GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION INC.
North Osmena, Bulaong, General Santos City
In partial fulfillment of the requirement In NCM 107 LEC
Submitted by: Helen Mae Olita, SN Jennie Rose Abay,SN
Submitted to: Alexander P. Balongoy, RN Clinical Instuctor
September 11, 2013
Communicable Disease Prevention and Control
Other names: Koch’s Disease CA: Mycobacterium tuberculosis, TB bacillus, Koch’s bacillus, Mycobacterium bovis(rod-shaped) MOT: Airborne-droplet and Direct invasion through mucous membranes and breaks in the skin(very rare) Incubation period : 4 – 6 weeks S/Sx: 1.Usually asymptomatic 2.Low-grade afternoon fever 3.Night sweating 4.Loss of appetite 5.W eigh t loss 6.Easy fatigability – due to increased oxygen demand 7.Temporary amenorrhea 8.Productive dry cough 9.Hemoptysis Diagnostic test
Sputum examination or the Acid-fast bacilli(AFB) / sputum microscopy 1.Confirmatory test 2.Early morning sputum about 3-5 cc 3.Maintain NPO before collecting sputum 4.Give oral care after the procedure 5.Label and immediately send to laboratory 6. If the time of the collection of the sputum is unknown, discard
resulti nterpreted after 72 hours Tine test – used for mass screening read after 48hours Interpretation : 0 .Determine the clinical activity of TB.To determine the size of the lesion:a . M i n i m a l – v e r y s m a l l b. whether it is inactive (in control) or active (ongoing) 2. then at school entrance. perform tuberculin testing (PPD). those who are close contacts with an active case. If given at 12months. positive for patients who are HIVpositive or have HIV risk factors and are of unknown HIV status. give BCG if negative. F a r a d v a n c e – l e s i o n i s > 4 c m
Tuberculin Test – purpose is to determine thehistory of exposure to tuberculosis Other names: Mantoux Test – used for single screening. 10 mm or greater – significant in individuals who have normal or mildly impaired immunity
Respiratory precautions • Cover the mouth and nose when sneezing to avoid mode of transmission • Give BCGBCG is ideally given at birth.Chest X-ray is used to: 1.
.Moderately advance – lesion is < 4 cmc .4 mm induration – not significant 5 mm or more – significant in individuals who are considered at risk. and those who have chest x-ray results consistent with tuberculosis .
Ethambutol (E). Streptomycin (S)CATEGORY 1:6months SCC Indications:> new (+) smear > (-) smear PTB withextensive parenchymal severe concominantHIV disease lesionson CXR > Extrapulmonary TB>
Intensive Phase: 2monthsR&I : 1 tab each.• Improve social conditions TREATMENT: SCC/Short Course Chemotherapy. P&E2 tabs each Continuation Phase :4 monthsR&I : 1 tab each CATEGORY 2:8months SCCIndications:> treatment failure> relapse> return after default Intensive Phase :3 mosR&I 1 tab each. P&E2 tabs each Continuation Phase: 4 monthsR&I 1 tab eachCATEGORY 4:Chronic (*Referralneeded)SIDE EFFECTS: Rifampicin • body fluiddiscoloration • hepatotoxic • permanentdiscoloration of contact lenses
. Direct –observed treatment short course/DOTS. Pyrazinamide (Z). Isoniazid (H). P&E 2tabs each Streptomycin – 1vial/day IM for first 2months = 56 vials (if given for > 2mos can cause nephrotoxicity Continuation Phase : 5monthsR&I : 1 tab eachE : 2 tabs CATEGORY 3:6months SCCIndications:> new (-) smear PTB with minimal lesions on CXR Same meds with Category 1 Intensive Phase: 2monthsR&I 1 tab each. Rifampicin (R).
Isoniazid • Peripheral neuropathy(Give VitB6/Pyridoxine) Pyrazinamide • hyperuricemia/gouty arthritis(increase fluid intake)
SIDE EFFECTS: Ethambutol • Optic neuritis • Blurring of vision(Not to be given to children below 6 y.o. short-course) – internationally-recommended TB control strategy Five Elements of DOTS: (RUSAS) R -recording & reporting system enabling outcome assessment of all patients U-uninterrupted supply of quality-assured drugs S-standardized SCC for all TB cases A-access to quality-assured sputum microscopy S-sustained political commitments
. due to inability to complain blurring of vision) • Inability to recognize green from blue Streptomycin • Damage to 8th CN • Ototoxic • Tinnitus • nephrotoxic Most hazardous period for development of clinical disease is the first 6-12 months after infection Highest risk of developing disease is children under 3years old
DOTS Strategy (directly observed treatment.
