, Ig D, Ig E
Ig G (GAMA GLOBULIN), 75% DARI TOTAL ANTIBODI, MENEMBUS PLASENTA,
TRANFER KEKBALAN DARI IBU KE JANIN, MELINDUNGI DR BAKTERI, TOXIN
DAN VIRUS, MENGAKTIFKAN SISTEM KOMPLEMEN
Ig A (15%), DITEMUKAN DI SALIVA, AIR MATA, KOLOSTRUM, BRONKUS, GI,
SKRESI PROSTAT DAN VAGINA. BERFUNGSI MELAWAN INFEKSI LOKAL PD
JARINGAN MUKOSA
Ig M (10%), YG PERTAMA MERESPON THD ANTIGEN
Ig D (0,2%), DITEMUKAN DI MEMBRAN SEL LIMPHOSIT B, BERPERAN SBG
RESEPTOR ANTIGEN UTK MENGAWALI DIFERENSIASISEL B
Ig E (0,004%), TERLIBAT DLM INFEKSI PARASIT, INFLAMASI, ALERGI, DAN
REAKSI HIPERSENSITIF TIPE I SEPERTI PD ASMA, ALERGI ATOPIK
RESPON PRIMER
PERTAMA TERPAPAR ANTIGENI, AB TDK DPT DIDETEKSI SAMPAI 4-10 HR
SETELAH MASUK ANTIGEN
AB DIPRODUKSI, PUNCAK PD 1-10 MINGGU, KMD TURUN
SEBAGIAN SEL B MEMBENTUK SEL MEMORY
RESPON SEKUNDER
TERPAPAR ANTIGEN YG SAMA MENIMBULKAN RESPON SEKUNDER
LEBIH CEPAT, EFISIEN, LEBIH BERKUALITAS
DPT DIDETEKSI DALAM 1-2 HARI
SELLULER
SEL T MEMPRODUKSI:
SEL T HELPER MERANGSANG SEL B UTK MEMPRODUKSI ANTIBODI
SELT SUPRESSOR MENGATUR JUMLAH ANTIBODI YG BEREDAR,
MENGATUR RESPON IMMUN AGAR TDK OVEREAKSI THD ANTIGEN
SEL T SITOTOKSIK MENGHANCURKAN ANTIGEN
KOMPLEMEN
SUATU KOMPLEK PROTEIN (> 25 PROTEIN) DIBENTUK DI HATI DAN
DITEMUKAN DI SERUM DARAH
BERAKSI DG AG-AB LISIS SEL ASING, MENINGKATKAN RESPON IMMUN
PENTING DLM MELAWAN VIRUS DAN BAKTERI
HASIL DARI AKTIVASI KOMPLEMEN; LISIS AG, MENINGKATKAN
PHAGOSITOSIS, MERANGSANG AKTIVITAS SEL T, MENGELUARKAN
CHEMOTACTIC FACTORS, PENGELUARAN HISTAMIN & KININ,
MENINGKATKAN PEMBEKUAN DARAH, PENGELUARAN WBC,
PEMBENTUKAN ANTIBODI
JENIS KEKEBALAN
ALAMI/BAWAAN NONSPESIFIK
DIDAPAT SPESIFIK (AKTIF, PASIF)
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PENGKAJIAN SISTEM IMMUN
DATA SUBJEKTIF
DATA DEMOGRAFI
NAMA
USIA
JENIS KELAMIN
SUKU/ETHNIK, DSB
RIWAYAT KESEHATAN SEKARANG
APA YANG DIKELUHKAN?
BAGIAN TUBUH MANA YANG TERKENA?
BAGAIMANA RASANYA? NYERI?, GATAL?
FAKTOR YANG MEMPERBERAT/MERINGANKAN?
KAPAN DIRASAKAN? BERAPA LAMA?
APAKAH MEMPENGARUHI AKTIVITAS?
