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RESPIRATORY SYSTEM
DIPHTHERIA
ö acute contagious disease characterized by general toxemia emanating from localized inflammatory
process characterized by the formation of “pseudomembrane” commonly in the face area & tonsils, & the
elaboration of a powerful exotoxin affecting the impt. viscera as the heart & kidneys & the peripheral
nervous system.

C.A. – Corynebacterium diphtheriae or Klebs Loffler bacillus

MOT
 Direct contact – discharges form respiratory passages; saliva
 Indirect contact – though various articles including toys & clothing contaminated by infected individual

Incubation period – 1 to 7 days

S/Sx
1. Nasal
- dryness & excoration of upper lip & nares with serosanguinous secretions & presence of
pseudomembrane in nasal system.
2. Pharyngeal
- pseudomembrane on throat (oropharynx)
- bull neck appearance
3. Laryngeal
- laryngeal stridor – harsh sound heard on inspiration.
- Hoarseness of voice leading to aphonia (no voice) reversible
- Signs of respiratory distress
4. Cutaneous or extra pulmonary
- spread of causative agent outside of respiratory tract (ears, eyes, wound)
Dx/Exam:
1. Nose & throat culture – there must be 3 consecutive (-) result
2. Schick’s test – det susceptibility & immunity to diphtheria.
3. Molony test – det hypersensitivity to diphtheria anti-toxin
Tx:
1. Drugs – (ADS) anti-diphtheria serum  to neutralize toxins = IM, IV ANST
2. Antibiotics – Penicillin G. Sodium, Eythromycin  to kill the m.o.
3. Supportive
- O2 inhalation
- Tracheostomy
- Suction secretions
Nsg Care:
1. TSB for fever
2. Provide liquid to soft diet with minimal CHON & sufficient CHO
3. Strict isolation
4. CBR – no early ambulation
5. Increase fluid intake
6. Small frequent feedings
7. Maintain patent airway
8. Proper disposal of naso-pharyngeal secretions
9. Diversional activities to children
Complications:
1. Myocarditis – dec apical pulse < 60 lead to cardiac arrest.
2. Peripheral neuritis
3. Broncho pneumonia
Prevention
1. Avoid MOT
2. Immunization – DPT 0.5cc IM – vastus lateralis
- given at the same time with OPV 6,10,14 wks
 after DPT don’t massage to prevent lump forming
 put hot moist compress if with lump formation
 expect fever within 24 hrs -- give Paracetamol q4hours for 24 hours
 check pt’s temp before giving DPT
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 don’t give succeeding doses if with convulsion

STREPTOCOCCAL SORETHROAT
ö “Group A streptococcus or Strep A.
ö secrete 70+ variety of enzymes or toxins; common to abusing voice.

CA – Group A beta hemolytic Streptococcus

MOT – droplet, direct
S/Sx
 sudden onset
 high-grade fever, rapid pulse, chills
 enlarge, tender cervical lymph nodes
 inflamed tonsils with whitish muco-purulent exudates
 headache, abdominal pain
 beefy red throat
Dx/exam:
 throat culture – det strep throat to a patient
 throat swab – det antigen
Nsg Care:
 bedrest, no sweets
 oral hygiene with oral antiseptic or with saline gargle
Saline solution – 1 glass lukewarm water + 1 tsp rocksalt taken 3 - 4x a day
Prevention:
 Avoid MOT
Complications:
 RHD
 AGN
Tx:
 Erythromycin – oral 10 days
 Single shot IM Benzathine (Penicillin) 1.2 MU single dose (adult)

PERTUSSIS
ö whooping cough, one hundred day cough, Tuspirina
ö contagious dse char by peculiar paroxysmal cough ending in a whoop.
ö Prolong cough 5 – 10 mins. 20 to 40 times a day

