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Mitchel, KUMAR, ABBAS & Fausto HIV is a retrovirus that causes immunodeficiency nontransforming cytopathic through cell destruction

- T cells to target LYDIA Harlina Martono & SATYA JOEWAANA HIV is short for Human Immunodeficiency Virus. This means that the virus can only infect humans, multiply in human cells, thus reducing the human resistance to infectious diseases IDA GOOD GDE Manuaba HIV is a disease that is like an iceberg, where the base is much larger than the tip is visible on the surface KOMKAT KWI HIV stands for Human Immunodeficiency Virus. This virus is slowly - slowly reducing the human immune Geri MORGAN & CAROLE HAMILTON HIV is a retrovirus that decreases the ability of the immune system. Once infected, HIV produces a spectrum of disease that will thrive in most cases, from a clinical latent or asymptomatic state to AIDS condition, characterized by CD4 cell count <200 or Opportunistic infection, regardless of CD4 cell count AIDS was first recognized as a disease in 1981. At that time the number of cases are still very few and mostly occurred in the United States. Currently the number of AIDS patients has increased rapidly. This is triggered by free lifestyle of the community and the number of drug users and illegal drugs rose sharply. It is the duty for all of us to prevent the increasing number of AIDS patients in the world.

Here is a definition and the definition of AIDS: # JOHN W. Santrock AIDS is a sexually transmitted disease caused by a virus Human Immunodeficiency Virus (HIV) # JONATHAN WEBER & ANNABEL Ferriman AIDS stands for aquired immune deficiency syndrome (Syndrome acquired defect in immunity). It is a viral infection that can cause severe damage and can not be treated in the immune system, so that the victim open to infections and certain cancers AIDS is a serious disease that has so far not yet known cure, and the majority of people who develop this condition will completely die within 2 years. As such, it is an epidemic proportions unprecedented in modern times

# NUR FARIDA AIDS is a global disease that is being sought to solve by various research institutions in the

world # Nursalam AIDS is a disease that is incurable and beum found a drug that can restore it to the present # MARK A. Graber, PETER P. Toth, ROBERT L. Herting AIDS is a spectrum of disease manifestations ranging from asymptomatic to fatal circumstances; characterized by severe immune deficiency, opportunistic infections and cancers, arise in people who did not receive immunosuppressive treatment with no disease other imunisupresif # Irwansyah AIDS is the final terminal phase of HIV infection # DAVID D. COOKE, PAMELA J. BALDWIN, Jaqueline HOWISON AIDS is a virus that attacks the immune system # MIKRAJUDDI AIDS is a disease caused by a virus that damages the human immune system. As a result, the body vulnerable to other diseases are fatal.

1. DEFINITION Aids is a collection of symptoms due to decreased immune system by a virus called HIV are on the mark with decreased immune system that AIDS patients vulnerable to opportunistic infections and cancers. (Djauzi and Djoerban, 2003) Aids is a set of symptoms that indicate weakness or damage endurance diakibat by external factors (not innate) Aids is most closely defined as a form of continuous ill health associated with human infection immunodetciency HIV virus. (Suzane C. Smetzler and Brenda G.Bare) Aids is defined as the most severe form of the most severe HIV infection, ranging from mild abnormalities in the immune response and without any real symptoms until the condition associated with immunosuppression and infections that can bring death and with rare disorders malignitas (center for disease control and prevention ). 1. Etiology Aids is caused by a virus that has several names HTL II, LAV, RAV. Its scientific name is mentioned Human Immunodeficiency Virus (HIV) in the form of viral agents, known as retrovirus diularkan by blood and have a strong affinity for T lymphocytes, Transmitted through: 1. Sexual intercourse (risk of 0.1 to 1% 2. Blood a) HIV-containing blood transfusion (risk 90-98) b) needle containing HIV (risk 0.3) c) Exposure mucosa containing HIV (risk 0.09) 1. Transmission from mother to child (damaged 25-45%) a) During pregnancy (broken 7%) b) During labor (18% broken)

