Gapuz Communicable Disease Nursing
Gapuz Communicable Disease Nursing
Gapuz Communicable Disease Nursing
Contagious Diseases
Diseases that can easily be transmitted
Concepts:
All communicable diseases are infectious but not
contagious
Because there is the presence of a living microorganism
Because not all of the microorganisms can be easily
transmitted
All contagious diseases are infectious
All contagious diseases are communicable diseases
Diphtheria is a disease, which is
o Contagious
o Communicable
o Infectious
Malaria is a disease, which is
o Communicable
o Infectious
o But not contagious
Tetanus is a disease, which is
o Infectious only
Epidemiological Triad
Three (3) factors for a disease to take place
1. HOST
A person
An animal
Concept:
Consider the susceptibility of the host
Susceptibility
o Pertains to degree of resistance
If resistance is low, susceptible person is prone to infection
Types of Hosts:
1.1)
Patient
A person infected manifesting signs and symptoms
1.2) Carrier
Individual who harbors microorganisms but shows no signs
and symptoms
1.3) Suspect
Individual whose medical history and symptoms suggests
that he may be developing a specific infection
Signs and symptoms are suggestive
1.4) Contact
Individuals who come in close association or in contact or
exposed to infected person
Horizontal Transmission
Manner of transfer of microorganisms is in a horizontal
position
Vertical Transmission
Manner in which microorganisms are transferred is in a
vertical manner from up going down
Example:
o Infected mother to newborn child transmission
Concepts:
The PATIENT is the least source of infection
The PATIENT has the least chance to spread
microorganisms
o Because he manifests signs and symptoms of
the disease, he is isolated
o Precautionary measures are now taken
The CARRIER has the highest potential to spread infection
o Because he does not manifest signs and
symptoms of the disease
o However, he has the microorganisms
Infectious Diseases
Diseases wherein there is a presence of a living
microorganism in the body, which may not be transmitted
through ordinary contact
Need not be transferred from one person to another
Concept:
There must be an interplay between the three factors:
Host
Agent
Environment
for infection to set in.
2. AGENT
Microorganisms
They have the highest population among all living things
Not all are susceptible to microorganisms
Not all microorganisms are virulent
Concepts:
Virulence
Strength and power of microorganisms to cause infection
Pathogenicity of microorganisms
Capacity of microorganisms to cause infection
2. Reservoir
A place where microorganisms can live and multiply
Examples:
o T. pallidums reservoir is the human genitalia
o Measles virus reservoir is the nasopharynx
o Salmonella typhosas reservoir are the Peyers
patches of the small intestines
3. Portal of Exit
From the reservoir, microorganisms look for a way out
This pertains to the individuals body system
Examples:
o T. pallidums portal of exit is the genitourinary
system
o Measles virus portal of exit is the respiratory
system
o Salmonella typhosas portal of exit is the
gastrointestinal tract
4. Mode of Transmission
When outside of the host, this pertains to the
microorganisms means of transportation
Examples:
o T. pallidums mode of transmission is sexual
contact
o Measles virus mode of transmission is airborne
nuclei
o Salmonella typhosas mode of transmission is
fecal-oral ingestion
5. Portal of Entry
A microorganisms way in to the new host
Also corresponds to the individuals body system
Examples:
o T. pallidums portal of entry is the genitourinary
system
o Measles virus portal of entry is the respiratory
system
o Salmonella typhosas portal of entry is the
gastrointestinal tract
6. Susceptible Host
Concept:
Objective or goal is to limit, prevent or control spread of
communicable diseases by breaking the chain of diseases
Look for the weakest link in the chain
3. ENVIRONMENT
Must be conducive and favorable to growth of
microorganisms
Example:
o Clostridium tetani will not cause infection in the
presence of oxygen because it is an anaerobic
microorganism
2. Acquired Immunity
This is the more common type of immunity
It is either a person is able to PRODUCE it or a person is
able to GET it
Two (2) Types of Acquired Immunity
2.1) Active Acquired Immunity
An actual participation of the individuals body tissues and
fluid in PRODUCING immunity
You produce the antibodies yourself when microorganisms
are given to you
Two (2) Ways of Producing Antibodies:
2.1.1) Naturally Acquired Active Immunity
Antibodies are produced by nature
Unintentionally
Examples:
o Previous attack of a disease
o Chicken pox attack wherein antibodies are
produced by nature
o Measles attack wherein antibodies are produced
by nature
Sub-clinical immunity
o Developed due to constant exposure to certain
infection
when
CDT VACCINE
Cholera, Dysentery, Typhoid Vaccine
Given by DOH for free
Adult dose is 0.5 cc
Adult injection site is the deltoid muscle
Child dose is 0.25 cc
Child injection site is the vastus lateralis
Given INTRAMUSCULARLY (I.M.)
Given when there are outbreaks of epidemic
Immunity lasts only for six (6) months.
Anti-Rabies Vaccine
Target group would be the animals
Animals are brought to the Barangay for free immunization
Barangay Captain is responsible for obtaining vaccines
from DOH
Dogs must initially be registered before this vaccine could
be administered
1.3) Environmental Sanitation
Objective:
o No proliferation of arthropods, rodents (both of
which are good vectors)
Presidential Decree 856
Sanitation Code
Also includes submission of sex workers in determination
of sexually transmitted diseases
o For gonorrhea two times a month
o For syphilis once a month
o Physical Examination once a month
1.4)
2. CONTROL ASPECT
Done when signs and symptoms are already present
There is already the presence of infection
Goal is to limit the infection
2.1) Isolation
Separation of an infected person during period of
communicability
Two (2) ways of Isolation
2.1.1) Strict Isolation
Intended to protect other persons (not the patient) from
infection
It intends to limit the microorganisms to be within the
patient
2.1.2) Reverse Isolation
Also called Protective Isolation
Intended to protect the immunocompromised patient from
infection
Intends to keep microorganisms out of the patient
Concepts:
Quarantine
Limitation of freedom of movement of a well person during
the longest incubation period
It involves the separation of persons who are carriers
These are persons who are not sick
These are persons who do not manifest signs and
symptoms of the disease
Droplet Precaution
No contact to mucous membrane, nose, mouth
Use mask ordinary mask will do
Use goggles
o For meningitis, mumps, pertussis, German
measles, diphtheria
Contact Precaution
Avoid person to person contact
Use gloves
Use gown
For diarrheal diseases, typhoid, cholera, hepatitis, skin
diseases like ringworm, scabies and pediculosis
Control Measures other than Isolation
1. Disinfection
Important Concepts:
When inside the human being, the spore transforms into a
VEGETATIVE FORM, which can be destroyed by the
presence of oxygen
Why is Clostridium tetani abundant in soil?
o Normal habitat of C. tetani is in the intestines of
herbivorous animals (i.e. cows, carabaos, goats,
sheep, horses)
o Manure of these animals is used as fertilizer
Mode of Transmission of C. tetani
o Break in skin integrity
Person is at risk for infection when there is any kind of
would (i.e. splinter or salubsob, tooth decay, otitis media)
Types of Disinfection
Concurrent Disinfection
Done when the person is still a source of infection
Example:
o When patient is still in the hospital
Boil all patient gowns
Terminal Disinfection
Done when person is no longer a source of infection
Example:
o Room of patient is cleaned upon discharge of
patient using UV rays or Lysol
Important Concepts!
You need not be wounded by a RUSTY OBJECT to acquire
tetanus
In the newborn, tetanus neonatorum is caused by poor
cord care.
When C. tetani enters the body, it seldom migrates to the
bloodstream where oxygen is present
C. tetani remains in the wound but the effects are systemic
2. Disinfestation
Killing of undesirable small animal forms such as
arthropods, rodents, insects by physical or chemical means
3. Fumigation
Use of gaseous agents to kill arthropods, rodents and
insects.
IMPORTANT CONCEPT!
Toxin is released to the blood and is responsible for the
manifesting signs and symptoms of the disease
4. Medical Asepsis
Hand washing
Gloving
Gowning
Masking
Placarding
o Placing NO SMOKING sign when there is
oxygen inhalation in progress.
2. Tetanospasmin
Causes muscle spasm
Acts on MYONEURAL JUNCTION of the muscles and on
the INTERNUNCIAL FIBERS of the spinal cord and the
brain.
Results into multiple muscle spasms
Inhibits the spastic muscle from sending transmissions to
the brain, which would inhibit progression of spasms. Due
to this, adjacent muscles will also undergo spasm similar to
a chain reaction or a domino reaction.