Criteria to be TB symptomatic
(any three of the following:)* cough/wheezing of 2 weeks or more* unexplained fever of 2 weeks or more* loss of appetite/loss of weight/failure to gain weight/weightfaltering* failure to respond to 2 weeks of appropriate antibiotic therapyfor lower respiratory tract infection* failure to regain previous state of health 2 weeks after a viralinfection or exanthem (e.cases of TB in children are reported and identified in 2instances: (a) patient was screened and was found symptomaticof TB after consultaion (b) patient was reported to have been exposed to an adult TB patient-ALL TB symptomatic children 0-9 y.MANAGEMENT OF CHILDREN WITH TUBERCULOSIS Prevention:
BCG immunization to all infants (EPI) Casefinding: .o. Ten children shall begathered for testing to avoid wastage.
Conditions confirming TB diagnosis (any 3 of the following:)* (+) history of exposure to an adult/adolescent TB case* (+) signs and symptoms suggestive of TB* (+) tuberculin test* abnormal CXR suggestive of TB* Lab findings suggestive or indicative of TB .g.for children with exposure to TB * a child w/ exposure to a TB registered adult patient shallundergo physical exam
and tuberculin testing* a child with productive cough shall be referred for sputumexam. EXCEPT sputum positive child shall be subjected to Tuberculin testing(Note:Only a trained PHN or main health center midwife shall do tuberculin testing and reading which shall be conducted once a week either on a Monday or Tuesday .
P.) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 4 monthsEXTRA-PULMONARY
TBIntensive: 4 anti-TB drugs (RIP&E/S) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 10 monthsPERIOD OF COMMUNICABILITY OFTUBERCULOSIS: contained in thesputum
Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment
Types: nasal pharyngeal
– most common> laryngeal fatal due to proximity toepiglottisCorynebacteriumdiphtheriaKlebbs– most
loffler ***Diphtheria transmission is increased in hospitals. after which tuberculin test shall be repeated Treatment (Child with TB): Short course regimenPULMONARY TBIntensive: 3 anti-TB drugs (R.for (+) sputum smear child. households. and other crowded areas. schools.I. repeat tuberculin test after 3 months* INH chemoprophylaxis for three months shall begiven to children less than 5y. start treatment immediately* TB asymptomatic but (+) tuberculin test and TB symptomatic but (-) tuberculin test shall be referred for CXR examinationfor TB symptomatic children *a TB symptomatic child with either known or unknown exposure to a TB case shall be referredfor tuberculin testing* (+) contact but (-) tuberculin test and unknowncontact but (+) tuberculin test shall be referred for CXR examination*(-) CXR. with (-) CXR.o. Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions Milk has served as a vehicle Incubation Period: 2 – 5 days
100.Abdominal binder to prevent abdominal hernia DPT
.000 .Complete bed
rest3. DOC: Erythromycinor Penicillin 20. Hemophilus pertussis. Bordetella pertussis.000 units IM once only Complication:
>Whooping cough CA: Tusperina No day cough.Avoid pollutants 4.000 -100. Pertussis bacillus MOD: Droplet especially from laryngeal and bronchial secretions Incubation Period: 7 – 10 days but not exceeding 21 days Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting Complication: abdominal hernia
Diagnostic: Bordet-gengou agar test Management: 1.Pseudomembrane – mycelia of the oral mucosa causing formation of white membrane on theoropharynx Bull neck Dysphagia Dyspnea
Diagnostic test: Nose/throat swab Moloney’s test – a test for hypersensitivity to diphtheria toxin Schick’s test – determines susceptibility to bacteria Drug-of-Choice: Erythromycin 20. Bordetgengou bacillus.000 units2.
animal and human feces.Body malaise No specific test.
Other names: Lock jaw Clostridium tetani – anaerobic spore-forming heat-resistant and lives in soil or intestine Neonate: umbilical cord Children: dental caries Adult: punctured wound.Difficulty of sucking 2. Check first for the gag reflex DPT immunization Tetanus toxoid (artificial active) immunization among pregnant women Training and Licensing of midwives/”hilots” Health education of mothers Puncture wounds are best cleaned by thoroughwashing with soap andwater.Excessive crying 3.
