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Communicable Disease Nursing Study Bullets

Communicable Disease Nursing

DRUG OF CHOICE

Tetanus: PEN G Na; DIAZEPAM (Valium)


Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory);
DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS
stimulant)
Rabies Vaccines: LYSSAVAC, VERORAB
Immunoglobulins: ERIG or HRIg

DIAGNOSTIC TESTS

Tetanus: WOUND CULTURE


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

CAUSATIVE AGENTS

Tetanus: CLOSTRIDIUM TETANI


Meningococcemia: NEISSERIA MENINGITIDIS
Rabies: RHABDOVIRUS
Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III
Leon)
Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile);
(Flaviviruses) (Common in the Phil.)
Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae;
P. Ovale
Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI
Leprosy: MYCOBACTERIUM LEPRAE
Measles: PARAMYXO VIRUS
German measles: TOGA VIRUS
Chicken pox: VARICELLA ZOSTER VIRUS
Herpes zoster: HERPES ZOSTER VIRUS
Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS
Scabies: SARCOPTES SCABIEI (itch mite)
Bubonic plague: YERSINIA PESTIS
Diphtheria: KLEBS LOEFFLER
Pertussis: BORDETELLA PERTUSSIS
Tuberculosis: MYCOBACTERIUM TUBERCULOSIS
Typhoid: SALMONELLA TYPHI
Cholera: VIBRIO CHOLERA
Amoebiasis: ENTAMOEBA HYSTOLITICA
Leptospirosis: LEPTOSPIRA Spirochete
Schistosomiasis: Schistosoma japonicum
Gonorrhea: N. GONORRHEAE
Syphilis: TREPONEMA PALLIDUM
Chlamydia: C. trachomatis, T. vaginalis
Genital herpes: HERPES SIMPLEX 2

CD PHARMACOLOGY

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

Infectious Agent or its toxic products - AGENT


Directly or Indirectly - MODE OF TRANSMISSION
Person, Animal or Intermediate Vector – HOST
Environment - ENVIRONMENT

ECOLOGIC TRIAD OF DISEASE


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

CONTAGIOUS VS. INFECTIOUS


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

What is Infection?
INFECTION - "the state or condition in which the body or part of the body is invaded by a pathogenic
agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects
which are injurious…"

Infectious Agent
A. RESIDENT ORGANISMS
deeply seated in the epidermis, not easily removed by simple handwashing,
Ex: Staphylococci

B. TRANSIENT ORGANISM
represent recent contamination,
survive for a limited period of time, acquired during contact with the infected colonized patient or
environment,
easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)

Infectious Agent
Bacteria – heama organism, systemic
Virus – nuero organism, systemic
Fungi – skin organism, local
Protozoa – GI organism, local
Infectious Agent

FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE


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

STAGES OF INFECTIOUS PROCESS


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

Indirect Contact (inanimate object)


- occurs when a person touches an inanimate object contaminated by an infected patient

2. AIRBORNE
- droplet, dust, organisms in env.
3. VECTOR - insects or animals
4. VEHICLE
- food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion)

PREVENTION OF
COMMUNICABLE DISEASE
Prevention is worth a pound than cure
PREVENTION OF
COMMUNICABLE DISEASE
Health Education – primary role of the nurse
Specific Protection- handwashing, use of protective devices
Environmental Sanitation – clean and conducive for health
Definition of Prevention
“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The
concept of prevention is best defined in the context of levels, traditionally called primary, secondary,
and tertiary prevention”

A Dictionary of Epidemiology, Fourth Edition


by John M. Last

Prevention of Needlestick Injuries


Dispose Used Needles in Puncture Proof Needle Containers
Don’t Recap Needles (Unless using the One-handed Technique)
Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of Transmitting
Diseases)

