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HANDOUTS CD DR SALVADOR • Handling and disposing of body fluids responsibly

• Handling food safely


COMMUNICABLE DISEASES • Monitoring soil and contaminated water in sensitive areas of
the hospital and washing hands carefully after contact with
Communicable Diseases are Primary Cause of Mortality Gap between either
Rich and Poor Countries Portal of exit

Non-communicable diseases account for 59% of all deaths worldwide the way the causative agent gets out of the reservoir (body fluid or
– estimated to rise from 28m in 1990 to 50m in 2020 skin)

About 60% of deaths caused by communicable diseases can be Reduce risk from portals of exit by:
attributed to:
• Covering coughs and sneezes with a tissue
 HIV/AIDS • Handling body fluids with gloves, then doing hand hygiene
• Keeping draining wounds covered with a dressing
 Malaria • Not working when you have exudative (wet) lesions or
weeping dermatitis
Mode of transmission
 Tuberculosis
any mechanism by which a pathogen is spread from a source or
 Measles
reservoir to a person
 Diarrheal disease
unwashed hands, things which are not cleaned between patients,
droplets, or, for a few diseases, the air
 Acute respiratory infection
Eliminate the mode of transmission by:
Philippines top 10 leading causes of morbidity & mortality in the
year 2007:
• Hand hygiene
• Wearing gloves to minimize contamination of hands and
1. Diarrhea discarding them after each patient
• Cleaning, disinfection, or sterilization of equipment used by
2. Bronchitis more than one patient
• Cleaning of the environment, especially high-touch surfaces
3. Pneumonia Portal of entry

4. Influenza hole in the skin that allows the infectious agent to get into the body
(mouth, nose, eyes, rashes, cuts, needlestick injuries, surgical wounds
5. Hypertension and IV sites)

6. Tuberculosis Protect portals of entry (our own and our patients) by:

7. Malaria • Dressings on surgical wounds


• IV site dressings and care
8. Heart diseases • Elimination of tubes as soon as possible
• Masks, goggles and face shields
9. Cancer • Keeping unwashed hands and objects away from the mouth
• Actions and devices to prevent needlesticks
10. Accidents • Food and water safety
Susceptible host
11. Chronic obstructive pulmonary disease and other
respiratory diseases a person or animal lacking effective resistance to a particular infectious
agent
12. Diabetes and Kidney diseases.
Minimize risk to susceptible hosts by:

• Vaccinating people against illnesses to which they may be


Goal of WHO exposed
• Preventing new exposure to infection in people who are
already ill, are receiving immunocompromising treatment, or
1. Prevention of disease
are infected with HIV
• Maintaining good nutrition
2. Prevention of disability and death from infection • Maintaining good skin condition
• Covering skin breaks
3.Prevention through immunization • Encouraging rest and balance in our lives
MICROBES against HUMAN

Definition:
Chain of Infection
Symptoms
Pathogen or causative agent
evidence of disease that is experienced or perceived (subjective)
biologic agent (organism) capable of causing disease
subjective changes in body function noted by
Eliminate organism by:
patient but not apparent to an observer
• Sterilizing surgical instruments and anything that touches
sterile spaces of the body Signs
• Using good food safety methods
• Providing safe drinking water objective evidence of a disease the physician can
• Vaccinating people so they do not become reservoirs of
illness
observe and measure
• Treating people who are ill
Reservoir
Syndrome
Any person, animal, arthropod, plant, soil, or substance (or
combination of these) in which an causative agent normally lives and a specific group of signs and symptoms that
multiplies, on which it depends primarily for survival, and where it
reproduces in such numbers that it can be transmitted to a susceptible accompany a particular disease
host
Incidence
Eliminate reservoirs by:
the number of people in a population who
• Treating people who are ill
• Vaccinating people develop a disease during a particular time period
Prevalence WBC may increase or decrease

the number of people in a population who develop a disease, can result to death if immune response or medical
regardless of when it appeared refers to both old and new cases
intervention fails
Classification of Infectious Disease
Period of Decline
Based on Behavior within host
s/sx subside
Infectious Disease
vulnerable to secondary infection
- Any disease caused by invasion and multiplication of
microorganisms Period of Convalescence

Contagious Disease regains strength and the body returns to its

disease that easily spreads from one person to another pre diseased state

recovery has occurred

Based on Occurrence of Disease Mode of Transmission

Sporadic Disease The process of the infectious agent moving from the reservoir to the
susceptible host
disease occurs only occasionally
Contact Transmission
i.e. botulism, tetanus
- the most important and frequent mode of transmission
Endemic Disease
Type of Contact Transmission
constantly present in a population, country or
Direct Contact Transmission
community
• Person to person transmission of an agent by
i.e. Pulmonary Tuberculosis • physical contact between its source and
• susceptible host
Epidemic Disease • No intermediate object involved
• i.e. kissing, touching, sexual contact
acquire disease in a relatively short period • Source → Susceptible Host
Indirect Contact Transmission
greater than normal number of cases in an area
• reservoir to a susceptible host by means of a
within a short period of time • non living object (fomites)
• Source → Non Living Object → Susceptible Host
Susceptible Host
Pandemic Disease
Recognition of high risk patients
epidemic disease that occurs worldwide
• Immunocompromised
i.e. HIV infection
• DM
• Surgery
Based on Severity or Duration of Disease • Burns
• Elderly
Acute Disease Percentage Nosocomial Infection

develops rapidly (rapid onset) but lasts only a short time


• 17% Surgical
i.e. measles, mumps, influenza • 34% UTI
• 13% LRI
Chronic Disease • 14% Bacteremia
Develops slowly, milder but longer lasting clinical manifestation • 22% Other (incldng skin Infxn)
Factors for Nosocomial Infection
Based on State of Host Resistance
Microorganism/Hospital Environment
Primary Infection
Most common cause
acute infection that causes the initial illness
• Staph aureus, Coag Neg Staph Enterococci
• E. coli, Pseudomonas, Enterobacter, Klebsiella
Secondary Infection
• Clostridium Difficile
• Fungi ( C. Albicans)
one caused by an opportunistic pathogen after primary infection • Other ( Gram (-) bacteria)
has weakened the body’s defenses • 70% are drug resistant bacteria
Compromised Host

One whose resistance to infection is impaired by


Stages of Disease
broken skin, mucous membranes and a suppressed immune
Incubation Period system

time interval between the initial infection and the

1st appearance of any s/sx Skin and Mucous Membrane

Prodromal Period physical barrier

early, mild symptoms of disease i.e. burns, surgical wounds, trauma, IV site

Period of Illness invasive procedures

overt s/sx of disease Suppressed Immune System


i.e. drugs, radiation, steroids, DM, AIDS Combats parasitic infections

IMMUNITY IMMUNIZATION
AND VACCINES
The human body has the ability to resist almost all types of organisms
or toxins that tend to damage the tissues and organs. This is called IMMUNIZATION
immunity
Process inducing immunity artificially by either vaccination (active) or
Functions of Immune System administration of antibody (passive)

1. Protects the body from internal threats Active : stimulates the immune system to produce antibodies, cellular
immune responses to protect against infectious agent
2. Maintains the internal environment by removing dead or damaged
cells. Passive : provides temporary protection through administration of
exogenous antibody
3. Provides protection against invasion from outside the body.
IMMUNIZING AGENTS

Vaccines : a preparation of proteins, polysaccharides or nucleic acids


The immune system of pathogens that are administered inducing specific responses that
inactivate or destroy or suppress the pathogen
The major components of the immune system includes the bone
marrow which produces the white blood cells (WBC), the lymphoid Toxoid : a modified bacterial toxin that has been made nontoxic but
tissues which includes the thymus, spleen, lymphnodes, tonsils and retains the capacity to stimulate the formation of antitoxin
adenoids.
IMMUNIZING AGENTS
Natural Immunity (INNATE)
Immune globulin : an antibody containing solution derived from human
Non-specific immunity present at birth. This includes; blood obtained by cold ethanol fractionation of large pools of plasma
and used primarily for immunodeficient persons or for passive
a. Phagocytosis of bacteria and other invaders by white immunization
blood cells and cells of the tissue macrophage system
Antitoxin : an antibody derived from serum of human or animals after
b. Destruction by the acid secretions of the stomach and by stimulation with specific antigens used for passive immunity
the digestive enzymes on organisms swallowed into the stomach.
Expanded Program of Immunization
c. Resistance of the skin invasion by organisms
launched in July 1976 by DOH with cooperation with WHO and
d. Presence in the blood of certain chemical compounds that UNICEF.
attach to foreign organism or toxins and destroy them like lysozyme,
natural killer cells and complement complex. Objective was to reduce the mortality and morbidity among infants and
children caused by the six childhood immunizable diseases.
Acquired Immunity
PKI, Diptheria, Polio, Measles and tetanus
The human body has the ability to develop extremely
powerful specific immunity against individual invading agents. It usually •PD no. 996 (September 16, 1976)- compulsory immunization
develops as a result of prior exposure to an antigen through for children below the age of eight.
immunization or by contracting a disease. • RA 7896 (December 30,1994) – compulsory hepatitis B for
children below eight years old
Active Acquired Immunity - immune defense are developed by the • PP no.1066 (August 26,1997) – national tetanus elimination
person’s own body. This immunity last many years or a lifetime. starting 1997
APPROACH TO ACTIVE IMMUNIZATION
Passive Acquired Immunity - temporary immunity from another source
that has developed immunity through previous disease or LIVE ATTENUATED VACCINES
immunization. It is used in emergencies to provide immediate, short
acting immunity when the risk is high. – induce response similar to an active infection

ANTIBODIES – Organisms in live vaccines : multiply in recipient until desired


immune response occurs, considered to confer lifelong
Agglutination - clumping effect of antibodies between two antigen. It protection
helps to clear the body of invading organisms by facilitating
phagocytosis. – Ex. Measles, mumps, rubella

Opsonization – in this process, the antigen-antibody molecule is APPROACH TO ACTIVE IMMUNIZATION


coated with a sticky substance that facilitates phagocytosis.
INACTIVATED OR DETOXIFIED VACCINE
1. IgG (75%)
– include whole organisms, detoxified exotoxin, purified protein
• Appears in serum and tissues antigens, polysaccharide
• Assumes a major role in bloodborne and tissue infections
• Activates the complement system – Lesser antigenic mass, requires booster vaccinations to
• Enhances phagocytosis provide protection
• Crosses placenta
2. IgA (15%) – Ex. Hepa B, pertussis, tetanus, diphtheria, influenza B,
pneumococcal
• Appears in body fluids (blood,saliva, tears, breat milk)
• Protects against respiratory, GIT and GUT EXPANDED PROGRAM OF IMMUNIZATION
• Prevents absorption of antigens from food
• Passes to neonate in breast milk for protection A fully immunized child under EPI (before 12 months of age)
3. IgM (10%)
• 1 BCG at birth or before 12 months
• Appears mostly in intravascular serum • 3 DPT and 3OPV > 6weeks old, 4 weeks apart
• First immunoglobulin produced in response to bacterial or • 3 Hepa B >6 weeks old, 4 weeks apart
viral infection
• Activates complement systems
4. IgD (.2%) BACILLE-CALMETTE-GUERIN (BCG)
Appears in small amount in serum • Only intradermal vaccine
• Attenuated bovine strains of tubercle bacilli (M.bovis)
5. IgE (.004%) • Freeze-dried, easily destroyed by heat and sunlight
• Dose : 0.05 ml ID
Allergic and hypersensitivity reactions
• Normal course : wheal disappears in 30 mins; induration-2 to – Functional or anatomical asplenia
3 wks later; pustular formation-4 to 6 wks; full scarification-6
to 12 wks later – Nephrotic syndrome or CRF
• Usually at right deltoid or buttocks (upper quadrant)
BACILLE-CALMETTE-GUERIN (BCG) – Immunosuppressive conditions

Complications : – HIV infections

– deep abscess at vaccination site due to subQ or deeper MENINGOCOCCAL


injection
– Approved for children 2 years older
– Indolent ulcer >12 weeks – 0.5 ml SC
– Can be given concurrently with other vaccines
– Regional lymphadenitis

ORAL POLIO VACCINE (OPV) EXPANDED PROGRAM OF IMMUNIZATION (WHO)

