GENERAL SANTOS DOCTORS MEDICAL SCHOOL FOUNDATION INC.

North Osmena, Bulaong, General Santos City

In partial fulfillment of the requirement In NCM 107 LEC

Submitted by: Helen Mae Olita, SN Jennie Rose Abay,SN

Submitted to: Alexander P. Balongoy, RN Clinical Instuctor

September 11, 2013

Communicable Disease Prevention and Control

Tuberculosis
Other names: Kochs Disease CA: Mycobacterium tuberculosis, TB bacillus, Kochs bacillus, Mycobacterium bovis(rod-shaped) MOT: Airborne-droplet and Direct invasion through mucous membranes and breaks in the skin(very rare) Incubation period : 4 6 weeks S/Sx: 1.Usually asymptomatic 2.Low-grade afternoon fever 3.Night sweating 4.Loss of appetite 5.W eigh t loss 6.Easy fatigability due to increased oxygen demand 7.Temporary amenorrhea 8.Productive dry cough 9.Hemoptysis Diagnostic test

Sputum examination or the Acid-fast bacilli(AFB) / sputum microscopy 1.Confirmatory test 2.Early morning sputum about 3-5 cc 3.Maintain NPO before collecting sputum 4.Give oral care after the procedure 5.Label and immediately send to laboratory 6. If the time of the collection of the sputum is unknown, 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 . M i n i m a l v e r y s m a l l b.Moderately advance lesion is < 4 cmc . F a r a d v a n c e l e s i o n i s > 4 c m

Tuberculin Test purpose is to determine thehistory of exposure to tuberculosis Other names: Mantoux Test used for single screening, resulti nterpreted 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 who are considered at risk; positive for patients who are HIVpositive or have HIV risk factors and are of unknown HIV status, those who are close contacts with an active case, and those who have chest x-ray results consistent with tuberculosis . 10 mm or greater significant in individuals who have normal or mildly impaired immunity

Respiratory precautions Cover the mouth and nose when sneezing to avoid mode of transmission Give BCGBCG is ideally given at birth, then at school entrance. If given at 12months, perform tuberculin testing (PPD), give BCG if negative.

 Improve social conditions TREATMENT: SCC/Short Course Chemotherapy, Direct observed treatment short course/DOTS; Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)CATEGORY 1:6months SCC Indications:> new (+) smear > (-) smear PTB withextensive parenchymal severe concominantHIV disease lesionson CXR > Extrapulmonary TB>

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 each Streptomycin 1vial/day IM for first 2months = 56 vials (if given for > 2mos can cause nephrotoxicity Continuation Phase : 5monthsR&I : 1 tab eachE : 2 tabs CATEGORY 3:6months SCCIndications:> new (-) smear PTB with minimal lesions on CXR Same meds with Category 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 Peripheral neuropathy(Give VitB6/Pyridoxine) Pyrazinamide hyperuricemia/gouty arthritis(increase fluid intake)

SIDE EFFECTS: Ethambutol Optic neuritis Blurring of vision(Not to be given to children below 6 y.o. due to inability to complain blurring of vision) Inability to recognize green from blue Streptomycin Damage to 8th CN Ototoxic Tinnitus nephrotoxic Most hazardous period for development of clinical disease is the first 6-12 months after infection Highest risk of developing disease is children under 3years old

DOTS Strategy (directly observed treatment, short-course) internationally-recommended TB control strategy Five Elements of DOTS: (RUSAS) R -recording & reporting system enabling outcome assessment of all patients U-uninterrupted supply of quality-assured drugs S-standardized SCC for all TB cases A-access to quality-assured sputum microscopy S-sustained political commitments

MANAGEMENT OF CHILDREN WITH TUBERCULOSIS Prevention:

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 been exposed 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 do tuberculin testing and reading which shall be conducted once a week 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 examinationfor 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: contained in thesputum

Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment

Diphtheria
Types: nasal pharyngeal

most common> laryngeal fatal due to proximity toepiglottisCorynebacteriumdiphtheriaKlebbs most

loffler ***Diphtheria transmission is increased in hospitals, households, schools, and other crowded areas. Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions Milk has served as a vehicle Incubation Period: 2 5 days

Pseudomembrane mycelia of the oral mucosa causing formation of white membrane on theoropharynx Bull neck Dysphagia Dyspnea

Diagnostic test: Nose/throat swab Moloneys test a test for hypersensitivity to diphtheria toxin Schicks test determines susceptibility to bacteria Drug-of-Choice: Erythromycin 20,000 - 100,000 units IM once only Complication:

Pertussis
>Whooping cough CA: Tusperina No day cough, Bordetella pertussis, Hemophilus pertussis, Bordetgengou bacillus, Pertussis bacillus MOD: Droplet especially from laryngeal and bronchial secretions Incubation Period: 7 10 days but not exceeding 21 days Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting Complication: abdominal hernia

Diagnostic: Bordet-gengou agar test Management: 1. DOC: Erythromycinor Penicillin 20,000 -100,000 units2.Complete bed

rest3.Avoid pollutants 4.Abdominal binder to prevent abdominal hernia DPT

immunization Booster: 2 years and 4-5yearsPatient should be segregated until after 3weeks from the appearance f paroxysmal cough4.

