Communicable Diseases Handouts)

Communicable DiseasesPocholo Santos

COMMUNICABLE DISEASE

It is an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agent, vector or inanimate object.

TWO TYPES:

Infectious Disease - Not easily transmitted by ordinary contact but require a direct inoculation through a break in the previously intact skin or mucous membrane

Contagious Disease - easily transmitted from one person to another through direct or indirect means.

Terminologies

Disinfection –destruction of pathogenic microorganism outside the body by directly applying physical or chemical means.

Concurrent – method of disinfection done immediately after the infected individual discharges infectious material/secretions. This method of disinfection is when the patient is still the source of infectionTerminal – applied when the patient is no longer the source of infection.

Disinfectant -chemical used on non living objectsAntiseptic – chemical used on living things.Bactericidal – kills microorganismSterilization – complete destruction of all microorganism

General Principles

Pathogens move through spaces or air current Pathogens are transferred from one surface to

another whenever objects touch Hand washing removes microorganism Pathogens are released into the air on droplet

nuclei when person speaks, breaths, sneezes Pathogens are transferred by virtue of gravity Pathogens move slowly on dry surface but

very quickly through moisture

INFECTION

invasion and multiplication of microorganisms on the tissues of the host resulting to signs and symptoms as well as immunologic response

injures the patient either by:o competing with the host’s metabolism o cellular damage produced by the microbes

intracellular multiplication.

CLASSIFICATION ACCORDING TO INCIDENCE

Sporadic - disease that occur occasionally and irregularly with no specific pattern

Endemic – those that are present in a population or community at times.

Epidemic – diseases that occur in a greater number than what is expected in a specific area over a specific time.

Pandemic – is an epidemic that affects several countries or continents

CAUSES OF INFECTION

Some bacteria develop resistance to antibiotics Some microbes have so many strains that a single

vaccine can’t protect against all of them ex. Influenza

Most viruses resist antiviral drugs Opportunistic organisms can cause infection in

immunocompromised patients Most people have not received vaccinations . Increased air travel can cause the spread of virulent

microorganism to heavily populated area in hours Use of immunosupressive drugs and invasive

procedures increase the risk of infection Problems with the body’s lines of defense

THREE LINES OF DEFENSE

First line of defenseo Mechanical Barrierso Chemical Barrierso Body’s own pop of microorganisms -

“microbial antagonism principle” Second – inflammatory response

o Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs

Third – immune response o Natural/Acquiredo Active/passive

RISK FACTORS

Age, sex, and genes Nutritional status, fitness, environmental factors General condition, emotional and mental state Immune system Underlying disease ( diabetes mellitus, leukemia,

transplant) Treatment with certain antimicrobials ( prone to

fungal infection), steroids, immunoisuppresive drugs etc.

CHAIN OF INFECTION

MODE OF TRANSMISSION

Contact transmission o Direct contact - person to persono Indirect - thru contaminated objecto Droplet spread - contact with respiratory

secretions thru cough, sneezing, talking. Microbes can travel up to 3 feet.

Airborne Transmission Vector Borne Transmission Vehicle Borne Transmission

EMERGING INFECTIOUS DISEASES

Developing resistance to antibiotics eg: anti tb drugs, MRSA, VRE

Increasing numbers of immunosuppressed patients. Use of indwelling lines and implanted foreign bodies

has increased.

INFECTION CONTROL MEASURES

Universal Control Measures – All blood, blood products and secretions from patients are considered as infected


Work Practice Control

Used needles and sharps shall not be bent, broken, recapped. Used needles must not be removed from disposable syringes.

Eating, drinking, smoking, applying cosmetics or handling contact lenses are prohibited in work areas.

Foods and drinks shall not be stored in refrigerators, freezers where blood or other infectious materials are stored.

All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, or spraying.

Masking – Wear mask if needed. Patient with infectious respiratory diseases should wear mask.

Handwashing – Practice it with soap and water. Gloving – Wear gloves for all direct contact with

patients. Change gloves and wash hands every after each patient.

Gowning - Wear gown during procedures which are likely to generate splashes of blood or sprays of blood and body fluids, secretions or excretions.

Eye protection (goggles) – wear it to prevent splashes.

Environmental disinfection – Clean surfaces with disnfectant (70% alcohol,diluted bleach)

ISOLATION PRECAUTIONS

separation of patients with communicable diseases from others so as to reduce or prevent transmission of infectious agents.

7 Categories Recommended in isolation

Strict isolation – prevent spread of infection from patient to patient/staff.- handwashing, infectous materials must be discarded, use of single room, use of mask, gloves and gowns and (-) pressure if possible

Contact isolation – prevent spread by close or direct contactRespiratory isolation – prevent transmission thru air.

TB isolation – for (+)TB or CXR suggesting active PTB.

Enteric Isolation – direct contact with feces Drainage/secretion precaution- prevent infection

thru contact with materials or drainage from infected person.

Universal Precaution – for handling blood and body fluids.( bloods, pleural fluid, peritoneal fluid etc.)

PREVENTION

Immunization – introduction of specific antibody to produce immunity to certain disease.

Natural – passive (from placenta), active (thru immunization & recovery from diseases)

Artificial – passive (antitoxins), active (vaccine, toxoid)

Maintain vaccine potency by preventing:

Heat and sunlight Freezing Antiseptic/ disinfectants/ detergents lessen the

potency of vaccine. Use water only when cleaning fridge/ref.

COLD CHAIN SYSTEM – maintenance of correct temperature of vaccines, starting from the manufacturer, to regional store, to district hospital, to the health center to the immunizing staff and to the client.

DISEASES ACQUIRED THRU RESPIRATORY

TUBERCULOSIS

Chronic respiratory disease affecting the lungs characterized by formation of tubercles in the tissues---> caseation –--> necrosis ---> calcification.

AKA: Phthisis, Consumption, Koch’s, Immigrant’s dse

Etiologic agent: – Mycobacterium tuberculosis Incubation period: 2 – 10 wks. Period of communicability: all throughout the life

if not treated MOT: Droplet Sources of infection – sputum, blood, nasal

discharge, saliva Classification

1. Inactive – asymptomatic, sputum is (-), no cavity on chest X ray

2. Active – (+) CXR, S/S are present, sputum (+) smear

Classification 0-51. Minimal – slight lesion confined to small part of

the lung2. Moderately advanced – one or both lungs are

involved, volume affected should not extend to one lobe, cavity not more than 4 cm.