c) Breast milk (14% broken) Vertikel HIV Transmission Without intervention: 35% of total risk During pregnancy (risk 7%) Maternity (18% risk) After childbirth (13% risk) 1. SIGNS AND SYMPTOMS Clinical stage (stage 1-4) Clinical stage of HIV (WHO) 1. Clinical stage 1: asymptomatic persistemt generalized lymphadenopathy (LGP) (Enlarged lymph nodes that persist in some places) 1. Clinical stage 2: BB decrease <10% of the original Abnormalities of the skin and mucosal irritations such as seborrheic dermatitis, fungal nail infections, oral ulcers Herpes zozter in last 5 years upper respiratory tract infections such as recurrent bacterial sinusitis 1. Clinical stage 3: BB continues to decline> 10% of the original Chronic diarrhea of unknown origin lasting> 1 year Fever without apparent cause Oral Candidiasis Pulmonary TB in the last 1 year severe bacterial infections (pneumonia) Herpes zozter the berkomlikasi 1. Clinical stage 4: Board to be thin Pneumocystis carinii pneumonia (PCP) Toxoplasmosis of the brain heper simplex virus infection Mycosis (fungal infection) Candidiasis of esophagus, trachea, bronchi or lungs Sarcoma koposi Lymphoma Signs and symptoms began a few weeks to several months before the onset of infection oportonistik: Fever Malaise Fatigue Night sweats Weight loss Chronic diarrhea Lymphadenopathy general Oral Kamdidiasis

1. CLINICAL AIDS is widespread and can basically about all organ.penyakit related to HIV / AIDS due unfeksi, malignancy or a direct effect of HIV on the body's tissues. The disease is often found: 1. Respiratory Pneumocystis carinii pneumonia, shortness of breath symptoms, shortness of breath (dyspnea), cough, chest pain and fever will accompany palbagai opportunistic infections, such as those caused by Mycobacterium aviumintracellulare (CMV) And legionella. 1. Gastrointestinal Include loss of appetite, nausea, vomiting, oral and esophageal candidiasis, and chronic diarrhea. 1. Cancer 2. Kaposi Sarcoma 3. Lymphoma burkit 4. Decreased immunity 5. 6. PATOFISOLOGI T cells and macrophages, and dendritic cells / Langerhans (immune cells) are cells infected with HIV and are concentrated in kelenje nodes, spleen and bone marrow. HIV infects cells by binding to a protein of peripheral CD 4, with the corresponding virus antigen group is 120. At T4-infected cells and participate in the immune response, then HIV infects cells by increasing reproduction and many T4 cell death also affected host killer cell immune response, in an effort to eliminate the virus and infected cells. The decline in the number of T4 cells, the cellular immune system progressively weaker. Followed by reduced function of B cells and macrophages and helper T cells decline in function. Someone who can keep HIV terinfeks no symptoms (asymptomatic) for many years.During this time, the number of T4 cells can be reduced from about 1000 perml blood cells before infection reaches about 200-300 per ml of blood, 2-3 years after infection . When the T4 cells reach these levels, symptoms of infection (herpes zoster and mushrooms oportunustik) appears, then the number of T4 decreased due to the emergence of new diseases will cause the virus to proliferate. Finally there is an infection that parah.seorang diagnosed AIDS case opurtunistik infection, cancer or AIDS dimension. 1. MANAGEMENT 1. Treatment suporatif Purpose: Improve the patient's general condition Providing appropriate nutrition Drug and vitamin sistomatik Support psikilogis 1. Treatment of opportunistic infections Infection: Candidiasis of esophagus Tuberculosis Toxoplasmosis Herpes PCP

