RABIES

DISEASE PROCESS

 Viral infection of the brain that is transmitted by animals and causes inflammation of the brain and spinal cord.  Incubation Period: 20-90 days.

PATHOPHYSIOLOGY DIAGNOSTIC EXAMINATION ELECTROMYOGRAPHYrecords electrical activity in muscles. Virus isolation from the patients saliva or throat Fluorescent rabies anti-body (FRA) provides the most definitive diagnosis. Presence of negri bodies in the dogs brain
ETIOLOGY: neurotropic rhabdovirus (dogs, cats, rattle) Virus transmission via peripheral nerves to spinal cord and brain (IP: 10 days-1 year) Multiplication Travel from CNS then to many tissues (salivary gland, saliva, urine, CSF, skin)

Vessel engorgement, edema, punctuate hemorrhage in meninges and brain

MEDICATION Rabies vaccine (active) Rabies immunoglobulin (passive) Tetanus toxoid Tetanus antiserum infiltrated
Negri bodies formation (neurons in cerebellum, cortex, spinal cord)

Headache, nausea, fever, chills, apathy, malaise, anxiety, depression, salivation, laryngeal spasm, hallucination, seizure, paralysis, coma, death

NURSING INTERVENTION Isolate the patient Give emotional and spiritual support. Provide optimum comfort. Darken the room and provide a quiet environment. Patient should not be bathed and there should not be any running water in the room or within hearing distance of the patient. 6. If IV fluid has to be given it should be wrapped and needle should be securely anchored in the vein to avoid dislodging in times of restlessness. 7. Concurrent and terminal disinfection should be carried out. 1. 2. 3. 4. 5.

MENINGITIS
DISEASE PROCESS

 Meningitis is an inflammation of the meninges of the brain and spinal cord as a result of viral and bacterial infection.

PATHOPHYSIOLOGY LABORATORY EXAMINATION Lumbar Puncture Gram Staining Smear and Blood Culture Smear from Petechiae Urine Culture
ETIOLOGY: Neisseria meningitis, Haemophilus Influenza and streptococcus Pnuemoniae PREDISPOSING FACTORS: skull fracture, brain and spinal surgery, sinus and upper respiratory infections, use of nasal sprays Transmission via direct contact of nasal discharge Invasion of respiratory passages (IP: 1-10 days) Disseminated by bloodstream into CSF spaces and meninges Inflammation; rash Neutrophils migration Exudates formation Damages CNS, obliterates CSF pathways Hydrocephalus Metabolites and cytokines generation Cell membrane damage;blood-brain barrier disruptions

MEDICATIONS Antibiotic therapy, usually for 2 weeks Digoxin (Lanoxin) to control arrhythmia. Mannitol to decrease cerebral edema Anticonvulsant or sedative to reduce restlessness Acetaminophen to relieve headache and fever.

NURSING INTERVENTIONS 1. Monitor vital signs and neurological signs.

Cerebral edema; brain damage Meningeal irritation: stiff neck, headache, brudzinskis sign and kernig;s sign, nuchal rigidity Fever, vomiting, change in consciousness, seizure, stupor, coma, death

2. Assess for signs of increased ICP. 3. Initiate seizure precautions. 4. Monitor for seizure activity. 5. Monitor for signs of meningeal irritation. 6. Perform cranial nerve assessment.

PERTUSIS
DISEASE PROCESS

 PERTUSIS OR ( WHOOPING COUGH)- highly contagious caused by the bacterium Bordetella Pertussis, which results in fits of coughing that usually end in a prolonged high-pitches, deeply indrawn breath ( the whoop).  Incubation Period 7-10 days but not excluding 21 days  Mode of transmission airborne droplet and direct contact.