Bacterial infections
Tetanus
Meningitis
Viral Infections
Encephalitis
Poliomyelitis
Rabies
TETANUS
Also called LOCKJAW
With painful muscular spasms
Ten times more painful than leg cramps
Clostridium tetani
o Causative agent of Tetanus
o Anaerobic microorganism
o Abundant in soil, dust, clothing
o It exists in the form of a SPORE outside the
human body
o That is why it survives outside the human body
even in the presence of oxygen
IMPORTANT CONCEPTS!!!
Masseter muscle is involved
o It functions for mastication, for opening and
closing of the mouth
o Tetanus affects strong muscles
o Therefore, it affects the closing of the mouth
muscle
o This is called LOCKJAW or TRISMUS
Facial muscle is affected
o Gives rise to risus sardonicus
o Known as the Sardonic Smile
o Also known as Ngiting Aso
o Patient is smiling but his eyebrows are raised.
Spinal muscle is affected
o Resulting into the Ophistotonus position
o This is the arching of the back
o In the vernacular, it is called LIAD
Respiratory muscles are affected
o Results to difficulty of breathing, dyspnea and
chest heaviness
Genitourinary tract muscles are affected
o Results into urinary retention
o Intervention would involve catheterization
Gastrointestinal muscles are affected
o Resulting into constipation
Abdominal muscles are affected
o Results into abdominal rigidity
o Abdomen is hard as a board
o This sign serves as a basis for recovery
o If abdominal rigidity decreases, it means that the
patient is on his way to recovery
Extremity muscles are affected
o Results into stiffness of extremities
o There is difficulty in flexing
o Robot gait is evident
Concept!
Thus, almost all of the muscles are rigid and stiff in
Tetanus!
Diagnostics for Tetanus:
1. Clinical Observation
Assess patient physically
Assess for the presence of lockjaw
If this is positive, a logical question would be Do you
have a wound
Physical Injury
For falls:
o Never leave the patient alone
o If you do leave the patient, keep the padded side
rails up
o Keep call light within the reach of the patient
Fractures due to spasm:
o Caused by restraining by relatives
1. Exteroceptive
Comes from outside environment of the patient
Examples are bright light and noise
Place the patient in dim and quiet environment
2. Interoceptive
Comes from inside or within the patient
Examples are stress, pain, coughing, passage of flatus
3. Proprioceptive
There is participation of patient and other persons
Examples are touching, turning, jarring the bed of the
patient
Nursing Care in Tetanus
Done to prevent patient from having spasms
Place the patient in a dim and quiet environment
Practice minimal handling of the patient
o Avoid unnecessary disturbance of the patient
Practice Cluster Care
o Do all nursing care activities in one setting
o Do other nursing care activities with vital signs
taking
Gentle handling of the patient
Touching is not contraindicated
Turning is not contraindicated
o However, do these as gently as possible
o Inform the patient before proceeding with any
procedure
Concept:
o Tetanus patients are isolated so as not to be
exposed to stimuli
IMPORTANT CONCEPT!!!
Attack of tetanus does not give permanent immunity
Vaccine Given:
Diphtheria Pertussis Tetanus Vaccine or DPT vaccine
When given:
o 1st Dose: 6 weeks after birth; 0.5 ml
o 2nd Dose: 10 weeks after birth; 0.5 ml
o 3rd Dose: 14 weeks after birth; 0.5 ml
Number of Doses:
o Three (3)
Interval between Doses:
o Four (4) weeks
Administration Site:
o Vastus lateralis muscle
Route:
o Intramuscular
IMPORTANT CONCEPTS!!!
Expect fever to set in after administration of DPT vaccine
o Give paracetamol
o Apply warm compress for better drug absorption
o Immediately follow up with cold compress to
avoid soreness
If tenderness or swelling on site of injection is present:
o Do cold compress within twenty-four (24) hours
o Then do warm compress
Observe for signs of convulsions within seven (7) days
after DPT immunization
o This indicates that child has reaction with the
pertussis component of the drug
o Therefore, succeeding doses of DPT will NOT BE
GIVEN
o Give ONLY the DT components
o If DPT is given again, this predisposes the child
to neurologic disorders
Observe if child cries uncontrollably
This is an indication of development of
neurologic disorders.
Prevent injury:
Respiratory injury
Airway obstruction
Tongue could be drawn back and cause blockage or
obstruction
Use padded tongue depressor for retaining patency of the
airway
Respiratory Infection
Turning to side is usually not done
o This results to pooling of respiratory secretions in
the lungs
o This leads to pulmonary infection
o Pia mater
Cerebrospinal Fluid or
SUBARACHNOID SPACE
CSF
is
found
in
the
Important Concept!
In children below four (4) years old, Neisseria meningitidis
is a normal flora in the nasopharynx.
If resistance goes down, these children become prone to
infection
Mode of Transmission
Droplet transmission
In cryptococcal meningitis:
o Inhalation of spores
Portal of Entry
Respiratory system via the nasopharynx
Pathophysiology of Meningitis
From the nasopharynx, the microorganism goes to the
bloodstream
Once in the bloodstream, the microorganism causes
petechiae formation (pin point red spots on the skin)
From the bloodstream, microorganism goes to the
meninges and irritates them
o There is inflammation of the meninges and
accumulation of substances in the meninges
This results into increased Intracranial Pressure (ICP)
Wound Care
Wash wound with soap and running water
Place antiseptic solution on wound
Use thin dressing
Band Aid Plastic Strips are allowable as they have air
ventilation holes
Do not use plaster
Use only those types of plasters with air ventilation holes to
introduce oxygen to the wound
Key Concept!!!
Avoid Wounds
MENINGITIS
Inflammation of the meninges (covering of the brain and
spinal cord)
Concepts!
Meninges are composed of:
o Dura mater
o Arachnoid mater
Pathophysiology of Meningococcemia
Portal of entry of Neisseria meningitidis is also the
nasopharynx
The bacteria then goes to the bloodstream
Presence of bacteria in the bloodstream causes
ecchymosis
o These ecchymoses are blotchy (pantal-pantal)
purpuric lesions
o They are purplish in color
o Usually found on the wrist and the ankles
From the bloodstream, they go to the meninges and irritate
them.
Same sequence of events follow as mentioned above
10
Preventive Measures
1.Proper disposal of nasopharyngeal secretions
Burning
Burying
Proper procedure for disposal of nasopharyngeal
secretions
o Use tissue paper
o Put it in a plastic bag after use
o Knot the plastic bag
o Dispose plastic bag in a trashcan
Important Concepts!
The best and most economic way preventing spread of
infection is through swallowing of nasopharyngeal
secretions
o This brings the secretions to the stomach and to
the intestines and would then be eliminated in the
stool
Children have less chance of spreading infection because
they swallow nasopharyngeal secretions.
This is contraindicated, however, for tuberculosis patients
Thus, for TB patients, they have to spit out nasopharygeal
secretions
Swallowing is allowable for other respiratory infections
Important Concept!
Dilantin is never given Intramuscularly
o This is irritating to the tissues
o This has an erratic effect
Nursing Care
Symptomatic
Supportive
Nursing Diagnoses
1. Alteration in body temperature related to infection
Priority is to lower body temperature
o Do TSB
o Provide cold compress
o Provide loose clothing
2. Pain: Alteration in comfort related to increased Intracranial
Pressure
BRAIN FEVER
Arbovirus
Arthropod-borne Virus
Primary cause
St. Louise
11
Japan B
Australian X: Equine (E-W)
Mode of Transmission
Mosquito bites
o Aedes Sollicitans
o Culex tarsalis
Ticks of horse
Migratory birds
Secondary cause
Post racene encephalitis
Toxic
Metal poisoning
o Lead poisoning
o Mercury poisoning
POLIOMYELITIS
Also called:
o Infantile Paralysis
o Heine-Medin Disease
Affects children below ten (10) years of age
Less risk for people above ten (10) years Old
Causative Agent
Virus
o Legio debilitans
Type 1 Brunhilde
Type 2 Lansing
Type 3 Leon
If Brunhilde
o Gives permanent immunity
If Lansing or Leon
o Gives temporary immunity
ENCEPHALITIS
Signs and Symptoms
With altered level of consciousness
With lethargy
o Difficult to awaken
o Patient is abnormally sleepy
With behavioral changes
Brain is immediately affected relative to meningitis
Important Concepts!
When Brunhilde infects you, Leon or Lansing will no longer
affect you!
In the Philippines, the most prominent type is Brunhilde!
