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Communicable Disease Nursing DRUG OF CHOICE Tetanus: PEN G Na; DIAZEPAM (Valium) Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant) Rabies Vaccines: LYSSAVAC, VERORAB Immunoglobulins: ERIG or HRIg DIAGNOSTIC TESTS Tetanus: WOUND CULTURE Meningitis: LUMBAR PUNCTURE Encephalitis: EEG Polio: EMG; Muscle testing Rabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody test Dengue: TOURNIQUET test (Rumpel lead) Malaria: Malarial smear; QBC (Quantitative Buffy Coat) Scarlet: DICK'S TEST; SCHULTZ-CHARLTON TEST Diphtheria: SCHICK'S TEST; Moloney's Test Pertussis: Nasal swab; agar plate Tuberculosis: MANTOUX test Leprosy: SLIT SKIN SMEAR Pinworm: SCOTCH TAPE SWAB Typhoid: WIDAL'S test HIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test CAUSATIVE AGENTS Tetanus: CLOSTRIDIUM TETANI Meningococcemia: NEISSERIA MENINGITIDIS Rabies: RHABDOVIRUS Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III Leon) Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses) (Common in the Phil.) Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P. Ovale Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI Leprosy: MYCOBACTERIUM LEPRAE Measles: PARAMYXO VIRUS German measles: TOGA VIRUS Chicken pox: VARICELLA ZOSTER VIRUS Herpes zoster: HERPES ZOSTER VIRUS Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS Scabies: SARCOPTES SCABIEI (itch mite) Bubonic plague: YERSINIA PESTIS Diphtheria: KLEBS LOEFFLER
Pertussis: BORDETELLA PERTUSSIS Tuberculosis: MYCOBACTERIUM TUBERCULOSIS Typhoid: SALMONELLA TYPHI Cholera: VIBRIO CHOLERA Amoebiasis: ENTAMOEBA HYSTOLITICA Leptospirosis: LEPTOSPIRA Spirochete Schistosomiasis: Schistosoma japonicum Gonorrhea: N. GONORRHEAE Syphilis: TREPONEMA PALLIDUM Chlamydia: C. trachomatis, T. vaginalis Genital herpes: HERPES SIMPLEX 2 CD PHARMACOLOGY Malaria: CHLOROQUINE Schistosomiasis: PRAZIQUANTEL Scabies: EURAX/ CROTAMITON Chicken pox: ACYCLOVIR/ZOVIRAX Tuberculosis: R.I.P.E.S. Pneumonia: COTRIMOXAZOLE; Procaine Penicillin Helminths: MEBENDAZOLE; PYRANTEL PAMOATE
Infectious Agent or its toxic products - AGENT Directly or Indirectly - MODE OF TRANSMISSION Person, Animal or Intermediate Vector HOST Environment - ENVIRONMENT ECOLOGIC TRIAD OF DISEASE Agent element, substance, animate or inanimate that may serve as stimulus to initiate a disease process Host organism that provides nourishment for another organism Environment physical (climate), biological (plants & animals) CONTAGIOUS VS. INFECTIOUS Contagious Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host Infectious Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane. NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS What is Infection? INFECTION - "the state or condition in which the body or part of the body is invaded by a pathogenic
agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious " Infectious Agent A. RESIDENT ORGANISMS deeply seated in the epidermis, not easily removed by simple handwashing, Ex: Staphylococci B. TRANSIENT ORGANISM represent recent contamination, survive for a limited period of time, acquired during contact with the infected colonized patient or environment, easily removed by good handwashing Ex: ( Klebsiella & Pseudomonas)
Infectious Agent Bacteria heama organism, systemic Virus nuero organism, systemic Fungi skin organism, local Protozoa GI organism, local Infectious Agent FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE Pathogenicity ability to cause a disease Infective dose no of organism to initiate infection Virulence ability to enter or move through tissues Specificity ability of the organism to develop antigens
STAGES OF INFECTIOUS PROCESS Means of Transmission 1. CONTACT - most common means of transmitting microorganisms from one person to another. A. Direct Contact (person to person) occurs when one person touches another best vehicle is the Hands especially those of the Health Care workers Indirect Contact (inanimate object) - occurs when a person touches an inanimate object contaminated by an infected patient
- droplet, dust, organisms in env. 3. VECTOR - insects or animals 4. VEHICLE - food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion) PREVENTION OF COMMUNICABLE DISEASE Prevention is worth a pound than cure PREVENTION OF COMMUNICABLE DISEASE Health Education primary role of the nurse Specific Protection- handwashing, use of protective devices Environmental Sanitation clean and conducive for health Definition of Prevention Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention A Dictionary of Epidemiology, Fourth Edition by John M. Last
Prevention of Needlestick Injuries Dispose Used Needles in Puncture Proof Needle Containers Don t Recap Needles (Unless using the One-handed Technique) Use Gloves When Handling Needles (Won t Prevent Injuries but May Lessen Chance of Transmitting Diseases) CONTROL OF C0MMUNICABLE DIESEASE 1. Notification 2. Epidemiological Investigation 3. Case finding; early dx and prompt treatment 4. Isolation and Quarantine 5. Disinfection; disinfestation 6. Medical Asepsis a. Handwashing b. Concurrent disinfection c. Personal protective equipments (PPEs) d. Barrier Cards/Placarding Objectives of CCD Restoration of health, reduce deaths and disability Interpretation of control measures to IFC for practice to prevent spread of CD.
