Communicable Diseases TOPIC • • • • • • • • • OUTLINE Definition of terms in Communicable Disease Chain of infection Control and Management of Infectious Disease

Immunization Protective Precautions / Isolation Diseases acquired thru GI tract Diseases acquired thru the skin Diseases acquired thru the respiratory tract Diseases acquired thru sexual contact

COMMUNICABLE DISEASE • It is an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agent, vector or inanimate object TWO TYPES INFECTIOUS DISEASE • Not easily transmitted by ordinary contact but require a direct inoculation through a break in the previously intact skin or mucous membrane CONTAGIOUS DISEASE • Easily transmitted from one person to another through direct or indirect means TERMINOLOGIES • DISINFECTION –destruction of pathogenic microorganism outside the body by directly applying physical or chemical means  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 host’s metabolism o cellular damage produced by the microbes intracellular multiplication Factors of severity of infection o disease producing ability o the number of invading microorganism

The strength of the host’s defence and some other factors. Epidemiological triad: o Agent o Host o Environment Classification accdg 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 • Some bacteria develop resistance to antibiotics • Some microbes have so many strains that a single vaccine can’t 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 body’s lines of defense Three Lines of Defense • FIRST LINE OF DEFENSE o MECHANICAL BARRIERS o CHEMICAL BARRIERS o BODY’S OWN POP. OF MICROORGANISM - “microbial antagonism principle” • SECOND – inflammatory response o Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs • THIRD – immune response - Natural/Acquired: active/passive RISK FACTORS • Age, sex, and genes • Nutritional status, fitness, environmental factors • General condition, emotional and mental state • Immune system • Underlying disease ( diabetes mellitus, leukemia, transplant) • Treatment with certain antimicrobials (prone to fungal infection), steroids, immunosuppresive drugs etc. CHAIN OF INFECTION

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Mode of Transmission Contact transmission • Direct contact - person to person • 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 Emerging problems in infectious diseases • 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 PRECAUTION – All blood, blood products and secretions from patients are considered as infected. WORK PRACTICE CONTROL • Handwashing o Before and after using gloves, after hand contact with patients, patient’s blood and other potentially infected materials. • Protective Equipment shall be removed immediately upon leaving the work area. Like apron, mask, gloves etc. o Place in designated area. • 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. Control Measures • 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. • Gowning - Wear gown during procedures which are likely to generate splashes of blood or sprays of blood and body fluids, secretions or excretions. • Eye protection (goggles) – wear it to prevent splashes. • Environmental disinfection – Clean surfaces with disnfectant 70% alcohol,diluted bleach) o Ex. Normal clean – clean the room post discharge, final clean- MRSA and infectious pts. ISOLATION PRECAUTIONS • Separation of patients with communicable diseases from others so as to reduce or prevent transmission of infectious agents. 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 contact • Respiratory isolation – prevent transmission thru air. • TB isolation – for (+) TB or CXR suggesting active PTB. • Enteric Isolation – direct contact with feces • Drainage/secretion precaution- prevents 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 Health Education – educate the family about • Immunization • MOT • Environmental sanitation – breeding places of mosquito, disposal of feces • Importance of seeking medical advice for any health problem • Preventing contamination of food and water. Environmental Sanitation o Water Supply Sanitation Program – DOH thru EHS (Environmental Health Services) o Policies on Food Sanitation Program o Policies on Hospital Waste Management • The CHNurse is in the best position to do health education such as o > development of materials for environmental sanitation o > providing group counselling, holding community assemblies and conferences. o > create programs for sanitation o > be a role model Immunization – introduction of specific antibody to produce immunity to certain disease. •

Natural – passive (from placenta), active (thru immunization & recovery from diseases) o Artificial – passive (antitoxins), active (vaccine, toxoid) Maintain vaccine potency by preventing: o Heat and sunlight o 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.

