SCABIES Scabies is an itchy, highly contagious skin disease caused by an infestation by the itch mite Sarcoptes scabiei.

Mites are small eight-legged parasites (in contrast to insects, which have six legs). They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching, which tends to be worse at night. The mites that infest humans are female and are 0.3 mm-0.4 mm long; the males are about half this size. Scabies mites can be seen with a magnifying glass or microscope. The scabies mites crawl but are unable to fly or jump. They are immobile at temperatures below 20 C, although they may survive for prolonged periods at these temperatures. Epidemiology Scabies is one of the three most common skin disorders in children along with tinea and pyoderma. The mites are distributed around the world and equally infects all ages, races, and socioeconomic classes in different climates. Scabies is more often seen in crowded areas with unhygienic living conditions.Globally as of 2009, it is estimated that 300 million cases of scabies occur each year, although various parties claim the figure is either over- or underestimated. There are one million cases of scabies in the United States annually. About 1 10% of the global population is estimated to be infected with scabies, but in certain populations, the infection rate may be as high as 50 80%.Scabies is one of the three most common dermatological disorders in children. Mode of Transmission The disease may be transmitted from objects but is most often transmitted by direct skin-to-skin contact, with a higher risk with prolonged contact. Sexual contact is the most common form of transmission among sexually active young people, and scabies has been considered by many to be a sexually transmitted disease (STD) Initial infections require four to six weeks to become symptomatic. Most common among people who live in overcrowded conditions, and whose ability to practice good hygiene is limited. Scabies can be passed between people by close skin contact. Although the mites can only live away from human skin for about three days, sharing clothing or bedclothes can pass scabies among family members or close contacts. Signs & Symptoms intense itching pruritus superficial burrows(include the sides of the fingers, between the fingers, the top of the wrists, around the elbows and armpits) skin rash composed of small red bumps and blisters

Medical Management The first-line drug for scabies continues to be 5% Permethrin cream. Permethrin acts by disrupting the sodium channel current, resulting in delayed repolarization, paralysis and death of the parasite. It is left for ten to twelve (10-12) hours. Lindane cream or lotion is an alternative when 5% permethrin is unavailable. It should be washed off after 6 hours after application in infants, 6-8 hours in children, and 8-12 hours after application in adults. The whole family should be examined before undertaking treatment, as long as a member of family remains infected, other members will get the disease Crotamiton cream applied for five consecutive nights. Neosporin ointment rubbed into the affected skin four to five times a day. Eurax and kwell lotion also prove effective to some patients. All clothes used before and during the treatment period should be disinfected by dry cleaning or boiling. Nursing Interventions Instruct patient to apply the cream at bedtime, from neck down to toes, covering the entire body. Advise patient to report any skin irritation. Suggest the family members and other close contact of the patient be checked for possible symptoms and be treated if necessary. If patient is hospitalized, practice good handwashing technique, or use gloves while performing nursing procedure. Terminal disinfection should be carried out after discharge of patient. Prevention and Control Good personal hygiene daily bath; washing the hands before and after eating, and after using the toilet; cutting off fingernails. Regular changing of clean clothing beddings and towels. Eating the right kind of food like rich in Vitamin A and Vitamin C such as green leafy vegetable and plenty of fruits and fluids. Keeping the house clean. Improving the sanitation of the surroundings.