AIDS-related treatment, malignum Lymphoma, Kaposi's sarcoma and cervical sarcoma, adjusted to standard cancer therapies. Therapy: Flikonasol Rifampicin, INH, Ethambutol, pyrazinamide, stremptomisin pyrimethamine, sulfadiazine, folic acid Acyclovir Cotrimoxazole 1. Treatment of anti-retro viral (ARV) Purpose: Reduce mortality and morbidity Reduce the amount of virus Enhance immune Reduce the risk of transmission Nursing HIV / AIDS 1.Pengkajian a. Hospital chart many chronic diseases associated with weakened immune function. As diabetes meilitus, aplastic anemia, cancer is some chronic disease. The existence of such diseases should be considered as a factor when assessing the status imonokompetensi supporting patients. b.Pemeriksaan physical and complaints Activity / rest o Symptoms: fatigue, activity intolerance, progression malaise, changes in sleep patterns. o Signs: muscle weakness, decreased muscle assa, respo physiological activity (changes in blood pressure, heart rate and breathing). o Circulation Symptoms: slow healing (anemia), bleeding time to injury. Signs: TD postural changes, decreasing the volume of peripheral pulses, pallor / cyanosis, capillary extension. Intergitas and ego Symptoms: The stress associated with losing, worried looks, deny the diagnosis, despair. Signs: deny, anxiety, depression, fear, withdrawal, anger. Elimination Symptoms: persistent diarrhea, often with abdominal cramping or without, pelvic pain, a sense of flaming when micturition. Signs: watery stool with or without mucus or blood, intense diarrhea, frequent abdominal tenderness, lesions / rectal abscess, perional, changes in the number, color and character of the urine. food or liquids Symptoms: anorexia, nausea, vomiting, dysphagia, Signs: poor skin turgor, lesions of the oral cavity healthy teeth and gums are bad, edema. Hygiene Symptoms: can not finish AKS Signs: Rapai not appearance, lack of confidence. Neurosensori

Symptoms: dizziness, headache, mental status changes, damage to sensory status, kelemaan muscles, tremors, changes in vision. Signs: altered mental status, paranoid ideas, anxiety, abnormal reflexes, tremors, seizures, hemiparesis. Pain / comfortable Symptoms: pain in general / local, burning, headache, chest pain pleuritas. Signs: swollen joints, painful glands, tenderness, decreased motion vulnerable. Breathing Symptoms: frequent UTIs / settled, shortness of breath, progressive, coughing, tightness in the chest. Signs: tachypnea, respiratory distress, change in breath sounds, presence of sputum. Security o Symptoms: history of falls, burns, fainting, wounds, blood transfusions, immune deficiency disease, recurrent fever, bekeringat night. o Signs: changes in the integrity of the skin, lymph node enlargement, decreased tekananan. o Sexuality Symptoms: a history of behaving, sejs high risk, Signs: pregnancy, herpes, genetalia. Social Interaction Symptoms: problems caused by the diagnosis, isolation, loneliness. Signs: changes in interaction Education / Learning o Symptoms: failures in care, high-risk sexual behavior, drug abuse obatan.alkohol. c. diagnostic examination 1. Laboratory tests Tests and laboratory tests used for HIV mendiaknosa and monitor disease progression and response to therapy of HIV. 1. Serological serum antibody tests HIV screening test results positf, but it is not a diagnosis western blot test Confirming the diagnosis of HIV T cell lymphocytes The decrease in total T4 helper cells Indicator immune system Tues T8 (Cell cytopathic suppressor) P24 (Protein wrapping HIV) Increasing the value of quantitative protein progression identified Levels of Ig polymerase chain reaction Detecting small amounts of viral DNA in peripheral cell infection monoseluler Test PHS 1. Culture Histologist, cytological examination, urine, blood, feces, spinal fluid, wound 1. Neutologis

