COMMUNICABLE

DISEASE NURSING
Host and Microbial Interaction
INTRODUCTION

Although most microorganisms

live in harmony with the human
body, some—called
pathogens—can infect the
body and cause disease.
Infectious diseases range from
mild illnesses, such as a cold, to
fatal illnesses, such as AIDS.
We occasionally come into
contact with people or animals
that are infected and thus
expose ourselves to the
pathogens of their diseases. In
fact, our environment is such
that everyday we live with
some risk of exposure to
diseases.
Communicable Disease
= any disease that spreads from one host to
another, either directly or indirectly
Contagious Disease
= disease that easily spreads directly from one
person to another
Infectious Disease
= disease not transmitted by ordinary contact
but require a direct inoculation through a break in a
previously intact mucous membrane. On the other
hand, all contagious diseases are infectious.
 Examples of communicable diseases include
herpes, malaria, mumps, HIV/AIDS, influenza,
chicken pox, ringworm, and whooping cough.
 Cancer, on the other hand, is not a
communicable disease.
 Carrier – is an individual who harbors the
organism and is capable of transmitting it to a
susceptible host without showing manifestations
of the disease.
 Contact - is any person or animal who is in
close association with an infected person,
animal, or freshly soiled material
Classification of Infectious Diseases:
 Based on Occurrence of Disease:
1. Sporadic Disease
= disease that occurs only occasionally &
irregularly with no specific pattern
i.e. botulism, tetanus
2. Endemic Disease
= constantly present in a population,
country or community
i.e. Pulmonary Tuberculosis; malaria
3. Epidemic Disease
= patient acquire the disease in a relatively
short period of time ; greater than normal
number of cases in an area within a short
period of time
i.e, cholera; typhoid
4. Pandemic Disease
= epidemic disease that occurs worldwide
i.e. HIV infection; SARS
 Based on Severity or Duration of Disease
1. Acute Disease
= develops rapidly (rapid onset) but
lasts only a short time
i.e. measles, mumps, influenza
 2. Chronic Disease
= develops more slowly (insidious onset)
disease likely to be continual or recurrent for
long periods
i.e. TB, Leprosy
3. Subacute Disease
= intermediate between acute and chronic
i.e. bacterial endocarditis
4. Latent Disease
= causative agent remains inactive for a time but
then becomes active to produce symptoms of
the disease
i.e. chickenpox → shingles (zoster); amoebiasis
 Based on State of Host Resistance:

1. Primary Infection
= acute infection that causes the initial
illness
2. Secondary Infection
= one caused by an opportunistic pathogen
after primary infection has weakened the body’s
defenses
3. Subclinical (Inapparent Infection)
= does not cause any noticeable illness
 Stages of Disease
 Incubation Period
- time interval between the initial infection and the 1st
appearance of any s/sx
- patient is not yet aware of the disease
 Prodromal Period
- early, mild appearance of symptoms of the disease
 Period of Illness
 Time of greatest symptomatic experience ( pt. is sick)
- overt s/sx of disease
WBC may increase or decrease
can result to death if immune response or medical
intervention fails
 Period of Decline
s/sx subside
pathogen replication is brought under control
vulnerable to secondary infection
 Period of Convalescence
 Replication of pathogenic organisms is stopped
regains strength and the body returns to its
pre diseased state
= recovery has occurred
Nurse Alert!!!!

 Note that in the case of acquired immunity

against a pathogen the progress of disease may end
during the prodromal period as a consequence of
the rapid immune system response to the infection.
 For example, acquired immunity might be as a
consequence of vaccination or previous natural
exposure to the pathogen.
MICROBES against HUMAN
Definitions:
 Symptoms
subjective evidence of disease that is experienced
or perceived
subjective changes in body function noted by
patient but not apparent to an observer
 Signs
objective evidence of a disease the physician can
observe and measure
 Syndrome
a specific group of signs and symptoms that
accompany a particular disease
 Incidence
the number of people in a population who
develop a disease during a particular time
period
 Prevalence
= the number of people in a population
who develop a disease, regardless of when it
appeared
= refers to both old and new cases
 INFECTION
- condition caused by the entry and
multiplication of pathogenic microorganisms
within the host body
 CONDITIONS THAT AFFECT INFECTION
DEVELOPMENT
 Pathogenicity – ability to cause disease
 Infective dose (sufficient number of
microorganisms needed to initiate infection)
 Virulence ( disease severity) and Invasiveness of
microorganisms ( ability to enter and move through
tissue)
 Organisms specificity ( host preference)
 Resistance of the host
 Immunity of the host
**Cycle of infection must be completed**
Chain of Infection
 Chain of Infection

The chain begins with the

existence of a specific
pathogenic microorganism

The second link is

the reservoir, an
environment where
the pathogen can
survive.
 Chain of Infection

The third link is the

means of escape from
the reservoir. ( Mode of Exit )

The fourth link is the

mode of transmission
from the reservoir to
the host.
 Chain of Infection

The fifth link is

the means of
entry into the
host ( Mode of
entry)

And the last link is the

host's susceptibility
to the pathogenic
microorganism
 Infection control: 1st line of
defense
 Hand hygiene, first line of defense and the
most important practice in preventing infection.
 Handwashing – single most important
way of preventing transfer of
microorganisms
 IMMUNITY
- is the condition of being secure against any
particular disease, particularly the power which a
living organism possesses to resist and overcome
infection
- is the resistance that an individual has against
disease
 IMMUNE SYSTEM

 PROTECTION AGAINST INFECTIVE OR

ALLERGIC DISEASES BY A SYSTEM OF
ANTIBODIES, IMMUNOGLOBULINS AND
RELATED RESISTANCE FACTORS.

 ANTIBODY

 - a specific immune substance produced by

the lymphocytes of the blood of tissue
juices of man or animal in response to the
introduction into the body of an antigen
 ANTIGEN
TRIGGERING AGENT OF THE IMMUNE
SYSTEM; FOREIGN SUBSTANCE
INTRODUCED INTO THE BODY causing the
body to produce antibodies
TYPES OF ANTIGENS:
1. INACTIVATED ( KILLED ORGANISM)
1. Not long lasting
2. Multiple doses needed
3. Booster dose needed
2. ATTENUATED ( LIVE WEAKENED
ORGANISM)
1. single dose needed
2. long lasting immunity
** all vaccines lose their potency after a certain time.
 TYPES OF IMMUNITY
 NATURAL =innate; within the HOST;
Immune System

 ACQUIRED = outside the HOST

Natural = active or passive
Artificial = active or passive
Types of Immunity

A. NATURAL :
1. Natural active – through exposure or
diseases; had the disease & recovered
2. Natural Passive – maternal antibodies;
acquired through placental transfer
B. ARTIFICIAL ( Laboratory )
1. Artificial active – introduction of antigen
Ex. Vaccines ; toxoids
( No exposure yet; preventive measure)
= gives long immunity – months to years
2. Artificial passive- introduction of
antibodies Ex. Antitoxins;
immunoglobulin ( gammaglobulin),
antiserum, convalescent serum
Ex. TAT ( tetanus antitoxin)
( w/ exposure to the causative agent)
= gives short immunity – 3-4 weeks
 Immunity

NATURAL ACQUIRED
- INHERENT BODY TISSUES Outside the host

1. NATURAL 2. ARTIFICIAL
( HUMAN) ( LABORATORY)

A. ACTIVE B. PASSIVE A. ACTIVE B. PASSIVE

-HAD THE DISEASE & - MATERNAL - VACCINES - ANTITOXINS
-RECOVERED ANTIBODIES - TOXOIDS - IG’S
 Infection control and prevention

 Immunization
 Active
 Passive
 IMMUNIZATION
- is the induction or introduction of
specific protective antibodies in a
susceptible person or animal, or the
production of cellular immunity in
such a person or animal.

- A PROCESS BY WHICH RESISTANCE TO

AN INFECTIOUS DISEASE IS INDUCED
OR AUGMENTED.
 Active Immunization
1. BCG
2. DPT
3. OPV/IPV
4. Measles
5. MMR
6. TB
7. Hepatitis B
8. Varicella
9. Hemophilus influenzae B (Hib)
 Active immunization not routinely
given
1. Cholera vaccine
2. Rabies
3. Typhoid
4. Influenza A & B
5. Meningococcal
6. Pneumococcal vaccine
7. HPV vaccine
 Passive immunization
1. Diphtheria antitoxin
2. Hepatitis B immunoglobulin (HBIG)
3. Measles immunoglobulin
4. Varicella immunoglobulin (VZIG)
5. Rabies Human immunoglobulin (RIG)
6. Tetanus human immunoglobulin (TIG)
7. Tetanus Toxin ( ATS)
 NURSE ALERT !!!

ALL VACCINE LOSE THEIR POTENCY

AFTER A CERTAIN TIME.
EXPIRY DATE SHOULD BE NOTED ON THE LABEL
 What
damages
vaccine ??
Heat and sunlight damages vaccine
Esp. LIVE VACCINE

Freezing damages the KILLED vaccine

And TOXOID
Use water only in cleaning the refrigerator
Or freezer.
( antiseptics, disinfectants and detergents
Or alcohol lessen potency of vaccine )

Cold Chain System

KEEP VACCINES IN CORRECT COLD TEMPERATURE
(0-8 c)
 Immunization
 EPI : PPD 996
 GOAL : universal child immunization
( Proc. No. 6)
 Common Goal to Prevent childhood diseases covered
by the EPI ( expanded program immunization)
1. Tb
2. Measles
3. Diphtheria, Pertussis
4. Polio ,
5. Tetanus
6. Hepatitis
 IMMUNOGLOBULINS
( IG’S)
 IgG
MOST PREVALENT ANTIBODY 80%, PRODUCED LATER IN THE
IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS PLACENTA
 IgA
FOUND IN COLOSTRUM, TEARS, SALIVA, SWEAT
 IgM
PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN
RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL
IMMUNIZATION
 IgE
RESPONDS TO ALLERGIC REACTION
 IgD
UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B
CELLS
 Expanded Program of
Immunization

BCG At birth ID Once None, mild fever, local rxn

DPT 6 weeks IM 3 x (4weeks int) Local rxn, acute

encephalopathy
MMR 15 wks

OPV 6 weeks oral 3 x (4wks int) None

Measles 9 mos SQ Once Fever

Hep B At birth IM 3 x ( 2,4,6 ) Mild local rxn

 Special-use Vaccine
Meningoccocal Epidemic areas SQ None

Rabies Exposures ID/IM Local rxn

Typhoid travellers IM Local rxn

Japanese encep travellers SC Anaphylactic

Pneumococcal immunocompro IM/SQ Local rxn

 Contraindications when giving
immunizations:

 Severe febrile illness

 Live virus vaccine are generally not administered
with altered immune system
 Allergic reaction
 Permanent C.I.
 Allergy
 Encephalopathy without known cause
 Convulsion within 7 days after
Pertussis vaccine
 Temporary C.I
 Pregnancy
 Immunocompromised
 Very severe disease
 Previously received blood
product/transfusion
 EPIDEMIOLOGY AND DISEASE
TRANSMISSION
Reservoirs of Infection:
= any site where the pathogen can multiply or
merely survive until it is transferred to the host
 Human Reservoir
= principal living reservoir of human disease
1. Direct Transmission
= usually associated with signs and symptoms
2. Carriers
= harbor the pathogen without associated signs
and symptoms
 Susceptible Host

 Recognition of high risk patients

 Immunocompromised
 DM
 Surgery
 Burns
 Elderly
Preventing the Spread of Communicable Disease
Community vs. Nosocomial
Community Acquired Infection
- infection present or incubating at the time of
consultation

Nosocomial Infection or hospital

acquired
- infection that develop during the course of hospital stay
& was not evident at time of admission
Percentage of Nosocomial Infections
 17% Surgical
 34% UTI
 13% LRI
 14% Bacteremia
 22% Other (incldng
skin Infxn)
 Factors for Nosocomial Infection

Microorganism/Hospital Environment
 Most common cause
Staph aureus, Staph Enterococci
E. coli, Pseudomonas, Enterobacter, Klebsiella
Clostridium Difficile
Fungi ( C. Albicans)
Other ( Gram (-) bacteria)
 70% are drug resistant bacteria
Compromised Host
 One whose resistance to infection is impaired by
broken skin, mucous membranes and a suppressed
immune system
INFECTION
CONTROL
MEASURES
 General Control Measures

Prevention of Airborne Contamination

 Cover mouth and nose ( coughing or

sneezing)
 Limit number of persons in a room
 Removal of dirt and dust
 Open room to fresh air and sunlight
 Roll linens together
 Remove bacteria from the air (air filters)
Handling of Food and Eating
Utensils
 Use high quality foods
 Proper refrigeration and storage of food
 Proper washing, preparing, and cooking of food
 Proper disposal of uneaten food
 Proper hand washing
 Proper disposal of oral and nasal secretion
 Cover hair and wear clean clothes and apron
 Provide periodic health exam for kitchen workers
 Keep cutting boards clean
 Prohibit anyone with respiratory or GIT disease
from handling food
 Rinse and wash utensils with a temperature above
80°C
 Handling of Fomites

 Use disposable equipments

 Sterilize or disinfect equipment
 Use individual equipment for each patient
 Use single use thermometers
 Empty bedpans and urinals properly and wash
with hot water, store in dry ,clean area or
storage
 Place used linens and personal care
equipments, and soiled laundry in a bag
Medical Asepsis
 CLEAN TECHNIQUE: Involves procedures and
practices that reduce the number and transfer of
pathogens
 Will exclude pathogens ONLY
Attained by:
 Frequent and thorough hand washing
 Personal grooming
 Proper cleaning of supplies and equipment
 Disinfection
 Proper disposal of needles, contaminated materials
and infectious waste
 Sterilization
Surgical Asepsis
 STERILE TECHNIQUE : Practices used to
render and keep objects and areas sterile
 Exclude ALL microorganism
Attained by:
 Use strict aseptic precautions for invasive
procedures
 Scrub hands and fingernails before entering O.R.
 Use sterile gloves, masks, gowns and shoe covers
 Use sterile solutions and dressings
 Use sterile drapes and create an sterile field
 Heat –sterilized surgical instruments
1. Universal Precaution ( Standard Precaution )
 Defined by center for disease control (CDC) 1996
 Primary strategy for reducing the risk of & controlling
Nosocomial infections
 Used for care of all hospitalized patients, regardless of
diagnosis and are presumed infectious
 Protect healthcare workers from contamination and infection
( i.e. HIV, HBV)
Hand Washing
 Routine: Plain (non microbial) soap

 Outbreak Control: Antimicrobial/Antiseptic Agent

 Wash After: 1.touching blood and other body fluids

2. touch contaminated items

3. removal of gloves
4. between patient contact, task, procedure
Infection Control Signage
Universal Precaution Materials
Patient Care Equipment
 Prevent contaminating yourself or transfer
microbes to others
 Properly clean, disinfect or sterilize
 Dispose single – use items
Linens
 Handled, transported and processed to prevent
contamination and transfer of microorganisms
Occupational Health and Blood –borne Pathogens
 Never recap used needles
 Puncture – resistant containers
Revised C.D.C. Isolation Precaution
( centers for disease control)

 2. Transmission-Based Precautions
 The second tier of precaution
 Precaution are instituted for patients who are known
to be or suspected of being infected with highly
transmissible infection.

