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    Peran Perawat Anti Retroviral

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    Tiur Poerba
    This document discusses the role of nurses in providing antiretroviral (ARV) therapy. It covers: 1) Types of ARVs including NRTI, NNRTI, and PI and how they work to prevent HIV replication. 2) Guidelines for starting ARV therapy based on WHO clinical staging and CD4 count. 3) The importance of adherence to the lifelong treatment regimen to avoid drug resistance. 4) Potential side effects of ARVs and the nurse's role in monitoring patients and providing education and support to improve adherence.

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    Peran Perawat Anti Retroviral

    Uploaded by

    Tiur Poerba
    68 views35 pages
    This document discusses the role of nurses in providing antiretroviral (ARV) therapy. It covers: 1) Types of ARVs including NRTI, NNRTI, and PI and how they work to prevent HIV replication. 2) Guidelines for starting ARV therapy based on WHO clinical staging and CD4 count. 3) The importance of adherence to the lifelong treatment regimen to avoid drug resistance. 4) Potential side effects of ARVs and the nurse's role in monitoring patients and providing education and support to improve adherence.

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    Peran Perawat Anti Retravial

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    This document discusses the role of nurses in providing antiretroviral (ARV) therapy. It covers: 1) Types of ARVs including NRTI, NNRTI, and PI and how they work to prevent HIV replication. 2) Guidelines for starting ARV therapy based on WHO clinical staging and CD4 count. 3) The importance of adherence to the lifelong treatment regimen to avoid drug resistance. 4) Potential side effects of ARVs and the nurse's role in monitoring patients and providing education and support to improve adherence.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    68 views35 pages

    Peran Perawat Anti Retroviral

    Uploaded by

    Tiur Poerba
    This document discusses the role of nurses in providing antiretroviral (ARV) therapy. It covers: 1) Types of ARVs including NRTI, NNRTI, and PI and how they work to prevent HIV replication. 2) Guidelines for starting ARV therapy based on WHO clinical staging and CD4 count. 3) The importance of adherence to the lifelong treatment regimen to avoid drug resistance. 4) Potential side effects of ARVs and the nurse's role in monitoring patients and providing education and support to improve adherence.

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    of 35

    Peran Perawat pada

    pemberian Terapi Anti


    Retroviral (ARV)
    NS.ZAHRAH MS, S.KEP, M.KEP

    Siklus hidup HIV

    Jenis Anti Retroviral (ARV)

    Nucleoside reverse transcriptase inhibitors


    (NRTI)
    Non-nucleoside reverse transcriptase
    inhibitors (NNRTI)
    Protease inhibitors (PI)

    Cara Kerja NRTI & NNRTI

    Mencegah HIV RNA menjadi HIV DNA


    Dampak 1: HIV tidak dapat masuk tempat
    pembentukan sel
    Dampak 2: HIV tidak dapat menjadi bagian
    material sel T

    Cara Kerja PI

    Bagian DNA virus HIV tidak dapat dipotong


    menjadi bagian2 kecil
    Dampak 1: HIV tidak dapat menyusun
    tubuhnya
    Dampak 2: Tidak tersusun virus2 baru

    Obat-obat ARV
    NRTI

    NNRTI

    PI

    Zidovudin (AZT)
    Lamivudine
    (3Tc)
    Stavudine (d4T)
    Didanosine (ddI)
    Abacavir (ABC)

    Nevirapine
    (NVP)
    Efavirenz
    (EFV)

    Saquinavir (SQV)
    Indinavir (IDV)
    Nelfinavir (NFV)
    Lopinavir/Ritonavir
    (LPV/r)
    Amprenavir (AMV)

    Manfaat ARV/ART

    Memperpanjang hidup
    Memperbaiki kualitas hidup
    Mengurangi viral load

    Manfaat ARV (lanjutan)

    Meningkatkan pertahanan tubuh


    Mencegah penularan HIV dari ibu ke anak
    Menurunkan biaya perawatan IO
    Meningkatkan produktifitas: ODHA bisa
    bekerja

