Community Health Nursin

Communicable Disease Lecture Notes

Prepared by: Mark Fredderick R. Abejo RN,, MAN

CAUSATIVE/INFECTIOUS AGENT:
A. Pathogenicity ability to cause disease
B. Virulence ( disease severity ) and invasiveness
(ability to enter and move through tissue)
C. Infective dose number of organisms needed to
initiate infection
D. Organisms specificity ( host preference) antigenic
variations
E. Elaboration of toxin
F. Viability- ability to survive outside the host
G. Invasiveness ability to penetrate the cell

RESERVOIR natural habitant of the organism that is

where resides and multiplies.
A. Human man is the reservoir of the diseases that is
more dangerous to humans than to other species.
B. Animal responsible for infestations with trophozoite,
worms, etc.
C. Non-animal street dust, garden soil, lint from
bedding.

COMMUNITY HEALTH NURSING

Communicable Disease
Lecturer: Mark Fredderick R. Abejo RN, MAN

Communicable Disease
Is defined as an illness caused by an infectious agent or
its toxins, which can be transmitted directly or
indirectly to a well person. Communicable diseases are
caused either by bacteria or virus.
Sources of infection consist of man, animal,
contaminated food or water, insects and environmental
factors, such as, dust and dirt.

Contagious
Easily
transmitted
through
direct
or
indirect mode
Transmitted via:
a. Airbornemeasles,
pneumonia
b. Droplet-PTB,
Hepatitis A,
Diphtheria

Carrier harbors the organism but w/o signs of infection

Categories of Carrier
Incubatory - no signs and symptoms
Convalescent disease subsided
Intermittent occasionally disseminate the infectious organism
Chronic carrying the infectious organism for years.

Infectious
Not easily transmitted

Transmitted via:

PORTAL OF EXIT / Mode of Escape from Reservoir:

A. Respiratory tract ( most common in man)
B. Gastrointestinal tract
C. Genito-urinary tract
D. Open lesions
E. Mechanical escape ( includes bite of insects)
F. Blood

MODE OF TRANSMISSION it indicates the potential of

the disease; conveyance of the agent to the host; it can be by
common source transmission, contact source, air-borne
transmission.

a. Blood Transfusion-AIDS,
Hepatitis B,
b. Sexual Intercourse: multiple sex
partners
1) Bacterial-gonorrhea, syphilis,
STD
2) Viral-AIDS, Hepatitis B
3) Fungal-Candidiasis
4)Protozoal-Trichomonas
vaginalis

There are four main routes of transmission

c. Contaminated Article/Equipment
-needles and syringes

A.

By Contact Transmission
1. Direct contact ( person to person )
2. Indirect contact ( usually an inanimate object)
3. Droplet contact ( from coughing, sneezing, or
talking, or talking by an infected person)

B.

By Vehicle Route ( through contaminated items)

1. Food salmonellosis
2. Water shigellosis, legionellosis
3. Drugs bacteremia resulting from infusion of a
contaminated infusion product
4. Blood hepatitis B,

C.

Airborne Transmission
1. Droplet of nuclei
2. Dust particle in the air containing the infectious
agent
3. Organisms shed into environment from skin, hair,
wounds or perineal area.

d. Placental Transfer

CHAIN OF INFECTION

D. Vector borne Transmission, arthropods such as flies,

mosquitoes, ticks and others.

PORTAL OF ENTRY / Mode of Entry of Organisms

into Human.
A. Respiratory tract
B. Gastrointestinal tract
C. Genitourinary tract
D. Direct infections of mucous membrane/skin

1
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

Mode of Transmission:
Droplet from respiratory tract of an infected person or a
carrier directly or indirectly.

SUSCEPTIBLE HOST a person or animal or plant upon

which parasite depends for its survival.
Host Factors:
1. Age, sex, genetic
2. Nutritional status, fitness, environment factors
3. General physical, mental and emotional health
4. Absent or abnormal Ig.
5. Status of hematopoetic system, efficacy of the RES.
6. Presence of underlying disease DM, lymphoma,
leukemia, neoplasia, granulocytopenia, or uremia.
7. Patient treated with certain antimicrobials,
corticosteroids, radiations, or immunosuppressive
agents.

Nursing Assessment:
A child with diphtheria usually seeks medical help for one
of the following complains (sometimes they are called types).
1. Sore throat:

Fever.

Difficulty to swallow.

Swelling of the neck.

Exudates or a yellow-gray membrane on

tonsils and may be the pharynx. (Membrane
varies from thin to thick one).
2.