THREE TYPES OF TRANSMISSION-

BASED PRECAUTIONS:
 1. Airborne precautions
 2.Droplet precautions
 3.Contact precautions
Infection Control Signage
Infection Control Signage
Infection Control Signage
Personal Protective Equipment
( PPE)
( Barrier Technique)
 mask

 gloves

 gown

 shoe cover

 goggles
Transmission based precautions for
Hospitalized patient :
Category Single Masks Gowns Gloves
Precaution Room

Airborne Yes, with (-) Yes No No

air pressure
ventilation

Droplet Yes Yes, mask for No No

persons close
to patient

Contact Yes yes yes yes

 Isolation
- is a protective procedure that limits
the spread of infectious diseases
among hospitalized clients, hospital
personnel, and visitors. It is the
separation from other persons of an
individual suffering from a
communicable disease.
- other terms are: protective aseptic
technique or barrier technique.
Quarantine - is the limitation of
freedom of movement of persons or
animals which have been exposed to
communicable disease / s for a period
of time equivalent to the longest
incubation period of that disease.
Surveillance -
 Seven categories recommended
in isolation
1. Strict isolation
 Use mask , gown and gloves (MUST)
 Private room
 For highly contagious or virulent infections
2. Contact isolation
3. Respiratory isolation
4. TB isolation
5. Enteric isolation
6. Drainage/secretion precaution
7. Universal precaution when handling blood and body
fluids
Type : STRICT
Purpose: Prevent Transmission of highly contagious or
virulent infections spread by air and contact

Specification: Private Room – necessary

Hand Washing – X
Gown – X
Masks – X
Gloves – X
Articles – Discard or bag and label and send
for decontamination and reprocessing.
Diseases requiring Isolation – Diphtheria (pharyngeal) , Lassa
fever, Smallpox , Varicella.
Type : Contact
Purpose: Prevent Transmission of highly transmissible
infections that do not require strict isolation.

Specification: Private Room – necessary

Hand Washing – X
Gown – wear if soiling is likely
Masks – wear in close contact with client
Gloves – wear if touching infective material.
Articles – Discard or bag and label and send
for decontamination and reprocessing.

Diseases requiring Isolation – Acute Resp. infection in

infant and young children, Herpes simplex, Impetigo,
multiple resistant bacterial infection.
Type : Respiratory

Purpose: Prevent Transmission of infectious diseases

primarily over short distances by air droplets.
Specification: Private Room – necessary
Hand Washing – X
Gown – not necessarily
Masks – wear in close contact with client
Gloves – not necessarily
Articles – Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation – Measles, Meningitis, Pneumonia,

Hemophilus Influenza in children , Mumps.
Type : Tuberculosis

Purpose: For client with PTB who

has positive
sputum or chest x-ray that indicates active
disease

Specification: Private Room – necessary

Hand Washing – X
Gown – Wear if soiling is likely
Masks – wear if client is coughing and does
not consistently cover mouth
Gloves – not necessarily
Articles – Rarely involved in transmission of
TB. Should still be thoroughly
cleansed and disinfected.

Disease requiring Isolation – Tuberculosis

Type : Enteric Precautions

Purpose:To prevent infections that are transmitted by

direct or indirect contact with feces.

Specification: Private Room – Indicated if client’s hygiene is poor and

there is risk of contamination with infective
materials.
Hand Washing – X
Gown – wear if soiling is likely
Masks – not necessary
Gloves – wear if touching infective material
Articles – Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation – Hepatitis, viral (type A),

Gastroenteritis caused by highly
infectious organism cholera, Diarrhea,
acute with infectious etiology.
Type : Drainage- secretion precautions
Purpose: To prevent infections that are transmitted by direct or
indirect contact with purulent material or
drainage from infected site.

Specification: Private Room – not necessary

Hand Washing – X
Gown – wear if soiling is likely
Masks – not necessary
Gloves – wear if touching infective material
Articles – Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation – Abscess, Burn infection,

conjunctivitis, decubitus- ulcer skin or wound
infection.
Type : Blood- body fluid precaution
Purpose: To prevent infections that are transmitted by
direct or indirect contact with blood or body fluid.

Specification: Private Room – Only if client’s hygiene is poor

Hand Washing – X
Gown – Wear if soiling with blood or body fluid
is likely
Masks – not necessary
Gloves – wear if touching blood or body fluid.
Articles – Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation – AIDS, Hepatitis, viral (Type B)

Malaria, Syphilis, primary and
secondary.
Reverse Isolation
 Protective or neutropenic isolation
 Used for patients with severe burns, leukemia,
transplant, immuno deficient persons,
receiving radiation treatment, leukopenic
patients
 Those that enter the room must wear masks
and sterile gowns to prevent from introducing
microorganisms to the room
Additional Pointers
Regarding Disposal Precaution

Secretion: Patient should be instructed to expectorate

into tissue held close to mouth. Suction catheters and
gloves should be disposed of in impervious, sealed
bags.

Excretion: Strict attention should be paid to careful

hand washing; disease can be spread by oral- fecal
route.

Blood: needles and syringes should be disposable.

Used needles should not be recapped. They should
be placed in a puncture-resistant container that is
prominently labeled “ Isolation “ Specimens should be
labeled “ Blood Precaution”.
Environmental Control

 Routine care, cleaning and disinfection of

environmental surfaces

PRECAUTIONS FOR INVASIVE

PROCEDURES:

 wear gloves during all invasive procedure +

goggles + mask
 Work Practice Precaution
 Prevent injuries caused by needles, scalpels and
other sharps instrument or devices when cleaning
used instrument, when disposing of used needles
 Do not recap used needles, bend , break nor remove
them from disposable syringes or manipulate them.
 Place sharps in puncture resistant containers
 If gloves tears or a needle-stick or other injury occurs,
REMOVE the gloves, wash hands, and wash sites of the
needle stick thoroughly then put new gloves
 Report injuries and mucous membrane exposure to appropriate
infection control officer.
 Waste management
 is the collection, transport, processing,
recycling or disposal of waste materials.
 Involves:
 1. sharps
 2.Solid infectious – cotton swab, dressing
 3. Anatomic Infectious – placenta / organ
 4.Solid non-infectious – used IV / bottle IV
 5.General waste – scrap paper / food material
 Philippines set-up
 black plastic bags are for non-biodegradable and
noninfectious
 wastes such as cans, bottles, tetrabrick
containers, styropor, straw, plastic, boxes,
 wrappers, newspapers.

 Green plastic bags are biodegradable wastes

such as fruits and vegetables' peelings, leftover
food flowers, leaves, and twigs.
 Philippines set-up

 Yellow plastic bags are for infectious waste

 such as disposable materials used for collection
of blood and body fluids like diapers, sanitary
pads, incontinent
 pads; materials (like tissue paper) with blood
secretions and other exudates; dressings,
bandages, used cotton balls, gauze; IV tubings,
used syringes; Foleys catheter/ tubings; gloves
and drains.
 Means of controlling the spread
of CD
1. Elimination of the source of infection
2. Interruption of transmission
3. Protection of susceptible host.
INFECTIOUS
DISEASE
 INFECTIOUS DISEASES
CLASSIFIED AS:
 Blood/ vector borne
 Enteric diseases
 Eruptive fever
 Respiratory diseases
 CNS infection
 Diarrheal Diseases
 EMERGING DISEASES
 INFECTIOUS DISEASES
CLASSIFIED AS :
1. Blood/ vector borne
a. DHF
b. Malaria
c. Leptospirosis
d. Filiariasis
2. Enteric diseases
a. Typhoid fever
b. Viral Hepatitis
c. Schistosomiasis
3. Eruptive fever
a. Measles (Rubeola)
b. Varicella
c. German Measles ( Rubella)
d. Small pox

4. Respiratory diseases
a. Pneumonia
b. Diphtheria
c. PTB
d. Mumps
5. CNS Infections  7. Emerging Diseases:
a. Encephalitis  SARS
b. Meningitis Birds FLU
c.Meningococcemia
d. Rabies
e. Tetanus
f. Snake bite
6.Diarrheal diseases
a. E.coli
b. Staphyloccus aureus
c. Cholera
d. Rotavirus
e. Salmonella
f. Parasitism
VECTOR BORNE DISEASES
 Dengue Fever, H-Fever, Dandy
Fever, Breakbone Fever, Phil
Hemorrhagic fever

 Acute Febrile Disease

 Flavivirus, dengue virus 1,2,3,4

Incidence: Rainy season, urban areas

IP: 3 to 10 days ( average 4-6 days
** Life span of the mosquito is 4 months
Pathognomonic sign: Herman’s rash
 Dengue Fever, H-Fever, Dandy Fever,
Breakbone Fever, Phil Hemorrhagic
fever
THE DISEASE PRESENTS WITH FEVER AND
HEMORRHAGIC MANIFESTATIONS AND
LABORATORY FINDINGS OF
THROMBOCYTOPENIA AND
HEMOCONCENTRATION
Pathogenesis
1. increased capillary fragility d/t immune complex
reactions
2. thrombocytopenia d/t faulty maturation of
megakaryocytes
3. decreased blood clotting factors
 Vector- Aedes aegypti

- Daybiting mosquito ( they appear 2 hours after

sunrise and 2 hours before sunset. Low flying ( Tiger
mosquito – white stripes, gray wings )
- Breeds on clear stagnant water
 CRITERIA FOR DIAGNOSIS:
 Fever ,acute, high continous, lasting for 2-
7 days
 Positive torniquet test
 Spontaneous bleeding
(petechiae,purpura,ecchymoses,pistaxis,
gum bleeding, hematemesis, melena)
 Laboratory: thrombocytopenia </=
100,000mm3, hemoconcentration- an increase
of at least 20% in the hematocrit or its steady
rise
 Assessment:
 Tourniquet test (Rumpel Leedes test) -
screening test, done by occluding the arm veins
for about 5 minutes to detect capillary fragility.
 Keep cuff inflated for 6 – 10 minutes ( child); 10-
15 minutes ( adults)
 Count the petechiae formation 1 square inch ( 20
petechiae/sq.in)(+)TT
 Platelet count ( decreased) – confirmatory
test
 Classification of Dengue Fever
according to severity

 Grade I – Dengue fever, saddleback fever plus

constitutional signs and symptoms plus positive
torniquet test
 Grade II – Stage I plus spontaneous bleeding,
epistaxis, GI, cutaneous bleeding
 Grade III – Dengue Shock Syndrome, all of the
following signs and symptoms plus evidence of
circulatory failure
 Grade IV – Grade III plus profound shock and
massive bleeding, undetectable BP and pulse
Laboratory criteria DHF:
 Platelet count Thrombocytopenia <100,000

 Hct – increased by 20 % or more

 1st 2 clinical criteria plus 2 laboratory criteria or

rising Hct – DHF( dengue hemorrhagic fever)
 Shock w/ high hematocrit and marked
thrombocytopenia – DSS ( dengue shock
syndrome)
Other :
 PT (Prothrombin Time)
 APTT (Activated Partial Thromboplastin Time)
 Bleeding time
 Coagulation time
Period of communicability – pts. are usually
infective to mosquito from a day before the
febrile period to the end of it
 The mosquito becomes infective from day 8 to
12 after the blood meal & remains infective all
throughout life
pathophysiology
Dengue Fever
DHF
Vector caries virus (AEDES aegypti)
Febrile phase
2-7 days
Bite host ( IP 3-10d)

First 2 days s/sx : Fever , headache, myalgia ,anorexia

Vascular injury Vomiting, sorethroat, rashes
Plasma leakage
IMPROVE
(+) petechiae , (+) TT
3rd day WBC, PLT Ct , Hct >20% (+) Pleural effussion

Circulatory failure
Dengue progress -hypotension death
-narrow pulse pressure
,20mm Hg (shock)
S/sx:
Mild dengue – abrupt onset of fever, headache,
muscle and joint pains, anorexia, abdominal
pain. Petecchiae, Herman’s rash (5th-7th day;
purplish macules w/ blanched areas on
extremities)
Severe dengue – DHF/DSS
*TRIAD: fever, rashes and muscle pain
Bleeding leading to hypovolemic shock
 Medical MX
 There is no effective antiviral therapy for dengue
fever. Treatment is entirely SYMPTOMATIC
 Paracetamol for headache ( never give ASPIRIN)
 IVF for hydration & replacement of plasma
 BT for severe bleeding
 O2 therapy is indicated to all patients in shock
 Sedatives for anxiety & apprehension
 No IM injections
 Nasal packing with epinephrine
 Gastric lavage
 Giving cytoprotectors
 Nursing Mx

 Symptomatic tx
 Mosquito free environment to avoid further
transmission of infection
 Keep patient at rest during bleeding episodes
 VS must be promptly monitored
 For nose bleeding, maintain pt’s position in
elevated trunk, apply ice bag to bridge of nose
 Observe for signs of shock
 Restore blood volume ( supine with legs elevated)
 Dengue hemorrhagic Fever
 PREVENTION : DOH 1995 Program

 C- hemically treated Mosquito Net

 L – arvae eating fish – Gold fish
 E – nvironmental Sanitation – 4 0’ clock habit
 A – antimosquito soap – lanzones peeling
 N – atural mosquito repellant – Neem tree , eucalyptus
, oregano
 PREVENTION
 Cover water drums and water pails at all times to
prevent mosquitoes from breeding.
 Replace water in flower vases once a week.
 Clean all water containers once a week. Scrub the
sides well to remove eggs of mosquitoes sticking
to the sides.
 Clean gutters of leaves and debris so that rain
water will not collect as breeding places of
mosquitoes.
 Old tires used as roof support should be punctured
or cut to avoid accumulation of water.
 Collect and dispose all unusable tin cans, jars,
bottles and other items that can collect and hold
water
 Prevention & Control
The 4-S Against DENGUE
1. Search and destroy breeding places
of dengue causing mosquitoes such as
old tires, coconut husks, roof
gutters, discarded bottles,
flower vases & other containers
that can hold clean stagnant water
2. Self – protection measures such as wearing
of long sleeve shirts and long pants and using
mosquito repellants are a must during daytime.

