Communicable Disease Nursing Study Bullets

Communicable Disease Nursing Study Bullets Communicable Disease Nursing DRUG OF CHOICE

Tetanus: PEN G Na; DIAZEPAM (Valium) Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant) stimulant) Rabies Vaccines: LYSSAVAC, VERORAB Immunoglobulins: ERIG or HRIg DIAGNOSTIC TESTS

Tetanus: WOUND CULTURE Meningitis: LUMBAR PUNCTURE Encephalitis: EEG Polio: EMG; Muscle testing Rabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody test Dengue: TOURNIQUET test (Rumpel lead) Malaria: Malarial smear; QBC (Quantitative Buffy Coat) Scarlet: DICK'S TEST; SCHULTZ-CHARLTON TEST Diphtheria: SCHICK'S TEST; Moloney's Test Pertussis: Nasal swab; agar plate Tuberculosis: MANTOUX test Leprosy: SLIT SKIN SMEAR Pinworm: SCOTCH TAPE SWAB Typhoid: WIDAL'S test HIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test CAUSATIVE AGENTS

Tetanus: CLOSTRIDIUM TETANI Meningococcemia: NEISSERIA MENINGITIDIS Rabies: RHABDOVIRUS Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III Leon) Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses) (Common in the Phil.) Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P. Ovale Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI Leprosy: MYCOBACTERIUM LEPRAE Measles: PARAMYXO VIRUS German measles: TOGA VIRUS Chicken pox: VARICELLA ZOSTER VIRUS Herpes zoster: HERPES ZOSTER VIRUS Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS Scabies: SARCOPTES SCABIEI (itch mite) Bubonic plague: YERSINIA PESTIS Diphtheria: KLEBS LOEFFLER

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Pertussis: BORDETELLA PERTUSSIS Tuberculosis: MYCOBACTERIUM TUBERCULOSIS Typhoid: SALMONELLA TYPHI Cholera: VIBRIO CHOLERA Amoebiasis: ENTAMOEBA HYSTOLITICA Leptospirosis: LEPTOSPIRA Spirochete Schistosomiasis: Schistosoma japonicum Gonorrhea: N. GONORRHEAE Syphilis: TREPONEMA PALLIDUM Chlamydia: C. trachomatis, T. vaginalis Genital herpes: HERPES SIMPLEX 2 CD PHARMACOLOGY

Malaria: CHLOROQUINE Schistosomiasis: PRAZIQUANTEL Scabies: EURAX/ CROTAMITON Chicken pox: ACYCLOVIR/ZOVIRAX Tuberculosis: R.I.P.E.S. Pneumonia: COTRIMOXAZOLE; Procaine Penicillin Helminths: MEBENDAZOLE; PYRANTEL PAMOATE

Infectious Agent or its toxic products - AGENT Directly or Indirectly - MODE OF TRANSMISSI ON Person, Animal or Intermediate Vector  HOST Environment - ENVIRONMENT ECOLOGIC TRIAD OF DISEASE

Agent  element, substance, animate or inanimate that may serve as stimulus to initiate a disease process Host  organism that provides nourishment for another organism Environment  physical (climate), biological (plants & animals) CONTAGIOUS VS. INFECTIOUS

Contagious Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host Infectious Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane. NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS







agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious" Infectious Agent A. RESIDENT ORGANISMS deeply seated in the epidermis, not easily removed by simple handwashing, Ex: Staphylococci B. TRANSIENT ORGANISM represent recent contamination, survive for a limited period of time, acquired during co ntact with the infected colonized patient or environment, easily removed by good handwashing Ex: ( Klebsiella & Pseudomonas)

Infectious Agent Bacteria  heama organism, systemic Virus  nuero organism, systemic Fungi  skin organism, local Protozoa  GI organism, local Infectious Agent FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE

Pathogenicity  ability to cause a disease Infective dose  no of organism to initiate infection Virulence  ability to enter or move through tissues Specificity  ability of the organism to develop antigens

STAGES OF INFECTIOUS PROCESS Means of Transmission Transmission

1. CONTACT - most common means of transmitting microorganisms from one person to another. A. Direct Contact (person to person) occurs when one person touches another best vehicle is the Hands especially those of the Health Care workers







- droplet, dust, organisms in env. 3. VECTOR - insects or animals 4. VEHICLE - food (salmonella), water (shig ellosis), blood (Hepa B), medication ( contaminated infusion) PREVENTION OF COMMUNICABLE DISEASE