• Oral preparation - live attenuated Sabin, trivalent OPV It is safe to vaccinate a sick child who is suffering from a minor illness
• Dose : 2 drops; as early as 6 weeks old, 4 weeks apart (cough, cold, diarrhea, fever or malnutrition) or who has already been
• Booster dose : 1 year after last dose of primary series and vaccinated against measles
between 4 to 6 years old
DIPHTHERIA, TETANUS,PERTUSSIS (DTP) If the vaccination schedule is interrupted, it is not necessary to restart.
Instead, the schedule should be resumed using minimal intervals
• Diphtheria and tetanus toxoid, inactivated pertussis between doses to catch up as quickly as possible.
adsorbed into aluminum salts
• Dose : 0.5 ml IM x 3 doses as early as 6 weeks old, 4 weeks A "first expiry and first out" (FEFO) vaccine system is practiced to
apart assure that all vaccines are utilized before its expiry date. Vaccine
• Booster doses : 1 year after last dose of primary series and temperature is monitored twice a day in all health facilities and plotted
between 4 to 6 years old to monitor break in the cold chain.
• Complications :
– Pertussis : not used in > 6 y/o because of increased risk of
neuroparalytic reaction
MEASLES
Most sensitive to Heat – Oral polio vaccine, Measles
– Live attenuated vaccine; freeze-dried
Least Sensitive to Heat – DPT vaccine, Hepa B, BCG, tetanus Toxoid
– Dose : 0.5 ml SC at 9 months, as early as 6 months
– Booster dose : 12 to 15 months old as MMR (Measles,
Mumps, Rubella) INFECTION CONTROL PROCEDURE
– Transplacental maternal IgG interferes with antibody
formation Medical Asepsis
MEASLES/MMR
– CLEAN Technique
– First dose at 12 to 15 months – Involves procedures and practices that reduce the number
– Second dose between 4-6 y/o and transfer of pathogens
– Mumps vaccine usually >15 months old given as MMR – Will exclude pathogens ONLY
HEPATITIS B Attain by:

– Infants born o HbsAg-positive mothers should receive HepB – Frequent and thorough hand washing
vaccine (below 7 days) plus 0.5 ml Hepa B immunoglobulin – Personal grooming
(HBIG) within 12 hours of birth at 2 diff.sites – Proper cleaning of supplies and equipment
– 2nd dose is recommended at 1-2 months and 3rd dose at 6 – Disinfection
months of age – Proper disposal of needles, contaminated materials and
– Infants born to mothers whose HbsAg is unknown should infectious waste
receive HepB vaccine within 12 hours of birth – Sterilization
Haemophilus Influenza type B (HIB) Surgical Asepsis

– Old pure capsular polysaccharide vaccine effective for > 18 STERILE technique
months
– HiB cause meningitis and serious respiratory infections in – Practices used to render and keep objects and areas sterile
<12 months
TYPHOID – Exclude ALL microorganism
Attain by:
– Live oral Ty21A. Thermolabile given 3 doses at 2 days
interval and 25-95% effective for 3 years – Use strict aseptic precautions for invasive procedures
– Vi Antigen typhoid vaccine (Typhim Vi).capsular – Scrub hands and fingernails before entering O.R.
polysaccharide of the organisms. Given 0.5 ml SC or IM with – Use sterile gloves, masks, gowns and shoe covers
75% effectivity for 3 years – Use sterile solutions and dressings
HEPATITIS A – Use sterile drapes and create an sterile field
– Heat –sterilized surgical instruments
– Vaccine contains formaldehyde-inactivated Hep A containing Universal Precautions
720 ELISA units
– Given at 1 to 16 years of age at a dose of 0.5 ml IM or SC Universal Precautions
followed by a booster dose 6 to 12 months after
– Effectivity of 99% and side effects are mild and uncommon – Infection control guidelines designed to protect workers from
INFLUENZA exposure to diseases spread by blood and certain body
fluids.
– Immunogenic, safe and associated with minimal side effects – For prevention of transmission of blood-borne pathogens in
– 6months to <36 months, 2 doses of vaccine 1 month apart health care settings to prevent contact with patient blood and
– Protection is 70 to 80% with range of 50 to 95% body fluids
– Duration or protection is <1 year – Stress that all patients should be assumed to be infectious
PNEUMOCOCCAL for blood-borne diseases such as AIDS and hepatitis B.
– Universal Precautions
–23-valent pneumococcal vaccine is composed of purified Followed when workers are exposed to blood and certain other body
capsular polysaccharide antigen of 23 serotypes fluids, including:
– Given SC or IM
– Reactivation after 3-5 years is recommended for children 10 – semen
years or younger who are at high risk of severe – vaginal secretions
Pneumococcal infection – synovial fluid
– Can be given concurrently with other vaccines – cerebrospinal fluid
PNEUMOCOCCAL – pleural fluid
– peritoneal fluid
The following serious patients should be immunized : – pericardial fluid
– amniotic fluid
– Universal Precautions
– sickle cell disease
do not apply to: – All persons entering the room of these patients must wear a
personal respirator that filters 1 µm particles with a n
– feces efficiency of at least 95% (N95 mask)
– nasal secretions – Gowns and gloves are used as dictated by standard
– sputum precautions
– sweat 1. Disseminated zoster
– tears 2. Measles
– urine 3. Smallpox
– vomitus 4. SARS
– saliva (except in the dental setting, where saliva is likely to 5. Tuberculosis (pulmonary or laryngeal)
be contaminated with blood) 6. Varicella
Standard Precautions 7.

Standard Precautions – Patient placed in a private room with monitored negative air
pressure in relation to surrounding areas, and the room air
Replaced universal precautions must undergo at least 6 exchanges per hour
– Door to the isolation room must remain closed
– Air from the isolation room should be exhausted directly to
Apply to all patients
the outside, away from air intakes, and not recirculated (high
efficiency filters may be used also)
Stipulate that gloves should be worn to touch any of the following: – Cough etiquette
– Patients should be instructed to cover his/her mouth and
- blood nose with tissue when coughing or sneezing

- all body fluids


Droplet Precautions
- secretions and excretions, except sweat, regardless of
whether they are visibly bloody Prevent transmission by large-particle (droplet) aerosols

- non-intact skin (unlike droplet nuclei, droplets are larger, do not remain suspended
in the air, and do not travel long distances)
- mucous membranes
Droplets are produced when the infected patient talks, coughs, or
Standard Precautions sneezes and during some procedures (e.g., suctioning, bronchoscopy)

Gloves A susceptible host may become infected if the infectious droplets land
on the mucosal surfaces of the nose, mouth, or eye.
– Prevent contamination of the hands with microorganisms
– Prevent exposure of the HCW to blood-borne pathogens – Require patients to be placed in a private room, but no
– Reduce the risk of transmission of microorganisms from the special air handling is necessary (patients with same
hands of HCWs to the patient disease can be placed in the same room if private rooms are
– Do not replace the need for hand hygiene not available)
Standard Precautions – Droplets do not travel long distances (generally no more
than 3 feet), the door to the room may remain open
Hands washed immediately after gloves are removed and between – HCW should wear a standard surgical mask when working
patient contacts within 3 feet of the patient
– Gowns and gloves should be worn by HCWs when dictated
– For procedures that are likely to generate splashes or sprays by standard precautions
of body fluid, a mask with eye protection or a face shield and 1. Diphtheria, pharyngeal
a gown should be worn 2. H. influenzae meningitis, epiglottitis, pneumonia
– Disposable gowns should be constructed of an impervious 3. Influenza
material to prevent penetration and subsequent 4. Meningococcal infections
contamination of the skin or clothing 5. Multi-drug resistant pneumococcal disease
Standard Precautions 6. Mumps
7. Mycoplasma pneumonia
– Needles should not be recapped, bent, or broken but should 8. Parvovirus B19 infections
be disposed of in puncture-resistant containers 9. Pertussis
Standard Precautions 10. Plague, pneumonic
11. Rubella
Hand Hygiene 12. Streptococcal pharyngitis

– Single most important means to prevent transmission of


nosocomial pathogens Contact Precautions
– Removes the transient flora recently acquired by contact
with patients or environmental surfaces – Prevent the transmission of epidemiologically important
– Alcohol-based hand rubs are recommended (if hands are organisms from an infected or colonized patient through
visibly soiled, washing with soap and water is direct contact (touching the patient) or indirect contact
recommended) (touching contaminated objects or surfaces in the patient’s
– Ring removal prior to patient care environment)
Transmission-Based Precautions – Patients are placed in a private room or patients infected
with same organism may be placed in the same roo
Transmission-Based Precautions – Barrier precautions to prevent contamination should be
employed
Apply to selected patients based on a suspected or confirmed clinical – Gloves and Hand hygiene
syndrome, a specific diagnosis, or colonization or infection with – Gowns – worn if the HCW anticipates substantial contact of
epidemiologically important organisms his or her clothing with the patient or surfaces in the patient’s
environment or there is an increased risk of contact with
Always implemented in conjunction with standard precautions potentially infective material
– Noncritical patient care equipment should remain in the room
3 types: and not used for other patients, if items must be shared, they
should be cleaned and disinfected before reuse
– Airborne –
– Droplet 1. Acute diarrheal illnesses likely to be infectious in origin
– Contact 2. Acute viral conjunctivitis
Airborne Precautions 3. Clostridium difficile diarrhea
Droplet Precautions 4. Ectoparasistic infections (lies and scabies)
Contact Precautions 5. HSV/Varicella/Disseminated zoster
6. MDR bacteria (MRSA, VRE, VISA, VRSA) infection or
Airborne Precautions colonization
7. SARS
– Prevent transmission of diseases by droplet nuclei (particles 8. Smallpox
smaller than 5 µm) or dust particles containing the infectious 9. Streptococcal (group A) major skin, burn or wound infection
agent 10. Viral hemorrhagic fevers
– Airborne Precautions
ISOLATION OF PATIENTS 4. Grade IV – Grade III plus irreversible shock and massive
bleeding
Source Isolation

Reverse Isolation Diagnostics

– Protective or neutropenic isolation Tournique test or Rumpel Leede Test – presumptive test for capillary
– Used for patients with severe burns, leukemia, transplant, fragility
immuno deficient persons, receiving radiation treatment,
leukopenic patients – keep cuff inflated for 6-10 mins (child), 10-15 min (adults)
– Those that enter the room must wear masks and sterile – count the petechiae formation 1 sq inch (>10-15
gowns to prevent from introducing microorganisms to the petechiae/sq inch)
room

Laboratory Procedures

AFB ISOLATION – CBC


– Bleeding Parameters
– Serologic test
- VISITORS - report to nurses’ station before entering the – Dengue blot, Dengue Igm
room – Other :
– PT (Prothrombin Time)
- MASKS – worn in patients room – APTT (Activated Partial Thromboplastin Time)
– Bleeding time
– Coagulation time
- GOWNS – prevent clothing contamination

- GLOVES – for body fluids and non intact skin Mgmt: symptomatic and supportive
- HANDWASHING - after touching patient or potentially
Management
contaminated articles and after removing gloves
– Specific Therapy – none
- articles discarded, cleaned or sent for decontamination and
– Symptomatic/Supportive therapy
reprocessing – Intravenous Fluids (IVF)
– with hemoconcentration, 5-7 ml/kg/hr
- room remains closed – with shock, 10-30ml/kg in <20mins
– Use of Blood/Blood Products
- patients wear masks during transport – Platelet concentrate 1 unit/5-7kg
– Cryoprecipitate, 1unit/5kg
Personal Protective Equipment – FFP, 15ml/kg x 2-4hrs
– given in patient in impending shock and unresponsive
– mask to isotonic or colloid transfusion.
– gloves – Prolonged PT
– gown – FWB 20cc/kg
– shoe cover – active bleeding
– goggles – check serum calcium
– PRBC 10cc/kg

