Communicable Disease  Virus-cannot multiply once the virus is not in

the body of a living matter. (They are self-

Based on the Morbidity: limiting)

-9/10 causes morbidity in the Ph are all CD. Goal: Boost the immune system.

Ex. Respiratory infections including pneumonia, Tb and  Encourage the patient to eat foods rich in
Influenza (Covid 19), animal bites (Rabies), Diarrheal Vitamin A, C, E, Zinc
diseases.  Increase oral fluid intake
 Enough rest and sleep
Based on the Mortality:
 Bacteria- can grow in both living and non-living
4 non communicable diseases that are common cause
things.
of death.
Based on the color of the sputum: Mucus secretion
Cardiovascular disease
 Yellowish/Brown: Bacterial infection
1. Hypertension
2. COPD  Clear: Viral Infection
3. Cancer  Protozoa/Fungus: Green
4. Diabetes Miletus 2. Reservoir
 all connected to unhealthy lifestyle. (Tobacco -temporary lodging area of your microorganism. It
could be living or non-living things.
smoking, unhealthy diet, sedentary lifestyle)
Communicable diseases can be prevented through 3. Portal of Exit
health education. - feces, urine
 Educate on how to prevent the transmission. 4. Mode of Transmission-Weakest leak
Chain of infection- Intervene on the mode of  Direct or indirect contact
transmission. (HANDWASHING)
Direct Contact: Intermediary object
4 Pandemic Communicable Diseases:
– person-to-person; face-to-face encounter with an infected
person (e.g. skin contact, kissing); droplet
1. COVID 19
2. Tuberculosis
3. HIV Aids Ex. Fecal oral transmission/ Diarrheal infections
4. Malaria
 5Fs- Fomites, Fingers. Flies, Food, and Fecs
Sporadic – on and off
Endemic – persistently present Droplet Airborne
Epidemic – sudden increase
Pandemic – present worldwide Source of Respiratory Droplet Respiratory Droplet
Infection (droplet nuclei) (droplet nuclei)

Respiratory Bigger, heavy Less than 1micrometer.

Chain of Infection Droplet (remains in the (Smaller)
surface), can be carried/suspended in
Pathologic carried for some the air, lighter
time only
Reservoir
Portal of Exit Distance Within 3ft of the More than3ft
Mode of transmission patient

Portal of Entry Equipment Surgical Mask N95 Mask (particulate

Susceptible Host respirator)

Isolation Barrier more than 3ft 1:1- 1pt is to 1 room

Negative pressure
1. Pathologic
Vector-– insects, arthropods, rodents
AKA: Etiologic Agent (bacteria, virus, protozoa and
fungus) C-chemically treated mosquito net
L-larvae eating fish (Zoo prophylaxis) Acquired
E-environmental sanitation (Most important) A. Active – actual participation of the
 remove breeding site individual’s body tissues and fluids in the
 DOH: 4’O Clock habit
production of antibodies.
A-anti mosquito
1.) Naturally Acquired – produce antibodies by
N-neem tree or Eucalyptus and Oregano
natural means; unintentionally
 previous infection
5. Portal of Entry  Subclinical Immunity – developed due to
 Break on your skin constant exposure to a certain infection.
 GI contaminated food
 Respiratory- droplet or airborne 2.) Artificially Acquired – artificial means; intentionally
done
6. Susceptible Host  (vaccines – attenuated/weakened
 Too young- problem in the thymus gland microorganisms)
 Too old- Atrophy of your thymus gland
 Patients taking corticosteroids- Can cause
bone marrow depression
B. Passive – presence of antibodies in the serum not
 Patients undergoing chemotherapy
 Immunocompromised patients coming from the individual himself (get antibodies)
Prevent: Through IMMUNIZATION 1.) Naturally acquired – get antibodies by natural
means/unintentionally
 Passive-Anti body
 Active- Antigen  placental transfer of maternal antibodies
 Baby protected up to 6mos. (antibodies from
Nagkasakit and body develops anti-body (Active
mom)
Natural)
 infection under 6mos. (mom’s fault)
Vaccines under EPI- PD996 (Active Artificial)
WHO – no immunization must be given earlier than
OA- OPD and Anti-measles (ayaw sa init) 2mos. (mom’s antibodies will fight infection

