The Community Health Nursing and Communicable Diseases

THE COMMUNITY HEALTH NURSING AND
COMMUNICABLE DISEASES
Community Health Nursing
COMMUNITY HEALTH NURSING
I - Definition of Terms Community- derived from a latin word comunicas which means a group of people.
a group of people with common characteristics or interests living together within a territory or geographical boundary
place where people under usual conditions are found
Health - is the OLOF (Optimum Level of Functioning)
Community Health - part of paramedical and medical intervention/approach which is concerned on the health of the whole population
Aims: 1. health promotion 2. disease prevention 3. management of factors affecting health
Nursing - both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
II - Community Health Nursing

The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities,
concerned with the promotion of health, prevention of disease and disability and rehabilitation.
Goal: To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as
to maximize their potential for high-level wellness
MISSION OF CHN
Health Promotion activities related to enhancement of health
Health Protection activities designed to protect the people
Health Balance activities designed to maintain well being
Disease prevention activities relate to avoid complication
Social Justice activities related to practice equity among clients
PHILOSOPHY OF CHN ACCORDING TO DR. MARGARET SHETLAND

The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.
Principles of Community Health:
1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group
(those who share common characteristics, developmental stages and common exposure to health problems e.g. children, elderly), and the
community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Role of CH Nurse:
Clinician - who is a health care provider, taking care of the sick people at home or in the RHU
Health Advocator speaks on behalf of the client
Advocator act on behalf of the client
Supervisor - who monitors and supervises the performance of midwives
Facilitator - who establishes multi-sectoral linkages by referral system
Collaborator working with other health team member
COMMON PROCEDURE IN CHN:
HOME VISIT
BAG TECHNIQUE
STERILIZATION
SPECIMEN COLLECTION
- URINE sterile bottle; midstream collection
- FECES - clean container; small amount of feces only
- SPUTUM - NPO midnight 1st collection early AM then submit at the health center immediately then 2nd collection following day early
in the Am then submit at the health center then collect the 3rd sputum; instruct patient to take a deep breath 4 times then
cough out
Levels of Client in CHN:

1. Application of Nursing Process to:
1.a Family
1.a.1 Family Coping Index
Physical Independence - ability of the family to move in & out of bed & performed activities of daily living
Therapeutic Independence - ability of the family to comply with the therapeutic regimen (diet, medication & usage of appliances)
Knowledge of Health Condition- wisdom of the family to understand the disease process
Application of General &Personal Hygiene- ability of the family to perform hygiene & maintain environment conducive for living
Emotional Competence ability of the family to make decision maturely & appropriately (facing the reality of life)
Family Living Pattern- the relationship of the family towards each other with love, respect & trust
Utilization of Community Resources ability of the family to know the function & existence of resources within the vicinity
Health Care Attitude relationship of the family with the health care provider
Physical Environment ability of the family to maintain environment conducive for living
****1.a.2 Family Life Cycle

Stage I Beginning Family (newly wed couples)
TASK: compliance with the PD 965 & acceptance of the new member of the family
Stage II Early Child Bearing Family(0-30 months old)

TASK: emphasize the importance of pregnancy & immunization & learn the concept of parenting
Stage III Family with Pre- school Children (3-6yrs old)

TASK: learn the concept of responsible parenthood
Stage IV Family with School age Children (6-12yrs old)

TASK: Reinforce the concept of responsible parenthood
Stage V - Family with Teen Agers (13-25yrs old)

TASK: Parents to learn the concept of let go system and understands the generation gap
Stage VI Launching Center (1st child will get married up to the last child)
TASK: compliance with the PD 965 & acceptance of the new member of the family
Stage VII -Family with Middle Adult parents (36-60yrs old)

TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect
Stage VIII Aging Family (61yrs old up to death)

TASK: learn the concept of death positively
1.b Community
COMMUNITY ASSESSMENT: Status information about morbidity, mortality & life expectancy Structure information about age, gender and
socio economic Process information about how the community function
TYPES OF COMMUNITY ASSESSMENT:
1. COMMUNITY DIAGNOSIS
A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the
population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and
strategies.
2 Types:
Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis
- aims to obtain general information about the community - type of assessment responds to a particular need
STEPS:
Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
Implementation Phase
1. data utilization
2. data collection
3. data organization/collation
4. data presentation
5. data analysis
Evaluation Phase
2. BIOSTATISTICS
2.1 DEMOGRAPHY - study of population size, composition and spatial distribution as affected by births, deaths and migration.
Sources : Census complete enumeration of the population
2 Ways of Assigning People:

1. De Jure - People were assigned to the place where assigned to the place they usually live regardless of where they are at the time of census.
2.De Facto - People were assigned to the place where they are physically present at are at the time of census regardless, of their usual place of
residence.
Components:
1. Population size
2. Population composition
* Age Distribution
* Sex Ratio
* Population Pyramid
* Median age - age below which 50% of the population fall and above which 50% of the population fall. The lower the median age, the younger
the population (high fertility, high death rates).
* Age Dependency Ratio - used as an index of age-induced economic drain on human resources
* Other characteristics: - occupational groups - economic groups - educational attainment - ethnic group
3. Population Distribution
* Urban-Rural - shows the proportion of people living in urban compared to the rural areas
* Crowding Index - indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host.
* Population Density - determines congestion of the place
3. VITAL STATISTICS
the application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health,
illness and health services of a community.
TYPES:
A. Fertility Rate
A. CRUDE BIRTH RATE

total # of livebirths in a given calendar year X 1000
estimated population as of July 1 of the same given year
B. GENERAL FERTILITY RATE

total # of livebirths in a given calendar year X 1000
Total number of reproductive age
B. Mortality Rate
A. CRUDE DEATH RATE

Total # of death in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year
B. INFANT MORTALITY RATE

Total # of death below 1 yr in a given calendar year X 1000
C. MATERNAL MORTALITY RATE

Total # of death among all maternal cases in a given calendar year X 1000
C. Morbidity Rate
A. PREVALENCE RATE
Total # of new & old cases in a given calendar year X 100
Total # of persons examined at same given time
B. INCIDENCE RATE
Total # of new cases in a given calendar year X 100
Estimated population as of July 1 of the same year
C. ATTACK RATE
Total # of person who are exposed to the disease X 100
# of persons exposed to the same disease in same given year
III - Epidemiology
the study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution
the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations
A. Patterns of disease occurrence:

Epidemic - a situation when there is a high incidence of new cases of a specific disease in excess of the expected.
- when the proportion of the susceptibles are high compared to the proportion of the immunes
Endemic - habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles e.g.
Malaria is a disease endemic at Palawan.
- the causative factor of the disease is constantly available or present to the area.
Sporadic - disease occurs every now and then affecting only a small number of people relative to the total population
- intermittent
Pandemic - global occurrence of a disease
Steps in EPIDEMIOLOGICAL IVESTIGATION:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
B. Role of the Nurse
Case Finding
Health Teaching
Counseling
Follow up visit
IV. Health Situation of the Philippines
Philippine Scenario:
In the past 20 years some infectious degenerative diseases are on the rise.
Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver the health services they need
The scarcity of doctors, nurses and midwives add to the poor health delivery system to the poor
VITAL HEALTH STATISTICS 2005
PROJECTED POPULATION :
MALE - 42,874,766
FEMALE - 42,362,147
BOTH SEXES - 85,236,913
LIFE EXPECTANCY
FEMALE - 70 yrs. old
MALE - 64 yrs. Old
LEADING CAUSES OF MORBIDITY

Most of the top ten leading causes of morbidity are communicable disease
These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella
Leading non CD are heart problem, HPN, accidents and malignant neoplasms
LEADING CAUSES OF MORTALITY
The top 10 leading causes of mortality are due to non CD
Diseases of the heart and vascular system are the 2 most common causes of deaths.
Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of deaths.
V. Health Care Delivery System the totality of all policies, facilities, equipments, products, human resources and services which address the
health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.
HEALTH SECTORS
GOVERNMENT SECTORS
Department of Health Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020
Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized
5 Major Functions:
1. Ensure equal access to basic health services

2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency
jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as public health goods
4. Plan and establish arrangements for the public health systems to achieve economies of scale
5. maintain a medium of regulations and standards to protect consumers and guide providers
NON GOVERNMENT SECTORS provides manpower in the execution of the program
PRIVATE SECTORS provides financial aspect in the execution of programs
PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS
Support for health goal

Assurance of health care
Increasing investment for PHC
Development of National Standard
MILESTONE IN HEALTH CARE DELIVRY SYSTEM
RA 1082 - RHU Act

RA 1891 - Strengthen Health Services
PD 568 - Restructuring HCDS
RA 7160 - LGU Code
VI National Health Plan
National Health Plan is a long-term directional plan for health; the blueprint defining the countrys health
PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS
GOAL : to enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economically-productive life,
with longer life expectancy, low infant mortality, low maternal mortality and less disability through measures that will guarantee access of
everyone to essential health care
OBJECTIVES:
promote equity in health status among all segments of society
address specific health problems of the population
upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to
changing the health needs of the population
promote active and sustained peoples participation in health care
MAJOR HEALTH PLANS TOWARDS HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020
A. MAJOR HEALTH PLAN

23 IN 93
Health for more in 94
Think health Health Link
5 in 95
B. PRIORITY PROGRAM IN YEAR 2000

Plan 50 (Pharmaceutical Plan)
Plan 500 ( Phil Health Insurance Plan)
Womens health
Childrens health
Healthy Lifestyle
Prevention & Control of Infectious Disease
C. PRIORITY PROGRAM IN THE YEAR 2005

Ligtas Buntis Campaign
Mag healthy Lifestlye tayo
TB Network
Blood Donation Program (RA 7719)
DTOMIS
Ligtas Tigdas Campaign
Murang Gamot
Anti Tobacco Signature Campaign
Doctors to the Barrios Program
Food Fortification Program
Sentrong Sigla Movement
D. NATIONAL HEALTH EVENTS FOR 2006
JANUARY
National Cancer Consciousness Week - (16-22)
FEBRUARY
Heart Month
Dental Health Month
Responsible Parenthood Campaign National Health Insurance Program
MARCH
Women's Health Month
Rabies Awareness Month
Burn Injury Prevention Month
Responsible Parenthood Campaign
Colon and Rectal Cancer Awareness Month
World TB Day - (24)
APRIL
Cancer in Children Awareness Month
World Health Day - (7)
Bright Child Week Phase I -
Garantisadong Pambata (11-17)
MAY
Natural Family Planning Month
Cervical Cancer Awareness Month
AIDS Candlelight Memorial Day - (21)
World No Tobacco Day - (31)
JUNE
Dengue Awareness Month
No Smoking Month
National Kidney Month
Prostate Cancer Awareness Month
JULY
Nutrition Month
National Blood Donation Month
National Disaster Consciousness Month
AUGUST
National Lung Month
National Tuberculosis Awareness Month
Sight-Saving Month
Family Planning Month
Lung Cancer Awareness Month
SEPTEMBER
Generics Awareness Month
Liver Cancer Awareness Month
OCTOBER
National Children's Month
Breast Cancer Awareness Month
National Newborn Screening Week (3-9)
Bright Child Week Phase II Garantisadong Pambata (10-16)
NOVEMBER
Filariasis Awareness Month
Cancer Pain Management Awareness Month
Traditional and Alternative Health Care Month
Campaign on Violence Against Women and Children
DECEMBER
Firecracker Injury Prevention Campaign:
OPLAN IWAS PAPUTOK
VII - INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)
IMCI is an integrated approach to child health that focuses on the well-being of the whole child.
IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in
children under five
Goal:
By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015.
AIM:
to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age.
IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
IMCI OBJECTIVES:
To reduce significantly global mortality and morbidity associated with the major causes of disease in children
To contribute to the healthy growth & development of children
IMCI COMPONENTS OF STRATEGY:

Improving case management skills of health workers
Improving the health systems to deliver IMCI
Improving family and community practices
**For many sick children a single diagnosis may not be apparent or appropriate
Presenting complaint:
Cough and/or fast breathing
Lethargy/Unconsciousness
Measles rash
Very sick young infant
Possible course/ associated condition:

Pneumonia, Severe anemia, P. falciparum malaria
Cerebral malaria, meningitis, severe dehydration
Pneumonia, Diarrhea, Ear infection
Pneumonia, Meningitis, Sepsis
Five Disease Focus of IMCI:

Acute Respiratory Infection
Diarrhea
Fever
Malaria
Measles
Dengue Fever
Ear Infection
Malnutrition
THE IMCI CASE MANAGEMENT PROCESS
Assess and classify
Identify appropriate treatment
Treat/refer
Counsel
Follow-up
THE INTEGRATED CASE MANAGEMENT PROCESS
Check for General Danger Signs:

A general danger sign is present if:
- the child is not able to drink or breastfeed
- the child vomits everything
- the child has had convulsions
- the child is lethargic or unconscious
ASSESS MAIN SYMPTOMS
Cough/DOB
Diarrhea
Fever
Ear problems
IMCI COLOR CODING
PINK (URGENT REFERRAL) YELLOW (Treatment at outpatient GREEN (Home management)

health facility)
OUTPATIENT HEALTH FACILITY OUTPATIENT HEALTH FACILITY HOME Caretaker is counseled on:
Pre-referral treatments Treat local infection Home treatment/s
Advise parents Give oral drugs Feeding and fluids
Refer child Advise and teach caretaker Follow-up When to return immediately Follow-up
Caretaker is counseled on:
REFERRAL FACILITY Treat oral infection
Home treatments
Emergency Triage and Treatment Give oral drugs
( ETAT) Feeding & fluids
Diagnosis, Treatment Advise & teach caretaker
When to return immediately
Monitoring, follow-up Follow up
Follow up
ASSESS AND CLASSIFY COUGH OR DIFFICULTY OF BREATHING
- Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs. Assess and
classify PNEUMONIA
cough or difficult breathing
an infection of the lungs
Both bacteria and viruses can cause pneumonia
Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection).
** A child with cough or difficult breathing is assessed for:
How long the child has had cough or difficult breathing
Fast breathing increase in RR
Chest indrawing Visible mark of ICS upon inhalation
Stridor in a calm child adventitious sounds heard even without the aid of stethoscope.
REMEMBER:
** If the child is 0 months up to 2 months the child has fast breathing if you count 60 breaths per minute or more
** If the child is 2 months up to 1 year old the child has fast breathing if you count 50 breaths per minute or more.
** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more.
PNEUMONIA TREATMENT SCHEME

Give first dose of an appropriate
antobiotic
Give Vitamin A
Any general danger sign or
SEVERE PNEUMONIA OR VERY Treat the child to prevent low blood
Chest indrawing or
SEVERE DISEASE sugar
Stridor in calm child
Refer urgently to the hospital
Give paracetamol for fever > 38.5oC
Give an appropriate antibiotic for 5 days

Soothe the throat and relieve cough with
a safe remedy
Fast breathing PNEUMONIA Advise mother when to return
immediately
Follow up in 2 days
Give Paracetamol for fever > 38.5oC
If coughing more than more than 30
days, refer for assessment
Soothe the throat and relieve the cough
No signs of pneumonia or very severe
NO PNEUMONIA : COUGH OR COLD with a safe remedy
disease
Advise mother when to return
immediately Follow up in 5 days if not
improving
Assess and classify DIARRHEA
A child with diarrhea is assessed for:

how long the child has had diarrhea
blood in the stool to determine if the child has dysentery
signs of dehydration.
Classify DYSENTERY
child with diarrhea and blood in the stool
Two of the following signs ? SEVERE DEHYDRATION If child has no other severe classification: -
Abnormally sleepy or difficult to awaken Give fluid for severe dehydration ( Plan C ) OR
Sunken eyes If child has another severe classification : -
Not able to drink or drinking poorly Skin pinch Refer URGENTLY to hospital with mother
goes back very slowly giving frequent sips of ORS on the way -
Advise the mother to continue breastfeeding
If child is 2 years or older and there is
cholera in your area, give antibiotic for cholera
Give fluid and food for some dehydration
( Plan B )
Two of the following signs :
If child also has a severe classification : -
Restless, irritable
Refer URGENTLY to hospital with mother
Sunken eyes SOME DEHYDRATION
giving frequent sips of ORS on the way -
Drinks eagerly, thirsty Skin pinch goes back
Advise mother when to return immediately
slowly
Follow up in 5 days if not improving
NO DEHYDRATION Home Care

Give fluid and food to treat diarrhea at home
Not enough signs to classify as some or severe
( Plan A )
dehydration
Follow up in 5 days if not improving
Types of Diarrhea
Treat dehydration before referral unless the
SEVERE PERSISTENT child has another severe classification
Dehydration present
DIARRHEA Give Vitamin a
Refer to hospital
Advise the mother on feeding a child who has
persistent diarrhea
No dehydration PERSISTENT DIARRHEA
Give Vitamin A
Follow up in 5 days
Treat for 5 days with an oral antibiotic
recommended for Shigella in your area
Blood in the stool DYSENTERY
Follow up in 2 days Give also referral
treatment
Does the child have fever? **Decide : - Malaria Risk - No Malaria Risk - Measles - Dengue
Malaria Risk
Give first dose of quinine ( under
medical supervision or if a hospital is not
accessible within 4hrs )
antibiotic
Any general danger sign or VERY SEVERE FEBRILE DISEASE /
Treat the child to prevent low blood
Stiff neck MALARIA
sugar
Give one dose of paracetamol in health
center for high fever (38.5oC) or above
Send a blood smear with the patient
Refer URGENTLY to hospital
Treat the child with an oral antimalarial
Blood smear ( + ) If blood smear not
done:
NO runny nose, and MALARIA
immediately
NO measles, and NO other causes of
Follow up in 2 days if fever persists
fever
If fever is present everyday for more
than 7 days, refer for assessment
Blood smear ( - ), or Advise mother when to return
Runny nose, or FEVER : MALARIA UNLIKELY immediately
Measles, or Other causes of fever Follow up in 2 days if fever persists
If fever is present everyday for more
than 7 days, refer for assessment
No Malaria Risk
Give first dose of an appropriate antibiotic
Treat the child to prevent low blood sugar
Any general danger sign or VERY SEVERE FEBRILE
Give one dose of paracetamol in health center
Stiff neck DISEASE
for high fever (38.5oC) or above
No signs of very severe febrile disease FEVER : NO MALARIA Give one dose of paracetamol in health center
for high fever (38.5oC) or above
Follow up in 2 days if fever persists
If fever is present everyday for more than 7
days, refer for assessment
Measles
Give Vitamin A
antibiotic
Clouding of cornea or
SEVERE COMPLICATED MEASLES If clouding of the cornea or pus draining
Deep or extensive mouth ulcers
from the eye, apply tetracycline eye
ointment
Give Vitamin A
If pus draining from the eye, apply
Pus draining from the eye or MEASLES WITH EYE OR MOUTH
tetracycline eye ointment If mouth ulcers,
Mouth ulcers COMPLICATIONS
teach the mother to treat with gentian
violet
Measles now or within the last 3 months MEASLES Give Vitamin A
Dengue Fever
Bleeding from nose or gums or
If skin petechiae or Tourniquet test,are
Bleeding in stools or vomitus or
the only positive signs give ORS
Black stools or vomitus or
If any other signs are positive, give
Skin petechiae or
SEVERE DENGUE HEMORRHAGIC fluids rapidly as in Plan C
Cold clammy extremities or
FEVER Treat the child to prevent low blood
Capillary refill more than 3 seconds or
sugar
Abdominal pain or
DO NOT GIVE ASPIRIN
Vomiting
Refer all children Urgently to hospital
Tourniquet test ( + )
DO NOT GIVE ASPIRIN
No signs of severe dengue hemorrhagic FEVER: DENGUE HEMORRHAGIC Follow up in 2 days if fever persists or
fever UNLIKELY child shows signs of bleeding
immediately
Does the child have an ear problem?

Give first dose of appropriate antibiotic
Tender swelling behind the ear MASTOIDITIS Give paracetamol for pain
Refer URGENTLY
Pus seen draining from the ear and Give antibiotic for 5 days
discharge is reported for less than 14 Give paracetamol for pain
ACUTE EAR INFECTION
days or Dry the ear by wicking
Ear pain Follow up in 5 days
Pus seen draining from the ear and
Dry the ear by wicking
discharge is reported for less than 14 CHRONIC EAR INFECTION
Follow up in 5 days
days
No ear pain and no pus seen draining
NO EAR INFECTION No additional treatment
from the ear
Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:
A. For Pneumonia, Acute ear infection or Very Severe disease
COTRIMOXAZOLE AMOXYCILLIN
BID FOR 5 DAYS BID FOR 5 DAYS

Age or Weight Adult tablet Syrup Tablet Syrup
2 months up to 12 months ( 4 - <
1/2 5 ml 1/2 5 ml
9 kg )
12 months up to 5 years ( 10
1 7.5 ml 1 10 ml
19kg )
B. For Dysentery
COTRIMOXAZOLE BID FOR 5 DAYS AMOXYCILLIN BID FOR 5 DAYS
AGE OR WEIGHT TABLET SYRUP SYRUP 250MG/5ML
2 4 months ( 4 - < 6kg ) 5 ml 1.25 ml ( tsp )
4 12 months ( 6 - < 10
5 ml 2.5 ml ( tsp )
kg )
1 5 years old ( 10 19
1 7.5 ml ( 1 tsp )
kg )
C. For Cholera
TETRACYCLINE QID FOR 3
COTRIMOXAZOLE BID FOR 3 DAYS
DAYS
AGE OR WEIGHT Capsule 250mg Tablet Syrup
2 4 months ( 4 - < 6kg ) 1/2 5ml
4 12 months ( 6 - < 10 kg ) 1/2 5 ml
1 5 years old ( 10 19 kg 1 1 7.5ml
Give an Oral Antimalarial

Primaquine Give single
CHOLOROQUINE Give for Primaquine Give daily for 14 Sulfadoxine + Pyrimethamine
dose in health center for
3 days days for P. Vivax Give single dose
P. Falciparum
TABLET ( 150MG ) TABLET ( 15MG) TABLET ( 15MG) TABLET ( 15MG)

AGE
DAY1 DAY2 DAY3
2months 5months
5 months 12
1/2
months
12months 3 years
1 1
old
3 years old - 5
1 1 1 1/2 1
years old
GIVE VITAMIN A
AGE VITAMIN A CAPSULES 200,000 IU
6 months 12 months 1//2 ( 100,000 IU) red capsules
12 months 5 years old 1 ( 200,000 IU) blue capsules
GIVE IRON
Iron/Folate Tablet FeSo4 200mg + 250mcg Folate Iron Syrup FeSo4 150 mg/5ml ( 6mg
AGE or WEIGHT
(60mg elemental iron) elemental iron per ml )
2months-4months ( 4 - <6kg ) 2.5 ml
4months 12months ( 6 - <10kg ) 4 ml
12months 3 years ( 10 - <14kg ) 1/2 5 ml
3years 5 years ( 14 19kg ) 1/2 7.5 ml
GIVE PARACETAMOL FOR HIGH FEVER ( 38.5oC OR MORE ) OR EAR PAIN

AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )
2 months 3 years ( 4 - <14kg ) 5 ml
3 years up to 5 years ( 14 19 kg ) 10 ml
GIVE MEBENDAZOLE Give 500mg Mebendazole as a single dose in health center if : > hookworm / whipworm are a problem in children in
your area, and > the child is 2 years of age or older, and > the child has not had a dose in the previous 6 months
VIII - DOH PROGRAMS DENTAL HEALTH PROGRAM

To improve the quality of life of the people through the attainment of the highest possible oral health.
Objective: To prevent and control dental diseases and conditions like dental caries and periodontal diseases thus reducing their
prevalence.
OSTEOPOROSIS PROGRAM
It is characterized by a decrease in bone mass and density that progresses without a symptom or pain until a fracture occurs
generally in the hip, spine or wrist.
Objectives:
To increase awareness on the prevention and control of osteoporosis as a chronic debilitating condition;
To increase awareness by physicians and other health professionals on the screening, treatment and rehabilitation of osteoporosis;
To empower people with knowledge and skills to adopt healthy lifestyle in preventing the occurrence of osteoporosis.
HEALTH EDUCATION & CO

Accepted activity at all levels of public health used as a means of improving the health of the people through techniques which may
influence peoples thought motivation, judgment and action.
Three aspects of health education:
Information Communication Education
Sequence of steps in health education:
Creating awareness Creating motivation Decision making action
REPRODUCTIVE HEALTH
1. Family Planning
2. MCH & Nutrition
3. Prevention / treatment of Reproductive Tract Infection & STD
4. Prevention of abortion & its complication
5. Education & counseling on sexuality & sexual health
6. Adolescent sexual reproductive health
7. Violence against women
8. Mens reproductive health ( Male sexual disorder )
9. Breast CA & other gyne problem
10. Prevention / treatment of infertility
OLDER PERSONS HEALTH SERVICES

Participation in the celebration of Healthy National Elderly Week ( Oct 1-7)
- Lecture on healthy lifestyle for the elderly
Provision of drugs for the elderly (20% discount)
GUIDELINES FOR GOOD NUTRITION

Nutritional Guidelines are primary recommendations to promote good health through proper nutrition.
ACTIVITIES:
1.Malnutrition Rehabilitation Program

Targeted Food Task Force Assistance Program (TFAP)
Nutrition Rehabilitation Ward
Akbayan sa Kalusugan sa Kabataan (ASK Project)
2.Micronutrient Supplementation Program