PATHOPHYSIOLOGY
ETIOLOGY: Bordetella Pertussis, Pertussis Bacillus

LABORATORY EXAMINATION Nasopharyngeal swabs Sputum culture CBC (leukocytosis)

Transmission via direct, indirect, airborne contact B. Pertussis attaches to the cilia of respiratory epithelial cells (IP: 7-10 days) Toxin absorption from respiratory tract into the lymph system Lymphocytosis CATARRHAL STAGE: drippy nose, sneezing, tearing and low-grade fever, listlessness, hacking nocturnal cough

MEDICATION
Antibiotics (erythromycin and ampicillin) Hyperimmune convalescent serum or gamma-globulin

Fluid and electrolyte replacement

PAROXYSMAL: exhausting paroxysms of prolonged coughing 2-3 times an hour that often end with an inspiratory whooping sound or choking and vomiting accompanied by production of copious, viscid mucus with cyanosis and apnea CONVALESCENT: diminished coughing and production of mucus

NURSING INTERVENTION 1. Isolate child during the catarrhal stage; if the child is hospitalized, institute airborne droplet precautions. 2. Administer antimicrobial therapy as prescribed. 3. Reduce environmental factors that cause coughing spasms, such as dust, smoke and sudden changes in temperature. 4. Ensure adequate hydration and nutrition. 5. Provide suction and humidified oxygen if needed. 6.Monitor cardiopulmonary status and pulse oximetry. 7. Infants do not receive maternal immunity to pertussis.

DIPTHERIA
DISEASE PROCESS

 Agent: cornybacterium diphtheria  Incubation period: 2 to 5 days  Transmission: direct contact with infected person, carrier, or contaminated articles.

LABORATORY EXAMINATION Swab from nose and throat or other suspected lesions Virulence test Schick test Molony test Loefler slant

PATHOPHYSIOLOGY
ETIOLOGY: Corynebacterium diphtheria

Pathogen invades in naspharynx via direct contact (IP: 2-5 days)

Multiplication Toxic production Necrosis Formation of a patchy, grayish-green pseudomembrane (bacteria, fibrin, leukocytes) Spread out systematically Lesion formation (lung, heart, kidney, CNS) Mild sore throat, nasal discharge, dysphagia, low grade fever, cough, hoarseness, nausea and vomiting, chills DOB,

MEDICATION Penicillin Erythromycin Diphtheria ntitoxin DPT vaccine Anti infective drugs

NURSING INTERVENTION 1. Ensure strict isolation for the hospitalized child. 2. Administer diphtheria antitoxin as prescribed (after a skin or conjunctival test to rule out sensitivity to horse serum). 3. Provide bedrest. 4. Administer antibiotics as prescribed. 5. Provide suction and humidified oxygen as needed. 6. Provide tracheostomy care if a tracheostomy is necessary.

DENGUE HEMORRHAGIC FEVER

DISEASE PROCESS

Is a Mosquito-borne viral infection that causes fever and generalized pain.

LABORATORY EXAMINATION PATHOPHYSIOLOGY Tourniquet test- screening test, done by occluding the arm veins for about five minutes to detect capillary fragility Platelet count (decreased)- confirmatory test Hemoconcentration- an increase at least 20 percent in hematocrit or steady rise in hematocrit. Occult blood Hemoglobin determination Contact with the infected person and standing water with Togaviridae/Aedes Egypti Infectious virus is deposited in the skin by vector Initial replication occur at the site of infection and in local lymphatic tissue Viremia MEDICATION Aspirin IV infusion to prevent dehydration and replacement of plasma Oxygen therapy Diazepam Hypovolemic shock resulting from increased permeability of the veascular endothelium Loss of plasma from the intravascular space Febrile convulsions may appear, anorexia, vomiting, myalagia

NURSING INTERVENTION 1. 2. 3. 4. 5. 6. 7. Patient should be kept in mosquito-free environment to avoid further transmission of infection. Keep the patient at rest during bleeding episodes. Vital signs must be promptly monitored. For nose bleeding, maintain patients position in elevated trunk, apply ice bag to the bridge of nose and to the forehead. Observe signs of shock, such as slow pulse, cold clammy skin, prostration, and fall of blood pressure. Restore blood volume by putting the patient in trendelenburg position to provide greater blood volume to the head part. Patient with dengue is not infectious; therefore, isolation is not required.

MALARIA
DISEASE PROCESS

 Is infection of red blood cells with the single-celled parasites Plasmodium, which causes fever, an enlarged spleen, and anemia.

LABORATORY EXAMINATION Malarial smear- in this procedure, a film of blood is placed on a slide, stained, and examined microscopically. Rapid diagnostic test (RDT)- this is a blood test for malaria that can be conducted outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the blood.