3. Far advance – more extensive than B

Manifestations

Primary Complex (TB in children): non contagious o children swallow phlegmo fevero cough o anorexiao weight losso easy fatigability

Adult TBo afternoon rise in temperatureo night sweatso weight losso cough dry to productiveo Hemoptysiso sputum AFB (+)

Milliary TB - very ill, with exogenous TB like Pott’s disease

Primary Infectiono Asymptomatico No manifestations even at CXR, Sputum

AFB Primary Complex

o Minimal manifestationo Lymphadenopathy

Diagnosis

Tuberculin testing Chest X-Ray Sputum AFB

Prevention

BCG Avoid overcrowding Improve nutritional status

Treatment

DOTS 6 months of RIPE Respiratory isolation,

Inhalation

Tubercle

lesions (Ghon’s Tubercl

e)

Granuloma

Caseation

Necrosis

Fibrosis

Scarring


Take medicines religiously – prevent resistance Stop smoking Plenty of rest Nutritious and balance meals, increase CHON, Vit.

A, C

MENINGITIS

Acute meningococcemia - with or without meningitis

o Waterhouse Friederichsen Syndrome Inflammation of the meninges usually some

combination of headache, fever, stiff neck, and delirium

Meningococcemia: cerebrospinal fever Etiologic agent: Neisseria meningitides Incubation: 2-10 days MOT: droplet

Diagnostics

Lumbar tap, CSF - high WBC and CHON, low glucose

Manifestations

Sudden onset of fever x 24h Petechiae, Purpuric rashes Meningeal irritation

o Stiff necko Opisthotonus o Kernig’s signo Brudzinski sign

ALOC S/S of Increase ICP

Nursing Management

Administer prophylactic antibiotics: Rifampicin - drug of choice

Aquaeous Pen Mannitol Dexamethasone Priority: AIRWAY, SAFETY Maintain seizure precaution Respiratory precaution Handwashing Suction secretions

DIPTHERIA

Acute contagious disease characterized by generalized toxemia coming from localized inflammatory process

Etiologic agent: Corynebacterium Diptheria (Klebs loffer bacillus)

Incubation period: 2-5 days Period of communicability: variable, ave:2-4

weeks MOT – Droplet, direct or intimate contact, fomites,

discharge from nose, skin, eyes

Manifestations

Pseudomembrane - grayish white, smooth, leathery and spider web like structure that bleeds when detached

Types of Respiratory Diptheriao Nasal

serous to serosanginous purulent discharge

Pseudomebrane on septum

Dryness/ excoriation on the upper lip and nares

o Pharyngeal pharyngeal pseudomembrane bull neck ( cervical adenitis) Difficulty swallowing

o Laryngeal Sorethroat, pseudomemb Barking, dry mettallic cough

Complications

Due to Toxemiao Toxic endocarditiso Neuritiso Toxic nephritis

Due to Intercurrent Infectiono Bronchopneumoniao Respiratory failure

Diagnostics

Nose and throat swabs - culture of specimen form beneath membrane

Virulence test Shick’s test : test for susceptibility to diptheria Moloney’s test: for hypersensitivity to diphtheria

Management

Penicillin, Erythromycin Diptheria Antitoxin – after – skin test if (+),

fractional dose Supportive

o O2, if laryngeal obstruction – tracheostomyo CBR for 2 weekso Increase fluids, adequate nutrition- soft

food, rich in Vit Co Ice collar

Isolation till 3 negative cultures

Prevention

DPT

PERTUSIS (WOOPHING COUGH)

Repeated attacks of spasmodic coughing with series of explosive expirations ending in long drawn force inspiration

Etiologic agent: Bordetella pertusis or Haemiphilus pertussis

Incubation period: 7-14 days Period of communicability: 7 days post exposure

to 3 wks post disease onset MOT – DropleT

Manifestation

rapid cough 5-10x in one inspiration ending a high pitched whoop.

Catarrhal – slight fever in PM, colds, watery nasal discharge, teary eyes, nocturnal coughing, 1-2 weeks

Paroxysmal – Spasmodic stage; 5-10 successive forceful coughing ending with inspiratory whoop, involuntary micturition and defecation, choking spells, cyanosis

Convalescent – 4th- 6th week; diminish in severity, frequency

Complications


Otitis media Acute bronchopneumonia Atelectasis or emphysema Rectal prolapse, umbilical hernia Convulsions (brain damage - asphyxia, hemorrhage)

Diagnostics

Elevated WBC Nasopharyngeal swab

Nursing Management

Prevention:o DPT

Parenteral fluids Erythromycin - drug of choice Prone position during attack Abdominal binder Adequate ventilation, avoid dust, smoke Isolation Gentle aspiration of secretions

MEASLES

Sources of infection – secretions from eyes, nose and throat

Pathognomonic sign:o Koplik’s spots

Manifestations

Pre eruptive stage / Prodromal (10-11 days)o Coryza, Cough, Conjunctivitiso Koplik’s Spots, whitish spot at the inner

cheeko Fever, photophobia

Eruptive stageo Maculopapular rasheso Rash is fully developed by 2nd dayo High grade fever –on and offo Anorexia, throat is sore

Convalescence (7-10 days)o Desquamation of the skin

Diagnostics

Nose and throat swab

Treatment

Antiviral drugs- Isoprenosine Antibiotics – if with complications Supportive – O2, IVF

Complications

Bronchopneumonia otitis media encephalitis

Nursing Management

Preventive – measles vaccine at 9 months, MMR 15 months and then 11-12; defer if with fever, illness

Isolation - contact/respiratory TSB , Skin care – daily cleansing wash

Oral and nasal care Plenty of fluids Avoid direct glare of the sun- due to photophobia

GERMAN MEASLES

Mild viral illness caused by rubella virus. AKA: Rubella; 3-Day Measles Incubation period– from exposure to rash 14 -21d Period of communicability – one week before and

and 4 days after onset of rashes. Worst when rash is at it’s peak.

