Communicable Dse Reviewer

COMMUNICABLE DISEASE NURSING SUMMER REVIEW

CHAIN OF INFECTION

COMMUNICABLE DISEASE

Disease caused by an infectious agent that are transmitted directly or indirectly to a well person through an agency, vector or inanimate object CONTAGIOUS DISEASE

Disease that is easily transmitted from one person to another INFECTIOUS DISEASE

Disease transmitted by direct inoculation through a break in the

INFECTIOUS AGENT

skin

Any microorganism capable of producing a disease

INFECTION -Entry and multiplication of an infectious agent into the tissue of the host INFESTATION - Lodgement and development of arthropods on the surface of the body ASEPSIS - Absence of disease – producing microorganisms SEPSIS - The presence of infection MEDICAL ASEPSIS -Practices designed to reduce the number and transfer of pathogens -Clean technique SURGICAL ASEPSIS -Practices that render and keep objects and areas free from microorganisms -Sterile technique

CARRIER – an individual who harbors the organism and is capable of transmitting it without showing manifestations of the disease

CASE – a person who is infected and manifesting the signs and symptoms of the disease

SUSPECT – a person whose medical history and signs and symptoms suggest that such person is suffering from that particular disease

CONTACT – any person who had been in close association with an infected person HOST - A person, animal or plant which harbors and provides nourishment for a parasite RESERVOIR - Natural habitat for the growth, multiplication and reproduction of microorganism ISOLATION - The separation of persons with communicable diseases from other persons QUARANTINE - The limitation of the freedom of movement of persons exposed to communicable diseases

STERILIZATION – the process by which all microorganisms including their spores are destroyed

DISINFECTION – the process by which pathogens but not their spores are destroyed from inanimate objects

CLEANING – the physical removal of visible dirt and debris by washing contaminated surfaces CONCURRENT - Done immediately after the discharge of infectious materials / secretions TERMINAL - Applied when the patient is no longer the source of infection BACTERICIDAL - A chemical that kills microorganisms BACTERIOSTATIC - An agent that prevents bacterial multiplication but does not kill microorganisms

RESERVOIR

Environment or object on which an organism can survive and multiply PORTAL OF EXIT

The venue or way in which the organism leaves the reservoir MODE OF TRANSMISSION The means by which the infectious agent passes from the portal of exit from the reservoir to the susceptible host PORTAL OF ENTRY Permits the organism to gain entrance into the host SUSCEPTIBLE HOST A person at risk for infection, whose defense mechanisms are unable to withstand invasion of pathogens STAGES OF THE INFECTIOUS PROCESS

Incubation Period – acquisition of pathogen to the onset of signs and symptoms

Prodromal Period – patient feels “bad” but not yet experiencing actual symptoms of the disease

Period of Illness – onset of typical or specific signs and symptoms of a disease

Convalescent Period – signs and symptoms start to abate and client returns to normal health MODE OF TRANSMISSION CONTACT TRANSMISSION Direct contact – involves immediate and direct transfer from person-to-person (body surface-to-body surface) Indirect contact – occurs when a susceptible host is exposed to a contaminated object DROPLET TRANSMISSION Occurs when the mucous membrane of the nose, mouth or conjunctiva are exposed to secretions of an infected person within a distance of three feet VEHICLE TRANSMISSION Transfer of microorganisms by way of vehicles or contaminated items that transmit pathogens AIRBORNE TRANSMISSION Occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens VECTOR-BORNE TRANSMISSION Transmitted by biologic vectors like rats, snails and mosquitoes TYPES OF IMMUNIZATION ACTIVE – antibodies produced by the body NATURAL – antibodies are formed in the presence of active infection in the body; lifelong ARTIFICIAL – antigens are administered to stimulate antibody production PASSIVE – antibodies are produced by another source NATURAL – transferred from mother to newborn through placenta or colostrum ARTIFICIAL – immune serum (antibody) from an animal or human is injected to a person SEVEN CATEGORIES OF ISOLATION STRICT- prevent highly contagious or virulent infections Example: chickenpox, herpes zoster CONTACT – spread primarily by close or direct contact Example: scabies, herpes simplex RESPIRATORY – prevent transmission of infectious distances over short distances through the air Example: measles, mumps, meningitis CD-Bucud

1

TUBERCULOSIS – indicated for patients with positive smear or chest x-ray which strongly suggests tuberculosis ENTERIC – prevent transmission through direct contact with feces Example: poliomyelitis, typhoid fever DRAINAGE – prevent transmission by direct or indirect contact with purulent materials or discharge Ex. Burns UNIVERSAL – prevent transmission of blood and body-fluid borne pathogens Example: AIDS, Hepatitis B