. punctured wound
Incubation Period: Varies from 3 daysto 1 month.Stiffness of jaw 4. soil. only a history of punctured wound Treatment:
Antitoxinantitetanus serum (ATS) tetanus immunoglobulin (TIG) (if the patient hasallergy. should be administered in fractional doses) Pen GDiazepam – for muscle spasms Note: The nurse can give fluid provided that the patient is able to swallow. street dust.immunization Booster: 2 years and 4-5yearsPatient should be segregated until after 3weeks from the appearance f paroxysmal cough4. after septic abortion Indirect contact – inanimate objects. sardonic grin Opisthotonus – arching of back For newborn: 1. falling between 7 – 14 days Risus sardonicus (Latin:“devil smile”) – facial spasm. There is risk of aspiration.
Cephalocaudal appearance of maculopapular rashes
.Incidence: highest under 7 years of age Mortality: highest among infants (<6 months) One attack confers definite and prolonged immunity.
Other names: MorbilliRubeola. motor is affected Man is the only reservoir MOD: Fecal – oral route Incubation period: 7 – 21 days – Paralysis. Muscular weakness. RNA containing paramyxovirus Period of Communicability: 4 days before and 5 days after the appearance of rash Droplet secretions from nose and throat Incubation period: 10 days – fever 14 days – rashes appear (8-13 days) 1. Koplik’s spots – whitish/bluish pinpoint patches on the buccalcavity 2. Hoyne’s sign – head lag after 4 months
Diagnostic test: •CSF analysis / lumbar tap • Pandy’s test Management: Rehabilitation involves ROM exercises OPV vaccination Frequent hand washing6. Polio virus. Second attack occasionally occurs
Other name: Infantile paralysis CA: Legio debilitans. Uncoordinated body movement. Enterovirus -attacks the anterior horn of the neuron.
Yellow-colored sclera 4. Stimson’s line – bilateral red line on thelower conjunctiva No specific diagnostic testManagement:Supportive and symptomaticMeasles vaccineDisinfection of soi ledarticles Isolation of cased from diagnosis until about 5-7days after onset of rash7. needs past history of infection to Hepatitis B Hepatitis E – oral-fecal
.Nausea and vomiting 6.Jaundice 3. post-transfusion hepatitis.Joint and Muscle pain 7. oral-fecal Hepatitis B – serum hepatitis.
Other names: serum Hepatitis Incubation period: 45 – 100 days 1.3.Steatorrhea 8. blood and body fluids.Low grade fever Diagnostic test: •Hepatitis B surface agglutination (HBSAg) test Management:> Hepatitis B ImmunoglobulinDiet: high in carbohydrates-Hepatitis B immunization-Wear protected clothing-Hand washing-Observe safe-sex-Sterilize
instruments used in minor surgical-dental procedures-Screening of blood products for transfusion Hepatitis A – infectious hepatitis.Dark-colored urine 9. blood and body fluids Hepatitis D – Delta hepatitis or dormant hepatitis. Right-sided Abdominal pain 2. blood and body fluids Hepatitis C – non-A non-B.Anorexia 5.
Amoebic Dysentery Entamoeba histolytica Protozoan (slipper-shaped body)Fecal-oral route •Abdominal cramping •Bloody mucoid stool •Tenesmus . usually 3 days Rice watery stool Period of Communicability: 7-14 days after onset.Cholera
Other names: El tor Vibrio cholera Vibrio coma Ogawa and Inaba bacteria MOD: Fecal-oral route 5 Fs Incubation Period: Few hours to 5 days. occasionally 2-3 months Diagnostic Test: Stool culture Treatment: Oral rehydration solution (ORESOL) IVF Drug-of-Choice: tetracycline (use straw. Fomites
.Oral tetracycline should beadministered with meals or after milk. Proper handwashing. Feces. Foods. Proper handwashing Proper food and water sanitation Immunization of Chole-vac2.
