Professional Documents
Culture Documents
Communicable
Diseases
What is Communicable
Disease?
Communicable disease is an illness caused
by an infectious agent or its toxic products
that are transmitted directly or indirectly to
a well person through an agency, and a
vector or an inanimate object.
Definition of Terms:
Contagious Disease – term given to a disease that
is easily transmitted from one person to another
through direct or indirect means.
Infectious Disease – transmitted not only by
ordinary contact but requires direct inoculation of
the organism through a break on the skin or
mucous membrane.
- all contagious diseases are infectious.
What is infection?
Infection – invasion and multiplication of
microorganisms on the tissues of the host
resulting to signs and symptoms as well as
immunologic response.
The nurse and the
Communicable Diseases:
He/she must be knowledgeable of the following:
2. The nature of the specific microorganism and its
capacity for survival both within and outside the
body.
3. The most effective method of destruction of the
specific organism.
4. How the organism invades the host and its route
of escape from the body.
4. The incubation period, prodromata, and the
length of communicability.
5. How a specific drug alters the clinical signs
and the infectious course of the disease.
6. The most recent methods and concepts of
prophylaxis for communicable diseases.
7. The rationale and control measures,
including isolation techniques.
Acquired Immune Deficiency
Syndrome (AIDS)
Human Immunodeficiency Virus (HIV) –
causes AIDS.
- retrovirus
- belongs to lentevirus, also called “slow
virus”.
Pathophysiology of AIDS:
HIV
Antibodies
Lymphocytes,
macrophages,
Langerhans & neurons
Mode of Transmission:
Transmitted through contaminated fingers
put into the mouth.
Ingestion of contaminated food and drinks.
Pathogenesis
10 days
Treatment:
Nystatin, for oral thrush
Clitrimasole, fluconasole, ketoconasole – for
mucous membrane & vaginal infection
Fluconasole or Amphotericine for systemic
infection.
Chickenpox
(Varicella)
- an acute and highly contagious disease of viral
etiology, characterized by vesicular eruptions on
the skin and mucous membrane with mild
constitutional symptoms.
Infectious Agent: Herpesvirus varicellae – a DNA
containing virus
Incubation Period – 10-21 days or maybe prolonged
after passive immunization.
Mode of Transmission
Direct contact – shedding of the virus from
the vesicles
Indirect contact – through linens or fomites
Airborne (droplet infection)
Period of Communicability
The patient is capable of transmitting the disease
about a day before the eruption of the first lesion
up to about five days after the appearance of the
last crop.
Diagnostic Tests:
- Complement Fixation Test – to determine the V-Z
virus
- Electron Microscopic Exam of the vesicular fluid
Clinical Manifestations
pre-eruptive manifestations are mild fever
& malaise
Eruptive Stage
a. Rash starts from the trunk, then spread to
other parts of the body.
b. Initial lesions are distinctively red
papules where contents become milky and a
pus-like within 4 days.
c. In adult and bigger children, the lesions are more
widespread and more severe.
d. Vesicular lesions are very pruritic.
e. “Celestial map” – scabs
f. Stages of lesions:
*Macule – lesion that is not elevated above the
skin surface.
*Papule – lesion that is elevated above the skin
surface with a diameter of about 3 mm.
*Vesicle – pop-like eruption filled with
fluid.
*Pustule – vesicle that is infected or filled
with pus.
*Crust – scab or eschar. Secondary lesion
caused by the secretion of vesicle drying on
the skin. The scars are superficial,
depigmented and take time to fade out.
Complications
Secondary infection of the lesions –
furuncles, cellulitis, skin abscess, erysipelas
Meningoencephalitis
Pneumonia
Sepsis
Treatment Modalities
Zoverax
Oral acyclovir
Oral antihistamine
Calamine lotion
Antipyretic
Nursing Management
Respiratory Isolation is a must until all vesicles
have crusted.
Prevent secondary infection of the skin lesion
through hygienic care of the patient.
Linens must be disinfected under the sunlight or
through boiling.
Cut fingers nails short and wash hands more often.
Provide activities to keep child occupied to lessen
pruritus.
Dengue Fever
(Breakbone Fever/Hemorrhagic Fever/Dandy
Fever/Infectious Thrombocytopenic Purpura)
Mode of Transmission:
5. Direct contact
6. Air droplets
7. Transplacental transmission
Clinical Manifestation
1. Prodromal Period
a. low grade fever
b. headache
c. malaise
d. mild coryza
e. conjunctivitis
2. Eruptive Period
a. Pinkish rash on the soft palate (Forchheimer’s
spot), en exanthematous rash that appears first on
the face, spreading to the neck, the arms, trunk,
and legs
b. Eruption appears after the onset of adenopathy
c. Children usually present less or no
constitutional symptoms.
d. The rash may last for one to five days
and leaves no pigmentation nor
desquamation.
e. Testicular pain in young adults.
f. Transient polyarthralgia and polyarthritis
may occur in adults and occasionally in
children.