23 in 93
Fortified Vitamin Rice
Health for More in 94
Buwan ng Kabataan, Pag-asa ng Bayan
National Focus: National Micronutrient Day or Araw ng Sangkap Pinoy
PROTEIN ENERGY MALNUTRITION

1. Marasmus looks like an old worried man - less subcutaneous fats
2. Kwashiorkor - a moon face child - with flag sign (hair changes) VITAMIN A DEFICIENCY
Early symptoms:
Xeropthalmia (Nigtblindess)
Bitots spot (silvery foamy spot located @ lateral sclera)
Corneal Xerosis (eye lesion)
Conjunctival Xerosis (scar in the eyes)
Keratomalacia ( whitish to grayish sclera)
BLINDNESS
RESPIRATORY INFECTION CONTROL

Provision of medicines
Consultative meetings with CARI coordinators
Monitoring of health facilities on the implementation of the program
ALTERNATIVE MEDICINE
RA 8423
23 IN 93
A. The 10 Herbal Medicine(LUBBY SANTA)

Herbal Medicine USES
Skin diseases Headache, Asthma, fever, cough&colds, Rheumatism, Eczema,
Lagundi ( Vitex Negundo) SHARED Dysentery
Lowers uric acid Rheumatism Arthritis

Ulasimang Bato (Peperonia Pellucida) RA
Headache and toothache
Bawang ( Allium Sativum) HAT
Anti septic, Anti-diarrheal
Bayabas ( Psidium Guajava)
Swollen gums, Pain, Insect bites, Toothache, Menstrual & gas pain, Arthritis &
Yerba Buena (Mentha Cordifolia) SPITMAND rheumatism, Nausea & vomiting & Diarrhea
Anti - edema, Diuretics, Anti uro-lithiasis

Sambong (Blumea Balsamifera) ADA
Fungal infection, skin diseases
Akapulko
Anti-helminthic
Niog Niogan (Quisqualis Indica)
Stomachache & Diarrhea
Tsaang Gubat (Carmona Retusa)SAD
Ampalaya (Momordica Charantia) DM
MATERNAL- CHILD CARE
I - Maternal Care
A. FAMILY PLANNING
I. Spacing / Artificial Method
A. Hormonal
B. Mechanical & Barrier
C. Biologic
D. Natural
II. Permanent (surgical/irreversible)
A. Tubal Ligation
B. Vasectomy
III. Behavioral Method
B. BREASTFEEDING
II - CHILD CARE
A. UNDER FIVE CARE PROGRAM

A package of child health-related services focused to the 0-59 months old children to assure their wellness and survival
Growth Monitoring Chart (GMC)
A standard tool used in health centers to record vital information related to child growth and development, to assess signs of malnutrition.
B. EXPANDED PROGRAM ON IMMUNIZATION
LEGAL BASIS
PD #996 Compulsory basic
PP #147 National Immunization Day
PP #773 Knock out Polio Days
PP # 1064 polio eradication campaign
PP #4 - Ligtas Tigdas month
MENTAL HEALTH a state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work
productively
Components of Mental Health Program Stress Management and Crisis Intervention Drugs and Alcohol Abuse Rehabilitation Treatment
and Rehabilitation of Mentally-Ill Patients Special Project for Vulnerable Groups
SENTRONG SIGLA MOVEMENT AIM: to promote availability of quality health services

4 pillars:
Quality assurance
Grants & technical assistance
Health promotion
Award
COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH
Community Organizing
a continuous and sustained process of
EDUCATING THE PEOPLE,
CRITICAL AWARENESS
MOBILIZING
Participatory Action Research

A combination of education, research and action.
The purpose is the EMPOWERMENT of people
4 Phases:
Pre entry
Entry
Organizational Building
Sustenance and Strengthening
Laws Affecting CHN Implementation:

RA 8749 - Clean Air Act (2000)
RA 6425 Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishable by law
RA 9173 Philippine Nursing act of 2002
RA 2382 Philippines Medical Act: define the practice of medicine in the Philippines
RA 1082 Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural areas to help raise the health condition.
RA 3573 - Reporting of Communicable Disease
RA 6675 Generic Act: promotes, requires and ensures the production of an adequate supply, distribution, use of drugs identified by their
generic names.
RA 6365
RA 6758
RA 4703 Advocates Home Treatment for all Leprae Patient
RA 7305 Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to promote and improve the social and
economic well being of health workers, their living and conditions.
RA 7160 Local Government Code: responsibility for the delivery of basic services of the national government
IX - CHRONIC COMMUNICABLE DISEASES
I - TUBERCULOSIS TB is a highly infectious chronic disease that usually affects the lungs.
Causative Agent: Mycobacterium Tuberculosis
S/S: cough afternoon fever weight loss night sweat blood stain sputum
Prevalence/Incidence: ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines sixth leading cause of mortality
(with 28507 cases) in the Philippines.
Nursing and Medical Management Ventilation systems Ultraviolet lighting Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
drug therapy
Preventing Tuberculosis BCG vaccination Adequate rest Balanced diet Fresh air Adequate exercise Good personal Hygiene
DOTS (Direct Observed Treatment Short Course)

Regimen Type of TB Patient
New pulmonary smear (+) cases New seriously ill pulmonary
smear (-) cases w/ extensive lung lesions New severely ill
Regimen I 2RIPE / 4RI
extra-pulmo TB
New pulmonary smear (+) case New seriously ill pulmonary

smear (-) cases w/ extensive lung lesions New severely ill
Regimen II 2RIPES/ 1RIPE / 5RIE
extra-pulmo TB
New smear(-) but with minimal pulmonary TB on radiography

Regimen III 2RIP / 4RI as confirmed by a medical officer New extra-pulmo TB (not
serious)
II - LEPROSY Sometimes known as Hansen's disease

is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
Gerhard Armauer Hansen - discovered the microbes
Historically, leprosy was an incurable and disfiguring disease
Today, leprosy is easily curable by multi-drug antibiotic therapy
Signs & Symptoms

Early stage(CLUMP)
Change in skin color
Loss in sensation
Ulcers that do not heal
Muscle weakness
Painful nerves
Late Stage(GMISC)
Gynocomastia
Madarosis(loss of eyebrows)
Inability to close eyelids (Lagopthalmos)
Sinking nosebridge
Clawing/contractures of fingers & nose
Prevalence Rate Metro Manila, the prevalence rate ranged from 0.40 3.01 per one thousand population.
MANAGEMENT: Dapsone, Lamprene clofazimine and rifampin Multi-Drug-Therapy (MDT) six month course of tablets for the milder form of
leprosy and two years for the more severe form
X - Vector Borne Communicable Disease
I LEPTOSPIROSIS an infectious disease that affects humans and animals, is considered the most common zoonosis in the world
Causative Agent: Leptospira interrogans
S/S: -high fever -severe headache -chills -muscle aches -vomiting -may include jaundice (yellow skin and eyes) -red eyes -abdominal pain
-diarrhea
TREATMENT: PET - > Penicillins , Erythromycin, Tetracycline
II - MALARIA Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease that is
widespread in many tropical and subtropical regions.
Causative Agent: Anopheles female mosquito
Signs & Symptoms: Chills to convulsion Hepatomegaly Anemia Sweats profusely Elevated temperature
Treatment: Chemoprophylaxis chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area.
Preventive Measures: (CLEAN)
Chemically treated mosquito nets
Larvae eating fish
Environmental clean up
Anti mosquito soap/lotion
Neem trees/eucalyptus tree
III - FILIARIASIS name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae
larvae transmit the disease to humans through a mosquito bite
can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis
S/S:
Asymptomatic Stage
Characterized by the presence of microfilariae in the peripheral blood
No clinical signs and symptoms of the disease
Some remain asymptomatic for years and in some instances for life
Acute Stage
Lymphadenitis (inflammation of lymph nodes)
Lymphangitis (inflammation of lymph vessels)
In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)
Chronic Stage
Hydrocoele (swelling of the scrotum)
Lyphedema (temporary swelling of the upper and lower extremities
Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)
MANAGEMENT: Diethylcarbamazine Ivermectin, Albendazolethe

No treatment can reverse elephantiasis
VI SCHISTOSOMIASIS parasitic disease caused by a larvae
Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)
Bulging abdomen
Abdominal pain
Loose bowel movement
Low grade fever
Inflammation of liver & spleen
Pallor
Seizure
Treatment: Diethylcarbamazepine citrate (DEC) or Hetrazan (drug of choice)
VII DENGUE DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern..
It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.
S/S: (VLINOSPARD)
Vomiting
Low platelet
Increase Platelet count
Nausea
Onset of fever
Severe headache
Pain of the muscle and joint
Abdominal pain
Rashes
Diarhhea
TREATMENT:
The mainstay of treatment is supportive therapy.
- intravenous fluids
- A platelet transfusion
- No aspirin
Communicable Disease
Module on Communicable Diseases

Community Health Nursing is faced with problems regarding communicable diseases. It is important therefore that the nurse poses basic
knowledge on how to deal with related problems and more so prevent its occurrence, since this is like wise the focus of community health
nursing.
INTRODUCTION
This module focuses on the basic communicable diseases affecting the patterns of mortality and morbidity in the Philippine community. It will give
you the basic information regarding the description, etiology, mode of transmission, incubation period, signs and symptoms, diagnostic
procedures and management of these diseases. As an added bonus each topic is carefully selected to prepare you both in the practical
application in the community setting and the board exam most especially. Due to this you are advised to be familiarized with the following
phrases:
ON THE BOARD refers to common question that comes out in the board exam.
CLINICAL FOCUS refers to the important reminders that are crucial in the actual practice.
GROUP ALERT refers to age group variation that also demand different approaches. A post test is prepared for your satisfaction so that you will
be able to measure your knowledge. It is recommended that you supplement your studies with text books which focus on the said topic. This is
just a guide and although careful review has been made the author waive any responsibility that may negatively occur due to application of the
concepts learned here in.
OBJECTIVE GENERAL To study the different communicable diseases affecting man and the family as a component of the community
SPECIFIC By the end of the module in 7 days you should be able to;
1. Understand the basic concepts of CD
2. Familiarize with the basic control and method of prevention to the said diseases.
3. be able to apply to practice the concepts learned by effectively giving health education all these is expected to be attained by you none the
less, by passing at least 65% of the final assessment questions.
What is infection? Infection is the successful entry and multiplication of micro-organism in the human body. Usually their entrance results in the
appearance of the disease. But it doesnt always follow the same. Some organism may enter the body but no obvious illness is apparent.
What are the types of infection? There are two types of infection it could be nosocomial or opportunistic.
Nosocomial refers to hospital acquired infection with sets in within the premises of the hospital during confinement.
Remember an infection is considered nosocomial if it sets in after 72 hours upon admission.
Most of the time the responsible organism are hospital pathogens such as pseudomonas, klebsiella etc.
Opportunistic refers to the type infection acquired due to the failure of the immune defenses.
Usually this is caused by the normal microflora.
What are communicable diseases and contagious diseases?

Communicable diseases are any disease that are caused by microorganism and can be transferred from one body to another, hence it is
communicable.
Contagious diseases are any communicable infection that are easily transmissible.
ON THE BOARD! Keep in mind that every contagious disease is communicable and all communicable diseases are infection but never the other
way around.
What is pathogenicity? It is the over all ability of the organism to cause pathogenic changes in the body. Which is further described by the
following terms:
Mode of action manner by which organism damages the host. Example clostridium tetani releases toxin while plasmodium falciparum kills the
RBC.
Virulence it is the over all strength of the microorganism
Dose the number of the organism required to cause infection for example as little as 4 tubercle bacilli inhaled is sufficient to cause
Tuberculosis among high risk patient. Invasiveness the ability of the organism to penetrate an intact barrier
Toxigenicity the ability of the organism to produce toxins
Specificity is the ability of the organism to attach on specific cellular surface receptors. Viability the ability to sustain life outside the body of
the host
Antigenicity the ability of the organism to stimulate and or resist antibody response
THE 3 LEVELS OF PREVENTION
PRIMARY focuses on health promotion and disease prevention