    Classification System for HIV


    Infection (CDC)
    CLINICAL CATEGORIES (CDC): A, B, C
    CD4+ T-CELL
    CATEGORIES

    (A) SYMPTOMATIC
    HIV, PGL

    (B) SYMPTOMATIC

    (C) AIDS- INDICATOR

    (A) CD4+ 500

    A1

    B1

    C1

    (B) CD4+ 200499

    A2

    B2

    C2

    (C) CD4+ < 200

    A3

    B3

    C3

    WHO Clinical Staging of HIV/AIDS for Adults and


    Adolescents
    Primary HIV Infection
    Asymptomatic
    Acute retroviral syndrome
    Clinical Stage 1
    Asymptomatic
    Persistent generalized lymphadenopathy
    Clinical Stage 2
    Moderate unexplained weight loss (<10% of presumed or measured body weight)
    Recurrent respiratory infections (sinusitis, tonsillitis, otitis media, and pharyngitis)
    Herpes zoster
    Angular cheilitis
    Recurrent oral ulceration
    Papular pruritic eruptions
    Seborrheic dermatitis
    Fungal nail infections

    WHO Clinical Staging of HIV/AIDS for


    Adults and Adolescents
    Clinical Stage 3
    Unexplained severe weight loss (>10% of presumed or measured body weight)
    Unexplained chronic diarrhea for >1 month
    Unexplained persistent fever for >1 month (>37.6C, intermittent or constant)
    Persistent oral candidiasis (thrush)
    Oral hairy leukoplakia
    Pulmonary tuberculosis (current)
    Severe presumed bacterial infections (eg, pneumonia, empyema, pyomyositis,
    bone or joint infection, meningitis, bacteremia)
    Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis
    Unexplained anemia (hemoglobin <8 g/dL)
    Neutropenia (neutrophils <500 cells/L)
    Chronic thrombocytopenia (platelets <50,000 cells/L)

    WHO Clinical Staging of HIV/AIDS for


    Adults and Adolescents
    Clinical Stage 4
    HIV wasting syndrome, as defined by the CDC (see Table 3, above)
    Pneumocystis pneumonia
    Recurrent severe bacterial pneumonia
    Chronic herpes simplex infection (orolabial, genital, or anorectal site for >1 month or visceral herpes at any site)
    Esophageal candidiasis (or candidiasis of trachea, bronchi, or lungs)
    Extrapulmonary tuberculosis
    Kaposi sarcoma
    Cytomegalovirus infection (retinitis or infection of other organs)
    Central nervous system toxoplasmosis
    HIV encephalopathy
    Cryptococcosis, extrapulmonary (including meningitis)
    Disseminated nontuberculosis Mycobacteria infection
    Progressive multifocal leukoencephalopathy
    Candida of the trachea, bronchi, or lungs
    Chronic cryptosporidiosis (with diarrhea)
    Chronic isosporiasis
    Disseminated mycosis (eg, histoplasmosis, coccidioidomycosis, penicilliosis)
    Recurrent nontyphoidal Salmonella bacteremia
    Lymphoma (cerebral or B-cell non-Hodgkin)
    Invasive cervical carcinoma
    Atypical disseminated leishmaniasis
    Symptomatic HIV-associated nephropathy
    Symptomatic HIV-associated cardiomyopathy
    Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)

    ARV menurunkan stigmatisasi

    Apabila diketahui pengobatan HIV tersedia,


    maka:

    Meningkatkan jumlah orang yang meminta VCT


    Meningkatkan kepedulian masyarakat
    Meningkatkan motivasi tenaga kesehatan
    mereka dapat melakukan sesuatu untuk pasien
    HIV

    Kapan Memulai ARV?

    Trend berubah
    Dahulu bukan suatu emergensi
    Apakah trend dapat dipercaya 100%???
    Kriteria yang masih dipakai di lapangan:

    Setelah pengobatan IO akut


    Semua stadium 4 WHO
    Stadium 2 & 3 WHO bila CD4<200 atau Hitung
    Limfosit <1200

    HAART?

    Highly Active Antiretroviral Therapy


    3 macam obat ARV yang berbeda
    2 NRTI + 1 NNRTI or 2 NRTI + 1 PI
    Contoh:
    1.
    2.
    3.

    AZT
    d4T
    AZT/d4T

    + 3TC + NVP (Bukan u/ TB)


    + 3TC + NVP (Anak)
    + 3TC + EFV (TB)

    Tujuan penggunaan Triple ARV/


    HAART

    Mengurangi jumlah virus sebanyak mungkin


    Meningkatkan jumlah CD4 sebanyak
    mungkin
    HIV sulit di stop
    Perlu penyerangan HIV dari berbagai cara
    Dapat menunda resistensi

    ARV dimulai bila:

    Kriteria WHO dipenuhi


    Pasien memiliki motivasi
    Tenaga kesehatan (dokter/perawat) terlatih
    Terjamin ketersediaan obat (Ada obat & dana)
    Monitoring Lab tersedia

    Kepatuhan/Adherence

    Kenapa kepatuhan penting?