CA – Bordetella pertussis – aerobic

MOT – Nasopharyngeal secretion
S/Sx
1. Catarrhal stage – most communicable stage
ö Fever, watery eyes, frequent sneezing
ö Watery nasal discharges dry cough at night
2. Paroxysmal stage
ö Coughs worsens – becomes rapid, successive, paroxysmal 3 to 10x during expiration with prolonged
inspiratory phase.
ö Force of coughing may cause involuntary micturation/defacation
ö The whoop follows the end of a series of short explosive cough with no time to catch a bread between
cough.
ö Protrusion of eyeballs, protruded tongue.
ö Swollen head & neck veins.
ö Abdominal hernia
ö Vomiting signals end attack.
3. Convalescence stage
- Symptoms subsides, frequency of paroxysmal attacks are reduced.
Dx/exam:
- Cough plate – Bordet Genghou agar plate
Tx:
 Erythromycin
 Ampicillin
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 Antitusive (Pertix) Sinecod (new generation)

Nsg Care:
 CBR
 Provide quiet & non-stimulating room
 Proper positioning during attacks
 Abdominal binders- Used in Infants to prevent abdominal hernia.
 Keep pt warm & out of drafts or wind
 Mouth & nose must be kept clean
 Light but nutritious diet with plenty of fruit juices but no seasoned foods.
 O2 inhalation
 Avoid factors that precipitate on neck (huwag sundutin)
 Avoid emotional physical stress
 Avoid irritating fumes & gases
 Diet no spices
Prevention:
 Avoid MOT
 Immunization – DPT
Complication:
 Bronchopneumonia
 Hemorrhages
 Convulsion
 Hernia
 Severe malnutrition

CORYZA – common colds, Acute Viral Rhinitis

ö viral infection of the lining of the nose, sinuses, throat and large airways. Produces coryza (profuse
discharge form nostrils)

CA – Adenovirus & Rhinovirus

MOT – droplet infection, direct contact
S/Sx:
 Preceded by feeling of burning & irritation in the nasopharynx
 Frequent sneezing, copious nasal discharge, teary eyes
 Diminished sense of taste, smell, hearing
 Cough, headache, malaise (tiredness)
 Later, nasal discharge become purulent
Nsg care:
 Rest
 Increase fluid intake
 Well balanced nutrition diet
 Warm saline gargle
 Cover nose/ mouth when coughing, sneezing
Prevention:
 Avoid MOT
 Frequent handwashing
 Proper disposal of oral and nasal discharges
 Disinfect eating & drinking utensils
 Avoid crowding & contact with infected individuals
Tx:
Symptomatic
Vit C
Increase fluids

Complication:
 Children – otitis media, bronchopneumonia
 Adult – sinusitis
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INFLUENZA
ö flu (tangkaso)
ö Highly contagious disease characterized by sudden onset of aches and pains.

CA – influenza virus A,B,C

MOT – droplet infection, contact with nasoparyngeal secretions
Incubation period – 18 – 36 hrs
S/Sx:
1. Respiratory – most common may lead to pneumonia end empyema
 Fever
 Chills
 Coryza
 Bitter taste
 Anorexia
 Muscle pains and aches
 Sore throat
 Pain behind the eyeballs
2. Intestinal
 Vomiting
 Fever
 Severe diarrhea
 Severe abdominal pain
 Obstinate constipation
3. Nervousness
 Headache
 Fever
 Arthralgia
 Myalgia – lead to encephalitis or meningitis

Nsg care – same as cold

Prevention:
 Avoid MOT
 Maintain optimum health
 Immunization – influenza vaccine
 Educate re-hazard form spitting, sneezing & coughing.

GASTROINTESTINAL DISORDERS

LEPTOSPIROSIS
ö Weil’s dse, Canicola fever, Swineherd’s dse, Icterohemorrhagica, Mud fever.
ö Seasonal dse; dse of lower form of animals/domestic animals like pig, skunk rat; common during rainy
season.
ö Rat- main host

CA – Leptospira interrogans – inhabitant moist humid soil

MOT – direct inoculation into broken skin, mucus membrane. Eg bathing in flooded water
- ingestion of urine/ fecally contaminated food & water

