Communicable Diseases Communicable disease are most often the leading cause of illness in our country today Knowing what type of communicable disease could prevent a health care provider from acquiring or harboring the disease •
COMMON TERMS Epidemiology – science that study the patterns the patterns of health and disease, disease, its occurrence & distribution for the prevention and control of disease. Sporadic – occasional or intermittent occurrence of disease with no specific pattern Endemic - constant or continuous occurrence of disease Epidemic – sudden increase in # of cases in short period of time, an outbreak Pandemic – worldwide epidemic Attack rate is the number of cases developing in a group people who were exposed to the infectious agent Morbidity rate calculated as the number of cases of illness given time period divided by the population at risk. Mortality rate the percentage of population that dies from disease incidence described as the number new cases in a specific time period in a given population risk way of measuring the risk of an individual contracting the disease Prevalence reflects the number of total existing cases (both old and new) useful to assess the overall impact of the diseases on society Outbreak generally implies a cluster of cases occurring during a brief time interval and affecting a specific population
from a pregnant woman to fetus, or from a mother to her infant during childbirth Three Primary routes (Contact, droplet and airborne) Two lesser routes ( Vehicle and vector) •
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Primary Routes A. Contact- most frequent source of nosocomial infection 1. Direct contact- transmission body to body and physical transmisssion (sexual intercourse, kissing or touching) 2. Indirect contact- contact with contaminated intermediate object ( needle, dressing or dirty hands) B. Droplet- transmission of large particle droplets ( larger the 5 microns) Diphtheria, pertusis, pnuemonia, etc. C. Airborne- transmission of small particle droplets or residue of 5 microns ( measles, varicella, TB) •
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The Infectious Process For an infection to occur a process involving six links or steps must be present A. if any of the links are missing, the infection will not occur B. Infection control measures can interrupt the process by eliminating one or more of the steps. •
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Two lesser routes Common Vehicle: transmission by contaminated items such as food, water or devices. Vector borne: Mosquitoes, fleas, rats, etc. 5. Portal of entry Mucous membrane, gastrointestinal (GI) tract, Genitourinary (GU) tract, Respiratory tract, Nonintact skin 6. Susceptibility of the host A host who is immunosuppressed, fatigue, malnourished, weakened by other diseases, elderly, stressed, or hospitalized with wounds, IV’s and catheters are at high risk. •
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INFECTIOUS DISEASE PROCESS or CHAIN OF INFECTION Infectious Agent Reservior Portal of Exit Route of Transmission of MO Portal of Entry Susceptible Host •
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Six links form the chain of infection 1. Infectious agent (Microorganism): Bacteria, virus, fungi, etc. A. Capability of producing an infection depends on: i. Virulence and number of organisms present ii. Susceptibility of the host. iii. Existence of portal of entry iv. Affinity of host to harbor MO 2. Reservoir: Provide survival for organism People, equipment, water, etc. A. Appropriate environment for growth and multiplication of microorganism must be present. B. Reservoir include respiratory, gastrointestinal, reproductive and urinary tracts, and the blood 3. Portal of exit Allows the microorganism to move from reservoir to host ( includes excretions, secretions, skin, droplets) 4. Route of transmission of MO (five routes) Types of transmission of pathogens: Horizontal transmission from one person to another through contact, ingestion of food or water, or via a living agent such as insect. Vertical transmission •
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TRIAD OF DISEASE CAUSATION – Epidemiologic Triad (suscepibility ) 1. Host (suscepibility - intrinsic or intrinsic or extrinsic extrinsic characteristics characteristics 2. Agent 3. Environment - Medium for culture of MO and MOT
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Characteristics of an Agent Infectious dose – number of causative agent Pathogenecity – ability to cause the disease Virulence / Potency – extent/severity of toxin quality Antigenecity – ability to stimulate an anti-body response •
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Viruses • •
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can only multiply in living things as its reservoir can pass through the filters of the body, Blood Brain Barrier & Placenta Barrier self limiting lasts for a specific length of time with or without treatment,
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patients are treated according to the symptoms it’s the body’s own resistance that will fight the infection
Bacteria can multiply in both living and non-living things can not pass through the filters of the body except for Treponema Palladium causing Syphilis which passes the placental barrier after the 16th week (4th month of pregnancy) INFECTIOUS DISEASES – disease caused by living MO which may not be transmitted through ordinary contact. CONTAGIOUS DISEASES – are diseases that can be easily transmitted. All communicable diseases are infectious but not all are easily transmitted All infectious diseases are communicable but not all are contagious All contagious diseases are both communicable and infectious •
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Stages of Communicable Disease Communicabilty period- entry of MO Incubation period – period – time interval from the 1st exposure from disease to appearance of the 1st s/sx. Prodromal – Prodromal – time interval from the 1st s/sx to appearance of the characteristics sx of the disease. Stages of Illness – period when the characteristic sx of the disease are manifested by patient and others. Convalescence – period of recovery, s/sx are gradually disappearing • •
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Goal: The person will have a change of KSA which eventually lead to a change in behaviour towards health or do some modification of behaviour.
