You are on page 1of 13

COMMUNICABLE DISEASE NURSING CHAIN OF INFECTION

SUMMER REVIEW

COMMUNICABLE DISEASE
Disease caused by an infectious agent that are transmitted directly
or indirectly to a well person through an agency, vector or inanimate
object

CONTAGIOUS DISEASE
Disease that is easily transmitted from one person to another
INFECTIOUS DISEASE
Disease transmitted by direct inoculation through a break in the INFECTIOUS AGENT
skin Any microorganism capable of producing a disease
RESERVOIR
INFECTION
-Entry and multiplication of an infectious agent into the tissue of the
Environment or object on which an organism can survive and
multiply
host
PORTAL OF EXIT
INFESTATION
- Lodgement and development of arthropods on the surface of the The venue or way in which the organism leaves the reservoir
body MODE OF TRANSMISSION
The means by which the infectious agent passes from the portal of
ASEPSIS exit from the reservoir to the susceptible host
- Absence of disease – producing microorganisms PORTAL OF ENTRY
SEPSIS Permits the organism to gain entrance into the host
- The presence of infection SUSCEPTIBLE HOST
A person at risk for infection, whose defense mechanisms are
MEDICAL ASEPSIS
unable to withstand invasion of pathogens
-Practices designed to reduce the number and transfer of pathogens
-Clean technique STAGES OF THE INFECTIOUS PROCESS
SURGICAL ASEPSIS Incubation Period – acquisition of pathogen to the onset of signs
-Practices that render and keep objects and areas free from and symptoms
microorganisms Prodromal Period – patient feels “bad” but not yet experiencing
-Sterile technique actual symptoms of the disease
Period of Illness – onset of typical or specific signs and symptoms
CARRIER – an individual who harbors the organism and is capable of a disease
of transmitting it without showing manifestations of the disease Convalescent Period – signs and symptoms start to abate and
CASE – a person who is infected and manifesting the signs and client returns to normal health
symptoms of the disease
MODE OF TRANSMISSION
CONTACT TRANSMISSION
SUSPECT – a person whose medical history and signs and Direct contact – involves immediate and direct transfer from
symptoms suggest that such person is suffering from that particular person-to-person (body surface-to-body surface)
disease
Indirect contact – occurs when a susceptible host is exposed to a
CONTACT – any person who had been in close association with an contaminated object
infected person DROPLET TRANSMISSION
Occurs when the mucous membrane of the nose, mouth or
HOST conjunctiva are exposed to secretions of an infected person within a
- A person, animal or plant which harbors and provides nourishment distance of three feet
for a parasite VEHICLE TRANSMISSION
RESERVOIR Transfer of microorganisms by way of vehicles or contaminated
- Natural habitat for the growth, multiplication and reproduction of items that transmit pathogens
microorganism AIRBORNE TRANSMISSION
ISOLATION
Occurs when fine particles are suspended in the air for a long time
- The separation of persons with communicable diseases from other or when dust particles contain pathogens
persons VECTOR-BORNE TRANSMISSION
QUARANTINE Transmitted by biologic vectors like rats, snails and mosquitoes
- The limitation of the freedom of movement of persons exposed to
communicable diseases TYPES OF IMMUNIZATION
ACTIVE – antibodies produced by the body
STERILIZATION – the process by which all microorganisms NATURAL – antibodies are formed in the presence of active
including their spores are destroyed infection in the body; lifelong
ARTIFICIAL – antigens are administered to stimulate antibody
DISINFECTION – the process by which pathogens but not their production
spores are destroyed from inanimate objects
PASSIVE – antibodies are produced by another source
CLEANING – the physical removal of visible dirt and debris by NATURAL – transferred from mother to newborn through placenta
washing contaminated surfaces or colostrum
ARTIFICIAL – immune serum (antibody) from an animal or human
CONCURRENT is injected to a person
- Done immediately after the discharge of infectious materials /
secretions SEVEN CATEGORIES OF ISOLATION
TERMINAL
STRICT- prevent highly contagious or virulent infections
- Applied when the patient is no longer the source of infection
Example: chickenpox, herpes zoster
BACTERICIDAL CONTACT – spread primarily by close or direct contact
- A chemical that kills microorganisms Example: scabies, herpes simplex
BACTERIOSTATIC RESPIRATORY – prevent transmission of infectious distances
- An agent that prevents bacterial multiplication but does not kill over short distances through the air
microorganisms
Example: measles, mumps, meningitis

CD-Bucud 1
TUBERCULOSIS – indicated for patients with positive smear or
chest x-ray which strongly suggests tuberculosis
ENTERIC – prevent transmission through direct contact with feces SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA
Example: poliomyelitis, typhoid fever
DRAINAGE – prevent transmission by direct or indirect contact with
purulent materials or discharge DIC
Ex. Burns
UNIVERSAL – prevent transmission of blood and body-fluid borne URTI: Micro-
Vasculitis:
pathogens cough, sore thrombosis
petechial
Example: AIDS, Hepatitis B throat,
rash in the Purpura
fever,
CENTRAL NERVOUS SYSTEM trunk and
headache, Hypotension
extremities
nausea and
ENCEPHALITIS MENINGITIS MENINGO- vomiting Shock
COCCEMIA
Death
MAIN PROBLEM
- Acute infection of
- Inflammation of - Inflammation of the bloodstream and
the brain the meninges developing vasculitis ENCEPHALITIS MENINGITIS MENINGO-
COCCEMIA
ETIOLOGIC AGENT - Streptococcus
- Arboviruses - Staphylococcus SIGNS AND SYMPTOMS Vasculitis
- Pneumococcus
- Tubercle bacillus Stiff neck Nuchal rigidity Waterhouse-
INCUBATION PERIOD - Neisseria meningitides Photophobia Opisthotonus Friderichsen
syndrome
5-15 days 1-10 days 3-4 days Lethargy Brudzinski’s
MODE OF TRANSMISSION Petechiae with
Bite of infected Convulsions Kernig’s sign the development
Respiratory droplets
mosquito of hemorrhage
INCIDENCE
SIGNS AND SYMPTOMS OF ENCEPHALITIS
5-10 years old < 5 years old 6 months–5
Virus enters neural cells years old