Tetanus
Other names: Lock jaw Clostridium tetani anaerobic spore-forming heat-resistant and lives in soil or intestine Neonate: umbilical cord Children: dental caries Adult: punctured wound; after septic abortion Indirect contact inanimate objects, soil, street dust, animal and human feces, punctured wound

Incubation Period: Varies from 3 daysto 1 month, falling between 7 14 days Risus sardonicus (Latin:devil smile) facial spasm; sardonic grin Opisthotonus arching of back For newborn: 1.Difficulty of sucking 2.Excessive crying 3.Stiffness of jaw 4.Body malaise No specific test, only a history of punctured wound Treatment:

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 (artificial active) immunization among pregnant women Training and Licensing of midwives/hilots Health education of mothers Puncture wounds are best cleaned by thoroughwashing with soap andwater.

Incidence: highest under 7 years of age Mortality: highest among infants (<6 months) One attack confers definite and prolonged immunity. Second attack occasionally occurs

Poliomyelitis
Other name: Infantile paralysis CA: Legio debilitans, Polio virus, Enterovirus -attacks the anterior horn of the neuron, motor is affected Man is the only reservoir MOD: Fecal oral route Incubation period: 7 21 days Paralysis, Muscular weakness, Uncoordinated body movement, Hoynes sign head lag after 4 months

Diagnostic test: CSF analysis / lumbar tap Pandys test Management: Rehabilitation involves ROM exercises OPV vaccination Frequent hand washing6.

Measles
Other names: MorbilliRubeola, RNA containing paramyxovirus Period of Communicability: 4 days before and 5 days after the appearance of rash Droplet secretions from nose and throat Incubation period: 10 days fever 14 days rashes appear (8-13 days) 1. Kopliks spots whitish/bluish pinpoint patches on the buccalcavity 2. Cephalocaudal appearance of maculopapular rashes

3. Stimsons line bilateral red line on thelower conjunctiva No specific diagnostic testManagement:Supportive and symptomaticMeasles vaccineDisinfection of soi ledarticles Isolation of cased from diagnosis until about 5-7days after onset of rash7.

Hepatitis B
Other names: serum Hepatitis Incubation period: 45 100 days 1. Right-sided Abdominal pain 2.Jaundice 3.Yellow-colored sclera 4.Anorexia 5.Nausea and vomiting 6.Joint and Muscle pain 7.Steatorrhea 8.Dark-colored urine 9.Low grade fever Diagnostic test: Hepatitis B surface agglutination (HBSAg) test Management:> Hepatitis B ImmunoglobulinDiet: high in carbohydrates-Hepatitis B immunization-Wear protected clothing-Hand washing-Observe safe-sex-Sterilize

instruments used in minor surgical-dental procedures-Screening of blood products for transfusion Hepatitis A infectious hepatitis; oral-fecal Hepatitis B serum hepatitis; blood and body fluids Hepatitis C non-A non-B, post-transfusion hepatitis; blood and body fluids Hepatitis D Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B Hepatitis E oral-fecal

Cholera
Other names: El tor Vibrio cholera Vibrio coma Ogawa and Inaba bacteria MOD: Fecal-oral route 5 Fs Incubation Period: Few hours to 5 days; usually 3 days Rice watery stool Period of Communicability: 7-14 days after onset, occasionally 2-3 months Diagnostic Test: Stool culture Treatment: Oral rehydration solution (ORESOL) IVF Drug-of-Choice: tetracycline (use straw; can cause staining of teeth).Oral tetracycline should beadministered with meals or after milk. Proper handwashing Proper food and water sanitation Immunization of Chole-vac2. Amoebic Dysentery Entamoeba histolytica Protozoan (slipper-shaped body)Fecal-oral route Abdominal cramping Bloody mucoid stool Tenesmus - feeling of incomplete defecation (Wikipedia)Treatment:

Metronidazole (Flagyl) * Avoid alcohol because of its Antabuse effect canc ause vomiting. Proper handwashing. Proper food and water sanitation3.