PERSEPSI PASIEN THD MASALAH?
RIWAYAT KESEHATAN SEBELUMNYA
PEMBEDAHAN (THYMECTOMY, SPLENECTOMY)
TRANSFUSI DARAH, RADIASI, PENGOBATAN (CORTICOSTEROID)
ALERGI MAKANAN, OBAT, LINGKUNGAN
KELAINAN AUTOIMMUN
GAYA HIDUP/PEKERJAAN
POLA DIET
STRESSOR, PERILAKU KOPING, SUPPORT SYSTEM
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DATA OBJEKTIF
PEMERIKSAAN FISIK
KEADAAN UMUM, POSTUR & GAYA BERJALAN, EKSPRESI WAJAH
KESADARAN ORIENTASI (TEMPAT, WAKTU, ORANG)
KULIT WARNA, CIANOSIS, ERITEMA, RASH (UKURAN, BENTUK,
LOKASI, TEKSTUR), PRURITUS
PEMERIKSAAN FISIK
SENDI TULANG BENGKAK, NODUL NYERI (RHEMATOID ARTHRITIS),
GERAK TERBATAS
KUKU LEPAS DARI DAGINGNYA (ONYCHOLYSIS) PD THIROIDITIS
GGN PENDENGARAN & PENGLIHATAN, CONJUNCTIVA PINK, LEMBAB,
ODEM PERIORBITAL HYPOTHIROID OR RENAL DISEASE
BUNYI NAPAS WHEEZING (ASMA), CRACKLES (ISNA)
KELENJAR LYMPH MEMBESAR?, LOKASI, UKURAN, BENTUK,
TEMPERATUR, KONSISTENSI, MOBILITAS, SIMETRI, PULSASI,
KEMERAHAN, ODEM
GASTROINTESTINAL MUAL, MUNTAH, DIARE
RENAL PERUB. URINE OUTPUT, NYERI PINGGANG/BAK, ODEM, BB
MENINGKAT
NEUROLOGI UMUM KEKUATAN OTOT, KOORDINASI, PERUBAHAN
SENSORI
PEMERIKSAAN DIAGNOSTIK
DARAH SEL DARAH MERAH & PUTIH, HITUNG SEL DARAH
PUTIH, IG (G,A,M,E), LED
RADIOLOGI RONTGEN DADA, MRI, CT
BIOPSI
SKIN TEST
PEMERIKSAAN GEN
BEBERAPA TEST YG BERKAITAN DG SISTEM IMMUN
RHEMATOID FAKTOR (RF)
ANTINUCLEAR ANTIBODI (ANA)
LUPUS ERITHEMATOSIS
WESTERN BLOT (HIV)
ELISA (ENZYME-LINKED IMMUNOSORBENT ASSAY)
CD4+ T CELLS
CD8+ T CELLS
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KONSEP DASAR GANGGUAN SISTEM IMMUN
KLASIFIKASI GGN SISTEM IMMUN:
IMMUNODEFICIENCY
SISTEM IMMUN GAGAL DLM MEMBERIKAN RESPON YANG
ADEQUAT THD ANTIGEN, MIS. AIDS
HIPERSENSITIFITAS
SISTEM IMMUN BEREAKSI BERLEBIHAN THD ANTIGEN
KERUSKAN JARINGAN, MIS. ALERGI, ANAFILAKSIS
AUTOIMMUN
TUBUH BEREAKSI THD ANTIGEN YG BERASAL DARI TUBUH
SENDIRI, MIS. RA, SLE
GAMMOPATHIES
PRODUKSI ABNORMAL DARI IMMONOGLOBULIN, MIS. MULTIPLE