Freezer Exception to the rule – in a country or state where

infectious diseases are constantly present, they can give
The rest body of the ref- 2-3 degree Celsius. vaccine before two months.
All vaccines can be given on the same day in a different Mother with HIV = baby with antibodies = doesn’t
site. mean baby is infected
IMMUNITY Mother’s antibodies stay up to18mos.
-State of being resistant to infection; state of being free >18mos. = body (+) HIV antibodies = baby has HIV
from infection. Breastfeeding (IgA) – colostrum
Two Types: IMMUNIZATION
Natural Active
 Inherent in the individual’s body tissues and  Weakened microorganism/toxin
fluids  Stimulate antibody production
 (born with it and die with it) – rare  Effect: 4-7 days
 Race (lahi)  Continuously produces antibody (long-lasting
 Genetic abnormality  immunity)
 EPI: BCG, OPV, MMR, DPT, AMV
  Tetanus Toxoid, Anti-rabies, HBV, Pneumovax, body to excrete microorganism. Just increase OFI to
Varivax, Fluvax prevent dehydration.
Passive 2.Cell Mediated Response- 2nd line of defense

 Antibodies -Explanation why we have an inflammation.

 Provide high titer of Antibodies (TX)
Wlang silbi ang local defenses natin the body will
 Effect: immediate
release chemical mediators:
 Not long-lasting/short-lived immunity
 ATS/TAT, TIg, Equinae, Rabies Ig, HRIg, ADS, PIg,  HISTAMINE (Primary)
VZIg  BRADYKININE
 Active (toxins) and Passive (antibodies)  PROSTAGLANDIN
Immunization
– do not inject on the same side/site. The effect of chemical mediators to the body:

Stages of Infection If there is infection walang silbi ang local protection

mamomobilize yung chemical mediators and will release
1. Incubation Period- entry of of CM primarily the histamine and will result to
microorganism/multiplication into the body and vasodilation.
to the onset of signs and symptoms.
2. Prodromal Stage- Non-specific signs and If there is vasodilation there is:
symptoms or constitutional signs of infection:  More WBC will go on the site of infection
 Fever  WBC- 5-10k (normal)
 Abdominal pain o Granulocytes
 Headache  Neutrophils- na nenew na 60%
 Body malaise will increase if there is acute
3. Acute or Illness Phase- specific infection
sign/pathognomonic sign. o Agranulocytes-
 Cataral stage- increase secretion. Highly  monocytes and lymphocytes-
communicable will increase if there is
 Paroxismal stage- Increase severity of suspected tumor or viral
signs and symptoms. infection.
Will lead to death if not manage o Basophils- will increase if there is
4. Convalescence or Recovery stage- All VS will go chronic infection (ex. TB)
back to normal. o Eosinophils- will increase if there is
parasitic infection
 More RBC will go on the site of infection- to
increase oxygenation- needed in the production
of ATP (energy)
Body Defenses
o Hemoglobin- oxygen carrying capacity
-It happens when there is an infection in the body. o Glucose + Oxygen= ATP (Byproduct is
heat)
-The body needs to compensate to maintain balance
 Platelets on the site of infection- for bleeding
and try to eliminate the microorganism.
- It will create a barrier to localize the
1. Superficial/Local Response- 1st line of defense infection para hind imaging systemic
infection.
 Skin
 Tears/Saliva
 Sweat-lysozyme-phagocytosis
 Sneezing and Coughing
 Goblets cells-produces mucus Signs and Symptoms of Inflammation
 Parietal cell- Produce HCL
1. Rubor- redness (blood is red)
If we have diarrheal infection- we do not give 2. Calor- heat (Hypothalamus)
loperamide- because it is the compensation of the 3. Dolor- pain (Prostaglandin causes spasm)
4. Tumor-swelling/increase permeability of the membrane=
fluid shifting= edema/tumor
5. Pallor- in the other parts of the body because the blood
 DSSM (Direct sputum smear microscopy)
 major tool in case finding of TB
 cannot give anti tb drugs without DSSM
 conducted 2 consecutive days (3x
collection of sputum)
3. Humoral Response- 3rd line of defense
1st Day- Spot collection- anytime of the day
-production of antibodies
when the pt had his/her consultation.
RESPIRATORY INFECTIONS 2nd Day- AM
3rd Day- PM after the 2nd collection\
Tuberculosis
AKA: Koch’s Infection or Consumption Disease  Tuberculin Test/ Mantox Test/ PPD Test
(Purified Protein
 cause by mycobacterium tubercle bacilli Derivative)
 aerobic bacteria-loves more oxygen  Administered intradermally
 Interpreted 48 to 72 hours
Payat- because the mycobacterium bacilli used the
 If there is redness in the result=
oxygen therefore if kulang sa oxygen kulang sa ATP
NEGATIVE
(energy) the body’s compensation to increase there will
be fat and protein metabolism (gluconeogenesis) to  (+) result of tuberculin testing > 10 mm
have other source of glucose in trying to increase your induration. (Exposure)
ATP. The problem is not the glucose but the oxygen. o Immunocompromised > 5 mm
induration. (maybe may HIV)
Subtypes of Mycobacterium Tuberculosis:  Chest X-ray – extent of the disease
 Hominis (human to human) Med Mgt:
 Bovis (Cattles)
 Avis (Birds)  Rifampicin
- Hepatotoxic
MOT: Airborne o Avoid alcoholic beverages
Incubation period: 3 to 8 weeks o Monitor liver enzymes
- Remove contact lenses and replace with glasses
Primary Complex- TB among children
o Turn to color orange
 -not contagious/infections  Isoniazid
- Hepatotoxic
S/Sx: o Avoid alcoholic beverages
 Hemoptysis- Low grade fever, night sweats o Monitor liver enzymes
- The only contraindication to sputum exam - Peripheral neuritis
- One tubercle bacilli enter the lungs it would o Vitamin B6 Pyridoxine
create scarring- didikit ang TB sa lung
parenchyma= it will invade the capillaries =  Pyrazinamide
Hemoptysis. - Hyperuricemia – Gout/ Kidney Stone
- Chest Physiotherapy- it will worsen the o Alkaline urine
hemoptysis  Increase OFI
- No back tapping cuz the TB could dislodge  Increase milk intake
from the lung parenchyma pwede mag  Increase vegetable intake
spread in the other system= extra
pulmonary TB.  Ethambutol- do not give below 6YO
- Optic neuritis
Dx Exam:
o Irreversible
 Sputum exam- collected for 3 days early in - Color blindness
the morning o Difficulty differentiating red and green
 No brushing of teeth
 Streptomycin
DOTS PROGRAM DOH - Nephrotoxicity
 o Monitor I and O CA: Mycobacterium Leprae (closely associated with M.
o Monitor creatinine level tuberculosis)
- Ototoxicity MOT: prolonged intimate skin-to-skin contact
o Monitor for signs of vertigo and tinnitus Research: droplet (highly concentrated in
Note: Stop taking anti TB drugs if there is Jaundice or
respiratory secretions
hepatomegaly= all are toxic in the liver.
Cardinal Signs:
Categories for TB treatment:  Peripheral Nerve Enlargement
“General”  Lossof sensation
Category 1: ALL POSITIVE  (+) skin smear test for M. leprae
 Positive sputum exam
 Patient maybe + of HIV Aids Structure/Organs Affected:
 Patient + extra PTB
 Eyes
 Extensive lesion/parenchymal damage (Chest
xray)  Skin
 6 months’ treatment  Muscles
Category 2: May letter R  Nerves
 Relapse/ Failure in treatment  Respiratory system- cough/mucus secretion
 8 Months treatment 1-week consistent treatment of the drugs for
Category 3: leprosy it’s no longer contagious.
 123 Negative smear but may minimal lung
RA 473- Advocate home treatment
damage
 4 month’s treatment
S/Sx:
Category 4: Chronic Early Manifestation
 After consistent treatment still + sputum exam C-hange in skin color from red to white
 8 Months treatment L-oss of sensation
U-lcer that does not heal
 Weeks bago hindi makahawa ang patient after
M-uscle weakness and paralysis
taking anti tb drugs: 2-4 weeks
 Who can conduct DSSM- ALL of the above P-ainful and thickened nerve
o RN, MW, Physician, RMT, trained BHW
Late Manifestation
5 Elements of DOTS program: Madarosis-loss of eyebrow, eyelashes
1. DSSM Lagopthalmus – inability to close eyelids
2. Politically funded hence, Sinking of the bridge of the nose (Saddle-nose
3. Drugs are free
deformity)
4. Direct observe treatment
5. Monitoring, recording and progress reports Contractures (clawing of fingers and toes)