Source of infection – urine and excreta of rodents, infected form and pet animals like rabbits.
Incubation period – 7 – 13 days
S/Sx
 sudden onset with chills, vomiting & headache followed by severe fever and pains in the extremities.
 Intense itching of the conjunctivae – orange eyes
 Myalgia/myosites particularly calf pain
 Abdominal pain
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 In some cases, acute renal failure – complication
Dx/exam:
1. Blood culture
2. LAT – leptospira agglutination test
LAAT – Leptospria Antigen Antibody test
Nsg Care- supportive and symptomatic Prevention:
 Eradication or rodents
 Environmental sanitation
 Urine precaution
Tx:
Drugs
ö Penicillin
ö Antiserum or convalescent serum

Common among/risk
 Miners
 Farmers
 Veterinarian
 Sewer workers
 Swimmers

TYPHOID FEVER
ö enteric fever
- gen infection characterized by the hyperplasia of the lymphoid tissues, esp. enlargement and ulceration of
the Peyer’s patches & enlargement of the spleen, by parenchymatous changes in various organs and
liberation of an endotoxin in the blood.

CA – Salmonella Typhosa
MOT – Fecal or oral
Sources: contaminated food and water
S/Sx:
1. Prodromal – flulike symptom
 Fever, headache
 Anorexia, lethargy
 Constipation or diarrhea, vomiting
 Abdominal pain
 Feeling of unwellness
2. Fastigal
 Ladder like curve temp – stairway curve
 Rose spots – maculo popular rashes appear on chest or abdomen of pt usually appear on 7 – 12
days.
 Spleenomegaly
 Typhoid state – “typhoid Psychosis” brain affected naloloko
1. altered LOC
2. Coma – vigil look; pupils dilated & patient appears to start without seeing
3. Locomotive disturbance carphologia – invol picking up of linens
4. Sultus tendium – involuntary twitching of tendons part of wrist.
3. Defervescence
 Fever gradually subsides – fever mild & sx subsides
Dx exam:
1. Hemoculture – confirmatory of typhoid (+) organism after 1 week
2. Widal’s test/ blood serum agglutination (+) end of 2nd week
3. Fecalysis – don’t eat red meat 1-2 days prior – rectal swab
4. Typhi Dot test- new method det IgH, IgG
Nsg Care;
 Supportive care
 Position patient to prevent aspiration
 Use of enteric precautions
 TSB for high fever
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 Increase fluid intake
 Five meds as prescribed
 Monitor for complications

Prevention:
 Handwashing
 Decontamination of water sources milk pasteurization,
Immunization – vaccine of C.T. cholera typhoid, oral vivotif.

Complications:
1. Perforation of the intestine – rupture blood vessels of intestine.
2. Intestinal hemorrhage
3. Relapse
4. Thrombophlebitis
5. Urinary infection
6. Meningitis

Tx:
 Chloramphenicol – 14 days
 Amoxicillin – oral in cases resistant to chloramphenicol
o monitor CBC to det chlormphenicol toxicity SE of chloramphenicol: Bone depression

CHOLERA
ö EL Tor
ö acute bacterial, diarrheal dse with profuse watery stools, occasional vomiting & rapid dehydration

CA – Vibro cholerae, Vibro comma (ogawa, Inoba)

MOT –
ö Fecal – oral route via contamination of water, milk and other foods.
ö ingestion of food or water contaminated with stools or vomitus of patients.
ö Flies, soiled hands and utensils also serve to transmit infection.
S/Sx:
 Profuse diarrhea – watery, whitish, grayish or greenish slightly muccid stools without any fecal matter,
called rice water stools “fishy odor”
 Stools are passed repeatedly, later becoming all
 Signs of severe dehydration – sunken fontanel & eyeballs
- prominences of sutures
- loss of turgor & elasticity of the skin
- (+) skin folds sigh with wrinkling of the finger tips
- cold clammy sweat and decreased BP
- vomiting, muscle cramps and inc exhaustion
- symptoms of severe dehydration – washer woman’s hand.

Nsg care:
1. Isolation of patient; entire precautions
2. Care of the buttocks – should dry & clean
3. Proper disposal of excreta
4. Proper preparation of food/ food sanitation
5. Boil water for drinking
6. Replacement of fluids & electrolytes
7. Antiseptic mouthwash in case of vomiting
8. Fluids is given as soon as he can tolerate it.
Dx/exam:
- stool exam
Tx:
 IVF – lactated Ringers Solution
 Tetracycline
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DYSENTERY
A. Bacillary dysentery
ö acute bacterial infection of the lining of the small & large intestine;

CA – Shigella Dysenteriae
MOT
ö Eating contaminated foods, hand to mouth transfer of contaminated materials, flies, objects and soiled
with discharges of infected person/ contaminated water.