BLOOD/VECTOR BORNE DISEASES


Nursing Intervention
Prevention
– Paracetamol (no aspirin)
Eradicate the source DOH CLEAN – Giving of cytoprotectors
– Gastric Lavage
– C – chemically treated mosquito net – trendelenberg position for shock
– L - larvae eating fish – Nasal packing with epinephrine
– E – environmental sanitation – No intramuscular injections
– A – anti-mosquito – manage anxiety of patient and family
– N – neem tree (oregano, eucalyptus)
Dengue Hemorrhagic Fever
Preventive measures
– caused by dengue virus (Flaviviridae) with 4 serotypes
– transmitted to a bite of female aedes aegypti mosquito Department of Health program for the control of Dengue
– incubation period 2-7 days Hemorrhagic Fever
– Vectors: (day biting)
– Aedes aegypti (breeds in water stored in houses) S eek and destroy breeding places
– Aedes albopictus
– Culex fatigans S ay no to left and right defogging
Clinical manifestation
S eek early consultation
First 4 days – Febrile or Invasive stage – high grade fever, headache,
body malaise, conjuctival injection, vomitting, epistaxis or gum
bleeding, positive tornique test.
FILARIASIS
4th – 7th day – Toxic or Hemorrhagic Stage – After the lyze of the
fever, this is were the complication of dengue is expected to come out – The disease often progresses to become chronic, debilitating
as manifested by abdominal pain, melena, indicating bleeding in the and disfiguring disease since it’s symptoms are unnoticed or
upper gastrointestinal tract, Unstable BP, narrow pulse pressure and unfamiliar to health workers.
shock. – High rates in region 5(bicol), 8 (samar and leyte, II (davao)
– Wuchereria bancrofti and Bulgaria malayi
7th – 10th day – Convalescent or recovery stage – after 3 days of – Transmitted to the bite of infected female mosquito (Aedes,
afebrile stage and the patient was properly hydrated and monitored BP Anopheles, Mansonia)
will become stable and laboratory values of platelet count and bleeding – The larvae are carried in the blood stream and lodged in
parameters will begin to normalize. lymphatic vessels and lymph glands where they mature in
adult form
Classification of Dengue Fever according to severity

1. Grade I – Dengue fever, saddleback fever plus constitutional Two biological type
signs and symptoms plus positive tornique test
2. Grade II – Stage I plus spontaneous bleeding, epistaxis, GI, Nocturnal
cutaneous bleeding
3. Grade III – Dengue Shock Syndrome, all of the following microfilaria circulate in peripheral blood at night (10pm – 2am)
signs and symptoms plus evidence of circulatory failure
Diurnal Shock, coma, CHF

microfilaria circulate in greater concentration at daytime Convalescent Period

Clinical Manifestation Diagnosis

Acute stage Clinical history and manifestation

- filarial fever and lymphatic inflammation tha occurs frequently as 10 Culture


times per year and usually abates spontaneously after 7 days
Blood: during the 1st week
- Lymphadenitis (Inflammation of the lymphnodes)
CSF: from the 5th to the 12th day
- Lymphangitis (Inflammation of the lymph vessels)
Urine: after the 1st week until convalescent period
Chronic Stage (10-15 years from the onset of the first attack)
LAAT (Leptospira Agglutination Test)
- Hydrocele (Swelling of the scotum)
other laboratory
- Lymphedema (Temporary swelling of the upper and lower
extremities) BUN,CREA, liver enzymes

- Elephantiasis (enlargement and thickening of the skin of the lower or


upper extremities)
Treatment

Specific
Laboratory Diagnosis
Penicillin 50000 units/kg/day
– Blood smear – presence of microfilaria
– Immunochromatographic Test (ICT) Tetracycline 20-40mg/kg/day
– Eosinophil count
Non-specific
Management Guidelines Supportive and symptomatic
– Specific Therapy Administration of fluids
– Dietylcarbamazine (DEC) 6mg/KBW in divided doses for 12
consecutive days
Peritoneal dialysis for renal failure
– Ivermectine (Mectican)
– Supportive Therapy
– Paracetamol Educate public regarding the mode of transmission, avoid swimming or
– Antihistamine for allergic reaction due to DEC wadding in potentially contaminated waters and use proper protective
– Vitamin B complex equipment.
– Elevation of infected limb, elastic stocking

DEC should be taken immediately after meals Nursing Responsibilities

It may cause loss of vision, night blindness, or tunnel vision with 1. Dispose and isolate urine of patient.
prolonged used.
2. Environmental sanitation like cleaning the esteros or dirty places
Ivermectin is best taken as single dose with a full glass of water in en with stagnant water, eradication of rats and avoidance of wading or
empty stomach. bathing in contaminated pools of water.

Cannot be used in patient with asthma 3. Give supportive and asymptomatic therapy

4. Administration of fluids and electrolytes.

Preventive Measures 5. Assist in peritoneal dialysis for renal failure patient (The most
important sign of renal failure is presence of oliguria.)
Health teachings
MALARIA
Environmental Sanitation
– Malaria
– “King of the Tropical Disease”
– an acute and chronic infection caused by protozoa
plasmodia
Leptosiprosis (Weil’s disease)
– Infectious but not contagious
– transmitted through the bite of female anopheles mosquito
a zoonotic systemic infection caused by Leptospires, that penetrate – Malaria Exacts Heavy Toll in Africa
intact and abraded skin through exposure to water, wet soil – Malaria
contaminated with urine of infected animals. – There are 300-500m new cases annually
– Over 1m die every year – almost 3000 per day
– 90% of deaths are in Sub-Saharan Africa
– Cost of malaria in Africa is $100bn
Anicteric Type (without jaundice) – Vector: (night biting)
– anopheles mosquito
manifested by fever, conjunctival injection – or minimus flavire
Life cycle:
signs of meningeal irritation
– Sexual cycle/sporogony (mosquito)
– sporozoites injected into humans
– Asexual cycle/schizogony (human)
Icteric Type (Weil Syndrome) – gametes is the infective stage taken up by biting mosquito
Plasmodium Vivax
Hepatic and renal manifestation
– more widely distributed
Jaundice, hepatomegally – causes benign tertian malaria
– chills and fever every 48 hours in 3 days
Plasmodium Falciparum
Oliguris, anuria which prigress to renal failure
– common in the Philippines – insect repellant, nets
– Causes the most serious type of malaria because of high
parasitic densities in blood.
– Causes malignant tertian malaria Nursing Care
Plasmodium malaria
1. Consider a patient with cerebral malaria to be an emergency
– much less frequent
– causes quartan malaria, fever and chills every 72 hrs in 4 – Administer IV quinine as IV infusion
days
– Plasmodium Ovale - Watch for neurologic toxicity from quinine transfusion like delirium,
– rarely seen. confusion, convulsion and coma
Pathology
2. Watch for jaundice – this is related to the density of the falciparum
– the most characteristic pathology of malaria is destruction of parasitemia,
red blood cells, hypertrophy of the spleen and liver and
pigmentation of organs.
3. Evaluate degree of anemia
– The pigmentation is due to the phagocytocis of malarial
pigments released into the blood stream upon rupture of red
cells 4. Watch for abnormal bleeding that are may be due to decrease
Clinical Manifestation production of clotting factors by damage liver.

uncomplicated Chemoprophylaxis

– fever, chills, sweating every 24 – 36 hrs – doxycycline 100mg/tab, 2-3 days prior to travel, continue up
Complicated to 4 weeks upon leaving the area
– Mefloquine 250mg/tab, 1 week before travel, continue up to
four weeks upon leaving the area
– sporulation or segmentation and rupture of erythrocytes
– Pregnant, 1st trimester, chloroquine, 2 tabs weekly, 2 weeks
occurs in the brain and visceral organs.
before travel, during stay and until 4 weeks after leaving
– Cerebral malaria
– 2nd and 3rd trimester, Pyrimethamine-sulfadoxine
– changes of sensorium, severe headache and vomiting
– seizures
Category of provinces
clinical manifestation
Category A – no significant improvement in malaria for the past 10
years. >1000
1. Cold stage – 10-15 mins, chills, shakes
2. hot stage – 4-6 hours, recurring high grade fever, severe
headache, vomitting, abdominal pain, face is blue - Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao, kalinga
3. Diaphoretic Stage – excessive sweating
Category B - <1000/year

Diagnosis - Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan, zambales,
bataan, laguna
– Malarial smear
– Quantitative Buffy Coat (QBC) Category C – significant reduction
Travel in endemic areas
-pampanga, la union, batangas, cavite, albay
Treatment:

Determine the species of parasite


CENTRAL NERVOUS SYSTEM DISEASES
Objectives of treatment
Inflammation of the meniges
1. Destroy all sexual forms of parasite to cure the clinical attack
2. Destroy the excerythrocytes (EE) to prevent relapse Caused by bacterial pathogen, N. menigitidis, H. Influenza, Strep.
3. Destroy gametocytes to prevent mosquito infections Pneumoniae, Mycobacterium Tuberculosis

PATHOLOGY
Treatment for P. Falciparum
Primary – spread of bacteria from the bloodstream to the meniges
1. chloroquine tablet (150mg/base/tab) Day 1,2,3 (4,4,2)
2. Sulfadoxine/Pyrimethamine 500mg/25mg/tab, 3tab single Secondary – results from direct spread of infection from other sources
dose or focus of infection.
3. Primaquine (15mg/tab) 3 tabs single dose
Treatment for P. Vivax

1. Choloroquine, Day 1,2,3 (4,4,2) The disease usually begins as an infection by normal body flora, of:
2. Primaquine 1 tab OD for 14 days
1. The ear (otitis media) - Haemophilus influenzae

Treatment for mixed 2. The lung (lobar pneumoniae) - Streptococcus pneumoniae

– chloroquine (4,4,2) 3. The upper respiratory tract (rhinopharyngitis) - Neisseria


– Sulfadoxine/Pyrimethamine 3 tabs once meningitidis, Haemophilus
– Primaquine 1 tab for 14 days influenzae, Streptococcus, Group B

4 The skin and subcutaneous tissue (furunculosis) S. aureus


Multi-drug resistant P. Falciparum
5. The bone (osteomyelitis) - S. aureus
quinine plus doxycycline, or tetracycline and primaquine
6. The intestine - E. coli
Complications
Clinical manifestation
– severe anemia
– cerebral malaria – Fever
– hypoglycemia – Rapid pulse, respiratory arrythmia
– Soreness of skin and muscles
– Convulsion/seizures
Prevention and Control – headache
– irritability
– Eliminate anopheles mosquito vectors – fever
– Advise travelers – neck stiffness
– limit dusk to dawn outdoor exposure – pathologic reflexes: kernig’s, Babinski, Brudzinski
Clinical Manifestation

Diagnosis sudden onset of high grade fever, rash and rapid deterioration of
clinical condition within 24 hours
– Lumbar puncture
– Blood C/S S/sx:
– other laboratories
1. Meningococcemia – spiking fever, chills, arthralgia, sudden
appearance of hemorrhagic rash
umbar Puncture
2. Fulminant Meningococcemia (Waterhouse Friderichsen) –
– To obtain specimen of CSF septic shock; hypotension, tachycardia, enlarging petecchial
– To reduce ICP rash, adrenal insufficiency
– To Introduce medication
– To inject anesthetic Laboratory

– Blood Culture
CSF Examination – Gram stain of peripheral smear, CSF and skin lesions
– CBC
– Fluid is turbid/purulent >1000cc/mm cells Treatment:
– WBC count increase
– Sugar content markedly reduced antimicrobial
– CHON increased
– Presence of microorganism – Benzyl Penicillin 250-400000 u/kg/day
– Chloramphenicol 100mg/kg/day
Symptomatic and supportive
– Treatment
Bacterial meningitis – fever
– TB meningitis – seizures
– Intensive Phase – hydration
– Maintainance Phase – respiratory function
– Fungal meningitis
– cryptococcal meningitis – fluconazole or amphotericin B
2. Supportive/Symptomatic Chemoprophylaxis

a. Antipyretic 1. Rifampicin 300-600mg q 12hrs x 4 doses


2. Ofloxacin 400mg single dose
b. treat signs of increased ICP 3. Ceftriaxone 125-250mg IM single dose

c. Control of seizures
Nursing Intervention
d. adequate nutrition
– Provide strict isolation
Nursing Intervention – Wearing of PPE
– Health teaching
– Contact tracing
Prevent occurrence of further complication
– Prophylaxis
– Meninggococcal vaccine for high risk patient
– Maintain strict aseptic technique when doing dressing or
lumbar puncture.
RABIES
– Early symptom should be recognize
– acute viral encephalomyelitis
– Vital signs monitoring – incubation period is 4 days up to 19 years
– risk of developing rabies, face bite 60%, upper extremities
– Observe signs of increase ICP 15-40%, lower extremities 10%
– 100% fatal
– Protect eyes from light and noises

