Care of Clients with Problems In Inflammatory

& Immunologic Response, Perception & Coordination
(NCM104)
Patients With Communicable Diseases II
Vector Borne Diseases
Malaria (Ague)
× Is an acute and chronic parasitic
disease transmitted by the bite of
infected mosquitoes and
× Is confined mainly to tropical and
subtropical areas
× The fever associated with this disease
is called “Afternoon fever”
ETIOLOGIC AGENT
- Protozoa of genus plasmodia
• Plasmodium falciparum (Malignant tertian)
• Plasmodium vivax (Benign tertian)
• Plasmodium malariae (Quartan)
• Plasmodium ovale
INCUBATION PERIOD
- P. Falciparum = 12 DAYS
- P. Vivax = 14 DAYS
- P. malariae = 30 DAYS
MODE OF TRANSMISSION
1. Bite of an infected female Anopheles mosquito
2. Blood transfusion
3. Rare occasions, from shared contaminated needles
4. Transplacental transmission of congenital malaria
CLINICAL MANIFESTATIONS
1. Paroxysms with shaking chills – Physiologic compensation (ATP is being used)
2. Rapidly rising fever, HA
3. Profuse swearing – Due to chilling to remove ATP breakdown
4. Myalgia
5. Splenomegaly (↑ Heme breakdown due to parasites), Hepatomegaly
6. Orthostatic hypotension
7. Paroxysms may last for 12 hours, may attack daily or every 2 days
8. In children:
a. Fever – Continuous
b. Convulsions, GI Symptoms – Prominent
c. Splenomegaly
9. Cerebral Malaria:
a. Severe HA, Vomiting, Changes in sensorium
b. Jacksonian, Grand mal seizure
۩Due to altered blood component going to the brain
۩Will cause ↑ ICP
jcmendiola_Achievers2013
Topics Discussed Here Are:
1. Vector Borne Diseases
a. Malaria (Ague)
b. Dengue Fever (Breakbone Fever/Hemorrhagic
Fever/Dandy Fever)
c. Filariasis (Elephantiasis)
d. Leptospirosis (Weil’s Disease, Canicola Fever/Mud Fever)
e. Lyme Disease
f. Rocky Mountain Spotted Fever
2. Sexually Transmitted Disease
a. Gonorrhea (Clap/Flores Blancas/Gleet)
b. Syphilis (Lues Venereal/Morbus Gallicus
c. Acquired Immune Deficiency Syndrome (AIDS)
LOOKY
HERE
©
Other CMs
× Easy fatigability
× Anemia
× Shock, due to bleeding
(↓ Platelet)
REMEMBER
Antipyretics with ANTICOAGULANT
effect are not given
PATHOPHYSIOLOGY
DIAGNOSTIC PROCEDURE
1. Malarial Smear – Blood is stained on a film and examined
2. Rapid Diagnostic Test (RDT) – Gives results within 10 – 15 minutes (Like a pregnancy
test, but blood)
MANAGEMENT
1. Medical
a. Anti-malarial drugs
۝ Chloroquine – Except P. malariae
۝ Quinine
۝ Sulfadoxine – P. falciparum
۝ Primaquine – P. vivax and ovale
b. Erythrocyte exchange transfusion – To replace blood components
2. Nursing Management
a. Closely monitor client!
b. I&O
۝ Serum bilirubin, BUN creatnine, parasitic count
۝ Respiratory and Renal symptoms – Determine ABGs and Plasma
electrolyte
c. Tepid Sponge Bath!
d. Heat and Hot drinks during chilling
e. Comfort
f. Drink plenty of fluids
g. Clothing should be kept dry
h. WOF: Neurologic toxicity ÷ Due to Quinine
i. Evaluate the degree of anemia
j. WOF: Abnormal bleeding
k. Consider SEVERE MALARIA as MEDICAL EMERGENCY ÷ Monitor VS
PREVENTION and CONTROL
jcmendiola_Achievers2013
Anopheles mosquito gets the parasite from an infected person
Parasite multiplies in the intestine of the mosquito (Producing sporozoites)
Sporozoites discharged into the saliva of the mosquito
Mosquito bites humans then injects the parasites
(2 Phases of asexual cycle within humans)
When sporozoites
inoculate to the
human blood
Changed form into
“exoerythrocytic” and
carried to the liver
They invade
hepatocytes
Erythrocytic –
Causes pathologic
findings to human
host
REMEMBER
Antibiotics are NOT given with
MALARIA, an ANTI-MALARIAL
drug is used instead
1. All cases should be reported
2. Screening of all infected persons from mosquitoes
3. Breeding places must be destroyed
4. Use of sprays / Effective insecticides
5. Mosquito nets
6. Insect repellents
7. People living in malaria-infested areas SHOULD NOT DONATE BLOOD (For at least 3
years)
8. Blood donors are SCREENED
NURSING DIAGNOSES
- Altered body temperature
- Activity intolerance
- Knowledge deficit
- Altered nutrition: Less than body requirements
Dengue Fever
(Breakbone Fever/Hemorrhagic Fever/Dandy Fever/Infectious Thrombocytopenic Purpura)
× Acute febrile disease caused by infection with one of the serotypes of dengue virus
× Dengue Hemorrhagic Fever
o A SEVERE, or FATAL manifestation (Bleeding diathesis and hypovolemic shock)
ETIOLOGIC AGENTS
1. Flavivirus 1, 2, 3, 4, a family of Togaviridae, small viruses that contain SINGLE-
STRANDED RNA
2. Arboviruses group B
MODE OF TRANSMISSION
1. Bite of Aedes Aegypti
a. Day-biting mosquito (Appears 2 hours AFTER SUNRISE, 2 hours BEFORE
SUNSET)
b. Breed in stagnant water
c. Limited, low-flying movement
d. Fine white dots at base of wings, white bands on legs
2. Aedes albopictus
a. May contribute to the transmission of the dengue virus in rural areas
3. Other contributory mosquitoes
a. Aedes polynesis
b. Aedes scutellaris simplex
INCUBATION PERIOD
- 3 – 14 Days
- Commonly 7 – 10 Days
PREIOD OF COMMUNICABILITY
× Day before the febrile period to the end
× Mosquito is infective from Day 8 – 12 after the blood meal and remains infective
throughout its life
SOURCES OF INFECTION
1. Infected persons
2. Standing water
jcmendiola_Achievers2013
INCIDENCE
1. Age
a. Any age
b. But common among children (Peak: 4 – 9 y/o)
2. Sex – Both
3. Season – More frequent during rainy season
4. Location – More prevalent in urban communities
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
1. Dengue Fever
1. Prodromal symptoms:
a. Malaise and anorexia (up to 12 hours)
b. Fever and Chills with frontal HA, ocular pain, myalgia, severe
backache and arthralgia
2. N/V
3. Fever – Non-remitting, persists for 3 – 7 days
4. Rash – Prominent on extremities and trunk (Face in some isolated cases)
5. Petechiae – Near end of the febrile period (Most common on lower extremities)
2. Dengue Hemorrhagic Fever (DHF)
+ Severe form
+ Manifested by:
a. Fever, hemorrhagic diathesis
b. Hepatomegaly, hypovolemic shock
PHASES OF THE ILLNESS
1. Initial Febrile Phase (Lasting from 2 – 3 Days)
a. Fever (39 - 40°C) with HA
b. Fever convulsions
c. PALMS and SOLES = FLUSHED!
d. (+) Tourniquet test
e. Anorexia, Vomiting, Myalgia
f. Maculopapular / Petechial rashes (Starts in distal portion of extremities, sparing
the axilla and chest)
jcmendiola_Achievers2013
Infectious virus is
deposited in the skin
Initial replication occurs at the site of
infection and in local lymphatic tissues
Viremia (viruses on blood) occurs within a few days
(Lasting until 4
th
– 5
th
day after onset of symptoms)
At the site of petechial rash, non-specific changes are
noted, which include endothelial swelling, perivascular
edema and extravasation of blood
Marked ↑ in vascular permeability, hypotension,
hemoconcentration, thrombocytopenia with ↑ platelet
agglutination and or moderate DIC
↑ Permeability to vascular endothelium and loss
of plasma from the intravascular space
Pathophysiological abnormality like Hypovolemia
g. Herman’s Sign = Skin appears PURPLE with blanched areas of varying sizes
÷ PATHOGNOMONIC SIGN
h. Generalized abdominal pain, hemorrhagic manifestations [(+) Tourniquet test,
purpura, epistaxis, gum bleeding]
2. Circulatory Phase
a. Fall of temperature with circulatory changes (3
rd
– 5
th
Day)
b. Client becomes restless with cold clammy skin
c. Cyanosis
d. Thrombocytopenia with SHOCK!
e. Bleeding diathesis leads to GIT Hemorrhage
f. SHOCK = Due to loss of plasma (↑ Hct)
g. Pulse: Rapid and weak; Narrow pulse pressure; ↓ BP
h. May result to coma, MAC and DEATH within 2 days
i. Therapy: Recovery 2 – 3 days
CLASSIFICATION ACCORDING TO SEVERITY (Halstead and Nimmanitya)
Grade Signs and Symptoms
Grade I × Fever
× Hemorrhagic manifestation
× (+) Tourniquet Test
Grade II × All signs of Grade I
× Spontaneous bleeding (Nose, gums, GIT)
Grade III × Respiratory failure (Weak pulse, narrow pulse pressure, hypotension, cold clammy
skin, restlessness)
Grade IV × Profound shock
× Undetectable BP and Pulse
COMPLICATIONS
1. Dengue Fever
a. Epistaxis; menorrhagia
b. GI Bleeding
c. GI Disorder (Peptic Ulcer)
2. DHF
a. MAC
b. Hyperkalemia
c. Tissue anoxia
d. Hemorrhage into CNS / Adrenal glands
e. Uterine bleeding
f. Myocarditis
3. Severe Manifestations
a. Dengue Encephalopathy
§ ↑ Restlessness, apprehension / anxiety
§ Disturbed sensorium, convulsions
§ Spacity, hyporeflexia
DIAGNOSTIC TESTS
1. Tourniquet Test
© Screening test
© Occlusion of arm veins for 5 mins
2. Platelet Count (decreased) – Confirmatory test
3. Hemoconcentration - ↑ of 20% in Hct or steady rise in Hct
4. Occult blood
jcmendiola_Achievers2013
5. Hemoglobin determination
TREATMENT MODALITIES
- There is no effective antiviral therapy for dengue fever (Entirely symptomatic)
• Analgesic Drugs – HA, ocular pain, myalgia
