COMMUNICABLE DISEASE NURSING SUMMER REVIEW
CHAIN OF INFECTION
COMMUNICABLE DISEASE
Disease caused by an infectious agent that are transmitted directly or indirectly to a well person through an agency, vector or inanimate object CONTAGIOUS DISEASE
Disease that is easily transmitted from one person to another INFECTIOUS DISEASE
Disease transmitted by direct inoculation through a break in the
INFECTIOUS AGENT
skin
Any microorganism capable of producing a disease
INFECTION -Entry and multiplication of an infectious agent into the tissue of the host INFESTATION - Lodgement and development of arthropods on the surface of the body ASEPSIS - Absence of disease – producing microorganisms SEPSIS - The presence of infection MEDICAL ASEPSIS -Practices designed to reduce the number and transfer of pathogens -Clean technique SURGICAL ASEPSIS -Practices that render and keep objects and areas free from microorganisms -Sterile technique
CARRIER – an individual who harbors the organism and is capable of transmitting it without showing manifestations of the disease
CASE – a person who is infected and manifesting the signs and symptoms of the disease
SUSPECT – a person whose medical history and signs and symptoms suggest that such person is suffering from that particular disease
CONTACT – any person who had been in close association with an infected person HOST - A person, animal or plant which harbors and provides nourishment for a parasite RESERVOIR - Natural habitat for the growth, multiplication and reproduction of microorganism ISOLATION - The separation of persons with communicable diseases from other persons QUARANTINE - The limitation of the freedom of movement of persons exposed to communicable diseases
STERILIZATION – the process by which all microorganisms including their spores are destroyed
DISINFECTION – the process by which pathogens but not their spores are destroyed from inanimate objects
CLEANING – the physical removal of visible dirt and debris by washing contaminated surfaces CONCURRENT - Done immediately after the discharge of infectious materials / secretions TERMINAL - Applied when the patient is no longer the source of infection BACTERICIDAL - A chemical that kills microorganisms BACTERIOSTATIC - An agent that prevents bacterial multiplication but does not kill microorganisms
RESERVOIR
Environment or object on which an organism can survive and multiply PORTAL OF EXIT
The venue or way in which the organism leaves the reservoir MODE OF TRANSMISSION The means by which the infectious agent passes from the portal of exit from the reservoir to the susceptible host PORTAL OF ENTRY Permits the organism to gain entrance into the host SUSCEPTIBLE HOST A person at risk for infection, whose defense mechanisms are unable to withstand invasion of pathogens STAGES OF THE INFECTIOUS PROCESS
Incubation Period – acquisition of pathogen to the onset of signs and symptoms
Prodromal Period – patient feels “bad” but not yet experiencing actual symptoms of the disease
Period of Illness – onset of typical or specific signs and symptoms of a disease
Convalescent Period – signs and symptoms start to abate and client returns to normal health MODE OF TRANSMISSION CONTACT TRANSMISSION Direct contact – involves immediate and direct transfer from person-to-person (body surface-to-body surface) Indirect contact – occurs when a susceptible host is exposed to a contaminated object DROPLET TRANSMISSION Occurs when the mucous membrane of the nose, mouth or conjunctiva are exposed to secretions of an infected person within a distance of three feet VEHICLE TRANSMISSION Transfer of microorganisms by way of vehicles or contaminated items that transmit pathogens AIRBORNE TRANSMISSION Occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens VECTOR-BORNE TRANSMISSION Transmitted by biologic vectors like rats, snails and mosquitoes TYPES OF IMMUNIZATION ACTIVE – antibodies produced by the body NATURAL – antibodies are formed in the presence of active infection in the body; lifelong ARTIFICIAL – antigens are administered to stimulate antibody production PASSIVE – antibodies are produced by another source NATURAL – transferred from mother to newborn through placenta or colostrum ARTIFICIAL – immune serum (antibody) from an animal or human is injected to a person SEVEN CATEGORIES OF ISOLATION STRICT- prevent highly contagious or virulent infections Example: chickenpox, herpes zoster CONTACT – spread primarily by close or direct contact Example: scabies, herpes simplex RESPIRATORY – prevent transmission of infectious distances over short distances through the air Example: measles, mumps, meningitis CD-Bucud
1