Shigellosis Other names: BacillarydysenteryShigella bacillus Sh-dysenterae– mostinfectious Sh-flesneri – common inthe Philippines Sh-conneiSh-boydii MOD: Fecal-oral route 5 Fs: Finger. Proper food and water sanitation3. can cause staining of teeth).feeling of incomplete defecation (Wikipedia)Treatment:
Metronidazole (Flagyl) * Avoid alcohol because of its Antabuse effect canc ause vomiting. Flies.
easily digestible foods Proper handwashing Proper food and water sanitation Fly control4. typhi) MOD: Fecal-oral route5 Fs Incubation Period: Usual range 1 to 3weeks. 5 Fs •Fever •Anorexia (early sign) •Headache •Jaundice (late sign) A V i r u s
.Incubation Period: 1 day. average 2weeks •Rose Spots in the abdomen – due to bleeding caused by perforation of the Peyer’s patches • Ladderlike fever Diagnostic Test: Typhi dot – confirmatory test. specimen is feces Widal’s test – agglutination of the patient’s serum Drug-of-Choice: Chloramphenicol Proper handwashing Proper food and water sanitation.
Other names:InfectiousH e p a t i t i s MOD: Fecal-oral route. plenty of fluids.feeling of incomplete defecation (Wikipedia)Drug-of-Choice: Co-trimoxazole Diet: Low fiber.
CA: Salmonella typhosa( plural. usually lessthan 4 days •Abdominal cramping •Bloody mucoid stool •Tenesmus .
average 20-30 days •Clay-colored stool •Lymphadenopathy Complete bed rest – to reduce the breakdown of fats for metabolic needs of liver Lowfat diet.
=PSP IRed tide poisoning)Dinoflagellates Phytoplankton Ingestion of raw
of inadequately cooked seafood usually bivalve mollusks during red tide season Incubation Period: 30 minutes to several hours after ingestion • Numbness of face especially around the mouth •Vomiting and dizziness •Headache •Tinglingsensation/paresthesia andeventful paralysis of hands •Floating sensation andweakness •Rapid pulse •Dysphonia •Dysphagia
. depending on dose. increase carbohydrates (high in sugar)In convalescent period.Prophylaxis:
Hepatitis immunoglobulin Avoid alcohol Proper handwashing Proper food and water sanitation Proper disposal of urine
Hepatitis /Epidemic Hepatitis /Catarrhal Jaundice
Incubation Period: 15-50 days.and feces Separate and proper cleaning of articles used by patient6. patient may have difficulty with maintaining a sense of well-being.
can cause congenital heartdisease and congenital cataract. commonly13 to 17 days Vesiculo-pustular rashes Centrifugal appearance of rashes – rashes which begin on the trunk ands pread peripherally andmore abundant on covered body parts Pruritus No specific diagnostic exam
Treatment is supportive. .
Other names: Varicella Human (alpha) herpesvirus 3 (varicella-zoster virus). Droplet spread Direct contact Indirect through articles freshly soiled by discharges of infected persons Incubation Period: 2-3 weeks.
.•Total muscle paralysisleading to respiratoryarrest and death. Drug-of-choice: Acyclovir / Zovirax ® (orally to reduce the number of lesions. topically to lessen the pruritus) NEVER give ASPIRIN. Aspirin when given tochildren with viral infection may lead todevelopment of REYE’S SYNDROME
Other Names: RubellaThree-day CA: Measles Rubella virus or RNA-containing Togavirus( Pseudoparamyxovirus)German measles is teratogenic infection. a member of the Herpes virus group Period of Communicability: From as early as 1 to 2days before the rashes appear until the lesion shave crusted.
gi ven in divided or fractionated doses and epinephrine should be at the bedside.MOD: Droplet Incubation Period: Three (3) days Forscheimer spots – red pinpoint patches on the oral cavity Maculopapular rashes Headache Low-grade fever Sore throat Enlargement of posterior cervical and postauricular lymph nodes
Diagnostic Test: Rubella Titer (Normal value is 1:10).3.
Other names: Shingles Cold sores CA: Herpes zoster virus(dormant varicella zoster virus) MOD: Droplet Direct contact from secretion PS: Painfulvesiculo-pustular lesions on limited portion of the body (trunk and shoulder) Low-grade fever
Treatment is supportive and symptomatic Acyclovir to lessen the pain Avoidance of mode of transmission4.
