SCENARIO 2

BLOK 14
Leader
GROUP 2
: Watil Jamila (16-014)
Secretary : Hidayatul fitri (16-012)
Members :
• Lestari (16-017)
• Monica Cerly (16-020)
• Nurmita Darma Putri (16-021)
• Farhan fadillah (16-041)
• Saskia Khairanisa Erman (16-045)
• Wahyu Wulandari (16-046)
• Tifani Dwi Agustin (16-048)
• Muhammad fadel (16-063)
• Mila Sartika (16-074)
• Ansyori Putra Pasaribu (16-084)
 The Prayer of the Maid

In a hospital there are some patients who

have no fever go away. Patient 1 has skin
abnormalities in the form of vesicles and
ulcer. Patient 2 looks pale on yellowish
skin and skin, with diagnosis of
hepatitis. Patient 3 looks pale, weak and
has a thin skin complaints of the oral
mucosa, there are patients who work as a
nurse and some consume drugs. In the
laboratory there are several blood test.
 1. Vesicles

Clarification of 4. Drugs
2. Ulcer
Terms

3. Hepatitis
 Learning Objective
1. Able to understand and explain the clinical examination of varicella,
hepatitis B, AIDS

2. Able to understand and explain the etiology of varicella, hepatitis B,

AIDS

3. Able to understand and explain the pathogenesis of varicella,

hepatitis B, AIDS

4. Able to understand and explain treatment plans and prognosis

varicella, hepatitis B, AIDS

5. Able to understand and explain prevention and prevention varicella,

hepatitis B, AIDS

6. Able to understand and explain manifestations in the oral cavity

varicella, hepatitis B, AIDS
 VIRUS
Varicella Hepatitis B AIDS

clinical examination

Etiology

Pathogenesis

Care Plan

Prevention

Manifestations in the oral cavity

 1. Able to understand and explain the clinical examination of
varicella, hepatitis B, AIDS

1. Varicella

• Tzanck smear
• Direct fluorescent assay (DFA)
• Polymerase chain reaction
(PCR)
• Skin biopsy
 1. Able to understand and explain the clinical examination of
varicella, hepatitis B, AIDS

2. Hepatitis B

• Biochemical examination
• Serological examination
• Molecular examination
1. Able to understand and explain the clinical examination of
varicella, hepatitis B, AIDS

3. AIDS

• HIV screening
• CD4 T-cell count
• Viral Load (VL)
• Secondary HIV Examination
• Histological Findings
• Pathological examination
 2. Able to understand and explain the etiology of varicella,
hepatitis B, AIDS

AIDS
The cause of
Varicella AIDS is a type
Hepatitis B
The virus that of virus
This disease is
causes this belonging to
caused by the
disease is VVZ the Retrovirus
hepatitis B
(Varicella called the
virus (HBV)
Zoster Virus) Human
Immunodeficie
ncy Virus (HIV).
 3. Able to understand and explain the pathogenesis of
varicella, hepatitis B, AIDS

Varicella
VZV enters the human body through the upper respiratory tract
mucosa, oropharynx or conjunctiva. The first viral replication
cycle occurs on days 2-4 which are located in regional
lymphnodes then followed by the spread of viruses in small
amounts through blood and lymph nodes, which results in
primary viremia (usually occurs on days 4-6 after the first
infection). In most infected patients, replication of the virus can
defeat the body's immature defense mechanisms so that it will
continue with the second viral replication cycle that occurs in the
liver and spleen, which results in secondary viremia. In this
phase, the virus particles will spread throughout the body and
reach the epidermis on day 14-16, which results in the
appearance of lesions in a typical skin.
 3. Able to understand and explain the pathogenesis of
varicella, hepatitis B, AIDS

Hepatitis B
In humans the liver is the target organ for the hepatitis B virus.
Hepatitis B virus (HBV) first attaches to specific receptors
membrane membranes and then penetrates into the liver cell
cytoplasm. In the cytoplasm the HBV releases its coat, releasing
nucleocapsid. Then the nucleocapsid will penetrate the liver cell
wall. In the nucleic nucleus of VHB acid will emerge from the
nucleocapsid and will attach to the host DNA and integrate into
the DNA. Furthermore HBV DNA instructs the liver gel to form
proteins for new viruses and then the formation of new viruses.
This virus is released into the bloodstream, the mechanism for
the occurrence of chronic liver damage due to the patient's
immunological response to infection. If the immunological
reaction is absent or minimal, a healthy career situation occurs.
 3. Able to understand and explain the pathogenesis of
varicella, hepatitis B, AIDS

AIDS
The main basis for HIV pathogenesis is the lack of a type of
lymphocyte T helper / inducer containing a CD 4 marker (T cell
4). T 4 lymphocytes are the center and the main cells involved
directly or indirectly in inducing immunological functions.
At the beginning of infection, HIV does not immediately cause
death from the cells it infects but first undergoes replication, so
there is an opportunity to develop in the patient's body, which
will eventually deplete or damage up to a certain amount of T4
lymphocyte cells. after a few months until a few years later, then
the patient will see clinical symptoms as a result of the HIV
infection. The period between HIV infection and the onset of
disease symptoms (incubation period) is 6 months to more than
10 years, an average of 21 months in children and 5 years in
adults..
 4. Able to understand and explain treatment plans and
prognosis varicella, hepatitis B, AIDS