CENTRAL NERVOUS SYSTEM ENCEPHALITIS

MENINGITIS

MAIN PROBLEM

- Inflammation of the brain

- Inflammation of the meninges

ETIOLOGIC AGENT

MENINGOCOCCEMIA - Acute infection of the bloodstream and developing vasculitis

- Streptococcus - Staphylococcus - Pneumococcus - Tubercle bacillus

- Arboviruses

5-15 days

1-10 days

DIC URTI: cough, sore throat, fever, headache, nausea and vomiting

3-4 days

Respiratory droplets

Purpura Hypotension Shock Death

ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA Vasculitis

Stiff neck

Nuchal rigidity

Photophobia

Opisthotonus

Lethargy

Brudzinski’s

Convulsions

Kernig’s sign

MODE OF TRANSMISSION

Bite of infected mosquito

Microthrombosis

Vasculitis: petechial rash in the trunk and extremities

SIGNS AND SYMPTOMS

- Neisseria meningitides

INCUBATION PERIOD

SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA

WaterhouseFriderichsen syndrome Petechiae with the development of hemorrhage

INCIDENCE SIGNS AND SYMPTOMS OF ENCEPHALITIS

Virus enters neural cells

Disruption in cellular functioning Lethargy Convulsions Seizures

Perivascular congestion

Headache Photophobia Vomiting Stiff neck

Inflammatory reaction

Fever Sore throat

5-10 years old

< 5 years old

DIAGNOSTIC EXAM  Informed consent  Empty bowel and bladder  Fetal, shrimp or “C” position  Spinal canal, subarachnoid space between L3-L4 or L4- L5  After: bedrest  Flat on bed to prevent spinal headache

ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA

TREATMENT MODALITIES

Dexamethasone

SIGNS AND SYMPTOMS OF MENINGITIS

6 months–5 years old

Ceftriaxone

Mannitol

Penicillin

Anticonvulsants

Chloramphenicol

Antipyretics PREVENTION

1. Japanese encephalitis VAX ENCEPHALITIS

1. HiB vaccine

Ciprofloxacin MENINGITIS

NURSING MANAGEMENT

THREE SIGNS OF MENINGEAL IRRITATION OPISTHOTONUS State of severe hyperextension and spasticity in which an individual’s head, neck and spinal column enter into a complete arching position BRUDZINSKI’S SIGN Place the patient in a dorsal recumbent position and then put hands behind the patient’s neck and bend it forward. If the patient flexes the hips and knees in response to the manipulation, positive for meningitis KERNIG’S SIGN Place the patient in a supine position, flex his leg at the hip and knee then straighten the knee; pain and resistance indicates meningitis

1. Comfort: quiet, well-ventilated room 2. Skin care: cleansing bath, change in position 3. Eliminate mosquito breeding sites: CULEX mosquito

Rifampicin

MENINGOCOCCEMIA 1. Side boards

1. Respiratory isolation 24-72 hours after onset of antibiotic therapy

2. Close contacts

2. Room protected against bright lights

S – ame daycare center

3. Safety: side-lying position and raised side rails

H – ouse I – nfected person kissing

S – hare mouth instruments 3. Antibiotics as prophylaxis

CD-Bucud

2

RABIES

TETANUS

Acute viral disease of the CNS – by saliva of infected animals

Acute infectious disease with systemic neuromuscular effects

ETIOLOGIC AGENT

Rhabdovirus

Clostridium tetani

Legio debilitans

Bullet-shaped

Anaerobic

Affinity to CNS

Gram positive

Killed by sunlight, UV light, formalin

Drumstick appearance

POLIOMYELITIS MAIN PROBLEM Acute infection of the CNS – muscle spasm, paresis and paralysis

Resistant to antibiotics

RABIES

POLIOMYELITIS INCUBATION PERIOD

7-21 days

TETANUS

2-8 weeks Distance of bite to brain

Adult: 3 days-3 weeks

Extensiveness of the bite

Neonate: 3-30 days

- Indirect with soiled linens and articles

POLIOMYELITIS

RABIES

SIGNS AND SYMPTOMS

1. Abortive type 2. Pre-paralytic or meningetic type 3. Paralytic type

Direct inoculation through a broken skin

TETANUS R – isus sardonicus

Respiratory isolation

POLIOMYELITIS

RABIES

TREATMENT MODALITIES

C – onvulsions

3. Moist heat application

H – eadache

4. Bed rest



Recovery within 72 hours and the disease passes by unnoticed PRE-PARALYTIC OR MENINGETIC TYPE  Slight involvement of the CNS  Pain and spasm of muscles  Transient paresis  (+) Pandy’s test (increased protein in the CSF) PARALYTIC TYPE  CNS involvement Flaccid paralysis Asymmetric Affects lower extremities Urine retention and constipation (+) HOYNE’S SIGN (when in supine position, head will fall back when shoulders are elevated)

1. Blood exam

2. Flourescent rabies antibody (FRA)

Enteric isolation

2. Excitement / neurological phase

T – rismus

1. Throat washings

ISOLATION PRECAUTION

O – pistothonus

POLIO ABORTIVE TYPE  Does not invade the CNS  Headache  Sore throat

   

DEATH

3. Negri bodies

1. Prodromal / invasion phase

I – rritability 3. Terminal / paralytic type L – aryngeal spasm



RESPIRATORY FAILURE

Paralysis of respiratory muscles

2. CSF culture

Bite of an infected animal

TETANUS

COMPLICATION

1. Stool culture

MODE OF TRANSMISSION

- Direct contact with respiratory secretions

RABIES

POLIOMYELITIS

DIAGNOSTIC PROCEDURES

Resistance of the host - Direct contact with infected feces

RABIES PRODROMAL/INVASION PHASE  Fever  Anorexia  Sore throat  Pain and tingling at the site of bite  Difficulty swallowing EXCITEMENT OR NEUROLOGICAL PHASE  Hydrophobia (laryngospasm)  Aerophobia (bronchospasm)  Delirium  Maniacal behavior  Drooling TERMINAL OR PARALYTIC PHASE  Patient becomes unconscious  Loss of urine and bowel control  Progressive paralysis  Death