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Minimal manifestations Lymphadenopathy

DX • • • Prevention • • Tuberculin testing CXR Sputum AFB BCG Avoid overcrowding Improve nutritional status

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, Koch’s, Immigrant’s 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


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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
• • Inflammation of the meninges usually some combination of headache, fever, stiff neck, and delirium Meningococcemia: cerebrospinal fever o Etiologic agent: Neisseria meningitidis o Incubation: 2-10 days o MOT: droplet Acute meningococcemia - with or without meningitis o Waterhouse Friederichsen Syndrome

Classification 1. Inactive – asymptomatic, sputum is (-), no cavity on chest X ray 2. Active – (+) CXR, S/S are present, sputum (+) smear Classification 0-5 A. Minimal – slight lesion confined to small part of the lung B. Moderately advanced – one or both lungs are involved, volume affected should not extend to one lobe, cavity not more than 4 cm. C. Far advance – more extensive than B MANIFESTATIONS • Primary Complex: TB in children: non contagious, children swallow phlegm, fever, cough, anorexia, weight loss, easy fatigability • Adult TB o afternoon rise in temperature o night sweats o weight loss o cough dry to productive o Hemoptysis o sputum AFB (+) • Milliary TB - very ill, with exogenous TB like Pott’s disease • Primary Infection o Asymptomatic o No manifestations even at CXR, Sputum AFB • Primary Complex

Diagnostic exams: o Lumbar tap, CSF - high WBC and CHON, low glucose Manifestations: o Sudden onset of fever x 24h o Petechiae, Purpuric rashes o Meningeal irritation

 Stiff neck  Opisthotonus  Kernig’s sign  Brudzinski sign o ALOC o S/S of Increase ICP Nursing Mgt: • Administer prophylactic antibiotics: Rifampicin - drug of choice • Aquaeous Pen • Mannitol • Dexamethasone • Priority: AIRWAY, SAFETY • Maintain seizure precaution • Respiratory precaution • Handwashing • Suction secretions

2. Diptheria Antitoxin – after – skin test if (+), fractional dose 3. Supportive • O2, if laryngeal obstruction – tracheostomy • CBR for 2 weeks • Increase fluids, adequate nutritionsoft food, rich in Vit C • Ice collar 4. Isolation till 3 NEGATIVE cultures Prevention  DPT

PERTUSIS (whooping cough)
• Repeated attacks of spasmodic coughing with series of explosive expirations ending in long drawn force inspiration • Etiologic agent: Bordetella pertusis or Haemiphilus pertussis • Incubation period: 7-14 days • Period of communicability: 7 days post exposure to 3 wks post disease onset • MOT – Droplet

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  PSEUDOMEMBRANE - grayish white, smooth, leathery and spider web like structure that bleeds when detached Types of Respiratory Diptheria • NASAL o serous to serosanginous purulent discharge o Pseudomebrane on septum o Dryness/ excoriation on the upper lip and nares • PHARYNGEAL o pharyngeal pseudomembrane o bull neck ( cervical adenitis) o Difficulty swallowing • LARYNGEAL o Sorethroat, pseudomemb o Barking, dry mettallic cough Complications o Due to TOXEMIA  Toxic endocarditis  Neuritis  Toxic nephritis o Due to Intercurrent Infection  Bronchopneumonia  Respiratory failure DX • Nose and throat swabs - culture of specimen form beneath membrane • Virulence test • SHICK’s TEST: test for susceptibility to diptheria • MOLONEY’s TEST: test for hypersensitivity to diptheria MANAGEMENT 1. Penicillin, Erythromycin

Manifestation 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) Dx: • Elevated WBC • Nasopharyngeal swab Nursing Management • Prevention: o DPT • Parenteral fluids • Erythromycin - drug of choice o

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Prone position during attack Abdominal binder Adequate ventilation, avoid dust, smoke Isolation Gentle aspiration of secretions

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TSB , Skin care – daily cleansing wash Oral and nasal care Plenty of fluids Avoid direct glare of the sun- due to photophobia

MEASLES
Acute viral disease with prodromal fever, conjunctivitis, coryza, cough and Koplik’s spots • AKA: Rubeola, 7-day measles • Etiologic agent: Morbilli Paramyxoviridae virus • Incubation period: 10-12 days • Period of communicability: 3 days before and 5 days after the appearance of rashes. Most communicable during the height of rash. • MOT: Airborne • Sources of infection – secretions from eyes, nose and throat Pathognomonic sign: • Koplik’s spots

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 it’s peak. • MOT: Droplet, nasal ceretions, transplacental in congenital Manifestations • 1. Prodromal – low grade fever, headache , malaise, colds, lymph node involvement on 3rd to 5th day • 2. Eruptive – FORSCHEIMER’S 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 • Treatment o symptomatic treatment Complications • 1. Encephalitis, neuritis • 2. Rubella syndrome – microcephaly, mental retardation, deaf mutism, congenital heart disease • RISK for congenital malformation • 1. 100% when maternal infection happens on first trimester of pregnancy. • 2. 4% - second/third trimester Nursing Management 1. Isolation. Bed rest 2. Room darkened – photophobia 3. Encourage fluid 4. Like measles tx PREVENTION; • MMR, Pregnant women should avoid exposure to rubella patients • Administration of Immune serum globulin one week after exposure to rubella.