Shigellosis Other names: BacillarydysenteryShigella bacillus Sh-dysenterae mostinfectious Sh-flesneri common inthe Philippines Sh-conneiSh-boydii MOD: Fecal-oral route 5 Fs: Finger, Foods, Feces, Flies, Fomites

Incubation Period: 1 day, usually lessthan 4 days Abdominal cramping Bloody mucoid stool Tenesmus - feeling of incomplete defecation (Wikipedia)Drug-of-Choice: Co-trimoxazole Diet: Low fiber, plenty of fluids, easily digestible foods Proper handwashing Proper food and water sanitation Fly control4.

Typhoid fever
CA: Salmonella typhosa( plural, typhi) MOD: Fecal-oral route5 Fs Incubation Period: Usual range 1 to 3weeks, average 2weeks Rose Spots in the abdomen due to bleeding caused by perforation of the Peyers patches Ladderlike fever Diagnostic Test: Typhi dot confirmatory test; specimen is feces Widals test agglutination of the patients serum Drug-of-Choice: Chloramphenicol Proper handwashing Proper food and water sanitation.

Hepatitis A
Other names:InfectiousH e p a t i t i s MOD: Fecal-oral route, 5 Fs Fever Anorexia (early sign) Headache Jaundice (late sign) A V i r u s

Prophylaxis:

IM

injection

of

gamma globulin

Hepatitis

vaccine

Hepatitis immunoglobulin Avoid alcohol Proper handwashing Proper food and water sanitation Proper disposal of urine

Hepatitis /Epidemic Hepatitis /Catarrhal Jaundice

Incubation Period: 15-50 days, depending on dose, average 20-30 days Clay-colored stool Lymphadenopathy Complete bed rest to reduce the breakdown of fats for metabolic needs of liver Lowfat diet; increase carbohydrates (high in sugar)In convalescent period, patient may have difficulty with maintaining a sense of well-being.and feces Separate and proper cleaning of articles used by patient6.

ParalyticShellfishPoisoning
=PSP IRed tide poisoning)Dinoflagellates Phytoplankton Ingestion of raw

of inadequately cooked seafood usually bivalve mollusks during red tide season Incubation Period: 30 minutes to several hours after ingestion Numbness of face especially around the mouth Vomiting and dizziness Headache Tinglingsensation/paresthesia andeventful paralysis of hands Floating sensation andweakness Rapid pulse Dysphonia Dysphagia

Total muscle paralysisleading to respiratoryarrest and death. .

Chickenpox
Other names: Varicella Human (alpha) herpesvirus 3 (varicella-zoster virus), a member of the Herpes virus group Period of Communicability: From as early as 1 to 2days before the rashes appear until the lesion shave crusted. Droplet spread Direct contact Indirect through articles freshly soiled by discharges of infected persons Incubation Period: 2-3 weeks, commonly13 to 17 days Vesiculo-pustular rashes Centrifugal appearance of rashes rashes which begin on the trunk ands pread peripherally andmore abundant on covered body parts Pruritus No specific diagnostic exam

Treatment is supportive. Drug-of-choice: Acyclovir / Zovirax (orally to reduce the number of lesions; topically to lessen the pruritus) NEVER give ASPIRIN. Aspirin when given tochildren with viral infection may lead todevelopment of REYES SYNDROME

GermanMeasles
Other Names: RubellaThree-day CA: Measles Rubella virus or RNA-containing Togavirus( Pseudoparamyxovirus)German measles is teratogenic infection, can cause congenital heartdisease and congenital cataract.

MOD: Droplet Incubation Period: Three (3) days Forscheimer spots red pinpoint patches on the oral cavity Maculopapular rashes Headache Low-grade fever Sore throat Enlargement of posterior cervical and postauricular lymph nodes

Diagnostic Test: Rubella Titer (Normal value is 1:10); below 1:10indicates susceptibility to Rubella. Instruct the mother to avoid pregnancy for threemonths after receiving

MMR vaccine.MMR is given at 15 months of age and is givenintramuscularly.MMR vaccine (live attenuated virus)-Derived from chick embryo Contraindication:-

A l l e r g y t o e g g s -If necessary, gi ven in divided or fractionated doses and epinephrine should be at the bedside.3.

Herpes Zoster
Other names: Shingles Cold sores CA: Herpes zoster virus(dormant varicella zoster virus) MOD: Droplet Direct contact from secretion PS: Painfulvesiculo-pustular lesions on limited portion of the body (trunk and shoulder) Low-grade fever

Treatment is supportive and symptomatic Acyclovir to lessen the pain Avoidance of mode of transmission4.