4 Temporary Contraindications for Immunization -doctor is the primary the primary giver of giver of health education (main responsibility)
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pregnancy
-nurse is the key provider of provider of information
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immunocompromised
B. Immunity/ Immunization
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very severe disease
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recently received blood products
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Immunity - state of being resistant to infection or a state of being free from infection Immunization – the process of rendering immunity to an individual
2 types of Immunity
3 Nursing Concerns in Dealing with a Patient with Communicable Disease Know the causative agent Know what body secretions harbour the MO Know the mode of transmission • • •
General nursing Care for Patients with Communicable Diseases Preventive Aspect Health education Immunization Environmental control Proper Supervision of Food Handlers Control Aspect Isolation Quarantine Disenfection Medical asepsis I. Preventive as aspect •
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2 Permanent Contraindications for Immunization •
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1. Active immunization occurs when a person’s own immune system is activated and generates a primary immune response. Immunity – the body a. Natural Acquired Active Immunity – will contracts the disease and recovers
b. Artificial Acquired Active Immunity- chemically killed bacteria, weakened forms
1. PD 856 – integrated all those working in night clubs and beer gardens to submit themselves for STD exams at least once a month and for gonorrhea at least twice a month. 2. PD 825 – anti-littering law or proper disposal of
- vaccine, toxoid Fine: P2,000-5,000 or 6 months-1year 2. Passive immunization - receives antibodies that were created in another person or animal. a. Naturally Acquired Passive Immunity – maternal transfer of antibodies (IgG/IgA)
imprisonment
D. Proper Supervision of Food Handlers 1. DOH responsibility 2. BFAD – monitor food and drugs for safe consumption
b. Artificially Acquire Passive Immunity – intentionally given for immediate protection from infection (ex: human immunoglobulin, human serum, anti-toxin, anti-tetanus) 3 Laws of Immunization:
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1. Expanded Program on Immunization (EPI) – PD #996
II. Control Aspect – there is already infection but control or limit the spread of infection A. Isolation - separation of the infected person based on the longest period of communicability of communicability of the disease.
2. UN Goal: Universal Child Immunization (UCI) – Proclamation #6 •
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encephalopathy without known cause or convulsions within 7 days after pertussis vaccine
C. Environmental Sanitation
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Allergy
garbage
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TB – BCG, DPT – DPT vaccine, Poliomyelitis – OPV, Hepatitis B , Measles
3. Health for Filipino CY 2000: National Immunization Day (NID) – Proclamation #46 Goal: To prevent the 7 Childhood Diseases for children
Strict isolation – protecting other person by containing the MO within the patient
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Reverse Isolation – protecting the patient wherein MO will be away from the patient
2 Revised Isolation Precaution to be practiced 1.
Stan Standa dard rd Prec Precau auti tion on
2. Transmission Based Precaution
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Contact Precaution – use of gloves and gowns
MOT: Droplet spread or direct contact in some instances it is Airborne
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B. Quarantine – limitation of freedom of movement of a well person during the longest incubation period ; - quarantine of person with no disease but were exposed.
applies to all body fluids, secretions and excretions except sweat
C. Disinfection – killing/destruction of pathogen by mechanical or chemical
2 Ways of Attaining Disinfection: •
Handwashing Wear gloves if there is a possibility of direct contact with blood or bodily secretions •
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Removal of false fingernails Protect clothing with gowns or plastic aprons if there is possibility of being splashed or direct contact with contaminated material Wear mask and/or goggles or face shields to avoid being splashed, suctioning, irrigations, during OR and deliveries Do not break needles into receptacles; rather discard them intact and uncapped into containers 2. Transmission Based Precaution – is instituted to patients with highly transmissible infections. Precautions are beyond the set for the standard precautions.
3 Ways to Practice Transmission Based Precaution:
Incubation period- 10 days from exposure 1. Pre-eruptive Stage – highly contagious stage - high grade fever – 3-4 days - 3 C’s – cough, colds, conjunctivitis - (+)Stimson sign / measle eye – puffiness of the eyelid with linear congestion of the lower conjunctiva
applies to non intact skin and mucous membrane
Gloves must be worn when in contact with items or surfaces soiled with blood or body fluids
affects children < 2y/o, malnourished
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CA: Paramyxovirus – rubeola virus
applies to all pts regardless of their dx
Elements of Standard Precaution CDC Centers for Disease Control and Prevention
death is usually due to complications (pneumonia)
Droplet Precaution – use ordinary mask and goggles
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1. Standard Precaution – the primary strategy for preventing nosocomial infection •
Airborne Precaution – use of respiratory protection such as use of special types of mask = ultra filter mask or particulate mask
Concurrent – done when a person is still the source of infection Terminal – done when the patient is no longer the source of infection Sterilization - killing of all MO including spores Disinfestation - destruction of MO, insects, rodents or animals that are living in the human habitat that can transmit disease to man.
- Photosensitivity - (+) enathem, fine red spot (grayish pecks) at the center found in the inner cheek just opposite the molars - (Koplik’s spot) –pathognomonic 2. Eruptive Stage –
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Rashes appear on the 3rd day - maculopapular, reddish, and blochy cephalo-caudal in distribution
3. Post-eruptive Stage •
Fumigation – Fumigation – killing of arthropods and rodents using gaseous agents
D. Medical Asepsis •
Hand washing – the no. 1 principle
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Use of protective barrier (PPE)
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Placarding – no smoking sign
Integumentary System Measles -aka RUBEOLA, Morbilli, Little Red Disease, 7 day measles, 9 day measles, Hard measles of First Disease
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fine, branny desquamation – peeling off
from red color rashes, it will fade to brown then peel off excluding skin
Preventive Measures •
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Avoid MOT •
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Immunization with Anti-measles vaccine (AMV) – 9 months old, 0.5cc SQ deltoid muscle –
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child may experience fever, mild rash formation 3-4 days after
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allergy to eggs and neomycin → anaphylaxis
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don’t get pregnant within 3 month
proper disposal of nasopharyngeal secretions covering of mouth and nose when sneezing and coughing
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aka Rubella, 3 day disease
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CA: Pseudoparamyxovirus = Rubella or Togavirus
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MOT: Droplet, direct,
3 Stages of German Measles: •
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Diagnostic Examination: by clinical observation and physical examination Medical Management: symptomatic – viral infection –
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antibiotic
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strict isolation
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increase or maintain body resistance
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presence or absence of fever, if (+) 1-2 days
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mild cough or mild colds
Vit A – to prevent xeropthalmia
Nursing Care
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1. Pre-eruptive Stage
Eruptive Stage •
Medical and Nursing treatment : Supportive care
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Immunity: Gives permanent immunity
Preventive Measures •
Avoid MOT
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Immunization: MMR