Manifestations • 1.Pre eruptive stage / Prodromal (10-11 days) o Coryza, Cough, Conjunctivitis o Koplik’s Spots, whitish spot at the inner cheek o Fever, photophobia • 2. Eruptive stage o Maculopapular rashes o Rash is fully developed by 2nd day o High grade fever –on and off o Anorexia, throat is sore • 3. Convalescence (7-10 days) o Desquamation of the skin Diagnostics • Nose and throat swab Treatment • 1. Antiviral drugs- Isoprenosine • 2. Antibiotics – if with complications • 3. Supportive – O2, IVF • Complications – bronchopneumonia, otitis media, encephalitis Nursing Management • Preventive – measles vaccine at 9 months, MMR 15 months and then 1112; defer if with fever, illness • Isolation - contact/respiratory

CHICKEN POX
• Acute and highly contagious viral disease characterized by vesicular eruptions on the skin • Infectious agent – Herpes zoster virus or Varicella zoster • Incubation period – 10 -21 days • Period of communicability: 1 day before eruption up to 5 days after the appearance of the last crop • MOT: airborne, direct, indirect o Direct contact thru shedding vesicles, o Indirect thru linens or fomites Manifestations • 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 Complications o pneumonia, sepsis Treatment • Zovirax 500mg tablet 1 tab BID X 7 days • Acyclovir • Oral antihistamine • Calamine lotion • Antipyretics NURSING MANAGEMENT • Strict isolation until all vesicles scabs disappear • Hygiene of patient • Cut finger nails short • Baking soda - pruritus • PREVENTION: Live attenuated varicella vaccine • VZIG - effective if given 96h post exposure

o Burning, itching, pain then erythematous patches followed by crops of vesicles o Eruptions are unilateral o Lesions may last 1-2 weeks o Fever, regional lymphadenopathy o Paralysis of cranial nerve, vesicles at external auditory canal o Paralytic ileus, bladder paralysis, encephalitis Complications o Opthalmia herpes – blindness because of damage of gasserian ganglion o Geniculate herpes – deafness because of infection of 7th CN (AKA: Ramsay Hunt Syndrome) Nursing Intervention o Compress of NSS or alluminum acetate over lesions o Analgesics, sedatives – weeks to mos o Steroids o Keep blister covered with sterile powder esp after break o Prevent bacterial invasion o Encourage proper disposal of secretions and usage of gown and mask

MUMPS
• 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 o 48 hrs immediately preceding the onset of swelling is the highest communicability. MOT: direct, indirect - droplet, airborne

Herpes Zoster
• • • • 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

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

CLINICAL MANIFESTATIONS 1. Sudden headache, earache, loss of appetite 2. Swelling of the parotid gland 3. Pain is related to extent of the swelling of the gland which reaches its peak in 2 days and continues for 7-10 days.

4. Fever may reach 40 C during acute stage, 5. One gland may be affected first and 2 days later the other side is involved COMPLICATIONS 1. Orchitis – testes are swollen and tender to palpation. 2. Oophoritis- pain and tendeness of the abdomen 3. Mastitis 4. Deafness may happen 5. Meningo-encephalitis -possible DIAGNOSTIC PROCEDURES 1. Viral culture 2. WBC count PREVENTION: MMR Vaccine TREATMENT MODALITIES 1. Antiviral drugs 2. NSAIDS - Acetaminophen Nursing Interventions o Symptomatic o Application of warm/ cold compress o Oral care, warm salt water gargle o Diet – semi solid, soft food easy to chew • Acid foods/fluids – fruit juices may increase discomfort Diseases Acquired thru GIT • 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 CLINICAL MANIFESTATIONS ONSET • 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 TYPHOID STATE • Tongue protrudes- dry and brown • sordes • (coma vigil) • (subsultus tendinus) • (Carphologia) • Always slip down to the foot part of the bed, • Severe case - delirum sets in often ending in death Complications o Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis DIAGNOSTIC PROCEDURES 1. WBC – elevated 2. Blood Culture – (+) S. typhosa 3. Stool Culture (+) 4. Widal test – blood serum agglutination test  O antigen – active typhoid  H antigen- previously infected or vaccinated  Vi antigen - carrier TREATMENT 1. Chloramphenicol – drug of choice 2.Paracetamol NURSING MANAGEMENT 1. Restore FE balance 2. Bedrest 3. Enteric precaution 4. Prevent falls/ safety prec 5. Oral/personal hygiene 6. WOF intestinal bleeding-bloody stool,sweating, pallor 7. NPO, BT