TUBERCULOSIS – indicated for patients with positive smear or chest x-ray which strongly suggests tuberculosis ENTERIC – prevent transmission through direct contact with feces Example: poliomyelitis, typhoid fever DRAINAGE – prevent transmission by direct or indirect contact with purulent materials or discharge Ex. Burns UNIVERSAL – prevent transmission of blood and body-fluid borne pathogens Example: AIDS, Hepatitis B
CENTRAL NERVOUS SYSTEM ENCEPHALITIS
MENINGITIS
MAIN PROBLEM
- Inflammation of the brain
- Inflammation of the meninges
ETIOLOGIC AGENT
MENINGOCOCCEMIA - Acute infection of the bloodstream and developing vasculitis
- Streptococcus - Staphylococcus - Pneumococcus - Tubercle bacillus
- Arboviruses
5-15 days
1-10 days
DIC URTI: cough, sore throat, fever, headache, nausea and vomiting
3-4 days
Respiratory droplets
Purpura Hypotension Shock Death
ENCEPHALITIS
MENINGITIS
MENINGOCOCCEMIA Vasculitis
Stiff neck
Nuchal rigidity
Photophobia
Opisthotonus
Lethargy
Brudzinski’s
Convulsions
Kernig’s sign
MODE OF TRANSMISSION
Bite of infected mosquito
Microthrombosis
Vasculitis: petechial rash in the trunk and extremities
SIGNS AND SYMPTOMS
- Neisseria meningitides
INCUBATION PERIOD
SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA
WaterhouseFriderichsen syndrome Petechiae with the development of hemorrhage
INCIDENCE SIGNS AND SYMPTOMS OF ENCEPHALITIS
Virus enters neural cells
Disruption in cellular functioning Lethargy Convulsions Seizures
Perivascular congestion
Headache Photophobia Vomiting Stiff neck
Inflammatory reaction
Fever Sore throat
5-10 years old
< 5 years old
DIAGNOSTIC EXAM Informed consent Empty bowel and bladder Fetal, shrimp or “C” position Spinal canal, subarachnoid space between L3-L4 or L4- L5 After: bedrest Flat on bed to prevent spinal headache
ENCEPHALITIS
MENINGITIS
MENINGOCOCCEMIA
TREATMENT MODALITIES
Dexamethasone
SIGNS AND SYMPTOMS OF MENINGITIS
6 months–5 years old
Ceftriaxone
Mannitol
Penicillin
Anticonvulsants
Chloramphenicol
Antipyretics PREVENTION
1. Japanese encephalitis VAX ENCEPHALITIS
1. HiB vaccine
Ciprofloxacin MENINGITIS
NURSING MANAGEMENT
THREE SIGNS OF MENINGEAL IRRITATION OPISTHOTONUS State of severe hyperextension and spasticity in which an individual’s head, neck and spinal column enter into a complete arching position BRUDZINSKI’S SIGN Place the patient in a dorsal recumbent position and then put hands behind the patient’s neck and bend it forward. If the patient flexes the hips and knees in response to the manipulation, positive for meningitis KERNIG’S SIGN Place the patient in a supine position, flex his leg at the hip and knee then straighten the knee; pain and resistance indicates meningitis
1. Comfort: quiet, well-ventilated room 2. Skin care: cleansing bath, change in position 3. Eliminate mosquito breeding sites: CULEX mosquito
Rifampicin
MENINGOCOCCEMIA 1. Side boards
1. Respiratory isolation 24-72 hours after onset of antibiotic therapy
2. Close contacts
2. Room protected against bright lights
S – ame daycare center
3. Safety: side-lying position and raised side rails
H – ouse I – nfected person kissing
S – hare mouth instruments 3. Antibiotics as prophylaxis
CD-Bucud
2
RABIES
TETANUS
Acute viral disease of the CNS – by saliva of infected animals
Acute infectious disease with systemic neuromuscular effects
ETIOLOGIC AGENT
Rhabdovirus
Clostridium tetani
Legio debilitans
Bullet-shaped
Anaerobic
Affinity to CNS
Gram positive
Killed by sunlight, UV light, formalin
Drumstick appearance
POLIOMYELITIS MAIN PROBLEM Acute infection of the CNS – muscle spasm, paresis and paralysis
Resistant to antibiotics
RABIES
POLIOMYELITIS INCUBATION PERIOD
7-21 days
TETANUS
2-8 weeks Distance of bite to brain
Adult: 3 days-3 weeks
Extensiveness of the bite
Neonate: 3-30 days
- Indirect with soiled linens and articles
POLIOMYELITIS
RABIES
SIGNS AND SYMPTOMS
1. Abortive type 2. Pre-paralytic or meningetic type 3. Paralytic type
Direct inoculation through a broken skin
TETANUS R – isus sardonicus
Respiratory isolation
POLIOMYELITIS
RABIES
TREATMENT MODALITIES
C – onvulsions
3. Moist heat application
H – eadache
4. Bed rest
Recovery within 72 hours and the disease passes by unnoticed PRE-PARALYTIC OR MENINGETIC TYPE Slight involvement of the CNS Pain and spasm of muscles Transient paresis (+) Pandy’s test (increased protein in the CSF) PARALYTIC TYPE CNS involvement Flaccid paralysis Asymmetric Affects lower extremities Urine retention and constipation (+) HOYNE’S SIGN (when in supine position, head will fall back when shoulders are elevated)
1. Blood exam
2. Flourescent rabies antibody (FRA)
Enteric isolation
2. Excitement / neurological phase
T – rismus
1. Throat washings
ISOLATION PRECAUTION
O – pistothonus
POLIO ABORTIVE TYPE Does not invade the CNS Headache Sore throat
DEATH
3. Negri bodies
1. Prodromal / invasion phase
I – rritability 3. Terminal / paralytic type L – aryngeal spasm