• IV Infusion – To prevent dehydration and replacement of plasma
• Blood Transfusion – For severe bleeding
• O2 Therapy – Clients with shock
• Sedatives – To allay anxiety and apprehension
NURSING MANAGEMENT
1. Mosquito-free environment
2. Rest during bleeding episodes
3. VS are promptly monitored
4. NOSE BLEED = Trunk elevated, apply ice bag (Bridge of nose, forehead)
5. Observe for signs of SHOCK – Slow pulse, cold clammy skin, prostration, ↓ BP
6. Trendelenburg Position – To restore blood volume to head part
7. Isolation not required – NOT INFECTIOUS!!
PREVENTION and CONTROL
1. Health Education!
2. Early detection and treatment
3. Treat mosquito nets with insecticides
4. House spraying
5. Eliminate vectors by:
a. Changing water / Scrubbing sides of flower vases (once a week)
b. Destroying breeding places
c. Keeping containers covered
6. Avoid hanging too many clothes in the house
7. Case finding
NURSING DIAGNOSES
- Altered body temperature
- Fear
- Anxiety
- Knowledge deficit
- Activity intolerance
Filariasis (Elephantiasis)
× Parasitic disease caused by nematodes which are microscopic
× Threadlike African eye worm
CAUSATIVE ORGANISM
- Wuchereria bancrofti – 4 – 5 cm long, affects lymph nodes and lymph nodes of legs, arms, vulva
and breasts
- Brugia malayi – Swelling of extremities confined to areas below knees and elbows
- Brugias timori – Rarely affects genitals
- Loa loa – Transmitted by the deer fly
MODE OF TRANSMISSION
- Mosquito bites
jcmendiola_Achievers2013
jcmendiola_Achievers2013
PATHOPHYSIOLOGY
NURSING MANAGEMENT
1. Health education – About mode of transmission
2. Destruction of breeding places of mosquitoes
3. Psychological and emotional support
4. Personal hygiene
5. Course of disease must be explained to client and family
jcmendiola_Achievers2013
Mosquito bites a person
with lymphatic filariasis
Microscopic worms circulating the person’s
blood enter and infect the mosquito
Microscopic worms enter lymph vessels where they
grow into adults
Adult worm lives for 7 years in lymph vessels; they mate
and release into bloodstream millions of microscopic
worms (Microfilaria)
Many mosquito bites over several months
to years before filariasis takes place
Adult worms die = First Symptoms Occur
Damages kidney and lymph system
Fluid collects and causes swelling in the arms,
breasts, legs and for men the genital area
Swelling and decreased function of lymphatic system
makes it difficult for the body to fight the infection
More bacterial infections in the skin, thus
skin hardens and thickens (Elephantiasis)
Worms can obstruct the vessels causing
the surrounding tissues to enlarge
In conjunctival filariasis, larvae migrate to the eyes
and can sometimes be seen beneath the conjunctiva
Blindness (Onchocerciasis)
SYMPTOMS
1. Begin with:
• On-and-off Chills
• Headaches
• Fever (3 months – 1 year)
2. Swelling, redness, pain in arms, legs or scrotum
3. Areas of abscesses may appear due to dying
worms / secondary bacterial infection
DIAGNOSTIC PROCEDURES
1. Circulating Filarial Antigen (CFA) – Finger-
prick blood droplet
2. Larvae can be found in the blood
3. Patient’s History = Pattern of inflammation,
signs of lymphatic obstruction
MODALITIES OF TREATEMENT
1. Ivermectin, albendazol, or Diethylcarbamazine
(DEC) – Used in treatment and act by:
- Eliminating the larvae
- Impairing the adult worm’s ability to
reproduce
- Killing the adult worm
Meds are given at low doses initially to prevent
immunologic reactions due to large number of
dying parasites
2. Surgery – To remove surplus tissue, drain the
fluid, and minimize massive enlargement of the
scrotum
3. Elephantiasis of the legs = ELEVATE and
ELASTIC BANDAGES
4. DEC-fortified salt is helpful
PREVENTION and CONTROL
× Mosquito net
× Mosquito repellants between dusk and dawn
× Take yearly dose of meds that kills the worms circulating in the blood
NURSNIG DIAGNOSES
• Impaired physical mobility
• Knowledge deficit
• Impaired skin integrity
• Activity intolerance
Leptospirosis
(Weil’s Diseases/Canicola Fever/Hemorrhagic Jaundice/Mud Fever/Swing Herd Disease)
× Zoonotic infectious bacterial diseases carried by animals, both domestic and wild
× Water / Food is contaminated by the infected which causes diseases when ingested / inoculated
through the skin
ETIOLOGIC AGENT
- Leptospira interrogans – Spirochete genus of Leptospira
INCUBATION PERIOD
- 6 – 15 DAYS
PERIOD OF COMMUNICABILITY
× Leptospira – Urine (10 – 20 Days after onset)
SOURCE OF INFECTION
× Rats – L. icterohaemorrhagiae, L. bataviae
× Dogs – L. canicola
× Mice – L. grippotyphosa
MODE OF TRANSMISSION
- Direct contact (Skin / mucous membranes) ÷ ANIMALS, Human transmission is RARE
• Eyes, nose, mouth, semen / breaks in skin
CLINICAL MANIFESTATIONS
1. Septic Stage
• Febrile (4 – 7 Days)
• Abrupt onset of remittent fever, chills, HA, anorexia
• Abdominal pain and severe prostration
• Respiratory distress
2. Immune or Toxic Stage
• With or without Jaundice (4 – 30 Days)
• If SEVERE: Death occurs in 9
th
– 16
th
Day
1. Anicteric Phase (Without Jaundice)
• Low-grade fever with rash
2. Icteric Phase (With Jaundice) ÷ Wet Syndrome
• Hepatic and renal manifestations (Prominent)
jcmendiola_Achievers2013
LABORATORY DIAGNOSIS
1. BUN and Creatinine
2. Agglutination – Test done after 2
nd
/3
rd
Week
a. Microagglutination
b. Macroagglutination
c. Indirect Hemoagglutination
3. Impaired liver and kidney Tests
PATHOPHYSIOLOGY
ORGANS OF THE BODY INVADED BY THE ORGANISM
1. LIVER = After gaining entrance, it multiplies in the bloodstream and invades this organ
causing JAUNDICE (Icteric – Gives an orange-colored skin)
2. KIDNEYS = Inflammation of the nephrons and tubular necrosis resulting in RENAL
FAILURE
3. Leptospira = May affect the muscles, causing PAIN and or EDEMA
4. EYES = Conjunctivitis, orange-colored sclera due to Icteric
TREATMENT (MANAGEMENT)
1. Medical
a. Suppression of causative agent
b. Fighting possible complications
1. Aetiotropic Drugs – Penicillin, Doxycycline, Ampicillin, Amoxicillin
• Doxycycline – 100 mg PO q12 hrs (1 week)
2. Peritoneal Dialysis – If client has kidney failure
3. Administration of F&E and blood as indicated
2. Nursing
a. Isolate (Proper disposition of urine)
b. Darken room (Irritating to client’s eyes)
c. Skin care to ease pruritus – No ointments on skin, except Calamine Lotion
d. Close surveillance
e. Keep homes clean
f. Eradicate rats and rodents
g. Health education on modes of transmission
jcmendiola_Achievers2013
Cattle, swine and
other livestock
Dogs Rodents, wild animals
Contact with contaminated water and soil entry
through the eyes, mouth, and broken skin
Man
h. Encourage OFI (Oral fluid intake)
PREVENTION and CONTROL
1. Sanitation in homes, workplaces and farms
2. Need for proper drainage system and control of rodents (40% - 60% infected)
3. Animals must be vaccinated (Cattle, dogs, cats and pigs)
4. Infected human and pets should be treated
5. Information dissemination campaign
NURSING DIAGNOSIS
• Body image disturbance
• High risk for injury
• Anxiety
• Altered nutrition: Less than body requirements
• Impaired physical mobility
• Impaired skin integrity
• Knowledge deficit
Lyme Disease
× Multisystem illness caused by tick borne spirochete
(Closely mimics Rheumatic(?) Disease)
CAUSATIVE AGENT
× Borrelia burgdorferi
INCUBATION PERIOD
× 3 – 32 Days
MODE OF TRANSMISSION
- Tick bite / Contact with tick feces
PERIOD OF COMMUNICABILITY
- Not communicable from person-to-person
PATHOPHYSIOLOGY
jcmendiola_Achievers2013
B. burgdorferi is injected into skin by
the bite of an infected tick
Spirochetes multiply and migrates outward
within the dermis
Appearance of characteristic EM lesions
Activation of inflammatory response to bacteria
Spirochetes avoid the immune response by ↓ expression of surface
proteins, which may interfere with the function of immune factors
Neutrophils fail to appear in the developing EM lesion
Permitting bacteria to survive and eventually
spread throughout the body
Spirochetes spread via the bloodstream to the joints,
heart, nervous system and distant skin sites
Joints
Subjective joint
pain, arthritis
CNS
Induce astrocytes to
undergo astroliosis
(Proloferation
followed by
apoptosis – Natural
death of neurons)
Spirochetes may
induce host cells to
secrete products
toxic to nerve cells
Fatigue and malaise
Chronic secretion of
stress hormones
↓ Tryptophan
in CNS
Dysregulation
of hormones
Neurological dysfunction
Heart
AV Block (First
Degree,
Wenckebach,
Complete Heart
Block)
Myopericarditis
chronic,
cardiomyopathy,
pericardial
effusion
CLINICAL MANIFESTATIONS
1. Erythema Migrans = Annular skin lesions for a period of days to weeks and develops
central clearing
2. Lesion – Warm to touch, not painful
3. Flulike symptoms
4. Inflamed, painful arthritis in large joint
5. Limb weakness, sensory lowers
6. Confusion, memory loss