DIAGNOSTIC EXAM
 Informed consent
Disruption in Perivascular Inflammatory
 Empty bowel and bladder
cellular congestion reaction
 Fetal, shrimp or “C” position
functioning  Spinal canal, subarachnoid space between L3-L4 or L4- L5
 After: bedrest
Lethargy Headache Fever  Flat on bed to prevent spinal headache
Convulsions Photophobia Sore throat ENCEPHALITIS MENINGITIS MENINGO-
Seizures Vomiting COCCEMIA
Stiff neck TREATMENT MODALITIES

Dexamethasone Ceftriaxone

Mannitol Penicillin
SIGNS AND SYMPTOMS OF MENINGITIS Anticonvulsants Chloramphenicol
Antipyretics

PREVENTION

1. Japanese 1. HiB vaccine Rifampicin


encephalitis
Ciprofloxacin
VAX
ENCEPHALITIS MENINGITIS MENINGO-
COCCEMIA
NURSING MANAGEMENT
1. Side boards
1. Comfort: quiet, 1. Respiratory 2. Close contacts
well-ventilated isolation 24-72
room hours after onset H – ouse
THREE SIGNS OF MENINGEAL IRRITATION of antibiotic
2. Skin care: I – nfected person
OPISTHOTONUS therapy
cleansing bath, kissing
State of severe hyperextension and spasticity in which an individual’s
head, neck and spinal column enter into a complete arching position change in 2. Room protected S – ame daycare
BRUDZINSKI’S SIGN position against bright center
Place the patient in a dorsal recumbent position and then put hands lights
behind the patient’s neck and bend it forward. 3. Eliminate S – hare mouth
If the patient flexes the hips and knees in response to the mosquito instruments
3. Safety: side-lying
manipulation, positive for meningitis breeding sites:
position and 3. Antibiotics as
KERNIG’S SIGN CULEX
raised side rails prophylaxis
Place the patient in a supine position, flex his leg at the hip and knee mosquito
then straighten the knee; pain and resistance indicates meningitis

CD-Bucud 2
POLIOMYELITIS RABIES TETANUS RABIES
PRODROMAL/INVASION PHASE
 Fever
MAIN PROBLEM  Anorexia
 Sore throat
Acute infection of Acute viral disease Acute infectious
the CNS – muscle of the CNS – by disease with systemic  Pain and tingling at the site of bite
spasm, paresis and saliva of infected neuromuscular  Difficulty swallowing
paralysis animals effects EXCITEMENT OR NEUROLOGICAL PHASE
 Hydrophobia (laryngospasm)
ETIOLOGIC AGENT Rhabdovirus Clostridium tetani  Aerophobia (bronchospasm)
 Delirium
Legio debilitans Bullet-shaped Anaerobic  Maniacal behavior
Affinity to CNS Gram positive  Drooling
Killed by sunlight, TERMINAL OR PARALYTIC PHASE
Drumstick
UV light, formalin  Patient becomes unconscious
appearance
 Loss of urine and bowel control
Resistant to  Progressive paralysis
antibiotics  Death
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
INCUBATION PERIOD
2-8 weeks
COMPLICATION
7-21 days Distance of bite to Adult: 3 days-3
weeks Paralysis of RESPIRATORY
brain DEATH
respiratory muscles FAILURE
Extensiveness of the Neonate: 3-30 days
bite
DIAGNOSTIC PROCEDURES
Resistance of the
1. Throat washings 1. Blood exam
host 1. Stool culture
MODE OF TRANSMISSION 2. Flourescent rabies
2. CSF culture antibody (FRA)
- Direct contact with
infected feces 3. Negri bodies
Bite of an infected Direct inoculation
- Direct contact with
respiratory secretions
animal through a broken ISOLATION PRECAUTION
skin
- Indirect with soiled Enteric isolation Respiratory
linens and articles isolation
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS

SIGNS AND SYMPTOMS R – isus sardonicus TREATMENT MODALITIES 1. Tetanus immune


1. Abortive type 1. Prodromal / O – pistothonus 1. Analgesics 1. Local globulin (TIG)
invasion treatment of 2. Tetanus antitoxin
2. Pre-paralytic phase 2. Morphine
T – rismus wound (TAT)
or meningetic
3. Moist heat 3. Penicillin G
type 2. Excitement / C – onvulsions 2. Active
application
neurological immunization 4. Tetracycline
3. Paralytic type H – eadache
phase 4. Bed rest 5. Diazepam
Lyssavac
3. Terminal / I – rritability 5. Rehabilitation Imovax
6. Phenobarbital
paralytic type 7. Tracheostomy
L – aryngeal Antirabies vax
spasm 8. NGT feeding
2. Passive
immunization
POLIO POLIOMYELITIS RABIES TETANUS
ABORTIVE TYPE
 Does not invade the CNS
 Headache NURSING MANAGEMENT
 Sore throat 1. Enteric isolation 1. Isolation 1. Adequate airway
 Recovery within 72 hours and the disease passes by unnoticed
2. Proper disposal 2. Quiet, semi-dark
PRE-PARALYTIC OR MENINGETIC TYPE 2. Optimum
of secretions comfort environment
 Slight involvement of the CNS
 Pain and spasm of muscles 3. Moist hot packs 3. Restful 3. Avoid sudden
 Transient paresis environment stimuli and light
 (+) Pandy’s test (increased protein in the CSF) 4. Firm /
PARALYTIC TYPE nonsagging bed 4. Emotional
 CNS involvement 5. Suitable body support
 Flaccid paralysis alignment 5. Concurrent
 Asymmetric and terminal
6. Comfort and
 Affects lower extremities disinfection
safety
 Urine retention and constipation
 (+) HOYNE’S SIGN (when in supine position, head will fall back
when shoulders are elevated)

CD-Bucud 3
POLIOMYELITIS RABIES TETANUS BIRD FLU SARS
TREATMENT MODALITIES
PREVENTION 1. Aseptic
1. If the dog is
1. Amantadine/Rimantadine 1. No definitive treatment
Salk vaccine healthy handling of for SARS
umbilical cord - Generic flu drugs
2. If the dog dies or
- Inactivated shows signs - H5N1 developed resistance 2. Antiviral drugs
polio vaccine suggestive of 2. Tetanus toxoid (normally used to treat
rabies immunization 2. Oseltamivir (TAMIFLU) AIDS)
- Intramuscular Zanamavir (RELENZA)
3. If dog is not 3. Antibiotic - RIBAVIRIN
Sabin vaccine available for prophylaxis - Primary treatment
- Oral polio
observation - Within 2 days at onset of 3. Corticosteroids
- Penicillin symptoms
vaccine 4. Have domestic
dog 3 months to - Erythromycin - 150 mg BID x 2 days
- Per orem 1 year old
immunized - Tetracycline

BIRD FLU SARS


RESPIRATORY SYSTEM PREVENTION

1.Culling – killing of 1.Quarantine


BIRD FLU SARS sick or exposed
MAIN PROBLEM birds 2. Isolation
A new type of atypical pneumonia
Flu infection in birds that
affects humans that infects the lungs 2. Banning of 3. WHO alert
importation of on SARS
ETIOLOGIC AGENT
birds (Executive
Avian influenza virus, H5N1 Corona virus
order # 280)
(March 12,
2003)
INCUBATION PERIOD 3. Cook chicken
3-5 days 2-8 days thoroughly
MODE OF TRANSMISSION
NURSING MANAGEMENT
Inhalation of feces and Respiratory droplets BIRD FLU
discharge of an infected bird WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD
FLU
• Isolation
BIRD FLU SARS • Face mask on the patient
SIGNS AND SYMPTOMS • Caregiver: use a face mask and eye goggles/glasses
• Distance of 1 meter from the patient
Body weakness or muscle • Transport the patient to a DOH referral hospital
pain
Cough REFERRAL HOSPITALS
• National Referral Center – Research Institute for Tropical
Difficulty breathing Medicine (RITM) (Alabang, Muntinlupa)

Episodes of sore throat • Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz,
Manila)
Fever • Visayas – Vicente Sotto Memorial Medical Hospital
(Cebu City)
High fever >38’Celsius • Mindanao – Davao Medical Center (Bajada, Davao City)
SARS
Chills SUSPECT CASE
1. A person presenting after 1 November 2002 with a history of:
BIRD FLU SARS  High fever >38 0C AND
COMPLICATIONS  Cough or breathing difficulty AND
Severe viral pneumonia Severe viral
pneumonia  One or more of the following exposures during the 10 days
Acute respiratory distress prior to the onset of symptoms:
syndrome
 Close contact, with a person who is a suspect or
Hypoxemia probable case of SARS
Fluid accumulation in
alveolar sacs  History of travel, to an area with recent local
transmission of SARS
Respiratory failure  Residing in an area with recent local transmission of
Severe breathing difficulties SARS
2. A person with an unexplained acute respiratory illness resulting
in death after 1 November 2002, but on whom no autopsy has
Multiple organ failure been performed :
AND
 One or more of the following exposures during the 10 days
DEATH prior to the onset of symptoms:
 Close contact, with a person who is a suspect or
probable case of SARS

CD-Bucud 4
 History of travel, to an area with recent local •With profuse sweating, involuntary urination and
transmission of SARS exhaustion
CONVALESCENT STAGE
 Residing in an area with recent local transmission of
• End of 4th-6th week
SARS • Decrease in paroxysms
PROBABLE CASE
1. A suspect case with radiographic evidence of infiltrates consistent DIPHTHERIA PERTUSSIS
with pneumonia or respiratory distress syndrome on Chest x-ray.
DIAGNOSTIC PROCEDURES
2. A suspect case of SARS that is positive for SARS coronavirus by  SCHICK’S TESTS  CBC– increase in
one or more assays. - Susceptibility and immunity to lymphocytes
diphtheria
3. A suspect case with autopsy findings consistent with the -ID of dilute diphtheria toxin (0.1
pathology of SARS without an identifiable cause. cc)
(+) local circumscribed area of
redness, 1-3 cm
DIPHTHERIA PERTUSSIS MALONEY’S TEST
MAIN PROBLEM -Determines hypersensitivity to
Acute bacterial disease diphtheria anti-toxin
Repeated attacks of spasmodic
characterized by the elaboration coughing -ID of 0.1 cc fluid toxoid
of an exotoxin
-(+) area of erythema in 24 hours
ETIOLOGIC AGENT