3. Seek early consultation when early signs such

as fever and rashes set in

4. Say NO to indiscriminate fogging except for

dengue outbreak
Malaria
 MALARIA (Ague)
King of Tropical Disease
 Acute and chronic parasitic diseases
 Causative agent : Protozoa of genus Plasmodia
4 species of Protozoa:
 1. Plasmodium falciparum ( malignant tertian)
 Most fatal ; common in the Philippines
 2. Plasmodium vivax ( Benign tertian)
 Non-life threatening except for the very
young & old ; manifest chills q48H on
the 3rd day onward if untreated
 MALARIA (Ague)
King of Tropical Disease
 3. Plasmodium malariae (Quartan)
 Less frequently seen ; non life
threatening , fever & chills usually
occur q72H usually on the 4th day
after the onset
 4. Plasmodium ovale
 rare
Vector – Female Anopheles
mosquito
Vector: (night biting)
 Female anopheles mosquito

or minimus flavirustris
= infectious but not contagious
= thrives in clear, free flowing shaded streams
usually in the mountains
= bigger in size than the ordinary mosquito
= brown in color, usually does not bite a person in
motion
= assumes a 36 degree position when it alights on
walls, trees, curtains and the like
Incubation Period:
 1. 12 days for P. falcifarum

 2. 14 days for P. vivax and Ovale

 3. 30 days for P. malariae

Period of Communicability:
 Untreated or insufficiently treated patient may
be the source of mosquito infection for more
than three years in P. malariae; one to two years
in P. vivax; and not more than one year on P.
falcifarum
 Pathogenesis
 Anopheles mosquito >> gets parasites in the
blood of infected person >>parasites multiply in
mosquito >>parasites invade the salivary gland
of mosquito >> mosquito bites the individual &
thus, injects the parasites >> parasites invade
RBC where they grow & undergo asexual
propagation >> RBC ruptures or bursts
releasing tiny organisms ( MEROZOITES) >>
merozoites invade new batch Of RBC to start
another schizonic cycle
 Pathology
 the most characteristic pathology of
malaria is destruction of red blood cells,
hypertrophy of the spleen and liver and
pigmentation of organs.
 The pigmentation is due to the
phagocytocis of malarial pigments
released into the blood stream upon
rupture of red cells
Plasmodium Life Cycle
 Malaria
 Transmission : sporozoites, injected travel
by anopheles mosquito to human liver

mature to be released into invade RBC as they

a blood stream as merozoites undergo sexual reproduction to

 PATHOPHYSIOLOGY : produce zygotes

 RBC decreases deformability and oxygen transport,

increase adhesion and fragility leading to anemia
 Clinical Manifestation
 uncomplicated
 fever, chills, sweating every 24 – 36 hrs
 Complicated
 sporulation or segmentation and rupture of
erythrocytes occurs in the brain and
visceral organs.
 Cerebral malaria
 changes of sensorium, severe headache
and vomiting
 seizures
 MALARIA (Ague)
 Clinical manifestations :
1. Cold stage
 Chilling sensation of the body ( 10-15 mins)
 Chattering of lips, shakes
 Keep the patient warm
 Hot water bath
 Expose to heat
 Warm drinks
 Last about 10-15min
2. . Hot stage (3-4Hrs)
 Recurring high grade fever , headache , abdominal pain
and vomiting
 TSB , cold compress
 Light clothing,
 MALARIA (Ague)
 Clinical manifestation :
 I. Cold stage ( 10-15mins)
 II. Hot stage (3-4Hrs)

 III. Wet stage

 Profuse sweating

 Keep patient comfortable

 Keep them warm and dry

 Increase fluid intake

Diagnostics:
1. Malarial smear - Peripheral blood extraction (extract
blood at the height of fever or 2 hrs before chilling (
AGUE)
2. Rapid diagnostic test ( RDT) – blood test for malaria
conducted outside the lab & in the field- result is
within 10-15 mins. This is done to detect malarial
parasite antigen in the blood.
Pathonomonic sign: Stepladder fever
Medical Mgmt:
A. IVF’s
B. Anti- Malarial Drugs
Chloroquine ( less toxic);
Premaquine
For chloroquine resistant plasmodium – quinine
• Prophylaxis – chloroquine or mefloquine,
pyrimethamine/sulfadoxine (fansidar)
C. Erythrocyte exchange transfusion for rapid
production of high levels of parasites in the blood.
 Nursing Considerations
 If entering an endemic area, travellers are advised
to take chloroquine from 1-2 weeks at weekly
interval. Protection is good for 1 year
 Patient must be closely monitored
 Soaking of mosquito nets in an insecticide solution
 Bio pond for fish
 On stream clearing – cut vegetation overhanging
stream banks to expose the breeding stream to
sunlight
 Vectors peak biting is at night (9pm-3am)
 Planting of neem tree ( repellant effect)
 Zooprophylaxis ( deviate mosquito bite from man
to animals
 Wear long sleeves/ pants/Socks
 Apply insect repellant on skin
 Screening of houses
Notes:
 Malaria stricken mother can still breastfeed
 Chloroquine ca be given to a pregnant woman
 If there is drug resistance, give quinine SO4
 BT in anemia
 Dialysis in renal failure
 Decreased fluids in cerebral edema
 No meds to destroy sporozoites
 Category of provinces
 Category A – no significant improvement in malaria
for the past 10 years. >1000
- Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao,
kalinga
 Category B - <1000/year

- Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan,

zambales, bataan, laguna
 Category C – significant reduction

-pampanga, la union, batangas, cavite, albay

 Filariasis, Elephantiasis
Lymphatic Filariasis
 Extremely debilitating and stigmatizing disease
caused by PARASITIC worm
 Affect men, women and children
 Causes extensive disability, gross disfigurement.
 CAUSATIVE AGENT: Wuchereria
bancrofti ( african eye worm)
 Only live in lymphatic system
 MOT : person to person by mosquito
bite
FILARIASIS
 FILARIASIS
 Parasitic disease caused by an african eye
worm ( microscopic thread like worm)
 Wuchereria bancrofti & Brugia malayi
 Wuchereria :Camarines norte/sur , albay ,
sorsogon , quezon , masbate , mindoro , romblon ,
marinduque , bohol , samar , leyte , palawan , sulu
, tawi-tawi and basilan.
 Malayi : Palawan , eastern samar , agusan ,sulu

Vector: Culex, Mansonia, Anopheles, Aedes

 Filariasis ( elephantiasis )

Mosquito bites
Aedes poiculus , culex
faligans and Person infected – bitten by mosquito
anopheles flavirostris Transmitted to another person

Bites a person with lymphatic filariasis Larvae migrate to LN, reach

& infect the mosquito Sexual maturity & cycle is
completed

Microscopic worms pass from mosquito

Through the human skin, travel to LN , grow as adult
Note: a person needs
Many mosquito bite
Adult worm lives for 7 yrs in lymph vessels Over several months- years to get
Mate release into blood stream- microfilaria Filariasis
 Organs affected : kidney & lymph system
 Fluid collects and causes swelling in the arms, breast,
legs and for men  genitalia
 Swelling decrease function of lymph system

 Susceptible to bacterial infection

 Skin harden and thicken  ELEPHANTIASIS
 Conjuctival filariasis  worm migrate eye  cause
blindness if untreated known as Onchoceriasis.
Assessment : s/sx
 Chills, headache and fever between 3 months and 1 year
after the insect bite
 Swelling redness and pain in arms ,legs or scrotum

 Areas of abscesses may appear as result of drying worm

or secondary bacterial infection
 Lymphadenitis. Oophoritis, orchitis

Diagnostics :Nocturnal Blood smear

 Demonstration of microfiliaria in fresh
blood obtained between 10:00 to 2:00 am
 Patient ‘s history must be taken and
pattern of inflammation and signs of
lymphatic obstruction must be Blood
observed.
/vector-borne
 Treatment :
 Drugs Ivermectin , albendazole and
DIETHYLCARBAMAZINE (DEC)- 6mg/KBW
in divided doses for 12 consecutive days
 Eliminate the larvae

 Impairing the adult worm’s ability to

reproduce
 Kill the adult worm

 Surgery – excision of subcutaneous nodule

 Elephantiasis of the legs – elevate and provide

elastic bandages
 Management Guidelines

 Supportive Therapy
 Paracetamol
 Antihistamine for allergic reaction due to DEC
 Vitamin B complex
 Elevation of infected limb, elastic stocking

 PREVENTIVE MEASURE
 Health teachings
 Environmental Sanitation
Mgmt: Environmental sanitation
 Personal Hygiene
 Provide mosquito nets

 Long sleeves, long pants & socks

 Mosquito repellant

 Take yearly dose of medicine that kills worms

circulating in the blood
 Screening of houses
Leptospirosis (Weil’s disease)
 Weil’s disease, Mud fever, Trench fever, Flood
fever, Spirochetal jaundice, Japanese 7 Days fever,
Leptospiral jaundice, Hemorrhagic jaundice,
Swine Herds disease, Canicola fever
 a zoonotic systemic infection caused by Leptospires,
that penetrate intact and abraded skin through exposure
to water, wet soil contaminated with urine of infected
animals.
Species:
 L. Manilae, L. Canicula, L. Pyrogens
 Incubation Period: 6-15 days
 Spirochete, Leptospira
interrogans, gram (-)
 Weil’s syndrome
– severe form
MOT:
 Contact of skin or open wound from soil water
contaminated with urine or feces of infected rats
(main host)
 INGESTION OF CONTAMINATED
FOOD/H2O
S/SX:
Anicteric Type (without jaundice)
 manifested by fever, conjunctival infection

 signs of meningeal irritation

Icteric Type (Weil Syndrome)

 Hepatic and renal manifestation

 Jaundice, hepatomegally

 Oliguria, anuria which progress to renal failure

 Shock, coma, CHF

 Convalescent Period
 Diagnosis

 Clinical history and manifestation

 Culture
 Blood: during the 1st week
 CSF: from the 5th to the 12th day
 Urine: after the 1st week until convalescent period
 LAAT (Leptospira Agglutination Test)
 other laboratory
 BUN,CREA, liver enzymes
 Treatment

 Specific
 Penicillin 50000 units/kg/day
 Tetracycline 20-40mg/kg/day

 Non-specific
 Supportive and symptomatic
 Administration of fluids & electrolytes
 Peritoneal dialysis for renal failure
 LEPTOSPIROSIS

JAUNDICE IS A BAD PROGNOSTIC SIGN

CASE FATALITY RATE : 40%

Blood /vector-borne
 Prevention Control & Nursing
Considerations:
 Avoidance of exposure to urine & tissues from infected
animals ( flood)
 Rodent Control
 Hygienic control in slaughterhouses, farmyard buildings &
bathing pools
 Use of protective clothing & boots
 Primarily a disease of domesticated & wild animals
transmitted via direct or indirect contact. It enters the skin,
mucus membrane, conjunctiva, inhalation
 Disease is usually short lived & mild but severe infection
can damage kidneys & liver
HEPATO-ENTERIC
DISEASES
GIT
 Typhoid Fever
 Salmonella typhosa, gram (-)
 Carried only by humans
Bacterial infection transmitted by contaminated
water, milk, shellfish ( oyster ) & other foods
Infection of the GIT affecting the lymphoid tissue (
payer’s patches) of the small intestine
Most severe form of salmonellosis caused by
salmonella typhi
MOT: oral fecal route
5 F’s : Fingers, Fomites, Flies, Feces, Food & Fluids
 Pathophysiology
Oral ingestion

Bloodstream

Reticuloendothelial system (lymph node, spleen, liver)

Bloodstream

Gallbladder

Peyer’s patches of SI necrosis and ulceration

 Typhoid Fever
Ulceration of the Peyer's Patches
 Typhoid Fever
Clinical Manifestations:
Incubation Period: 1-2 weeks
1. Prodromal – 1st week: Step ladder fever 40-41
deg, headache, abdominal pain, GI manifestations
3 cardinal signs of pyrexial stage:
1.ROSE SPOTS ( irregular rashes found on the
chest, abdomen, back
2. Remittent fever ( ladder like)
3. Spleenomegaly
Typhoid Fever
Rose Spots
 2. Fastidial = 2nd week ( Typhoid)
 a. High fever, typhoid psychosis w/
hallucination, confusion, delirium
 Drug of choice: Antibiotics
 1. Chloramphenicol
 2. Ampicillin

 3. Cotrimoxazole

b. Severe abdominal pain

c Sordes typhoid state
1st week step ladder fever (BLOOD)
2nd week rose spot and fastidial
 typhoid psychosis (URINE & STOOL)