Mode of Transmission
Droplet
o In early stage of infection, virus if found at
nasopharyngeal secretions
Fecal-Oral Route
o In late stage of transmission, virus is found at the
mouth
Diagnostic Tests
1. Lumbar Puncture
Specimen is cerebrospinal fluid (CSF)
Laboratory Results would indicate:
o Increased Proteins
o Increased White Blood Cells
o Normal Sugar Content
Portal of Entry
Gastrointestinal Tract
Pathophysiology
Legio debilitans goes to the nasopharynx or the mouth
If in the nasopharynx, it goes to the tonsils and causes:
o Sore throat
o Fever and chills
o Headache with body malaise
If at the mouth, it goes to the Peyers patches and causes:
o Abdominal pain
o Anorexia
o Nausea and Vomiting
o Diarrhea or Constipation
2. Electroencephalogram (EEG)
To assess extent of brain damage
Patient recovers but because he is epileptic, he develops
irreversible brain damage
Medical Management
Symptomatic due to viral cause
Concepts!
No permanent immunity is obtained from attack of
encephalitis, only temporary immunity, due to causation by
various viruses
Preventive Management:
CLEAN PROGRAM
o C Chemically Treated Mosquito Net
o L Lavivorous fishes
o E Environmental Sanitation
o A Anti-mosquito Soap (Basic Soap)
o N Neem Trees or Eucalyptus Tree (draws away
mosquitoes)
Concepts!
To kill mosquitoes in canal, pour oil or gas in canal
o This depletes oxygen present in the canal
o There is no need to light it up
STAGES of POLIOMYELITIS
1ST Stage: Invasive Stage or Abortive Stage
All the abovementioned signs and symptoms will appear
Patient recovers
Disease process is aborted
But there will be instances when disease process will not
be aborted
Tonsils
Cervical
12
Peyers Patches
Mesenteric
Lymph
Lymph
Nodes
Nodes
BLOODSTREAM
3. Bulbo-Spinal Type
Combination of Bulbar and Spinal types
Patient has cranial nerve affectations and anterior horn cell
affectations
Important Concepts!!!
Not all patients will develop paralysis
If patient is non-paralytic,
o He has GOOD PROGNOSIS
Diagnostic Tests
1. Lumbar Puncture
Laboratory results would reveal:
o Increased White Blood Cell levels
o Increased Protein levels
o Normal Sugar levels
2. Muscle Testing
To determine what specific muscle is affected
3. Electromyelogram
To determine extent of muscle involvement
4. Stool Examination
Perfomed at the late stage
About ten (10) days after being affected
5. Nasopharyngeal Examination
Performed at the early stage
Medical Management
Symptomatic
Causative agent is viral
If there is respiratory paralysis
Place patient in a MECHANICAL VENTILATOR
Use the IRON LUNG MACHING
o This works on the principle of Negative Pressure
Breathing
o No tracheostomy tube needed (tracheostomy
tube or endotracheal tube work on the principle
of Positive Pressure Breathing)
o Capsular in shape
o With glass windows
Paralysis
Concept!
From the CNS, the patient will experience paralysis.
This leads to the third (3rd) stage of the disease
rd
3 Stage: Paralytic Stage
Presence of paralysis
Characteristics of Paralysis:
o Flaccid
Soft
Flabby
Limp
Important Concept!
Flaccid Paralysis is PATHOGNOMONIC SIGN
Poliomyelitis
of
13
o
o
Preventive Measures
1. Immunization
Vaccine given:
o Oral Polio Vaccine (OPV) or Sabin
o Dose:
Two (2) to three (3) drops
o Route:
Oral
o Number of Doses:
Three (3)
o Interval:
Four (4) weeks
o When given:
1st Dose at six (6) weeks old
2nd Dose at ten (10) weeks old
3rd Dose at fourteen (14) weeks old
o Important Concepts!!!
Do not feed child for thirty (30) minutes
after administration of OPV
o Rationale:
For better absorption
o If child vomits, REPEAT!!!
o If child has diarrhea
Give OPV
But do not record it
Not all of the vaccine may be absorbed
properly
When OPV 3 is given four weeks after,
record it as OPV 2
Three (3)
Interval:
Four (4) weeks
When given:
1st Dose at six (6) weeks old
2nd Dose at ten (10) weeks old
3rd Dose at fourteen (14) weeks old
Rationale:
Because stool of child may contain the
virus if OPV is given
RABIES
Also called:
o Hydrophobia
o Lyssa
o La Rage
A disease of a low form of animal
o Not a human infection
o Only accidentally transmitted to man
Occurs in canine animals or animals with fangs:
o Fox
o Wolves
o Boar
o Monkeys
o Bats
o Cats
o Dogs
Causative Agent:
Rhabdovirus
o A neurotropic virus
o Has special affinity to neurons and the Central
Nervous System
R H A B D O V I R U S
Peripheral
Efferent
Nerves
Nerves
CNS
Salivary
Pathologic
Gland
Lesions
of Rabid
(negri bodies)
Animal
Important Concept!
Pathologic lesions that are formed as microorganism
multiplies
If there is no multiplication of the microorganisms at the
Central Nervous System, there will be NO negri bodies.
Mode of Transmission
Contact with saliva of a rabid animal
14
Important Concept!
Therefore, you need not be bitten
Even a scratch could cause rabies as animals lick their
paws
Infection may occur through:
o Corneal transplantation
o Kissing animal
o Dog licking wounds
Important Concept!
When a family member at home is bitten by a rabid animal,
vaccinate all people at home because patient has virus at
saliva
Stage 2 Excitement Stage
Acrophobia
o Fear of Air
Hydrophobia
o Fear of Water
Important Concept!
Air and Water both cause PHARYNGOLARYNGEAL
SPASM
This is characterized by:
o A drowning sensation
o Strangulation to death syndrome
o Like breathing in thick smoke
Other signs and symptoms
o Photosensitivity
o Maniacal behavior
o Resembles attitude of a rabid animal
o Easily agitated
o Runs after people
o Violent
o Club walls
o Jumps out of window
Important Concepts!
Before, THORAZINE and BENADRYL were given for
maniacal behavior but had proven to be ineffective
Now, HALOPERIDOL and BENADRYL are administered
and are very effective against maniacal behavior
Stage 3 Paralytic Sage
Patients spasms will stop
He can be fed, etc.,
Paralysis sets in from toes going upwards
If respiratory system is affected, the patient will die
Manifestation of signs and symptoms sets within 24 hours
and death follows
Important Concept!!!
Rabies is a preventable but not a curable disease
Maximum time before death occurs is seventy-two (72)
hours.
Manifestation:
In Animals
o Incubation Period
Three (3) to eight (8) weeks
Stages of Manifestations in Animals
Stage 1 Dumb Stage
Animal will have complete change in disposition
May show any of the following behaviors:
o Withdrawn
o Stays in one corner
o Depressed
o May be overly affectionate
Can lick wounds
o May be walking to and from
o Hyperactive
o Manic
It is better if the animal is withdrawn as it is easy to note
Stage 2 Furious Stage
Easily agitated
Easily bites
With vicious look
With drooling of the saliva
Expect the animal to die
Dying and biting happens on this stage
Animal can die without biting
Manifestation:
In Humans
o Incubation Period
Ten (10) days to twenty one (21) years
(this is the longest incubation period
recorded in the Philippines)
Stage 1 Invasive Stage
Numbness on the site of the bite
Itchiness on the site of the bite
Flu-like symptoms
o Fever
o Headache
o Sore throat
Marked Insomnia
Restless
Irritable
Apprehensive
Slight photosensitivity
Vague symptoms
15
07
3rd
21
3/12/
2005
3/26/
2005
1 vial
1 vial
Important Concepts!!!
Counting is ALWAYS BASED on the FIRST DOSE!!!
You can afford not to continue vaccine if dog does not die
after ten (10) days
However, continuance is encouraged because doing so
would give three (3) years of immunity
If you abort vaccination, you will not get three (3) years of
immunity
When you get bitten again, you start all over again
In case the dog:
o Died
o Disappeared
o Was killed within (3) days
Avail of complete doses plus a BOOSTER DOSE
o Booster Dose
Given at DAY 91
In the tabulated example
Schedule would be at
6/05/2005
Dosage is one vial
If via I.D.
Schedule is:
Dose Day
Example
Dosage
Remarks
1st
00
03/05/
0.1 cc if
Given on
2005
Verorab
each site:
or
Right and
0.2 cc if
Left
Lyssavac
Or
Rabipur
2nd
03
3/08/
0.1 cc if
Given on
2005
Verorab
each site:
or
Right and
0.2 cc if
Left
Lyssavac
Or
Rabipur
2nd
Remarks
1 cc on
each site;
One on
the left
and one
on the
right
One site
only
One site
only
Important Concepts!!!