Corynebacterium diphtheriae or Bordetella pertussis


Klebs-Loeffler bacillus DIPHTHERIA PERTUSSIS
INCUBATION PERIOD
COMPLICATIONS Convulsions (brain
2-5 days 7-14 days Toxins in the bloodstream
damage from
MODE OF TRANSMISSION
asphyxia)
1. Respiratory droplets Myocarditis Peripheral Broncho-

2. Direct contact with respiratory secretions


(epigastric
or chest
paralysis
(tingling,
pneumonia
(fever,
Otitis media
pain) numbness, cough) (invading
3. Indirect contact with articles paresis)
organisms)
DIPHTHERIA PERTUSSIS
Heart Respirat Bronchopneumonia
SIGNS AND SYMPTOMS Decreased
failure in ory
respiratory arrest
(most dangerous
Types: Stages: rate complication)
1.Nasal 1. Catarrhal DEATH
2.Tonsilopharyngeal
2. Paroxysmal DIPHTHERIA PERTUSSIS
3.Laryngeal
3. Convalescent TREATMENT MODALITIES
4.Wound or
cutaneous 1. Diphtheria anti-toxin 1. Erythromycin – drug of
- Requires skin testing choice
- Early administration 2. Ampicillin – if resistant
aimed at neutralizing the to erythromycin
NASAL DIPHTHERIA toxin present in the 3. Betamethasone
• Bloody discharge from the nose circulation before it is (corticosteroid) –
• Excoriated nares and upper lip absorbed by the tissues decrease severity and
TONSILOPHARYNGEAL DIPHTHERIA
2. Antibiotic therapy length of paroxysms
• Low grade fever
• Sore throat - Penicillin G 4. Albuterol
• Bull-neck appearance (bronchodilator)
- Erythromycin
• Pseudomembrane- Group of pale yellow membrane over
tonsils and at the back of the throat as an inflammatory
response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA DIPHTHERIA PERTUSSIS
• Hoarseness NURSING MANAGEMENT
• Croupy cough 1. Isolation: 4-6 weeks from
• Aphonia 1. Isolation: 14 days (until onset of illness
• Membrane lining thickens à airway obstruction
2-3 cultures, 24 hours
apart) 2. Supportive measures
• Suffocation, cyanosis or death
(bedrest, avoid
WOUND OR CUTANEOUS DIPHTHERIA 2. Bedrest for 2 weeks excitement, dust, smoke
• Yellow spots or sores in the skin and warm baths)
3. Care for nose and
PERTUSSIS throat (gentle swabbing) 3. Safety (during
CATARRHAL STAGE 4. Ice collar (decrease pain paroxysms, patient
• Lasts for 1 to 2 weeks of sore throat) should not be left alone)
• Most communicable stage 5. Diet (soft food, small 4. Suctioning (kept at
frequent feedings) bedside for emergency
• Begins with respiratory infection, sneezing, cough and
use)
fever
• Cough becomes more frequent at night
PAROXYSMAL STAGE MUMPS
• Lasts for 4 to 6 weeks MAIN PROBLEM
• Aura: sneezing, tickling, itching of throat An acute contagious disease, with swelling of one or both of the
• Cough, explosive outburst ending in “whoop” parotid glands
ETIOLOGIC AGENT
• Mucus is thick, ends in vomiting Filterable virus of paramyxovirus group
• Becomes cyanotic INCUBATION PERIOD
CD-Bucud 5
12-26 days
MODE OF TRANSMISSION
AMOEBIASIS SHIGELLOSIS
Respiratory droplets SIGNS AND SYMPTOMS
PERIOD OF COMMUNICABILITY
6 days before and 9 days after onset of parotid swelling 1. Acute amoebic dysentery
SIGNS AND SYMPTOMS
Fever
- Diarrhea alternated with
PRODROMAL PHASE constipation Abdominal pain
F-ever (low grade) - Tenesmus
H-eadache
- Bloody mucoid stools Diarrhea and
M-alaise
2. Chronic amoebic tenesmus
PAROTITIS dysentery
F-ace pain
- Enlarged liver Bloody mucoid
E-arache
S-welling of the parotid glands - Large sloughs of intestinal stool
tissues accompanied by
COMPLICATIONS hemorrhage
• Orchitis – the most notorious complication of mumps
• Oophoritis – manifested by pain and tenderness of the AMOEBIASIS SHIGELLOSIS
abdomen
DIAGNOSTIC TESTS
• CNS involvement – manifested by headache, stiff neck,
1. Stool exam
delirium, double vision
• Deafness as a result of mumps 2. Blood exam
NURSING MANAGEMENT
3. Sigmoidoscopy
1. Prevent complications
− Scrotum supported by suspensory
TREATMENT MODALITIES
− Use of sedatives to relieve pain
− Treatment: oral dose of 300-400 mg cortisone followed by 100 1. Metronidazole – drug 1. Cotrimoxazole – drug
mg every 6 hours of choice of choice
− Nick in the membrane
2. Diet 2. Tetracycline
- Soft or liquid diet
- Sour foods or fruit juices are disliked 3. Chloramphenicol
3. Respiratory isolation
4. Comfort: ice collar or cold applications over the parotid glands may
relieve pain AMOEBIASIS SHIGELLOSIS
5. Fever: aspirin, tepid sponge bath
6. Concurrent disinfection: all materials contaminated by these NURSING MANAGEMENT
secretions should be cleansed by boiling 1.Enteric isolation
7. Terminal disinfection: room should be aired for six to eight hours
2. Boil water for
drinking
GASTROINTESTINAL TRACT
3. Handwashing
AMOEBIASIS SHIGELLOSIS 4. Sexual activity
MAIN PROBLEM 5. Avoid eating
Acute infection of the lining uncooked leafy
Protozoal infection of the large
intestine
of the small intestine vegetables
ETIOLOGIC AGENT
Entamoeba histolytica Shigella group
- Prevalent in areas with ill 1. Shigella flesneri – most
sanitation common in the Philippines CHOLERA TYPHOID FEVER
-Acquired by swallowing 2. Shigella connei MAIN PROBLEM