7. Bell’s Palsy
DIAGNOSTIC TESTS
1. Blood, skin, CSF and joint fluid collection
2. Observation of skin, myocardial, retinal and synovial lesions
MEDICAL TREATMENT
1. Anti-infective Drugs
a. Tetracycline (Achromycin)
b. Chloramphenicol (Chloromycetin)
GENERAL MANAGEMENT
1. IV Fluids and electrolytes
2. Sedation – Paraldehydration or Chloral hydrate
3. ↑ Protein, ↑ Caloric Diet
4. Serum albumin transfusion
5. Packed RBC for anemia
6. O2 for pulmonary complications
7. Fever control
Rocky Mountain Spotted Fever
× Acute rickettsial infective disease transmitted to humans by infected ticks and manifested by
severe systemic signs and a macular or papular rash
CAUSATIVE AGENT
- Rickettsia rickettsii
INCUBATION PERIOD
- 3 – 14 Days
MODE OF TRANSMISSION
× Bite from ticks,
× Contamination with tick feces
PERIOD OF COMMUNICABILITY
× Not communicable from person-to-person
PATHOPHYSIOLOGY ÷ NOTEBOOK
jcmendiola_Achievers2013
PROGRESSION
- Rapid progressive systemic angiitis with severe systemic manifestations
- Vascular endothelial edema
- Fibrin and platelet deposition
- Microthrombi develops and obstructs and occludes small vessels
- Tissue infection
- Necrosis
CLINICAL MANIFESTATIONS
1. Petechial skin rash that becomes purpuric
2. Clouded sensorium ÷ BADTRIP XD
3. Edema
4. Hypotension
5. Peripheral vascular circulatory collapse
6. Myocardial involvement
• Myocarditis – Focal vascular lesion plus mononuclear cell infiltration
DIAGNOSTIC PROCEDURES
1. Immunofluorescence of Skin Tissue
2. Serologic
3. Indirect Fluorescent Antibody – Confirmatory
4. Complement Fixation
5. Blood Component
MEDICAL AND GENERAL MANAGEMENT
- Same with Lyme Disease ÷ LOL XD
Sexually Transmitted Disease
Gonorrhea (Clap/Flores Blancas/Gleet)
× Sexually-transmitted bacterial disease involving the mucosal lining of the genitourinary tract,
rectum and pharynx
INFECTIOUS AGENT
× Neisseria gonorrhoeae
o Gram-negative (-) coccus found in pairs
o Non-spore former and non-motile
o Fragile and can’t survive long outside the body
o Readily killed by: Drying, sunlight, UV Light
o Can be killed with ordinary disinfectants
jcmendiola_Achievers2013
INCUBATION PERIOD
× 3 – 21 Days (Averages from 3 – 5 Days)
PERIOD OF COMMUNICABILITY
- Infected person remains communicable as long as the organism is present
MODE OF TRANSMISSION
1. Contact with exudates from the mucous membranes (Usually sexual activity)
2. Utero = Upon rupture of membranes
3. Direct Contact – Contaminated vaginal secretion (During delivery)
4. Sexual Contact (Orogenital, Anogenital)
• Between opposite sexes / Same Sex
5. Fomites ÷ FAIL C
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
1. In Females
a. Burning sensation and frequent urination
b. Yellowish purulent vaginal discharge
c. Redness and swelling of genitals
d. Itching of vaginal area
e. Pain on urination
f. Urethritis / Cervicitis = A few days after exposure (Can become STERILE)
g. Endometritis salpingitis or pelvic peritonitis
h. Pregnant women – May infect the eye of her baby during the passage through
the birth canal
2. In Males (After 3 – 6 Days incubation period)
a. Dysuria = With purulent discharge (Gleet) – 2 – 7 Days after exposure
b. Rectal Infection = Common to homosexuals
c. Prevention of passage of urine
d. Prostatitis
e. Urethritis
f. Pelvic pain and fever
OTHER CLINICAL FEATURES VARY ACCORDING TO SITE INVOLVED
jcmendiola_Achievers2013
Infection with Neisseria gonorrhoeae
Becomes adherent to the
urethral epithelium
Penetration of the
mucosa
Acute inflammatory
response
Polymorphonuclear
leukocytes in
submucosa
Inflammatory edema
of the gland ducts
occurs
Formation of
microabscesses
Larger abscesses form
Spread along mucosal surfaces
Fallopian
tubes
Endometrium
Peritoneal
cavity
Can lead to
STERILITY
1. Urethra
a. Dysuria
b. Urinary frequency and incontinence
c. Purulent discharge
d. Itching
e. Red and edematous meatus
2. Vulva
a. Occasional itching
b. Burning and pain
c. More severe BEFORE PUBERTY and AFTER MENOPAUSE
3. Vagina
a. Engorgement, redness and swelling
b. Profuse purulent discharge
4. Liver – RUQ Pain
5. Other possible symptoms – Pharyngitis, Tonsilits, Rectal Burning
DIAGNOSTIC EXAM
1. Females = Culture of specimen (Cervix and Anal Canal): 24 – 72 Hours
2. M ales = Gram Staining
TREATEMENT MODALITIES
1. Uncomplicated Gonorrhea (Adults)
• Ceftriaxone 125 – 250 mg, IM single dose
• Doxycycline 100 mg, orally (For 7 days)
2. Pregnant Women
• Ceftriaxone 125 – 250 mg, IM single dose PLUS…
• Erythromycin 500 mg, orally (For 7 days)
3. Aqueous Procaine Penicillin = 4 million units IM after (-) Skin test
4. Disseminated Gonococcal Infection (Adults and Adolescents)
• Ceftriaxone 1 gram IM or IV q24 hours
• Spectinomycin 2 grams IM q12 hours (If allergic to B-lactam antibiotics)
5. Therapy may be switched to the following regimens to complete one full week of
antimicrobial therapy
• Cefixime 400 mg PO, BID
• Ciprofloxacin 500 mg PO, BID
º CI: Children, adolescents, and pregnant lactating women
• Gonococcal Conjunctivitis – Ceftriaxone 1 gram, single dose, IM and irrigation
of infected eye with NSS
NURSING MANAGEMENT
1. Ask the client if he / she has drug sensitivities and WOF AE during therapy (Before
therapy)
2. Explain that client is still infectious and can transmit Gonococcal infection until cultures
prove (-)
3. Standard precautions
4. Confidentiality
5. Isolated until recovered from disease
6. Gonococcal arthritis = Apply moist heat
7. Infants born to mothers (+) positive for gonorrhea:
• 1% Silver Nitrate
• Or any ophthalmic prophylaxis on both eyes at birth
jcmendiola_Achievers2013
8. Report all gonorrheal cases
9. Refrain from sexual intercourse until treatment is completed
SIGNS OF GONOCOCCAL OPTHALMIA NEONATORUM
- Lid edema
- Bilateral conjunctival edema
- Purulent discharge (2 – 3 Days after birth)
- Corneal Ulceration and Blindness = IF LEFT UNTREATED
PREVENTION and CONTROL
1. Sex Education (Schools, and community)
2. Case findings
3. Incidence of gonorrhea must be reported so contacts can be treated
NURSING DIAGNOSES
• Altered sexuality pattern
• Social isolation
• Knowledge deficit
• Altered urinary isolation
• Risk for infection
Syphilis (Lues Venereal/Morbus Gallicus)
× Chronic, infectious sexually-transmitted disease that usually begins in the mucous membranes and
quickly becomes systemic
ETIOLOGIC AGENT
- Treponema pallidum
• Spirochete – Can pass through mucosa / cracks / placentas
SOURCES OF INFECTIONS
1. Discharges = Lesions of the skin or mucous membranes
2. Semen, blood, tears and urine
3. Mucous Discharges = Nose, eyes, genital tract or bowels
4. Surface lesions
INCUBATION PERIOD
× 10 – 90 Days (Average is 3 Weeks)
PERIOD OF COMMUNICABILITY
× Variable and indefinite
MODE OF TRANSMISSION
1. Direct Transmission – Contact with an infected person
2. Indirect Contact – Articles freshly soiled with discharges / blood
3. Congenitally through the placenta
4. Syphilitic baby to a wet nurse / Anyone carelessly handling diapers
PATHOPHYSIOLOGY ÷ GAWA
jcmendiola_Achievers2013
CLINICAL MANIFESTATIONS
1. Primary Syphilis
a. One or more chancres (Painless) that erupt in the genitalia, anus, nipples,
tonsils / eyelids (Painless, start as papules, then erode)
b. Chancres have endurated, raised edges, and clear bases (Disappears after 3 – 6
weeks even without therapy)
c. Chancres are often overlooked in females
2. Secondary Syphilis
Development of mucocutaneous lesions and generalized lymphadenopathy (Days – 8 weeks
after onset)
a. Macular, popular, pustular or nodular
b. Lesions = Uniform size, well-defined and generalized
c. Erupt between rolls of fat on: Trunk, arms, palms, soles, face and scalp
d. Perineum, vulva, rolls of fats in the scrotum, lesions enlarge and erode,
pink/grayish-white lesions (Condylomata lata)
e. HA, anorexia, malaise, weight loss, N/V, sore throat, slight fever
f. Alopecia (Temporary)
g. Nails – Brittle and pitted
3. Latent Syphilis
a. No clinical symptoms – But serologic test is reactive
b. 2/3 of clients asymptomatic until death C
4. Late Syphilis
a. Destructive but non-infectious stage
b. Three Subtypes:
i. Late, Benign Syphilis
1. 1 – 10 Years after the infection
2. Gumma = Chronic, superficial nodule or deep granulomatous
lesion (Solitary, asymmetric, painless, endurated)
a. Can be found in any bone
ii. The Late Syphilis
1. Involves the Liver = Epigastric pain, tenderness, enlarged
SPLEEN, anemia
2. Upper Respiratory Tract = Perforation of the nasal septum /
palate
3. Bones / Organs = Destroyed which lead to death (Severe
cases)
iii. Cardiovascular Syphilis
1. Develops about 10 years after infection
jcmendiola_Achievers2013
2. Asymptomatic but may suffer from aortic regurgitation and
aneurysm
5. Congenital Syphilis
a. Fetus
Ö Overwhelmed by infection and die