If given intramuscularly (I.M.)
o Do skin testing first
16
3rd
4th
5th
07
28
to
30
90
3/12/
2005
04/01/
2005
to
04/03/
2005
06/03/
2005
0.1 cc if
Verorab
or
0.2 cc if
Lyssavac
Or
Rabipur
0.1 cc if
Verorab
or
0.2 cc if
Lyssavac
Or
Rabipur
0.1 cc if
Verorab
or
0.2 cc if
Lyssavac
Or
Rabipur
Given on
each site:
Right and
Left
o
o
o
Given on
one site
only
Nursing Care
Place patient in a dim and quiet environment
Keep patient away from sub-utility room
Restrain the patient before he exhibits maniacal behavior
Wear all Personal Protective Equipment when you enter
the room because patient continues to spit
Preventive Measures
Be a responsible pet owner
o Have pets immunized
Wash wound with soap, water and antiseptic
Then observe the dog
Important Concept!!!
Virus rabies is destroyed by 60C heat for thirty-five (35)
seconds
Therefore, you will not acquire rabies from eating dog meat
Given on
one site
only
Important Concepts!!!
Verorab
o Once reconstituted is only potent for eight (8)
hours
Antibodies are produced in about seven (7) days
Therefore, also give passive form of vaccine.
Passive Forms
Temporary antibodies
Animal Serum
Equine Rabies Immunoglobulin (ERIG)
o Anti-rabies serum
o HyperRab
o FaviRab
Important Concepts!
Do skin test first
o If negative for skin test, give drug
Dosage is based on body weight and is
provided in direct proportion
0.2 cc / kg body weight is the standard
Example:
A 50 kg person would receive
10 ml of ERIG
Cost
is
approximately
Php1,800 / 5.0 cc
o If positive for skin test, give HRIG or Human
Rabies Immunolobulin
Imogam
Rabuman
0.133 cc / kg body weight is the
standard dose
Example:
A 50 kg person would receive
6.65 cc of HRIG
Cost is approximately Php4,500 / 2.0
cc
o This is given as a single dose within seven (7)
days from the date of the bite
17
(causes easy
(allows shifting
bleeding;
of fluid from
difficult to stop
one
due to
compartment
thrombocytopenia;
to
poor clotting
another leads
to ascites;
hemoconcentration
Important Concept!
If patient recovers, he only has Dengue Fever (and not
Dengue Hemorrhagic Fever)
Dengue Fever is also called:
o Dandy Fever
o Breakbone Fever
DHF Grade 2
If there is persistence of signs and symptoms of DHF
Grade 1
If there is bleeding from:
o Nose epistaxis
o Gums gum bleeding
o Vomiting of blood Hematamesis (coffee ground
appearance from the stomach)
Upper Gastro-Intestinal Tract Bleeding
o Melena
Passing of black tarry stool
Acted upon by digestive enzymes
Lower Gastro-Intestinal Tract Bleeding
o Hematochezia
Passing of fresh blood in the stool
Then, these signs and symptoms indicate the START OF
HEMORRHAGIC FEVER
DHF Grade 3
Persistence of signs and symptoms of DHF Grade 2
With signs of circulatory collapse or failure
With cold clammy skin
Nursing Alert!
o Check for capillary refill
o How?
Apply pressure on nailbeds
Normal capillary refill time is about one
(1) to two (2) seconds
If capillary refill time is about three (3)
seconds or more, blood flow is sluggish
due to circulatory failure
Check Vital Signs
o Indicators of Circulatory Failure:
Hypotension or decreased blood
pressure
Rapid but weak pulse
Rapid respiration
DHF Grade 4
With signs and symptoms of DHF Grade 3
INFECTED MOSQUITO
BLOODSTREAM (multiplies)
Increased
Increased
Capillary
Capillary
Fragility
Permeability
18
With shock
Hypovolemic shock due to excessive blood loss due to
uncontrolled bleeding
19
Pathophysiology of Malaria
P LAS M O D I U M
BLOODSTREAM
Inside RBC
Nursing Responsibilities
o Make patient comfortable
o Keep patient dry and warm
o Provide fluids to prevent dehydration
o Make patient rest comfortably in bed
Important Concepts!!!
In other types of sicknesses or disorders, chills occur
before fever
This is due to bodys response to heat loss
In ordinary infections, higher temperatures are seen during
CHILLS because patient is trying to retain heat
In malaria, increased temperature occurs on FEVER or
HOT STAGE
There is no fever during the cold stage
Chills occur due to the release of Plasmodium
Key Concept!
If causative agent is P. falciparum, its rapid multiplication
and RBC destruction would lead to
o Anemia
o Liver then compensates and results to
HEPATOMEGALY
o Splenomegaly
o Mild jaundice sometimes occurs
o Cerebral Hypoxia
Restlessness
Confusion
Delirium
Convulsions
Loss of consciousness
Coma
Important Concepts!!!
Once inside the Red Blood Cells (RBC), the microorganism
multiplies and destroys the RBC.
This leads to ANEMIA!
Rupturing of membranes of Plasmodium coincides with the
presence of CHILLS in the patient
Presence of more or new microorganisms in the
bloodstream causes FEVER!
Important Concepts!
If you have malaria and your last attack is more than five
(5) years ago, then you can be a blood donor
If your last attack is less than five (5) years ago, you
CANNOT BE A BLOOD DONOR
Malaria can also be obtained by BLOOD TRANSFUSION
Manifestations of Malaria
Stage 1 Cold Stage
Lasts for ten (10) to fifteen (15) minutes
Chilling sensation is present
20
COMMUNICABLE
SYSTEM
DISEASES
OF
THE
INTEGUMENTARY
Important Concept!
An attack of Malaria does not provide permanent immunity
21
Concept!
There is no specific diagnostic test for measles
1.Clinical Observation
Medical Management for Measles
Symptomatic Management
Recovery dependent on Nursing Care
Nursing Care
Maintain and increase body resistance of the patient
Provide the following:
Adequate rest
Adequate nutrition
o No diet restrictions
o Provided that patient is not a hypersentitive
individual (i.e. prone to allergies)
o Seafood or poultry products are contraindicated if
the patient is allergic to these foods
o Increase oral fluid intake
o Especially those rich in Vitamin C
Keep patients back dry and warm
o Rationale
Exposure to draft gives rise to cough
and cold
It gives rise to a good medium for
growth of microorganisms
Leads to pulmonary complications like
pneumonia, which could lead to death
Provide hygienic measures
o Eye care
Measles patients have much MUTA
To prevent eye complications
o Ear care
To prevent otitis media
o Mouth care
o Nasal care
o Skin care
Taking a bath or taking a sponge bath
is not contraindicated
However, do not expose the patient to
draft
Other Nursing Care
Symptomatic nursing care
Patient is photophobic
o Provide dim and quiet environment
Route:
o Subcutaneous
Site:
o Deltoid muscle
Important Instructions to be given to the mother of the
patient!
o Child may experience fever
o Give paracetamol to lower the body temperature
o After three (3) to four (4) days, child will have a
rash formation. This is a NORMAL REACTION
to the vaccine
o In fact, it is a good reaction, indicating that the
patients body has produced anti-bodies to
measles
Important Concepts!
In the private setting, MMR vaccine is given
When:
o Age of fifteen (15) months
Dosage:
o 0.5 cc
Route:
o Subcutaneous
Site:
o Deltoid muscle
Ask mother if the child has allergies to egg and neomycin
o MMR is made up of duck embryo and neomycin
o If patient is allergic to egg
Give vaccine
But observe for signs and symptoms of
allergies
o If patient is allergic to neomycin
Do NOT give MMR vaccine
It may cause anaphylaxis
Important Concept!
DOH Program on Measles
o Ligtas Tigdas Immunization Program in 2004
Mode of Transmission
Airborne
Prevention
Proper disposal of nasopharyngeal secretions
Cover the mouth when coughing or sneezing
Key Concepts!!!
Measles is not fatal by itself
Common complications
o Bronchopneumonia
o Encephalitis
GERMAN MEASLES
Also called:
o Rubella
o Three (3) day disease
o Poteln
Causative Agent
Pseudoparamyxovirus
Important Concept!
Attack of measles gives permanent immunity to the
disease
Key Concept!
When is the patient communicable?
Patient is communicable before rashes appear or during
the pre-eruptive stage.
Preventive Measures
1. Immunization
Anti-measles vaccine (AMV)
When given:
o Age of nine (9) months
Dosage:
o 0.5 cc
22
Rubella Virus
Togavirus
Mode of Transmission
Droplet (not airborne)
o
CHICKEN POX
Also called Varicella
Causative Agent
Varicella Zoster Virus
o Can be found both on:
Nasopharyngeal Secretions
Secretions of rashes
o But only causes infection if. . .