Prevention is worth a pound than cure PREVENTION OF COMMUNICABLE DISEASE Health Education  primary role of the nurse Specific Protection- handwashing, use of protective devices Environmental Sanitation  clean and conducive for health Definition of Prevention Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the contex t of levels, traditionally called primary, secondary, and tertiary prevention A Dictionary of Epidemiology, Fourth Edition by John M. Last

Prevention of Needlestick Injuries

Dispose Used Needles in Puncture Proof Needle Containers Dont Recap Needles (Unless using the One-handed Technique) Use Gloves When Handling Needles (Wont Prevent Injurie s but May Lessen Chance of Transmitting Diseases) CONTROL OF C0MMUNICABLE DIESEASE

1. Notification 2. Epidemiological Investigation 3. Case finding; early dx and prompt treatment 4. Isolation and Quarantine 5. Disinfection; disinfestation 6. Medical Asepsis a. Handwashing b. Concurrent disinfection







Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring: 1. Acute flaccid paralysis (AFP) polio 2. Measles 3. Severe acute diarrhea (SAD) 4. Neonatal tetanus 5. AIDS Diseases that require reporting w/in 24 hrs 1. Acute flaccid paralysis (AFP) polio 2. Measles Diseases targeted for eradication 1. Acute flaccid paralysis polio 2. Neonatal tetanus 3. Measles 4. Rabies Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease frequency  frequency of disease occurrence Sporadic On and off occurrence of the disease Most of the time it is not found in the c ommunity One or two cases that occur are not related Endemic Persistently present in the community all year round Ex: malaria in Palawan Epidemic An unexpected increase in the number of case s of disease Pandemic Epidemic of a worldwide proportions Time Related Patterns of Occurrence cyclical variation a periodic increase in the number of cases of a disease







Short time fluctuation A change in the frequency of occurren ce of a disease over a short period of time Maybe (+) or (-) Secular variation A change in the frequency of occurren ce of a diseae taking place over a long period of time Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints. b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today Types of Epidemiology Descriptive Epidemiology - concerned with disease frequency & distribution Analytic Epidemiology Is a study of the factors affecting oc currence and distribution of the disease. Ex. Epidemiologic investigation Therapeutic/Clinical Study of the efficacy of a treatment of a particular disease Ex. Clinical trial of a newly proposed therapeutic regimen Evaluation Epidemiology Study of the over-all effectiveness of a total/ comprehensive public health program. Ex. Evaluation of the under five clinic Note: We make use of the epidemiology epidem iology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment Types of Epidemiologic Data Demographic data Demography is the study of population groups Ex. Population size and distribution Vital Statistics Environmental data Health services data Ex. Ratio between nurse and the population being served Ex. Degree of utilization of health facility/ service Epidemiologic Investigation 1st step- Statement of the problem 2nd step- Appraisal of facts  describing the epidemic in terms of time, place, person. 3rd step- formulation of hypothesis 4th step-Testing the hypothesis









Disinfectant  substance use on inanimate objects Concurrent disinfection  ongoing practices in the care of the patient to limit or control the spread of microorganisms. Terminal disinfection  practices to remove pathogens from the patients environment after his illness is no longer communicable FACTORS AFFECTING ISOLATION

Mode of Transmission Source Status of the clients defense mechanism Ability of client to implement precautions ISOLATION EPI Launched by DOH in cooperation with WHO and UNICEF last July 1976 Objective  reduce morbidity and mortality among infants and children caused by the si x childhood immunizable diseases PD No. 996 (Sept. 16, 1076)   Providing for compulsary basic immunization for infants and children below 8 y/o PP No. 6 (April 3, 1996)   Implementing a United Nations goal on Universal Child Immunization by 1990 RA 7846 (Dec. 30, 1994)  immunization hepa B PD No. 4 (July 29, 1998)  Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measle s Elimination Campaign

Legislation, Laws affecting EPI







-conditions that require hospitalization For DPT 2 and 3  history of seizures/ convulsions within 3 days after the first immunization with DPT Nursing responsibility: ask how the child reacts to the first dose For infant BCG  clinical AIDS The following conditions are NOT contraindications: Fever up to 38.5 ºC Simple or mild acute respiratory infection Simple diarrhea without dehydration Malnutrition (it is indication for immunization)

Schedule of immunization Infant BCG 0 to 11 months or 0 to 1 year at birth 0.05 ml (dose)  ID, right arm School entrance BCG When the child enters Grade 1 with or without scar on the right r ight arm then still g o on with the vaccination except if he is repeating Grade 1