Dengue Hemorrhagic Fever

Other name: h-fever Dengue virus 1, 2, 3, and Chikungunya virus Types 1 and 2 are Bite of infected

mosquito (Aedes Aegypti) - characterized by black and white Classification (WHO): Grade I: a. flu-like symptoms

Diagnostic Test: Torniquet test (Rumpel Leads Test / capillary fragility test) PRESUMPTIVE; positive when 204 oclock habit Chemically treated mosquito net

Malaria
CA: Plasmodium Parasites: Vivax Falciparum (most fatal; most common in the Philippines) Ovale Malariae-attacks the red blood cells Bite of infected anopheles mosquito Night time biting High-flying Rural areas Clear running water Cold Stage: severe, recurrent chills (30minutes to 2 hours) Hot Stage: fever (4-6hours) Wet Stage: Profuse sweating, Episodes of chills, fevers, and profuse sweating area ssociated with rupture of the red blood cells.- intermittent chills and sweating- anemia / pallor - tea-colored urine- malaise- hepatomegaly- splenomegaly- abdominal pain and enlargement- easy fatigability NURSING CARE: 1. TSB (Hot Stage)2. Keep patent warm (Cold Stage)3. Change wet clothing (Wet Stage)4. Encourage fluid intake5. Avoid draftsEarly Diagnosis and Prompt Treatment Early diagnosis identification of a patient with malaria as soon as he is seen through clinical and/or microscopic method

Clinical method based on signs and symptoms of the patient and the history of his having visited malariaendemic area Microscopic method based on the examination of the blood smear of patient through microscope (done by the medical technologist) QBC/quantitative Buffy Coat fastest Malarial Smear best time to get the specimen is at height of fever because the microorganisms are very active and easily identified Chemoprophylaxis Only chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering he endemic area). In pregnant women, it is given throughout the duration of pregnancy. Treatment: Blood Schizonticides drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations 1.QUININE oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism quinine toxicity 2.CHLOROQUINE 3.PRIMAQUINE sometimes can also beg iven as chemoprophylaxis 4.FANSIDAR combination treatment o f pyrimethamine and of mosquito net*House sulfadoxine*CLEAN (nighttime

Technique*Insecticide

Spraying

fumigation)*On Stream Seeding construction of bio-pondsfor fish propagation.

Filariasis
Other names: Elephantiasis Endemic in 45 out of 78 provinces Highest prevalence rates: Regions 5, 8, 11 and CARAGAWuchereria

CA: BancroftiBrugia malayiBrugia timori nematode parasites Bite of Aedes poecillus(primarily)Aedes flavivostris(secondary) Incubation period: 8 16 months Asymptomatic Stage :Presence of microfilariaein the blood but no clinical signs and symptoms of disease Acute Stage :Lymphadenitis Lymphangitis Affectation of male genitalia Chronic Stage : (10-15years from onset of firs attack)Hydrocele Lymphedema Elephantiasis Diagnosis Physical examination, history taking, observation of major and minor signs and symptoms Laboratory examinations Nocturnal Blood Examination (NBE) blood are taken from the patient at his residence or in hospital after 8:00 pmImmunochromatographic Test (ICT) rapid assessment method; an antigen test that can bedone at daytime Treatment: Drug-of-Choice: Diethylcarbamazine Citrate(DEC) or HetrazanCLEAN TechniqueUse of mosquito repellentsAnytime fumigationWear a long sleeves, pantsand socks3.

Shistosomiasis
Other Names: Snail Fever Bilharziasis Endemic in 10regions and 24 provinces High prevalence: Regions 5, 8, 11 CA: Schistosoma mansoniS. haematobiumS. japonicum (endemic int he

Philippines)Contact with the infected freshwater with cercaria and penetrates the skin Vector: Oncomelania Quadrasi Diarrhea- Bloody stools (on and off dysentery) Enlargement pallor weakness Diagnostic Test: of abdomen= SplenomegalyHepatomegalyAnemia /

COPTor cercum ova precipitin test (stool exam) Treatment: Drug-of-Choice: PRAZIQUANTEL(Biltracide )Oxamniquine for S. mansoni Metrifonate for S. haematobium*Death is often due to hepatic complication Dispose the feces properlynot reaching body of water Use molluscides Prevent exposure tocontaminated water (e.g.use rubber boots) Apply 70% alcoholimmediately to skin to killsurface cercariae Allow water to stand 48-72hours before use