Communicable Diseases
o Environment
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
o The strength of the host’s defence and some
other factors.
Epidemiological triad:
o Agent
o Host
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
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.
o 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.
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
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 Diagnostic exams:
• Primary Infection o Lumbar tap, CSF - high WBC and CHON, low
o Asymptomatic glucose
o No manifestations even at CXR, Sputum AFB Manifestations:
• Primary Complex o Sudden onset of fever x 24h
o Minimal manifestations o Petechiae, Purpuric rashes
o Lymphadenopathy 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
DX  Priority: AIRWAY, SAFETY
• Tuberculin testing  Maintain seizure precaution
• CXR  Respiratory precaution
• Sputum AFB  Handwashing
Prevention  Suction secretions
• BCG
• Avoid overcrowding DIPTHERIA
• Improve nutritional status
 Acute contagious disease characterized by generalized toxemia
TX
coming from localized inflammatory process
• DOTS
 Etiologic agent: Corynebacterium Diptheria (Klebs loffer
• 6 months of RIPE
bacillus)
• Respiratory isolation,
 Incubation period: 2-5 days
• Take medicines religiously – prevent resistance
 Period of communicability: variable, ave:2-4 weeks
• Stop smoking
 MOT – Droplet, direct or intimate contact, fomites, discharge
• Plenty of rest
from nose, skin, eyes
• Nutritious and balance meals, increase CHON, Vit. A, C
Manifestation
 PSEUDOMEMBRANE - grayish white, smooth, leathery and
MENINGITIS spider web like structure that bleeds when detached
• Inflammation of the meninges usually some
Types of Respiratory Diptheria
combination of headache, fever, stiff neck, and
• NASAL
delirium
o serous to serosanginous purulent discharge
• Meningococcemia: cerebrospinal fever
o Pseudomebrane on septum
o Etiologic agent: Neisseria meningitidis
o Dryness/ excoriation on the upper lip and nares
o Incubation: 2-10 days
• PHARYNGEAL
o MOT: droplet
o pharyngeal pseudomembrane
• Acute meningococcemia - with or without meningitis
o bull neck ( cervical adenitis)
o Waterhouse Friederichsen Syndrome
o Difficulty swallowing
• LARYNGEAL
o Sorethroat, pseudomemb
o Barking, dry mettallic cough
Complications
o Due to TOXEMIA
  Toxic endocarditis • Convulsions (brain damage - asphyxia,
 Neuritis hemorrhage)
 Toxic nephritis Dx:
o Due to Intercurrent Infection • Elevated WBC
 Bronchopneumonia • Nasopharyngeal swab
 Respiratory failure Nursing Management
DX • Prevention:
• Nose and throat swabs - culture of o DPT
specimen form beneath membrane • Parenteral fluids
• Virulence test • Erythromycin - drug of choice
• SHICK’s TEST: test for susceptibility to diptheria • Prone position during attack
• MOLONEY’s TEST: test for hypersensitivity to diptheria • Abdominal binder
MANAGEMENT • Adequate ventilation, avoid dust, smoke
1. Penicillin, Erythromycin • Isolation
2. Diptheria Antitoxin – after – skin test if (+), fractional dose • Gentle aspiration of secretions
3. Supportive
• O2, if laryngeal obstruction – tracheostomy MEASLES
• CBR for 2 weeks • Acute viral disease with prodromal fever,
• Increase fluids, adequate nutrition- soft food, rich in conjunctivitis, coryza, cough and Koplik’s spots
Vit C • AKA: Rubeola, 7-day measles
• Ice collar • Etiologic agent: Morbilli Paramyxoviridae virus
4. Isolation till 3 NEGATIVE cultures • Incubation period: 10-12 days
Prevention • Period of communicability: 3 days before and 5 days
 DPT after the appearance of rashes. Most communicable
during the height of rash.