3rd week (complications) intestinal bleeding,

perforation, peritonitis, encephalitis,
4th week (lysis) decreasing S/SX
5th week (convalescence)
Dx: Blood culture (typhi dot) 1st week
Stool and urine culture 2nd week
Widal test
Mgmt: Chloramphenicol, Amoxicillin,
Sulfonamides, Ciprofloxacin, Ceftriaxone
** Observe standard precaution until 3 negative
stool culture**
Nursing Interventions
 Environmental
Sanitation
 Food handlers
sanitation permit
 Supportive therapy

 Assessment of
complications
(occuring on the 2nd to
3rd week of infection )
- typhoid psychosis,
typhoid meningitis
- typhoid ileitis
 Schistosomias/Snail
Fever/Bilharziasis/Katayama
 Causative agent : Oriental Blood Fluke
 Schistosoma japonicum (affects intestinal tract)
 S. hematobium ( affects urinary tract)
 S. mansoni ( affects intestinal tract)
 IP: 2 months
 Source: feces of infected persons
 Dogs, pigs, cows, carabaos, monkeys, wild rats
serve as HOSTS
Pathogenesis- Snail fever Ulceration in the mucosa
Eggs able to escape in the lumen
Larvae ( cercaria) Of intestine, excreted in the feces

Penetrate skin Some eggs carried by portal

Circulation, filtered in the
Work their way to Liver , formed granulomas
Liver venous portal circulation
Granulomas are resolved
In portal vessel , & replaced by fibrous tissues
they mature in 1-3 months Scar formation occur
Diseases progresses
Mature worms live in copula in the portal vessels
Liver enlarges due
Migrate to some part of the body
To increasing fibrosis

Female cercaria lays egg in the blood vessels Blood flow interrupted
Large intestine or bladder Result to portal hypertension
 Schistosomias/Snail
Fever/Bilharziasis/Katayama
 Causative agent : Oriental Blood Fluke
 Schistosoma japonicum (affects intestinal tract)
 S. hematobium ( affects urinary tract)
 S. mansoni ( affects intestinal tract)
 IP: 2 months

 Cycle: Egg - larvae (miracidium) - intermediary host

(oncomelania quadrasi/tiny amphibious snail) – cercaria (
infective stage)
 Egg - larvae
(miracidium

intermediary host
(oncomelania
quadrasi/tiny
amphibious snail)
 Schistosomias/Snail Fever
MOT: penetration of cercaria
to the skin >parasites live in
the blood vessels of
intestines>cercaria migrates
to the liver for maturation>
gets out of the liver & goes
against blood flow>
obstruction of hepatic portal
vessels> inc pressure>portal
hpn>leads to esophageal &
gastric varices, ascites &
hepatomegaly
 Assessment :
 Swimmer’s itch or cercarial dermattitis –
itching within 24hrs after penetration of the
skin by cercaria last 2-3 days
 Migratory phase : sensitized individual
develop systemic reaction of FEVER,
CHILLS , SWEATING , DIARRHEA ,
COUGH and EOSINOPHILIA
 Acute Phase : (+) fever , generalized
lympagenopathy, hepatomegaly and
splenomegaly ( KATAYAMA FEVER) 2-3
weeks after initial infection and last for 1-2
months
 Diagnostics:
 Fecalysisor direct stool exam
 Kato katz technique

 Liver and rectal biopsy

 ELISA ( enzyme link Immunosorbent Assay)

 COPT ( circum-oval precipitin test)

confirmatory diagnostic test

 Prevention : proper disposal of feces ; snail

control
 Treatment: Praziquantel for 6 mos
PO
 Fuadin
 Prevention & Nursing
Considerations:
 Wear knee rubber boots
 Avoid washing clothes or bathing in streams
 Use potable water supply
 Proper & sanitary disposal of human feces
 Snail control may be undertaken by chemicals (
Niclosemide)- Molluscides
 Annual stool exam in endemic places
 Educate people about transmission
 Proper maintenance of Latrine
Viral hepatitis
 VIRAL HEPATITIS
 A diffuse inflammation of the cells of the liver
that produces liver enlargement and jaundice
 Hepatitis A (HAV) – fecal-oral route
 Hepatitis B ( HBV) – contact with body
fluids
 Hepatitis C (HCV) – percutaneous exposure
to blood ( non A non B)
 Hepatitis D (HDV)- contact with body fluids

 Hepatitis E (HEV) – water , fecal-oral route

 VIRAL HEPATITIS
HAV HBV HCV HDV HEV

IP 15-50d 45-180d 14-182d 14-70d 15-64d

MOT Fecal oral Parenteral Blood Same w/ B Fecal oral

Percutaneous transfusion
placental
commun Till 1 wk During IP As carrier- Throughout Unknown
icability after onset Entire clinical indefinite clinical
of course 1 wk before disease
jaundice Years if carrier clinical
onset
 Virus infect liver-interlobular infiltration

Necrosis and hyperplasia of kuffer cells

Failure of the bile to reach intestine in normal

amount

Obstructed jaundice
s/sx: dark urine, pale feces, itchness

Liver cell damage

Necrosis and autolytic type destroy
parenchyma
 VIRAL HEPATITIS
 Assessment : s/sx
 Prodromal / Preicteric
 S – symptoms of URTI

 W – weight loss

 A – anorexia , chills , fever

 R – right upper quadrant pain

 M – malaise

 Icteric

 J – jaundice

 A – acholic tool

 B – bile colored urine ( tea colored)

 Laboratory :
 Liver function test
 SGPT/SGOT

 Specific : the presence of IgM antibody

 Hepatitis A  IgM HAV

 Hepatitis B  HbsAg – acute or chronic infected

 Anti-HBs – resolved or immunity

 HbeAg – infected risk of transmitting
 Anti-HBe – lower risk of transmitting
 Anti-HBc – acute resolved or chronic
HBV infection
 IgM anti-HBc – acute with recent
HBV infection “ window phase “
Enteric fever
 VIRAL HEPATITIS
 Analysis
 Knowledge deficit related to unfamiliarity with the disease
course and treatment
 Activity intolerance related to decreased metabolism of
nutrient / increased basal metabolic rate caused by viral
infection
 High risk for Diversional activity deficit secondary to
isolation / lack of energy
 High risk for altered body nutrition : less than body
requirement secondary to anorexia
 VIRAL HEPATITIS
 Treatment
 No specific treatment
 Bed rest essential

 Diet : high carbohydrate , low fat , low protein

 Vitamin supplement ( B complex)

 VIRAL HEPATITIS
 Nursing Mgt
 Isolation of patient ( enteric isolation)
 Standard precaution

 Patient should be encouraged to rest during acute or

symptomatic phase
 Improved nutritional status

 Utilize appropriate measures to minimize spread of the

disease
 VIRAL HEPATITIS
 Nursing Mgt
 Observe patient for Melena and check stool for the presence of
blood
 Provide optimum i and oral care
 Increase in ability to carry out activities
 Encourage the patient to limit activity when fatigued
 Assist the client in planning period of rest and activity
 Encourage gradual resumption of activities and mild exercise during recovery
 PREVENTION AND CONTROL
 Handwashing every after use of toilet

 Travelers should avoid water and ice if unsure of their purity

 Educate on the mode of transmission of the disease.

ERUPTIVE FEVER
 MEASLES
 Extremely contagious
 Breastfed babies of mothers have 3 months
immunity for measles
 The most common complication is otitis media
 The most serious complications are pneumonia
and encephalitis
 Measles, Rubeola, Morbili, 7 Day
Fever, Hard Red Measles,
 RNA, Paramyxoviridae
 Measles virus is rapidly inactivated by heat, UV
light, & extreme degrees of acidity & alkalinity
 Active immunity (MMR and Measles vaccine)

 Passive immunity (Measles immune globulin)

 Lifetime Immunity

IP: 8-12 days

MOT: Direct ( droplets, airborne); Indirect ( fomites)
*Contagious 1-2 days before rash and 4 days after the
appearance of rash
 Sources of Infection:
 Patient’s blood
 Secretions from the eyes, nose & throat

Diagnostics:
 Nose & throat swab

 Urinalysis

 Blood exams ( CBC, leukopenia, leukocytosis)

Rashes: maculopapaular,
cephalocaudal (hairline
and behind the ears to
trunk and limbs),
confluent, desquamation,
pruritus)
 Clinical manifestations:
1. Pre-eruptive stage:
(2-4 days) - malaise, cough, conjunctivitis, , fever,
kopliks spots ( PATHOGNOMONIC SIGN)
(1-2 mm blue white spots on red background along
2nd molars), stimsons ( puffiness of eyelid)
photophobia
2. Eruptive stage:
Rash is usually seen late on the 4th day
Maculo-papular rash
3. Stage of convalescence:
Rashes fade away, desquamation begins,fever
subsides
Cx: pneumonia, meningitis,
 MEASLES

 Fever persist  means (+) complication

 Bronchopneumonia- most common

 Otitis media, reactivation of previous TB

 Bronchitis, laryngitis, exacerbation

malnutrition
 Encephalitis
 MEASLES
 Diagnostic procedure
 Physical examination
 Nose and throat swab

 Urinalysis

 CBC ( leukopenia & leukocytosis)

 Complement fixation or hemogglutinin test

Eruptive fever
 MANAGEMENT
1. Supportive
2. Hydration
3. Proper nutrition
4. Vitamin A
5. Antibiotics – if w/
secondary bacterial
infection
6. Vaccine- measles
vaccine @ 9 mos and
MMR @ 15 mos
7. Anti viral drugs (
Isoprenosine)

Observe respiratory Isolation

 Nursing Care
 Isolation of the patient if necessary
 TSB for fever
 Skin care is of utmost importance. The pt. should
have a daily cleansing bed bath.
 Oral & nasal hygiene is a very important aspect of
nursing care of patients with measles
 Restrict to quiet environment
 Dim light if photophobia is present; care of the
eyes is necessary
 Administer antipyretic
 Use cool mist vaporizer for cough
 German Measles, Rubella, Rotheln
Disease, 3 Day Measles
 = contagious viral disease characterized by fever,
URTI, arthralgia, DIFFUSED fine red
maculopapular rash)
 CA - RNA, rubella virus ( Togaviridae)
 Immunity: Active natural ( permanent or lifetime)
 Active immunity - rubella vaccine and MMR
 Passive immunity - gammaglobulin
 Period of communicability – contagious 7 days
before & 7 days after appearance of rash &
probably during the catarrhal stage
German Measles, Rubella, Rotheln Disease, 3
Day Measles

IP: 14-21 days

MOT: Direct contact: droplets spread through the
nasopharynx
Indirect contact: transplacental

** Highly
communicable infant may shed virus for
months after birth**
Rashes:
Maculopapular,
Diffuse/not
confluent, No
desquamation,
spreads from the
face downwards
Clinical Manifestations:
> FORSCHEIMER’S SPOTS (petecchial lesion
on buccal cavity or soft palate)
> oval, rose red papule about the size of pin head
> cervical lymphadenopathy,
> low grade fever
Dx: clinical
CX: rare; pneumonia, meningoencephalitis
CX to pregnant women:
 1st tri-congenital anomalies ( microcephaly, heart
defects, cataracts, deafness
 2nd tri-abortion or bleeding
 3rd tri-pre mature delivery
Nursing Considerations:
 MMR immunization
 Use of immunoglobulins ( IG’s)- ppost exposure
prophylaxis – 72 hrs after exxposure
 Prevention of congenital measles
 Avoid exposure
 Roseola Infantum,
Exanthem Subitum, Sixth disease
 Human herpes virus 6
 3mos-4 yo, peak 6-24 mos

MOT: probably respiratory secretions

S/sx: Spiking fever w/c subsides 2-3 days, Face and trunk
rashes appear after fever subsides, Mild pharyngitis and
lymph node enlargement
Mgmt: symptomatic
 Most highly contagious childhood disease
 Affects adults more severely than children
 Virus may become dormant
 Chicken Pox, Varicella
 Acute & highly contagious disease of viral etiology
 Childhood disease & adolescents (adults – more
severe) Not common in infancy
 Locally called “ Bulutong”
 Human beings are the only source of infection
 CA = Varicella Zoster virus, Herpes virus
 IP – 10-21 days
 MOT: droplet spread
> nose & throat secretions
> Vesicles ( contagious in early stage of
eruption
> Airborne
 Prodromal period: headache , vomiting, fever
 Papulovesicular rashes appear on trunk 
spreading to face and extremties (
centrifugal)

 Macules papules vesicles with clear fluid

inside crusting and scar formation

 The disease is communicable until the last

crust disappear ( D1 before D6 after
appearance of rashes)
Period of Communicability – 5 days before rashes & 5 days
after rashes – crusting - dry
Rashes:
Maculopapulovesicular
(covered areas),
Centrifugal rash
distribution, starts
on face and trunk and
spreads to entire body

 Leaves a pitted scar

(pockmark)
CX = secondary bacterial infection, furunculosis,
pneumonia, meningoencephalitis ( rare)

 Dormant: remain at the dorsal root ganglion and

may recur as shingles (VZV)
Curative & Nursing Considerations:
 If it feels itchy, give oral antihistamine or local
antihistamine
 Avoid rupture of lesions
 Cut nails short
 Pay attention to nasopharyngeal secretions/
discharges
 Disinfection of linen ( sunlight or boiling)
 Prophylactic antibiotics
Tepid water and wet compresses for pruritus
Soothing Baths, cool baths
Treatment:
a. oral acyclovir
b. Tepid water and wet compresses for pruritus
c. Potassium Permanganate (ABO)
a. Astringent effect
b. Bactericidal effect
c. Oxidizing effect (deodorize the rash)
 Exclusion from school for 1 week after eruption
appears
 An attack gives lifetime immunity. Second attack
is rare
 Immunoglobulins can be given ( 12 mos)
 Drug of choice: Acyclovir ( Zovirax ) – topical
cream applied to crusts
 Preventive measures
 Active immunization with LIVE
ATTENUATED VARICELLA VACCINE
 Start at 1 yr old ( 1 dose )
 booster – 4-12y