Maintain normal amount of fluid and electrolyte balance Clinical Manifestation

– Note and record the amount of vomitus – pain or numbness at the site of bite
– fear of water
– Check signs of dehydration – fear of air

Prevent Spread of the disease


4 STAGES
– Having proper disposal of secretions
1. prodrome - fever, headache, paresthesia,
– Emphasize the importance of masking
2. encephalitic – excessive motor activity, hypersensitivity to
– Explain the importance of isolation bright light, loud noise,

Ensure patient’s full recovery hypersalivation, dilated pupils

– Maintain side rails up in episodes of siezures 3. brainstem dysfunction – dysphagia,


hydrophobia, apnea
– Prevent sudden jar of bed
4. death
– Keep patient in a dark room and complete physical rest

– Diversional activities and passive exercises


Diagnosis

– FAT (fluorescent antibody test)


MENINGOCOCCEMIA – Clinical history and signs and symptoms

– caused by Neisseria meningitides, a gram negative


diplococcus Management
– transmitted through airborne or close contact
– incubation is 1-3 days – No treatment for clinical rabies
– natural reservoir is human nasopharynx – Prophylaxis
Postexposure prophylaxis A. Respirator
B. Tracheostomy – life saving procedure when
respiratory failure and inability to swallow are not
corrected
A. Active vaccine (PDEV,PCEC,PVRV) C. Oxygen therapy
Intradermal (0,3,7,30,90) D. Rehabilitation

Intramuscular (0,3,7,14,28)
SNAKEBITE
(0,7,21)
Management
B. Passive Vaccine
– Lie the victim flat
a. ERIG wt in kg x .2 = cc to be injected im (ANST) – ice compress and constrictives materials are
contraindicated
– Transport the patient to the nearest hospital
b. HRIG wt in Kg x .1333
– Antivenim administration in patient’s with signs of
envenomation
– It is never too late to give anti-venim
– Antivenim is given thru intravenous infusion, which is
Pre-exposure Prophylaxis the safest and most effective route. 2-5 ampules plus
D5W to run iver 1-2 hours every 2 hours
Intradermal/Intramuscular (0,7,21) – Antimicrobial therapy
– sulbactam/Ampicillin or co-amoxiclav
– Substitute
– Prostigmine IVinfusion, 50-100ug/kg/dose q 8hrs
Infection control – Atropine

– Patient is isolated to prevent exposure of hospital personnel,


watchers and visitors TETANUS
– PPE
– Preventive Measures – caused by Clostridium tetani, grows anaeronically
– Education – Tetanus spores are introduced into the wound contaminated
– Post-exposure and Pre-exposure Prophylaxis with soil.
– Incubation period 4-21 days

Poliomyelitis
Clinical manifestation
– RNA, Polio virus
– Fecal oral route/droplets – Difficulty of opening the mouth (trismus or lockjaw)
– IP 7-12 days – Risus sardonicus
– Disease of the lower motor neurin involving the anterior horn – Abdominal rigidity
cells – Localized or generalized muscle spasm
– Infantile paralysis; Helne-Medin disease
Predisposing Factors
Treatment
– Children below 10 years old
– Male more often affected 1. Neutralize the toxin
– Poor environmental and hygienic conditions
Causative Agent: Legio debilitans 2. Kill the microorganism

– Brunhilde (permanent) 3. Prevent and control the spasm


– Lansing and Leon (temporary)
– May exist in contaminated water, sewage and milk - muscle relaxants
S/sx: disease manifestations:
- Sedatives
1. mild febrile illness – fever, malaise, sore throat (abortive stage)
- Tranquilizers
2. Pre-paralytic stage - flaccid asymetrical ascending paralysis
(Landry’s sign), Hayne’s sign (head drop), Pofer’s sign (opisthotonus)
4. Tracheostomy
3. Paralytic stage

bulbar or spinal
Treatment:
Mode of Transmission
anti-toxin
– Droplet infection – in early infection
Tetanus Anti-Toxin (TAT)
– Body secretions – nasopharyngeal
– Fecal oral – during late stage
– Flies may act as mechanical vectors – Adult,children,infant 40,000 IU ½ IM,1/2 IV
– Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
TIG
A. I – Abortive or inapparent
B. II – Meningitis (non-paralytic) – Neonates 1000 IU, IV drip or IM
C. III – Paralytic (anterior horn of spinal cord)
D. IV – Bulbar (encephalitis)
– Adult, infant, children 3000 IU, IV drip or IM
Antimicrobial Therapy

Dx: Pandy’s test - CSF (increased CHON) Penicillin !-3 mil units q 4hours

MGMT: Pedia 500000 – 2mil units q 4 hrs

Active – OPV (Sabin) and IPV (Salk) Neonatal 200000 units IVP q 12hrs or q8hrs

Immunity is acquired for 3 strains Control of spasms

A. Legio brunhilde (fatal) – diazepam


B. Legio lansing – chlorpromazine
C. Legio leon Nursing care

– Patient should be in a quiet, darkened room, well ventilated.


Respiratory distress – Minimal/gentle handling of patient
– Liquid diet via NGT
– Prevent Injury - prepare for intestinal decompression or surgical intervention
– Preventive Measures
– Treatment of wounds b. Intestinal hemorrhage - withold food and give blood
– Tetanus toxoid (0,1,6,1,1) transfusion

Nursing Interventions
HEPATO-ENTERIC DISEASES
– Environmental Sanitation
SCHISTOSOMIASIS – Food handlers sanitation permit
– Supportive therapy
– caused by blood flukes, Schistosoma – Assessment of complication (occuring on the 2nd to 3rd week
– has 3 species, S. haematobium, S. Mansoni, S. japonicum
of infection )
– S. japonicum is endemic in the Philippines (leyte, Samar,
– typhoid psychosis, typhoid meningitis
Sorsogon, Mindoro,Bohol)
– typhoid ileitis
– Intermediate host, Oncomelania Quadrasi

Hepatitis
DIAGNOSIS
– Hepa A – fecal oral route
– Schistosoma eggs in stool
– Hepa B – body fluids
– Rectal bipsy
– Hepa C – non A non B, BT, body fluids
– Kato Katz
– Hepa D – hypodermic, body fluids
– Ultrasound of HBT
– Hepa E – fecal oral route, fatal and common among
pregnant women
– Hepa G – BT, parenteral
Clinical Manifestation

– severe jaundice Hepatitis A


– edema
– ascites
– Infectious hepatitis, epidemic hepatitis
– hepatosplenomegally
– Young people especially school children are most commonly
– S/S of portal hypertention
affected.
– Predisposing factors:
– Poor sanitation, contaminated water supply, unsanitary
Management preparation of food, malnutrition, disaster conditions
– Praziquantrel 60mg/kg Once dosing
– Supportive and sympromatic Incubation Period: 15-50 days

Signs/Symptoms:
Methods of Control
– Influenza
– Educate the public regarding the mode of transmission and
methods of protection.
– Malaise and easy fatigability
– Proper disposal of feces and urine
– Prevent exposure to contaminated water. To minimize
penetration after accidental water exposure, towel dry and – Anorexia and abdominal discomfort
apply 70% alcohol.
The organism is pathogenic only in man – Nausea and vomiting

TYPHOID FEV ER – Fever, CLAD

– Spread chiefly by carriers, ingestion of infected foods – jaundice


– Endemic particularly in areas of low sanitation levels
– Occurs more common in may to august

Dx: Anti HAV IgM – active infection


MOT: oral fecal route
Anti HAV IgG – old infection; no active disease
– S/sx: Rose spot (abdominal rashes), more than 7days Step
ladder fever 40-41 deg, headache, abdominal pain, Management:
constipation (adults), mild diarrhea (children)
– Prophylaxis

Diagnosis – Complete bed rest

Blood examination WBC usually leukopenia with lymphocytosis – Low fat diet but high sugar

Isolation – Ensure safe water for drinking


– Sanitary method in preparing handling and serving of food.
– Blood culture 1st week\ – Proper disposal of feces and urine.
– Washing hands before eating and after toilet use.
– Separate and proper cleaning of articles used by patient
– Urine culture 2nd week

– Stool culture 3rd week Hepatitis B

– Widal test O or H – DNA, Hepa B virus


– 1st week step ladder fever (BLOOD) – Serum hepa
– 2nd week rose spot and fastidial – Worldwide distribution
– typhoid psychosis (URINE & STOOL) – Main cause of liver cirrhosis and liver cancer

Mgmt: Chloramphenicol, Amoxicillin, Sulfonamides, IP: 2-5 months


Ciprofloxacin, Ceftriaxone
Mode of Transmission

– From person to person through


Watch for complication – contact with infected blood through broken skin and mucous
membrane
a. Perforation – symptoms of sharp abdominal pain, – sexual contact
abdominal rigidity and absent of bowel sounds. – sharing of personal items
– Parenteral transmission through
– blood and blood products
– use of contaminated materials
– Perinatal transmission Measles, Rubeola, 7 Day Fever, Hard Red Measles
High Risk group
– RNA, Paramyxoviridae
– Newborns and infants of infected mothers – Active MMR and Measles vaccine
– Health workers exposed to handling blood – Passive Measles immune globulin
– Persons requiring frequent transfusions – Lifetime Immunity
– Sexually promiscuous individuals – IP: 7-14 days
– Commercial sex workers
– Drug addicts
MOT: droplets, airborne

Possible Outcome – *Contagious 4 days before rash and 4 days after rash

– Most get well completely and develop life long immunity.


– Some become carriers of the virus and transmit disease to Clinical Manifestation
others.
– Almost 90% of infected newborns become carriers Pre eruptive stage

– Patient is highly communicable


Hepatitis C
– 4 characteristic features
– Post transfusion Hepatitis
– Mode of transmission – percutaneous, BT
A. Coryza
– Predisposing factors – paramedical teams and blood
B. Conjunctivitis
recepients
C. Photophobia
– Incubation period – 2weeks – 6 months
D. Cough
– Koplik’s spots
– Stmsons line
Hepatitis D

– Dormant type Eruptive stage


– Can be acquired only if with hepatitis B
– Maculopapular rashes appears first on the hairline, forehead,
post auricular area the spread to the extremities
Hepatitis E (cephalocaudal)
– If hepatitis E recurs at age 20-30, it can lead to cancer of the – Rashes are too hot to touch and dry
liver
– Enteric hepatitis
– High grade fever and increases steadily at the height of the
– Fecal-oral route
rashes

Stage of convalescence
DX:
– Rashes fade in the same manner leaving a dirty brownish
– Elevated AST or SGPT (specific) and ALT or SGOT
pigmentation (desquamation)
– Increased IgM during acute phase
– (+) or REACTIVE HBsAg = INFECTED, may be acute,
chronic or carrier – Black measles – severe form of measles with hemorrhagic
rashes, epistaxis and melena
– (+) HBeAg = highly infectious
– ALT – 1st to increase in liver damage Rashes: maculopapaular, cephalocaudal (hairline and behind the ears
○ HBcAg = found only in the liver cells to trunk and limbs), confluent, desquamation, pruritus
– (+) Anti-HBc = acute infection Complication
– (+) Anti-HBe = reduced infectiousness
– Bronchopneumonia
– (+) Anti-HBs = with antibodies (FROM vaccine or
– Secondary infections
disease) – Encephalitis
– Blood Chem. Analysis (to monitor progression) – Increase predisposition to TB
– Liver biopsy (to detect progression to CA)

MANAGEMENT
Mgmt:
1. Supportive
– Prevention of spread – Immunization and Health Education
– Enteric and Universal precautions
2. Hydration
– Assess LOC
– Bed rest
– ADEK deficiency intervention 3. Proper nutrition
– High CHO, Moderate CHON, Low fat
– FVE prevention 4. Vitamin A

5. Antibiotics
Cx:
6. Vaccine
1. Fulminant Hepatitis – s/sx of encephalopathy
Nursing Care
2. Chronic Hepatitis - lack of complete resolution of clinical sx and
persistence of hepatomegaly – Respiratory precautions
– Restrict to quite environment
3. HBsAg carrier – Dim light if photophobia is present
– Administer antipyretic
ERUPTIVE FEVER – Use cool mist vaporizer for cough

