Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

Second inflammatory response

COMMUNICABLE DISEASE
o
Phagocytic cells and WBC to destroy invading
microorganism manifesting the cardinal signs

It is an illness caused by an infectious agent or its toxic

Third immune response

products that are transmitted directly or indirectly to a well
o
Natural/Acquired
person through an agent, vector or inanimate object.
o
Active/passive
TWO TYPES:
RISK FACTORS

Infectious Disease - Not easily transmitted by ordinary

Age, sex, and genes

contact but require a direct inoculation through a break in
the previously intact skin or mucous membrane

Nutritional status, fitness, environmental factors

Contagious Disease - easily transmitted from one person

General condition, emotional and mental state

to another through direct or indirect means.

Immune system

Underlying disease ( diabetes mellitus, leukemia, transplant)

Terminologies

Treatment with certain antimicrobials ( prone to fungal

infection), steroids, immunoisuppresive drugs etc.
Disinfection destruction of pathogenic microorganism outside
the body by directly applying physical or chemical means.
CHAIN OF INFECTION
Concurrent method of disinfection done
immediately after the infected individual discharges
infectious material/secretions.
This method of
disinfection is when the patient is still the source of
infection
Terminal applied when the patient is no longer the
source of infection.
Disinfectant -chemical used on non living objects
Antiseptic chemical used on living things.
Bactericidal kills microorganism
Sterilization complete destruction of all microorganism
General Principles

Pathogens move through spaces or air current

Pathogens are transferred from one surface to another
whenever objects touch
Hand washing removes microorganism
Pathogens are released into the air on droplet nuclei
when person speaks, breaths, sneezes
Pathogens are transferred by virtue of gravity
Pathogens move slowly on dry surface but very quickly
through moisture

INFECTION

invasion and multiplication of microorganisms on the tissues

of the host resulting to signs and symptoms as well as
immunologic response
injures the patient either by:
o
competing with the hosts metabolism
o
cellular damage produced by the microbes
intracellular multiplication.

CLASSIFICATION ACCORDING TO INCIDENCE

Sporadic - disease that occur occasionally and irregularly

with no specific pattern
Endemic those that are present in a population or
community at times.
Epidemic diseases that occur in a greater number than
what is expected in a specific area over a specific time.
Pandemic is an epidemic that affects several countries or
continents

CAUSES OF INFECTION

MODE OF TRANSMISSION

EMERGING INFECTIOUS DISEASES

Some bacteria develop resistance to antibiotics

Some microbes have so many strains that a single vaccine
cant protect against all of them ex. Influenza
Most viruses resist antiviral drugs
Opportunistic organisms
can cause
infection in
immunocompromised patients
Most people have not received vaccinations .
Increased air travel can cause the spread of virulent
microorganism to heavily populated area in hours
Use of immunosupressive drugs and invasive procedures
increase the risk of infection
Problems with the bodys lines of defense

First line of defense

o
Mechanical Barriers
o
Chemical Barriers
o
Bodys own pop of microorganisms - microbial
antagonism principle

Developing resistance to antibiotics eg: anti tb drugs, MRSA,

VRE
Increasing numbers of immunosuppressed patients.
Use of indwelling lines and implanted foreign bodies has
increased.

INFECTION CONTROL MEASURES

Universal Control Measures All blood, blood products
and secretions from patients are considered as infected
Work Practice Control

THREE LINES OF DEFENSE

Contact transmission
o
Direct contact - person to person
o
Indirect - thru contaminated object
o
Droplet spread - contact with respiratory
secretions thru cough, sneezing, talking. Microbes
can travel up to 3 feet.
Airborne Transmission
Vector Borne Transmission
Vehicle Borne Transmission

Used needles and sharps shall not be bent, broken,

recapped. Used needles must not be removed from
disposable syringes.
Eating, drinking, smoking, applying cosmetics or
handling contact lenses are prohibited in work areas.
Foods and drinks shall not be stored in refrigerators,
freezers where blood or other infectious materials are
stored.
All procedures involving blood or other potentially
infectious materials shall be performed in such a manner
as to minimize splashing, or spraying.

Masking Wear mask if needed. Patient with infectious

respiratory diseases should wear mask.
Handwashing Practice it with soap and water.
Gloving Wear gloves for all direct contact with patients.
Change gloves and wash hands every after each patient.

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
o
afternoon rise in temperature

Gowning - Wear gown during procedures which are likely

o
night sweats
to generate splashes of blood or sprays of blood and body
fluids, secretions or excretions.
o
weight loss

Eye protection (goggles) wear it to prevent splashes.

o
cough dry to productive
o
Hemoptysis

Environmental disinfection Clean surfaces with

o
sputum AFB (+)
disnfectant (70% alcohol,diluted bleach)

Milliary TB - very ill, with exogenous TB like Potts disease

ISOLATION PRECAUTIONS

Primary Infection
o
Asymptomatic

separation of patients with communicable diseases from

o
No manifestations even at CXR, Sputum AFB
others so as to reduce or prevent transmission of infectious

Primary Complex
agents.
o
Minimal manifestation
o
Lymphadenopathy
7 Categories Recommended in isolation

Strict isolation prevent spread of infection from patient

to patient/staff.- handwashing, infectous materials must be
discarded, use of single room, use of mask, gloves and gowns
and (-) pressure if possible
Contact isolation prevent spread by close or direct
contactRespiratory isolation prevent transmission thru air.
TB isolation for (+)TB or CXR suggesting active PTB.
Enteric Isolation direct contact with feces
Drainage/secretion precaution- prevent infection thru
contact with materials or drainage from infected person.
Universal Precaution for handling blood and body
fluids.( bloods, pleural fluid, peritoneal fluid etc.)

PREVENTION
Immunization introduction of specific antibody to produce
immunity to certain disease.

Natural passive (from placenta), active (thru

immunization & recovery from diseases)
Artificial passive (antitoxins), active (vaccine, toxoid)

Maintain vaccine potency by preventing:

Heat and sunlight

Freezing
Antiseptic/ disinfectants/ detergents lessen the potency of
vaccine. Use water only when cleaning fridge/ref.
COLD CHAIN SYSTEM maintenance of correct
temperature of vaccines, starting from the manufacturer, to
regional store, to district hospital, to the health center to the
immunizing staff and to the client.