EEG, MRI, CT scan of the brain, EMG (nerve examination) 1. Chest X-ray 2. Pulmonary function tests 2. Antibody tests If a person is infected with HIV the immune system will react by producing antibodies to the virus. Anti body formed within 3-12 weeks after infection, or it could be up to 6-12 months. B. Diaknosa nursing Nursing Diagnosis Planning Nursing Goals and outcome criteria Rational Intervention High risk of infection associated with immunosuppression, malnutrition and lifestyle risk. Patients will be free of opportunistic infections and complications with criteria no signs of a new infection, lab no opportunistic infections, vital signs within normal limits, no injuries or exudate. 1. Monitor signs of a new infection. 2. using aseptic technique at all invasive. Wash hands before gave the action. 3. Instruct the patient method of preventing exposure to environmental pathogens. 4. Collect specimens for lab tests appropriate order. 5. Set the appropriate order granting anti-infective for the treatment of premature Preventing patients exposed to pathogens acquired in the hospital. Prevent further infection Convincing accurate diagnosis and treatment Maintain therapeutic blood levels High risk of infection (patient contact) associated with HIV infection, an infection that can be transmitted nonopportunisitik. HIV infection is not transmitted, the observance of universal precautions health care team noticed kriteriaa contact with patients and health teams are not exposed to HIV, other pathogens such as tuberculosis infection. 1. Instruct the patient or a significant other methods of preventing the transmission of HIV and other pathogens. 2. Use of blood and body fluid precautions Bial treating patients. Use a mask if necessary. Patients and families want and need to inform this Transimisi prevent HIV infection to others Intolerans activity associated with weakness, the exchange of oxygen, malnutrition, exhaustion. Patients participating in the activities, with dyspnea and tachycardia independent criterion for activity. 1. Monitor physiological response to activity 2. Please help us care that patients themselves can not afford 3. Schedule patient care so it does not interfere isitirahat. Immune Response Against HIV Infection To find a summary of the body's response to immunologic challenge, see Chapter 5. In HIV infection, both humoral and cellular immune responses come into play. Immediately after exposure to HIV, the individual will do intensive immune resistance. B cells produce antibodies specific to different viral proteins. Found neutralizing antibodies against region-region in the viral envelope gp120 and gp41 external parts. Detection of anti-body is the basis for a variety of HIV testing (eg, enzime-linked immunosorbent assay [ELISA]). In a class of antibodies found in the blood of immunoglobulin G (IgG) and immunoglobulin M (IgM), but with decreasing titer IgM, IgG titer (in most cases) remained high throughout infection. IgG antibodies are the primary antibodies used in the testing. Antibodies to HIV can appear in the first months after the initial infection and the majority of people infected with HIV within 6

