Communicable DiseasesPocholo Santos Chinese General Hospital College of Nursing

TOPIC OUTLINE• Definition of terms in Communicable Disease• Chain of infection• Control and Management of Infectious Disease• Immunization• Protective Precautions / Isolation• Diseases acquired thru GI tract• Diseases acquired thru the skin• Diseases acquired thru the respiratory tract• Diseases acquired thru sexual contact

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 infection

Terminal – applied when the patient is no longer the source of infection.

• Disinfectant -chemical used on non living objects• Antiseptic – chemical used on living things.• Bactericidal – kills microorganism• Sterilization – 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 moistureINFECTION

• 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 multiplicationFactors of severity of infection

o disease producing ability o the number of invading microorganismo The strength of the host’s defence and some

other factors.

Epidemiological triad: o Agento Host o Environment

Classification accdg 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 DEFENSE

o MECHANICAL BARRIERS o CHEMICAL BARRIERS o BODY’S OWN POP. OF MICROORGANISM -

“microbial antagonism principle”• SECOND – inflammatory response

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

• THIRD – immune response - Natural/Acquired: 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, immunosuppresive drugs etc.CHAIN OF INFECTION

Mode of TransmissionContact transmission

• Direct contact - person to person• Indirect - thru contaminated object

o 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 problems in 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 PRECAUTION – All blood, blood products and secretions from patients are considered as infected.

WORK PRACTICE CONTROL• Handwashing

o Before and after using gloves, after hand contact with patients, patient’s blood and other potentially infected materials.

• Protective Equipment shall be removed immediately upon leaving the work area. Like apron, mask, gloves etc.

o Place in designated area. • 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.

Control Measures• 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)o Ex. Normal clean – clean the room post

discharge, final clean- MRSA and infectious pts.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 contact

• Respiratory isolation – prevent transmission thru air.• TB isolation – for (+) TB or CXR suggesting active PTB.• Enteric Isolation – direct contact with feces • Drainage/secretion precaution- prevents infection thru

contact with materials or drainage from infected person.

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

PREVENTIONHealth Education – educate the family about

• Immunization• MOT • Environmental sanitation – breeding places of mosquito,

disposal of feces • Importance of seeking medical advice for any health

problem• Preventing contamination of food and water.

Environmental Sanitation o Water Supply Sanitation Program – DOH thru

EHS (Environmental Health Services)o Policies on Food Sanitation Programo Policies on Hospital Waste Management

• The CHNurse is in the best position to do health education such as

o > development of materials for environmental sanitation

o > providing group counselling, holding community assemblies and conferences.

o > create programs for sanitationo > be a role model

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

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

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

Maintain vaccine potency by preventing:o Heat and sunlighto 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

Classification1. Inactive – asymptomatic, sputum is (-), no cavity on chest X ray2. Active – (+) CXR, S/S are present, sputum (+) smearClassification 0-5

A. Minimal – slight lesion confined to small part of the lungB. Moderately advanced – one or both lungs are involved, volume affected should not extend to one lobe, cavity not more than 4 cm.C. Far advance – more extensive than B

MANIFESTATIONS• Primary Complex: TB in children: non contagious, children

swallow phlegm, fever, cough, anorexia, weight loss, easy fatigability

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

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

o Asymptomatico No manifestations even at CXR, Sputum AFB

• Primary Complexo Minimal manifestationso Lymphadenopathy

DX• Tuberculin testing • CXR • Sputum AFB

Prevention• BCG• Avoid overcrowding• Improve nutritional status

TX• DOTS• 6 months of RIPE• Respiratory isolation,• Take medicines religiously – prevent resistance• Stop smoking• Plenty of rest • Nutritious and balance meals, increase CHON, Vit. A, C

MENINGITIS• Inflammation of the meninges usually some

combination of headache, fever, stiff neck, and delirium

• Meningococcemia: cerebrospinal fevero Etiologic agent: Neisseria meningitidis o Incubation: 2-10 dayso MOT: droplet

• Acute meningococcemia - with or without meningitiso Waterhouse Friederichsen Syndrome

Diagnostic exams:o Lumbar tap, CSF - high WBC and CHON, low

glucoseManifestations:

o Sudden onset of fever x 24ho Petechiae, Purpuric rasheso Meningeal irritation Stiff neck Opisthotonus Kernig’s sign Brudzinski sign o ALOCo S/S of Increase ICP