MYELOMA
TIPE-TIPE REAKSI HIPERSENSITIFITAS
TIPE I: ANAFILAKTIK
TERJADI SEGERA (IMMEDIATE)
DPT MENGANCAM KEHIDUPAN
ALERGEN MENSTIMULASI IG. E
DEGRANULASI SEL MAST HISTAMIN PERMEABILITAS
PEMBULUH DARAH MENINGKAT ODEM, URTIKARIA
TIPE II: SITOLITIK/SITOTOKSIK
REAKSI ALERGEN DG IG. M & IG. G MENEMPEL PADA
PERMUKAAN SEL (BIASANYA SEL DARAH MERAH) LISIS &
RUSAK. CONTOH; ANEMIA HEMOLITIK AKIBAT OBAT
(PENICILLIN, QUININE, QUINIDINE) ATAU KETIDAKCOCOKAN
DG DARAH PADA TRANSFUSI
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TIPE III: KOMPLEK IMMUN
ANTIGEN YG DAPAT LARUT BEREAKSI DG ANTIBODI (IG.G)
MEMBENTUK KOMPLEK IMMUN YG MASUK KE DLM
JARINGAN TUBUH DAN DARAH
CONTOH; SERUM SICKNESS DEMAM, MALAISE, RASH,
EDEM PD MUKA, LEHER & SENDI, ARTHRALGIA,
LYMPHADENOPATHY DAN SPLENOMEGALY
TIPE II: MEDIASI SEL
REAKSI LAMBAT (SAMPAI 24 JAM)
REAKSI ANTIGEN DG SEL T MELEPASKAN LYMPHOKIN
MEMULAI SERANGKAIAN REAKSI INFLAMASI
CONTOH; SKIN TEST, REAKSI PENOLAKAN GRAFT
(TRANSPLANTASI)
AIDS (ACQUIRED IMMUNODEFICIENCY SYNDROME) MERUPAKAN
SUATU TAHAP AKHIR DARI KELAINAN FUNGSI IMMUN YANG
KRONIK DAN PROGRESIF YANG DISEBABKAN OLEH VIRUS HIV
DIAGNOSIS AIDS (CDC):
CD4+ T LYMPHOSIT < 200 SEL/MICROLITER, ATAU
CD4+ T LYMPHOSIT < 14% TOTAL LYMPHOSIT, DAN
INFEKSI OPORTUNISTIK
PENYEBAB:
HIV (HUMAN IMMUNODEFICIENY VIRUS) RETROVIRUS, ADA 2
TIPE; HIV-1(ASIA, EROPA, NEGARA2 BARAT) & HIV-2 (AFRIKA
BARAT)
SANGAT LEMAH MATI DI LUAR TUBUH MANUSIA
MERUSAK SEL T HELPER & SEL TUBUH LAINNYA
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Kasus AIDS pertama : di Bali tahun 1987
Di Jabar tahun 1989
Di Indonesia 1987 s/d Desember 2011 :
Pengidap HIV (+) : 76.879 orang
Pengidap AIDS : 29.879 orang
Di Jabar s/d Sept. 2011 No 4 terbesar
Pengidap HIV (+) : 3.925 orang
Pengidap AIDS : 2.354 orang
Di Kota Bandung s/d April 2011: 2.380 HIV/AIDS
Penularan : IDUs (15,3 %), heteroseksual (49,5%),
homoseksual (4,8%).
