1.

WHOOPING COUGH
Whooping cough (also known as pertussis) is a bacterial infection called Haemophilus pertussis
that gets into your nose and throat. It spreads very easily, but vaccines like DTaP and Tdap can
help prevent it in children and adults.
Early Symptoms
Early symptoms can last for 1 to 2 weeks and usually include:

Runny nose

Low-grade fever (generally minimal throughout the course of the disease)

Mild, occasional cough

Apnea a pause in breathing (in babies)

Because pertussis in its early stages appears to be nothing more than the common cold, it is often
not suspected or diagnosed until the more severe symptoms appear.
Later-stage Symptoms
After 1 to 2 weeks and as the disease progresses, the traditional symptoms of pertussis may
appear and include:

Paroxysms (fits) of many, rapid coughs followed by a high-pitched "whoop"

Vomiting (throwing up) during or after coughing fits

Exhaustion (very tired) after coughing fits

Diagnosis
Diagnosis of whooping cough will involve an assessment of the nature and history of the
symptoms experienced. The disease can be difficult to diagnose in its early stages because of its
resemblance to a common cold or bronchitis. As the whooping cough bacteria can be detected in
respiratory secretions, nose and throat swabs may be taken to confirm the diagnosis. A chest xray and blood tests may also be performed.
As whooping cough is a notifiable disease, the doctor who diagnoses it is required to notify a
Medical Officer of Health.

Treatment
Antibiotics are used in the treatment of whooping cough. They are most effective in reducing the
severity of whooping cough when given in the very early stages of the disease. Antibiotic
treatment commenced once the disease is well established may be recommended to reduce the
likelihood of the bacteria spreading but it may not reduce the severity of symptoms.
Antibiotics may also be prescribed to treat any secondary infections that may have developed.
Prophylactic (preventative) antibiotic treatment may be recommended for other members of the
household to prevent the spread of the disease in the community.
Further treatment of whooping cough is supportive and involves making the child comfortable.
This should include:

Bed rest

Small frequent meals

Maintaining fluid intake

Use of a humidifier to warm and moisten the air may be helpful in soothing the airways and
reducing coughing spasms. Sitting with the child in a steamy bathroom can also be effective.
Cough suppressant medicines are not effective in treating whooping cough.
In particularly severe cases of whooping cough, treatment in hospital may be necessary. This is
most commonly required in infants under six months of age, with approximately 75% of those
affected in this age group requiring hospitalisation.
Treatment in hospital may include:

Administering oxygen

Suctioning secretions and mucous

Administering fluids through a drip in the hand or arm in order to prevent dehydration

Monitoring for signs of complications

Isolation from other children to prevent the spread of the disease

Complications
Complications of whooping cough can include:

Dehydration

Pneumonia

Convulsion

Middle ear infections

Temporary cessation of breathing (apnoea)

Hernias (commonly in the groin) caused by excessive coughing

Encephalopathy (disruption in brain function) eg: swelling, damage, seizures

Prevention

Immunization is given early in children.The vaccines used are INFANRIX-hexa,

INFANRIX-IPV and Boostrix
Proper disposal of sputum

2. JAUNDICE
This is a yellow discoloration of the skin of mucus membrane to excess bile pigments in the
blood stream
Pathophysiology
The new born baby is delivered with a high percentage of red blood cells. After delivering the
excess blood cells is destroyed and bilirubin is produced. The liver then converts the bilirubin in
bile to be excreted. In a new born the liver is not mature enough to convert this bilirubin so
bilirubin keeps accumulating in the blood to cause the yellow discolorations of the skin.

Types of jaundice
1. Physiological jaundice
It is mild jaundice which affect all new born babies between the 2 and 5 days after birth.
Yellowness of the sclera and urine are notice on the first day. The jaundice clears by the
end of the week and doesnt need any particular treatment.
2. Pathological jaundice
If physiological jaundice does not clear off by the 5 day and or the condition gets worst
and considered as pathological jaundice. Pathological jaundice can also start up after the
end of the week. Hemolytic anemia can also cause hemolysis of red blood cells resulting
to excess bilirubin more than the liver can handle.
Signs and symptoms

Yellowish coloration that starts from the conjunctiva, face, skin, chest, abdomen and
descends to the lower limbs
Lethargic or weak
Refusal to suck
Cerebral irritation with head retraction which may lead to convulsion
Reflexes such as Moro rooting maybe excess bilirubin

Nursing Diagnosis for Jaundice and Nursing Intervention for Jaundice

1. Deficient Fluid Volume related to inadequate fluid intake, photo-therapy, and diarrhea.
Goal:
Adequate neonatal body fluids
Intervention:

Record the number and quality of stools,

Monitor skin turgor,

Monitor intake output,

Give water between breast-feeding or give bottle.

2. Hyperthermia related to the effects of phototherapy

Goal:

The stability of the baby's body temperature can be maintained

Intervention:

Give a neutral ambient temperature,

Keep the temperature between 35.5 - 37 C,

Check vital signs every 2 hours.

3. Impaired skin integrity related to hyperbilirubinemia and diarrhea

Goal:
The integrity of the baby's skin can be maintained
Intervention:

Assess skin color every 8 hours,

Monitor direct and indirect bilirubin,

Change position every two hours,

Massage the area that stands out,

Keep skin clean and moisture.

4. Anxiety related to medical therapy given to the baby.

Goal:
Parents know about treatment, symptoms can be identified to deliver the health care team.
Intervention:

Review knowledge of the client's family,

Give the cause of yellow health education, therapy and treatment process.

Give health education on infant care to home

Complications
High levels of bilirubin that cause severe jaundice can result in serious complications if not
treated.
Acute bilirubin encephalopathy
Kernicterus
Prevention
The underlying medical condition causing jaundice can in some cases be prevented. Some
preventive measures include the following:

Avoid heavy alcohol use (alcoholic hepatitis, cirrhosis, and pancreatitis).

Vaccines for hepatitis (hepatitis A, hepatitis B)

Take medications which prevent malaria before travelling to high-risk regions.

Avoid high-risk behaviors such as intravenous drug use or unprotected intercourse

(hepatitis B).

Avoid potentially contaminated food/water and maintain good hygiene (hepatitis A).

Avoid medications that can cause hemolysis in susceptible individuals (such as those with
G6PD deficiency, a condition that leads to red blood cell breakdown after consumption of
certain substances).

Avoid medications and toxins which can cause hemolysis or directly damage the liver.

3. Mumps
It is a contagious infection caused by the mumps virus characterize by tender swelling of
the parotid gland or other salivary glands.
Incubation period

14 to 21 dqya but is rare within the first six months of life because of transplacental
protection.
Mode of transmission
Direct contavt with infected person
Droplet spreads from infected person
Signs and symptoms

Fever
Headache
Vomiting
Anorexia
Generalized malaise
Swelling of the angles of the jaw either unilateral or bilateral

Nursing Diagnosis and Interventions for mumps

Imbalanced nutrition less than body requirements related to inability to ingest adequate nutrients
due to infectious conditions.
Goal: Demonstrate an increase in body weight reached the expected range.
Expected outcomes: body weight returned to normal ranges.
Interventions and Rational :
1. Give eat soft foods little by little and little extra, right. Avoid acidic foods.
Rational: The food is hard, is not able to be chewed by patients parotitis. Acidic foods, adding a
sense of discomfort in patients with parotitis.
2. Give liquid diet or food tube / hyperalimentation when needed.
Rational: When caloric intake fails to meet the metabolic needs, nutritional support can be used
to prevent malnutrition.
3. Give the drink a little by little but often.
Rational: Moisten the mucous membranes of the mouth are less wet because it is rarely used
Management

Use respiratory precautions to improve on the child breathing

Bed rest until the swollen parotid glands subside

Apply hot or cold compresses to the neck

Give antipyretics to relief pains and fever

Administration of mumps immunoglobulin for prevention

Complications of Mumps
Mumps can occasionally cause complications, especially in adults.
Complications include:

inflammation of the testicles (orchitis) in males who have reached puberty; rarely does
this lead to fertility problems

inflammation of the brain (encephalitis)

inflammation of the tissue covering the brain and spinal cord (meningitis)

inflammation of the ovaries (oophoritis) and/or breasts (mastitis) in females who have
reached puberty

deafness

Prevention

Exclude the person with mumps from childcare, preschool, school and work for 5 days
after the onset of swelling

tissues and other objects soiled with nasal secretions should be disposed of appropriately

mumps is best prevented by the measles, mumps and

rubella (MMR) combination vaccine or the measles, mumps, rubella and varicella
(MMRV) combination vaccine

almost 100% of people who have had 2 doses of a mumps-containing vaccine will be
protected against mumps

vaccination of contacts* after exposure will not stop the infection, though it will protect
against future exposures.

4. Meningitis
It is a serious disease in which there is inflammation of the meninges, caused by viral or bacterial
infection, and marked by intense headache and fever, sensitivity to light, and muscular rigidity.
Ethology
Meningitis is generally caused by infection of viruses, bacteria, fungi, parasites, and certain
organisms. Anatomical defects or weak immune systems may be linked to recurrent bacterial
meningitis. In the majority of cases the cause is a virus. However, some non-infectious causes of
meningitis also exist.

