SLE

Definition
• A chronic inflammatory disease that has
protean manifestations and follows a relapsing
and remitting course.
• More than 90% of cases of SLE occur in
women, frequently starting at childbearing
age
 Etiology
• Although the specific cause of SLE is unknown
• Environmental and exposure-related causes of
SLE are less clear. Possible early-life risk factors
include the following:
– Low birthweight (<2,500 g)
– Preterm birth (≥1 month early)
– Childhood exposure to agricultural pesticides
• Possible early-life risk factors include the
following :
– Low birthweight (<2,500 g)
– Preterm birth (≥1 month early)
– Childhood exposure to agricultural pesticides
• Other potential factors include the following:
– Silica dust and cigarette smoking
– Administration of estrogen to postmenopausal
women.
– Photosensitivity is clearly a precipitant of skin
disease
– Ultraviolet light
– Breastfeeding  decreased risk of developing SLE
 Epidemiology
• SLE from the 1970s to 2000s  1 to 10 per
100,000 population,
• prevalence of SLE  5.8 to 130 per 100,000
population.
• SLE symptoms may develop slowly over
months or years, or they may appear
suddenly.
• Common symptoms of SLE include:
– Joint pain and stiffness, which is often
accompanied by swelling and redness (fingers,
wrists, elbows, knees, and ankles)
– Skin rash, “butterfly rash” on the face or other
skin areas that are exposed to sun.
– Fever, Extreme fatigue, Weight loss
– Loss of appetite, nausea, and weight loss
– Chest pain, Bruising, Menstrual irregularities
– Dry eyes, Mouth ulcers, Brittle hair or hair loss
– Painful, pale or purple fingers or toes triggered by
cold or stress (Raynaud’s phenomenon)
– Anxiety, depression, forgetfulness, and difficulty
concentrating
 Diagnosis
• ACR Criteria for Diagnosing Systemic Lupus
Erythematosus
– Butterfly (malar) rash across cheeks and nose
– Discoid (skin) rash, which appears as scaly raised
red patches
– Photosensitivity
– Oral (mouth) ulcers
– Arthritis in two or more joints; joints will have
tenderness and swelling but will not have become
deformed
– Inflammation of the lining around the lungs
(pleuritis) or the heart (endocarditis)
– Evidence of kidney disease
– Evidence of severe neurologic disease, such as
seizures or psychosis
– Blood disorders, including low red and white
blood cell and platelet counts
– Immunologic abnormalities as evidenced by
positive tests for anti-double stranded DNA (anti-
dsDNA), anti-SM, anti-Ro, and anti-LA antibodies
– Positive antinuclear antibody (ANA) test
• Note: A patient must experienced four of the criteria
before a doctor can classify the condition as SLE. These
criteria, proposed by the American College of
Rheumatology, are not exclusive criteria for diagnosis,
however.
• Blood Tests
– Complement.
• Common complement tests measure C3, C4, C1q, and
CH50. Complement levels are especially low if there is
kidney involvement or other disease activity.
– Blood Count. White and red blood cell and
platelet counts are usually lower than normal
– Erythrocyte Sedimentation Rate (ESR).
– C-Reactive Protein (CRP). High levels of this blood
protein indicate inflammation.
• Skin Tests  immunoglobulin G (IgG)
antibodies,
• Tests for Complications of SLE
– Kidney Damage (Lupus Nephritis).
• Blood tests that measure creatinine, a protein
metabolized in muscles and excreted in the urine.
• Urine tests to measure protein levels
• Tests for detecting anti-ds DNA antibodies and blood
complements.
 Treatment
• No treatment cures systemic lupus
erythematosus  suppress symptoms and
relieve discomfort.
• Four drugs are specifically FDA-approved for
the treatment of lupus:
– Prednisone, Aspirin, Belimumab (Benlysta)
– Hydroxychloroquine (Plaquenil, generic)
• Treating Mild Systemic Lupus Erythematosus
– Creams and sunblocks for rashes
– Nonsteroidal anti-inflammatory drugs for fever,
arthritis, and headache
– Hydroxychloroquine or similar antimalarial drugs
for pleurisy, mild kidney involvement, and
inflammation of the tissue surrounding the heart
• Treating Severe Systemic Lupus
Erythematosus
– Hemolytic anemia
– Low platelet count with an accompanying rash
(thrombocytopenia purpura)
– Major involvement in the lungs or heart
– Significant kidney damage
 – Acute inflammation of the small blood vessels in
the extremities or gastrointestinal tract
– Severe central nervous system symptoms
• The primary approach to treating severe SLE is
to suppress the inflammation and overactive
immune system with corticosteroids or
immunosuppressant drugs
HIV
 Definition
• HIV (human immunodeficiency virus).
Untreated, HIV  AIDS (acquired
immunodeficiency syndrome).
• HIV attacks the body’s immune system,
specifically the CD4 cells (T cells), which help