ÖWill be expelled by the uterus (Miscarriage / stillbirth)
b. Macerated appearance (Collapsed skull and protuberant abdomen)
c. Skin = Livid red color, number of bullae filled with hemorrhagic fluid
d. Autopsy = Spleen and Liver ENLARGED, Pancreatitis, thickening of intestines
e. May still show alterations in fetal development at various stages
CLINICAL MANIFESTATIONS
1. Early Congenital Syphilis
a. Lesions of the skin and mucous membranes
º “Syphilitic Pemphigus” – Bullous rash
º Loss of weight, wrinkling of skin “Old man look”
º Syphilitic papules – Skin at the base of nails, nails may be loosened and
shed
(Syphilitic Nonychia)
º Mucous patches = Lips, mouth, throat, nasal passages
b. Liver and Spleen
º Protuberant abdomen (Enlargement of the liver and spleen)
º Liver cells are immature and imperfectly formed
º Hepatic insufficiency = Failure of protein metabolism
2. Late Congenital Syphilis
a. Interstitial Keratitis – Commonest late lesion
º 4 – 60 years old or even later
º Circomcorneal Vascularization, followed by vascular infiltration
º Severe lesions – Corneal scarring (Opacities lead to slight impairment /
complete blindness)
DIAGNOSTIC PROCEDURES
1. Dark Field Illumination – Most effective if lesions present
2. Fluorescent Treponemal Antibody Absorption Test
3. VDRL Slide Test and Rapid Plasma Reagent Test
4. CSF Analysis
MODALITIES OF TREATMENT
1. Early Syphilis – Penicillin G benzathine IM (2.4 million units)
2. More than a year duration – Penicillin G benzathine (2.4 million units/week x 3weeks)
3. Allergy to Penicillin
 Oral Tetracycline / Doxycycline (15 days for early, 30 days for late)
4. Abstain from sexual contact until infection has healed (Can’t during treatement)
NURSING MANAGEMENT
1. Stress – Importance of completing the treatment even after the symptoms subside
2. Instruct infected individuals to inform their partner to be treated
3. Universal precaution
4. Secondary Syphilis – Keep lesions dry
5. Cardiovascular Syphilis – WOF signs of ↓ CO (↓ Sensorium and UO and hypoxia) and
pulmonary congestion
jcmendiola_Achievers2013
6. Neurosyphilis – Assess LOC, mood, coherence; WOF: Ataxia
7. Encourage to undergo VDRL Testing after 3, 6, 12, and 24 months if any relapse
8. Report all cases
PREVENTION and CONTROL
1. Report Cases
2. Control prostitution
3. Require sex workers to have regular check-ups ÷ LOL
4. Proper sex education
5. Contact tracing
NURSING DIAGNOSES
1. Altered sexual pattern
2. Self-esteem disturbance
3. Social isolation
4. Knowledge deficit
5. Impaired skin integrity
6. Anxiety
Acquired Immune Deficiency Syndrome (AIDS)
× Aids involves an immune deficiency
× HIV – Causes AIDS
o Retrovirus belonging to the family of lentiviruses
o Lentiviruses = ‘Slow Viruses’
MODIFIED CLASSIFICATION (STAGES) OF HIV INFECION
× Clinical Stage 1: Asymptomatic – CD4 Count of <500
o Acute HIV infection
o Characterized by: General lymphadenopathy
× Clinical Stage 2: Early (Mild)
o Weight loss greater than 10% in a month (GIT can’t absorb nutrients)
o Minor mucocutaneous manifestations:
º Seborrhic dermatitis
º Fungal nail infection
º Recurrent oral ulcerations
º Angular cheilitis – Inflammation of the tongue
º Recurrent respiratory infection (Rhinitis, tonsillopharyngitis)
× Clinical Stage 3: Intermediate (Moderate)
o Weight loss (Greater than 10%)
o Diarrhea (More than one month)
o Oral candidiasis (Thrush)
o Oral hairy leukoplakia ÷ White patches
o Severe bacterial infection (E.g. pneumonia)
× Clinical Stage 4: Late (Severe) AIDS
o HIV wasting syndrome
o Pneumonia – Pneumocystis carinii
o Toxoplasmosis of the brain
o Cryptosporidiosis with diarrhea for more than one month
o Herpes simplex virus
o Multifocal leukoencephalopathy
o Disseminated endemic mycosis
SIGNS AND SYMPTOMS
× Asymptomatic, feeling and appearing healthy for years (Immune system starts to be impaired)
× May exhibit neurological symptoms: (AIDS-Related Complex ARC)
o Memory loss, altered gait, depression
jcmendiola_Achievers2013
PATHOPHYSIOLOGY
o Sleep disorders, GI Symptoms (Diarrhea)
× Normal CD4 Count: 500 – 1,500 (T lymphocytes)
× Normal Viral Load: 10,000 – 100,000
MINOR SIGNS
1. Persistent cough (1 month)
2. Pruritic Dermatitis (Generalized)
3. Herpes Zoster Infection (Recurrent)
4. Orophyaryngeal candidiasis
5. Chronic Disseminated Herpes Simplex Infection
6. Lymphadenopathy (Generalized)
MAJOR SIGNS
1. Loss of weight – 10% of body weight
2. Chronic Diarrhea – More than one month
3. Prolonged Fever – For on month
TOP 10 SYMPTOMS OF HIV/AIDS
1. Depression
2. Diarrhea
3. Thrush
4. Weight loss
5. Lipodystrophy (Fat distribution syndrome)
6. Sinus infection
7. Fatigue
8. N/V
9. Lactic Acidosis – Damage in the mitochondria
10. Burning and tingling sensation of feet and hands
jcmendiola_Achievers2013
COMMON OPPURTUNISTIC INFECTIONS
1. Bacterial
a. MAC – Mycobacterium avium complex (TB-like manifestations)
b. Tuberculosis
c. Salmonillosis
2. Viral
a. Herpes
b. Hepatitis
c. Genital warts
d. CMV (Cytomegalovirus)
i. Can Cause: Retinitis, pain on swelling, numbness of legs
ii. Transmitted: Semen, vaginal secretions, blood and breast-milk
e. Molluscum contagiosum – Produces oral thrush (Dome-shaped papules)
3. Fungal
a. Candidiasis
b. Cryptococcal meningitis
c. Histoplasmosis – Skin lesions, transmitted by direct contact
4. Pneumonias
a. Bacterial
b. Pneumocystis carinii pneumonia (PCP)
5. Cancers
a. Kaposi’s Sarcoma – Cancerous lesion (Due to overgrowth of blood vessels)
b. Cervical Dysplasia and Cancer
º Cervical Carcinoma = Associated with HPV (Human Papilloma Virus)
c. Non-Hodgkin’s Lymphoma – Cancerous tumor of the lymph nodes (Late manifestation of
HIV infection)
6. Parasitic
a. Toxoplasmosis – Parasitic infection causing neurologic symptoms
b. Cryptosporidiosis – Cryptosporidium also known as Crypto
i. Signs and Symptoms
1. Watery diarrhea
2. Abdominal cramps
3. Low-grade fever
4. Weight loss – Due to persistent diarrhea
ii. Preventive Measures Against Crypto
1. Handwashing
2. Safe sex
3. Careful not to swallow water when swimming
4. Wash/Cook Food properly
5. Drink safe water
MODE OF TRANSMISSION
1. Sexual intercourse
2. Blood transfusion, sharing of infected syringes / needles among IV drug users
3. Vertical / Perinatal transmission
4. Several ways of receiving infected blood
a. Blood transfusions
b. Sharing of syringes and needles
c. Transplacental
d. Organ donation
e. Accidental exposure in hospitals / clinics
DIAGNOSTIC EXAMINATIONS
1. EIA or ELISA
2. Particle Agglutination (PA) Test
3. Western Blot Analysis – Confirmatory
4. Immunofluorescent Test
5. Radio Immuno-Precipitation Assay (RIPA)
jcmendiola_Achievers2013
6. HIV Antibody Test
a. Not detectable – Negative Antibody Test
b. Present in blood – Positive Antibody Test (HIV Positive)
7. Serum Conversion Test
a. HIV Positive but UNDETECTED (Window Phase)
TREATMENT MODALITIES
1. Reverse Transcriptase Inhibitors
+ Cannot kill the virus, but slows its progression and prolongs life
+ Reverse transcriptase
+ These drugs are:
i. Zedovudine (ZDV) – Retirvir
ii. Zalcitabine – Havid
iii. Stavudine – Zerit
iv. Lamivudine – Epivir
v. Nevirapine – Viramune
vi. Didanosine – Videx
2. Protease Inhibitors – Inhibit protease which are needed for assembly of viral particles
+ These Drugs are:
i. Saquinavir – Invarase
ii. Ritonavir – Norvir
iii. Indinavir – Crixivan
NURSING MANAGEMENT
1. Health Education
a. Practical advise
b. Health teaching about the mode of transmission
c. AIDS Awareness Program
d. Avoid judgmental and moralistic messages
e. Consistent and concise in giving instructions
f. Positive statement
g. For proper management, identify previous contacts
2. Practice Universal / Standard Precaution
a. Through medical handwashing before and after contact with patients
b. Universal barriers / Personal Protective Equipment (PPE)
3. Prevention
a. Avoid accidental pricks
b. Gloves = Worn when handling blood specimens and other body secretions
c. Label the specimens with “AIDS Precaution”
d. Blood spills should be cleaned using common household disinfectants (Chlorox)
e. Needles should be disposed into a puncture resistant container
f. Personal articles are not shared with others
g. Isolation
h. Risk for HIV – Not allowed to donate blood / any organ of the body
i. Encourage monogamous relationships
j. HIV-infected pregnant woman – Regular prenatal, interpartal and postpartal care
k. Speak openly with partner(s) about safe sex techniques and HIV status
THE FOUR Cs IN THE MANAGEMENT OF HIV/AIDS
1. Compliance – Client sticks with the program
2. Counseling / Education
3. Contact Tracing – Tracing and providing treatment to partners
4. Condoms
NURINSG DIAGNOSES
● Knowledge deficit
● Social Isolation
● Risk for Infection
● Anxiety
jcmendiola_Achievers2013
● Self-esteem disturbance
● Altered role performance
jcmendiola_Achievers2013

