TROPICAL DESEASE

Nursing Care Of Patient with AIDS

Member Of Group III : 1. Astrilia Diah Kartikasari (130915011) 2. Dian Panorama (130915024) 3. Sisfani Mirzana (130915027) 4. Suci Wulandari (130915047) 5. Tuti Wijaya (130915061) 6. Fayadita Mahdia Izzati (130915071) 7. Agustian Saqurin (130915085) 8. Kinta Astriyati (130915120) 9. Sylvia (130915128) 10.Rizky Putra Prihatama (130915134) 11. Febianca (130915143)

FAKULTAS KEPERAWATAN UNIVERSITAS AIRLANGGA 2010

TROPICAL DISEASE 1. DEFINITION Tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions. These disease may carry a parasite, bacterium or virus that is infectious to humans and animals. The transmission process from the infectious agent through subcutaneous blood exchange. Vaccines are not available for any of the diseases listed here. 2. ANATOMY AND PHYSIOLOGY 2.1 Blood A tissue of body that exists in the blood vessel and the color is red. The red color depends on the amount of O2 and CO2 inside the blood. This blood flow through the body because of heart activity. Commonly in the health body, there are about 1/13 of total weight body or + 4-5 liter. This condition depends on age, occupation, and the condition of heart or blood vessel. The main role of blood: a. Transport CO2 and O2, nutrition, and remove unuseful substances through skin and kidney b. As immune function c. Keep the temperature of the body 2.2 Composition of the Blood Blood consist of formed elements that are suspended and carried in of fluid called plasma. The formed elements are erythrocytes, leukocytes, and platelets-function. Plasma is a straw colored liquid consisting of water dissolved solutes. The major solute of the plasma in terms of its concentration is Na +. In addition to Na+ , plasma contains many other ions, as well as organic molecules such as metabolites, hormones, enzymes, antibodies, and other proteins. Erithrocytes are flattened, biconcave discs, about 7m in diameter and 2,2 m thick. The amount of Erithrocytes about 5 millions in 1 mm 3 blood. Their unique shape relates to the function of transporting oxygen, it provides an increased surface area through which gas can diffuse. Each erythrocyte contains approximately 280 millions hemoglobin molecules, which gives blood its red color. The functions are carrying 0 2 from lungs to the body and remove CO2 from tissues trough lungs. Leukocytes differ from Erythrocytes in several respects. It has no color, the amount about 6.000-9.000 in 1 mm3. Leukocytes contain nuclei and mitochondria and can move ameboid fashion. It supports the function of leukocytes as immune function. Platelets or thrombocytes are the smallest of the formed elements. And are actually fragments of large cells called megakaryocytes which found in bone marrow. The platelet count per cubic milimeters of blood ranges from 130.000

to 140.000 but this count can vary greatly under different physiological conditions. Platelets play an important role in blood clotting. 3. PATHOPHYSIOLOGY, SIGN AND SYMPTOMS OF AIDS 3.1 Pathophysiology The human immunodeficiency virus, or HIV, is a sexually-transmitted infection (though it can be transmitted in other ways) whose effects include the decreased functioning of the immune system. HIV is the root cause of the condition known as AIDS (acquired immune deficiency syndrome), which is not itself a disease, but rather a series of symptoms and conditions caused, by a poorly or non-functioning immune system. -Free sex -Drugs use (e.g. with syringe) -Blood transfusion - infected mom to the baby (antepartum, intrapartum, postpartum, ASI) -unsterile medical equipments Decreasing immune system

HIV infections

Positive AIDS

Gb.1 HIV

b. Sign and symptoms 1. Depression 2. Diarrhea 3. Thrush 4. Weight Loss 5. Lipodystrophy 6. Lactic Acidosis 7. Sinus Infections 8. Fatigue 9. Nausea / Vomiting 10. Burning and Tingling of the Feet and Hands 4. NURSING PROCESS 4.1 Assessment Nursing History I. Patient Identity (Name, Age, Race, Religion, Education, Occupation, Address) II. History of present illness 1. Chief Complain : Fatigue, nausea, depression 2. Present illness history : about 3 months continuously diarrhea, oral candida III. Past Nursing History 1. History of contagious diseases 2. Hereditary Diseases 3. Allergic History IV. V. Family Health History Observation And P. E 1. B1 : Breathing(respiratory system)Dyspnea, TBC, and Pneumonia 2. B2 : Bleeding(cardiovascular system) cardiomyopathy 3. B3 : Brain(nervous system)brain toksoplasmosis, bacterial meningitis 4. B4 : Bladder(genitourinary system)vulvovaginal candida, sifilis 5. B5 : Bowel(GI system)nausea, vomiting, dysphagia, weight body 10% per 3 months, diarhea 6. B6 : Bone(bone, muscle, integument)oedema

