ASUHAN KEPERAWATAN

PADA PASIEN HIV/AIDS

Pengkajian
• Assess physical and psychosocial status
• Identify potential risk factors: IV drug abuse and risky
sexual practices
• Assess immune system function
• Assess nutritional status
• Assess skin integrity
• Assess respiratory status and neurologic status
• Assess fluid and electrolyte balance
• Assess knowledge level
 Nursing Diagnosis of the Patient
With AIDS
• Pain
• Impaired skin integrity
• Imbalanced
• Fluid imbalance nutrition
• Risk for infection • Social isolation
• Activity intolerance • Anticipatory
grieving
• Disturbed thought processes
• Deficient
• Ineffective airway clearance knowledge
Collaborative Problems/Potential
Complications
• Opportunistic infections

• Impaired breathing or respiratory failure

• Wasting syndrome

• Fluid and electrolyte imbalance

• Adverse reaction to medication

 Planning the Care of the Patient
• Goals may include:

– Achievement and maintenance of skin integrity

– Resumption of usual bowel patterns

– Absence of infection

– Improved activity tolerance

– Improved thought processes

– Improved airway clearance

– Increased comfort
– Improved nutritional status
– Increased socialization
– Expression of grief
– Increased knowledge regarding disease prevention and self-care
– Absence of complications
 Skin Integrity
• Conduct frequent routine assessment of skin and
mucosa
• Encourage patient to maintain balance between rest and
activity
• Reposition at least every two hours and as needed
• Use pressure reduction devices
• Instruct patient to avoid scratching
• Use gentle, nondrying soaps or cleansers
• Avoid adhesive tape
• Provide perianal skin care
 Promoting Usual Bowel Pattern
• Assess bowel pattern and factors that may exacerbate
diarrhea

• Avoid foods that act as bowel irritants, such as raw fruits

and vegetables, carbonated beverages, spicy foods, and
foods of extreme temperatures

• Small, frequent meals

• Administer medications as prescribed

• Assess and promote self-care strategies to control

diarrhea
 Activity Intolerance
• Maintain balance between activity and rest

• Instruction regarding energy conservation techniques

• Relaxation measures

• Collaboration with other members of the health care

team
Maintaining Thought Processes
• Assess mental and neurologic status
• Use clear, simple language if mental status is altered
• Establish and maintain a daily routine
• Use orientation techniques
• Ensure patient safety and protect from injury
• Implement strategies to maintain and improve functional
ability
• Instruct and involve family in communication and care
 Nutrition
• Monitor weight, I&O, dietary intake, and factors that
interfere with nutrition
• Provide dietary consultation
• Control nausea with antiemetics
• Provide oral hygiene
• Treat oral discomfort
• Administer dietary supplements
• May require enteral feedings or parenteral nutrition
 Decreasing Isolation
• Promote an atmosphere of acceptance and
understanding
• Assess social interactions and monitor behaviors
• Allow patient to express feelings
• Address psychosocial issues
• Provide information related to the spread of infection
• Educate ancillary personnel, family, and partners
 Other Interventions
• Improve airway clearance
– Use semi-Fowler's or high-Fowler’s position
– Pulmonary therapy; coughing and deep breathing;
postural drainage; percussion; and vibration
– Ensure adequate rest
• Pain
– Administer medications as prescribed
– Provide skin and perianal care
 Prinsip Perawatan dan
Penanganan AIDS
• Perawatan penderita tergantung gejala
yang muncul
• Pada umumnya tidak memerlukan
perawatan tersendiri (isolasi), kecuali bila
muncul gejala-gejala yang mungkin
membahayakan lingkungannya (source
isolation) atau kemungkinan lingkungan
yang membahayakan pasien (protective
isolation).
 Penderita di isolasi :
• Penderita tidak/kurang kooperatif
• Ada gejala infeksi menular : batuk-batuk,
diare, penyakit oportunistik lainnya
• Perdarahan berat
• Neutropenia
 Perlindungan :
• Masker
• Sarung tangan’
• Skort
• Cuci tangan
• Sepatu boot
• Penyuntikan hanya oleh perawat/petugas
terlatih dan harus hati-hati
 Bila terluka atau tertusuk oleh
alat tajam bekas pasien :???
• Segera lapor pada Tim AIDS/pimpinan untuk
dilakukan pengawasan sesuai ptokol yang ada
• Pertolongan awal dapat dilakukan segera
dengan mencuci luka dengan air mengalir dan
sabun, biarkan darah mengalir secukupnya
kemudian dilakukan perawatan luka biasa.
 Penanganan Alat Tajam:
• Jarum suntik dan alat intravena yang telah
digunakan harus disimpan ke dalam kotak atau
bahan yang berdinding kuat tahan tusukan dan
tidak bocor (misal kaleng/botol)
• Jarum jangan ditutup kembali, dibengkokkan
maupun dipatahkan untuk menghindari
kemungkinan resiko tertusuk.
• Peralatan tersebut disimpan pada tempat
khusus, diberi tanda merah untuk menghindari
kesalahan pembuangan untuk kemudian
dibakar.
 Penanganan Bahan Tenun :
• Penggunaan bahan tenun dianjurkan
menggunakan lapisan tambahan berupa
plastik
• Bahan tenun bekas pasien dibungkus
dengan 2 kantong (sesuai protokol RS),
diikat kuat dan dikirimkan ke tempat cuci
untuk disterilkan. Gunakan sarung tangan.
 Bahan yang terkontaminasi
• Semua bahan bekas pakai pasien
dimasukkan dalam kantong khusus yang
tebal berwarna kuning, kemudian ditutup
rapat dan dibakar.
 Penanganan Barang Pecah
belah :Gelas, piring
• Direndam dalam desinfektan selama 30 menit,
kemudian dicuci menggunakan sarung tangan.