DISEASES ACQUIRED THRU RESPIRATORY

TUBERCULOSIS

Chronic respiratory disease affecting the lungs characterized

by formation of tubercles in the tissues---> caseation -->
necrosis ---> calcification.
AKA: Phthisis, Consumption, Kochs, Immigrants dse
Etiologic agent: Mycobacterium tuberculosis
Incubation period: 2 10 wks.
Period of communicability: all throughout the life if not
treated
MOT: Droplet
Sources of infection sputum, blood, nasal discharge,
saliva
Classification
1.
Inactive asymptomatic, sputum is (-), no cavity on
chest X ray
2. Active (+) CXR, S/S are present, sputum (+) smear
Classification 0-5
1.
Minimal slight lesion confined to small part of the
lung
2. Moderately advanced one or both lungs are
involved, volume affected should not extend to one
lobe, cavity not more than 4 cm.
3.
Far advance more extensive than B

Manifestations

Primary Complex (TB in children): non contagious

o
children swallow phlegm
o
fever
o
cough
o
anorexia
o
weight loss
o
easy fatigability
Adult TB

Diagnosis

Tuberculin testing
Chest X-Ray
Sputum AFB

Prevention

BCG
Avoid overcrowding
Improve nutritional status

Treatment

DOTS
6 months of RIPE
Respiratory isolation,
Take medicines religiously prevent resistance
Stop smoking
Plenty of rest
Nutritious and balance meals, increase CHON, Vit. A, C

MENINGITIS

Acute meningococcemia - with or without meningitis

o
Waterhouse Friederichsen Syndrome
Inflammation of the meninges usually some combination of
headache, fever, stiff neck, and delirium
Meningococcemia: cerebrospinal fever
Etiologic agent: Neisseria meningitides
Incubation: 2-10 days
MOT: droplet

Diagnostics

Lumbar tap, CSF - high WBC and CHON, low glucose

Manifestations

Sudden onset of fever x 24h

Petechiae, Purpuric rashes
Meningeal irritation
o
Stiff neck
o
Opisthotonus
o
Kernigs sign
o
Brudzinski sign

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

ALOC

Repeated attacks of spasmodic coughing with series of

explosive expirations ending in long drawn force inspiration

S/S of Increase ICP

Etiologic agent: Bordetella pertusis or Haemiphilus

pertussis
Nursing Management

Incubation period: 7-14 days

Period of communicability: 7 days post exposure to 3

Administer prophylactic antibiotics: Rifampicin - drug of

wks post disease onset
choice

MOT DropleT

Aquaeous Pen

Mannitol

Dexamethasone

Priority: AIRWAY, SAFETY

Maintain seizure precaution

Respiratory precaution

Handwashing

Suction secretions
DIPTHERIA

Acute contagious disease characterized by generalized

toxemia coming from localized inflammatory process
Etiologic agent: Corynebacterium Diptheria (Klebs loffer
bacillus)
Incubation period: 2-5 days
Period of communicability: variable, ave:2-4 weeks
MOT Droplet, direct or intimate contact, fomites,
discharge from nose, skin, eyes

Manifestation

Manifestations

Pseudomembrane - grayish white, smooth, leathery and

spider web like structure that bleeds when detached
Types of Respiratory Diptheria
o
Nasal

serous to serosanginous purulent

discharge

Pseudomebrane on septum

Dryness/ excoriation on the upper lip

and nares
o
Pharyngeal

pharyngeal pseudomembrane

bull neck ( cervical adenitis)

Difficulty swallowing
o
Laryngeal

Sorethroat, pseudomemb

Barking, dry mettallic cough

Complications

Due to Toxemia
o
Toxic endocarditis
o
Neuritis
o
Toxic nephritis
Due to Intercurrent Infection
o
Bronchopneumonia
o
Respiratory failure

Diagnostics

Nose and throat swabs - culture of specimen form beneath

membrane
Virulence test
Shicks test : test for susceptibility to diptheria
Moloneys test: for hypersensitivity to diphtheria

rapid cough 5-10x in one inspiration ending a high pitched

whoop.
Catarrhal slight fever in PM, colds, watery nasal
discharge, teary eyes, nocturnal coughing, 1-2 weeks
Paroxysmal Spasmodic stage; 5-10 successive forceful
coughing ending with inspiratory whoop, involuntary
micturition and defecation, choking spells, cyanosis
Convalescent 4th- 6th week; diminish in severity,
frequency

Complications

Otitis media
Acute bronchopneumonia
Atelectasis or emphysema
Rectal prolapse, umbilical hernia
Convulsions (brain damage - asphyxia, hemorrhage)

Diagnostics

Elevated WBC
Nasopharyngeal swab

Nursing Management

Prevention:
o
DPT
Parenteral fluids
Erythromycin - drug of choice
Prone position during attack
Abdominal binder
Adequate ventilation, avoid dust, smoke
Isolation
Gentle aspiration of secretions

MEASLES

Sources of infection secretions from eyes, nose and

throat
Pathognomonic sign:
o
Kopliks spots

Management

Penicillin, Erythromycin
Diptheria Antitoxin after skin test if (+), fractional
dose
Supportive
o
O2, if laryngeal obstruction tracheostomy
o
CBR for 2 weeks
o
Increase fluids, adequate nutrition- soft food, rich
in Vit C
o
Ice collar
Isolation till 3 negative cultures

Prevention

DPT

PERTUSIS (WOOPHING COUGH)

Manifestations

Pre eruptive stage / Prodromal (10-11 days)

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
o
Coryza, Cough, Conjunctivitis

MMR, Pregnant women should avoid exposure to rubella

o
Kopliks Spots, whitish spot at the inner cheek
patients
o
Fever, photophobia

Administration of Immune serum globulin one week after

exposure to rubella.

Eruptive stage
o
Maculopapular rashes
CHICKENPOX
o
Rash is fully developed by 2nd day
o
High grade fever on and off

Acute and highly contagious viral disease characterized by

o
Anorexia, throat is sore
vesicular eruptions on the skin

Convalescence (7-10 days)

Infectious agent Herpes zoster virus or Varicella zoster

o
Desquamation of the skin

Incubation period 10 -21 days

Diagnostics

Period of communicability: 1 day before eruption up to 5

days after the appearance of the last crop

MOT: airborne, direct, indirect

Nose and throat swab

o
Direct contact thru shedding vesicles,
o
Indirect thru linens or fomites
Treatment

Antiviral drugs- Isoprenosine

Antibiotics if with complications
Supportive O2, IVF

Complications

Bronchopneumonia
otitis media
encephalitis

Manifestations

Nursing Management

Preventive measles vaccine at 9 months, MMR 15

months and then 11-12; defer if with fever, illness
Isolation - contact/respiratory
TSB , Skin care daily cleansing wash
Oral and nasal care
Plenty of fluids
Avoid direct glare of the sun- due to photophobia

GERMAN MEASLES

Mild viral illness caused by rubella virus.

