Communicable Disease Nursing

TERMINOLOGIES
Communicable Disease
Disease caused by an infectious agent from an infected individual and
transmitted to a susceptible host either by:
Direct
Indirect contact
Through direct inoculation through a broken skin
Infectious Disease
Diseases of man or an animal resulting from infection
Contagious Disease
Diseases that can be easily transmitted from the source to another like
direct contact
All communicable disease are infectious but not necessarily contagious
All contagious diseases are infectious but not all infectious diseases are
contagious
NATURE OF INFECTIOUS PROCESS
** Magkakaroon nang disease if there is increased force of infection and
decreased force of resistance**
Immunity:
! Natural Immunity
a! "assive Immunity # from mother to baby
b! Active Immunity # if I e$perience the disease% by having the disease%
the disease itself develop a lifelong immunity in me &e$!
Chickenpo$'
(! Arti)cial Immunity
a! "assive Immunity # from immunoglobulin% antito$in
b! Active Immunity # provided by vaccines
Cycle:
HUMAN
BODY
Force of
Infectio
n
Force of
Resistanc
e
MODE OF TRANSMISSION
Direct Contact
- actual physical contact *ith the infected person
- from one person to another
Indirect Contact
- contact of a susceptible person *ith a contaminated ob+ect
- from inanimate ob+ect to a person
- fomite &soiled clothes'
,reak in the -kin Integrity
- infection from an open *ound% abrasion% bite
.ertical Transmission
- from mother to child
/ori0ontal Transmission
- direct% indirect% break in skin integrity
BREAKING THE CHAIN OF INFECTION
- 1eakest link is the mode of transmission
Contact
- in close association *ith an infected person or animal2 e$posed
- I *as not able to harbor the organisms
Carrier
- *ithout symptoms of disease *ho harbors the speci)c agent and may
serve as a source of infection
- *as able to harbor the organisms
-uspect
- medical history suggests development of infection
"atient
- sho*s signs and symptoms of the disease
STAGES OF INFECTION
! Incubation
It doesnt mean na kung
exosed ka sa causati!e agent"
infected na ka
Reser!oir#
Bod$ of man or anima%
a! 3ntry of microorganism into the body to the onset of signs and
symptoms
(! "rodromal
a! 4nset of non5speci)c signs and symptoms to the appearance of
speci)c signs and symptoms
b! The only stage of the disease6 &Catarrhal'
7! "eriod of Illness8Acme
a! "eak of the disease
b! -peci)c signs and symptoms develop and become evident
9! :ecovery% Convalescence or Decline
a! -igns and symptoms start to abate until the client returns to normal
state of health
EPIDEMIOLOGY
- study of the spread of the disease in the community
"attern of Disease 4ccurrence
! -poradic
a! Intermittent occurrence or on5and5o; presence of a disease
(! 3ndemic
a! Continuous or constant occurrence of a disease in a certain area
7! 3pidemic
a! -udden increase in the number of cases in a short period of time in
a certain area
b! outbreak
9! "andemic
a! 1orld*ide epidemic or global outbreak
INFLAMMATORY PROCESS
! In<ammant
a! Microorganisms
b! "hysical
c! Mechanical
(! 1ould lead to Tissue In+ury
a! =ocal Adaptation -yndrome # it *ill only locali0e the e$perience
b! >eneral Adaptation -yndrome 5 systemic
7! In<ammation
9! .asoconstriction 5 para naay local e$perience
a! 1ould lead to /yperemia # cu0 nacontain ang blood didto sa
locali0ed area
i! :edness8rubor &
st
'
ii! /eat8Calor &(
nd
'
b! 1ould lead to Tissue "ermeability
i! ?luid shifting
ii! 3dema formation due to <uid shifting
iii! -*elling or Tumor &7
rd
'
iv! "ain or Dolor &9
th
' # due to compression of nerve endings
v! =oss of ?unction &@
th
'
GENERAL NURSING CARE
- number one role is to stop transmission &priority'
! "reventive Aspect
a! /ealth 3ducation # increasing the kno*ledge% skills and attitude
b! Immuni0ation # PD 996 &compulsory immuni0ation of all children
belo* age A years old'
c! 3nvironmental -anitation # PD 856 3nvironmental -anitation Code
of the "hilippines2 PD 825 >arbage Disposal =a*2 RA9003
3cological -olid 1aste Management Act2 RA 8749 Clean Air Act2 RA
9275 Clean 1ater Act
i! 1ater -ource
ii! 3$creta Disposal
iii! >arbage Disposal
iv! ?ood /andling
- ?our rights in food handling
a! :ight source
b! :ight preparation
c! :ight cooking
d! :ight storage
V!!"#$
M"#"%&%
A'$
( )*(
D+*$
N&%,
$-
+.
D+*$
*
D+*
$
M"#"%&% I#($-/0
B$(1$$# D+*$*
R+&($ S"($ R$*+#
B!"00&*
C0%$(($2
G&3-"#
,irth or
anytime
after birth

B!B@
m=
55 Intradermal
:ight
deltoid
region of
the arm
,C> given at earliest possible
age protects the possibility of
infections in *hich infants are
prone from other family
members
D"4(5$-"2
P$-(&**"*2
T$(#&*
V!!"#$
C *eeks 7
B!@
m=
9 *eeks
&C
th
*eek # B
th
*eek #
9
th
*eek'
Intramuscu
lar
.astus
lateralis or
Dpper
outer
portion of
the thigh
An early start *ith D"T
reduces the chance of severe
pertussis!
O-0 P+0"+
V!!"#$
C *eeks 7
(
drop
s
9 *eeks
&C
th
*eek # B
th
*eek #
9
th
*eek'
4ral Mouth
The e$tent of protection
against polio is increased the
earlier the 4". is given!
Eeeps the "hilippines polio5
free!
H$4("("* B
V!!"#$
At birth 7
B!@
m=
C *eeks interval from
st dose to (nd dose%
A *eeks interval from
(nd dose to third dose!
&At birth # Cth *eek # 9th
*eek'
Intramuscu
lar
.astus
lateralis or
Dpper
outer
portion of
the thigh
An early start of /epatitis ,
vaccine reduces the chance of
being infected and becoming
a carrier!
"revents liver cirrhosis and
liver cancer *hich are more
likely to develop if infected
*ith /epatitis , early in life!
About F%BBB die of
complications of /epatits ,!
BG of ?ilipinos have /epatitis
, infection
M$*0$*
V!!"#$
F months B!@
m=
55 -ubcutane
ous
.astus
lateralis
Dpper
At least A@G of measles can
be prevented by immuni0ation
at this age
(not MMR)
outer
portion of
the thigh
TT
Deltoid
region of
the upper
arm
Ma$imum Transport:
:/4 &7 months' # "/4 &7 months' # D/4 & month'
Most sensitive to heat:
4".% AM. &so ibutang sa free0er2 tempH5@ to 5(@IC
"lace sa body: ,C>% /epa% D"T
(! =evels of "revention
a! "rimary
i! /ealth promotion8speci)c protection
ii! Target: *ell clients &prepathogenic'
iii! Aspects: >eneral health promotions &health education'%
-peci)c "rotection &Immuni0ation'%
"rimordia% "revention &elimination of risk factors'
b! -econdary
i! 3arly diagnosis8"rompt Treatment
ii! Target: 3arly -ick &p*edeng hindi pa alam'%
"athogenic%
Asymptomatic &best *ay to treat kay early pa ang
infection'
iii! Aspects: 3arly Detection &-creening% case )nding% determining
and identifying signs and symptoms' and prompt treatment
&to prevent complication'
c! Tertiary
i! :ehabilitation
ii! Target: =ate -ick% symptomatic and pathogenic% at
Convalescence -tage na
iii! Aspects: :ehabilitation%
"revention of ?urther Disability%
"revention of permanent damage
7! Control Aspect
a! Isolation
i! -eparation from the period of communicability of infected
persons from other persons *ho are susceptible
ii! ,est time to do isolation techniJue: During period of
communicability
b! Kuarantine
i! Complete Kuarantine
- limitation of freedom of movement of person e$posed to
communicable diseases during the longest incubation
period
ii! Modi)ed Kuarantine
- selective partial limitation of freedom
c! -urveillance
i! Monitoring
ii! Close supervision of contacts *ithout restriction of their
movement
d! Disinfection
i! Eilling a pathogenic agent by chemical or physical means
e! ?umigation
i! Eilling of animal forms by gaseous agent
f! Medical Asepsis
i! >loving% go*ning and hand *ashing% eye shield% eye goggles
ii! Dsing barriers
9! -tandard "recaution
a! Correlates *ith Dniversal "recaution
i! All patients are considered infectious
b! ?ocused on use of protective barriers
i! Interrupting transmission
c! Added Airborne% Contact and Droplet routes as categories of
precautions
@! /and /ygiene
a! Most e;ective means of preventing the spread of disease
b! 3lements:
i! ?riction
ii! -oap
iii! 1ater
c! ,efore and after contact
C! ,arrier "rotection
a! >loves # protect hands from being e$posed to blood and body
secretions or *hen you are touching an instrument e$posed to blood
or any secretion
b! >o*n # protect the body from accidental splashing or splattering of
blood
c! 3ye *ear # eye shields to protect the eyes
d! ?ace shield # especially if there is an outbreak2 protect mouth% eyes%
nose
e! Mask # protect nose and mouth2 airborne and droplet precaution
&*ithin 7 feet from patient'
f! Isolation
L! Transmission ,ased "recaution
a! Airborne precaution # mask NF@2 less than @ micron or smaller &e$
T,'
b! Droplet "recaution # mask2 larger than @ micron particles &e$
coughing% snee0ing'
c! Contact "recaution # if there is direct and indirect
-trict # highly transmissible diseases by direct contact and airborne routes
of transmission
:espiratory # droplet transmission
T, # suspected8active T, patients
Contact # infectious diseases or multiple resistant microorganisms that are
spread by close or direct contact
P-"/($
R++%
H#61*
5"#'
G0+/"#' G+1#"#' M*7
-trict 8 8 8 8 8
:espirator
y
8 8 8 8
T, 8 8 8
Contact 8 8 8 8 8
3nteric 8 8
Drainage 8 8
Dniversal 8 8 8 8
CENTRAL NERVOUS SYSTEM
TETANUS 8 L+!7291
! De)nition
a! An infectious disease *hich produces potent e$oto$in *ith
prominent neuromuscular e;orts
(! 3tiologic agent
a! Clostridium tetani
7! Incubation "eriod
a! 7 days to 7 *eeks # adult
b! 7 to 7B days # neonate
9! -ource of Infection
a! ?eces% soil% dust% rusty materials
@! Mode of Transmission
a! Direct inoculation through punctured *ound
C! Avenues for entrance of organisms
a! :ugged traumatic *ound or burns
b! Dmbilical stump
c! Dnrecogni0ed *ound
d! Dental e$traction% ear piercing% circumcision
L! -igns and -ymptoms
a! -pasm and tightening of the +a* muscle
b! Trismus # prolonged spasm of the masseter
c! :isus sardonicus # spasm of the facial muscle
d! 4pisthotonus # arching of the back2 a;ecting muscles of the back
holding the spine
e! -*allo*ing diMculty
f! /and or foot spasm
g! "ain
h! Dncontrolled urination or defecation
A! "athophysiology
a! 3ntry via open *ound
b! ,acterial proliferation
c! Immune response &increased body temperature'
d! ,acteria is reached after successful proliferation
e! -ecretion of to$ins
f! Tetanolysin &destruction of rbc'
g! -pasms of muscles
i! ?acial muscle # risus sardonicus
ii! Masseter # trismus
iii! -pine # opisthotonus
iv! :esp muscles # dyspnea% chest heaviness
v! >DT # urinary retention
vi! >IT # constipation
vii! Abdomen # abdominal rigidity
viii! 3$tremity # robot gait
F! Modalities of Treatment
a! Antito$in
b! "enicillin >
c! -urgical e$ploration and cleaning of *ound
d! Muscle rela$ant
e! 4$ygen inhalation
f! N>T feeding # to facilitate proper nutrition
g! Tracheostomy # pag severe na +ud
B! Nursing Mgt
a! ,edrest *ith non5stimulating environment
b! AdeJuate air*ay
c! 3levate head
d! 3Mcient *ound care
e! Avoid contractures% pressure sores% urinary retention
f! 4ptimum comfort measures
! "revention and Control
a! Active immuni0ation *ith tetanus to$oid for adults
b! Tetanus to$oid # @ doses
c! D"T immuni0ation for babies and children
d! 3arly consultation and adeJuate *ound care after an in+ury
Additional Notes:
Tetanospasm # muscle spasm
Clostridium tetani # anaerobic2 gram5positive2 drumstick appearance
-ource of tetanus infection in a neonate # umbilical stump or cord
V!!"