Croup:

Hoarse or croupy cough and stridor.

Noisy respiration, the child may have severe

respiratory distress.

The membrane may cover the vocal cord

(When examined with laryngoscope).

3.

Nasal discharge:

Purulent, bloody nasal discharge.

The membrane can be seen on the nasal

septum.

4.

Infected skin ulcer:

This skin ulcer can be confused with

impetigo (skin disease). The membrane is
not always present in diphtheria.

5.

Other sings and symptoms:

That could be present (especially in severe cases):

Purulent conjunctivitis.

Otitis media.

Ulcerative vulvo-vaginitis.

Toxins from organisms produces fever and

malaise.

Control of Communicable Diseases:

Control of Communicable Disease regulated under R.A 3573:
Public Health Workers (PHW) to report any occurrence and
incidence of communicable diseases
PHWs:
namely
1.
2.
3.
4.
5.
6.
7.
8.

are members of the health team who are professionals

Medical Officer (MO)-Physician
Public Health Nurse (PHN)-Registered Nurse
Rural Health Midwife (RHM)-Registered MidwifeDentist
Nutritionist
Medical Technologist
Pharmacist
Rural Sanitary Inspector (RSI)-must be a sanitary
engineer

5 Communicable Diseases to be reported weekly and monthly:

1. Rabies
2. Measles
3. Polio
4. Neonatal Tetanus-children delivered at home by
midwives/hilots
5. Sexually Transmitted Disease (STD)-all forms
Diarrhea-not a disease but a symptom which should be
reported by PHN monthly

Nursing Consideration:
1. Isolate the child (place him in isolating room, use
medical aseptic techniques). Keep the child in isolation
until 2 consecutive nose and throat culture are negative
(24 hours apart between the two cultures).
2. Bed rest for about 6 weeks for all types except in nasal
diphtheria.
3. For respiratory distress (if present): suction to trachea
and larynx to remove secretions and pieces of
membrane, oxygen humidifier.
4. For fever: check vital signs, use 2-3-4 hours schedule;
depending on the degree of fever, degree of respiratory
embarrassment and change in pulse rate. Check blood
pressure frequently.
5. For the membrane: Oral hygiene (warm mouth wash,
never use tooth brush or swabs because of danger of
distracting the membrane leading to bleeding and rapid
spread of toxins into blood system.
6. Observe: vital signs, secretion and the need for suction,
observe signs and symptoms of paralysis.
7. Tracheostomy and /or intubation trays must be ready at
bedside table of the child. If tracheostomy or intubation
is done, apply the proper care of tracheostomy or
intubation.
In intubation, the child can expel the tube when he
coughs, so watch constantly as he cant call for
help. Frequent suctioning of the tube use proper
restraints so that he will not remove the tube.
8. If myocarditis appears as a complication,
guard the child for exhaustion, beside the
other nursing care.

Common Communicable Diseases Caused by

Bacteria

1. DIPHTHERIA

Etiology:
Corynebacterium diphtheria (Diphtheria bacillus).
Incubational Period:
2-5 days or longer.

Treatment:

Communicability Period:
Several hours before onset of the disease until organism
disappear from the respiratory tract.

Bed rest.
Antibiotics.
Anti-toxins.

2
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

Prevention:
1. Active immunization: DPT
vaccine.
2. Passive
immunization:
injection with anti-toxins.

Nursing Consideration:
1. Isolation: Disinfection all utensils.
2. Bed rest: keep the child in bed in a well ventilated
room.
3. For paroxysmal stage: Provide;

Calm atmosphere to avoid emotional swings as

laugh and cry causing coughing attacks.

Avoid dust in the room.

Oxygen with humidity to relief cyanosis (may

use oxygen tent).
4. For vomiting:

Raise head and shoulders of older children to

avoid aspiration of vomitus. For young children,
place them on abdomen if no one is attending in
the room.

Mouth care.

Small frequent feeding. Refeed the child

immediately after vomiting.

Accurate intake and output must be kept.

5. For anorexia:

High caloric soft diet. Encourage the child to eat.

Weight the child daily.

6. If anoxia occurs during paroxysms a tracheopharyngeal suction may be needed. So keep the suction
machine available.
7. Protect the child from secondary infection, keep him
warm.
8. Observe: respiratory distress and convulsions.
9. Observe signs and symptoms of airway obstruction e.g.
restlessness, cyanosis, retraction.

Complications;

Bronchopneumonia.

Kidney dysfunction.

Paralysis.

Myocarditis.