 Mumps (epidemic parotitis) -is a viral disease of the human species, caused by the mumps virus. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide. Source of infection Secretion of the mouth and nose Incubation Period

The incubation period is from 12 to 26 days, usually 18 days. Signs and symptoms Fever Headache Loss of appetite Anorexia Orchitis Painful swelling in front of ear, angle of jaw, and down the neck Mumps Virus Paramyxovirus RNA virus One antigenic type Rapidly inactivated by chemical agents, heat, and ultraviolet light Mumps Pathogenesis Respiratory transmission of virus Replication in nasopharynx and regional Lymph nodes Viremia 12-25 days after exposure with spread to tissues Multiple tissues infected during viremia Cause Mumps virus is a single strand of RNA housed inside a two-layered envelope that provides the virus its characteristic immune signature. Only one type of mumps virus has been demonstrated to exist (in contrast to multiple virus types which may cause the common cold). How is mumps transmitted? Mumps is highly contagious and has a rapid spread among members living in close quarters. The virus most commonly is spread directly from one person to another via respiratory droplets. Less frequently, the respiratory droplets may land on fomites (sheets, pillows, clothing) and then be transmitted via hand-to-mouth contact after touching such items. The incubation period from exposure to the virus and onset of symptoms is approximately 14-18 days. Viral shedding is short lived and a patient should be

isolated from other susceptible individuals for the first five days following the onset of swelling of the salivary (parotid) glands. Mumps Clinical Case Definition Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting more than 2 days without other apparent cause. Mumps Complications There are four serious complications of mumps: meningitis (infection of the spinal fluid which surrounds the brain and spinal cord), encephalitis (infection of the brain substance), deafness, and orchitis (infection of the testicle/testicles). All three complications may occur without the patient experiencing the classic involvement of the parotid gland. Meningitis: More than 50% of patients with mumps will have meningitis, which may occur during any period of the disease. Generally patients make a full recovery without permanent side effects. Encephalitis: Until the 1960s mumps was the primary cause of confirmed viral encephalitis in the United States. Since the successful introduction of a vaccination program, the incidence of mumps encephalitis has fallen to 0.5%. Fortunately, most patients recover completely without permanent side effects. Deafness: Preceding the mumps vaccination program, permanent nerve damage resulting in deafness was not unusual. While occasionally bilateral, more commonly only one ear was affected. Orchitis: This complication was the most common side effect (40%) to postpubertal males who contracted mumps. Severe pain (often requiring hospitalization for pain management) was onesided in 90% of cases. Between 30%-50% of affected testes atrophied (decreased in size), and 13% demonstrated impaired fertility. The "common knowledge" of sterility was actually rare. Previous concerns regarding mumps orchitis and later testicular cancer have not been proven. (Ovarian involvement occurred in approximately 7% of postpubertal girls.) Mumps Laboratory Diagnosis A physical examination confirms the presence of the swollen glands. Detection of mumps antigen by PCR Serologic testing Treatment There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by acetaminophen/paracetamol (Tylenol) for pain relief.

Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms. Nursing Care Encourage control of scratching to prevent local infection and scars. Assist and direct family in carrying out concurrent and terminal disinfection.

Prevention Measles, Mumps, Rubella vaccine 1st dose: 12-15 months 2nd dose: 11-12 years old Isolate the client and observe droplet precaution until 9 days after the onset of parotid swelling.

MMR Vaccine Contraindications and Precautions Severe allergic reaction to vaccine component or following a prior dose Pregnancy Immunosuppression Moderate or severe acute illness Recent blood product Epidemiology Causative agent: RNA virus of myxovirus group Reservoir of infection: only man Mode of transmission: droplet (close contact) Incubation period: 12-26 days (average 18 days) Infectivity period: 7days  PNEUMONIA DESCRIPTION An acute infectious disease of the lungs usually caused by the pneumoccocus resulting in the consolidation of one or more lobes of either one or more lungs.