Promotion of health and prevention of spread of CD
Diseases that require weekly monitoring: 1. Acute flaccid paralysis (AFP) polio 2. Measles 3. Severe acute diarrhea (SAD) 4. Neonatal tetanus 5. AIDS Diseases that require reporting w/in 24 hrs 1. Acute flaccid paralysis (AFP) polio 2. Measles Diseases targeted for eradication 1. Acute flaccid paralysis polio 2. Neonatal tetanus 3. Measles 4. Rabies Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease frequency of disease occurrence Sporadic On and off occurrence of the disease Most of the time it is not found in the community One or two cases that occur are not related Endemic Persistently present in the community all year round Ex: malaria in Palawan Epidemic An unexpected increase in the number of cases of disease Pandemic Epidemic of a worldwide proportions Time Related Patterns of Occurrence cyclical variation a periodic increase in the number of cases of a disease a seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular time hot spot-a rising increase that may lead to an epidemic Time Related Patterns of Occurrence
Short time fluctuation A change in the frequency of occurrence of a disease over a short period of time Maybe (+) or (-) Secular variation A change in the frequency of occurrence of a diseae taking place over a long period of time Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints. b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today Types of Epidemiology Descriptive Epidemiology - concerned with disease frequency & distribution Analytic Epidemiology Is a study of the factors affecting occurrence and distribution of the disease. Ex. Epidemiologic investigation Therapeutic/Clinical Study of the efficacy of a treatment of a particular disease Ex. Clinical trial of a newly proposed therapeutic regimen Evaluation Epidemiology Study of the over-all effectiveness of a total/ comprehensive public health program. Ex. Evaluation of the under five clinic Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment Types of Epidemiologic Data Demographic data Demography is the study of population groups Ex. Population size and distribution Vital Statistics Environmental data Health services data Ex. Ratio between nurse and the population being served Ex. Degree of utilization of health facility/ service Epidemiologic Investigation 1st step- Statement of the problem 2nd step- Appraisal of facts describing the epidemic in terms of time, place, person. 3rd step- formulation of hypothesis 4th step-Testing the hypothesis 5th step- Conclusion and recommendation TERMS Disinfection pathogens but not spores are destroyed
Disinfectant substance use on inanimate objects Concurrent disinfection ongoing practices in the care of the patient to limit or control the spread of microorganisms. Terminal disinfection practices to remove pathogens from the patient s environment after his illness is no longer communicable FACTORS AFFECTING ISOLATION Mode of Transmission Source Status of the client s defense mechanism Ability of client to implement precautions ISOLATION EPI Launched by DOH in cooperation with WHO and UNICEF last July 1976 Objective reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases PD No. 996 (Sept. 16, 1076) Providing for compulsary basic immunization for infants and children below 8 y/o PP No. 6 (April 3, 1996) Implementing a United Nations goal on Universal Child Immunization by 1990 RA 7846 (Dec. 30, 1994) immunization hepa B PD No. 4 (July 29, 1998) Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign
Legislation, Laws affecting EPI Proclamation No. 46 polio eradication project Proclamation No. 1064 AFP surveillance Proclamation No. 1066 National Neonatal Tetanus Elimination Campaign
EPI BCG - TB DPT Diptheria, Pertussis, Tetanu OPV - Poliomyletis Hepatitis B Measles Immunization Contraindications
-conditions that require hospitalization For DPT 2 and 3 history of seizures/ convulsions within 3 days after the first immunization with DPT Nursing responsibility: ask how the child reacts to the first dose For infant BCG clinical AIDS The following conditions are NOT contraindications: Fever up to 38.5 ºC Simple or mild acute respiratory infection Simple diarrhea without dehydration Malnutrition (it is indication for immunization)
Schedule of immunization Infant BCG 0 to 11 months or 0 to 1 year at birth 0.05 ml (dose) ID, right arm School entrance BCG When the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1
Schedule of immunization DPT 3 doses, 4 weeks or 1 month interval Target age: 1 ½ to 11 months but child is eligible up to 6 years If 7 years old and above DT only not P 0.5 ml, IM, vastus lateralis
Schedule of immunization OPV 3 doses, 4 weeks/1 month Target population: same as above, eligibility until Grade 6 2-3 drops, oral route *Feb 8-March 8: Oplan Polio Revival Drive No side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination
Schedule of immunization Hepa B 3 doses, 4 weeks
Can be given at birth Target age 1 ½ to 11 months 0.5 ml, IM, vastus lateralis Patient may experience local tenderness Schedule of immunization Measles 9 to 11 months Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine 0.5 ml, subcutaneous, any arm Measles Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) Immunization Fully Immunized Child when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB) Completely Immunized Child All vaccines given but went beyond 0ne year of age