Cardiac failure.

2. PERTUSSIS (Whooping Cough)

Treatment:

Symptomatic: sedatives and antispasmodics are important.

Antibiotics are effective if given early

(Ampicillin and Erythromycin).

Etiology:
Gram-negative bacillus.

Prevention:
1. Active immunization: DPT vaccine.
2. Passive immunization: Gamma Globulin.
3. In exposed immunized children, give an immediate booster
dose of pertussis vaccine.

Incubation Period:
5-14 days.
Communicability Period:
4-6 weeks from the onset of the disease.

Complication:

Mode of Transmission:
Droplet (direct and indirect).

Nursing Assessment:
Three stages:

Otitis media.
Bronchiectasis.
Hemorrhage may occur.

Marasmus.
Encephalitis.
Pneumonia.

3. TETANUS (Lock Jaw)

aCatarrhal stage: (coryza or prodormal

stage) It lasts 7-14 days.

Mild fever, headache, anorexia.

Sneezing.

Persistent cough with tearing.

bParoxysmal stage (Spasmodic or whooping
stage): Lasts 14-28 days (2-4 weeks).

Paroxysmal cough develops. It is

characterized by several sharp coughs
in one expiration, followed by one deep
inspiration, which may be accompanied
by a whoop. Cough is worse at night,
interferes with sleep and frequently
causes vomiting.

With cough, face becomes flushed

and in some instances cyanosis and
dyspnea might occur.

Anorexia.

Lymphocytosis occurs.
c-

Etiology:
Clostridium tetanti (tetanus bacillus).
Incubational Period:
3-21 days.
Communicability Period:
Not communicable from man to man, as the organism
usually live in animals intestinal tract.

Convalescent stage: It lasts 21 days.

Cough and vomiting become less.

Mode of Transmission:
Through a wound as organism is present in soil.

3
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

Nursing Assessment:

4. SCARLET FEVER

Onset of the disease is either gradual or acute.

1. Convulsions are the first warning symptoms in
children.
2. Excessive irritability and restlessness.
3. Difficulty in swallowing.
4. Stiff neck.
5. Within 24-48 hours, the muscular stiffness progress:

Trismus i.e. tight jaw, inability to open the

mouth.

Stiff arm and legs, then entire stiffness of the

body.

Swallowing usually becomes impossible.

Resus sardonicus due to spasm of facial

muscles.

Opisthotonos, i.e., backward arching of the

back as a result of the dominance of the extensor
muscles of the spine, head draws back.

These ongoing tetanic spasms lasts about 10

seconds and occurs following a slightest stimuli,
such as, claming the door or bumping the bed.
6. Dyspnea and cyanosis can develop.
7. Fever 38.5 -40C.
8. Constipation may develop.
9. Lumbar puncture reveals increase reveals increase
spinal fluid pressure.

Etiology:
Streptococcus pyogeneous. (Beta hemolytic streptococcus
group A).
Incubational Period:
2-5 days.
Communicability Period:
From onset to recover.
Mode of Transmission:
Droplet infection, direct and indirect.
Nursing Assessment:

Nursing Consideration:
1. Isolation.
2. Protect the child from any stimuli (auditory or
tactile stimuli), so place the child in dark, quite
room and minimum handling.
3. If dyspnea and cyanosis are present, give oxygen.
4. For tetanic spasm:

Protect the child from falling.

The nurse must be alert for number, duration

and frequency of convulsion (in relation to
sedation administered).

Record any change in trismus or inability to

swallow.
5.

6.
7.
8.
9.

In acute sudden onset: (toxin from the site of infection is

absorbed into blood stream).
Prodromal signs:

Vomiting.

High fever then it drops when rash appears.

Headache.

Rapid pulse.

Tongue: white tongue coating desquamates and red

strawberry tongue results.

Tonsils are red, enlarged, swallow, and may have a

patchy whitish exudates on their surface.

For inability to swallow:

I.V. therapy for nutrition and fluid balance.

Gavage feeding may be ordered. So, the nurse

must report if insertion of the tube causes
convulsions.

Accurate intake and output chart is necessary.

Mouth care if he can open his mouth.

Then, rash appears within the first 5 days of the disease. The rash
will be all over the body but not on the face. The chest and back
are affected first, and then the rash moves down-wards involving
the legs last. The rash fades upon pressure.

Distinct odor of the skin.

Desquamation i.e., peeling of the skin, is the typical of

scarlet fever. Desquamation could occur early at 4-5-6 day
or later to 4th week of the disease. It starts at the top of the
body and proceeds downwards.

