INFECTIOUS DISEASES OF THE AIRBORNE AND CONTACT TRANSMISSION PRECAUTION

RESPIRATORY SYSTEM • Dispose secre ons properly

• Cover mouth when sneezing or coughing preferably
DEFINITION OF TERMS: with a disposable ssue
• Handwashing a er sneezing and coughing
UPPER RESPIRATORY TRACT • Proper disposal and handling of fomites
• Structures from the nasal cavity to the
pharynx (which also includes paranasal TEACH AN ADULT PATIENT COUGH AND DEEP BREATHING
sinuses and tonsils) EXERCISES
• Back rub
LOWER RESPIRATORY TRACT • Bronchial tapping
• Structures from the larynx to the
alveolus MASS EDUCATION ON THE MODE OF BACTERIAL
TRANSMISSION
PNEUMONIA • Stress importance of good personal
• Inflamma on of the mucous membrane hygiene
lining of the pulmonary alveoli
ADMINISTER ANTIBIOTICS AS ORDERED
BRONCHITIS
 Inflamma on of the mucous membrane lining of the ADVISE PATIENT TO STOP SMOKING
bronchial tubes
COMMON BACTERIAL RESPIRATORY DISEASES
PHARYNGITIS
 Commonly known as “sore throat”  TUBERCULOSIS (Mycobacterium tuberculosis)
 Inflamma on of the mucous membrane lining of the  WHOOPING COUGH (Bordetella pertussis)
pharynx  BACTERIAL PNEUMONIA
 DIPHTHERIA (Corynebacterium diphtheriae)
LARYNGITIS  STREP THROAT (Streptococcus pyrogenes)
 Inflamma on of the mucous membrane lining of the  ANTHRAX (Bacillus anthracis)
larynx

SINUSITIS
 Inflamma on of the mucous membrane lining of the
paranasal sinuses

COMMON NURSING MANAGEMENT FOR

RESPIRATORY DISEASES (BACTERIAL AND VIRAL)

MAINTAIN PATIENT’S AIRWAY AND ADEQUATE

OXYGENATION
• Elevate head and shoulders

BED REST
• Must not be permi ed to bathe himself
• Must avoid exer on when defeca ng
• Purposes:
• To conserve energy
• To decrease workload of the heart

MAINTAIN ADEQUATE NUTRITION; ENCOURAGE FLUIDS

• Small frequent feedings of so food
• Encourage pa ent to drink fruit juices rich in vitamin C
 TUBERCULOSIS
INFO: KOCH’S INFECTION
• Primary Complex / Primary Koch’s Infection
o Among children

EA: Mycobacterium tuberculosis (Koch’s Bacilli)

MILIARY TB / DISSEMINATED TB
• large number of bacteria spread throughout the body via blood stream
• potentially life-threatening
• results in gradual wasting of the body (cachexia)

MODE OF • Inhalation of airborne droplets (Droplet or Airborne)

TRANSMISSION: • Prolonged direct contact (controversial)
• Ingestion of sputum (common among children)
MOST • AFB (+) sputum
INFECTIOUS o Active Tuberculosis
PERIOD:
**Primary Complex in children is NOT contagious; but it is communicable
S/SX Generalized:
• Malaise
• Fever usually in the late afternoon
• Night sweats
• Weight loss, anorexia

Pulmonary:
• Productive cough
• Fine crepitant rales over the apical areas
• Chest/Pleural pain
• Hemoptysis (coughing up blood)
• often considered as pathognomonic
sign by other authors
• Dyspnea
MAY AFFECT • Kidney
OTHER ORGANS • Fallopian tube
• Meninges
o causes TB meningitis
▪ most common type of meningitis in the Philippines
• Urinary bladder
• Intestines
• Bones especially the spine/vertebra
o Pott’s disease (TB of the Spine)
PRVNTN TEST: Mantoux test or PPD test.