Promotive there is no risk of having the disease. Activity is directed in promoting healthy lifestyle, proper nutrition, adequate exercise and
environmental sanitation.
Preventive risk of having the disease is already existing and activity is directed in avoiding the risk ergo the disease it self. Example are EPI,
Pap smear, BSE and STE.
SECONDARY focuses on the Curative aspect of care.
Curative effort is directed for early treatment. Move is also undertaken to avoid possible complications
TERTIARY focuses on the rehabilitative aspect
Rehabilitative effort of helping the patient adjust with the limitations and disability brought about by the previous disease.
ELEMENTS OF DISEASE CAUSATION Refers to the relationship of the Agent (microorganism), Host (Human) and the Environment (reservoir).
If balance between the three is present disease is absent but if one of the three gain advantage over the other it may compromise one element
and cause disease.
STAGES OF INFECTION
a) Exposure the stage of contact with the infectious agent
b) Incubation or latent the organism successfully entered the body. No apparent illness is present. The organism is still multiplying so as to
manifest an actual illness.
c) Prodromal the manifestation of vague signs and symptoms start to appear. Example fever, cough, pain etc.
d) Acute disease an acute disruption in the physiologic mechanism. Disease due to the infecting organism is already present.
e) Convalescence the stage of resolution. The body is able to maintain homeostasis. The infectious organism is under control
f) Relapse a stage of reactivation of a previous infection which may be due to re-exposure or waning immunity.
CHAIN OF INFECTION
The series of events that takes place in order for infection to occur.
The following subtopics describe each component of the chain.
ON THE BOARD! Remember infection will never occur unless the six chain are completed.
a) Causative agent refers to the microorganism such as fungi, protozoa, parasite, viruses, bacteria etc.
b) Reservoir the medium or body which the microorganism thrive and survive.
c) Portal of Entry opening in the body where in the microorganism could use as passageway to reach the internal physiological structures. For
example mouth, nose, wound etc.
d) Portal of exit any opening to which the organism uses to exit from the body. Example are anus, nose, vagina, penis, etc.
e) Mode of transmission the method on how the organism travels from one infected host to another.
i. Direct requires physical contact from the point source of infection. Such as kissing and unprotected sexual intercourse.
ii. Indirect transmitted through fomites and other non living organism. Contaminated surgical instruments.
iii. Vector borne relies greatly on the presence of the secondary host to cause infection. e.g. mosquitos, flies and rats
iv. Droplet organism travels through droplet nuclei that comes out during coughing, sneezing etc.
v. Airborne the organism can uniquely suspend in the air and carried on air current and the like method.
f) Susceptible host any person whose immune defenses are weak or those who are healthy but do not posses adequate specific immunity
ON THE BOARD! Remember that the mode of transmission is the chain that is easiest to break!
THE DEFENSE MECHANISM OF THE BODY The defensive mode is divided into three, namely:
i. 1st line of defense
ii. 2nd line of defense
iii. 3rd line of defense
1st LINE OF DEFENSE Non specific defense mechanism this is the first to come in contact with harmful organism. E.g. skin, saliva,. Tears,
stomach acids, urine etc.
2ND LINE OF DEFENSE Non specific phagocytic response. E.g. phagocytosis by neutrophils.
3RD LINE OF DEFENSE Specific immune response dependent upon the presence of specific anti bodies. E.g. immunity against chickenpox
IMMUNITY Ability of the body to effectively mount an immune response to prevent infection. it is usually dependent on the presence of
antibodies.
a. Natural active contact with infectious organism and the immunity that follows after that.
b. Natural passive immunity received from the mother through the placenta
c. Artificial active immunity gained after the administration of vaccines
d. Artificial passive immunity gained after receiving immune serum or immune globulin.
EPIDEMIOLOGY Refers to study of the pattern and distribution of diseases among the identified population.
a. Endemic the disease is always present in a community the rise and fall remains steadily predictable.
b. Epidemic there is a sharp increase in the number of disease as it affects the population over a period of time and specific locality.
c. Pandemic nations are affected by a disease. It is commonly referred to as international epidemic.
d. Sporadic patches in appearance. The disease does not manifest it self as a dominant entity. Most often the disease affects only a small
portion of the community.
e. Out break the disease has affected the population but the number of the people afflicted is above the endemic proportion but lower than
epidemic levels. An outbreak is an indicator of impending epidemic.
GENERAL MEASURES TO CONTROL COMMUNICABLE DISEASES

Hand washing the most basic of infection control practices. It is the use of soap and water to remove contaminant from our hands.
Disinfection the use of chemicals like alcohol or other physical means to destroy disease causing organism outside the body.
a. Terminal disinfection disinfecting the surroundings of the patient
b. Concurrent disinfection disinfection of substances and materials discharged from the body.
Sterilization all forms of microbial life are eliminated.
Isolation the act of separating an infected patient to prevent cross infection. The following are the types of isolation precaution.
i. First Tier Standard precaution ; applied to all patient regardless of their clinical diagnosis. It is desired that the application of this tie will
protect the nurse and the patient from body fluids including blood as well as wounds or any break in the skin and mucous membrane. Use of
gloves.
ii. Second Tier Transmission based precaution refers to any patient who require more stringent control that necessitates deeper method than
those identified above. These includes contact, airborne and droplet precaution.
a. Contact precaution to protect against direct and indirect transmission. Mask and gown are added.
b. Airborne precaution the use of air filters to prevent infection due to organism suspended in the air.
c. Droplet precaution maintaining a distance of 3 feet from the point source of infection to avoid droplet nuclei. The use of high particulate
mask and goggles are added.
Quarantine the act of limiting the movement and freedom of travel of any patient who have been exposed from an infectious organism. The
length of time is dependent to the maximum incubation period of the suspected disease.
Surveillance - monitoring of patients, high risk groups or families to predict, identify and control infection.
CHEMICAL DISINFECTANTS THAT ARE COMMONLY USED

Germicide also known as disinfectant this can kill disease causing organism.
Bactericidal refers to its ability to kill bacteria only.
Bacteriostatic the ability of a chemical agent to halt bacterial reproduction
Antiseptic chemicals that can kill or control the growth of microorganism. This are usually applied on the skin to prevent wound infection.
Soaps and detergents effective against bacteria found in clothes.
Phenols (Lysol) effective against gram negative bacteria.
Alcohol ideally isopropyl alcohol in 70% solution. Effective in killing broad range of microbes.
Chlorine one of the most effective water disinfectants Iodine equally effective with chlorine in antimicrobial activity. This is also used in skin
disinfection (Betadine) Hydrogen Peroxide wound cleanser and disinfectant for surgical devices.
COMMUNICABLE DISEASES NEUROLOGICAL SYSTEM
TETANUS ALSO KNOWN AS LOCK JAW

An acute infection associated with painful muscular spasm
Description:
Caused by Clostridium tetani which are found on soils and human feces
Etiology:
Contamination of wound
Mode of transmission:
5 10 days
Incubation period:
Fever, lock jaw, the most important sign is trismus and risus sardonicus. While laryngospasm is the most life
Signs and symptoms threatening condition.
None. History of wound and possible contamination are usually enough to arouse suspicion and take necessary
Diagnostic procedure management.
Wash wound, apply wound antiseptic.

Assess for history of immunization
Give tetanus toxoid for negative history of immunization
Administer Antitoxin after negative skin test
Management
Penicillin is the drug of choice
Prepare for intubation. NGT feeding may become necessary.
Avoid over stimulation to prevent painful muscle contraction.
Diazepam is the drug of choice for muscle spasm
MENINGITIS
An acute inflammation of the meninges
Description:
Caused by Neisseria meningitides this is usually a normal inhabitant of the nasopharynx.
Etiology:
Droplet infection
Incubation period: 2 10 days
The organism enters the bloodstream after invading the respiratory tissues. Reaches the spinal cord and of course
the meninges. It stimulates chemotaxis that leads to leukocyte infiltration of the meninges. As a result inflammation
Pathophysiology: follows. This build up pressure, pus and compresses sensitive nervous tissues, that may decrease the level of
consciousness and in more severe cases pus could impede blood flow and brain infarct my ensue.
The most significant finding indicating meningeal irritation: brudzinski and kernigs sign. Other sign observable are
Signs and symptoms headache, opisthotonus, fever and petechiae
Lumbar puncture (CSF analysis)
Diagnostic procedure
Institute droplet precaution

Rifampicin or Ciprofloxacin for prophylaxis
Ampicillin is the drug of choice
Ceftriaxone for systemic and CNS infection given in combination with Ampicillin to combat resistant organism.
Management Mass prophylaxis is not needed provided that all children in day care centers who have been exposed are exempted
hence they need prophylaxis, this also includes all other children who are close to the infected patient such as when
they share eating utensils.
Nurses and Doctors are not at risk of having the disease except when close contact occurred like in mouth to mouth
resuscitation.
ENCEPHALITIS
Inflammation of the tissues of the Brain
Description:
Mosquito borne Japanese enceph, West Nile enceph etc Viral borne Complication of chicken pox or measles
Etiology: Amebic Acanthamoeba hystolytica
Mosquito borne bite of the infected mosquito Viral may be droplet or airborne Amebic accidental entry in the
Mode of transmission: naso - pharynx due to swimming in infested waters.
Mosquito borne varied Viral 5 15 days Amebic 3 7 days

Incubation period:
The infectious organism regardless of the type penetrate the brain and causes inflammation of the brain tissues it self.
the inflammatory response compresses the brain structure which explains the rapid deterioration of the LOC.
Pathophysiology:
Encephalitis is more severe than meningitis.
Marked decrease in LOC. Brudzinski and kernigs may also be present if meningeal irritation result. The most
Signs and symptoms significant though is the appearance of decorticate and decerebate rigidity.
Lumbar Tap (CSF analysis) EEG

Primarily supportive. The body can neutralize the organism thru the presence of antibody. Amebic encephalitis may
Management
benefit from metronidazole. Anti inflammatory may be given Mannitol could decrease ICP
POLIOMYELITIS
An acute paralytic infection that destroys the affected nerves.
Description:
Caused by polio virus 1 (Brunhilde), 2 (Lansing), 3 (Leon)
Etiology:
Fecal oral route. Particularly rampant among those in the squatters area who have no access to sanitary toilet
Mode of transmission: facilities
7 14 days
Incubation period:
The virus enters the oral cavity and reproduces in the intestines which later penetrate the intestinal wall causing
viremia and reaching the motor nerves and the spinal cord. The virus reproduces inside the nerve and as they are
Pathophysiology:
released, the infected cell die, hence paralysis results.
Pokers sign, Haynes sign, tonsillitis, abdominal pain and flaccid paralysis
Signs and symptoms
Stool exam, pandys test, EMG
Management Prevention OPV
No anti viral therapy.
Toilet hygiene must be reinforced Watch out for respiratory paralysis Assist in rehabilitation (physical therapy and
comfort measures OPV is preferred over IPV because the latter can only provide
RABIES
Another acute viral infection which have a zoonotic origin
Description:
Primarily carried by mammals specially land and aerial mammals. In the Philippines Dogs and Cats are among the
Etiology: most important reservoir. The causative organism is Rhabdo Virus
Bite of infected animal. Scratch wound from cats can also cause infection since cats usually lick their paws.
10 days for man 14 days for animals
Incubation period:
The virus replicates at sight of infection which later proceeds to infect the nearby axons and then reaches the nerve
itself. From that point onwards the virus travels along the nerve pathway to reach the brain. In the brain the virus
insights inflammatory reaction that give rise to the appearance of encephalitis like symptoms later the organism
Pathophysiology:
descends from the brain and exit to affect other nerves in he body. The affectation of trigeminal nerve causes throat
spasms which gives rise to its classic finding hydrophobia
Hydrophobia, aerophobia, laryngeal, Pharyngeal spasm excessive salivation.

Signs and symptoms
Fluorescent antibody Staining, Negri bodies found in brain biopsy of the infected animal
Human Diploid Cell Vaccine, Rabies Immunoglobulin, Rabies Anti serum. tetanus anti serum is also given if with
negative or inadequate immunization history Wash wound with soap and water, may apply wound antiseptic Once
sign and symptoms are present passive immunization is already useless. Supportive therapy comes next. Protect
Management
from glare and sunlight, protect from water and air current. Cover IV bottle and tubing with carbon paper or any other
else that can effectively hide the iv fluids. Secure consent and restrain the patient. Observed contact and droplet
precaution.
LEPROSY
A chronic infection that usually affects the peripheral nerves and leads to paresthesias
Description:
A possible zoonotic infection which is rarely cultured in laboratory but seen to be growing freely among armadillo.
Etiology:
Causative organism is Mycobacterium leprae
Droplet infection is the most important transmission. Skin contact may cause infection only if there is an open lesion
with prolonged contact.
6 months to 8 years
Incubation period:
The organism enters the body via droplet infection. It is ingested by macrophages but cant be killed, as this
circulating macrophage reaches the skin the bacteria penetrate the nerves. Later due to immune recognition WBC
Pathophysiology: attacks the infected cell which results to the destruction of the affected cell hence the appearance of paresthesias and
consumption of the involved extremity becomes apparent due to immune response it self.
Painless wound, paresthesias, ulcer that does not heal, leonine appearance, maderosis. Nerve involvement with acid
Signs and symptoms fast bacilli is the pathognomic sign of leprosy
Scraped incision method.