TYPHOID FEVER

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Infection of the GIT affecting the lymphoid tissues(ulceration of Peyer’s 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.

CHOLERA

• An acute bacterial disease of the GIT
characterized by profuse diarrhea, vomiting, loss of fluid.

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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

PREVENTION 1. Protection of food and water supply from fecal contamination. 2. Water should be boiled/ chlorinated. 3. Milk should be pasteurized. 4. Sanitary disposal of human excreta 5. Environmental sanitation.

DYSENTERY

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• Clinical manifestations o Acute, profuse, watery diarrhea. o Initial stool is brown and contains fecal material à becomes “rice water” o Nausea/ Vomiting o S/s of Dehydration o poor tissue trugor, eyes are sunken o Pulse is low or difficult to obtain, BP is low and later unobtainable. o RR – rapid and deep o Cyanosis – later o 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 1. Severe dehydration - circulatory collapse 2. Metabolic acidosis – loss of large volume of bicarbonate rich stool. RR rapid and deep 3. Hypokalemia – massive loss of K. abdominal distention – paralytic ileus DIAGNOSTIC EXAMS Fecal microscopy 1. Rectal swab 2. Stool exam Treatment 1. IVF- rapid replacement 2. Oral rehydration 3. Strict I and O 4. Antibiotics – Tetracycline, Cotrimoxazole. NURSING MANAGEMENT 1. Medical Asepsis 2. Enteric precaution 3. VS monitoring 4. I and O 5. Good personal hygiene 6. Proper excreta disposal 7. Concurrent disinfection. 8. Environmental sanitation

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Acute bacterial infection of the intestine characterized by diarrhea and fever Etiologic Agent: Shigella group o Shigella flesneri - commmon in the Philippines o Shigella boydii, S. connei, o 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.

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 1. Maintain fluid and electrolyte balance 2. Restrict food until nausea and vomiting subsides. 3. Enteric precaution 4. Excreta must be disposed properly. 5. 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 • Type I - most paralytogenic, most frequent • Type II - next most frequent • 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: o 7-16 days before and few days after onset of s/s • S/S o Febrile episodes with varying degrees of muscle weakness o Occasionally progressive Flaccid Paralysis

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Paralytic: asymmetrical weakness, paresthesia, urinary retention, constipation Non paralytic: slight involvement of the CNS; stiffness and rigidity of the spine, spasms of hamstring muscles, with paresis Tripod position: extend his arms behind him for support when upright Hoyne’s sign: head falls back when he is in supine position with the shoulder elevated Meningeal irritation: (+) Brudzinski, Kernig’s sign

Diagnostic tests: • 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)

3 Types of Paralysis • Spinal Paralytic o Flaccid paralysis o Autonomic involvement o Respiratory difficulty • Bulbar Form o Rapid & serious o Vagus and glossopharyngeal nerves affected o Cardiac and respiratory reflexes altered o Pulmo edema o Hypertension, impaired temp regulation o Encephalitic s/s • Bulbospinal o Combination • Minor Polio o Inapparent / subclinical o Abortive: recover within 72 hours; flulike; backache; vomiting • Major Polio

Clinical manifestations Prodromal/ pre icteric • S/S of URTI • Weight loss • Anorexia • RUQ pain • Malaise Icteric • Jaundice • Acholic stool • Bile-colored urine Diagnostic tests: HaV Ag, Ab, SGOT, SGPT Nursing Interventions o Provide rest periods

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

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S/S

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 • Indirect - Ingestion of food contaminated with E.Histolytica cysts, polluted water supply, exposure to flies, unhygienic food handlers. • Direct contact – sexual, oral, or anal, proctogenital