Nursing Management
1. The patient should be isolated.
2. The patient should be advised to rest in bed until
fever subsides.
3. The patient’s room must be darkened to avoid
photophobia.
4. The patient must take mild liquid but nourishing
diet.
5. The patient’s eyes should be irrigated with warm
normal saline to relieve irritation.
Prevention
Administration of live attenuated vaccine
(MMR).
Pregnant women should avoid exposure to
patients infected with Rubella virus.
Administration of Immune Serum Globulin
one week after exposure to Rubella.
Gonorrhea
(Clap/Flores Blancas/Gleet)
- sexually transmitted bacterial disease
involving the mucosal lining of the genito-
urinary tract, the rectum, and pharynx.
Period of Communicability:
The patient is capable of transmitting the
virus during the latter part of the incubation
period and during the acute phase.
The virus may persist in the blood for many
years.
Mode of Transmission
Direct contact via infected body fluids.
Through contaminated needles and
syringes.
Through infected blood or body fluids
introduced at birth
Through sexual contact
HBV transmission does not occur:
By fecal-oral route
By food-borne or water-borne transmission
By arthropod (mosquito) transmission
Clinical Manifestations
Prodromal Period
a. Fever, malaise, and anorexia
b. Nausea, vomiting, abdominal discomfort, fever,
and chills
c. Jaundice, dark urine, and pale stools
d. Recovery is indicated by a decline of fever and
improved appetite
*Fulminant Hepatitis – fatal & manifested by ascitis
and bleeding
Diagnostic Procedures
1. Compliment Fixation test
2. Radio-immunoassay-hemaglutinin test
3. Liver function test
4. Bile examination in blood and urine
5. Blood count
6. Serum transaminase – SGOT, SGPT, ALT
7. HbsAg
Prevention
Blood donors must be screened to exclude
carriers.
Caution must be observed in giving care to
patients with known HBV.
Hands and other skin areas must be washed
immediately and thoroughly after contact with
body fluids.
Avoid injury with sharp objects or instruments.
Use disposable needles and syringes only once
and discard properly.
Avoid sharing of toothbrush, razor, and other
instruments that may be contaminated with blood.
Observe “safe sex”.
Have adequate rest, sleep, and exercise, and eat
nutritious food.
Hep B vaccine is recommended for pre-exposure.
Hepatitis Immune Globulin (HBIg) should be
administered within 72 hours to those exposed
directly to hep B virus either by ingestion, by
prick or by inoculation.
Influenza
- an acute viral infectious disease affecting
the respiratory system.
Mode of Transmission:
4. Through airborne spread among crowded
populations.
5. Droplet
3. Influenza virus persists for hours in dried mucus.
Pathology/Pathogenesis
Influenza virus
complications
Clinical Manifestations
Onset is sudden chilly sensation,
hyperpyrexia, malaise, sore throat, coryza,
rhinorrhea, myalgia, and headache.
Severe aches and pain usually at the back
associated with severe sweating may
manifest.
Sometimes there are gastrointestinal
elements with vomiting.
The worst symptoms usually last from 3 to
5 days before the condition begins to
improve.
Influenza makes everybody feel terrible ,
but most people recover.
Management
1. Stay at home
2. Drink plenty of fluids
3. Take the following to relieve fever and
headache:
a. Paracetamol
b. Aspirin, unless contraindicated; should not to
be given to children below 16 years old
c. Ibuprofen or other anti-inflammatory drugs
4. Sponge down with tepid water
5. Isolate patient to decrease risk of infecting
others
6. Limit strenuous activity specially in
children
7. Watch out for complications especially
among people at risk.
Preventive Measures
Immunization
Avoidance of crowded places
Educate the public and health care
personnel regarding the basic personal
hygiene
People who should receive the vaccine
annually:
a. the elderly
b. people who have poor immunity
c. those with DM, lung disease, kidney
disease, heart disease or liver disease
Leprosy
- chronic systemic infection characterized by
progressive cutaneous lesions.
Mode of Transmission
4. Through respiratory droplet
5. Through the skin break & mucous
membrane
Clinical Manifestations
1. Clawhand, footdrop, and ocular manifestations
such as corneal insensitivity, and ulceration,
conjunctivitis, photophobia, and blindness
develop.
2. Lepromatous leprosy can invade tissues in every
organ of the body.