months after exposure. However, HIV antibodies do not neutralize HIV or cause protection against further infection. Immunoglobulin production regulated by CD4 + T lymphocytes. As discussed in Chapter 5, CD + T lymphocytes are activated by antigen presenter cells (APC) to produce a variety of cytokines such as interleukin-2 (IL-2), which helps stimulate B cells to divide and differentiate into plasma cells. Plasma cells are then produced imunoglobuin specific to stimulate antigen. Cytokine IL-2 is just one of many cytokines that affect both humoral immune response and cellular. Although the level of control, expression, and potential functions of cytokines in HIV infection is still under study, but it is obviously important cytokines in intracellular activity. For example, the addition of the cytokine IL-12 (NK cell stimulatory factor) appears against a decrease in activity and function of NK cells as occurs in HIV infection. NK cells are important cells because under normal circumstances it is these cells that recognize and destroy cells infected by viruses by secreting perforin similar to that produced by CD8 cells. Recent research support the role of CD8 + cytotoxic and suppressor cells in HIV infection. The role of cytotoxic CD8 cells is binding cells infected by the virus and secrete perforin, which causes cell death. Activities sitotosik CD8 cells was superb in early HIV infection. CD8 cells can also suppress HIV replication in CD4 + lymphocytes. This emphasis is evident varies not only among different people but also on the same line with the progression of the disease. CD8 + cell antiviral activity decreases with development of disease. With increasing severity of the disease, the number of CD4 + lymphocytes is also reduced. Various hypotheses about the causes of the gradual decline will be discussed below: Essential regulatory function of CD4 + lymphocytes in cellular immunity uncontested. As discussed earlier and in Chapter 5, CD4 + lymphocytes secrete cytokines that facilitate processes such as the production of immunoglobulin and T cell pengaktivan additional and macrophages. Two specific cytokines produced by lymphocytes CD4 +-IL-2 and interferon-gamma plays an important role in cellular immunity. In normal conditions, CD4 + lymphocytes secrete interferon gamma attract macrophages and intensify the immune response to the antigen. However, when CD4 + lymphocytes is not functioning properly then interferon gamma production will decline. IL-2 is important to facilitate not only the production but also the growth of plasma cells and CD8 + cell antiviral activity and self-replicating population of CD4 + lymphocytes. Although the mechanism of CD4 + lymphocytes sitopatogenisitas certainly unknown, but arguments can be made for various hypotheses such as apoptosis, anergy, syncytium formation, and cell lysis. Antibody-dependent, complement-mediated cytotoxicity (ADCC, antibodydependent cytotoxicity and complement-mediated) may be one of the humoral immune effect that helps get rid of CD4 + lymphocytes are infected by HIV. Antibodies against two glycoproteins, gp120 and gp41, induce ADCC. Cells such as NK cells then act to kill infected cells. Apoptosis is one of several theories proposed to explain the markedly reduced CD4 + lymphocytes in the blood throughout the course of HIV disease. Many CD4 + lymphocytes seem to do a 'suicide' of a substance when stimulated by activators or by activating signal interruption (Gougeon, Montagnier, 1993). CD4 + lymphocytes also may not be able to divide causing a phenomenon called anergy. Another theory suggested a role of syncytium formation. In infected syncytium formation fuse with cells infected with "the bystander effect" ("stray bullet effect"; Weiss, 1993) so as to eliminate many uninfected cells. Finally, the decline in the number of CD4 + lymphocytes may be caused by the formation of new viruses through a process of bud formation; these viruses cause the rupture of the membrane of CD4 + lymphocytes, which

effectively shut down the cell. Whatever the theories that explain the reduced CD4 + lymphocytes, the main features of the infection remains depletion of these cells. Depletion of CD4 + lymphocytes varies among people living with HIV infection. Some of the factors that influence this variation is a function of host immune system, the presence of other factors in the host (eg, congenital or metabolic disease, nutritional deficiencies, other pathogens), or differences in viral strain (Schattner, Laurence, 1994).

NURSING CARE PATIENTS WITH HIV POSITIVE NURSING CARE PATIENTS WITH HIV POSITIVE A. Basic Concepts 1. Definition AIDS stands for Acquired Immune Deficiency Syndrome is a syndrome that shows a person's cellular immune deficiency in the absence of known causes for these deficiencies may explain the occurrence of such malignancies, immune suppressive drugs, which are well known infectious diseases and so on. 2. Etiology The cause is a retro virus group called Human Immunodeficiency Virus (HIV). HIV was first discovered in 1983 as a retro virus called HIV and 1. In 1986 in Africa found another new retrovirus called HIV-2. HIV-2 is considered as a less pathogenic virus than HIV-1. So to facilitate both called HIV. Transmission of HIV infection and AIDS consists of five phases: a. The window period, the duration of 4 weeks to 6 months after infection. No symptoms b. Phase of acute primary HIV infection, duration of 1-2 weeks with flu symptoms likes illness. c. Asymptomatic infection, duration of 1-15 or more years with no symptoms. d. Symptomatic immunosuppression, over 3 years with symptoms of fever, night sweats, beat loss, diarrhea, neuropathy, weakness, rash, lymphadenopathy, and oral lesions. e. AIDS, the duration varies between 1-5 years of AIDS was first established conditions. Obtained serious opportunistic infections and tumors in various body systems and neurological manifestations. AIDS can affect all age groups including infants, men and women. Which included highrisk groups are homosexual or bisexual men, who are addicted to intravenous drugs, sex partners of patients with AIDS, recipients of blood or blood products (platelets). 3. Patofisioogi Once infected with HIV, 50-70% of patients will experience symptoms called acute HIV syndrome. These symptoms are similar to symptoms of a viral infection that generally include fever, headache, sore throat, myalgia (achy body), enlarged glands and weakness. In some people, the infection can be severe with decreased consciousness. This syndrome usually disappear within a few weeks. Within 3-6 months later a new serological test would be positive because it has formed antibodies. Period of 3-6 months is called the window period where people can pass but the laboratory results of his HIV test was negative. After going through the primary infection, the patient will go into the future without symptoms. At this time, the virus continues to multiply progressively in lymph nodes. This period lasted long enough that is 5-10 years. After this time the patient will go into full blown AIDS stage.