PERTUSIS (whooping cough) • MOT: Airborne
• Repeated attacks of spasmodic coughing with series of • Sources of infection – secretions from eyes, nose and
explosive expirations ending in long drawn force inspiration throat
• Etiologic agent: Bordetella pertusis or Haemiphilus pertussis Pathognomonic sign:
• Incubation period: 7-14 days • Koplik’s spots
• Period of communicability: 7 days post exposure to 3 wks post
disease onset
• MOT – Droplet

Manifestations
• 1.Pre eruptive stage / Prodromal (10-11 days)
o Coryza, Cough, Conjunctivitis
Manifestation o Koplik’s Spots, whitish spot at the inner
o rapid cough 5-10x in one inspiration ending cheek
a high pitched whoop. o Fever, photophobia
• Catarrhal – slight fever in PM, colds, watery nasal • 2. Eruptive stage
discharge, teary eyes, nocturnal coughing, 1-2 weeks o Maculopapular rashes
• Paroxysmal – Spasmodic stage; 5-10 successive o Rash is fully developed by 2nd day
forceful coughing ending with inspiratory whoop, o High grade fever –on and off
involuntary micturition and defecation, choking spells, o Anorexia, throat is sore
cyanosis • 3. Convalescence (7-10 days)
• Convalescent – 4th- 6th week; diminish in severity, o Desquamation of the skin
frequency Diagnostics
Complications: • Nose and throat swab
• Otitis media Treatment
• Acute bronchopneumonia • 1. Antiviral drugs- Isoprenosine
• Atelectasis or emphysema • 2. Antibiotics – if with complications
• Rectal prolapse, umbilical hernia • 3. Supportive – O2, IVF
 • Complications – bronchopneumonia, otitis • Eruptive: rash starts from trunk
media, encephalitis • Lesions - red papules then becomes milky and pus like within 4
days,
Nursing Management • Pruritis
• Preventive – measles vaccine at 9 months, MMR Stages of skin affectations
15 months and then 11-12; defer if with fever, o Macule – flat
illness o Papule – elevated above the skin diameter about 3 cm
• Isolation - contact/respiratory o Vesicle
• TSB , Skin care – daily cleansing wash o Pustule
• Oral and nasal care o Crust – scab , drying on the skin
• Plenty of fluids Complications
• Avoid direct glare of the sun- due to o pneumonia, sepsis
photophobia Treatment
• Zovirax 500mg tablet 1 tab BID X 7 days
GERMAN MEASLES • Acyclovir
• Mild viral illness caused by rubella virus. • Oral antihistamine
• AKA: Rubella; 3-Day Measles • Calamine lotion
• Incubation period– from exposure to rash 14 -21d • Antipyretics
• Period of communicability – one week before and and 4 NURSING MANAGEMENT
days after onset of rashes. Worst when rash is at it’s peak. • Strict isolation until all vesicles scabs disappear
• MOT: Droplet, nasal ceretions, transplacental in congenital • Hygiene of patient
Manifestations • Cut finger nails short
• 1. Prodromal – low grade fever, headache , malaise, colds, • Baking soda - pruritus
lymph node involvement on 3rd to 5th day • PREVENTION: Live attenuated varicella vaccine
• 2. Eruptive – FORSCHEIMER’S SPOTS: pinkish rash on soft • VZIG - effective if given 96h post exposure
palate, rash on face, spreading to the neck, arms and trunk
o lasts1-5 days with no pigmentation or Herpes Zoster
desquamation • Acute inflammatory disease known to be caused by herpes
o muscle pain virus varicellae or VZ virus
• Treatment • Infection of the sensory nerve charac by extremely painful
o symptomatic treatment infection along the sensory nerve pathway
Complications • Occurs as reinfection of VZ virus
• 1. Encephalitis, neuritis • MOT
• 2. Rubella syndrome – microcephaly, mental retardation, o Direct
deaf mutism, congenital heart disease o Indirect – airborne
• Incubation: 1-2 weeks

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.