Usia: 25 49 th (73,7%), 20 24 th (14,8%), > 50 th
(4,5%)
PATHOFISIOLOGI
HIV SEL TUBUH COVERNYA RUSAK MENGGUNAKAN ENZIM
RESERVE TRANSCIPTASE MENEKAN SEL MANUSIA UTK PRODUKSI
DNA BARU DARI RNA VIRUS DNA BARU BERSATU KE DNA SEL
MANUSIA SEL MANUSIA MEMBENTUK BANYAK PARTIKEL VIRUS
MENYEBAR KE SYSTEM LYMPHOID
HIV MENEMPEL KE SEL IMMUN MLL RESEPTOR CD4 (LYMPHOCYTE,
MACROPHAGE)
TARGET UTAMA HIV CD4+ T LYMPHOCYTE KERUSAKAN
PROGRESSIF RESPON SISTEM IMMUN
DPT BERKEMBANG SYNDROME MONONUCLEOSIS; DEMAM, RASH,
NYERI SENDI, LYMPHADENOPATHY, KELELAHAN
TAHAP LATEN: VIRUS MASIH DI KELENJAR LYMPH, LIVER, LIMPHA,
TERUS BEREPRODUKSI, TERJADI PENURUNAN CD4+ T LYMFOSIT,
PENDERITA DISEBUT TERINFEKSI HIV (HIV +)
PERIODE DARI INFEKSI SP AWAL GEJALA BERVARIASI 8 12 TH,
PADA TAHAP GEJALA AWAL: TAMPAK GEJALA MELEMAHNAYA SISTEM
IMMUN, SEMAKIN BERAT INFEKSI OPORTUNISTIK DAN KANKER
PENDERITA DIDIAGNOSIS AIDS
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PERJALANAN PENYAKIT PERJALANAN PENYAKIT
Tertular
HIV
Periode
jendela
HIV+ AIDS
0
1-6
Bulan
4-10
Tahun
1-2
Tahun
HIV Life Cycle HIV Life Cycle
HIV
RNA RNA
DNA DNA
ds DNA ds DNA
RT RT
Integrase Integrase
Transcription Transcription
Proviral DNA Proviral DNA
Spliced mRNA Spliced mRNA
mRNA mRNA
Genomic RNA Genomic RNA
Polyprotein Polyprotein
Protein Protein
Protease

vpr
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PERJALANAN GEJALA PENYAKIT HIV PERJALANAN GEJALA PENYAKIT HIV
FASE LATEN AIDS
HIV
AIDS
ACUT
RETRO-
VIRAL
SERO
KON
VERSI
ASIMP
TOMATIC
2-3 MGG
1,3 TH SAMPAI 10 TH
MATI
6 6 12 Mg 12 Mg
POLA PENULARAN
MELALUI DARAH TERINFEKSI, SEMEN, SEKRESI VAGINA, ASI
CARA; SEXUAL (ANAL, VAGINAL, ORAL), PARENTHERAL
(SHARING NEEDLE, TRANSFUSI), PERINATAL (TRANSPLASENTA,
MENYUSUI)
TANDA & GEJALA:
TAHAP AWAL SETELAH TERINFEKSI:
TIDAK ADA GEJALA ATAU SYNDROME MONONUCLEOSIS
MUNCUL SEKITAR 6 12 MINGGU SETELAH TERPAPAR HIV,
BERLANGSUNG BBRP HARI SAMPAI BBRP MINGGU
TAHAP SYMPTOMATIK:
NAPAS PENDEK, DEMAM, BB MENURUN, FATIGUE, KERINGAT
MALAM, PERSISTEN DIARE, ULKUS ORAL/VAGINA, KULIT KERING
& LESI, PERIPHERAL NEUROPATHY, VARICELLA, KEJANG,
DIMENSIA
TAHAP AKHIR: INFEKSI OPPRTUNISTIK
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KOMPLIKASI:
AIDS WASTING SYNDROME; BB > 10%, CHRONIC WEAKNESS,
DEMAM > 30 HARI, DIARE KRONIK > 30 HR
FAKTOR YG MEMPERBERAT; KURANG NAFSU MAKAN, LESI PD
MULUT, MALABSORPSI, INFEKSI GI, DIARE
INFEKSI OPPORTUNISTIK; CANDIDA ALBICANS, CYTOMEGALOVIRUS,
PNEUMOCYSTIS CARINII PNEUMONIA, TUBERCULOSIS, INFEKSI
VIRUS, SARCOMA KAPOSI, AIDS DIMENSIA COMPLEX)
DIAGNOSTIK:
HIV ANTIBODI TEST TDK DITEMUKAN DLM 3 MINGGU 3 BULAN
ATAU LEBIH DLM BEBERAPA KASUS
POLA PEMERIKSAAN; ELISA (ENZYME-LINKED IMMUNOABSORBENT
ASSAY), (+) DIULANG (+) WESTERN BLOT (+) HIV
ANTIBODI (+)
PEMERIKSAAN DARAH LENGKAP; DIULANG 3-4 BULAN ATAU LEBIH
SERING BILA KONDISI KLINIS TDK STABIL
CD+/CD8+ (N RASIO CD4+/CD8+ 2:1, N CD4+; 500-1600 SEL/MM)
VIRAL LOAD
GENERAL TEST; SYPHILIS, HEPATITIS
PENGOBATAN
TUJUAN MENEKAN PERKEMBANGBIAKAN HIV,
MENGATASI INFEKSI OPORTUNISTIK, DAN KANKER
TERAPI ANTIRETROVIRAL: NRTIS, NNRTIS,
PROTEASE INHIBITORS , FUSION/ENTRY INHIBITORS.
