HIV IN PREGNANCY

BACHELOR OF NURSING

Presented By :
1. Angga Wahyu M
2. Irfan Fauzi
 OBJECTIVES
1. Definition of HIV/AIDS
2. Etiology of HIV
3. Sign and Symptom
4. Pathways/Pathophysiology
5. Therapy Management
6. Nursing Process
 WHATS HIV/AIDS?

HIV stands for the Human Immunodeficiency Virus. It first emerged 30 years ago. HIV
attacks the bodys immune system leading to a progressive reduction in the number
of T cells expressing CD4
Only affects human beings
AIDS stands for Acquired Immune Deficiency Syndrome.
HIV is passed on from one person to another via body fluids
 HIV TRANSMITED

The main routes of transmission are :

Through vaginaal or anal sex without condom
By sharing injecting equipment or needles for injecting drugs or tattooing
Les commonly, HIV is passed on through:
Oral sex
Mother to baby transmission
Breast feeding
 HIV TRANSMITTED

3. PERINATAL
1. SEX 2. PARENTERAL
Vertical transmitted
Unsafe sexuality, Horizontal Transmitted from mother who by HIV
Heterosexsual/ (through blood/ body infected to infant
Homosexsual liquid/ blood transpalant
 HIV TRANSMITTED IN PREGNANT

intrauterin intrapartum Postpartum

Virus Factor : more higher of viral load, more infection.

Host (mother pregnant) Factor: immune system, nutrition, anemia.
Obstetric Factor: prolonged labor
Baby Factor: Breast Feeding
 FACTOR AFFECTING HIV TRANSMISSION

1. Virus

Penularan meningkat dengan meningkatnya viral load yaitu 12% pada mereka yang mempunyai jumlah
viral load < 1000 RNA/ ml dibandingkan dengan 29% pada mereka dengan yang mempunyai jumlah viral
load >10.000 RNA/ml.

2. Mother

Penurunan status kekebalan ibu, tercermin dari jumlah CD4. Peningkatan risiko penularan dari ibu ke
anak jika CD4 ibu jumlahnya < 700/mm3. Transmisi meningkat hampir linear dengan penurunan jumlah
CD4.
 FACTOR AFFECTING HIV TRANSMISSION

3. obstetric

Kontak kulit secara langsung, yaitu kontak antara selaput lendir bayi dan ibu melalui sekresi cairan
serviko-vaginal . HIV-1 dalam cairan sekresi serviko-vaginal akan meningkat 4 kali lipat selama kehamilan.
Persalinan melalui operasi sesaria elektif dapat menyebabkan tingkat transmisi < dari 1%.

4. Baby

> 30% infeksi HIV perinatal akan terjadi melalui ASI. Selama menyusui, risiko penularan yang diperkirakan
sekitar 30%. Risiko penularan melalui ASI juga tergantung pada faktor-faktor lain, seperti stadium penyakit ibu,
abses payudara, mastitis, puting yang retak .
PATHOPHYSIOLOGY

Virus HIV menempel pada permukaan sel inang.

RNA HIV memasuki sel inang, terbentuklah DNA

pro virus.

DNA provirus memasuki inti sel dan akan

berikatan dgn DNA sel

Sel inang m= RNA HIV dan protein HIV

RNA virus baru dan protein pindah ke permukaan

sel yang baru dan masih imatur

terbentuklah virus HIV baru.

(Virus matang oleh enzim protease HIV)
CLINICAL MANIFASTED
 Stadium 1 Stadium 2 Stadium 3 Stadium 4
Asimptomatik, Simptomatik, aktivitas normal: Pada umumnya lemah, aktivitas di Pada umumnya sangat lemah, aktivitas di
aktivitas normal: a. Berat badan menurun < 10% tempat tidur kurang dari 50%: tempat tidur lebih dari 50%:
a. Asimptoatik b. Kelainan kulit dan mukosa yang a. Berat badan menurun > 10 % a. HIV wasting syndrome seperti yang
b. Limfadenopati ringan seperti, dermatitis b. Diare kronis yang berlangsung lebih didefinisikan oleh CDC.
generalisata seboroik, prurigo, onikomikosis, dari 1 bulan b. Pneumonia Pneumocystis carinii.
ulkus oral yang rekuren, dan c. Damam berkepanjangan lebih dari 1 c. Toksoplasmosis otak.
kheilitis angularis. bulan d. Diare kriptosporidiosis lebih dari 1 bulan.
c. Herpes zoster dalam 5 tahun d. Kandidiasis orofaringeal e. Kriptokokosis ekstrapulmonal
terakhir. e. Oral hairy leukoplakia. f. Retinitis virus sitomegalo
d. Infeksi saluran nafas bagian atas, f. TB paru dalam tahun terakhir. g. Herpes simplek mukokutan > 1 bulan
seperti sinusitis bakterialis. g. Infeksi bacterial yang berat seperti h. Leukoensefalopati multifocal progesif
pneumonia dan piomiositish i. Mikosis diseminata seperti histoplaosis
j. Kandidiasis di esophagus, trakea,
bronkus, dan paru
k. Mikobakteriosis atipikal diseminata
l. Septismia salmonellosis nontifoid
m. Tuberculosis di luar paru
n. Limfoma
o. Sarcoma Kaposi
p. Ensefalopati HIV
 THERAPY MANAGEMENT

HIV testing of all pregnant women are recommended

Fetal ultrasound imaging should be performed of maternal HIV status
ANTENATAL ART