#$
M"#"%&%
A'$8I#($-/0
P$-!$#(
P-+($!($6
D&-("+# +. P-+($!("+#
TT
As early as
possible
during pregnancy
55
primary dose2 given as early in pregnancy as possible2 not given at
)rst trimester because it has a teratogenic e;ect that *ould lead to
deformity2 starting @
th
or C
th
month of pregnancy
TT(
At least 9 *eeks
later
ABG
infants born to the mother *ill be protected from neonatal
tetanus
gives 7 years protection for the mother
TT7
At least C months
later
F@G
infants born to the mother *ill be protected from neonatal
tetanus
gives @ years protection for the mother
***booster dose
TT9
At least year
later
FFG
infants born to the mother *ill be protected from neonatal
tetanus
gives B years protection for the mother
***booster dose
TT@
At least year
later
FFG
gives lifetime protection for the mother
all infants born to that mother *ill be protected
***booster dose
MENINGITIS :AKA C$-$,-+*4"#0 F$/$-;
! De)nition
a! In<ammation of the meninges of the brain and spinal cord
(! 3tiologic agent
a! Neisseria meningitidis
7! Incubation "eriod
a! ( to B days
9! -ource of Infection
a! :espiratory droplets
b! Direct invasion
@! -igns and -ymptoms
a! -evere headache
b! -ti; neck
c! Dislike of bright lights
d! ?ever8vomiting &pro+ectile'
e! Dro*sy and less responsive8vacant &decrease level of
consciousness'
f! :ashes &develops any*here on the body'
g! ,rud0inskiNs -ign # automated re<e$ of the hips and knees *hen a
patientOs neck is <e$ed for*ard *hile lying do*n
h! EernigNs -ign # -evere sti;ness and pain of the hamstrings causes
an inability to straighten the leg *hen the hip is <e$ed to FB
degrees

C! "athophysiology
a! 3ntry of causative agent to the respiratory tract
b! -8-$ of Dpper :espiratory Tract Infection
i! Cough% cold% fever% sore throat
c! ,loodstream% crossing blood brain barrier
d! Meninges: in<ammatory response
i! Nuchal rigidity # neck sti;ness
ii! EernigNs sign
iii! ,rud0inskiNs sign
e! Decreased <o* of C-?
f! Increased IC"
i! Mannitol # decrease IC"2 osmotic diuretic
ii! There is severe headache
iii! "ro+ectile vomiting
iv! 1idening of pulse pressure
L! Diagnostic 3$am
a! =umbar "uncture *ith C-? glucose measurement and C-? cell count
b! >ram stain and culture of C-?
c! /ead CT -can
A! Modalities of Treatment
a! Antibiotic Therapy
b! Mannitol # nursing responsibility: monitor urine output8 IP4
assessment
c! Anticonvulsants # priority: safety8sei0ure precaution% siderails up
d! Acetaminophen
F! Nursing Management
a! :espiratory isolation
b! Assess neurologic condition
c! Monitor <uid balance
d! "osition patient carefully # elevate head
e! Eeeping e$traneous noise to minimum # to avoid sei0ures
f! 3nsure patientNs comfort
ENCEPHALITIS :AKA B-"# F$/$-;
! De)nition
a! Acute in<ammatory condition of the brain
(! 3tiologic agent
a! Arboviruses
7! Incubation "eriod
a! @ to @ days
9! Mode of Transmission
a! Transmitted to humans by bite of an infected mosJuito
@! -igns and -ymptoms
a! ?lu5like -ymptoms &prodromal'
i! Chills
ii! /eadache
iii! ?ever
iv! Nausea
v! .omiting
b! Neurologic Manifestations
i! Confusion
ii! Dro*siness
iii! -ti; neck
iv! -ei0ures
v! "hotophobia
C! Classi)cation
a! 3astern 3Juine # horse and children belo* 9 years old
b! Qapanese # @ to B years old
c! -econdary 3ncephalitis
i! "ost5infection encephalitis
ii! viral infection )rst occurs else*here in your body and then
travels to your brain
L! "athophysiology
a! Causative agent reaches brain
b! Activation of the in<ammatory process
c! =ymphocytic in)ltration of brain tissues
d! Cerebral edema
e! Degeneration of the brain ganglion cells
f! Di;used brain cell destruction
A! Diagnostic 3$am
a! =umbar puncture test
i! C-? <uid
ii! C-? test
iii! ?etal or shrimp position bet*een =9 and =@
b! -erology tests
c! 33>
d! ,rain M:I
e! CT scan of the head # to check for in<ammation of the head
F! Nursing Management
a! -ymptomatic and supportive
b! Control of convulsions
c! T-,
d! Dnless comatose% oral <uid should be encouraged
e! 4bserve for neurologic signs
MENINGOCOCCEMIA
! De)nition
a! Acute infection of the bloodstream and developing vasculitis
(! 3tiologic agent
a! Neisseria meningitidis
7! Incubation "eriod
a! 7 to 9 days
9! Mode of Transmission
a! :espiratory droplets
b! Eissing distance
c! Direct contact *ith discharges from the nose and throat *hich
contain the bacteria
d! -ecretions of the nose% mouth and throat propelled through
coughing% snee0ing and kissing
e! Through saliva &spit' *hen sharing items such as food or drinks%
cups% utensils and drinking stra*s
@! 1ho is considered close contactR
a! Those *ho live in the same house
b! Those *ho have kissed the infected person
c! Those *ho share bed
d! Children in daycare center
e! -haring drinks% cigarette% lipstick% etc
C! -igns and -ymptoms
a! ?ever
b! .omiting
c! Cough and sore throat
d! -ti; neck
e! Convulsion
f! Delirium
g! "inpoint rashes then become *ider and appear like bruises starting
on the legs and arms
h! -evere skin lesions may lead to gangrene
i! Acute vasculitis
i! 1aterhouse5?riderichsen -yndrome
- combination of dermal manifestations and adrenal
medullary hemorrhage
- development of petechial spots in association *ith
shock
ii! ?ulminant Type
- short course and usually fatal
L! "reventive Measures
a! /and *ashing
b! Avoid close contact
c! Increase resistance by having healthy diet% regular e$ercise% healthy
lifestyle
d! Maintain clean environment
e! Avoid sharing utensils% cups% etc
f! Avoiding cro*ded areas
g! Do not self medicate unless directed by doctors
Additional Notes:
- Most common among children C months to @ years
- Most devastating form of meningococcemia is fulminant
meningococcemia *hich consists of hemorrhagic episodes
POLIOMYELITIS
! De)nition
a! Acute infectious disease characteri0ed by the changes in the CN-
*hich may result in pathologic re<e$es% muscle spasm% paresis or
paralysis% more on the lo*er e$tremities
(! 3tiologic agent
a! =egio debilitans
7! Incubation "eriod
a! L to 9 days
9! "eriod of Communicability
a!
st
7 days to 7 months of illness
@! Mode of Transmission
a! Contact transmission
C! Clinical ?eatures
a! Acute onset% <accid paralysis
b! ?ever present at onset
c! No progression after (57 days
d! Asymmetric
e! =egs a;ected most often
f! Mortality rate @ to BG
g! "ermanent paralysis
L! Types
a! Abortive Type
i! 1as e$posed% able to harbor but di nagtuloy ang sakit
b! "re5paralytic
i! To bloodstream
c! "aralytic
i! To CN-
A! -igns and -ymptoms
a! Nasopharyn$
i! tonsilitis
b! Mouth
i! "eyerNs patches
c! Cervical =ymph Nodes
i! -evere muscle pain
ii! /ayneNs sign # head drop
iii! "okerNs sign # opisthotonus *ith head retraction
iv! ?laccid paralysis # soft% <abby% limp
d! CN-
i! "aralysis
F! Diagnostic 3$am
a! .irus isolation from throat *ashings or s*ab
b! -tool culture throughout the disease # kung nagtravel sa >I
c! Culture from C-?