 If >13 yrs = 2 doses

 Given SC

 Avoid exposure as much as possible to infected

person
 Small Pox, Variola
 DNA, Pox virus
 Last case 1977
 spreads from man-to-
man only
 Active: Vaccinia pox virus

IP: 1-3 weeks

S/sx:
Rashes:
Maculopapulovesiculopustular
 Centripetal rash distribution
 contagious until all crusts disappeared
 SMALL POX
 Complications:
 Scarring
 Pneumonia

 Blepharitis

 Corneal ulceration

 Mortality rate : 30%

 Diagnostic : clinical evaluation
 Treatment : analgesic ( pain) antibiotic for
secondary infection
 SMALL POX
 Nursing mgt
 Strict respiratory and contact isolation
 Supportive

 Adequate hydration

 Mandatory reporting

 PREVENTION
 Pre-exposure vaccination
 Strict isolation of identified cases
Respiratory Diseases
 Meningococcemia

 CA : Neisseria meningitides ( bacteria) gram (-

)diplococci
 May also be caused by H. Influenzae and S.
Pneumoniae
MOT: Droplets (urti) to blood stream to CNS

IP: 1-2 days ( even faster)

 High risk: immunocompromised
S/sx:
1. Meningococcemia – usually starts as
nasopharyngitis, followed by sudden onset of
spiking fever, chills, arthralgia. Bacteria is carried by
circulation & when it reaches the meninges of the
brain, BLEEDING occurs into the medulla which
extends to the cortex & petechial, purpuric or
ecchymotic hemorrhage is scattered in the entire
body surface appear.
2. Fulminant Meningococcemia (Waterhouse
Friedrichsen) – septic shock; hypotension,
tachycardia, enlarging petecchial rash, adrenal
insufficiency
 Clinical Manifestation
 sudden onset of high grade fever, rash and rapid
deterioration of clinical condition within 24 hours
 Meningococcal Septicemia
Waterhouse-friedrichsen Syndrome
 Treatment:
 antimicrobial
 Benzyl Penicillin 250-400000 u/kg/day ( drug of choice)
 Chloramphenicol 100mg/kg/day

 Symptomatic and supportive

 fever
 seizures
 hydration
 respiratory function
 Chemoprophylaxis
 Rifampicin 300-600mg q 12hrs x 4 doses
 Ofloxacin 400mg single dose
 Ceftriaxone 125-250mg IM single dose ( Ciprobay)
Nursing Intervention
1. To prevent the occurrence of further complications
 -maintain strict surgical aseptic technique when doing
dressings or lumbar puncture in order to prevent the
spread of microorganism
 -administer O2 inhalation to prevent respiratory
distress and to maintain a clear open airway
 -TSB for fever to prevent convulsions
 -observe signs and symptoms of increase intracranial
pressure
 -change positions at least every 2 hours to prevent
pressure sore
 -protect the eyes from bright lights and noise
 2. Maintain normal amount of fluid and
electrolyte balance
 3. Prevent spread of the disease, prophylaxis for
close contacts ( Rifampicin )
 4. Ensure the patients full comfort, prevent
stress provoking factors that may retard
convalescence and to prevent from injury
 5. Prevent the spread of infection,
microorganisms and contamination some
precautions should be carried out
 6. Maintain personal hygiene and cleanliness and
avoid microorganisms to harbor in the patients
body
 7. Maintain proper elimination of waste product
of metabolism
 8. Nutritional intake
 Diphtheria
 CA: Corynebacterium diphtheriae, gram (+)
( Klebs Loeffler’s Bacillus)
 IP: 2-5 days
 Period of Communicability: 2-4 wks if untreated, 1-2 days
if treated
 Active (DPT) and
Passive Immunization
(Diphtheria antitoxin)
 Source: Discharges of the nose, pharynx, eyes, or lesion
of other parts of the body infected
 More severe in unimmunized and partially immunized

MOT: Direct/indirect contact = Airborne/droplet, fomites

Toxin – producing organism = EXOTOXIN
1. Nasal – invades nose by extension from pharynx
2. Tonsillar – low fatality rate
3. NasoPharygeal- more severe type
- sore throat causing dysphagia
- Pseudomembrane in uvula, tonsils, soft
palate – gray exudate
- Bullneck – inflammation of cervical LN; neck
tissues are edematous
- increasing hoarseness until aphonia
- wheezing on expiration
- dyspnea
 4. Cutaneous diphtheria affect mucous
membrane & any break on the skin
S/sx: sore throat, fever,
“Bull-neck appearance”(
CHARACTERISTIC
SIGN)
,Pseudomembrane-(
PATHOGNOMONIC
SIGN) gray exudate, foul
breath, massive swelling
of tonsils and uvula,
thick speech, cervical
lymphadenopathy,
swelling of
submandibular and
anterior neck),
obstruction of
respiratory tract
Dx: 1.Schick test -
susceptibility to
diphtheria toxin
2. Moloney - sensitivity
to diphtheria toxoid
3. Throat swab (K
tellurite and Loeffler’s
coagulated blood serum
 Treatment
 Neutralize the toxins – antidiptheria serum
 Kill the microorganism – penicillin,
erythromycin, rifampicin, clindamycin
 Considered cured after 3 negative throat cultures
 Prevent respiratory obstruction – tracheostomy,
intubation
 CBR up to 2 weeks to prevent myocarditis
 Strict isolation
 Nursing intervention
 Strict isolation of the hospitalized child
 Administer anti-toxin
 Supportive
 Maintenance of adequate nutrition
 Encouraged drinks rich in vitamin C
 Maintenance of adequate fluid and electrolytes
 Bed rest – for at least 2 weeks
 Avoid exertion
 Ice collar must be applied to the neck
 Nose and throat must be taken care of
 Administer antibiotics as prescribed
 Penicillin – effective for respiratory diphtheria
Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
 DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
 Household contacts
(+) primary immunization and (-) culture - booster dose
(+) culture and (-) immunization – treated as a case of
Diptheria
 Complications
 Myocarditis – most common ( caused by
diphtheria toxin on the heart muscles)
 Polyneuritis – paralysis of the soft palate,
paralysis of the ciliary muscle of the eye,
pharyns, larynx, or extremities
 Airway obstruction can lead to death through
asphyxiation
 Pertussis/ Whooping Cough
 Bordetella pertussis, B. parapertussis, B.
bronchiseptica, gram (-)
 Pertussis toxin, tracheal cytotoxin,

“ Bordet Gengou Bacillus”

 Common in Infants and young children & fatal
to toddlers
IP: 5-21 days
MOT: airborne/droplet; direct contact ( nose &
throat secretions); indirect contact ( articles)
S/sx:
1. Catarrhal stage (1-2 wks; highly contagious) – sneezing, runny nose,tearing
lacrimation, mild cough, low grade fever
2. Paroxysmal stage (2-4 wks) - Clusters of cough that ends with a whoop,
vomiting, exhaustion
3. Convalescent stage (2-3 wks) – less frequent cough

Dx: WHO - >21 days cough + close contact w/ pertussis px + (+) culture OR
rise in Ab to FHA or pertussis toxin
* throat culture w/ Bordet gengou agar
Cx: bronchopneumonia, pneumonia
Management:
 liquefy thick secretions with Ferrous
iodide
 CBR
 Warm fresh air is better than cold air
w/c induces vomiting ( NO AIRCON)
 Hydration and nutrition
 Vit C to inc body resistance
 Oxygen ( 1-2L/min)- to lessen the
occurrence of paroxysm
 Erythromycin or Ampicillin
 Isolation = 4 wks after coughing begins
& continued for 7 days after the onset
of antiobiotic therapy
Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
 DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
 Household contacts
(+) primary immunization and (-) culture - booster dose
(+) culture and (-) immunization – treated as a case of
Diphtheria
 Pulmonary Tuberculosis( Koch’s
Disease/Pthisis/Consumption disease)
 CA: Mycobacterium tuberculosis ( bacteria), acid
fast bacilli
 The organism multiplies slowly & is characterized as
acid fast aerobic organism which can be killed by
heat, sunshine, drying & ultraviolet light.
 Sputum of persons with TB is the most common
source of the organism spread through droplet (
airborne)
 Pott’s disease – thoracolumbar
 Milliary TB – kidney, liver, lungs
- Is a chronic, or subacute or acute respiratory
disease commonly affecting the lungs
characterized by formation of tubercles in the
tissues which tend to undergo caseation, necrosis
and calcification.
IP: 2 – 10 weeks
Mode of Transmission:
 Direct: droplet ( sneezing, coughing)

 Indirect: continuous exposure to infected persons

within the family
Source of Infection:sputum, blood from
hemoptysis, nasal discharges and saliva
 Classification :
 Minimal – slight lesion
 Moderately advanced – one or both lung may be
involved
 Far advanced- more extensive
 Clinical classification:
 1. inactive TB
 Symptoms absent
 Sputum negative

 CXR – no evidence of cavity

 2. Active
 Tuberculin test positive
 CXR – progressive

 (+) of symptoms

 Sputum (+)

 3. Activity not determined

 Clinical manifestation:
 Afternoon rise of temperature for 1 mo. or more
 Night sweating

 Body malaise, weight loss

 Cough, dry to productive

 Dyspnea, horseness of voice

 Hemoptysis – pathognomonic

 Occasional chest pain

 (+) sputum for AFB

PD 996 – Compulsory Immunization below 8 years
( 0 -7 yrs)
Proclamation # 6 WHO – Universal Child
Immunization
Etiologic Factors that contribute heavily to the
high Incidence & high mortality rate of TB:
 Poverty / Overcrowded homes

 Protein undernutrition

 Deficiencies in Vit A,D,C

 Children below 5 years old – prone to infection

due to inadequate levels of immunity
 Pathophysiology
Inhalation

Local infiltration of neutrophils and macrophage

Multiply and survive in macrophage

Destroy bacteria

present it to T helper cells in LN

Sensitized T cells searches bacteria and release lymphokines

Attract macrophages w/c attack bacteria caseous necrosis

bacteria dormant
Heal w/ fibrosis, calcification
and granuloma; Primary TB
If reactivated, Secondary TB
 DX
 1. Case Finding:
A. Sputum Microscopy ( cheapest & confirmatory )
 Results take about 3 weeks to confirm
 Sputum sample shld be taken 1st thing in the
morning upon arising
3 specimens:
 1st – on the spot = HC
 2nd- upon arising = Home
 3rd – on the spot = HC
 2. Sputum Culture & Sensitivity
 3. Chest X-ray – cavitary lesion
 4. Tuberculin Test
 1. PPD – Purified Protein Derivative
 2. Mantoux Test- (more reliable) = ID injection of
tuberculin extract into the inner aspect of forearm to
detect infection/exposure to CA.
Localized reaction- detected in 48 to 72 hours
(+) induration of 10 mm or above
Tuberculin test. Erythema and induration at site of intradermal
injection of 5 tuberculin units in a child with primary tuberculosis.
This is an unusually severe reaction. Mantoux method.
 Classification of PTB
0 = No exposure; No infection
1 = (+) exposure but not infected = INH for 1
mo especially below 5yo
2 = (+) with infection but w/o disease
(+) skin test; No S/S; CXR(-) -INH 1 yr
( -) sputum exam
3 = infected & w/ the disease = anti TB drug Tx
 CATEGORIES OF TB
 category I (new PTB) - (+) sputum(+) chest xray

 category II (PTB relapse not less than 6 mos)

 category III (active PTB case) - (-) sputum chest x-

ray, regression of infiltrates
 Category 1V – partially treated; poor compliance to
DOTS
 Category V – PTB suspect ( (+) skin test; (+) family
member with PTB
Management:
 short course – 6-9 months

 long course – 9-12 months

 DOTS- directly observe treatment short course

* 2 wks after medications – non communicable

3 successive (-) sputum - non communicable
rifampicin or INH- prophylactic
 TREATMENT:

 CATEGORY 1 - NEW PTB, (+) SPUTUM

GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS

 CATEGORY 2 - PREVIOUSLY TREATED WITH RELAPSES

GIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH,
MAINTENANCE RIE 5 MONTHS

 CATEGORY 3 - NEW PTB (-) SPUTUM FOR 3X

GIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS

* IF RESISTANT TO DRUGS GIVE ADDITIONAL MONTH/S AS

PRESCRIBED
 Primary Anti TB Drugs
 1. Rifampicin =
 SE = orange colored urine, GI upset,
Jaundice, Renal failure, thrombocytopenia
 Primary Anti TB Drugs
 2. Isoniazid (INH) = ( Bacteriostatic) inhibits
 ( Bactericidal ) kills
 Used prophylactically to patients (+) of PPD
 SE = Rashes (give anti-histamine); Peripheral
neuritis ( Give Vit B6- Pyridoxine)50 mg;
Jaundice; Psychosis
3. Pyrazinamide ( PZA)
 SE = Hyperuricemia ( inc uric acid)

 Mx: Inc fluid intake

4. Ethambutol = 15-20mg/day
 SE = Optic neuritis ( dec visual acuity)

 Give Vit. B6(Pyrdoxine)

5. Streptomycin
 SE = Ototoxicity, 8th cranial nerve damage
 ( Tinnitus, dizziness, N&V)
MDT side effects
 r-orange urine
 i-neuritis and hepatitis
 p-hyperuricemia
 e-impairment of vision
 s-8th cranial nerve damage
 PTB- NURSING
MANAGEMENT
1. MAINTAIN REPIRATORY ISOLATION
2. Administer medicine as ordered
3. Always check sputum for blood or purulent expectoration
4. Encourage questions and conversation so that the patient
can air his or her feelings
5. Teach or educate the patient all about PTB
6. Encourage patient to stop smoking
7. Teach how to dispose secretion properly
8. Advised to have plenty of rest and eat balanced diet
9. Be alert of drug reaction
10. Emphasize the importance of follow-up
 PULMONARY TUBERCULOSIS
( Koch’s Disease/Phthisis/ consumption
Disease)
PREVENTION:
1. Submit all babies for BCG immunization

2. Avoid overcrowding

3. Improve nutritional and health status

4. Advise persons who have been exposed to infected

persons to receive tuberculin test if necessary CXR
and prophylactic isoniazid.
 Mumps ( Epidemic Parotitis); Infectious
Parotitis
 -Acute contagious VIRAL disease. Characteristic
feature is swelling of one or both of the parotid glands
 RNA, Mumps virus ; paromyxovirus of the Varicella
family( found in the saliva)
 Mumps vaccine - > 1yo
 MMR – 15 mos
 Lifetime Immunity
IP: 14-25 days, usually 18 days
Incidence: 5-15 y/o, cold weather, common in men.
Adults less likely to be attacked ( If so, causes sterility)
MOT: droplet, fomites, saliva
S/sx: Pain at the angle of the jaw (Unilateral or
bilateral) PATHOGNOMONIC SIGN
parotitis, Orchitis - sterility if bilateral,
Period of communicability: 6 days before swelling
; until 9 days after swelling subsides ( 7th – 9th
day)
** highest communicability – 48 hrs after onset
of swelling
Dx: serologic testing, ELISA
Mgmt: supportive
Supporter for orchitis
Analgesics Antipyretic, cold compress, steroids
 Diet : soft. Don’t give sour foods
Promotive:
 Proper disposal of nasal & throat secretions

 Bed rest

Preventive: MMR vaccine ( 15 mos.)