Nursing Mgt: 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, eyesManifestation

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

Types of Respiratory Diptheria • NASAL o serous to serosanginous purulent discharge o Pseudomebrane on septumo Dryness/ excoriation on the upper lip and nares • PHARYNGEALo pharyngeal pseudomembrane o bull neck ( cervical adenitis)o Difficulty swallowing• LARYNGEAL

o Sorethroat, pseudomemb o Barking, dry mettallic cough

Complicationso Due to TOXEMIA

Toxic endocarditis

Neuritis Toxic nephritis

o Due to Intercurrent Infection Bronchopneumonia Respiratory failure

DX • Nose and throat swabs - culture of

specimen form beneath membrane• Virulence test

• SHICK’s TEST: test for susceptibility to diptheria • MOLONEY’s TEST: test for hypersensitivity to diptheria

MANAGEMENT 1. Penicillin, Erythromycin2. Diptheria Antitoxin – after – skin test if (+), fractional dose3. Supportive

• O2, if laryngeal obstruction – tracheostomy • CBR for 2 weeks• Increase fluids, adequate nutrition- soft food, rich in

Vit C• Ice collar

4. Isolation till 3 NEGATIVE culturesPrevention

DPT

PERTUSIS (whooping 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 o 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)

Dx:• 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• Acute viral disease with prodromal fever,

conjunctivitis, coryza, cough and Koplik’s spots• AKA: Rubeola, 7-day measles• Etiologic agent: Morbilli Paramyxoviridae virus• Incubation period: 10-12 days• Period of communicability: 3 days before and 5 days

after the appearance of rashes. Most communicable during the height of rash.

• MOT: Airborne• Sources of infection – secretions from eyes, nose and

throatPathognomonic sign:

• Koplik’s spots

Manifestations• 1.Pre eruptive stage / Prodromal (10-11 days)

o Coryza, Cough, Conjunctivitiso Koplik’s Spots, whitish spot at the inner

cheeko Fever, photophobia

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

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

Diagnostics• Nose and throat swab

Treatment• 1. Antiviral drugs- Isoprenosine • 2. Antibiotics – if with complications• 3. 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• 1. Prodromal – low grade fever, headache , malaise, colds,

lymph node involvement on 3rd to 5th day• 2. Eruptive – FORSCHEIMER’S SPOTS: pinkish rash on soft

palate, rash on face, spreading to the neck, arms and trunko lasts1-5 days with no pigmentation or

desquamationo muscle pain

• Treatment o symptomatic treatment

Complications• 1. Encephalitis, neuritis• 2. Rubella syndrome – microcephaly, mental retardation,

deaf mutism, congenital heart disease

RISK for congenital malformation• 1. 100% when maternal infection happens on first

trimester of pregnancy.• 2. 4% - second/third trimester

Nursing Management1. Isolation. Bed rest2. Room darkened – photophobia3. Encourage fluid4. Like measles tx

PREVENTION;• MMR, Pregnant women should avoid exposure to rubella

patients• Administration of Immune serum globulin one week after

exposure to rubella.

CHICKEN POX• 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 affectationso Macule – flat o Papule – elevated above the skin diameter about 3 cmo Vesicleo Pustuleo Crust – scab , drying on the skin

Complications o 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 Zoster• 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 procedureo Hx of chickenpoxo Pain and burning sensation over lesions of

vesicles along nerve pathwayo Smear of vesicle fluid- giant cellso Viral cultures of vesicle fluido Electron microscopyo Giemsa-stained scraping – multinucleate giant

epithelial cellsS/S

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

o Eruptions are unilateralo Lesions may last 1-2 weekso Fever, regional lymphadenopathy o Paralysis of cranial nerve, vesicles at external auditory

canal

o Paralytic ileus, bladder paralysis, encephalitis

Complicationso Opthalmia herpes – blindness because of

damage of gasserian gangliono Geniculate herpes – deafness because of

infection of 7th CN (AKA: Ramsay Hunt Syndrome)

Nursing Interventiono Compress of NSS or alluminum acetate over

lesionso Analgesics, sedatives – weeks to mos o Steroidso Keep blister covered with sterile powder esp

after breako Prevent bacterial invasiono 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 swellingo 48 hrs immediately preceding the onset of