Bacterial meningitis in newborns and premature babies

A type of streptococci, called group B streptococci commonly inhabits the vagina and is a
common cause of meningitis among premature babies and newborns during the first week of life.
Escherichia coli, which inhabit the digestive tract, may also cause meningitis among newborns.
Meningitis that occurs during epidemics can affect newborns - Listeria monocytogenes being the
most common.
Bacterial meningitis in children under 5
Children under five years of age in countries that do not offer the vaccine are generally infected
by Haemophilus influenzae type B.
Bacterial meningitis in older children
Older children generally have meningitis caused by Neisseria meningitides (meningococcus),
and Streptococcus pneumoniae.
Nursing diagnosis
1. deficient fluid volume (physiological need for fluid)
2. hyperthermia (physiological need for control of body temperature)
3. acute pain (physiological need for comfort)
4. deficient knowledge (safety need)
5. risk for ineffective cerebral tissue perfusion (anticipated need for oxygen to the
brain)
6. risk for trauma/suffocation (anticipated need for oxygen to the lungs--trumps the
anticipated need for protection)

7. risk for infection (anticipated need for physiological safety)

Nursing Intervention
1. Patient's total bed rest with supine sleeping position without a pillow.
Rationale: Changes in intracranial pressure will be able to mislead the risk for brain herniation.
2. Monitor signs of neurological status with a GCS.
Rational: To reduce further brain damage.
3. Monitor vital signs such as BP, pulse, temperature, respiration, and caution in systolic
hypertension.
6. Collaboration
Give intravenous fluids with strict attention.
8. Provide appropriate treatment advice by the doctors

5. Cholera
Cholera is an acute diarrhoeal illness caused by some strains of the bacterium Vibrio cholerae.
The cholera organism is known to be present in some rivers along the eastern Australian coast,
but cholera acquired in Australia is very rare. In Australia, because of our high standards of
sanitation, water and food quality, cholera outbreaks do not occur. Typically, cholera is seen only
in travellers arriving from countries where the disease is still common, such as Africa, Central
Europe, Latin America and Asia.
Cholera is a notifiable condition
How cholera is spread
Infection occurs when the bacteria are taken in by mouth, usually in food or water contaminated
by human faeces.
Cholera is spread by:

drinking contaminated water

eating food contaminated by dirty water, soiled hands or flies

eating fish or shellfish from contaminated waters.

The cholera organism can survive for long periods in water and ice.
Signs and symptoms
Infection is often mild, or without any symptoms, but it can be severe.
Symptoms include:

sudden onset of painless, profuse, watery diarrhoea

nausea and vomiting early in the illness

dehydration.

In severe untreated cases, death may occur within hours, but with simple treatment full recovery
can be expected.
Diagnosis
Diagnosis is suspected on clinical signs and confirmed by growing Vibrio cholerae from a faecal
specimen. A few hours to 5 days, usually 2 to 3 days.

Nursing Diagnosis for Cholera

1. Deficient fluid volume related to excessive fluid loss through the stool or emesis
2. Imbalanced Nutrition: Less Than Body Requirements related to loss of fluids through
diarrhea, inadequate intake
3. Risk for infection related to microorganisms that penetrate the gastrointestinal tract.
4. Impaired Skin Integrity: perianal, related to irritation from diarrhea
5. Anxiety related to separation from parents, unfamiliar environment, a stressful procedure.
6. Interrupted Family Processes related to crisis situations, lack of knowledge about
diseases, treatment of clients.

Nursing Interventions for Cholera

Deficient fluid volume related to excessive fluid loss through the stool or emesis
Goal :

Maintain adequate hydration

Expected outcomes:
No signs of dehydration: elastic skin turgor, sunken fontanel not, the patient is not agitated,
mucous membranes moist, no weight loss.
Nursing Interventions and Rational:
1) Record Intake Output every 24 hours.
R / Knowing the status of dehydration and evaluate the effectiveness of interventions.
2) Measure the child's weight every day.
R / observe dehydration.
3) Measure vital signs and evaluation of skin turgor, mucous membranes, mental status.
R / observe dehydration.
4) Tell the family to give the child a drink gradually.
R / improve hydration.
collaboration:
5) Give oral rehydration solution (ORS).
R / rehydration and replacement of fluid loss through the stool.
6) Provide and monitor IV fluids as indicated (collaboration).
R / replacement fluid loss.
7) Observe the results of the electrolyte.
R / know the level of hydration and the effectiveness of interventions.

Imbalanced Nutrition: Less Than Body Requirements related to loss of fluids through
diarrhea, inadequate intake
Goal :

consume adequate nutrition intake.

Expected outcomes:

No weight loss (weight stable)

Eating out 1 serving.

No nausea, vomiting.

Nursing Interventions and Rational:

1) Evaluation of nutritional status and weight loss
R / Identifying the need for further intervention.
2) Notify and motivation of mothers / families to continue breast-feeding.
R / breast milk reduces the severity and duration of disease and provide additional nutrients.
3) Tell the mother to give the child to eat small meals but often
R / increase food intake.
4) Observe and record the response to feeding.
R / know the tolerance of feeding.
Treatment
Anyone who has been in a high-risk region within the previous 5 days and develops severe
vomiting and diarrhoea should seek urgent medical assessment.
Although cholera can be life-threatening, it is easily treated by immediate rehydration, that is,
replacement of the fluid and salts lost through diarrhoea.
Oral rehydration fluid is recommended. This can be obtained from pharmacies.
Patients with severe dehydration or who are unable to keep oral fluids down require
hospitalisation and intravenous fluid replacement
Complication

Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of
fluids and electrolytes can lead to death within two to three hours. In less extreme situations,
people who don't receive treatment may die of dehydration and shock hours to days after cholera
symptoms first appear.
Although shock and severe dehydration are the most devastating complications of cholera, other
problems can occur, such as:

Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose)
the body's main energy source may occur when people become too ill to eat. Children
are at greatest risk of this complication, which can cause seizures, unconsciousness and
even death.

Low potassium levels (hypokalemia). People with cholera lose large quantities of
minerals, including potassium, in their stools. .

Kidney (renal) failure. When the kidneys lose their filtering ability, excess amounts of
fluids, some electrolytes and wastes build up in your body a potentially lifethreatening condition.

Prevention

Exclude people with cholera from childcare, preschool, school and work until there has
been no diarrhoea for 24 hours. If working as a food handler in a food business, the
exclusion period should be until there has been no diarrhoea or vomiting for 48 hours.

Infants, children and adults with cholera infection should not swim until there has been
no diarrhoea for 24 hours.

Follow good hand washing procedures.

Severely ill patients should be isolated in hospital.

People who are less severely ill can be nursed at home. Faeces and vomit can be disposed
of into the toilet except in areas where there is not an adequate sewage disposal system.

All linen and articles used by the patient should be washed in hot soapy water and the
room thoroughly cleaned when the person has recovered.

Vaccines are available but are recommended only for travellers to high-risk countries.
They may not protect against all strains of cholera bacteria and protection is for several
months only.

When travelling to high-risk countries, seek advice from a travel medical clinic or an
experienced general practitioner on how to protect yourself from cholera and other
diarrhoeal illnesses. In particular, drink only water that has been boiled or disinfected
with iodine or chlorine tablets. Carbonated bottled drinks are usually safe, if no ice is
added.

Good food handling procedures should always be followed, including when travelling.

Contacts (for example, family members) of a case should be observed for 5 days from the
date of the last exposure to the infected person. A contact is any person who has been
close enough to an infected person to be at risk of having acquired the infection from that
person.

6. Kwashiorkor
Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema,
irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. The
presence of edema caused by poor nutrition defines kwashiorkor.
Description
This disease is more common in very poor countries. It often occurs during a drought or other
natural disaster, or during political unrest. These conditions are responsible for a lack of food,
which leads to malnutrition.
Kwashiorkor is very rare in children in the United States. There are only isolated cases.
However, one government estimate suggests that as many as 50% of elderly people in nursing
homes in the United States do not get enough protein in their diet.
When kwashiorkor does occur in the United States, it is usually a sign of child abuse and severe
neglect.
Etiology
Kwashiorkor is caused by a lack of protein in the diet. Every cell in your body contains protein.
You need protein in your diet for your body to repair cells and make new cells. A healthy human
body regenerates cells in this way constantly. Protein is also especially important for growth
during childhood and pregnancy. If the body lacks protein, growth and normal body functions
will begin to shut down, and kwashiorkor may develop.
Nursing diagnosis

Imbalance nutrition less than body requirements related to the intake that is less (protein)
is characterized by not eating, anorexia, weight loss, height is not increased.
Activity intolerance related to physical infirmity
Risk for Infection related to low body resistance

Nursing intervention
1- The nurse must notice any elevation in the temperature or hypothermia.
2- The nurse is also responsible for measuring urine output.
3- Daily weighing.
4- Initial oral feeding should be low in quantities and calories.
5- Small but frequent blood transfusion to correct anemia.
6- Vitamins A, B, C, D may be given.
7- Change the position frequently.
8- Should be isolated since his resistance is low.
9- He should be watched for sign of peripheral collapse.
10- Treatment of infection

7. Common cold
The common cold may be caused by any of over 100 known cold viruses.

Getting a cold has nothing to do with being cold or chilled and there is no scientific evidence that
feeding a cold (or starving a fever) makes the slightest difference to how long it lasts.
How the common cold is spread
The common cold spread is when an infected person talks, coughs or sneezes small droplets
containing infectious agents into the air. The droplets in the air may be breathed in by those
nearby. The common cold is also spread by indirect contact with hands, tissues or other articles
soiled by nose and throat discharges.
Newborn babies are protected for about the first 6 months of life by antibodies from their
mothers. After this, young children are very susceptible to colds because they havent built up
immunity, they have close contact with adults and other children, they cannot practice good
personal hygiene and they have tiny nose and ear passages which are easily blocked.
Signs and symptoms
Symptoms include:

runny nose

sneezing

coughing

mild sore throat

watery eyes

feeling unwell.

Fever is very uncommon, especially in people over 3 years of age. Most people will recover
within 10 days.
Nursing Diagnosis for common cold - Nursing Care Plan for common cold

1. Acute Pain / Chronic Pain: head, throat, sinus related to inflammation of the nose.
2. Anxiety related to lack of client knowledge about diseases and medical procedures (sinus
irrigation operation).

3. Ineffective Airway Clearance related to obstruction secret is thickened.

4. Disturbed Sleep Pattern related to clogged nose, nasal inflammation secondary pain.
5. Imbalanced Nutrition: Less than Body Requirements related to decreased appetite secondary
to sinus inflammation.
6. Self-concept disturbance related to bad breath and a runny nose
Nursing Interventions Nursing Care Plans for Common Cold

Pain Management

Administer analgesics, as indicated

Energy Management: Regulating energy use to treat or prevent fatigue and optimize
function

Exercise Promotion: Facilitation of regular physical exercise to maintain or advance to a

higher level of fitness and health

Nutrition Management: Assisting with or providing a balanced dietary intake of foods

and fluids

Temperature Regulation: Attaining and/or maintaining body temperature within a normal

range.

Fever Treatment: Management

nonenvironmental factors.

Malignant Hyperthermia Precautions: Prevention or reduction of hypermetabolic

response to pharmacological agents used during surgery

Maintain airway patency.

Expectorate/clear secretions readily.

