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Nursing Review Bullets
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5
Communicable Disease Nursing
I.EPI DISEASESDISEASECAUSATIVE AGENTMODE OFTRANSMISSIONPATHOGNOMONICSIGNMANAGEMENT/TREATMENTPREVENTION
1.
TuberculosisOther names:
Koch’s DiseaseConsumptionPhthisisWeak lungsMycobacteriumtuberculosisTB bacillusKoch’s bacillusMycobacterium bovis(rod-shaped)Airborne-dropletDirect invasionthrough mucousmembranes and breaks in the skin(very rare)
Incubation period :
4 – 6 weeks
1.
Usually asymptomatic2.Low-grade afternoonfever 3.Night sweating4.Loss of appetite5.Weight loss6.Easy fatigability – dueto increased oxygendemand7.Temporary amenorrhea8.Productive dry cough9.HemoptysisDiagnostic test:
•
Sputum examination or the Acid-fast bacilli(AFB) / sputum microscopy
1.Confirmatory test2.Early morning sputum about 3-5 cc3.Maintain NPO before collecting sputum4.Give oral care after the procedure5.Label and immediately send to laboratory
6.
If the time of the collection of the sputum isunknown, discard
•
Chest X-ray
is used to:1.Determine the clinical activity of TB, whether it is inactive (in control) or active (ongoing)2.To determine the size of the lesion:a.Minimal – very small b.Moderately advance – lesion is < 4 cmc.Far advance – lesion is > 4 cm
•
Tuberculin Test
– purpose is to determine thehistory of exposure to tuberculosis
Other names:
Mantoux Test
– used for single screening, resultinterpreted after 72 hours
Tine test
– used for mass screening read after 48hours
Interpretation
:
0 - 4 mm
induration – not significant
5 mm or more
– significant in individuals whoare considered at risk; positive for patients whoare HIV-positive or have HIV risk factors and areof unknown HIV status, those who are closecontacts with an active case, and those who havechest x-ray results consistent with tuberculosis
.
10 mm or greater
– significant in individualswho have normal or mildly impaired immunity
•
Respiratory precautions
•
Cover the mouth andnose when sneezing toavoid mode of transmission
•
Give BCGBCG is ideally given at birth, then at schoolentrance. If given at 12months, performtuberculin testing(PPD), give BCG if negative.
•
Improve socialconditionsTREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS;
R
ifampicin (R),
I
soniazid (H),
P
yrazinamide (Z),
E
thambutol (E),
S
treptomycin (S)CATEGORY 1:6months SCCIndications:> new (+) smear > (-) smear PTB withextensive parenchymal lesionson CXR > Extrapulmonary TB> severe concominantHIV disease
Intensive Phase:
2monthsR&I : 1 tab each; P&E2 tabs each
Continuation Phase
:4 monthsR&I : 1 tab each
CATEGORY 2:8months SCCIndications:> treatment failure> relapse> return after default
Intensive Phase
:3 mosR&I 1 tab each; P&E 2tabs eachStreptomycin – 1vial/day IM for first 2months = 56 vials (if given for > 2mos cancause nephrotoxicity
Continuation Phase
: 5monthsR&I : 1 tab eachE : 2 tabs
CATEGORY 3:6months SCCIndications:> new (-) smear PTBwith minimal lesionson CXR Same meds withCategory 1
Intensive Phase:
2monthsR&I 1 tab each; P&E2 tabs each
Continuation Phase:
4 monthsR&I 1 tab eachCATEGORY 4:Chronic (*Referralneeded)SIDE EFFECTS:
Rifampicin
•
body fluiddiscoloration
•
hepatotoxic
•
permanentdiscoloration of contact lenses
Isoniazid
•
Peripheralneuropathy(Give VitB6/Pyridoxine)
Pyrazinamide
•
hyperuricemia/gouty arthritis(increase fluidintake)
SIDE EFFECTS:
Ethambutol
•
Optic neuritis
•
Blurring of vision(Not to be giventochildren below 6 y.o. dueto inability to complain blurring of vision)
•
Inability to recognizegreen from blue
Streptomycin
•
Damage to 8
th
CN
•
Ototoxic
•
Tinnitus
•
nephrotoxic
Most hazardous period for development of clinicaldisease is the first
6-12 months after infection
Highest risk of developing disease is children under
3years old
6
Communicable Disease Nursing
NATIONAL TB CONTROL PROGRAM:
Vision
: A country where TB is no longer a public health problem
Mission
: Ensure that TB DOTS Services are available, accessible, andaffordable to the communities in collaboration with LGUs and others
