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PENGKAJIAN

Pengkajian
o Riwayat kesehatan
o Status nutrisi
o Infeksi
o Imunisasi
o Alergi
o Riwayat penyakit : gangguan autoimun, kanker dan
penyakit kronis
o Pembedahan
o Pengobatan
o Transfusi darah
Pemeriksaan fisik
o Palpasi nodul limfe
o Pemeriksaan kulit, membran mukosa, respirasi,
gastrointestinal, genitourinaria, kardiovaskuler, neurosensori
Riwayat Kesehatan
1. Umur
Umur berhubungan dengan fungsi sistem imun
Sistem Tubuh Perubahan Akibat
Sistem Imun o Gangguan fungsi limfosit Menekan respon terhadap
B dan limfosit T patogen dan meningkatkan
o Penurunan produksi resiko infeksi
antibodi
o Menekan respon imun
fagosit
Sistem GIT o Penurunan sekresi gaster o Proliferasi organisme
dan motilitas dalam intestinal yang
o Penurunan fagositosis menyebabkan GE dan
oleh sel kupffer di hepar diare
o Intake nutrisi (protein) o Peningkatan insiden dan
tidak ademuat keparahan hepatitis B
o Peningkatan insiden abses
hepar
o Menekan respon imun
Umur berhubungan dengan fungsi sistem imun
Sistem Tubuh Perubahan Akibat
Uurinaria Penurunan fungsi ginjal Urine statis
Respirasi Gangguan aktivitas cilia Gangguan bersihan sekresi
paru
Integumen Penurunan elastisitas Resiko cidera
Sirkulasi Gangguan mikrosirkulasi Ulkus
Persarafan Penurunan sensasi dan Resiko cidera
fungsi refleks
2. Nutrisi
o Status nutrisi termasuk intake kalori, nutrisi yang adekuat
merupakan dasar fungsi sistem imun yang optimal
o Intake vitamin yang dibutuhkan dalam pembentukan DNA
dan sintesa protein dapat menyebabkan defisiensi kalori-
protein yang dan mempengaruhi fungsi imun.
o Asam lemak untuk membentuk komponen struktur
membran sel. Kelebihan atau kekurangan asam lemak
dapat menekan fungsi imun.
o Kekurangan protein menyebabkan terjadinya atropi
jaringan limfoid, mengurangi respon antibodi,
berkurangnya jumlah T cells dalam sirkulasi dan
mengganggu fungsi fagosit dan peningkatan resiko untuk
mengalami infeksi.
3. Riwayat Infeksi
4. Riwayat Alergi
5. Penyakit Neoplastic
o Mengkaji tentang riwayat kanker yang dialami pasien,
termasuk tentang jenis kanker, mulai didiagnosa dan hasil
pemeriksaan. Penekanan imun berkontribusi dalam
perkembangan kanker.
o Tumor dapat mengeluarkan antigen dalam darah yang akan
berinteraksi dengan antibodi.
o Kanker hematologi (leukemia, limphoma) berhubungan dengan
perubahan produksi dan fungsi leukosit dan limfosit.
o Riwayat terapi (radiasi, kemoterapi), radiasi dapat
mempengaruhi limfosit. Kemoterapi juga mempengaruhi sel
imun dan menyebabkan immunosuppression.
6. Riwayat Penyakit Kronis & Pembedahan
o Penyakit kronis berkontribusi terhadap gangguan sistem imun.
o Mengkaji penyakit kronis seperti diabetes mellitus, gagal
ginjal dan COPD.
o Renal failure berhubungan dengan defisiensi limfosit dalam
sirkulasi, pertahanan imun dipegaruhi adanya asidosis dan
toksin uremik.
o Diabetes mellitus meningkatkan resiko infeksi berhubungan
dengan insufisiensi vaskuler, neuropati dan peningkatan kadar
glukosa darah.
o Infeksi saluran pernafasan berhubungan dengan COPD akibat
adanya perubahan fungsi dan tidak efektifnya bersihan jalan
nafas.
o Riwayat pembedahan (limpa, nodus limfe, thymus),
transplantasi organ berhubungan dengan resiko gangguan
fungsi imun.
Aspects of Immune Dysfunction in End-stage Renal Disease
Sawako Kato, Michal Chmielewski, Hirokazu Honda, Roberto Pecoits-
Filho, Seiichi Matsuo, Yukio Yuzawa, Anders Tranaeus, Peter Stenvinkel,
Bengt Lindholm. CJASN September 2008 vol. 3 no. 5 1526-1533
Abstract
End-stage renal disease (ESRD) is associated with significantly increased
morbidity and mortality resulting from cardiovascular disease (CVD) and
infections, accounting for 50% and 20%, respectively, of the total mortality
in ESRD patients.
It is possible that these two complications are linked to alterations in the
immune system in ESRD, as uremia is associated with a state of immune
dysfunction characterized by immunodepression that contributes to the
high prevalence of infections among these patients, as well as by
immunoactivation resulting in inflammation that may contribute to CVD.
This review describes disorders of the innate and adaptive immune
systems in ESRD, underlining the specific role of ESRD-associated
disturbances of Toll-like receptors. Finally, based on the emerging links
between the alterations of immune system, CVD, and infections in ESRD
patients, it emphasizes the potential role of the immune dysfunction in
ESRD as an underlying cause for the high mortality in this patient
population and the need for more studies in this area.
Inflammation and Activated Innate Immunity in the Pathogenesis of Type
2 Diabetes
John C. Pickup. Diabetes Care March 2004 vol. 27 no. 3 813-823