• Bagi penderita dengan infeksi rongga

mulut/enterik, atau TBC, biasanya digunakan
alat sekali pakai dan diperlakukan sebagai
bahan terkontaminasi.
 Penanganan Spesimen
• Harus menggunakan sarung tangan
• Diberi label khusus
• Pembuangan limbahnya diperlakukan
sebagai bahan terkontamiansi
 Hal-hal yang harus diperhatikan
• Pada konseling pertama umumnya
penderita mengalami syok dan harus
mendapatkan bimbingan
• Kerahasiaan identitas pasien
 Petugas :
• Kecakapan bekerja
• Berdedikasi tinggi untuk rela bekerja demi
keselamatan semua pihak
• Mental stabil
• Sehat, tidak sedang menderita infeksi
• Dapat dipercaya/mampu menjaga rahasia
Nutrition and HIV / AIDS

Ns. Rahmawati, M.Kep., Sp.MB

 Pendahuluan
• Virus HIV  menyerang sistem imun
• Imun menurun  IO  demam, diare
• IO  menurunkan nafsu akan, gangguan
absorpsi zat makanan  intake makanan
menurun  malnutrisi, kehilangan berat badan
• Pasien underweight  sistem imun –
• Gejala awal AIDS klinis : kehilangan berat badan
6 – 7 kg pada pasien dewasa
• Status nutrisi baik  kualitas hidup ODHA
baik
Gangguan nutrisi pada pasien HIV/AIDS
- Adanya infeksi : demam, diare
- Pengobatan HIV/AIDS : mempengaruhi nafsu makan,
pola makan dan nutrisi
- Gejala mual, muntah, lesi pada mulut : kesulitan makan
- Kelemahan, isolasi sosial dan depresi : mempengaruhi
nafsu makan dan keinginan serta kemampuan
menyiapkan makanan
- Keterbatasan ekonomi untuk membeli makanan
Efek malnutrisi pada penderita HIV/AIDS :
imunitas makin menurun --- dampak lebih
serius -- timbul starvasi – perubahan
fisiologik pada cairan tubuh, lemak, protein
dan massa sel  gangguan metabolisme
Penderita HIV/AIDS membutuhkan :
- nutrisi yang sehat dan seimbang,
- pengobatan infeksi secara dini,
- Pemulihan nutrisi yang tepat setelah
infeksi dapat mengurangi kehilangan berat
badan dan mengurangi dampak infeksi di
masa datang.
 Perawatan
- Perbaiki nafsu makan
- Jelaskan pentingnya makan makanan
seimbang
- Bantu penderita mengidentifikasi makanan
yang dapat memperkuat imunitas :
Makanan kaya kandungan karbohidrat,
lemak, protein, vitamin dan mineral
 Cara Pemberian Makan
• Oral
• Enteral
• Total Parenteral Nutrition
Intervensi Program Pengaturan Nutrisi yang
Adekuat :
1.Pertimbangkan secara ekonomis
2.Memberi informasi yang cukup pada
penderita dan keluarga dalam cara
pemberian makanan
3.Mengetahui masalah gangguan fisik
4.Mengetahui masalah gangguan psikologis
 Perawatan
Diare
• Drink lots of fluids (non-alcoholic) to prevent dehydration.
• Eat soft, liquid foods that are easy to eat and swallow, like soup.
• Eat small meals five or more times a day.
• Eat food that is low in fat.
• Eat food high in carbohydrates to provide energy (e.g., rice,
potatoes, bread).
• Eat soft fruits and vegetables, such as banana, papaya,
watermelon, and potatoes.
• Avoid milk and milk products.
• Avoid acidic fruits and vegetables, including onions, tomatoes, and
pineapple. Do not use “hot” spices
Nausea and vomiting
• Sit up when eating. Try not to lie down until one or two
hours after eating.
• Drink plenty of fluids after meals.
• Try not to prepare food yourself. The smell of preparing
or cooking food may worsen the feeling of nausea.
• Ask somebody else to prepare food or eat foods that
require little preparation.
Sore Mouth
• Eat soft, smooth or moist foods such as avocados,
pumpkins, papaya, bananas, yoghurt, creamed
vegetables, soups, pasta dishes.
• Add liquids to foods or soften dry food by dipping in
liquids.
• Drink cold drinks, soups, juices.
• Use a straw for drinking fluids.
• If the gums are painful and brushing the teeth is not
possible, rinsing the mouth with water will make the
mouthfeel fresh.
• Chewing small pieces of green mango, kiwi or green
papaya may help to relieve pain.
Changes in The Taste of Food
• Experiment with different foods and spices until you find
foods you like.
• Try to have a varied diet.
• Mint, garlic, ginger, and other herbs and spices may
seem to lose their taste when medicines are being taken.
• Try preparing food with sugar, or lemon instead.
Skin Problems
• Eating foods rich in vitamin A and/or B6 may help to
prevent skin problems or improve the condition over
time.
• Good sources of vitamin A are yellow, orange and green
vegetables and liver.
• Good sources of vitamin B6 are cereals, whole grains,
seeds and nuts and green leafy vegetables.
Colds, Coughs and Influenza
• Drink plenty of water or other fluids and have
plenty of rest.
• Crush a lemon and mix it with honey. Take a
large spoonful as necessary.
• Gargle with a strong solution of salt and water
several times a day.
• Prepare teas and plant extracts for sore
throats.