Pneumonia (pneumonitis) is an inflammatory process in lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid. ETIOLOGY 1. Bacterial pneumonia may be caused by the following organisms: a. Stretococcus pneumonia (haemolytic type A; accounts for 90% of cause) b. Staphylococcus aureus c. Haemophilus influenza (type B) d. Klebsiella pneumonia, Pseudomonas aeruginosa, Escheerihia coli, Enterobacter and other gram-negative enteric bacilli 2. Nonbacterial pneumonia may be caused by the following organisms: a. Mycoplasm pneumonia b. Influenza viruses, Parainfluenza viruses and other viral infections c. Pneumocystis carinii d. Aspergillus fumigates 3. Causes and contributing factors to pneumonia include: a. Inability to move pulmonary secretions b. Aspiration pneumonia due to an abnormal swallowing mechanism or tube feedings c. Clients who are immunosuppressed d. Frequent alcohol intoxication e. Immobility f. Vomiting g. Inhalation of toxic or caustic chemicals, smoke, dusts or gases MAJOR RISK FACTORS:                Advanced age History of smoking Upper respiratory tract infection Tracheal intubation Prolonged immobility Immunosuppressive therapy A non-functional immune system Malnutrition Dehydration Homelessness Chronic disease states (such as diabetes, heart disease, chronic lung disease, renal disease, and cancer) Dysphagia Exposure to air pollution Altered consciousness Residence in institutional settings, where transmission of the disease is more likely.

CLASSIFICATION OF PNEUMONIA A. Based on Causative Agent  Streptococcal pneumonia  Pneumocystic carini pneumonia

 Stapylococca pneumonia  Aspiration pneumonia B. Based on Location  Lobular pneumonia  Lobar pneumonia  Bronchial pneumonia C. Based on how you acquired  Community Acquired Pneumonia - With pneumonia upon admission - Incubation period: less than 2 days  Hospital Acquires Pneumonia - Without pneumonia upon admission but develop eventually during hospital stay - Caused by Staphylococcus aureus and is more virulent - Incubation period: more than 2 days

CLINICAL MANIFESTATIONS: y y y y y y y y y y y y y y y y y y Rhinitis/common cold Chest indrawing Rusty sputum Productive cough Fast respiration High fever Vomiting at times Convulsions may occur Flushed face Dilated pupils Severe chills in young children Pain over affected lung Altered mental status Dehydration Chest auscultation reveals bronchial breath sounds over areas of consolidation Crackles Increased tactile fremitus Unequal chest expansion

LABORATORY AND DIAGNOSTIC FINDINGS y y y y Chest radiograph shows density changes, primarily in the lower lung fields Sputum culture and sensitivity are positive for specific causative organism WBC count is elevated in pneumonia of bacterial origin; WBC count is depressed in pneumonia of mycoplasmal or viral origin Highly colored urine with reduced chlorides and increase urates

DIAGNOSTIC TREATMENT        Sputum culture analysis Serologic testing Fiberoptic bronchoscopy or transcutaneous needle aspiration Skin test Complete blood count Urinalysis X-ray

MEDICAL MANAGEMENT:       Bronchodilators Antibiotics Analgesics Mucolytics Expectorants Antitussive

NURSING INTERVENTION:          Reposition the client every 2 hours to promote lung expansion Oxygen administration Bed rest Increase fluid intake to liquefy secretions Suctioning Prevent complication Administer medication as ordered Adequate salt, fluid, calorie and vitamin intake Tepid sponge for fever

COMPLICATION OF PNEUMONIA       Shock Atelectasis Respiratory failure Pleural effusion (fluid in thoracic cavity) Superinfection Septic shock

NURSING DIAGNOSIS     Ineffective airway clewarance Ineffective breathing technique Ineffective breathing pattern Impaired gas exchange

     

Activity intolerance Anxiety Deficient fluid volume Pain Impaired oral mucous membrane Imbalanced nutrition: Less than body requirements

PREVENTION OF NEUMONIA
 Practice good hygiene.  Get an influenza shot  Get a pneumonococcal vaccine. People who stand to benefit most from vaccination are those:

-over the age 65; -anyone with chronic health problems (such as diabetes, kidney disease, heart disease, etc.); - anyone who has had their spleen removed; -anyone living in a nursing home or chronic care facility; -caregivers of the chronically ill (healthcare workers or family caregivers); - children with chronic respiratory diseases (such as asthma), and anyone who has had pneumonia in the past (due to increased risk of reinfection). The pneumonococcal vaccine is 90 percent effective against the bacteria and protects against infection for five to 10 years.  Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep.  Do not smoke.