1. Analgesics 2. Morphine

5. Rehabilitation

1. Local treatment of wound

1. Tetanus immune globulin (TIG) 2. Tetanus antitoxin (TAT)

2. Active immunization

3. Penicillin G

Lyssavac

5. Diazepam

Imovax

6. Phenobarbital

Antirabies vax 2. Passive immunization POLIOMYELITIS

TETANUS

RABIES

4. Tetracycline

7. Tracheostomy 8. NGT feeding

TETANUS

NURSING MANAGEMENT

1. Enteric isolation

1. Isolation

1. Adequate airway

2. Proper disposal of secretions

2. Optimum comfort

2. Quiet, semi-dark environment

3. Moist hot packs

3. Restful environment

3. Avoid sudden stimuli and light

4. Firm / nonsagging bed 5. Suitable body alignment 6. Comfort and safety

4. Emotional support 5. Concurrent and terminal disinfection

CD-Bucud

3

RABIES

POLIOMYELITIS PREVENTION

Salk vaccine - Inactivated polio vaccine - Intramuscular Sabin vaccine - Oral polio vaccine - Per orem

TETANUS

1. If the dog is healthy 2. If the dog dies or shows signs suggestive of rabies

1. Aseptic handling of umbilical cord

4. Have domestic dog 3 months to 1 year old immunized

SARS

TREATMENT MODALITIES

- Penicillin

1. Amantadine/Rimantadine 1. No definitive treatment for SARS - Generic flu drugs - H5N1 developed resistance 2. Antiviral drugs (normally used to treat 2. Oseltamivir (TAMIFLU) AIDS) Zanamavir (RELENZA) - RIBAVIRIN - Primary treatment - Within 2 days at onset of 3. Corticosteroids symptoms

- Erythromycin

- 150 mg BID x 2 days

2. Tetanus toxoid immunization 3. Antibiotic prophylaxis

3. If dog is not available for observation

BIRD FLU

- Tetracycline

BIRD FLU RESPIRATORY SYSTEM

BIRD FLU

PREVENTION

SARS

MAIN PROBLEM

Flu infection in birds that affects humans

A new type of atypical pneumonia that infects the lungs

ETIOLOGIC AGENT

Avian influenza virus, H5N1

Corona virus

INCUBATION PERIOD

3-5 days

2-8 days

MODE OF TRANSMISSION

Inhalation of feces and discharge of an infected bird

Respiratory droplets

BIRD FLU

SARS

Body weakness or muscle pain Cough Difficulty breathing Episodes of sore throat Fever High fever >38’Celsius Chills

COMPLICATIONS

Severe viral pneumonia Acute respiratory distress syndrome Fluid accumulation in alveolar sacs Severe breathing difficulties Multiple organ failure DEATH

SARS Severe viral pneumonia Hypoxemia Respiratory failure

1.Quarantine

1.Culling – killing of sick or exposed birds

2. Isolation 3. WHO alert on SARS (March 12, 2003)

2. Banning of importation of birds (Executive order # 280) 3. Cook chicken thoroughly NURSING MANAGEMENT

BIRD FLU WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD FLU • Isolation

• • • •

SIGNS AND SYMPTOMS

BIRD FLU

SARS

Face mask on the patient Caregiver: use a face mask and eye goggles/glasses Distance of 1 meter from the patient Transport the patient to a DOH referral hospital

REFERRAL HOSPITALS

•

National Referral Center – Research Institute for Tropical Medicine (RITM) (Alabang, Muntinlupa)

•

Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz, Manila)

•

Visayas – Vicente Sotto Memorial Medical Hospital (Cebu City)

• Mindanao – Davao Medical Center (Bajada, Davao City) SARS SUSPECT CASE 1. A person presenting after 1 November 2002 with a history of:   

High fever >38 0C

AND

Cough or breathing difficulty

AND

One or more of the following exposures during the 10 days prior to the onset of symptoms:



Close contact, with a person who is a suspect or probable case of SARS



History of travel, to an area with recent local transmission of SARS



Residing in an area with recent local transmission of SARS 2. A person with an unexplained acute respiratory illness resulting in death after 1 November 2002, but on whom no autopsy has been performed : AND  One or more of the following exposures during the 10 days prior to the onset of symptoms:



Close contact, with a person who is a suspect or probable case of SARS CD-Bucud

4



History of travel, to an area with recent local transmission of SARS



Residing in an area with recent local transmission of SARS PROBABLE CASE 1. A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome on Chest x-ray.

•

With profuse sweating, involuntary urination and exhaustion CONVALESCENT STAGE • End of 4th-6th week • Decrease in paroxysms

DIPHTHERIA

PERTUSSIS

DIAGNOSTIC PROCEDURES  CBC

2. A suspect case of SARS that is positive for SARS coronavirus by one or more assays.

 SCHICK’S TESTS

3. A suspect case with autopsy findings consistent with the pathology of SARS without an identifiable cause.

-ID of dilute diphtheria toxin (0.1 cc)

DIPHTHERIA

PERTUSSIS

MAIN PROBLEM

Acute bacterial disease characterized by the elaboration of an exotoxin

Repeated attacks of spasmodic coughing

- Susceptibility and immunity to diphtheria

– increase in lymphocytes

(+) local circumscribed area of redness, 1-3 cm MALONEY’S TEST -Determines hypersensitivity to diphtheria anti-toxin -ID of 0.1 cc fluid toxoid -(+) area of erythema in 24 hours

ETIOLOGIC AGENT

Corynebacterium diphtheriae or Klebs-Loeffler bacillus

Bordetella pertussis

INCUBATION PERIOD

7-14 days

2-5 days

DIPHTHERIA

PERTUSSIS

COMPLICATIONS

Convulsions (brain

Toxins in the bloodstream

damage from asphyxia)