4. Diagnostic Examination a. Tests for the diagnosis of HIV infection: 1. ELISA 2. Western Blot 3. P24 antigen test 4. Culture HIV b. Tests for the detection of immune system disorders 1. Hematocrit 2. LED 3. CD4 / lymphocyte CD 4. Serum microglobulin 5. Hemoglobulin B. Nursing 1. Assessment Nursing assessment includes identification of potential risk factors, including risky sexual practices and the use of intravenous drugs. Physical and psychological status of the patient should be assessed. All the factors that affect the functioning of the immune system needs to be explored carefully. Nutritional status was assessed by asking diet history and identify factors that can disrupt the brain intake such as anorexia, nausea, vomiting, oral pain or difficulty swallowing. In addition, the patient's ability to buy and prepare food to be assessed. Weight considerations, antopometrik measurement, inspection BUN levels (Blood Urea Nitrogen), serum protein, albumin and transparerin will provide objective parameters of nutritional status. Skin and mucous membrane inspected every day to find signs of lesions, ulceration or infection. Examined the oral cavity to monitor symptoms redness, ulceration and the presence of white patches indicating creamy candidiasis. Perianal area should be checked for excoriation and infection in patients with diarrhea profus. Wound culture examination may be requested to identify infectious microorganisms. Respiratory status began with the monitoring of patients to detect symptoms of cough, sputum production, short napasyang and orthopnea, tachipnea and chest pain. The presence of respiratory sounds and nature should also be checked. Another measure of lung function include thoracic X rays, the results of gas toward arterial and pulmonary function test results. Neurological status was determined by assessing the patient's level of consciousness, orientation to person, place and time as well as memory loss. Patients were also assessed for the detection of impaired sensory (visual changes, headache, and paresthesias in the extremities patirasa) and motor disturbances (changes in gait, paresis or paralysis) and seizures. Fluid and electrolyte status was assessed by examining the skin and mucous membranes to determine turgor and dryness. Increased thirst, decreased output of urine, low blood pressure and a decrease in systolic blood pressure between 10 and 15 mmHg, accompanied by increases in frequency pulse when the patient sits, weak pulse, and rapid, and urine specific gravity of 1.025 or more, indicating dehydration. Fluid and electrolyte balance disorders such as decreased levels of sodium, potassium, calcium, magnesium and chloride in serum typically would occur because of severe diarrhea. Examination was also conducted to assess the patient's signs and symptoms of electrolyte depletion,