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

CLINICAL MANIFESTATIONS1. Sudden headache, earache, loss of appetite2. Swelling of the parotid gland 3. Pain is related to extent of the swelling of the gland which reaches its peak in 2 days and continues for 7-10 days.4. Fever may reach 40 C during acute stage,5. One gland may be affected first and 2 days later the other side is involved

COMPLICATIONS1. Orchitis – testes are swollen and tender to palpation.2. Oophoritis- pain and tendeness of the abdomen3. Mastitis4. Deafness may happen5. Meningo-encephalitis -possible

DIAGNOSTIC PROCEDURES 1. Viral culture

2. WBC count

PREVENTION: MMR Vaccine

TREATMENT MODALITIES1. Antiviral drugs2. NSAIDS - Acetaminophen

Nursing Interventionso Symptomatico Application of warm/ cold compresso Oral care, warm salt water gargleo Diet – semi solid, soft food easy to chew

Acid foods/fluids – fruit juices may increase discomfort

Diseases Acquired thru GIT• Diseases caused by Bacteria

o Typhoid Fever o Cholera o Dysentery

• Diseases caused by Viruso Poliomyelitiso Infectious Hepatitis A

• Diseases caused by Parasiteso Amoebiasis o Ascariasis

TYPHOID 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.

CLINICAL MANIFESTATIONSONSET

• 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

TYPHOID STATE • Tongue protrudes- dry and brown• sordes • (coma vigil)• (subsultus tendinus)• (Carphologia)• Always slip down to the foot part of the bed,• Severe case - delirum sets in often ending in

deathComplications

o Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis

DIAGNOSTIC PROCEDURES1. WBC – elevated2. Blood Culture – (+) S. typhosa 3. Stool Culture (+)4. Widal test – blood serum agglutination test

O antigen – active typhoid H antigen- previously infected or vaccinated Vi antigen - carrier

TREATMENT1. Chloramphenicol – drug of choice 2.Paracetamol

NURSING MANAGEMENT1. Restore FE balance 2. Bedrest3. Enteric precaution 4. Prevent falls/ safety prec 5. Oral/personal hygiene6. WOF intestinal bleeding-bloody stool,sweating, pallor 7. 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 manifestationso Acute, profuse, watery diarrhea.o Initial stool is brown and contains fecal

material à becomes “rice water” o Nausea/ Vomiting

o S/s of Dehydrationo poor tissue trugor, eyes are sunkeno Pulse is low or difficult to obtain, BP is low

and later unobtainable.o RR – rapid and deep o Cyanosis – latero 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 deficits1. Severe dehydration - circulatory collapse2. Metabolic acidosis – loss of large volume of bicarbonate rich stool. RR rapid and deep3. Hypokalemia – massive loss of K. abdominal distention – paralytic ileus

DIAGNOSTIC EXAMSFecal microscopy1. Rectal swab 2. Stool exam

Treatment1. IVF- rapid replacement2. Oral rehydration 3. Strict I and O4. Antibiotics – Tetracycline, Cotrimoxazole.

NURSING MANAGEMENT1. Medical Asepsis2. Enteric precaution3. VS monitoring4. I and O5. Good personal hygiene6. Proper excreta disposal7. Concurrent disinfection.8. Environmental sanitation

PREVENTION1. Protection of food and water supply from fecal contamination.2. Water should be boiled/ chlorinated.3. Milk should be pasteurized.4. Sanitary disposal of human excreta5. Environmental sanitation.

DYSENTERY• Acute bacterial infection of the intestine characterized by

diarrhea and fever• Etiologic Agent: Shigella group

o Shigella flesneri - commmon in the Philippineso Shigella boydii, S. connei, o 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.