B! Most commonly a;ected parts
a! Muscles that straighten or bend hip
b! Muscles that straighten knee
c! -houlder muscles
d! Muscles behind the arms
e! Muscles that lift the food
! Modalities of Treatment
a! Analgesics
b! Morphine # pain reliever
c! Moist heat application
d! 3ncourage bed rest
e! :ehabilitation # because of permanent paralysis
(! Nursing Management
a! 3nteric isolation
b! 1atch out for signs and symptoms of paralysis
c! Check ," regularly
d! 14? signs of fecal impaction
e! /ot packs
f! Dispose e$creta and vomitus properly
7! Dntreated "olio "atient
a! Kuadriplegic "atient
b! -evere "aralysis
c! Cra*ling
d! "atient Dragging ?lail =o*er =imbs
e! All ?ours
f! Crouching >ait
9! "revention
a! Immuni0ation
b! "roper disposal of >IT secretions
c! 3nteric isolation
d! -anitation
e! Avoid overcro*ding
RABIES :AKA L<**;
! De)nition
a! Acute viral infection communicated to man by the saliva of an
infected animal
(! 3tiologic agent
a! :habdovirus
7! Incubation "eriod
a! ( to A *eeks # rabid animals
b! B to ( days 5 man
9! "eriod of Communicability
a! 7 to B days before onset of symptoms
@! Mode of Transmission
a! ,ite of an infected animal
C! Clinical Manifestations
a! Animals
i! 1ithdra*n and Juiet
ii! Manic behavior
iii! Dumb -tage: complete change in position
iv! ?urious -tage: easily agitated% )erceful look% drooling of saliva
b! /umans
i! Invasive -tage
! numbness of the bite site
(! <u5like symptoms
7! insomnia
9! restless% irritable% apprehensive
@! slight photosensitivity
ii! 3$citement -tage
! aerophobia% hydrophobia
(! manic behavior
iii! "aralytic -tage
! spasms stop
(! paralysis starts from the toes
7! death *ithin (9 to L( hours
L! "athophysiology
a! :ahbdo virus enters
i! "eripheral Nerves
ii! CN- &negri bodies' e$cept cerebrum
b! 3;erent Nerves
i! -alivary >land &drooling of saliva'
A! Diagnostic 3$am
a! Isolation of virus from patientNs saliva or throat
b! ?luorescent :abies Antibody # provides the most de)nitive diagnosis
c! "resence of negri bodies in the dogNs brain
F! Nursing Management
a! Isolation
b! 4ptimum comfort
c! Darken room and Juiet environment
d! No running *ater
e! Concurrent and terminal disinfection
B! "revention and Control
a! .accination of all dogs # at 7 months
b! "icking up of astray dogs
c! Con)nement for B to 9 days of any dog that has bitten a person
d! =aboratory facilities
e! "ublic education
Additional Notes:
- 3very B to @ minutes somebody dies of rabies in the *orld
- In most instances dog
- 1arm5blooded animals susceptible
- ,rain biopsy is a diagnostic test
- .irus: ,ullet5shaped )lterable virus% has strong aMnity to the CN-%
sensitive to sunlight
RESPIRATORY SYSTEM
DIPHTHERIA
! De)nition
a! Acute infectious disease that can infect the throat and skin
(! 3tiologic agent
a! Corynebacterium diphtheriae &Eleb5=oeSer bacillus'
7! Incubation "eriod
a! ( to @ days
9! "eriod of Communicability
a! ( to 9 *eeks
@! -ource of Infection
a! Discharges from nose% pharyn$% eyes or lesions
C! Mode of Transmission
a! Contact
L! Types
a! Nasal
i! ,loody discharge from the nose
ii! 3$coriated nares and upper lip
iii! 3nlarged cervical and sub ma$illary gland
b! Tonsilopharyngeal
i! ?ever
ii! -ore throat
iii! "seudomembrane:
- )brinous% dirty gray and foul5smelling
iv! T,ull5neckU appearance
v! Death occurs from to$ic myocarditis or bronchopneumonia
c! =aryngeal
i! Increasing hoarseness
ii! Croupy cough
iii! Aphonia
iv! Cyanosis
v! Diaphoresis
vi! Death due to su;ocation
vii! Management: lo* tracheostomy to establish air*ay
d! 1ound or Cutaneous Diphtheria
i! Vello* spots or sores in the skin
A! Complications:
a! Myocarditis
b! ,ronchopneumonia
c! Air*ay obstruction
d! Nose bleeding
F! -igns and -ymptoms
a! "seudomembrane
b! T,ull NeckU appearance
B! Diagnostic 3$am
a! -*ab from nose and throat and other suspected lesions
b! -chickNs Test: determines susceptibility and immunity to diphtheria
c! MaloneyNs Test: determine hypersensitivity to diphtheria anti5to$in
! Nursing Management
a! "enicillin # broad spectrum antibiotic
b! Anti5to$in
c! 3rythromycin
d! Nutrition
e! ,ed rest
f! Tracheostomy
g! Isolation for minimum of 9 days from onset of the disease until
three cultures from nose and throat are negative
Additional Notes:
- bacteria destroyed by heat
PERTUSSIS
! De)nition
a! A highly contagious disease characteri0ed by repeated attacks of
spasmodic coughing
(! 3tiologic agent
a! ,ordetella pertussis
7! Incubation "eriod
a! L to ( days
9! "eriod of Communicability
a!
st
( *eeks of the disease
b! Dp to 7 *eeks
c! Catarrhal period of the disease
@! -ource of Infection
a! -ecretions of nose and throat
C! Mode of Transmission
a! Direct contact
b! Droplet
L! -igns and -ymptoms
a! Catarrhal -tage
i! Most communicable
ii! =asts for one to t*o *eeks
iii! Cory0a% snee0ing% lacrimation
iv! Dry% bronchial cough
v! Cough becomes irritating% hacking% nocturnal and more severe
b! "aro$ysmal -tage
i! Cough becomes spasmodic and recurrent
ii! 1ith e$cessive e$plosive outburst in series
iii! 3nds *ith loud% cro*ing inspiratory *hoop
iv! Choking on mucus causes vomiting
v! ?ace becomes cyanotic
vi! Accompanied by profused s*eating% involuntary urination and
e$haustion
vii! "rovoked by crying% eating% drinking or physical e$ertion
viii! =asts 9 to C *eeks
c! Convalescent -tage
i! >radual decrease in paro$ysms
ii! After si$ *eeks% the attack subsides
A! Diagnostic 3$am
a! Nasopharyngeal s*abs
b! -putum culture
c! C,C
F! Nursing Management
a! Antibiotics
b! ?luid and electrolyte replacement
c! Nutrition
d! 4$ygen therapy
e! Isolation
f! ,ed rest
g! 1arm baths
TUBERCULOSIS
! De)nition
a! ?ormation of tubercles in lung tissues *hich undergo caseation%
necrosis and calci)cation
b! EochNs Disease
(! 3tiologic agent
a! Mycobacterium tuberculosis
b! Mycobacterium africanum # pag human type
c! Mycobacterium bovis # kung sa cattle
7! Incubation "eriod
a! ( to B *eeks
9! "eriod of Communicability
a! Dntil capable of discharging the organism
@! -ource of Infection
a! -putum% nasal discharge% saliva
C! Mode of Transmission
a! Airborne method
b! Droplet
L! -igns and -ymptoms
a! Cough
i! 3arly stage # dry
ii! "ag nagdevelop na 5 productive
b! Afternoon fever
c! 1eight loss
d! ,lood strained sputum
e! Night s*eats
f! Chest pain
g! /emoptysis
A! Diagnostic 3$am
a! Chest W5ray
i! To determine e$tent or severity of lung a;ectation
b! Mantou$ Test
i! ""D
! ID
(! gaga*a nang *heal
7! best time to interpret results: 9A to L( hours
9! after L( hours% titingnan ang induration and measure
@! positive kung Bmm% kung foreigner and also sa mga
immunosuppressed na patient @mm positive na
c! -putum smear and culture e$amination
d! ,ronchoscopy% lavage and tissue biopsy
e! Direct -putum -mear Microscopy
i! 7 times for 7 consecutive days
ii! 3arly in the morning8upon a*akening
iii! Di p*ede mag toothbrush
iv! Dili p*ede mag gargle nang mouth*ash
v! 4nly plain *ater
vi! 1ho is only allo*ed to perform D--MR
! Medical technologist
(! in the absence of med tech: ,arangay /ealth 1orker
only *ith proper training and supervision
vii! dili p*ede pag mag hemoptysis ang client% only pag *ala nay
episodes sa hemoptysis
F! Modalities of Treatment
a! Anti5T, chemotherapy
i! 7 to 9 drug regimen
B! T, "revention
a! ,C>
Additional Notes:
- Categori0ation
- Multi5Drug Therapy
! ( phases:
Intensive
Maintenance
(! :I"3-
- Combination drug
- :ifampicin% Isonia0id% "yra0inamide% 3rythromycin%
-ulfonamide
CATEGORY D$*!-"4("+# I#($#*"/$ M"#($##!$ R$%-7*
I
&X' --% &X'
CW:
:I"3
&( months'
:I
&9 months'
Eung &X'% plus
month pa
II :elapse
:I"3-
&7 months'
:I3
&@ months'
Eung &X'% plus
month pa
III &5' --% &X' CW:
:I"3
&( months'
:I
&9 months'
Eung &X'% plus
month pa
IV Chronic
:efer to any D4T- Center immediately!
"rimary element of D4T-: "olitical 1ill8"olitical
Commitment
BIRD FLU
! De)nition
a! ?lu infection in birds that a;ects humans
(! 3tiologic agent
a! Avian in<uen0a &AI' virus
7! Incubation "eriod
a! ( to 9 days
9! Mode of Transmission
a! /andling infected bird
@! 1hat is ,ird ?luR
a! Contagious disease of birds
b! /@N virus # can also cause severe infections in humans
c! ,ird <u can cause death to almost% if not all poultry infected by the
/@N in<uen0a virus
d! .irus can cause serious and fatal disease in humans
e! ,ird <u can enter the country through smuggling of infected birds
f! Migratory birds may carry the virus to our country
C! /o* is ,ird ?lu Transmitted to 4ther ,irdsR
a! Direct contact *ith discharges of infected birds% especially feces and
respiratory secretions
b! Contaminated feed% *ater% cages% eJuipment% vehicle% clothing
c! -ea and migratory birds may introduce the virus into <ocks
d! ,roken contaminated eggs may infect chicks in the incubator
L! /o* Transmitted to /umansR
a! Close contacts *ith infected birds
b! Through inhalation or contamination *ith infected discharges or
feces of infected birds
c! The feces *ith the virus dries up% become pulveri0ed and can be
inhaled
d! ?lapping of *ings of sick bids can hasten transmission
e! 4ne does not get bird <u from thoroughly cooked chicken meat
f! No evidence of transmission of the virus to humans from ra*% chilled
or fro0en poultry
A! -igns and -ymptoms
a! In Chickens
i! 1eakness
ii! ?ever% snee0ing and cough
iii! Diarrhea
iv! 3$cessive thirst
v! ?acial edema and s*elling
vi! Cro*n and *attle turn purple
vii! :uSed feathers
viii! -udden death
i$! Drastic decline in egg production
b! /umans
i! ?ever
ii! Cough
iii! ,ody *eakness or muscle pain
iv! -ore throat
v! DiMculty of breathing &in severe cases'
vi! -ore eyes and diarrhea may be present
F! 1hat to do *ith a person suspected to have bird <uR
a! "lace patient in an area a*ay from other persons% like in a separate
room or a covered or shaded area
b! "lace a face mask on the patient
c! "rotect oneself by using face mask and eye goggles8glasses
d! Eeep a distance of meter from the patient # dapat more than 7
feet from patient
e! Transport the patient to a D4/ referral hospital
B! :eferral /ospitals
a! National :eferal Center # :esearch Institute for Tropical Meidcine
b! =u0on # -an =a0aro /ospital
! Modalities of Treatment
a! Treatments are the same as for other in<uen0a virus
b! Antiviral drugs% such as 4setalmivir &Tami<u' halts of the illness is
given *ithin the )rst ( days from the onset of fever
c! -amples of /@N from human infections proved resistant to anti5
viral medications amantadine and rimantadine
(! D4/ ACTI4N-
a! 4"=AN -9 .- ,I:D ?=D
i! -tructure
! re5activate -ars structure and system
(! close coordination *ith ,AI at all levels
ii! -urveillance
! issue guidance for enhanced surveillance
(! strengthen laboratory capacity
iii! -tatements to the "ublic
! disseminate fact sheets8*ebsite
(! +oint statements from D4/ and DA
7! press conferences
iv! -upplies
! inventory of vaccines8antivirals
Additional Notes:
/ongkong in FFL # place *here the )rst AI virus infected a human
SARS
! De)nition
a! A ne* type of atypical pneumonia that infects the lungs
(! 3tiologic agent
a! Corona virus # can survive sa surface for 9 hours
7! Incubation "eriod
a! ( to 7 days
9! Mode of Transmission
a! Droplet
@! -igns and -ymptoms
a! /igh grade fever &Y7A degrees Celsius'
b! Muscle aches
c! Chills and shaking
d! Cough
e! /eadache
f! Di00iness
g! "roductive cough
h! -ore throat
i! :unny nose
C! >lobal Alert% >lobal :esponse
a! >uangdong% China # initial cases appear
b! /ongkong and .ietnam # outbreak as severe form of pneumonia
*ere reported
L! ,ackground
a! A signi)cant number of cases have been in health care *orkers and
household contacts
b! A;ects all age groups% highest number of deaths have been among
people *ith pre5e$isting chronic conditions
A! Infectious Agent
a! A ne* member of the corona virus family
b! Able to survive inanimate ob+ects for up to 9 hours
c! Can be killed by e$posure to unltra5violet light
d! Mutate easily
e! =o* infectivity # infectivity is the ability of a virus to +ump from one
person to another
f! /igh virulent # virulence is the property of the virus to cause
damage to the patientNs organs
g! Transmitted through droplet spread to as far as one meter or
roughly three feet a*ay
F! /ost
a! Civet cats
B! "athophysiology
a! -A:- virus enters the body
b! @
th
or C
th
day% chest $ ray *ill sho* a *hitening of the lung tissue
c! 4ver the ne$t fe* days% in<ammation spreads and the lung tissue
s*ells! Millions of tiny air sacs in the lungs )ll *ith <uid% *hite blood
cells and other debris!