MODE OF TRANSMISSION

1. Respiratory droplets 2. Direct contact with respiratory secretions 3. Indirect contact with articles

DIPHTHERIA

PERTUSSIS

SIGNS AND SYMPTOMS

Types: 1.Nasal 2.Tonsilopharyngeal 3.Laryngeal 4.Wound or cutaneous

Stages: 1. Catarrhal 2. Paroxysmal 3. Convalescent

NASAL DIPHTHERIA • Bloody discharge from the nose • Excoriated nares and upper lip TONSILOPHARYNGEAL DIPHTHERIA • Low grade fever • Sore throat • Bull-neck appearance

•

Pseudomembrane- Group of pale yellow membrane over tonsils and at the back of the throat as an inflammatory response to a powerful necrotizing toxins LARYNGEAL DIPHTHERIA • Hoarseness • Croupy cough • Aphonia

•

Membrane lining thickens à airway obstruction • Suffocation, cyanosis or death WOUND OR CUTANEOUS DIPHTHERIA • Yellow spots or sores in the skin PERTUSSIS CATARRHAL STAGE

• • •

Lasts for 1 to 2 weeks Most communicable stage Begins with respiratory infection, sneezing, cough and fever

• Cough becomes more frequent at night PAROXYSMAL STAGE • Lasts for 4 to 6 weeks • • • •

Aura: sneezing, tickling, itching of throat Cough, explosive outburst ending in “whoop” Mucus is thick, ends in vomiting Becomes cyanotic

Myocarditis (epigastric or chest pain)

Heart failure

Peripheral paralysis (tingling, numbness, paresis)

Decreased in respiratory rate

Bronchopneumonia (fever, cough)

Respirat ory arrest

Otitis media (invading organisms)

Bronchopneumonia (most dangerous complication)

DEATH

DIPHTHERIA

PERTUSSIS

TREATMENT MODALITIES

1. Diphtheria anti-toxin - Requires skin testing - Early administration aimed at neutralizing the toxin present in the circulation before it is absorbed by the tissues 2. Antibiotic therapy - Penicillin G - Erythromycin

DIPHTHERIA NURSING MANAGEMENT

1. Isolation: 14 days (until 2-3 cultures, 24 hours apart) 2. Bedrest for 2 weeks 3. Care for nose and throat (gentle swabbing) 4. Ice collar (decrease pain of sore throat) 5. Diet (soft food, small frequent feedings)

1. Erythromycin – drug of choice 2. Ampicillin – if resistant to erythromycin 3. Betamethasone (corticosteroid) – decrease severity and length of paroxysms 4. Albuterol (bronchodilator)

PERTUSSIS 1. Isolation: 4-6 weeks from onset of illness 2. Supportive measures (bedrest, avoid excitement, dust, smoke and warm baths) 3. Safety (during paroxysms, patient should not be left alone) 4. Suctioning (kept at bedside for emergency use)

MUMPS MAIN PROBLEM An acute contagious disease, with swelling of one or both of the parotid glands ETIOLOGIC AGENT Filterable virus of paramyxovirus group INCUBATION PERIOD CD-Bucud

5

12-26 days MODE OF TRANSMISSION Respiratory droplets PERIOD OF COMMUNICABILITY 6 days before and 9 days after onset of parotid swelling SIGNS AND SYMPTOMS PRODROMAL PHASE F-ever (low grade) H-eadache M-alaise

AMOEBIASIS SIGNS AND SYMPTOMS

1. Acute amoebic dysentery

Abdominal pain Diarrhea and tenesmus

- Bloody mucoid stools 2. Chronic amoebic dysentery

Bloody mucoid stool

- Enlarged liver - Large sloughs of intestinal tissues accompanied by hemorrhage

COMPLICATIONS

• •

Orchitis – the most notorious complication of mumps

•

CNS involvement – manifested by headache, stiff neck, delirium, double vision

Oophoritis – manifested by pain and tenderness of the abdomen

• Deafness as a result of mumps NURSING MANAGEMENT 1. Prevent complications − Scrotum supported by suspensory − Use of sedatives to relieve pain − Treatment: oral dose of 300-400 mg cortisone followed by 100 mg every 6 hours − Nick in the membrane 2. Diet - Soft or liquid diet - Sour foods or fruit juices are disliked 3. Respiratory isolation 4. Comfort: ice collar or cold applications over the parotid glands may relieve pain 5. Fever: aspirin, tepid sponge bath 6. Concurrent disinfection: all materials contaminated by these secretions should be cleansed by boiling 7. Terminal disinfection: room should be aired for six to eight hours

AMOEBIASIS

SHIGELLOSIS

DIAGNOSTIC TESTS 1. Stool exam 2. Blood exam 3. Sigmoidoscopy TREATMENT MODALITIES