AKA: Rubella; 3-Day Measles
Incubation period from exposure to rash 14 -21d
Period of communicability one week before and and 4
days after onset of rashes. Worst when rash is at its peak.
MOT: Droplet, nasal ceretions, transplacental in congenital

Manifestations

Prodromal low grade fever, headache , malaise, colds,

lymph node involvement on 3rd to 5th day
Eruptive Forscheimers spots: pinkish rash on soft
palate, rash on face, spreading to the neck, arms and trunk
o
lasts1-5 days with no pigmentation or
desquamation
o
muscle pain

Complications

Nursing Management

Isolation. Bed rest

Room darkened photophobia
Encourage fluid
like measles tx

Prevention

Live attenuated varicella vaccine

VZIG - effective if given 96h post exposure

HERPES ZOOSTER

Encephalitis, neuritis
Rubella syndrome microcephaly, mental retardation,
deaf mutism, congenital heart disease
RISK for congenital malformation
o
100% when maternal infection happens on first
trimester of pregnancy.
o
4% - second/third trimester

Strict isolation until all vesicles scabs disappear

Hygiene of patient
Cut finger nails short
Baking soda - pruritus

Prevention

Zovirax 500mg tablet 1 tab BID X 7 days

Acyclovir
Oral antihistamine
Calamine lotion
Antipyretics

Nursing Management

Complications

pneumonia
sepsis

Treatment

Treatment
symptomatic treatment

Pre eruptive: Mild fever and malaise

Eruptive: rash starts from trunk
Lesions - red papules then becomes milky and pus like
within 4 days,
Pruritis
Stages of skin affectations
o
Macule flat
o
Papule elevated above the skin diameter about 3
cm
o
Vesicle
o
Pustule
o
Crust scab , drying on the skin

Acute inflammatory disease known to be caused by herpes

virus varicellae or VZ virus
Infection of the sensory nerve charac by extremely painful
infection along the sensory nerve pathway
Occurs as reinfection of VZ virus
MOT
o
Direct
o
Indirect airborne
Incubation: 1-2 weeks

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

sudden headache, earache , loss of appetite

swelling of the parotid gland

pain is related to extent of the swelling of the gland which

reaches its peak in 2 days and continues for 7-10 days.

fever may reach 40 C during acute stage,

one gland may be affected first and 2 days later the other
side is involved
Complications

Diagnostic procedure

Hx of chickenpox
Pain and burning sensation over lesions of vesicles along
nerve pathway
Smear of vesicle fluid- giant cells
Viral cultures of vesicle fluid
Electron microscopy
Giemsa-stained scraping multinucleate giant epithelial
cells

Signs and Symptoms

Burning, itching, pain then erythematous patches followed

by crops of vesicles
Eruptions are unilateral
Lesions may last 1-2 weeks
Fever, regional lymphadenopathy
Paralysis of cranial nerve, vesicles at external auditory canal
Paralytic ileus, bladder paralysis, encephalitis

Complications

Opthalmia herpes blindness because of damage of

gasserian ganglion
Geniculate herpes deafness because of infection of 7th
CN (AKA: Ramsay Hunt Syndrome)

Nursing Intervention

Compress of NSS or alluminum acetate over lesions

Analgesics, sedatives weeks to mos
Steroids
Keep blister covered with sterile powder esp after break
Prevent bacterial invasion
Encourage proper disposal of secretions and usage of gown
and mask

Diagnostics

Acute viral disease manifested by swelling of one or both of

the parotid glands, with occasional involvement of other
glandular structures,particularly testes in male.
Etiologic agent filterable virus of paramyxovirus group
usually found in saliva of infected person.
AKA: Epidemic/ infectious parotitis
Incubation period: 14 -25 days.
Period of communicability 6d before and 9d post
onset of parotid gland swelling
48 hrs immediately preceding the onset of swelling is the
highest communicability.
MOT: direct, indirect - droplet, airborne

Clinical Manifestations

Viral Culture
1. Viral culture
WBC count

Prevention

MMR Vaccine

Treatment Modalities

Antiviral drugs
NSAIDS Acetaminophen

Nursing Interventions

Symptomatic
Application of warm/ cold compress
Oral care, warm salt water gargle
Diet semi solid, soft food easy to chew
o
Acid foods/fluids fruit juices may increase
discomfort

DISEASES ACQUIRED THRU GIT

MUMPS

Orchitis testes are swollen and tender to palpation.

Oophoritis- pain and tendeness of the abdomen
Mastitis
Deafness may happen
Meningo-encephalitis possible

Diseases caused by Bacteria

o
Typhoid Fever
o
Cholera
o
Dysentery
Diseases caused by Virus
o
Poliomyelitis
o
Infectious Hepatitis A
Diseases caused by Parasites
o
Amoebiasis
o
Ascariasis

THYPHOID FEVER

infection
of
the
GIT
affecting
the
lymphoid
tissues(ulceration of Peyers patches) of the small intestine
Etiologic Agent: Salmonella typhosa and typhi, Typhoid
bacillus
Incubation period: 1-2 weeks
Period of communicability: as long as the patient is
excreting the microorganism,
MOT: fecal-oral route, contaminated water, milk or other
food
Sources of Infection
o
A person who recovered from the disease can be
potential carrier.
o
Ingestion of shellfish taken from waters
contaminated by sewage disposal
o
Stool and vomitus of infected person are sources of
infection.

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

Clinical manifestations

Clinical Manifestations

Ladderlike fever
Nausea, vomiting and diarrhea
RR is fast, skin is dry and hot, abdomen is distended
Head-ache, aching all over the body
Worsening of symptoms on the 4th and 5th day
Rose spots

Complications

Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis

Diagnostics

WBC elevated
Blood Culture (+) S. typhosa
Stool Culture (+)
Widal test blood serum agglutination test
o
antigen active typhoid
o
H antigen- previously infected or vaccinated
o
Vi antigen carrier

Treatment

Chloramphenicol drug of choice

Paracetamol

Nursing Management

Restore FE balance
Bedrest
Enteric precautions
Prevent falls/safety precautions
WOF intestinal bleeding
o
Bloody stools
o
Sweating
o
Pallor
NPO, BT

CHOLERA

an acute bacterial disease of the GIT characterized by

profuse diarrhea, vomiting, loss of fluid.
Etiologic agent: Vibrio cholerae, V. comma
Pathognomonic sign: rice watery stool
Incubation period: 2-3 days
Period of Communicability: entire illness, 7-14d
MOT: fecal oral route

Acute, profuse, watery diarrhea.