7. Endocrine systemdecreasing immunity 8. Psychosocial assessment

VI. -

DIAGNOSTIC TEST AND MEDICAL TREATMENT

Enzyme-linked immunosorbent assay (ELISA): A positive test result may be indicative of exposure to HIV but is not diagnostic. Sensitivity varies, with the incidence of false-positive results being approximately 10%. (Seroconversion can occur between 4 wk to 6 mo after exposure.)Western blot test (blood/urine): Confirms diagnosis of HIV-1 in individuals with positive ELISA screening. Viral load tests RI-PCR : Detects viral RNA levels as low as 50 copies/mL of plasma. bDNA 3.0 assay: Has a wider range: 50500,000 copies/mL. (The RI-PCR range is 5075,000/mL.) Therapy can be initiated, or changes made in treatment approaches, based on rise of viral load or maintenance of a low viral load. This is currently the leading indicator of effectiveness of therapy. CD8+ CTL (cytopathic suppressor cells): Current quantitative assays allow for rapid evaluation of levels. CD8+ (CTL) have been strongly implicated in the control of HIV-1 replications. At late stage of infection, CD8+ (CTL) numbers are reduced. CD4+ lymphocyte count (previously T4 helper cells): Reduced. Patients with counts below 500 benefit from antiretroviral therapy; counts equal to/or below 200 define progression to AIDS. Levels are measured immediately before and again 48 wk after initiation of antiretroviral therapy. Thus, it is used to diagnose HIV infection and progression and to monitor effects of drug therapy. The role of CD4+ T-cells is unclear. CD4+ cells are a target for HIV infection and destruction. Some researchers postulate CD4+ cells are eliminated early. They may not contribute to host defense substantially in the late stages of disease. Screening tests: Purified protein derivative (PPD): Used to screen for TB exposure. A positive result reflects current or prior exposure to TB. The criterion for positive PPD when immunodeficiency is present is 5-mm indurations. Serologies: Rapid plasma regains (RPR)/VDRL: Determines current/past exposure to syphilis and need for more specific testing. Toxoplasma and hepatitis B and C serologies may be done. Pap smear: Higher incidence (40%) of abnormal cells occurs in HIV-infected women. The critical role of Pap smear screening relates to its ability to detect precursor lesions that can precede the diagnosis of invasive carcinoma by several years. Pelvic/genital examination: Identifies presence of lesions from sexually transmitted diseases (STDs), cervical and vaginal abnormalities. Chemistries: Glucose levels elevated as a result of insulin resistance, and lipids rise as HIV infection progresses. Albumin/prealbumin and transferring

levels are decreased secondary to malabsorption/malnutrition that is usually progressive. CBC: Haemoglobin, RBC counts are decreased and abnormalities in iron metabolism can result in anaemia, which occurs in 17% of asymptomatic patients and up to 85% of patients with advanced disease. Chest x-ray: Abnormalities suggest presence of TB in PPD-positive, anergic, and/or symptomatic individuals. Diagnosis is then verified by sputum cultures or other tests, such as gallium scan. 4.2 Nursing diagnosis a. Problem Etiology

Sign and symptoms b.Problem Etiology Sign and symptoms c.Problem Etiology Sign and symptoms 4.3 Intervention No 1

: Altered nutrition, less than body requirement : Candida as an opportunistic infection usually Appear in the mouth till esophagus it causes client Has impaired swallowing and nausea so the client lack of nutrition. It also cause by certain medicine influence : Diarrhea, pale, loss of body weight, oral candidas, nausea. : Risk for infection : HIV is a virus that attacks our immune system. Then the immune system decreasing or become weak, it makes client easily get another infections. : fatigue, fever, infections of candida albicans,pneumocystis carini, herpes simplex, TB : Anxiety death : Powerless over issues related to dying, deep sadness because there is no permanent medicine to cure AIDS : pale, cold, moist skin/wet, depression, decrease blood pressure, tachycardia.

Nursing Goal Statements Diagnoses (NOC) Altered nutrition -maintain weight less than body between 0,9 1,35 requirements kg loss from weight loss before sick. -maintain mass of adequate muscle. -show that laboratorys test on

Intervention (NIC) -determine the general weight before patients diagnosed HIV. -make new anthropometric measures. -determine the proper diet and nutrition knowledge.

Rationale -Early weight-loss provisions would not chart weight and normal height. thereby determining trakhir weight in relation to weight pradiagnosis more useful.

normal limits. -report improvement energy level.

-noted side effects of drugs on nutrition. -provide information about nutrition with calories, vitamins, proteins and high minerals. help patients plan how to maintain the suggestion. -press the importance of maintaining adequate nutritional balance. -help the patient to formulate a diet plan. -encourage a supportive environment for food. encourage usage spices for cooking.

2. Risk for

infection.

