HEALTH TEACHING I.
A. GENERAL OBJECTIVES:
I- General Objectives: By Health Teaching the patient gain sufficient knowledge about the nature of leptospirosis, and will apply their said knowledge to their daily living by means of preventing their selves that will help them to have a healthy life.
II- Specific Objectives: After 30 minutes of health teaching the patient will be able to: a. Knowledge 1. Define leptospirosis 2. Identify the causes of leptospirosis 3. Know the signs and symptoms of leptospirosis 4. Know the different procedures and medicines for the treatment ofleptospirosis b.Skills 1. Demonstrate the different nursing intervention for leptospirosis 2. Discuss and show the factors that contribute to leptospirosis, its nature and magnitude 3. Guide the relatives or the primary health care giver in making decisions about certain lifestyles that has a great effect on the health problem. b. Attitude 1. To develop trust and rapport between the patient and health care provider II. READINESS TO LEARN
The patient is conscious, responsive and able to ambulate. III. CAPABILITY TO LEARN Both relatives and primary health care giver have a good memory recognition and understanding. The relatives and care giver knows the patient’s condition and they can understand and speak Filipino.
METHODOLOGY The method to be used in delivering the health teaching is the conventional method which is discussion of the topic in its simplest form and according to the understanding of the listener. Also, the selection of the topic is based on the patient needs. The language to be used is vernacular form. In addition, we will just used simple word in order for them to understand clearly and an illustration of some points maybe given to increase comprehension.
PHYSICAL ENVIRONMENT Before the health teaching is to be given the room should be properly ventilated and lighted. This makes the room conducive to learning. In addition, the listener is encouraged to take a meal before the health teaching and the place should be cleaned. This makes the listener comfortable which increases the level of understanding.
leptospirosis I. INTRODUCTION
Leptospirosis (also known as Weil's disease, Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, "Rat Catcher's Yellows", "Fort Bragg fever," and "Pretibial fever":290) is a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles. It was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis". Leptospira was first observed in 1907 from a post mortem renal tissue slice. Though being recognised among the world's most common zoonoses, leptospirosis is a relatively rare bacterial infection in humans. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, eyes or with the mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring August–September/February–March.
Etiology Leptospirosis is caused by a spirochaete bacterium called Leptospira interrogans. Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. that has at least 5 serovars of importance in the United States and Canada causing disease in dogs (Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, and Bratislava) There are other (less common) infectious strains. It should however be noted that genetically different leptospira organisms may be identical serologically and vice versa. Hence, an argument exists on the basis of strain identification. The traditional serologic system is seemingly more useful from a diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like PCR). Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as it is still moist. Although rats, mice and voles are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and even certain marine mammals are also able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil, or drink from an infected puddle. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks, ditches, gulleys and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount
of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates. Leptospirosis is also transmitted by the semen of infected animals. Abattoir workers can contract the disease through contact with infected blood or body fluids. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among watersport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Surfers are especially at high risk in areas that have been shown to contain the bacteria and can contract the disease by swallowing contaminated water, splashing contaminated water into their eyes or nose, or exposing open wounds to infected water. Occupations at risk include veterinarians, slaughter house workers, farmers, sewer workers, and persons working on derelict buildings. Anatomy and Physiology Lower Respiratory Tract: It is composed of trachea, right and left main bronchus segmental bronchi, subsegmental bronchi and terminal bronchioles. Smooth muscles wound around in these structures and when it contracts it decreases the diameter of the airways therefore increasing the air resistance. Trachea – also knows as the windpipe. It extends from the larynx to the level of the 7th thoracic vertebrae where it divides into 2 main bronchus. The point where it divides is called carina. Bronchi and Bronchioles Right main bronchus is shorter and wider. It also extends more vertically downwards. Foreign bodies tend to lodge there more compared to the left main bronchus. The bronchi further divides and spread in an inverted tree like formation through each lungs until it becomes bronchioles. The terminal bronchioles are the last airways of the conducting system. It does not participate in the gas exchange.
Lungs Lie on either side of the mediastinum (area containing heart, great blood vessels, bronchi, trachea, esophagus) Hilus: mediastinal surface of each lungs is where blood vessels of pulmonary and circulatory systems enter and exit; where primary bronchus enters. Apex of each lung lies just below clavicle; base rests on diaphragm. Note: Two lungs differ in size and shape. 1. Left lung is smaller, has 2 lobes, 8 segments 2. right lung has 3 lobes, 10 segments Vascular System 1. Pulmonary arteries and veins; pulmonary capillary network which surround the alveoli 2. Bronchial arteries supply lung tissue and drained by bronchial and pulmonary veins. Alveoli Alveoli cluster around alveolar sacs, which open into common chambers, atrium, alveoli provide enormous surface area for gas exchange External surface of alveoli covered with pulmonary capillaries which together form respiratory membrane where gas exchange occurs by simple diffusion. Alveoli walls have cells which secrete surfactant in fluid which maintains moist. Note: gas exchange occurs in the respiratory membrane. The alveolus comprises of 2 cell types namely: Type 1 pneumocytes which are incapable of reproduction but are effective in gas exchange and Type 2 pneumocytes that do not participate in gas exchange but produces surfactants.