S/Sx:
 Chills, fever
 N/V
 Colicky abdominal pain with tenderness
 Diarrhea with tenesmus – painful straining during defecation or feeling to defecate. (watery, mucoid, with
blood streaks)

Dx/exam:
 Stool exam- should be submitted 1 to 2 hrs after collection because organism will dry.
Nsg care:
 Monitor I & O – frequently & amount, consistency of stool
 Replacement of fluids & electrolytes
 Enteric precaution
 Pre-anal care
 Investigation of source of infection (food, water, milk etc)

Prevention:
 Good sanitation/ hygienic practices
 Safe water supply – boiling water
 Handwashing
 Avoid 5 F’s

Tx: Cotrimoxazole

Cholera Bacillary D. Amoebic D.

Synonym El tor Shigellosis Amoebiasis
C.A. Vibrio comma Shigellosis Entamoeba
Vibrio cholerae Shigella Dysenteriae Hystolitica
>Bacteria > Bacterial > Protozoan
M.O.T. Fecal/oral Fecal/oral Fresh/raw vegetables
Contaminated water Fresh raw vegetables Fresh raw vegetables
Sea shells, oysters
Sx. Explosive -diarrhea, vomiting Fever, diarrhea > On & off diarrhea
> dehydration a. stool – solid (initial) greenish stool
> death – rigor mortis sets in b. mucoid blood streak > Mucoid blood
(stiffening of muscle) > some signs of dehydration streak
ATP – responsible for stiffening of > Bubbly
muscle > Flatulence
Washer woman’s hand
Pathog RICE WATERY STOOLS MUCOID BLOOD STREAKED
STOOL
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Mgt:
ö Monitor I&O particularly the amount consistency, frequency of stool, vomitus
ö Assess degree of dehydration
ö Replace fluids & electrolytes loss with IVF as ordered ORESOL100ml fluids.
ö Handwashing
ö Enteric precaution
ö Perianal care
ö Avoid gas forming fatty foods
ö Proper disposal of exreta
ö Proper preparation of food/food sanitation
ö Increase fluid intake
Tx: Tetracycline Cotrimoxazole Metronidazole (Flagyl)
- Stain of teeth
- Below 8 y/o don’t give
- Contraindication ot pregnant because it inhibit growth of long bones

Prevention:
- Immunization
- Good sanitation / hygiene practices
- Safe water supply
- Handwashing
- Avoid 5 F’s
Flies
Food
Fingers
Fomites
Feces

PARISITISM
ö parasite worms defind; worms affect not only the gastrointestinal system but also found in the lungs, heart
& other body systems.
ö As parasite, they feed off the host which leads to variety of symptoms.
3 main group of helminthes
1. Cestode – flat forms – tapeworm
2. Nematode – roundworms
3. Trematode – fluke

A. Tapeworm - Taeniasis
ö from beef, fish and pork – common in pork
ö eating inadequately cooked meat.

S/Sx:
1. abdominal pain
2. muscle soreness
3. nervousness
4. nodular fict like mass

B. Giant intestinal roundworms (Ascariasis)

CA – Ascaris Lumbricoides
Sx – Voracious appetite, thin

C. Whipworm – Trichuriasis “pot bellied”

CA – Trichuris trichura
Sx – diarrhea with tenesmus – rectal prolapse

D. Pinworm – Enterobiasis or seatworm

CA – Oxyuriasis, Enterobius vermicularis
Source – fomites, autoinfection, fecal contamination, from food, meat, inhalation and
finger – most common
Symptoms – itching around the anus, nocturnal, convulsion in children.
Incidence: affects one in family & invariably infects entire family
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Dx: Tape test – early in the morning before washing.