Schedule of immunization DPT 3 doses, 4 weeks or 1 month interval Target age: 1 ½ to 11 months but child is eligible up to 6 years If 7 years old and above DT only not P 0.5 ml, IM, vastus lateralis







Can be given at birth Target age 1 ½ to 11 months 0.5 ml, IM, vastus lateralis Patient may experience local tenderness Schedule of immunization Measles 9 to 11 months Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine 0.5 ml, subcutaneous, any arm Measles Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) Immunization Fully Immunized Child when he received all the antigens that should be given in the first year of life (1 dose B CG, MV; 3 doses DPT, OPV, HB) Completely Immunized Child All vaccines given but went beyond 0ne year of age

1. The clinic nurse notes that the physician has documented a diagnosis of herpes zoster (shingles) in the client¶s chart. Based on an understanding of the cause of this disorder, the nurse would determine that this definitive diagnosis was made foll following owing which wh ich diagnostic test? A. B.

Skin Wood¶s

light

biopsy examination







C. mask, D. gown, gloves, goggles

gloves,

goggles,

gown

ANSWER:

B No need of goggles because causative agent cannot cause infection when it enters the mucous membrane of the eyes.

3. Eunice, six year old, is scheduled to receive a measles, mumps, mumps, rubella (MMR) vaccine. vaccine. The nurse preparing to administer the vaccine reviews the c hild¶s record and questions the order ord er if which of the following is documented in the child¶s record? A. B. C. D.

a

llocal ocal reaction at the site a history of an a history of recent recovery from a cold.

of injection of a previous MMR MMR vaccine anaphylactic reaction to neomycin neomycin frequent respiratory infections

ANSWER:

MMR vaccine contains aminoglycosides antibiotic. antibiotic. aminoglycosides warrant further check by the do ctor.

Allergic

reaction

to

B neomycin

4. Ms. Flores clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5-year-old child. The nurse administers this vaccine: A. B. C. D.

Intramuscularly in the anterolateral Intramuscularly Intram uscularly in the Subcutaneously in the outer aspect aspect Subcutaneously in the gluteal muscle.

aspect

of deltoid of the

the

thigh muscle upper arm

ANSWER:

C

MMR vaccine is given via via this route. Before administration administration always check for allergy to eggs. 5. Mrs. Analesa Analesa Plaga mother brings her six six years old child to the clinic because the child has developed a rash on the trunk and on the scalp. Mrs. Analesa reports that the child has had a low







ANSWER:

B This is the POC of chicken pox. Remember chicken pox is not not contagious when crust or scabs appear.

6. A nurse provides instructions to the mother of a child with mumps regarding respiratory precautions. The mother asks the nurse about a bout the length of time required for the respiratory precautions. The nurse most appropriately approp riately responds: responds: A. B. C. D.

Respiratory precautions are not necessary once the swelling appears. Respiratory precautions are not necessary before the swelling begins. Respiratory precautions are indicated indicated during the period period of communicability. Respiratory Respi ratory precautions are indicated for 18 days following following the onset of parotid swelling. swelling.

ANSWER:

C The patient is placed on is isolation olation during the period per iod of communicability.

7. Decontamination of surgical instrument by soaking in 0.5% chlorine bleach for 10 minutes results to which of the following? A. B. C. D.

Makes the micororganisms Completely kills Enables the health health worker to reuse Rapidly kills viruses causing AIDS and Hepatitis Hepatitis B.

less all the

contaminated. microorganisms. insturment insturment immediately. immediately.

ANSWER:

D Chlorine is used in disinfecting objects because it rapidly kills viruses causing AIDS and Hepatitis B. It does not kill all microorganisms but is effective effective in killing most microorganisms. microorganisms. The presence of pathogenic microbes would mean contamination.

8. In Communicable Diseases cases, which of the following should be done to the CHN bag? A. B.

Thoroughly Well Kept

and

cleanse convenient

and

disinfected. the









C. D.

Take out hand towels. Handwashing.

ANSWER:

C During home visit, the nurse performs handwashing first after placing the bag in a convinient place, As a preparation for handwashing activity, the nurse first takes the towel out, soap dish as well as the apron. The nurse then performs handwashing. handwashing.

10. After completion of the nursing care o r treatment, the nurse must protect himself and prevent the spread of infection. infection. What is used to clean item item used? A. B. C. D.

Alcohol Isopropyl Zephiran Wet ones

ANSWER: A

After completing nursing care or treatment, c lean and alcoholize the things th ings used.

Communicable Disease Nursing Study Bullets

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