Initial stool is brown and contains fecal material becomes
rice water
Nausea/ Vomiting
S/s of Dehydration
poor tissue trugor, eyes are sunken
Pulse is low or difficult to obtain, BP is low and later
unobtainable.
RR rapid and deep
Cyanosis later
Voice becomes hoarse speaks in whisper
Oliguria or anuria
Conscious, later drowsy
Deep shock
Death may occur as short as four hours after onset.
Usually first or 2nd day if not treated
Principal deficits
o
Severe dehydration - circulatory collapse
o
Metabolic acidosis loss of large volume of
bicarbonate rich stool. RR rapid and deep
o
Hypokalemia massive loss of K. abdominal
distention paralytic ileus

Diagnostics

Fecal microscopy
o
Rectal swab
o
Stool exam

Treatment

IVF- rapid replacement

Oral rehydration
Strict I and O
Antibiotics Tetracycline, Cotrimoxazole.

Nursing Management

Medical Asepsis
Enteric precaution
VS monitoring
I and O
Good personal hygiene
Proper excreta disposal
Concurrent disinfection.
Environmental sanitation

Prevention

protection of food and water

contamination.
Water should be boiled/ chlorinated.
Milk should be pasteurized.
Sanitary disposal of human excreta
Environmental sanitation.

supply

from

fecal

DYSENTERY

Acute bacterial infection of the intestine characterized by

diarrhea and fever
Etiologic Agent: Shigella group
Shigella flesneri - commmon in the Philippines
Shigella boydii, S. connei,
S. dysenteria most infectious, habitat exclusively in man,
they develop resistance to antibiotics
Incubation period 7 hrs. to 7 days

Period of communicability during acute infection until

the feces are (-)
MOT fecal-oral route, contaminated water/ milk/ food.

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

Clinical Manifestations

Fever esp. in children

Nausea, vomiting and headache
Anorexia, body weakness
Cramping abdominal pain (colicky)
Diarrhea bloody and mucoid
Tenesmus
Weight loss

Diagnostics

Fecalysis
Rectal Swab/culture
Bloods WBC elevated
Blood culture

Treatment

Antibiotics- Ampicillin, Cotrimoxazole, Tetracycline

IVF
Anti diarrheal are Contraindicated

Nursing Management

Maintain fluid and electrolyte balance

Restrict food until nausea and vomiting subsides.
Enteric precaution
Excreta must be disposed properly.
Prevention- food preparation, safe washing facilities, fly
control

POLIOMYELITIS

An acute infectious disease caused by any of the 3 types of

poliomyelitis virus which affects mainly the anterior born
cells of the spinal cord and the medulla, cerebellum and the
midbrain
AKA: Acute anterior poliomyelitis, heinmedin disease,
infantile paralysis
Etiologic Agent: Poliovirus (Legio Debilitans)
3 Types of Poliovirus
o
Type I - most paralytogenic, most frequent
o
Type II - next most frequent
o
Type III - least frequent associated with paralytic
disease
3 Strains
o
Brunhilde
o
Laasing
o
Leon
MOT: Fecal-Oral
Incubation period: 7-14 days ave (3-21 days)
Period of communicability: 7-16 days before and few
days after onset of s/s

Sign and Symptoms

Febrile episodes with varying degrees of muscle weakness

Occasionally progressive Flaccid Paralysis

3 Types of Paralysis
o
Spinal Paralytic

Flaccid paralysis

Autonomic involvement

Respiratory difficulty
o
Bulbar Form

Rapid & serious

Vagus and glossopharyngeal nerves

affected

Cardiac and respiratory reflexes altered

Pulmo edema

Hypertension, impaired temp regulation

Encephalitic s/s
o
Bulbospinal

Combination
Minor Polio
o
Inapparent / subclinical
o
Abortive: recover within 72 hours; flulike;
backache; vomiting
Major Polio
o
Paralytic: asymmetrical weakness, paresthesia,
urinary retention, constipation
o
Non paralytic: slight involvement of the CNS;
stiffness and rigidity of the spine, spasms of
hamstring muscles, with paresis
o
Tripod position: extend his arms behind him for
support when upright
o
Hoynes sign: head falls back when he is in
supine position with the shoulder elevated
o
Meningeal irritation: (+) Brudzinski, Kernigs
sign

Diagnostics

Throat swab, stool exam, LP

Nursing Interventions

Supportive, Preventive Salk and Sabin Vaccine

NO morphine
Moist heat application for spasms
Airway: tracheotomy
Footboard to prevent foot drop
Fluids, NTN, Bedrest
Enteric and strict precautions

HEPATITIS A

Inflammation of the liver caused by hepatitis A virus

AKA: infectious hepatitis
Incubation period: 2-6weeks
MOT: oral-fecal/ enteric transmission
Diagnostic test: liver function (SGOT/SGPT)

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

Stool Exam ( cyst, amoeba+++)

WBC elevated
Treatment

Amoebacides Metronidazole(Flagyl) 800mg TID

7days
Bismuth gylcoarsenilate combined with Chloroquine
Antibiotic Ampicillin, Tetracycline, Chloramphenicol
Fluid replacement IVF, oral

Nursing Management

Clinical Manifestations

Prodromal/ pre icteric

o
S/S of URTI
o
Weight loss
o
Anorexia
o
RUQ pain
o
Malaise
Icteric
o
Jaundice
o
Acholic stool
o
Bile-colored urine

Enteric precaution
Health education- boil drinking water (20-30 mins), Use
mineral water.
Cover leftover food.
Avoid washing food from open drum/pail.
Wash hands after defecating and before eating.
Observe good food preparations.
Fly control

ASCARIASIS

Helminthic infection of the small intestine caused by

Ascaris Lumbrecoides
MOT: fecal-oral
Incubation period: 4-8 weeks
Communicability: as long as mature fertilized female
worms live in intestine

Diagnostic tests

HaV Ag, Ab, SGOT, SGPT

Nursing Interventions

Provide rest periods

Increase CHO, mod Fat, low CHON
Intake of vits/minerals
Proper food preparation/handling
Handwashing to prevent transmission

AMOEBIASIS

involves the colon in general but may involve the liver or

lungs as well
Etiologic agent: Entamoeba histolytica
Incubation: 3-4 weeks
Period of communicability: duration of illness
MOT: fecal oral route
o
Indirect - Ingestion of food contaminated with
E.Histolytica cysts, polluted water supply,
exposure to flies, unhygienic food handlers.
o
Direct contact sexual, oral, or anal, proctogenital

Diagnostics

Microscopic identification of eggs in stool

CBC
Hx of passing out of worms (oral or anal), Xray,

Signs and Symptoms

Stomachache
Vomiting
Passing out of worms

Complications

Energy / Protein malnutrition

Anemia
Intestinal obstruction

Treatment:

Pyrantel Pamoate
Piperazine Citrate
Mebendazole, Tetramizole
Dicyclomine Hcl, NSAIDS for abdominal pain
For intestinal obstruction
o
Decompression
o
Fluid and electrolyte therapy
o
If persistent, laparotomy
FF up stool exam 1-2 weeks after treatment

Nursing Intervention

Clinical Manifestations

Intermittent fever
Nausea, vomiting, weakness
Later : anorexia, weight loss, jaundice
Diarrhea watery and foul smelling stool often containing
blood streaked mucus
Colic and abdominal distention
Intestinal perforation bleeding

Diagnostics

Isolation- not needed

Enteric precaution
Handwashing
Proper nutrition
Maintenance of hydration / fluid balance / boil of water
Improve personal hygiene
Proper food prep/handling
Administer meds (NSAIDS, MEBENDAZOLE)

DISEASES ACQUIRED THRU THE SKIN

Diseases caused by Trauma and Inoculation

o
Tetanus
o
Rabies
o
Malaria
o
DHF

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
o
Leptospirosis

NGT feeding
o
Schistosomiasis

Tracheostomy

Disease acquired thru Contact

Adequate fluid, electrolyte, caloric intake

O
Leprosy

During convalescence

Determine vertebral injury

TETANUS

Attend to residual pulmonary disability

Physiotherapy

an acute, often fatal, disease characterized by generalized

TT
rigidity and convulsive spasms of skeletal muscles caused by
the endotoxin released by C. Tetani
Nursing Interventions

AKA: Lockjaw

Etiologic Agent: Clostridium Tetani

Prevention
o
Anerobic
o
DPT
o
Spore forming, gram positive rod
Adverse Reactions

Sources:
Local reactions (erythema, induration)
o
Animal and human feces
Fever and systemic symptoms not common
o
Soil and dust
Exagerated local reactions
O
Plaster, unsterile sutures, rusty scissors, nails and
pins

Prevention of CV and respiratory complications

MOT:
o
Adequate airway
o
Direct or indirect contact to wounds
o
ICU ET- MV
o
Traumatic wounds and burns

Provide cardiac monitoring

o
Umbilical stump of the newborn

KVO
o
Dirty and rusty hair pins

Wound care (TIG, Debridement, TT)

o
GIT- port of entry rare

Administer antibiotics as ordered

o
Circumcision/ ear pearcing
o
Penicillin

Incubation period: 3d-3week (ave:10d)

Care during tetanic spasm/ convulsion

o
Administer Diazepam muscle rigidity/spasm
o
Administer neuromuscular blocking agents
(metocurin iodide) relax spasms and prevent
seizure

Keep on seizure precaution

Parenteral nutrition

Avoid complications of immobility (contractures, pressure

sores)

WOF urinary retention, fractures

RABIES

Signs and Symptoms

persistent contraction of muscles in the same anatomic area

as the injury
Local tetanus
Cephalic tetanus - rare form
otitis media (ear infections)
Generalized tetanus
o
trismus or lockjaw
o
stiffness of the neck
o
difficulty in swallowing
o
rigidity of abdominal muscles
o
elevated temperature
o
sweating
o
elevated blood pressure episodic rapid heart rate
Neonatal tetanus - a form of generalized tetanus that occurs
in newborn infants

a viral zoonotic neuroinvasive disease that causes acute

encephalitis
Etiologic agent: Rhabdovirus
AKA: Hydrophobia, Lyssa
Negri bodies in the infected neurons pathognomonic
Incubation period: 4-8 weeks; 10d-1yr
Period of communicability: 3-5 days before the onset of s/s
until the entire course of disease
MOT: contamination of a bite of infected animals

Diagnostics

History of exposure
PE/ assessment of s/s
Microscopic examination of Negri bodies using Sellers MayGrunwald and Mann Strains
Fluorescent Rabies Antibody technique / Direct
Immunofluorescent test

Diagnostics

entirely clinical
CSF normal
WBC- normal or slight elevated

Treatment

Wounds should be cleaned

Necrotic tissue and foreign material should be removed
Tetanic spasms - supportive therapy and maintenance of an
adequate airway
Tetanus immune globulin (TIG)
o
help remove unbound tetanus toxin
o
cannot affect toxin bound to nerve endings
o
single intramuscular dose of 3,000 to 5,000 units
o
contains tetanus antitoxin.
Oxygen

Clinical Manifestations

Prodromal Phase / Stage of Invasion

o
Fever, anorexia, malaise, sorethroat, copious
salivation, lacrimation, perspiration, irritability,
hyperexcitability, restlessness, drowsiness, mental
depression, marked insomia
o
Sensitive to light, sound, and changes in temp
o
Myalgia, numbness, tingling, burning or cold
sensation along nerve pathway; dilation of pupils

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
o

Stage of Excitement
o
Marked excitation, apprehension
o
Delirium, nuchal stiffness, involuntary twitching
o
Painful spasms of muscles of mouth, pharynx, and
larynx on attempting to swallow food or water or
the mere sight of them hydrophobia
o
Aerophobia
o
Precipitated by mild stimuli touch or noise
o
Death spasm from or from cardiac / respiratory
failure
Terminal Phase or Paralytic Stage
o
Quiet and unconscious
o
Loss of bowel and bladder control
o
Tachycardia, labored irregular respiration, steady
rising temp
o
Spasm, progressively increasing paralysis
o
Death due to respiratory paralysis

12days P. falciparum, 14 days P vivax and ovale, 30

days P. malariae
Period of communicability
o
If not treated /inadequate more than 3 yrs. P
malariae, 1-2 yrs. P. vivax, 1 yr- P. falciparum
Mode of transmission
o
Mosquito bite: Vector female Anopheles
mosquito
o
Also by blood transfusion

Diagnostics

Malarial smear film of blood is placed on a slide, stained

and examined
Rapid diagnostic test (RDT) done in field. 10 -15 mins
result blood test

Treatment

No cure
No specific symptomatic/ supportive directed toward
alleviation of spasm
Employ continuing cardiac and pulmonary monitoring
Assess the extent and location of the bite biting incident/
status of the animal
o
Severe exposure
o
Mild exposure
Wound treatment (local care)
o
Cleanse thoroughly with soap and water (or
ammonium
compounds,
betadine,
or
benzalkonium cl)
o
Anti rabies serum
o
Tetanus prophylaxis
o
Antibiotics
o
Suturing should be avoided
Antirabies sera
o
Heterologous
serum
obtained
by
hyperimmunization of different animal species i.e.
horses
o
HRIG Homologous reabies immunoglobulin
human origin
Rabies Vaccine
Active immunization
o
Administered 3 years duration
o
Used for lower extremity bites
o
Lyssavac (purified protein embryo), Imovax, Antirabies vaccine
Passive immunization
o
3 months
o
Rabuman, Hyper Rab, Imogam