MOT: Droplet, nasal ceretions, transplacental in congenital

Manifestations

Prodromal – low grade fever, headache , malaise, colds, lymph node involvement on 3rd to 5th day

Eruptive – Forscheimer’s spots: pinkish rash on soft palate, rash on face, spreading to the neck, arms and trunk

o lasts1-5 days with no pigmentation or desquamation

o muscle pain

Treatment

symptomatic treatment

Complications

Encephalitis, neuritis Rubella syndrome – microcephaly, mental

retardation, deaf mutism, congenital heart disease RISK for congenital malformation

o 100% when maternal infection happens on first trimester of pregnancy.

o 4% - second/third trimester

Nursing Management

Isolation. Bed rest Room darkened – photophobia Encourage fluid like measles tx

Prevention

MMR, Pregnant women should avoid exposure to rubella patients

Administration of Immune serum globulin one week after exposure to rubella.

CHICKENPOX

Acute and highly contagious viral disease characterized by vesicular eruptions on the skin

Infectious agent – Herpes zoster virus or Varicella zoster

Incubation period – 10 -21 days Period of communicability: 1 day before eruption

up to 5 days after the appearance of the last crop MOT: airborne, direct, indirect

o Direct contact thru shedding vesicles,o Indirect thru linens or fomites

Manifestations

Pre eruptive: Mild fever and malaise Eruptive: rash starts from trunk Lesions - red papules then becomes milky and pus

like within 4 days, Pruritis Stages of skin affectations

o Macule – flat o Papule – elevated above the skin diameter

about 3 cmo Vesicleo Pustuleo Crust – scab , drying on the skin


Complications

pneumonia sepsis

Treatment

Zovirax 500mg tablet 1 tab BID X 7 days Acyclovir Oral antihistamine Calamine lotion Antipyretics

Nursing Management

Strict isolation until all vesicles scabs disappear Hygiene of patient Cut finger nails short Baking soda - pruritus

Prevention

Live attenuated varicella vaccine VZIG - effective if given 96h post exposure

HERPES ZOOSTER

Acute inflammatory disease known to be caused by herpes virus varicellae or VZ virus

Infection of the sensory nerve charac by extremely painful infection along the sensory nerve pathway

Occurs as reinfection of VZ virus MOT

o Directo Indirect – airborne

Incubation: 1-2 weeks

Diagnostic procedure

Hx of chickenpox Pain and burning sensation over lesions of vesicles

along nerve pathway Smear of vesicle fluid- giant cells Viral cultures of vesicle fluid Electron microscopy Giemsa-stained scraping – multinucleate giant

epithelial cells

Signs and Symptoms

Burning, itching, pain then erythematous patches followed by crops of vesicles

Eruptions are unilateral Lesions may last 1-2 weeks Fever, regional lymphadenopathy Paralysis of cranial nerve, vesicles at external

auditory canal Paralytic ileus, bladder paralysis, encephalitis

Complications

Opthalmia herpes – blindness because of damage of gasserian ganglion

Geniculate herpes – deafness because of infection of 7th CN (AKA: Ramsay Hunt Syndrome)

Nursing Intervention

Compress of NSS or alluminum acetate over lesions Analgesics, sedatives – weeks to mos Steroids Keep blister covered with sterile powder esp after

break Prevent bacterial invasion Encourage proper disposal of secretions and usage

of gown and mask

MUMPS

Acute viral disease manifested by swelling of one or both of the parotid glands, with occasional involvement of other glandular structures,particularly testes in male.

Etiologic agent – filterable virus of paramyxovirus group usually found in saliva of infected person.

AKA: Epidemic/ infectious parotitis Incubation period: 14 -25 days. Period of communicability – 6d before and 9d

post onset of parotid gland swelling 48 hrs immediately preceding the onset of swelling

is the highest communicability. MOT: direct, indirect - droplet, airborne

Clinical Manifestations

sudden headache, earache , loss of appetite swelling of the parotid gland pain is related to extent of the swelling of the gland

which reaches it’s peak in 2 days and continues for 7-10 days.

fever may reach 40 C during acute stage, one gland may be affected first and 2 days later the

other side is involved

Complications

Orchitis – testes are swollen and tender to palpation. Oophoritis- pain and tendeness of the abdomen Mastitis Deafness may happen Meningo-encephalitis –possible

Diagnostics

Viral Culture WBC count

Prevention

MMR Vaccine

Treatment Modalities

Antiviral drugs NSAIDS – Acetaminophen

Nursing Interventions

Symptomatic Application of warm/ cold compress Oral care, warm salt water gargle Diet – semi solid, soft food easy to chew

o Acid foods/fluids – fruit juices may increase discomfort


DISEASES ACQUIRED THRU GIT

Diseases caused by Bacteriao Typhoid Fever o Cholera o Dysentery

Diseases caused by Viruso Poliomyelitiso Infectious Hepatitis A

Diseases caused by Parasiteso Amoebiasiso Ascariasis

THYPHOID FEVER

infection of the GIT affecting the lymphoid tissues(ulceration of Peyer’s patches) of the small intestine

Etiologic Agent: Salmonella typhosa and typhi, Typhoid bacillus

Incubation period: 1-2 weeks Period of communicability: as long as the patient

is excreting the microorganism, MOT: fecal-oral route, contaminated water, milk or

other food Sources of Infection

o A person who recovered from the disease can be potential carrier.

o Ingestion of shellfish taken from waters contaminated by sewage disposal

o Stool and vomitus of infected person are sources of infection.


Ladderlike fever Nausea, vomiting and diarrhea RR is fast, skin is dry and hot, abdomen is distended Head-ache, aching all over the body Worsening of symptoms on the 4th and 5th day Rose spots

Complications

Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis

Diagnostics

WBC – elevated Blood Culture – (+) S. typhosa Stool Culture (+) Widal test – blood serum agglutination test

o antigen – active typhoido H antigen- previously infected or

vaccinatedo Vi antigen – carrier

Treatment

Chloramphenicol – drug of choice Paracetamol

Nursing Management

Restore FE balance

Bedrest Enteric precautions Prevent falls/safety precautions WOF intestinal bleeding

o Bloody stoolso Sweatingo Pallor

NPO, BT

CHOLERA

an acute bacterial disease of the GIT characterized by profuse diarrhea, vomiting, loss of fluid.