Demonstrate absence/reduction of congestion with breath sounds clear, respirations

noiseless, improved oxygen exchange

Infection Protection: Prevention and early detection of infection in a patient at risk

of

patient

with

hyperpyrexia

caused

by

Infection Control: Minimizing the acquisition and transmission of infectious agents

Surveillance: Purposeful and ongoing acquisition, interpretation, and synthesis of patient

data for clinical decision making

Treatment
There is no specific antiviral treatment against the viruses which cause colds.
Paracetamol and other medications available from pharmacies may provide
relief of symptoms. Aspirin should not be given to children under 12 years of
age unless specifically recommended by a doctor.
Complications

Acute ear infection (otitis media). Ear infection occurs when bacteria or viruses
infiltrate the space behind the eardrum. It's a frequent complication of common colds in
children.

Wheezing. A cold can trigger wheezing in children with asthma.

Sinusitis. In adults or children, a common cold that doesn't resolve may lead to sinusitis
inflammation and infection of the sinuses.

Other secondary infections. These include strep throat (streptococcal pharyngitis),

pneumonia, and croup or bronchiolitis in children.

Prevention

Exclusion from childcare, preschool, school or work is not necessary, but a person with a
cold should stay home until he or she feels well.

Wash hands after contact with soiled tissues or with nose and throat discharges.

Cover your mouth and nose when sneezing or coughing.

Some viruses live for several days on surfaces (for example telephones, door handles,
computer keyboards). Wipe down all frequently touched surfaces with a cloth dampened
with detergent.

8. Chickenpox and shingles

Chickenpox (varicella) is a viral infection caused by the varicella-zoster virus. Shingles (herpes
zoster infection) is caused by re-activation of the chicken-pox virus.
How chickenpox and shingles are spread
Chickenpox is spread when an infected person talks, breathes, coughs or sneezes tiny particles
containing infectious agents into the air. These are called small particle aerosols. Due to their tiny
size, small particle aerosols can travel long distances on air currents and remain suspended in the
air for minutes to hours. These small particle aerosols may be breathed in by another person.
Direct contact with the blister fluid in shingles can cause chickenpox in a non-immune person.
There is no spread through the air from people with shingles, except perhaps in some very severe
cases of disseminated (widespread) shingles. Contact with chickenpox or shingles cannot lead to
shingles in the exposed person since shingles can only follow the reactivation of a previous
chickenpox infection.
Signs and symptoms of Chickenpox
Symptoms of chickenpox may include:

Slight fever and cold-like symptoms, followed by a rash (see image).

A rash appears as blisters which crust to form scabs and is usually itchy.

Crops of blisters may appear over several days and various stages of blisters may be
present. The rash is usually more noticeable on the trunk than on the limbs. It may affect
the scalp and the inside of the mouth, nose, and throat.

In childhood, chickenpox is usually a mild illness and can be so mild it might not be
noticed. Infection in adults is uncommon, since more than 95% of unimmunised
Australians get the infection in childhood. Chickenpox in adults is more severe and may
be complicated by pneumonia (lung infection or inflammation).

Chickenpox may be particularly severe in children with leukaemia, pregnant women and
young babies. Congenital malformation of the fetus may occur in up to 2 % of
pregnancies where chickenpox occurs in early pregnancy. If chickenpox occurs around
the time of delivery, the baby may become infected and up to 30% of newborns will
become severely ill.

Shingles

Shingles follows a previous chickenpox infection, usually several decades later. Shingles
occurs when the bodys immunity to the virus drops and the virus, which has been resting
near the spinal cord, becomes active again. The elderly, children and adults being treated
for cancer, and people with advanced HIV infection are at greater risk of developing
shingles.

A blistering rash with band-like distribution (see image), usually associated with severe
pain, occurs in the skin supplied by the spinal nerves carrying the reactivated virus. The
rash may be followed by persistent pain in the area, lasting for weeks.

For chickenpox, 10 to 21 days, commonly 14 to 16 days, but may vary in people whose immune
system is suppressed.
.
For shingles, a person is infectious from when the rash appears until all blisters have dried up.
Treatment
Specific antiviral treatment for both chickenpox and shingles is available. Treatment is usually
only given to those with severe disease or at risk of severe disease. To be effective, treatment
must be commenced early, usually within 24 hours of onset of the rash.
For all cases, calamine lotion or promethazine [Phenergan] (available from pharmacies) may be
useful for the itch. If treatment to reduce temperature or discomfort is necessary, paracetamol is
recommended. Aspirin should not be given to children or adolescents who have chickenpox or
shingles.

chickenpox develops in a child or adult with an immune deficiency (including a history

of leukaemia, even if in remission).

Nursing Diagnosis
1. Hypertermia related to the disease.
2. Impaired Skin Integrity related to mechanical factors (eg stress, tear, friction)
3. Disturbed Body Image related to lesions on the skin.
4. Deficient Knowledge: about the condition and treatment needs
5. Risks of infection related to open sores
Nursing Intervention for Chicken Pox:
There are different types of nursing intervention for Chicken Pox; those are mentioned in the
following:
1. Assess patient sign condition carefully and check any complication.
2. Provide 100% cotton and loose dress to prevent discomfort and break up blister.
3. Give baths with cool or Luke warm water every 3 to 4 hours for first few days.
4. Use backing soda in water to give bath.
5. Use cool and wet towels to dry skin.
6. Apply calamine lotion over the lesions to reduce itching.
7. Apply a soothing moisturizer after bathing to soften and cool the skin.
8. Encourage patient to do not scratching blister and trim finger nails.
9. Cover child hands with socks or mittens to avoid scratching.
10. Avoid nappy or diaper as much as possible to allow the vesicle dry out and scab.
11. Monitor fever and give age appropriate paracetamol as ordered.
12. Administer antibiotic if any secondary bacterial complication arise.
13. Administer over the counter medication for alive itching as ordered.

14. Keep hold aspirin like medication if patient takes previously as doctor advised.
15. Serve cold, soft and bland diet because chicken pox in mouth can make drinking or eating
difficult.
16. Instruct patient to avoid prolonged exposure to excessive heat and humidity.
17. Provide isolation care to prevent spread of infection and dispose all PPE properly.
18. Limited visitor to reduce chance of infection.
19. Encourage patient to pit in a bin carefully to prevent spread.
20. Wash hands carefully before and after each treatment to Prevent of secondary infection of
the skin lesions.
Instruct patient and family members to disinfect cloths and linen by hot water and soap and dry
in sunlight.
Complication for Chicken Pox:
There are different complications for Chicken Pox, those are in the below:
1. Persistent sleepiness or lethargy,
2. Dehydration,
3. Bleeding problems,
4. Encephalitis, Cerebral ataxia, meningitis,
5. Bacterial infection,
6. Bone and joint infection (Transient Arthritis),
7. Toxic shock syndrome,
8. Death,
9. Reyes Syndrome,
10. Myocarditis,

11. Pneumonia
Prevention

Exclude people with chickenpox and shingles from childcare, preschool, school and work
until all blisters have dried (usually about 5 days). Some remaining scabs are not a reason
for continued exclusion.

Any person with an immune deficiency (for example, leukaemia) or receiving

chemotherapy should be excluded from contact with a case of chickenpox or shingles for
their own protection.

Immunisation against chickenpox is recommended in the National Immunisation

Program. In South Australia this is given as the combined measles, mumps, rubella,
varicella (MMRV) vaccine

Wash hands after contact with soiled articles (for example, tissues). Keeping areas clean,
especially where articles have been soiled with nose and throat discharges, will limit the
spread of infection. Dispose of tissues appropriately.

People with shingles should cover the rash with a dry bandage or clothing to ensure that
others are not exposed.

Varicella-zoster immunoglobulin (VZIG) is made from blood products and contains

antibodies to the varicella-zoster virus. Antibodies are proteins produced by the body as
part of the immune response which help the body to fight infections. VZIG is effective in
preventing or reducing the severity of chickenpox if given to non-immune people within
96 hours of exposure to a person with chickenpox or shingles. Only people without a
history of chickenpox, and with no evidence of immunity on blood testing, need to
receive VZIG. VZIG is only of value if given before chickenpox occurs. VZIG is of no
use in treatment of chickenpox or shingles.

People at high risk of complications from chickenpox infection (for example, people with
leukaemia, young babies or pregnant women) should seek medical advice regarding
VZIG if they have been exposed to a person with chickenpox or shingles.

Antiviral medicines may also sometimes be used to prevent chickenpox after exposure.

Several studies have shown that chickenpox vaccine is effective in preventing chickenpox
infection, particularly moderate to severe disease, following exposure. This is generally

successful when given within 3 days, and up to 5 days after exposure, with earlier
administration preferable.

A vaccine to prevent shingles is licensed in Australia. It is recommended for adults aged

60 years and over

9. CLEFT LIP AND PALATE

Its an opening in the roof of the mouth due to a failure of the palatal shelves to come fully
together from either sides of the mouth and fuse during the months of development of embryo.
This is also known as Orofacial cleft and cleft lip and palate. A cleft contains an opening in the
upper that extends into the nose. The opening may be on one side, both sides or in the middle. A
cleft palate is when the roof of the mouth contains an opening into the nose and can result in
feeding problems, speech, and frequent ear infections.
This condition comes as a result tissue of the face not properly joining together during
development and its a type of birth defect, I most cases the cause is unknown but the risk factors
include diabetes, in older mothers, obesity, and certain medications.

Etiology
Many factors are associated with the development of cleft lip and palate, and cleft lip with or
without cleft palate is developmentally and genetically different from isolated cleft palate. Most
cases appear to be consistent with the concept of multifactorial inheritance in relatives and
monozygotic twins.
Cleft lip is heterogeneous with both genetics and environmental contributions. A variety of
genetic polymorphisms have studied in population based associations studies and candidates
gene studies. The results suggest that a role of genes responsible for growth factors, transcription
factors, factors which influence xenobiotic metabolism etc. have been amongst the most widely
investigated variants over the years. Also the defect of chromosomal deletion and duplication
was found out that it was also a contributing factor.
Nursing diagnosis
-

Imbalance nutrition less than body requirements related to inability to ingest /difficulty in
eating, secondary disability and surgery.
Risk for aspiration related to inability to secret secretion secondary to patatoschisis.
Risk for infection related to disability and or surgical incision.
Knowledge deficit; family related to techniques of feeding and care at home.
Acute pain related to surgical incision.
Impaired skin integrity related to surgical incision.