COMMON TYPES OF PNEUMONIA TYPES OF PNEUMONIA Pneumococcal pneumonia (caused by Streptococcus pneumoniae) CLINICAL MANIFESTATIONS y Sudden onset with single shaking chill, high fever, stabbing pleuritic chest pain, malaise, weakness, occational vomiting,tachypnea, dyspnea, and elevated WBC count. y Single or multiple lobar consolidation on chest x-ray film y Cough productive of rusty brown or blood-streaked purulent sputum that

turns yellow and mucoid Staphylococcal pneumonia (caused by Staphylococcus aureus) y Sudden onset with fever, multiple chills, pleuritic pain, dyspnea, rales, decreased breath sounds, elevated WBC count, and exaggerated cough productive of purulent golden-yellow or bloodstreaked sputum Chest x-ray film may show patchy infiltrates, empyema, abscesses, and pneumothorax. Disease may start withheadache, cough and myalgia Similar to those of pneumococcal pneumonia Cough productive of apple-or lime-green purulent sputum, which may be bloodtinged. Sudden onset with high fever, multiple chills, pleuritic pain, dyspnea, cyanosis and elevated WBC count Lobar consolidation and cavitation on chest x-ray film Cough productive of red sputum resembling currant jelly (mucoid, sticky and difficult to expectorate) Insidious onset with low-grade fever, dyspnea,crackles, cyanosis,hypertension, tachycardia, and elevated WBC count. Patchy infiltrates in dependent lung segment on chest x-ray film Cough productive of purulent, greenishyellow, foul smelling sputum Insidious onset with slow rising fever, headache, myalgia, malaise, and normal WBC count Pulmonary infiltrate sometimes extensive- on chest x-ray film Cough productive of scant mucoid sputum Client may show only minimal signs and symptoms Prodrome with headache and myalgia followed by high fever, dyspnea, normal breath sounds with occasional wheezing and crackles, normal or slightly elevated WBC count

y Influenzal pneumonia (caused by Haemophilus Influenzae) y y

Gram-negative bacterial pneumonia (most commonly caused by klebsiella pneumoniae)

y y

Anaerobic bacterial pneumonia, hypostatic pneumonia (caused by normal oral flora)

y y Mycoplasma pneumonia (caused by mycoplasma microorganism) y

y y y Viral pneumonia (caused by influenza A virus) y

y y y y y

Fungal pneumonia (caused by histoplasmosis, candidiasis, aspergillosis)

Aspiration pneumonia (caused by aspiration of gastric contents, foods or oropharyngeal secretions)

y y y

Diffuse patchy infiltrates on chest x-ray film Dry cough with initial mucoid sputum that laters turn purulent Cough may be unproduuctive Usually asymptomatic When manifestation occur; they range from brief periods of malaise to severe life-threatening illness Typical illness resembles inflluenza Often asymptomatic with minor aspiration Major aspiration may lead to tachypnea, apnea, cyanosis, hypotension, fever, adventitious lung sounds (crackles, rhonchi, wheezing), hypoxemia, respiratory failure, leukocytosis