Varicella

In immunocompetent children, usually no specific treatment is needed and

the treatment given is symptomatic, namely:
• Broken lesions in the form of vesicles, powder can be given to prevent
breakage.
• Broken vesicles or crustaceans, antibiotic ointments can be given to prevent
secondary infection.
• Can be given antipyretics and analgesics, but may not be a group of
salicylates (aspirin) to avoid the occurrence of Reye's syndrome.
• The fingernails must be cut to prevent secondary infection from scratching.
Antiviral medication:
• Antiviral administration can reduce the duration of illness, severity and
healing time will be shorter.
• Antiviral administration should take less than 48-72 hours after the skin
eruption appears.
• Antiviral groups that can be given are acyclovir, valacyclovir and famasiklovir.
Prognosis: varicella in immunocompetent children without prognosis
complications is usually very good whereas in immunocompromised children,
the morbidity and mortality are significant.
 4. Able to understand and explain treatment plans and
prognosis varicella, hepatitis B, AIDS

Hepatitis B

For current treatment, 7 types of drugs for hepatitis B are interferon alfa-2a,
peginterferon alfa-2a, lamivudine, adefovir, entecavir, telbivudin, and tenofovir.

Prognosis: good without complications

 4. Able to understand and explain treatment plans and
prognosis varicella, hepatitis B, AIDS

AIDS

Giving anti-retrovirals (ARVs) has caused health conditions in patients to be

much better. Other severe opportunistic diseases can be cured. Emphasis on
viral replication causes a decrease in the production of cytokines and viral
proteins that can stimulate growth. ARV drugs consist of several groups such as
nucleoside reverse transcriptase inhibitors, non nucleotide reverse transcriptase
inhibitors and protease inhibitors. These drugs only play a role in inhibiting
viral replication but can not eliminate the virus that has developed.

Prognosis: bad because the patient cannot recover completely, the treatment is
only to inhibit the work of the virus.
 5. Able to understand and explain prevention and prevention
varicella, hepatitis B, AIDS

Varicella
• Vaccine
• Patients with chickenpox should keep away from others (and not
attend child care or school) until at least five days after the rash has
appeared and all the blisters have dried.
• Patients with chickenpox should cover their nose and mouth when
coughing or sneezing, removing dirty tissues, washing their hands
properly and not together using the same cutlery, food or cup.
• Pregnant women must stay away from anyone who has chickenpox
or a nerve rash and must see their doctor if they are close to
someone who has the disease.
• Children who suffer from a lack of immunity (such as leukemia) or
are undergoing chemotherapy should stay away from anyone who
has chickenpox or a nerve rash because the infection may be very
severe.
 5. Able to understand and explain prevention and prevention
varicella, hepatitis B, AIDS

Hepatitis B

Prevention of Hepatitis B transmission:

Prevention can be done through Health Promotion actions both on
host and environment and special protection against transmission.
Prevention of disease:
Disease prevention is done through immunization both actively and
passively
Treatment until now has not found a specific treatment for HBV
infection. Management is generally supportive.
 5. Able to understand and explain prevention and prevention
varicella, hepatitis B, AIDS

AIDS

Prevention of AIDS by prohibiting the use of shared needles,

prohibiting blood transfusions in patients, sexual contact should be
avoided in patients, not changing sexual partners, for those who
have not had sex (teenagers) need to be educated.
AIDS prevention efforts through education have a very strategic
meaning because of the large population of adolescents on the
school track and politically this group is the nation's asset and
successor. One of the most targeted target groups of teenagers is
teenagers in the closed environment.
 6. Able to understand and explain manifestations in the oral
cavity varicella, hepatitis B, AIDS

Varicella
Intraoral manifestations in most patients, mucosal lesions often
precede lesions in the skin area. All areas of the oral mucosa can
be affected, mostly in the form of yellowish discrete vesicles
which are rapidly ulcerated. Lesions that do not feel painful are
ulcerated surrounded by a clear red halo.
 6. Able to understand and explain manifestations in the oral
cavity varicella, hepatitis B, AIDS

Hepatitis B
Manifestation of hepatitis B in the oral cavity, namely the
presence of jowndis, pale oral mucous tongue, green teeth, ulcer
due to reduced vitamin substances in the oral cavity.
 6. Able to understand and explain manifestations in the oral
cavity varicella, hepatitis B, AIDS

AIDS
• Fungal infections (Oral Candidiasis)
Candiasi so far is a sign in the mouth that is most often found in
both AIDS and AIDS related complex (ARC) patients and is a sign
of clinical manifestations in patients at high risk groups in more
than 59% of cases. Oral cystasis in AIDS patients can be seen in
the form of oral thrush, acute atrophic candidiasis, chronic
hyperplastic candidiasis, and angularis statics (Perleche).
• Virus infection
Infection because the herpes virus is most often found in people
with AIDS and ARC. Viral infections in patients can be seen in the
form of stomatic herpetiformis, herpes zoster, hairy leukoplakia,
sarcoma caposi, cytomegalovirus.
• Bacterial infections
Infection because bacteria can be either HIV necrotizing gingivitis
or HIV periodontitis.