Etiologic agent: Vibrio cholerae, V. comma Pathognomonic sign: rice watery stool Incubation period: 2-3 days Period of Communicability: entire illness, 7-14d MOT: fecal oral route

Clinical manifestations

Acute, profuse, watery diarrhea. Initial stool is brown and contains fecal material

becomes “rice water” Nausea/ Vomiting S/s of Dehydration poor tissue trugor, eyes are sunken Pulse is low or difficult to obtain, BP is low and later

unobtainable. RR – rapid and deep Cyanosis – later Voice becomes hoarse– speaks in whisper Oliguria or anuria Conscious, later drowsy Deep shock Death may occur as short as four hours after onset. Usually first or 2nd day if not treated Principal deficits

o Severe dehydration - circulatory collapseo Metabolic acidosis – loss of large volume

of bicarbonate rich stool. RR rapid and deep

o Hypokalemia – massive loss of K. abdominal distention – paralytic ileus

Diagnostics

Fecal microscopyo Rectal swab o Stool exam

Treatment

IVF- rapid replacement Oral rehydration Strict I and O Antibiotics – Tetracycline, Cotrimoxazole.

Nursing Management

Medical Asepsis Enteric precaution VS monitoring I and O Good personal hygiene


Proper excreta disposal Concurrent disinfection. Environmental sanitation

Prevention

protection of food and water supply from fecal contamination.

Water should be boiled/ chlorinated. Milk should be pasteurized. Sanitary disposal of human excreta Environmental sanitation.

DYSENTERY

Acute bacterial infection of the intestine characterized by diarrhea and fever

Etiologic Agent: Shigella group Shigella flesneri - commmon in the Philippines Shigella boydii, S. connei, S. dysenteria – most infectious, habitat exclusively

in man, they develop resistance to antibiotics Incubation period – 7 hrs. to 7 days

Period of communicability – during acute infection until the feces are (-)

MOT – fecal-oral route, contaminated water/ milk/ food.


Fever esp. in children Nausea, vomiting and headache Anorexia, body weakness Cramping abdominal pain (colicky) Diarrhea – bloody and mucoid Tenesmus Weight loss

Diagnostics

Fecalysis Rectal Swab/culture Bloods – WBC elevated Blood culture

Treatment

Antibiotics- Ampicillin, Cotrimoxazole, Tetracycline IVF Anti diarrheal are Contraindicated

Nursing Management

Maintain fluid and electrolyte balance Restrict food until nausea and vomiting subsides. Enteric precaution Excreta must be disposed properly. Prevention- food preparation, safe washing facilities,

fly control

POLIOMYELITIS

An acute infectious disease caused by any of the 3 types of poliomyelitis virus which affects mainly the anterior born cells of the spinal cord and the medulla, cerebellum and the midbrain

AKA: Acute anterior poliomyelitis, heinmedin disease, infantile paralysis

Etiologic Agent: Poliovirus (Legio Debilitans) 3 Types of Poliovirus

o Type I - most paralytogenic, most frequento Type II - next most frequento Type III - least frequent associated with

paralytic disease 3 Strains

o Brunhildeo Laasingo Leon

MOT: Fecal-Oral Incubation period: 7-14 days ave (3-21 days) Period of communicability: 7-16 days before and

few days after onset of s/s

Sign and Symptoms

Febrile episodes with varying degrees of muscle weakness

Occasionally progressive Flaccid Paralysis

3 Types of Paralysiso Spinal Paralytic

Flaccid paralysis Autonomic involvement Respiratory difficulty

o Bulbar Form Rapid & serious Vagus and glossopharyngeal

nerves affected Cardiac and respiratory reflexes

altered Pulmo edema Hypertension, impaired temp

regulation Encephalitic s/s

o Bulbospinal Combination

Minor Polioo Inapparent / subclinicalo Abortive: recover within 72 hours; flulike;

backache; vomiting Major Polio

o Paralytic: asymmetrical weakness, paresthesia, urinary retention, constipation

o Non paralytic: slight involvement of the CNS; stiffness and rigidity of the spine, spasms of hamstring muscles, with paresis

o Tripod position: extend his arms behind him for support when upright

o Hoyne’s sign: head falls back when he is in supine position with the shoulder elevated

o Meningeal irritation: (+) Brudzinski, Kernig’s sign

Diagnostics

Throat swab, stool exam, LP


Supportive, Preventive – Salk and Sabin Vaccine


NO morphine Moist heat application for spasms Airway: tracheotomy Footboard to prevent foot drop Fluids, NTN, Bedrest Enteric and strict precautions

HEPATITIS A

Inflammation of the liver caused by hepatitis A virus AKA: infectious hepatitis Incubation period: 2-6weeks MOT: oral-fecal/ enteric transmission Diagnostic test: liver function (SGOT/SGPT)


Prodromal/ pre icterico S/S of URTIo Weight losso Anorexiao RUQ paino Malaise

Icteric o Jaundiceo Acholic stoolo Bile-colored urine

Diagnostic tests

HaV Ag, Ab, SGOT, SGPT


Provide rest periods Increase CHO, mod Fat, low CHON Intake of vits/minerals Proper food preparation/handling Handwashing to prevent transmission

AMOEBIASIS

involves the colon in general but may involve the liver or lungs as well

Etiologic agent: Entamoeba histolytica Incubation: 3-4 weeks Period of communicability: duration of illness MOT: fecal oral route

o Indirect - Ingestion of food contaminated with E.Histolytica cysts, polluted water supply, exposure to flies, unhygienic food handlers.

o Direct contact – sexual, oral, or anal, proctogenital


Intermittent fever Nausea, vomiting, weakness Later : anorexia, weight loss, jaundice Diarrhea – watery and foul smelling stool often

containing blood streaked mucus Colic and abdominal distention Intestinal perforation –bleeding

Diagnostics

Stool Exam ( cyst, amoeba+++) WBC – elevated

Treatment

Amoebacides – Metronidazole(Flagyl) 800mg TID X 7days

Bismuth gylcoarsenilate combined with Chloroquine Antibiotic – Ampicillin, Tetracycline,

