Acquired Immune Deficiency syndrome (AIDS)

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Acquired Immune Deficiency syndrome (AIDS)

Acquired Immune Deficiency syndrome (AIDS)

Definition

AIDS or Acquired Immune Deficiency syndrome is a collection of symptoms of diseases caused by decreasing the body's immune system by vurus called HIV. In the Indonesian language as the syndrome can be converted katakana Immune Defect income.

Acquired: Acquired, not a hereditary disease

Immune: immune system

Deficiency: Lack of

Syndrome: A collection of disease symptoms

Progrwsif damage on the immune system causes the PLHA (people living with HIV / AIDS) is very fragile and easily affected by various diseases. The attacks are usually not dangerous disease even in the long run will cause the patient severe pain and even death.
AIDS is a collection of symptoms that indicate weakness or damage to the immune system caused by external factors (not taken from birth)
AIDS is most closely defined as a form of state of constant pain associated with human infection Immunodefciency Virus (HIV). (Suzanne C. Smetzler and Brenda G. Bare)
AIDS is defined as the most severe form of HIV infection, ranging from mild abnormalities in the immune response with no apparent signs and symptoms until the condition associated with immunosuppression and pelbagi infection that can bring death and with rare disorders malignitas (Centers for Disease Control and Prevention)

Etiology

AIDS is caused by a virus that has several names that HTL II, LAV, RAV. Which scientific name is called Human Immunodeficiency Virus (HIV) in the form of viral agents known as retroviruses that are transmitted by blood and have a strong affinity towards T lymphocytes

Pathophysiology

T cells and macrophages and dendritic cells / Langerhans (immune cells) are cells that are infected with Human Immunodeficiency Virus (HIV) and concentrated dikelenjar nodes, spleen and bone marrow. Human Immunodeficiency Virus (HIV) infects cells by binding to proteins of peripheral CD 4, with the corresponding virus antigen group is 120. At the time of infected T4 cells and participate in the immune response, the Human Immunodeficiency Virus (HIV) to infect other cells by increasing the number of reproductive cell death and T 4 which is also influenced host killer cell immune response, in an attempt to eliminate the virus and infected cells.

With the decline in the number of T4 cells, the cellular immune system progressively weaker. Followed by reduced function of B cells and macrophages and decreased T helper cell function.

Someone who is infected with Human Immunodeficiency Virus (HIV) may still not show any symptoms (asymptomatic) for many years. During this time, the number of T4 cells can be reduced from about 1000 perml blood cells before the infection reaches about 200-300 per ml blood, 2-3 years after infection.

When T4 cells reach this level, symptoms of infection (herpes zoster and fungal opportunistic) appears, Total T4 and then decline due to the emergence of new diseases will cause the virus proliferates. Finally, a severe infection. One was diagnosed with AIDS when the number of T4 cells fall below 200 cells per ml of blood, or if there opurtunistik infection, cancer or AIDS dementia.

Classification

Since 1 January 1993, the people with the condition that an indicator of AIDS (category C) and those included in categories A3 or B3 considered suffering from AIDS.

Clinical category A

Includes one or more of these conditions in adults / adolescents with human immunodeficiency virus infection (HIV) which can be ascertained without a state already in clinical categories B and C

Infection with Human Immunodeficiency Virus (HIV) is symptomatic.
Limpanodenopati persistent generalized (PGI: Persistent Generalized Limpanodenophaty)
Infection with Human Immunodeficiency Virus (HIV) primary with pain that accompanies acute or past infection with Human Immunodeficiency Virus (HIV) is acute.