PATHOPHYSIOLOGY
ETIOLOGY: protozoan parasites F. mosquito bites a human host and injects the sporozoites Reside and multiply in the hives (2-4 weeks) Leave hives and invades erythrocytes Multiplication Cell ruptures Toxin, pyroxins, nerozoites increase

MEDICATION
Hemolysis, sluggish blood flow in the

Chloroquine Quinine Sulfadoxine for resistant P. falciparum Primaquine for repalse of P. vivax and ovale. erythrocyte

capillaries Adherence to venous walls Obstruction Prodromal: low grade fever, malaise, headache, joint aches, chills Paroxysmal: sweats shaking chills, fever,

NURSING INTERVENTION
1. 2. 3. 4. 5. 6. 7. 8. 9.

The patient must be closely monitored Intake and output should be closely monitored to prevent pulmonary edema. During the febrile stage, tepid sponges, alcohol rubs, and ice cap on the head will help bring the temperature down. Application of external heat and offering hot drinks during chilling stage is helpful. Provide comfort and psychological support. Encourage the patient to take plenty of fluids. As the temperature falls and sweating begins, warm sponge baths may be given. The bed and clothing should be kept dry. Watch for neurologic toxicity (from quinine infusion) like muscular twitching, delirium, confusion, convulsion, and coma. 10. Evaluate the degree of anemia. 11. Watch for any sig ns especially abnormal bleeding. 12. Consider severe malaria as medical emergency that requires close monitoring of vital signs.

BACTERIAL PNEUMONIA/TB
DISEASE PROCESS

 Is a chronic, sub-acute or acute respiratory disease commonly affecting the lungs characterized b the formation of tubercles in the tissues which tend to undergo caseation, necrosis, and calcification.

PATHOPHYSIOLOGY LABORATORY EXAMINATION Sputum analysis for AFB- confirmatory Chest x-ray Tuberculin testing y Mantaux test (PPD) y Time test (OT) y Heaf test Enter of the M. Tuberculosis in the body Penetration of the microorganism in the lining of the respiratory tract M. Tuberculosis was picked up by the lymph and blood channels Microorganisms lodges to the lungs Development of original lesion, the tubercle Bacilli will establish themselves in the alveoli of the lungs, the walls of the blood vessels, in the lymph channels or gland/walls of bronchi Afternoon rise of temperature, Night sweating, Body malaise & weight loss, Cough, dry to productive, Dyspnea, hoarseness of voice, Hemoptysispathognomonic sign, Occasional chest pains, Sputum positive for AFB

MEDICATION Isoniazid Rifampicin Pyrazinamide ethambutol

NURSING INTERVENTION 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Administer oxygen as prescribed. Monitor respiratory status. Monitor for labored respiration, cyanosis, and cold and clammy skin. Encourage coughing and deep breathing and use of the incentive spirometer. Place the client in a semi-fowlers position to facilitate breathing and lung expansion. Change the clients position frequently and ambulate as tolerated to mobilize secretions. Provide CPT. Perform nasotracheal suctioning if the client is unable to clear secretions. Monitor pulse oximetry. Monitor and record color, consistency, and amount of sputum. Provide a high calorie, high- protein diet with small frequent meals. Encourage fluids, up to 3 L/day, to thin secretions unless contraindicated. Provide a balance of rest and activity, increasing activity gradually. Administer antibiotic as prescribed.

TETANUS
DISEASE PROCESS

 (lockjaw) is a disease in which a toxin produced by the anaerobic bacterium Clostridium tetani causes severe muscle spasms.  Incubation Period: usually 3-21 days; average 3-10 days.

PATHOPHYSIOLOGY LABORATORY EXAMINATION The diagnosis is made by history and physical examination. Blood and wound cultures and tetanus antibody tests are commonly negative.
Clostridium Tetani Enters through a used contaminated with soil and feces contains viable spores Bacilli spores enter and multiply in skin wound Tetanospasmin toxin production Toxin travel to the CNS via bloodstream and peripheral motor

MEDICATION Metocarbamol Chlorpromazine hydrochloride Pen G Na to control infection Tetanus toxoid given in standard schedule Within 72 hours after a punctured wound, ATS, TAT

nerves Ganglioside membrane binding Inhibitory transmits release blockage Hyperexcitability induced Tonic rigidity and voluntary muscle spasm Trismus: painful spasm of masticatory

NURSING INTERVENTION 1. 2. 3. 4. 5. 6. 7. 8. 9. Maintain adequate airway. Provide cardiac monitoring Maintain an IV line for medication and emergency care if necessary. Carry out efficient wound care. Avoid stimulation; warn visitors not to upset or overly stimulate the patient. Avoid contractures and pressure sores Watch out for urinary retention. Close monitoring vitals signs and muscle tone Provision of optimum comfort

MEASLES
DISEASE PROCESS

 (Rubeola, 9-day measles) is a highly contagious viral infection that produces various symptoms and a characteristic rash.