1. Metronidazole – drug of choice

1. Cotrimoxazole – drug of choice

2. Tetracycline 3. Chloramphenicol

AMOEBIASIS

SHIGELLOSIS

NURSING MANAGEMENT

1.Enteric isolation 2. Boil water for drinking

GASTROINTESTINAL TRACT

3. Handwashing

SHIGELLOSIS

4. Sexual activity 5. Avoid eating uncooked leafy vegetables

MAIN PROBLEM Protozoal infection of the large intestine

Fever

- Diarrhea alternated with constipation - Tenesmus

PAROTITIS F-ace pain E-arache S-welling of the parotid glands

AMOEBIASIS

SHIGELLOSIS

Acute infection of the lining of the small intestine

ETIOLOGIC AGENT

Entamoeba histolytica

Shigella group

- Prevalent in areas with ill sanitation

1. Shigella flesneri – most common in the Philippines

-Acquired by swallowing

2. Shigella connei

- Trophozoites: vegetative form

3. Shigella boydii

- Cyst: infective stage

4. Shigella dysenterae – most infectious type

CHOLERA

TYPHOID FEVER

MAIN PROBLEM

Acute bacterial disease of the GIT characterized by profuse secretory diarrhea

An infection affecting the Peyer’s patches of the small intestines

ETIOLOGIC AGENT

Vibrio cholerae

Salmonella typhi

INCUBATION PERIOD

1 to 3 days

1 to 3 weeks

MODE OF TRANSMISSION

1. Fecal-oral transmission 2. 5 F’s

CD-Bucud

6

CHOLERA

TYPHOID FEVER

SIGNS AND SYMPTOMS

Fever (ladder-like)

Rice-water stool Abdominal cramps

Rose spots Diarrhea

Vomiting

TYPHOID STATE

Intravascular Dehydration

Sordes

Shock

Coma vigil

CHICKENPOX PERIOD OF COMMUNICABILITY

One day before eruption of 1st lesion and five days after appearance of last crop

PRODROMAL PERIOD - Fever (low-grade) - Headache

Carphologia

TYPHOID FEVER

TREATMENT MODALITIES

1.Lactated Ringer’s solution

1.Chloramphenicol – drug of choice 2. Ampicillin/ Amoxicillin – for typhoid carriers

2. Oral rehydration therapy 3. Antibiotic therapy - Tetracycline – drug of choice

3. Cotrimoxazole – for severe cases with relapses

- Malaise

CHICKENPOX SIGNS AND SYMPTOMS

• Rashes

: Centrifugal distribution •Rash stages: macule papule vesicle pustule crust • Pruritus

- Cotrimoxazole - Chloramphenicol

CHOLERA

TYPHOID FEVER

NURSING MANAGEMENT

CHICKENPOX COMPLICATIONS

1. Maintain and restore the fluid and electrolyte balance 2. Enteric isolation 3. Sanitary disposal of excreta 4. Adequate provision of safe drinking water 5. Good personal hygiene

One day before eruption of 1st rash and five to six days after the last crust

SIGNS AND SYMPTOMS

Subsultus Tendinum

CHOLERA

HERPES ZOSTER

SCARRING – most common complication; associated with staphylococcal or streptococcal infections from scratching NECROTIZING FASCIITIS – most severe complication REYE SYNDROME – abnormal accumulation of fat in the liver plus increase of pressure in the brain resulting to coma, therefore leading to DEATH

HERPES ZOSTER • Rashes

-Unilateral, band-like distribution -Dermatomal - Erythematous base - Vesicular, pustular or crusting •Regional lymphadenopathy •Pruritus •Pain – stabbing or burning

HERPES ZOSTER RAMSAY-HUNT SYNDROME - Involvement of the facial nerve in herpes zoster with facial paralysis, hearing loss, loss of taste in half of the tongue GASSERIAN GANGLIONITIS – Involvement of the optic nerve resulting to corneal anesthesia ENCEPHALITIS – acute inflammatory condition of the brain

INTEGUMENTARY SYSTEM

CHICKENPOX

HERPES ZOSTER

MAIN PROBLEM

A highly contagious disease characterized by vesicular eruptions on the skin and mucous membranes ETIOLOGIC AGENT

An acute viral infection of the sensory nerve

Varicella zoster virus

INCUBATION PERIOD

10-21 days MODE OF TRANSMISSION

13-17 days 1. Droplet method 2. Direct contact 3. Indirect contact

CD-Bucud

7

CHICKENPOX

HERPES ZOSTER

- Soft palate to mucus membrane

MEASLES

GERMAN MEASLES

TREATMENT MODALITIES

1. Antihistamines – symptomatic relief of itching Ex. Diphenhydramine (Benadryl)

4. Corticosteroids – antiinflammatory and decreased pain Ex. Prednisone

2. Analgesics and antipyretics Ex. Acetaminophen 3. Antiviral agents – for patient to experience less pain and faster resolution of lesions when used within 48 hours of rash onset

SIGNS AND SYMPTOMS

ERUPTIVE STAGE

2. ERUPTIVE STAGE Rashes - Elevated papules - Begin on the face and behind the ears - Spread to trunk and extremities Color: Dark red – purplish hue – yellow brown 3. Stage of Convalescence - Desquamation - Rashes fade from the face downwards

1. Rash - pinkish, maculopapular - Begins on the face - Spread to trunk or limbs - No pigmentation or desquamation 2. Posterior auricular and suboccipital lymphadenopathy

Ex. Acyclovir (Zovirax)

CHICKENPOX

HERPES ZOSTER

MEASLES

GERMAN MEASLES

NURSING MANAGEMENT

COMPLICATIONS

Strict isolation

Pneumonia Otitis media Severe diarrhea (leading

Prevent secondary infection (cut fingernails short, wear mittens)

Eliminate itching: calamine lotions, warm baths, baking soda paste

to dehydration)

Encourage not going to school:

Encephalitis

usually 7 days

Disinfection of clothes and linen with nasopharyngeal discharges by sunlight or boiling

MEASLES

GERMAN MEASLES A benign communicable exanthematous disease caused by rubella virus Rubella virus