ANTIRETROVIRAL THERAPY 50% PENURUNAN
TOTAL HIV ANTIBODI
PENGOBATAN BERLANGSUNG SEUMUR HIDUP, DAN
HARUS SESUAI YANG DIINSTRUKSIKAN, JANGAN
ADA DOSIS YANG TERLEWAT ATAU MELEBIHI
DOSIS.
EFEK SAMPING : SAKIT KEPALA, MUAL, MUNTAH,
LIPODYATROPHY (PENGURANGAN LAPISAN LEMAK)
MENGGANGGU KETAATAN PENDERITA DALAM
MENJALANI PENGOBATAN
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MEKANISME KERJA ART;
MENCEGAH VIRUS MENEMPEL PADA RESEPTOR
CD4+ LIMFOSIT
MENGGANGGU PROSES PEMBUKAAN COVER
VIRUS AGAR TDK MENYATU KE SEL DNA
MENGHAMBAT RT
MEMUTUS PENGATURAN DAN AKTIVASI PROTEIN
YG TERLIBAT DLM TRANSLASI DAN AKTIVASI
PROTEIN RNA
MENHAMBAT PROTEASE
MENCEGAH PENYEMPURNAAN BENTUK VIRUS
PENGELOLAAN KEPERAWATAN
PENGKAJIAN:
RIWAYAT SEKSUAL; PERILAKU SEKSUAL, PASANGAN SEJENIS,
LAWAN JENIS, SERING BERGANTI PASANGAN
PENGGUNAAN OBAT-OBAT IV, TRANSFUSI, JARUM SUNTIK SECARA
BERGANTIAN
STATUS NUTRISI; NAFSU MAKAN , BB , LESU, LEMAH, MATA
BERKUNANG-KUNANG
STATUS RESPIRASI; NAPAS CEPAT & PENDEK, BATUK, SPUTUM (+),
KERINGAT DINGIN, GELISAH, CYANOSIS
STATUS NEUROLOGIS; KEJANG, BINGUNG, DIMENSIA, GELISAH,
KELUMPUHAN, DISORIENTASI
KESEIMBANGAN CAIRAN; TURGOR JELEK, BIBIR & MULUT KERING,
MATA CEKUNG, PUCAT, HAUS, GELISAH, DIARE
KULIT DAN MUKOSA; STOMATITIS, INFEKSI JAMUR DI
MULUT/GENITALIA, DERMATITIS, HERPES ZOSTER/SIMPLEKS,
SARKOMA KAPOSI
PENGETAHUAN; PENYEBAB, TANDA & GEJALA, PENULARAN &
PENCEGAHAN
PSIKOSOSIALSPIRITUAL; CEPAT TERSINGGUNG, DEPRESI, CEMAS,
TAKUT DIKUCILKAN, TAKUT MATI
PEMERIKSAAN DIAGNOSTIK
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DIAGNOSA KEPERAWATAN:
GANGGUAN PERTUKARAN GAS B.D. ANEMIA, INFEKSI
SALURAN NAPAS ATAU KEGANASAN
PERUBAHAN NUTRISI; KURANG DARI KEBUTUHAN B.D. ME
KEB. METABOLIK, MUAL/MUNTAH, DIARE, SULIT MENELAN,