For constipation, give enema.

Check vital signs carefully.
If tracheostomy is performed;
care of tracheostomy.
Naso-pharyngeal suction is
done frequently.

Nursing Considerations:
1. Isolation.
2. Bed rest for 12 days and good ventilated room.
3. Keep patient warm, dry and comfortable as possible.
4. For the distinct odor which associates with scarlet fever:
daily bath and change linen frequently.
5. For skin:

Lubricate skin well with oil (daily) as Dr. order.

Protect skin under and around the nose and lips with
ointment. (When nasal discharge is constant).
6. Nasal aspiration by gentle suction or soft rubber ear
syringe is essential.
7. If the child is less than 2 years, elevate head and shoulders
to prevent danger of otitis media.
8. Accurate intake and output chart is important.
9. Diet in the first week: High caloric liquids then soft diet.
Avoid irritant liquid juice citrus.
10. For constipation, which accompanies scarlet fever enema
or mild cathartics is needed.
11. If there is pain in cervical lymph nodes, treat with heat in
the form of hot packs or cold in the form of ice collar
according to doctors order.
12. Observe for complications.

Treatment:

Antibiotics (Penicillin).

Antitoxin.

Tranquilizers.
Prevention:
1. Active immunization: DPT vaccine.
2. Passive immunization: Injection of tetanus
immuno-globulin or antitoxin (a few hours
after a wound occur).
Complication:

Anoxia.

Atelectasis.

Pneumonia.

4
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

Treatment:

Penicillin.

Diet.

Sedatives for pain.

2.

For rash (lesion):

Cleaning the skin according to doctors order

once or twice daily. Cool sponge bath without soap.

Change childs clothes and bed linens daily to

prevent skin infection.

For itchy lesions, nails must be cut and cleaned.

Mittens and gloves to prevent skin scratching.

Restraints may be needed to control scratching.

Observe the skin lesions, change in appearance

and it must be recorded.

If lesions in mouth, mouth wash.

If lesions in genital organ, apply cold

compresses.

3.

For fever:

Check vital signs and record it, especially

temperature.

Keep records for the first 7 days of the disease.

4.

If secondary infection to skin occurs: intake

and out put chart must be kept accurate.
Observe for complications and report
immediately to the doctor.

Prevention:
No immunization.
Complication:

Rheumatic fever.

Glomerulo-Nephritis.

Pneumonia.

Communicable Diseases Caused by Virus

5.
1. CHICKEN POX (Varicella)
This is a highly communicable disease in children.

Treatment:

No specific treatment.

To
relieve
itching,
calamine
lotion,
antihistamine and local aneaethetaic ointment are
prescribed.

Antibiotics for secondary infection.

Dont give aspirin due to high risk of Reye

syndrome.
Prevention:
None
Complication:

Abscess.

Encephalitis.

Glomerulonephritis may occur.

Etiology:
Virus [Varicella- Zoster- Virus (VZV)].

2. MEASLES (Rubeola)

Incubational Period:
10-21 days (2-3 weeks).

Most cases occur before adolescent and it occurs more in

spring months.

Communicability Period:
One day before and six days after the appearance of the
first vesicle.
Mode of Transmission:
Droplet (direct or indirect). Dry scabs are not infectious.
Nursing Assessment:
Onset is sudden with:
Prodromal Stage:

Mild or light fever.

Anorexia.

Headache.
Etiology:
Paramyxoviridae Virus

Acute Phase:

Rash: Successive crops of macules, papules, vesicles,

crusts (vesicles heals by forming the crusts by the end of
the two weeks). (Acute Phase).

Rash appears in successive crops and lesions in all

stages of development at the same time.

Rash is itchy.

Incubational Period:
7-14 days (usually 10-20 days).
Communicability Period:
4 days before the appearance of rash to 5days after rash
appearance.

Nursing Consideration:
1. Isolation:

Use medical aseptic technique.

Nasal and oral discharge, cloths and linens are

currently disinfected.

Keep the child in isolation until all crusts

disappear.

Mode of Transmission:
Droplet (direct or indirect).

5
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

Nursing Assessment:
aCoryza: Primary symptoms which resembles common
cold and occur before rash appearance:

Sneezing.

Fever (range from 38.5 to 40C, tending to be

highest just before the appearance of rash).

Brassy or barking cough.

On the 4th day, conjunctivitis and photophobia.

Acute catarrhal inflammation of the mucous

membrane of the nose.

Enlarged posterior cervical lymph nodes.