- Trophozoites: vegetative form 3. Shigella boydii Acute bacterial disease of the An infection affecting the
GIT characterized by profuse Peyer’s patches of the small
- Cyst: infective stage 4. Shigella dysenterae – most
secretory diarrhea intestines
infectious type
ETIOLOGIC AGENT

Vibrio cholerae Salmonella typhi


INCUBATION PERIOD

1 to 3 days 1 to 3 weeks
MODE OF TRANSMISSION

1. Fecal-oral transmission
2. 5 F’s

CD-Bucud 6
CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
SIGNS AND SYMPTOMS
Fever (ladder-like) PERIOD OF COMMUNICABILITY

Rice-water stool One day before eruption


Rose spots One day before eruption
of 1st lesion and five days
Abdominal cramps of 1st rash and five to six
Diarrhea after appearance of last
days after the last crust
Vomiting crop
TYPHOID STATE
SIGNS AND SYMPTOMS
Intravascular Sordes
PRODROMAL
Dehydration
Subsultus Tendinum PERIOD
Shock Coma vigil
- Fever (low-grade)
- Headache
Carphologia
- Malaise

CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER


TREATMENT MODALITIES • Rashes
SIGNS AND SYMPTOMS
1.Chloramphenicol –
1.Lactated Ringer’s -Unilateral, band-like
drug of choice • Rashes : Centrifugal distribution
solution distribution -Dermatomal
2. Ampicillin/
2. Oral rehydration Amoxicillin – for •Rash stages: macule - Erythematous base
therapy typhoid carriers papule vesicle - Vesicular, pustular or
3. Antibiotic therapy pustule crust crusting
3. Cotrimoxazole – for •Regional
- Tetracycline – drug severe cases with lymphadenopathy
• Pruritus
of choice relapses •Pruritus
- Cotrimoxazole •Pain – stabbing or
burning
- Chloramphenicol
CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
NURSING MANAGEMENT
COMPLICATIONS
RAMSAY-HUNT
1. Maintain and restore the fluid SYNDROME - Involvement of
SCARRING – most common
and electrolyte balance complication; associated with
the facial nerve in herpes zoster
with facial paralysis, hearing
staphylococcal or streptococcal
2. Enteric isolation infections from scratching
loss, loss of taste in half of the
tongue
3. Sanitary disposal of excreta NECROTIZING FASCIITIS – GASSERIAN
most severe complication GANGLIONITIS –
4. Adequate provision of safe Involvement of the optic nerve
REYE SYNDROME –
drinking water abnormal accumulation of fat in resulting to corneal anesthesia
the liver plus increase of
ENCEPHALITIS – acute
5. Good personal hygiene pressure in the brain resulting to
inflammatory condition of the
coma, therefore leading to
brain
DEATH

INTEGUMENTARY SYSTEM

CHICKENPOX HERPES ZOSTER


MAIN PROBLEM

A highly contagious disease An acute viral infection of


characterized by vesicular the sensory nerve
eruptions on the skin and
mucous membranes
ETIOLOGIC AGENT
Varicella zoster virus
INCUBATION PERIOD

10-21 days 13-17 days


MODE OF TRANSMISSION
1. Droplet method
2. Direct contact
3. Indirect contact

CD-Bucud 7
- Soft palate to mucus membrane
CHICKENPOX HERPES ZOSTER
MEASLES GERMAN MEASLES
TREATMENT MODALITIES

1. Antihistamines – 4. Corticosteroids – anti- SIGNS AND SYMPTOMS ERUPTIVE STAGE


symptomatic relief of itching inflammatory and decreased 2. ERUPTIVE STAGE 1. Rash
pain Rashes
Ex. Diphenhydramine - pinkish, maculopapular
Ex. Prednisone - Elevated papules
(Benadryl) - Begins on the face
- Begin on the face and behind
the ears - Spread to trunk or limbs
2. Analgesics and antipyretics - Spread to trunk and
extremities - No pigmentation or
Ex. Acetaminophen desquamation
Color: Dark red – purplish hue
– yellow brown 2. Posterior auricular and
3. Antiviral agents – for patient to
3. Stage of Convalescence suboccipital
experience less pain and faster lymphadenopathy
resolution of lesions when used within - Desquamation
48 hours of rash onset - Rashes fade from the face
downwards
Ex. Acyclovir (Zovirax)