Incubation period: 4-8 weeks Communicability: as long as mature fertilized female worms live in intestine Diagnostic exams: Microscopic identification of eggs in stool, CBC, Hx of passing out of worms (oral or anal), Xray, o o o o o Stomachache Vomiting Passing out of worms Complications Energy / Protein malnutrition, Anemia Intestinal obstruction

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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 DIAGNOSTIC EXAM • Stool Exam ( cyst, amoeba+++) • WBC – elevated TREATMENT o Amoebacides – Metronidazole(Flagyl) 800mg TID X 7days o Bismuth gylcoarsenilate combined with Chloroquine o Antibiotic – Ampicillin, Tetracycline, Chloramphenicol o Fluid replacement – IVF, oral NUSING MANAGEMENT • Enteric precaution • Health education- boil drinking water (2030 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

o Pyrantel Pamoate o Piperazine Citrate o Mebendazole, Tetramizole o Dicyclomine Hcl, NSAIDS for abdominal pain o For intestinal obstruction  Decompression  Fluid and electrolyte therapy  If persistent, laparotomy o FF up stool exam 1-2 weeks after treatment Nursing Intervention o Isolation- not needed o Enteric precaution o Handwashing o Proper nutrition o Maintenance of hydration / fluid balance / boil of water o Improve personal hygiene o Proper food prep/handling o Administer meds (NSAIDS, MEBENDAZOLE Diseases Acquired thru the Skin • Diseases caused by Trauma and Inoculation o Tetanus o Rabies o Malaria o DHF o Leptospirosis o Schistosomiasis • Disease acquired thru Contact o Leprosy

TETANUS

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ASCARIASIS

Helminthic infection of the small intestine caused by ASCARIS LUMBRECOIDES MOT: fecal-oral

An acute, often fatal, disease characterized by generalized rigidity and convulsive spasms of skeletal muscles caused by the endotoxin released by C. Tetani AKA: Lockjaw Etiologic Agent: Clostridium Tetani o Anerobic o Spore forming, gram positive rod Sources: o Animal and human feces o Soil and dust o Plaster, unsterile sutures, rusty scissors, nails and pins MOT:

Direct or indirect contact to wounds o Traumatic wounds and burns o Umbilical stump of the newborn o Dirty and rusty hair pins o GIT- port of entry – rare o Circumcision/ ear pearcing Incubation period: 3d-3week (ave:10d) o

Oxygen NGT feeding Tracheostomy Adequate fluid, electrolyte, caloric intake During convalescence o Determine vertebral injury o Attend to residual pulmonary disability o Physiotherapy o TT Nursing Interventions: • Prevention • DPT o Adverse Reactions o Local reactions (erythema, induration) o Fever and systemic symptoms not common o Exagerated local reactions • • • • • Nursing interventions: • Prevention of CV and respiratory complications o Adequate airway o ICU – ET- MV • Provide cardiac monitoring • KVO • Wound care (TIG, Debridement, TT) • Administer antibiotics as ordered o Penicillin • 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

S/s: persistent contraction of muscles in the same anatomic area as the injury • Local tetanus • Cephalic tetanus - rare form o 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 Complications: o Laryngospasm  Hypostatic pneumonia  Hypoxia  Atelectasis o Trauma  Fractures o Septicemia  Nosocomial infections o Death Diagnostic procedure:  entirely clinical CSF – normal WBC- normal or slight elevation 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. •

RABIES

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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 Diagnostic procedures o History of exposure o PE/ assessment of s/s o Microscopic examination of Negri bodies using Seller’s May-Grunwald and Mann Strains o Fluorescent Rabies Antibody technique / Direct Immunofluorescent test