3. GERMAN MEASLES (Rubella)

It is not as communicable as measles. Fetus may contact
the disease in uterus if the mother develops the disease during the
pregnancy (1st trimester).

bKopliks Spots: Are pathogenic appear on day before

rash. Whitish spots resting on a reddish base appear on the
inside of the mouth. They can appear and disappear suddenly.
cRash: Rash appears on 2nd to 5th day and remain about a
week.

Appears first on face, behind the ears, on the neck,

forehead or cheeks. Then, spread downwards over the
rest of the body (trunk, arms, and legs).

The rash is pinkish in color, begins with macular

lesions which progress to the popular type. Then, rash
becomes dark in color (brownish color on 5th day).

Desquamation, which is find usually, follow the rash

appearance and then fads (disappear).

Rash is itchy.

Etiology:
Rubella Virus ( Togaviridae, genus: Rubivirus)
Incubation Period:
14 to 21 days.
Communicable Period:
During Prodromal period and for 5 days after the rash.

Nursing Consideration:
1. Isolation.
2. Bed rest: Occupy the child in bed after acute phase with
activities. Explain the reason for being in bed if the child
is old enough to understand.
3. For photophobia and conjunctivitis:

Subduced light make the child more comfortable.

Dark room.

Eye care with warm saline solution to remove

secretions or crust.

Keep childs hands away from eyes, examine

coma for signs and symptoms of ulceration.
4.

For fever:

Measure the temperature carefully.

Antipyretic as doctors order.

Encourage fluids.

Tipped compresses.

5.

For itchy rash: Observe degree of itching and apply

lotion or ointment as doctors order.
For Kopliks spots: Mouth care. Use gargle solution.
Carry out the plan of care of complicated cases, such as,
encephalitis (convulsions), dyspnea. etc.

6.
7.

Mode of Transmission:
1. Direct contact with nose and throat secretions of
infected persons.
2. Indirect via articles freshly contaminated with
nasopharyngeal secretion.
3. Trans-placenta congenital infection form infected
mother to the fetus.
Nursing Assessment:
Prodromal Stage:

Mild fever (Disappear when rash appear).

Slight malaise, headache, and anorexia.

Running nose, sore throat.

Rash is faint macular rash. It is small pinpoint pink

or pale red macules which are closely grouped to look
like scarlet blush (botchy), which fades on pressure. It
begins on face and hairline move to trunk then
extremities.
Rash disappears
in 3 days.

Swelling of posterior cervical and occipital lymph

nodes.

No Kopliks spots or photophobia.

Treatment:

Symptomatic.

Antibacterial therapy.

Nursing Consideration:
1. Isolation especially form pregnant
women.
2. Bed rest until fever subsided.

Prevention:
aActive immunization: live attenuated vaccine.
bPassive immunization:

Newborn through the mothers

while they were in uterus.

Gamma-globulin.

Treatment:

Symptomatic.
Prevention:
aActive immunization; live attenuated rubella
virus vaccine.
bPassive immunization: Gamma- globulin.

Complication:

Otitis media.

Tracheobronchitis.

Imptiago,purpura.

Lymphoadenitis.

Pneumonia.

Encephalitis.

Complication:

Fetus damage if mother contacts the disease

during pregnancy.

Newborn may have congenital anomalies, such

as deafness, mirocephaly, mental retardation.

Encephalitis.

6
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

5. POLIOMYELITIS (infantile Paralysis)

It attacks the brain stem and spinal cord.

4. MUMPS (Infectious Parotitis)

Mumps is common in children 5-10 years. It is acute virus
infectious disease, which may involve, many organs but
commonly affects the salivary glands (mainly parotids glands).

Etiology:
Paramyxovirus Virus.
Incubational Period:
14-21 days.
Communicability Period:
One to six days before the first symptoms appears until the
swelling disappears.
Etiology:
Virus. The disease is caused by any one of 3 polioviruses:
aType 1 (Brunhilde).
bType 2 (Lansing).
cType 3 (Leon).

Mode of Transmission:
Direct or indirect contact with salivary secretion of infected
person.
Nursing Assessment:

Incubational Period:
5-14 days.

Prodromal stage Corayza:

Low-grade fever.

Vomiting.

Headache.

Malaise and anorexia.

Communicability Period:
Latter period of incubational period till the first week of
acute illness.
Mode of Transmission:
Oral contamination by intestinal and pharyngeal secretions
of infected person.