CHICKENPOX HERPES ZOSTER


MEASLES GERMAN MEASLES
NURSING MANAGEMENT
COMPLICATIONS 1. Encephalitis
Strict isolation
2. Congenital rubella syndrome
Prevent secondary infection (cut Pneumonia - Spontaneous abortion
fingernails short, wear mittens) - Intrauterine growth retardation
Otitis media (IUGR)
Eliminate itching: calamine - Thrombocytopenia purpura
lotions, warm baths, baking soda
paste
Severe diarrhea (leading “blueberry muffin skin”
- Cleft lip, cleft palate, club foot
to dehydration)
- Heart defects (PDA, VSD)
Encourage not going to school:
usually 7 days Encephalitis - Eye defects (Cataract,
glaucoma)
Disinfection of clothes and linen - Ear defects (Deafness)
with nasopharyngeal discharges - Neurologic (microcephaly,
by sunlight or boiling mental retardation, behavioral
disturbances

MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES


TREATMENT MODALITIES
MAIN PROBLEM

A contagious exanthematous A benign communicable 1.Vitamin A – helps 1. Aspirin – help reduce


disease with chief symptoms to exanthematous disease caused prevent eye damage inflammation and
the upper respiratory tract by rubella virus and blindness fever
ETIOLOGIC AGENT 2. Antipyretics – for
Filterable virus of Rubella virus fever
paramyxoviridae
3. Penicillin – given
INCUBATION PERIOD only when secondary
10-12 days 14-21 days infection sets in
MODE OF TRANSMISSION
1. Droplet method
2. Direct contact with respiratory discharges
3. Indirect with soiled linens and articles

MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES


NURSING MANAGEMENT
PERIOD OF COMMUNICABILITY
1. Darkened room to relieve photophobia
4 days before and 5 days after One week before and four days
the appearance of rashes after the appearance of rashes 2. Diet: should be liquid but nourishing

SIGNS AND SYMPTOMS 3. Warm saline solution for eyes to relieve


eye irritation
PRE-ERUPTIVE STAGE PRE-ERUPTIVE STAGE
4. For fever: tepid sponge bath and anti-
Cough Fever pyretics
Coryza Headache 5. Skin care: during eruptive stage, soap is
omitted; bicarbonate of soda in water or
Conjunctivitis Malaise lotion to relieve itchiness
Fever (high-grade) Coryza 6. Prevent spread of infection: respiratory
Photophobia Conjunctivitis isolation

KOPLIK’S SPOT (Rubeola)


- Bluish white spots surrounded by a red halo SCABIES
- Appear on the buccal mucosa opposite the premolar teeth MAIN PROBLEM
FORCHEIMER’S SPOTS (Rubella) Infestation of the skin produced by the burrowing action of a parasite
- small, red lesions mite resulting in skin irritation and formation of vesicles and pustules
ETIOLOGIC AGENT
Sarcoptes scabiei
CD-Bucud 8
INCUBATION PERIOD
Within 24 hours
AIDS SYPHILIS
MODE OF TRANSMISSION
Direct contact SIGNS AND SYMPTOMS
Indirect contact
OPPORTUNISTIC INFECTIONS

Sarcoptes scabiei 1. Pneumocystis carinni


1. Yellowish white in color pneumonia
2. Barely seen by the unaided eye
3. Female parasite burrows beneath the epidermis to lay eggs 2. Oral candidiasis
4. Males are smaller and reside on the surface of the skin 3. Toxoplasmosis
SIGNS AND SYMPTOMS
4. Acute/chronic diarrhea
• Thin, pencil-mark lines on the skin
5. Pulmonary tuberculosis
• Itching, especially at night
• Rashes and abrasions on the skin MALIGNANCIES
PRIMARY LESIONS 1. Kaposi’s sarcoma
NODULAR LESIONS
2. Non-Hodgkin’s lymphoma
SECONDARY LESIONS
TREATMENT MODALITIES
• SCABICIDE : Eurax ointment (Crotamiton) AIDS SYPHILIS
• PEDICULICIDE : Kwell lotion (Gamma Benzene
Hexachloride) – contraindicated in young children and SIGNS AND SYMPTOMS 1. PRIMARY SYPHILIS
pregnant women
• Topical steroids - CHANCRE: small, painless,
• Hydrogen peroxide : cleanliness of wound pimple-like ulceration on the
• Lindane Lotion penis, labia majora, minora
NURSING MANAGEMENT and lips
• Apply cream at bedtime, from neck to toes - May erupt in the genitalia,
• Instruct patient to avoid bathing for 8 to 12 hours anus, nipple, tonsils or eyelids
• Dry-clean or boil bedclothes
• Report any skin irritation - Lymphadenopathy
• Family members and close contact treatment
• Good handwashing
• Terminal disinfection

SEXUALLY TRANSMITTED DISEASES

AIDS SYPHILIS AIDS SYPHILIS

SIGNS AND SYMPTOMS 2. SECONDARY SYPHILIS


MAIN PROBLEM
- Skin rash
Final and most serious stage Infectious disease caused
of HIV disease, which causes - Mucous patches
severe damage to the immune
by a spirochete
- Hair loss
system
- CONDYLOMATA LATA:
ETIOLOGIC AGENT
coalescing papules which
Retrovirus – Human T-cell form a gray-white plaque
lymphotropic virus III Treponema pallidum frequently in skin folds
(HTLV-3)

INCUBATION PERIOD

3 to 6 months to 8 to 10 years 10-90 days

AIDS SYPHILIS AIDS SYPHILIS


MODE OF TRANSMISSION SIGNS AND SYMPTOMS 3. TERTIARY SYPHILIS
• Sexual contact – oral, anal or - 1 to 10 years after infection
vaginal sex - Appear on the skin, bones,
mucus membrane, URT, liver
•Blood transfusion and stomach