RESPIRATORY FAILURE
Paralysis of respiratory muscles
2. CSF culture
Bite of an infected animal
TETANUS
COMPLICATION
1. Stool culture
MODE OF TRANSMISSION
- Direct contact with respiratory secretions
RABIES
POLIOMYELITIS
DIAGNOSTIC PROCEDURES
Resistance of the host - Direct contact with infected feces
RABIES PRODROMAL/INVASION PHASE Fever Anorexia Sore throat Pain and tingling at the site of bite Difficulty swallowing EXCITEMENT OR NEUROLOGICAL PHASE Hydrophobia (laryngospasm) Aerophobia (bronchospasm) Delirium Maniacal behavior Drooling TERMINAL OR PARALYTIC PHASE Patient becomes unconscious Loss of urine and bowel control Progressive paralysis Death
1. Analgesics 2. Morphine
5. Rehabilitation
1. Local treatment of wound
1. Tetanus immune globulin (TIG) 2. Tetanus antitoxin (TAT)
2. Active immunization
3. Penicillin G
Lyssavac
5. Diazepam
Imovax
6. Phenobarbital
Antirabies vax 2. Passive immunization POLIOMYELITIS
TETANUS
RABIES
4. Tetracycline
7. Tracheostomy 8. NGT feeding
TETANUS
NURSING MANAGEMENT
1. Enteric isolation
1. Isolation
1. Adequate airway
2. Proper disposal of secretions
2. Optimum comfort
2. Quiet, semi-dark environment
3. Moist hot packs
3. Restful environment
3. Avoid sudden stimuli and light
4. Firm / nonsagging bed 5. Suitable body alignment 6. Comfort and safety
4. Emotional support 5. Concurrent and terminal disinfection
CD-Bucud
3
RABIES
POLIOMYELITIS PREVENTION
Salk vaccine - Inactivated polio vaccine - Intramuscular Sabin vaccine - Oral polio vaccine - Per orem
TETANUS
1. If the dog is healthy 2. If the dog dies or shows signs suggestive of rabies
1. Aseptic handling of umbilical cord
4. Have domestic dog 3 months to 1 year old immunized
SARS
TREATMENT MODALITIES
- Penicillin
1. Amantadine/Rimantadine 1. No definitive treatment for SARS - Generic flu drugs - H5N1 developed resistance 2. Antiviral drugs (normally used to treat 2. Oseltamivir (TAMIFLU) AIDS) Zanamavir (RELENZA) - RIBAVIRIN - Primary treatment - Within 2 days at onset of 3. Corticosteroids symptoms
- Erythromycin
- 150 mg BID x 2 days
2. Tetanus toxoid immunization 3. Antibiotic prophylaxis
3. If dog is not available for observation
BIRD FLU
- Tetracycline
BIRD FLU RESPIRATORY SYSTEM
BIRD FLU
PREVENTION
SARS
MAIN PROBLEM
Flu infection in birds that affects humans
A new type of atypical pneumonia that infects the lungs
ETIOLOGIC AGENT
Avian influenza virus, H5N1
Corona virus
INCUBATION PERIOD
3-5 days
2-8 days
MODE OF TRANSMISSION
Inhalation of feces and discharge of an infected bird
Respiratory droplets
BIRD FLU
SARS
Body weakness or muscle pain Cough Difficulty breathing Episodes of sore throat Fever High fever >38’Celsius Chills
COMPLICATIONS
Severe viral pneumonia Acute respiratory distress syndrome Fluid accumulation in alveolar sacs Severe breathing difficulties Multiple organ failure DEATH
SARS Severe viral pneumonia Hypoxemia Respiratory failure
1.Quarantine
1.Culling – killing of sick or exposed birds
2. Isolation 3. WHO alert on SARS (March 12, 2003)
2. Banning of importation of birds (Executive order # 280) 3. Cook chicken thoroughly NURSING MANAGEMENT
BIRD FLU WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD FLU • Isolation
• • • •
SIGNS AND SYMPTOMS
BIRD FLU
SARS
Face mask on the patient Caregiver: use a face mask and eye goggles/glasses Distance of 1 meter from the patient Transport the patient to a DOH referral hospital
REFERRAL HOSPITALS
•
National Referral Center – Research Institute for Tropical Medicine (RITM) (Alabang, Muntinlupa)
•
Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz, Manila)
•
Visayas – Vicente Sotto Memorial Medical Hospital (Cebu City)
• Mindanao – Davao Medical Center (Bajada, Davao City) SARS SUSPECT CASE 1. A person presenting after 1 November 2002 with a history of:
High fever >38 0C
AND
Cough or breathing difficulty
AND
One or more of the following exposures during the 10 days prior to the onset of symptoms:
Close contact, with a person who is a suspect or probable case of SARS
History of travel, to an area with recent local transmission of SARS
Residing in an area with recent local transmission of SARS 2. A person with an unexplained acute respiratory illness resulting in death after 1 November 2002, but on whom no autopsy has been performed : AND One or more of the following exposures during the 10 days prior to the onset of symptoms:
Close contact, with a person who is a suspect or probable case of SARS CD-Bucud
4
History of travel, to an area with recent local transmission of SARS
Residing in an area with recent local transmission of SARS PROBABLE CASE 1. A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome on Chest x-ray.
•
With profuse sweating, involuntary urination and exhaustion CONVALESCENT STAGE • End of 4th-6th week • Decrease in paroxysms