Acute Phase:
1. Pain in or behind ears and pain on swallowing or
chewing.
2. Swelling and pain in glands (unilateral or bilateral),
which return to normal in 10 days.
3. Orchitis in males and mastitis in female adolescent
may occur.

Predisposing Factors:
1. Fatigue and muscle exertions.
2. Cortisone administration.
3. Tonsillectomy and adenoectomy.
4. Tooth extraction.
5. I.M injection of D.P.T. vaccine.

Nursing Consideration:
1. Isolation.
2. Bed rest until swelling disappears.
3. For fever: Encourage fluids and soft food, avoid food
required chewing, and tipped compresses, antipyretics.
4. For glands:

Mouth care and gargle frequently.

Apply hot or cold compresses for the

swelling. Use ice bag (watch weight of the
bag in order not to increase the pain).
5.

6.

Nursing Assessment:
Severity of nerve involvement can vary from an absence of
all clinical signs of paralysis to complete paralysis. There are
different possible consequences of infection:
Inapparent Poliomyelitis: (Silent) No signs or
symptoms appears.
Abortive Poliomyelitis: Initial symptoms of upper
respiratory tract infection: fever, headache,
vomitingetc.

For Orchitis: Support scrotum, use cold compresses

for 20 minutes, then, remove it for 30 minutes, then,
reapply it for 20 minutesetc.
For Mastitis: Breast support, use cold compresses.

Non-Paralytic Poliomyelitis:
Problems as those of Aseptic Meningitis Syndrome:

Stiffness of neck, back and limbs.

Nausea and vomiting become more severe than stage II.

Fever.

Increase protein in C.S.F.

Treatment:

Symptomatic.

Sedatives.
Prevention:

Paralytic Poliomyelitis: This may begin with

manifestations of the abortive or non-paralytic type.

Spinal: paralysis appear within a day or two after the

above manifestations and 2-5 days from onset of the
disease:

Active immunization: Live attenuated vaccine.

Passive immunization: Gamma- globulin.
Complication: (rare)

Sterility

Ovaritis

inflammation of testicles

Deafness.

Paralysis of limbs is the most common affected

muscles.

7
CHN

Abejo

Community Health Nursin

Communicable Disease Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN

Passive immunization: Gamma- globulin.

Muscles of the chest, abdominal wall,

diaphragm, urinary bladder and bowel can be
affected constipation or stool incontinent and
urinary incontinent may occur.

Complication:

Emotional disturbance.

Gastric dilatation.

Hypertension.

Bulbar: More life threatening. It causes damage to

cranial nerve nuclei, vital centers of respiration,
circulation and temperature control.

It may leads to swallowing problem and

regurgitation of fluids from nose and inability to
swallow saliva, which puddles in the pharynx. If not
aspirated chocking may occur.

Encephalitis: Manifesting as encephalitis, only

diagnosed as polioencephalitis if spinal or bulbar
affections or both are present:

Convulsion.
Personality disturbances.

Nursing Considerations:
1. Isolation and bed rest.
2. In acute stage:

Put the child under close observation.

Notify the doctor about the degree and progress of

the paralysis (7or8 days of the disease).

Rate and type of respiration and signs of

respiratory distress must be observed and reported.

Oxygen therapy or place the child on respirator

when cyanosis occurs.

If tracheostomy is done in case of diaphragmatic

paralysis, care of tracheostomy.
3.

For paralysis:

Change position frequently. Careful positioning

for affected limbs each time he is turned or moved.

To minimize the degree of deformity, correct

body alignment and optimum position must be
maintained.

Place the child on firm mattress.

Use footboard to prevent foot drop when child is

on back. If the child is on abdomen, pull the
mattress away from foot of bed and letting feet
protrude over the edge to prevent pressure on toes.

Application of heat to affected muscles to relax

them.

4.

Suction of the pharynx and postural

drainage to prevent aspiration of secretions.
For swallowing difficulties:

Soft diet if they can swallow with difficulty.

If swallowing is difficult, use gavage feeding.

For incontinent:

Skin care and perineal region is padded to

provide absorption for excretions. Catheter may be
done.
For constipation: Use enemas.
Treat fever and headache.

5.

6.

7.
8.

Treatment:

Symptomatic.

Physiotherapy.
Prevention:
Active immunization: Trivalent poliovirus vaccine.
(TOPV).

Sabine: Attenuated virus, which is administered

orally.

Salk: Killed virus, which is administered by

injection.
Note: If a child is affected by poliomyelitis, he must receive the
vaccine to prevent further infection from the other poliovirus
types.

8
CHN

Abejo