Nursing intervention
-

Ensure adequate nutrition and prevent aspiration by providing special nipples or feeding
devices, hold the child semi upright position and make sure to feed the infant slowly and
burp frequently to prevent excessive swallowing of air and regurgitation.
Give social and emotional support to the child and parents to enable family acceptance of
infant by encouraging the parents to express their feelings and concerns
Provide preoperative care by giving mouth care to prevent infection. Also provide
postoperative care by always doing vital signs assessments, observe for edema, liquidly
secretions and minimize distress.

10.Measles
Measles is an illness caused by infection with the measles virus.
Measles is a notifiable condition
How measles is spread
Measles is spread when an infected person talks, breathes, coughs or sneezes tiny particles
containing infectious agents into the air. These are called small particle aerosols. Due to their tiny
size, small particle aerosols can travel long distances on air currents and remain suspended in the
air for minutes to hours. These small particle aerosols may be breathed in by another person.
Measles is also spread by contact with hands, tissues and other articles soiled by nose and throat
discharges. The virus is very infectious and droplets in the air may infect people entering a room
up to 30 minutes after an infected person has left
Signs and symptoms
Early in the infection, symptoms may include:

fever

tiredness

cough

sore throat

runny nose

sore eyes

photophobia (discomfort when looking at light).

These symptoms usually worsen over 3 to 5 days, then a blotchy rash (see image) begins on the
head and over the next day or two spreads down the entire body.
The rash lasts 4 to 7 days. Measles illness usually lasts about 10 days. The cough may be the last
symptom to disappear.
Measles is often a severe disease, frequently followed by middle ear infection (7% of cases) or
bacterial pneumonia (lung infection or inflammation) in 6% of cases. In as many as 1 in every
1000 cases, brain infection occurs (encephalitis), often resulting in death or permanent brain
damage. Sometimes brain damage may not appear until many years later.
Complications from measles are more common and more severe in the chronically ill and in very
young children.Usually 10 days to onset of fever (range 7 to 18 days) and about 14 days to onset
of rash.
Nursing rational and interventions
1. Impaired social interaction related to isolation from friends.
Expected results:

Children demonstrate an understanding of the restrictions.

Appropriate child activities and interact.

Intervention:
1. Explain the reason for the isolation and use of special vigilance.
Rational: to increase children's understanding of the discussion.
2. Let the children play the gloves and masks.
Rational: to facilitate positive coping.
3. Provide diversion activities.
Rational: the right to perform activities and interact.
4. Encourage parents to stay with their children during hospitalization.
Rational: to reduce separation and provide proximity.

5. Prepare children for changes perampilan friends physically.

Rationale: to encourage the acceptance of friends.

2. Risk for impaired skin integrity related to raking pruritus.

Expected results: the skin remains intact
Intervention:
1. Keep nails short and clean.
Rational: to minimize the trauma and secondary infection.
2. Wear gloves or elbow restrains.
Rational: to prevent scratching.
3. Give clothes are thin, loose, and not to irritate.
Rationale: because excessive heat can increase itching.
4. Close area of pain (long sleeves, long pants, underwear layer).
Rational: to prevent scratching.
5. Give lotion that softens (very little on the open lesions).
Rationale: because the open lesions to reduce drug absorption increased pruritus.
6. Avoid exposure to sunlight or heat.
Rationale: cause rashes.
Treatment
There is no specific antiviral treatment for measles. Complications may require antibiotic
treatment. Treatment for the symptoms includes plenty of fluids and paracetamol for the fever.
Aspirin should not be given to children under 12 years of age unless specifically recommended
by a doctor
Complications
Complications of measles may include:

Ear infection.

Bronchitis, laryngitis or croup

Pneumonia.

Encephalitis.

Pregnancy problems.

Low platelet count (thrombocytopenia).

Prevention
Exclude the person with measles from childcare, preschool, school and work for at least 4 days
after the onset of the rash.
Exclusion periods for contacts*:

Unvaccinated children should be excluded for 14 days from the first day of appearance
of rash in the last case. If vaccinated within 72 hours of their contact with the virus, they
may then return to childcare, preschool or school.

Immune suppressed - should be excluded until 14 days after the first day of the
appearance of rash in the last case.

*A contact is any person who has been close enough to an infected person to be at risk of having
acquired the infection from that person.

11.Polio (poliomyelitis)
Poliomyelitis or polio is an infection caused by the polio virus. It is a serious disease affecting a
persons brain and spinal cord. Infection with the poliovirus can lead to a life-threatening
muscular paralysis of the body.
In the last 20 years the number of polio cases around the world has reduced. This is largely due
to global vaccination programs that aim to immunise people against the poliovirus.
How polio is spread

People can become infected with polio when they ingest the poliovirus though their mouth.
Ingestion can occur in the following ways:

eating food prepared by someone who has polio

drinking untreated water that has been contaminated with the poliovirus via sewage

contact with the nose and throat discharge of a person infected with the poliovirus for
example contact with soiled handkerchiefs or discarded tissues

contact with objects or surfaces touched by an infected person whose hands contain
traces of faeces or alternatively having direct contact with the infected persons hands

inhaling or ingesting airborne droplets from the coughs and sneezes of someone infected
with poliovirus.

Polio can be easily transmitted when someone infected with the poliovirus has close contact with
many other people, such as in day care centres and family homes.
Signs and symptoms
Most people infected with the poliovirus will have no symptoms. Ten per cent of infected people
may experience flu-like symptoms such as:

fever

fatigue

nausea

vomiting

headache

occasionally neck and back stiffness referred to as non-paralytic aseptic meningitis

(inflammation of the lining of the brain and spinal cord).

Less than 1% of people infected with poliovirus develop severe muscle weakness (acute flaccid
paralysis) affecting the limbs, diaphragm muscle (essential for breathing), and the head and neck
muscles.

The risk of permanent limb paralysis is less than 1%. Death occurs in 2 to 5% of children and 15
to 30% of adults with paralytic polio.
Typically 7 to 14 days with a range of 3 to 35 days.
Nursing Diagnosis for Poliomyelitis
Imbalanced Nutrition: Less Than Body Requirements related to anorexia, nausea and vomiting
1. Ineffective Thermoregulation related to the infection process
2. Ineffective Airway Clearance related to muscle paralysis
3. Ineffective Breathing Pattern related to muscle paralysis
4. Acute pain related to the infection that attacks the nerve
5. Impaired physical mobility related to paralysis
6. Anxiety: in children and families related to disease conditions
Nursing interventions.
1. Maintain a patent airway, and keep a tracheotomy tray at the patients bed side.
2. Encourage a return to mild activity as soon as possible.
3. Prevent fecal impaction by giving enough fluids to ensure an adequate daily urine output
of low specific gravity.
4. Provide tube feedings when needed.
5. Provide good skin care, reposition the patient often, and keep bed linens dry.
6. To alleviate discomforts, use foam rubber pads and sandbags or light splints as ordered.
7. Wash hands thoroughly after contact with the patient or any of his secretions and
excretions.
8. Frequently check blood pressure, especially if the patient has bulbar poliomyelitis.
9. Assess bladder retention that cause muscle paralysis.

10. Have the patient wear high-top sneakers or use a footboard to prevent foot drop.
11. Provide emotional support to the patient and his family.

Treatment
There is no cure for poliovirus infection.
Treatment focuses on managing the consequences of severe muscle weakness. This may include
admission to intensive care to assist with breathing, and physiotherapy or medicines to reduce
muscle spasm.
Complications
Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities
of the hips, ankles and feet. Although many deformities can be corrected with surgery and
physical therapy, these treatments may not be options in developing nations where polio is still
common. As a result, children who survive polio may spend their lives with severe disabilities.
Prevention

Exclude people with polio from childcare, preschool, school and work until a public
health doctor has given a clearance to return

vaccination provides protection from poliovirus infection

there are two types of polio vaccines

o oral poliomyelitis vaccine (OPV)
o inactivated poliomyelitis vaccine (IPV). All the polio vaccines recommended for
use in Australia are IPV

the first dose of polio vaccine, in combination with other vaccines, is now recommended
to be given at 6 weeks of age. Adults should have received a minimum of 3 doses of
vaccine previously.

12.Tetanus
An often fatal infectious disease that is caused by the bacterium Clostridium tetani, which
usually enters the body through a puncture, a cut, or an open wound.
Description
Tetanus is characterized by an acute onset of hypertonia, painful muscular contractions (usually
of the muscles of the jaw and neck), and generalized muscle spasms without other apparent
medical causes.
Neonatal tetanus (tetanus neonatorum) is a major cause of infant mortality in underdeveloped
countries but is rare in the United States. Infection results from umbilical cord contamination
during unsanitary delivery, coupled with a lack of maternal immunization. At the end of the first
week of life, infected infants become irritable, feed poorly, and develop rigidity with spasms.
Neonatal tetanus has a very poor prognosis.
Although at present, tetanus is rare, it has not been eradicated, and early diagnosis and
intervention are lifesaving. Prevention is the ultimate management strategy for tetanus.
Ethology
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces.
When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin,
tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The
effect of the toxin on your motor neurons can cause muscle stiffness and spasms the major
signs of tetanus.
Nursing diagnosis
1. Ineffective Airway Clearance related to accumulation of secretions result of damage to
the muscles of swallowing.
2. Acute Pain related to injury agents (biological).
3. Risk for Aspiration related to loss of consciousness, swallowing disorders.
4. Ineffective Tissue Perfusion related to damage to transport oxygen through the alveolar
and capillary membranes.

5. Risk for Injury related to an increase in muscle coordination (convulsions), irritability.

6. Imbalanced Nutrition, Less Than Body Requirements related to decreased swallowing
reflexes, less intake.

Nursing Intervention
1. Clear the airway by adjusting the position of head extension.
2. Physical examination by auscultation of breath sounds heard every 2-4 hours.
3. Clean the mouth and respiratory tract of mucus with a secret and do section.
4. Oxygenation according to physician instructions.
5. Observation of vital signs every 2 hours.
6. Observation of the onset of respiratory failure / apnea.