these signs include a decrease in mental status, muscle twitching, irregular pulse, nausea and vomiting and shallow breathing. Patient's level of knowledge about the disease and ways of transmission of the disease should be evaluated. Besides, the level of knowledge of family and friends need to be assessed. Psychological reactions to a diagnosis of AIDS patients is important information that should be explored. Reactions can vary from one patient to another and may include denial, anger, fear, shame, withdrawal from social relationships and depression. An understanding of how patients facing illness and a history of major stress ever experienced before often beneficial. Sources owned patient to give him support should also be identified. 2. Nursing Diagnosis a. Berhubunan high risk of infection with immunosuppression, malnutrition and lifestyle risk b. High risk of infection (patient contact) associated with HIV infection, an infection that can be transmitted nonoportunistik. c. Ineffective family coping related to anxiety about the state of the person loved. d. Isolation social stigma associated with the disease, the withdrawal of support systems, isolation procedures and fear when he infect others. e. Grieving anticipated related to changes in lifestyle as well as their role and the prognosis is not fun f. Lack of knowledge related to ways of preventing HIV and self-care. 3. Planning nursing a. Nursing Diagnosis I: The objectives and expected outcomes: the patient will be free of opportunistic infections and complications with criteria no signs of a new infection, lab.tidak no opportunistic infections, vital signs within normal limits, no injuries or exudate. Intervention: - Monitor the signs of a new infection - Use aseptic technique on any invasive measures. Wash hands before giving action. - Instruct the patient methods of preventing exposure to environmental pathogens. - Collect specimens for laboratory tests. Appropriate order. - Set the appropriate order granting anti-infective. For early treatment: - Prevent patients exposed to pathogenic bacteria acquired in the hospital - Preventing the increase in infections - Ensuring accurate diagnosis and treatment - Maintaining a therapeutic blood levels b. Nursing Diagnosis 2: The objectives and expected outcomes: HIV infection is not transmitted, the health care team noticed observance of universal precautions with patient contact criteria and health teams are not exposed to HIV, no other pathogen infection such as tuberculosis. Intervention: - Instruct the patient or a significant other methods of preventing the transmission of HIV and other pathogenic bacteria.

- Use of blood and body fluid precautions when caring for patients. Use a mask if necessary. - Patients and families want and need this information - Preventing the transmission of HIV infection to others c. Nursing Diagnosis 3: The objectives and expected outcomes: Family or significant others to maintain support system and adaptation to changes in the criteria would need to interact with patients and families in a constructive way. Intervention: - Assess the patient's family coping to pain and its treatment - Allow the family to express feelings verbally. - Teach the family about the disease and its transmission. Starting a relationship to work constructively with family They do not realize that they speak freely. Eliminate worry about transmission through simple contact. d. Nursing Diagnosis 4: Intervention: - Assess patient's level of social interaction - Perform infection control measures in hospitals or at home to contribute to the patient's emotions. - Nurses should understand and accept people with HIV and their families and their sexual partners. - Provide information on how to protect yourself and others can help patients not to avoid social contact. - Education for physicians, nurses will reduce the factors that helped make patients feel isolated. Evaluation: Experienced a reduction in feelings of isolation from social interaction. e. Nursing Diagnosis 5: - Help patients express in words how he felt. - Motivation of patients to maintain contact with family and friends and memanfaatan AIDS support groups as well as local and national hotlines. Evaluation: Through the process of grief / bereavement f. Nursing Diagnosis 6: - Tell family and friends of patients about ways of AIDS transmission. Talk about fear and misunderstanding the problem closely. - Convey necessary safeguards measures to prevent the transmission of HIV, including the use of condoms during sexual intercourse. Evaluation: Reported an increased understanding of HIV / AIDS as well as possible to participate in the activities of independent nursing. Assessment Biodata: Name: Mr.. W Age: 40 years