Institute concurrent disinfection specially of nasal discharge.
Management Prevention is achieved by BCG immunization Rifampin, Dapsone and lampreme are effective treatment against this
infection
CIRCULATORY SYSTEM
DENGUE HEMORRHAGIC SHOCK SYNDROME

An acute arthropod borne infection which causes massive bleeding.
Description:
Causative organism is Dengue virus 1, 2, 3 and 4 the primary vector is Aedes egypti other wise known as tiger
mosquito because of the black stripes present at the dorsal legs of the insect. The mosquito prefers to thrive
Etiology:
on clean stagnant water.
Bite of the infected vector mosquito

6 7 days
Incubation period:
The virus is carried by the infected mosquito and transferred through bites in the victim. Once the proboscis
pierced the capillaries it also leaves the viral organism. The virus mixes in the bloodstream survive and
reproduce causing viremia which explains the appearance of generalized flushing. The virus will then
Pathophysiology: successfully enters the bone marrow and arrest the maturation of megakaryocyte. Since the precursor of
platelets can not take full course it will result to massive drop in the patients platelet count which significantly
raises the risk for hemorrhage.
Petechiae, bleeding, epitaxis, Hermans sign and fever

Signs and symptoms
Tourniquet test, platelet count.
Watch out for bleeding.
Minimize injections and other parenteral procedures if possible.
Apply pressure for 10 minutes on injection site.
Avoid aspirin use acetaminophen provide TSB as an adjunct to anti pyretics.
Management
Monitor platelet closely.
Prepare for platelet concentrate or fresh whole blood as the need may call for it.
Hydrate with PNSS Preventive measure focuses on 4 o clock habit Use DEET as an effective mosquito
repellant Use mosquito nets
MALARIA
Another type of mosquito borne infection most common in the tropics
Description:
The causative organisms are Plasmodium Vivax, Falciparum, Ovale, and Malariae. The primary vectors are
Etiology: anopheles mosquitoes.
Bite of the infected mosquito

For Falciparum 12 days, for Vivax and Ovale 14 days and for Malariae 30 days
Incubation period:
From the bite of the infected mosquito the organism enters the body via bloodstream and immediately proceed
to the liver in the form of sporozoites. Inside the hepatocytes reproduction continues until the host burst
releasing the parasite in the form trophozoites that enters the RBC, inside it the organism divides and form
Pathophysiology:
schizont. This will later produce merozoites that enters RBC the process causes drop in the number of
circulating RBC leading to anemia and cachexia.
A cycle of hot stage (high fever) followed by diaphoretic stage (sweating) and then cold stage (chilling). The
Signs and symptoms cycle repeats leading to malarial cachexia
Malarial smear or peripheral blood smear

Chloroquine is the drug of choice.
Primaquine must be given to prevent relapse.
Management
Prevent by using mosquito repellant and mosquito net
Chloroquine is the drug of choice for prophylaxis.
FILIRIASIS
A chronic lymphatic disorder that is related to elephantiasis
Description:
Causative organism is Wuchereria bancrofti primary vector Culex spp.
Etiology:
Bite of the infected mosquito
6 12 months
Incubation period:
The organism enters the body after the vectors bite, it then matures and migrate on the lymphatic vessels but it
usually affects those in the lower extremity. The protozoal parasite crowds and destroy the filtering ability of the lymph
Pathophysiology: nodes which then leads to the accumulation of lymph or body fluids causing edema and at worst cases gross
deformity hence it could lead to elephantiasis.
Recurrent low grade fever, lymphangitis, nocturnal asthma and in worst cases elephantiasis
Signs and symptoms
Microscopic examination of peripheral blood.

Management
Use of mosquito repellant and nets Hetrazan is effective against Filiriasis adverse reaction though are seen in a
number of patients, if such may be present may use Ivermectin
RESPIRATORY SYSTEM
DIPHTHERIA
An acute infection of the upper respiratory system whose complication may include the lower respiratory tract.
Description:
The organism, Corynebacterium diphtheriae is ubiquitous.
Etiology:
Droplet infection is the means of spread
1 7 days
Incubation period:
The organism infects the oral cavity which later due to its ability of releasing toxins causes the death of the involved
tissues. This gives rise to the appearance of psudomembarne which may be dislodge and block the airway. As toxins
Pathophysiology: are secreted the heart, kidney and the nerves absorb it, this toxins halt protein synthesis of the infected cell which
later on causes its death.
Pathognomonic Sign is pseudo membrane. Tonsillitis may also be present. Fever and malaise. If complication arises
Signs and symptoms paralysis, endocarditis and kidney failure may be seen.
Throat swab
Gather specimen for culture Prepare for epinephrine and possible intubation Be ready for antitoxin therapy after
Management
checking for allergy Administer penicillin or erythromycin
PERTUSIS
A widespread organism that threaten any one who have no immunity against it.
Description:
Causative organism is Bordetella pertussis
Etiology:
Droplet infection
7 21 days
Incubation period:
The organism enters the upper respiratory tract attaches to the respiratory epithelium and causes an increased
production of cyclic amino phosphate that essentially leads to hyperactivity of the mucous secreting cells. Thick
tenacious secretions blocks the airway. The organism also halts the mucociliary escalator leaving coughing reflex the
Pathophysiology:
last effective protective mechanism of expelling sputum. Due to its relative tenaciousness the body experiences
difficulty in coughing out phlegm thus we observe patient to manifest violent cough.
Pathognomonic of this infection is violent cough w/out intervening inhalation followed by an inspiratory whoop.
Signs and symptoms Vomiting may be present, Increased in ICP and IOP are also seen. Hernia is also a high risk incident.
Throat swab
Penicillin, Erythromycin ; Mucolytic may be ordered. Nebulization may also be indicated; Provide small feedings Apply
Management
abdominal binder ; Avoid dust and drafts
TUBERCULOSIS
A chronic lung infection that leads to consumption of alveolar tissues
Description:
Causative organism is acid fast bacillus mycobacterium tuberculosis.
Etiology:
Droplet infection as well as airborne
2 4 weeks
Incubation period:
Pathophysiology: The bacilli is inhaled and taken in the alveoli where macrophage will ingest but fail to kill the organism. As these
macrophages migrate to nearby lymph nodes it will die and leave the capsulated bacteria undigested. Once the
bodys immune system dropped, the bacteria will be activated and stimulate immune response which likewise damage
the alveolar tissues leading to casseation necrosis and could eventually consume the entire lungs if the process is
repeated frequently
Afternoon fever, night sweats, cough for 2 weeks, anorexia weight loss.
Signs and symptoms
Sputum microscopy, CXR, Mantoux test
Institute DOTS Give as ordered;
Pyrazinamide, Izoniazid, Rifampicin, Ethambutol and Streptomycin.
Check for sensitivity to any of the drug mentioned
Management
Provide B6 if receiving Izoniazid
Watch out for visual problem if receiving Ethambutol
=Ethambutol is contra indicated for children who cant verbalize visual problems yet.
PNEUMONIA
an acute usually bacterial in nature
Description:
the most common causative organism is strptococcus pneumoniae ubiquitous, orgainsm and may be transferred
among population that has poor ventilation and impaired respiratory cilliary function. certain disease like measles may
Etiology:
promote the development of pneumonia
Droplet infection
24 to 72 hrs usually 48 hrs
Incubation period:
the organism enters the respiratory tract and if the cilliary mechanism fails to prevent its further entry the organism
then infects the lower respiratory centers where it stimulate an inflammatory reaction. this response leads to migration
of WBC in particular with neutrophil hence leukocyte infiltration is seen in chest x-rays as consolidation. the build up
Pathophysiology:
puss increases the alveolar presure causing in atelectasis once collapsed alveoli cant participate in gas exchange
anymore leading to impaired DOB.
Rusty colored sputum is the pathognomonic sign this is caused by WBC infiltrates, RBC and sputum. DOB, increased
Signs and symptoms RR, coughing and in late cases lethargy, cyanosis and death.
sputum exam
Co-Trimoxazole and gentamycin are the drug of choice.
although Co-tri is used more widely than gentamycin because of its oral preparation which are allowed to be
administered by midwives for patient in far flung areas. instruct the mothers to continue the administration of antibiotic
Management
for 5 straight days
TSB if in case fever may arise
Promote proper room ventilation avoid crowding as much as possible Use Pneumococcal vaccine as indicated
COLDS (CORYZA)
The causative agent comes from adenovirus and rhino virus.
Description:
Droplet infection, direct contact.
1 3 days
Incubation period:
As the virus enters the respiratory tract, it attaches itself to the mucous membrane and causes local irritation and
inflammation. In response, the mucous membrane releases mucous to flush out the virus. Since there is an increased
in the production of the mucous it usually flows back and causes rhino rhea and because of the naso-lacrymal duct,
Pathophysiology:
increased mucous production impedes the drainage of tears thus watery eyes is present. Complications: Children
otitis media and bronchopneumonia Adult sinusitis
General malaise
Fever, chills
Signs and symptoms Sneezing, dry and scratchy throat
Teary eyes, headache
Continues water discharge from nares
a. Provide adequate rest and sleep b.

Increase fluid intake c.
Management
Provide adequate and nutritious diet d.
Encourage vitamins specially vitamin C
INFLUENZA (LA GRIPPE OF FLU)
A highly contagious disease characterized by sudden onset of aches and pains.
Description:
Influenza virus A, B, C
Etiology:
Droplet infection, contact with nasopharyngeal secretions
24 48 hrs.
Incubation period:
Upon entry in the upper respiratory tract, it is deposited in the same site and penetrates the mucosal cells. Causing
lysis and destruction of the ciliated epithelium the virus releases neuramidase that decreases the viscosity of the
mucosa. Facilitating the spread of the infected exudates to the lower respiratory tract, this causes intestinal
Pathophysiology: inflammation, and necrosis of the alveolar and bronchiolar epithelium. Thus, the alveoli are filled with exudates
containing WBC, RBC and hyaline cartilage. This places the patient to increased possibility of acquiring bacterial
pneumonia usually caused by S. Aureus.
Respiratory most common

fever
anorexia
chills
muscle pain and aches
coryza
sore throat
bitter taste
Signs and symptoms orbital pain
Intestinal
vomiting
severe abdominal pain
fever
obstinate constipation
severe diarrhea
Nervous
headache
a. provide adequate rest and ventilation

b. tepid sponge bath to reduce the temperature
c. monitor the vital signs
Management d. provide adequate nutrition
e. assist the patient in conserving strength when she is very weak
f. drug of choice:
antibiotics sulfonamides
INTEGUMENTARY SYSTEM
SCARLET FEVER (SCARLATINA)

Is an acute, febrile, contagious condition characterized by sudden onset usually with vomiting and by punctuate
Description: erythematous skin eruption followed by characteristic exfoliation of the skin during convalescence, rapid pulse and
sore throat.
Group A hemolytic streptococcus group
Etiology:
Direct contact, droplet infection and indirect contact
1 7 days
Incubation period:
The bacterium releases erythrogenic toxins, which causes sensitivity reaction in the body. The toxin can cause toxic
injury to the small capillaries of vascular epithelium found in the body. The skin is the site where the manifestations
are most visible where one will observed strawberry like tongue, rashes, etc.
Pathophysiology:
Complications: sinusitis nephritis otitis media myocarditis/endocarditis mastoiditis

I. Prodomal stage
fever
tachycardia
sore throat
vomiting
headache
abdominal pain
Signs and symptoms body malaise
II. Eruptive stage
rashes: appears at the end of 24 hours on the chest spread gradually upward and downward
enanthem: macular eruption on the hard palate
pastias line: due to the grouping of macules found around the folds of the skin particularly on the elbow
tiny subcuticular vesicles: found in the cuticles of the nails
strawberry tongue: tongue becomes red at the edges and enlarged papillae show
raspberry tongue: circumoral pallor
III. Desquamation (8 10 days) skin begins to peel shedding of the hair and nails
Scultz-Charlton rash extinction or blanching test for sensitivity to scarlet fever antitoxin
Dick test determines whether or not a person is naturally immune to scarlatine
nasal swab
Diagnostic procedure Laboratory:
positive throat culture for strep
elevated ASO titer
white and differentiated count high as 50,000 increase in eosinophils
1. isolation medical aseptic technique

2. bed rest
3. keep the patient warm at all times and avoid drafts
4. apply ice cap/packs for high fever
5. give TSB for high temperature
6. increase oral fluid intake
7. take vital signs q 3 4 hrs
8. daily bath should be given: sodium bicarbonate or starch is used in excessive itching and oil rub
Management after bath is useful
9. use of mouthwashes and gargles for good oral hygiene
10. prevent exoriations by wiping nasal discharges with soft tissues and application of cold creams
11. encourage daily elimination
12. diet should be of high calorie foods and fruit juices, milk cream and soups
Medical management:
a. antitoxins
b. convalescent serum
c. gamma globin administered IM
d. sulfonamides e. antibiotics penicillin (for cleaning the throat of streptococcus)
LEPROSY (HANSENS DISEASE, HANSENOSIS, LEPRAE, LEONTHIASIS)

A chronic infectious disease characterized by the appearance of modules in the skin or mucous membranes or by
Description: changes in the nerves leading to anesthesia, paralysis or other changes
Mycobacterium leprae (acid fast bacillus), sporadic/endemic cases, occurs in tropical and semitropical countries
throughout the world. It can be contracted in childhood (manifested at age 15 and diagnosed by the age of 20 years).
Etiology: Prognosis: > the longer the time of active disease, severe lesions, the more rapidly they have advanced without ability
to produce the lepromin reaction the poorer the prognosis > case under 21 years old high relapse rate
Prolonged intimate skin to skin contact, nasal secretions