E. Threadwrom – strongyloidiasis
CA – stronglyoides stercoralis
Prevention – wear shoes & use sanitary toilets
Symptom – intermittent diarrhea

F. Hookworm – Ancyclostosomiasis
- by walking barefoot
Symptoms : sama with thread worm
 Anemia chronic – Pica (severe anemia) eating non edible food.
 Diarrhea
 Mental & growth retardation
 Dermatitis
 Obstruction of the biliary or pancreatic duct

G. Capillariasis – endemic in the Phil

- Inadequately cooked bagoong fish- brackish water
- Burborygmic gurgling sound in abdomen

H. Paragonimiasis – lung fluke mystery dse before

- eating of fresh or inadequately cooked crabs. (Kinilaw)
- Manifestation like PTB that most often is misdiagnosed
Incidence: Endemic – Mindoro, Camarines Sur, Camarines Norte
CA – Paragonimus westermani
Metacercariae – infective larvae
Symptoms:
1. Cough of lung duration
2. Hemoptysis
3. Chest back pain
4. PTB like symptoms not responding to anti TB meds
Dx/exam
 sputum exam – eggs in brown spots

SCHISTOSOMIASIS
ö Bilhariasis, snail fever, Oriental Schisosomiasis

CA – Schistosoma Japonicum
I. host snail – oncomelania quadrasi

MOT – life cycle of Schistosoma Japonicum

S/Sx –
 Diarrhea Infectious to snail - Maracidia
 Bloody stools Infections to man – Cercaria
 Enlargement of abdomen
 Spleenomegaly
 Weakness
 Anemia
 Inflamed liver

Dx/exam
 Direct fecal smears – det eggs in stool
 Stool exam – in early & heavy infections
 Intradermal test
 Immunodiagnostic test – rec in view of the difficulty of demonstrating eggs in feces.
Tx:
Praziquantel (Biltricide)
Nitidozole
Prevention:
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 Avoid washing cloths and bathing in streams
 Proper & sanitary disposal of human feces
 Destruction of snail host – snail control use of chemicals
 Improve irrigation & agriculture practices – reduce snail habitat
Dx/exam :
All stool exam except pinworm,

HEPATITIS
ö Widespread inflammation of the liver tissue with liver cell damage due to hepatic cell degeneration &
necrosis, proliferation & enlargement of the Kupffer cells & inflammation of the periportal areas thus may
cause interruption of the bile blow.

Hepa A Hepa B Non A, Non B, (HepaC)

Synonyms ö Epidemic hepa ö Serum hepatitis ö Post transfusion
ö Catarrhal Jaundice ö Transfusion hepa
ö Infectious hepa ö virus, viral hepatitis

Prognosis 0 – 1% mortality 2 –10% mortality No data

Carrier state NO YES YES
Risk ö Crowding ö multiple sex partners ö Blood recipients – blood
ö Homosexuals ö members of medical transfusion received.
ö Food handlers team, blood, drug
ö Poor sanitation addicts.
ö Unsafe water ö blood transfusion
supply ö Promiscuous partners
ö eg. Travelers

Incubation 2 – 6 wks 6 wks – 6 months 7 wks – 8 months or 5 – 6 wks

period
M.O.T. ö Fecal – oral ö person to person ö percutaneous
ö Oral – anal ö parenteral ö blood transfusion
ö percutaneous
ö placental 3 P’s
ö blood, semen
ö cervical secretions
Source of
infection Feces
C.A. HAV HBV NANBV or others-
(Hepa A virus) Hepa B virus > hepa C virus
Prevention ö proper ö vaccine ö Same with hepa B except
handwashing ö sterile disposal needle vaccine
ö sanitation ö monogamous sexual
ö serum food partners
handlers
ö enteric precaution
ö immunization

CAN’T DONATE BLOOD.