the immune system fight off infections.
• AIDS is the final stage of HIV infection, and not
everyone who has HIV advances to this stage.
• AIDS is the stage of infection that occurs when
your immune system is badly damaged and
you become vulnerable to opportunistic
infections.
 WHERE DID HIV COME FROM?
• Chimpanzee in Central Africa  simian
immunodeficiency virus (SIV)  humans and
mutated into HIV when humans hunted these
chimpanzees for meat  contact with their
infected blood.
• HIV may have jumped from apes to humans as
far back as the late 1800s (Africa). United
States since at least the mid- to late 1970s.
HOW DO YOU GET HIV OR AIDS?
 WAYS HIV IS TRANSMITTED
• Having anal or vaginal sex with someone who
has HIV without using a condom or taking
medicines to prevent or treat HIV.
• In the United States, HIV is spread mainly by:
– Having anal or vaginal sex with someone who has
HIV without using a condom or taking medicines
to prevent or treat HIV.
• Anal sex is the highest-risk sexual behavior. For the HIV-
negative partner, receptive anal sex (“bottoming”) is
riskier than insertive anal sex (“topping”).
• Vaginal sex is the second highest-risk sexual behavior.
– Sharing needles or syringes, rinse water, or other
equipment (“works”) used to prepare injection
drugs with someone who has HIV.
– HIV can live in a used needle up to 42 days
depending on temperature and other factors
• Less commonly, HIV may be spread:
– From mother to child during pregnancy, birth, or
breastfeeding.
– By being stuck with an HIV-contaminated needle
or other sharp object  mainly for health care
workers
• In extremely rare cases, HIV has been
transmitted by:
– Oral sex, Receiving blood transfusions, blood
products, or organ/tissue transplants that are
contaminated with HIV.
– Eating food that has been pre-chewed by an HIV-
infected person.
– Being bitten by a person with HIV.
– Contact between broken skin, wounds, or mucous
membranes and HIV-infected blood or blood-
contaminated body fluids.
– Deep, open-mouth kissing if the person with HIV
has sores or bleeding gums and blood from the
HIV-positive partner gets into the bloodstream of
the HIV-negative partner. HIV is not spread
through saliva.
 HIV IS NOT SPREAD BY…
• HIV does not survive long outside the human
body (such as on surfaces) and it cannot
reproduce outside a human host. It is not
spread by:
– Air or water, Mosquitoes, ticks or other insects
– Saliva, tears, or sweat that is not mixed with the
blood of an HIV-positive person
– Shaking hands, hugging, sharing toilets, sharing
dishes/drinking glasses, or closed-mouth or
“social” kissing with someone who is HIV-positive
– Drinking fountains
– Other sexual activities that don’t involve the
exchange of body fluids (for example, touching).
SYMPTOMS OF HIV
 SYMPTOMS OF HIV
• EARLY STAGE OF HIV
– Flu-like symptoms can include:
• Fever, Chills, Rash, Night sweats
• Muscle aches, Sore throat
• Fatigue, Swollen lymph nodes, Mouth ulcers
• PROGRESSION TO AIDS
– Rapid weight loss, Recurring fever or profuse night
sweats
– Extreme and unexplained tiredness
– Prolonged swelling of the lymph glands in the
armpits, groin, or neck
– Diarrhea that lasts for more than a week
– Sores of the mouth, anus, or genitals, Pneumonia
– Red, brown, pink, or purplish blotches on or under
the skin or inside the mouth, nose, or eyelids
– Memory loss, depression, and other neurologic
disorders.
 WHAT ARE THE TYPES OF HIV TESTS?
• There are three main types of HIV tests:
– antibody tests
– combination tests (antibody/antigen tests), and
– nucleic acid tests (NATs)
 Treatments
• Housing, Mental health care
• Supportive care and in-home health care
• Food assistance, Support groups
• Activity groups
• Pharmacy-assisted medication management
programs
 ARV
• When is it time to start taking HIV medicine?
– Treatment with HIV medicines (called
antiretroviral therapy or ART for short) is
recommended for everyone infected with HIV. ART
helps people with HIV live longer, healthier lives
and reduces the risk of HIV transmission.
• What conditions increase the urgency to start
ART?
– Pregnancy
– AIDS
– Certain HIV-related illnesses and coinfections
– Early HIV infection
 REDUCE YOUR RISK:
• Lower Your Sexual Risk for HIV
• Understanding Risk Activities
• When One Partner Is HIV+
• Substance Abuse/Use
• Pregnancy & Childbirth
• Pre-Exposure Prophylaxis
• Post-Exposure Prophylaxis (PEP)
• Blood Transfusions/Organ Donation
• Using Condoms
• Who is at Risk for HIV?
 ASKEP FOR HIV
• Movie
Diagnosa Keperawatan pada HIV dengan infeksi
mulut & tenggorokan
1. Gangguan integritas mukosa mulut
2. Tidak efektifnya pemenuhan kebutuhan
nutrisi
 Intervensi Keperawatan dari Dx Infeksi
mulut: 1