Clinical manifestations• 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 MANAGEMENT1. Maintain fluid and electrolyte balance2. Restrict food until nausea and vomiting subsides.3. Enteric precaution4. Excreta must be disposed properly.5. 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

• Type I - most paralytogenic, most frequent• Type II - next most frequent• Type III - least frequent associated with paralytic

disease3 Strains

o Brunhilde o Laasing o Leon

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

o 7-16 days before and few days after onset of s/s

• S/So Febrile episodes with varying degrees of

muscle weakness o Occasionally progressive Flaccid Paralysis

3 Types of Paralysis• Spinal Paralytic

o Flaccid paralysiso Autonomic involvemento Respiratory difficulty

• Bulbar Form o Rapid & seriouso Vagus and glossopharyngeal nerves affectedo Cardiac and respiratory reflexes alteredo Pulmo edemao Hypertension, impaired temp regulationo Encephalitic s/s

• Bulbospinal o 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

Diagnostic tests:• Throat swab, stool exam, LP

Nursing Interventions• 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)

Clinical manifestationsProdromal/ pre icteric

• S/S of URTI• Weight loss• Anorexia• RUQ pain• Malaise

Icteric • Jaundice• Acholic stool• Bile-colored urine

Diagnostic tests: HaV Ag, Ab, SGOT, SGPT

Nursing Interventionso Provide rest periodso Increase CHO, mod Fat, low CHONo Intake of vits/mineralso Proper food preparation/handlingo 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• Indirect - Ingestion of food contaminated with E.Histolytica

cysts, polluted water supply, exposure to flies, unhygienic food handlers.

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

Clinical manifestations• 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

DIAGNOSTIC EXAM• Stool Exam ( cyst, amoeba+++)• WBC – elevated

TREATMENTo Amoebacides – Metronidazole(Flagyl) 800mg TID X 7dayso Bismuth gylcoarsenilate combined with Chloroquine o Antibiotic – Ampicillin, Tetracycline, Chloramphenicol o Fluid replacement – IVF, oral

NUSING 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• Diagnostic exams: Microscopic identification of eggs in

stool, CBC, Hx of passing out of worms (oral or anal), Xray, S/S

o Stomachacheo Vomitingo Passing out of wormso Complicationso Energy / Protein malnutrition, Anemiao Intestinal obstruction

Treatment:o Pyrantel Pamoate o Piperazine Citrateo Mebendazole, Tetramizole

o Dicyclomine Hcl, NSAIDS for abdominal paino For intestinal obstruction

Decompression Fluid and electrolyte therapy If persistent, laparotomy

o FF up stool exam 1-2 weeks after treatmentNursing Interventiono Isolation- not neededo Enteric precautiono Handwashing o Proper nutritiono Maintenance of hydration / fluid balance / boil of watero Improve personal hygieneo Proper food prep/handlingo Administer meds (NSAIDS, MEBENDAZOLE

Diseases Acquired thru the Skin• Diseases caused by Trauma and Inoculation

o Tetanuso Rabieso Malariao DHF

o Leptospirosis o 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 Anerobic o 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)

S/s:• persistent contraction of muscles in the same

anatomic area as the injury• Local tetanus • Cephalic tetanus - rare form

o 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 infantsComplications:

o Laryngospasm Hypostatic pneumonia Hypoxia Atelectasis

o Trauma

Fractureso Septicemia

Nosocomial infectionso Death

Diagnostic procedure: entirely clinical

CSF – normalWBC- normal or slight elevationTreatment:

• 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

o Determine vertebral injuryo Attend to residual pulmonary disabilityo Physiotherapyo TT

Nursing Interventions:• Prevention• DPT

o Adverse Reactionso Local reactions (erythema, induration)o Fever and systemic symptoms not commono Exagerated local reactions

Nursing interventions:• Prevention of CV and respiratory complications

o 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/spasmo 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 • Diagnostic procedures

o History of exposureo PE/ assessment of s/so Microscopic examination of Negri bodies using

Seller’s May-Grunwald and Mann Strainso Fluorescent Rabies Antibody technique / Direct

Immunofluorescent test

Clinical ManifestationsProdromal Phase / Stage of Invasion

• Fever, anorexia, malaise, sorethroat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability, restlessness, drowsiness, mental depression, marked insomia

• Sensitive to light, sound, and changes in temp• Myalgia, numbness, tingling, burning or cold

sensation along nerve pathway; dilation of pupils Stage of Excitement

• Marked excitation, apprehension• Delirium, nuchal stiffness, involuntary twitching• Painful spasms of muscles of mouth, pharynx,

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

• Aerophobia• Precipitated by mild stimuli – touch or noise• Death – spasm from or from cardiac / respiratory

failureTerminal Phase or Paralytic Stage

• Quiet and unconscious• Loss of bowel and bladder control• Tachycardia, labored irregular respiration, steady

rising temp• Spasm, progressively increasing paralysis• 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 monthso Rabuman, Hyper Rab, Imogam