Diagnostic procedure
o Hx of chickenpox
CHICKEN POX o Pain and burning sensation over lesions of
• Acute and highly contagious viral disease characterized by
vesicles along nerve pathway
vesicular eruptions on the skin
o Smear of vesicle fluid- giant cells
• Infectious agent – Herpes zoster virus or Varicella zoster
o Viral cultures of vesicle fluid
• Incubation period – 10 -21 days
o Electron microscopy
• Period of communicability: 1 day before eruption up to 5 days
o Giemsa-stained scraping – multinucleate giant
after the appearance of the last crop
• MOT: airborne, direct, indirect epithelial cells
o Direct contact thru shedding vesicles, S/S
o Burning, itching, pain then erythematous patches followed
o Indirect thru linens or fomites
by crops of vesicles
Manifestations
o Eruptions are unilateral
• Pre eruptive: Mild fever and malaise
o Lesions may last 1-2 weeks
 o Fever, regional lymphadenopathy
o Paralysis of cranial nerve, vesicles at external auditory DIAGNOSTIC PROCEDURES
canal 1. Viral culture
o Paralytic ileus, bladder paralysis, encephalitis 2. WBC count

Complications PREVENTION: MMR Vaccine

o Opthalmia herpes – blindness because of
damage of gasserian ganglion TREATMENT MODALITIES
o Geniculate herpes – deafness because of 1. Antiviral drugs
infection of 7th CN (AKA: Ramsay Hunt Syndrome) 2. NSAIDS - Acetaminophen
Nursing Intervention Nursing Interventions
o Compress of NSS or alluminum acetate over o Symptomatic
lesions o Application of warm/ cold compress
o Analgesics, sedatives – weeks to mos o Oral care, warm salt water gargle
o Steroids o Diet – semi solid, soft food easy to chew
o Keep blister covered with sterile powder esp  Acid foods/fluids – fruit juices may increase
after break discomfort
o Prevent bacterial invasion
o Encourage proper disposal of secretions and Diseases Acquired thru GIT
usage of gown and mask • Diseases caused by Bacteria
o Typhoid Fever
MUMPS o Cholera
• Acute viral disease manifested by swelling of one or both o Dysentery
of the parotid glands, with occasional involvement of other • Diseases caused by Virus
glandular structures,particularly testes in male. o Poliomyelitis
• Etiologic agent – filterable virus of paramyxovirus group o Infectious Hepatitis A
usually found in saliva of infected person. • Diseases caused by Parasites
• AKA: Epidemic/ infectious parotitis o Amoebiasis
• Incubation period: 14 -25 days. o Ascariasis
• Period of communicability – 6d before and 9d post onset
of parotid gland swelling TYPHOID FEVER
o 48 hrs immediately preceding the onset of • Infection of the GIT affecting the lymphoid
swelling is the highest communicability. tissues(ulceration of Peyer’s patches) of the small intestine
• MOT: direct, indirect - droplet, airborne • 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.

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
CLINICAL MANIFESTATIONS o Initial stool is brown and contains fecal
ONSET material à becomes “rice water”
• Ladderlike fever o Nausea/ Vomiting
• Nausea, vomiting and diarrhea o S/s of Dehydration
• RR is fast, skin is dry and hot, abdomen is o poor tissue trugor, eyes are sunken
distended o Pulse is low or difficult to obtain, BP is low
• Head-ache, aching all over the body and later unobtainable.
• Worsening of symptoms on the 4th and 5th day o RR – rapid and deep
• Rose spots o Cyanosis – later
TYPHOID STATE o Voice becomes hoarse– speaks in whisper
• Tongue protrudes- dry and brown • Oliguria or anuria
• sordes • Conscious, later drowsy
• (coma vigil) • Deep shock
• (subsultus tendinus) • Death may occur as short as four hours after onset.
• (Carphologia) • Usually first or 2nd day if not treated
• Always slip down to the foot part of the bed, Principal deficits
• Severe case - delirum sets in often ending in 1. Severe dehydration - circulatory collapse
death 2. Metabolic acidosis – loss of large volume of bicarbonate
Complications rich stool. RR rapid and deep
o Hemorrhage, Peritonitis, Pneumonia, Heart failure, 3. Hypokalemia – massive loss of K. abdominal distention –
Sepsis paralytic ileus
DIAGNOSTIC PROCEDURES DIAGNOSTIC EXAMS
1. WBC – elevated Fecal microscopy
2. Blood Culture – (+) S. typhosa 1. Rectal swab
3. Stool Culture (+) 2. Stool exam
4. Widal test – blood serum agglutination test
 O antigen – active typhoid
 H antigen- previously infected or vaccinated Treatment
 Vi antigen - carrier 1. IVF- rapid replacement
TREATMENT 2. Oral rehydration
1. Chloramphenicol – drug of choice 3. Strict I and O
2.Paracetamol 4. Antibiotics – Tetracycline, Cotrimoxazole.