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It is communicable during the entire course of the disease = 3 days Not fatal but could be fatal on a pregnant woman- it affects fetal growth
4 Possible Major Congenital Anomaly •
Microcephaly
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Congenital Cataract
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CHD – Tetralogy of Fallot
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Deafness and Mutism
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If pregnant and exposed to german measles, give gamma globulin 1 amp within 72 hours – gives temporary immunity
Chicken Pox •
(Forsheimer’s spot) - pathognomonic
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Cephalocaudal
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Lymphadenopathy
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Immunity : Gives permanent immunity It is highly contagious during 4 days before the appearance of rashes and 5 days after the appearance
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(+) enanthem– seen at the soft palate, maculopapular, pinkish or reddish, discrete or finer to look at
keep patient warm and dry hygienic measures – eye care, ear care, oral care, skin care
If given to women who wants to bear a child à wait for 3 months
Treatment
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German Measles
Rubella Titer test – to determine the titer of antibodies to german measles
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3. Post-Eruptive Stage – occurs after 24 hours where rashes starts to disappear and enlarge lymph nodes subsides Laboratory Exam
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aka varicella
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CA: Varicella zoster virus
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MOT: Airborne, direct contact, droplet
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Duration of sickness: 2 weeks
3 Stages Chicken Pox 1. Pre-Eruptive - (+) or (-) of low grade fever, body malaise, musle pain, HA lasting for 24-48 hours
2. Eruptive Stage
begins as a macule, 5-10 crops → papule →vesicle → pastule
rashes are classified as vesiculo-pastular
rashes have generalized distribution all over the body (trunk and scalp 1st)
contagious from the time rashes appear until the last rash have dried or crusted
Immunization using Varicella vaccine (Viravax) given 12 months old, 0.5cc SQ deltoid
If <13 y/o – single dose ; if > 13y/o – 2 doses, 1 month interval
Proper disposal of nasopharyngeal secretions
Cover mouth and nose when sneezing and coughing
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aka SHINGLES, Zona, Acute Posterior Ganglionitis
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adults are usually affected
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CA: inactive or dormant type of chicken pox
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MOT: Airborne or droplet
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Duration of Illness – 2 weeks
Signs and Symtoms •
Management
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Diagnostic Examination: by clinical observation and physical examination
B- Bacteri Bactericid cidal al
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Oxidizing
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analgesic for pain
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Zovirax can also be given
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Herpes Zoster
centrifugal in spread of rash
3. Post-Eruptive Stage – rashes starts to dry/crust and peel off by itself
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(+) vesiculo-papular rashes- painful rashes- painful rather rather than itchy bec it affects nerve endings and that pain persists within 2 months even if patient had recovered.
---decre ---decrease ase chance chance of skin skin infectio infection n ---deodorizes the rashes
Nursing Care and Preventive Measures: same as Chicken pox
Nervous System Tetanus •
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aka Lock Jaw CA: Clostridium tetani – anaerobic, non-motile, sporeforming
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Normal habitat: intestines of plant eating animal
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Break in the skin
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MO stays in the wound à releases toxins à travel to the blood à produces s/sx •
unilateral distribution of rashes period of communicability is the same as chicken pox when all rashes have dried
Medical:
New born – umbilical cord (tetanus neonatorum)
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Children – dental caries
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Adult – any king of wound
treated symptomatically
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Toxins released by MO are:
Anti-viral agent – Zovirax (Acyclovir)
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Tetanolysin – dissolves RBC causing anemia
Anti-histamine
Nursing Care
skin care to prevent infection
increase resistance and adequate rest and nutrition to prevent encephalitis
Immunity: Gives permanent immunity
Avoid MOT
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Management •
Diagnostic Examination: Clinical observations and physical examination
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Potassium Permanganate (KMNO4) with 3 Fold EffectS:
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A- Astr Astrin inge gent nt
Tetanoplasmin – brings about the muscle spasm affecting the myonueral junction and internuncial fibers of the brain Immunity: No permanent immunity
s/Sx: –
Trismus – lock jaw
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Risus sardonicus- sarcastic smile
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Opisthotonus- arching of the back
---d ---dri ries es rash rashes es
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Intermittent muscle spasm ,(+) boardlike rigidity on the abdomen
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Extension of the extremities (gastrocnemius)
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Diaphoresis
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Low grade fever
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Type of contraction: tonic
DPT 6 weeks after birth for 3 doses at 1 month interval (0.5ml VL)
Health Health teaching: ng: fever, swelling swelling and tenderness, signs of convulsions w/in 7 days
Tetanus Toxoid given to pregnant women on the 2nd trimester of pregnancy, 2 doses
Tetanus Toxoid given for persons in high risk to tetanus
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Inclusion bodies develop called Negri Bodies pathognomonic MOT: Contact with saliva of a rabid animal, scratching, licking of wound by dogs Incubation Period: animals = 3-8 weeks; humans = 10 days-years
2 Stages of Manifestations in Animals
3 Objectives in Nursing Management of tetanus:
1. Dumb Stage - depressive stage, manic behaviour
1. To prevent pt from having spasm –
2. Furious Stage – agitated, fierceful, drooling of saliva → will die.
Exteroceptive stimuli – stimuli – coming from external/outside environment
Interoceptive stimuli – stimuli – coming from within the pt., fatigue, stress
Proprioceptive stimuli – stimuli – there is participation of pt and another person
Isolation is to prevent exposing pt to the stimuli despite being not communicable. 2. To prevent pt from having injury a.Respiratory a.Respiratory injury
1. Prevent airway obstruction - padded tongue depressor, O2 administration – cyanosis during spasm
2. Prevent respiratory infection
3. Prevent respiratory aspiration
3 Stages of Manifestation in Human 1. Invasive Stage – virus is transferred through saliva by direct or indirect contact •
Rabies •
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disease of low form of animal that is accidentally transmitted to man through animal bites
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An acute form of encephalitis
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CA: Neurotropic virus
2 Pathways for Virus to Travel: Travel: Rhabdovirus ↓
b. Fracture – due to restraining when having
3. To provide comfort measures - provide dark, quiet room – prevent stimuli
- Proper wound care Avioid MOT
flu-like symptoms, slight photosensitivity
aerophobia and hydrophobia
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drooling of saliva and spitting
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photosensitive
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maniacal behaviour
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CNS
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Rhabdovirus – transferred from animal to man
spasm
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numbness on site, sore throat, marked insomia, restlessness, irritable & apprehensive
2. Excitement Stage – patient is confined in the hospital
Peripheral Nerves
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aka Hydrophobia and Lyssa
S/Sx:
Management: Haloperidol with Benadryl 3. Paralytic Stage – when spasm is no longer observed because paralysis sets in and within 24-72 hours → patient dies.