d! -*ollen tissue surrounding the alveoli collapses the <uid5)lled sacs%
impairing the C4( and 4( e$change
e! ,y the (
th
day% the patient becomes hypo$ic% patient dies of lung
failure
! Modalities of Treatment
a! No treatment
b! 3arly detection to improve chances of recovery
c! No vaccines available
d! Can use steroids since there is in<ammation
e! >eneric anti5virals can be used
f! Antibacterial # to recover secondary bacterial infections% together
*ith antiviral and anti5in<ammants
g! "ersonal "rotective 3Juipment # NF@ mask% goggles% shoe cover%
gloves% plastic apron
(! "revention
a! Maintain good personal hygiene
b! Adopt a healthy lifestyle
c! -trict observance of preventive measures among health personnel
d! Do not spit
e! 1ash hands al*ays *ith soap freJuently
f! -erve meals *ith serving spoon para *alang transfer nang saliva
g! Avoid touching your mouth% nose% etc
h! Automatic consult doctor kung naa signs and symptoms
i! 3nsure good ventilation &open *indo*s at all times'
+! Avoid visiting cro*ded areas
k! 1hen traveling on public transport% open *indo*s *henever
possible
l! AdeJuate rest
m! :educe stress
n! A balanced diet
o! Avoid smoking or alcohol consumption
p! Intake of vitamins
Additional Notes:
March (% (BB7 # )rst 1/4 alert
PNEUMONIA IMCI
SIGNS CLASSIFICATION TREATMENT
*DAN>3: -I>N
*-tridor
*C/3-T IND:A1IN>
*.3:V -3.3:3 DI-3A-3
*-3.3:3 "N3DM4NIA
*?irst dose of ANTI,I4TIC
YClotrimo$a0ole

*.IT A
YBB%BBB ID
*,reast Milk8-ugar
*Drgent :3?3::A=
*Cough
*?A-T ,:3AT/IN>
Z( mos: [ CB
( mos # less than
yo: [@B
yo # @ yo: [9B
*"N3DM4NIA *ANTI,I4TIC 5 DAYS
Y ( mos to Z yo: @ml
Y to Z@yo: Bml
F+- !+&'5=
! ,reastfeeding
(! -=E
Ysampalok
Yluya
Ykalamansi
*?4==41 D" 2 DAYS
*-peci)c Treatment
*C4D>/ AND C4=D *N4 "N3DM4NIA: Common
cough or cold
:elieve cough *ith safe
remedy
*C4D>/ Y7B DAV-H
REFER
*C4NDITI4N N4T
IM":4.3H FOLLO> UP
5 DAYS
! \ problems among acute respiratory problems% *hich could lead to
death among children
(! Ma+or factor that leads to death of children having "neumonia: MotherNs
failure to recogni0e the signs and symptoms of pneumonia
7! 1hat should the nurse do *hen having contact *ith client having
pneumonia: Ask% =ook and =isten &Assessment by asking'
9! A>3 # important to ask sa child
@! -teps
a! ?ocused Assessment: &Integrated approach'
i! Danger signs
ii! Main symptoms
iii! Nutritional status
iv! Immuni0ation status
v! 4ther problems
b! Classi)cation
i! Drgent :eferral &pink'
! "ag may danger sign
(! Drgent referral sa hospital
7! indicates severe disease
ii! -peci)c treatment &Vello*'
! May sakit ang bata% *alang danger sign
(! -aan ginaga*aR /ealth Center
iii! /ome Management &green'
iv! -a home
! May sakit ang bata% *alang danger
c! Treatment
i! identify treatment plan
d! Counsel and ?ollo*5up
i! Counsel Caretaker
ii! Advise *hen to come back for follo* up check up
C! Danger sign
a! Inability to feed or drink
b! .omits everything
c! Convulsion
d! -leeping abnormality
L! =o*er lip # to stimulate sucking re<e$
A! /o* to kno* if there is sleeping abnormalityR
a! "ag clap nimo% *alay reaction ang bata
F! Altered =evel of Consciousness8=ethargic
a! "ag clap nimo% *ala nakurat% *alay reaction% *ala namilok
B! Main -ymptoms
a! Cough or diMculty breathing # indicates pneumonia
b! Diarrhea
c! ?ever
d! 3ar problems
! A==
a! Ask: If cough is more than 7B days% refer to hospital
b! =ook: Dapat calm ang bata
i! :: # to establish *hether there is fast breathing
ii! -tridor # adventitious sound% harsher than a *hee0e% heard
upon inspiration8*hen the client breaths in
iii! Chest indra*ing # if there is retraction or subcostal retraction
GASTROINTESTINAL TRACT
AMOEBIASIS
! De)nition
a! A proto0oal infection of the bo*el
(! 3tiologic agent
a! 3ntamoeba histolytica
7! Incubation "eriod
a! 7 to 9 *eeks8( to (A *eeks
9! "eriod of Communicability
a! ?or the *hole duration of illness
@! -ource of Infection
a! /uman e$creta
C! Mode of Transmission
a! 4ro5fecal route or ?ecal54ral :oute
b! Direct and indirect contact
L! -igns and -ymptoms
a! Acute amoebic dysentery
i! Diarrhea alternated *ith constipation
ii! Tenesmus 5 is a feeling of incomplete defecation! It is
e$perienced as an inability or diMculty to empty the bo*el at
defecation! It is freJuently painful and may be accompanied
by involuntary straining and other gastrointestinal symptoms!
iii! ,loody mucoid stool
b! Chronic amoebic dysentery
i! 3nlarged liver
ii! =arge sloughs of intestinal tissues accompanied by
hemorrhage
c! /epatic forms
i! :DK &:ight upper Juadrant' pain and +aundice &due to
obstruction'
A! "athophysiology
a! ,acteria enters
b! Multiplication in mucosa
c! 3ndoto$ic production
d! Necrosis of mucosal layer
e! Dlceration
f! >angrene
g! To$emia
F! In untreated cases
a! 1atery stools
b! -evere blood5mucoid stools
c! /emorrhage
d! Intestinal perforation
e! "eritonitis
f! Death
B! Diagnostic 3$am
a! -tool e$am
i! If there is causative agent in stool
b! ,lood 3$am
i! Increased 1,C
c! -igmoidoscopy
i! To check for ulceration
! "revention
a! /ealth education
b! -anitary disposal of feces
c! "rotect% chlorinate and purify drinking *ater
d! Cleanliness in food preparation% handling and storage
e! Detection and treatment of carriers &enteric precaution'
f! ?ly control
(! Modalities of Treatment
a! Metronida0ole &?lagyl'
b! Tetracycline # for children
c! Chloramphenicol
Additional Notes:
Infective stage # during cysts stage
3$tra5intestinal amoebiasis% it can spread to: liver% lungs% brain
BACILLARY DYSENTERY :AKA S5"'$00+*"*;
! De)nition
a! Acute infection of the lining of the small intestine
(! 3tiologic agent
a! -higella group
7! Incubation "eriod
a! to 7 days
9! "eriod of Communicability
a! During acute infection until feces is negative for the organism
@! Mode of Transmission
a! ?ecal5oral route
b! 4r through contaminated food and *ater
C! -igns and -ymptoms
a! ?ever
b! /eadache
c! Nausea and vomiting
d! Tenesmus # painful defecation% tidbits ang tae
e! Colicky or cramping abdominal pain
f! Diarrhea *ith bloody mucoid stool
g! Dehydration
h! 1eight loss # pag more than BG% suspect that there is dehydration
L! Diagnostic 3$am
a! ?ecalysis # to determine presence of organisms in stool
b! Isolation of microorganisms from rectal s*ab or culture
c! "eripheral blood e$amination
d! ,lood culture
i! 1,C more than B%BBB &bacterial'
ii! =ess than @BBB &viral'
A! Modalities of Treatment
a! Antibiotics # Clotrimo$a0ole
b! -evere cases: Ampicillin% tetracycline% Cotrimo$a0ole
c! I. infusion of N--
d! =o*5residue diet
F! Nursing Management
a! ?luid and electrolyte balance # P4 Monitoring
b! :estrict food # especially if contraindicated sa sakit2 oily food
promote diarrhea2 dili +apun p*ede ang irritants
c! Concurrent and terminal disinfection
d! "ersonal hygiene
e! "roper disposal of e$creta
Additional Notes:
-higella dystenterai # pinaka infectious
Eung minsan *ithin (9 hours% lumalabas na signs and symptoms!