VACCINE:
o BCG (Bacillus of Calmette and Guerin)

administered during:
• early neonatal period
• before entering primary school
TX Rifampicin (RIF) • red-orange urine
Isoniazid (INH) • hepatotoxicity
• peripheral neuropathy
o must be taken with Vitamin B6
Pyrazinamide (PZA) • hepatotoxicity
Ethambutol (EMB) • optic neuritis
Streptomycin • CN VIII damage (vertigo)

**Rifampicin (RIF) and Isoniazid (INH)

• MOST EFFECTIVE DRUG for the treatment of TB
• 2 drugs should never be given alone; always used in combination with each other as well as with other drugs
• resistance to one drug alone occurs very rapidly

**Good compliance to medications renders the patient NOT contagious 2 to 4 weeks after initiation of treatment

NURSING INTERVENTIONS: TUBERCULOSIS

➢ All babies should be vaccinated with BCG

➢ Always check sputum for blood
➢ Maintain respiratory isolation until patient:
o responds to treatment.
o is no longer contagious.

➢ TB education program
o stress importance of:
▪ continuing to take medications for the prescribed time;
▪ regular follow-ups
- these are the highest priority in nursing intervention
o controlling spread of TB
▪ Handwashing after sneezing and coughing
▪ Cover mouth when sneezing or coughing preferably with a disposable tissue
- do not use bare hands
o High CHON, CHO, Caloric, and Vit. C diet
▪ small frequent meals
o Plenty of rest
o Be alert for side effects of anti-TB drugs
 WHOOPING COUGH
INFO: • 100 days cough
EA: Bordetella pertussis
• 3 stages:
o Prodromal / Catarrhal stage
o Paroxysmal Stage
o Recovery Stage

M.O.T : • Direct contact

• Indirect contact via fomites contaminated
with respiratory secretions or saliva
• Droplet / Airborne
MOST • PRODROMAL / CATARRHAL STAGE
INFECTIOUS • most communicable stage
PERIOD:
S/SX PRODROMAL / CATARRHAL
• mild flu-like symptoms
• cough becomes irritating, hacking, nocturnal, and becoming more severe

PAROXYSMAL STAGE
• Cough in series of successive explosive outbursts; 5-10 cough in one expiration
• Ending in a sudden noisy inspiration; Assoc with long, high-pitched “whoop”;
• Usually followed by vomiting

PRODROMAL / CATARRHAL
• Gradual decrease in paroxysms of coughing.
PRVNTN • Immunization (DPT)
TX • Antibiotic therapy; (Erythromycin)

NURSING INTERVENTIONS: WHOOPING COUGH

• MAJOR OBJECTIVE: PREVENT COMPLICATIONS
• isolation and medical asepsis
• patient should not be left alone during coughing fits; suctioning equipment should be ready at ALL TIMES.
• child should be kept as quiet as possible
• provide warm baths and keep linens dry and free from soiling

STREPTOCOCCAL PHARYNGITIS / “STREP THROAT”

INFO: EA: Group A Streptococcus (Streptococcus Pyogenes)
• which produces Erythrogenic Toxin
M.O.T : •Inhalation via droplets (Droplet / Airborne)
• Direct and Indirect contact with respiratory secretions
S/SX • sore throat (syempre), fever, chills and headache
• if a sunburn-like, pink-red rash develops with the characteristic “Strawberry tongue”
• sand paper-feel papules on trunk towards extremities sparing the palm and
soles
↓
• SCARLET FEVER
TX • Anti-microbial therapy
 DIPHTHERIA
INFO: EA: Corynebacterium diphtheriae
• also known as Klebs-Loeffler bacillus
• secretes an exotoxin

M.O.T : •Inhalation via droplets (Droplet / Airborne)

• Direct and Indirect contact with respiratory secretions
S/SX • Starts as sore throat (most common manifestation)
• Progresses in the formation of Pseudo membrane made up of:
o Leukocytes
o Fibrin
o Necrotic tissue
o Microorganism