Chloramphenicol Fluid replacement – IVF, oral

Nursing Management

Enteric precaution Health education- boil drinking water (20-30

mins), Use mineral water. Cover leftover food. Avoid washing food from open drum/pail. Wash hands after defecating and before eating. Observe good food preparations. Fly control

ASCARIASIS

Helminthic infection of the small intestine caused by Ascaris Lumbrecoides

MOT: fecal-oral Incubation period: 4-8 weeks Communicability: as long as mature fertilized

female worms live in intestine

Diagnostics

Microscopic identification of eggs in stool CBC Hx of passing out of worms (oral or anal), Xray,

Signs and Symptoms

Stomachache Vomiting Passing out of worms

Complications

Energy / Protein malnutrition Anemia Intestinal obstruction

Treatment:

Pyrantel Pamoate Piperazine Citrate Mebendazole, Tetramizole


Dicyclomine Hcl, NSAIDS for abdominal pain For intestinal obstruction

o Decompressiono Fluid and electrolyte therapyo If persistent, laparotomy

FF up stool exam 1-2 weeks after treatment

Nursing Intervention

Isolation- not needed Enteric precaution Handwashing Proper nutrition Maintenance of hydration / fluid balance / boil of

water Improve personal hygiene Proper food prep/handling Administer meds (NSAIDS, MEBENDAZOLE)

DISEASES ACQUIRED THRU THE SKIN

Diseases caused by Trauma and Inoculationo Tetanuso Rabieso Malariao DHFo Leptospirosiso Schistosomiasis

Disease acquired thru ContactO Leprosy

TETANUS

an acute, often fatal, disease characterized by generalized rigidity and convulsive spasms of skeletal muscles caused by the endotoxin released by C. Tetani

AKA: Lockjaw Etiologic Agent: Clostridium Tetani

o Anerobico Spore forming, gram positive rod

Sources:o Animal and human feceso Soil and dustO Plaster, unsterile sutures, rusty scissors,

nails and pins MOT:

o Direct or indirect contact to woundso Traumatic wounds and burnso Umbilical stump of the newborno Dirty and rusty hair pins o GIT- port of entry – rareo Circumcision/ ear pearcing

Incubation period: 3d-3week (ave:10d)

Signs and Symptoms

persistent contraction of muscles in the same anatomic area as the injury

Local tetanus Cephalic tetanus - rare form otitis media (ear infections) Generalized tetanus

o trismus or lockjaw

o stiffness of the necko difficulty in swallowingo rigidity of abdominal muscleso elevated temperatureo sweatingo elevated blood pressure episodic rapid

heart rate Neonatal tetanus - a form of generalized tetanus

that occurs in newborn infants

Diagnostics

entirely clinical CSF – normal WBC- normal or slight elevated

Treatment

Wounds should be cleaned Necrotic tissue and foreign material should be

removed Tetanic spasms - supportive therapy and

maintenance of an adequate airway Tetanus immune globulin (TIG)

o help remove unbound tetanus toxino cannot affect toxin bound to nerve endingso single intramuscular dose of 3,000 to 5,000

unitso contains tetanus antitoxin.

Oxygen NGT feeding Tracheostomy Adequate fluid, electrolyte, caloric intake During convalescence Determine vertebral injury Attend to residual pulmonary disability Physiotherapy TT


Preventiono DPT

Adverse ReactionsLocal reactions (erythema, induration)Fever and systemic symptoms not commonExagerated local reactions

Prevention of CV and respiratory complicationso Adequate airwayo ICU – ET- MV

Provide cardiac monitoring KVO Wound care (TIG, Debridement, TT) Administer antibiotics as ordered

o Penicillin Care during tetanic spasm/ convulsion

o Administer Diazepam – muscle rigidity/spasm

o Administer neuromuscular blocking agents (metocurin iodide) – relax spasms and prevent seizure

Keep on seizure precaution Parenteral nutrition Avoid complications of immobility (contractures,

pressure sores) WOF urinary retention, fractures

RABIES

a viral zoonotic neuroinvasive disease that causes acute encephalitis

Etiologic agent: Rhabdovirus AKA: Hydrophobia, Lyssa Negri bodies in the infected neurons –

pathognomonic Incubation period: 4-8 weeks; 10d-1yr Period of communicability: 3-5 days before the onset

of s/s until the entire course of disease MOT: contamination of a bite of infected animals

Diagnostics

History of exposure PE/ assessment of s/s Microscopic examination of Negri bodies using

Seller’s May-Grunwald and Mann Strains


Fluorescent Rabies Antibody technique / Direct Immunofluorescent test


Prodromal Phase / Stage of Invasiono Fever, anorexia, malaise, sorethroat,

copious salivation, lacrimation, perspiration, irritability, hyperexcitability, restlessness, drowsiness, mental depression, marked insomia

o Sensitive to light, sound, and changes in temp

o Myalgia, numbness, tingling, burning or cold sensation along nerve pathway; dilation of pupils

Stage of Excitemento Marked excitation, apprehensiono Delirium, nuchal stiffness, involuntary

twitchingo Painful spasms of muscles of mouth,

pharynx, and larynx on attempting to swallow food or water or the mere sight of them – hydrophobia

o Aerophobiao Precipitated by mild stimuli – touch or noiseo Death – spasm from or from cardiac /

respiratory failure Terminal Phase or Paralytic Stage

o Quiet and unconsciouso Loss of bowel and bladder controlo Tachycardia, labored irregular respiration,

steady rising tempo Spasm, progressively increasing paralysiso Death due to respiratory paralysis

Treatment

No cure No specific – symptomatic/ supportive – directed

toward alleviation of spasm Employ continuing cardiac and pulmonary

monitoring Assess the extent and location of the bite – biting

incident/ status of the animalo Severe exposureo Mild exposure

Wound treatment (local care)o Cleanse thoroughly with soap and water (or

ammonium compounds, betadine, or benzalkonium cl)

o Anti rabies serum o Tetanus prophylaxiso Antibioticso Suturing should be avoided

Antirabies serao Heterologous serum obtained by

hyperimmunization of different animal species i.e. horses

o HRIG – Homologous reabies immunoglobulin – human origin

Rabies Vaccine Active immunization

o Administered 3 years durationo Used for lower extremity biteso Lyssavac (purified protein embryo), Imovax,

Anti-rabies vaccine Passive immunization

o 3 months

o Rabuman, Hyper Rab, Imogam


Isolation of patiento Provide comfort for the patient by:o Place padding of bedside or use restraintso Clean and dress wound with the use of

gloveso Do not bathe the patient, wipe saliva or

provide sputum jar Provide restful environment

o Quiet, dark environmento Close windows, no faucets or running water

should be heardo IVF should be coveredo No sight of water or electric fans

MALARIA

Acute and chronic disease transmitted by mosquito bite confined mainly to tropical areas.

