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

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 - 1140 sel/ul) Viral Load Testing <10.000 copies/ml low risk for AIDS 10.000 100.000 copies/ml the risk double > 100.000 copies/ml high risk for AIDS

Five Goals of ART

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

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

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.

ARV drugs

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, which cuts reproduced HIV strands.Interrupt formation of mature viral particles and reduce viral replication. Rapid resistance development if not taken as directed Blocks HIV-1 fusion with the CD4+cell membrane to prevent cell entry

Fusion Inhibitors

Cairan
Estimasi rata-rata tubuh orang dewasa akan kehilangan 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)

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))

Natrium (Na)
Minimum kebutuhan untuk orang dewasa 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

Kalium (K)
Konsentrasi antara 3.5-5.0 mmol /L. Kebutuhan minimum kalium diperkirakan sebesar 782 mg/hari Konsentrasi total kalium di dalam tubuh diperkirakan sebanyak 2g/kg berat badan. Nam

Klorida (Cl)
Dalam jaringan tubuh diperkirakan sebanyak 1.1 g/ Kg berat badan Konsentrasi antara 98-106 mmol / L

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

Immunologic Effects of Specific Micronutrient Deficiences

Body Mass Indeks

BMI =

Kategori Kurus

BMI

Kekurangan BB Berat < 17 Kekurangan BB Ringan 17 18,4

Normal Gemuk

18,5 - 25 Kelebihan BB Ringan > 25 - 27

Kelebihan BB Berat > 27

Cara Menghitung Kebutuhan Kalori

Aktivitas Ringan BB Idaman x Keb.Sedang Kalori BBBerat Idaman
Gemuk Normal Kurus 25 30 35 30 35 40 35 40 40 - 50

Nursing Diagnosis

Risk for infection related to decreased immune 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

Diarrhea
DEFINITION: Passage of loose, unformed stools

Related factors Infectious processes, medications Subjective Abdominal pain Urgency, cramping

Objective Hyperactive bowel sounds At least three loose liquid stools per day

DESIRED OUTCOMES/EVALUATION CRITERIA

Client Will (Include Specic 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.g., proper food preparation or avoidance of irritating foods).

risk for decient Fluid Volume

DEFINITION: At risk for experiencing vascular, cellular, or intracellular dehydration

RISK FACTORS Excessive losses through normal routes (e.g., diarrhea)

DESIRED OUTCOMES/EVALUATION CRITERIA

Client Will (Include Specic Time Frame) Maintain uid volume at a functional level as evidenced by individually adequate urinary output with normal specic gravity, stable vital signs, moist mucous membranes, good skin turgor, and prompt capillary rell

DESIRED OUTCOMES/EVALUATION CRITERIA

Client/Caregiver Will (Include Specic Time Frame) Identify individual risk factors and appropriate interventions. Demonstrate behaviors or lifestyle changes to prevent development of uid volume decit.

risk for Electrolyte Imbalance

DEFINITION: At risk for change in serum electrolyte levels that may compromise health.

RISK FACTORS Fluid imbalance (e.g., dehydration, water intoxication); diarrhea; vomiting

DESIRED OUTCOMES/EVALUATION CRITERIA

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

imbalanced Nutrition: less than body requirements

DEFINITION: Intake of nutrients insufcient to meet metabolic needs

RELATED FACTORS Inability to ingest or digest food; inability to absorb nutrients

Subjective Reported 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

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

Objective [Abnormal laboratory studies (e.g., decreased albumin, total proteins; iron deciency; electrolyte imbalances)]

DESIRED OUTCOMES/EVALUATION CRITERIA

Client Will (Include Specic Time Frame) Demonstrate progressive weight gain toward goal. Display normalization of laboratory values and 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.

risk for Infection

DEFINITION: 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 uids, change in pH secretions, altered peristalsis) Inadequate secondary defenses (e.g., decreased hemoglobin, leukopenia, suppressed inammatory response) Inadequate acquired immunity; immunosuppression

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

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; 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

Objective Lethargic; listless; drowsy; lack of energy Decreased performance,

Client Will (Include Specic 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 treatment program.

Activity Intolerance
DEFINITION: Insufcient physiological or psychological energy to endure or complete required or desired daily activities

Subjective Verbal report of fatigue, weakness Exertional discomfort, dyspnea [Verbalizes no desire for and/or lack of interest in activity] Objective Abnormal heart rate or blood pressure response to activity Electrocardiographic changes reecting arrhythmias or ischemia [Pallor, cyanosis]

Client Will (Include Specic Time Frame) Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible. Use identied 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).

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 specic health goals

Subjective Verbalizes difculty 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