COMMUNICABLE DISEASE NURSING

SUMMER REVIEW

- An agent that prevents bacterial multiplication but does not kill

microorganisms

COMMUNICABLE DISEASE

Disease caused by an infectious agent that are transmitted

directly or indirectly to a well person through an agency, vector or
inanimate object

CHAIN OF INFECTION

CONTAGIOUS DISEASE

Disease that is easily transmitted from one person to

another
INFECTIOUS DISEASE

Disease transmitted by direct inoculation through a break in

the skin
INFECTION
-Entry and multiplication of an infectious agent into the tissue of the
host
INFESTATION
- Lodgement and development of arthropods on the surface of the
body
ASEPSIS
- Absence of disease producing microorganisms
SEPSIS
- The presence of infection
MEDICAL ASEPSIS
Practices designed to reduce the number and transfer of
pathogens
Clean technique
SURGICAL ASEPSIS
Practices that render and keep objects and areas free from
microorganisms
Sterile technique

CARRIER an individual who harbors the organism and is

capable of transmitting it without showing manifestations of the
disease

CASE a person who is infected and manifesting the signs

and symptoms of the disease

SUSPECT a person whose medical history and signs and

symptoms suggest that such person is suffering from that particular
disease

CONTACT any person who had been in close association

with an infected person
HOST
- A person, animal or plant which harbors and provides nourishment
for a parasite
RESERVOIR
- Natural habitat for the growth, multiplication and reproduction of
microorganism
ISOLATION
- The separation of persons with communicable diseases from other
persons
QUARANTINE
- The limitation of the freedom of movement of persons exposed to
communicable diseases

STERILIZATION the process by which all microorganisms

including their spores are destroyed

DISINFECTION the process by which pathogens but not

their spores are destroyed from inanimate objects

CLEANING the physical removal of visible dirt and debris

by washing contaminated surfaces
CONCURRENT
- Done immediately after the discharge of infectious materials /
secretions
TERMINAL
- Applied when the patient is no longer the source of infection
BACTERICIDAL
- A chemical that kills microorganisms
BACTERIOSTATIC

INFECTIOUS AGENT

Any microorganism capable of producing a disease

RESERVOIR

Environment or object on which an organism can survive

and multiply
PORTAL OF EXIT

The venue or way in which the organism leaves the

reservoir
MODE OF TRANSMISSION

The means by which the infectious agent passes from the

portal of exit from the reservoir to the susceptible host
PORTAL OF ENTRY

Permits the organism to gain entrance into the host

SUSCEPTIBLE HOST

A person at risk for infection, whose defense mechanisms

are unable to withstand invasion of pathogens
STAGES OF THE INFECTIOUS PROCESS

Incubation Period acquisition of pathogen to the onset of

signs and symptoms

Prodromal Period patient feels bad but not yet

experiencing actual symptoms of the disease

Period of Illness onset of typical or specific signs and

symptoms of a disease

Convalescent Period signs and symptoms start to abate

and client returns to normal health
MODE OF TRANSMISSION
CONTACT TRANSMISSION

Direct contact involves immediate and direct transfer

from person-to-person (body surface-to-body surface)

Indirect contact occurs when a susceptible host is

exposed to a contaminated object
DROPLET TRANSMISSION

Occurs when the mucous membrane of the nose, mouth or

conjunctiva are exposed to secretions of an infected person within a
distance of three feet
VEHICLE TRANSMISSION

Transfer of microorganisms by way of vehicles or

contaminated items that transmit pathogens
AIRBORNE TRANSMISSION

Occurs when fine particles are suspended in the air for a

long time or when dust particles contain pathogens
VECTOR-BORNE TRANSMISSION

Transmitted by biologic vectors like rats, snails and

mosquitoes
TYPES OF IMMUNIZATION

ACTIVE antibodies produced by the body

NATURAL antibodies are formed in the presence of

active infection in the body; lifelong

ARTIFICIAL antigens are administered to stimulate

antibody production

PASSIVE antibodies are produced by another source

NATURAL transferred from mother to newborn through

placenta or colostrum

ARTIFICIAL immune serum (antibody) from an animal or

human is injected to a person
SEVEN CATEGORIES OF ISOLATION

STRICT- prevent highly contagious or virulent infections

Example: chickenpox, herpes zoster

CONTACT spread primarily by close or direct contact

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Example: scabies, herpes simplex

RESPIRATORY prevent transmission of infectious
distances over short distances through the air

Example: measles, mumps, meningitis

TUBERCULOSIS indicated for patients with positive

smear or chest x-ray which strongly suggests tuberculosis

ENTERIC prevent transmission through direct contact with

feces

Example: poliomyelitis, typhoid fever

DRAINAGE prevent transmission by direct or indirect

contact with purulent materials or discharge

Ex. Burns

UNIVERSAL prevent transmission of blood and body-fluid

borne pathogens

Example: AIDS, Hepatitis B

If the patient flexes the hips and knees in response to the

manipulation, positive for meningitis
KERNIGS SIGN
Place the patient in a supine position, flex his leg at the hip and knee
then straighten the knee; pain and resistance indicates meningitis