BOTULISM
! De)nition
a! A paralytic illness caused by a potent e$oto$in
(! 3tiologic agent
a! Clostridium botulinum
7! Incubation "eriod
a! A to 7C hours
9! Mode of Transmission
a! 1ounds # hori0ontal infection
b! Improperly canned or preserved food # if home made% dili sakto
pagka preserve ang food
@! 7 /uman ?orms of ,otulism
a! ?ood5,orne
i! Ingestion of inadeJuately cooked contaminated food
b! 1ound
i! ?ormation of ulcers *ith sharply demarcated edges and a
membranous base
c! Infant
i! /ypotonic infant syndrome
ii! ?eeble cry% depressed gag re<e$% inability to drink
C! Clinical Characteristics
a! Manifest *ithin ( to 7C hours
b! ?irst (9 hours # critical
c! Intial -8-$
i! Dry mouth
ii! -ore throat
iii! 1eakness
iv! .omiting
v! Diarrhea
d! Neurological symptoms
L! Management
a! -upportive care% especially respiratory and nutritional needs
b! ?ood5borne: emetics and gastric lavage
c! 1ound: e$ploration and debridement
d! Infant: supportive care
e! Antibiotics and aminoglycosides
A! "revention and Control
a! /ealth education on proper food preparation% especially home
canning
b! Avoid tasting food from a bulging can or one *ith a peculiar odor
c! -terili0e utensils
d! Do not give honey or corn syrups to infants
Additional Notes:
Classical botulism # food5borne
CHOLERA :AKA E0(+-$;
! De)nition
a! Acute bacterial infection of the small intestine
b! .iolent dysentera
(! 3tiologic agent
a! .ibrio cholerae or eltore
7! Incubation "eriod
a! ?e* hours to @ days
9! "eriod of Communicability
a! During stool positive stage
@! Mode of Transmission
a! ?ecal5oral route
b! Ingestion of contaminated food or *ater
c! ?lies% soiled hands and utensils
C! -igns and -ymptoms
a! Acute% profuse% *atery diarrhea *ith no tenesmus or intestinal
cramping
b! Initial: stools bro*n *ith fecal materials
c! =atter: "ale gray% rice5*ater in appearance *ith ino;ensive% slightly
)shy odor
d! .omiting
e! "oor tissue turgor # because of <uid loss leading to dehydration2 skin
pinch: slo* ang return sa skin
f! 1asher5*omanNs5hand
g! :adial pulses imperceptible
h! Cyanosis
i! /oarseness and aphonia
+! :apid and deep breathing
k! 4liguria # because kino5conserve <uid
l! -hock # because of <uid loss% there is <uid volume de)cit
L! "revention
a! "rotection of food and *ater supply from fecal contamination
b! ,oiling or chlorination of *ater
c! "asteuri0ation of milk
d! -anitary disposal of human e$creta
e! -anitary supervision of food handlers
f! Meticulous hand *ashing
A! Modalities of Treatment
a! 4b+ective: :eplacement of <uids and electrolytes lost
b! Intravenous infusion
c! 4ral rehydration therapy # may use 4resol
d! Antibiotics
i! Tetracycline # drug of choice% especially for children
ii! ?ura0olidone
iii! Chloramphenicol
iv! Cotrimo$a0ole
F! Nursing Management
a! 3nteric isolation
b! Accurate recording of vital signs
c! Accurate measurement of I and 4
d! "ersonal hygiene
e! "roper disposal of e$creta
f! "roper preparation of food
g! 3nvironmental sanitation
Additional Notes:
"osterior pituitary gland # mag signal nga mag drink na
?irst sign of dehydration # thirst
At least (@ meters ang distance sa
@ to B minutes after boiling point # to kill the contaminants
DIARRHEA FROM IMCI
! Dehydration
(! "ersistent or chronic diarrhea # 9 days or more
7! ,lood in the -tool &dysentery'
FOR DEHYDRATION
! Classi)cation
a! -evere
i! ( or more of the follo*ing:
! -leeping abnormality **
(! Inability to feed8drink or thirst
7! -unken eyes &<uid de)cit'
9! "oor skin turgor &skin pinch goes back so slo*'
ii! "lan C # To treat severe dehydration Juickly
! >ive .itamin A BB%BBB ID
(! I. Therapy
a! =: is the solution of choice2
b! "N-- kung *alay =:2
c! BBml8kg
d!
st
7B minutes H 7B ml
e! :emaining minutes H LBml
f! Infants: C hours duration
i!
st
hour H 7B ml
ii! :emaining @ hours H LBml
g! Children: 7 hours duration
h! To be started *ithin 7B minutes
i! Eung hindi na start *ithin 7B minutes% give 4resol
per N>T
+! If *ala na insert ang tube% give 4resol per orem
k! >aga*in sa health center until ma reach ang
hospital for Drgent :eferral
b! -ome Dehydration
i! Manifestation:
! :estless% Irritable
(! -unken eyes
7! "oor skin turgor
ii! "lan ,
! >ive oresol
a! ( rehydration solution packs
b! Eung *alay rehydration solution% make home
made rehydration solution: &A' available for (9
hours
i! liter of boiled *ater
ii! A tsp sugar
iii! tsp salt
c! (
i! liter of boiled *ater
ii! ( pinch of sugar
iii! pinch salt
(! 1eight
a! Determine *eight in kg W L@ H ml to be given to
the child
b! To be given for 9 hours
c! Eung dili p*ede ang *eight% determine age of
child
7! Age
a! Z 9 mos H (BB to 9BB ml
b! 9 mos to Z year old H 9BB to LBB ml
c! to Z ( yo H LBB to FBB ml
d! ( yo to Z@ yo H FBB to 9BBml
9! Teach mother ho* to give 4resol: through freJuent sips
from a cup
@! 1hat if the child vomits: -top and *ait for B minutes
and continue feeding
C! If child *ants to breastfeed: Allo* to do so
L! 1hen to stop feeding:
a! "u;y eyelids or periorbital edema # signs of
overhydration
A! After 9 hours% reassess the child
F! 1hat to feed to the child:
a! If purely breastfed # oresol
b! If not purely breastfed # food based <uid
i! -oup
ii! :ice *ater
iii! ,uko +uice
c! No dehydration
i! Not in pink% not in yello*
ii! Nagtatae% no other signs and symptoms
iii! "lan A &.olume per volume <uid replacement''
! >ive e$tra <uids
a! If child is up to ( years old H @B to BBml
b! ( years up to @ years old H BB ml to (BB ml
(! -tart feeding the child
a! "urely breastfed # oresol
b! Not purely breastfed # food based <uid
7! "ag nibalik ang danger signs% balik agad sa health
center
d! -evere% "ersistent diarrhea
i! "ersistent diarrhea% 9 days or more
ii! "lus dehydration
iii! Treatment: Dehydration% "lan C
iv! >ive .itamin A BB%BBB ID
v! "ink
e! "ersistent Diarrhea
i! Manifestation:
! "ersistent diarrhea
(! *ithout dehydration
ii! Treatment
! advise feeding
(! give vitamin A
iii! ?ollo* up in @ days
iv! Vello* card
f! Dysentery
i! Manifestation
! ,lood in stool
ii! Treatment:
! Antibiotic
a! ,acillary -higgellosis
i! Cotrimo$a0ole
ii! Nalidi$ic Acid
b! .iolent
i! Tetracycline
! (@B mg8cap
(! 9$8day for 7 days
7! 9 months to Z year old H ]
9! Y yo to @ yo H cap
ii! Cotrimo$a0ole
(! >ive .itamin A
iii! Vello*
INTEGUMENTARY SYSTEM
CHICKENPO?
! De)nition
a! Characteri0ed by vesicular eruptions on skin and mucous membrane
b! Centrifugal &starts from trunk% palabas'
(! 3tiologic agent
a! .aricella 0oster virus
7! Incubation "eriod
a! ( to 7 *eeks &7 to L days'
9! "eriod of Communicability
a! day before eruption of )rst lesion and C days after appearance of
)rst crop or C days after crusting
@! Mode of Transmission
a! Airborne or droplet
b! Direct contact
c! Indirect contact
C! Complication
a! -econdary infection
b! Meningoencephalitis
c! "neumonia
d! -epsis
e! /emorrhagic varicella
L! -igns and -ymptoms
a! "re5eruptive -tage &"rodromal -tage'
i! ?ever
ii! Malaise
b! 3ruptive -tage
i! :ashes starts from trunk
ii! Initial lesions: red papules
iii! Contents of lesions become milky and pus5like *ithin 9 days%
<uid5)lled vesicles
iv! "ruritus
A! "athophysiology
a! Macule
b! "apule
c! ?luid5?illed .esicles
d! Crusting
F! Modalities of Treatment
a! ^ovira$
b! Acyclovir
c! 4ral antihistamine
d! Calamine lotion # or baking po*der paste for pruritus
e! Antipyretic
B! Nursing Management
a! -trict isolation
b! "revention of secondary infection
c! "roper disposal of secretions and disinfection of linen
d! Cut )ngernails short and hand *ashing
e! Diversionary activities &e$! ,rick game% gameboy'
RUBELLA :AKA G$-%# M$*0$*;
! De)nition
a! Mild viral illness
(! 3tiologic agent
a! :ubella virus
7! Incubation "eriod
a! 9 to ( days or ( to 7 *eeks
9! "eriod of Communicability
a! *eek before and four days after onset of rashes
@! Mode of Transmission
a! Direct contact
b! Droplet method
C! Complication
a! 3ncephalitis
b! Neuritis
c! Arthritis
d! Arthralgias
e! :ubella syndrome # especially in infants or children
i! "DA
ii! Microcephaly
iii! Cataracts
L! -igns and -ymptoms
a! "rodromal "eriod
i! =o* grade fever
ii! Malaise
iii! /eadache
iv! Mild cory0a
v! Con+unctivitis
b! 3ruptive "eriod
i! ?orcheimerNs spots
ii! 3$anthematous rash
A! Nursing Management
a! Isolation
b! ,ed rest until fever subsides
c! Darken room # kay sometimes a;ected ang eyes
d! =iJuid diet
e! 3ye irrigation # especially during prodromal stage nga naay
con+unctivitis
f! >ood ventilation
g! "revent spread of infection
h! "revent occurrence of complications
Additional Notes:
>erman measles # no desJuamation
Measles # *ith desJuamation
Neurologic defects secondary to congenital rubella syndrome:
- microcephaly% mental retardation% behavioral disturbances
MEASLES :R&,$+0;
! De)nition
a! Acute e$anthematous disease and symptoms referable to the upper
respiratory tract
(! 3tiologic agent
a! ?ilterable virus of paramy$oviridae
7! Incubation "eriod
a! B &fever' to 9 &rashes' days
9! "eriod of Communicability
a! 9 days before and @ days after the appearance of rashes &catarrhal
stage'
@! -ource of Infection
a! ,lood% secretion of the eyes% nose and throat
C! Mode of Transmission
a! Direct and indirect contact
b! Droplet
L! Complication
a! ,ronchopneumonia # most common
b! 4titis media
c! Nephritis
d! 3ncephalitis
e! ,lindness
A! -igns and -ymptoms
a! "re5eruptive -tage &"rodromal'
i! ?ever
ii! Catarrhal symptoms: :hinitis% con+unctivitis% photophobia%
cory0a
iii! :espiratory symptoms
iv! EoplikNs spot # at buccal cavity
b! 3ruptive -tage
i! :ash: 9
th
to @
th
day
ii! :ash: cheeks% bridge of the nose% along the hairline temple or
earlobe% but not on the nape &cephalocaudal'
iii! Anore$ia and irritability
iv! "ruritus
v! =ethargy
vi! Throat is red and s*ollen
c! -tage of Convalescnece
i! :ashes fade: face do*n*ards
ii! DesJuamation
iii! ?irst in% )rst out nag pag*ala sa rashes
F! Nursing Management
a! Isolation
b! ?ever control
c! -kin care
d! 4ral and nasal hygiene
e! Care of the ears
f! Daily elimination
g! Nutrition
h! "enicillin # to prevent secondary infection% especially during
desJuamation or convalescence period
Additional Notes:
Darkened room # to prevent blindness
HERPES @OSTER
! De)nition
a! Acute viral infection of the sensory nerve
b! Di;erence *ith chickenpo$: Dnilateral in terms of rashes and rashes
are clustered
(! 3tiologic agent
a! .aricella 0oster virus
7! Incubation "eriod
a! 7 to L days
9! "eriod of Communicability
a! A day before the appearance of
st
rash and @5C days after the last
crust
@! Mode of Transmission
a! Droplet and contact
C! Complication
a! 3ncephalitis
b! ,lindness
c! Deafness
d! ?acial paralysis
e! =oss of taste
f! :ecurrence
L! -igns and -ymptoms
a! 3rythematous base
b! Cluster of vesicles
c! "ain% described as burning or stabbing
d! "ruritus
e! ?ever% malaise% anore$ia and headache
f! =ymphadenopathy
g! :amsay /unt -yndrome # an infection of your facial nerve thatOs
accompanied by a painful rash and facial muscle *eakness2 a;ected
ang facial nerve
A! Diagnostic 3$am
a! Characteristic skin rash
b! Tissue culture # to determine causative agent
c! -mear of vesicle <uid
d! Microscopy
F! Modalities of Treatment
a! -ymptomatic
i! ?or pruritus% mga anti pruritic agent
b! Antiviral drugs
c! Analgesics
d! Anti5in<ammatory drugs
B! Nursing Management
a! -trict isolation
b! Cool% *et dressings
c! "revent secondary infection
Additional Notes:
:amsay5hunt syndrome # facial a;ectation% leading to facial paralysis
A0iclovir # drug of choice
ANTHRA?