MEASLES
German Measles (rubella)
– Extremely contagious
– Breastfed babies of mothers have 3 months immunity for – Acute infection caused by rubella virus characterized by
measles fever, exanthem and retroauricular adenopathy.
– The most common complication is otitis media – Has a teratogenic potential on the fetuse of women in the 1st
– The most serious complications are bronchopneumonia and trimester
encephalitis s/sx:
– forschheimer’s (petecchial lesion on buccal cavity or soft – Cx: same with chicken pox
palate),
– cervical lymphadenopathy, low grade fever
– “ Oval, rose red papules about the size of pinhead KAWASAKI DISEASE

– Mucocutaneous lymph node syndrome


Dx: clinical – Children younger than 5 years old are primarily affected.
– Associated with large coronary blood vessel vasculitits
CX: rare; pneumonia, meningoencephalitis – A febrile, exanthematous, multisystem illness characterized
by
CX to pregnant women: ○ Acute febrile phase manifested by high spiking
fever, rash, adenopathy, peripheral edema,
– 1st tri-congenital anomalies conjunctivitis and exanthem
– 2nd tri-abortion ○ sub acute phase, thrombocytosis, desquamation
– 3rd tri-pre mature delivery and resolution of fever.
Rashes: Maculopapular, Diffuse/not confluent, No desquamation, ○ Convalescent stage
spreads from the face downwards Manifestations

– bilateral, non purulent conjuctivitis


– congested oropharynx, strawberry tongue, erythematous
Roseola Infantum, lymphs
Exanthem Subitum, Sixth disease – erythematous palms/soles, edematous hands/feet
– periungal desquamation, truncal rash
– Human herpes virus 6 – CLADP ( 1node >1.5cm)
– 3mos-4 yo, peak 6-24 mos
– MOT: probably respiratory secretions
S/sx:

Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear Diagnosis
after fever subsides, Mild pharyngitis and lymph node enlargement
– CBC: leukocytosis
– Platelet count >400000
– 2D echo (if coronary artery involvement is highly suggestive
Chicken Pox, Varicella – ESR and CRP elevated

– Herpes zoster virus (shingles), Management


varicella zoster virus(chocken pox)
– Active : Varicella vaccine – IV Gamma globulin – 2g/kg as single dose for 10-12 hours.
– Passive: VZIG, ZIG – given 72-96 hrs Effective to prevent coronary vascular damage if given within
w/n exposure 10 days of onset.
– Lifetime Immunity – Salicylates: 80-100mg/kg/24 hours in 4 divided doses
– IP: 14-21 days – Symptomatic and supportive therapy

MOT: Respiratory route Respiratory System

* Contagious 1 day before rash and 6 days after first crop of vesicles Mumps

– RNA, Mumps virus


– S/sx:
– Mumps vaccine - > 1yo
fever, malaise, headache – MMR – 15 mos
– Rashes: Maculopapulovesicular (covered areas), – Lifetime Immunity
Centrifugal, starts on face and trunk and spreads to entire – IP: 12-16 days
body – MOT: Droplet, saliva, fomites
– Leaves a pitted scar (pockmark)
– CX furunculosis, erysipelas, meningoencephalitis
– Dormant: remain at the dorsal root ganglion and may recur
S/sx: Unilateral or bilateral
as shingles (VZV)
– parotitis, Orchitis - sterility if bilateral,
– Oophoritis, Stimulating food cause severe pain, aseptic
Mgmt:
meningitis
– Dx: serologic testing, ELISA
a. oral acyclovir

b. Tepid water and wet compresses for pruritus Mgmt: supportive


c. Aluminum acetate soak for VZV Nursing care
d. Potassium Permanganate (ABO) – Respiratory precautions
– Bed rest until the parotid gland swelling subsides
a. Astringent effect – Avoid foods that require Chewing
– Apply hot or cold compress
b. Bactericidal effect – To relieve orchitis, apply warmth and local support with tight
fitting underpants
c. Oxidizing effect (deodorize the rash) Diptheria

Small Pox, Variola – Acute contagious disease


– Characterized by generalized systemic toxemia from a
– DNA, Pox virus localized inflammatory focus
– Last case 1977 – Infants immune for 6 months of life
– spreads from man-to-man only – Produces exotoxin
– Active: Vaccinia pox virus – Capable of damaging muscles especially cardiac, nerve,
– IP: 1-3 weeks kidney and liver
S/sx: – Increase incidence prevalence during cooler months
– Mainly a disease of childhood with peak at 2-5 years,
– Rashes: uncommon in >6months
– Maculopapulovesiculopustular
– Centripetal
– contagious until all crusts disappeared Corynebacterium diphtheriae, gram (+), slender, curved clubbed
Dx: organism “Klebs-Loeffler Bacillus”

– Paul’s test - instilling of vesicular fluid w/ small pox into the IP: 2-6 days
cornea; if keratitis develops, small pox
Mode of transmission is direct or indirect contact expiration and a sudden noisy inspiration with a long high
pitched “whoop”
1. Nasal – invades nose by extension from pharynx – During attack the child becomes cyanotic and the eyes
appear to bulge or popping out of the eyeball and tongue
2. Pharygeal protrudes

- sorethroat causing dysphagia


Diagnosis
- Pseudomembrane in uvula, tonsils, soft palate
– WBC count 20000-50000
- Bullneck – inflammation of cervical LN – Culture with Bordet Gengou Agar

3. Laryngeal
Treatment
- increasing hoarseness until aphonia
– Erythromycin shorten the period of communicability
– Ampicillin if with allergy to erythromycin
- wheezing on expiration
– Heperimmune pertusis gamma globulin in <2 years old
(1.25ml IM)
- dyspnea – Control of cough with sedatives
Diagnosis
Dx: WHO - >21 days cough + close contact w/ pertussis px + (+)
– Nose and throat swab using loeffler’s medium culture OR rise in Ab to FHA or pertussis toxin
– Schick test – determine susceptibility or immunity in diptheria
– Maloney test – determines hypersensitivity to diptheria * throat culture w/ Bordet gengou agar
toxoid
Management
Complications
– CBR to conserve energy
– Prevent aspiration
Toxic myocarditis – due to action of toxin in the heart muscles (1 10-
st
– High calorie, bland diet
14 days) – Omit milk and milk product because it increases the mucous
– Refeeding of infants 20 min after vomitting
Neuritis caused by absorption of toxin in the nerve – Milk should be given at room temperature

– Palate paralysis (2nd week)


complications
– Ocular palsy (5 week)
th
– Bronchopneumonia
– Abdominal hernia
– Diapgram paralysis (6-10wk causing GBS) – Severe malnutrition
– TB, asthma
– Motor and skeletal muscle paralysis – encephalitis

Treatment
Pre exposure prophylaxis for Diphtheria, Pertussis, Tetanus
A. Neutralize the toxins – antidiptheria serum
B. Kill the microorganism – penicillin DPT- 0.5 ml IM
C. Prevent respiratory obstruction – tracheostomy, intubation

– 1 - 1 ½ months old
Treatment 2 - after 4 weeks
3 - after 4 weeks
Serum therapy (Diptheria antitoxin) – 1st booster – 18 mos

- early administration aimed at neutralizing the toxin present in the


– 2nd booster – 4-6 yo
– subsequent booster – every 10 yrs thereafter
general circulation

Antibiotics
Infectious Mononucleosis
- Penicillin G 100000mg/kg.day
– Epstein Barr virus
– Inc. period: 4-6 weeks
- Erythromycin 40mg/kg – Communication period: Unknown, virus is shed before the
onset of the dse until 6 months or longer after recovery
Nursing Intervention
– Source: oral secretions
– Rest. – Transmission: Direct intimate contact, infected blood
– Patient should be confined to bed for at least 2 weeks
– Prevent straining on defecation
– vomiting is very exhausting, do not do procedures that may Assessment
cause nausea
– Care for the nose and throat – Fever, sorethroat, malaise, headache, fatigue, nausea,
– Ice collar to reduce the pain of sorethroat abdominal pain
– Soft and liquid diet
– CLADP, hepatosplenomegally

Whooping Cough, 100 day fever Nursing care

Bordetella pertussis, B. parapertussis, B. bronchiseptica, gram (-) – Supportive


– Monitor signs of splenic rupture, which include abdominal
IP: 3-21 days pain, left upper quadrant pain or left shoulder pain

MOT: airborne/droplet
PULMONARY TUBERCULOSIS
Signs and symptoms
– The world’s deadliest disease and remains as a major public
– Invasion or catarrhal stage (7-14days) starts with ordinary health problem.
cough – Badly nourished, neglected and fatigued individuals are
– Spasmodic or paroxysmal more prone
– 5-10 spasms of explosive cough (no time to catch breath. A – Susceptibility is highest in children under 3 years
peculiar inspiratory crowing sound followed by prolonged – AKA: Koch’s disease: Galloping consumption
S/sx: 2. Pneumonia

– Wt loss - young infant >60/min, fast breathing without chest indrawing


– night sweats
– low fever, 3. Severe pneumonia
– non productive to productive cough
– anorexia, - fast breathing, severe chest indrawing, with one of danger signs
– Pleural effusion and hypoxemia
– cervical lymphadenopathy 4. Very severe pneumonia

- below 2 mos old, fast breathing, chest indrawing, with danger signs
PPD – ID
4 Danger Signs
– macrophages in skin take up Ag and deliver it to T cells
– T cells move to skin site, release lymphokines
1. Vomits
– activate macrophages and in 48-72 hrs, skin becomes
indurated
– > 10 mm is (+) 2. Convulsion
Dx:
3. Drowsiness/lethargy
– Chest xray - cavitary lesion
– Sputum exam 4. Difficulty of swallowing or feeding
– sputum culture
S/sx:

The National Tuberculosis Control Program 1. Typical – sudden onset Fever of > 38 x 7-10 days,
productive cough, pleuritic chest pain, dullness,
– Vision: A country where TB is no longer a public health inc fremitus, rales
problem.
– Mission: Ensure that TB DOTS services are available to the 2. Atypical – gradual onset, dry cough, headache, myalgia,
communities. sore throat
– Goal: To reduce the prevalence and mortality from TB by
half by the year 2015 Watch out for complications; In 24 hours death will occur from
respiratory failure
Targets:

1. To cure at least 85% of the sputum smear positive TB Nursing Diagnosis


patient discovered.
• Ineffective airway clearance
2. Detect at least 70% of the estimated new sputum smear • Ineffective breathing pattern
positive TB cases. • Impaired gas exchange
• Risk for activity intolerance
Mgmt: Mgmt:

short course – 6-9 months • Antibiotics, hydration, nutrition, nebulization


• CARI-health teaching
long course – 9-12 months • Nursing Interventions
• Respiratory support
Follow-up – oxygen supplementation
– mechanical ventilation
• 2 wks after medications – non communicable • Positioning
○ 3 successive (-) sputum - non communicable • Rest
○ rifampicin - prophylactic • Suctioning of secretions
• Antipyretic and TSB
• Nutrition
MDT side effects

• r-orange urine Scarlet fever


• i-neuritis and hepatitis
• p-hyperuricemia – Group A beta hemolytic streptococcus
• e-impairment of vision – Respiratory
• s-8th cranial nerve damage – Incubation 2-5 days
Methods of Control – Fever, red sandpaper rash, white strawberry tongue, flushed
cheeks, red strawberry tongue
• Prompt treatment and diagnosis – Diagnostics is throat culture
• BCG vaccination – Penicillin for 10 days
• Educate the public in mode of transmission and importance
of early diagnosid
• Improve social condition GIT

Amoebiasis

Pneumonia – Entamoeba Hystolitica, protozoa


– IP: few days to months to years,
1. Community acquired – usually 2- 4 weeks
– MOT: Ingestion of cysts from fecally contaminated sources
Typical– Strep. Pneumoniae, H. Influenzae type B (Oral fecal route)
oral and anal sexual practices
Atypical Pneumonia – S. Aureus, M. Pneumoniae, L. Pneumophila, P. – Extraintestinal amoebiasis- genitalia, spleen, liver, anal,
Cariini lungs and meninges
s/sx:
2. Nosocomial – Pseudomonas, S. Aureus
– Blood streaked, watery mucoid diarrhea, foul smelling,
MOT: aspiration, inhalation, hematogenous, direct inoculation, – abdominal cramps
contiguous spread – Pain on defecation (tenesmus)
– Hyperactive bowel sounds
CHILDHOOD PNEUMONIA