Clinical Manifestations Prodromal Phase / Stage of Invasion • Fever, anorexia, malaise, sorethroat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability, restlessness, drowsiness, mental depression, marked insomia • Sensitive to light, sound, and changes in temp • Myalgia, numbness, tingling, burning or cold sensation along nerve pathway; dilation of pupils Stage of Excitement • Marked excitation, apprehension • Delirium, nuchal stiffness, involuntary twitching • Painful spasms of muscles of mouth, pharynx, and larynx on attempting to swallow food or water or the mere sight of them – hydrophobia • Aerophobia • Precipitated by mild stimuli – touch or noise • Death – spasm from or from cardiac / respiratory failure Terminal Phase or Paralytic Stage • Quiet and unconscious • Loss of bowel and bladder control • Tachycardia, labored irregular respiration, steady rising temp • Spasm, progressively increasing paralysis • Death due to respiratory paralysis 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, Anti-rabies vaccine • Passive immunization o 3 months o Rabuman, Hyper Rab, Imogam Nursing Intervention o Isolation of patient o Provide comfort for the patient by:  Place padding of bedside or use restraints  Clean and dress wound with the use of gloves  Do not bathe the patient, wipe saliva or provide sputum jar o Provide restful environment  Quiet, dark environment  Close windows, no faucets or running water should be heard  IVF should be covered  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 Plasmodium Falciparum (malignant tertian) o most serious, high parasitic densities in RBC with tendency to agglutinate and form into microemboli. Most common in the Philippines P. Vivax - non life threatening except for the very young and old. o Manifests chills every 48 hrs on the 3rd day onward if not treated, P. malarie (Quartan) – less frequent, non life threatening, fever and chills occur every 72 hrs on the 4th day of onset P. ovale - rare Incubation period: o 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

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o Mosquito bite VECTOR – female Anopheles mosquito DIAGNOSTICS

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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

TSB, ice cap on head Hot drinks during chilling, lots of fluid Monitoring of serum bilirubin Keep clothes dry, watch for signs of bleeding PREVENTION o Mosquito breeding places should be destroyed o Insecticides, insect repellant o Blood donor screening

DENGUE FEVER
• Is an acute febrile disease cause by infection with one of the serotypes of dengue virus which is transmitted by mosquito ( Aedes aegypti). • Dengue hemorrhagic fever – fatal characterized by bleeding and hypovolemic shock • Etiologic agent – Arbovirus group B – • AKA: Chikungunya, O’ nyong nyong, west nile fever • Mode of Transmission: Bite of infected mosquito – AEDES AEGYPTI • Incubation period – 3-14 days • Period of communicability – mosquito all throughout life Sources of infection • Infected person- virus is present in the blood and will be the reservoir when sucked by mosquitoes • Stagnant water = any

Clinical Manifestions • 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 • GIT o Bleeding from GUT, N/V, Diarrhea, abdominal pain, gastric, tyhoid, choleric, dysenteric • CNS or Cerebral Malaria o Changes in sensorium o Severe headache o N/V • Hemolytic • Blackwater fever o Reddish to mahogany colored urine due to hemoglobinuria o Anuria – death • 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

Diagnostic Tests • 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 ( Herman’s sign) o Generalized or abdominal pain

Hemorrhagic manifestations – epistaxis, gum bleeding • 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 • BT as necessary • O2 therapy o NURSING MANAGEMENT 1. Kept in mosquito free environment 2. Keep pt. at rest 3. VS monitoring 4. Ice bag on the bridge of nose and forehead. 5. Observe for signs of shock – VS (BP low), cold clammy skin PREVENTION • Mosquito net • Eradication of breeding places of mosquitoo house spraying o change water of vases o scrubbing vases once a week o cleaning the surroundings o keep water containers covered o avoid too many hanging clothes inside the house

LEPTOSPIROSIS
• 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 o found in river, sewerage, floods AKA: Weil’s disease, mud fever, Swineherd’s disease Incubation Period: 6 -15 days Period of Communicability – found in urine between 10-20 days MOT – contact with skin of infected urine or feces of wild/domestic animals; ingestion, inoculation Diagnostic tests: o Clinical manifestations o Culture


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SOURCE OF INFECTION o Rats, dogs, mice MANIFESTATIONS o Septic Stage  Early  Fever (40 ‘C), tachycardia, skin flushed, warm, petechiae  Severe  Multiorgan  Conjunctival affectation, jaundice, purpura, ARF, Hemoptysis, head-ache, abdominal pain, jaundice o Toxic stage – with or w/o jaundice, meningeal irritation, oliguria– shock, coma , CHF o Convalescence – recovery MANAGEMENT 1. IV antibiotic Pen G Na Tetracycline Doxycycline 2. Dialysis – peritoneal 3. IVF 4. Supportive 5. Symptomatic Nursing Interventions o Isolation of patient – urine must properly disposed o Care of exposed persons – keep under close surveillance o Control measures  Cleaning of the environment/ stagnant water  Eradicate rats  Avoid bathing or wading in contaminated pool of water  vaccination of animals (cattles,dogs,cats,pigs)