INCUBATION PERIOD

14-21 days

10-12 days

- Heart defects (PDA, VSD) - Eye defects (Cataract, glaucoma) - Ear defects (Deafness)

MEASLES

GERMAN MEASLES

TREATMENT MODALITIES

ETIOLOGIC AGENT

Filterable virus of paramyxoviridae

2. Congenital rubella syndrome - Spontaneous abortion - Intrauterine growth retardation (IUGR) - Thrombocytopenia purpura “blueberry muffin skin” - Cleft lip, cleft palate, club foot

- Neurologic (microcephaly, mental retardation, behavioral disturbances

MAIN PROBLEM

A contagious exanthematous disease with chief symptoms to the upper respiratory tract

1. Encephalitis

1.Vitamin A – helps prevent eye damage and blindness 2. Antipyretics – for fever 3. Penicillin – given only when secondary infection sets in

1. Aspirin – help reduce inflammation and fever

MODE OF TRANSMISSION

1. Droplet method 2. Direct contact with respiratory discharges 3. Indirect with soiled linens and articles

MEASLES

GERMAN MEASLES

GERMAN MEASLES

NURSING MANAGEMENT

PERIOD OF COMMUNICABILITY

4 days before and 5 days after the appearance of rashes

MEASLES

1. Darkened room to relieve photophobia

One week before and four days after the appearance of rashes

2. Diet: should be liquid but nourishing 3. Warm saline solution for eyes to relieve eye irritation

SIGNS AND SYMPTOMS

PRE-ERUPTIVE STAGE

PRE-ERUPTIVE STAGE

Cough Coryza Conjunctivitis Fever (high-grade) Photophobia

Fever Headache Malaise Coryza Conjunctivitis

KOPLIK’S SPOT (Rubeola) - Bluish white spots surrounded by a red halo - Appear on the buccal mucosa opposite the premolar teeth FORCHEIMER’S SPOTS (Rubella) - small, red lesions

4. For fever: tepid sponge bath and antipyretics 5. Skin care: during eruptive stage, soap is omitted; bicarbonate of soda in water or lotion to relieve itchiness 6. Prevent spread of infection: respiratory isolation

SCABIES MAIN PROBLEM Infestation of the skin produced by the burrowing action of a parasite mite resulting in skin irritation and formation of vesicles and pustules ETIOLOGIC AGENT Sarcoptes scabiei CD-Bucud

8

INCUBATION PERIOD Within 24 hours MODE OF TRANSMISSION Direct contact Indirect contact

AIDS SIGNS AND SYMPTOMS OPPORTUNISTIC INFECTIONS

Sarcoptes scabiei 1. Yellowish white in color 2. Barely seen by the unaided eye 3. Female parasite burrows beneath the epidermis to lay eggs 4. Males are smaller and reside on the surface of the skin SIGNS AND SYMPTOMS

• • •

SYPHILIS

Thin, pencil-mark lines on the skin Itching, especially at night

Rashes and abrasions on the skin PRIMARY LESIONS NODULAR LESIONS SECONDARY LESIONS TREATMENT MODALITIES • SCABICIDE : Eurax ointment (Crotamiton) • PEDICULICIDE : Kwell lotion (Gamma Benzene Hexachloride) – contraindicated in young children and pregnant women • Topical steroids • Hydrogen peroxide : cleanliness of wound • Lindane Lotion NURSING MANAGEMENT • Apply cream at bedtime, from neck to toes • Instruct patient to avoid bathing for 8 to 12 hours • Dry-clean or boil bedclothes • Report any skin irritation • Family members and close contact treatment • Good handwashing • Terminal disinfection

1. Pneumocystis carinni pneumonia 2. Oral candidiasis 3. Toxoplasmosis 4. Acute/chronic diarrhea 5. Pulmonary tuberculosis MALIGNANCIES 1. Kaposi’s sarcoma 2. Non-Hodgkin’s lymphoma

AIDS SIGNS AND SYMPTOMS

SYPHILIS 1. PRIMARY SYPHILIS - CHANCRE: small, painless, pimple-like ulceration on the penis, labia majora, minora and lips - May erupt in the genitalia, anus, nipple, tonsils or eyelids - Lymphadenopathy

SEXUALLY TRANSMITTED DISEASES

AIDS

SYPHILIS

SIGNS AND SYMPTOMS

MAIN PROBLEM Final and most serious stage of HIV disease, which causes severe damage to the immune system

AIDS

SYPHILIS 2. SECONDARY SYPHILIS - Skin rash

Infectious disease caused by a spirochete

- Mucous patches - Hair loss - CONDYLOMATA LATA: coalescing papules which form a gray-white plaque frequently in skin folds

ETIOLOGIC AGENT Retrovirus – Human T-cell lymphotropic virus III (HTLV-3)

Treponema pallidum

INCUBATION PERIOD 3 to 6 months to 8 to 10 years

10-90 days

AIDS

SYPHILIS

MODE OF TRANSMISSION

contact – oral, anal or vaginal sex

AIDS SIGNS AND SYMPTOMS

SYPHILIS 3. TERTIARY SYPHILIS

• Sexual

- 1 to 10 years after infection

•Blood transfusion

- Appear on the skin, bones, mucus membrane, URT, liver and stomach

•Mother-to-child •Indirect contact through soiled articles

- GUMMA: chronic, superficial nodule or deep granulomatous lesion that is solitary, painless, indurated

