Diphtheria

Diphtheria
Etiologic Agent:
Etiologic Agent:
Corynebacterium
Corynebacterium
diphtheria
diphtheria (Klebs-Loefer
bacillus)
Source of Infection:
Discharges and Secretions
from mucus surface of the
nose and nasopharynx and
from the skin and other
lesions
Description:
Description:
cute febrile infection of
the tonsil! throat! nose
larynx! or a "ound
marked by a patch or
patches of grayish
membrane from "hich
the diphtheria bacillus is
readily cultured#
$asal Diphtheria is
commonly marked by one
sided nasal discharge and
excoriated nostril# $on-
respiratory or cutaneous
diphtheria appears as
locali%ed punched out
ulcers#
Mode of Transmission:
Contact "ith a carrier&
eg#& "ith articles soiled
"ith discharges of
infected persons#
'ilk ser(e as (ehicle#
Incubation Period:
)-* Days! occasionally
longer
Period of
Communicability:
+ariable until +#bacilli has
disappeared from
secretions and lesions,
usually ) "ks# - seldom
more than ."ks#
Ris !actors
Ris !actors
n operation in an area of
the nose and throat
/conomic Status
Lack of proper $utrition
0(ercro"ding
Symptoms
Symptoms
1eeling of fatigue
'alaise
Slight sore throat
Lo" 2rade 1e(er
3n se(ere cases, entire neck
becomes s"ollen (bull4s neck)
"ith /dema extending to the
chest
5reathing Di6culty
7usky (oice
3ncrease 7eart 8ate
Stridor (shrill breathing sound
heard in aspiration)
$asal Drainage&Secretions
(Serosanguinous "& foul
smell)
S"elling of palate
Complications:
Complications:
'yocarditis cause by the
action of Diphtheria toxin
on the heart muscles
9olyneuritis that includes
paralysis of the soft
palate! the ciliary muscles
of the eyes! pharynx!
larynx! or extremities#
ir"ay obstruction may
lead to death through
asphyxiation
Cer(ical adenitis
0titis 'edia
5ronchopneumonia
Diagnostic
Diagnostic
Tests:
Tests:
S"ab from nose and
throat or other suspected
lesions
+irulence test
- measures the degree of
pathogenicity
Schick :est
- Determines the immunity
status# ; ml# of Diphtheria toxin
is in<ected intradermally and
results is read after =)hrs#
9resence of immunity is
indicated by absence of any
erythema and in>ammation at
point of in<ection#
Susceptibility"
Susceptibility"
Resistance" and
Resistance" and
#ccurrence:
#ccurrence:
3nfants born of mother
"ho had diphtheria
infection are relati(ely
immune but the immunity
disappears before the ?
th

mon#
8eco(ery from attack of
Diphtheria is usually but
not necessarily follo"ed
by persistent immunity
3mmunity is often
ac@uired through
unrecogni%ed infection
:"o-thirds or more of the
urban cases are in
children under ;Ayrs# of
age#
Treatment:
Treatment:
9enicillin- eBecti(e in
treating 8espiratory
diphtheria before it
releases toxins in the
blood#
ntitoxins combination
"ith 9enicillin (Skin test
before admin.)
/rythromycin
Supporti(e :herapy
a# 'aintain ade@uate
nutrition! >uid and
electrolyte balance
b# 5ed rest
c# 0xygen 3nhalation
d# :racheostomy (C
laryngeal obstruction)
Methods of Pre$ention
Methods of Pre$ention
and Control:
and Control:
cti(e immuni%ation of all
infants (?"ks#) and
children "ith D doses of
Diphtheria! 9ertussis! and
:etanus (D9:) toxoid
administered at .-? "ks#
3nter(als and then
booster doses follo"ing
year after the last dose of
primary series and
another dose on the .
th
or
*
th
yr# of age
9asteuri%ation of 'ilk
/ducation of parents
8eporting of the case to
the 7ealth 06cer for
proper medical Care#
%ursing
%ursing
Diagnosis:
Diagnosis:
3neBecti(e ir"ay
Clearance
8isk for acti(ity
intolerance
9oor tissue 9erfusion
1ear
nxiety
%ursing Care
Management:
1ollo" prescribed dosage
and Correct techni@ue in
administering antitoxin
infections#
Comfort of the eg#
Should al"ays be in mind#
eg# d(ised to take full
bed rest (atleast )"ks#)#
$ot permitted to bathe by
himself and a(oid
exertion during
defecation to conser(e
energy - decrease
cardiac "orkload#
D3/:, Soft Diet & Small
1re@uent 1eeding
/ncourage drinking fruit
<uice rich in +it# C to
maintain alkalinity of the
blood and increase body
resistance#
3ce collar must be applied
to the neck
$ose and throat care is
prioriti%ed#
Pertussis
Pertussis
&'hooping
&'hooping
Cough(
Cough(
Description:
Description:
cute infection of the
respiratory tract# 5egins
"ith ordinary cold!
becomes increasingly
se(ere! and after the )
nd