13.Diphtheria
Diphtheria is an infection of the throat and nose caused by a toxin produced by the bacterium
Corynebacterium diphtheriae.
Diphtheria has been rare in Australia since the introduction of an effective vaccine, but a century
ago, was the most common infectious cause of death. Outbreaks still occur in countries where
vaccination rates are not high.
Diphtheria is a notifiable condition
How diphtheria is spread
People can carry the diphtheria bacterium harmlessly in the nose and throat (carriers). The
diphtheria bacterium is spread when an infected person (patient or carrier) talks, coughs or
sneezes small droplets containing infectious agents into the air. The droplets in the air may be
breathed in by those nearby. The diphtheria bacterium is also spread by indirect contact with
hands, tissues or other articles soiled by nose and throat discharges, or by indirect contact with
skin sores. It usually 2 to 5days

Signs and symptoms

Symptoms include:

sore throat

swollen neck glands

discharge from the nose.

The bacteria can also produce a toxin capable of damaging nerves or the heart.
Occasionally these bacteria can cause skin infections, usually in people with poor health or poor
hygiene.
Diagnosis
Diphtheria is suspected when a white or grey membrane is seen on the back of the throat and is
confirmed when the bacteria are seen under the microscope and grown in the laboratory.
Nursing Diagnosis and Interventions for Pediatric Diphtheria

Nursing Diagnosis I : Body temperature imbalance: Hyperthermia related to the release of an

exotoxin.
Goal: The client shows the body temperature within normal limits.
Outcomes:

Normal temperature (36.5 to 37.2 C)

Sweat out naturally.

Intervention:
1. Maintain room temperature.
R /: Can an exchange by convection temperature.
2. Give thin clothes that easily absorbs sweat.
R /: Helping the process of evaporation.
3. Give drink that much.
R /: Drinking a lot helps the drop in body temperature.

4. Collaborate with physicians for the provision of anti-pyretic.

R /: Reduce the heat in the center of the hypothalamus.

Nursing Diagnosis II : Imbalanced Nutrition: Less than Body Requirements related to pain
swallow.
Goal:

Clients can demonstrate and maintain a normal weight.

Nutritional needs are met.

Outcomes:

The existence of interest and appetite.

Portions as needed.

Increased weight.

Intervention:
1. Monitor calorie intake and quality of food consumption.
R /: Knowing food intake.
2. Monitor signs of paralysis of the soft palate and durum.
R /: food in small portions easily consumed by the client and avoid the occurrence of anorexia.
3. Give foods that stimulate appetite.
R /: Increase food intake
4. Measure body weight each day.
R /: Monitoring the effectiveness of weight and lack of nutrition are given.
Nursing Diagnosis III : Impaired gas exchange related to pseudomembranous
Goal : Maintaining the effectiveness of breathing.

Outcomes:

No sound extra breath.

No respirator muscle pull.

There is no cough.

No secretion of excessive respiratory tract.

Respiratory frequency within normal limits.

Intervention
1. Auscultation of breath sounds, note the presence of an additional breath sounds.
R/ : The presence of airway obstruction in the airways manifested.
2. Help the patient in a comfortable position, the head higher than the feet.
R/ : lower diaphragm can improve chest expansion.
3. Increase fluid intake as needed.
R/ : Thurasi helps reduce viscosity and facilitate secret spending.
4. Help perform chest physiotherapy.
R/ : Postural drainare and percussion is an important cleansing action to remove the secret and
improve ventilation.
5. Perform suction.
R/ : When cleaning mechanism or airway suctioning done coughing ineffective.
6. Give oxygen as indicated.
R/ : Maximizing transport in tissue.

Treatment
Specific treatment with antibiotics and an antidote to the toxin is available.
Complications
Left untreated, diphtheria can lead to:

Breathing problems

Heart damage. .

Nerve damage.

Prevention

People with diphtheria need to be kept in isolation until they are certified to be free of the
disease by SA Health's Communicable Disease Control Branch (CDCB).

Contacts of people with diphtheria need to be investigated for the disease, receive
antibiotics and receive vaccination if required. A contact is any person who has been
close enough to an infected person to be at risk of having acquired the infection from that
person.

Family or household contact with diphtheria should be excluded from childcare,

preschool, school and work until cleared to return by the CDCB.

Contacts whose work involves food handling or caring for unimmunised children are
excluded from work until they certified to be free of the disease by the CDCB.

Widespread immunisation against diphtheria is the only effective control. The diphtheria
vaccine is administered through the National Immunisation Program. The first dose of
diptheria vaccine, in combination with other vaccines, is now recommended to be given
at 6 weeks of age. For adolescents and adults, the combined diphtheria, tetanus, pertussis
vaccine is preferred, if not given previously, as it provides additional protection against
whooping cough (pertussis).

14. AUTISM
Autism is a cognitive disorder that affects the developmental or learning ability of an individual.
The manifestations of the disorder usually appear as early as the first three years of life. As a
result of the neurological disorder, it disrupts the normal functioning of the brain affecting the
development of the communication skills and social interaction skills of the person. Difficulties
in verbal and non-verbal communication, leisure activities, and social interaction are seen in both
children and adults with the disorder.
Etiology
The actual cause of autism is still unknown. However, following are some of the known causes
of autism:

Structural or functional damage of central nervous system

Genetic conditions
Abnormal development of brain
Rett syndrome
Biochemical defects
Seizure
Landau kleffner syndrome

Symptoms of Autism
The symptoms of autism differ from person to person. However, following are some of the
symptoms of autism:
Problem in non-verbal communication
Resisting changes
Restricted interests
Seizures
Self-injurious and aggressive behavior

Nursing diagnosis
Risk for Self-Mutilation related to:
Developmental tasks that are not resolved from trust to distrust.
Maternal deprivation.
Sensory stimulation that is not appropriate.
Impaired Social Interaction related to:
Impaired self-concept.
The absence of people nearby.
Maternal deprivation.
Sensory stimulation that is not appropriate.

Impaired Verbal Communication related to:

The inability to trust.
Withdrawal from self
Maternal deprivation.
Disturbed Personal Identity related to:
Uncompleted tasks of trust versus mistrust.
Maternal deprivation
Nursing Interventions
Reduced self-destructive behaviors. Physically stop the child from harming himself, while firmly
saying no. When he responds to your voice, first give a primary reward (such as food); later,
substitute verbal or physical reinforcement (such as good or a hug or a pat on the back.
Encourage self-care. For example, place a brush in the childs hand and guide his hand to brush
his hair. Similarly, teach him to wash his hands and face.
Provide emotional support to the parents. Refer them to the autism society of America for further
assistance.
Teach the parents how to physically care for the childs needs.

15.Human immunodeficiency virus infection (HIV and AIDS)

Without treatment, human immunodeficiency virus (HIV) infection will usually result in
acquired immune deficiency syndrome (AIDS). New HIV therapies introduced in the mid-1990s

have resulted in much less AIDS related illness and death. However, HIV remains a lifelong
infection.
Human immunodeficiency virus is a notifiable condition
How HIV is spread
HIV infection occurs when particular body fluids (blood, semen, vaginal fluid and breast milk)
containing the virus come into contact with another persons tissues beneath the skin (for
example, though needle puncture or broken skin), or mucous membranes (the thin moist lining of
many parts of the body such as the nose, mouth, throat and genitals).
In Australia, most infections have resulted from:

unprotected sex (anal and vaginal intercourse)

sharing injecting equipment

receiving blood or blood products before the introduction of screening in 1985

mother-to-baby transmission during pregnancy, birth or breastfeeding.

Routine social or community contact with an HIV infected person carries no risk of infection.
There is no evidence of spread of HIV through social contact in schools, at home or in the work
place. HIV has not been transmitted through:

air or water

swimming pools or toilets

sharing of plates, cups or cutlery

kissing

coughing

sneezing or spitting.

In addition, there is no evidence HIV can be spread by mosquitoes or other biting insects.
Signs and symptoms

A few weeks after infection with HIV, the infected person may develop an illness
(seroconversion illness) which is often mild, consisting of:

muscle aches

low-grade fever

headaches

sometimes a rash

swelling of the lymph glands may also occur.

This illness at the beginning of the infection is so similar to many other viral infections that the
diagnosis of HIV infection may not be made at this time. This flu-like illness may last for a few
weeks and then there is a return to seemingly normal health.
The length of this period of normal health varies widely between people. Some experience
fairly rapid development of disease due to the HIV infection, whereas others may remain free of
any symptoms for many years.
When symptoms do eventually develop, they may not be specific and can include:

chronic loss of appetite

diarrhoea

weight loss

fever

lethargy

fatigue.

HIV destroys certain cells within the immune system (CD4+ or helper T cells) from the time of
infection onwards, causing more and more damage. Eventually the point is reached where the
damage to the immune system is so great the body can no longer stop some infections or cancers
it normally fights successfully. Infections not usually seen in healthy people, called opportunistic
infections, and certain unusual tumours such as Kaposis sarcoma, may occur. Women with HIV
infection are at increased risk of developing cervical cancer and both men and women are at

increased risk of anal cancer. HIV can cause infection in the brain, which can lead to nervous
system disorders or dementia in some people with HIV infection.
Diagnosis
Diagnosis of HIV infection is made using blood tests. A positive blood test indicates the
development of antibodies to HIV and therefore the presence of the virus. Antibodies to HIV
usually develop within a few weeks to 3 months. Even though the blood test for antibodies may
not be positive during the early stage of infection, the virus will be present in blood and body
fluids, making them infectious to other people. PCR (polymerase chain reaction) tests in a
pathology laboratory can be used for the early detection of HIV genetic material in the blood.

Human Immunodeficiency Virus (HIV) test (opens in a new window)

Clinic 275 can offer you a confirmatory HIV test and result within 36 hours. Please ask one of
the staff for more information at your next visit.
Incubation period (time between becoming infected and developing symptoms)
Illness may not occur for months or years after HIV infection. Without treatment, most adults
will develop severe disease within 10 years of infection. Treatment of HIV with drug therapy has
become much more effective in the past few years, prolonging the life of people with this
infection, as well as increasing their quality of life. It is uncertain what effect these treatments, or
treatments yet to be developed, will have upon long-term HIV infection in any individual.
Infectious period (time during which an infected person can infect others)
Once a person has been infected with HIV he or she remain infected for life and are able to
transmit the virus to others. The risk of transmitting the infection to another person may be
dependent on the level of virus in body fluids of the infected person.
The risk is higher when the viral load (the amount of HIV in the blood) is higher, in particular in
early infection (when a person may not even be aware he or she has HIV) and late in infection
(when the immune system is failing). Even when the viral load is undetectable by blood tests,
some potential for transmission remains.