Diagnostic Examinations: Efferent nerves •
Brain Biopsy of Animal
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Direct Flourescent Antibody Test (DFAT)
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Observation of animal for 10 days
↓ Salivary glands and to other organs
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Factors to consider in observing the animal:
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inflammation of the meninges
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Site of the bite
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CA:
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Extent of the bite
Viruses – CytoMegaloVirus – viral meningitis
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Reason for the bite
Fungus – Cryptococccal meningitis
Medical Management 1. Vaccine – post exposure prophylaxis only •
Active form of Vaccine a. Purified Duck Embryo Vaccine (PDEV) – Lyssavac b. Purified Vero Cell Vaccine (PVCV) – Verorab with in 24 hours
Bacteria – common cause TB meningitis, streptococcal meningitis, hemophilus influenza B Meningococcal Meningits Spotted fever / Meningococcemia •
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c. Purified Chick Embryo Cell Vaccine – (PCEV) •
2 Ways of Administration: IM or ID
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Passive form of Vaccine
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b. Human rabies Immunoglobulin – human serum Nursing Care •
Wash wound with running water
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Seek consultattion asap.
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Place patient in dim and quiet room
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Room of patient should be away from sub-utility room
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Waterhouse Friedrichsen Syndrome – caused by massive invasion of blood by meningococcus infection resulting in organ failure, coma or even death, unless effective antibiotic or tx is quickly rendered
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Rifampicin 450 mg once/day x 3 days
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Ciprobay 500 mg once/day x 3 days
Incresed ICP -----CsF in subarachnoid space
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severe HA
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projectile vomiting altered VS:increase temp, decrease PR, decrease RR, increase systolic but N diastolic
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convulsions
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diplopia – optic nerve/disc
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tinnitus, difficulty of hearing/deafness, loss of balance, vertigo altered LOC Others/sx: anorexia, gen body malaise and loss of apetite
Diagnostic exams:
CA: Neisseria Meningitides
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Incubation Period: 2-10 days
a. Color:yellowish, turbid/cloudy
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Portal of Entry: Respiratory system via the nasopharynx
b. increased CHON, increased WBC, decreased sugar
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Neisseria Meningitides à Nasopharynx
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d. Counter Immuno Electrophoresis (CIE) – if clear CSF either viral or protozoa
↓ Vascular changes (petechiae,
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echymossis)
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Keep away from stray dogs
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Keep animal caged or chained
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Meningeal irritation manifested by: nuchal rigidity/stiffneck (1st sign of
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meningitis)
Lumbar Puncture (L3 & L4) – tap or aspirate CSF to
c. C & S – to determine CA and specific drug to kill the MO
Blood stream
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Wear complete protective barriers when entering the room
If bitten – wash with soap and running water, use strong antiseptic solution and observe the dog
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Preventive Measures:
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vascular system is affected resulting to vascular collapse (DIC)
AbN reflexes – (+) kernig’s sign, (+) brudzinki’s sign (pathognomonic sign)
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highly fatal and highly contagious type of meningitis
a. Equine Rabies Immunoglobulin (ERIg) – from animal serum
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Blood culture – done if lumbar puncture cant be done yet bec MO travels to the blood stream Antimicrobial drugs a. Viral – supportive b. Fungus – antifungal c. Bacteria – antibiotic
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Corticosteriods – Dexamethasone or Solu-Cortef
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M an an ni ni to to l
- os os mo mo titi c d iu iu re re titi c, c, re re mo mo ve ve s C SF SF
Stages of Poliomyelitis: •
- flu-like sx, non-specific
- monitor I/O, assess effectiveness of drug
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- assess hydration •
Anticonvulsant drug – Phenytoin (Dilantin)
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Symptomatic and supportive
Invasive or Abortive –stage when virus invades the host
Non-paralytic – slight CNS involvement - hump temp curve
- (+) Poker spine - stiffness of the back (opisthotonus) (opisthotonus) with head retraction - spasm of the hamstrings
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if phenytoin is given IV, it should be sandwich with NSS (NSS-Dilanti-NSS) à can cause crystallization when mixed with CSF
- hypersensitivity of the skin (hyperparesthesia) Diagnostic Exams: - (+) babinski reflex,
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if per orem, do oral care and gum massage à gingival hyperplasia
Paralytic Stage – severe CNS involvement
Preventive Measures: Proper disposal of nasal secretions, covering of mouth and nose, avoid MOT
- flaccid (soft, flabby and limp) paralysis pathognomonic sign
Immunity: No permanent immunity
4 Types
Poliomyelitis
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aka Infantile Paralysis or Heine-Medin’s dse
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high risk – below 10y/o
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CA: Legio Debilitans virus
- swallowing, vocal cord and respiratory
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Early Stage: Nasopharyngeal secretions MOT: droplet Port of Entry: respiratory system by
nasopharynx
Spinal – c0mmon type, AHC affectation - paralysis of U/L extremities – uni or bilateral - intercostal muscle paralysis
Type 2 – Lansing
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Bulbar – CN9 (glossopharyngeal) and 10th (vagus) affectation
paralysis
Type 1 – Brunhilde – common in the Phil.