1. No pneumonia Diagnostic test

- infant, 60/min and no chest indrawing – Stool culture of 3 stool specimens


– Sigmoidoscopy
– Recto-sigmoidoscopy and coloscopy for intestinal
amoebiasis

Medical treatment Ascariasis

– Metronidazole – trichomonocide and amoebicide for – Common worldwide with greatest frequency in tropical
intestinal and extra intestinal sites (monitor liver function countries.
test) – Has an infection rate of 70-90% in rural areas
– Diloxanide furoate – luminal amoebicide – MOT: ingestion of embryonated egss (fecal-oral)
– Paromomycin – eradicate cyst of histolytica – Worms reach maturity 2 months after ingestion of eggs.
– Tinidazole – hepatic amebic abscess – Adult worms live less than 10 months(18 months max.)
– Female can produce up to 200000 eggs per day
– Eggs may be viable in soils for months or years
Bacillary Dysentery – Worms can reach 10-30cm in length
Shigellosis

– Shiga bacillus: dysenteriae (fatal), flexneri (Philippines), Initial symptom:


boydii, sonnei; gram (-)
– Shiga toxin destroys intestinal mucosa – loss of appetite
– Humans are the only hosts – Worms in the stool
– Not part of normal intestinal flora – Fever
– IP: 1-7 days – Wheezing
– MOT : oral fecal route – Vomiting
S/sx: fever, severe abdominal pain, diarrhea is watery to bloody – Abdominal distention
with pus, tenesmus – Diarhea
– dehydration
Dx: stool culture

Mgmt: Oresol, Ampicillin, Trimethoprim-Sulfamethoxazole, Medical Management


Chloramphenicol, Tetracycline, Ciprofloxacin
A. Mebendazole (antihelmintic) effect occurs by blocking the
glucose uptake of the organisms, reducing the energy until
death
Cholera B. Pyrantel pamoate: neuromuscular blocking effect which
paralyze the helminth, allowing it to be expelled in the feces
– Vibrio coma (inaba, ogawa, hikojima), vibrio cholerae, vibrio C. Pierazine citrate: paralyze muscles of parasite, this
el tor; gram (-) dislodges the parasites promoting their elimination
– Choleragen toxin induces active secretion of NaCl
– Active Immunization
– IP: few hours to 5 days Nursing Intervention
– MOT: oral fecal route
S/sx: Rice watery stool with flecks of mucus, s/sx of severe – Environmental sanitation
dehydration ie Washerwoman’s skin, poor skin turgor – Health teachings
– Assessment of hydration status
Dx: stool culture – Use of ORS
– Proper waste disposal
mgmt: IV fluids, Tetracycline, Doxycycline, Erythromycin, – Enteric precautions
Quinolones, Furazolidone and Sulfonamides (children)

Via the skin Complications

Hookworm (Roundworm) – Migration of the worm to different parts of the body Ears,
mouth,nose
– Necator Americanus, Ancylostoma Duodenale – Loefflers Pneumonia
– Leads to iron deficiency and hypochromic microcytic anemia – Energy protein malnutrition
– Gain entry via the skin – Intestinal obstruction
– Dx: microscopic exam (stool exam)
– Mgmt: Pyrantel Pamoate and Mebendazole
– don’t give drug without (+) stool exam Tapeworm (Flatworms)
– members of the family must be examined and treated also
– Taenia Saginata (cattle), Taenia Solium (pigs)
– MOT: fecal oral route
Paragonimiasis (ingestion of food contaminated by the agent)
– s/sx: neurocysticercosis – seizures, hydrocephalus
– Chronic parasitic infection – Dx: Stool Exam
– Closely resembles PTB – Mgmt: Praziquantel, Niclosamide
– Endemic areas: mindoro, camarines sur, norte, samar,
sorsogon, leyte, albay, basilan
– Paragonimiasis Pinworm
– AKA: Lung fluke disease
– causative agent: paragonimus westermani; Trematode – Enterobius Vermicularis
– Eating raw or partially cooked fish or fresh water crabs – MOT: fecal oral route
– S/sx: Itchiness at the anal area d/t eggs of the agent
Signs and symptoms – Dx: tape test at night time
(agents release their eggs during night time)
– Cough of long duration – flashlight
– Hemoptysis – Mgmt: Pyrantel Pamoate, Mebendazole
– Chest/back pain
– PTB not responding to anti-koch’s meds
Nursing Intervention

Diagnosis – Promote hygiene


– Environmental Sanitation
- sputum examination – eggs in brown spots – Proper waste and sewage disposal
– Antihelmintic medications repeated after 2 weeks (entire
family)
Treatment

1. Praziquantrel (biltrizide)
PARALYTIC SHELLFISH POISONING
2. Bithionol
– A syndrome of characteristic symptoms predominantly s/sx: itching worse at night and after hot shower; rash; burrows (dark
neurologic which occurs within minutes or several hours wavy lines that end in a bleb w/ female mite) in between fingers, volar
after ingestion of poisonous shellfish wrists, elbow, penis; papules and vesicles in navel, axillae, belt line,
– Single celled dinoflagellates (red planktons) become buttocks, upper thighs and scrotum
poisonous after heavy rain fall preceded by prolonged
summer Dx: biopsies/scrapings of lesions
– Common in seas around manila bay, samar, bataan and
zambales Mgmt: Permethrin (Nix) cream, crotamiton cream, Sulfur soap,
MOT = Ingestion of contaminated bi-valve shellfish antihistamines and calamine for pruritus, wash linens with hot water,
single dose of Ivermectin, treat close contacts
IP = within 30 minutes
Dx: biopsies/scrapings of lesions
CLINICAL MANIFESTATIONS:
NURSING CARE
– NUMBNESS OF THE FACE ESPECIALLY AROUND THE
MOUTH A. Administer antihistamines or topical steroids to relieve
– VOMITING, DIZZINESS, HEADACHE itching.
– TINGLING SENSATION, WEAKNESS
– RAPID PULSE, DIFFICULTY OF SPEECH (ATAXIA), B. Apply topical antiscabies creams or lotion like
DYSPHAGIA, RESPI PARALYSIS, DEATH. lindasne(kwell), Crotamiton (Eurax), permithrin

C. d. Lindane (kwell) not used in <2 years old, causes


MANAGEMENT AND CONTROL MEASURES: neurotoxicity and seizures
D. e. Apply thinly from the neck down and leave for 12-14hrs
– NO DEFINITE MEDICATIONS then rinse
– INDUCE VOMITING (EARLY INTERVENTION) E. f. Apply to dry skin, moist skin increases absorption
– DRINKING PURE COCONUT MILK (WEAKENS TOXIC F. g. All family members and close contacts
EFFECT) DON’T GIVE DURING LATE STAGE IT MAY G. h. Beddings and clothings should be washed in very hot
WORSEN THE CONDITION. water and dried on hot dryer
– NaHCO3 SOLUTION (25 GRAMS IN ½ GLASS OF
WATER)
– RESPIRATORY SUPPORT Leprosy
– AVOID USING VINEGAR IN COOKING SHELLFISH
AFFECTED BY RED TIDE (15X virulence)
– Chronic infectious and communicable disease
– TOXIN OF RED TIDE IS NOT TOTALLY DESTROYED IN
– No new case arises without previous contact
COOKING.
– Majority are contracted in childhood, manifestation arises by
– AVOID TAHONG, TALABA, HALAAN, KABIYA,
15 yrs old and will definitely diagnose at 20
ABANIKO. WHEN RED TIDE IS ON THE RISE.
– it is no hereditary
– Does not cross placenta
BOTULISM
Cardinal Sign
– A True poison known to be one of the deadliest substance
and usually released into the food shortly after it has been
A. Presence of Hansen’s bacilli in stained smear or dried
canned
biopsy material.
– Botulism
B. Presence of localized areas of anesthesia
– Clostridium Botulinum, gram (+), spore forming
– Ingestion of contaminated foods (canned foods), wound
contamination, infant botulism (most common; ingestion of
honey) * Lepromatous or malignant
– Neurotoxins block AcH
– IP: 12-36H (canned food) – many microorganisms
– IP: 4-14 days (wound) – open or infectious cases
– Active and passive immunization – negative lepromin test
S/sx: Diplopia, dysphagia, symmetric descending flaccid paralysis, * Tuberculoid or benign
ptosis, depressed gag reflex, nausea, vomiting, dry mouth, respiratory
paralysis – few organism
– noninfectious
Dx: gastric siphoning, wound culture, serum bioassay (food borne) – positive reaction to lepromin test

Mgmt: respiratory support, antitoxin


s/sx:

• Early/Indeterminate – hypopigmented / hyperpigmented


CONTACT anesthetic macules/plaques

Pediculosis • Tuberculoid – solitary hypopigmened hypesthetic macule,


neuritic pain, contractures of hand and foot, ulcers, eye
involvement ie keratitis
Blood sucking lice/Pediculus humanus
• Lepromatous – multiple lesions, Loss of lateral portion of
p. capitis-scalp
eyebrows (madarosis), corugated skin (leonine facies),
septal collapse (saddlenose)
p. palpebrarum-eyelids and eyelashes
Diagnosis
p. pubis-pubic hair
– Skin smear test
p. corporis-body – Skin lesion biopsy
– Lepromin test -
MOT: skin contact, sharing of grooming implements

s/sx: nits in hair/clothing, irritating maculopapular or urticarial rash Mgmt:

Mgmt: disinfect implements, Lindane (Kwell) topical MDT-RA 4073 (home meds)

Permethrin (Nix) topical Paucibacillary - 6-9 months


1. Dapsone
Scabies
2. Rifampicin
– Sarcoptes scabiei
– Pruritus (excreta of mites) Multibacillary- 12-24 months
– Mites come-out from burrows to mate at night
– MOT: skin contact 1. Dapsone – mainstay; hemolysis, agranulocytosis
2. Clofazimine – reddish skin pimentation, intestinal toxicity – Report unusual reactions such as rash, fever or chills
– Check the drug expiration date before using it. Discard
3. Rifampicin – bactericidal; renal and liver toxicity unused drug
– Don’t share the drug with family or friends
– Don’t stop taking the drug, even if symptoms are relieved.
– Don’t take drug left over from a previous illness or someone
else drugs
– Don’t take over the counter drugs or herbal products without
consulting a doctor
Nursing Intervention
– Take drug with full glass of water
– Follow the manufacturer’s directions for reconstituting,
– Health teachings dilution and storing drugs . Check expiration dates.
– Counseling involving the family members and even the – Refrigerate oral suspension (stable 14 days), shake well
community before administering to ensure dosage
– Prevention of transmission ( use of mask ) – Give I.M dose into large muscle mass. Rotate injection site
to minimize tissue injury
Anthrax
Penicillin – interfere with bacterial cell wall synthesis; broad spectrum
– Bacillus anthracis, gram (+)
– Releases exotoxin a. Amoxicillin, ampicilin, methicillin, Penicillin
– Cattle, sheep, goat and pig
– IP: 1-3 days
Cephalosporin
– Dx: gram stain, culture, Ab testing
– Mgmt: parenteral Penicillin G, cutaneous lesions should be
cleaned a. 1st generation – cefazolin, cephalexin, cephalothin

b. 2nd generation – Cefaclor, Cefamandole


MOT
c. 3rd generation – Ceftriaxone, cefotaxime
– Inhalation (Woolsorter’s disease)
URTI (fever x 3-5 days) lower infection (alveoli) metabolic Inhibits cell wall synthesis
acidosis hypoxia
- Erythromycin
– Skin (most common)
itchiness papule-vesicle depressed black eschars - Tetracycline
(painless) septicemia
- Aminoglycosides
Spectrum of Activity of Anti-infectives
- Chloramphenicol
– Anti-infectives that interfere with the ability of the cell to
reproduce/replicate without killing them are called Side Effects
BACTERIOSTATIC drugs. Tetracycline is an example.
– Antibiotics that can aggressively cause bacterial death are Tetracycline – hepatotoxic, phototoxicity, hyperurecemia, enamel
called BACTERICIDAL. These properties (-cidal and –static) hypoplasia
can also depend on the antibiotic concentration in the blood.
Aminoglycosides – ototoxicity, leukopenia, thrombocytopenia,
neurotoxicity
Common Adverse Reactions to Anti-infective Therapy
Chloramphenicol – bone marrow depression, hypersensitivity
The most common adverse effects are due to the direct action of the
drugs in the following organ system- Neuro, nephro and GI system

1. Nephrotoxicity Infective endocarditis

Antibiotics that are metabolized and excreted in the kidney most Infection of the heart valves and the endothelial surface of the
frequently cause kidney damage.. heart

Common Adverse Reactions to Anti-infective Therapy Can be acute or chronic

2. Gastro-intestinal toxicity Etiologic factors

Direct toxic effect to the cells of the GI tract can cause nausea, 1. Bacteria- Organism depends on several factors
vomiting, stomach pain and diarrhea. Some drugs are toxic to liver
cells and can cause hepatitis or liver failure. 2. Fungi
Common Adverse Reactions to Anti-infective Therapy

3. CNS toxicity Risk factors


When drugs can pass through the brain barrier and 1. Prosthetic valves
accumulate in the nervous tissues, they can interfere with neuronal
function.
2. Congenital malformation
Common Adverse Reactions to Anti-infective Therapy
3. Cardiomyopathy
4. Hypersensitivity
4. IV drug users
Most protein antibiotics can induce the body’s immune
5. Valvular dysfunctions
system to produce allergic responses. Drugs are considered foreign
substances and when taken by the individual, it encounters the body’s
immune cells.