CD-Bucud

9

AIDS

SYPHILIS

COMPLICATIONS

DIAGNOSTIC PROCEDURES

1.ELISA 2. Western blot

4. PCR

3. VDRL

GONORRHEA

Women

1.Dark Field Illumination test 2. Flourescent Treponemal Antibody Absorption Test

3. RIPA

CHLAMYDIA

Pelvic inflammatory disease Ectopic pregnancy Sterility Men

Epididymitis Newborn

Sterility

Conjunctivitis

Newborn

Otitis media

Gonococcal ophthalmia

Pneumonia

AIDS TREATMENT MODALITIES

1. Antivirals - Shorten the clinical course, prevent complications, prevent development of latency, decrease transmission - Example: Zidovudine (Retrovir)

SYPHILIS 1. Penicillin G Benzathine

CHLAMYDIA TREATMENT MODALITIES

- Disease < 1 year: 2.4 M units once in two injection sites

1. Azithromycin (Zithromax)

- Disease > 1 year: 2.4 M units in 2 injection sites x 3 doses

- Drug of choice because of single-dose treatment effectiveness and lower cost

2. Doxycycline – if allergic to penicillin 3. Tetracycline - if allergic to penicillin - Contraindicated for pregnant women

2. Doxycycline - Secondary drug of choice

CANDIDIASIS CHLAMYDIA

GONORRHEA

MAIN PROBLEM

Sexually transmitted disease caused by a bacteria Purulent inflammation of mucous membrane surfaces ETIOLOGIC AGENT

Chlamydia trachomatis

Neisseria gonorrhea

INCUBATION PERIOD

2-3 weeks (males)

2-10 days

Sexual contact: Oral, vaginal or anal sex

GONORRHEA Women

Women

Bleeding after intercourse

Abdominal or pelvic pain

Burning sensation during urination

Bleeding after intercourse and in-between menses Unusual vaginal discharge

- Drug of choice because of oral efficacy, single dose 2. Ciprofloxacin 3. Ceftriaxone 4. Erythromycin

HERPES SIMPLEX A viral disease characterized by the appearance of sores and blisters on the skin

ETIOLOGIC AGENT

Candida albicans

2-3 weeks

MODE OF TRANSMISSION

SIGNS AND SYMPTOMS

Mild superficial fungal infection

1. Cefixime

Herpes simplex virus types 1 and 2

INCUBATION PERIOD

Asymptomatic (females)

CHLAMYDIA

MAIN PROBLEM

GONORRHEA

Yellow or bloody vaginal discharge

Men Burning with urination Swollen, painful testicles Discharge from the penis

White, yellow or green pus from the penis

CANDIDIASIS

2-12 days

HERPES SIMPLEX

MODE OF TRANSMISSION

1. Rise in glucose as in diabetes mellitus

TYPE 1

2. Lowered body resistance as in cancer

- Direct exposure to infected saliva

3. Increase in estrogen level in pregnant women

- Kissing and sharing utensils

4. Broad-spectrum antibiotics are used

TYPE 2

- Respiratory droplets

- Sexual or genital contact

SIGNS AND SYMPTOMS (Candidiasis) ONYCHOMYCOSIS • Red, swollen darkened nailbeds • Purulent discharge • Separation of pruritic nails from nailbeds DIAPER RASH • Scaly, erythematous, papular rash • Covered with exudates CD-Bucud 10

•

Appears below the breasts, between fingers, axilla, groin and umbilicus

THRUSH • Cream-colored or bluish-white patches on the tongue, mouth or pharynx • Bloody engorgement when scraped MONILIASIS • White or yellow discharge • Pruritus • Local excoriation • White or gray raised patches on vaginal walls with local inflammation

CANDIDIASIS

HERPES SIMPLEX

TREATMENT MODALITIES

1. Antifungals

1. Antivirals

- Fluconazole (Diflucan)

- Acyclovir (Zovirax)

- Ketoconazole (Nizoral) - Imidazole (Nystatin) - Used for oral thrush - 48 hours until symptoms disappear - Cotrimoxazole

CD-Bucud 11

VECTOR-BORNE DISEASES

DENGUE

DENGUE MALARIA

DIAGNOSTIC PROCEDURES 1. TORNIQUET TEST

MAIN PROBLEM An acute febrile disease The most common arboviral illness transmitted globally

An acute and chronic parasitic disease The most deadly vector-borne disease in the world

ETIOLOGIC AGENT

-

Screening test for dengue

-

A test for the tendency for blood capillaries to break down or produce petechial hemorrhage

-

-

Performed by examining the skin of the forearms after the arm veins have been occluded for 5 minutes

Plasmodium falciparum

2. PLATELET COUNT

Chikungunya virus

Plasmodium vivax

-

Confirmatory test for dengue

O’nyong’nyong virus

Plasmodium ovale

-

Decreased count is confirmatory

West Nile virus

Plasmodium malariae

MALARIA

3-14 days

MODE OF TRANSMISSION

TREATMENT MODALITIES

P. Falciparum – 12 days

- acetaminophen

P. Vivax – 14 days

2. Volume expanders

P. Ovale – 14 days

- Used in the treatment of intravascular volume deficits

P. Malariae – 30 days

- Example: Lactated Ringers

Blood transfusion, contaminated syringe or needle

Based on triad symptoms, 50% accuracy

2. BLOOD SMEAR -

Definitive diagnosis of infection is based on demonstration of malaria parasites in blood film