Dx Test:
 Slip Skin Smear
Medical Mgt: Multiple Drug Therapy
Combination of Drugs to:
1. Prevent drug resistance (esp. Dapsone – mainstay
drug)
2. Hasten recovery
3. Lessen period of communicability (1-2 weeks)
LEPROSY  Reportable Side Effects: (discontinue treatment)
 Rifampicin – given on Day 1
AKA: Hansen’s Disease; Hansenosis
 Lepers – Hansenites
  Dapsone – 2nd to 28 days or a period of 6-9  Fast breathing
months  Chest indrawing
o Subcostal retraction – use
Paucibacillary Multibacillary (Lepromatous type)
of accessory muscles
1st Day-Rifampicin 1st Day- give ∙ Rifampicin & o Stridor – harsh breath sound
2nd Day- Dapsone Dapsone during
(2nd to 28 days) 2nd Day- give ∙ Rifampicin & o INSPIRATION
Duration: 6-9 mos. Dapsone + clofazimine 20mg o Wheezing – high pitched
Duration: 24-30 months
sound during EXPIRATION

S/e: (N)
Dx Exam:
Clofazimine - brownish/blackish discoloration
 Chest X-ray – Confirmatory test
▪ Lung consolidation
▪ Patchy infiltrates
PNEUMONIA
 Sputum exam
 Inflammation of the lung parenchyma ▪ Specific cause
CA: Virus, Protozoa, Bacteria (common)
 PCP – Pneunocystis Carinii Pneumoniae Med Mgt:
(protozoa)  Antibiotic
 CAP – Streptococcus (bacteria)  Inhalation therapy – nebulization
 HCAP – Staphylococcus, Gram (-) Bacteria Nrsg Care:
 ICU - Pseudomonas, Klebsiella  Maintain patent airway
 Inhalation of noxious substances o Provide adequate rest
 Aspiration pneumonia o Provide adequate nutrition
 Lipid pneumonia – use of oil for cleaning o Provide comfort measures
the nose or as lubricant  Prevention:
 Stasis Pneumonia (Hypostatic)- immobility o Immunization
MOT: Direct (droplet) o Proper disposal of nasopharyngeal
S/sx: secretions o Covering of the nose and the
Cardinal Signs: mouth when sneezing and coughing
 Rusty Sputum
 High Fever Postural Drainage and Back tapping=
 Increase tactile fremitus DEPENDENT INTERVENTION
o Normally equal vibration both sides
o If increase (whatever side) that’s
the affected lung.
Lung Assessment for Consilidation:
 Bronchophony- tactile fremitus- icnease
vibration on the affected lung. May
consolidation=may pneumonia
 Egophony- uses stethoscope (Say “E’)
o Normal ‘E’ sound must be CLEAR
 Whisper Pectoriloquy- use stethoscope
o Say 123 (Normally “punga”)
o If clear 123= Consolidation= May
DIPTHERIA
Pneumonia
CA: Corynebacterium Diphteriae (Klebs
IMCI
Loeffler Bacillus)
 CA: Bordetella Pertussis, Hemophilus Pertussis
MOT: Direct (droplet) MOT: Direct (droplet)
IP: 7-10 days
Pathognomonic Sign: Pathognomonic Sign
Pseudomembrane – grayish white membrane
 Explosive outburst of 5-10 coughs that ends
 Do not remove (Myocarditis if remove)
with a whoop.
o might cause bleeding
o Might cause hernia that’s why we need
o General toxemia
adb.binder.
 Tracheostomy set
o Possible occurrence of asphyxia o Provoke/ aggravated if the pt is crying,
drinking or eating
 Nasal septum BON: The hole of the nipple should be small or use
 Larynx dropper when feeding.
 Soft palate o During the acute attack the patient
 Uvula should be on NPO to avoid aspiration.
 Pillars of the tonsils Med Mgt:
S/sx:  Antibiotic-Erythromycin
 Irritating nasal discharge – sero-sanguinous; foul
mousy odor
 Sore throat
 Dysphagia
 Neck edema – bullneck appearance
 Hoarseness of voice, aphonia
 Temporary, larynx is affected
Dx Exam:
 Nose and throat swab – Definitive Test
 Schick Test – Immunity/ susceptibility
 Moloney Test – Hypersensitivity to diphtheria
antitoxin
Med Mgt:
 Antidiphteria serum (ADS) – neutralize toxin
o PASSIVE ARTIFICIAL VACCINE
 Antibiotic – Penicillin – kill the microorganism
 Vaccine= DPT- given 6 weeks with 4 weeks’
interval for 3 doses- 0.5ml/IM via vastus lateralis
Summary:
 Do not remove the pseudomembrane
 No hemoptysis during sputum exam
 Tracheostomy set at bedside
 2 negative culture is needed
 DOC: Penicillin

PERTUSSIS- Below 6 y/o

AKA: Whooping Cough, Chin Cough