Abstract
There is increasing evidence that an ongoing cytokine-induced acute-phase response
(sometimes called low-grade inflammation, but part of a widespread activation of the innate
immune system) is closely involved in the pathogenesis of type 2 diabetes and associated
complications such as dyslipidemia and atherosclerosis. Elevated circulating inflammatory
markers such as C-reactive protein and interleukin-6 predict the development of type 2
diabetes, and several drugs with anti-inflammatory properties lower both acute-phase
reactants and glycemia (aspirin and thiazolidinediones) and possibly decrease the risk of
developing type 2 diabetes (statins). Among the risk factors for type 2 diabetes, which are
also known to be associated with activated innate immunity, are age, inactivity, certain
dietary components, smoking, psychological stress, and low birth weight. Activated
immunity may be the common antecedent of both type 2 diabetes and atherosclerosis,
which probably develop in parallel. Other features of type 2 diabetes, such as fatigue, sleep
disturbance, and depression, are likely to be at least partly due to hypercytokinemia and
activated innate immunity. Further research is needed to confirm and clarify the role of
innate immunity in type 2 diabetes, particularly the extent to which inflammation in type 2
diabetes is a primary abnormality or partly secondary to hyperglycemia, obesity,
atherosclerosis, or other common features of the disease.
Masalah Khusus
o Keadaan lain yang dapat mempengaruhi fungsi imun
dintaranya adalah luka bakar dan cidera lain.
o Luka bakar yang luas merupkan faktor penyebab kerusakan
integritas kulit dan pertahanan utama tubuh.
o Kehilangan serum dalam jumlah yang banyak pada luka
bakar menyebabkan hilangnya protein termasuk
imunoglobulin.

o Stress fisik dan psikologis yang berhubungan dengan


pembedahan dan cidera akan menstimulasi pengeluaran
kortisol dari korteks adrenal, peningkatan kortisol serum
dapat memengaruhi respon imun.
Riwayat Pengobatan
o Bone marrow suppression.
o Imunosuppression.
Gaya hidup dan faktor lain
o Riwayat merokok
o Kosumsi alkohol
o Diet dan status nutrisi
o Stress
o Sexual transmitted disease
o occupational
Mechanical, physical, and chemical components of the
innate immune system.
o Mechanical barriers presented by the skin and mucus
membranes.
o Expulsive actions of coughing and sneezing, as well as
peristalsis in the gastrointestinal tract.
o Washing effects of the body fluids, such as saliva, tears and
urine.
o Unfavourable, acidic pH of the skin and stomach.
o Antimicrobial agents in body fluids such as lysozyme in tears
and saliva, defensins in the skin and respiratory and
gastrointestinal tracts, and surfactant proteins A and D in the
lung.
o Elevated body temperatures, unfavourable for the growth of
fastidious microbial pathogens
PEMERIKSAAN FISIK
Indications of Immune Dysfunction
Respiratory System Genitourinary System
• Changes in respiratory rate • Frequency and burning on urination
• Cough (dry or productive) • Hematuria
• Abnormal lung sounds (wheezing, • Discharge
crackles, rhonchi) Skin
• Rhinitis • Rashes
• Hyperventilation • Lesions
• Bronchospasm • Dermatitis
Cardiovascular System • Hematomas or purpura
• Hypotension • Edema or urticaria
• Tachycardia • Inflammation
• Dysrhythmia • Discharge
• Vasculitis Neurosensory System
• Anemia • Cognitive dysfunction
Gastrointestinal System • Hearing loss
• Hepatosplenomegaly • Visual changes
• Colitis • Headaches and migraines
• Vomiting • Ataxia
• Diarrhea • Tetany
Pharmaceuticals 2010, 3, 1694-1710; doi:10.3390/ph3051694
Pharmaceuticals ISSN 1424-8247
www.mdpi.com/journal/pharmaceuticals Review
Beneficial and Harmful Interactions of Antibiotics with Microbial Pathogens
and the Host Innate Immune System
Ronald Anderson, Gregory Tintinger ,Riana Cockeran, Moliehi Potjo,
Charles Feldman