Hepatitis
ö infection of liver cause by bacteria or virus A,B,C,D,E,G or substances that are toxic to liver.
S/Sx:
1. Pre-icteric stage
 Flu-like symptoms
 Slight RUQ pain
 Anorexia
 N/V
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 Fatigue
 Constipation or diarrhea
 Wt loss
 Hepatomegaly
 Spleenomegaly
 Lymphadenopathy

2. Icteric stage
 Light colored stools (alcoholic stool)
 Jaundice – sclera
 Tea colored urine (dark)
 Pruritus
 Continued hepatomegaly with tenderness
3. Post-icteric
 Fatigue but increased sense of will-being
 Hepatomegaly; gradual decreasing
 Symptoms gradually subsides

Dx/exam:
1. All 3 types
a.) SGPT (ALT) serum
b.) SGOT (AST) enzyme all inc in pre-icteric
c.) Alkaline phosphate LF test
d.) Bilirubin
2. Ultrasound of liver
3. liver agglutination test
4. Liver biopsy
5. HbsAg – Hepa B
anti – HAV – hepa A
anti – HCV – hepa B
Tx:
1. Essential phospholipids – Jelapor
2. Sylimarine – helps liver regenerate

Chronic hepa B antiviral drug

1. Lamivudine (Zeffix) – necrotic hepa B
ö inhibit reproduction hepa B virus
ö 100 mg/tab OD P.O. x 1 yr
ö effective to Asian $5000
2. White people alpha interferon $5000

Nsg Care:
1. Bedrest – conserve energy
2. increase CHON, CHO low fat diet – simple case only
 protein restricted for further progress – hepatoencelopathy
 sugar – encourage high CHO increase sugar (eg hard candy)
3. oral care
4. psychological support
3 – 6 mos – 1 yr before liver can regenerate
5. monitor / relieve pruritus – cool, moist compress, emollient lotion.

Prevention:
ö Importance of not donating blood
ö Avoid persons with known infections
Hepa A
ö Good hand washing
ö Good personal hygiene
ö Control & serving of food handlers
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ö Passive immunization - ISG to exposed individual & prophylaxis for travelers to developed
countries
Hepa B
ö Screen blood donors Hb3Ag
ö Use disposable needles & syringes
ö Registration of all carriers
ö Passive immunization ISG – hepatavax B vaccine & formation treated hepatitis B vaccine given in
3 doses.

SEXUALLY TRANSMITTED DISEASES

ö end stage of infection
ö infection that involves the gradual & progressive destruction of the immune system including
M.S later.

AIDS
ö Acquired Immune Deficiency syndrome
ö an acquired immune deficiency chac a defect in natural immunity.

C.A.
ö Retrovirus – human immunodeficiency virus (HIV-I & HIV – 2)
ö Previously referred to as human T – lymphotropic virus type III (HTLV-III)
MOT
 Blood, sexual contact
 Contaminated needles
 Perinatal transmission

Incubation period – 6 mos – 9 yrs Ave 1yr

HIV enzyme – reverse transcriptase – conversion

Immune system – T4 (T helper, T lymphocyte, CD4 lymphocyte)
Affected
Coordination of immune system

Fx of T4
 Identify organisms
 Mobilize other elements to act against invading organism
 Help fight infection through reproducing

T4 has CD4 (receptor)

ö enable retrovirus to identify DNA then
ö Apoprtosis – process of reproducing HIV DNA
ö NORMAL T4 COUNT: 800 – 1000 and above
ö 200 – 800 -- ARC
ö less than 200 – AIDS
ö HIV called retrovirus because they have the ability to transform/ convert itself from RNA containing virus
to DNA containing virus.
S/Sx:
1. Window phase – initial exposure/ no lab yet
 Initial infection
 Last for 4 weeks – 6 mos
 Not detectable by present lab test
2. Acute primary HIV infection-
 Short symptomatic period
 Flu- like
 Ideal time to go screening test
3. Asymptomatic HIV infection
 With antibodies against HIV but not protective
 Lasts from 1 – 20 yrs depends on factors
 Status of immune system at the time of infection
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 Healthful lifestyle engage in
 Tx & regimen – delays dse
4. ARC (Aids related complex)-
 Group symptoms indicating the dse is likely to progress to aids
 Fever of unknown origin
 Night sweats
 Chronic or intermittent diarrhea – repeated chronic, watery diarrhea
 Lymphodenopathy 3 mos – armpit, inguinal area – 1 cm diameter
 10% body wt loss
 Slight T4 200 – 400
5. AIDS
 Manifestation of severe immuno-depression
 Presence of a variety weakening
 T4 decrease 200
Infection:
 Oral candidiasis, leuckoplashia – covered by E. Barr virus
 Aids diameter comples
 Diarrhea
 Hepatitis
 Cytomegalovirus, Pneumocytis carinii pneumonia
 TB
 Kaposi’s sarcoma – AIDSdefining dse
 Herpes simplex
 Pseudomonas infection
 Blindness
 Skin – scabies, herpes zoster
 NS – encephalitis, meningitis, cerebral toxoplasmosis, aids dimentia, short term memory
Dx/exam:
ELISA – (Enzyme-linked Immunosorbent Assay)
ö Screening test do det presence of antibody against HIV
ö (-) Once wait for 4 – 12 wks to 6 months before doing another ELISA
Western blot – confirmatory test