Etiologic agent – Protozoa of genus Plasmodiao Plasmodium Falciparum (malignant tertian)

most serious, high parasitic densities in RBC with tendency to agglutinate and form into microemboli. Most common in the Philippines

o P. Vivax - non life threatening except for the very young and old. Manifests chills every 48 hrs on the 3rd day onward if not treated

o P. malarie (Quartan) – less frequent, non life threatening, fever and chills occur every 72 hrs on the 4th day of onset

o P. ovale - rare Incubation period:

o 12days P. falciparum, 14 days P vivax and ovale, 30 days P. malariae

Period of communicabilityo If not treated /inadequate – more than 3

yrs. P malariae, 1-2 yrs. P. vivax, 1 yr- P. falciparum

Mode of transmissiono Mosquito bite: Vector – female Anopheles

mosquitoo Also by blood transfusion

Diagnostics

Malarial smear – film of blood is placed on a slide, stained and examined

Rapid diagnostic test (RDT) – done in field. 10 -15 mins result blood test

Clinical Manifestions

Rapidly rising fever with severe headache Shaking chills Diaphoresis, muscular pain Splenomegaly, hepatomegaly Hypotension

o May lasts for 12 hours daily or every 2 days.

Complicated Malariao GIT


Bleeding from GUT, N/V, Diarrhea, abdominal pain, gastric, tyhoid, choleric, dysenteric

o CNS or Cerebral Malaria Changes in sensorium Severe headache N/V

o Hemolytic Blackwater fever - Reddish to

mahogany colored urine due to hemoglobinuria

Anuria – deatho Malarial lung disease

Management

Antimalarial drugs – Chloroquine (all but P. Malarie), quinine, Sulfadoxine (resistant P falciparum) Primaquine (relapse P vivax/ovale)

RBC replacement/ erythrocyte exchange transfusion

Nursing Management

Isolation of patient Use mosquito nets Eradicate mosquitos Care of exposed persons – case finding I and O BUN & creatinine – dialysis could be life saving ABG TSB, ice cap on head Hot drinks during chilling, lots of fluid Monitoring of serum bilirubin Keep clothes dry, watch for signs of bleeding

Prevention

Mosquito breeding places should be destroyed Insecticides, insect repellant Blood donor screening

DENGUE FEVER

Is an acute febrile disease cause by infection with one of the serotypes of dengue virus which is transmitted by mosquito (Aedes aegypti).

Dengue hemorrhagic fever – fatal characterized by bleeding and hypovolemic shock

Etiologic agent – Arbovirus group B – AKA: Chikungunya, O’ nyong nyong, west nile fever Mode of Transmission: Bite of infected mosquito –

Aedes Aegypti Incubation period – 3-14 days Period of communicability – mosquito all

throughout life Sources of infection

o Infected person- virus is present in the blood and will be the reservoir when sucked by mosquitoes

o Stagnant water = any

Diagnostics

Torniquet test Platelet Count

Hematocrit

Manifestations

Prodromal symptomso malaise and anorexia up to 12 hrs.o Fever and chills, head-ache, muscle paino N &V

Febrile Phase o Fever persists (39-40 C)o Rash - more prominent on the extremities

and trunko (+) torniquet test- petechia more than 10.o Skin appears purple with blanched areas

with varied sizes ( Herman’s sign)o Generalized or abdominal paino Hemorrhagic manifestations – epistaxis,

gum bleedingo

Circulatory Phaseo Fall of temp on 3rd to 5th dayo Restless, cool clammy skino Profound thrombocytopeniao Bleeding and shocko Pulse - rapid and weako Untreated shock --- coma – deatho Treated – recovery in 2 days

Classification

Grade 1 Grade 2 Grade 3 Grade 4

Treatment

No specific antiviral therapy for dengue Analgesic – not aspirin for relief of pain IV fluid BT as necessary O2 therapy

Nursing Management

Kept in mosquito free environment Keep pt. at rest VS monitoring Ice bag on the bridge of nose and forehead. Observe for signs of shock – VS (BP low), cold

clammy skin

Prevention

Mosquito net Eradication of breeding places of mosquito

o house sprayingo change water of vaseso scrubbing vases once a weeko cleaning the surroundingso keep water containers coveredo avoid too many hanging clothes inside the

house

LEPTOSPIROSIS

Infectious bacterial disease carried by animals whose urine contaminates water or food which is ingested or inoculated thru the skin.

Etiologic agent: spirochete Leptospira interrogans found in river, sewerage, floods AKA: Weil’s disease, mud fever, Swineherd’s

disease Incubation Period: 6 -15 days Period of Communicability – found in urine

between 10-20 days MOT – contact with skin of infected urine or feces of

wild/domestic animals; ingestion, inoculation

Diagnostics

Clinical manifestations Culture


Source of Infection Rats, dogs, mice

Manifestations Septic Stage

o Early - Fever (40 ‘C), tachycardia, skin flushed, warm, petechiae

o Severe – (Multiorgan)Conjunctival affectation, jaundice, purpura, ARF, Hemoptysis, head-ache, abdominal pain, jaundice

Toxic stage – with or w/o jaundice, meningeal irritation, oliguria– shock, coma , CHF

Convalescence – recovery

Management

IV antibiotic o Pen G Nao Tetracyclineo Doxycycline

Dialysis – peritoneal IVF Supportive Symptomatic


Isolation of patient – urine must properly disposed Care of exposed persons – keep under close

surveillance Control measures

o Cleaning of the environment/ stagnant water

o Eradicate ratso Avoid bathing or wading in contaminated

pool of watero vaccination of animals

(cattles,dogs,cats,pigs)