DIPHTHERIA
PERTUSSIS
DIAGNOSTIC PROCEDURES CBC
2. A suspect case of SARS that is positive for SARS coronavirus by one or more assays.
SCHICK’S TESTS
3. A suspect case with autopsy findings consistent with the pathology of SARS without an identifiable cause.
-ID of dilute diphtheria toxin (0.1 cc)
DIPHTHERIA
PERTUSSIS
MAIN PROBLEM
Acute bacterial disease characterized by the elaboration of an exotoxin
Repeated attacks of spasmodic coughing
- Susceptibility and immunity to diphtheria
– increase in lymphocytes
(+) local circumscribed area of redness, 1-3 cm MALONEY’S TEST -Determines hypersensitivity to diphtheria anti-toxin -ID of 0.1 cc fluid toxoid -(+) area of erythema in 24 hours
ETIOLOGIC AGENT
Corynebacterium diphtheriae or Klebs-Loeffler bacillus
Bordetella pertussis
INCUBATION PERIOD
7-14 days
2-5 days
DIPHTHERIA
PERTUSSIS
COMPLICATIONS
Convulsions (brain
Toxins in the bloodstream
damage from asphyxia)
MODE OF TRANSMISSION
1. Respiratory droplets 2. Direct contact with respiratory secretions 3. Indirect contact with articles
DIPHTHERIA
PERTUSSIS
SIGNS AND SYMPTOMS
Types: 1.Nasal 2.Tonsilopharyngeal 3.Laryngeal 4.Wound or cutaneous
Stages: 1. Catarrhal 2. Paroxysmal 3. Convalescent
NASAL DIPHTHERIA • Bloody discharge from the nose • Excoriated nares and upper lip TONSILOPHARYNGEAL DIPHTHERIA • Low grade fever • Sore throat • Bull-neck appearance
•
Pseudomembrane- Group of pale yellow membrane over tonsils and at the back of the throat as an inflammatory response to a powerful necrotizing toxins LARYNGEAL DIPHTHERIA • Hoarseness • Croupy cough • Aphonia
•
Membrane lining thickens à airway obstruction • Suffocation, cyanosis or death WOUND OR CUTANEOUS DIPHTHERIA • Yellow spots or sores in the skin PERTUSSIS CATARRHAL STAGE
• • •
Lasts for 1 to 2 weeks Most communicable stage Begins with respiratory infection, sneezing, cough and fever
• Cough becomes more frequent at night PAROXYSMAL STAGE • Lasts for 4 to 6 weeks • • • •
Aura: sneezing, tickling, itching of throat Cough, explosive outburst ending in “whoop” Mucus is thick, ends in vomiting Becomes cyanotic
Myocarditis (epigastric or chest pain)
Heart failure
Peripheral paralysis (tingling, numbness, paresis)
Decreased in respiratory rate
Bronchopneumonia (fever, cough)
Respirat ory arrest
Otitis media (invading organisms)
Bronchopneumonia (most dangerous complication)
DEATH
DIPHTHERIA
PERTUSSIS
TREATMENT MODALITIES
1. Diphtheria anti-toxin - Requires skin testing - Early administration aimed at neutralizing the toxin present in the circulation before it is absorbed by the tissues 2. Antibiotic therapy - Penicillin G - Erythromycin
DIPHTHERIA NURSING MANAGEMENT
1. Isolation: 14 days (until 2-3 cultures, 24 hours apart) 2. Bedrest for 2 weeks 3. Care for nose and throat (gentle swabbing) 4. Ice collar (decrease pain of sore throat) 5. Diet (soft food, small frequent feedings)
1. Erythromycin – drug of choice 2. Ampicillin – if resistant to erythromycin 3. Betamethasone (corticosteroid) – decrease severity and length of paroxysms 4. Albuterol (bronchodilator)
PERTUSSIS 1. Isolation: 4-6 weeks from onset of illness 2. Supportive measures (bedrest, avoid excitement, dust, smoke and warm baths) 3. Safety (during paroxysms, patient should not be left alone) 4. Suctioning (kept at bedside for emergency use)
MUMPS MAIN PROBLEM An acute contagious disease, with swelling of one or both of the parotid glands ETIOLOGIC AGENT Filterable virus of paramyxovirus group INCUBATION PERIOD CD-Bucud
5
12-26 days MODE OF TRANSMISSION Respiratory droplets PERIOD OF COMMUNICABILITY 6 days before and 9 days after onset of parotid swelling SIGNS AND SYMPTOMS PRODROMAL PHASE F-ever (low grade) H-eadache M-alaise
AMOEBIASIS SIGNS AND SYMPTOMS
1. Acute amoebic dysentery
Abdominal pain Diarrhea and tenesmus
- Bloody mucoid stools 2. Chronic amoebic dysentery
Bloody mucoid stool
- Enlarged liver - Large sloughs of intestinal tissues accompanied by hemorrhage
COMPLICATIONS
• •
Orchitis – the most notorious complication of mumps
•
CNS involvement – manifested by headache, stiff neck, delirium, double vision
Oophoritis – manifested by pain and tenderness of the abdomen
• Deafness as a result of mumps NURSING MANAGEMENT 1. Prevent complications − Scrotum supported by suspensory − Use of sedatives to relieve pain − Treatment: oral dose of 300-400 mg cortisone followed by 100 mg every 6 hours − Nick in the membrane 2. Diet - Soft or liquid diet - Sour foods or fruit juices are disliked 3. Respiratory isolation 4. Comfort: ice collar or cold applications over the parotid glands may relieve pain 5. Fever: aspirin, tepid sponge bath 6. Concurrent disinfection: all materials contaminated by these secretions should be cleansed by boiling 7. Terminal disinfection: room should be aired for six to eight hours