It enters the nasopharynx
o Does NOT cause infection by skin to skin contact
Mode of Transmission
Airborne
23
Period of Communicability
o Until the LAST RASH has crusted!!!
o Easily and highly-contagious upon the
appearance of rashes
Important Concepts!
During the summer season, if you have not had chicken
pox and if you are immunocompromised, DO NOT GO
OUT
Duration of the Disease
o Two (2) weeks
Important Characteristic of Chicken Pox Rashes
Rashes have UNIFOCULAR appearance
They have one focus
Rashes appear one at a time and they NEVER FUSE
TOGETHER
There is always a gap between one rash to another rash
o If rashes get into contact with each other, it is no
longer Chicken Pox.
o It is HERPES ZOSTER
Permanent
Scar
(Pox mark)
Leads to skin
Infection
Becomes a
Boil,
or a Furuncle
(big Boil),
or a Carbuncle
(several boils
attached to one
another)
Results to cellulitis
or gangrene
Important Concepts:
The distribution of the rashes are:
o Generalized
o Found all over the body
Found first on the trunk
Found on the covered parts of the body
Then found on the scalp
Abundantly found on the covered parts of the body and
then on the exposed parts of the body
Key Concept!
24
1. Immunization
Varivax
o Varicella Vaccine
Dosage
o 0.5 cc
Route
o Subcutaneous
For children below thirteen (13) years old
o Single dose is given
o Site of administration is the deltoid muscle
For those thirteen (13) years old and above
o Two doses are given
o With one (1) month interval
HERPES ZOSTER
Also called
o Shingles
o Zone
o Acute Posterior Ganglionitis
Causative Agent
Varicella Zoster Virus
Mode of Transmission
Droplet
Manifestations of Herpes Zoster
Same as those of Chicken Pox
Rashes are also vesiculopustular
However, there are differences in the characteristics of
rashes
Herpes Zoster rashes are:
o Not itchy
o More of painful because nerves are affected
o Even if patient has recovered and rashes are
long gone, pain may be persistent up to two (2)
months. This is NORMAL
o Rashes do not have generalized distribution
o Has a unilateral distribution because it follows the
nerve pathway
o Always vertical or longitudinal (on one side)
o Rashes do not have unifocular appearance but
APPEARS IN CLUSTERS
Diagnostic Test and Medical Management for Herpes Zoster
25
Important Concepts!
Respiratory Diphtheria
o Is the more common type of diphtheria
Wound Diphtheria
o Is the rare type of diphtheria
3. Laryngeal Type
Affects the larynx or the voice box
With hoarseness of voice
With loss of voice
o Aphonia but only temporary
Larynx also serves as airway passage
o Therefore, there is:
Dyspnea
Difficulty of breathing
Body compensates and uses accessory muscles
Important Concepts!
Overuse of accessory muscles results to chest retractions
or chest indrawing
Important Concepts!!!
Normally, when a person breathes in, the chest expands
But with over usage of accessory muscles, chest wall does
not expand, rather, it DRAWS IN!!!
In order to detect chest indrawing, look at the subcostal
area (lower area of the chest region). This elevates due to
severe dyspnea
Do not look at the sternum or at the intercostals spaces
Check for chest indrawing when:
o The patient is calm
o The patient is not crying
o The patient is not breast-feeding (chest indrawing
is NORMAL under this condition)
o The patient is bottle-feeding (chest indrawing is
NORMAL under this condition)
Chest indrawing is constant in a patient with diphtheria
Chest indrawing is always present in any position in a
patient with diphtheria
Important Concepts!!!
Pseudomembrane is also present
o Present in the larynx
o Laryngoscope is needed to see the
pseudomembranes
Pseudomembranes may trigger cough
Characteristics of cough:
o Barking cough
o Dry
o Metallic
o Croupy
o Husky
Due to hoarseness of voice
Key Concept!
Laryngeal Type of Diphtheria may become severe
Mode of Transmission
Droplet
Manifestations of Diphtheria
Depends upon its classification
Three (3) Types of Respiratory Tract Infections
1. Nasal Type
Nasal passages are affected
With irritating nasal discharge
o Characterized by serosanguinous secretion with
foul mousy odor (whitish, bloody, smells like a
rat)
Due to rubbing of nose, this results to upper lip and nasal
excoriation
Pathognomonic Sign
o Presence of pseudomembrane
o However, not appreciable in the NASAL TYPE
o This is found within the nasal septum
o Speculum is needed
o But is usually covered by irritating nasal
discharge
2. Pharyngeal Type or Faucial Type
Affects the pharynx and the tonsils
Patient complains of:
o Sore Throat
o Dysphagia
Presence of pseudomembrane, which is visible upon
opening of the mouth
Pseudomembrane is present on the following:
o Soft palate,
o Uvula
o Pillars of the tonsils
The pseudomembrane can be described as:
o Grayish-white membrane
o Like cigarette ash
Patient also has a BULL NECK appearance
o Enlargement of the neck
o Specifically of the anterior upper aspect of the
neck
o This is due to inflammation and enlargement of
cervical lymph nodes
o Anterior upper aspect of the neck is:
Reddish
Warm to touch
There is pain
Tenderness
The difference between a person with Pharyngeal Type of
Diphtheria and a person with double chin is that double
chin people have on their necks:
o Normal skin color
o Normal temperature
o No pain
Laryngeal Edema
Airway Obstruction
Respiratory Obstruction
Respiratory Distress
Death
26
Therefore,
management
is
EMERGENCY
TRACHEOSTOMY
Among the three types of Diphtheria, Laryngeal Diphtheria
is the most fatal due to the possibility of respiratory
obstruction, which may lead to death.
1. Schicks Test
Test for immunity or susceptibility to diphtheria
2. Moloney Test
Test to determine hypersensitivity to diphtheria toxin
Nose and Throat Swab
Most commonly done test
Confirmatory Test
o To identify the microorganism
o To determine if patient is still communicable
Important Concept!
o Patient is still communicable until three (3)
consecutive results of negative (-) nose and
throat culture are obtained
Medical Management for Diphtheria
Three (3) Objectives:
1. Neutralize the toxin
The toxin brings about systemic effects
Therefore, give anti-diphtheria toxin
o Do skin test first
o If positive for the skin test
Give drug
Because there is no Diphtheria Ig
But give in fractional doses
Also have ready and handy the following:
o Epinephrine
o Corticosteroid
2. Kill microorganism
Give anti-biotics
Drug of Choice
o Penicillin
Important Concept!
Scraping the pseudomembrane does not kill the
microorganism
It only causes bleeding
3.Prevent Respiratory Obstruction
Performance of emergency tracheostomy
Preventive Measures
1. Immunization
DPT vaccine
2.Proper disposal of nasopharyngeal secretions
3. Cover the nose and the mouth when sneezing or coughing
4. Never kiss the patient.
Diphtheria affects all ages
Common in children
PERTUSSIS
Also called
o Whoofing cough
o Chin cough
Only affects children below six (6) years old
Causative Agent
Cocobacillus
Both aerobic and anaerobic
o Bordatella pertussis
o Haemophilus pertussis
Mode of Transmission
Droplet
Manifestations of Pertussis
27
1. Catarrhal Stage
Highly contagious
Colds
Nocturnal coughing
o Coughing is present at night
Fever
Tiredness
Listlessness
2. Paroxysmal or Spasmodic Stage
With five (5) to ten (10) successive, forceful coughings,
which ends on a prolonged inspiratory phase or a WHOOF
To loosen mucous plug on airway (this causes the patient
to cough)
To loosen thick and tenacious secretions
Therefore, child coughs for five (5) to ten (10) times
When patient is unsuccessful in expectorating narrow
passageway requires long inhalation
If patient keeps on coughing
o He may choke on his mucous
o This results to vomiting
o Therefore, the patient is positive for vomiting
Due to pressure exerted on vomiting, there could be
o Congested face (bloated face)
o Congested tongue
Purple in color
Due to pressure exerted on the tongue
by the teeth when coughing
o Teary-red eyes with protrusion due to pressure
exerted when coughing
o Distention of face and neck veins
o Involuntary micturition and defecation
o Abdominal hernia due to pressure exerted on
abdominal wall when coughing
If patient is vomiting:
o Metabolic alkalosis occurs
This will trigger convulsions due to electrolyte imbalance
Convalescent Stage
Patient is no longer communicable
Signs and symptoms will now start to subside
Patient is now on the road to recovery
28
TB2
Manifestations of Tuberculosis
Afternoon low-grade fever with night sweats
Anorexia
Weight loss
Fatigability
Body malaise
Chest pain / back pain
Positive for productive cough
Hemoptysis
Difficulty of Breathing
Anemia
Amenorrhea in females
Positive ( + ) to TB exposure
Positive ( + ) to TB infection
Positive ( + ) to TB testing
Negative ( - ) to TB symptoms
Inactive PTB patients and carriers are under this category
They are given prophylactic management so that they
would not exhibit signs and symptoms
Start on Anti-Tuberculosis drugs
o INH
o Isoniazid
The most effective TB drug
Side Effect
Peripheral Neuritis
Give Vitamin B6 or pyridoxine to counteract INH side effect
Increase Vitamin B6 by intake of:
o Beans
Mongo
Red beans
White beans
Black beans
o Prophylaxis is given for six (6) months
For children
o Prophylaxis is given for nine (9) months
For Immunocompromised patients
o Prophylaxis is given for twelve (12) months
TB3
TB0
Positive ( + ) to TB exposure
Negative ( - ) to TB infection
Negative ( - ) to TB testing
Medical and other healthcare workers are under this
classification
They are given preventive management in the form of
Personal Protective Equipment (PPEs); and increased
body resistance through vitamins, adequate rest and
adequate hand washing
Negative ( - ) to TB exposure
Negative ( - ) to TB infection
Negative ( - ) to TB testing
Newborns are under this classification
They are given preventive management in the form of BCG
vaccine immediately after birth
TB1
29
Positive ( + ) to TB exposure
Positive ( + ) to TB infection
Positive ( + ) to TB testing
Positive ( + ) to TB symptoms
Active PTB patients are under this classification
They are given curative management
Combination of Anti-Tuberculosis drugs to prevent drug
resistance
Short-Course Chemotherapy
o Composed of RIP(E)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
May or may not be given
Standard Regimen
o Composed of SI(E)
Streptomycin
Isoniazid
Ethambutol
May or may not be given
Important Concepts!!!