•Mother-to-child - GUMMA: chronic, superficial


nodule or deep
•Indirect contact through soiled granulomatous lesion that is
solitary, painless, indurated
articles

CD-Bucud 9
AIDS SYPHILIS CHLAMYDIA GONORRHEA
DIAGNOSTIC PROCEDURES COMPLICATIONS
Women

1.ELISA 1.Dark Field Pelvic inflammatory


disease
Illumination test Ectopic pregnancy
2. Western blot
Sterility
2. Flourescent
3. RIPA
Treponemal Men

4. PCR Antibody Epididymitis

Absorption Test Newborn


Sterility
Conjunctivitis Newborn
3. VDRL Otitis media Gonococcal ophthalmia
Pneumonia

AIDS SYPHILIS CHLAMYDIA GONORRHEA


TREATMENT MODALITIES TREATMENT MODALITIES
1. Penicillin G Benzathine 1. Cefixime
1. Antivirals - Disease < 1 year: 2.4 M units 1. Azithromycin
once in two injection sites (Zithromax) - Drug of choice
- Shorten the clinical
- Disease > 1 year: 2.4 M units because of oral
course, prevent - Drug of choice because
in 2 injection sites x 3 doses efficacy, single dose
complications, prevent of single-dose treatment
development of 2. Doxycycline – if allergic to effectiveness and lower
penicillin
2. Ciprofloxacin
latency, decrease cost
transmission 3. Tetracycline 3. Ceftriaxone
2. Doxycycline
- if allergic to penicillin
- Example: Zidovudine - Secondary drug of 4. Erythromycin
- Contraindicated for
(Retrovir) pregnant women choice

CANDIDIASIS HERPES SIMPLEX

CHLAMYDIA GONORRHEA MAIN PROBLEM


A viral disease
Mild superficial fungal characterized by the
MAIN PROBLEM
appearance of sores and
Sexually transmitted disease caused by a bacteria infection
blisters on the skin
Purulent inflammation of mucous
ETIOLOGIC AGENT
membrane surfaces
ETIOLOGIC AGENT Herpes simplex virus
Chlamydia trachomatis Neisseria gonorrhea
Candida albicans types 1 and 2
INCUBATION PERIOD INCUBATION PERIOD
2-3 weeks (males)
2-10 days
2-3 weeks 2-12 days
Asymptomatic (females)
MODE OF TRANSMISSION

Sexual contact: Oral, vaginal or anal sex


CANDIDIASIS HERPES SIMPLEX

CHLAMYDIA GONORRHEA MODE OF TRANSMISSION


1. Rise in glucose as in TYPE 1
SIGNS AND SYMPTOMS Women diabetes mellitus - Respiratory droplets
Women Bleeding after intercourse
2. Lowered body - Direct exposure to
Abdominal or pelvic pain Burning sensation during resistance as in cancer infected saliva
Bleeding after intercourse and urination
in-between menses Yellow or bloody vaginal 3. Increase in estrogen - Kissing and sharing
Unusual vaginal discharge discharge level in pregnant women utensils
4. Broad-spectrum TYPE 2
Men
antibiotics are used
Burning with urination - Sexual or genital
contact
Swollen, painful testicles
White, yellow or
Discharge from the penis green pus from the SIGNS AND SYMPTOMS (Candidiasis)
penis ONYCHOMYCOSIS
• Red, swollen darkened nailbeds
• Purulent discharge
• Separation of pruritic nails from nailbeds
DIAPER RASH
• Scaly, erythematous, papular rash
• Covered with exudates
CD-Bucud 10
• Appears below the breasts, between fingers, axilla, groin
and umbilicus
THRUSH
• Cream-colored or bluish-white patches on the tongue,
mouth or pharynx
• Bloody engorgement when scraped
MONILIASIS
• White or yellow discharge
• Pruritus
• Local excoriation
• White or gray raised patches on vaginal walls with local
inflammation
CANDIDIASIS HERPES SIMPLEX
TREATMENT MODALITIES

1. Antifungals 1. Antivirals
- Fluconazole (Diflucan) - Acyclovir (Zovirax)
- Ketoconazole (Nizoral)
- Imidazole (Nystatin)
- Used for oral thrush
- 48 hours until
symptoms disappear
- Cotrimoxazole

CD-Bucud 11
VECTOR-BORNE DISEASES DENGUE MALARIA

DENGUE MALARIA DIAGNOSTIC PROCEDURES 1. CLINICAL DIAGNOSIS

1. TORNIQUET TEST - Based on triad symptoms, 50%


accuracy
MAIN PROBLEM - Screening test for dengue
2. BLOOD SMEAR
An acute febrile disease An acute and chronic parasitic - A test for the tendency for blood
capillaries to break down or produce - Definitive diagnosis of infection is
disease petechial hemorrhage based on demonstration of malaria
The most common arboviral - Performed by examining the skin of
parasites in blood film
illness transmitted globally The most deadly vector-borne the forearms after the arm veins 3. RAPID DIAGNOSTIC TEST
disease in the world have been occluded for 5 minutes
- Uses immunochromatographic
ETIOLOGIC AGENT - To detect unusual capillary fragility methods to detect Plasmodium-
Dengue virus types 1, 2, 3 and 4 Plasmodium falciparum 2. PLATELET COUNT
specific antigens
- Takes about 7 to 15 minutes
Chikungunya virus Plasmodium vivax - Confirmatory test for dengue
- Sensitivity and specificity > 90%
- Decreased count is confirmatory
O’nyong’nyong virus Plasmodium ovale