AMOEBIASIS
SHIGELLOSIS
DIAGNOSTIC TESTS 1. Stool exam 2. Blood exam 3. Sigmoidoscopy TREATMENT MODALITIES
1. Metronidazole – drug of choice
1. Cotrimoxazole – drug of choice
2. Tetracycline 3. Chloramphenicol
AMOEBIASIS
SHIGELLOSIS
NURSING MANAGEMENT
1.Enteric isolation 2. Boil water for drinking
GASTROINTESTINAL TRACT
3. Handwashing
SHIGELLOSIS
4. Sexual activity 5. Avoid eating uncooked leafy vegetables
MAIN PROBLEM Protozoal infection of the large intestine
Fever
- Diarrhea alternated with constipation - Tenesmus
PAROTITIS F-ace pain E-arache S-welling of the parotid glands
AMOEBIASIS
SHIGELLOSIS
Acute infection of the lining of the small intestine
ETIOLOGIC AGENT
Entamoeba histolytica
Shigella group
- Prevalent in areas with ill sanitation
1. Shigella flesneri – most common in the Philippines
-Acquired by swallowing
2. Shigella connei
- Trophozoites: vegetative form
3. Shigella boydii
- Cyst: infective stage
4. Shigella dysenterae – most infectious type
CHOLERA
TYPHOID FEVER
MAIN PROBLEM
Acute bacterial disease of the GIT characterized by profuse secretory diarrhea
An infection affecting the Peyer’s patches of the small intestines
ETIOLOGIC AGENT
Vibrio cholerae
Salmonella typhi
INCUBATION PERIOD
1 to 3 days
1 to 3 weeks
MODE OF TRANSMISSION
1. Fecal-oral transmission 2. 5 F’s
CD-Bucud
6
CHOLERA
TYPHOID FEVER
SIGNS AND SYMPTOMS
Fever (ladder-like)
Rice-water stool Abdominal cramps
Rose spots Diarrhea
Vomiting
TYPHOID STATE
Intravascular Dehydration
Sordes
Shock
Coma vigil
CHICKENPOX PERIOD OF COMMUNICABILITY
One day before eruption of 1st lesion and five days after appearance of last crop
PRODROMAL PERIOD - Fever (low-grade) - Headache
Carphologia
TYPHOID FEVER
TREATMENT MODALITIES
1.Lactated Ringer’s solution
1.Chloramphenicol – drug of choice 2. Ampicillin/ Amoxicillin – for typhoid carriers
2. Oral rehydration therapy 3. Antibiotic therapy - Tetracycline – drug of choice
3. Cotrimoxazole – for severe cases with relapses
- Malaise
CHICKENPOX SIGNS AND SYMPTOMS
• Rashes
: Centrifugal distribution •Rash stages: macule papule vesicle pustule crust • Pruritus
- Cotrimoxazole - Chloramphenicol
CHOLERA
TYPHOID FEVER
NURSING MANAGEMENT
CHICKENPOX COMPLICATIONS
1. Maintain and restore the fluid and electrolyte balance 2. Enteric isolation 3. Sanitary disposal of excreta 4. Adequate provision of safe drinking water 5. Good personal hygiene
One day before eruption of 1st rash and five to six days after the last crust
SIGNS AND SYMPTOMS
Subsultus Tendinum
CHOLERA
HERPES ZOSTER
SCARRING – most common complication; associated with staphylococcal or streptococcal infections from scratching NECROTIZING FASCIITIS – most severe complication REYE SYNDROME – abnormal accumulation of fat in the liver plus increase of pressure in the brain resulting to coma, therefore leading to DEATH
HERPES ZOSTER • Rashes
-Unilateral, band-like distribution -Dermatomal - Erythematous base - Vesicular, pustular or crusting •Regional lymphadenopathy •Pruritus •Pain – stabbing or burning
HERPES ZOSTER RAMSAY-HUNT SYNDROME - Involvement of the facial nerve in herpes zoster with facial paralysis, hearing loss, loss of taste in half of the tongue GASSERIAN GANGLIONITIS – Involvement of the optic nerve resulting to corneal anesthesia ENCEPHALITIS – acute inflammatory condition of the brain
INTEGUMENTARY SYSTEM
CHICKENPOX
HERPES ZOSTER
MAIN PROBLEM
A highly contagious disease characterized by vesicular eruptions on the skin and mucous membranes ETIOLOGIC AGENT
An acute viral infection of the sensory nerve
Varicella zoster virus
INCUBATION PERIOD
10-21 days MODE OF TRANSMISSION
13-17 days 1. Droplet method 2. Direct contact 3. Indirect contact
CD-Bucud
7
CHICKENPOX
HERPES ZOSTER
- Soft palate to mucus membrane
MEASLES
GERMAN MEASLES
TREATMENT MODALITIES
1. Antihistamines – symptomatic relief of itching Ex. Diphenhydramine (Benadryl)
4. Corticosteroids – antiinflammatory and decreased pain Ex. Prednisone
2. Analgesics and antipyretics Ex. Acetaminophen 3. Antiviral agents – for patient to experience less pain and faster resolution of lesions when used within 48 hours of rash onset
SIGNS AND SYMPTOMS
ERUPTIVE STAGE
2. ERUPTIVE STAGE Rashes - Elevated papules - Begin on the face and behind the ears - Spread to trunk and extremities Color: Dark red – purplish hue – yellow brown 3. Stage of Convalescence - Desquamation - Rashes fade from the face downwards
1. Rash - pinkish, maculopapular - Begins on the face - Spread to trunk or limbs - No pigmentation or desquamation 2. Posterior auricular and suboccipital lymphadenopathy