Type 3 – Leon
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Lumbar Puncture Test – Pandy’s Test – increased CHON, increased WBC, N sugar
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Muscle testing – test for threshold for pain
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EMG
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Stool exam – (+) all throughout the process
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Throat swab – maybe (+) in 2 weeks of the dse course
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Supportive and Symptomatic
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Preventive Measurement:
1. Immunization: OPV – Sabin Vaccine, given 6 weeks after birth Instructions to mothers: a. Don’t feed child 30 mins before administration
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Bulbo-spinal – CN and AHC are both affected
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Landry’s – ascending paralysis (quadriplegia)
b. If vomiting occurs, repeat dose c. Be careful in handling the stool of the child who had received OPV d. for immunocompromised – give Inactivated Polio Vaccine (IPV-Salk Vaccine) – 0.5 cc IM, VL in 3 doses at one month interval 2. Avoid MOT
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Late Stage: found in stool MOT: fecal-oral route
Circulatory System
a. fever – 3-5 days
Dengue
b. HA; periorbital, abdominal, joint and bone pains
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CA:
c. N/V
Arbovirus-Dengue virus
Flavivirus MOT: biological transmitter – Aedes Aegypti mechanical transmitter – Celux fatigan •
day biting and low flying mosquito
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breed in clear stagnant water
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urban area
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white stripes on legs, gray wings
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d. pathological vascular changes: petechiae and Herman sign (generalized flusing/redness of the skin
West Nile virus
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e. diagnosed as Dengue Fever or Dandy Fever Breakbone Fever •
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or
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Grade 2 a. persistence of s/sx of Grade 1 + Bleeding
b. bleeding bleeding from: 1. nose – epistaxi epistaxis s
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2. gum - gum bleeding
Release the cuff, check and count the petechial formation per one square inch (>20 petechial formation = (+) tourniquet test Platelet Count - ↓ in DHF – definitive test Hematocrit (Hct) determination - ↑ in DHF due to hemoconcentration Symptomatic treatment Antipyretic – but never give Acetyl Salicylic or Aspirin (ASA) Reye’s Syndrome – a neurologic d/o associated with viral infection (<12y/o) Vit K (Aquamephyton, Phytomenadion, Synkavit and Konakion)
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Vit C
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Blood Transfusion
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1. To prevent and control bleeding
3. stomach 4. hematemesis, melena, hematochezia
Mosquito (Aedes Aegypti) ↓
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Bloodstream ↓ Creates multiple lesions in the bloodstream ----------------------------------------------------
Grade 3
a. Epistaxis
a. persistence of s/sx s/sx of Grade 2 + Circulatory Failure
b. Gum Bleeding
b. cold clammy skin
c. Hematemesis
c. check for capillary refill
d. Melena
d. hypotension, very rapid weak pulse and rapid respiration
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↑ capi capill llar ary y frag fragil ilit ity y
↑ capi capill llar ary y perm permea eabi bili lity ty
( ea easily bl bleeds )
(allows sh sh ifting of of flfluid fr fr 1 comp to another)
Grade 4 a. persistence of s/sx of Grade 3 + Hypovolemic Shock
Torniquet Test or Rumpel Leede Test - presumptive
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Test for capillary fragility
3 Criteria before performing Torniquet test 1. 6 months or older 2. fever > 3 days
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Grade 1
Increase body resistance – proper nutrition and adequate rest Preventive Measures: CLEAN Program of DOH
↓ edema, ascites, and hemoconcentration
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Supportive & Symptomatic
→ Death •
Thrombocytopenia
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C- hemically treated mosquito net L- arva eating fish E- nvironmental Sanitation A- nti mosquito soap/off lotion N- atural mosquito repelant trees
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Immunity: No permanent immunity
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Tuberculosis •
↓ Malaria •
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RBC is penetrated Liver
aka AGUE king of tropical diseases manifested by indefinite period of fever and chills
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(MO reproduce)
(MO stay for 3-5years)
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↓ •
RBC Nursing Care:
3. Blood – TB meningitis, TB of bones, TB of the spine
2. Plasmodium Falciparum – most fatal
4. Plasmodium Ovale
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Cold Stage – shaking of body & chattering of lips (1015mins) Hot Stage – fever, chills, vomiting, abdominal pain (4-6 hours)