3. The lesions enlarge and form plagues on nodules
on the earlobes, nose, eyebrows, and forehead,
giving the patient a leonine appearance.
4. Loss of eyebrows and eyelashes.
5. Loss of function of sweat and sebaceous
glands.
6. Epistaxis, ulceration of the uvula and
tonsils, septal perforation and nasal
collapse.
Diagnostic Procedures
Identification of the signs and symptoms
Tissue biopsy
Tissue smear
Blood tests show increased RBC and ESR;
decreased Ca, albumin, and cholesterol
level.
Modalities of Treatment
Sulfone therapy
Multiple Drug Therapy
Rehabilitation, recreational and
occupational therapy
Prevention
1. Report all cases and suspects of leprosy.
2. Newborn infants should be separated from
leprous mothers.
3. BCG vaccine may be protective if given
during the first 6 months of life.
4. Health education should be given as to the
mode of transmission.
Leptospirosis
- zoonotic infectious bacterial disease carried
by animals, both domestic and wild, whose
urine contaminates water or food which is
ingested or inoculated through the skin.
1. Penicillin G Na
2. Tetracycline
3. Peritoneal Dialysis
4. Administration of fluid and electrolyte
and blood as indicated.
Nursing
death
Management
Medical
a. Anti-malarial drugs
- Chloroquine
- Quinine
- Sulfadoxine for the resistant P. falciparum
- Primaquine for relapse of P. vivax & ovale
b. Erythrocyte exchange transfusion for rapid
production of high levels of parasites in the blood.
Nursing Management
b. The patient must be closely monitored.
c. Intake and output should be closely monitored to
prevent pulmonary edema.
> daily monitoring of patient’s serum bilirubin,
BUN creatinine, and parasitic count.
> if the patient exhibits respiratory and renal
symptoms, determine the ABG and plasma
electrolyte.
c. During the febrile stage, tepid sponges, ice cap on
the head will help bring the temperature down.
d. Application of external heat and offering hot
drinks during chilling stage is helpful.
e. Provide comfort and psychological support.
f. Encourage the patient to take plenty of fluids.
g. As the temperature falls and sweating begins,
warm sponge baths maybe given.
h. The bed and clothing should be kept dry.
ii. Watch for neurologic toxicity (from quinine
infusion) like muscular twitching, delirium,
confusion, convulsion, and coma.
j. Evaluate the degree of anemia.
k. Watch for any signs especially abnormal bleeding.
l. Consider severe malaria as medical emergency that
requires close monitoring of vital signs.
Prevention and Control
Malaria cases should be reported.
A thorough screening of all infected
persons from mosquitoes is important.
Mosquito breeding places must be
destroyed.
Homes should be sprayed with effective
insecticides which have residual actions on
the walls.
Mosquito nets should be used especially
when in infected areas.
Insect repellents must be applied to the
exposed portion of the body.
People living in malaria-infested areas
should not donate blood for at least 3 years.
Blood donors should be properly screened.
Measles
(Rubeola/Morbilli)
- an acute, contagious and exanthematous disease
that usually affects children which are susceptible
to URTI.
Sources of Infection:
- patient’s blood
- Secretions from the eyes, nose and throat.
Mode of Transmission
1. Through direct contact with the droplets
spread through coughing & sneezing
2. Indirect contact (articles or fomites freshly
contaminated with respiratory secretions
of infected patients.
Pathognomonic Sign
Koplik’s spots - inflammatory lesions of the
buccal mucous glands with superficial necrosis.
2. They appear on the mucosa of the inner cheek
opposite to the second molars, or near the
junction of the gum and the inner cheek.
3. They usually appear 1 to 2 days before the
measles rash.
Clinical Manifestations
(3 Stages)
1. Pre-eruptive stage
a. fever
b. catarrhal symptoms (rhinitis,
conjunctivitis, photophobia, coryza)
c. respiratory symptoms start from
common colds to persistent coughing
d. enanthema sign (Koplik’s spot)
2. Eruptive stage
a. the rash is usually seen late on the 4th day.
b. maculo-papular rash appears first on
either the cheeks, bridge of the nose, along
the hairline, at the temple or at the earlobe.
c. the rash is fully developed by the end of
the second day and all symptoms are at
their maximum at this time.
d. High grade fever comes on and off.
e. Anorexia and irritability.
f. Abdominal tympanism, pruritus, lethargy
g. The throat is red and often extremely sore.
h. As fever subsides, coughing may diminish,
but more often it hangs on for a week or
two, become looser and less metallic.
3. Stage of Convalescence
a. rashes fade away in the manner as they
erupted.
b. fever subsides as eruption disappears.
c. when the rashes fade, desquamation
begins.
d. symptoms subside and appetite is
restored.