PATHOPHYSIOLOGY LABORATORY EXAMINATION Nose and throat swab Urinalysis Blood exams (CBC, leucopenia, leukocytosis) Complement fixation or hemogglutin test.
ETIOLOGY: Paramyxo virus (airborne, direct contact) Invasion via nasopharynx and respiratory epithelium Invasion of Filtrable virus Infection in the local lymphatic tissues Amplification of virus in regional lymph nodes

MEDICATION Anti-viral drugs (isoprenisone) Antibiotics if with no complication Supportive therapy (oxygen inhalation, IV fluids)
Dessimination of virus to the various organs Appearance of rashes Generalized immunosuppression Predisposition of the individual to secondary opportunities infections Fever, enanthema sign, anorexia, irritability, macula-papular rash appears

NURSING INTERVENTION
1. 2. 3. 4. 5. 6. Use airborne droplet precaution if the child is hospitalized. Restrict child to quiet activities and bed rest. Use a cool mist vaporizer for cough and coryza. Dim lights if photophobia is present. Administer antipyretics. Skin care is utmost. The patient should have daily cleansing bed bath. The water should be comfortably warm. 7. Oral and nasal hygiene is a very important aspect nursing care of the patient with measles. 8. Daily elimination is important. This can be accomplished by mid laxative or as prescribed by the physician. 9. Patients position should be changed every three to four hours.

HEPA B
DISEASE PROCESS

 Is the inflammation of the liver caused by hepatitis B virus. This is considered to be more serious than hepatitis A due to the possibility of severe complication such as massive damage and hepato carcinoma of the liver.

PATHOPHYSIOLOGY LABORATORY EXAMINATION Compliment fixation test Radio-immnuassay-hemaglutin test Liver function test Bile examination in blood and urine Blood count Serum transaminase- SGOT, SGPT, ALT HbsAg
RISK FACTORS: exposure to blood, bloody fluids, health care workers, male homosexual and bisexual activities, IV injection Presence of HBV via percutaneous and permucosal routes

Invasion of virus in the mononuclear cells in the liver Replication Inflammatory response in parenchyma and portal ducts

MEDICATION Serum enzymes: Increase Serum bilirubin: Increase Hepatitis B surface antigen (HbsAG)- (+) Liver function test: inflamed/enlarged

Hepatic cell necrosis-cellular collapse Accumulation of necrotic tissue Interference with bilirubin excretion Jaundice Light colored stools, dark urine, rashes, arthralgia, fever arthritis, anorexia, headache

NURSING INTERVENTION
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Strict hand washing is required. Hospitalization is required in the event of coagulopathy or fulminant hepatitis. Standard precautions and enteric precautions are followed during hospitalization. Provide enteric precaution for at least 1 week after the onset of jaundice with HAV. The hospitalized child usually is not isolated in a separate room unless he or she is focally incontinent and items are likely to become contaminated with feces. Children are discouraged from sharing toys. Instruct the parent to disinfect diaper-changing surfaces thoroughly with a solution of cup bleach in 1 gallon of water. Provide a low fat, well-balanced diet. Maintain a comfort, and provide adequate rest and sleep. Instruct the child and parents in effective hand washing techniques. Inform the parents that jaundice may appear worse before it resolves.

LEPTOSPIROSIS

DISEASE PROCESS

 Is a potentially serious illness caused by species of the spirochete leptospira.