Clinical Manifestions

Nursing Interventions

Isolation of patient
o
Provide comfort for the patient by:
o
Place padding of bedside or use restraints
o
Clean and dress wound with the use of gloves
o
Do not bathe the patient, wipe saliva or provide
sputum jar
Provide restful environment
o
Quiet, dark environment
o
Close windows, no faucets or running water should
be heard
o
IVF should be covered
o
No sight of water or electric fans

MALARIA

Acute and chronic disease transmitted by mosquito bite

confined mainly to tropical areas.
Etiologic agent Protozoa of genus Plasmodia
o
Plasmodium Falciparum (malignant tertian)
most serious, high parasitic densities in RBC with
tendency to agglutinate and form into
microemboli. Most common in the Philippines
o
P. Vivax - non life threatening except for the very
young and old.
Manifests chills every 48 hrs on the 3rd day
onward if not treated
o
P. malarie (Quartan) less frequent, non life
threatening, fever and chills occur every 72 hrs on
the 4th day of onset
o
P. ovale - rare
Incubation period:

Rapidly rising fever with severe headache

Shaking chills
Diaphoresis, muscular pain
Splenomegaly, hepatomegaly
Hypotension
o
May lasts for 12 hours daily or every 2 days.
Complicated Malaria
o
GIT

Bleeding from GUT, N/V, Diarrhea,

abdominal
pain,
gastric,
tyhoid,
choleric, dysenteric
o
CNS or Cerebral Malaria

Changes in sensorium

Severe headache

N/V
o
Hemolytic

Blackwater fever - Reddish to mahogany

colored urine due to hemoglobinuria

Anuria death
o
Malarial lung disease

Management

Antimalarial drugs Chloroquine (all but P. Malarie),

quinine, Sulfadoxine (resistant P falciparum) Primaquine
(relapse P vivax/ovale)
RBC replacement/ erythrocyte exchange transfusion

Nursing Management

Isolation of patient
Use mosquito nets
Eradicate mosquitos
Care of exposed persons case finding
I and O
BUN & creatinine dialysis could be life saving
ABG
TSB, ice cap on head
Hot drinks during chilling, lots of fluid
Monitoring of serum bilirubin
Keep clothes dry, watch for signs of bleeding

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
Prevention

BT as necessary

O2 therapy

Mosquito breeding places should be destroyed

Insecticides, insect repellant

Nursing Management

Blood donor screening

Kept in mosquito free environment

DENGUE FEVER

Keep pt. at rest

VS monitoring

Is an acute febrile disease cause by infection with one of the

Ice bag on the bridge of nose and forehead.

serotypes of dengue virus which is transmitted by mosquito

Observe for signs of shock VS (BP low), cold clammy skin

(Aedes aegypti).

Dengue hemorrhagic fever fatal characterized by

Prevention
bleeding and hypovolemic shock

Etiologic agent Arbovirus group B

Mosquito net

AKA: Chikungunya, O nyong nyong, west nile fever

Eradication of breeding places of mosquito

Mode of Transmission: Bite of infected mosquito Aedes

o
house spraying
Aegypti
o
change water of vases

Incubation period 3-14 days

o
scrubbing vases once a week

Period of communicability mosquito all throughout

o
cleaning the surroundings
life
o
keep water containers covered

Sources of infection
o
avoid too many hanging clothes inside the house
o
Infected person- virus is present in the blood and
will be the reservoir when sucked by mosquitoes
LEPTOSPIROSIS
o
Stagnant water = any

Infectious bacterial disease carried by animals whose urine

contaminates water or food which is ingested or inoculated
thru the skin.
Etiologic agent: spirochete Leptospira interrogans
found in river, sewerage, floods
AKA: Weils disease, mud fever, Swineherds disease
Incubation Period: 6 -15 days
Period of Communicability found in urine between 1020 days
MOT contact with skin of infected urine or feces of
wild/domestic animals; ingestion, inoculation

Diagnostics
Diagnostics

Clinical manifestations
Culture

Torniquet test
Platelet Count
Hematocrit

Manifestations

Prodromal symptoms
o
malaise and anorexia up to 12 hrs.
o
Fever and chills, head-ache, muscle pain
o
N &V
Febrile Phase
o
Fever persists (39-40 C)
o
Rash - more prominent on the extremities and
trunk
o
(+) torniquet test- petechia more than 10.
o
Skin appears purple with blanched areas with
varied sizes ( Hermans sign)
o
Generalized or abdominal pain
o
Hemorrhagic manifestations epistaxis, gum
bleeding
o
Circulatory Phase
o
Fall of temp on 3rd to 5th day
o
Restless, cool clammy skin
o
Profound thrombocytopenia
o
Bleeding and shock
o
Pulse - rapid and weak
o
Untreated shock --- coma death
o
Treated recovery in 2 days

Classification

Grade 1
Grade 2
Grade 3
Grade 4

Treatment

No specific antiviral therapy for dengue

Analgesic not aspirin for relief of pain
IV fluid

Source of Infection

Rats, dogs, mice

Manifestations

Septic Stage
o
Early - Fever (40 C), tachycardia, skin flushed,
warm, petechiae
o
Severe (Multiorgan)Conjunctival affectation,
jaundice, purpura, ARF, Hemoptysis, head-ache,
abdominal pain, jaundice

Toxic stage with or w/o jaundice, meningeal irritation,

oliguria shock, coma , CHF

Convalescence recovery
Management

IV antibiotic
o
Pen G Na
o
Tetracycline
o
Doxycycline
Dialysis peritoneal
IVF
Supportive
Symptomatic

Nursing Interventions

Isolation of patient urine must properly disposed

Care of exposed persons keep under close surveillance
Control measures
o
Cleaning of the environment/ stagnant water
o
Eradicate rats

o
o

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
Avoid bathing or wading in contaminated pool of
o
Stibophen (Fuadin) given per IM
water

Praziquantel per orem

vaccination of animals (cattles,dogs,cats,pigs)

Niridazole

SCHISTOSOMIASIS

Parasitic disease caused by Schistosoma japonicum, S.

mansoni, S. Hematobium
AKA: Bilharziasis, Snail fever
Incubation period: 2-6 weeks
MOT: bathing, swimming, wading in water
o
Vector: Oncomelania quadrasi
o
Cercariae: most infective stage

Diagnostics

Fecalysis
o
Identification of eggs

Liver and rectal biosy

Immunodiagnostic tests / circumoval precipitin test and

cercarial envelope reactions

Nursing Interventions

Administer prescribed drugs as ordered

Prevent contact with cercaria-laden waters in endemic areas
like streams
Proper sanitation or disposal of feces
Creation of a program on snail control chemical or
changing snail environment

LEPROSY

Chronic systemic infection characterized by progressive

cutaneous lesions
Etiologic agent: Mycobacterium leprae
Acid fast bacilli that attack cutaneous tissues, peripheral
nerves producing skin lesions, anesthesia, infection and
deformities.
Incubation period 5 1/2 mo - eight years.
MOT respiratory droplet, inoculation thru break in skin
and mucous membrane.