SCHISTOSOMIASIS

Parasitic disease caused by Schistosoma japonicum, S. mansoni, S. Hematobium

AKA: Bilharziasis, Snail fever Incubation period: 2-6 weeks MOT: bathing, swimming, wading in water

o Vector: Oncomelania quadrasio Cercariae: most infective stage

Diagnostics Fecalysis

o Identification of eggs Liver and rectal biosy Immunodiagnostic tests / circumoval precipitin test

and cercarial envelope reactions

Signs and Symptoms

Swimmers itcho Itchinesso Redness and pustule formation at site of

entry of cercariaeo Diarrheao Abdominal paino Hepatosplenomegaly


Abdominal pain Cough Diarrhea Eosinophilia - extremely high eosinophil granulocyte

count. Fever Fatigue Hepatosplenomegaly - the enlargement of both the

liver and the spleen. Colonic polyposis with bloody diarrhea (Schistosoma

mansoni mostly) Portal hypertension with hematemesis and

splenomegaly (S. mansoni, S. japonicum); Cystitis and ureteritis with hematuria bladder

cancer; Pulmonary hypertension (S. mansoni, S. japonicum,

more rarely S. haematobium); Glomerulonephritis; and central nervous system

lesions.

Complications

Pulmonary hypertension Cor pulmonale Myocardial damage Portal cirrhosis

Treatment

Trivalent antimonyo Tartar emetic – administered thru veino Stibophen (Fuadin) – given per IM

Praziquantel – per orem Niridazole


Administer prescribed drugs as ordered Prevent contact with cercaria-laden waters in

endemic areas like streams Proper sanitation or disposal of feces Creation of a program on snail control – chemical or

changing snail environment

LEPROSY


Chronic systemic infection characterized by progressive cutaneous lesions

Etiologic agent: Mycobacterium leprae Acid fast bacilli that attack cutaneous tissues,

peripheral nerves producing skin lesions, anesthesia, infection and deformities.

Incubation period – 5 1/2 mo - eight years. MOT – respiratory droplet, inoculation thru break in

skin and mucous membrane.

Diagnosis

Identification of signs and symptoms Tissue biopsy Tissue smear Bloods – inc. ESR Lepromin skin test Mitsuda reaction

Manifestations

Corneal ulceration, photophobia –blindness Lesions are multiple, symmetrical and

erythematous– macules and papules Later lesions enlarge and form plaques on nodules

on earlobes, nose eyebrows and forehead Foot drop Raised large erythemathous plaques appear on skin

with clearly defined borders. – rough hairless and hypopigmented – leaves an anesthetic scar.

Loss of eyebrows/eyelashes Loss of function of sweat and sebaceous glands Epistaxis

Prevention

multiple drug therapy sulfone rehab occupational Health isolation moral support

Prevention

Report cases and suspects of leprosy BCG vaccine may be protective if given during the

first 6 months.


Isolation of patient – until causative agent is still present

Care of exposed persons Household contact – Diaminodiphenylsulfone for 2

years Observe carefully for symptoms of the disease

DISEASES ACQUIRED THRU SEXUAL CONTACT

HIV/AIDS

Chronic disease that depresses immune function Charecterized by opportunistic infections when

T4/CD4 count drops <200 MOT – sexual contact with infected – unprotected,

injection of blood/products, placental transmission

History

1959 - African man 1981- 5 homosexual men 1982-Designated as disease by CDC 1983- HIV 1 discovered 1987- 1.5 million HIV-infected in USA 1994- WHO reports 8-10 mil. Worldwide & protease

inhibitors introduced 1999-First clinical trials for HIV vaccine

The Immune System

Macrophages Humoral response Cell-mediated response RNA virus Retrovirus Reverse transcriptase Protease

Diagnostics

ELISA Western Blot CD4 count Viral load testing Home test kits

HIV/AIDS Spectrum

Manifestations


Minor signs – cough for one month, general pruritus, recurrent herpes zoster, oral candidiasis, generalized lymphadenopathy

Major signs – loss of weight 10% BW, chronic diarrhea 1month up, prolonged fever one month up.

Persistent lymphadenopathy Cytopenias (low) PCP Kaposis sarcoma Localized candida Bacterial infections TB STD Neurologic symptoms

Criteria for Diagnosis of AIDS

CD4 counts of 200 or less Evidence of HIV infection and any of

o Thrusho Bacillary angiomatosiso Oral hairy leukoplakiao Peripheral neuropathyo Vulvovaginal candidiasiso Shingleso Idiopathic thrombocytopeniao Fatigue, night sweats, weight losso Cervical dysplasia, carcinoma in situ

Evidence of HIV infection and any one of the following:

o Bronchial candidiasis o Esophageal candidiasis o CMV diseaseo CMV retinitiso HIV encephalopathyo Histoplasmosis o Kaposi’s Sarcomao Herpes simplex ulcers, bronchitis,

pneumonia

Treatment

Started in CD4 counts of <200 Viral load >10,000 copies All symptomatic regardless of counts Note: CD4 reflects immune system destruction.

Viral load- degree of viral activity Nucleoside Reverse Transcriptase Inhibitors

o Blocks reverse transcriptaseo Acts by binding directly to the reverse

transcriptase enzymeo Not used aloneo Rapid development of resistance

Generic Trade Dose Notes

Zidovudine AZT, ZDV, Retrovir

300 mg. Bid

Taken with food

Didanosine ddI, Videx 200 mg bid

Peripheral neuropathy

Zalcitibine ddC,Hivid .75 mg TID

No antacids

Stavudine d4T, Zerit 400 mg bid

Peripheral neuropathy

Lamivudine 3TC, Epivir

150 mg bid

Used as resistance develops

Lamiduvine/Zidovudine

Combivir 150/300mg

Bone marrow toxicity

Protease Inhibitorso Introduced in 1995o Acts by blocking protease enzymeo Indinavir (Crixivan)o CDC Guidelines