"k# 3s attended by
paroxysms of cough
ending in a characteristic
"hoop as the breath is
dra"n in#
+omiting may follo"
spasm
Cough may last for
se(eral "eeks and
occasionally )-D mons#
/tiologic gent,
7emophilus 9ertussis&
5ordet 2engou 5acil
lus& 5ordetella pertussis&
pertussis bacillus
Mode of Transmission:
Mode of Transmission:
Direct spread through
respiratory and sali(ary
contacts (Droplets)#
Cro"ding and close
association "ith patients
facilitate spread#
7ighly contagious
1irst Stage
(9rodromal&catarrhal
stage)
-in(ol(es mild! cold like
symptoms
Second stage, (paroxysmal
Stage)
-produces se(ere!
uncontrollable coughing
Ets# Coughing often ends
in a prolonged ! high-
pitched! deeply indra"n
breath # Coughing Ets
produce a clear!
tenacious mucus and
(omiting# :hey may be
so se(ere as to cause
lung rupture! bleeding in
the eyes and brain!
broken ribs! rectal
prolapse! or hernia
:hird Stage (8eco(ery or
Con(alescent Stage)
- Fsually begins "&in
."ks# of onset#
Incubation Period:
Incubation Period:
=-;. days
Period of
Period of
Communicability:
Communicability:
3n early catarrhal stage!
paroxysmal cough
conErms pro(isional
clinical diagnosis = days
after exposure to D "ks#
fter onset of typical
paroxysms#

Symptoms
Symptoms
:he disease starts like the
common cold! "ith runny
nose or congestion!
snee%ing! and maybe mild
cough or fe(er# 5ut after
;G) "eeks! se(ere
coughing can begin#
series of coughing Ets
that continues for "eeks!
can cause (iolent and
rapid coughing
Complication
Complication
:issues around the
bronchioles become
in>amed and interstitial
pneumonia occurs#
ir passage become
obstructed by mucus
plugs# :his results in
atelectasis#
Con(ulsion due to lack of
oxygen on the tissues
Fmbilical 7ernia
0titis 'edia
5ronchopnemunia
Se(ere malnutrition and
star(ation! due to
persistent (omiting! sleep
and rest
Diagnostic
Diagnostic
Procedures
Procedures
$asopharyngeal s"ab
Sputum Culture
C5C (leukocytes)
Treatment
Treatment
Supporti(e :herapy
a# 1luid and /lectrolytes
8eplacement
b# de@uate $utrition
c# 0xygen :herapy
)# ntibiotics (erythromycin
and ampicillin) Ghelpful in
eliminating infection and
to shorten the period of
communicability
D# 7yperimmune
con(alescent serum&
gammaglobulin
%ursing
%ursing
Management
Management
3solation and medical
asepsis should be carried
out
Duration of paroxysm! the
patient should not be left
alone# Suctioning
e@uipment should be
ready at all times for
emergency use to a(oid
obstruction of the
air"ays#
Sunshine and fresh air
important! but the patient
should be protected from
drafts#
:he child should be kept
still and @uiet as possible
since acti(ity and
excitement precipitate
paroxysm#
9ro(ide "arm baths and
keep the bed dry and free
from soiled linens
3ntake and output should
be closely monitored#
%ursing
%ursing
Diagnoses
Diagnoses
3neBecti(e ir"ay
Clearance
ltered $utrition, Less
than body re@uirement
8isk for 3nfection&
Complication
Sleep 9attern Disturbance
lteration in Comfort
Susceptibility"
Susceptibility"
Resistance" and
Resistance" and
#ccurrence:
#ccurrence:
Susceptibility is general!
predominantly a
childhood disease#
7ighest under = yrs# of
age - 'ortality highest in
infants under ? mons#
0ne attack confers
deEnite and prolonged
immunity# Second attack
occasionally occurs#
9re(alent and common in
children#
Method of pre$ention
and control:
8outine D9:
immuni%ation! started at
; H mons# 2i(en at
monthly inter(als in D
consecuti(e mons#
5ooster gi(en at ) yrs# of
age and again in .-* yrs#
9atient should be isolated
.-? "eeks from the onset
of illness#
9ublic education for
acti(e immuni%ation and
early diagnosis! together
"ith reporting of all
cases! should be
encouraged#
Tetanus &)oc*a+(
Tetanus &)oc*a+(
Description:
Description:
cute disease induced by
toxin of tetanus bacillus
gro"ing anaerobically in
"ounds - at site of
umbilicus among infants#
Characteri%ed by painful
muscular contractions!
primarily of the masseter
('uscle that closes the
<a") and the neck
muscles! spasm! and rigid
paralysis#
8espiratory failure and
death may occur
Etiologic Agent:
Etiologic Agent:
:etanus 5acillus
(Clostridium :etani)
Source of Infection:
Source of Infection:
3mmediate source of
infection is soil! street
dust! animal and human
feces#
Mode of Transmission:
Mode of Transmission:
;# 8ugged! traumatic
;# 8ugged! traumatic
"ounds and burns
"ounds and burns
)# Fmbilical stump of a ne"
)# Fmbilical stump of a ne"
born! especially if
born! especially if
deli(ered at home and
deli(ered at home and
thus ha(e faulty cord
thus ha(e faulty cord
dressings
dressings
D# 5abies deli(ered to
D# 5abies deli(ered to
mothers "ithout :# :oxoid
mothers "ithout :# :oxoid
immuni%ation
immuni%ation
.# Fnrecogni%ed "ounds
.# Fnrecogni%ed "ounds
*# Dental extraction!
*# Dental extraction!
circumcision! and ear
circumcision! and ear
piercing
piercing
Incubation Period:
Incubation Period:
+aries from D days-;mon#&
more! falling bet"een = -
;. days in high proportion
of cases#
Symptoms
Symptoms
$eonate
;# 1eeding and Sucking
di6culties
)# 'ay cry excessi(elyI
most of the time!
ho"e(er the cry is short!
mild and (oiceless
D# ttempt to suck results
to spasms and cyanosis
.# 1e(erI due to infection
and dehydration
*# Ja" becomes so stiB
that the baby can4t
s"allo"&suck
?# :onic&rigid muscular
contractions! spasms or
con(ulsions are pro(oked
by stimuli#
=# Cyanosis and pallor
de(elop
K# Se(ere cases may lead
to >accidity! exhaustion
and D/:7#
0lder children and dult
;# 3f tetanus remains
locali%ed! signs of onset
are Spasm and increased
muscle tone near the
"ound#
)# 3f it becomes systemic or
generali%ed! signs
includes,
a# $eck and 'uscle
rigidity (trismus)
b# 2rinning expression
(risus sardonicus)
c# 5oard-like abdomen&
abdominal rigidity
d# 0pisthotonos G form
of tetanic spasm "here
the body bends
back"ards
e# 3ntermittent tonic
con(ulsion lasting for
se(eral mins#! may result
in cyanosis and sudden
death due to asphyxiation
f# Se(ere casesI
laryngospasm is follo"ed
by accumulation of
secretions in the lo"er
air"ays! resulting to
respiratory distress
g# 1racture of the
(ertebrae during spasm!
leading to coma and
Death
Complications
Complications
8esults of laryngospasm
and in(ol(ement of the
respiratory muscles,
a# 7ypostatic pneumonia
b# 7ypoxia due to
laryngospasm and
decreased oxygen
c# telectasis and
pneumothorax
d# :raumatic glossitis and
microglossia