 HIV / AIDS Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome What Is It? AIDS is one of the most serious, deadly diseases in human history. More than 20 years ago, doctors in the United States identified the first cases of AIDS in San Francisco and New York. Now there are an estimated 42 million people living with HIV or AIDS worldwide, and more than 3 million die every year from AIDS-related illnesses. This sexually transmitted disease spread so rapidly that it soon occurred in epidemic proportion in several countries of the world including the Philippines. It is currently pandemic. Causative Agent: Retrovirus Human T-cell lymphotropic virus 3 (HTLV-3) AIDS is caused by the human immunodeficiency virus (HIV). HIV destroys a type of defense cell in the body called a CD4 helper lymphocyte. These lymphocytes are part of the body's immune system, the defense system that fights infectious diseases. But as HIV destroys these lymphocytes, people with the virus begin to get serious infections that they normally wouldn't that is, they become immune deficient. The name for this condition is acquired immunodeficiency syndrome (AIDS). As the medical community learns more about how HIV works, they've been able to develop drugs to inhibit it (meaning they interfere with its growth). These drugs have been successful in slowing the progress of the disease, and people with the disease now live much longer. But there is still no cure for HIV and AIDS. Mode of Transmission: y HIV can be transmitted from an infected person to another person through blood, semen (also known as "cum," the fluid released from the penis when a male ejaculates), vaginal fluids, and breast milk. y Blood transfusion

y Contaminated syringes, needs, nipper, razor blades The virus is spread through high-risk behaviors including: y Unprotected oral, vaginal, or anal sexual intercourse ("unprotected" means not using a condom) y Sharing needles, such as needles used to inject drugs (including needles used for injecting steroids) and those used for tattooing People who have another sexually transmitted disease, such as syphilis, genital herpes, chlamydia, gonorrhea, or bacterial vaginosis are at greater risk for getting HIV during sex with infected partners. If a woman with HIV is pregnant, her newborn baby can catch the virus from her before birth, during the birthing process, or from breastfeeding. If doctors know an expectant mother has HIV, they can usually prevent the spread of the virus from mother to baby. All pregnant teens and women should be tested for HIV so they can begin treatment if necessary. Incubation Period: Although the time from infection to the development of detectable antibodies is generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed range of less than 1 year to 15 years or longer. How Does HIV Affect the Body? A healthy body is equipped with CD4 helper lymphocyte cells (CD4 cells). These cells help the immune system function normally and fight off certain kinds of infections. They do this by acting as messengers to other types of immune system cells, telling them to become active and fight against an invading germ. HIV attaches to these CD4 cells, infects them, and uses them as a place to multiply. In doing so, the virus destroys the ability of the infected cells to do their job in the immune system. The body then loses the ability to fight many infections. Because their immune systems are weakened, people who have AIDS are unable to fight off many infections, particularly tuberculosis and other kinds of otherwise rare infections of the lung (such as Pneumocystis carinii pneumonia), the surface covering of the brain (meningitis), or the brain itself (encephalitis). People who have AIDS tend to keep getting sicker, especially if they are not taking antiviral medications properly. AIDS can affect every body system. The immune defect caused by having too few CD4 cells also permits some cancers that are stimulated by viral illness to occur some people with AIDS get forms of lymphoma and a rare tumor of blood vessels in the skin called Kaposi's sarcoma. Because AIDS is fatal, it's important that doctors detect HIV infection as early as possible so a person can take medication to delay the onset of AIDS. How Do People Know They Have HIV? Once a person's blood lacks the number of CD4 cells required to fight infections, or the person has signs of specific illnesses or diseases that occur in people with HIV infection, doctors make a diagnosis of AIDS. Severe symptoms of HIV infection and AIDS may not appear for 10 years. And for years leading up to that, a person may not have symptoms of AIDS. The amount of time it takes for symptoms of AIDS to appear varies from person to person. Some people may feel and look healthy for years while they are infected with HIV. It is still possible to infect others with HIV, even if the person with the virus has absolutely no symptoms. You cannot tell simply by looking at someone whether he or she is infected. Signs and Symptoms: extreme weakness or fatigue rapid weight loss

y y

y y y y y y y y

frequent fevers that last for several weeks with no explanation heavy sweating at night swollen lymph glands minor infections that cause skin rashes and mouth, genital, and anal sores white spots in the mouth or throat chronic diarrhea a cough that won't go away trouble remembering things