PATHOPHYSIOLOGY
Anopheles mosquito gets the parasite from an infected person

Parasite multiplies in the intestine of the mosquito (Producing sporozoites)

Sporozoites discharged into the saliva of the mosquito

Mosquito bites humans then injects the parasites (2 Phases of asexual cycle within humans )

When sporozoites inoculate to the human blood Changed form into “exoerythrocytic” and carried to the liver

Erythrocytic – Causes pathologic findings to human host

They invade hepatocytes

DIAGNOSTIC PROCEDURE
1. Malarial Smear – Blood is stained on a film and examined

2. Rapid Diagnostic Test (RDT) – Gives results within 10 – 15 minutes (Like a pregnancy
test, but blood)

MANAGEMENT
1. Medical REMEMBER a. Anti-malarial drugs Antibiotics are NOT given with ‫ ۝‬Chloroquine – Except P. malariae MALARIA, an ANTI-MALARIAL ‫ ۝‬Quinine drug is used instead ‫ ۝‬Sulfadoxine – P. falciparum ‫ ۝‬Primaquine – P. vivax and ovale b. Erythrocyte exchange transfusion – To replace blood components Nursing Management a. Closely monitor client! b. I&O ‫ ۝‬Serum bilirubin, BUN creatnine, parasitic count ‫ ۝‬Respiratory and Renal symptoms – Determine ABGs and Plasma electrolyte c. Tepid Sponge Bath! d. Heat and Hot drinks during chilling e. Comfort f. Drink plenty of fluids g. Clothing should be kept dry h. WOF: Neurologic toxicity  Due to Quinine i. Evaluate the degree of anemia j. WOF: Abnormal bleeding k. Consider SEVERE MALARIA as MEDICAL EMERGENCY  Monitor VS

2.

PREVENTION and CONTROL

jcmendiola_Achievers2013

a family of Togaviridae. 2. Breed in stagnant water c. People living in malaria-infested areas SHOULD NOT DONATE BLOOD (For at least 3 years) 8. Insect repellents 7. Infected persons Standing water jcmendiola_Achievers2013 . Aedes scutellaris simplex 2. 2 hours BEFORE SUNSET) b. 2. 3. white bands on legs Aedes albopictus a. INCUBATION PERIOD 3 – 14 Days Commonly 7 – 10 Days PREIOD OF COMMUNICABILITY Day before the febrile period to the end  Mosquito is infective from Day 8 – 12 after the blood meal and remains infective throughout its life  SOURCES OF INFECTION 1. May contribute to the transmission of the dengue virus in rural areas Other contributory mosquitoes a. 3. 3. Blood donors are SCREENED NURSING DIAGNOSES Altered body temperature Activity intolerance Knowledge deficit Altered nutrition: Less than body requirements Dengue Fever (Breakbone Fever/Hemorrhagic Fever/Dandy Fever/Infectious Thrombocytopenic Purpura)   Acute febrile disease caused by infection with one of the serotypes of dengue virus Dengue Hemorrhagic Fever o A SEVERE. Bite of Aedes Aegypti a. 4. small viruses that contain SINGLESTRANDED RNA 2. Flavivirus 1. All cases should be reported Screening of all infected persons from mosquitoes Breeding places must be destroyed Use of sprays / Effective insecticides Mosquito nets 6. Fine white dots at base of wings. Aedes polynesis b. low-flying movement d. Day-biting mosquito (Appears 2 hours AFTER SUNRISE. 2. 4. or FATAL manifestation (Bleeding diathesis and hypovolemic shock) ETIOLOGIC AGENTS 1. Limited. Arboviruses group B MODE OF TRANSMISSION 1. 5.1.

Fever and Chills with frontal HA. hypotension. Maculopapular / Petechial rashes (Starts in distal portion of extremities. Fever – Non-remitting. hemoconcentration. 4. Pathophysiological abnormality like Hypovolemia 2. persists for 3 – 7 days 4. 2. Rash – Prominent on extremities and trunk (Face in some isolated cases) 5. Vomiting.40°C) with HA b. Petechiae – Near end of the febrile period (Most common on lower extremities) Dengue Hemorrhagic Fever (DHF)  Severe form  Manifested by: a. non-specific changes are noted. Fever convulsions c. Initial Febrile Phase (Lasting from 2 – 3 Days) a. Myalgia f. perivascular edema and extravasation of blood Marked ↑ in vascular permeability . Prodromal symptoms: a. hypovolemic shock PHASES OF THE ILLNESS 1. sparing the axilla and chest) jcmendiola_Achievers2013 . (+) Tourniquet test e. PALMS and SOLES = FLUSHED! d. severe backache and arthralgia 2. Age a. Malaise and anorexia (up to 12 hours) b. Fever. Hepatomegaly. thrombocytopenia with ↑ platelet agglutination and or moderate DIC ↑ Permeability to vascular endothelium and loss of plasma from the intravascular space CLINICAL MANIFESTATIONS 1. But common among children (Peak: 4 – 9 y/o) Sex – Both Season – More frequent during rainy season Location – More prevalent in urban communities PATHOPHYSIOLOGY Infectious virus is deposited in the skin Initial replication occurs at the site of infection and in local lymphatic tissues Viremia (viruses on blood) occurs within a few days (Lasting until 4th – 5th day after onset of symptoms) At the site of petechial rash. 3. which include endothelial swelling . N/V 3. myalgia. Dengue Fever 1.INCIDENCE 1. Anorexia. Fever (39 . hemorrhagic diathesis b. Any age b. ocular pain.

Bleeding diathesis leads to GIT Hemorrhage f. GI Disorder (Peptic Ulcer) DHF a.g. © Screening test © Occlusion of arm veins for 5 mins Platelet Count (decreased) – Confirmatory test Hemoconcentration . 3. Tourniquet Test 2. hyporeflexia 2. gums. menorrhagia b. Myocarditis Severe Manifestations a. Fall of temperature with circulatory changes (3rd – 5th Day) b. Generalized abdominal pain. Narrow pulse pressure. Therapy: Recovery 2 – 3 days 2. Uterine bleeding f. Thrombocytopenia with SHOCK! e. SHOCK = Due to loss of plasma (↑ Hct) g. hemorrhagic manifestations [(+) Tourniquet test. hypotension. CLASSIFICATION ACCORDING TO SEVERITY (Halstead and Nimmanitya) Grade Signs and Symptoms Grade I         Fever Hemorrhagic manifestation (+) Tourniquet Test All signs of Grade I Spontaneous bleeding (Nose. apprehension / anxiety § Disturbed sensorium. gum bleeding] Circulatory Phase a. Dengue Fever a. May result to coma. jcmendiola_Achievers2013 . GI Bleeding c. ↓ BP h. restlessness) Profound shock Undetectable BP and Pulse Grade II Grade III Grade IV COMPLICATIONS 1. Pulse: Rapid and weak. Tissue anoxia d. Epistaxis. GIT) Respiratory failure (Weak pulse. MAC and DEATH within 2 days i.↑ of 20% in Hct or steady rise in Hct Occult blood 3. Cyanosis d. purpura. Hyperkalemia c. cold clammy skin. 4. Dengue Encephalopathy § ↑ Restlessness. convulsions § Spacity. narrow pulse pressure. Hemorrhage into CNS / Adrenal glands e. DIAGNOSTIC TESTS 1. epistaxis. Herman’s Sign = Skin appears PURPLE with blanched areas of varying sizes  PATHOGNOMONIC SIGN h. MAC b. Client becomes restless with cold clammy skin c.