Short-Course Chemotherapy Side Effects
Causes hepatotoxicity
Nursing Management
o Therefore, monitor liver enzyme tests
Advise patient to avoid alcoholic beverages, which
increase hepatotoxic effects
Key Concept!
The American Pulmonary Society classification is the best
classification!!!
Diagnostic Examinations for Tuberculosis
1. Tubercullin Testing
This is only a screening test for Tuberculosis
If result is positive ( + ), it does not mean that the person is
infected but the person may have an exposure
If result is CONSISTENTLY POSITIVE, it means that the
patient is sensitive to the organism
Important Concepts!!!
o This test uses Purified Protein Derivative or PPD
o PPD is administered intradermally
o Tubercullin testing is interpreted after forty-eight
(48) to seventy-two (72) hours
o A positive result would give you an induration of
greater than ten (10) mm.
o If patient is positive for HIV, a positive result
would give the patient an induration of greater
than five (5) mm
Three (3) Ways of Performing Tubercullin Testing
1.1) Mantoux Test
Just like a skin test
Utilizes the same technique as a skin test
Uses PPD
Interpreted after forty-eight (48) to seventy-two (72) hours
Positive result is bigger wheal induration
1.2) Tine Test or Multi-puncture Test
Soak sterile needle in PPD for three (3) to four (4) hours
Get arm
Puncture for six (6) to eight (8) times in a circular manner
This is commercially prepared
This utilizes a special syringe with four (4) small needles
for one simultaneous application
1.3) Vollmer and Pirquet Test
Skin scratch or skin patch test
Get sterile needle
Get gauze containing PPD
Apply this gauze over the scratch or tape this gauze over
the scratch
Keep gauze on for seventy-two (72) to ninety-six (96) hours
Remove after three (3) to four (4) days
Results cannot be interpreted yet
Wait for another forty-eight (48) to seventy-two (72) hours
Therefore, results could be obtained after five (5) to seven
(7) days!!!
Important Concept!
Mantoux Test is the best type of test!!!
o Easier to perform
o Less pain to patient
o Most accurate results
Key Concept!
Rifampicin
Side effects are:
o Orange urine
o Orange tears
o Orange secretions and excretions
o Orange saliva
o Orange sputum
o Orange feces
Nursing Management
o Inform the patient that this normally happens
o Therefore, remove soft contact lenses
These may be permanently stained
with orange color
o Advise the patient to use eyeglasses instead
Isoniazid
Side effect is peripheral neuritis
Nursing Management
o Give Vitamin B6 or pyridoxine
Pyrazinamide
PZA
Side effect is hyperuricemia
Patient is predisposed to stone formation
Therefore, make urine alkaline
Nursing Management
o To alkalinize the urine
o Increase fluid intake
o Increase intake of vegetables
Ethambutol
Side effect is Optic Neuritis
o Causes color blindness or inability to distinguish
red from green
Nursing Management
o IMMEDIATELY STOP the medication because
this side effect is IRREVERSIBLE
Important Concepts!!!
Standard Regimen
Streptomycin
o No hepatotoxicity
o But causes RENAL TOXICITY
o Nursing Management
o Monitor the following:
Creatinine levels
Blood Urea Nitrogen (BUN) levels
Monitor Intake and Output
o Also causes OTOTOXICITY
o Nursing Management
o Assess patient for tinnitus or ringing of the ears
2. Sputum Examination
This is the CONFIRMATORY TEST for Tuberculosis
30
Given
subcutaneously
instead of intradermally
Additional Concepts!!!
At school entrance
Give booster dose of BCG
When given:
o About six (6) to seven (7) years old
Dosage of Booster Dose
o 0.01 cc
Route of Booster Dose:
o Intradermal
Site of Booster Dose
o Left Deltoid muscle
Important Concepts!!!
o No abscess formation on site of booster dose
o Site depends on preference of the mother in a
private setting
Preventive Measures (continued)
2.Proper disposal of nasopharyngeal secretions
3. Cover nose and mouth when sneezing or coughing
4. Proper pasteurization of milk
PNEUMONIA
Inflammation of the lung parenchyma
Caused by several organisms
Causative Agents:
Virus
o Cytomegalovirus
Common opportunistic infection in
AIDS
Protozoa
o Pneumocystis carinii Pneumonia
Also a common opportunistic infection
in AIDS
Bacteria
o Most common cause
o Can be caused by primary infection
o Can be secondary to previous infection:
A complication
A debilitating disease
Mode of Transmission
Droplet
Manifestations of Pneumonia
Five (5) Cardinal Signs of Pneumonia
1. Fever
2. Shaking Chills
3. Sputum Production
o Rusty sputum
31
o
o
32
Mucoid Stool
Which could become blood streaked if
severe
Microorganisms endotoxin destroys
the intestinal wall
If Cholera
Rice-watery stool, which is one after
the other
The microorganisms do not destroy the
intestinal wall
They only stimulate peristalsis
Rapid dehydration occurs
o Manifested by washer womans hand
Decreased skin integrity
Poor skin turgor
Very dry
Nursing Management
o Patient is placed on a special bed called the
WATEN BED bed with a hole
o Pail is positioned underneath the hole on the bed
o Bed pan is not advised
o Continuous diarrhea makes the bedpan
inadequate in containing all the fecal material
o Vomiting also contributes to dehydration
Number 1 indicator of dehydration in a patient with diarrhea
is LOSS OF WEIGHT
o This occurs within or before forty-eight (48) hours
Other manifestations of dehydration, which are seen after
forty-eight (48) hours are:
o Thirst
o Sunken eyes
o Sunken fontanelles
o Poor skin turgor
o
33
o
o
o
Fomites
o
o
Environmental Sanitation
Insecticide
Screening
Do not put anything into your mouth
Most common is the ball pen
LEPTOSPIROSIS
Also called
o Mud Fever
o Swamp Fever
o Canicola Fever
o Pre-tibia
o Weils Disease
o Swine Herds Disease
o Ictero-hemorrhagic disease
A disease of a low form of animal found in the farm
RATS
Source of Infection
Excreta of Rats
Urine of Rats
Preventive Management
1. Immunization
CDT immunization
Given only free during epidemic
Provides six (6) months immunity
2. Avoid the five (5) Fs
Usual source of infection are the Five (5) Fs:
Feces
o Proper excreta disposal
Food
o Proper food preparation
o Proper food handling
o Proper food storage
o Avoid eating in unsanitary places
Fingers
o Hand washing
Flies
o Eradicate
Key Concepts!