NURSING MANAGEMENT
1. Restore FE balance NURSING MANAGEMENT
2. Bedrest 1. Medical Asepsis
3. Enteric precaution 2. Enteric precaution
4. Prevent falls/ safety prec 3. VS monitoring
5. Oral/personal hygiene 4. I and O
6. WOF intestinal bleeding-bloody stool,sweating, pallor 7. 5. Good personal hygiene
NPO, BT 6. Proper excreta disposal
7. Concurrent disinfection.
CHOLERA 8. Environmental sanitation
• An acute bacterial disease of the GIT characterized by PREVENTION
profuse diarrhea, vomiting, loss of fluid. 1. Protection of food and water supply from fecal
• Etiologic agent: Vibrio cholerae, V. comma contamination.
• Pathognomonic sign: rice watery stool 2. Water should be boiled/ chlorinated.
• Incubation period: 2-3 days 3. Milk should be pasteurized.
• Period of Communicability: entire illness, 7-14d 4. Sanitary disposal of human excreta
• MOT: fecal oral route 5. Environmental sanitation.

DYSENTERY
• 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
o Acute, profuse, watery diarrhea.
Clinical manifestations
• Fever esp. in children
• Nausea, vomiting and headache
• Anorexia, body weakness
• Cramping abdominal pain (colicky)
• Diarrhea – bloody and mucoid 3 Types of Paralysis
• Tenesmus • Spinal Paralytic
• Weight loss o Flaccid paralysis
DIAGNOSTICS o Autonomic involvement
• Fecalysis o Respiratory difficulty
• Rectal Swab/culture • Bulbar Form
• Bloods – WBC elevated o Rapid & serious
• Blood culture o Vagus and glossopharyngeal nerves affected
TREATMENT o Cardiac and respiratory reflexes altered
• Antibiotics- Ampicillin, Cotrimoxazole, Tetracycline o Pulmo edema
• IVF o Hypertension, impaired temp regulation
• Anti diarrheal are Contraindicated o Encephalitic s/s
NURSING MANAGEMENT • Bulbospinal
1. Maintain fluid and electrolyte balance o Combination
2. Restrict food until nausea and vomiting subsides. • Minor Polio
3. Enteric precaution o Inapparent / subclinical
4. Excreta must be disposed properly. o Abortive: recover within 72 hours; flulike;
5. Prevention- food preparation, safe washing facilities, fly backache; vomiting
control • Major Polio
o Paralytic: asymmetrical weakness,
POLIOMYELITIS paresthesia, urinary retention, constipation
• An acute infectious disease caused by any of the 3 o Non paralytic: slight involvement of the
types of poliomyelitis virus which affects mainly the CNS; stiffness and rigidity of the spine,
anterior born cells of the spinal cord and the medulla, spasms of hamstring muscles, with paresis
cerebellum and the midbrain o Tripod position: extend his arms behind
• AKA: Acute anterior poliomyelitis, heinmedin disease, him for support when upright
infantile paralysis o Hoyne’s sign: head falls back when he is in
• Etiologic Agent: Poliovirus (Legio Debilitans) supine position with the shoulder elevated
3 Types of Poliovirus o Meningeal irritation: (+) Brudzinski, Kernig’s
• Type I - most paralytogenic, most frequent
sign
• Type II - next most frequent
Diagnostic tests:
• Type III - least frequent associated with paralytic
• Throat swab, stool exam, LP
disease
Nursing Interventions
3 Strains
• Supportive, Preventive – Salk and Sabin Vaccine
o Brunhilde
• NO morphine
o Laasing • Moist heat application for spasms
o Leon • AIRWAY: tracheotomy
• MOT: Fecal-Oral • Footboard to prevent foot drop
• Incubation period: 7-14 days ave (3-21 days) • Fluids, NTN, Bedrest
• Period of communicability: • Enteric and strict precautions
o 7-16 days before and few days after onset of
s/s HEPATITIS A
• S/S • Inflammation of the liver caused by hepatitis A virus
o Febrile episodes with varying degrees of • AKA: infectious hepatitis
muscle weakness • Incubation period: 2-6weeks
o Occasionally progressive Flaccid Paralysis • MOT: oral-fecal/ enteric transmission
• Diagnostic test: liver function (SGOT/SGPT)
 • 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 (20-30 mins),
Clinical manifestations Use mineral water.