Modifiable/Precipitating Factor - Aspiration of food, fluids or vomitus - Inhalation of toxic or caustic chemicals - Smoke, dust, gases - Exposure to affected individual Inhalation of infection particle | Inflammatory pulmonary response | Reactivation of pathogens |
Non-Modifiable /Non-precipitating factor - Young age - History of Asthma - Upper respiratory infection
Disruption of the mechanical defenses | Inflamed and fluid filled alveolar sacs | Increase difficult to appreciate - Fever - Chills - Sweating - Pleuritic chest pain - Sputum production - Hemoptysis - Dyspnea - Headache - Fever
On infection the microorganism can be found in blood for the first 7 to 10 days (invoking serologically identifiable reactions) and then moving to the kidneys. After 7 to 10 days the microorganism can be found in fresh urine. Hence, early diagnostic efforts include testing a serum or blood sample serologically with a panel of different strains. It is also possible to culture the microorganism from blood, serum, fresh urine and possibly fresh kidney biopsy. Kidney function tests (Blood Urea Nitrogen and creatinine) as well as blood tests for liver functions are performed. The latter reveal a moderate elevation of transaminases. Brief elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) levels are relatively mild. These levels may be normal, even in children with jaundice. Diagnosis of leptospirosis is confirmed with tests such as Enzyme-Linked Immunosorbent Assay (ELISA) and PCR. Serological testing, the MAT (microscopic agglutination test), is considered the gold standard in diagnosing leptospirosis. As a large panel of different leptospira need to be subcultured frequently, which is both laborious and expensive, it is underused, mainly in developing countries. Differential diagnosis list for leptospirosis is very large due to diverse symptomatics. For forms with middle to high severity, the list includes dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever. Light forms should be distinguished from influenza and other related viral diseases. Specific tests are a must for proper diagnosis of leptospirosis. Under circumstances of limited access (e.g., developing countries) to specific diagnostic means, close attention must be paid to anamnesis of the patient. Factors like certain dwelling areas, seasonality, contact with stagnant contaminated water (Bathing swimming, working on flooded meadows, etc) and/or rodents in the medical history support the leptospirosis hypothesis and serve as indications for specific tests (if available). Leptospira can be cultured in Ellinghausen-McCullough-Johnson-Harris medium, which is incubated at 28 to 30 °C. The median time to positivity is three weeks with a maximum of 3 months. This makes culture techniques useless for diagnostic purposes, but is commonly used in research.
Complications: Complications include meningitis, extreme fatigue, hearing loss, respiratory distress, azotemia, and renal interstitial tubular necrosis, which results in renal failure and often liver failure (the severe form of this disease is known as Weil's disease, though it is sometimes named Weil Syndrome). Cardiovascular problems are also possible.
MEDICAL MANAGEMENT: Aetiotropic drugs are antibiotics, such as cefotaxime, doxycycline, penicillin, ampicillin,
and amoxicillin (doxycycline can also be used as a prophylaxis).
TREATMENT: Leptospirosis treatment is a relatively complicated process comprising two main components: suppressing the causative agent and fighting possible complications. Aetiotropic drugs are antibiotics, such as cefotaxime, doxycycline, penicillin, ampicillin, and amoxicillin (doxycycline can also be used as a prophylaxis). There are no human vaccines; animal vaccines are only for a few strains, and are only effective for a few months. Human therapeutic dosage of drugs is as follows: doxycycline 100 mg orally every 12 hours for 1 week or penicillin 1–1.5 MU every 4 hours for 1 week. Doxycycline 200–250 mg once a week is administered as a prophylaxis. In dogs, penicillin is most commonly used to end the leptospiremic phase (infection of the blood), and doxycycline is used to eliminate the carrier state. Supportive therapy measures (esp. in severe cases) include detoxication and normalization of the hydro-electrolytic balance. Glucose and salt solution infusions may be administered; dialysis is used in serious cases. Elevations of serum potassium are common and if the potassium level gets too high special measures must be taken. Serum phosphorus levels may likewise increase to unacceptable levels due to renal failure. Treatment for hyperphosphatemia consists of treating the underlying disease, dialysis where appropriate, or oral administration of calcium carbonate, but not without first checking the serum calcium levels (these two levels are related). Corticosteroids administration in gradually reduced doses (e.g., prednisolone starting from 30–60 mg) during 7–10 days is recommended by some specialists in cases of severe haemorrhagic effects. Organ specific care and treatment are essential in cases of renal, liver or heart involvement.
NURSING INTERVENTIONS 1. Do back rubbing for easy aid in respiration and easy expectoration of sputum 2. Do bronchial tapping and position the patient in side-lying position with the head lowered than the trunk to facilitate expectoration of secretions. High take of fluids may help to liquify viscous secretions in order to help expectorate easily. 3. Keep the patient absolutely at rest and avoid unnecessary and strenuous activities in order to avoid strain on the heart (muscles) or extra strain for the lungs
4. Elevate the head and shoulders of the patient by means of a pillow often to relieve labored breathing and to lessen coughing (coughing aggravated chest pain.) 5. Bony prominence should be cushioned when at rest, to prevent formation of bedsores 6. Let patient in a daily routine bath unless contraindicated or if resisted, prefer cleansing bed bath as necessary to keep the skin clear, clean and active, and to relieve restlessness. 7. Instruct patient to have adequate and sufficient intake of fluid and elimination 8. Give nourishing high-calorie diet (fluid diet) at 2 hours intervals include milk malted milk, gruels, beef juice, soup and fruit juices. Omit fluids and food that are gas forming like softdrinks. 9. Measure and record intake and output to be sure that both the intake and elimination are sufficient to the metabolic needs of the patients. 10. Teach and supervise effective coughing, turning and deep breathing techniques 11. Observed for increasing ineffective breathing patterns and chest pain associated with respiration and report immediately to the physician on duty to prevent complications such as respiratory distress and respiratory arrest 12. Turn the patient every 2 hours.