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 Vector: Oncomelania quadrasi o Cercariae: most infective stage Diagnostic test: ova seen in fecalysis Diagnostic procedures  Fecalysis • Identification of eggs


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Liver and rectal biosy Immunodiagnostic tests / circumoval precipitin test and cercarial envelope reactions •

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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 o 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 • 1. Identification of S/s • 2. Tissue biopsy • 3. Tissue smear • 4. Bloods – inc. ESR • 5. Lepromin skin test • 6. Mitsuda reaction S/s o Swimmers itch  Itchiness  Redness and pustule formation at site of entry of cercariae  Diarrhea  Abdominal pain  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 àbladder cancer; • Pulmonary hypertension (S. mansoni, S. japonicum, more rarely S. haematobium); • Glomerulonephritis; and central nervous system lesions. • Complications o Pulmonary hypertension o Cor pulmonale o Myocardial damage o Portal cirrhosis Treatment: • Trivalent antimony o Tartar emetic – administered thru vein o Stibophen (FUADIN) – given per IM • PRAZIQUANTEL – per orem • Niridazole • Nursing Interventions: o Administer prescribed drugs as ordered o Prevent contact with cercaria-laden waters in endemic areas like streams 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

TREATMENT • multiple drug therapy • sulfone • rehab • occupational Health • isolation • moral support PREVENTION 1. Report cases and suspects of leprosy 2. BCG vaccine may be protective if given during the first 6 months. 3. Nursing Interventions:

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Isolation of patient – until causative agent is still present Care of exposed persons 1. Household contact – Diaminodiphenylsulfone for 2 years 2. Observe carefully for symptoms of the disease

Diseases Acquired Thru Sexual Contact

HIV /AIDS
• • • Chronic disease that depresses immune function Characterized by opportunistic infections when T4/CD4 count drops <200 MOT – sexual contact with infected – unprotected, injection of blood/products, placental transmission

History of HIV / AIDS 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 o Macrophages  Humoral response  Cell-mediated response • • • • • •

Diagnostic Tests • ELISA • Western Blot • CD4 count • Viral load testing • Home test kits Manifestations o Minor signs – cough for one month, general pruritus, recurrent herpes zoster, oral candidiasis, generalized lymphadenopathy o 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 • 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 Kaposi’s Sarcoma o Herpes simplex ulcers, bronchitis, pneumonia o Primary brain lymphoma o Pneumocystis Carinii Pneumonia o Recurrent pneumonia o Mycobacterium infection

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Progressive multifocal leukoencepalopathy Salmonella septicemia Toxoplasmosis Wasting syndromes

Treatment • Started in CD4 counts of <200 • Viral load >10,000 copies • All symptomatic regardless of counts • Note: CD4 reflects immune system destruction. Viral load- degree of viral activity • Nucleoside Reverse Transcriptase Inhibitors • Blocks reverse transcriptase NRT • Acts by binding directly to the reverse transcriptase enzyme • Not used alone • Rapid development of resistance • Acts by binding directly to the reverse transcriptase enzyme • Not used alone • Rapid development of resistance Generic Zidovudine Didanosine Zalcitibine Stavudine Lamivudine Trade AZT, ZDV, Retrovir ddI, Videx ddC,Hivid d4T, Zerit 3TC, Epivir Dose 300 mg. Bid 200 mg bid .75 mg TID 400 mg bid 150 mg bid 150/300 mg Notes Taken with food Peripheral neuropathy No antacids Peripheral neuropathy Used as resistance develops Bone marrow toxicity

Lamiduvine/ Zidovudine

Combivir

Protease Inhibitors • Introduced in 1995 • Acts by blocking protease enzyme • Indinavir (Crixivan) CDC Guidelines o Combination of 2 NRTI + PI • Nursing Management o Administer Antiviral meds as ordered o Universal precaution o Reverse isolation  gloves, needle stick injury prevention o Assist in early diagnosis and management of complications • 4 C’s o Compliance – info, + drugs o Counselling – education o Contact tracing – tracing out and tx for partners o Condoms – safe sex