3. RAPID DIAGNOSTIC TEST -

Uses immunochromatographic methods to detect Plasmodiumspecific antigens

-

Takes about 7 to 15 minutes

-

Sensitivity and specificity > 90%

MALARIA 1. Chloroquine 2. Primaquine 3. Pyrimethamine

3. Blood transfusion – for severe bleeding

Bite of an infected mosquito

-

DENGUE

1. Analgesics and antipyretics

INCUBATION PERIOD

1. CLINICAL DIAGNOSIS

To detect unusual capillary fragility

Dengue virus types 1, 2, 3 and 4

DENGUE

MALARIA

4. Sulfadoxine 5. Quinine 6. Quinidine

4. Oxygen therapy 5. Sedatives

Trans-placentally

SCHISTOSOMIASIS DENGUE

LEPTOSPIROSIS

MALARIA MAIN PROBLEM

VECTOR

Aedes aegypti

Anopheles flavirostris

A zoonotic infectious disease

ETIOLOGIC AGENT

(Aedes albopictus)

1. SCHISTOSOMA JAPONICUM

White stripes on the back and legs (Tiger mosquito)

Brown in color

Day biting (2 hours after sunrise and 2 hours before sunset)

Night biting (9 PM-3 AM)

Breeds on clear stagnant water

Breeds on clear, flowing and shaded streams

Urban-based

Rural-based

DENGUE

A slowly progressive disease caused by a blood fluke

-

Leptospira interrogans

Intestinal tract, endemic in the Philippines

2. SCHISTOSOMA MANSONI -

Africa

3. SCHISTOSOMA HAEMATOBIUM - Middle East countries like Iran and Iraq

SCHISTOSOMIASIS

LEPTOSPIROSIS

MALARIA INCUBATION PERIOD

SIGNS AND SYMPTOMS

At least 2 months

FEVER

FEVER

HEADACHE

CHILLS

MALAISE RASH

PROFUSE SWEATING

7 to 19 days

MODE OF TRANSMISSION Ingestion Skin penetration Contact with the skin

EPISODES OF BLEEDING

CD-Bucud 12

SCHISTOSOMIASIS

LEPTOSPIROSIS

VECTOR

SCHISTOSOMIASIS TREATMENT MODALITIES

Oncomelania quadrasi

1. Praziquantel (Biltricide)

1. Thrives in fresh water stream

- Taken for 6 months - 1 tablet BID for 3 months

2. Clings to grasses and leaves

- 1 tablet OD for 3 months

3. Greenish brown in color

SIGNS AND SYMPTOMS

LEPTOSPIROSIS Septic or Leptospiremic Stage F – ever (remittent

1. Cercarial dermatitis (swimmer’s itch)

H – eadache

2. Katayama syndrome

N – ausea

H – eadache and fever A – norexia and lethargy

M – yalgia V – omiting C – ough C – hest pain

R – ash M - yalgia

SCHISTOSOMIASIS SIGNS AND SYMPTOMS

LEPTOSPIROSIS Immune or Toxic Stage

CHRONIC STAGE

- Lasts for 4 to 30 days

1. Hepatic: pain, abdominal distension, hematemesis, melena

- Iritis, headache, meningeal manifestations

2. Intestinal: fatigue, abdominal pain, dysentery

- Oliguria, anuria with renal failure

3. Urinary: dysuria, urinary frequency, hematuria 4. Cardiopulmonary: palpitations, dyspnea on exertion

- Shock, coma and congestive heart failure

5. CNS: seizures, headache, back pain and paresthesia

SCHISTOSOMIASIS DIAGNOSTIC PROCEDURES 1. Fecalysis 2. Kato-Katz Technique 3. Cercum ova precipitin test (COPT)

1. Penicillin G – drug of choice 2. Doxycycline 2nd line drugs

4. Amoxicillin

ACUTE STAGE

C - ough

1st line drugs

3. Ampicillin

4. Size is as big as the smallest grain of palay

SCHISTOSOMIASIS

LEPTOSPIROSIS

LEPTOSPIROSIS

FILARIASIS MAIN PROBLEM A parasitic disease caused by an African eye worm ETIOLOGIC AGENT Wuchereria bancrofti Brugia malayi Brugia timori INCUBATION PERIOD 8 to 16 months MODE OF TRANSMISSION Person-to-person by mosquito bites ACUTE STAGE

• •

Lymphadenitis (inflammation of lymph nodes)

Lymphangitis (inflammation of lymph vessels) Male genitalia affected leading to funiculitis, epididymitis and orchitis (redness, painful and tender scrotum) CHRONIC STAGE • Develop 10-15 years from onset of first attack •

• •

Hydrocele (swelling of the scrotum)

•

Elephantiasis (enlargement and thickening of the skin of the upper and lower extremities, scrotum and breast

Lymphedema (temporary swelling of the upper and lower extremities)

LABORATORY EXAMINATIONS

•

Nocturnal blood examination (NBE) – taken at patient’s residence/hospital after 8PM

•

Immunochromatographic test (ICT) – rapid assessment method; an antigen test done at daytime TREATMENT

•

Diethylcarbamazine Citrate (DEC) or HETRAZAN – an individual treatment kills almost all microfilaria and a good proportion of adult worms. PREVENTION AND CONTROL • Measures aimed to control vectors

•

Environmental sanitation such as proper drainage and cleanliness of surroundings

• Spraying with insecticides PREVENTION AND CONTROL • • • • •

Measures aimed to protect individuals and families: Use of mosquito nets Use of long sleeves, long pants and socks Application of insect repellants Screening of houses

- Confirmatory test for schistosomiasis

CD-Bucud 13