Nursing Care Plan

Assesment
Nursing
Diagnosis

Planning

Data Subjective: High body

temperature
He said fever associated
with the
Data Objective: disease
process.
He looks
weak

After nursing
action 324
hours, the body
temperature
down until
normal.

The results of
laboratory are:
Hb: 11 g/dL

Body
temperature
within normal
range 36-37C

Leukocytes:
20.000/Ul,
Thrombocyte:
160.000/UL
Na: 8 mmol/L
K: 2.8 mmol/L

Criteria results:

Clients free
of fever

Nursing
Intervention

Rationale

1. Consider the 1. Client looks a

causes of
cooperative
fever

Evaluation

S: The client said it

was no longer a fever

O: Clients seem fresh

again.

2. Give warm
compresses 2. Giving a warm
compress to
Vital signs:
stimulate a decrease
in body temperature. BP: 120/80 mmHg
HR: 18x/min
3. Water is the
1. Levels of
bodys temperature
calories and control. Every rise in T: 37,5C
give plenty of temperatures in
RR: 24x/min
drinks
excess of normal,
(liquid)
increased metabolic
P: 90x/min
needs water

A: Problem solved
4. Thin clothes will
be easy to absorb
P: Intervention is
sweat.
stopped

Cl: 11 mmol/L.
Vital signs
are: BP: 120/80
mmHg
HR: 18x/min
T: 39C
RR: 28x/min
P: 90x/min

Data Subjective: Fluid volume After nursing

deficit relatedaction 324
He said has to excessive hours, the fluid
diarrhea for 2
output.
volume will be
weeks and did
adequate for
not get better
body
after seeing a
requirements
doctor. He was
diarrhea 15 times
Fluid intake of
a day.
at least 2500
ml/day
Data Objective:
Weight: 53 kg
He looks
weak

5. Observation of
vital signs is early
1. Advise
detection to
wearing thin determine the
clothes that complications that
absorb sweat. happen so quickly
take action
2. Observation
of vital signs, 6. The provision of
especially
medicines, especially
temperature antibiotics will kill
and pulse
the bacteria that
accelerate the
healing process
while antipyretics to
lower body
temperature.
1. Give a
medicines,
especially
anti-pyretic.

1. Skin turgor,
mucous
membranes,
and thirst
2. Monitor fluid
intake and
output at
least 2500 ml
/ day
3. Remove
potential food
that causes
diarrhea

S: Client said he was

diarrhea
1. Can reduce
diarrhea.

O: Client looks still

weak, Feces is mushy
consistency, yellow
color, skin turgor
medium.
Vital Sign:

1. Reduced
BP: 120/80 mmHg
sense of
wanting to HR: 18x/min
vomit, stool
consistency T: 37,5C
decreases the
amount of

 Intravenous
normal saline
infusion 20
drops/min

Dry turgor

Vital Signs:
BP: 120/80
mmHg

Collaborated
1. Give
medications
as indicated:
antiemetikum
, antidiarrhea
or
antispasmodi
c.

HR: 18x/min
T: 39C
RR: 28x/min
1. Monitor the
results of
laboratory
tests

reducing
intestinal
spasm and
peristalsis.

2. Indirect
indicators of
fluid status.

P: 90x/min

A : Partially solved th
1. aware problem
of the
existe P :Intervention is
nce of continued
electr
olyte
distur
bance
s and
to
deter
mine
the
need
electr
olytes

1. Required to
support the
volume of
circulation,
especially if
the income is
inadequate
1. Give fluid or
electrolyte
through a
feeding tube

RR: 24x/min

3. Maintaining
fluid balance,
reduce the
thirst,
moisten the
mucosa.

Data Subjective: Less of

knowledge
He said not related to the
understand about lack of
the disease and information
did not get better
Data Objective:

After done
130 minute
nursing actions,
Expressing
understanding
of the condition
of the client /
process and
treatment of
certain diseases

1. Review the
disease
process and
what is the
hope of the
future
2. Review the
way of
transmission
of disease

1. Provide
information
on the
management
of symptoms
that
complement
medical
rules, such
as:
intermittent
diarrhea
2. Emphasize
the need for
continuing

S: Client said have

understood the disease
and its treatment.

O: Clients can answe

all questions properly

1. Provide an
opportunity A: Problem solved
to change the
rules to meet P: Intervention is
the changing stopped
needs /
individual
2. Facilitate the
transfer of
acute care
environment,
supporting
the recovery
with
independence

medical care
and
evaluation

1. Identify
community
resources,
such as:
hospital /
residential
treatment
center (if
any)
2. Provide basic
knowledge in
which clients
can make
informed
choices
3. Correcting
myths and
misconceptio
ns, improve
safety for
clients /
others
4. Giving
clients
control
reduces the
risk of
embarrassme
nt and
increase

comfort

B.

Nursing Care Plan

Treatment
Specific therapy (antiretrovirals) is available and all people with HIV infection should have
access to this treatment. Available antiretroviral drugs have dramatically improved the outlook
for people with HIV.
In countries such as Australia where there is access to HIV treatment, about 80% of people on
treatment will have long-term suppression of symptoms and a reduced viral load. Without
antiviral treatment the majority of people with HIV will develop AIDS and die from infections,
cancers and other illnesses the immune system can no longer fight.
Antiretroviral treatment outcomes over a whole lifetime are not yet known and drug resistance
can limit the treatment options available to the person. Some of the drugs have significant side
effects and all must be taken very accurately, requiring quite some effort on the part of the HIV
infected person to take the medications for a long period, and probably for life.
There is no vaccine against HIV. There is no drug yet which can cure HIV infection.
When HIV infection is advanced and has caused immune system destruction, secondary
infections (opportunistic infections) can occur. Using other antiviral drugs and antibiotics to
prevent secondary infection may prevent severe illness and premature (early) death.
Regular assessment is important in monitoring the effects of HIV infection, determining the best
time to start therapy and monitoring the effect of therapy or the development of complications.
Measurement of the viral load and the levels of CD4+ cells assists in indicating the effectiveness
of treatments.
An infectious diseases specialist or general practitioner with expertise in HIV medicine is
recommended to undertake these assessments.
Prevention

Exclusion from childcare, preschool, school and work is not necessary. Children with HIV
infection may be advised to stay away from school during outbreaks of infectious disease (for
example, chickenpox) to prevent them getting the infection.
Health Care Workers with HIV infection must comply with the requirements of their professional
boards.
Although there is no HIV vaccine, HIV infections are entirely preventable through safe
behaviour. Everyone has a responsibility to help prevent transmission of HIV and to take care of
themselves and others. This means:

Practising safer sex use condoms and water based lubricants for penetrative sex. These
reduce the risk of getting HIV, as well as other sexually transmitted infections (STIs).
Having any STI increases the risk of getting HIV infection.

Not sharing any injecting equipment (including needles, syringes, filters, spoons, swabs,
tourniquets).

Safely disposing of found or used needles and syringes in a sharp safe, or other sealable
and puncture-proof container.

Always using standard precautions if blood or body fluids must be handled. This will
minimise and generally eliminate the risk of transmission of HIV.

Covering any open sores, cuts or abrasions with waterproof dressings.

Understanding the risk of body tattooing or any body piercing. The risk of being infected
with HIV through these practices is lower than for hepatitis B or hepatitis C, but there is
still a risk if there is use of unsterile equipment or re-used dyes.

People with HIV or at risk of infection with HIV should not donate blood, organs or other tissue.
All donated blood and body organs are screened for HIV infection.
Post Exposure Prophylaxis (PEP) for HIV
PEP for HIV is a four week treatment that may prevent you from becoming infected if you have
been exposed to HIV.
PEP needs to begin as soon as possible within 72 hours after exposure to be effective.

Complications
HIV infection weakens your immune system, making you highly susceptible to numerous
infections and certain types of cancers.
Infections common to HIV/AIDS

Tuberculosis (TB).

Cytomegalovirus.

Candidiasis.

Cryptococcal meningitis.

Toxoplasmosis.

Cryptosporidiosis

Cancers common to HIV/AIDS

Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare in people not
infected with HIV, but common in HIV-positive people.
Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In
people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can
also affect the internal organs, including the digestive tract and lungs.

Lymphomas. This type of cancer originates in your white blood cells and usually first
appears in your lymph nodes. The most common early sign is painless swelling of the
lymph nodes in your neck, armpit or groin.

Other complications

Wasting syndrome.

Neurological complications.

Kidney disease.

Prevention of mother-to-child transmission of HIV

Administration of anti-HIV medication to HIV-positive pregnant women during pregnancy and

labour and after delivery, as well as to the newborn baby, reduces mother-to-baby transmission of
HIV.

16.Conjunctivitis
Conjunctivitis, sometimes known as sticky eye, is an inflammation of the lining of the eye and
eyelid caused by bacteria, viruses, chemicals or allergies.
How conjunctivitis is spread
Viral and bacterial conjunctivitis can be spread by direct contact with eye secretions or indirectly
by contact with towels, washcloths, handkerchiefs and other objects that have been contaminated
with eye secretions. In some cases it can be spread by insects such as flies. Conjunctivitis caused
by chemicals or allergies is not infectious. It usually 24 to 72 hours.
Signs and symptoms
Symptoms may include:

redness in the whites of the eyes

irritation in one or both eyes

discharge, causing the eyelids to stick together in the morning (see image)

swelling of the eyelids (see image)

sensitivity to light.

Nursing Diagnosis for Conjunctivitis

1. Acute pain related to inflammation of the conjunctiva.
2. Anxiety related to lack of knowledge about the disease process.
3. Risk of spread of infection associated with inflammatory processes.

4. Impaired self-concept (body image decreases) related to the change of the eyelids
(swelling / edema).
5. Risk for injury related to limited vision.
Nursing intervention for Conjunctivitis:
There are different types of Nursing Intervention for Conjunctivitis which are mentioned in the
following:

Teach proper hand washing technique and instruct keep hand away of eyes

Use disinfected for eye examination

Encourage pt avoid sharing personal cloths with other

Apply warm compression over eye and drop and ointment as order

Instruct patient to clean eye discharge with tissue and dispose carefully.