Tx:
1. Nutritional rehabilitation
2. Tx of opportunistic infection
3. AZT (Zidovudine - Anti viral drug)
4. Anti – retroviral drugs
 Reverse transcriptase inhibits (RTI)
 Protease inhibitors (PI’S)
 Nuclosides reverse transcriptase inhibitors (NRTI)
Nsg care:
 Provide frequent rest periods
 Provide skin care
 Provide high-calorie, high CHON diet to prevent wt loss
 Provide good oral hygiene
 Provide measures to reduce pain
 Protect the client form secondary; carefully assess for early signs
 Encourage verbalization of feelings
 Teach client the importance of:
ö informing sexual contacts of diagnosis
ö not sharing needle with other individuals
ö continuing medical supervision
Prevention:
 Abstinence
 Be faithful
 Safe and non penetrative sex practices – condom
4 Folds:
1. Education – familiar with dse / symptoms
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2. Training – health workers
- commercial health workers
3. Screening – blood donor
4. Counseling – voluntary – CSW, military personnel ,

SYPHILIS
ö Lues, Pox, Bad blood disease
ö contagious dse that leads to many structural & cutaneous lesions
CA: Treponema pallidum
MOT – sexual partners & 3 P’s (parenteral, placental, peructaneous)
Incubation period – 10 – 90 days

S/Sx:
Adult syphilis
1. Primary
 Chancre on genitalia – painless pimple moth or anus
Male -- glans penis
Female -- labia majora, minor
 Serous drainage form chancre
 Enlarged by lymphnodes
 Maybe painful or painless
 Highly infectious
2. Secondary
 Skin rash on palms & soles of feet
 Reddish copper- colored lesions on pals of hands & soles of feet
 Condylomata – moist popular eruption – observe on skin and genital area
 Sore throat, mucous patches of the mouth
 Alopecia
 Enlarged lypmphnodes
3. Tertiary
 Gumma formation – necrotic tissue that can be found on blood vessels supplying blood to the
essential organs of the bodies heart, brain, lungs
 Cardiovascular changes
 Ataxia
 Stroke, blindness
 Dementia praecox – neurological
Dx/exam:
1. Darkfield examination
2. Serologic test
ö VDRL – Venereal dse research lab
ö CRPR – CT
ö FTA – ABS – Fluorescent Treponemal Antibody Absorption Test – most reliable, more
sensitive.
Complications:
Still birth
Child born with syphilis
 Placenta is bigger than the baby
 Persistent vesicular eruptions & nasal discharge
 Old man feature
 Mucus patches on mouth & anus
Child born with late syphilis (s/sx after 2 yrs)
 Deafness
 Hutchinson’s teeth – sawlike teeth
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 Saddle nose – pango
 High palate
 Keratitis – blindness
Nsg Care:
 Explain need to complete course of antibiotic therapy
 Symptomatic
 Medical asepsis
Prevention:
 Practice monogamy
 Sex education
 Strict personal hygiene in a absolute requirement
Tx: Penicillin
GONORRHEA
ö Strain, Clap, Jack
ö an infectious dse which causes inflammation of the mucus membranes of the genitourinary tract.