! De)nition
a! Acute infectious disease usually a;ecting the skin
(! 3tiologic agent
a! ,acillus anthracis
7! Incubation "eriod
a! ?e* hours to L days
9! Mode of Transmission
a! Animal bites
b! Airborne
c! Ingestion of contaminated meat
@! Types
a! Cutaneous &skin infection'
i! to ( days: macule
ii! 7
rd
to 9
th
day: ring of vesicles develop around the papule
iii! .esicular <uid may e$ude
iv! Marked edema
v! @
th
to L
th
day: original papule ulcerates to form eschar
vi! /igh fever% to$emia and painful lymphadenopathy
vii! (BG of untreated cases result to death
b! Inhalation
i! 1oolsorterNs disease
ii! 4rganisms directly deposited into alveolar ducts causing
hemorrhagic necrosis
iii! Dyspnea
iv! -tridor
v! /ypo$ia
vi! /ypotension
vii! Death *ithin (9 hours
viii! FBG untreated cases lead to death
c! >astrointestinal
i! Ingestion of inadeJuately cooked meat *hich is infected *ith
the causative agent
ii! ?ever
iii! Nausea and vomiting
iv! Abdominal pain
v! ,loody diarrhea
vi! Ascites
vii! (@ to CBG untreated cases lead to death
C! Modalities of Treatment
a! "enicillin% Do$ycycline% and Cipro<o$acin
b! 3rythromycin% Tetracycline &for gastrointestinal' or Chloramphenicol
c! =ength of treatment: CB days
d! "roper handling
Additional Notes:
,acillus anthracis:
- Aerobic and spore forming
- :od5shaped and encapsulated
- Can be destroyed by boiling for ten minutes
LEPROSY :AKA H#*$#A* D"*$*$;
! De)nition
a! A chronic systemic infection characteri0ed by progressive cutaneous
lesions
b! A chronic mild communicable disease caused by Mycobacterium
leprae% a rod5shaped bacteria
c! Mainly a;ects the skin% peripheral nerves% eyes% mucosa of the
upper respiratory tract
d! 3arly s8s$: skin lesions% ulcers that do not heal
(! 3tiologic agent
a! Mycobacterium leprae
7! Incubation "eriod
a! @ ] months to A years
9! Mode of Transmission
a! Contact # prolonged skin to skin contact
b! Droplet # a very rare mode of transmission
@! -igns and -ymptoms
a! 3arly signs and symptoms:
i! Anhdrosis
ii! :eddening of the eyes
iii! =ight discoloration or reddish skin lesions8*ith de)nite loss of
sensation
iv! =oss of sensation and *eakness of the muscles of the hands%
feet or face
v! "ositive slit skin smears
vi! Neonyne ?ace
b! =ate signs and symptoms:
i! =oss of eyelid re<e$
ii! >ynecomastia in males
iii! -unken nose bridge
iv! Madarosis # falling of the eyebro*s
v! Cla*ing and contracture
vi! Chronic ulcers H sole% palm% )ngers
vii! =agophthalmos
C! Diagnostic 3$am
a! ,ased on the clinical signs and symptoms
b! "ositive slit skin smear
L! Medical Management
a! Multi drug therapy is the accepted standard treatment for =eprosy
and is proven safe and e;ective
b! MDT must be started as soon as the diagnosis is made
c! It is the combination of t*o or more anti5leprosy drugs that renders
the patient non5infectious *ithin *eek after starting treatment
A! Nursing Management
a! /ealth education
b! ,C> vaccination
c! AdeJuate nutrition
d! >ood "ersonal hygiene
C0**"B!("+#
C0**"B!("+# S"#'0$ L$*"+#
P&!",!"00-<
:SLPB;
P&!",!"00-<
:PB;
M&0(",!"00-<
:MB;
-kin lesions
include:
Y?lat lesion
Y:aised lesion
and nodule
4nly one lesion ( to @ lesions%
uneJually
districuted%
de)nite loss of
sensation
More than @
lesions% eJually
distributed% loss of
sensation
Nerve Damage:
:esulting in loss of
sensation and
*eakness of
muscles supplies
by the e;ected
nerve
No nerve
involvement
None or one nerve
Ytuberculoid
Ynon infectious
Many nerves
Y=uprematous or
borderline
Yinfectious
M&0("6-&' T5$-4<
C5"06-$# A6&0(
PB :if # 9@B mg
Dap # @B mg
:if # CBB mg
Dap # BB mg
C blister packs F months
MB :if # 9@B mg
Dap # @B mg
Clo # @B mg
:if # CBB mg
Dap # BB mg
Clo # 7BB mg
( blister
packs
A months
:if # :ifampicin
Dap # Dapsone
Clo 5 Clofa0imine
-ide 3;ects:
>astric irritation
Discoloration of the skin scaling due to Clofa0imine
Dermatitis due to Dapsone
1eakness% +oint and muscle pains for :ifampicin
"sychosis due to Dapsone &rare case'
Contraindication:
cases of severe liver and kidney disease
kno*n severe drug hypersensitivity to any of the MDT drugs
severe anemia
4<o$acin and Minocycline are not recommended for use in pregnant
*omen and children belo* @ years
Dapsone should not be given to people *ith sulfone sensitivity
**Management and -torage: Cool dry place to prevent coating
**TC # Treatment Completed
**Eung T, patient% dili na maghatag ug :ifampicin para dili mag overdose
**:elapse # reoccurrence of leprosy successful completion of treatment
characteri0ed by occurrence of ne* lesion% but very rare and con)rmed by
laboratory
SCABIES
! De)nition
a! Infestation of the skin produced by the burro*ing action of a
parasite mite resulting in irritation and the formation of vesicles or
pustules
(! 3tiologic agent
a! -arcoptes scabiei
7! Incubation "eriod
a! 1ithin (9 hours
9! "eriod of Communicability
a! ?or the entire period the host is infected
@! Mode of Transmission
a! Direct contact
b! Indirect contact
C! Dsually infected sites:
a! Nipples
b! Armpits
c! 1rists
d! ?ingers
e! ,elly button
f! "ubic area
L! -igns and -ymptoms
a! Itching% especially at night
b! Thin% pencil5mark lines on the skin
c! :ashes
d! -kin abrasions
A! Modalities of Treatment
a! -cabicide: 3ura$ 4intment &Crotamiton'
b! "ediculicide: E*ell lotion &>amma ,en0ene /e$achloride' #
contraindicated in young children and pregnant *omen
c! Topical steroids
d! /ydrogen pero$ide: cleanliness of *ound
e! =indane =otion for itchiness
F! Nursing Management
a! Apply cream at bedtime% from neck to toes
b! Instruct patient to avoid bathing for A to ( hours
c! Dry5clean or boil bedclothes # boil 7B minutes before laundering
d! :eport any skin irritation
e! ?amily members and close contact treatment
f! >ood hand *ashing
g! Terminal disinfection through scabicides
Additional Notes:
Description of the causative agent:
Vello*ish5*hite in color
Can barely be seen by the unaided eye
?emale parasite burro*s beneath the epidermis to lay their eggs
MUMPS :AKA P-+("("*;
! De)nition
a! Manifested by s*elling of one or both parotid glands
(! 3tiologic agent
a! "aramy$ovirus
7! Incubation "eriod
a! ( to (C days
9! "eriod of Communicability
a! ,efore onset of parotid gland s*elling until it remains
@! Mode of Transmission
a! :espiratory droplets
b! Direct contact
C! Complication
a! 4rchitis
b! 4ophoritis
c! Mastitis
d! Central nervous system involvement
e! Nuchal rigidity
f! Deafness
g! -terility
L! -igns and -ymptoms
a! -udden earache
b! ?ace pain
c! -*elling of the parotid glands
d! /eadache
e! ?ever
f! -ore throat
g! -*elling of the temples or +a*
A! Modalities of Treatment
a! :elief of pain
b! ,ed rest
c! 4rchitis
i! -uspensory
ii! -edatives
iii! 7BB to 9BB mg of Cortisone follo*ed by BB mg every C hours
iv! Nick in the membrane
d! Diet
i! -oft or liJuid
ii! -our food or fruit +uices
iii! /ot and cold foods
F! Nursing Management
a! Isolation
b! Concurrent and terminal disinfection
c! 4ral care and personal hygiene
d! 3ye care
e! Diet
f! ,ed rest
g! Diversional activities # since there is pain
Additional Notes:
9A5hour after onset of s*elling # highest communicability
SE?UALLY TRANSMITTED INFECTIONS
AIDS
! De)nition
a! ?inal and most serious stage of /I. disease
(! 3tiologic agent
a! :etrovirus5/uman T5Cell =ymphotropic virus 7 &/T=.57'
7! Incubation "eriod
a! 57 months to 5@ years
9! Most common method of transmission:
a! Dnprotected se$ *ith an infected partner
b! -haring needles *ith infected person
@! Almost eliminated risk factors for /I. transmission are:
a! Infection from blood products
b! Transmission from mother to fetus
C! Mode of Transmission
a! -e$ual contact
b! ,lood transfusion
c! Contaminated syringes% needles% nipper% ra0or blades
d! Direct contact of open *ound8mucous membrane *ith contaminated
blood% body <uids% semen and vaginal discharge
L! -afer -e$ Methods
a! 4ne se$ual partner
b! Condom
A! -igns and -ymptoms
a! =oss of appetite
b! 1eight loss
c! ?ever
d! Malaise
e! "ersistent diarrhea
F! "athophysiology
a! /I. infection
b! Acute illness
i! ?ever% rash% +oint and muscle pain and sore throat
c! Chronic Illness
d! AID-
i! EaposisNs sarcoma
ii! "neumocystis carinii pneumonia
iii! Cyrptococcal menigitis
B! Diagnostic 3$am
a! 3=I-A
b! 1estern ,lot Analysis # con)rmatory test
c! :adio Immuno5precipitation assay &:I"A'
! "revention &?our CNs In The Management of Aids'
a! Compliance
b! Counseling8education
c! Contact tracing
d! Condoms
(! "revention
a! Maintain monogamous relationship
b! Avoid promiscuous se$ual contact
c! -terili0e needles% syringes and instruments used for cutting
operations
d! "roper screening of blood donors
e! :igid e$amination of blood donors
f! :igid e$amination of blood and other products for transfusion
g! Avoid oral% anal contact and s*allo*ing of semen
h! Dse condom and other protective devices
7! Nursing Management
a! ?atigue
i! "rovide restful environment
ii! Assist *ith personal care
iii! Monitor tolerance for visitors
b! "ain
i! >ive meds as appropriate
ii! Assess level of pain
c! Disease susceptibility
i! Implement infection control precautions
ii! /and*ashing on entering and leaving room
iii! Monitor for oral infections and meningitis
iv! >ive antibiotics as ordered
d! :espiratory distress
i! Monitor vital signs% chest sounds # especially ::
ii! >ive bronchodilators and antibiotics as ordered
iii! -uction and maintain o$ygen as ordered # hyper o$ygenate
before suctioning
iv! Monitor for symptoms of secondary infection
e! An$iety% depression
i! Dse tact% sensitivity in gathering personal in gathering data
ii! 3ncourage e$pression of feelings # encourage verbali0ation
iii! :espect clientNs o*n limits in ability to discuss problems #
sense of privacy
f! Anore$ia% diarrhea
i! Monitor *eight
ii! 3ncourage nutritional supplements
iii! Assess hydration
Additional Notes:
***4pportunistic infections such as pneumocystosis or malignancies such as
EaposiNs sarcoma can signal the )nal stage of /I. infection% AID-!