Clinical category B

Examples of conditions in clinical category B include:

Angiomatosis Baksilaris
Oropharyngeal candidiasis / Vulvavaginal (peristen, frequent / poor response to therapy
Cervical dysplasia (moderate / severe cervical carcinoma in situ)
Constitutional symptoms such as hot (38.5 ° C) or diarrhea for more than 1 month.
Leukoplakial haired
Herpes Zoster which includes two distinct events / happening on more than one nerve dermaton.
Idiopathic thrombocytopenic Purpura
Pelvic inflammatory disease, especially with abscess Tubo Varii

Clinical category C

Examples of circumstances in the adult and youth categories include:

Candidiasis bronchus, trachea / lung, esophagus
Cervical cancer inpasif
Koksidiomikosis extrapulmonary / disseminated
Extrapulmonary cryptococcosis
Chronic internal Kriptosporidosis
Cytomegalovirus (not the liver, spleen, or lymph nodes)
Refinitis Cytomegalovirus (impaired vision)
Enselopathy associated with Human Immunodeficiency Virus (HIV)
Herpes simplex (chronic ulcer, bronchitis, pneumonitis / esophagitis)
Histoplamosis disseminated / extrapulmonary)
Chronic intestinal Isoproasis
Kaposi's sarcoma
Burkit lymphoma, Imunoblastik, and primary brain lymphoma
Mycobacterium avium complex (M.kansasi are disseminated / extrapulmonary
M. Tubercolusis at each location (pulmonary / extrapulmonary)
Mycobacterium, other species, disseminated / extrapulmonary
Pneumonia Pneumocystic Cranii
Recurrent Pneumonia
Leukoenselophaty multifocal progresiva
Recurrent Salmonella septicemia
Toksoplamosis brain
Pelisutan syndrome due to Human Immunodeficiency Virus (HIV)

5. Symptoms And Signs

AIDS patients typically have a history of symptoms and signs of disease. On infection of Human Immunodeficiency Virus (HIV), primary acute length of 1-2 weeks the patient will feel pain like the flu. And while symptomatic phase of immunosuppression (3 years) patients will experience fever, night sweats, weight loss, diarrhea, neuropathy, fatigue skin rash, limpanodenopathy, added cognitive, and oral lesions.

And while the infection phase of the Human Immunodeficiency Virus (HIV) to AIDS (bevariasi 1-5 years from the first determination of the condition of AIDS) will have symptoms of infection opurtunistik, the most common is Pneumocystic carinii (PCC), interstitial pneumonia caused by a protozoa, other infections including menibgitis, candidiasis, cytomegalovirus, mikrobakterial, atypical

infection of Human Immunodeficiency Virus (HIV)

Acute non-specific symptoms and signs and symptoms similar to common illnesses such as fever, sweating, lethargy drowsiness, joint pain, headache, diarrhea, sore throat, inflammation of lymph nodes, and red spots in your body.

Infection with Human Immunodeficiency Virus (HIV) without symptoms

Known by the examiners levels of Human Immunodeficiency Virus (HIV) in blood will be obtained positive results.

Inflammation of the lymph nodes comprehensive and settled, with symptoms of swollen lymph nodes throughout the body for more than 3 months.

6. Complication

a. Oral Lesions

Because kandidia, herpes simplex, Kaposi sarcoma, oral HPV, gingivitis, peridonitis Human Immunodeficiency Virus (HIV), oral leukoplakia, nutrition, dehydration, weight loss, fatigue and disability.

b. Neurologic

- AIDS dementia complex because it directly attacks the Human Immunodeficiency Virus (HIV) in nerve cells, an effect personality changes, damage to motor skills, weaknesses, disfasia, and social isolation.

- Enselophaty acute, because therapeutic reaction, hypoxia, hypoglycemia, electrolyte imbalance, meningitis / encephalitis. With effects: headache, malaise, fever, paralise, total / partial.

-. Cerebral infarction corneal meningovaskuler syphilis, systemic hypotension, and maranik endocarditis.

- Neuropathy due to demyelination by attack imflamasi Human Immunodeficienci Virus (HIV)

c. Gastrointestinal

- Diarrhea caused by bacteria and viruses, rapid growth of normal flora, lymphoma, and Kaposi sarcoma. In effect, weight loss, anorexia, fever, malabsorption, and dehydration.