Gender: Male Address: Kebumen Disease History Now Patients come to the hospital VCT Kebumen on January 11, 2010 with complaints often feel weak and tired, the patient had repeatedly went to the health and health care but not yet healed. On the advice of a nurse in the local health center patients are encouraged to consult the VCT Clinic Hospital Kebumen. In the VCT clinic, patients examined blood laboratory and the results are HIV positive. Patients feel anxious and confused. History of past illness The patient had never suffered from a severe illness and the patient had never suffered from pain that does not go away as it is now. Family history of disease Family members of patients who have suffered severe perrnah to be hospitalized in the Hospital. Nutritional Status The patient never did the diet in foods daily, lately patient felt sick but did not interfere with the day-today eating habits. Skin and mucosal membrane status There are no signs of lesions, ulceration or infection in the body. No abnormalities of the oral cavity. Perianal area no abnormalities. Respiratory status The patient did not complain of cough, shortness of breath and chest pain. On examination of lungs breathing and heart no abnormalities. Neurological status Compos mentis patient awareness, orientation to person, time and place is good, good memories. The patient did not complain of dizziness, headache. Patients Feel limp just there all extremities, feeling tired easily. Fluid and electrolyte status Either the patient's skin turgor, good fluid intake and output. Drink a day 8 glasses a day, six times a day BAK, Chapter 1x a day. The level of knowledge Knowledge of patients is still lacking with current disease information, especially HIV / AIDS. Patients feel anxious and confused by the disease now and laboratory results were declared HIV positive. Data Analysis DS: - complain of fatigue, tired, anxious with laboratory results: HIV Positive, confused. DO: The LAB: - Hb 11 g / dl - Leukocytes 20.000/uL - Platelets 160.000/uL - LED 30 mm - Na 98 mmol / L - K 2.8 mmol / L - Cl 110 mmol / L

- Positive HIV Test 2. Nursing Diagnosis 1. Isolation social stigma associated with the disease, the withdrawal of support systems, isolation procedures and fear when he infect others. 2 Lack of knowledge related to ways of preventing HIV and self-care. Analysis of data No etiology Data Problem 1 DS: anxious with laboratory results: HIV Positive, confused. DO: - Na 98 mmol / L - K 2.8 mmol / L - Cl 110 mmol / L - Positive HIV Stigma disease, withdrawal of support systems, isolation procedures, fear of infecting other people to social isolation 2 DS: confused with illness DO: - Leukocytes 20.000/uL - Platelets 160.000/uL - LED 30 mm, are HIV positive do not know the ways to prevent HIV and its treatment. Lack of knowledge Nursing care plan Diagnosis: Isolation of social stigma associated with the disease, the withdrawal of support systems, isolation procedures and fear when he infect others. Objective: social isolation does not occur. Expected outcomes: reduced anxious and confused, Rational Intervention Mandiri - Assess patient's level of social interaction - Perform infection control measures in hospitals or at home to contribute to the patient's emotions. - Nurses should understand and accept people with HIV and their families and their sexual partners. - Provide information on how to protect yourself and others can help patients not to avoid social contact. - Education for physicians, nurses will reduce the factors that helped make patients feel isolated. Collaboration Give medications as indicated: tranquilizers and others. Monitor the results of laboratory tests. . - Experiencing a reduction in feelings of isolation from social interaction. Dx: Lack of knowledge related to ways of preventing HIV and self-care. Objective: Patients and families understand about ways to prevent HIV and self-care. Expected outcomes: Reporting an increased understanding of HIV / AIDS as well as possible to participate in the activities of independent nursing. Rational Intervention Mandiri

- Tell family and friends of patients about ways of AIDS transmission. Talk about fear and misunderstanding the problem closely. - Convey necessary safeguards measures to prevent the transmission of HIV, including the use of condoms during sexual intercourse. Collaboration Give antibiotics or antimicrobial agents, eg trimetroprim (Bactrim or Septra), nistasin, pentamidine or Retrovir. With the patient's family to know about ways of HIV transmission is expected to help prevent the spread of HIV / AIDS. Evaluation 1. Experienced a reduction in feelings of isolation from social interaction. 2. Reported an increased understanding of HIV / AIDS as well as possible to participate in the activities of independent nursing

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