PATHOPHYSIOLOGY LABORATORY EXAMINATION Blodd urea-ntrogen and urea Enzyme lin immune-sorbent assay (ELISA) Liver function test usu. Are slightl to moderately elevate. y Aspartase Aminotransferase (AST) y Alanine Aminotransferase (ALT) y Gamma- Glutamyltransferase (GGT)
Leptospira Antigen-antibody test (LAAT) Leptospira Antibody Test

Invasion of leptospira Rapid access to the bloodtream Leptospiremia Septicemia Rapid immune clearance Leptospires remain in renal Leptospiruria LEPTOSPIROSIS; SEPTIC STAGE- remittent fever, anorexia. IMMUNE/TOXIC STAGE- iritis, headache, disorientation, renal failure. CONVALESCENCE- relapse may occur

MEDICATION

Aetiotropic drugs y Penicillin, doxycycycline, amoxillin

ampicillin,

NURSING INTERVENTION

1. 2. 3. 4. 5. 6. 7. 8.

Isolate the patient, urine must be properly disposed of. Darken the patients room because light is irritating to the eyes of the patient. Observe meticulous skin care to ease pruritus. Keep the clients under close surveillance. For home care, clean near dirt places, pools, and stagnant water. Eradicate rats and rodents Encourage oral fluid intake. Health education and information dissemination as to the mode o transmission must be carried out. 9. Environmental sanitation and the destruction of breeding places of mosquitoes must be emphasized.

LEPROSY
DISEASE PROCESS

 (Hansens disease) is a chronic infection caused by the bacterium Mycobacterium Leprae that results in damage primarily to the peripheral nerves (the nerves outside the brain and spinal cord), skin, testes, eyes, and mucous membrane of the nose.

LABORATORY EXAMINATION Identification of the signs and symptoms Tissue biopsy Tissue smear Blood test show increased RBC and ESR; and decreased Ca, albumin, and cholesterol level.

PATHOPHYSIOLOGY

M. Leprae attacks the peripheral nerves Ulnar, radial, posteriorpopliteal, anterior-tibial, and facial nerves Bacilli damage the skins fine nerves Cause anesthesia, anhidrosis, and dryness If they attack a large nerve trunk, motor nerve damage, weakness, and pain occur

MEDICATION Sulfone therapy Multiple drug therapy (MDT) y Rifampicin, clofazimine and dapsone for multibacillary y Rifampicin and dapsone for pausibacillary.

Peripheral anesthesia, muscle paralysis, atrophy

NURSING INTERVENTION 1. If the patient is admitted to the hospital, isolation and medical asepsis should be carried out. 2. Moral support and encouragement are necessary. 3. Diet should be full, wholesome or nutritious. 4. Special attention should be given to personal hygiene. 5. Terminal disinfection should be carried out.

CHICKEN POX
DISEASE PROCESS

 Is a highly contagious infection with the varicella-zoster virus that produces a characteristics itchy rash, consisting of small, raised, blistered or crusted spots.  Agent: Varicella- zoster virus  Incubation period: 13 to 17 days  Transmission: direct contact, droplet (airborne) spread, and contaminated objects.

PATHOPHYSIOLOGY LABORATORY EXAMINATION Determination of V-Z virus through complement fixation test Determination of V-z through electron Microscopic examination of vesicular fluid. Tzanck smear shows multinucleated giant cells.
Inhalation of contaminated respiratory droplet Infection in the conjunctivae or the mucosa of the upper respiratory tract Viral proliferation in regional lymph nodes Primary viremia 2nd viral replication in the internal organs

MEDICATION
Secondary viremia

Oral acyclovir Oral antihistamine Salicylates Antipyretic

Infection of cells of the malpighian layer Intercellular & intracellular edema/vesicles Pre-eruptive manifestations; Mild fever and malaise. Eruptive stage; Rash starts from the trunk., Appearance of rashes through following stages: macule, papule, vesicle, pustule, crust, All stages are present simultaneously before all are covered with scabs, known as Celestial map.

NURSING INTERVENTION 1. Respiratory isolation is a must. 2. Provide hygienic care of the client. 3. Attention should be given to nasopharyngeal secretions and discharges. 4. Cut fingernails short and wash hands more often. 5. A child must wear mittens. 6. Provide activities to keep child occupied to lessen pruritus.