UNIVERSAL PRECAUTION
INTRAPARTUM

PREVENT BREAST FEEDING ( all mother known to be HIV positive,

regardless of ART, and infant PEP (post-exposure prophylaxis),
POSTPARTUM should be advised to exclusively formula feed from birth
ANTIRETROVIRAL THERAPY

Purpose :
Reducing number of virus, however
less of probablities are perinatal
transmitted
INITIATE ART
Triple ART TDF+3TC(atau FTC)+EFV
 MONITORING PERKEMBANGAN DARI HIV KE
AIDS

Pengujian dalam memonitor perkembangan HIV/AIDS:

1. Pengujian CD4 untuk mengukur jumlah dari CD4 atau sel Thelper didalam
darah.
2. Pengujian viral load adalah mengukur jumlah virus HIV didalam darah dalam
setiap ml darah. Semakin tinggi viral load maka semakin cepat pula
perkembangannya ke AIDS.
NURSING PROCESS
 ASSESSMENT

1. Client Identity
2. Medical History
Many chronic diseases that influences with the weakness of immune function.
Diabetic meilitus, aplastic anemia, cancer are some of chronic disease, the
existence of such diseases should be considered as an additional factor when
assessing the patient's status immuno-competens.
3. Physical Examination(Objective) and Keluhan (Subyective)
Activity/ Rest
Symptoms : Easy to get fatigue, activity intolerance, malaise progression,
sleep patern changing.
Signs : Muscle weakness, decrease of muscle mass, activity phisiology
respons (BP changing, heart and breath frequently).
 Circulation
Symptoms: Healing is slow (anemia), bleeding in injury time.
Signs: TD postural changes, decreased peripheral pulse volume,
pale / cyanosis, capillary refill renewal.
Integrity and Ego
Symptoms: Stress related to loss, worrying about appearances, to deny
the diagnosis, despair, and so on.
Signs: Denying, anxiety, depression, fear, withdrawal, anger.
 Elimination
Symptoms: Diarrhea intermittent, continuous, often with or without abdominal cramps, pelvic
pain, a burning sensation during micturition
Symptoms: Feces dilute with or without mucus or blood, dense and frequent diarrhea, abdominal
tenderness, lesions or rectal abscess, perianal, changes in the number, color and characteristics
of urine.

Food / Fluids
Symptoms: Anorexia, nausea, vomiting, dysphagia
Symptoms: poor skin turgor, lesions of the oral cavity, teeth and gums are bad, edema
 Hygiene
Symptom: Unable to resolve AKS
Signs: sloppy appearance, lack of self-care.
Neurosensori
Symptoms: Dizziness, headache, altered mental status, status senses
damage, muscle weakness, tremors, changes in vision.
Signs: Changes in mental status, paranoid ideas, anxiety, abnormal
reflexes, tremors, seizures, hemiparesis, seizures.
 Pain / Leisure
Symptoms: Pain general / local, burning, headache, chest pain pleurisy.
Signs: Swelling joints, glands pain, tenderness, decreased susceptible
motion, limping.
Breathing
Symptoms: UTI frequent or persistent, progressive shortness of breath,
coughing, tightness in the chest.
Signs: Tachypnea, respiratory distress, change in breath sounds, the sputum.
 Security
Symptoms: History falls, burns, fainting, wounds, blood transfusions, immune
deficiency diseases, recurrent fevers, night sweats.
Signs: Changes in skin integrity, perianal wounds / abscesses, the emergence
of nodules, widening lymph nodes, a general decline in strength, general
pressure.
Sexuality
Symptoms: History behave in sex with high risk, decreased libido, use of
birth control pills.
Signs: Pregnancy, genital herpes.
 Social interaction
Symptoms: Problems caused by the diagnosis, isolation, loneliness,
trauma AIDS.
Signs: Changes interaction.
4. Diagnostic Examination
Laboratorium Test
Neurologic
EEG, MRI, CT Scan otak, EMG
Antibody test
Tes Enzym Linked Immunosorbent Assay ( ELISA)
Western Blot Assay
Indirect Immunoflouresence
Radio Immuno Precipitation Assay ( RIPA )
 NURSING DIAGNOSIS

1. High risk of infection related to immunosuppression, malnutrition and lifestyle risk.

2. Changes in nutrition: less than body requirements related to the excessive
spending (vomiting and severe diarrhea).
3. Acute /Chronic Pain related to inflammation, abdominal spasms and infections.
4. Lack of knowledge related to HIV and AIDS (travel, the spread of the disease, long-
term effects on the woman and the fetus.
 NURSING INTERVENTION

tugas\HIV &
Pregnancy\Intervensi.docx
 EVALUATION
Evaluation criteria includes the success of the process and the success of the nursing
actions. The success of the process can be seen by comparing the process with
guidelines / plan the process. While the success of the action can be seen by
comparing the patient's degree of independence in daily life and health of the
patient's level of progress with the goal that had been formulated before.
After doing nursing actions in the hope the patient:
1. Dx 1: Identify / engage in behaviors that reduce the risk of infection, no fever and is free
of expense / purulent secretions and other signs of infection condition.
2. Dx 2: Maintaining weight or show an increase in weight and demonstrate a positive
nitrogen balance, free from malnutrition and showed improvement energy levels.
3. Dx 3: Loss / uncontrolled pain, showing the position / relaxed facial expression.
4. Dx 4: Expressing understanding of the condition / disease process and actions, perform
the appropriate lifestyle changes and participate in treatment rules.