Prolonged, undetermined and varies from one to many years
Incubation period:
The bacterium, which is an acid-fast bacillus, attacks the skin tissues and peripheral nerve, which causes skin lesions,
Pathophysiology:
anesthesia, infection and deformities
Assessment:
1. Tuberculoid type shows high resistance to Hansens bacilli. Clinical manifestations are mainly in the skin
and nerves and usually are used or non-infectious.
2. Lepromatous type minimal resistance to the multiplication, existence of the bacillus, constant presence
of large numbers in the lesions and form globi (characteristic manifestations in the skin and mucus
membranes) and peripheral nerves.
3. Open or infectious cases
4. Inderterminate type clinical manifestations are located chiefly in skin and nerves; lesions are flat
macules.
5. Borderline
Clinical Manifestations:
1. Early stage
loss of sensation
paralysis of extremities
absence of sweating (anhydrosis)
Signs and symptoms
nasal obstruction
loss of hair (eyebrows)
eye redness
change in the skin color
ulcers that does not heal
muscle weakness
2. Late symptoms
contractures
leonine appearance (due to nodular and thickened skin of the forehead and face)
madarosis (falling of eyebrows)
gynecomastia sinking of bridge of nose
3. Cardinal signs
presence of Hansens bacilli
presence of localized areas of anesrhesia
peripheral nerve enlargement
1. Lepromin reaction a positive test develops a nodule at the site of inoculation (first and third week)
2. Wassermann reaction
Planning and implementation

1. Prevention
o separate infants from lepromatous parents at birth
o segregate and treat open cases of leprosy
o require public health supervision and control of cases of Hansens disease
2. Medical management
1. Multiple drug therapy
paucibacillary treatment six months or until negative (-) results occur
refampicin once a month
dapsone - once a day
Management
2. Multibacillary treatment for 2 consecutive years or until negative (-) for leprosy test
rifampicin once a month
lamprene once a day
dapsone once a day
3. full, wholesome generous diet
4. alcohol or TSB may be used for high fever
5. patient should have a daily cleansing bath and change of clothing
6. good oral hygiene
7. normal elimination should be maintained
h. meticulous skin care for ulcers
MEASLES (RUBEOLA, MORBILLI, 7 DAY MEASLES)

An extremely contagious exanthematous disease of acute onset which most often affects children and the chief
Description: symptoms of which are referable to the upper respiratory passages.
The causative agent is the paramyxo virus

Etiology:
Mode of transmission: Nasal throat secretions, droplet infection, indirect contact with articles
8 20 days
Incubation period:
As the virus enters the body it immediately multiplies in the respiratory epiyhelium. It disseminate by way of the
lymphatic system causing hyperplasia of the infected lymphoid tissue. As a result there is a primary viremia which
infects the leukocyte and involves the whole reticuloendothelial system. As the infected cells die it necrose and
release more viruses to infect other leukocytes leading to secondary viremia, which also causes edema of upper
respiratory tract producing its symptoms and it may predispose to pneumonia.
Complications:
Pathophysiology:
otitis media
bronchopnuemonia
severe bronchitis Prognosis:
death rate is highest in the first two years of life (20%)
after 4 years uncommon
over all mortality less than
Assessment:
1. Stages
1. incubation period (average of 10 days)
2. Pre-eruptive stage or stage of invasion (3-6 days)

from the appearance of the first signs and symptoms to the earliest evidence of the eruption.
fever, severe cold
frequent sneezing
profuse nasal discharge
eyes are red and swollen with mucopurulent discharge (lids stick together)
Stimsons sign (puffiness of lower eyelids with definite line of congestion on the conjunctivae)
redness of both eardrums
vomiting, drowsiness
hard, dry cough
Signs and symptoms
Kopliks spot (appears on second day): small bright, red macules or papules with a tiny or bluish-white specks on the
center and can be found on the buccal cavity
macupapular rashes (seen late in 4th day): appears first on the cheeks or at the hairline
true measles rash: slightly elevated sensation to touch, appears first on the face and spreads downward over neck,
chest trunk, limbs and appearing last on the wrist and back of the hand
3. Eruptive stage
characterized by a general intensification of all local constitutional symptoms of the pre-eruptive stage with the
appearance of bronchitis and loose bowels
irritability and restlessness
red and swollen throat
enlargement of cervical glands fever subsides
4. Desquamation stage follows after the rash fades follows the order of distribution seen in the formation of eruption
Diagnostic procedure No specific diagnostic exam except only for the presence of leucopenia.
a. prevention
education of parents regarding the disease
passive immunization of infants and children (gammaglobulin)
active immunization (1st year of life)
b. management
Management drugs
antibiotics
sulfodiazine isolation
meticulous skin care warm alcohol rub to prevent pressure sores good oral and nasal hygiene increase oral fluid
intake
proper care of the eyes eye screen to avoid direct light; wear dark glasses ears should be cleaned after bath if
there is discharges patient should lie the affected ear down or towards the bed

give ample of fluids during febrile stage
GERMAN MEASLES (RUBELLA, ROTHEIN, ROSEOLA, 3-DAY MEASLES)

Description: An acute infectious disease characterized by mild constitutional symptoms, rose colored macular eruption which may
resembles measles and enlargement and tenderness
Caused by myxovirus. Occurs mostly in spring and seen mostly in children over 5 years of age
Etiology:
Direct contact
14 21 days Period of communicability 7 days before to 5 days after the rash appears
Incubation period:
As the virus gains entrance to the nasopharynx, it immediately invades the nearest lymph gland causing
lymphadenopathy. Later on, the virus enters the blood stream that stimulates the immune response, which is the
cause of rashes found in the body of infected individual. If rashes has appeared it means that viremia has subsided.
Since the disease is generally mild and serious complication has ha been very rare, what should be watched out
rather are its congenital effects because it can cross the placental barrier, which may kill the fetus or cause congenital
Pathophysiology:
rubella syndrome.
Complications: otitis media encephalitis transient albuminuria arthritis congenital defects for babies whos
mother were exposed in early pregnancy
Prognosis: very favorable
fever, cough loss of appetite enlargement of lymph nodes sweating leucopenia vomiting (in some cases)
headache, mild sore throat desquamation follows the rash enanthem of uvula with tiny red spots rash (cardinal
Signs and symptoms
symptom) accompanied with cervical adenitis: begins on the face including the area around the mouth; oval, pale,
rose-red papules about the size of a pinhead; covers the body within 24 hours and gone by the end of the 4th day
Planning and implementation
a. Prevention: vaccination gamma globulin given to pregnant women with negative history and who have been
Management exposed in the first trimester of pregnancy include in MMR given at 15months to the baby
b. management isolation (catarrhal stage to prevent infection to others) bed rest for first few days meticulous
skin care especially after the rash fades good oral and nasal hygiene (use of petroleum jelly if lips become dry) no
special diet is necessary, increase oral fluid intake
VARICELLA (CHICKEN POX)

A very contagious acute disease usually occurring in small children, characterized by the appearance of vesicles
Description: frequently preceded by papules, occasionally followed by postules but ending in crusting
Varicella zoster virus (airborne)

Etiology:
Droplet infection, direct contact
2 -3 weeks
Incubation period:
The virus gain entrance via the upper respiratory tract it crosses the mucous membrane and cause systemic infection
followed by appearance of numerous macupapular rash. The rash are fluid filled that contain polymorphonuclear
leukocytes.
Pathophysiology: Period of communicability: highly contagious from 2 days prior to rash to 6 days after rash erupt. Full blown case
imports permanent immunity.
Complications: pneumonia nephritis encephalitis impetigo pitting or scarring of the skin
slight fever: first to appear body malaise, muscle pain eruption (maculopapular) then progresses to vesicle (3-4
days); begins on trunk and spreads to extremities and face (even on the scalp, throat and mucus membranes)
Signs and symptoms
intense pruritus vesicles ended as a granular scab irritability
1. Drugs penicillin can be used when the crusts are severe or infected to prevent scarring or secondary invasion
alkalinizing agent to prevent nephritis and to stop vomiting acyclovir, immunosin antiviral hydrocortisone lotion 1%
for itching
2. isolation in a room by itself
Management 3. provide a well ventilated, warm room to the patient
4. warm bath should be given daily to relieve itching; use a calamine lotion
5. avoid injuring the lesions by using soft absorbent towel and the patient should be patted dry instead of rubbed dry
6. maintain good oral hygiene, if lesions are found in the mouth or nasal passages, antiseptic prep may be used 7.
diet should be regular
HERPES ZOSTER (SHINGLES)

Description: Acute viral infection of the peripheral nervous system due to reactivation of varicella zoster virus. The virus causes an
inflammatory reaction in isolated spinal and cranial sensory ganglia and the posterior gray matter of the spinal cord.
Contagious to anyone who has not had varicella or who immunosupressed.
neuralgic pain malaise burning fever cluster of skin vesicles along course of peripheral sensory nerves
Signs and symptoms (unilateral and found in trunk, thorax or face); appears 3-4 days
1. drugs
o analgesics
o corticosteroids
o acetic acid compresses or white petrolatum
Management o anti-viral (acyclovir)
2. isolate client
3. apply drying lotion
4. administer medications as ordered
5. instruct client to preventive measures
SCABIES
An infection of the skin produced by burrowing action of a parasite mite resulting in irritation and the formation of
Description: vesicles or postules.
Itchmite, sarcoptes scabei, occurs in individual living in area of poverty where cleanliness is lacking.
Etiology:
Direct contact with infected persons, indirect contact through soiled bed linens, clothing and others.
-
Incubation period:
Both female and male parasites live on the skin. A female parasite burrows into the superficial skin to deposit eggs.
Pruritus occurs and scratching of skin may produce secondary infection. Scattered follicular. Eruption contains
Pathophysiology: immature mites. Inflammation may produce postules and crust. Eggs is hatched in 4 days. Larvae undergo a series of
matts before becoming adult. Life cycle is complete in 1-2 weeks.
intense itching especially at night sites between fingers or flexor surfaces of wrists and palms, around nipples,
Signs and symptoms
umbilicus, in axillary folds, near groin or gluteal folds, penis, scrotum.
Presence on skin of female mite, ova and feces upon skin scrapping.
1. Take a warm soapy shower bath or bath to remove scaling debris from crusts.
2. Apply prescribed scabicide such as:
Management o lindane lotion (kwell) 1%
o crotamiton (Eurax) cream or lotion
o 6-10% precipitate of sulfur in petrolatum
3. encourage to change clothing frequently
RINGWORM (TRICHOPHYTOSIS)
A group of diseases caused by a number of vegetable fungi and affecting various portion of the body in different ways
Description: (skin, hair, nails)
TINEA PEDIS (Athletes foot) a superficial fungal infection due to trichophyton Rubrum, mentagrophytes, or
epidermophyton floccosum which may manifest itself as an acute, inflammatory, vesicular process or as chronic rash
involving the soles of the feet and the inter-digital web spaces. particularly common in summer, contracted swimming
area and locker rooms.
TINEA CORPORIS or TINEA CIRCINATA ringworm of the body.
Etiology:
TINEA CRURIS (Jock itch) superficial fungal infection of the groin which may extend to the inner thigh and buttocks
areas and commonly associated with tinea pedis.
TINEA CAPITIS (ringworm of the scalp) caused by microsporum canis, trichophyton tonsurans. usually spread
through child to child contact, use of towels, combs, brushes and hats kitten and puppies may be the source of the
infection primarily seen in children before puberty
TINEA PEDIS scaly fissures between toes, vesicles on sides of feet pruritus burning and erethema lymphangitis
and cellulites may occur
TINEA CORPORIS or TINEA CIRCINATA intense itching appearance: begins as scaling erythematous lesions
advancing to rings of vesicles with central clearing and appears on exposed areas of body.
Signs and symptoms
TINEA CRURIS dull red brown eruption of the upper thighs and extends to form circular plaques with elevated scaly
or vesicular borders. itching seen most in joggers, obese individuals and those wearing tight undercoating.
TINEA CAPITIS reddened, oval or round areas of alopecia presence of kerion: an acute inflammation that produces
edema, postules and granulomatous swelling
TINEA PEDIS direct examination of scrapings (skin, nails, hair) isolation of the organisms in culture TINEA CAPITIS
woods lamp microscopic evaluation
TINEA PEDIS
1. Prevention: instruct client to keep feet dry such as by using talcum powder.
2. Management:
o Drugs: topical agent, clotrimazole, miconazole, tolnaftate
o Systemic anti-fungal therapy: griseofulvin, ketoconazole
o Elevate feet for vesicular type o pain infection.
TINEA CORPORIS or TINEA CIRCINATA
1. Prevention: infected pet is a common source and should be inspected and treated by a veterinarian.
2. Management
o see treatment for tinea pedis
Management o wear clean cotton clothing next to skin
o use clean towel daily
o dry all areas and skin folds thoroughly
o use self monitoring for signs of re-infection after a course of therapy.
TINEA CRURIS
1. Prevention: avoid nylon underclothing, tight-fitting underwear and prolonged wearing of wet bathing suit.
2. Management:
o Drugs topical therapy (miconazole cream); griseofulvin (oral)
o avoid excessive washing or scrubbing; wear cotton underwear.
TINEA CAPITIS same with other fungal infection
GASTROINTESTINAL DISORDERS
TYPHOID FEVER (ENTERIC FEVER)