ANOREXIA
GGN KESEIMBANGAN CAIRAN B.D. DIARE KRONIS
GGN INTEGRITAS KULIT B.D. IMOBILITAS, INKONTINEN,
HYPERTERMIA. MALIGNASI, INFEKSI
NYERI AKUT/KRONIS B.D. NEUROPATHY, KANKER, INFEKSI,
DYSPEPSIA
FATIGUE B.D. INFEKSI HIV
GGN SELF ESTEMM B.D. PERUB. BODY IMAGERESIKO
INFEKSI B.D. PENURUNAN FUNGSI IMMUN
ISOLASI SOSIAL B.D. STIGMA, PENULARAN, KONTROL
INFEKSI
GGN POLA SEKSUAL B.D. RESIKO PENULARAN PENYAKIT
INTERVENSI KEPERAWATAN:
GGN PERTUKARAN GAS; ATUR POSISI, TH/ OKSIGEN, SUCTION
LENDIR, OBSERVASI POLA NAPAS, KOLABORATIFPEMBERIAN OBAT
PERUBAHAN NUTRISI; DIET TKTP DG MENU BERVARIASI, UKUR BB
HARIAN, PERIKSA HB, OBSERVASI K.U., PARENTERAL NUTRISI (BILA
PERLU)
KESEIMBANGAN CAIRAN; MINUM SESUAI KEBUTUHAN, INFUS,UKUR
INTAKE-OUTPUT, OBSERVASI TANDA VITAL, CRT, DAN TANDA-TANDA
DEHIDRASI
INTEGRITAS KULIT; PERSONAL HYGIENE, PAKAIAN/ALAT TENUN
KERING DAN BERSIH, HINDARI PENEKANAN LAMA, MOLITOR
PERKEMBANGAN LESI, LOTION U KULIT KERING
RESIKO INFEKSI; STANDARD PRECAUTION + TRANSMISION BASED
PRECAUTION, ISOLASI PROTEKTIF, SUPLAI MATERIAL TERPISAH DH
KLIEN LAIN, BATASI PENGUNJUNG, KEBERSIHAN RUANGAN
SELF ESTEEM; PRIVACY, SUASANA MENERIMA, AMAN, DUKUNG SELF
CARE, KEMANDIRIAN, KONTROL DIRI, PENGAMBILAN KEPUTUSAN
ISOLASI SOSIAL; PENDIDIKAN KESEHATAN, PEER THERAPHY,
SUPPORT SYSTEM
25
EVALUASI:
TUJUAN PERAWATAN TERCAPAI BILA PASIEN BEBAS ATAU
MINIMAL DARI INFEKSI, MEMEPERTAHANKAN AKTIVITAS,
KUALITAS HIDUP DAN HARGA DIRI SEOPTIMAL MUNGKIN
KONSELING:
PRE DAN POST TEST HIV
DIBERIKAN OLEH TENAGA TERLATIH
BANTU PASIEN MEMAHAMI PENYAKITNYA, BAGAIMANA
MENGINFORMASIKAN KE PASANGAN/KELUARGA,
MENGURANGI FAKTOR RESIKO, PERAWATAN,
PENCEGAHAN PENULARAN, DAN PENGGUNAAN OBAT
STANDARD PRECAUTION (CDC, 1996)
CUCI TANGAN: GUNAKAN SABUN; SEB, & SES.