PSEUDOMEMBRANE:
• grayish in appearance at first but becomes dull-white as it thickens
• located at the back of the throat that may cause:
o DOB
o Sore throat
o Tender cervical lymph nodes
o Neck swelling (“bull-neck” appearance)
• adherent to the underlying tissues and leaves a raw bleeding area when detached
PRVNTN VACCINATION
• (DPT) – Diphtheria, Pertussis, Tetanus
TX • Anti-microbial therapy (Penicillin)
• Anti-toxin ASAP

NURSING INTERVENTIONS: DIPHTHERIA

• Absolute bed rest for at least two weeks
• Ice collar must be applied to the neck
• Nose and throat care

WHOOPING COUGH
INFO: • 100 days cough
EA: Bordetella pertussis
• 3 stages:
o Prodromal / Catarrhal stage
o Paroxysmal Stage
o Recovery Stage

M.O.T : • Direct contact

• Indirect contact via fomites contaminated
with respiratory secretions or saliva
• Droplet / Airborne
MOST • PRODROMAL / CATARRHAL STAGE
INFECTIOUS • most communicable stage
PERIOD:
S/SX PRODROMAL / CATARRHAL
• mild flu-like symptoms
• cough becomes irritating, hacking, nocturnal, and becoming more severe
 PAROXYSMAL STAGE
• Cough in series of successive explosive outbursts; 5-10 cough in one expiration
• Ending in a sudden noisy inspiration; Assoc with long, high-pitched “whoop”;
• Usually followed by vomiting

PRODROMAL / CATARRHAL
• Gradual decrease in paroxysms of coughing.
PRVNTN • Immunization (DPT)
TX • Antibiotic therapy; (Erythromycin)

BACTERIAL PNEUMONIA
INFO: • Inflammation of the mucous membrane lining of the alveoli

ETIOLOGY
• Escherichia coli
• MC: among neonates and infants
• Haemophilus influenza
• MC: among children (5 months to 5 yo)
• Streptococcus pneumoniae
• MC: among adults
• Pseudomonas aeruginosa
• MC: Nosocomial pneumonia

Other bacteria:
• Mycoplasma pneumoniae
• Primary Atypical Pneumonia
• Walking Pneumonia
• Legionella pneumoniae
• Legionnaire’s disease
• found in water of air-conditioners
• can cause some epidemics in hotels, business districts, spas, etc.
• Not transmitted from person-to-person
• Staphylococcus aureus
• Klebsiella pneumoniae
• Bacillus anthracis

M.O.T : •Inhalation via droplets (Droplet / Airborne)

• Direct and Indirect contact with respiratory secretions
MOST
INFECTIOUS N/A
PERIOD:
S/SX • Fever and chills
• Productive cough
• Tachycardia and tachypnea
• Acute chest pain with DOB
• Body malaise
PRVNTN VACCINATION
• HiB (Haemophilus influenza)
• Pneumovaccine (Pneumococcus)
TX • Antibiotic therapy
 ANTHRAX
INFO: • Disease of sheep, cattle, horses, goats, and swine, affecting mostly farmers and veterinarians
• Highly contagious and potentially fatal disease
• spores from B. anthracis can survive for years in soil but can be destroyed by boiling for ten minutes

• EA: Bacillus anthracis

Types:
• Skin Anthrax
• Gastro-intestinal Anthrax
• Inhalation / Pulmonary Anthrax
M.O.T : ENTRY OF SPORES THROUGH…
• Skin injury (skin contact or animal bite)
• Ingestion
• Inhalation
S/SX SKIN ANTHRAX
• results from direct skin contact with spores; presents with:
• Malignant pustules of the skin leading to septicemia
• Eschar formation occurs and sloughs off
• black scab
• skin becomes thick and crusty which restricts blood flow

Eschar sloughs off → Hematogenous spread → Sepsis may occur → Shoch (septic shock)

GASTROINTESTINAL ANTHRAX
• results from ingestion of inadequately-cooked meat from animals with Anthrax
• very rare compared to the other types of Anthrax