Ex. Acyclovir (Zovirax)
CHICKENPOX
HERPES ZOSTER
MEASLES
GERMAN MEASLES
NURSING MANAGEMENT
COMPLICATIONS
Strict isolation
Pneumonia Otitis media Severe diarrhea (leading
Prevent secondary infection (cut fingernails short, wear mittens)
Eliminate itching: calamine lotions, warm baths, baking soda paste
to dehydration)
Encourage not going to school:
Encephalitis
usually 7 days
Disinfection of clothes and linen with nasopharyngeal discharges by sunlight or boiling
MEASLES
GERMAN MEASLES A benign communicable exanthematous disease caused by rubella virus Rubella virus
INCUBATION PERIOD
14-21 days
10-12 days
- Heart defects (PDA, VSD) - Eye defects (Cataract, glaucoma) - Ear defects (Deafness)
MEASLES
GERMAN MEASLES
TREATMENT MODALITIES
ETIOLOGIC AGENT
Filterable virus of paramyxoviridae
2. Congenital rubella syndrome - Spontaneous abortion - Intrauterine growth retardation (IUGR) - Thrombocytopenia purpura “blueberry muffin skin” - Cleft lip, cleft palate, club foot
- Neurologic (microcephaly, mental retardation, behavioral disturbances
MAIN PROBLEM
A contagious exanthematous disease with chief symptoms to the upper respiratory tract
1. Encephalitis
1.Vitamin A – helps prevent eye damage and blindness 2. Antipyretics – for fever 3. Penicillin – given only when secondary infection sets in
1. Aspirin – help reduce inflammation and fever
MODE OF TRANSMISSION
1. Droplet method 2. Direct contact with respiratory discharges 3. Indirect with soiled linens and articles
MEASLES
GERMAN MEASLES
GERMAN MEASLES
NURSING MANAGEMENT
PERIOD OF COMMUNICABILITY
4 days before and 5 days after the appearance of rashes
MEASLES
1. Darkened room to relieve photophobia
One week before and four days after the appearance of rashes
2. Diet: should be liquid but nourishing 3. Warm saline solution for eyes to relieve eye irritation
SIGNS AND SYMPTOMS
PRE-ERUPTIVE STAGE
PRE-ERUPTIVE STAGE
Cough Coryza Conjunctivitis Fever (high-grade) Photophobia
Fever Headache Malaise Coryza Conjunctivitis
KOPLIK’S SPOT (Rubeola) - Bluish white spots surrounded by a red halo - Appear on the buccal mucosa opposite the premolar teeth FORCHEIMER’S SPOTS (Rubella) - small, red lesions
4. For fever: tepid sponge bath and antipyretics 5. Skin care: during eruptive stage, soap is omitted; bicarbonate of soda in water or lotion to relieve itchiness 6. Prevent spread of infection: respiratory isolation
SCABIES MAIN PROBLEM Infestation of the skin produced by the burrowing action of a parasite mite resulting in skin irritation and formation of vesicles and pustules ETIOLOGIC AGENT Sarcoptes scabiei CD-Bucud
8
INCUBATION PERIOD Within 24 hours MODE OF TRANSMISSION Direct contact Indirect contact
AIDS SIGNS AND SYMPTOMS OPPORTUNISTIC INFECTIONS
Sarcoptes scabiei 1. Yellowish white in color 2. Barely seen by the unaided eye 3. Female parasite burrows beneath the epidermis to lay eggs 4. Males are smaller and reside on the surface of the skin SIGNS AND SYMPTOMS
• • •
SYPHILIS
Thin, pencil-mark lines on the skin Itching, especially at night
Rashes and abrasions on the skin PRIMARY LESIONS NODULAR LESIONS SECONDARY LESIONS TREATMENT MODALITIES • SCABICIDE : Eurax ointment (Crotamiton) • PEDICULICIDE : Kwell lotion (Gamma Benzene Hexachloride) – contraindicated in young children and pregnant women • Topical steroids • Hydrogen peroxide : cleanliness of wound • Lindane Lotion NURSING MANAGEMENT • Apply cream at bedtime, from neck to toes • Instruct patient to avoid bathing for 8 to 12 hours • Dry-clean or boil bedclothes • Report any skin irritation • Family members and close contact treatment • Good handwashing • Terminal disinfection
1. Pneumocystis carinni pneumonia 2. Oral candidiasis 3. Toxoplasmosis 4. Acute/chronic diarrhea 5. Pulmonary tuberculosis MALIGNANCIES 1. Kaposi’s sarcoma 2. Non-Hodgkin’s lymphoma
AIDS SIGNS AND SYMPTOMS
SYPHILIS 1. PRIMARY SYPHILIS - CHANCRE: small, painless, pimple-like ulceration on the penis, labia majora, minora and lips - May erupt in the genitalia, anus, nipple, tonsils or eyelids - Lymphadenopathy
SEXUALLY TRANSMITTED DISEASES
AIDS
SYPHILIS
SIGNS AND SYMPTOMS
MAIN PROBLEM Final and most serious stage of HIV disease, which causes severe damage to the immune system
AIDS
SYPHILIS 2. SECONDARY SYPHILIS - Skin rash
Infectious disease caused by a spirochete
- Mucous patches - Hair loss - CONDYLOMATA LATA: coalescing papules which form a gray-white plaque frequently in skin folds
ETIOLOGIC AGENT Retrovirus – Human T-cell lymphotropic virus III (HTLV-3)
Treponema pallidum
INCUBATION PERIOD 3 to 6 months to 8 to 10 years