A curable infection caused by the bacteria Neisseria gonorrhoea • AKA: Clap, Drip, G. vulvovaginitis • MOT: transmitted during vaginal, anal, and oral sex • Incubation period: 3-10 days initial manifestations • Period of communicability: considered infectious from the time of exposure until treatment is successful Manifestations: • Urethritis – both male and female • S/S: dysuria and purulent discharge • Cervicitis • Upper Genital Tract – females (PID) Endometritis, Salpingitis, Pelvic Abscess • Complications : • PID • Infertility Complications: • Upper Genital Tract – male o Epididymitis, Prostatitis, Seminal Vesiculitis • Disseminated Gonococcal Infection (DGI) o Tenosynovitis or Polyarthritis, skin lesions and fever • Anorectal Infection • Pharyngeal Infection • Gonococcal Conjuctivitis o Opthalmia Neonatorum • Meningitis, Endocarditis Diagnosis: • Culture & Sensitivity • Blood tests for N. gonorrhoeae antibodies Treatment: • ANTIBIOTICS • Penicillin • Single dose Ceftriaxone IM + doxycycline PO BID for 1 week • Prophylaxis: Silver nitrate, Tetracycline, Erythromycin Nursing Interventions: o Case finding o Health teaching on importance of monogamous sexual relationship o Treatment should be both partners to prevent reinfection o Instruct possible complications like infertility o Educate about s/s and importance of taking antibiotic for the entire therapy

SYPHILIS
• • • a curable, bacterial infection, that left untreated will progress through four stages with increasingly serious symptoms Etiologic agent: Treponema pallidum AKA: Lues, The pox, Bad blood Type of Infection: Bacterial Modes of transmission : o Through sexual contact/ intercourse, kissing o abrasions o Can be passed from infected mother to unborn child (transplacental)


GONORRHEA

Symptoms o Primary syphilis (10 – 90 days after infection)  Chancre – a firm, painless skin ulceration localized at the point of initial exposure to the bacterium appear on the genitals • can also appear on the lips, tongue, and other body parts Secondary syphilis (last 2 – 6 weeks)

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syphilis rash - an infectious brown skin rash that typically occurs on the bottom of the feet and the palms of the hand condylomata lata - flat broad whitish lesions Fever, sore throat, swollen glands, and hair loss can also be experienced

Mutual monogamy Latex condoms for vaginal and anal sex Nursing interventions o Case finding o Health teaching and guidance along preventive measures o Utilization of community health facilities o Assist in interpretation and diagnosis o Reinforce ff up treatment o VD control program participation o Medical examination of patient’s 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 S/s: • Jaundice • Pruritus • Fatigue • RUQ - Abdominal pain • Loss of appetite • Nausea, vomiting • Joint pain Prevention: • Hepatitis B vaccine has been available since 1982. o Routine vaccination of 0-18 year olds o Vaccination of risk groups of all ages • Immune globulin if exposed MEDICAL MANAGEMENT • Interferon alfa-2b • Lamivudine • Telbivudine • Entecavir • Adefovir dipivoxil Nursing Interventions: o Blood and body secretions precautions o Prevention- Hepa B vaccine o Proper rest periods o Prevent stress – physio/psychological o Proper NTN, increase in CHO, high in CHON, low fats, Vit. K rich foods and minerals o Assistance to prevent injury, promote safety AAT •

Third stage o Will manifest 1 – 10 years after the infection o characterised by gummas - soft, tumorlike growths  seen in the skin and mucous membranes – occurs in bones o joint and bone damage o increasing blindness o Numbness in the extremities, or difficulty in coordinating movements.

Neurosyphilis • generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes • cardiovascular syphilis • aortitis, aortic aneurysm, Aneurysm of sinus of valsalva and aortic regurgitation, - death Consequences in Infants • Congenital syphilis • extremely dangerous • Deformities • Seizures • Blindness • 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 • Syphilis is easily treatable when early detected • Penicillin & other antibiotics Prevention • Abstinence

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WOF s/s bleeding, edema Health education on safe sex

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 o


S/s

flu like: fever, myalgia, lethargy, gastrointestinal symptoms, cough, sore throat o fever above 38 °C (100.4 °F) o Shortness of breath o Symptoms usually appear 2–10 days following exposure o require mechanical ventilation Diagnostic Test: • 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 • fever of 38 °C (100.4 °F) or more AND • Either a history of: o Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days OR o 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 has the 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

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