-identify behaviours that reduce the risk of infection. -reached during wound healing. -no fever and free

-administering medicine and antibiotic -wash your hands before and after treatment contacts made. instruct patients to wash their hands

-help monitor and determine the decrease in nutritional needs according to disease progression. -identification of these factors may help to plans to individual needs. -drugs commonly used cause anorexia and nausea / vomiting: a few affect the production of human bone marrow. -information can help patients understand the diet balanced. -recognize the importance of input of nutrients to maintain health can motivate patients to maintain a proper diet. -provide assistance and back for increased unmpan sense of control, confidence, and revenue. -improve the nutrition of income because of drugs and diseases can alter the sense of smell and taste. -Antibiotics administered at the proper timing interval ensure adequate maintenance of therapeutic levels

from purulent expenses and other signs of infection conditions.

nearest appropriate indications. -provide a clean environment and a well-ventilated. -maintain personal health and discuss the rational level and preventive isolation. -check vital signs, including temperature. -examine the frequency of respiratory. -investigate complaints of headache, stiff neck, and change in vision. note change in mentality and behaviour. -check the skin of white spot. -clean nails every day. and avoid cutting cuticles. -monitor complaints heartburn, dysphagia, retrosternal pain during swallowing, increased abdominal cramps, diarrhoea. -check the wound and watch the signs of local infection. -wear gloves and skort for direct contact with secretions or whenever there is damage to the skin of the nurse's hand. -oversee disposal syringes and blades. -label on the tube of blood, body fluid containers, soiled bandages and wrapped properly. -clean spray of body fluids or blood with a bleach solution.

-reduce the risk of cross contamination. -reduce pathogens in the immune system and the possibility of infection. -improve cooperation and try to reduce the sense of isolation. -provide basic data information, the increase temperature repeatedly. -respiratory congestion may indicate the development of PCP, the most common diseases occur. -general and neurological abnormalities may be associated with HIV or sekuner infection. -oral candidiasis, KS, herpes, CMV, and Cryptococcus is a common disease and effect on the skin membrane. -reduce the risk of transmission of pathogens through the skin. -oesophagitis may occur secondary to oral candidacies or herpes. -early identification of secondary infections may prevent the

3. Anxiety Death

-express feelings and awareness about healthy ways to deal with it. -shows the normal range of feelings and less fear. -showed the ability to overcome the problem. -using the resources effectively.

-assure patient confidentiality within the limits of a particular situation. -maintain good relationships with patients. -provide accurate and consistent information about prognosis. -alert to signs of rejection / depression. determine the incidence of suicide ideation and examine its potential on a scale of 1-10. -provide an open environment where patients feel safe to discuss their feelings. -allow patients to express anger, fear, despair, without confrontation. -recognize and support phase of the patient / family in the grieving process. -explain procedures, provide an opportunity to ask and answer honestly.

occurrence of sepsis. -use of masks, gloves skort and conducted by OSHA for direct contact with body fluids. -prevent accidental inoculation from caregivers. -avoid crosscontamination. -control of microorganisms on hard surfaces. -show a sense of respect and accept these people, improve selfconfidence -give the opportunity to solve the problem -reduce patient anxiety and inability to make decisions based on reality -sense of guilt and spiritual stress may cause patients to withdraw and believe that suicide is one of the alternatives -helps patients to feel welcome without feeling judged and enhance self-esteem and feelings of control -acceptance would make the patient feel accepted the situation -choice of intervention is determined by the

-encourage interaction with the patient's support system. -provide reliable information and consistent support for the nearest. -Similar people involved in the decision-making are major.

grieving stage, coping behaviour -accurate information will make the patient can be effective in dealing with the reality of the situation -reduce feelings of isolation -interpersonal interactions create a better and reduce the anxiety and fear -guarantee the existence of support systems for patients and allows people closest to participate in the life of the patient

4.4 Evaluation Subjective Objective Assessment : Interview and symptoms : Laboratory test and sign : Goal met stop planning Goal partially met continue and modify Goal not met modify New Problem new assesment : stop planning Goal met continue and modify Goal partially met modify Goal not met new assessment New Problem

Planning

REFERENCES Brashers, V.L. 1998. Clinical Application Of Phatophysiology. Mosby. Bullock, B.L & Henze, R. L. 2000. Pathophisiology. Philadelphia : Lippincot Carpenito, L. J.2000. Nursing Diagnosis Aplication to Clinical Practice. Philadelphia: Lippincott. Doenges, Marilynn. 1999. Rencana Asuhan Keperawatan. Jakarta : EGC Hicken, Ian & Faugjer, Jean. 1996. AIDS And HIV The Nursing Response. London :Chapman & Hall. Nursalam.2010.English in Nursing-Midwifery Sciences And Technology. Jakarta: Salemba Medika Nursalam & Kurniawati, Ninuk Dian.2008. Asuhan Keperawatan pada pasien terinfeksi HIV/AIDS. Jakarta: Salemba Medika Syaifudin.1997. Anatomi Fisiologi. Jakarta : EGC Wilkinson, J. M. 2005. Nursing Diagnosing Handbook. Pearson Prentice Hall.