INHALATION / PULMONARY ANTHRAX

o “Wool sorter’s disease”
o results from inhalation of spores
o initially presents with flu-like symptoms
o involves mediastinitis, sepsis, meningitis, and hemorrhagic pneumonia
o Almost always fatal

TX Tx : Penicillin (mortality rate is high despite antibiotic therapy)

COMMON VIRAL RESPIRATORY DISEASES

1. Influenza / Flu
2. Common Cold
3. Croup
4. Viral Pneumonia
5. SARS
6. COVID-19
MODE OF TRANSMISSION:
• Direct Contact
• Indirect Contact (fomites)
• Droplet / Airborne
 INFLUENZA / FLU
INFO: • 100 days cough
EA: Influenza v. A, B, & C
o only Influenza virus-A causes pandemic form of influenza

RESERVOIR
• Humans
• Birds (Avian/Bird/Chicken Flu)
• Pigs* (Swine Flu)

*Pigs contain receptors to both human and avian influenza viruses

• infection coming from pigs results in the formation of new strains of influenza virus
o New types of diseases
o More morbid diseases
o Resistant to new methods of treatment
o Fatal resultsoften considered as “mixing bowls” in the process of influenza infection.

• considered as “mixing bowls” in the process of influenza infection.

• Reasons why bird flu difficult to treat:

o Antigenic Drift
o Antigenic Shift
ANTIGENIC DRIFT
• mutation of surface proteins (adhesins) of influenza virus
• a continuous process for influenza viruses
• can be substantial and has led to extensive epidemics with severe disease

ANTIGENIC SHIFT
• exchange of entire gene segments between viruses of human and animal origin (usually avian)
• involves production of new viral strains
• often results into pandemics

BULLSHIT TO KNOW: An avian strain (H5N1) of Influenza-A emerged as a cause of human

influenza in Hong Kong in 1997, but pandemic spread did not occur.

S/SX PRIMARY SITE OF THE DISEASE

• Tracheobronchial tree

Involved in the development of “Flu-like symptoms”

• which are used to describe early, illdefined, non-specific symptoms of a disease:
• Cough (most prominent symptom)
• Fever
• Chills
• Headaches
• Body pains/Malaise
• Sore throat
• Nasal drainage

Can lead to pneumonia and death (because of secondary bacterial infections)

Flu can lead to Reye’s syndrome if aspirin is given during illness
• Encephalomyelitis with liver damage
 NURSING MANAGEMENT: INFLUENZA / FLU
• there is no specific treatment; so the best thing to do is:
o stay at home
o drink plenty of fluids
o provide symptomatic relief
o TSB
o isolate
o limit strenuous sctivities

COMMON COLD
INFO: • ACUTE AFEBRILE UPPER RESPIRATORY DISEASE
• ACUTE VIRAL RHINITIS
• ACUTE CORYZA

• causes an infection of the upper respiratory tract

o most prevalent acute respiratory illness

EA: Rhinovirus (most common)

• Coronavirus
• Influenza virus
• Parainfluenza virus
• Respiratory syncytial virus (RSV)

RESERVOIR: HUMANS

Often responsible during outbreaks in relatively closed populations, such as in a school or barrack

S/SX • Onset is abrupt, with a burning sensation in the nose or throat, followed by sneezing, rhinorrhea, nasal
obstruction, and malaise

• Can lead to otitis media and lower respiratory tract infection

• It is NOT usually accompanied with fever because Rhinovirus thrives at a temperature slightly lower that
of the normal body temperature (33°C)
o temperature of nasal epithelium

CROUP
INFO: • LARYNGO-TRACHEOBRONCHITIACUTE VIRAL RHINITIS

EA: Parainfluenza v.