Prodromal/ pre icteric • Cover leftover food.
• S/S of URTI • Avoid washing food from open drum/pail.
• Weight loss • Wash hands after defecating and before eating.
• Anorexia • Observe good food preparations.
• RUQ pain • Fly control
• Malaise
Icteric ASCARIASIS
• Jaundice • Helminthic infection of the small intestine caused by
• Acholic stool ASCARIS LUMBRECOIDES
• Bile-colored urine • MOT: fecal-oral
• Incubation period: 4-8 weeks
Diagnostic tests: HaV Ag, Ab, SGOT, SGPT • Communicability: as long as mature fertilized female
worms live in intestine
Nursing Interventions • Diagnostic exams: Microscopic identification of eggs in
o Provide rest periods stool, CBC, Hx of passing out of worms (oral or anal), Xray,
o Increase CHO, mod Fat, low CHON S/S
o Intake of vits/minerals o Stomachache
o Proper food preparation/handling o Vomiting
o Handwashing to prevent transmission o Passing out of worms
o Complications
AMOEBIASIS o Energy / Protein malnutrition, Anemia
• Involves the colon in general but may involve the liver or lungs o Intestinal obstruction
as well Treatment:
• Etiologic agent: Entamoeba histolytica o Pyrantel Pamoate
• Incubation: 3-4 weeks o Piperazine Citrate
• Period of communicability: duration of illness o Mebendazole, Tetramizole
• MOT: fecal oral route o Dicyclomine Hcl, NSAIDS for abdominal pain
• Indirect - Ingestion of food contaminated with E.Histolytica o For intestinal obstruction
cysts, polluted water supply, exposure to flies, unhygienic food  Decompression
handlers.  Fluid and electrolyte therapy
• Direct contact – sexual, oral, or anal, proctogenital  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

Clinical manifestations • Diseases caused by Trauma and Inoculation
• Intermittent fever o Tetanus
• Nausea, vomiting, weakness o Rabies
• Later : anorexia, weight loss, jaundice o Malaria
o DHF
 o Leptospirosis o Septicemia
o Schistosomiasis  Nosocomial infections
• Disease acquired thru Contact o Death
o Leprosy Diagnostic procedure:
 entirely clinical
TETANUS CSF – normal
• An acute, often fatal, disease characterized by WBC- normal or slight elevation
generalized rigidity and convulsive spasms of skeletal Treatment:
muscles caused by the endotoxin released by C. Tetani • Wounds should be cleaned
• AKA: Lockjaw • Necrotic tissue and foreign material should be removed
• Etiologic Agent: Clostridium Tetani • Tetanic spasms - supportive therapy and maintenance of
o Anerobic an adequate airway
o Spore forming, gram positive rod • Tetanus immune globulin (TIG)
• Sources: o help remove unbound tetanus toxin
o Animal and human feces o cannot affect toxin bound to nerve endings
o Soil and dust o single intramuscular dose of 3,000 to 5,000 units
o Plaster, unsterile sutures, rusty scissors, o Contains tetanus antitoxin.