Combination of 2 NRTI + PI

Nursing Management

Administer Antiviral meds as ordered Universal precaution Reverse isolation gloves, needle stick injury prevention Assist in early diagnosis and management of

complications 4 C’s

o Compliance – info, + drugso Counselling – educationo Contact tracing – tracing out and tx for

partnerso Condoms – safe sex

GONORRHEA

a curable infection caused by the bacteria Neisseria gonorrhoea

AKA: Clap, Drip, G. vulvovaginitis MOT: transmitted during vaginal, anal, and oral sex Incubation period: 3-10 days initial manifestations Period of communicability: considered infectious

from the time of exposure until treatment is successful

Manifestations

Urethritis – both male and female S/S: dysuria and purulent discharge Cervicitis Upper Genital Tract – females (PID), Endometritis,

Salpingitis, Pelvic Abscess

Complications PID Infertility Upper Genital Tract – male Epididymitis, Prostatitis, Seminal Vesiculitis Disseminated Gonococcal Infection (DGI) Tenosynovitis or Polyarthritis, skin lesions and fever Anorectal Infection Pharyngeal Infection Gonococcal Conjuctivitis Opthalmia Neonatorum Meningitis, Endocarditis

Diagnosis

Culture & Sensitivity Blood tests for N. gonorrhoeae antibodies

Treatment

Antibioticso Penicillino Single dose Ceftriaxone IM + doxycycline

PO BID for 1 weeko Prophylaxis: Silver nitrate, Tetracycline,

Erythromycin


Case finding Health teaching on importance of monogamous

sexual relationship Treatment should be both partners to prevent

reinfection Instruct possible complications like infertility Educate about s/s and importance of taking

antibiotic for the entire therapy

SYPHILIS

a curable, bacterial infection, that left untreated will progress through four stages with increasingly serious symptoms

Etiologic agent: Treponema pallidum AKA: Lues, The pox, Bad blood Type of Infection: Bacterial

Modes of transmission :o Through sexual contact/ intercourse,

kissingo abrasions


o Can be passed from infected mother to unborn child (transplacental)

Symptoms

Primary syphilis (10 – 90 days after infection)o Chancre – a firm, painless skin ulceration

localized at the point of initial exposure to the bacterium appear on the genitals

o can also appear on the lips, tongue, and other body parts

Secondary syphilis (last 2 – 6 weeks)o syphilis rash - an infectious brown skin

rash that typically occurs on the bottom of the feet and the palms of the hand

o condylomata lata - flat broad whitish lesions

o Fever, sore throat, swollen glands, and hair loss can also be experienced

Third stage o Will manifest 1 – 10 years after the

infectiono characterised by gummas - soft, tumor-like

growths o seen in the skin and mucous membranes –

occurs in boneso joint and bone damage o increasing blindness o numbness in the extremities, or difficulty in

coordinating movements.

neurosyphilis o generalized paresis of the insane which

results in personality changes, changes in emotional affect, hyperactive reflexes

cardiovascular syphilis o aortitis, aortic aneurysm, Aneurysm of

sinus of valsalva and aortic regurgitation, - death

Consequences in Infantso congenital syphilis o extremely dangerouso Deformitieso Seizureso Blindnesso Damage to the brain, bones, teeth, and

ears.

Test and diagnosis

Venereal Disease Research Laboratory (VDRL) test Flourescent treponemal antibody absorption (FTA –

Abs) Micro hemagglutination test (MHA - TP) CSF examination

Treatment

Syphilis is easily treatable when early detected Penicillin & other antibiotics Prevention Abstinence Mutual monogamy Latex condoms for vaginal and anal sex

Nursing interventions

Case finding Health teaching and guidance along preventive

measures Utilization of community health facilities Assist in interpretation and diagnosis Reinforce ff up treatment VD control program participation Medical examination of patient’s contacts

HEPATITIS B

serious disease caused by a virus that attacks the liver

Etiologic agent: hepatitis B virus (HBV) Source of infections: Blood and body secretions

Risk factors

multiple sex partners or diagnosis of a sexually transmitted disease

Sex contacts of infected persons Injection-drug users Household contacts of chronically infected persons Infants born to infected mothers Infants/children of immigrants from areas with high

rates of HBV infection Health-care and public safety workerr Hemodialysis patients

Complications

Lifelong infection Liver cirrhosis Liver cancer Liver failure Death

Signs ans Symptoms

Jaundice Pruritus Fatigue RUQ - Abdominal pain Loss of appetite Nausea, vomiting Joint pain

Prevention

Hepatitis B vaccine has been available since 1982. Routine vaccination of 0-18 year olds Vaccination of risk groups of all ages Immune globulin if exposed

Medical Management

Interferon alfa-2b Lamivudine Telbivudine Entecavir Adefovir dipivoxil


Blood and body secretions precautions Prevention- Hepa B vaccine Proper rest periods Prevent stress – physio/psychological Proper NTN, increase in CHO, high in CHON, low

fats, Vit. K rich foods and minerals Assistance to prevent injury, promote safety AAT WOF s/s bleeding, edema Health education on safe sex

SEVERE OF ACUTE RESPIRATORY SYNDROME

An acute and highly contagious respiratory disease in humans

Etiologic agent: SARS coronavirus November 2002 and July 2003, with 8,096 known

infected cases and 774 deaths Incubation period: 2-3days MOT: Airborne

Signs and Symptoms


flu like: fever, myalgia, lethargy, gastrointestinal symptoms, cough, sore throat

fever above 38 °C (100.4 °F) Shortness of breath Symptoms usually appear 2–10 days following

exposure

require mechanical ventilation

Diagnostics

Chest X-ray (CXR)- abnormal with patchy infiltrates WBC and PLT CT. - LOW ELISA test detects antibodies to SARS

o but only 21 days after the onset of symptoms

Immunofluorescence assay can detect antibodies 10 days after the onset of the disease

o labour and time intensive test Polymerase chain reaction (PCR) test that can

detect genetic material of the SARS virus in specimens ranging from blood, sputum, tissue samples and stools

CXR - increased opacity in both lungs, indicative of pneumonia

SARS may be suspected

o fever of 38 °C (100.4 °F) or more AND

o Either a history of:

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).

probable case of SARS

o above findings plus positive chest x-ray findings of atypical pneumonia or respiratory distress syndrome

Treatment

supportive with antipyretics, supplemental oxygen and ventilatory support as needed.

Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with full barrier nursing precautions taken for any necessary contact with these patients

steroids antiviral drug SARS vaccine

Communicable Diseases Handouts)

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