C.A. Neisseria gonorrheae

MOT – sexual contact
Incubation – 2 – 7 days average 3 days
S/Sx:
1. Male – usually 1st to manifest
 Burning sensation in the urethra upon irritation
 Passage of purulent (yellowish discharges)
 Pelvic pain
 Fever
 Painful urination
2. Female – 2nd to manifest
 Burning sensation upon urination
 Presence or absence of vaginal discharges
 Pelvic pain
 Abdominal distension
 N/V
 Urinating frequency
Dx/exam
Female – papsmear or cervical smear
Male – urethral smear
Tx: Drugs
Penicillin – (obsolete)
Tetracyclines
Amoxicillin (Augmentin)
Ceftriaxone sodium (Rocephim)

Complications:
1. Male – bilateral epididymitis, sterility
2. Female – pelvic inflammatory dse, sterility
3. Opthalmia neonatorium- mother to child

Nsg care:
 Monitor urinary & bowel elimination
 Make arrangements for follow-up culture 2 weeks therapy is initiated.
 Educate men/women to recognize signs of gonorrhea & treat immediate tx
 Medical asepsis
 Symptomatic
Prevention:
 Credes prophylaxis
 Avoid contact with secretions
 Practice monogamy
 Important to treat sexual partner, as client may become reinfected
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KAWASAKI DISEASE
ö Mucocutaneous lymph node syndrome
ö dse most common cause of acquired heart disease in 5 yo & below among children.
ö Common in USA, Japan & England
ö Common in children of Asian ancestry

Direct cause – unknown

P. Factors:
1. Exposure to rug shampoos
2. Infections against as retrovirus, Propironibacteriae, group A streptococcus.

The class ff: Kawasaki

1. Staphylococcus & streptococcal infection
2. Measles
3. Leptospirosis
4. Steven Johnson – due to allergy/ hypersensitivity reaction to a drug
5. Juvenile rheumatoid arthritis

S/Sx:
 Fever for 5 days
 Unresponsive to antipyretic & antibiotic
 Bilateral non purulent conjunctivitis – both sides
 Cervical lymphodenopathy – 1.5cm diameter 1 side of neck
 Change in mouth & lips – dry crack lips
 Strawberry tongue & red dry lips
 Changes in hands feet & integumental area
 Erythema
 Swelling & edema
 Desquamation
Dx/exam:
 No specific
 5 to 6 symptoms
Tx:
 High dose of aspirin
 Parenteral injection of immuno globulin (gamma globulin)

Nsg mgt:
 Symptomatic & supportive
 Emphysema importance of follow-up checkup
 2D echogram 2 mos.

Complications:
1. Endocarditis, ischemia
 Coronary arteritis, aneurismal thromosis or rupture
 Coronary arteritis, myocardial infarction, CHF
2. Aspirin toxicity
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SCABIES
ö “galis”
ö An infection of the skin produced by the burrowing action of a parasite mite resulting in irritation &
the formation of vesicles or pustules.
ö Associated with poverty, poor environmental sanitation, hygiene.

CA – ithcmite – stays in warm moist fold,

Sarcoptes scabeis – hominis, canis “Pulgas”
Burrow in skin, sero-sangunous in nature.

MOT
ö direct contact with affected persons
ö indirect contact through soiled bed linens, clothing & others

S/Sx:
 Itchy papulo – vesicular eruptions on warm folder & areas of friction of the body.
 Intense itching especially at night
 Sites – bet fingers or feet or surfaces of wrists & palms, aroung nipples, umbilicus, in axillary folds, near
groin or gluteal fold, penis, scrotum
 Typical symptom – weeping itch
 Oozing serosanguinous secretion
Dx/exam:
 Culture of wound secretion
 Presence on skin of female mite, ova & feces upon skin scraping.
Tx:
 Precipitate of sulfur in petrolatum
 Crotamiton (Eurax) – cream/lotion safer then Kwell
 Lindane loton (Kwell) – contraindicated to pregnant women & young children.

Nsg Care:
 Contact isolation
 Encourage to change clothing frequently
 Launder & iron soiled clothes – dry under sun
 All members of the family should be treated at the same time
 Take a warm soapy shower/bath to remove a scaling debris form crusts.
Preventions:
 Personal hygiene & cleanliness
 Avoid playing with affected dog.