10-90 days
AIDS
SYPHILIS
MODE OF TRANSMISSION
contact – oral, anal or vaginal sex
AIDS SIGNS AND SYMPTOMS
SYPHILIS 3. TERTIARY SYPHILIS
• Sexual
- 1 to 10 years after infection
•Blood transfusion
- Appear on the skin, bones, mucus membrane, URT, liver and stomach
•Mother-to-child •Indirect contact through soiled articles
- GUMMA: chronic, superficial nodule or deep granulomatous lesion that is solitary, painless, indurated
CD-Bucud
9
AIDS
SYPHILIS
COMPLICATIONS
DIAGNOSTIC PROCEDURES
1.ELISA 2. Western blot
4. PCR
3. VDRL
GONORRHEA
Women
1.Dark Field Illumination test 2. Flourescent Treponemal Antibody Absorption Test
3. RIPA
CHLAMYDIA
Pelvic inflammatory disease Ectopic pregnancy Sterility Men
Epididymitis Newborn
Sterility
Conjunctivitis
Newborn
Otitis media
Gonococcal ophthalmia
Pneumonia
AIDS TREATMENT MODALITIES
1. Antivirals - Shorten the clinical course, prevent complications, prevent development of latency, decrease transmission - Example: Zidovudine (Retrovir)
SYPHILIS 1. Penicillin G Benzathine
CHLAMYDIA TREATMENT MODALITIES
- Disease < 1 year: 2.4 M units once in two injection sites
1. Azithromycin (Zithromax)
- Disease > 1 year: 2.4 M units in 2 injection sites x 3 doses
- Drug of choice because of single-dose treatment effectiveness and lower cost
2. Doxycycline – if allergic to penicillin 3. Tetracycline - if allergic to penicillin - Contraindicated for pregnant women
2. Doxycycline - Secondary drug of choice
CANDIDIASIS CHLAMYDIA
GONORRHEA
MAIN PROBLEM
Sexually transmitted disease caused by a bacteria Purulent inflammation of mucous membrane surfaces ETIOLOGIC AGENT
Chlamydia trachomatis
Neisseria gonorrhea
INCUBATION PERIOD
2-3 weeks (males)
2-10 days
Sexual contact: Oral, vaginal or anal sex
GONORRHEA Women
Women
Bleeding after intercourse
Abdominal or pelvic pain
Burning sensation during urination
Bleeding after intercourse and in-between menses Unusual vaginal discharge
- Drug of choice because of oral efficacy, single dose 2. Ciprofloxacin 3. Ceftriaxone 4. Erythromycin
HERPES SIMPLEX A viral disease characterized by the appearance of sores and blisters on the skin
ETIOLOGIC AGENT
Candida albicans
2-3 weeks
MODE OF TRANSMISSION
SIGNS AND SYMPTOMS
Mild superficial fungal infection
1. Cefixime
Herpes simplex virus types 1 and 2
INCUBATION PERIOD
Asymptomatic (females)
CHLAMYDIA
MAIN PROBLEM
GONORRHEA
Yellow or bloody vaginal discharge
Men Burning with urination Swollen, painful testicles Discharge from the penis
White, yellow or green pus from the penis
CANDIDIASIS
2-12 days
HERPES SIMPLEX
MODE OF TRANSMISSION
1. Rise in glucose as in diabetes mellitus
TYPE 1
2. Lowered body resistance as in cancer
- Direct exposure to infected saliva
3. Increase in estrogen level in pregnant women
- Kissing and sharing utensils
4. Broad-spectrum antibiotics are used
TYPE 2
- Respiratory droplets
- Sexual or genital contact
SIGNS AND SYMPTOMS (Candidiasis) ONYCHOMYCOSIS • Red, swollen darkened nailbeds • Purulent discharge • Separation of pruritic nails from nailbeds DIAPER RASH • Scaly, erythematous, papular rash • Covered with exudates CD-Bucud 10
•
Appears below the breasts, between fingers, axilla, groin and umbilicus
THRUSH • Cream-colored or bluish-white patches on the tongue, mouth or pharynx • Bloody engorgement when scraped MONILIASIS • White or yellow discharge • Pruritus • Local excoriation • White or gray raised patches on vaginal walls with local inflammation
CANDIDIASIS
HERPES SIMPLEX
TREATMENT MODALITIES
1. Antifungals
1. Antivirals
- Fluconazole (Diflucan)
- Acyclovir (Zovirax)
- Ketoconazole (Nizoral) - Imidazole (Nystatin) - Used for oral thrush - 48 hours until symptoms disappear - Cotrimoxazole
CD-Bucud 11
VECTOR-BORNE DISEASES
DENGUE
DENGUE MALARIA
DIAGNOSTIC PROCEDURES 1. TORNIQUET TEST
MAIN PROBLEM An acute febrile disease The most common arboviral illness transmitted globally
An acute and chronic parasitic disease The most deadly vector-borne disease in the world
ETIOLOGIC AGENT
-
Screening test for dengue
-
A test for the tendency for blood capillaries to break down or produce petechial hemorrhage
-
-
Performed by examining the skin of the forearms after the arm veins have been occluded for 5 minutes
Plasmodium falciparum
2. PLATELET COUNT
Chikungunya virus
Plasmodium vivax
-
Confirmatory test for dengue
O’nyong’nyong virus
Plasmodium ovale
-
Decreased count is confirmatory
West Nile virus
Plasmodium malariae
MALARIA
3-14 days
MODE OF TRANSMISSION
TREATMENT MODALITIES
P. Falciparum – 12 days
- acetaminophen
P. Vivax – 14 days
2. Volume expanders
P. Ovale – 14 days
- Used in the treatment of intravascular volume deficits