- Hepatitis due to bacteria and viruses, lymphoma, Kaposi sarcoma, illegal drugs, alcoholic. With anorexia, nausea, vomiting, abdominal pain, jaundice, fever arthritis.

- Diseases due to abscess and anorectal fistula, perianal ulceration and inflammation that as a result of infection, with inflammatory effect is difficult and painful, rectal pain, itching and siare.

d. Respiration

Infections due to Pneumocystic carinii, cytomegalovirus, influenza virus, pneumococcus, and strongyloides with effects shortness of breath, cough, pain, hypoxia, fatigue, respiratory failure.

e. Dermatologik

Staphylococcal skin lesions: herpes simplex and zoster, dermatitis due to xerosis, muscular reaction, lesions of scabies / louse, and dekobitus with the effects of pain, itching, burning, secondary infection and sepsis.

f. Sensory

- View: Kaposi's sarcoma of the conjunctiva effect blindness

- Hearing: Acute external otitis and otitis media, hearing loss with the effects of pain.

7. Management

There is no cure for AIDS, so prevention needs to be done Human Immunodeficiency Virus (HIV) to prevent exposure of Human Immunodeficiency Virus (HIV), can be done by:

- Perform abstinence sex / having sex with uninfected partners.

- Checking the existence of a virus at least 6 months after last sex unprotected.

- Use protective when dealing with people who do not clear the status of Human Immunodeficiency Virus (HIV) it.

- Not sharing needles, tattoo needles, and so forth.

- Preventing infection kejanin / newborn.

When infected with Human Immunodeficiency Virus (HIV), then terpinya namely:

Infection Control Opurtunistik

Aims to eliminate, control, and recovery opurtunistik infection, nasokomial, or sepsis. Act of safe infection control to prevent complications of bacterial contamination and cause of sepsis should be maintained for patient critical care environment.

AZT therapy (Azidotimidin)

FDA Approved (1987) for the use of effective antiviral drug AZT to AIDS, these drugs inhibit the replication of antiviral Human Immunodeficiency Virus (HIV) by inhibiting the enzyme reverse traskriptase. AZT available to AIDS patients that his T4 cell count <> 3. Now, AZT available to patients with Human Immunodeficiency Virus (HIV) positive asymptomatic and T4 cells> 500 mm3

New Antiviral Therapy

Several new antiviral that enhances immune system activity by inhibiting viral replication / reproduction chain decided virus in the process. These medications are:

- DdI

- Ribavirin

- Diedoxycytidine

- Recombinant soluble CD 4

Virus Vaccines and Reconstruction

Immune reconstruction efforts and vaccine with these agents such as interferon, the special unit of critical care nurses can use their expertise in the field of nursing process and research to support the understanding and the success of AIDS therapy.

Education to avoid alcohol and drugs, eating-healthy foods, avoid stress, poor nutrition, alcohol and drugs that interfere with immune function.
Avoiding other infections, because infections that can activate T cells and accelerate reflikasi Human Immunodeficiency Virus (HIV).

Nursing Basic Concepts

1. Assessment

a. Hospital chart

This type of infection often provide the first clue as the nature of immune disorders. Chronological age of the patient also affects imunokompetens. Very depressed immune response in people who are very young because underdeveloped thymus gland. In the elderly, atrophy of the thymus gland can increase susceptibility to infection. Many chronic diseases associated with weakened immune function. Diabetes meilitus, aplastic anemia, cancer is a chronic disease, the existence of such disease should be considered as a supporting factor when assessing the status imunokompetens patients. The following forms of host disorders and diseases and therapies associated with abnormalities of host:

- Damage to cellular immune response (T lymphocytes)

Radiation therapy, nutritional deficiencies, aging, aplasia timik, lymphoma, corticosteroids, anti-lymphocyte globulin, timik congenital dysfunction.