Goal
:To reduce prevalence and mortality from TB by half by the year 2015(Millennium Development Goal)
Targets:
1. Cure at least 85% of the sputum smear (+) patients discovered2. Detect at least 70% new sputum smear (+) TB cases
Objectives:
1. Improve access to and quality of services2. Enhance stakeholder’s health-seeking behavior 3. Increase and sustain support for TB control activities4. Strengthen management of TB control activities at all levelsKEY POLICIES:
*Case finding:
-DSSMshall be the primary diagnostic tool in NTP case finding- No TB Dx shall be made based on CXR results alone- All TB symptomatic shall be asked to undergo DSSM before treatment- Only contraindication for sputum collection is hemoptysis- PTB symptomatic shall be asked to undergo other tests (CXR and culture),only after three sputum specimens yield negative results in DSSM- Only trained med techs / microscopists shall perform DSSM- Passive case finding shall be implemented in all health stations
*Treatment:
Domiciliary treatment – preferred mode of careDSSM – basis for treatment of all TB cases
*Hospitalization is recommended
: massive hemoptysis, pleural effusion,military TB, TB meningitis, TB pneumonia, & surgery is needed or withcomplications*All patients undergoing treatment shall be supervised*National & LGUs shall ensure provision of drugs to all smear (+
) TB cases*Quality of fixed-dose combination (FDC) must be ensured*Treatment shall be based on recommended category of treatment regimen
DOTS Strategy
– internationally-recommended TB control strategyFive Elements of DOTS: (RUSAS)
R
ecording & reporting system enabling outcome assessment of all patients
U
ninterrupted supply of quality-assured drugs
S
tandardized SCC for all TB cases
A
ccess to quality-assured sputum microscopy
S
ustained political commitment
s
MANAGEMENT OF CHILDREN WITH TUBERCULOSISPrevention:
BCG immunization to all infants (EPI)
Casefinding:
- cases of TB in children are reported and identified in 2instances: (a) patient was screened and was found symptomaticof TB after consultaion (b) patient was reported to have beenexposed to an adult TB patient-ALL TB symptomatic children 0-9 y.o, EXCEPT sputum positive child shall be subjected to Tuberculin testing(Note:Only a trained PHN or main health center midwife shall dotuberculin testing and reading which shall be conducted once aweek either on a
Monday or Tuesday
.
Ten children
shall begathered for testing to avoid wastage.-
Criteria to be TB symptomatic
(any three of the following:)* cough/wheezing of 2 weeks or more* unexplained fever of 2 weeks or more* loss of appetite/loss of weight/failure to gain weight/weightfaltering* failure to respond to 2 weeks of appropriate antibiotic therapyfor lower respiratory tract infection* failure to regain previous state of health 2 weeks after a viralinfection or exanthem (e.g. measles)-
Conditions confirming TB diagnosis
(any 3 of the following:)* (+) history of exposure to an adult/adolescent TB case* (+) signs and symptoms suggestive of TB* (+) tuberculin test* abnormal CXR suggestive of TB* Lab findings suggestive or indicative of TB
- for children with exposure to TB
* a child w/ exposure to a TB registered adult patient shallundergo physical exam and tuberculin testing* a child with productive cough shall be referred for sputumexam, for (+) sputum smear child, start treatment immediately* TB asymptomatic but (+) tuberculin test and TB symptomatic but (-) tuberculin test shall be referred for CXR examination-
for TB symptomatic children
*a TB symptomatic child with either known or unknown exposure to a TB case shall be referredfor tuberculin testing* (+) contact but (-) tuberculin test and unknowncontact but (+) tuberculin test shall be referred for CXR examination*(-) CXR, repeat tuberculin test after 3 months* INH chemoprophylaxis for three months shall begiven to children less than 5y.o. with (-) CXR
; after which tuberculin test shall be repeated
Treatment (Child with TB):