CONTROL OF C0MMUNICABLE DIESEASE


1. Notification
2. Epidemiological Investigation
3. Case finding; early dx and prompt treatment
4. Isolation and Quarantine
5. Disinfection; disinfestation
6. Medical Asepsis
a. Handwashing
b. Concurrent disinfection
c. Personal protective equipments (PPEs)
d. Barrier Cards/Placarding
Objectives of CCD
Restoration of health, reduce deaths and disability
Interpretation of control measures to IFC for practice to prevent spread of CD.
Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring:


1. Acute flaccid paralysis (AFP) polio
2. Measles
3. Severe acute diarrhea (SAD)
4. Neonatal tetanus
5. AIDS

Diseases that require reporting w/in 24 hrs


1. Acute flaccid paralysis (AFP) polio
2. Measles

Diseases targeted for eradication


1. Acute flaccid paralysis polio
2. Neonatal tetanus
3. Measles
4. Rabies
Epidemiology
Study of the occurrence and distribution of diseases in the population

Patterns of occurrence of disease –frequency of disease occurrence


Sporadic
On and off occurrence of the disease
Most of the time it is not found in the community
One or two cases that occur are not related
Endemic
Persistently present in the community all year round
Ex: malaria in Palawan
Epidemic
An unexpected increase in the number of cases of disease
Pandemic
Epidemic of a worldwide proportions
Time Related Patterns of Occurrence
cyclical variation
a periodic increase in the number of cases of a disease
a seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons
are increased but it is not considered an epidemic because it is expected to rise at this particular time
hot spot-a rising increase that may lead to an epidemic

Time Related Patterns of Occurrence


Short time fluctuation
A change in the frequency of occurrence of a disease over a short period of time
Maybe (+) or (-)
Secular variation
A change in the frequency of occurrence of a diseae taking place over a long period of time
Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden
repport of cases in 2001 due to mutant restraints.
b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today
Types of Epidemiology
Descriptive Epidemiology - concerned with disease frequency & distribution
Analytic Epidemiology
Is a study of the factors affecting occurrence and distribution of the disease.
Ex. Epidemiologic investigation
Therapeutic/Clinical
Study of the efficacy of a treatment of a particular disease
Ex. Clinical trial of a newly proposed therapeutic regimen
Evaluation Epidemiology
Study of the over-all effectiveness of a total/ comprehensive public health program.
Ex. Evaluation of the under five clinic

Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to
determine the effectiveness of a particular treatment
Types of Epidemiologic Data
Demographic data
Demography is the study of population groups
Ex. Population size and distribution
Vital Statistics
Environmental data
Health services data
Ex. Ratio between nurse and the population being served
Ex. Degree of utilization of health facility/ service
Epidemiologic Investigation

1st step- Statement of the problem


2nd step- Appraisal of facts – describing the epidemic in terms of time, place, person.
3rd step- formulation of hypothesis
4th step-Testing the hypothesis
5th step- Conclusion and recommendation

TERMS
Disinfection – pathogens but not spores are destroyed
Disinfectant – substance use on inanimate objects

Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of
microorganisms.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his illness is
no longer communicable

FACTORS AFFECTING ISOLATION


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

Legislation, Laws affecting EPI

Proclamation No. 46 – “polio eradication project”


Proclamation No. 1064 – AFP surveillance
Proclamation No. 1066 – National Neonatal Tetanus Elimination Campaign

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

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

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

Schedule of immunization
OPV
3 doses, 4 weeks/1 month
Target population: same as above, eligibility until Grade 6
2-3 drops, oral route
*Feb 8-March 8: Oplan Polio Revival Drive
No side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if
vomits within the 30 minute period, repeat the vaccination

Schedule of immunization
Hepa B
3 doses, 4 weeks
Can be given at birth
Target age 1 ½ to 11 months
0.5 ml, IM, vastus lateralis
Patient may experience local tenderness
Schedule of immunization
Measles
9 to 11 months
Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months
because the time where the maternal antibodies wear off, other virus if it still active it will kill the
vaccine
0.5 ml, subcutaneous, any arm
Measles
Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles)

Immunization
Fully Immunized Child
when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses
DPT, OPV, HB)
Completely Immunized Child
All vaccines given but went beyond 0ne year of age

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

A. Skin biopsy
B. Wood’s light examination
C. Culture of the lesion

D. Patch test

ANSWER: C
Viral culture is the confirmatory test for Herpes.  Patch test is an allergy test.