Complication
Complication
Changes related to
symphathetic ner(ous
system,
:ransitory hallucinosis
7ypersali(ation!
diaphoresis! and unusual
tachycardia! especially
"ith the use of
aerosoli%ed
bronchodilators
Cardiac Standstill and
5radycardia
Due to trauma
Laceration of the tongue
and buccal mucosa
3ntramuscular 7ematoma
1racture of the spine and
ribs
Septicemia
:reatment
:reatment
SpeciEc
:etanus toxoid! #*cc 3'!
gi(en on standard
schedule
9en 2 $a! to control
infection
'uscle relaxant
$on-speciEc
0xygen inhalation
$2: 1eeding
:racheostomy
de@uate >uid and
electrolyte! and caloric
intake
%ursing
%ursing
Diagnosis
Diagnosis
ltered nutrition, Less
than body re@uirement
3mpaired physical mobility
cti(ity intolerance
Sensory perceptual
lteration
7igh risk for
3nfection&complication
Kno"ledge deEcit
Method of
Method of
Pre$ention and
Pre$ention and
Control:
Control:
9regnant "omen should
be acti(ely immuni%ed#
9roper methods!
e@uipment and
techni@ues in sepsis in
childbirth
D9: for babies and
children
7ealth education of
mothers! relati(es and
attendants in the practice
of strict aseptic methods
of umbilical care in the
ne"born#
%ursing Care:
%ursing Care:
/mploy measures "hich
decrease fre@uency -
se(erity of con(ulsions#
Keep eg# a"ay from
noise! bright lights or
anything that might
irritate him&her
dmin# 9rescribed
medication by physician
- obser(e - report
unto"ard eBects to
physician#
7ealth teaching about the
infectious process
Control accompanying
discomfort
!I%,,,,
!I%,,,,
:7$K L0FM