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Incubation Period: 1-2 months (4-8 weeks)
•
S/Sx: 1. low grade fever with night sweats
- Only female mosquitoes suck blood Nursing Care:
2. anorexia and weight loss
- P. Vivax and P. Falciparum – common causes of •
Wet Stage – profuse sweating, feeling of weakness
3. fatigability
malaria in the Phils. Nursin Nursing g Care: Care: •
Make Make patient e nt comfort comfortabl able e
4. chest pain and dyspnea
MOT: mosquito bite, blood transfusion Keep patient warm
•
Night biting from dusk til dawn
Increase fluid intake •
•
Breeds in a clear slow flowing water
•
Rural areas – mountains and forest
•
Lands on surface – 45 degrees angle/slanting
•
5. dry cough à productive (yellowish/greenish) blood streak sputum/hemoptysis – pathognomonic sign
Diagnostic Examinations:
7. anemia and amennorhea in female •
- Mantoux test – most reliable skin test for TB. - 0.1 cc Purified Protein Derivative, volar aspect
Medical Management:
- bleb or wheal formation
1. Chloroquine (Aralen) – mainstay
=
2. Other Drugs: Primaquine, Atabrine, fansidar and Quinine (reserve drug for severe cases)
= 5-9 mm à doubtful (repeat the test)
If infected by mosquito •
Used cautiously for pregnant women
Blood stream
•
Immunity: No permanent immunity
Tuberculin skin testing – screening, ID - a presumptive test
2. Quantitative Buffy Count (QBC) – no need for the height of fever to set in
↓
à
6. back and epigastric pain
Cerebral Hypoxia – caused by P. falciparum causes anemia
1. Malarial Smear/ Blood Smear – blood is extracted at peak of fever
•
MOT:
2. Ingestion of infected milk of cows
1. Plasmodium Vivax
3. Plasmodium Malariae
CA: Acid Fast Bacilli - M. Tuberculosis, M. Bovis, M. Avium/Avis
1. Airborne and droplet
CA: Protozoa – Plasmodium,
•
aka Kokh’s Infection, Phthisis, PTB, Galloping Consumption
= > or = 10mm •
à positive
Sputum Examination – confirmatory, done in 3 series
•
•
3. Chest X-ray - not definite test, tells only the extent of involvement of the lungs According to extent of disease based on cavitations within the lungs
c. Pyrazinamide (P)– causes hyperurecemia d. Ethambutol (E)– causes irreversible optic neuritis that brings about blindness
a. Minimal
2. Standard Regimen(SR) – Streptomycin, Isoniazid & Ethambutol (SIE)
b. Moderately advanced
a. Streptomycin (S)
•
c. Advanced – (+) of cavitations within the lungs •
Side Side Eff Effec ects ts::
According to clinical manifestations
•
1. Nep Nephr hrot otox oxic icit ity y
According to American Pulmonary Society
CA: Corynebacterium diphtheria or Klebs-Loeffler bacillus MOT: Droplet (direct contact) – affects all ages
•
Nasal - dryness, excoriation of upper lip and nares
3. Directly Observed Treatment Short Course (DOTS) WHO- “tutuk gamutan”
turbinate–
- grayish-white membrane with leathery consistency 1. Political will to support the program
b. TB I- (+) exposure (-) infection (-) tuberculin testing
2. Microscopic availability
c. TB II – (+) exposure (+) infection (+) tuberculin testing
3. Steady supply of medicine
•
(-) s/sx d. TB III – (+) exposure (+) infection (+) tuberculin testing (+) s/sx
5. Documentation and recording
- (+) laryngeal stridor – brassy metallic cough
a. Isoniazid (INH) – mainstay drug
D – rugs - adequate drugs and emphasize emphasize importance of compliance
- small frequent nutritious foods
•
•
R – est est - conse conserve rve energ energy y • •
- 12mons for immunocompromised patients •
1. Peripheral p heral neuropa neuropathi thies/ es/neu neurit ritis is •
a. Foods rich in Vit B6 (pyroxidine) 2. Hepatotoxicity – (+) jaundice a. Monitor liver enzymes
Contraindicated Nursing Care: Do not do chest physiotherapy
Nose and Troat Culture Shick’s Test – to determine resistance or susceptibility to diphtheria Moloney’s Test – to determine hypersensitivity to diphtheria
*Removal of the pseudomembrane is not encouraged à facilitate bleeding and fast regrowth
Avoid MOT Immunization with BCG immediately after birth 0.5cc ID ® deltoid area
Instruction to mothers: don’t massage the area, (+) fever, (+) abscess formation the site of injection →scar
•
Neutralize toxin
ADS – IM,IV ANST; if (+) give in dose – desensitization on IV fluid to dilute toxin Antibiotic – Penicillin
•
Proper disposal of nasopharyngeal secretions
•
•
Covering of mouth when sneezing
•
Supportive – O2 inhalation, tracheostomy
•
Immunization : Gives temporary immunity
•
Strict Isolation – highly contagious
b. Avoid alcohol b. Rifampicin (R) – causes orange color of tears, urine and stool
Laryngeal – (+) respiratory distress - (+) hoarseness/aponia
D – iet
- 6mons for carrier & inactive adult patient
•
Pharyngeal – (+) bullneck appearance (enlargement of the cervical lymphnode)
4. Personnel – RN and midwife
Short Course Chemo therapy – Rifampicin, Isoniazid, Pyrazinamide Ethambutol (RIPE)
- 9mons for children
- (+) of pseudomembrane in the nasal pathognomonic sign
5 Elements:
a. TB 0 – (-) exposure (-) infection (-) tuberculin testing
Side Side Effect Effects: s:
acute contagious dse char by generalized toxaemia coming from a localized inflammatory process known as PSEUDOMEMBRANE.
•
2. Ototoxicity – CN8
•
b. Inactive PTB
•
•
(tinnitus/vertigo)
a. Active PTB
•
Diphtheria
fractional
•
CBR – to limit the circulation of toxin Myocarditis, bronchopneumonia & peripheral neuritis – fatal complications
•
2. nocturnal coughing
•
3. fever
•
4. tiredness and listlessness
3. Fluid and Electrolyte Replacement 4. Mild form of sedation: Codeine •