= LIFETIME IMMUNITY
Diarrheal

Diseases
 Cholera / El Tor
 Causative agent: Vibrio coma (inaba, ogawa,
hikojima), vibrio cholerae, vibrio el tor; gram (-)
 Curved rod or coma shaped organism; motile

 Habitat: small intestine

 Can survive longer in refrigerated foods

IP: few hours to 5 days

MOT: oral fecal route ( by contaminated food,
water, shellfish)
S/sx: Severe vomiting, abdominal cramps, massive
diarrhea of watery voluminous whitish grayish
greenish slightly mucoid stools (Rice watery
stool with flecks of mucus & fishy odor), s/sx of
severe dehydration ie Washerwoman’s hands,
sunken eyeball & fontannel, thirst, poor skin
turgor
Period of communicability: 1st day – 10th day ( as
long as CA is seen in feces)
Dx: stool culture (+) vibrio cholerae
Mgmt: IV fluids, Tetracycline, Doxycycline,
Erythromycin, Quinolones, Furazolidone and
Sulfonamides (children)
 Cholera
Sigmoidoscopic view of colonic mucosa
Fatal case of infection
Rice Watery Stool in Cholera
Cholera Cot and Bucket
 Nursing Mx:
 Replacement of lost F & E
 Administer D5LR ( more in Na) DLR ( more in
K)
 Enteric Isolation
 All patients should be isolated until rectal swab
shows (-) result
 All water & milk should be boiled for 15 minutes
 Food must be protected from flies
 Prepare food properly
 Proper disposal of excreta
 Good environmental sanitation
 Bacillary Dysentery
Shigellosis
 Shiga bacillus: dysenteriae (fatal), flexneri
(Philippines), boydii, sonnei; gram (-)
 Shiga toxin destroys intestinal mucosa
 Humans are the only hosts
IP: 1-7 days
MOT : oral fecal route ( contamination
of fingers, toilet seats, glass & table
Ware
 Pathophysiology
 Shigella >>> releases toxins>>headache
>>>>vomiting>>.LBM>>>stool ( bloody,
mucoid with pus
S/sx: fever,colicky abdominal pain, diarrhea is
watery to bloody with pus, tenesmus
( pain on defecation)
Dx: stool culture
Mgmt: Oresol, Ampicillin, Trimethoprim-
Sulfamethoxazole, Chloramphenicol,
Tetracycline, Ciprofloxacin
 Nursing Mx:
 Replacement of F & E
 Good environmental sanitation
 Sanitary disposal of human feces
 Clean processing, preparation, serving of food
 Fly control
 SALMONELLA INFECTION
( Salmonellosis)
 Source : contaminated food, drinks ;meat and poultry
product.
 MOT : fecal oral-route
 Period of communicability : throughout duration of
fecal excretion
 IP : 6-72H ( < 24H)
 S/SX : abrupt onset nausea, vomiting, abdominal
cramps, chills, LBM with bloody mucoid stool
occassionally
 SALMONELLA INFECTION
( Salmonellosis)
 Physical findings: hyperactive peristalsis, abdominal
tenderness and signs of dehydration.
 Diagnosis:
 Stool culture
 Stool examination
 Treatment
 Non-specific
 Correction of fluid and electrolytes
 Dietary
 Antimicrobial not indicated unless patient is septic
 Resistant to antibiotics likes : ampicllin, chloramphenicol and
cotrimoxazole
 Paralytic shellfish Poisoning
Red Tide Poisoning
 Pyromidium Bahamense ( Algae), Dinoflagellates
Plankton
 Ingestion of Saxitoxin in contaminated bi-valve shellfish
 Saxitoxin binds w/ Na channels leading to loss of skeletal
muscle excitability
 IP 15 min- 12 hrs
S/sx: Circumoral and extremity numbness, nausea and
vomiting, headache ( bec of the toxins),dizziness, muscle
and respiratory paralysis, rapid pulse, difficulty of speech
( ataxia)
Dx: history
Mgmt: emesis/gastric lavage + activated charcoal,
supportive
 Paralytic shellfish Poisoning
Red Tide Poisoning
Dx: history
Mgmt:
1. Induce vomiting (gastric lavage + activated charcoal)
2. Drink pure coconut milk ( weakens toxins)
3. Give NaHCO3(25 mgs) in ½ glass of water
4. Avoid using vinegar in cooking shellfish affected by red
tide ( 15x increase when mixed with acid)
5. Toxin of red tide is not totally destroyed in cooking
6. Avoid eating tahong , halaan, Kabiya, abaniko during
red tide
7. No specific medicines
 Botulism
 Fatal form of food poisoning caused by an
endotoxin
 CA = Clostridium Botulinum
 MOT = Food borne or contaminated wound
 IP = 12-36 hrs after eating improperly canned
foods
 S/SX
1. Severe intoxication
2. Visual difficulty, Dysphagia, dry mouth
3. Descending, symmetrical flaccid paralysis (
weak, soft)
4. Vomiting, constipation, Diarrhea
5. Double vision, difficulty focusing eyes
Dx
 Culture of stool & stomach contents

 Serum positive of Botulinum toxins

Nursing & Medical Management:

 1. IV & IM trivalent Botulinum antitoxin

 2. IV fluids & Electrolytes

 3. Intensive care to manage respiratory failure

 4. No questionable canned food should be

tested
Intestinal

Parasitism
 INTESTINAL PARASITISM
 are parasites that populate the gastro-intestinal
tract.
 MOT : they are often spread by poor hygiene
related to feces
 contact with animals, or poorly cooked food
containing parasites.
 Two main types of intestinal parasites:
 A. Helminths
 Tapeworms, pinworms, and roundworms are among the
most common helminths
 B. Protozoa.
 Cause of intestinal Parasitism
 high risk for getting intestinal parasites:
 Living in or visiting an area known to have parasites
 Poor sanitation (for both food and water)

 Poor hygiene

 Age -- children are more likely to get infected

 Exposure to child and institutional care centers

 INTESTINAL PARASITISM
 Some asymptomatic
 S/SX:
 Diarrhea
 Nausea or vomiting
 Gas or bloating
 Dysentery (loose stools containing blood and mucus)
 Rash or itching around the rectum or vulva
 Stomach pain or tenderness
 Feeling tired
 Weight loss
 Passing a worm in your stool
 Anemia
 Fecal testing (stool exam) can identify both
helminths and protozoa..

 The "Scotch tape" test identifies pinworm by

touching tape to the anus. Then the tape is
examine under a microscope for eggs
 Ascariasis (Roundworm)
CA: Ascaris Lumbricoides
IP: weeks to months
MOT: transmitted through contaminated fingers
into the mouth; ingestion of food and drinks
contaminated by embryonated eggs
Affects 4-12 years old

Dx: stool for ova

Mgmt: Mebendazole,/ Albendazole/ Pyrantel

Pamoate
MOT: ingestion of food
contaminated by ascaris eggs
larvae in large intestine
penetrate wall lung
where larvae grow and
coughed up intestine
larvae mature and
passed out in feces
Ascariasis ( roundworm infection)
 Nursing Intervention:
 Isolation is not needed
 Preventive measures in each home and in the
community should be enforced
 Wash hands before handling food
 Wash all fruits and vegetable thoroughly
 Availability of toilet facilities must be ensured
 Importance of personal hygiene should be explained
 Proper waste disposal.
Ascariasis ( roundworm infection)
 Prevention:
 Improved sanitation and hygienic practices
 Improved nutrition

 Deworming may be advised

 Complications
 Migration of the worm to different parts of the
body Ex. Ears, mouth,nose
 Loefflers Pneumonia
 Tapeworm (Flatworms)
 CA: Taenia Saginata (cattle), Taenia Solium
(pigs)
MOT: fecal oral route
(ingestion of uncooked, infected meat )
IP: 2-3 mos - years
Dx: Stool Exam
Mgmt: Praziquantel, Niclosamide
ISOLATION OF HOSPITALIZED
PATIENTS. STANDARS PRECAUTIONS
RECOMMENDED
 Pinworm
 Enterobius Vermicularis
MOT: fecal oral route
S/sx: Itchiness at the anal area d/t eggs of the
agent
Dx: tape test at night time
(agents release their eggs during night time)
Mgmt: Pyrantel Pamoate, Mebendazole
Enterobius vermicularis (PIN
WORM)
The pinworm lives in
the lower part of the
small intestine and
the upper part of the
colon
Human the only
natural host
IP : 1-2 months or
longer
MOT : indirectly by
Isolation is not needed contaminated fomites
-shared toys, toilet
seat and bath
 Nursing Intervention
 Promote hygiene
 Environmental Sanitation
 Proper waste and sewage disposal
 Antihelmintic medications repeated after 2
weeks (entire family)
 Hookworm (Roundworm)
 CA: Necator Americanus, Ancylostoma
Duodenale
 IP - few weeks to months to years

S/sx: Ground itch or dew itch at site of entry

of filariform larvae involving the feet/legs,
abd’l cramps, diarrhea, abd’l distention,
anemia, perforation to peritonitis to
septicemia
** Isolation is not necessary **
Dx: microscopic exam (stool exam)
Mgmt: Pyrantel Pamoate and
Mebendazole
 don’t give drug without (+) stool
exam
 members of the family must be
examined and treated also
Nsg. Intervention:
1. Proper disposal of excreta

2. Avoid walking or playing

barefooted
3. Periodic deworming of school age
group
Amoebiasis ( Amoebic Dysentery)
 Protozoal infection of human beings initially
involving the colon, but may spread to soft tissues,
most commonly to the liver or lungs.
 CA: Entamoeba Hystolitica, protozoa
 Prevalent in unsanitary areas
 Common in warm climate
 Acquired by swallowing
 Cyst survives a few days after outside of the body
 Cyst passes to the large intestine & hatch into
TROPHOZOITES. It passes into the mesenteric veins, to
the portal vein, to the liver thereby forming AMOEBIC
LIVER ABSCESS.
 Entomoeba histolytica has two developmental stages:

 1. Trophozoites/vegetative form
 Trophozoites are facultative parasites that may invade
the tissues or may be found in the parasites tissues
and liquid colonic contents.
2. Cyst
a. Cyst is passed out with formed or semi-formed
stools and are resistant to environmental conditions.
 b. This is considered as the infective stage in the life cycle
of E. histolytica

Pathology
When the cyst is swallowed, it passes through the stomach
unharmed and shows no activity while in an acidic
environment. When it reaches the alkaline medium of the
intestine, the metacyst begins to move within the cyst
wall, which rapidly weakens and tears. The quadrinucleate
amoeba emerges and divides into amebulas that are swept
down into the cecum. This is the first opportunity of the
organism to colonize, and its success depends on one or
more metacystic trophozoites making contact with the
mucosa.
Mature cyst in the large intestines leaves the host
in great numbers (the host remains
asymptomatic). The cyst can remain viable and
infective in moist and cool environment for at
least 12 days, and in water for 30 days. The cysts
are resistant to levels of chlorine normally used
for water purification. They are rapidly killed by
desiccation, and temperatures below 5 and
above 40 degrees.
MOT: Ingestion of cysts from fecally contaminated
sources (Oral fecal route)
oral and anal sexual practices
 Extraintestinal amoebiasis- genitalia, spleen, liver,
anal, lungs and meninges
lifecycle
s/sx: Blood streaked, watery mucoid diarrhea,
abdominal cramps
Dx: microscopic stool exam - trophozoites
 Pd of Communicability: the microorganism is
communicable for the entire duration of the illness
Mgmt:
 Tetracycline 250 mg every 6 hours
 Ampicillin, Quinolones, sulfadiazine
 Metronidazole (Flagyl) 800 mg TID x 5 days
 Strptomycin SO4, Chloramphenicol
 F&E balance
 Nsg. Mx
 Observe isolation & enteric precaution
 Provide health education & instruct patient to:
 Boil water for drinking or use purified water
 Avoid washing food from open drum or pail

 Cover leftover food

 Wash hands after defecation or before eating

 Avoid ground vegetables ( lettuce, carrots, etc)

 Prevention:

 Health education
 Sanitary disposal of feces
 Protect, chlorinate & purify drinking water
 Observe scrupulous cleanliness in food
preparation & food handling
 Detection & tx of carriers
 Fly control ( they can serve as vectors)
CNS Infections
 MENINGITIS
( Cerebrospinal fever)
 Is the inflammation of the meninges of the brain
and spinal cord as a result of viral or bacterial
infection.
 IP : varies from 1-10 days
 MOT : respiratory droplet
direct invasion through otitis media
may result after skull fructure
 Caused by bacterial pathogen, N.
menigitidis, H. Influenza, Strep.
Pneumoniae, Mycobacterium
Tuberculosis
 Clinical manifestations

 headache
 irritability
 fever
 neck stiffness
 pathologic reflexes: kernig’s, Babinski,
Brudzinski
 Diagnostics:
 Lumbar puncture
 Gram staining

