CHAPTER 1

INTRODUCTION

1.1 Background
As we know that a lot of infectious cases that spreading in our world. Almost of them is
dangerous for us. Such as Anthrax is one of the cases that the most infected in
development country like Indonesia. As a nurse we must know the next action to handle
this cases, how to take care of patient, how to take the prevention of this cases, etc.
1.2 Purpose
1.2.1 To know the definition of anthrax
1.2.2 To know the history of anthrax
1.2.3 To know the etiology of anthrax
1.2.4 To know the pathophysiology of anthrax
1.2.5 To know the sign and symptoms of anthrax.
1.2.6 Define the Nursing Care Plan of Anthrax
 CHAPTER 2

LITERATURE REVIEW

2.1 Definition

Anthrax is zoonotic diseases of major historical significance microbiologically, because

the etiologic agent, B. anthracis,was the first bacterial pathogen to be grown in a culture medium
from infected tissue (by Koch, in 1876) and was the model used in development of Koch
postulates. The causative agen is an aerobic, spore-forming, gram positive rod.

2.2 History

Anthrax has been an influential disease since its discovery by Robert Koch in the 1870s.
It is bacterial in nature and, in most cases, leads to death. The discovery was made by Robert
Koch when he uncovered the existence of a new bacterium, Bacillus anthracis, which results in
black scabs and boils on the skin (Porter, 1996, pp.200-201). Anthrax, a potentially fatal
infection, is a virulent and highly contagious disease. It does not, however, originate from the
current pool of constantly mutatating bacteria. In fact, historical medical records throughout
history show that the descriptions of Anthrax symptoms date back as far as 1491 BC in early
Egyptian and Mesopotamian civilizations. Furthermore, such spread might be considered so
catastrophic for the early civilizations reference to the aftermath of anthrax outbreaks is evident
in various literatures, namely prominent Hindi works (Koch, 1961, pp.89-90). The fifth and sixth
biblical plagues have been characterized as anthrax. Additionally, the burning plague in
Homers The Iliad is also thought to have been anthrax. Finally, Virgil, in his work Georgics
wrote about an anthrax epidemic and even linked the origin of anthrax to animals (Lord, 2001,
p.1).

2.3 Etiology

The organisms and its spores are commonly present on imported raw animal fibers,
including goat hair, goat skin, and wool. In some areas of the world, agricultural soures such as
infected cattle also a major sourse the organism its of increasing medical and political interest
because of its potential used in biological warfare or terrorism.
2.4 Pathophysiology

Human anthrax take a variety of clinical forms, with cutaneous infection (known as a
malignant pustule) caused local inoculation being responsible for 95% of the diseases reported in
the United state. Anthrax pneumonia (inhalation anthrax) occurs when B. anthracis spores are
inhaled and the posited into alveolar duct or alveoli. After being phagocycitez by alveolar
macrophages, the organism spreads through the lymphatics, with resultant, often massive, hilar
and mediastinal adenophaty and bacteremia. Early diagnosis of inhalation anthrax is very
difficult, and this form of the illness is considered uniformly fatal, although approximately 10%
of identified cases survived the bioweapons facility outbreak in Sverdiovsk (Russia) in 1979. The
chest roentgenogram classically shows a widened mediastinum, and pleural effusion are
common.

2.5 Sign and symptoms

Anthrax has 4 types : 1. Cutaneous Anthrax; 2. Gastrointestinal Anthrax; 3. Inhalation

(Pulmonary Anthrax); 4. Injection Anthrax. From each type has different sign and symptoms,
following :

1. Cutaneous anthrax

A cutaneous anthrax infection enters your body through a cut or other sore on your skin. It's by
far the most common route the disease takes. It's also the mildest with appropriate treatment,
cutaneous anthrax is seldom fatal. Signs and symptoms of cutaneous anthrax include:

A raised, itchy bump resembling an insect bite that quickly develops into a painless sore
with a black center
Swelling in the sore and nearby lymph glands
1-2 days, develops into a vesicle (cyst)
Develops into painless ulcer (1-3 cm diameter)
Ulcer has black center
Swelling of surrounding tissues.
 2. Gastrointestinal anthrax

This form of anthrax infection begins by eating undercooked meat from an infected animal.
Signs and symptoms include:

Nausea
Vomiting
Abdominal pain
Headache
Loss of appetite
Fever
Severe, bloody diarrhea in the later stages of the disease
Sore throat and difficulty swallowing
Swollen neck