When the microorganism enters, it travels along the
bloodstream
It affects other organs
o Striated Muscles
o Liver
o Kidneys
Spirochetes have a special affinity here
They destroy the nephrons
34
Preventive Measures
Eradicate rats by environmental sanitation
o Use of rat poison
Avoid walking through flooded areas
o Wash with soap and running water after walking
in floods
MUMPS
Infectious parotitis
Manifestations of Leptospirosis
Fever with chills
Presence of intense itchiness of the conjunctiva
Abdominal Pain
Nausea and Vomiting
Muscle tenderness and pain on the calf muscle
(gastrocnemius)
o Therefore, the patient does not like to walk or
stand
For ictero-hemorrhagic type of leptospirosis:
o Jaundice
o Hemorrhages on skin and mucous membrane
Causative Agent
Paramyxovirus
o Found on the saliva of the infected individual
Mode of Transmission
Droplet
Manifestations of Mumps
High-grade fever
Earache
o Ear pain
Pain upon mastication or chewing
Swelling of the parotid glands
Diagnostic Tests for Mumps
Clinical Observation
Medical Management for Mumps
Symptomatic as the causative organism is viral
Recovery depends on nursing care provided
Important Concept!
Pathognomonic sign of leptospirosis are the orange eyes
or orange sclera of the eyes
Important Concept!
If the kidney is affected, there would be signs and
symptoms of kidney failure:
o Decreased urine output
o Leading to anuria
Diagnostic Tests for Leptospirosis
Blood Examinations
o Leptospira Agglutination Test (LAT)
o Leptospira Antigen-Antibody Test (LAAT)
o Microscopic Agglutination Test (MAT)
Reveals the microorganism
35
o Hepatitis H
HEPATITIS A
Also called:
o Infectious Hepatitis
o Catarrhal Jaundice Hepatitis
o Epidemic hepatitis
Incidence is in epidemic proportions
Causative Agent
Hepatitis A virus
o RNA-containing virus
Important Concepts!
In Hepatitis A infected individuals:
o The feces
Harbors the microorganism in
abundant amounts
o The blood
Harbors the microorganism in minimal
amounts
Mode of Transmission
Fecal Oral Transmission
Rarely percutaneous or by blood transmission
Individuals AT RISK for Hepatitis A:
Those living in unsanitary conditions
Those who practice anal oral sex
Incubation Period:
Two (2) to six (6) weeks
HEPATITIS B
Also called:
o Serum Hepatitis
o Homologous Hepatitis
o Viral Hepatitis
The most fatal form of hepatitis
The most fulminant form of hepatitis
Causative Agent
Hepatitis B virus
o DNA-containing virus
Important Concept!
In Hepatitis B infected individuals
o The Blood
Harbors the microorganism
o Other body fluids
Tears
Saliva
Sweat
Cerebrospinal Fluid
Milk
Urine
Semen
o In fact, all fluids
Harbor the microorganism
HEPATITIS
Inflammation of the liver
Brought about by several causes:
o Alcoholism
o Drug intoxication
Hepatotoxic Drugs
Anti-Tuberculosis drugs
Tylenol
Acetaminophen
o Chemical Intoxication
Arsenic
o Microorganisms
Viral
Communicable microorganisms
Important Concept!
Current Number of Viruses causing Hepatitis
Capable of Infecting Humans
o Hepatitis A virus
o Hepatitis B virus
o Hepatitis C virus
o Hepatitis D virus
o Hepatitis E virus
o Hepatitis G virus
Non-pathogenic in Man
Mode of Transmission
Percutaneous
o Use of contaminated sharps and needles
o Blood Transfusion
Oral to oral Transmission
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o In saliva
Sexual Transmission
o Seminal fluid
o Cervical fluid
Vertical Transmission
Swallowing of amniotic fluid by the baby
Individuals AT RISK for Hepatitis B:
Healthcare workers
o All who are in contact with body fluids of patients
Blood recipients
Hemodialyzing patients
Drug addicts
Promiscuous individuals with multiple sex partners
Incubation Period
Six (6) weeks to six (6) months
Sweat
Cerebrospinal Fluid
Milk
Urine
Semen
o In fact, all fluids
Harbor the microorganism
Mode of Transmission
Percutaneous
o Use of contaminated sharps and needles
o Blood Transfusion
Oral to oral Transmission
o In saliva
Sexual Transmission
o Seminal fluid
o Cervical fluid
Vertical Transmission
Swallowing of amniotic fluid by the baby
Individuals AT RISK for Hepatitis D:
Healthcare workers
o All who are in contact with body fluids of patients
Blood recipients
Hemodialyzing patients
Drug addicts
Promiscuous individuals with multiple sex partners
Incubation Period
Three (3) weeks to twelve (12) weeks
HEPATITIS C
Also called:
o Post-transfusion Hepatitis
Rationale:
o Because people who develop this are those who
have undergone blood transfusion
Causative Agent
Hepatitis C virus
Important Concept!
In Hepatitis C infected individuals
Blood
Harbors the microorganism
Mode of Transmission
Percutaneous
Individuals AT RISK for Hepatitis C:
Hemodialyzing patients
Healthcare workers
Drug addicts
Blood Recipients
Incubation Period
Five (5) to twelve (12) weeks
HEPATITIS D
Also called
Dormant Type of Hepatitis B
Important Concepts!
A person must have Hepatitis B before he could be infected
with Hepatitis D
Hepatitis D cannot multiply by itself
It cannot bring about infection
If Hepatitis B is present in the body, Delta virus activates
Hepatitis B virus to help the Delta virus multiply
HEPATITIS E
Also called
o Enteric Hepatitis
Causative Agent
Hepatitis E virus
Important Concept!
In individuals with Hepatitis E
o The Feces
Harbors the microorganism
Mode of Transmission
Fecal Oral route
Individuals AT RISK for Hepatitis E:
Those living in unsanitary conditions
Those who practice anal oral sex
Incubation Period:
Two (2) to six (6) weeks
HEPATITIS G
No synonyms
Causative Agent
Hepatitis G virus
Important Concept!
In individuals with Hepatitis G
o The Blood
Harbors the microorganism
Mode of Transmission
Percutaneous
Causative Agent
Hepatitis D virus
Delta virus
Important Concept!
In Hepatitis D infected individuals
o Blood
Harbors the microorganism
o Other body fluids
Tears
Saliva
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Healthcare workers
Drug addicts
Blood Recipients
Incubation Period
Unknown
IMPORTANT CONCEPTS!!!
Similar Types or Partner Types
Hepatitis A and Hepatitis E
Hepatitis B and Hepatitis D
Hepatitis C and Hepatitis G
Manifestations of Hepatitis
Three (3) Stages
ALT
Alanine Aminotransferase
Formerly SGPT
Serum Glutamic-Pyruvic Transaminase
If increased, there is a liver problem
First enzyme to increase in the presence of a liver problem
1.2)
AST
Aspartate Transaminase
Formerly SGOT
Serum Glutamic-Oxaloacetic Transaminase
Increases only upon the onset of jaundice
1.3) ALP
Alkaline Phosphatase
Increase indicates:
o Obstructive Jaundice
o Obstructive Hepatitis
o Obstruction in the Biliary Tract
1.4) GGT
Gamma Glutamyl Transferase
When increased
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Dosage:
Two (2) to three (3) times a week for
six (6) months
o Action:
Kills the virus
o Cost:
Approximately Php85,000!!!
Nursing Care for Hepatitis
Two (2) Important Aspects
o
1.5) LDH
Lactate Dehydrogenase
When identified, it indicates liver organ damage
2. Serum Antigen-Antibody Test for Hepatitis
2.1) For Hepatitis A
HAsAg
Hepatitis A Surface Antigen
Anti-HAV
Presence of IgG
Presence of IgM
2.2) For Hepatitis B
HBsAg
Hepatitis B Surface Antigen
Anti-HBs
2.3) For Hepatitis E
HBeAg
Protein-independent Antigen
Anti-HBe
2.4) For Hepatitis C
HCsAg
Hepatitis C Surface Antigen
Anti-HCs
Medical Management of Hepatitis
No specific treatment
Treatment is symptomatic as causative agent is a virus
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Dosage:
o 0.5 cc
Route:
o Intramuscular
Site:
o Vastus lateralis
Important Concepts!!!
o Inform the mother that there would be pain and
soreness on the injection site
o A slight elevation on liver enzyme tests is a
NORMAL REACTION to the vaccine
2. Avoid the different modes of transmission
For Hepatitis B, C, and D
o Blood-borne diseases
There is a Needle-exchange Program in the United States
and in Australia
o Every 6:00 PM a healthcare worker is given a
knapsack with needles and sharps
o He then proceed to areas of distribution alleys
o Exchanges new syringes with old syringes used
by drug addicts.