CENTRAL NERVOUS SYSTEM

DIAGNOSTIC EXAM

Informed consent

Empty bowel and bladder

Fetal, shrimp or C position

Spinal canal, subarachnoid space between L3-L4 or L4- L5

After: bedrest

Flat on bed to prevent spinal headache

THREE SIGNS OF MENINGEAL IRRITATION

OPISTHOTONUS
State of severe hyperextension and spasticity in which an individuals
head, neck and spinal column enter into a complete arching position
BRUDZINSKIS SIGN
Place the patient in a dorsal recumbent position and then put hands
behind the patients neck and bend it forward.
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Recovery within 72 hours and the disease passes by
unnoticed
PRE-PARALYTIC OR MENINGETIC TYPE

Slight involvement of the CNS

Pain and spasm of muscles

Transient paresis

(+) Pandys test (increased protein in the CSF)

PARALYTIC TYPE

CNS involvement

Flaccid paralysis

Asymmetric

Affects lower extremities

Urine retention and constipation

(+) HOYNES SIGN (when in supine position, head will fall

back when shoulders are elevated)

RABIES
PRODROMAL/INVASION PHASE

Fever

Anorexia

Sore throat

Pain and tingling at the site of bite

Difficulty swallowing
EXCITEMENT OR NEUROLOGICAL PHASE

Hydrophobia (laryngospasm)

Aerophobia (bronchospasm)

Delirium

Maniacal behavior

Drooling
TERMINAL OR PARALYTIC PHASE

Patient becomes unconscious

Loss of urine and bowel control

Progressive paralysis

Death

POLIO
ABORTIVE TYPE

Does not invade the CNS

Headache

Sore throat
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RESPIRATORY SYSTEM

NURSING MANAGEMENT
BIRD FLU
WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD
FLU

Isolation

Face mask on the patient

Caregiver: use a face mask and eye goggles/glasses

Distance of 1 meter from the patient

Transport the patient to a DOH referral hospital

REFERRAL HOSPITALS

National Referral Center Research Institute for Tropical

Medicine (RITM) (Alabang, Muntinlupa)

Luzon San Lazaro Hospital (Quiricada St., Sta. Cruz,

Manila)

Visayas Vicente Sotto Memorial Medical Hospital

(Cebu City)

Mindanao Davao Medical Center (Bajada, Davao City)

SARS
SUSPECT CASE
1. A person presenting after 1 November 2002 with a history of:

High fever >38 0C

AND

Cough or breathing difficulty

AND

One or more of the following exposures during the 10 days

prior to the onset of symptoms:
Close contact, with a person who is a suspect or
probable case of SARS
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History of travel, to an area with recent local

transmission of SARS
Residing in an area with recent local transmission of
SARS
2. A person with an unexplained acute respiratory illness resulting
in death after 1 November 2002, but on whom no autopsy has been
performed :
AND

One or more of the following exposures during the 10 days

prior to the onset of symptoms:
Close contact, with a person who is a suspect or
probable case of SARS
History of travel, to an area with recent local
transmission of SARS
Residing in an area with recent local transmission of
SARS
PROBABLE CASE
1. A suspect case with radiographic evidence of infiltrates consistent
with pneumonia or respiratory distress syndrome on Chest x-ray.

Begins with respiratory infection, sneezing, cough and

fever

Cough becomes more frequent at night

PAROXYSMAL STAGE

Lasts for 4 to 6 weeks

Aura: sneezing, tickling, itching of throat

Cough, explosive outburst ending in whoop

Mucus is thick, ends in vomiting

Becomes cyanotic

With profuse sweating, involuntary urination and

exhaustion
CONVALESCENT STAGE

End of 4th-6th week

Decrease in paroxysms

2. A suspect case of SARS that is positive for SARS coronavirus by

one or more assays.
3. A suspect case with autopsy findings consistent with the
pathology of SARS without an identifiable cause.

NASAL DIPHTHERIA

Bloody discharge from the nose

Excoriated nares and upper lip

TONSILOPHARYNGEAL DIPHTHERIA

Low grade fever

Sore throat

Bull-neck appearance

Pseudomembrane- Group of pale yellow membrane over

tonsils and at the back of the throat as an inflammatory
response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA

Hoarseness

Croupy cough

Aphonia

Membrane lining thickens airway obstruction

Suffocation, cyanosis or death

WOUND OR CUTANEOUS DIPHTHERIA

Yellow spots or sores in the skin

PERTUSSIS
CATARRHAL STAGE

Lasts for 1 to 2 weeks

Most communicable stage

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MUMPS
MAIN PROBLEM
An acute contagious disease, with swelling of one or both of the
parotid glands
ETIOLOGIC AGENT
Filterable virus of paramyxovirus group
INCUBATION PERIOD
12-26 days
MODE OF TRANSMISSION
Respiratory droplets
PERIOD OF COMMUNICABILITY
6 days before and 9 days after onset of parotid swelling
SIGNS AND SYMPTOMS
PRODROMAL PHASE
F-ever (low grade)
H-eadache
M-alaise
PAROTITIS
F-ace pain
E-arache
S-welling of the parotid glands
COMPLICATIONS