•
Diet: Liquid to soft diet. (-) spices , small frequent feeding, observe strict aspiration precaution, increase fluid intake
•
Provide diversional activities for children
•
Avoid MOT
•
Immu Immuni niza zati tion on::
1. CBR •
2. Spasmodic or Paroxysmal stage
•
s/sx:
•
DPT DPT 0.5 0.5cc cc IM VL 6,10,14 wks of age simultaneous with
•
OPV - do not massage area to prevent lump formation (press)
3. Provide adequate nutrition
b. (+) production of mucus (tenacious) plug on airway passage c. other manifestations
•
4. Proper positioning when feeding 5. Provide abdominal binder to prevent hernia •
Preventive Measures: same as Diptheria
•
Immunity: No permanent immunity
- congested face, tongue
- (+) fever – give paracetamol; cooling measures
•
2. Maintain F&E balances
a. 5-10 successive forceful coughing which ends in a prolonged inspiratory phase or whoop
- (+) lump à hot moist compress
•
Nursing Care:
Adverse side effect: CONVULSION Nsg Mx: take temp accurately to differentiate it from febrile convulsion
- teary eyes with protrusion of eyeball
Typhoid Fever
- distended face and neck veins
CA: Salmonella typhosa →Payer’s patches
- involuntary mict. and defecation
MOT: Fecal-oral
- abdominal/inguinal hernia
Sources of infection: feces, fingers, food, flies and fomites
- deafness due to hemorrhage of vestibular apparatus of ear
1. Prodromal Stage – (+) MO in the blood stream
Pertusiss •
aka as Whooping cough and Chin cough
•
affects below 6 y/o
•
CA: Coccobacillus -
•
•
a. Bordetella pertussis
•
3. Convalescent stage – s/sx starts to disappear - patient no longer communicable and on road to recovery Nasal Swab
- fever, dull HA, N/V, abd pain, diarrhea or constipation 2. Fastigial/Pyrexial - MO invades the payer’s patches Features: 1. rose spots in the the abdomen –pathognomonic sign
b. Hemophilus pertussis
•
Bordet-Gengou Test
2. ladder like fever
•
Incubation Period: 7-10 days
•
Agar Plate – use nasopharyngeal secretions
3. splenomegaly
•
MOT: Droplet
•
Cough Plate
4. Typhoid psychosis – due to release of toxins
•
•
1. Catarrhal stage – highly contagious, child stays at home s/sx:
1. (+) of colds
•
Medical
a. coma vigil look
1. Immunization: Pertussis Immune Globulin
b. difficulty in protruding the tongue
2. Antibiotics: Erythromycin
c. carphologia – involuntary picking up of linen
d. sabsultus tendinum – involuntary twitching of tendon
•
CA:
•
1. Leptospira (spirochete) – bacteria
3. Defervescence Stage – (+) ulcer formation àintestinal perforation à bleeding àspillage in peritoneal cavity
•
2. Leptospira canicola •
S/Sx of Peritonitis:
3. Leptospira hemorrhagica
1. sudden and severe abd pain 2. persistence of fever 3. board-like rigid abd
•
MOT: Skin penetration
•
Incubation Period: 2 dyas to 4 weeks
•
still have to observe for relapse 1. Blood Culture a. Widal Test Antigen O (AG O) or Somatic Antigen = presently infected Antigen H (Ag H) or Flagellar Antigen = previously exposed to TF or has has had had an immun immuniz izat atio ion n
•
•
2. Stool and Urine Exams
•
Medical:
2. Warm compress for muscle pain 3. I/O,consistency, frequency & amt
striated muscles
•
liver
•
kidneys
•
•
fever, HA, vomiting myalgia and myositesàcalf muscles jaundice with hemorrhages on skin & mucous membrane icter-hemorrhagic à yellow and red orange skin, orange eyes à pathognomonic sign
1. Blood Blood culture culture
1. Fluid and Electrolyte Management
•
Leptospira antigen-antibody test (LAAT)
•
Microscopic agglutination test (MAT)
aka Mud fever, Swamp fever, Canicola fever, Pre-tibial fever, Weil dse, Swineherd dse and Ictero-Hemorrhagica dse
Medical Management:
•
1. Antibiotics – Tetracyline
•
- not given to a. child <8y/o àstaining of teeth
à
5.Incubatio n Period 6. Risk
drug of choice
b. pregnant women – teratogenic effect àbone
•
defect •
2. Source of Infection 3. Causative agent 4. MOT
Hepa A Infectiuos Hepa, Catarrhal Jaundice, Epidemic Hepa Feces HAV or RNA cointaining virus Fecal-oral
Leptospira Leptospira agglutination utination test test (LAT)
•
Source of infection: Excreta of rats particularly urine
inflammation of the liver
1. Synonym
•
Leptospirosis
2. Avoid walking through floods Hepatitis
Nursing Care:
Antibiotic – Chloramphenicol
3. Provide comfort measures
•
•
•
Diagnostic Examination:
2. Provide adequate nutrition – (+) vomiting-small,freq meals; (+)diarrhea-(x) fatty food
•
•
Preventive Measures: 1. Environmental sanitation by eradication of rats
Incidence: rainy seasons
•
•
Nursing Care: Symptomatic 1. Provide eye care
People at risk: sewage workers, farmers, miners, people living in Manila areas
•
•
b. Thypi dot – uses blood specimen where it identifies antibodies
- give 1hr before meals or 2hrs after meals or empty stomach
4. Leptospira enterogans – common in Phils.
•
4. Convalescent /Lysis Stage – s/sx starts to subside
2. Give Penicillin to patient allergic to tetracycline
- never give tetracycline with calcium rich food, antacid
7.
2-7 wks Crowding, homosexual s, food handlers, poor sanitation, unsafe water supply, children
Carri Carrier er No
state
Hepa B Serum Hepa, Homologous Homologous Hepa, Viral Hepa
Hepa C Posttransfusion Hepa
Blood,semen,cervic al secretions HBV of DNA containing virus
Blood
Person-person, parenteral/ percutaneous, placental 6wks-6mons
percutaneou s
Multiple sex partners, partners, members of medi medica call team, team, blood, drug addicts
No
HCV
5wks-7-8 wks/12wks Blood recipients
Yes
8.
