NERVOUS SYSTEM communicable diseases LEPROSY In order, the ten countries with the most leprosy cases: India

Brazil Myanmar (Burma) Indonesia Nepal Epidemiology in the Philippines Ilocos Norte Ilocos Sur Abra La Union Pangasinan Leprosy CA: Mycobacterium Leprae or Hansens bacillus MT: prolonged skin to skin contact, droplet infection Susceptible: below 12 yrs. Old Incubation: 3 – 5 years Dx: Skin Slit test, Prevention: B CG vaccination A voidance of prolonged skin B to skin contact with active untreated case, G ood Personal Hygiene A dequate Nutrition H ealth Education Leprosy Early Signs – reddish or white change in skin color, loss of sensation on the skin lesion, decrease/loss of sweating and hair growth over the lesion, thickened and or painful nerves, Muscle weakness, pain or redness of the eye, nasal obstruction/bleeding, ulcers that do not heal Late Signs – Loss of eyebrow (madarosis), Inability to close eyelids (lagopthalmos), clawing of fingers and toes, contractures, Sinking of the nose bridge, enlargement of the breast in males (gynecomastia), chronic ulcers Leprosy Mgt/Tx: Ambulatory Chemo by MDT (2 drugs), Domiciliary- home by RA 4073 Completion of Tx: Cured – all who complied, even is with sequelae of leprosy remain. Patient Classification Paucibacillary: Negative slit skin smear, or

5 skin lesions or less Multibacillary: Positive slit skin smear and More than 5 skin lesions Single-lesion paucibacillary (SLPB): Single dose of three drugs (ROM): Rifampicin 600 mg Ofloxacin 400 mg Minocycline 100 mg Multidrug therapy: Paucibacillary case Supervised dose (day 1): Rifampicin 600 mg Dapsone 100 mg Daily dose (days 2-28): Dapsone 100 mg 6 blister packs to be taken monthly in 6 to 9 months Multidrug therapy: Multibacillary case Supervised dose (day 1): Rifampicin 600 mg Dapsone 100 mg Clofazimine 300 mg Daily dose (days 2-28): Dapsone 100 mg Clofazimine 50 mg 12 blister packs to be taken monthly in 12 to 18 months TETANUS Causative Agent: Clostridium Tetani Mode of Transmission: thru break in the skin and mucous membrane Neonates – umbilical cord Children – dental carries Adults – e.g. septic abortion, puncture wound, etc Incubation Period: 3 – 14 days Release of tetanospasmin – spasm Release of Tetanolysin – lysis of RBC & WBC TETANUS Signs and Symptoms: Neonate – malaise

difficulty in sucking excessive crying stiffness of jaw Trismus – painful spasm of the masticatory muscles Risus sardonicus – painful spasm of the facial nerve Opisthotonus – aching of the back, neck bowed backward Muscular spasm TETANUS Diagnostic examination: History of wound Clinical manifestations Treatment: ATS/TAT – Anti Tetanus Serum, Tetanus Aglutunin Toxoid TIG – Tetanus Gammaglobulins IVF Penicillin G Sodium Diazepam Supportive: O2 inhalation Tracheostomy Suction secretions TETANUS Nursing care: Quiet room Avoid unnecessary handling Padded tongue-depressor NPO, if can’t open mouth liquid to soft diet, with partial lockjaw observe aspiration precautions suction secretions Observe frequency, duration of muscular spasm assess respiration during spasm put bedrails do not restrain Prevention: Proper wound care Immunization

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