A general infection characterized by the hyperplasia of the lymphoid tissues, especially enlargement and ulcerations
of the Peyers patches and enlargement of the spleen, by parechymatous changes in various organs and liberation of
Description:
an endotoxin in the blood.
Salmonella typhosa, prevalent in temperate climates, high incidence in fall, and mostly affected are the males and in
Etiology: youth and infant.
Infected urine and feces and intake of contaminated food and water
The organism enters the body via the GI tract and invades the walls of the GI tract leading to bacteremia that localizes
in mesenteric lymph nodes, in the masses of lymphatic tissue, in the mucus membrane of the intestinal wall (Peyers
patches) and in small, solitary lymph follicles in the ileum and colon thus ulceration of the intestines may result.
Complication:
perforation of the intestine from erosion of one of the ulcers
intestinal hemorrhage from erosion of blood vessels
relapse
thrombophlebitis
Pathophysiology: urinary infection
meningitis
Signs and symptoms
1. Gradual onset
o severe headache, malaise, muscle pains, non-productive cough
o chills and fever, temperature rises slowly
o pulse is full and slow
o skin eruption irregularly spaced small rose spots on the abdomen, chest and back; fades 3-4
days
o splenomegally
2. Second week
fever remains consistently high
abdominal distention and tenderness, constipation or diarrhea
delirium in severe infection
coma-vigil look; pupils dilate and patient appears to stare without seeing
sultus tendium twitching of the tendon sets
3. Third week
gradual decline in fever and symptoms subsides
white blood cell counts blood or bone marrow culture positive urine and stool cultures in later stage blood serum
agglutination (+) at the end of scond week
1. Prevention: decontamination of water sources, milk pasteurization, individual vaccination of high risk
persons, control carriers.
2. Drugs
o chloramphenicol
o ampicillin
o sulfamethoxazole
o trimethoprim
o furazolidone
3. intravenous infusion to treat dehydration and diarrhea
4. Nursing care
o give supportive care
Management o position the patient to prevent aspiration
o use of enteric precautions
o TSB for high fever
o encourage high fluid intake
o monitor for complications
5. intestinal decompression procedure, IV fluids and surgical intervention for perforation
6. withhold food, blood transfusions and bowel resection for intestinal hemorrhage
LEPTOSPIROSIS (WEILS DISEASE, CANICOLA FEVER, HEMMORHAGIC JAUNDICE, ICTEROHEMORRHAGIC SPIROCHETOSIS, SWINEHERDS
DISEASE, MUD FEVER)
Worldwide in its distribution and especially in areas where sanitation is poorest; common in Japan. Usually those who
Description: are affected are the sewer workers, miners and swimmers in polluted water
.
Leptospira icterohaemorrhagiae carried by wild rat
Etiology:
Incubation period: 5 6 days
sudden onset with chills, vomiting and headache by severe fever and pains in the extremities
intense itching of the conjunctivae
Signs and symptoms severe jaundice with hemorrhage in the skin and mucus membranes
hematemesis, hematuria and hepatomegaly for severe cases
convalescence occurs in the third week unless there is a complication
Diagnostic procedure Positive agglutination test

Prevention eradication of rats and environmental sanitation Drugs antiserum or convalescent serum; penicillin
Management
Nursing care supportive and symptomatic
DYSENTERY
BACILLARY DYSENTERY (shigellosis, bloody flux) caused by shigella dyseteriae and shigella paradysenteriae
coming from bowel discharges of infected persons and carriers.
Etiology:
VIOLENT DYSENTERY (Cholera) caused by vibrio cholera, vibrio comma (ogawa and inaba) from infected feces or
vomitus.
BACILLARY DYSENTERY eating of contaminated foods, hand to mouth transfer of contaminated material, flies,
objects soiled with discharges of infected person, contaminated water.
VIOLENT DYSENTERY direct or indirect fecal contamination of water or food supplies by soiled hands, utensils or
mechanical carriers such as flies.
BACILLARY DYSENTERY 1-7 days (average of 4 days)
period of communicability during acute phase and until (-) stool exam VIOLENT DYSENTERY from a few hours
to five days (average 3 days)
period of communicability until the infectious organism is absent from the bowel discharges (7-14 days)
Incubation period:
BACILLARY DYSENTERY
chills
fever
nausea and vomiting
tenesmus
severe fiarrhea accompanied by blood and mucus
alternating episodes of diarrhea and constipation (chronic)
VIOLENT DYSENTERY
1. Onset
o acute colicky pain in the abdomen
o mild diarrhea (yellowish)
o marked mental depression
Signs and symptoms o headache, vomiting
o fever, may or may not be present
2. Collapse stage after 1 or 2 days
profuse watery stools (grayish white or rice water)
thirst
severe/violent cramps in the legs and feet
thickly furred tongue
sunken eyeballs
ash-gray colored skin
3. Reaction stage after 3 days
increased consistency of stools
skin becomes warm and cyanosis disappear
peripheral circulation improves
urine formation increases
BACILLARY DYSENTERY
stool exam
serologic test
VIOLENT DYSENTERY
(+) stool exam/vomitus
Management
BACILLARY DYSENTERY
1. Methods of control and prevention
o recognition of disease and reporting
o concurrent disinfection from bowel discharges
o investigation of source of infection (food, water and milk supplies, general sanitation and search
for carriers)
o prevention of flybreeding, screening
o sanitary disposal of human excreta
o protection and purification of public water supplies and prevention of subsequent contamination
2. Drugs
kaolin
bismuth and paregoric (combination of sulfonamide)
chloramphenicol
3. Nursing care
isolation by medical aseptic technique
daily cleansing bath
increase oral fluids in acute stage
TSB for fever
record and the character of stools passed, amount and frequency of vomiting
VIOLENT DYSENTERY
1. Prevention
immunization
screen the sickroom from flies
protect the food supplies for contamination
b. Drugs tetracycline
c. Replacement of fluids and electrolytes
d. Isolation
e. Patient should be spared all unnecessary efforts during the acute stage
f. Buttocks should be kept clean with warm water and soap and rubbed dry
g. antiseptic mouthwash in case of vomiting
h. fluids is given as soon as they can be tolerated
MUMPS (INFECTIOUS OR EPIDEMIC PAROTITIS)

An acute contagious disease the characteristic feature of which is the swelling of one or both of the parotid glands
Description: usually occurring in epidemic form.
Filterable virus, member of myxovirus family, infected oral and nasal secretions is the source of infection
Complication: orchitis or epididymp-orchitis Prognosis: favorable in most cases of mumps, complete recovery
Etiology:
ordinarily takes place even complications take place.
Mode of transmission: Direct contact with a person who has the disease or by contact with articles which is contaminated.
14 21 days
Incubation period:
period of communicability: before the glands is swollen to the time present of localized swelling
pain in the parotid region

headache
earache
Signs and symptoms
fever
difficulty to open the mouth wide
general malaise
sore throat
moderate leukocytosis
complement fixation test
skin test for susceptibility to mumps
a. Prevention: immunization (MMR given at 15 months)
b. Drugs aspirin for fever, cortisone
c. isolation
d. absolute bed rest to prevent complications (at least 4 days)
Management e. daily bath should be given
f. soft bland diet for sore jaw
g. advise male to wear well fitting support to relieve the pull of gravity on the testes and blood vessels
h. TSB for fever
i. ice pack/collar application
PARASITISM
Description:
PINWORM (Enteropiasis) oxyuris vermicularis, occurs from fomites, autoinfection, fecal contamination, affects one
in family and invariably infects entire family.
GIANT INTESTINAL ROUNDWORMS (Ascariasis) ascaris lumbricoides, from sputum and ova in soil.
THREADWORM strongyloides stercoralis, from fecal soil contamination
WHIPWORM (trichuriasis) from fecal soil contamination
HOOKWORM (ancylostomiasis) from larvae in fecal soil contamination
Etiology: TAPEWORM (taeniasis)
Types:
hymenolepis nana from fecal contamination
taenia saginata (beef) from insufficiently cooked meat
taenia solium (pork) contaminated meat
diphyllobothrium latun poorly cooked infested fish
PINWORM mouth
GIANT INTESTINAL ROUNDWORMS mouth
THREADWORM enter usually through the skin or feet
WHIPWORM mouth
HOOKWORM through skin of the feet
TAPEWORM - mouth
PINWORM
eosinophilia, itching around the anus, convulsions in children.
GIANT INTESTINAL ROUNDWORMS
chest pain, cough after two months, malnutrition, indigestion, diarrhea, colicky abdominal pain.
Signs and symptoms THREADWORM
intermittent diarrhea
WHIPWORM nausea and vomiting, diarrhea, anemia, stunted growth; may cause prolapse of rectum in children and
occasionally appendicitis.
HOOKWORM anemia, diarrhea, stunted growth, bronchial symptoms, obstruction of the biliary and pancreatic duct.
PINWORM adults and ova in stool

GIANT INTESTINAL ROUNDWORMS adults and ova in stool
THREADWORM larvae WHIPWORM ova in stool
HOOKWORM ova in stool
TAPEWORM ova and segments of the worm in the stool
THREADWORM Prevention: wear shoes and use sanitary toilets

use of sanitary toilets
Management provide hygiene education of the family
dispose of the infected stools carefully
meticulous cleansing of skin especially anal region, hands and nails
drugs antihelminthic drugs, piperazine citrate, pyrantel pamoate, mebendazole
HEPATITIS
Widespread inflammation of the liver tissue with liver cell damage due to hepatic cell degeneration and necrosis;
Description: proliferation and enlargement of the Kuffer cells and inflammation of the periportal areas thus may cause interruption
of bile flow.
TYPE A (infectious hepatitis) occurs in crowded living conditions; with poor personal hygiene or from contaminated
food, milk, water or shellfish. Common occurrence during fall and winter months usually affecting children and young
adults.
Etiology:
TYPE B (serum hepatitis, SH virus, viral hepatitis, transfusion hepatitis, homologous serum jaundice)
TYPE C (non-A, non-B hepatitis)
TYPE A fecal/oral route

TYPE B blood and body fluids (saliva, semen, vaginal secretions), often from contaminated needles among IV drug
Mode of transmission: abusers, intimate/sexual contact.
TYPE C by parenteral route, through blood and blood products, needles and syringes
TYPE A 15-45 days

Incubation period: period of communicability 3 weeks prior and one week after developing jaundice
TYPE B 50-180 days
TYPE C 7-50 days
Pathophysiology: -
Signs and symptoms
a. Pre-icteric stage
anorexia
nausea and vomiting
fatigue constipation or diarrhea
weight loss
right upper quadrant discomfort
hepatomegaly
spleenomegaly
lymphadenopathy
b. Icteric stage
fatigue
weight loss
light colored stools
dark urine
jaundice
pruritus
continued hepatomegaly with tenderness
c. Post-icteric stage
fatigue but increased sense of well being
hepatomegaly: gradually decreasing
a. All 3 types
SGPT, SGOT, alkaline phospatase, bilirubin, ER all increased in pre-icteric
leukocytes, lymphocytes, neutrophils all decreased
prolonged PT
b. HEPA A: Hepa A (HAV) in stool before onset

Anti-HAV (IgG) appears soon after onset of jaundice, peaks in 1-2 months and persist indefinitely
Anti-HA (IgM) positive in acute infection lasts 4-6 weeks
c. HEPA B
HbsAG (surface antigen) positive, develops 4-12 weeks after infection
Anti-HbsAg negative in 80% cases
Anti-HBC associated with infectivity, develops 2-16 weeks after infection
ABeAG associated with ineffectively and disappears before jaundice
Anti-Hbe present in carriers, represents low in effectivity
a. Prevention
I. Type A
good hand washing
good personal hygiene
control and screening of food handlers
passive immunization ISG, to exposed individuals and prophylaxis for travelers to developing countries
II. Type B
screen blood donors HB3Ag
use disposable needles and syringes
registration of all carriers
passive immunization ISG
active immunization hepatavax B vaccine and formalin treated hepatitis B vaccine given in 3 doses
Management
b. Nursing management
promote adequate nutrition small frequent meals of high CHO, moderate to high CHON, high vitamin, high caloric
diet, avoid very hot or cold foods.
ensure rest and relaxation
monitor/relive pruritus cool, moist compresses, emollient lotion
administer corticosteroid as ordered
isolation procedures as required
provide client teaching and discharge planning with regards to:
importance of avoiding alcohol
importance of not donating blood
recognition/reporting of signs of inadequate convalescence
avoidance of persons with known infections
Drugs liver protector (essentiale, jectofer, interferon drug)
FOOD POISONING
A gastroenteritis often produced by the presence of a disease organism or its toxins.
Description:
SALMONELLA GASTROENTERITIS salmonella typhimurium, salmonella paratyphi A, B, and C;
salmonella new port
STAPHYLOCOCCUS GASTROENTERITIS coagulase positive, gram positive: grows rapidly on food containing
Etiology:
carbohydrates
Recovery: within 24 36 hours BOTILISM clostridium botulinum