Keeping containers covered Avoid hanging too many clothes in the house Case finding 5. 2. 6. prostration. Destroying breeding places c. NURSING DIAGNOSES Altered body temperature Fear Anxiety Knowledge deficit Activity intolerance Filariasis (Elephantiasis)   Parasitic disease caused by nematodes which are microscopic Threadlike African eye worm CAUSATIVE ORGANISM . 3. arms. 4. 3. 6. Changing water / Scrubbing sides of flower vases (once a week) b. 7. affects lymph nodes and lymph nodes of legs. Health Education! Early detection and treatment Treat mosquito nets with insecticides House spraying Eliminate vectors by: a. forehead) Observe for signs of SHOCK – Slow pulse. apply ice bag (Bridge of nose.Wuchereria bancrofti – 4 – 5 cm long. myalgia IV Infusion – To prevent dehydration and replacement of plasma Blood Transfusion – For severe bleeding O2 Therapy – Clients with shock Sedatives – To allay anxiety and apprehension NURSING MANAGEMENT 1.There is no effective antiviral therapy for dengue fever (Entirely symptomatic) • • • • • Analgesic Drugs – HA.5. Hemoglobin determination TREATMENT MODALITIES . PREVENTION and CONTROL 1. ocular pain. 2. Mosquito-free environment Rest during bleeding episodes VS are promptly monitored NOSE BLEED = Trunk elevated. vulva and breasts Brugia malayi – Swelling of extremities confined to areas below knees and elbows Brugias timori – Rarely affects genitals Loa loa – Transmitted by the deer fly MODE OF TRANSMISSION Mosquito bites jcmendiola_Achievers2013 . ↓ BP Trendelenburg Position – To restore blood volume to head part Isolation not required – NOT INFECTIOUS!! 4. 5. cold clammy skin. 7.

jcmendiola_Achievers2013 .

or Diethylcarbamazine (DEC) – Used in treatment and act by:  Eliminating the larvae  Impairing the adult worm’s ability to reproduce  Killing the adult worm Meds are given at low doses initially to prevent immunologic reactions due to large number of dying parasites Surgery – To remove surplus tissue. larvae migrate to the eyes and can sometimes be seen beneath the conjunctiva 4. 2. pain in arms. drain the fluid. 3. albendazol. Begin with: • On-and-off Chills • Headaches • Fever (3 months – 1 year) Swelling. 4. Health education – About mode of transmission Destruction of breeding places of mosquitoes Psychological and emotional support Personal hygiene Course of disease must be explained to client and family jcmendiola_Achievers2013 . 2.PATHOPHYSIOLOGY Mosquito bites a person with lymphatic filariasis Microscopic worms circulating the person’s blood enter and infect the mosquito Microscopic worms enter lymph vessels where they grow into adults Adult worm lives for 7 years in lymph vessels . Ivermectin. Blindness (Onchocerciasis) NURSING MANAGEMENT 1. 3. 5. Adult worms die = First Symptoms Occur Circulating Filarial Antigen (CFA) – Fingerprick blood droplet Larvae can be found in the blood Patient’s History = Pattern of inflammation. In conjunctival filariasis . they mate and release into bloodstream millions of microscopic worms (Microfilaria) SYMPTOMS 1. legs or scrotum Areas of abscesses may appear due to dying worms / secondary bacterial infection 2. legs and for men the genital area Swelling and decreased function of lymphatic system makes it difficult for the body to fight the infection More bacterial infections in the skin. thus skin hardens and thickens (Elephantiasis) 2. DIAGNOSTIC PROCEDURES Many mosquito bites over several months to years before filariasis takes place 1. and minimize massive enlargement of the scrotum Elephantiasis of the legs = ELEVATE and ELASTIC BANDAGES DEC-fortified salt is helpful Fluid collects and causes swelling in the arms. breasts. redness. Worms can obstruct the vessels causing the surrounding tissues to enlarge 3. 3. signs of lymphatic obstruction Damages kidney and lymph system MODALITIES OF TREATEMENT 1.

mouth. chills.Direct contact (Skin / mucous membranes)  ANIMALS. canicola  Mice – L. icterohaemorrhagiae.Leptospira interrogans – Spirochete genus of Leptospira INCUBATION PERIOD 6 – 15 DAYS PERIOD OF COMMUNICABILITY  Leptospira – Urine (10 – 20 Days after onset) SOURCE OF INFECTION  Rats – L. jcmendiola_Achievers2013 . anorexia • Abdominal pain and severe prostration • Respiratory distress Immune or Toxic Stage • With or without Jaundice (4 – 30 Days) • If SEVERE: Death occurs in 9th – 16th Day 1. both domestic and wild Water / Food is contaminated by the infected which causes diseases when ingested / inoculated through the skin ETIOLOGIC AGENT . L. semen / breaks in skin CLINICAL MANIFESTATIONS 1. Anicteric Phase (Without Jaundice) • Low-grade fever with rash 2. Human transmission is RARE • Eyes. bataviae  Dogs – L.PREVENTION and CONTROL    Mosquito net Mosquito repellants between dusk and dawn Take yearly dose of meds that kills the worms circulating in the blood NURSNIG DIAGNOSES • • • • Impaired physical mobility Knowledge deficit Impaired skin integrity Activity intolerance Leptospirosis (Weil’s Diseases/Canicola Fever/Hemorrhagic Jaundice/Mud Fever/Swing Herd Disease)   Zoonotic infectious bacterial diseases carried by animals. Icteric Phase (With Jaundice)  Wet Syndrome • Hepatic and renal manifestations (Prominent) 2. HA. nose. Septic Stage • Febrile (4 – 7 Days) • Abrupt onset of remittent fever. grippotyphosa MODE OF TRANSMISSION .

wild animals Contact with contaminated water and soil entry through the eyes. Fighting possible complications 1. LIVER = After gaining entrance. Medical a. EYES = Conjunctivitis. Aetiotropic Drugs – Penicillin. mouth. Microagglutination b. it multiplies in the bloodstream and invades this organ causing JAUNDICE (Icteric – Gives an orange-colored skin) 2. Macroagglutination c. Health education on modes of transmission 2. Isolate (Proper disposition of urine) b. Indirect Hemoagglutination Impaired liver and kidney Tests PATHOPHYSIOLOGY Cattle. and broken skin Man ORGANS OF THE BODY INVADED BY THE ORGANISM 1. Close surveillance e. Ampicillin. jcmendiola_Achievers2013 . causing PAIN and or EDEMA 4. Darken room (Irritating to client’s eyes) c. BUN and Creatinine Agglutination – Test done after 2nd /3rd Week a. Administration of F&E and blood as indicated Nursing a. orange-colored sclera due to Icteric TREATMENT (MANAGEMENT) 1. Doxycycline. except Calamine Lotion d. Suppression of causative agent b. 2. 3. Keep homes clean f. Leptospira = May affect the muscles. KIDNEYS = Inflammation of the nephrons and tubular necrosis resulting in RENAL FAILURE 3. Peritoneal Dialysis – If client has kidney failure 3.LABORATORY DIAGNOSIS 1. Amoxicillin • Doxycycline – 100 mg PO q12 hrs (1 week) 2. Eradicate rats and rodents g. Skin care to ease pruritus – No ointments on skin. swine and other livestock Dogs Rodents.

2. nervous system and distant skin sites MODE OF TRANSMISSION Tick bite / Contact with tick feces PERIOD OF COMMUNICABILITY Joints . 3.60% infected) Animals must be vaccinated (Cattle. Complete Heart Block) Myopericarditis chronic. pericardial effusion Dysregulation of hormones Neurological dysfunction jcmendiola_Achievers2013 . 4. Wenckebach. workplaces and farms Need for proper drainage system and control of rodents (40% . cardiomyopathy. dogs. 5.Not communicable from person-to-person PATHOPHYSIOLOGY Subjective joint pain. burgdorferi is injected into skin by the bite of an infected tick Spirochetes multiply and migrates outward within the dermis Appearance of characteristic EM lesions Lyme Disease  Multisystem illness caused by tick borne spirochete (Closely mimics Rheumatic(?) Disease) Activation of inflammatory response to bacteria Spirochetes avoid the immune response by ↓ expression of surface proteins. cats and pigs) Infected human and pets should be treated Information dissemination campaign NURSING DIAGNOSIS • • • • • • • Body image disturbance High risk for injury Anxiety Altered nutrition: Less than body requirements Impaired physical mobility Impaired skin integrity Knowledge deficit B. arthritis CNS Heart Induce astrocytes to undergo astroliosis (Proloferation followed by apoptosis – Natural death of neurons) Spirochetes may induce host cells to secrete products toxic to nerve cells Fatigue and malaise Chronic secretion of stress hormones ↓ Tryptophan in CNS AV Block (First Degree. Sanitation in homes. Encourage OFI (Oral fluid intake) PREVENTION and CONTROL 1.h. heart. which may interfere with the function of immune factors CAUSATIVE AGENT  Borrelia burgdorferi Neutrophils fail to appear in the developing EM lesion INCUBATION PERIOD  3 – 32 Days Permitting bacteria to survive and eventually spread throughout the body Spirochetes spread via the bloodstream to the joints.