Replace eye cosmetics and do not share

Teach the patient to install eye drops and ointments correctly without touching tip of
container with eye or lashes

Encourage patient to stay away of school for at least 7 days

Instruct to use dark black eye glass to avoid bright light and contamination

Use and care of contact lenses correctly

Avoid rubbing eyes

Treatment

Antibiotic eye drops or ointment may be prescribed by a doctor.

Since bacterial and viral infections look the same, a person with symptoms of conjunctivitis
should always be seen by a doctor for examination, diagnosis and treatment.
Complication
In both children and adults, pink eye can cause inflammation in the cornea. This can affect
vision. Prompt evaluation and treatment by your doctor can reduce the risk of complications.
Prevention

Exclude people with conjunctivitis from childcare, preschool, school and work until
discharge from the eyes has ceased.

Good personal hygiene must be followed. Careful hand washing, using soap and warm
water.

17.Malaria
Malaria is caused by a parasite called Plasmodium. There are 5 species of Plasmodium which
infect humans:

Plasmodium vivax

Plasmodium falciparum

Plasmodium malariae

Plasmodium ovale

Plasmodium knowlesi which is less common.

Of these, Plasmodium falciparum infection is the most severe and can cause death in up to 10%
of cases. It can be rapidly fatal. Pregnant women and children are especially at risk. Other types
of malaria are less severe, but still may cause death.
Malaria is a notifiable condition
How malaria is spread

The parasite is transmitted to humans by the bite of infected female Anopheles species
mosquitoes.
The parasites multiply in the liver and the bloodstream of the infected person. The parasite may
be taken up by another mosquito when it bites an infected person. The mosquito is then infected
for the duration of its life and can infect other humans when it bites them. Occasionally malaria
is transmitted by blood transfusion.
Over 600,000 people living in these countries die from malaria each year. Many thousands of
tourists also get malaria during their travels to countries where malaria is present. Tourists often
get severe illness because they have had no previous exposure to malaria and have no resistance
to the disease.
Signs and symptoms
Symptoms of malaria may include:

fever, which may come and go, or may be constant

chills

profuse sweating

malaise (feeling of unwellness)

muscle and joint pain

headache

confusion

nausea

loss of appetite

diarrhoea

abdominal pain

cough

anemia.

Plasmodium falciparum may cause cerebral malaria, a serious complication resulting from
inflammation of the brain that may cause coma.
Diagnosis
Diagnosis is made by a blood test sometimes it is necessary to repeat the test a number of
times, as the parasites can be difficult to detect.
Incubation period
(time between becoming infected and developing symptoms)
Varies with the type:

P. falciparum: 9 to 14 days

P . vivax: 12 to18 days but some strains may have an incubation period of 8 to 10 months
or longer

P. ovale: 12 to 18 days

P. malariae: 18 to 40 days

P. knowlesi 9 to 12 days.

These periods are approximate and may be longer if the person has been taking drugs taken to
prevent infection.
Treatment
Specific antimalarial treatment is available and must always be started as
soon as malaria is diagnosed. There is increasing resistance to currently
available drugs and treatment should be carried out by an infectious
diseases
Nursing Care Plan for Malaria
Nursing Diagnosis 1.

Hyperthermia related to the development of malaria parasites in red blood

cells.
Nursing Intervention:
1. Assess any complaints or signs of increased body temperature changes.
R /: Increased body temperature will exhibit a variety of symptoms such as
red eyes and the body feels warm.
2. Observation of vital signs, especially body temperature as indicated.
R /: To determine interventions.
3. Warm water compress on the forehead and both axilla.
R /: stimulates the hypothalamus to the center of the temperature setting.
4. Collaboration of antipyretic drugs.
R /: Controlling fever.
Nursing Diagnosis 2.
Risk for Fluid Volume Deficit related to hyperthermia
Nursing Interventions:
1. Supervise the input and output of fluids. Estimate loss of fluid through
sweat.
R /: Provides information about the fluid balance, are guidelines for fluid
replacement.
2. Observations of decreased skin turgor.
R /: Indicates excessive fluid loss / dehydration.
3. Give parenteral fluids if needed.
R /: Helping peroral fluid intake.
Nursing Diagnosis 3.
Imbalanced Nutrition, Less Than Body Requirements related to anorexia
Nursing Interventions:

1. Encourage bed rest / or activity restrictions.

R /: Maintaining sufficient energy savings.
2. Provide oral hygiene.
R /: a clean mouth can enhance the flavor of food.
3. Provide food in a well ventilated, pleasant environment, the situation is not
in a hurry, accompany.
R /: Pleasant surroundings lower stress and more conducive to eating.
4. Collaboration of antiemetic drugs.
R /: Eliminate the symptoms of nausea and vomiting.
Nursing Diagnosis 4
Knowledge Deficit: about disease
Nursing Interventions:
1. Determine the patient's perception of the disease process.
R /: Creating a knowledge base and provide awareness of individual learning
needs.
2. Review the disease process, the cause / effect relationship factors that
cause symptoms and identify ways to lose factors. Encourage questions.
R /: Trigger factors / ballast individuals, so the patient needs to be aware of
lifestyle factors may trigger symptoms. Accurate knowledge base gives
patients the opportunity to make an informed decision / choice about the
future and control of chronic diseases. Although many patients know about
the disease itself, they can experience that has been left behind or wrong
concept.
3. The review: medicine, destination, frequency, dosage, and possible side
effects.
R /: Improving understanding and to increase cooperation in the
program.specialist or other expert in the field.
Complications

Malaria can be fatal, particularly the variety that's common in tropical parts of Africa. The
Centers for Disease Control and Prevention estimate that 90 percent of all malaria deaths occur
in Africa most commonly in children under the age of 5.
In most cases, malaria deaths are related to one or more serious complications, including:

Cerebral malaria. If parasite-filled blood cells block small blood vessels to your brain
(cerebral malaria), swelling of your brain or brain damage may occur.

Breathing problems. Accumulated fluid in your lungs (pulmonary edema) can make it
difficult to breathe.

Organ failure. Malaria can cause your kidneys or liver to fail, or your spleen to rupture.

Anemia..

Low blood sugar

Malaria may recur

Some varieties of the malaria parasite, which typically cause milder forms of the disease, can
persist for years and cause relapses.
Prevention

Exclusion from childcare, preschool, school or work is not necessary but cases should
avoid being bitten by mosquitoes while they are unwell. Travellers to areas with malaria
are usually advised to take preventative anti-malarial drugs.

There is no vaccine to prevent human infection by this parasite.

Personal protection and the environmental management of mosquitoes are important in

preventing illness. See Fight the Bite for tips to on how to protect yourself.

18.Scarlet fever
Scarlet fever (known as scarlatina in older literature references) is a syndrome
characterized by exudative pharyngitis (see the image below), fever, and bright-red
exanthem. It is caused by streptococcal pyrogenic exotoxins (SPEs) types A, B, and C
produced by group A beta-hemolytic streptococci (GABHS) found in secretions and

discharge from the nose, ears, throat, and skin. Scarlet fever may follow streptococcal
wound infections or burns, as well as upper respiratory tract infections
Etiology
Scarlet fever is a streptococcal disease. Streptococci are gram-positive cocci that grow in chains.
They are classified by their ability to produce a zone of hemolysis on blood agar and by
differences in carbohydrate cell wall components (A-H and K-T). They may be alpha-hemolytic
(partial hemolysis), beta-hemolytic (complete hemolysis), or gamma-hemolytic (no hemolysis).
Group A streptococci are normal inhabitants of the nasopharynx. Group A streptococci can cause
pharyngitis, skin infections (including erysipelas pyoderma and cellulitis), pneumonia,
bacteremia, and lymphadenitis.
Most streptococci excrete hemolyzing enzymes and toxins. The erythrogenic toxins produced by
GABHS are the cause of the rash of scarlet fever. The erythema-producing toxin was discovered
by Dick and Dick in 1924. Scarlet fever is usually associated with pharyngitis; however, in rare
cases, it follows streptococcal infections at other sites.
Although infections may occur year-round, the incidence of pharyngeal disease is highest in
school-aged children during winter and spring and in a setting of crowding and close contact.
Person-to-person spread by means of respiratory droplets is the most common mode of
transmission. It can rarely be spread through contaminated food, as seen in an outbreak in China.
[2]

The organism is able to survive extremes of temperature and humidity, which allows spread by
fomites. Geographic distribution of skin infections tends to favor warmer or tropical climates and
occurs mainly in summer or early fall in temperate climates.
The incubation period for scarlet fever ranges from 12 hours to 7 days. Patients are contagious
during the acute illness and during the subclinical phase.

Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on
the face or neck and spreads to the trunk, arms and legs. If pressure is applied to the
reddened skin, it will turn pale.

Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually
become a deeper red than the surrounding rash.

Flushed face. The face may appear flushed with a pale ring around the mouth.

Strawberry tongue. The tongue generally looks red and bumpy, and it's often covered
with a white coating early in the disease.

The rash and the redness in the face and tongue usually last about a week. After these signs and
symptoms have subsided, the skin affected by the rash often peels. Other signs and symptoms
associated with scarlet fever include:

Fever of 101 F (38.3 C) or higher, often with chills

Very sore and red throat, sometimes with white or yellowish patches

Difficulty swallowing

Enlarged glands in the neck (lymph nodes) that are tender to the touch

Nausea or vomiting

Headache

-Nursing Diagnoses
Acute pain
Hyperthermia
Impaired oral mucous membrane
Impaired skin integrity
Impaired swallowing
Risk for infection
-Nursing Interventions
Implement droplet precautions for 24 hours after starting antibiotic therapy.
Perform meticulous hand washing.
Offer frequent oral fluids and oral hygiene.
Give prescribed drugs, such as antibiotics, antipyretics, and antihistamines.
Provide skin care to relieve discomfort from the rash.
Provide warm liquids or cold foods to ease sore throat pain.
Use a cool mist humidifier to keep the air moist and prevent the throat from getting too dry and
sore.