- Damage to immune humoral (antibody)

Chronic lymphocytic leukemia, myeloma, hipogamaglobulemia congenital, protein - liosing enteropathy (intestinal inflammation)

b. Physical Examination (Objective) and Complaints (Sujektif)

- Activity / Rest

Symptoms: Easy fatigue, activity intolerance, progression malaise, changes in sleep patterns.

Signs: muscle weakness, reduced muscle mass, physiological response activities (Amendment TD, Jantun and respiratory frequency).

- Circulation

Symptoms: The healing is slow (anemia), bleeding time on the injury.

Signs: TD postural changes, decreased peripheral pulse volume, pale / cyanotic, extension of the filling capillary.

- Integrity and Ego

Symptoms: Stress associated with loss, alarming appearance, denying doagnosa, despair, and so forth.

Signs: Denying, anxiety, depression, fear, withdrawal, angry.

- Elimination

Symptoms: Diarrhea intermittent, continued - again, often with or without abdominal cramps, pelvic pain, burning sensation when miksi

Signs: watery stool with or without mucus or blood, intense and frequent diarrhea, abdominal tenderness, lesions or rectal abscess, perianal, change the number, color, and characteristics of urine.

- Food / Fluids

Symptoms: Anorexia, nausea, vomiting, dysphagia

Signs: poor skin turgor, lesions of the oral cavity, health, bad teeth and gums, edema

- Hygiene

Symptoms: Unable to resolve AKS

Signs: Appearances are not tidy, less self-care.

- Neurosensoro

Symptoms: Dizziness, headache, altered mental status, sensory status damage, muscle weakness, tremors, changes in vision.

Signs: Changes in mental status, paranoid ideas, anxiety, abnormal reflexes, tremors, convulsions, hemiparesis, seizures.

- Pain / Leisure

Symptoms: Pain general / local, burning sensation, headache, chest pain pleuritis.

Signs: Swollen joints, painful glands, tenderness, decreased susceptible of motion, limping.

- Respiratory

Symptoms: UTI frequent or persistent, progressive shortness of breath, coughing, tightness in the chest.

Signs: Tachypnoea, respiratory distress, change in breath sounds, the presence of sputum.

- Security

Symptoms: History falls, burns, fainting, injury, blood transfusions, immune deficiency disease, recurrent fever, night sweats.

Signs: Changes in skin integrity, perianal wound / abscess, the emergence of nodules, lymph node enlargement, the decline in public power, public pressure.

-Sexuality

Symptoms: History behave high-risk sex, decreased libido, the use of birth control pills.

Signs: Pregnancy, herpes genetalia

- Social Interaction

Symptoms: The problem posed by the diagnosis, isolation, loneliness, trauma AIDS

Signs: Changes in interaction

- Extension / Learning

Symptoms: Failure in care, high risk sexual behavior, IV drug abuse, smoking, alcoholism.

c. Diagnostic Examination

a. Laboratory Tests

Has developed a number of diagnostic tests that some still are research. Tests and laboratory examinations used to diagnose human immunodeficiency virus (HIV) and monitor disease progression and response to therapy Human Immunodeficiency Virus (HIV)

1. Serological

- Tests of serum antibody

Screening for Human Immunodeficiency Virus (HIV) and ELISA. Positive test result, but is not a diagnosis

- Western blot test

Confirming the diagnosis of Human Immunodeficiency Virus (HIV)

- T cell lymphocytes

The decrease in total

- Cell helper T4

Indicators of immune system (number <200>

- T8 (suppressor cell sitopatik)

Inverse ratio (2: 1) or greater than suppressor cells on helper cells (T8 to T4) indicates immunosuppression.

- P24 (Protein wrapper Human ImmunodeficiencyVirus (HIV))

Increasing the value of quantitative protein identify progression of infection

- Levels of Ig

Increased, especially Ig A, Ig G, Ig M is normal or nearly normal

- Polymerase chain reaction

Detecting small amounts of viral DNA in peripheral cell infection monoseluler.