Girls may also experience severe vaginal yeast infections that don't respond to usual treatment, as well as pelvic inflammatory disease (PID). Prevention: y maintain monogamous relationship y avoid promiscuous sexual contact y sterilize needles, syringes and instruments used for cutting operations y proper screening of blood donors y rigid examination of blood and other products for transfusion y avoid oral, anal contact and swallowing of semen y used of condoms Community Health Nursing Responsibilities: y Prevention, case finding and supportive-care during management of AIDS cases y Must be well-informed of signs and symptoms as well as the mode of transmission of the disease in order to give effective health education y Isolate patients with active AIDS y Proper assessment of surgical or invasive instruments y Proper labeling of blood and semen containers

 Meningococcemia is an acute and potentially life-threatening infection of the bloodstream that commonly leads to inflammation of the blood vessels (vasculitis). caused by a bacteria called Neisseria meningitidis. The bacteria frequently lives in a person's upper respiratory tract without causing visible signs of illness. The bacteria can be spread from person to person through respiratory droplets RF: Family members and those closely exposed to someone with the condition are at increased risk. The infection occurs more frequently in winter and early spring.

SIGNS AND SYMPTOMS Anxiety Fever Irritability

Spotty red or purple rash (petechiae)

Additional symptoms may include: Headache Muscle and joint pain Nausea Vomiting

Later symptoms may include: Changing level of consciousness Ill appearance Large areas of bleeding under the skin (purpura) Shock

TESTS AND DIAGNOSTICS Blood tests will be done to rule out other infections and help confirm meningococcemia. Such tests may include: Blood culture Complete blood counT with differential Clotting studies (PT, PTT)

Other tests that may be done include: Lumbar puncture to obtain spinal fluid sample for CSF culture Skin biopsy and gram stain Urinalysis

TREATMENTS Persons with this type of infection are often admitted to the intensive care unit of the hospital, where they are closely monitored. The person may be placed in respiratory isolation for the first 24 hours to help prevent the spread of the infection to others. Treatments may include: Antibiotics given through a vein (IV)

Breathing support Clotting factors or platelet replacement -- if bleeding disorders develop Fluids through a vein (IV) Medications to treat blood pressure problems

Wound care for areas of skin with blood clots COMPLICATIONS Arthritis Blood clotting that leads to the loss of the arms or legs Disseminated intravascular coagulopathy (DIC) Inflammation of blood vessels in the skin (cutaneous vasculitis) Irreversible shock Pericarditis Profound shock Severe damage to adrenal glands that can lead to low blood pressure (Waterhouse-Friderichsen syndrome)

PREVENTION Preventive antibiotics for family members and contacts are often recommended. Speak with your health care provider about this option. A vaccine that covers some -- but not all -- strains of meningococcus is available, and has been suggested for use by college students who live in dormitories. You should discuss the appropriate use of this vaccine with your health care provider.

 HEPATITIS B I. Definition: is an inflammation of the liver, usually caused by viral infection, which is characterized by jaundice. Hepatitis B- is also called "serum hepatitis"

- virus enters the bloodstream through contact with contaminated blood or other body fluids, such as semen or through the use of contaminated hypodermic needles. - begins more gradually than does Hepatitis A, disease may be 40 to 180 days before the onset of symptoms. - can be transmitted through saliva, semen, tears, sexual contact contact. -virus may persist for years or even a lifetime.

with stool or present or rarely casual

II. Signs and Symptoms: - jaundice - general fatigue, joint and muscle pain, body malaise - loss of appetite - Nausea/Vomiting - chills, weight loss - diarrhea or constipation may follow with a low grade fever - enlarged and tender liver - right sided abdominal pain - dark colored urine

III. Treatment : There is no specific treatment IV. Preventions: > immunization-Hepa B vaccine > observe good personal hygiene > have adequate sleep, rest, exercise > eat nutritious food; carbohydrates-rich foods > avoid sharing of toothbrush, razors, etc. > observe safe sex practices > avoid injuries with sharp instruments e.g. needles, blades