Assist with respiratory hygiene care measures to reduce the risk for transmission.
Inspect the skin for signs of secondary infection.
Complications
Cervical lymphadenitis
Severe disseminated toxic illness
Septicemia
Rheumatic heart disease
Liver damage
Otitis media
Pneumonia
Peritonsillar and retropharyngeal abscess
Sinusitis
Glomerulonephritis
Meningitis
Brain abscess
Treatment-Medications
Antibiotics, such as penicillin V potassium as a first-line agent or erythromycin if the patent is
allergic to penicillin
Antipyretics such as acetaminophen
Emollients for rash
Oral antihistamines such as diphenhydrAMINE hydrochloride to control pruritus
Treatment-Surgery
Tonsillectomy for recurrent bouts of pharyngitis
Prevention
The best prevention strategies for scarlet fever are the same as the standard precautions against
infections:

Wash your hands. Show your child how to wash his or her hands thoroughly with warm
soapy water.

Don't share dining utensils or food. As a rule, your child shouldn't share drinking
glasses or eating utensils with friends or classmates. This rule applies to sharing food,
too.

Cover your mouth and nose. Tell your child to cover his or her mouth and nose when
coughing and sneezing to prevent the potential spread of germs.

If your child has scarlet fever, wash his or her drinking glasses, utensils and, if possible, toys in
hot soapy water or in a dishwasher.

19. Bronchiolitis
Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs
(bronchioles). It is usually due to a viral infection.
Causes
Bronchiolitis usually affects children under the age of 2, with a peak age of 3 to 6 months. It is a
common, and sometimes severe illness. Respiratory syncytial virus (RSV) is the most common
cause. More than half of all infants are exposed to this virus by their first birthday.
Other viruses that can cause bronchiolitis include:

Adenovirus

Influenza

Parainfluenza

The virus is spread to infants by coming into direct contact with nose and throat fluids of
someone who has the illness. This can happen when another child or an adult who has a virus:

Sneezes or coughs nearby and tiny droplets in the air are then breathed in by the infant

Touches toys or other objects that are then touched by the infant

Bronchiolitis occurs more often in the fall and winter than other times of the year. It is a very
common reason for infants to be hospitalized during winter and early spring.
Risk factors of bronchiolitis include:

Being around cigarette smoke

Being younger than 6 months old

Living in crowded conditions

Not being breastfed

Being born before 37 weeks of pregnancy

Symptoms
Some children may have few or mild symptoms.
Bronchiolitis begins as a mild upper respiratory infection. Within 2 to 3 days, the child develops
more breathing problems, including wheezing and a cough.
Symptoms include:

Bluish skin due to lack of oxygen (cyanosis) - emergency treatment is needed

Breathing difficulty including wheezing and shortness of breath

Cough

Fatigue

Fever

Muscles around the ribs sink in as the child tries to breathe in (called intercostal
retractions)

Infant's nostrils get wide when breathing

Rapid breathing (tachypnea)

Nursing Diagnosis For Bronchitis

1. Ineffective airway clearance
related to: increased production of secretions.
2. Acute pain
related to: the inflammation of the pleura.
3. Impaired gas exchange

related to: airway obstruction by secretions, spasm of the bronchus.

4. Ineffective breathing pattern
related to: bronchoconstriction, mucus.
5. Imbalanced Nutrition, Less Than Body Requirements
related to: dyspnoea, anorexia, nausea, vomiting.
6. Risk for infection
related to: the settlement of secretions, chronic disease processes.
7. Activity intolerance
related to: insufficiency of ventilation and oxygenation.
8. Anxiety
related to: changes in health status.
9. Knowledge Deficit
related to: the lack of information about the disease process and treatment at home.
Nursing Interventions: Chronic Bronchitis
1. Answer the patients questions and encourage him and his family to express their concerns
about the illness.
2. As needed, perform chest physiotherapy, including postural drainage and chest
percussion and vibration for involved lobes several times daily.
3. Make sure the patient receives adequate fluids (at least 3 liters per day) to loosen
secretions.
4. Schedule respiratory therapy for the patient at least 1 hour before or after meals.
5. Provide mouth care after bronchodilator inhalation therapy.
6. Encourage daily activity and provide diversional activities as appropriate.
7. To conserve the patients energy and prevent fatigue, help him to alternate periods of rest
and activity.
8. Administer medications as ordered and note the patients response to them.

9. Assess the patient for changes in baseline respiratory function.

10. Evaluate sputum quality and quantity, restlessness, increased tachypnea, and altered
breath sounds. Report changes immediately.
11. Monitor the patients weight by weighing him three times weekly. Assess for edema.
12. Evaluate the patients nutritional status regularly.
13. Watch the patient for signs and symptoms of respiratory infection, such as fever,
increased cough and sputum production, and purulent sputum.
14. Advise the patient to avoid crowds and people with known infections and obtain
influenza and pneumococcus immunizations.

20. Diarrhea
Diarrhea is defined as the passage of three or more loose or liquid
stools per day (or more frequent passage than is normal for the
individual). Frequent passing of formed stools is not diarrhea, nor is the
passing of loose, "pasty" stools by breastfed babies.
Etiology
Infection: Diarrhea is a symptom of infections caused by a host of
bacterial, viral and parasitic organisms, most of which are spread by
feces-contaminated water. Infection is more common when there is a
shortage of adequate sanitation and hygiene and safe water for
drinking, cooking and cleaning. Rotavirus and Escherichia coli are the
two most common etiological agents of diarrhea in developing
countries.
Malnutrition: Children who die from diarrhea often suffer from
underlying malnutrition, which makes them more vulnerable to
diarrhea. Each diarrheal episode, in turn, makes their malnutrition even
worse. Diarrhea is a leading cause of malnutrition in children under five
years old.

Source: Water contaminated with human feces, for example, from

sewage, septic tanks and latrines, is of particular concern. Animal feces
also contain microorganisms that can cause diarrhea.
Other causes: Diarrheal disease can also spread from person-toperson, aggravated by poor personal hygiene. Food is another major
cause of diarrhea when it is prepared or stored in unhygienic
conditions. Water can contaminate food during irrigation. Fish and
seafood from polluted water may also contribute to the disease.
Description
Diarrhea is usually a symptom of an infection in the intestinal tract,
which can be caused by a variety of bacterial, viral and parasitic
organisms. Infection is spread through contaminated food or drinkingwater, or from person-to-person as a result of poor hygiene.
Interventions to prevent diarrhea, including safe drinking-water, use of
improved sanitation and hand washing with soap can reduce disease
risk. Diarrhea can be treated with a solution of clean water, sugar and
salt, and with zinc tablets.
There are three clinical types of diarrhea:
acute watery diarrhea lasts several hours or days, and includes
cholera;
acute bloody diarrhea also called dysentery; and
Persistent diarrhea lasts 14 days or longer.
Scope of diarrheal disease
Diarrheal disease is a leading cause of child mortality and morbidity in
the world, and mostly results from contaminated food and water
sources. Worldwide, 780 million individuals lack access to improved
drinking-water and 2.5 billion lack improved sanitation. Diarrhea due to
infection is widespread throughout developing countries.
In developing countries, children under three years old experience on
average three episodes of diarrhea every year. Each episode deprives
the child of the nutrition necessary for growth. As a result, diarrhea is a
major cause of malnutrition, and malnourished children are more likely
to fall ill from diarrhea.
Dehydration
The most severe threat posed by diarrhea is dehydration. During a
diarrheal episode, water and electrolytes (sodium, chloride, potassium
and bicarbonate) are lost through liquid stools, vomit, sweat, urine and
breathing. Dehydration occurs when these losses are not replaced.
The degree of dehydration is rated on a scale of three.
1. Early dehydration no signs or symptoms.
2. Moderate dehydration:

o thirst
o restless or irritable behavior
o decreased skin elasticity
o sunken eyes
3. Severe dehydration:
o symptoms become more severe
o Shock, with diminished consciousness, lack of urine output, cool,
moist extremities, a rapid and feeble pulse, low or undetectable
blood pressure, and pale skin.
Death can follow severe dehydration if body fluids and electrolytes are
not replenished, either through the use of oral rehydration salts (ORS)
solution, or through an intravenous drip

Prevention
Key measures to prevent diarrhea include:
access to safe drinking-water;
use of improved sanitation;
hand washing with soap;
exclusive breastfeeding for the first six months of life;
good personal and food hygiene;
health education about how infections spread; and
rotavirus vaccination

Nursing diagnosis
Deficient Fluid Volume related to excessive fluid loss through the stool
or vomit
characterized by:
Subjective data:

Thirst, nausea, anorexia.

Objective data:

Inadequacy of oral fluid intake

Negative balance between intake and output
Weight loss
Dry mucous membranes
Decreased urine output
Decrease in skin turgor
Increase in serum sodium

 Imbalanced Nutrition: less than body requirements related to loss of

fluids through diarrhea, inadequate intake is characterized by:
Subjective data:

Family clients reported a portion of food that is spent.

Abdominal cramps.

Objective data:

Weight loss below ideal body weight.

Upper arm circumference below the ideal.

Anemic conjunctiva.
Anorexia.
Muscle weakness.
Decrease in serum albumin.

Risk for infection: related to microorganisms that penetrate the

gastrointestinal tract.
Impaired skin integrity: perianal related to irritation from diarrhea
characterized by:
Subjective data:

Changes in comfort: pain, itching

Objective data:

Damage to the skin layer (dermis): lesions and skin irritation due to
diaper.
Perianal area moist and redness.

Anxiety / fear related to separation from parents, unfamiliar

environment, stressful procedure
characterized by:
Subjective data:

Reported feelings of anxiety, fear

Objective data:

Restless
Focus on yourself
Less eye contact
Choleric
Tremor
Facial tension
Increased respiratory and pulse

Sweat

Nursing intervention

Replace fluid and electrolyte losses

Provide good perianal care. Diarrheal stool is oftentimes highly acidic.
This causes anal soreness and irritation in the perianal area.
Promote rest. To reduce peristalsis.
Diet
Small amounts of bland foods
Low fiber diet
BRAT Diet (banana, rice, apple, toast)
Avoid excessively hot or cold fluids. These are stimulants.
Potassium-rich foods and fluid (e.g. banana, Gatorade)
Antidiarrheal medications as ordered:
Demulcents mechanically coat the irritated bowel and act as
protective.
Absorbents absorbs gas or toxic substances from the bowel
Astringents Shrink swollen or inflamed tissues in the bowel.