 Smear and blood culture

 Urine culture
Supportive/Symptomatic:

 a. Antipyretic
 b. treat signs of increased ICP
 c. Control of seizures
 d. adequate nutrition
Poliomyelitis/Infantile Paralysis/ Heine
Medin Disease
- acute infectious disease characterized by changes in the
CNS which may result in pathologic reflexes, muscle
spasm and paralysis
- it is a disease of the lower neurons, and there is
anterior horn involvement
CA: Filterable Virus ( Legio Debilitans)
 3 Strains:
 Legio Brumhilde
 Legio Lansing
 Legio Leon ( rare)
MOT: The virus is transmitted from person to person
by:
1. indirectly through contaminated articles and
flies, contaminated water, food & utensils
2. Intimate contact w/ infected person
3. Direct contact thru nasopharyngeal secretions
Dx: 1.Pandy’s test – culture of CSF (increased CHON)
 2. Stool culture throughout the disease

 3. Isolation of the virus from throat washings or swab

early in the disease
 IP: 7-21 days
 Period of Communicability: first three days after
onset of S/SX until three months of illness
 The disease is most contagious during
the first few days of active disease,
and possibly from 3-4 days before that
 Types of Polio:
1. Abortive or inapparent type –does not
invade the CNS ( fever, malaise, sore throat,
headache, N&V) pt. usually recovers within 72
hours
2. Non-paralytic – all the above signs;
marked w/ meningeal irritation; pain in the
neck, back, arms legs & abdomen; inability to
place the head in between the knees; (+)
pandy’s test; more severe than abortive type (
3. Paralytic polio – s/sx listed above are
present; flaccid asymmetrical ascending
paralysis (Landry’s sign),
(+) Hoyne’s sign (head drop),
Poker’s sign (opisthotonus), (+) Kernig and
Brudzinski sign
4. Bulbar ( Brain stem) –develops rapidly & is
the more serious type; motor neuron in the
brainstem is attacked & affects the medulla. It
weakens the muscles supplied by the cranial
nerves especially the 9th ( glossopharyngeal)
& 10th ( vagus); facial, pharyngeal & ocular
muscles are paralyzed; respiratory failure &
cardiac irregularities
 Predisposing causes
 Age – about 60% of patients are under 10 yrs of
age
 Sex – males are more prone to the disease than
females with a ratio of 3:2
 Heredity – poliomyelitis is not hereditary
 Environment & hygienic condition. The rich are
more often spared than the poor. Excessive
work, strain, marked overexertion are also
factors causing the disease.
 Pathology
 The organism enters the body through the
alimentary tract, multiplies in the oropharynx &
lower intestinal tract.
 Then the organisms are spread to the regional
lymph nodes & the blood
 There seems to be subsequent congestion,
edema & necrosis in the area
 Complications
 Respiratory failure
 Circulatory collapse
 Electrolyte imbalance
 Bacterial infection
 Urinary problems r/t retention or paralysis of
the urinary bladder
MGMT:
 Analgesics for pain. Morphine is contraindicated
because of the danger of additional respiratory
suppression.
 CBR

 Moist heat application may reduce spasm & pain

 Paralytic polio requires rehabilitation using physical

therapy , braces, corrective shoes & in some cases,
orthopedic surgery
Prevention:
 Active – OPV (Sabin) and IPV (Salk)
 Nursing Management:
 Carry out enteric isolation
 Observe the patient carefully for paralysis & other
neurologic damage
 Perform neurologic assessment 1x a day
 Check BP regularly especially in bulbar polio
 Maintain good personal hygiene, particularly oral care &
skin care
 Provide emotional support both to patient & family
 Dispose excreta & vomitus properly
 Apply hot packs to affected limb to relieve pain &
muscle shortening
 Tetanus/Lockjaw/Trismus
CA:
 Clostridium tetani (gram (+), spore forming,
anaerobic ( survives w/o air) non-motile,
vegetative( ability to grow)
 Produces potent exotoxin
 Tetanus spores are introduced into the wound
contaminated with soil
 IP: 4-21 days
 Tetanus neonatorum - umbilical cord
 Pathophysiology
Clostridium tetani in puncture wound

Release of Neurotoxin (Tetanospasmin)

Hemolysin ( tetanolysin

attack PNS and CNS

GABA and Glycine inhibited

Tetanic spasm
 Clinical manifestations

 Difficulty of opening the mouth

(trismus or lockjaw)
 Risus sardonicus ( sneering grin) – “ngiting aso”
 Dysphagia
 Generalized muscle rigidity
 Opisthotonus ( severe arching of the back)
 Localized or generalized muscle spasm
 Respiratory paralysis to death
Neonatal Tetanus (Wrinkled brow and risus sardonicus)
Source: Color Guide to Infectious Diseases, 1992
S/Sx:
Neonatal tetanus - Poor sucking, irritability,
excessive crying, grimaces, intense rigidity, and
opisthotonus
Criteria Stage I Stage II Stage III

Incubation Period > 11 days 8-10 days <7days

Trismus mild moderate Severe

Muscle rigidity mild Pronounced Severe, boardlike

Spasm absent Mild, short Frequent,

prolonged

Dyspnea, absent absent Present

cyanosis
Dx: history, leukocytosis, serum antitoxin levels

Mgmt:
Anticonvulsant, muscle relaxants, antibiotics, wound
cleansing and debridement
Active-DPT and tetanus toxoid
Passive-TIG and TAT, placental immunity
 Tetanus
Treatment:
1. Specific :
-within 72 hours after punctured wound 
received ATS,TAT or TIG espicially if no
previous immunization
- Pen G to control infection
- muscle relaxant to decrease muscle rigidity.
2. Non-specific
- oxygen inhalation
 Treatment:
anti-toxin
 Tetanus Anti-Toxin (TAT)
Adult,children,infant 40,000 IU ½ IM,1/2 IV
Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
 TIG
Neonates 1000 IU, IV drip or IM
Adult, infant, children 3000 IU, IV drip or IM
 Pre exposure prophylaxis
 DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
 TT – 0.5 ml IM
TT1 6 months within preg
TT2 one month after TT1
TT3 to TT5 every succeeding preg or every year
Antimicrobial Therapy
Penicillin !-3 mil units q 4hours
Pedia 500000 – 2mil units q 4 hrs
Neonatal 200000 units IVP q 12hrs or
q8hrs
 3 types of patients w/ skin wounds
post exposure prophylaxis

1. (+) immunization as a child w/ boosters but

last shot > 10 yrs – give TT + TIG/TAT
2. (-) immunization - TT + TIG/TAT

3. (+) tetanus – TIG/TAT + TT + Abx + wound

cleansing + supportive therapy
Control of spasms
 diazepam

 chlorpromazine
Preventive Measures
 Treatment of wounds

 Tetanus toxoid (0,1,6,1,1)

 Rabies

 CA: GenusLyssavirus, Family

Rhabdoviridae ( RNA virus)

 Bite/wound setting
 acute viral encephalomyelitis
 incubation period is 4 days up to 19 years
 risk of developing rabies, face bite 60%, upper
extremities 15-40%, lower extremities 10%
 100% fatal
 Pathophysiology
Bite/wound

Local wound replication

CNS encephalitis

ANS

Salivary glands, adrenal medulla, kidney, lungs, skeletal

muscles, skin, heart
 Rabies Virus
The rabies virus is usually transmitted to humans by a bite from an infected dog, but the bite
of any animal (wild or domestic) is suspect in an area where rabies is present. Symptoms of
the disease appear after an incubation period of ten days to one year and include fever,
breathing difficulties, and muscle spasms in the throat that make drinking painful. Death
almost invariably occurs within three days to three weeks of the onset of symptoms. For this
reason, the emphasis of treatment is on prevention. In the United States, veterinarians
recommend regular vaccination of domestic dogs.
 Clinical Manifestation
 pain or numbness at the site of bite
 fear of water
 fear of air

4 STAGES
1. prodrome - fever, headache, paresthesia,
2. encephalitic – excessive motor activity,
hypersensitivity to bright light, loud noise,
hypersalivation, dilated pupils
3. brainstem dysfunction – dysphagia,
hydrophobia, apnea
4. death
Dx: history
virus isolation from saliva and CSF
serial serum Ab sample
Staining of brain tissue (dog) - Negri bodies
 Postexposure prophylaxis
Category I Observe the dog for 14 days
Licking of intact skin

Category II 1.Activevaccine
Abrasion, laceration, punctured 2.Observe dog for 14 days
wound on the lower extremities

Category III
Abrasion, laceration on upper 1.Active
extremities, head and neck 2.Passive
Dog is killed, lost, died
 Category of bites
 I – intact skin (lick or scratch)
 II – mucosal, non bleeding wounds, abrasions

 III – bleeding bites and above neck, stray dogs,

laceration, multiple bites
Mgmt:
- wound cleansing
- tetanus prophylaxis
- Observe and quarantine dog for maniacal s/sx
- Active- antirabies vaccine (human diploid cell
vaccine)
- 7-10 days to induce an active immune response,
with immunity x 2 years
- Passive – human rabies immunoglobulin
Management
 No treatment for clinical rabies

 Prophylaxis
Active vaccine (PDEV,PCEC,PVRV)
 Intradermal (0,3,7,30,90)
 Intramuscular (0,3,7,14,28)
 (0,7,21)
 Post exposure prophylaxis
 Antirabies vaccine
1 ml IM
day 0, 3, 7, 14, 28

OR
0.1 ml ID
day 0 (8 sites), 7 (4 sites), 28, 91 (1 site)

OR
0.1 ml ID
day 0, 3, 7 (2 sites), 30, 90 (1 site)

 Rabies immunoglobulin (HRIG/equine antiserum)

20/40 units/kg IM
single shot
wound 40%, deltoid 60%
Passive Vaccine
 a. ERIG wt in kg x .2 = cc to be injected im
(ANST)
 b. HRIG wt in Kg x .1333
Pre-exposure Prophylaxis
 Intradermal/Intramuscular (0,7,21)
Infection control
 Patient is isolated to prevent exposure of
hospital personnel, watchers and visitors
 PPE

Preventive Measures
 Education

 Post-exposure and Pre-exposure Prophylaxis

 SNAKEBITE

Neurotoxic Slow swelling Ptosis, Cobra

then necrosis respiratory
paralysis,
cardiac
problems

Myotoxic None Myalgia on Sea snake

moving
paresis

Vasculotoxic Rapid Bleeding Vipers

swelling abnormalities
 Management

 Lie the victim flat

 ice compress and constrictive materials are
contraindicated
 Transport the patient to the nearest hospital
 Antivenim administration in patient’s with signs of
envenomation
 It is never too late to give anti-venim
 Antivenim is given thru intravenous
infusion, which is the safest and most
effective route. 2-5 ampules plus D5W to run
over 1-2 hours every 2 hours
 Antimicrobial therapy
 sulbactam/Ampicillin or co-amoxiclav
 Substitute
 Prostigmine IVinfusion, 50-100ug/kg/dose
q 8hrs
 Atropine
Skin Transmission Diseases
 Leprosy/Hansen’s disease
 Chronic communicable disease of the skin & the
peripheral nerves
 Causative Agent: Mycobacterium Leprae, acid fast bacilli
 MOT: may be due to prolonged
skin-skin contact or droplets
 IP - years to decades

 Active immunization (BCG)

 Types of Leprosy:
 1. Lepromatous or Nodular or Gravis ( most
severe) Early s/sx: many lesions or patches
 2. Tuberculoid – high resistant, less severe
 3. Mixed type or Borderline or Dimorphous
 4. Indeterminate
TYPES:
PAUCIBACILLARY
1. Early/Indeterminate – hypopigmented /
hyperpigmented anesthetic macules/plaques
2. Tuberculoid – solitary hypopigmened hypoesthetic
macule, neuritic pain, contractures of hand and foot,
ulcers, eye involvement ie keratitis
MULTIBACILLARY
1. Lepromatous – inability to close eyelids “unblinking
eyes” ( lagophthalmos) multiple lesions, Loss of lateral
portion of eyebrows (madarosis), corugated skin
(leonine facies), septal collapse (saddlenose) clawing of
fingers & toes, loss of digits, enlargement of male
breasts ( gynecomastia)
2. Borderline – between lepromatous and tuberculoid
Leprosy (Hansen's disease)
Severe Bone Destruction in Advanced Leprosy

Source: Diagnostic Picture Tests in Infectious Diseases, 1994

 Mgt:
 Domiciliary home treatment ( RA 4073)
 Multi Drug Therapy ( MDT) – use of 2 or
more drugs for the tx of leprosy. Proven
effective cure for leprosy & renders patients
non-infectious a week after starting treatment.
 Paucibacillary- Rifampicin and Dapsone
 Multibacillary-Rifam,Dapsone,Clofazimine
 Diaminodiphenylsulfone DDS( Dapsone)
 Rifampicin
 Clofazimine (lamprene)
 Treatment is from 9 mos to 18 mos(2 years )

Pediculosis
Blood sucking lice/Pediculus humanus
p. capitis-scalp
p. palpebrarum-eyelids and eyelashes
p. pubis-pubic hair
p. corporis-body

MOT: skin contact, sharing of grooming implements

s/sx: nits in hair/clothing, irritating maculopapular or urticarial rash
Mgmt: disinfect implements, Lindane (Kwell) topical
Permethrin (Nix) topical
CX: impetigo to AGN, RHD
Scabies
 Sarcoptes scabiei
 Pruritus (excreta of mites)
 Mites come-out from burrows to mate
at night

MOT: skin contact

s/sx: itching worse at night and after hot

shower; rash; burrows (dark wavy lines
that end in a bleb w/ female mite) in
between fingers, volar wrists, elbow,
penis; papules and vesicles in navel,
axillae, belt line, buttocks, upper thighs
and scrotum
Dx: biopsies/scrapings of lesions