. below 1:10indicates susceptibility to Rubella.MMR is given at 15 months of age and is givenintramuscularly.MMR vaccine (live attenuated virus)-Derived from chick embryo Contraindication:-
A l l e r g y t o e g g s -If necessary. Instruct the mother to avoid pregnancy for threemonths after receiving
intermittent chills and sweating. recurrent chills (30minutes to 2 hours) Hot Stage: fever (4-6hours) Wet Stage: Profuse sweating.easy fatigability NURSING CARE: 1. most common in the Philippines) Ovale Malariae-attacks the red blood cells Bite of infected anopheles mosquito Night time biting High-flying Rural areas Clear running water Cold Stage: severe. flu-like symptoms
Diagnostic Test: Torniquet test (Rumpel Leads Test / capillary fragility test) – PRESUMPTIVE. positive when 204 o’clock habit Chemically treated mosquito net
CA: Plasmodium Parasites: Vivax Falciparum (most fatal.tea-colored urine.splenomegaly. fevers. 2. Encourage fluid intake5. Change wet clothing (Wet Stage)4.abdominal pain and enlargement. 3.Dengue Hemorrhagic Fever
Other name: h-fever Dengue virus 1.anemia / pallor . Keep patent warm (Cold Stage)3. TSB (Hot Stage)2. and profuse sweating area ssociated with rupture of the red blood cells.hepatomegaly.. Episodes of chills. and Chikungunya virus Types 1 and 2 are Bite of infected
mosquito (Aedes Aegypti) .malaise.characterized by black and white Classification (WHO): Grade I: a. Avoid draftsEarly Diagnosis and Prompt Treatment Early diagnosis – identification of a patient with malaria as soon as he is seen through clinical and/or microscopic method
ALERT: Cinchonism – quinine toxicity 2. it is given throughout the duration of pregnancy. In pregnant women.QUININE – oldest drug used to treat malaria.PRIMAQUINE – sometimes can also beg iven as chemoprophylaxis 4.Clinical method – based on signs and symptoms of the patient and the history of his having visited malariaendemic area Microscopic method – based on the examination of the blood smear of patient through microscope (done by the medical technologist) QBC/quantitative Buffy Coat – fastest Malarial Smear – best time to get the specimen is at height of fever because the microorganisms are very active and easily identified Chemoprophylaxis Only chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering he endemic area).CHLOROQUINE 3. 11 and CARAGAWuchereria
Other names: Elephantiasis Endemic in 45 out of 78 provinces Highest prevalence rates: Regions 5.FANSIDAR – combination – treatment o f pyrimethamine and of mosquito net*House sulfadoxine*CLEAN (nighttime
fumigation)*On Stream Seeding – construction of bio-pondsfor fish propagation. Treatment: Blood Schizonticides drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations 1. from the bark of Cinchona tree. 8.
haematobiumS. pantsand socks3. observation of major and minor signs and symptoms Laboratory examinations Nocturnal Blood Examination (NBE) – blood are taken from the patient at his residence or in hospital after 8:00 pmImmunochromatographic Test (ICT) – rapid assessment method.
Other Names: Snail Fever Bilharziasis Endemic in 10regions and 24 provinces High prevalence: Regions 5.Bloody stools (on and off dysentery) Enlargement pallor weakness Diagnostic Test: of abdomen= SplenomegalyHepatomegalyAnemia /
. japonicum (endemic int he
Philippines)Contact with the infected freshwater with cercaria and penetrates the skin Vector: Oncomelania Quadrasi Diarrhea.CA: BancroftiBrugia malayiBrugia timori – nematode parasites Bite of Aedes poecillus(primarily)Aedes flavivostris(secondary) Incubation period: 8 – 16 months Asymptomatic Stage :Presence of microfilariaein the blood but no clinical signs and symptoms of disease Acute Stage :Lymphadenitis Lymphangitis Affectation of male genitalia Chronic Stage : (10-15years from onset of firs attack)Hydrocele Lymphedema Elephantiasis Diagnosis Physical examination. 8. history taking. an antigen test that can bedone at daytime Treatment: Drug-of-Choice: Diethylcarbamazine Citrate(DEC) or HetrazanCLEAN TechniqueUse of mosquito repellentsAnytime fumigationWear a long sleeves. 11 CA: Schistosoma mansoniS.
use rubber boots) Apply 70% alcoholimmediately to skin to killsurface cercariae Allow water to stand 48-72hours before use
.g. mansoni Metrifonate for S. haematobium*Death is often due to hepatic complication Dispose the feces properlynot reaching body of water Use molluscides Prevent exposure tocontaminated water (e.COPTor cercum ova precipitin test (stool exam) Treatment: Drug-of-Choice: PRAZIQUANTEL(Biltracide )Oxamniquine for S.