Short course regimenPULMONARY TBIntensive: 3 anti-TB drugs (R.I.P.) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 4 monthsEXTRA-PULMONARY TBIntensive: 4 anti-TB drugs (RIP&E/S) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 10 monthsPERIOD OF COMMUNICABILITY OFTUBERCULOSIS:
as long as bacillus is contained in thesputum
Primary complex in children is NOTcontagious
Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment
7
Communicable Disease Nursing
2. DiphtheriaTypes:>
nasal
>
pharyngeal
– most common>
laryngeal
– most fatal due to proximity toepiglottisCorynebacteriumdiphtheriaKlebbs-loffler ***Diphtheriatransmission is increasedin hospitals, households,schools, and other crowded areas.Droplet especiallysecretions frommucous membranesof the nose andnasopharynx andfrom skin and other lesionsMilk has served as avehicle
Incubation Period:
2 – 5 days
Pseudomembrane
– mycelia of the oral mucosacausing formation of whitemembrane on theoropharynxBull neck DysphagiaDyspneaDiagnostic test:
•
Nose/throat swab
•
Moloney’s test
– a test for hypersensitivity todiphtheria toxin
•
Schick’s test
– determines susceptibility to bacteria
Drug-of-Choice:
Erythromycin 20,000 - 100,000 units IM once only
Complication:
MYOCARDITIS
(Encourage bedrest)Plan nursing care to improve respiration.DPT immunizationPasteurization of milk Education of parents***Infants born to immunemothers maybe protectedup to 6-9 months. Recoveryfrom clinical attack isalways followed by alasting immunity to thedisease.3.
Pertussis
Whooping coughTusperina No day coughBordetella pertussisHemophilus pertussisBordet-gengou bacillusPertussis bacillusDroplet especiallyfrom laryngeal and bronchial secretions
Incubation Period:
7 – 10 days but notexceeding 21 daysCatarrhal period: 7 days paroxysmal coughfollowed by continuousnonstop accompanied byvomitingComplication: abdominalherniaDiagnostic:
•
Bordet-gengou agar test
Management:
1.
DOC:Erythromycinor Penicillin 20,000 -100,000 units2.Complete bed rest3.Avoid pollutants4.Abdominal binder to prevent abdominal herniaDPT immunizationBooster: 2 years and 4-5yearsPatient should besegregated until after 3weeks from the appearanceof paroxysmal cough4.
TetanusOther names:
Lock jaw
Clostridium tetani –
anaerobicspore-formingheat-resistant and lives insoil or intestine Neonate: umbilical cordChildren: dental cariesAdult: punctured wound;after septic abortionIndirect contact – inanimate objects,soil, street dust,animal and humanfeces, puncturedwound
Incubation Period:
Varies from 3 daysto 1 month, falling between
7 – 14 daysRisus sardonicus
(Latin:“
devil smile
”) – facialspasm; sardonic grin
Opisthotonus
– arching of back
For newborn:
1.Difficulty of sucking2.Excessive crying3.Stiffness of jaw4.Body malaise No specific test, only a history of punctured woundTreatment:
Antitoxinantitetanus serum (ATS)tetanus immunoglobulin (TIG)
(if the patient hasallergy, should be administered in fractional doses)
Pen GDiazepam –
for muscle spasms Note: The nurse can give fluid provided that the patient is able to swallow. There is risk of aspiration.Check first for the gag reflex
DPT immunization
Tetanus toxoid (artificialactive) immunizationamong pregnant women
Training and Licensingof midwives/”hilots”
Health education of mothers
Puncture wounds are bestcleaned by thoroughwashing with soap andwater.
Incidence: highest under 7 years of ageMortality: highest among infants (<6 months)One attack confers definite and prolongedimmunity. Second attack occasionally occurs
of 00
COMMUNICABLE DISEASE NURSING (Part II: Diseases)
REVIEWER ON COMMUNICABLE DISEASES NURSING for the NURSE LICENSURE EXAMINATION
Sources:
>Note Taking Guide from the Royal Pentagon Review Specialists, Inc (prepared by SIR... (More)
Sources:
>Note Taking Guide from the Royal Pentagon Review Specialists, Inc (prepared by SIR... (More)
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BAKIT GANUN DATI RATI ANG DALI LNG MAG-DOWNLOAD..NAGYUN ANG HIRAP..AHHA..MAY BAYAD NA ATA..SAYANG!!
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sir bkt ala po part one
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