Mgmt: Permethrin (Nix) cream, crotamiton

cream, Sulfur soap, antihistamines and calamine
for pruritus, wash linens with hot water, single
dose of Ivermectin, treat close contacts
Emerging Diseases
Severe Acute Respiratory Syndrome
(SARS)
 is a respiratory disease in humans which is caused
by the SARS Coronavirus .
 SARS appears to have started in Guangdong Province,
China in November 2002.  Pandemic

 MOT : direct Mucous membrane/ droplet /

exposure to fomites.
 Virus is stable in urine/feces for 1-2 days ; for patient
with diarrhea up to 4 days.
 IP: 2-7 days ( max 10d)
 Mortality rate – 5% only

 Heat at 56 c rapidly kills the virus

 Severe Acute Respiratory Syndrome
(SARS)

 Clinical criteria :
 1. Asymptomatic or mild respiratory illness , fever >38c (
>100.4 F )
 2.One or more clinical finding of respiratory illness
 cough / shortness of breath / DOB /hypoxia
 Epidemiologic Criteria:
 Contact (sexual or casual) with someone with a diagnosis of SARS
within the last 10 days OR
 Travel to any of the regions identified by the WHO as areas with
recent local transmission of SARS (affected regions as of 10 May
2003 were parts of China, Hong Kong, Singapore and the province of
Ontario, Canada).
 SARS
 Treatment
 Antibiotics are ineffective as SARS is a viral disease.
 supportive with antipyretics, supplemental oxygen and
ventilatory support as needed.
 Preventive measures ( HEALTH TEACHING)
 Consult doctor promptly – early treatment is the KEY
 Build up good body immunity
 Maintain good personal hygiene
 Wear mask if develop runny nose, cough
 Wear protective mask in public areas
 Wash hand properly and keep them clean
 Droplet & contact PRECAUTION
 BIRDS FLU
 is an AVIAN FLU , a type of influenza known
to exist worldwide.
 Etiologic agent : avian influenza H5N1 strain
 MOT : spread in air and manure.
 Transmitted through contaminated feeds, water,
equipment, and clothing
 No evidence that virus can survive in well cooked
meat
 Spread rapidly among birds not infect human easily
 No confirmed human-human transmission
 Bird Flu
 Human cases of influenza A (H5N1)
infection have been reported in :
 Cambodia

 China

 Indonesia

 Thailand

 Vietnam.
 BIRDS FLU
 Incubation period : 3-5 days
 S/sx :
 Symptoms in animal vary - can cause death within few
days
 In human – same as in human influenza
 Fever/ sorethroat/ cough/ severe cases Pneumonia.
 The highly pathogenic form spreads more rapidly
through flocks of poultry. This form may cause
disease that affects multiple internal organs and has a
mortality rate that can reach 90-100% often within 48
hours.
 BIRDSFLU
 Prevention & treatment
 Avian influenza in human can be detected with :
STANDARD INFLUENZA TEST
 Antiviral drugs – clinically effective in both
preventing and treating the disease.
 oseltamavir and zanamavir
 Vaccines  take at least 4 months to produce and
must be prepared for each sub-type
 Nursing Intervention :
Health Teaching
 Wash hands with soap and warm water for at least 20 seconds before and
after handling raw poultry and eggs.

 Clean cutting boards and other utensils with soap and hot water to keep raw
poultry from contaminating other foods.

 Use a food thermometer to make sure you cook poultry to a temperature of

at least 165 degrees Fahrenheit Consumers may wish to cook poultry to a
higher temperature for personal preference.

 Cook eggs until whites and yolks are firm.

 FYI
 There are only three known A subtypes of
influenza viruses (H1N1, H1N2, and H3N2)
currently circulating among humans.
 Influenza A viruses are constantly changing, and
they might adapt over time to infect and spread
among humans.
END
 Important concepts of Public
Health Nursing
 Science and art of preventing disease,
prolonging life and efficiency
WINSLOW
 Highest level of physical, mental, and
social well being
HANLON
 Promotion of clients OLOF; learned practice
principle
JACOBSON
 Service rendered professional nurse;
Prevention, Promotion, Curative and
Rehabilitative
FREEMAN
 Worth and Dignity of man

MARGARET SHETLAND
 NURSING PROCEDURES
CLINIC VISIT

 Registration/Admission
 Waiting time
 Triaging
 Triage Priority Color Conditions

category Triage in Disaster

Immediate 1 RED Chest
wounds,
shock, open
fractures, 2-3
burns

Delayed 2 YELLOW Stable

abdominal
wound, eye
and CNS
injuries

Minimal 3 GREEN Minor burns,

minor
fractures,
minor
bleeding

Expectant 4 BLACK Unresponsive,

high spinal
cord injury
 Clinical Evaluation (Nursing Process)
 Laboratory/Diagnostic Test
 Referral system
 Prescription/Dispensing
 Health Education
 HOME VISIT
-Family-nurse contact which allows HW
to ASSESS and PROVIDE nursing
care.

KNOW FIRST!
1. Purpose
CBQ: EAR
2. Priciples
CBQ: PLANNING
F – lexible
N – eeds priority
R – ecords

3. Frequency
Willingness
 Steps in HV
 Greet
 State
 Observe
 Bag Technique
 Perform
 Record
 Return
 BAG TECHNIQUE
CBQ:
1. Which of the following is an
important tool that a PHN must
carry during HV?
a.Vaccines b.Umbrella
c. Batuta d. PHN Bag
CBQ:
2. Which principle of bag technique is
important to prevent infection:
a. Put on an Apron b. Open bag gently
c. Apply alcohol d. Handwash
  Principle

Prevent INFECTION
BP apparatus are carried
separately
 EPIDEMIOLOGY
- Deals with

Occ
Dist
Det
Imp
Epidemiologic Triangle

HOST
AGENT
ENVIRONMENT
Infection Control Signage
Universal Precaution Materials
Infection Control Signage
Infection Control Signage
Infection Control Signage
CBQ:
Function of PHN during epidemic:
 Implement ____________

 _____________ Personnel

 Conduct _______________

 Evaluate _______________

 _____________Financial Report

 Inventory and ___________of

equipment
CBQ:
5. The following are roles of nurses during
an epidemic, except:
a. Isolate cases

b. Educate the public

c. Refer cases

d. Accomplish records/reports

e. Diagnose medical condition

 PUBLIC HEALTH PROGRAMS

1. Maternal Health Programs

 BEMOC
 Antenatal Registration
 Micronutrient Supplementation
 Safe Delivery
 Manage diseases during pregnancy
2. FAMILY PLANNING PROGRAM
3. CHILD HEALTH PROGRAMS

 Infant and Young Child Feeding

Goal: Reduce Mortality by 2/3 2015
Breast milk/breast feeding
Complimentary Feeding
Law that protects INFANT and
YOUNG CHILD feeding

• Milk Code
• Rooming IN and Breast feeeding Act
of 1992
• Food fortification law
Staple foods

S
E
R
F
3. EXPANDED PROGRAM ON
IMMUNIZATION

CBQ:
You are in charge of the Rural Health
Unit. For your immunization activities,
you see to it that you have adequate
supply of vaccines. This year 300
infants are due to DPT and Measles.
CBQ:
6. To complete the DPT immunization for
infants, you vaccine good for:

a. 300 doses b. 600 doses

c. 900 doses c. undetermined
CBQ:
6. To complete the Measles immunization
for infants, you vaccine good for:

a. 300 doses b. 600 doses

c. 900 doses c. undetermined
MANAGEMENT OF CILDHOOD
ILLNESS

MILD
(Home care)
MODERATE
(Management at RHU)
SEVERE
(Referral)
 URGENT REFFERAL
OUT PATIENT FACILITY
Triage
CHECK FOR DS! Diagnosis
CUVA Treatment
Follow up
Assess MAIN SYMPTOMS
Cough/DOB
Diarrhea MANAGE AT RHU
Fever
Ear Problems Treat local infection
Give oral drugs
Assess NUTRITION, Follow up
IMMUNIZATION, and VITAMIN
A supplementation, potential
FEEDING Problems
HOME TREATMENT
Classify Conditions according to
COLOR
Follow up
 NUTRITION PROGRAM

 ASAP “Araw ng Sangkap

Pinoy”/Garantisadong Pambata
2x a year
Vitamin A, Iron and Iodine
 ORAL HEALTH PROGRAM

 Philippines rank 2nd WORST among

21 Western Pacific countries

GOAL: Reduce the rate of dental

caries and periodontal diseases
 NON COMMUNICABLE DISEASE
PREVENTION AND CONTROL

1. Cardiovascular disease
Hypertension
Coronary Artery Disease
Cerebrovascular accident(Stroke)
2. CANCER
C - change in bowel/bladder
A - a sore that does not heal
U - unusual bleeding/discharge
T - thickening of lump
I - indigestion/dysphagia
O - obvious change in mole
N - nagging cough/hoarseness
U - unexplained anemia
S - sudden unexplained wl
3.DIABETES MELLITUS

4. COPD
 COMMON RISK FACTORS
RF CVD DM Ca COPD
Smoking    
Nutrition/Diet    
Physical inactivity    
Obesity    
Alcohol    
Hypertension    
High blood    
glucose
Blood lipids    
CIGARETTE HAS

 TAR, damage air sacs sauses Ca

 NICOTINE, addicting
 CO, hypoxia
 ACETONE, nail polish
 AMMONIA, toilet cleaners
 ARSENIC, rat poison
 BUTANE, cigarette lighter
 CADMIUM, rechargeable battery
 FORMALIN, preserve dead body
 METHANE, gasoline
 NAPTHALENE, moth balls
 NITROUS OXIDE, disifectant
 STEARIC ACID, candle wax
 VINYL CHLORIDE, PVC pipe
 DDT, insecticide
HOW?
Nurse, Help!

A - ASK
No. Cigarettes
Duration
Age started
Pattern of inhaling
HOW?
Nurse, Help!

A - ADVISE TO STOP
Motivate to quit
Encourage Complete cessation
Discuss alternatives
HOW?
Nurse, Help!

A - ASSIST
Develop plan
Provide Materials
Set a QUIT DATE
HOW?
Nurse, Help!

A - ARRANGE FOLLOW UP
Other DOH Programs

NATIONAL BLINDNESS
PREVENTION PROGRAM

 Vision: Right to Sight!

 Goal: Provide Quality Eye care
Other DOH Programs

RENAL DISEASECONTROL
PROGRAM
(REDCOP)

 Vision: Reduce No. of Kidney

diseases!
 Remember:

 Common cause: CGN

 Implementing Agency: NKTI
 Kidney transplant
 ORGAN DONATION ACT
RA 7170

 Heart Bone Marrow

 Liver Skin
 Pancreas Kidneys
 Lungs
 ORGAN DONATION ACT
RA 7170

 Brain Dead
 Informed Consent

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results
in the patient's authorization or agreement to undergo a specific medical intervention.

“informed consent” describes the physician's duty to disclose to the patient the risks and hazards of medical care that would influence a reasonable person's decision
to give or withhold consent to that treatment
 COMMUNITY BASED
REHABILIATION PROGRAM

 Disabled Persons
 Goal: Improved quality of life

To PWD’s
RA 7277 Magna Carta for Disabled
Persons
NATIONAL TUBERCULOSIS
CONTROL PROGRAM

 Mission: TB DOTS are

A____________
A____________
A____________
 WATER SUPPLY SANIATION
PROGRAM

Sanitation Code: PD 856



 Approved types:

LEVEL I: Point Source 15-25 households

LEVEL II: Communal faucet or House
hold 100 households
LEVEL III: WATER WORKS SYSTEM
FOOD SANITATION PROGRAM

4 R’s in Food Safety

So_________
 Buy _________

 Avoid ________

 Clean and ________

 Boil atleast ____ min.

FOOD SANITATION PROGRAM

4 R’s in Food Safety

Pr _________
 Avoid contact with ____ foods

 ___________ milk

 Wash _____ and kitchen _______

 Remove food droppings

 FOOD SANITATION PROGRAM

4 R’s in Food Safety

Co_______
 Cook foods at___degrees centigrade
 Eat foods immediately

 Wash hands
 FOOD SANITATION PROGRAM

4 R’s in Food Safety

St___________
“When in doubt, throw it out”
 Left over not more than ___ hrs.

 Store in tightly sealed containers

 Store either above 60 degrees or below

10 degrees
  Former QAP
 Goal: Quality health care, service and
facilities
 NATIONAL VOLUNTARY
BLOOD SERVICE PROGRAM

RA 7719 Blood Services Act 1994

 National Voluntary Blood Services
Program
 PRC

 PBCC
 BOTIKA NG BARANGGAY

DOH Admin. Ord. 23 A

“cut half the price of drugs thru Pharma project”
 Analgesics/antipyretics
 Antacid
 Antihelmintics
 Anti histamine
 NSAID’s
 Anti vertigo
 Diuretics
 Bronchodilators/cough
 Anti tussives
 Nasal decongestants
 Antimotility
 Oral hydrations
 Laxatives/cathartics
 Anti anemic
 Anti scabies
 Anti fungal
 Vitamins
 Minerals
 Antiinfectives
 Disinfectants
 Topical nasal
decongestants
 Other medications
for chronic diseases
here's a little info on the people currently
sitting in the BON:

>Carmencita Abaquin, RN, MAN

formerly connected to UP-CN
focus is on Medical-Surgical Nursing

>Marco Antonio Sto. Tomas, RN, MAN

former dean of St. Joseph's College in
Cavite
>Perla Po, RN, MAN
formerly connected to UP-CN
focus is on Psychiatric Nursing

> Leonila Faire, RN, MAN

formerly connected to UP-CN and
Nursing Services of PGH
focus is on Medical Surgical Nursing and
Obstetrics
> Yolanda Arugay, RN, MAN
former dean of Philippine Women's
University
focus is on Medical Surgical Nursing

> Betty Meritt, RN, MAN

formerly connected to UP-CN
focus is on Psychiatric Nursing

Amelia Rosales, RN, MAN

former dean of Makati Medical Center-CN
focus is on Medical Surgical Nursing