GERMAN MEASLES
DISEASE PROCESS

 Is a highly contagious viral infection that produces various symptoms and a characteristic rash.  Agent: Rubella virus  Incubation period: 14 to 21 days  Transmission: airborne or direct contact with infectious droplets, indirectly via articles freshly contaminated with nasopharyngeal secretions, feces, or urine, transplacental

PATHOPHYSIOLOGY LABORATORY EXAMINATION Nasal or throat swab for culture Blood test
ETIOLOGY: rubella virus

Transmission via droplet and direct contact with secretion Virus invasion of nasopharynx Travels to the lymph glands

MEDICATION Rubella vaccine (12 mos.) Rubella gamma globulin (passive) Antipyretic drugs Analgesics Carimune Gamunex Octagam Panglobulin

After 5-7 days enter the bloodstream

lymphadenopathy

viremia and immune response stimulation skin rash results (last for 3 days) PRODROME: swollen suboccipital, postauricular and post cervical glands; fever, sore throat, cough, fatigue RASH: tiny reddish spots on the soft palate; light pink to red, discrete rash that starts on the face and trunk POST RASH: headache, mild conjunctivitis

NURSING INTERVENTION In the hospital, ensure strict isolation (contact and droplet precautions). At home, isolate the infected child until the vesicles have dried. Supportive care Prevent secondary infection of the skin lesion through hygienic care of the patient. Attention should be given to nasopharyngeal secretions and through boiling. Cut fingernails short and wash hand more often to minimize bacterial infections that may be introduced by scratching. 7. A child must wear mittens. 8. Provide activities to keep child\d occupied to lessen pruritus. 9. Observe oral and nasal care as rash may appear at the buccal cavity. 1. 2. 3. 4. 5. 6.

INFLUENZA
DISEASE PROCESS

 (flu) is infection of the lungs and airways with one of the influenza viruses, causing a fever, runny nose, sore throat, cough, headache, muscle aches (myalgias), and a general feeling of illness (malaise).

PATHOPHYSIOLOGY LABORATORY EXAMINATION Blood examination- usu. Normal but leucopenia has been noted. Virus may be cultured from oropharngeal washing or swabbing during the first few days of illness. Viral serology y Complement fixation test y Hemo-agglutination test y Neutralization test
ETIOLOGY: orthomyxo virus type A, B, C

Transmission via airborne, direct contact (IP: 1-3 days) Penetration on upper respiratory tract mucosa Epithelium destruction Mucosal viscousity secretion reduction Facilitate spread of virus laden exudates to lower respiratory tract

MEDICATION Flu vaccine (6 mos. Old) Anti viral drug in type A Aamantadine, Rimantadine Inhaled anti viral (Zanamavir and Oseltamivir) for type A and B Analgesics for headache and pain Antitussive drug for cough Nasal spray for congestion

Necrosis and degeneration of bronchi and alveoli

Chills, fever, aches, pain, headache, photophobia, prostration, coryza, rhinorrhea Respiratory symptoms: scratchy, sore throat, substernal burning, nonproductive coughproductive, weakness, fatigue

NURSING INTERVENTION 1. Encourage rest.

2. Encourage fluids to prevent pulmonary complications (unless contraindicated). 3. Monitor lung sounds. 4. SSSS Provide supportive therapy such as antipyretics or antitussives as indicated. 5. Administer antiviral medications as prescribed for current strain of influenza.

FILARIASIS
DISEASE PROCESS

 Filariasis is a parasitic disease caused by an African eye worm, Wuchereria bancrofti.

PATHOPHYSIOLOGY
Mosquito bite infected with W. Bancrofti

LABORATORY EXAMINATION Circulating Filarial Antigen (CFA); CBC

Development of microfilaria

Migration of larvae to the lymph nodes

MEDICATION Ivermectin Albendazole Diethylcarbamazine (DEC)

Microfilaria reaches maturity

Adult worm dies

Damage in the kidney and the renal and lymph system FILARIASIS; Chills, headache and fever between 3 mos. and one year after the insect bite. There may be also swelling, redness, and pain in the arms, legs, or scrotum.

NURSING INTERVENTION 1. Monitor for any alteration in respiratory function. 2. Assess for drug reaction. 3. Advised foe meticulous hygiene. 4. Encourage bed rest. 5. Advise to wear elastic stockings.

Catanduanes State Colleges COLLEGE OF HEALTH SCIENCES Department of Nursing SY 2011-2012

(15 COMMUNICABLE DISEASES)

SUBMITTED TO:

DR. ALVIN C. OGALESCO PROFESSOR

SUBMITTED BY:

LOUDETTE MARIE D. MOLINA BSN 3A

FEBRUARY 14, 2012