Common Adverse Reactions to Anti-infective Therapy Dukes criteria

5. Superinfections I. Criteria for IE

Opportunistic infections that develop during the course of – Two major criteria or
antibiotic therapy are called SUPERINFECTIONS. – One major and three minor
– Five major criteria
Major criteria
Teaching about anti-infective therapy
– Positive blood culture typical for IE
– Take the drug exactly as prescribed. Complete the entire
– Positive echocardiogram study
prescribe regiment, comply with instruction RTC
Minor criteria – Fever (38.9-40C)
– Chills
– Predisposing heart condition – Sore throat
– Febrile syndrome – Diffuse redness of throat
– Vascular phenomena: conjuctival hemorrhage, janeway – CLADP
lesions – Abdominal pain (children)
– Immunologic phenomena – Tiny translucent vegetations or growths, which resemble
– Osler nodes and roth spots pinhead size beads at the valves.
– Echocardiogram suggestive of IE but not classified as major – Cause valvular regurgitation (mitral valve)
– MV (Left sided heart failure)
– Risk for embolic phenomena on the lungs , kidney, spleen,
Acute heart, brain

- nafcillin or oxacillin
Urinary Tract Infection (UTI)
- gentamycin
Bacterial invasion of the kidneys or bladder (CYSTITIS) usually
Subacute caused by Escherichia coli

- penicillin 1. Bacterial infections of urinary tract are a very common


reason to seek health services
- gentamycin
2. Common in young females and uncommon in males under
age 50
Assessment findings
3. Common causative organisms
1. Intermittent fever
a. Escherichia coli (gram-negative enteral bacteria) causes
2. anorexia, weight loss
most community acquired infections
3. cough, back pain and joint pain
b. Staphylococcus saprophyticus, gram-positive organism
causes 10 – 15%
4. splinter hemorrhages under nails
c. Catheter-associated UTI’s caused by gram-negative
5. Osler’s nodes- painful nodules on fingerpads bacteria: Proteus, Klebsiella, Seratia, Pseudomonas
6. Roth’s spots- pale hemorrhages in the retina Normal mechanisms that maintain sterility of urine
7. Heart murmurs a. Adequate urine volume
8. Heart failure b. Free-flow from kidneys through urinary meatus

c. Complete bladder emptying


Prevention d. Normal acidity of urine
Antibiotic prophylaxis if patient is undergoing procedures like e. Peristaltic activity of ureters and competent ureterovesical
dental extractions, bronchoscopy, surgery, etc. junction
LABORATORY EXAM f. Increased intravesicular pressure preventing reflux
Blood Cultures to determine the exact organism g. In males, antibacterial effect of zinc in prostatic fluid
Nursing management Pathophysiology
1. regular monitoring of temperature, heart sounds 1. Pathogens which have colonized urethra, vagina, or perineal
area enter urinary tract by ascending mucous membranes of perineal
2. manage infection area into lower urinary tract

3. long-term antibiotic therapy 2. Bacteria can ascend from bladder to infect the kidneys

Medical management 3. Classifications of infections

1. Pharmacotherapy a. Lower urinary tract infections: urethritis, prostatitis, cystitis

IV antibiotic for 2-6 weeks b. Upper urinary tract infection: pyelonephritis (inflammation of
kidney and renal pelvis)
Antifungal agents are given – amphotericin B
Urethrovesical reflux – backward flow of urine from the urethra to the
2. Surgery badder

Valvular replacement Ureterovesical reflux – backward flow of urine from the bladder to the
ureters
Prevention
Risk Factors
– AnTibiotic prophylaxis is recommended for high risk patients
before or after procedure 1. Aging

a. Increased incidence of diabetes mellitus


Rheumatic Endocarditis
b. Increased risk of urinary stasis
– Occurs most often in children
– Grp A beta hemolytic streptococcal pharyngitis c. Impaired immune response
– It is a preventable disease
– Penicillin therapy can prevent RHD 2. Females: short urethra, having sexual intercourse, use of
– Throat culture contraceptives that alter normal bacteria flora of vagina and perineal
– The heart itself must receive enough oxygenated blood. tissues; with age increased incidence of cystocele, rectocele
– Blood is supplied to the heart through the coronary arteries, (incomplete emptying)
two main branches which originate just above the aortic
valve.
3. Males: prostatic hypertrophy, bacterial prostatitis, anal
intercourse
Signs and Symptoms
4. Urinary tract obstruction: tumor or calculi, strictures 4. Flank pain

5. Impaired bladder innervation 5. Costovertebral tenderness

6. Bowel incontinence 6. Urinary frequency, dysuria

7. Diabetes mellitus Assessment findings: Upper UTI

8. Instrumentation of urinary tract ○ Fever and CHIILS


○ Flank pain
○ Costovertebral angle tenderness

Cystitis
Laboratory Examination
○ Most common UTI
○ Remains superficial, involving bladder mucosa, Urinalysis: assess pyuria, bacteria, blood cells in urine; Bacterial
which becomes hyperemic and may hemorrhage count >100,000 /ml indicative of infection
○ General manifestations of cystitis
○ Dysuria b. Rapid tests for bacteria in urine
○ Frequency and urgency
○ Nocturia 1. Nitrite dipstick (turning pink = presence of bacteria)
○ flank or low back pain
○ Suprapubic pain and tenderness 2. Leukocyte esterase test (identifies WBC in urine)

c. Gram stain of urine: identify by shape and characteristic


Assessment and laboratories (gram positive or negative); obtain by clean catch urine or
catheterization
○ Urinalysis – bactereriuria >10’5 colonies of bacteria/ml
○ E.coli – 55% Urinary Tract Infection (UTI)
○ Pseudomonas and enterrococcus – catheter associated UTI
○ Urine culture- gold standard Nursing interventions
Criteria
○ Administer antibiotics as ordered
○ All men ○ Provide warm baths and allow client to void in water to
○ All children alleviate painful voiding.
○ Women with commpromised IS ○ Force fluids. Nurses may give 3 liters of fluid per day
○ DM pt ○ Encourage measures to acidify urine (cranberry juice,
○ Recent documentation acid-ash diet).
○ Prolonged or persistent uti ○ Provide client teaching and discharge planning
○ >3 UTI/year concerning
○ Pregnant women a. Avoidance of tub baths
○ Women sexually active or have new partners b. Avoidance of bubble baths that might irritate
urethra
c. Importance for girls to wipe perineum from
5. Readily responds to treatment front to back
d. Increase in foods/fluids that acidify urine.
6. Untreated, may involve kidneys
Pharmacology
7. Severe or prolonged may cause sloughing of bladder
mucosa with ulcer formation
1. Sulfa drugs
8. Chronic cystitis may lead to bladder stone formation
Highly concentrated in the urine

Effective against E. coli!


Pyelonephritis
Can cause CRYSTALLURIA
1. Inflammation of renal pelvis and parenchyma (functional
kidney tissue) 2. Quinolones

2. Acute pyelonephritis Not given to less than 18 because they can cause cartilage
degradation
a. Results from an infection that ascends to kidney from lower
urinary tract 3. Pyridium= urinary antiseptic

Risk factors Can cause urine discoloration

1. Pregnancy Acute Glomerulonephritis

2. Urinary tract obstruction and congenital malformation ○ Inflammation of the glomerular capillaries
○ Disease of children older than 2 years old
3. Urinary tract trauma, scarring ○ Preceded by a throat infection due to Grp A betahemolytic
streptococal infection
4. Renal calculi

5. Polycystic or hypertensive renal disease Clinical Manifestation

6. Chronic diseases, i.e. diabetes mellitus ○ Hematuria –microscopic, gross


○ Coca cola colored urine due to RBC and protein cast
7. Vesicourethral reflux ○ Abrupt onset, 10 days after streptococcal infection
○ May be mild or severe presenting with ARF with oliguria
○ Proteinuria due to increased permeability of the glomerular
membrane
Manifestations ○ Edema and hypertension in 75%
○ Headache, malaise and flank pain
1. Rapid onset with chills and fever

2. Malaise Diagnostic findings

3. Vomiting ○ Serial Anti-streptolysin O


○ Serum IgA and complement level
○ Electron microscopy and immunofluorescent identify the Needle biopsy of the kidney
nature of the lesion
○ Kidney biopsy – definitive diagnosis Complications

○ Infection
Complications ○ Thromboembolism (renal vein)
○ Pulmonary emboli
○ Hypertensive Encephalopathy ○ Accelerated atherosclerosis
○ Pulmonary edema ○ ARF (hypovolemia)
○ RPGN, rapid and progressive decline in renal function. Will
go to ESRD in weeks to months
○ Crescent shaped cells accumulate in Bowman’s space, Medical Management
disrupting the filtering surface.
○ to preserve the renal function
○ Diuretics with ACE inhibitors to reduce the degree of
Medical Management proteinuria
○ Low sodium diet, liberal potassium diet
Goals ○ Protein intake .8g/kg/day (eggs, meats, dairy products)
Nursing Intervention
1. Treating symptoms
○ Provide bed rest
2. Preserve kidney function ○ conserve energy
○ quiet play
3. Treatment of complications ○ Provide high protein and low sodium diet
○ Maintain skin integrity
Antibiotics - penicillin ○ Avoid IM-edematous
○ Turn frequently
○ Corticosteroid and Immunosuppressants ○ Obtain morning urine for protein studies
○ Protein and sodium restriction ○ Provide scrotal support
○ Loop diuretics ○ Monitor I and O, VS, Weigh daily
Nursing Management ○ Administer Steroids
○ Protect for infection
Hospital setting