Chloramphenicol (Chloromycetin) GENERAL MANAGEMENT 1. Erythema Migrans = Annular skin lesions for a period of days to weeks and develops central clearing 2. myocardial. Confusion. memory loss 7. not painful 3. Lesion – Warm to touch. Inflamed. skin. Limb weakness. Tetracycline (Achromycin) b. Blood. Flulike symptoms 4. 2. Bell’s Palsy DIAGNOSTIC TESTS 1. IV Fluids and electrolytes Sedation – Paraldehydration or Chloral hydrate ↑ Protein. 7. 4. 5. painful arthritis in large joint 5. Anti-infective Drugs a. 2. 3. Contamination with tick feces PERIOD OF COMMUNICABILITY Not communicable from person-to-person PATHOPHYSIOLOGY  NOTEBOOK jcmendiola_Achievers2013 . CSF and joint fluid collection Observation of skin.CLINICAL MANIFESTATIONS 1. Rocky Mountain Spotted Fever  Acute rickettsial infective disease transmitted to humans by infected ticks and manifested by severe systemic signs and a macular or papular rash CAUSATIVE AGENT Rickettsia rickettsii INCUBATION PERIOD 3 – 14 Days MODE OF TRANSMISSION    Bite from ticks. ↑ Caloric Diet Serum albumin transfusion Packed RBC for anemia O2 for pulmonary complications Fever control 6. sensory lowers 6. retinal and synovial lesions MEDICAL TREATMENT 1.

UV Light o Can be killed with ordinary disinfectants jcmendiola_Achievers2013 . Immunofluorescence of Skin Tissue Serologic Indirect Fluorescent Antibody – Confirmatory Complement Fixation Blood Component MEDICAL AND GENERAL MANAGEMENT . 5.Rapid progressive systemic angiitis with severe systemic manifestations - - Vascular endothelial edema Fibrin and platelet deposition Microthrombi develops and obstructs and occludes small vessels Tissue infection Necrosis CLINICAL MANIFESTATIONS 1. sunlight. rectum and pharynx INFECTIOUS AGENT  Neisseria gonorrhoeae o Gram-negative (-) coccus found in pairs o Non-spore former and non-motile o Fragile and can’t survive long outside the body o Readily killed by: Drying. Edema Hypotension Peripheral vascular circulatory collapse Myocardial involvement • Myocarditis – Focal vascular lesion plus mononuclear cell infiltration DIAGNOSTIC PROCEDURES 1. 4. Clouded sensorium  BADTRIP XD 3. 5.PROGRESSION . 3. 2. 6. Petechial skin rash that becomes purpuric 2. 4.Same with Lyme Disease  LOL XD Sexually Transmitted Disease Gonorrhea (Clap/Flores Blancas/Gleet)  Sexually-transmitted bacterial disease involving the mucosal lining of the genitourinary tract.

Can lead to STERILITY Fallopian tubes Endometrium Peritoneal cavity 2. Dysuria = With purulent discharge (Gleet) – 2 – 7 Days after exposure b. 5. 2. Rectal Infection = Common to homosexuals c. Contact with exudates from the mucous membranes (Usually sexual activity) Utero = Upon rupture of membranes Direct Contact – Contaminated vaginal secretion (During delivery) Sexual Contact (Orogenital. Pain on urination f.INCUBATION PERIOD  3 – 21 Days (Averages from 3 – 5 Days) PERIOD OF COMMUNICABILITY Infected person remains communicable as long as the organism is present MODE OF TRANSMISSION 1. 3. Prostatitis e. Yellowish purulent vaginal discharge c. Prevention of passage of urine d. Redness and swelling of genitals d. Urethritis / Cervicitis = A few days after exposure (Can become STERILE) g. Itching of vaginal area e. Anogenital) • Between opposite sexes / Same Sex Infection with Neisseria gonorrhoeae Fomites  FAIL  Becomes adherent to the urethral epithelium 4. Urethritis f. Burning sensation and frequent urination b. Pregnant women – May infect the eye of her baby during the passage through the birth canal In Males (After 3 – 6 Days incubation period) a. PATHOPHYSIOLOGY Penetration of the mucosa Inflammatory edema of the gland ducts occurs Formation of microabscesses Acute inflammatory response Polymorphonuclear leukocytes in submucosa Larger abscesses form Spread along mucosal surfaces CLINICAL MANIFESTATIONS 1. Pelvic pain and fever OTHER CLINICAL FEATURES VARY ACCORDING TO SITE INVOLVED jcmendiola_Achievers2013 . Endometritis salpingitis or pelvic peritonitis h. In Females a.

Isolated until recovered from disease 6. single dose. Itching e. orally (For 7 days) 3. 3. 5. Uncomplicated Gonorrhea (Adults) • Ceftriaxone 125 – 250 mg.1. 4. Burning and pain c. Tonsilits. Confidentiality 5. IM single dose • Doxycycline 100 mg. M ales = Gram Staining TREATEMENT MODALITIES 1. Therapy may be switched to the following regimens to complete one full week of antimicrobial therapy • Cefixime 400 mg PO. orally (For 7 days) 2. IM and irrigation of infected eye with NSS NURSING MANAGEMENT 1. Rectal Burning DIAGNOSTIC EXAM 1. and pregnant lactating women • Gonococcal Conjunctivitis – Ceftriaxone 1 gram. Purulent discharge d. Pregnant Women • Ceftriaxone 125 – 250 mg. Aqueous Procaine Penicillin = 4 million units IM after (-) Skin test 4. BID  CI: Children. Occasional itching b. Profuse purulent discharge Liver – RUQ Pain Other possible symptoms – Pharyngitis. Females = Culture of specimen (Cervix and Anal Canal): 24 – 72 Hours 2. Urinary frequency and incontinence c. Red and edematous meatus Vulva a. More severe BEFORE PUBERTY and AFTER MENOPAUSE Vagina a. Infants born to mothers (+) positive for gonorrhea: • 1% Silver Nitrate • Or any ophthalmic prophylaxis on both eyes at birth jcmendiola_Achievers2013 . Disseminated Gonococcal Infection (Adults and Adolescents) • Ceftriaxone 1 gram IM or IV q24 hours • Spectinomycin 2 grams IM q12 hours (If allergic to B-lactam antibiotics) 5. adolescents. Engorgement. Standard precautions 4. BID • Ciprofloxacin 500 mg PO. Gonococcal arthritis = Apply moist heat 7. Dysuria b. 2. Urethra a. redness and swelling b. Explain that client is still infectious and can transmit Gonococcal infection until cultures prove (-) 3. Ask the client if he / she has drug sensitivities and WOF AE during therapy (Before therapy) 2. IM single dose PLUS… • Erythromycin 500 mg.

and community) 2. Refrain from sexual intercourse until treatment is completed SIGNS OF GONOCOCCAL OPTHALMIA NEONATORUM Lid edema Bilateral conjunctival edema Purulent discharge (2 – 3 Days after birth) Corneal Ulceration and Blindness = IF LEFT UNTREATED - PREVENTION and CONTROL 1.8. 3. 2. Report all gonorrheal cases 9. eyes. Sex Education (Schools. 4. INCUBATION PERIOD   10 – 90 Days (Average is 3 Weeks) Variable and indefinite PERIOD OF COMMUNICABILITY MODE OF TRANSMISSION 1. tears and urine Mucous Discharges = Nose. Case findings Incidence of gonorrhea must be reported so contacts can be treated NURSING DIAGNOSES • • • • • Altered sexuality pattern Social isolation Knowledge deficit Altered urinary isolation Risk for infection Syphilis (Lues Venereal/Morbus Gallicus)  Chronic. Direct Transmission – Contact with an infected person Congenitally through the placenta Syphilitic baby to a wet nurse / Anyone carelessly handling diapers 2. infectious sexually-transmitted disease that usually begins in the mucous membranes and quickly becomes systemic ETIOLOGIC AGENT Treponema pallidum • Spirochete – Can pass through mucosa / cracks / placentas Discharges = Lesions of the skin or mucous membranes Semen. Indirect Contact – Articles freshly soiled with discharges / blood PATHOPHYSIOLOGY  GAWA jcmendiola_Achievers2013 . blood. 4. 3. 3. genital tract or bowels Surface lesions SOURCES OF INFECTIONS 1.

Involves the Liver = Epigastric pain. enlarged SPLEEN. face and scalp d. Destructive but non-infectious stage b. well-defined and generalized c. Gumma = Chronic. jcmendiola_Achievers2013 . 1 – 10 Years after the infection 2. Late.CLINICAL MANIFESTATIONS 1. Lesions = Uniform size. Develops about 10 years after infection 2. One or more chancres (Painless) that erupt in the genitalia. The Late Syphilis 1. slight fever f. lesions enlarge and erode. HA. Erupt between rolls of fat on: Trunk. N/V. 2/3 of clients asymptomatic until death  Late Syphilis a. Upper Respiratory Tract = Perforation of the nasal septum / palate 3. start as papules. 4. popular. weight loss. soles. Nails – Brittle and pitted Latent Syphilis a. pustular or nodular b. Macular. rolls of fats in the scrotum. No clinical symptoms – But serologic test is reactive b. 3. pink/grayish-white lesions (Condylomata lata) e. Alopecia (Temporary) g. Cardiovascular Syphilis 1. arms. raised edges. then erode) b. Three Subtypes: i. Chancres are often overlooked in females Secondary Syphilis Development of mucocutaneous lesions and generalized lymphadenopathy (Days – 8 weeks after onset) a. and clear bases (Disappears after 3 – 6 weeks even without therapy) c. nipples. Benign Syphilis 1. anus. malaise. Primary Syphilis a. anorexia. asymmetric. Bones / Organs = Destroyed which lead to death (Severe cases) iii. tonsils / eyelids (Painless. Can be found in any bone ii. painless. Perineum. tenderness. palms. superficial nodule or deep granulomatous lesion (Solitary. endurated) a. anemia 2. Chancres have endurated. sore throat. vulva.