Nursing Interventiono Isolation of patiento Provide comfort for the patient by:

Place padding of bedside or use restraints

Clean and dress wound with the use of gloves

Do not bathe the patient, wipe saliva or provide sputum jar

o Provide restful environment Quiet, dark environment Close windows, no faucets or running water should

be heard IVF should be covered 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 Plasmodia• Plasmodium Falciparum (malignant tertian)

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

• P. Vivax - non life threatening except for the very young and old.

o Manifests chills every 48 hrs on the 3rd day onward if not treated,

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

• 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 transmission

o Mosquito biteVECTOR – female Anopheles mosquito

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 • Hypotensiono May lasts for 12 hours daily or every 2 days.• Complicated Malaria• GIT o Bleeding from GUT, N/V, Diarrhea, abdominal pain, gastric,

tyhoid, choleric, dysenteric• CNS or Cerebral Malariao Changes in sensorium o Severe headacheo N/V• Hemolytic• Blackwater fever

o Reddish to mahogany colored urine due to hemoglobinuria

o Anuria – death• 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 transfusionNursing 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

o Mosquito breeding places should be destroyed

o Insecticides, insect repellant o 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 • Infected person- virus is present in the blood and will

be the reservoir when sucked by mosquitoes• Stagnant water = any

Diagnostic Tests• Torniquet test • Platelet Count • Hematocrit

Manifestations• PRODROMAL symptoms

o 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

bleeding• CIRCULATORY Phase

o 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 MANAGEMENT1. Kept in mosquito free environment 2. Keep pt. at rest3. VS monitoring4. Ice bag on the bridge of nose and forehead.5. 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 o 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• Diagnostic tests:

o Clinical manifestationso Culture

SOURCE OF INFECTIONo Rats, dogs, mice

MANIFESTATIONSo Septic Stage

Early Fever (40 ‘C), tachycardia, skin flushed,

warm, petechiae Severe Multiorgan Conjunctival affectation, jaundice,

purpura, ARF, Hemoptysis, head-ache, abdominal pain, jaundice

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

o Convalescence – recoveryMANAGEMENT

1. IV antibiotic Pen G NaTetracyclineDoxycycline

2. Dialysis – peritoneal3. IVF4. Supportive5. Symptomatic

Nursing Interventionso Isolation of patient – urine must properly

disposedo Care of exposed persons – keep under close

surveillanceo Control measures

Cleaning of the environment/ stagnant water

Eradicate rats Avoid bathing or wading in

contaminated pool of water 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• Vector: Oncomelania quadrasi

o Cercariae: most infective stage• Diagnostic test: ova seen in fecalysis • Diagnostic procedures

Fecalysis Identification of eggs

Liver and rectal biosy Immunodiagnostic tests / circumoval

precipitin test and cercarial envelope reactions

S/so Swimmers itch

Itchiness Redness and pustule formation at site of entry of

cercariae Diarrhea

Abdominal pain hepatosplenomegaly

CLINICAL MANIFESTATIONS:• 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 àbladder cancer;• Pulmonary hypertension (S. mansoni, S. japonicum, more

rarely S. haematobium); • Glomerulonephritis; and central nervous system lesions.• Complications

o Pulmonary hypertensiono Cor pulmonale o Myocardial damageo Portal cirrhosis

Treatment:• Trivalent antimony

o Tartar emetic – administered thru veino Stibophen (FUADIN) – given per IM

• PRAZIQUANTEL – per orem • Niridazole • Nursing Interventions:

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

endemic areas like streamso Proper sanitation or disposal of feceso 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

o 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

• 1. Identification of S/s • 2. Tissue biopsy• 3. Tissue smear • 4. Bloods – inc. ESR• 5. Lepromin skin test• 6. 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

TREATMENT • multiple drug therapy• sulfone • rehab• occupational Health• isolation• moral support

PREVENTION1. Report cases and suspects of leprosy2. BCG vaccine may be protective if given during the first 6

months.3. Nursing Interventions:

1. Isolation of patient – until causative agent is still present

2. Care of exposed persons1. Household contact –

Diaminodiphenylsulfone for 2 years2. Observe carefully for symptoms of the

disease

Diseases Acquired Thru Sexual Contact

HIV /AIDS• Chronic disease that depresses immune function • Characterized by opportunistic infections when T4/CD4

count drops <200• MOT – sexual contact with infected – unprotected,

injection of blood/products, placental transmission

History of HIV / AIDS• 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 systemo Macrophages Humoral response

Cell-mediated response

Diagnostic Tests• ELISA• Western Blot• CD4 count• Viral load testing• Home test kits

Manifestationso Minor signs – cough for one month, general

pruritus, recurrent herpes zoster, oral candidiasis, generalized lymphadenopathy

o 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 angiomatosis o Oral hairy leukoplakia o Peripheral neuropathyo Vulvovaginal candidiasis

o 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, pneumoniao Primary brain lymphomao Pneumocystis Carinii Pneumoniao Recurrent pneumoniao Mycobacterium infectiono Progressive multifocal leukoencepalopathy o Salmonella septicemiao Toxoplasmosiso Wasting syndromes

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• Blocks reverse transcriptase

NRT• Acts by binding directly to the reverse transcriptase

enzyme• Not used alone• Rapid development of resistance• Acts by binding directly to the reverse transcriptase

enzyme• Not used alone• 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 Inhibitors• Introduced in 1995• Acts by blocking protease enzyme• Indinavir (Crixivan)

CDC Guidelineso Combination of 2 NRTI + PI

• Nursing Managemento Administer Antiviral meds as orderedo Universal precautiono Reverse isolation

gloves, needle stick injury preventiono 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 successfulManifestations:

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

Endometritis, Salpingitis, Pelvic Abscess

• Complications : • PID • Infertility

Complications:• Upper Genital Tract – male

o Epididymitis, Prostatitis, Seminal Vesiculitis • Disseminated Gonococcal Infection (DGI)

o Tenosynovitis or Polyarthritis, skin lesions and fever

• Anorectal Infection• Pharyngeal Infection• Gonococcal Conjuctivitis

o Opthalmia Neonatorum • Meningitis, Endocarditis

Diagnosis:• Culture & Sensitivity• Blood tests for N. gonorrhoeae antibodies

Treatment:• ANTIBIOTICS• Penicillin• Single dose Ceftriaxone IM + doxycycline PO BID for 1

week• Prophylaxis: Silver nitrate, Tetracycline, Erythromycin

Nursing Interventions:o Case findingo Health teaching on importance of monogamous

sexual relationshipo Treatment should be both partners to prevent

reinfection o Instruct possible complications like infertilityo 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 abrasionso Can be passed from infected mother to unborn

child (transplacental)Symptoms

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

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

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

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

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

condylomata lata - flat broad whitish lesions

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 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 • generalized paresis of the insane which

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

• cardiovascular syphilis • aortitis, aortic aneurysm, Aneurysm of sinus

of valsalva and aortic regurgitation, - deathConsequences in Infants

• Congenital syphilis • extremely dangerous• Deformities• Seizures• Blindness• 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

o Case findingo Health teaching and guidance along preventive

measureso Utilization of community health facilitieso Assist in interpretation and diagnosiso Reinforce ff up treatmento VD control program participationo 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

S/s:• Jaundice• Pruritus • Fatigue• RUQ - Abdominal pain• Loss of appetite• Nausea, vomiting• Joint pain

Prevention:• Hepatitis B vaccine has been available since 1982.

o Routine vaccination of 0-18 year oldso Vaccination of risk groups of all ages

• Immune globulin if exposedMEDICAL MANAGEMENT

• Interferon alfa-2b• Lamivudine • Telbivudine • Entecavir • Adefovir dipivoxil Nursing Interventions:

o Blood and body secretions precautionso Prevention- Hepa B vaccineo Proper rest periodso Prevent stress – physio/psychologicalo Proper NTN, increase in CHO, high in CHON, low

fats, Vit. K rich foods and mineralso Assistance to prevent injury, promote safety AATo WOF s/s bleeding, edemao 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

S/so flu like: fever, myalgia, lethargy, gastrointestinal

symptoms, cough, sore throato fever above 38 °C (100.4 °F)o Shortness of breath o Symptoms usually appear 2–10 days following

exposureo require mechanical ventilation

Diagnostic Test:• 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 • fever of 38 °C (100.4 °F) or more AND • Either a history of:

o Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days OR

o 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 has the 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