West Nile virus Plasmodium malariae DENGUE MALARIA

DENGUE MALARIA TREATMENT MODALITIES 1. Chloroquine


1. Analgesics and antipyretics
2. Primaquine
INCUBATION PERIOD P. Falciparum – 12 days - acetaminophen
3. Pyrimethamine
3-14 days P. Vivax – 14 days 2. Volume expanders
- Used in the treatment of 4. Sulfadoxine
P. Ovale – 14 days intravascular volume deficits
5. Quinine
P. Malariae – 30 days - Example: Lactated Ringers
MODE OF TRANSMISSION 6. Quinidine
3. Blood transfusion – for severe
bleeding
Bite of an infected mosquito
4. Oxygen therapy
Blood transfusion, contaminated
syringe or needle 5. Sedatives

Trans-placentally
SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
MAIN PROBLEM
VECTOR A slowly progressive disease A zoonotic infectious disease
caused by a blood fluke
Aedes aegypti Anopheles flavirostris
ETIOLOGIC AGENT
(Aedes albopictus)
1. SCHISTOSOMA JAPONICUM Leptospira interrogans
White stripes on the back and Brown in color - Intestinal tract, endemic in the
legs (Tiger mosquito) Philippines

Day biting (2 hours after sunrise 2. SCHISTOSOMA MANSONI


Night biting (9 PM-3 AM)
and 2 hours before sunset) - Africa

Breeds on clear stagnant water Breeds on clear, flowing and


3. SCHISTOSOMA HAEMATOBIUM
shaded streams
- Middle East countries like Iran and Iraq

Urban-based Rural-based
SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
INCUBATION PERIOD
SIGNS AND SYMPTOMS At least 2 months 7 to 19 days

FEVER FEVER
MODE OF TRANSMISSION
HEADACHE CHILLS
Ingestion
MALAISE PROFUSE SWEATING Skin penetration
RASH Contact with the skin

EPISODES OF
BLEEDING

CD-Bucud 12
SCHISTOSOMIASIS LEPTOSPIROSIS SCHISTOSOMIASIS LEPTOSPIROSIS

VECTOR TREATMENT MODALITIES


1st line drugs
Oncomelania quadrasi 1. Praziquantel (Biltricide)
1. Thrives in fresh water 1. Penicillin G – drug of choice
- Taken for 6 months
stream 2. Doxycycline
- 1 tablet BID for 3 months
2. Clings to grasses and leaves 2nd line drugs
- 1 tablet OD for 3 months
3. Greenish brown in color 3. Ampicillin
4. Size is as big as the smallest 4. Amoxicillin
grain of palay

SCHISTOSOMIASIS LEPTOSPIROSIS FILARIASIS


MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
SIGNS AND SYMPTOMS Septic or Leptospiremic Stage Wuchereria bancrofti
ACUTE STAGE F – ever (remittent Brugia malayi
Brugia timori
1. Cercarial dermatitis H – eadache INCUBATION PERIOD
(swimmer’s itch) 8 to 16 months
M – yalgia
MODE OF TRANSMISSION
2. Katayama syndrome N – ausea Person-to-person by mosquito bites
C - ough ACUTE STAGE
V – omiting
H – eadache and fever • Lymphadenitis (inflammation of lymph nodes)
C – ough
A – norexia and lethargy • Lymphangitis (inflammation of lymph vessels)
C – hest pain • Male genitalia affected leading to funiculitis, epididymitis
R – ash and orchitis (redness, painful and tender scrotum)
CHRONIC STAGE
M - yalgia
• Develop 10-15 years from onset of first attack

SCHISTOSOMIASIS LEPTOSPIROSIS • Hydrocele (swelling of the scrotum)


• Lymphedema (temporary swelling of the upper and lower
extremities)
SIGNS AND SYMPTOMS Immune or Toxic Stage • Elephantiasis (enlargement and thickening of the skin of
the upper and lower extremities, scrotum and breast
CHRONIC STAGE - Lasts for 4 to 30 days
1. Hepatic: pain, abdominal - Iritis, headache, meningeal LABORATORY EXAMINATIONS
distension, hematemesis, melena manifestations • Nocturnal blood examination (NBE) – taken at patient’s
2. Intestinal: fatigue, abdominal pain, residence/hospital after 8PM
- Oliguria, anuria with renal
dysentery
failure • Immunochromatographic test (ICT) – rapid assessment
3. Urinary: dysuria, urinary method; an antigen test done at daytime
frequency, hematuria - Shock, coma and congestive TREATMENT
heart failure
4. Cardiopulmonary: palpitations, • Diethylcarbamazine Citrate (DEC) or HETRAZAN – an
dyspnea on exertion individual treatment kills almost all microfilaria and a good
5. CNS: seizures, headache, back
proportion of adult worms.
pain and paresthesia PREVENTION AND CONTROL
• Measures aimed to control vectors
SCHISTOSOMIASIS LEPTOSPIROSIS • Environmental sanitation such as proper drainage and
cleanliness of surroundings
• Spraying with insecticides
DIAGNOSTIC PROCEDURES PREVENTION AND CONTROL
1. Fecalysis • Measures aimed to protect individuals and families:
• Use of mosquito nets
2. Kato-Katz Technique • Use of long sleeves, long pants and socks
• Application of insect repellants
3. Cercum ova precipitin test
(COPT) • Screening of houses

- Confirmatory test for


schistosomiasis

CD-Bucud 13