Orchitis the most notorious complication of mumps

Oophoritis manifested by pain and tenderness of the

abdomen

CNS involvement manifested by headache, stiff neck,

delirium, double vision

Deafness as a result of mumps

NURSING MANAGEMENT
1.
Prevent complications

Scrotum supported by suspensory

Use of sedatives to relieve pain

Treatment: oral dose of 300-400 mg cortisone followed by

100 mg every 6 hours

Nick in the membrane

2. Diet
- Soft or liquid diet
- Sour foods or fruit juices are disliked
3. Respiratory isolation
4. Comfort: ice collar or cold applications over the parotid glands may
relieve pain
5. Fever: aspirin, tepid sponge bath
6. Concurrent disinfection: all materials contaminated by these
secretions should be cleansed by boiling
7. Terminal disinfection: room should be aired for six to eight hours

GASTROINTESTINAL TRACT

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INTEGUMENTARY SYSTEM

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- Soft palate to mucus membrane

KOPLIKS SPOT (Rubeola)

- Bluish white spots surrounded by a red halo
- Appear on the buccal mucosa opposite the premolar teeth
FORCHEIMERS SPOTS (Rubella)
- small, red lesions

SCABIES
MAIN PROBLEM
Infestation of the skin produced by the burrowing action of a parasite
mite resulting in skin irritation and formation of vesicles and pustules
ETIOLOGIC AGENT
Sarcoptes scabiei
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INCUBATION PERIOD
Within 24 hours
MODE OF TRANSMISSION
Direct contact
Indirect contact
Sarcoptes scabiei
1. Yellowish white in color
2. Barely seen by the unaided eye
3. Female parasite burrows beneath the epidermis to lay eggs
4. Males are smaller and reside on the surface of the skin
SIGNS AND SYMPTOMS

Thin, pencil-mark lines on the skin

Itching, especially at night

Rashes and abrasions on the skin

PRIMARY LESIONS
NODULAR LESIONS
SECONDARY LESIONS
TREATMENT MODALITIES

SCABICIDE : Eurax ointment (Crotamiton)

PEDICULICIDE : Kwell lotion (Gamma Benzene

Hexachloride) contraindicated in young children and
pregnant women

Topical steroids

Hydrogen peroxide : cleanliness of wound

Lindane Lotion
NURSING MANAGEMENT

Apply cream at bedtime, from neck to toes

Instruct patient to avoid bathing for 8 to 12 hours

Dry-clean or boil bedclothes

Report any skin irritation

Family members and close contact treatment

Good handwashing

Terminal disinfection

SEXUALLY TRANSMITTED DISEASES

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SIGNS AND SYMPTOMS (Candidiasis)

ONYCHOMYCOSIS

Red, swollen darkened nailbeds

Purulent discharge

Separation of pruritic nails from nailbeds

DIAPER RASH

Scaly, erythematous, papular rash

Covered with exudates

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Appears below the breasts, between fingers, axilla, groin

and umbilicus

THRUSH

Cream-colored or bluish-white patches on the tongue,

mouth or pharynx

Bloody engorgement when scraped

MONILIASIS

White or yellow discharge

Pruritus

Local excoriation

White or gray raised patches on vaginal walls with local

inflammation

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VECTOR-BORNE DISEASES

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FILARIASIS
MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
Wuchereria bancrofti
Brugia malayi
Brugia timori
INCUBATION PERIOD
8 to 16 months
MODE OF TRANSMISSION
Person-to-person by mosquito bites
ACUTE STAGE

Lymphadenitis (inflammation of lymph nodes)

Lymphangitis (inflammation of lymph vessels)

Male genitalia affected leading to funiculitis, epididymitis

and orchitis (redness, painful and tender scrotum)
CHRONIC STAGE

Develop 10-15 years from onset of first attack

Hydrocele (swelling of the scrotum)

Lymphedema (temporary swelling of the upper and lower

extremities)

Elephantiasis (enlargement and thickening of the skin of

the upper and lower extremities, scrotum and breast
LABORATORY EXAMINATIONS

Nocturnal blood examination (NBE) taken at patients

residence/hospital after 8PM

Immunochromatographic test (ICT) rapid assessment

method; an antigen test done at daytime
TREATMENT

Diethylcarbamazine Citrate (DEC) or HETRAZAN an

individual treatment kills almost all microfilaria and a good
proportion of adult worms.
PREVENTION AND CONTROL

Measures aimed to control vectors

Environmental sanitation such as proper drainage and

cleanliness of surroundings

Spraying with insecticides

PREVENTION AND CONTROL

Measures aimed to protect individuals and families:

Use of mosquito nets

Use of long sleeves, long pants and socks

Application of insect repellants

Screening of houses

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