P. Malariae – 30 days
- Example: Lactated Ringers
Blood transfusion, contaminated syringe or needle
Based on triad symptoms, 50% accuracy
2. BLOOD SMEAR -
Definitive diagnosis of infection is based on demonstration of malaria parasites in blood film
3. RAPID DIAGNOSTIC TEST -
Uses immunochromatographic methods to detect Plasmodiumspecific antigens
-
Takes about 7 to 15 minutes
-
Sensitivity and specificity > 90%
MALARIA 1. Chloroquine 2. Primaquine 3. Pyrimethamine
3. Blood transfusion – for severe bleeding
Bite of an infected mosquito
-
DENGUE
1. Analgesics and antipyretics
INCUBATION PERIOD
1. CLINICAL DIAGNOSIS
To detect unusual capillary fragility
Dengue virus types 1, 2, 3 and 4
DENGUE
MALARIA
4. Sulfadoxine 5. Quinine 6. Quinidine
4. Oxygen therapy 5. Sedatives
Trans-placentally
SCHISTOSOMIASIS DENGUE
LEPTOSPIROSIS
MALARIA MAIN PROBLEM
VECTOR
Aedes aegypti
Anopheles flavirostris
A zoonotic infectious disease
ETIOLOGIC AGENT
(Aedes albopictus)
1. SCHISTOSOMA JAPONICUM
White stripes on the back and legs (Tiger mosquito)
Brown in color
Day biting (2 hours after sunrise and 2 hours before sunset)
Night biting (9 PM-3 AM)
Breeds on clear stagnant water
Breeds on clear, flowing and shaded streams
Urban-based
Rural-based
DENGUE
A slowly progressive disease caused by a blood fluke
-
Leptospira interrogans
Intestinal tract, endemic in the Philippines
2. SCHISTOSOMA MANSONI -
Africa
3. SCHISTOSOMA HAEMATOBIUM - Middle East countries like Iran and Iraq
SCHISTOSOMIASIS
LEPTOSPIROSIS
MALARIA INCUBATION PERIOD
SIGNS AND SYMPTOMS
At least 2 months
FEVER
FEVER
HEADACHE
CHILLS
MALAISE RASH
PROFUSE SWEATING
7 to 19 days
MODE OF TRANSMISSION Ingestion Skin penetration Contact with the skin
EPISODES OF BLEEDING
CD-Bucud 12
SCHISTOSOMIASIS
LEPTOSPIROSIS
VECTOR
SCHISTOSOMIASIS TREATMENT MODALITIES
Oncomelania quadrasi
1. Praziquantel (Biltricide)
1. Thrives in fresh water stream
- Taken for 6 months - 1 tablet BID for 3 months
2. Clings to grasses and leaves
- 1 tablet OD for 3 months
3. Greenish brown in color
SIGNS AND SYMPTOMS
LEPTOSPIROSIS Septic or Leptospiremic Stage F – ever (remittent
1. Cercarial dermatitis (swimmer’s itch)
H – eadache
2. Katayama syndrome
N – ausea
H – eadache and fever A – norexia and lethargy
M – yalgia V – omiting C – ough C – hest pain
R – ash M - yalgia
SCHISTOSOMIASIS SIGNS AND SYMPTOMS
LEPTOSPIROSIS Immune or Toxic Stage
CHRONIC STAGE
- Lasts for 4 to 30 days
1. Hepatic: pain, abdominal distension, hematemesis, melena
- Iritis, headache, meningeal manifestations
2. Intestinal: fatigue, abdominal pain, dysentery
- Oliguria, anuria with renal failure
3. Urinary: dysuria, urinary frequency, hematuria 4. Cardiopulmonary: palpitations, dyspnea on exertion
- Shock, coma and congestive heart failure
5. CNS: seizures, headache, back pain and paresthesia
SCHISTOSOMIASIS DIAGNOSTIC PROCEDURES 1. Fecalysis 2. Kato-Katz Technique 3. Cercum ova precipitin test (COPT)
1. Penicillin G – drug of choice 2. Doxycycline 2nd line drugs
4. Amoxicillin
ACUTE STAGE
C - ough
1st line drugs
3. Ampicillin
4. Size is as big as the smallest grain of palay
SCHISTOSOMIASIS
LEPTOSPIROSIS
LEPTOSPIROSIS
FILARIASIS MAIN PROBLEM A parasitic disease caused by an African eye worm ETIOLOGIC AGENT Wuchereria bancrofti Brugia malayi Brugia timori INCUBATION PERIOD 8 to 16 months MODE OF TRANSMISSION Person-to-person by mosquito bites ACUTE STAGE
• •
Lymphadenitis (inflammation of lymph nodes)
Lymphangitis (inflammation of lymph vessels) Male genitalia affected leading to funiculitis, epididymitis and orchitis (redness, painful and tender scrotum) CHRONIC STAGE • Develop 10-15 years from onset of first attack •
• •
Hydrocele (swelling of the scrotum)
•
Elephantiasis (enlargement and thickening of the skin of the upper and lower extremities, scrotum and breast
Lymphedema (temporary swelling of the upper and lower extremities)
LABORATORY EXAMINATIONS
•
Nocturnal blood examination (NBE) – taken at patient’s residence/hospital after 8PM
•
Immunochromatographic test (ICT) – rapid assessment method; an antigen test done at daytime TREATMENT
•
Diethylcarbamazine Citrate (DEC) or HETRAZAN – an individual treatment kills almost all microfilaria and a good proportion of adult worms. PREVENTION AND CONTROL • Measures aimed to control vectors
•
Environmental sanitation such as proper drainage and cleanliness of surroundings
• Spraying with insecticides PREVENTION AND CONTROL • • • • •
Measures aimed to protect individuals and families: Use of mosquito nets Use of long sleeves, long pants and socks Application of insect repellants Screening of houses
- Confirmatory test for schistosomiasis
CD-Bucud 13