    Pengobatan seumur hidup


    Mempengaruhi gaya hidup

    Kapan terjadi resistensi ARV?

    Tanpa interupsi efektif menekan


    perkembangan virus
    Interupsi terjadi mutasi HIV resisten

    Penyebab Resistensi

    Rendahnya kadar ARV dalam darah

    Mutasi alamiah

    Interaksi obat ttt dapat menurunkan kadar ARV


    Salah dosis atau minum tidak teratur
    Dalam replikasi kadang virus error, error = mutasi
    Mutasi alamiah tidak terlalu berbahaya

    Mutasi pada pemberian HAART

    Saat ODHA dengan HAART virus mengalami mutasi


    berbahaya, karena mutasi membentuk virus yg paling kuat

    Interaksi ARV dengan makanan

    Perhatikan label obat ARV


    Yang diketahui memiliki interaksi dengan
    makanan: EFV. Hindari intake makanan yang
    berminyak/berlemak saat mendapatkan terapi
    EFV.

    Bantuan untuk kepatuhan pasien pada


    ARV

    Pill chart
    Pill box
    Pill beeper atau Alarm watch

    Bantuan untuk kepatuhan pasien pada


    ARV

    Teman/Friend helper
    Support group
    Home visits
    Dukungan finansial (uang transport)

    Contoh Pill Chart


    Nama
    Obat

    Pagi
    6.00

    7.00

    8.00

    9.00

    Sore
    10.00

    11.00

    15.00

    16.00

    17.00

    18.00

    19.00

    20.00

    Contoh Pill Chart


    AZT 300 mg 2x1 + 3TC 150 mg 2x1 + NVP 200 mg 2x1

    AZT 100 mg

    3TC 150 mg

    NVP 200 mg

    Efek Samping ARV

    Tidak nyaman, tapi tidak terlalu berbahaya


    Potensial serius, sering terjadi pada bulan
    pertama pemberian ARV
    Terjadi pada waktu yang lama setelah ARV
    diberikan

    Efek Samping ARV


    Gejala

    ARV

    Tindakan

    Mual, muntah

    Semua ARV

    Jelaskan pada pasien bahwa


    umum terjadi

    Rasa lelah

    AZT

    Kaji apakah pasien kurang


    tidur, jk tidak kolaborasi
    dokter

    Ruam Kulit

    NVP, EFV

    Kolaborasi ke dokter

    Gangguan tidur

    EFV, AZT

    Kaji penyebab, minimalkan


    penyebab. Jk berlanjut,
    konsulkan ke dokter

    Mimpi buruk, sensitif, depresi

    EFV

    Jelaskan umum terjadi pd bbrp


    pasien, jk mengganggu
    kolaborasi dokter

    Baal, lemah, kesemutan

    d4T

    Kolaborasi dokter

    Efek Samping ARV


    Gejala

    ARV

    Tindakan

    Nyeri perut, mual, muntah,


    jaundice, lemah, anorexia

    NVP, EFV, d4T, 3TC, AZT

    Anjurkan menghirup bau2an


    segar, oral hygiene, minum
    jahe hangat, istirahat cukup,
    makan porsi kecil & sering

    Lipodistrofi/Atrofi

    d4T

    Jelaskan umum tjd pd bbrp


    pasien. Jk tidak dapat
    menerima, stop obat

    Nyeri otot

    AZT

    Biasanya membaik setelah fase


    inisial

    Sakit kepala

    AZT, EFV

    Biasanya membaik setelah fase


    inisial

    Pertanyaan yang sering ditanyakan


    Pasien tentang ARV

    Bagaimana jika saya lupa minum obat?


    Dapatkah saya meminum obat tradisional saat
    minum ARV?
    Haruskah pasien tetap menggunakan kondom
    saat berhubungan jika minum ARV?
    Bagaimana penyimpanan obat?

    Peran Perawat pada Kepatuhan ARV

    Kaji kesiapan ODHA memulai ARV


    Mengidentifikasi masalah keperawatan pada
    pemberian ARV
    Monitor & evaluasi kepatuhan berkala
    Melakukan intervensi keperawatan berdasarkan
    masalah yang muncul
    Pemberian informasi & tindakan spesifik pd
    pengobatan ARV (Efek Samping)

    Sudahkah anda kompeten dalam


    tindakan kolaborasi: Pengobatan ARV
    pada ODHA?

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