- Test PHS

Packaging and antibody hepatitis B, syphilis, CMV may be positive

2. Culture

Histological, cytological examination of urine, blood, feces, fluid spine, wounds, sputum, and secretion, to identify the presence of infection: parasites, protozoa, fungi, bacteria, viral.

3. Neurological

EEG, MRI, CT scan of the brain, EMG (nerve examination)

Other Tests

Chest X-ray

Stating the development of interstitial filtration of advanced PCP or any other complications

Pulmonary Function Tests

Early detection of interstitial pneumonia

Gallium Scan

Uptake of pulmonary diffusion occurs in PCP and other forms of pneumonia.

Biopsies

Another diagnosis of Kaposi sarcoma

Brankoskopi / washing trakeobronkial

Performed with biopsy at the time of PCP or suspected lung damage

b. Antibody Test

If a person is infected with Human Immunodeficiency Virus (HIV), the immune system will react by producing antibodies against the virus. Antibody formed in 3-12 weeks after infection, or can be up to 6-12 months. This explains why people who are infected initially showed no positive test results. But the antibodies found to be ineffective, the ability to detect antibodies Human Immunodeficiency Virus (HIV) in blood allows the screening of blood products and facilitate the diagnostic evaluation.

In 1985 the Food and Drug Administration (FDA) gave the license of the test - content Human Immunodeficiency Virus (HIV) for all donors of blood or plasma. The tests, namely:

1. Enzyme tests - Linked Immunosorbent Assay (ELISA)

To identify antibodies that are specifically aimed at the virus Human Immunodeficiency Virus (HIV). ELISA did not establish the diagnosis of AIDS but only indicates that a person is infected or were infected with Human Immunodeficiency Virus (HIV). People who have antibodies in their blood Human Immunodeficiency Virus (HIV) are called seropositive.

2. Western Blot Assay

Antibody recognizing human immunodeficiency virus (HIV) and ensure seropositifitas Human Immunodeficiency Virus (HIV)

3. Indirect Immunoflouresence

Substitute checks to ensure seropositifitas western blot.

4. Radio Immuno Precipitation Assay (RIPA)

Detecting the protein from the antibody.

c. Tracking Human Immunodeficiency Virus (HIV)

Direct Determination of the activity there and the Human Immunodeficiency Virus (HIV) to track the course of the disease and its response. Protein called p24 viral protein, p24 antigen capture assay examination is very specific for HIV - 1. but levels of p24 in patients with human immunodeficiency virus infection (HIV) is very low, the patient had a p24 dengantiter more likely to be greater than AIDS.

This check is used with other tests to evaluate the anti-viral effects. Examination of culture Human Immunodeficiency Virus (HIV) or quantitative plasma culture and plasma viremia are additional tests that measure viral load (viral burden)

AIDS emerged after the body's defenses is the natural defense system against germs of collapse by the HIV virus, with the collapse / destruction of cells of T lymphocytes due to lack of T cells, then the patient is very easy to infections and cancers that simple though, that for a normal person does not mean . So it was not his own that causes AIDS patient's death, but infection and his cancer.

HIV is usually transmitted through sexual intercourse with a person who contracted the virus and there is direct contact with blood or blood products and other body fluids. In women the virus may enter through cuts or abrasions in the mouth of the uterus / vagina. Similarly, the virus enters the blood flow in genital male if there are ulcers or blisters. Through anal sex at high risk for infection, but also vaginal and oral. HIV can be spread by direct contact of blood with the blood, such as syringes (injection narcotic drug addicts), transfusion of blood / blood products and pregnant mothers to their babies during childbirth. There is no evidence of transmission through daily contact such as shaking hands, kissing, gels used former patient, a towel or through a common closet, because this virus is very fragile.

The period of incubation / latent period depends on the endurance of each person, an average of 5-10 years. During this time people do not show symptoms, although the number of HIV-T4 cells growing and increasingly menururn. The lower the number of T4 cells, the more damaged the immune system.

At the time the immune system is already in severe circumstances, a person living with HIV / AIDS will begin to show symptoms of AIDS.

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