4 million units/week x 3weeks) 4. Autopsy = Spleen and Liver ENLARGED. Liver and Spleen  Protuberant abdomen (Enlargement of the liver and spleen)  Liver cells are immature and imperfectly formed  Hepatic insufficiency = Failure of protein metabolism Late Congenital Syphilis a. followed by vascular infiltration  Severe lesions – Corneal scarring (Opacities lead to slight impairment / complete blindness) 2. More than a year duration – Penicillin G benzathine (2. Early Syphilis – Penicillin G benzathine IM (2. 3. Macerated appearance (Collapsed skull and protuberant abdomen) c. mouth. Early Congenital Syphilis a. 3. Cardiovascular Syphilis – WOF signs of ↓ CO (↓ Sensorium and UO and hypoxia) and pulmonary congestion jcmendiola_Achievers2013 . Dark Field Illumination – Most effective if lesions present Fluorescent Treponemal Antibody Absorption Test VDRL Slide Test and Rapid Plasma Reagent Test CSF Analysis MODALITIES OF TREATMENT 1. NURSING MANAGEMENT 1. 3. DIAGNOSTIC PROCEDURES 1. Stress – Importance of completing the treatment even after the symptoms subside 2. wrinkling of skin “Old man look”  Syphilitic papules – Skin at the base of nails. Instruct infected individuals to inform their partner to be treated Universal precaution 4. nasal passages b. 30 days for late) Abstain from sexual contact until infection has healed (Can’t during treatement) 2.4 million units) Allergy to Penicillin  Oral Tetracycline / Doxycycline (15 days for early. Skin = Livid red color. Fetus Ö Overwhelmed by infection and die Ö Will be expelled by the uterus (Miscarriage / stillbirth) b. number of bullae filled with hemorrhagic fluid d. 2. Asymptomatic but may suffer from aortic regurgitation and 5. throat. thickening of intestines e. May still show alterations in fetal development at various stages CLINICAL MANIFESTATIONS 1.2. Secondary Syphilis – Keep lesions dry 5. Interstitial Keratitis – Commonest late lesion  4 – 60 years old or even later  Circomcorneal Vascularization. nails may be loosened and shed (Syphilitic Nonychia)  Mucous patches = Lips. 4. Lesions of the skin and mucous membranes  “Syphilitic Pemphigus” – Bullous rash  Loss of weight. aneurysm Congenital Syphilis a. Pancreatitis.

feeling and appearing healthy for years (Immune system starts to be impaired) May exhibit neurological symptoms: (AIDS-Related Complex ARC) o Memory loss. 5. Control prostitution 3. and 24 months if any relapse 8. tonsillopharyngitis) Clinical Stage 3: Intermediate (Moderate) o Weight loss (Greater than 10%) o Diarrhea (More than one month) o Oral candidiasis (Thrush) o o Oral hairy leukoplakia  White patches Severe bacterial infection (E. Report Cases 2. 12.6. 6. 6. 3.g. WOF: Ataxia 7. Neurosyphilis – Assess LOC. coherence. 2. Require sex workers to have regular check-ups  LOL 4. Proper sex education Contact tracing NURSING DIAGNOSES 1. depression PATHOPHYSIOLOGY jcmendiola_Achievers2013 . Encourage to undergo VDRL Testing after 3. 4. pneumonia) Clinical Stage 4: Late (Severe) AIDS o HIV wasting syndrome  o o Pneumonia – Pneumocystis carinii Toxoplasmosis of the brain Cryptosporidiosis with diarrhea for more than one month Herpes simplex virus Multifocal leukoencephalopathy Disseminated endemic mycosis o o o o SIGNS AND SYMPTOMS   Asymptomatic. mood. altered gait. Report all cases PREVENTION and CONTROL 1. 5. Altered sexual pattern Self-esteem disturbance Social isolation Knowledge deficit Impaired skin integrity Anxiety Acquired Immune Deficiency Syndrome (AIDS)   Aids involves an immune deficiency HIV – Causes AIDS o Retrovirus belonging to the family of lentiviruses o Lentiviruses = ‘Slow Viruses’ MODIFIED CLASSIFICATION (STAGES) OF HIV INFECION   Clinical Stage 1: Asymptomatic – CD4 Count of <500 o Acute HIV infection o Characterized by: General lymphadenopathy Clinical Stage 2: Early (Mild) o Weight loss greater than 10% in a month (GIT can’t absorb nutrients) o Minor mucocutaneous manifestations:  Seborrhic dermatitis  Fungal nail infection  Recurrent oral ulcerations  Angular cheilitis – Inflammation of the tongue   Recurrent respiratory infection (Rhinitis.

GI Symptoms (Diarrhea)   Normal CD4 Count: 500 – 1.500 (T lymphocytes) Normal Viral Load: 10. 8. 10. 1. 5. jcmendiola_Achievers2013 . 3. 2. 7. 3. 2. Depression Diarrhea Thrush Weight loss Lipodystrophy (Fat distribution syndrome) Sinus infection Fatigue N/V Lactic Acidosis – Damage in the mitochondria Burning and tingling sensation of feet and hands 9.000 – 100. 6. MAJOR SIGNS Loss of weight – 10% of body weight Chronic Diarrhea – More than one month Prolonged Fever – For on month TOP 10 SYMPTOMS OF HIV/AIDS 1. Persistent cough (1 month) Pruritic Dermatitis (Generalized) Herpes Zoster Infection (Recurrent) Orophyaryngeal candidiasis Chronic Disseminated Herpes Simplex Infection Lymphadenopathy (Generalized) 6. 4. 3. 4.o Sleep disorders. 2. 5.000 MINOR SIGNS 1.

Can Cause: Retinitis. 5. Viral a. sharing of infected syringes / needles among IV drug users Vertical / Perinatal transmission Several ways of receiving infected blood a. Transplacental d. c. Toxoplasmosis – Parasitic infection causing neurologic symptoms b. 3. Blood transfusions b. Pneumocystis carinii pneumonia (PCP) Cancers a. Abdominal cramps 3. Watery diarrhea 2. blood and breast-milk Molluscum contagiosum – Produces oral thrush (Dome-shaped papules) 4. Fungal a. pain on swelling. 2. Cryptococcal meningitis c. Bacterial b. Sexual intercourse Blood transfusion. Cryptosporidiosis – Cryptosporidium also known as Crypto i. Kaposi’s Sarcoma – Cancerous lesion (Due to overgrowth of blood vessels) b. transmitted by direct contact Pneumonias a. i. b. jcmendiola_Achievers2013 . 6. Handwashing 2. Organ donation e. MAC – Mycobacterium avium complex (TB-like manifestations) Tuberculosis Salmonillosis Herpes Hepatitis Genital warts CMV (Cytomegalovirus) d. Candidiasis b. e. Cervical Dysplasia and Cancer  Cervical Carcinoma = Associated with HPV (Human Papilloma Virus) c. Non-Hodgkin’s Lymphoma – Cancerous tumor of the lymph nodes (Late manifestation of HIV infection) Parasitic a. Transmitted: Semen. Wash/Cook Food properly 5. Bacterial a. Sharing of syringes and needles c. EIA or ELISA Particle Agglutination (PA) Test Western Blot Analysis – Confirmatory Immunofluorescent Test Radio Immuno-Precipitation Assay (RIPA) 4. Safe sex 3. Histoplasmosis – Skin lesions. 2. Preventive Measures Against Crypto 1.COMMON OPPURTUNISTIC INFECTIONS 1. numbness of legs ii. Drink safe water MODE OF TRANSMISSION 1. 3. 4. Low-grade fever 4. b. c. Weight loss – Due to persistent diarrhea ii. Careful not to swallow water when swimming 4. 5. vaginal secretions. 3. Signs and Symptoms 1. Accidental exposure in hospitals / clinics DIAGNOSTIC EXAMINATIONS 1. 2.

Ritonavir – Norvir iii. For proper management. interpartal and postpartal care 2. 1. Zalcitabine – Havid iii. Zedovudine (ZDV) – Retirvir ii. 2. identify previous contacts Practice Universal / Standard Precaution a. Consistent and concise in giving instructions f. Indinavir – Crixivan 2. Avoid accidental pricks b. Avoid judgmental and moralistic messages e. Through medical handwashing before and after contact with patients b. 3. Nevirapine – Viramune vi. but slows its progression and prolongs life  Reverse transcriptase  These drugs are: i. Needles should be disposed into a puncture resistant container f. Blood spills should be cleaned using common household disinfectants (Chlorox) e. HIV Antibody Test a. Didanosine – Videx Protease Inhibitors – Inhibit protease which are needed for assembly of viral particles  These Drugs are: i.6. Personal articles are not shared with others g. Lamivudine – Epivir v. Positive statement g. Label the specimens with “AIDS Precaution” d. Practical advise b. 3. Speak openly with partner(s) about safe sex techniques and HIV status THE FOUR Cs IN THE MANAGEMENT OF HIV/AIDS Compliance – Client sticks with the program Counseling / Education Contact Tracing – Tracing and providing treatment to partners Condoms NURINSG DIAGNOSES ● ● ● ● Knowledge deficit Social Isolation Risk for Infection Anxiety jcmendiola_Achievers2013 . NURSING MANAGEMENT 1. Saquinavir – Invarase ii. Health teaching about the mode of transmission c. Encourage monogamous relationships j. Health Education a. HIV Positive but UNDETECTED (Window Phase) TREATMENT MODALITIES 1. 7. Stavudine – Zerit iv. Present in blood – Positive Antibody Test (HIV Positive) Serum Conversion Test a. Reverse Transcriptase Inhibitors  Cannot kill the virus. Gloves = Worn when handling blood specimens and other body secretions c. Universal barriers / Personal Protective Equipment (PPE) Prevention a. AIDS Awareness Program d. Risk for HIV – Not allowed to donate blood / any organ of the body i. HIV-infected pregnant woman – Regular prenatal. Isolation h. Not detectable – Negative Antibody Test b. k. 4.

● ● Self-esteem disturbance Altered role performance jcmendiola_Achievers2013 .

Sign up to vote on this title
UsefulNot useful