Diagnostic Procedures
Nose and throat swab
Urinalysis
Blood exams (CBC, leukopenia,
leukocytosis)
Complement fixation or hemogglutinin test
Modalities of Treatment
Anti-viraldrugs (Isoprenosine)
Antibiotics if with complication
Supportive therapy (oxygen inhalation, IV
fluids)
Unfavorable Signals
1. Violent onset with high grade fever
2. Fading eruption with rising fever
3. Hemorrhagic or black measles
4. Persistence of fever for 10 days or more
5. Slight eruptions accompanied by severe
symptoms, especially those of
encephalitis.
Nursing Management
1. Isolation of the patient is necessary (the room
must be quiet, well ventilated, and must have
subdued light)
2. Control the patient’s high temperature with
warm or tepid sponges.
3. Skin care is utmost.
4. Provide oral and nasal hygiene.
5. Care of the eyes. The patient is sensitive to light.
Keep eyes free of secretions.
Preventive Measures
Immunization with:
Anti-measles at the age of 9 months, as single
dose
Mumps, measles, rubella (MMR) vaccine to be
given at 15 months, 2nd dose at 11 to 12 years.
Measles vaccine should not be given to pregnant
women or to persons with active tuberculosis,
leukemia, lymphoma or depressed immune
system.
Meningitis
- inflammation of the meninges of the brain
and spinal cord as a result of viral and
bacterial infection. (dura mater, the
arachnoid & the pia mater)
Etiologic Agent:
4. Pediculus humanos var. capitis (head lice)
5. Pediculus humanos var. corporis (body
lice)
6. Pdiculus pubis or pubic lice (crab lice)
a. Feed on human blood & lay their eggs in
body hair & clothing fibers.
b. After the nits hatch, the lice must feed
within 24 hours otherwise it will die.
c. They mature in about 2 – 3 weeks.
d. It injects toxin into the skin that produces
mild irritation & a purpuric spot.
Clinical Manifestations
1. The head louce
a. more common in female than in male. Infects
more children than adults.
b.Itching is the first & predominant symptom.
c. irritation, excoriation & crusting & foul
smelling mass consisting of matted hair, nits,
ova, pus, crusts, & pediculi results (plica
polonica)
2. Body louse
a. initial lesions are minute red spots
b. spot swells & secondary crust &
excoriation is formed on the surrounding
skin as a result of scratching.
3. Crab lice
a. unusual, persistent itching in the pubic
region
b. Maculae caeruleae – grayish pigmented
spots – found in the surface of the inner
thighs or the abdomen, pea-size to a small
coin.
Treatment
1. Head lice
a. dusting the scalp with 1% malathion
powder is a reliable & convenient method
b. massage with gamma benzene
hexachloride shampoo in the scalp for 4
minutes, then rinse.
2. Body louse
a. laundry (dry clean) or boil the clothing &
beddings
b. good body hygiene must be observed
always.
3. Crab lice
a. apply Kwell or Gamene (Lindane) cream or
lotion
b. Rub crotaminon (Eurax, Geigy) into the
affected area.
c. repeat the application of crotaminon after 1
week.
d. simultaneously treat the person who had sexual
contact with the patient
e. remove remaining nits mechanically.
Pertussis
Whooping cough – infectious disease
characterized by repeated attacks of
spasmodic coughing which consists of a
series of explosive expirations, typically
ending in a long-drawn forced inspiration
which produces a crowing sound, the
“whoop” & usually followed by vomiting.
Causative Agent – Bordetella pertussis
Period of Communicability:
- first 3 days to 3 months of illness
- Most contagious during the first few days of
active disease, & possibly from 3 to 4 days
before that.
Mode of Transmission
Direct contact with infected oropharyngeal
secretions & feces
Person to person transmission through
healthy carriers
Indirect through contaminated articles &
flies, contaminated water, food & utensils.
Diagnostic Procedures
Throat swab
Stool culture throughout the disease
Culture from the CSF
Modalities of Treatment
Analgesics to ease headache, back pain &
leg spasm
Moist heat application to reduce muscle
spasm & pain
Bed rest is necessary
Paralytic polio requires rehabilitation
Nursing Management
Carry out enteric isolation.
Observe patient carefully for signs of paralysis &
other neurologic damage
Perform a neurologic assessment at least once a
day
Check blood pressure regularly
Watch for signs of fecal impaction due to
dehydration & immobility.
Prevent the occurrence of bed sores.
Wash hands after every contact with
patient.
Apply hot packs to affected limb to relieve
pain and muscle shortening.
Dispose excreta & vomitus properly.
Provide emotional support both to patient &
family.
Maintain good personal hygiene, oral &
skin care.