1. Monitor intake and output Acne Vulgaris


2. High carbohydrate to provide energy and reduce catabolism ○ Common, self limiting, multifactorial skin disease
of protein ○ Over production of sebum, propionibacterium acnes,
hormonal,
3. Bp monitoring ○ Closed comedones – whiteheads
○ Open comedones – blackheads
Home Care ○ Requires active treatment
○ Intervention: don’t squeeze, prick or pick, Isotretinoin
Health education regarding
Accutane (avoid sunlight and vit A, may increase
triglycerides), antibiotics
1. Notify physician of renal failure symptoms. ○ No evidence that chocolate, nuts, fatty foods or cosmetics
affects acne
2. Fluid and diet restrictions to avoid worsening of edema and ○ Exacerbation coincides with menstrual activity.
HPN ○ Heat, increase sweat increase acne
3. Importance of follow up evaluations of BP, Urinalysis protein,
BUN, CREA
Nursing care
Nephrotic syndrome
○ Use of topical or oral antibiotics
○ Instruct in the use of isotretinoin (ACCUTANE) to decrease
a. Group of clinical findings, not specific disorder
sebum production
○ Adverse effect, cheilitis, skin dryness, elevated triglycerides
b. Characterized by
and eye discomfort
○ Stop Vit A supplement during treatment
1. Massive proteinuria ○ Instruct not to squeeze, prick or pick at lesions
○ Use products labeled noncomedogenic and cosmetics that
2. Hypoalbuminemia
are water based
3. Hyperlipidemia
Decubitus Ulcer
4. Edema (often facial and periorbital)
○ Skin impairment secondary to immobility
Pathophysiology ○ Common to immobilized and with decreased sensory
perception patient
Characterized by loss of plasma protein (albumin) in the urine. Risk Factors
The liver cannot keep up with the daily loss of albumin in the urine ○ Malnutrition
○ Incontinence
Clinical manifestation ○ Immobility
○ Skin shearing
Edema – soft and pitting
○ Decreased sensory perception
Nursing care
– periorbital, in dependent areas, ascites
○ Institute measures to prevent decubitus ulcer
– Headache
○ Assess the nutritional status
○ Provide adequate nutritional intake to promote skin integrity
– Irritability
○ Monitor for alteration in skin integrity
○ Relieve or remove pressure on skin
– fatigue
○ Turn every 2 hours
○ Ambulate the patient
Diagnosis
○ Provide active and passive exercise q 8hrs
Proteinuria > 3-3.5g/day ○ Keep skin clean and dry and bed wrinkle free
○ Apply medications or dressing on the wound
Protein electrophoresis and immunophoresis
Emerging Diseases A total of 55 people have died from the H5N1 virus since the beginning
of the epidemic in 2003
Severe Acute Respiratory Syndrome
Trivalent Inactivated Vaccine (TIV)
○ Coronavirus
○ Severe acute respiratory syndrome ○ Most widely used influenza vaccine
○ IP: 2-7 days ○ Administered IM
○ Mortality rate – 5% only ○ Indicated for all persons older than 6 months of age
Risk Factors: ○ Studies in children have shown efficacy from 30-90%

○ history of recent travel to China, Hong Kong, singapore


Taiwan, vietnam, canada. or close contact w/ ill persons with STD
a hx of recent travel to such areas, OR
○ Is employed in an occupation at particular risk for SARS Gonorrhea, Morning drop, Clap, Jack
exposure, healthcare worker with direct patient contact or a
worker in a laboratory that contains live SARS, OR ○ Neisseria gonorrheae, gram (+)
○ Is part of a cluster of cases of atypical pneumonia without an ○ IP: 3-7 days
alternative diagnosis S/sx:

– Females: usually asymptomatic or minimal urethral


Clinical Manifestations discharge w/ lower abdominal pain
sterility or ectopic pregnancy
○History of travel to SARS affected country or close contact – Male: Mucopurulent discharge, Painful urination
with persons suspected of having SARS and within 14 days decreased sperm count
manifest the ff DX:
○ High grade fever (>38.0 c)
○ Headache, body malaise, muscle pain –gram stain and culture of cervical secretions on Thayer
○ Cough, sneezing, nasal congestion Martin VCN medium
○ Difficulty of breathing after 2-7 days Mgmt: single dose only
SARS suspect
– Ceftriaxone (Rocephin) 125 mg IM
Probable SARS – Ofloxacin (Floxin) 400 mg orally
– treat concurrently with Doxycycline or Azithromycin for 50%
Diagnosis: infected w/ Clamydia
CX:
Chest X-ray, CBC, Isolation of virus
PID, ectopic pregnancy and infertility, peritonitis,
perihepatitis, Ophthalmia neonatorum, sepsis and arthritis
Mgt:
Syphilis
Supportive
Treponema pallidum, spirochete
Treat as Atypical Pneumonia
“ Beautiful” fast moving but delicate spiral thread
Quarantine
IP: 10-90 days
AVIAN INFLUENZA
Primary (3-6 wks after contact) – nontender lymphadenopathy and
Serious consequences for ASIA
chancre; most infectious; resolves 4-6 wks
Avian Influenza…..
Chancre – painless ulcer with heaped up firm edges appears at the
site where the treponema enters. Related to pattern of sexual behavior
○Is an infectious disease of birds caused by Type A strains of (genitalia, rectal, oral, lips)
the influenza virus
○ First identified in Italy more than 100 years ago
BUBO – swelling of the regional lymphnode
○ Occurs worldwide
○ Infection causes a wide spectrum of symptoms in birds, Secondary – systemic; generalized macular papular rash including
ranging from mild illness to a highly contagious and rapidly palms and soles and painless wartlike lesions in vulva or scrotum
fatal disease resulting in severe epidemics (condylomata lata) and lymphadenopathy
○ “ highly pathogenic avian influenza”
Pathogenesis Tertiary – (6-40 years) - neurosyphilis/permanent damage (insanity);
gumma (necrotic granulomatous lesions), aortic aneurysm
○ Avian influenza do not normally infect species other than
birds and pigs DX:
○ First documented infection of humans with avian flu occurred
in Hong Kong in 1997 Dark-field examination of lesion- 1st and 2nd stage
○ Affected 18 humans, 6 died
Bird Flu Non specific VDRL and RPR
Human cases of influenza A (H5N1) infection have been reported FTA-ABS
in Cambodia, China, Indonesia, Thailand, and Vietnam.
Mgmt
Clinical manifestations
– Primary and secondary - Pen G
Patients develop fever, sore throat, cough, in fatal cases, severe – Tertiary - IV Pen G
respiratory distress may result secondary to pneumonia

A constantly mutating virus Chlamydia


All type A influenza virus, including those that regularly cause seasonal – Chlamydia trachomatis, gram (-)
epidemics of influenza in humans are genetically labile and well – IP: 2-10 days
adapted to elude host defenses – S/sx:
– Maybe asymptomatic
So far bird flu is mainly transmitted between birds, but experts fear the – Gray white discharge, Burning and itchiness at the urethral
H5N1 virus could be devastating to humans if it genetically mutates opening
and develops the capacity to be transmitted from human to human. DX:

Deadly Avian Flu – Gram stain


– Antigen detection test on cervical smear
The WHO has warned that if this happens it could trigger a new human – Urinalysis
flu pandemic, potentially killing up to 50 million people worldwide Mgmt:
– Doxycycline or Azithromycin • Immunity declines and opportunistic microbes set in
– Erythromycin and Ofloxacin • No known cure
CX: • HIV/AIDS Reverses Development and Poses Serious Threat
to Future Generations
– PID • Since 1980s, 60m have been infected and 25m have died
– Ectopic pregnancy • About 40m live with HIV/AIDS – 38m in developing countries
– Fetus transmittal (vaginal birth) and 28m in Africa alone
• The spread is accelerating in India, Russia, the Caribbean
and China
Herpes Genitalis • AIDS is stretching health care systems beyond their limits
• There are 12m AIDS orphans – they are estimated to rise to
HSV 2 40m by 2010
• In Sub-Saharan Africa, 58% of HIV/AIDS infected adults are
women. More than two-thirds of newly infected teenagers
S/sx: Painful sexual intercourse, Painful vesicles (cervix, vagina,
are female.
perineum, glans penis)
• Life expectancy has declined by more than 10 years in
South Africa and Botswana – Swaziland faces the risk of
– Dx: extinction
– Viral culture • Most HIV/AIDS Infected Live in Africa and South Asia
– Pap smear (shows cellular changes) Health
– Tzanck smear (scraping of ulcer for staining)
Mgmt:
Health care workers often have rates of infection as high or higher than
adults in general
Anti viral - acyclovir (zovirax)
Illness and death of skilled personnel further weakens the sector
• CX:
• Meningitis
Education
• Neonatal infection (vaginal birth)
Education faces decimation of skilled teachers
Genital Warts,
Condyloma Acuminatum Children of families struck by AIDS often have to leave school to help
generate income or undertake basic household tasks
• HPV type 6 & 11, papilloma virus
• S/sx: Single or multiple soft, fleshy painless growth of the MOT:
vulva, vagina, cervix, urethra, or anal area, Vaginal bleeding,
discharge, odor and dyspareunia •
Sexual intercourse (oral, vaginal and anal)
DX: •
Exposure to contaminated blood, semen, breast milk and
other body fluids
• Pap smear-shows cellular changes (koilocytosis) • Blood Transfusion
• Acetic acid swabbing (will whiten lesion) • IV drug use
• Cauliflower or hyperkeratotic papular lesions • Transplacental
Treatment • Needlestick injuries
HIGH RISK GROUP
- liquid nitrogen
• Homosexual or bisexual
• Intravenous drug users
- podophylin resin
• BT recipients before 1985
• Sexual contact with HIV+
• Babies of mothers who are HIV+
s/sx:
Mgmt:
1. Acute viral illness (1 mo after initial exposure) – fever,
Laser treatment is more effective malaise, lymphadenopathy

CX: 2. Clinical latency – 8 yrs w/ no sx; towards end, bacterial and


skin infections and constitutonal sx – AIDS related complex;
• Neoplasia CD4 counts 400-200
• Neonatal laryngeal papillomatosis (vaginal birth)
3. AIDS – 2 yrs; CD4 T lymphocyte < 200 w/ (+) ELISA or
Western Blot and opportunistic infections
Candidiasis, Moniliasis
HIV CLASSIFICATION
• Candida Albicans, Yeast or fungus
• S/sx: Cheesy white discharge, CATEGORY 1 – CD4+ 500 OR MORE
• \Extreme itchiness
DX: CATEGORY 2 – CD4+ 200-499
KOH (wet smear indicate positive result) CATEGORY 3 – CD4+ LESS THAN 200
Mgmt: HIV TEST
Imidazole, Monistat, Diflucan • Elisa
• Western Blot
CX: • Rapid hiv test

Oral thrush to baby (vaginal birth)


How to Diagnose
Trichomoniasis
HIV+
• Trichomona vaginalis, parasite 2 consecutive positive ELISA and
• S/sx: Females: itching, burning on urination, Yellow gray 1 positive Western Blot Test
frothy malodorous vaginal discharge, Foul smelling
• Males: usually asymptomatic AIDS+
• Dx: microscopic exam of vaginal discharge HIV+
• Mgmt: Metronidazole (Flagyl); include partners CD4+ count below 500/ml
• CX: PROM Exhibits one or more of the ff: (next slide)

Full blown AIDS


HIV and AIDS CD4 is less than 200/ml

• Retrovirus (HIV1 & HIV2) Exhibits one or more of the ff:


• Attacks and kills CD4+ lymphocytes (T-helper)
• Capable of replicating in the lymphocytes undetected by the ○ Extreme fatigue
immune system
○ Intermittent fever Parameters for assessing dehydration
○ Night sweats
○ Chills • Eyes – sunken, absent of tears, lack of laster
○ Lymphadenopathy • Fontanelles
○ Enlarged spleen • Skin turgor
○ Anorexia • Mouth
○ Weight loss • Abnormally sleepy
○ Severe diarrhea • Level of thirst
END
○ Apathy and depression
○ PTB
○ Kaposis sarcoma
○ Pneumocystis carinii
○ AIDS dementia
• Kaposis

Treatment

Anti-retroviral Therapy (ART) – ziduvirine (AZT)

a. Prolong life

b. Reduce risk of opportunistic infection

c. Prolong incubation period

PREVENTION

• A – ABSTINENCE
• B – BE FAITHFUL
• C – CONDOMS
• D – DON’T USE DRUGS

Integrated Management of Childhood Diseases

IMCI process can be used by doctors, nurses and other health care
personnel in a primary health care facility like health centers, clinics or
OPD.

Components of IMCI

A. Upgrading the case management and counseling skills of


health care providers.
B. Strengthening the health care system for effective
management of childhood illness
C. Improving family and community practices related to child
health and nutrition.

Focused on the common childhood diseases.

A. Pneumonia
B. Measles
C. Malaria
D. Diarrhea
E. Malnutrition
F. Ear infection
G. Dengue

IMCI case management process

Assess a child by checking first for danger signs, examining the child,
checking nutritional and immunization status.

Classify the child illness using the color coded triage system

- (pink) urgent

- (yellow) OPD treatment

- (green) Home management

• Identify the specific treatments for the child. If the child


needs urgent referral, give essential treatment before the
patient is transferred.
• Provide practical treatment instructions
• Assess feeding problems
• Follow up care
Danger signs

• Not able to drink


• Vomiting
• Convulsions
• Abnormally sleepy