2.  Nurse Jezel is preparing to care for a child with rubella (German measles) and anticipates
contact with infectious material during care.  She enters the supply closet where the masks,
gloves, gowns, and goggles are kept. Which item(s) does the nurse obtain to care for this child?

A.    mask, goggles


B.    mask, gown and gloves
C. mask, gloves, goggles, gown
D. gown, gloves, goggles

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

3.  Eunice, six year old,  is scheduled to receive a measles, mumps, rubella (MMR) vaccine. The
nurse preparing to administer the vaccine reviews the child’s record and questions the order if
which of the following is documented in the child’s record?

A.    a local reaction at the site of injection of a previous MMR vaccine


B.    a history of an anaphylactic reaction to neomycin
C.    a history of frequent respiratory infections
D.    recent recovery from a cold.

ANSWER: B
MMR vaccine contains aminoglycosides antibiotic.  Allergic reaction to neomycin
aminoglycosides warrant further check by the doctor.

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

A.    Intramuscularly in the anterolateral aspect of the thigh


B.    Intramuscularly in the deltoid muscle
C.    Subcutaneously in the outer aspect of the upper arm
D.    Subcutaneously in the gluteal muscle.

ANSWER: C
MMR vaccine is given via this route.  Before administration always check for allergy to eggs.

5.  Mrs. Analesa Plaga mother brings her six years old child to the clinic because the child has
developed a rash on the trunk and on the scalp. Mrs. Analesa reports that the child has had a low
grade fever, has not felt like eating and generally has been tired. The child is diagnosed with
chickenpox. Mrs. Plaga  inquires about the communicable period associated with chickenpox. A
nurse plans to base the response on which of the following?

A.    The communicable period is unknown.


B.    The communicable period s one to two days before the onset of rash to 6 days after the first
crop of vesicles, when crusts have formed.
C.     The communicable period is 10 days before the onset of symptoms to 15 days after the rash
appears.
D.    The communicable period ranges from 2 weeks or less to several months.
ANSWER: B
This is the POC of chicken pox.  Remember chicken pox is not contagious when crust or scabs
appear.

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

A.    Respiratory precautions  are not necessary once the swelling appears.
B.    Respiratory precautions are not necessary before the swelling begins.
C.    Respiratory precautions are indicated during the period of communicability.
D.    Respiratory precautions are indicated for 18 days following the onset of parotid swelling.

ANSWER: C
The patient is placed on isolation during the period of communicability.

7. Decontamination of surgical instrument by soaking in 0.5% chlorine bleach for 10 minutes


results to which of the following?

A.    Makes the micororganisms less contaminated.


B.    Completely kills all microorganisms.
C.    Enables the health worker to reuse the insturment immediately.
D.    Rapidly kills viruses causing AIDS and Hepatitis B.

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

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

A.    Thoroughly cleanse and disinfected.


B.    Well Kept and convenient to the nurse.
C.    Basic Medication and articles competence.
D.    Contents thoroughly completed.

ANSWER: A
In communicable diseases cases in the community in relation to CHN bag; the main goal is to
prevent the spread of infection.  Therefore the bag should be thoroughly cleanse and disinfected. 
Option B would be appropriate if the question is asking for neatness and organization of the
nurse.  Option C and D are not related to the topic in communicable disease.

9. Which of the following should be done first?


A.    Putting Apron.
B.    Put out things needed for the case.
C.    Take out hand towels.
D.    Handwashing.

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

10. After completion of the nursing care or treatment, the nurse must protect himself and prevent
the spread of infection.  What is used to clean item used?

A.    Alcohol
B.    Isopropyl
C.    Zephiran
D.    Wet ones

ANSWER: A
After completing nursing care or treatment, clean and alcoholize the things used.

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