3. Inhalation (pulmonary) anthrax

Inhalation anthrax develops when you breathe in anthrax spores. It's the most deadly way to
contract the disease, and even with treatment it is often fatal. Initial signs and symptoms of
inhalation anthrax include:

Flu-like symptoms, such as sore throat, mild fever, fatigue and muscle aches, which may
last a few hours or days
Mild chest discomfort
Shortness of breath
Nausea
Coughing up blood
Painful swallowing

As the disease progresses, you may experience:

High fever
Trouble breathing
 Shock
Meningitis a potentially life-threatening inflammation of the brain and spinal cord

4. Injection anthrax

This is the most recently identified route of anthrax infection. It's contracted through injecting
illegal drugs and has been reported only in Europe so far. Initial signs and symptoms of injection
anthrax include:

Redness at the area of injection (without an area that changes to black)

Significant swelling

As the disease progresses, you may experience:

Shock
Multiple organ failure
Meningitis

NURSING CARE PLAN

Assessment :

Assess vital sign (esp :temperature)

Assess pain level.
Diagnose :

Hyperthermia r/t infectious process.

Outcome :

Thermoregulation, maintain normal body temperature of the client within 3 days.

Explain measures needed to maintain normal temperature
Remain free of dehydration with giving enough fluid.
Nursing interventions
1. Measure and record a febrile clients
temperature using an oral or rectal thermometer
every 1-4 hours depending on severity of the
fever or whenever a change in condition occurs
2. Use the same side and method (device) for
temperature measurement for a given client so
that temperature trends are assessed accurately,
record site of temperature measurement.
3. Work with the physician to help determine the
cause of the temeperature increase, which will
often help direct appropriate treatment. Colect
stat cultures before beginning antibiotic therapy,
and ensure that needed imaging studies are
performed quickly
4. Administer antipyretic medication per
physician orders, when the cause of the
temperature is not adaptive (neurological, heat
stroke, critically ill client), when infection-
induced fever is greater than 38.30C, and when
the client cannot tolerate the increase in
metabolic demand, such as the acutely ill client.
5. Assess fluid loss and falicitate oral intake or
administer intravenous fluids as ordered to
accomplish fluid replacement
6. Recognize that a hypothermia blanket use is
indicated for temperature reduction if the clients
fever is above 39.50C and cannot be controlled
with antipyretics, or if a high body temperature
is related to a disorder of temperature regulation
Rationales
Oral temperature measurement provides a
more accurate temperature than tympanic
measurement, axillary measurement, or use
of a chemical dot thermometer.
There are significant differences in
temperature depending on the site
It is generally more important to treat the
underlying cause of the temperature
increase than treat the symptom of fever
Elimination of fever will interfere with its
enhancement of the immune response, but
temperature elevation is accompanied by
an increase in oxygen consumption and
metabolic rate that may not be tolerated by
the acutely ill client.
Increased metabolic rate and diaphoresis
associated with fever cause loss of body
fluids
Use cooling blanket temperatures closer to
body temperature because this will help
prevent shivering and skin breakdown, and
it is more comfortable
 7. Use nonsteroidal antipyretic (e.g.,
acetaminophen) as ordered instead of or in
conjunction with a cooling blanket to improve
fever reduction and decrease the duration of
cooling blanket use.
Although external cooling and use of
antipyretics were equally effective in
decreasing body temperature in critically
ill clients, there was an increase in energy
expenditure with the use of the external
cooling versus a decrease of energy
expenditure with the use of an antipyretics.

Diagnose :
Imbalace Nutrition : Less Body Requirement related to abdominal pain, loss of appitate as
evidence by nause, vomiting.
Outcomes :
- Progressively gain weight toward desired goal.
- Patient will consume adequate nourishment.
- Patient will be free of sign of malnutritions.

Intervention
Monitor the food intake; record the
percentages of served food that is eaten
(25%,50%). Keep a 3-day food diary to
determine actual intake, consult with dietitian of diet.
for actual calorie count if needed.
Administer antiemetics and pain medications
as ordered and needed before meals.
Determine relationship of eating and other
event to onset of nausea, vomiting, diarrhea,
or abdominal pain.
Rationals
Use of a food diary is helpful for both of the
client and nurse, to examine usual food eaten,
pattern of eating, and presence of deficience
The presence of nausea or pain decrease the
appetite.
To take the action more well.
if the client has minimally functioning To make patients get protein and calories.
gastrointestinal tract and is on clear fluids,
consults with dietitian regarding use of clear
liquid product that contains increased
amounts of protein and calories.
If client anorexia and dry mouth from These action help to stimulate saliva
medication side effects, offer sips of fluids formation.
throughout the day, along with sugarless hard
candy and chewing gum.
Evaluation :

- Is patient free from signs of malnutritions?