MENGGUNAKAN SARUNG TANGAN, ANTARA PASIEN, ANTARA
PROSEDUR PADA PASIEN YANG SAMA
SARUNG TANGAN : SEBELUM KONTAK DG SEMUA CAIRAN
ATAU SEKRET TUBUH
BARAK SHORT (GOWN)
BUANG BENDA2 TAJAM DG TEPAT, JANGAN GUNAKAN ULANG
JARUM
BERSIHKAN ALAT-ALAT YG AKAN DIGUNAKAN ULANG
SEBELUM DIGUNAKAN
PENGELOLAAN LINEN UNTUK MEMUSNAHKAN ZAT-ZAT
KONTAMINAN
PENEMPATAN PASIEN ISOLASI UNTUK PASIEN INFECTIOUS
26
PENCEGAHAN PENULARAN PENCEGAHAN PENULARAN
A= ABSTINENCE, TIDAK MELAKUKAN HUBUNGAN
SEKSUAL ATAU TIDAK MELAKUKAN HUBUNGAN
SEKSUAL SEBELUM MENIKAH
B= BEING FAITHFUL, SETIA PADA SATU PASANGAN,
ATAU MENGHINDARI BERGANTI-GANTI PASANGAN
SEKSUAL
C=CONDOM, BAGI YANG BERESIKO DIANJURKAN
SELALU MENGGUNAKAN KONDOM SECARA BENAR
SELAMA BERHUBUNGAN SEKSUAL
D= DRUGS INJECTION, JANGAN MENGGUNAKAN OBAT
(NARKOBA) SUNTIK DENGAN JARUM TIDAK STERIL
ATAU DIGUNAKAN SECARA BERGANTIAN
E= EDUCATION, PENDIDIKAN DAN PENYULUHAN
KESEHATAN TENTANG HAL-HAL YANG BERKAITAN
DENGAN HIV/AIDS
HIDUP DENGAN HIV/AIDS HIDUP DENGAN HIV/AIDS
Perlu ketahanan yang cukup kuat baik Perlu ketahanan yang cukup kuat baik
fisik, psikis, sosial, dan spiritual. fisik, psikis, sosial, dan spiritual.
Perlu pengetahuan yang memadai, Perlu pengetahuan yang memadai,
sikap yang positif, keterampilan sikap yang positif, keterampilan
dalam mengelola permasalahan dalam mengelola permasalahan
Dukungan dari lingkungan yang Dukungan dari lingkungan yang
kondusif kondusif
Perhatikan: Perhatikan: pengobatan, perawatan, pengobatan, perawatan,
dan konseling dan konseling
27
DAFTAR PUSTAKA
Beare, P.G., Myers, J.L. (1990). Principles and practice of adult health nursing.
St. Louis: The CV Mosby Company
Ignatavicius, D.D. (1995). Medical surgical nursing, a nursing process
approach. Philadelphia: W.B. Saunders Company
Isselbacker, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S., Hasper,
D.L. (1995). Prinsip-prinsip ilmu penyakit dalam, diterjemahkan oleh Ahmad
H. Asdie. Jakarta: Penerbit buku kedokteran EGC
Lewis, S.M.L, Heitkemper, M.M., Dirksen, S.R. (2000). Medical surgical nursing,
assessment and management of clinical problems. St. Louis: Mosby
Monahan, F.D., Neighborns, M. (1998). Medical surgical nursing, foundations
for clinical practice, 2 nd edition. Philadelphia: W.B. Saunders Company
Noer, H.M.S. (2002). Buku ajar ilmu penyakit dalam. Jakarta: Balai penerbit
FKUI
Williams, L.S., Hopper, P.D. (2003). Understanding medical surgical nursing, 2
nd. Philadelphia: F.A. Davis Company
Four year old Anucha Phoupinta (centre) and other students outside their
school in Phayao, northern Thailand. Anucha's father died of AIDS and his
mother left home after learning that she, too, was infected with the virus.
Anucha Phoupinta now lives with his grandparents.