RESERVOIR: HUMANS

S/SX • Signs and symptoms are similar to the common cold or flu
• Hoarseness
• Croup
• “barking cough” (like a seal) most severe and dangerous manifestation in children and often requires
hospitalization
 VIRAL PNEUMONIA
INFO: • ACUTE FEBRILE RESPIRATORY DISEASE

EA: Respiratory Syncytial v. (most common)

• Parainfluenza v.
• Measles v.

RESERVOIR: HUMANS

S/SX • Fever with one or more of the following symptoms:

o Chills headache, general aching, malaise, anorexia, and GI disturbances (in infants)
o May accompany rhinitis, pharyngitis, tonsilitis, laryngitis, bronchitis, pneumonia, conjunctivitis, otitis
media, and sinusitis.

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

INFO: • 100 days cough
EA: Coronavirus (SARS-Cov : SARS-asscoiated Coronavirus)

RESERVOIR: HUMANS

M.O.T : • Direct and indirect contact (fomites) of respiratory secretions

• Droplet/ airborne
o Even with casual and social exposure
S/SX The illness is biphasic:
Beginning with typical viral symptoms:
• fever
• headache
• chills/rigors
• myalgias

After 3 to 7 days:
• lower respiratory symptoms develop
• dyspnea
• dry cough

Majority of patients have a mild illness and recover within 1 to 2 weeks.

• the remaining develop:
• Respiratory distress with marked dyspnea
• Hypoxemia
• Occasionally Adult Respiratory Distress Syndrome (ARDS).

Death is due to respiratory failure.

Worldwide, about half of these patients have required mechanical ventilation.

Areas with documented or suspected community transmission of SARS:

• Peoples' Republic of China (Mainland and Hong Kong)
• Hanoi, Vietnam
• Singapore
 COVID 19
INFO: • Inflammation of the mucous membrane lining of the alveoli

ETIOLOGY: Novel Coronavirus (SARS-CoV-2)

Dx: RT-PCR (confirmatory), COVID-19 Ag Test

RESERVOIR: HUMANS

First detected in the Wuhan province of China in December 2019

M.O.T : • Direct and indirect contact (fomites) of respiratory secretions
• Droplet/ airborne
• Even with casual and social exposure
S/SX MOST COMMON SYMPTOMS
• fever
• cough
• tiredness
• loss of taste or smell

LESS COMMON SYMPTOMS

• sore throat
• headache
• aches and pains
• diarrhea
• a rash on skin, or discoloration of fingers or toes
• red or irritated eyes

SERIOUS SYMPTOMS
• difficulty breathing or shortness of breath
• loss of speech or mobility, or confusion
• chest pain
PRVNTN VACCINATION
TX • Symptomatic treatment
• Antivirals (experimental)
• Monoclonal antibodies
• Convalescent blood plasma therapy
• Steroids (dexamethasone)

MANAGEMENT:
• A- air circulation
• P – Physical distancing
• A – Always wear face mask
• T – Thirty minutes interaction or less
 COMMON PARASITIC RESPIRATORY DISEASES

PARAGONIMIASIS
INFO: ➢ Endemic Hemoptysis

EA: Paragonimus westermani (Lung fluke)

• An infection with parasitic worms.

• It is caused by eating undercooked crab or crayfish.
• Paragonimiasis can cause illness resembling pneumonia or stomach flu.

M.O.T : ➢ (Food-borne: ingestion of raw infected crabs or crayfish)

•infected persons can contaminate water/ponds with feces
• crabs ingest parasite where it further matures
S/SX • PRIMARY SITE OF DAMAGE: LUNGS
o Organism moves from GIT to the lungs,

• Can cause respiratory distress and Hemoptysis (bloody sputum)

• Endemic areas include: Sorsogon, Camarines, Samar, Leyte, Mindoro, Agusan and some provinces in
Mindanao

\ NURSING MANAGEMENT: PARAGONIMIASIS

• Proper waste disposal / Use sanitary latrines

• Sanitary disposal of sputum
• Avoid drinking or bathing in contaminated waters
• Handwashing
• Cook crabs and crayfish thoroughly