0.5%
Prognosis 9. Prevention
mortality Proper handwashin g, sanitation, screen screen food food handlers, enteric precautions
1-10% mortality
1-2%
Screen donors
mortality Screen blood donors
blood
- Anti- HAV b. Hepatitis B - Hep B Surface Antigen (HBsAG): (+) acute hepatitis B - Hep B Protein Independent Antigen (HBeAa)= (+)chronic hep B
RUQ pain
d. Urinalysis •
•
Manifestation:
•
–
–
a. essentiale for adults
redness & edema of urinary meatus à acidic urine passes through àburning sensation à (+) pain purulent urethral discharges abundant in the morning – morning drop abscess forms on the prostate gland à prostitis epidydimitis à formation of scar on epidydimis à obstruction flow of the sperm cellàsterility à
b. Jetepar or Silymarine for pedia 2. New trends in treating Hepatitis a. Antiviral : Lamivudine
passing out of alcoholic or clay colored or no
b. Immuno-modulating drug: Interferon
color stool •
persistence of sx of pre-ecteric stage but to a
Nursing Care: 1. Provide rest to promote liver regeneration
lesser degree
2. Low fat diet, High CHON intake to spare protein metabolism
- energy starts to increase and patient is on the road to
In US, “butterball” diet
recovery •
Immuniz Immunizati ation: on: Hep B vaccin vaccine e is give given n at 6 wks wks after after birth, 3 doses at one month interval, Dose: 0.5cc IM, VL
•
Avoid MOT
•
Immunity: Don’t give a permanent immunity
•
For Female: –
–
–
a. Hepatitis A
dysuria
Medical
urine is tea colored or brown
2. Serum Antigen- Antibody (Ag-Ab) Test
Male- Urethritis
For Male:
–
(+) pruritus
ALT, AST, GGT, ALP, LDH
Incubation Period: 3-21 days
1. Hepatic Protectors or Liver Aides contain vitamins, minerals and phospholipids
2. Icteric Stage – (+) jaundice – inability of liver liver to eliminate (N) amt of bilirubin
1. Liver Enzyme Test – determine extent of liver damage
•
–
signs of anemia
- it takes 3-4 months for the liver to recover (avoid alcohol for 1year and ASA & acetaminophen)
MOT: Sexual Contact, transferred to baby during birth
b. Prothrombin Time Testing (PTT)
fever
3. Post-Icteric Stage – jaundice and other s/sx starts to disappear
•
Female – Cervicitis a. Bilirubin Testing
c. Ultrasound or CT Scan of Liver
N/V, anorexia
CA: Neisseria Gonorrhea
3. Routine Test
1. Pre-Icteric Stage – S/Sx:
fatigability, weight loss, body malaise
•
•
Gonorrhea – aka Jack, Gleet, Clap, Strain, GC and Morning Drop
–
dysuria and urinary frequency itchy, red and edematous meatus, if cervix is affected burning pain and purulent discharges, if urethra is affected abscess forms on the bartholin’s and skene’s gland à endocervitis & endometritis
–
•
(+) narrowing of fallopian tube à sterility
•
Medical : A nt nt ib ib io io titi c: c: (Penadur)
If pregnant, it will cause: ectopic pregnancy or opthalmia neonatorum •
B en en za za th th in in e P en en ic ilill in in G
Nursing Care & Preventive Management: gonorrhea
same as
HIV infection means one is infected with AIDS Virus •
2. Secondary Stage: highly infectious & contagious a. fever & malaise b.skin rashes & dermatitis: dry, hard, lesions à Condyloma lata •
C&S by mucosal scrapping
•
Pap Smear or Vaginal Smear
•
Medical Management:
wart like
c. Oral mucous patches
Antibiotic
d. alopecia – patchy, polka dot or moth appearance of hair and thinning of pubic hair
AIDS = infected by virus + incompetent immunoresponse
•
CA: Human Immuno-Deficiency Virus (HIV) retrovirus
•
MOT: MOT:
BT, BT, sex sexual ual cont contac act, t, exposure to infected blood, products or tissuesvertical (mother-child) or (pregnancy,delivery&breastfeeding)
Perinatal eaten
sharing needles •
a. Ceftriaxone (Rocephin)
Incubation Period: 6 mons – 7 years
b. Doxycycline (Tetracycline) •
•
MOà detected by macrophageàalert T Cells
Psychological aspect of care – low self-esteem Health education: - safe sex, monogamous relationship, masturbation
↓ HIV ← Antibodies ← stimulate B cells
use of condom, behaviour modification •
•
•
Syphilis
3. Tertiary Stage –
aka Pox, Lues, SY, and Bad Blood Disease
a. Gumma – infiltrating lesion found on deeper tissues & body organs such as skin, bone and liver
CA: Treponema Pallidum – a spirochete that passes to the placental barrier during the 16th week of pregnancy (2nd & 3rd trimester)
b. aortitis & aneurysm c. paresthesia, abnormal reflexes, dementia and psychosis
•
MOT: Sexual contact, vertical transmission
•
Incubation period: 10-90 days
•
•
1. Primary Stage
•
Dark Field Microscope
•
Serologic Test
•
Flourescent Treponema Antibody Absorption Test –
•
a. Chancre, a painless popular lesion on face, lips, tongue, under the breast, fingers and genitals
fever with night sweats without a cause
•
enlargement of the lymph nodes without a cause
•
fatigability
•
weight loss
•
altered sleeping patterns
•
temporary memory loss
•
altered gait
C&S by mucosal scrapping
Adults: Child
2 Major sxs and 1 Minor sx 2 M j
d 2 Mi
3 Ma Ma jo r Sx :
1 . f ev eve r – 1 m on on th th & a bo bo ve ve
4. Dideoxyinosine (DDI) - Didanosine
2. diarrhea – 1 month & above
4. Dideoxycytidine (DDC) – Zalcitabine, Hivid
3. 10% weight loss/ stunted growth for pedia 6 Min Minor or Sx: Sx:
1. pers persis iste tent nt coug cough h – 1 mon month th & abov above e
b. Non-Nucleoside reverse Transcriptase (NNRTI)
2. persistent generalized lymphadenopathy
a. Delavirdine
3. generalized pruritic dermatitis
b. Nevirapine
4. oropharyngeal candidiasis
2. Protase Inhibitor (PI) prevets virus to multiply during the last phase of call division
5. recurrent herpes zoster a. Indinavir 6. progressive dessiminated herpes zoster b. Retonavir Opportunistic Infection: c. Saquinavir •
TB is the most common of the Avium Type (from birds)
•
PCP
•
CMV
•
CNS à lungs
•
•
d. Nalfinavir 3. Fusion Inhibitor- Fuseon (Enfuritide)
à
•
Promote knowledge and understanding
•
Promote quality of life
•
Provide self care and comfort
•
Preventive Measures:
•
1. Practice Practice ABCD ABCD of HIV: HIV: A – bstinenc bstinence e
eyes
Cancer : Kaposi Sarcoma à malignancy of blood vessel (skin) – appearing as pink/purple painless sots on the skin called Leopard Look Enzyme Link Immunoassorbent Assay (ELISA) Test – screening test
•
Western Blot – confirmatory
•
CD4 and T cell count
B – e faithful C – ondom D – on’t use drugs
- if more than or equal to 200 à HIV infected - if less than 200 à AIDS Nucleus Analogs prevent the virus to multiply during the initial phase of cell division a. Nucleoside Reverse Transcriptase Inhibitor (NRTI) 1. Azidothymidine (AZT) – Zidovudin, retrovir 2. Lamivudine -3#TC, Epion 3. Stavudine – Cd4T, Zerit
•
2. Education
•
3. Counselling
•
4. Behavior Modification