***Africa # /I.8AID- )rst occur
CANDIDIASIS
! De)nition
a! Mild super)cial fungal infection
(! 3tiologic agent
a! Candida albicans
7! Candida Albicans
a! Normal <ora of the >IT% mouth% vagina and skin
b! :ise in glucose &diabetes'
c! =o*ered resistance &cancer'
d! Immunosuppression &aging% radiation therapy% /I.% drug'
e! Increase in estrogen &pregnancy'
f! ,road5spectrum antibiotics
9! A;ected ,ody "arts
a! Nails &4NVC/4MVC4-I-'
b! -kin &Diaper :ash'
c! 4ropharyn$ &oral thrush'
d! .agina &Moniliasis'
@! -igns and -ymptoms
a! -kin
i! -caly% erythematous% popular rash
ii! Covered *ith e$udates
iii! Appear belo* breasts% bet*een )ngers% a$illae% groin and
umbilicus
b! Nail
i! :ed% s*ollen% darkened nailbeds
ii! "urulent discharge
iii! -eparation of pruritic nails from nailbeds # indication of
4nychomycosis
c! Thrush
i! Cream5colored or bluish5*hite patches on the tongue% mouth
or pharyn$
ii! ,loody engorgement *hen scraped
d! Moniliasis
i! 1hite or yello* discharge
ii! "ruritis
iii! =ocal e$coriation
iv! 1hite or gray5raised patches on vaginal *alls *ith local
in<ammation
C! Mode of Transmission
a! Contact *ith secretions from mouth% vagina% skin and feces
L! Modalities of Treatment
a! Nystatin or Imida0ole
b! Cotrimo$a0ole
c! Eetocona0ole
d! ?lucona0ole
e! Nystatin solution
f! Cranberry +uice or yogurt # rich in .itamin C
CHLAMYDIA
! De)nition
a! -e$ually transmitted disease caused by a bacteria
(! 3tiologic agent
a! Chlamydia trachomatis
7! Incubation "eriod
a! ( to 7 *eeks &males'
b! Asymptomatic &females'
9! Mode of Transmission
a! .aginal or rectal intercourse
b! 4ral5genital contact *ith infected person
c! Children born to mothers
@! -igns and -ymptoms
a! Males
i! ,urning sensation during urination
ii! Discharge from the penis
iii! Testicular tenderness or pain
iv! :ectal discharge or pain
b! ?emales
i! ,urning sensation during urination
ii! .aginal discharge
iii! "ainful se$ual intercourse
iv! :ectal pain or discharge
C! Diagnostic 3$am
a! -*ab from site of infection
b! Culture of aspirated materials
c! 3=I-A
d! Direct <uorescent antibody test
L! Chlamydia 3;ects
a! Causes a build5up of scarring that can block the fallopian tube and
prevent fertili0ation
b! Cause sterility
c! 3ctopic pregnancy
A! Modalities of Treatment
a! Do$ycycline given orally for L days
b! A0ithromycin in single dose
c! Dniversal precaution
d! -ubmit for /I. testing
GONORRHEA :AKA G0$$(C D-"4C GCC C04;
! De)nition
a! A se$ually transmitted disease involving mucosal lining of the >DT%
rectum and pharyn$
(! 3tiologic agent
a! Neisseria gonorrhea
7! Incubation "eriod
a! ( to B days
9! "eriod of Communicability
a! As long as organisms present in discharges
@! Mode of Transmission
a! -e$ual contact
b! .aginal delivery
c! Contact *ith e$udates
C! Complication
a! ?emales
i! -alphingitis
ii! "elvic In<ammatory Disease
iii! .ulvovaginitis
iv! -terility
v! Dyspareunia
b! Males
i! "eriurethral abscess
ii! Drethral stricture
iii! Drination problems
L! -igns and -ymptoms
a! ?emales
i! ,urning and freJuent urination
ii! Vello*ish% purulent vaginal discharge
iii! :edness and s*elling of the genitals
iv! ,urning and itching of the vaginal area
v! Drinary freJuency and pain on urination
b! Males
i! Dysuria *ith purulent discharge &gleet' from the urethra (5L
days after e$posure
ii! :ectal infection common among homose$uals
iii! In<ammation of urethra
iv! "elvic pain
v! ?ever
A! Modalities of Treatment &usually broad spectrum antibiotics'
a! A0ithromycin ( g by mouth% single dose
b! Ce)$ime 9BB mg by mouth% single dose
c! Ceftria$one (@ mg IM% single dose
d! Do$ycycline (BB mg by mouth ,ID $L days
e! ?or pregnant *omen:
i! Ceftria$one (@5(@B mg IM single dose
ii! 3rythromycin @BB mg orally $L days
f! AJueous procaine penicillin 9 million units IM
F! Nursing Management
a! All information about patient is considered con)dential
b! Infants born to mothers positive of gonorrhea should be instilled
*ith G silver nitrate or any recommended ophthalmic prophyla$is
into both eyes at the time of birth
Additional Notes:
Characteristics of Neisseria gonorrhea:
>ram5negative
:eadily killed by drying% sunlight or ultraviolet
?ragile and does not survive long outside the body
HERPES SIMPLE?
! De)nition
a! A viral disease characteri0ed by the appearance of sores and
blisters on the skin
(! 3tiologic agent
a! /erpes simple$ virus &/-.'
7! Incubation "eriod
a! ( to ( days
9! Types
a! Type virus
i! Tiny% clear% <uid5)lled blisters
ii! Commonly a;ect lips% mouth% nose% chin or cheeks
iii! Transmitted by kissing% sharing kitchen utensils or sharing
to*els
iv! Dsually last for L to B days
b! Type ( virus
i! Cause genital sores% a;ecting buttocks% penis% vagina or cervi$
ii! AcJuired by se$ual contact
iii! Can also be spread by touching an una;ected part of the body
after touching the herpes lesion
iv! Manifestations: minor rash or itching% painful sores% fever%
muscular pain% burning sensation on urination
v! -mall% painful sores or blisters
vi! Dsually heal in to 7 *eeks
vii! Can come back *eeks
SYPHILIS :AKA L&$* /$#$-$0;
! De)nition
a! Infectious disease caused by a spirochete
(! 3tiologic agent
a! Treponema pallidum
7! Incubation "eriod
a! B to FB days
9! "eriod of Communicability
a! .ariable and inde)nite
@! -ource of Infection
a! Discharges from skin lesions or mucous membrane
b! -emen% blood% tears and urine
C! Mode of Transmission
a! Direct transmission
b! Indirect contact
c! Trans5placentally
L! Types
a! "rimary -yphilis
i! C/ANC:3-: small% painless% pimple5like ulceration on the
penis% labia ma+ora and minora and lips
ii! Disappear after 7 to C *eeks even *ithout treatment
iii! 3nlarged lymph nodes
b! -econdary -yphilis
i! 3$tensive lymph node enlargement
ii! -kin rash
iii! Mucous patches
iv! C4NDV=4MATA =ATA: Coalescing papules *hich form a gray5
*hite plaJue freJuently in folds such as groin% genital areas%
a$illa and under the breasts
v! /air loss
c! Tertiary -yphilis
i! In)ltrative destructive lesions of skin% bones or liver
ii! >DMMA: chronic% super)cial nodule or deep% granulomatous
lesion that is solitary% asymmetric% painless% and indurated
iii! Cardiovascular syphilis
A! Modalities of Treatment
a! 3ncourage patient to undergo .D:= &.enereal Disease :esearch
=aboratory' testing after 7% C% ( and (9 months
b! 3arly treatment: "enicillin > ben0athine IM &(!9 million units'
c! More than year: "enicillin > ben0athine (!9 m units $7 *eeks
d! Nonpregnant patients: Tetracycline or Do$ycycline &@ days # early2
7B days # late'
F! Nursing Management
a! Importance of completing treatment
b! "artners should be tested and treated
c! Dniversal precaution
d! -econdary syphilis: keep lesions dry2 dispose contaminated
materials properly
e! Cardiovascular: check for signs of decreased cardiac output
f! Neurosyphilis: 14? decreasing =4C
g! :eport all cases to local health authorities for early detection and
prompt treatment
BLOODDBORNE DISEASES
DENGUE
! De)nition
a! Dengue fever
b! Dengue hemorrhagic fever
c! A mosJuito5borne viral disease
d! Transmitted by the bite of an infected female Aedes mosJuito
e! Caused by 9 serotypes: Den5% Den5(% Den57 and Den59
f! Dengue by characteri0ed by:
i! ?ever
ii! :ash
iii! Muscle and +oint pains
iv! ,leeding
g! Common during rainy seasons
h! 1here is Dengue foundR
i! :eported from over BB countries
ii! ?irst outbreak in F@(
i! 1ho is most a;ected by dengueR
i! Anybody can get sick regardless of age% se$% health and social
status
ii! /o*ever infants and school children are mostly a;ected
iii! >enerally B to F year old age group are vulnerable
+! 4nly through the bite of an infected female
k! .irus *ill reproduce inside the body then illness follo*s after @ to
days
l! The vector mosJuito becomes infected *hen it bites people *ith
D?8D/? follo*ing A to B days after the bite! The infected mosJuito
then transmits the disease through its bite to other people!
m! Characteristics of Dengue MosJuito
i! -mall% black and *hite insects
! *ith stripes on its legs% body and back
(! measures about @mm in si0e
ii! feeding
! female 5 blood meal
(! male feeds on plant +uices and nectars
iii! generally day biters
! prefers to bite +ust after sunrise and before sunset
iv! can <y from @B to 7BB meters only to look for blood meal or
breeding site
v! female lays about CB to BB eggs per batch2 lays about 759
batches of eggs in its lifetime
vi! "refers dark color for oviposition2 breeds in arti)cial or natural
containers
vii! Ae! Aegypti prefers to rest cool shaded places% dark corners%
closets and dra*er% clear stagnant *aters
(! 3tiologic agent
a! Dengue virus
b! Arboviruses
c! ?lavivirus
7! Incubation "eriod
a! Dncertain &up to *eek' or C to L days
9! -tages
a! Dengue /emorrhagic ?ever
i!