1. The clinic nurse notes that the physician has documented a diagnosis of herpes zoster (shingles) in the client¶s chart. Based on an understanding of the cause of this disorder, the nurse would determine that this definitive diagnosis was made following which diagnostic test? A. B. Wood¶s C. Culture of the lesion D. Patch test ANSWER: Viral culture is the confirmatory test for Herpes. Patch test is an allergy test. 2. Nurse Jezel is preparing to care for a child with rubella (German measles) and anticipates contact with infectious material during care. She enters the supply closet where the masks, gloves, gowns, and goggles are kept. Which item(s) does the nurse obtain to care for this child? A. B. mask, gown goggles gloves C Skin light biopsy examination
C. mask, D. gown, gloves, goggles
ANSWER: B No need of goggles because causative agent cannot cause infection when it enters the mucous membrane of the eyes. 3. Eunice, six year old, is scheduled to receive a measles, mumps, rubella (MMR) vaccine. The nurse preparing to administer the vaccine reviews the child¶s record and questions the order if which of the following is documented in the child¶s record? A. B. C. D. local reaction at the site a history of an a history of recent recovery from a cold. a of injection of a previous MMR vaccine anaphylactic reaction to neomycin frequent respiratory infections
ANSWER: MMR vaccine contains aminoglycosides antibiotic. aminoglycosides warrant further check by the doctor.
Allergic reaction to
4. Ms. Flores clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5-year-old child. The nurse administers this vaccine: A. B. C. D. Intramuscularly in the anterolateral Intramuscularly in the Subcutaneously in the outer aspect Subcutaneously in the gluteal muscle. aspect of deltoid of the thigh muscle upper arm the
ANSWER: C MMR vaccine is given via this route. Before administration always check for allergy to eggs. 5. Mrs. Analesa Plaga mother brings her six years old child to the clinic because the child has developed a rash on the trunk and on the scalp. Mrs. Analesa reports that the child has had a low grade fever, has not felt like eating and generally has been tired. The child is diagnosed with chickenpox. Mrs. Plaga inquires about the communicable period associated with chickenpox. A nurse plans to base the response on which of the following? A. The communicable period is unknown. B. The communicable period s one to two days before the onset of rash to 6 days after the first crop of vesicles, when crusts have formed. C. The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears. D. The communicable period ranges from 2 weeks or less to several months.
ANSWER: B This is the POC of chicken pox. Remember chicken pox is not contagious when crust or scabs appear. 6. A nurse provides instructions to the mother of a child with mumps regarding respiratory precautions. The mother asks the nurse about the length of time required for the respiratory precautions. The nurse most appropriately responds: A. B. C. D. Respiratory precautions are not necessary once the swelling appears. Respiratory precautions are not necessary before the swelling begins. Respiratory precautions are indicated during the period of communicability. Respiratory precautions are indicated for 18 days following the onset of parotid swelling.
ANSWER: C The patient is placed on isolation during the period of communicability. 7. Decontamination of surgical instrument by soaking in 0.5% chlorine bleach for 10 minutes results to which of the following? A. B. C. D. Makes the micororganisms Completely kills Enables the health worker to reuse Rapidly kills viruses causing AIDS and Hepatitis B. less all the contaminated. microorganisms. insturment immediately.
ANSWER: D Chlorine is used in disinfecting objects because it rapidly kills viruses causing AIDS and Hepatitis B. It does not kill all microorganisms but is effective in killing most microorganisms. The presence of pathogenic microbes would mean contamination. 8. In Communicable Diseases cases, which of the following should be done to the CHN bag? A. B. C. D. Thoroughly Well Kept and Basic Medication Contents thoroughly completed. cleanse convenient and and to articles disinfected. nurse. competence.
ANSWER: A In communicable diseases cases in the community in relation to CHN bag; the main goal is to prevent the spread of infection. Therefore the bag should be thoroughly cleanse and disinfected. Option B would be appropriate if the question is asking for neatness and organization of the nurse. Option C and D are not related to the topic in communicable disease. 9. Which of the following should be done first? A. Putting Apron. B. Put out things needed for the case.
C. Take out hand towels. D. Handwashing. ANSWER: C During home visit, the nurse performs handwashing first after placing the bag in a convinient place, As a preparation for handwashing activity, the nurse first takes the towel out, soap dish as well as the apron. The nurse then performs handwashing. 10. After completion of the nursing care or treatment, the nurse must protect himself and prevent the spread of infection. What is used to clean item used? A. B. C. D. Alcohol Isopropyl Zephiran Wet ones
ANSWER: A After completing nursing care or treatment, clean and alcoholize the things used.
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