- Is patient weight within in normal range for heigh and age?

Diagnose :

acute pain r/t injury agents (biological)

Outcome :

Decrease pain in a week

Explain to the client the pain management approach

Nursing interventions Rationales

1. Assess pain level in a client using a
valid and reliable self-report pain tool,
such as the 0-10 numerical pain rating
scale.
2. Assess the client for pain presence
routinely at frequent intervals, often at
The first step in pain assessment is to
determine if the client can provide a
self report. Ask the client to rate pain
intensity or select descriptors of pain
intensity using a valid and reliable
self-report pain tool.
Pain assessment is as important as
physiological vital signs and pain is
the same time as vital sign are taken,
and during activity and rest. Also
assess for pain with interventions or
procedures likely to cause pain.
3. ask the client to describe prior
experiences with pain, effectiveness of
pain management interventions,
response to analgesic medications
including occurence of adverse effects, factors that may influence pain
and concerns about pain and its
treatment (e.g.,fear about addiction,
worries or anxiety) and informational
needs
4. Describe the adverse effect of
unrelieved pain
5. Determine the clients current
medication use. Obtain an accurate
and complete list of medications the
client is taking or has taken
6. Avoid giving pain medications
intramuscularly (IM)
7. Explain to the client the pain
considered as fifth vital sign.
Obtaining an individualized pain
history helps to identify potential
factors that may influence the clients
willingness to report pain, as well as,
intensity, the client response to pain,
anxiety and pharmacokinetics of
analgesics
Unrelieved acute pain can have
physiological and psychological
consequence that falicitate negatives
client outcomes.
Accurate medication reconciliation
can prevent errors associated with
incorrect medications, dosages,
omission of components of the home
medication regime, drug-drug
interactions, and toxity that can occur
when incompatible drugs are
combined or when allergies are
present.
IM injections are painful, result in
unreliable absorption, and lead to
variable blood levels of the
administered medication
One of the most important steps
 management approach, including
pharmacological and
nonpharmacological interventions, the
assessment and reassessment process,
potential adverse effects, and the
importance of prompt reporting of
unrelieved pain
8. in addition to administering
analgesics, support the clients use of
nonpharmacological methods to help
control pain such as distraction,
imagery, relaxation, and application of
heat and cold
9. teach and implement
nonpharmacological interventions
when pain is relatively well-controlled
with pharmacological interventions.
toward improved control of pain is a
better client understanding of the
nature of pain, its treatment, and the
role the client needs to play in pain
conrol
Cognitive-behaviour strategies can
restore the clients sense of self
control, personal efficac, and active
participation in his or her own care
Nonpharmalogical interventions
should be used to supplement, not
replace, pharmacological interventions

Evaluation :

Assess vital signs

Assess client pain intensity after interventions
Assess the client response to the each intervention
Ask the clients how she or he manage pain
Assess any contra-indication related to pharmacological medications.
 CHAPTER 3

CLOSING

3.1 Summary

Anthrax is zoonotic diseases of major historical significance microbiologically, because

the etiologic agent, B. anthracis. Anthrax is devide into 4 type ; 1. Cuttaneous anthrax that
infection the skin; 2. Gastointestinal anthrax that infection the disgestive system; 3. Inhalation
(Pulmonary) anthrax injected the lung can make some difficulities in breathing; 4. Injection
Anthrax is infected with injection.

Base on the sign and symptoms of anthrax we have 3 diagnose: Hyperthermia r/t
infectious process, Imbalance nutrition : Less than body requirement, and acute pain r/t injury
agents (biological).

3.2 Suggestion

It will be better if we do a little precaution to prevent the anthrax infectious us like do the
handwashing, cooked meet well, have safe contact with the animal, take care of animal healthy,
etc.
REFERENCES

Fauci A Braunwald E, Kasper D. 2008. Harrisons Principle of Internal Medicine, ed17.

McGraw Hill : New York.

Hill PD.2004. A comparison of tympanic and oral temperature readings on adults

[diseratation]. Gonzaga University : Washington.