Diagnosis

Identification of signs and symptoms

Tissue biopsy
Tissue smear
Bloods inc. ESR
Lepromin skin test
Mitsuda reaction

Signs and Symptoms

Swimmers itch
o
Itchiness
o
Redness and pustule formation at site of entry of
cercariae
o
Diarrhea
o
Abdominal pain
o
Hepatosplenomegaly

Clinical Manifestations

Abdominal pain
Cough
Diarrhea
Eosinophilia - extremely high eosinophil granulocyte count.
Fever
Fatigue
Hepatosplenomegaly - the enlargement of both the liver and
the spleen.
Colonic polyposis with bloody diarrhea (Schistosoma
mansoni mostly)
Portal hypertension with hematemesis and splenomegaly (S.
mansoni, S. japonicum);
Cystitis and ureteritis with hematuria bladder cancer;
Pulmonary hypertension (S. mansoni, S. japonicum, more
rarely S. haematobium);
Glomerulonephritis; and central nervous system lesions.

Complications

Pulmonary hypertension
Cor pulmonale
Myocardial damage
Portal cirrhosis

Treatment

Trivalent antimony
o
Tartar emetic administered thru vein

Manifestations

Corneal ulceration, photophobia blindness

Lesions are multiple, symmetrical and erythematous
macules and papules
Later lesions enlarge and form plaques on nodules on
earlobes, nose eyebrows and forehead
Foot drop
Raised large erythemathous plaques appear on skin with
clearly defined borders. rough hairless and hypopigmented
leaves an anesthetic scar.
Loss of eyebrows/eyelashes
Loss of function of sweat and sebaceous glands
Epistaxis

Prevention

multiple drug therapy

sulfone
rehab
occupational Health
isolation
moral support

Prevention

Report cases and suspects of leprosy

BCG vaccine may be protective if given during the first 6
months.

Nursing Interventions

Isolation of patient until causative agent is still present

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
Care of exposed persons
Household contact Diaminodiphenylsulfone for 2 years
Observe carefully for symptoms of the disease

DISEASES ACQUIRED THRU SEXUAL CONTACT

HIV/AIDS

Chronic disease that depresses immune function

Charecterized by opportunistic infections when T4/CD4
count drops <200
MOT sexual contact with infected unprotected, injection
of blood/products, placental transmission

History

1959 - African man

1981- 5 homosexual men
1982-Designated as disease by CDC
1983- HIV 1 discovered
1987- 1.5 million HIV-infected in USA
1994- WHO reports 8-10 mil. Worldwide & protease
inhibitors introduced
1999-First clinical trials for HIV vaccine

The Immune System

Macrophages
Humoral response
Cell-mediated response
RNA virus
Retrovirus
Reverse transcriptase
Protease

Manifestations

Minor signs cough for one month, general pruritus,

recurrent herpes zoster, oral candidiasis, generalized
lymphadenopathy
Major signs loss of weight 10% BW, chronic diarrhea
1month up, prolonged fever one month up.
Persistent lymphadenopathy
Cytopenias (low)
PCP
Kaposis sarcoma
Localized candida
Bacterial infections
TB
STD
Neurologic symptoms

Criteria for Diagnosis of AIDS

Diagnostics

ELISA
Western Blot
CD4 count
Viral load testing
Home test kits

HIV/AIDS Spectrum

CD4 counts of 200 or less

Evidence of HIV infection and any of
o
Thrush
o
Bacillary angiomatosis
o
Oral hairy leukoplakia
o
Peripheral neuropathy
o
Vulvovaginal candidiasis
o
Shingles
o
Idiopathic thrombocytopenia
o
Fatigue, night sweats, weight loss
o
Cervical dysplasia, carcinoma in situ

Evidence of HIV infection and any one of the following:

o
Bronchial candidiasis
o
Esophageal candidiasis
o
CMV disease
o
CMV retinitis
o
HIV encephalopathy
o
Histoplasmosis
o
Kaposis Sarcoma
o
Herpes simplex ulcers, bronchitis, pneumonia

Treatment

Started in CD4 counts of <200

Viral load >10,000 copies
All symptomatic regardless of counts
Note: CD4 reflects immune system destruction. Viral loaddegree of viral activity
Nucleoside Reverse Transcriptase Inhibitors
o
Blocks reverse transcriptase
o
Acts by binding directly to the reverse
transcriptase enzyme
o
Not used alone
o
Rapid development of resistance

Generic

Trade

Dose

Notes

Zidovudine

300
mg.
Bid
200 mg bid

Taken with food

Didanosine

AZT, ZDV,
Retrovir
ddI, Videx

Zalcitibine
Stavudine

ddC,Hivid
d4T, Zerit

.75 mg TID
400 mg bid

Peripheral
neuropathy
No antacids
Peripheral

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos

Educate about s/s and importance of taking antibiotic for the

neuropathy
entire therapy
Lamivudine
3TC, Epivir
150 mg bid
Used
as
resistance
develops
SYPHILIS
Lamiduvine
Combivir
150/300
Bone
marrow
/
mg
toxicity
Zidovudine

a curable, bacterial infection, that left untreated will progress

through four stages with increasingly serious symptoms

Etiologic agent: Treponema pallidum

Protease Inhibitors

AKA: Lues, The pox, Bad blood

o
Introduced in 1995

Type of Infection: Bacterial

o
Acts by blocking protease enzyme
o
Indinavir (Crixivan)

Modes of transmission :
o
CDC Guidelines
o
Through sexual contact/ intercourse, kissing

Combination of 2 NRTI + PI
o
abrasions
o
Can be passed from infected mother to unborn
child (transplacental)
Nursing Management
Symptoms

Administer Antiviral meds as ordered

Universal precaution

Primary syphilis (10 90 days after infection)