st
9 days: ?ebrile or Invasive -tage
ii! 9
th
to L
th
day: To$ic or /emorrhagic -tage
iii! L
th
to B
th
day: Convalescent or :ecovery -tage
@! 1hat should be doneR
a! all dengue suspects should be brought to the nearest health facility%
do not self medicate
b! donNt give aspirin # it may lead to bleeding and or gastric irritation
c! start oral rehydration int eh early stages of fever
d! if symptoms persists for 7 or more days or if danger signs appear%
refer the patient immediately to the hospital
e! pag more than 7 days na ang fever% mag tourniJuet test
C! -igns and -ymptoms
a! /igh continuous fever lasting ( to L days
b! =oss of appetite
c! Nausea and vomiting
d! Muscle and +oint pain
e! Abdominal pain
f! ,ody *eakness
g! ,leeding tendencies # if there are signs of bleeding% rehydration
daun
h! "resence of small reddish spots% or skin <ushing
i! :ashes
L! Danger -igns
a! -pontaneous bleeding
b! -udden onset of abdominal pain
c! "ersistent vomiting
d! =istlessness
e! Changes in mental status8restlessness
f! 1eak% rapid pulse
g! Cold% clammy skin # indicative of shock due to hemorrhage
h! DiMculty of breathing
A! Diagnostic 3$am
a! TourniJuet test &:umpels =ead Test' # using bp cu;2 sJuare inch%
positive if (B or more
b! "lately count
i! Normal @B to 9@Bk
c! /emoconcentration
d! 4ccult blood
F! "revention
a! ,est *ay: search and destroy
b! Destroy breeding sites
i! Cover all *ater containers
ii! Change *ater of <o*er vases and scrub side of containers
once a *eek
iii! Dispose of garbage properly and remove rubbish around
premises that can collect rain *ater
iv! Inspect and clean roof gutters
v! "roperly arrange discarded tires under the shade or stock pile
and place a cover on top
c! "reventing mosJuito bites
i! Install screens on *indo*s and doors
ii! -e protective clothing or repellants
iii! Dse mosJuito nets for infants or adults *hile sleeping at
daytime
iv! Isolate the person sick *ith dengue in a screened room or by
using a mosJuito net
B! Modalities of Treatment
a! "aracetamol
b! ,lood transfusion
c! 4$ygen therapy
d! -edatives
e! Intravenous <uids
Additional Notes:
Arbovirus:
1est nile virus
4Nnyong _nyong virus
Chikungunya virus
FILARIASIS
! De)nition
a! A parasitic disease caused by an African eye *orm
(! 3tiologic agent
a! 1uchereria bancrofti% ,rugia malayi and ,rugia timori
7! Incubation "eriod
a! A to C months
9! Mode of Transmission
a! "erson5to5person by mosJuito bites
@! -tages
a! Acute -tage
i! =ymphadenitis # in<ammation of lymph nodes
ii! =ymphangitis # in<ammation of lymph vessels
iii! Male genitalia a;ected leading to funiculitis% epididymitis and
orchitis &redness% painful and tender scrotum'
b! Chronic -tage
i! Develop B to @ years from onset of )rst attack
ii! /ydrocele &s*elling of the scrotum'
iii! =ymphedema &temporary s*elling of the upper and lo*er
e$tremities'
iv! 3lephantiasis &enlargement and thickening of the skin of the
upper and lo*er e$tremities% scrotum and breast'
C! Diagnostic 3$am
a! Nocturnal blood e$amination &N,3' # taken at patients residence or
hospital after A pm
b! Immunochromatographic test &ICT' # rapid assessment method2 an
antigen test done at daytime
L! Modalities of Treatment
a! Diethylcarbama0ine Citrate &D3C' or /3T:A^AN # an individual
treatment kills almost all micro)laria and a good proportion of adult
*orms
A! Mass Treatment
a! Distribution to all population
b! 3ndemic and infected or not infected *ith )lariasis in established
endemic areas
c! The dosage is C mg8kg of body *eight taken as a single dose per
year
F! -urgical Treatment
a! Mild lymphedema: lymphovenous anastamosis distal to the site of
the lymphatic destruction
b! /ydrocele managed by inversion or resection of tunica vaginalis
c! Chyluria is operated on by ligation and stripping of the lymphatics of
the pedicle of the a;ected kidney
B! "revention and Control
a! Measures aimed to control vectors
b! 3nvironmental sanitation such as proper drainage and cleanliness of
surroundings
c! -praying *ith insecticides
d! Measures aimed to protect individuals and families:
i! Dse of mosJuito nets
ii! Dse of long sleeves% long pants and socks
iii! Application of insect repellant
iv! -creening of houses
v! /ealth education
Additional Notes:
MarinduJue% -aranggani # provinces *hich are considered endemic for )lariasis
LEPTOSPIRORIS :AKA M&6 .$/$-C >$"0A* D"*$*$C F0++6 F$/$-;
! De)nition
a! A 0oonotic infectious bacterial disease carried by animals
(! 3tiologic agent
a! =eptospira interrogans
7! Incubation "eriod
a! L to F days2 average B days
9! "eriod of Communicability
a! B to (B days after onset
@! -ource of Infection
a! Contaminated food and *ater
C! Mode of Transmission
a! Ingestion or contact *ith skin and mucous membrane *ith infected
urine
L! -igns and -ymptoms
a! -eptic8=eptospiremic -tage
i! ?ebrile% lasting for 9 to L days
ii! :emittent fever
iii! /eadache
iv! Myalgia
v! Nausea
vi! .omiting
vii! Cough
viii! Chest pain
b! Immune or To$ic -tage
i! =asts for 9 to 7B days
ii! Iritis% headache% meningeal manifestations
iii! 4liguria and anuria *ith progressive renal failure
iv! -hock% coma and congestive heart failure
v! Death may occur bet*een the F
th
and C
th
day
A! "revention and Control
a! 3ducation on ho* to control leptospirosis specially during rainy
season
b! "rotective clothing
c! -tringent community5*ide rat eradication program
d! :eport all cases
F! Modalities of Treatment
a! "enicillin at (m units JChours IM8I.
b! Tetracycline8Do$ycycline BB mg J( hours per orem
c! 3rythromycin @BB mg J(hours per orem in patient allergic to
penicillin
d! Drine must be properly disposed # using gloves
Additional Notes:
:eservoir hosts: rat% rabbits% cattles
MALARIA
! De)nition
a! "rimary vector breeds in clear slo* <o*ing streams% vector in
coastal areas
(! 3tiologic agent
a! "lasmodium falciparum # LBG
b! "lasmodium viva$ # 7BG
c! "! malariae # G very rare
d! "! ovale # not found in philippines
7! Mode of Transmission
a! ?rom an infected mosJuito
9! -igns and -ymptoms
a! :ecurrent chills
b! ?ever
c! "rofuse s*eating
d! Anemia # destruction of rbc
e! malaise
f! hepatomegaly
g! splenomegaly
@! "athophysiology
a!
st
vector
b! Initial human host
c! =iver infection
d! ,lood infection
e! (
nd
vector
f! Ne$t human host
C! Top B provinces:
a! "ala*an
L! A;ected:
a! At high risk: pregnant *omen &sulfado$ine pyrimethamine' and
children
b! /igh5risk groups: indigenous cultural communities% non5immune
travelers to endemic areas% soldiers% forest product gatherers
A! Diagnosti c 3$am
a! Clinical diagnosis # but have @BG accuracy
b! ,lood smear # at the peak of the fever
c! Microscopic Diagnosis &>old -tandard' # de)nite diagnosis
d! :apid Diagnostic Test &:DT' # to detect plasmodium5speci)c
antigens2 takes about L to @ minutes% very senstivite% accurate
FBG% fast to detect
F! Control "rogram
a! .ision: malaria5free by year (B(B
b! Chemoprophyla$is # for pregnant *omen
c! Dse of mosJuito repellants
B! Modalities of Treatment
a! 3arly diagnosis and treatment
Additional Notes:
ChloroJuine # )rst line drugs
HELMINTHS
ASCARIASIS
! De)nition
a! An infection caused by a parasitic round*orm
(! 3tiologic agent
a! Ascaris lumbricoides
7! Incubation "eriod
a! 9 to A *eeks
9! Mode of Transmission
a! ?ecal5oral route
@! Complication
a! ,iliary tract obstruction
b! /epatic abscess
c! Intestinal obstruction
d! "eritonitis
e! Malnutrition
C! -igns and -ymptoms
a! "assing *orms in stool
b! .omiting up *orms
c! 1orms e$iting through nose or mouth
d! =o* grade fever
e! ,loody sputum
f! 1hee0ing
g! -hortness of breath
h! -tomach pain
L! Modalities of Treatment
a! Drug of choice: Albenda0ole or Mebenda0ole @cc as single dose
b! "ipera0ine citrate L@ mg8kg% daily $( doses orally
c! "yrantel pamoate mg8kg as a single dose orally
d! Niyog5niyogan # herbal remedy
A! Nursing Management
a! No isolation needed
b! "reventive measures
c! /and*ashing
d! "roper se*age disposal
e! "ersonal hygiene
Additional Notes:
year old # safest time to start de*orming
Dnfertili0ed egg # *ill not undergo biological development
"almar pallor8malaki ang tiyan8muscle *asting8sagging of gluteal folds &signs of
malnutrition' # mag de*orm!
If more than year old *ala pa nag de*orm% p*ede magde*orm!
HOOK>ORM
! De)nition
a! :ound*orm infestation a;ecting small intestines and lungs
(! 3tiologic agent
a! Necator americanus
b! Ancylostoma duodenale
7! Incubation "eriod
a! ( to A *eeks
9! Mode of Transmission
a! Contaminated drinking *ater or food
b! Direct skin contact
@! -igns and -ymptoms
a! Itchy rash
b! Cough
c! ?ever
d! ,loody sputum
e! =oss of appetite
f! Nausea% vomiting
g! Diarrhea
h! Abdominal discomfort
C! Infected Children
a! Dnderdeveloped mentally and physically
b! "rotruding abdomen
c! =ethargic
d! Malnourished
e! =a0y and have no energy
f! "upils dilated
g! "erverted appetite
L! "athophysiology
a! Direct entry of causative agent &e$! 1alking barefooted'
b! 3ggs in feces
c! 3gg become larva
d! ?ilariform larva
e! ?ilariform penetrates skin
f! And penetrates intestines
A! Management:
a! "yrantel pamoate &Kuantrel'
b! Diet # rich in iron
c! "ersonal hygiene
d! "roper disposal of e$creta
e! Avoid going barefoot
f! Dse puri)ed or boiled *ater for drinking
g! .egetables should not be eaten ra*
PIN>ORM
! De)nition
a! An intestinal infection due to small intestinal *orm
(! 3tiologic agent
a! 3nterobius vermicularis
7! Incubation "eriod
a! to ( *eeks
9! "eriod of Communicability
a! As long as the person harbors the organism
@! Mode of Transmission
a! Direct and indirect contact
C! -igns and -ymptoms
a! Intense itching around the anus
b! DiMculty sleeping
c! Irritability
d! .aginal irritation
e! =oss of appetite
L! Diagnostic 3$am
a! -cotch tape test
A! Nursing Management
a! "ipera0ine he$ahydrate
b! ?amily treatment
c! Toilet seats must be *ashed
d! -leep alone
e! /and*ashing