• Kaji integritas
membran mukosa
• Berikan intake cairan
2,5-3L/hari
• Lakukan oral hygiene,
gunakan H2O2 kumur
Intervensi Keperawatan dari Dx Infeksi
mulut: 1

• Anjurkan gosok gigi

dg sikat gigi lembut
• Berikan
pengobatan untuk
Kandidiasis atau
Oral hairy leukoplakia
 Intervensi Keperawatan dari Dx
Infeksi mulut: 2

• Hitung kebutuhan
kalori pasien
• Berikan porsi kecil &
sering
• Berikan makanan
dingin/segar, tidak
pedas
Intervensi Keperawatan dari Dx Infeksi
mulut: 2

• Berikan
minuman/cemila
n bergizi antar
waktu makan
• Cuci mulut
sebelum makan
 Infeksi Oportunistik:
• Diare
– B.a.b. cair >3x/24 jam
– Penyebab: infeksi bakteri, virus, & jamur
– Infeksi permukaan usus  berkurang permukaan
usus tempat menyerap makanan  diare
 Terapi Diare

• Salmonella & shigelosis

– Kotrimoxazol 2 x 960 mg/hr slm 7 hr
– Ciprofloxasin 2 x 500 mg/hr slm 7 hr
• Campilobakter
– Eritromycine 4 x 500 mg/hr slm 5 hr
• Giardiasis
– Metronidazol 3 x 500 mg/hr slm 5 hr
• E. histoltika
– Metronidazol 3 x 500 mg/hr slm 7 hr
 Diagnosa Keperawatan pada HIV dengan diare

1. Gangguan keseimbangan cairan & elektrolit

2. Gangguan pola eliminasi
 Intervensi Keperawatan dari Dx Diare: 1 &
2

• Kaji intake & output

• Kaji tanda-tanda dehidrasi
• Berikan intake cairan 2,5-
3L/hari
• Anjurkan pasien tirah baring
Intervensi Keperawatan dari Dx Diare:
1&2

• Tempatkan pasien di
tempat tidur berlubang
• Feses segera di buang
• Identifikasi
makanan/minuman
pencetus diare
• Berikan pengobatan untuk
diare
 Bagaimana dengan intervensi
keperawatan pada
• ODHA yang Hepatitis &
• ODHA yang Meningitis

???
Diagnosa Keperawatan pada HIV dengan
Hepatitis

 Gangguan nutrisi: kurang dari

kebutuhan tubuh
 Keterbatasan aktifitas
 Intervensi Keperawatan dari Dx
Hepatitis: 1 & 2

• Hitung kebutuhan
kalori pasien
• Beri posisi duduk
saat makan
• Bersihkan mulut
sebelum makan
• Berikan jus buah
• Catat asupan/hari
 Intervensi Keperawatan dari Dx
Hepatitis: 1 & 2

• Anjurkan pasien untuk

bed-rest
• Libatkan pasien dalam
perencanaan aktifitas
• Lakukan aktifitas secara
bertahap
 Diagnosa Keperawatan pada HIV dengan
Meningitis
• Gangguan perfusi jaringan otak
• Resiko cedera
• Gangguan pemenuhan kebutuhan sehari-hari
 Intervensi Keperawatan dari Dx
Meningitis: 1, 2 & 3
• Berikan posisi tidur terlentang dengan posisi
0
kepala di tinggikan 15-30
• Anjurkan pasien bed-rest
• Pastikan pembatas tempat tidur terpasang
 Intervensi Keperawatan dari Dx
Meningitis: 1, 2 & 3

• Berikan terapi O2 & pengobatan

sesuai program
• Berikan latihan pergerakan. Mulai
dengan memperkuat otot akibat
bed rest lama
• Bantu pasien memenuhi
kebutuhan sehari-hari
• Movie 2
SEMANGAT BELAJAR