Reverse isolation
o
Chancre a firm, painless skin ulceration
localized at the point of initial exposure to the

gloves, needle stick injury prevention

bacterium appear on the genitals

Assist in early diagnosis and management of complications

o
can also appear on the lips, tongue, and other body

4 Cs
parts
o
Compliance info, + drugs

Secondary syphilis (last 2 6 weeks)

o
Counselling education
o
syphilis rash - an infectious brown skin rash
o
Contact tracing tracing out and tx for partners
that typically occurs on the bottom of the feet and
o
Condoms safe sex
the palms of the hand
o
condylomata lata - flat broad whitish lesions
GONORRHEA
o
Fever, sore throat, swollen glands, and hair loss
can also be experienced

a curable infection caused by the bacteria Neisseria

Third stage
gonorrhoea
o
Will manifest 1 10 years after the infection

AKA: Clap, Drip, G. vulvovaginitis

o
characterised by gummas - soft, tumor-like

MOT: transmitted during vaginal, anal, and oral sex

growths

Incubation period: 3-10 days initial manifestations

o
seen in the skin and mucous membranes occurs

Period of communicability: considered infectious from

in bones
the time of exposure until treatment is successful
o
joint and bone damage
o
increasing blindness
Manifestations
o
numbness in the extremities, or difficulty in
coordinating movements.

Urethritis both male and female

S/S: dysuria and purulent discharge

neurosyphilis

Cervicitis
o
generalized paresis of the insane which results in

Upper Genital Tract females (PID), Endometritis,

personality changes, changes in emotional affect,
hyperactive reflexes
Salpingitis, Pelvic Abscess

cardiovascular syphilis
Complications
o
aortitis, aortic aneurysm, Aneurysm of sinus of

PID
valsalva and aortic regurgitation, - death

Infertility

Upper Genital Tract male

Epididymitis, Prostatitis, Seminal Vesiculitis

Disseminated Gonococcal Infection (DGI)

Tenosynovitis or Polyarthritis, skin lesions and fever

Anorectal Infection

Pharyngeal Infection

Gonococcal Conjuctivitis

Opthalmia Neonatorum

Meningitis, Endocarditis
Diagnosis

Culture & Sensitivity

Blood tests for N. gonorrhoeae antibodies

Treatment

Antibiotics
A
o
Penicillin
o
Single dose Ceftriaxone IM + doxycycline PO BID
for 1 week
o
Prophylaxis:
Silver
nitrate,
Tetracycline,
Erythromycin

Nursing Interventions

Case finding
Health teaching on importance of monogamous sexual
relationship
Treatment should be both partners to prevent reinfection
Instruct possible complications like infertility

Consequences in Infants
o
congenital syphilis
o
extremely dangerous
o
Deformities
o
Seizures
o
Blindness
o
Damage to the brain, bones, teeth, and ears.

Test and diagnosis

Venereal Disease Research Laboratory (VDRL) test

Flourescent treponemal antibody absorption (FTA Abs)
Micro hemagglutination test (MHA - TP)
CSF examination

Treatment

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos
Syphilis is easily treatable when early detected

Proper NTN, increase in CHO, high in CHON, low fats, Vit. K

rich foods and minerals
Penicillin & other antibiotics

Assistance to prevent injury, promote safety AAT

Prevention

WOF s/s bleeding, edema

Abstinence

Health education on safe sex

Mutual monogamy

Latex condoms for vaginal and anal sex

Nursing interventions

Case finding
Health teaching and guidance along preventive measures
Utilization of community health facilities
Assist in interpretation and diagnosis
Reinforce ff up treatment
VD control program participation
Medical examination of patients contacts

HEPATITIS B

serious disease caused by a virus that attacks the liver

Etiologic agent: hepatitis B virus (HBV)
Source of infections: Blood and body secretions

Risk factors

multiple sex partners or diagnosis of a sexually transmitted

disease
Sex contacts of infected persons
Injection-drug users
Household contacts of chronically infected persons
Infants born to infected mothers
Infants/children of immigrants from areas with high rates of
HBV infection
Health-care and public safety workerr
Hemodialysis patients

Complications

Lifelong infection
Liver cirrhosis
Liver cancer
Liver failure
Death

Signs ans Symptoms

SEVERE OF ACUTE RESPIRATORY SYNDROME

An acute and highly contagious respiratory disease in

humans
Etiologic agent: SARS coronavirus
November 2002 and July 2003, with 8,096 known infected
cases and 774 deaths
Incubation period: 2-3days
MOT: Airborne

Signs and Symptoms

S

flu like: fever, myalgia, lethargy, gastrointestinal symptoms,

cough, sore throat
fever above 38 C (100.4 F)
Shortness of breath
Symptoms usually appear 210 days following exposure

require mechanical ventilation

Diagnostics

Chest X-ray (CXR)- abnormal with patchy infiltrates

WBC and PLT CT. - LOW
ELISA test detects antibodies to SARS
o
but only 21 days after the onset of symptoms
Immunofluorescence assay can detect antibodies 10
days after the onset of the disease
o
labour and time intensive test
Polymerase chain reaction (PCR) test that can detect
genetic material of the SARS virus in specimens ranging
from blood, sputum, tissue samples and stools

CXR - increased opacity in both lungs, indicative of

pneumonia

SARS may be suspected

Jaundice
Pruritus
Fatigue
RUQ - Abdominal pain
Loss of appetite
Nausea, vomiting
Joint pain

fever of 38 C (100.4 F) or more AND

Either a history of:

Prevention

Hepatitis B vaccine has been available since 1982.

Routine vaccination of 0-18 year olds
Vaccination of risk groups of all ages
Immune globulin if exposed

Interferon alfa-2b
Lamivudine
Telbivudine
Entecavir
Adefovir dipivoxil

Nursing Interventions

Blood and body secretions precautions

Prevention- Hepa B vaccine
Proper rest periods
Prevent stress physio/psychological

Contact (sexual or casual) with someone

with a diagnosis of SARS within the last
10 days OR

Travel to any of the regions identified by

the WHO as areas with recent local
transmission of SARS (affected regions
as of 10 May 2003 were parts of China,
Hong Kong, Singapore and the province
of Ontario, Canada).

probable case of SARS

Medical Management

above findings plus positive chest x-ray findings of

atypical pneumonia or respiratory distress
syndrome

Treatment

supportive with antipyretics, supplemental oxygen and

ventilatory support as needed.
Suspected cases of SARS must be isolated, preferably in
negative pressure rooms, with full barrier nursing
precautions taken for any necessary contact with these
patients
steroids
antiviral drug
SARS vaccine

Chinese General Hospital College of Nursing

Communicable Diseases
Pocholo Santos