In females:
Burning sensation upon urination if urinary meatus is
involved
o Urinary meatus is seldom involved in gonorrhea.
o Cervix is usually the one that is affected
Presence or absence of purulent discharges
Important Concept!
o If there is no burning pain and no purulent
discharge, the patient may not know that she is
infected
o Presence of abscess formation on the Bartholins
Gland or the Skeenes Gland
o When this abscess goes up, it gives rise to
ENDOCERVICITIS or ENDOMETRITIS
Hypogastric Pain
o Due to presence of endocervicitis or endometritis
Important Concept!
o Either of Endocervicitis or Endometritis could
give rise to Pelvic Inflammatory Disease
o Pelvic Inflammatory Disease
A systemic disease characterized by:
Fever
Severe abdominal pain
Nausea and Vomiting
This is secondary to
gonococcal infections
Sterility and Ectopic Pregnancy
o If gonorrhea persists, it causes a narrowing of the
Fallopian Tube
Gonococcal Septicemia
o Occurs when gonorrhea is already systemic
o Signs and symptoms would include:
Presence of Gonococcal Rashes
Papular
Elevated Rashes
Pustular
With pus
May be necrotic gonococcal rashes
Polyarthritis develops
Tenosynovitis
o Tendons and synovium are affected
Important Concept!
o Effect of disease to child of mother with
gonorrhea:
Opthalmic neonatorum
o Management:
Give CREEDES PROPHYLAXIS to
prevent blindness in the newborn
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Preventive Measures
Safe Sex
According to the Center for Disease Control, safe sex
means:
o No sex
o Mutual monogamous relationship
o Mutual masturbation without direct contact
Holding of body parts but no sex
Important Concepts!
o Condom is not an example of safe sex
o Condom use is not 100% guaranteed in
preventing infection
o Best way to prevent spread of infection is through
BEHAVIOR MODIFICATION
o Also called LOW-RISK Behavior
SYPHILIS
Also called:
o Pox
o Lues
o Sy
o Bad Blood Disease
Causative Agent
Treponema pallidum
Mode of Transmission
Sexual Contact
May be transmitted vertically
o May pass placental barrier after sixteenth (16 th)
week of pregnancy
Rarely transmitted thorough Blood Transfusion
Manifestations of Syphilis
Three (3) Stages
Primary Stage of Syphilis
Patient exhibits:
Chancre
o Characteristic lesion
o Painless popular lesions that heal spontaneously
without treatment
o Found on the:
Genitals
Face
Lips
Tongue
Under the breasts
On fingers
o If without treatment, chancre disappears, it will
signal the start of the Secondary Stage
Secondary Stage of Syphilis
Patient exhibits:
Flu-like symptoms
o Sore throat
o Headache
o Fever
Several forms of dermatitis
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Rashes (Kulugo)
All over the body
o Presence of dry, hard wart-like lesions
Condylomalata
o Infectious lesions that are fused together
o Found under the breast and on the genitals
o Highly infectious lesions
Key Concept!
o Secondary Stage is highly infectious
o Also called Infectious Stage
Changes in hair growth
o Patchy Alopecia all over
o Patient has MOTH-EATEN APPEARANCE
Affects growth of pubic hair
o Thinning of pubic hair
o Management:
Patient uses aloe vera
Patient uses Mane and Tail
Key Concept!!!
o Before the Tertiary Stage of Syphilis occurs, the
patient becomes ASYMPTOMATIC
o This may be called the LATENT PHASE
A transition period of one (1) to two (2)
years.
Tertiary Stage of Syphilis
Patient exhibits:
Gummatous Lesions or Gumma
o Characteristic lesion
o Lesions that are found on deeper tissues and
organs of the body
o Some are in the form of infiltrating tumors
Other organs of the body are also affected
o Most commonly affected is the HEART
o This gives rise to CARDIOVASCULAR SYPHILIS
Neurosyphilis
o Central Nervous System affectation
o Neurologic symptoms are present
Lack of Balance
Dementia
1. Anti-biotics
Drug of Choice
o Penicillin
If patient is sensitive to Penicillin
o Administer a Cephalosporin instead
o Choice of Cephalosporin
Ceptriaxone or Rocephin
Given per I.M. or per I.V.
o Different diluents are used:
o When given I.V.
Diluent used is Sterile Water
o When given I.M.
Diluent used is Xylocaine
Important Concepts!!!
o Do NOT INTERCHANGE diluents!
o If I.M. preparation is given via I.V.
Patient dies due to dysrhythmias
o If I.V. preparation is given via I.M.
Viscous medication would give rise to
pain upon administration
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Important Concepts!!!
If you are pregnant, do not be infected with syphilis
Do not get infected with syphilis, particularly in the third
(3rd) trimester of pregnancy.
The nearer you give birth to a child, the greater is the
chance that the child would develop congenital anomalies
Modes of Transmission
Blood Transfusion per Single Exposure
Single Blood Transfusion
o Provides 90% chance of infection
Sexual Contact
Pandemically, the number one mode of transmission
o Single exposure gives 0.1% to 1.0% chance of
infection
o However, due to repeated sexual encounters,
chance of infection increases
Contaminated Sharps and Needles
Single exposure gives 0.1% to 0.5% chance of infection
Vertical Transmission
From the infected mother to the unborn fetus
o Gives 30% chance of infection
Important Concepts!!!
If a child is born to a mother who is HIV positive, the child
would ALWAYS have a POSITIVE RESULT for HIV
TESTING
o HIV testing identifies the presence of antibodies
in the blood
Child possesses maternal antibodies
o Therefore, child is positive for HIV but may this
may not mean the child is infected
Child is given up to eighteen (18) months for HIV testing
o After eighteen (18) months, child must be
negative for HIV testing
o If child is still positive for HIV testing after
eighteen (18) months, then the child is REALLY
INFECTED!!!
NORMAL IMMUNE RESPONSE
Microorganism
43
Important Concept!
In HIV Infection, there is an alteration in the NORMAL
Immune Response
Months to years
Months to years
DEATH occurs
HIV (Retrovirus)
Has special affinity for T cells
T cell is DAMAGED
No B cell stimulation
No antibody production
Important Concepts!
AIDS Related Complex Symptoms include the following:
Fever with night sweats without a cause
o All laboratory works are negative
Enlargement of lymph nodes without a cause
o All laboratory works are negative
Fatigability
Weight Loss
Altered Sleeping Patterns
Temporary Memory Loss
Altered Gait
Manifestations of AIDS
For adults
o Two (2) major symptoms
o One (1) minor symptom
For Children
o Two (2) major symptoms
o Two (2) minor symptoms
Major Symptoms
Fever: One (1) month and above in duration and is
recurrent
Diarrhea: One (1) month and above
Ten percent (10%) weight loss
o Staunted growth in children
Minor Symptoms
Persistent generalized lymphadenopathy
Generalized pruritic dermatitis
Persistent cough: One (1) month and above
Oropharyngeal Candidiasis
Recurrent Herpes Zoster
Progressive Disseminated Herpes Simplex
Continually multiplying and continually growing mouth
sores
Important Concept!
In the course of the HIV infection, the macrophages
CANNOT IDENTIFY the HIV
As the body takes more time to develop antibodies to the
HIV, the person BECOMES INFECTED but REMAINS
ASYMPTOMATIC
A WELL-WORRIED INDIVIDUAL
Important Concepts!
False-Negative Result for AIDS
o No antibodies are identified but patient is already
infected
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3. Western Blot
If a person is diagnosed with HIV
Tests continue
Monitor the following:
o 3.1) Viral Load
o Monitors replicating activity of the virus
o Negative ( - ) Viral Load
Means virus is not actively multiplying
but is still present
o 3.2) CD4 and T cell Count
o Establishes STAGE OF INFECTION, whether it is
HIV or AIDS
Indicates HIV infection
If greater than or equal to
200
Indicates AIDS
If less than 200
Medical Management for AIDS
Symptomatic management as virus is the causative agent
Latest Trend in Pharmacologic Management of AIDS
o COCKTAIL DRUGS
Patient
must
take
medication
composed of at least twenty-one (21)
tablets per day
Patient
spends
approximately
Php1,000 per day on drugs
Prevents multiplication of the virus but
DOES NOT KILL THE VIRUS
1.Nucleoside Reverse Transcriptase Inhibitors
NRTIs
o AZT Azidothymidine
Retrovir
Zidovudine
o ddc
Dideoxycitidine
Zalcitadine
o ddI
Dideoxyinosine
Didanosine
Tastes sour
Give together with fruit juice
o Lamivudine
o Stavudine
1. ELISA
Enzyme-Linked Immunosorbent Assay
o This is only a SCREENING TEST for AIDS
2. PCR Test
Polymerase Chain Reaction Test
o Likewise, a SCREENING TEST for AIDS
o Relatively expensive
o Costs approximately Php5,000 to Php7,000 per
test
o Results are known within two (2) to three (3)
hours
Important Concept!
If a person
o Has been twice positive for ELISA and;
o Has been positive once for PCR
Then confirm the results by doing the next test
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