SALMONELLA GASTROENTERITIS 6 to 48 hours after the ingestion of contaminated food STAPHYLOCOCCUS
Incubation period:
GASTROENTERITIS 2 to 6 hours after ingestion BOTILISM 24 hours after the ingestion
Signs and symptoms
SALMONELLA GASTROENTERITIS
headache
nausea and vomiting
diarrhea (stools are usually fluid and contain mucus; bloody if in severe infection)
STAPHYLOCOCCUS GASTROENTERITIS
sudden abdominal pain
excessive perspiration
vomiting
diarrhea
pallor weakness
BOTILISM
peripheral nervous system
vomiting
ataxia
constipation
ocular paralysis
aphonia
other neufromascular signs
paralysis of the respiratory system which may lead to death
Diagnostic procedure SALMONELLA GASTROENTERITIS history of illness after ingestion of certain foods
SALMONELLA GASTROENTERITIS/STAPHYLOCOCCUS GASTROENTERITIS
replacement of fluids and salts
sedatives and anticholinergic to reduce hypermobility of the intestine
good oral hygiene
application of heat to abdomen to relieve cramps
BOTILISM
prevention
Management regulation of commercial processing of canned foods
education of housewives concerning proper processing of home canned foods
canned foods should be boiled first to destroy the toxins
polyvalent antitoxins (botulinum antitoxin)
patient with botulinum should be placed on quiet room and avoidance of unnecessary activity
symptomatic
intubation for feeding
tracheostomy in respiratory failure
oxygen by IPPB
SEXUALLY TRANSMITTED DISEASE
GONORRHEA (STRAIN, CLAP, JACK, MORNING DROP, G.C. GLEET)

An infectious disease, which causes inflammation of the mucous membranes of the genitourinary tract.
Description: Complications:
MALE bilateral epididymitis, sterility
FEMALE pelvic inflammatory disease, sterility
NEWBORN opthalmia neonatorum mother to child
Neisseria gonorrhea
Etiology:
Sexual contact
2 5 days
Incubation period:
MALE
burning sensation in the urethra upon urination
passage of purulent (yellowish) discharge
pelvic pain
fever
painful urination
Signs and symptoms FEMALE
burning sensation upon urination
presence or absence of vaginal discharge
pelvic pain
abdominal distention
nausea and vomiting
urinary frequency
culture and sensitivity
female: pap smear or cervical smear; male: urethral smear
blood exam VDRL
educate men and women to recognize signs of gonorrhea and to seek immediate treatment
monitor urinary and vowel elimination
important to treat sexual partner, as client may become re-infected
Management
make arrangements for follow-up culture 2 weeks after therapy is initiated
Drugs penicillin: drug of choice
tetracyclines
ceftriaxone sodium (rocephin)
amoxicillin (augmentin)
SYPHILIS (LEUS, POX, BAD BLOOD DISEASE)

A contagious disease that leads to many structural and cutaneous lesions
Complications: a. still birth b. child born with syphilis placenta is bigger than the baby persistent vesicular eruptions
and nasal discharges old man feature mucus patches on mouth and anus c. child born with late syphilis (signs and
Description:
symptoms after 2 years)
hutchinsons teeth deafness saddle nose high palate
Treponema pallidum
Etiology:
Sexual contact
3 6 weeks
Incubation period:
a. Primary syphilis
chancre on genitalia, mouth or anus
serous drainage from chancre
enlarge lymph nodes
maybe painful or painless
highly infectious
b. Secondary syphilis
skin rash on palms and soles of feet
reddish copper colored lesions on palms of hands and soles of feet
condylomas: lesions/sores that fused together
Signs and symptoms
erosions of oral mucus membranes
alopecia
enlarged lymph nodes
fever, headache, sore throat and general malaise
c. Tertiary syphilis
gumma the characteristic lesions
cardiovascular changes
ataxia
stroke, blindness

a. positive test for syphilis
venereal disease research laboratory (VDRL)
rapid plasma reagin circle card test (CRPR-CT)
automate reagin test (ART)
fluorescent treponemal antibody absorption test (FTA-ABS)
Diagnostic procedure wessermann test
khan precipitation test
kline, hinton and mazzin tests
b. darkfield examination
c. culture and sensitivity
d.
strict personal hygiene is an absolute requirement
assist in case finding
Management instruct client to avoid sexual contact until clearance is given by physician
encourage monogamous relationship
explain need to complete course of antibiotic therapy
Drugs penicillin, tetracyclins/kithramycin
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

An acquired immune deficiency characterized by a defect in natural immunity
Description:
Retrovirus, human immunodeficiency virus (HIV-1 and HIV-2) previously referred to as human T-lymphotropic virus
Etiology: type III (HTLV-III)
Blood transfusion, sexual contact, contaminated needles, perinatal transmission

6 months to 9 years
Incubation period:
Pathophysiology:
anorexia
fatigue
dyspnea
night sweats
fever
diarrhea
Signs and symptoms
enlarged lymph nodes
HIV encephalopathy: memory loss, lack of coordination, partial paralysis, mental deterioration
HIV wasting syndrome, emaciation
positive test for HIV antibody
positive test for presence of HIV itself
opportunistic infection: neumocystic carinii, cystomegalovirus, kaposis sarcoma
Diagnostic procedure ELISA test (enzyme-linked immunosorbent assay) a screening test

western blot a confirmatory test
provide frequent rest periods

provide skin care
provide high-calorie, high protein diet to prevent weight loss
provide good oral hygiene
provide oxygen and maintain pulmonary function
Management
provide measures to reduce pain
protect the client from secondary infection; carefully assess for early signs
encourage verbalization of feelings
teach client the importance of:
informing sexual contacts of diagnosis
not sharing needle with other individuals
continuing medical supervision
CHLAMYDIAL INFECTION
A sexually transmitted disease that is highly contagious caused by chlamydial organism
Description:
Chlamydia trachomatis
Etiology:
2 -3 weeks for males
Sexual intercourse
Incubation period:
-
Pathophysiology:
pruritus in vagina
burning sensation in vagina
Signs and symptoms painful intercourse
pruritus of urethral meatus in men
burning sensation during urination
Diagnostic procedure Culture of aspirated material from vaginal, anal or penile discharges
Management doxycycline or azithromycin (recommended for pregnant woman)

universal precaution should be practiced
TRICHOMONIASIS
Another type of sexually transmitted disease that may also be transmitted by other means such as handling of
Description: infected fomites. It is caused by a protozoan parasites.
Trichomonas vaginalis
Etiology:
Sexual intercourse, contact with wet towels and wash clothes infected by the organism
Incubation period: 4 20 days, usually 7 days
vaginal discharge
burning and pruritus of vagina
Signs and symptoms
redness of the introitus
usually asymptomatic in men
Diagnostic procedure culture of obtained specimen
metronidazole
Management sitz bath may relieve symptom
acid douches
tetracyclines may be given on male who are also infected
BIOTERRORISM AND PANDEMICS
In the recent course of international conflicts, which has lead to war, has used weapon that are quite different from the conventional ones used
before. The medical science is being used not to prolong life but to cause immediate death by infection of various biological organisms. The
following gives an insight of these dangerous biological terrorism leading to pandemics.
SMALL POX
For about two decades the WHO has declared that the world is already small pox free. Although eliminated in the
Description: world over, the specimen is still kept in two laboratory facility in the United States.
Variola virus (DNA virus)

Etiology:
Direct contact or by droplet from person to person
12 days
Incubation period:
Signs and symptoms
high fever
malaise
headache
back ache
maculopapular rash in the face, mouth and pharynx (the patients are contagious after the appearance of the
rash)
generally supportive care

Management before rendering care transmission precaution should be specifically indicated
autoclaving of soiled linens is needed
isolation is necessary until no longer contagious
ANTHRAX
Also known as whoolsorters disease, the capsulated form of this organism is found in soil worldwide. The organism
Description: needs to take about 8,000 to 50,000 to put a person at risk of contracting the disease.
Bacillus anthracis
Etiology:
inhalation of spores
Mode of transmission: ingestion of spores
entrance through skin lesions
For inhalation anthrax 60 days,

Incubation period: for cutaneous anthrax 1-6 days
a. Inhalation anthrax cough headache fever vomiting chills weakness dyspnea syncope
Signs and symptoms b. Cutaneous anthrax nausea and vomiting abdominal pain hematochexia ascites massive diarrhea
a. standard precaution is already sufficient to control the spread of the infection

Management b. ciprofloxacin/doxycycline is prescribed for mass exposure/casualty with infecting organism
c. important pharmacologic interventions are penicillin, erythromycin, chlorampenicol and gentamycin
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Latest among all the rest of pandemics which has its origin from China and has spread to USA, Canada, Philippines
Description: and other South East Asian Country
Corona virus
Etiology:
Airborne
7 10 days
Incubation period:
fever
cough
Signs and symptoms
rapid respiratory compromise
dyspnea
atelectasis
Management supportive treatment

provide ventilatory assistance
use N95 mask to avoid infection

The Community Health Nursing and Communicable Diseases

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

The Community Health Nursing and Communicable Diseases

Transféré par

Droits d'auteur :

Formats disponibles

THE COMMUNITY HEALTH NURSING AND

Community Health Nursing

COMMUNITY HEALTH NURSING

II - Community Health Nursing

PHILOSOPHY OF CHN ACCORDING TO DR. MARGARET SHETLAND

COMMON PROCEDURE IN CHN:

Levels of Client in CHN:

****1.a.2 Family Life Cycle

Stage II Early Child Bearing Family(0-30 months old)

Stage III Family with Pre- school Children (3-6yrs old)

Stage IV Family with School age Children (6-12yrs old)

Stage V - Family with Teen Agers (13-25yrs old)

Stage VII -Family with Middle Adult parents (36-60yrs old)

Stage VIII Aging Family (61yrs old up to death)

TYPES OF COMMUNITY ASSESSMENT:

2 Ways of Assigning People:

A. CRUDE BIRTH RATE

B. GENERAL FERTILITY RATE

A. CRUDE DEATH RATE

B. INFANT MORTALITY RATE

C. MATERNAL MORTALITY RATE

A. Patterns of disease occurrence:

IV. Health Situation of the Philippines

VITAL HEALTH STATISTICS 2005

LEADING CAUSES OF MORBIDITY

1. Ensure equal access to basic health services

NON GOVERNMENT SECTORS provides manpower in the execution of the program

PRIVATE SECTORS provides financial aspect in the execution of programs

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

Support for health goal

MILESTONE IN HEALTH CARE DELIVRY SYSTEM

RA 1082 - RHU Act

VI National Health Plan

A. MAJOR HEALTH PLAN

B. PRIORITY PROGRAM IN YEAR 2000

C. PRIORITY PROGRAM IN THE YEAR 2005

VII - INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

IMCI COMPONENTS OF STRATEGY:

Possible course/ associated condition:

Five Disease Focus of IMCI:

THE INTEGRATED CASE MANAGEMENT PROCESS

Check for General Danger Signs:

PINK (URGENT REFERRAL) YELLOW (Treatment at outpatient GREEN (Home management)

PNEUMONIA TREATMENT SCHEME

Give an appropriate antibiotic for 5 days

Assess and classify DIARRHEA

A child with diarrhea is assessed for:

NO DEHYDRATION Home Care

Does the child have an ear problem?

Check for Malnutrition and Anemia

BID FOR 5 DAYS BID FOR 5 DAYS

Give an Oral Antimalarial

TABLET ( 150MG ) TABLET ( 15MG) TABLET ( 15MG) TABLET ( 15MG)

GIVE PARACETAMOL FOR HIGH FEVER ( 38.5oC OR MORE ) OR EAR PAIN

VIII - DOH PROGRAMS DENTAL HEALTH PROGRAM

HEALTH EDUCATION & CO

OLDER PERSONS HEALTH SERVICES

GUIDELINES FOR GOOD NUTRITION

1.Malnutrition Rehabilitation Program

2.Micronutrient Supplementation Program

PROTEIN ENERGY MALNUTRITION

RESPIRATORY INFECTION CONTROL

A. The 10 Herbal Medicine(LUBBY SANTA)