nails and pins • Oxygen
• MOT: • NGT feeding
o Direct or indirect contact to wounds • Tracheostomy
o Traumatic wounds and burns • Adequate fluid, electrolyte, caloric intake
o Umbilical stump of the newborn • During convalescence
o Dirty and rusty hair pins o Determine vertebral injury
o GIT- port of entry – rare o Attend to residual pulmonary disability
o Circumcision/ ear pearcing o Physiotherapy
• Incubation period: 3d-3week (ave:10d) 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
S/s: • Wound care (TIG, Debridement, TT)
• persistent contraction of muscles in the same • Administer antibiotics as ordered
anatomic area as the injury o Penicillin
• Local tetanus • Care during tetanic spasm/ convulsion
• Cephalic tetanus - rare form o Administer Diazepam – muscle rigidity/spasm
o otitis media (ear infections) o Administer neuromuscular blocking agents
• Generalized tetanus (metocurin iodide) – relax spasms and prevent
o trismus or lockjaw seizure
o stiffness of the neck • Keep on seizure precaution
o difficulty in swallowing • Parenteral nutrition
o rigidity of abdominal muscles • Avoid complications of immobility (contractures, pressure
o elevated temperature sores)
o sweating • WOF urinary retention, fractures
o elevated blood pressure episodic rapid
heart rate RABIES
• Neonatal tetanus - a form of generalized tetanus that • A viral zoonotic neuroinvasive disease that causes acute
occurs in newborn infants encephalitis
Complications: • Etiologic agent: Rhabdovirus
o Laryngospasm • AKA: Hydrophobia, Lyssa
 Hypostatic pneumonia • Negri bodies in the infected neurons – pathognomonic
 Hypoxia • Incubation period: 4-8 weeks; 10d-1yr
 Atelectasis • Period of communicability: 3-5 days before the onset of s/s
o Trauma until the entire course of disease
 Fractures • MOT: contamination of a bite of infected animals
 • Diagnostic procedures o Tetanus prophylaxis
o History of exposure o Antibiotics
o PE/ assessment of s/s o Suturing should be avoided
o Microscopic examination of Negri bodies using • Antirabies sera
Seller’s May-Grunwald and Mann Strains o Heterologous serum obtained by
o Fluorescent Rabies Antibody technique / Direct hyperimmunization of different animal
Immunofluorescent test 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
Clinical Manifestations
the use of gloves
Prodromal Phase / Stage of Invasion
 Do not bathe the patient,
• Fever, anorexia, malaise, sorethroat, copious
wipe saliva or provide
salivation, lacrimation, perspiration, irritability,
sputum jar
hyperexcitability, restlessness, drowsiness,
o Provide restful environment
mental depression, marked insomia
 Quiet, dark environment
• Sensitive to light, sound, and changes in temp
 Close windows, no faucets or running water should be
• Myalgia, numbness, tingling, burning or cold
heard
sensation along nerve pathway; dilation of pupils
 IVF should be covered
Stage of Excitement
 No sight of water or electric fans
• Marked excitation, apprehension
• Delirium, nuchal stiffness, involuntary twitching
• Painful spasms of muscles of mouth, pharynx, MALARIA
and larynx on attempting to swallow food or • Acute and chronic disease transmitted by mosquito bite
water or the mere sight of them – hydrophobia confined mainly to tropical areas.
• Aerophobia • Etiologic agent – Protozoa of genus Plasmodia
• Precipitated by mild stimuli – touch or noise • Plasmodium Falciparum (malignant tertian)
• Death – spasm from or from cardiac / respiratory o most serious, high parasitic densities in RBC with
failure tendency to agglutinate and form into
Terminal Phase or Paralytic Stage microemboli. Most common in the Philippines
• Quiet and unconscious • P. Vivax - non life threatening except for the very young
• Loss of bowel and bladder control and old.
• Tachycardia, labored irregular respiration, steady o Manifests chills every 48 hrs on the 3rd day
rising temp onward if not treated,
• Spasm, progressively increasing paralysis • P. malarie (Quartan) – less frequent, non life threatening,
• Death due to respiratory paralysis fever and chills occur every 72 hrs on the 4th day of onset
TREATMENT • P. ovale - rare
• No cure • Incubation period:
• No specific – symptomatic/ supportive – directed o 12days P. falciparum, 14 days P vivax and ovale,
toward alleviation of spasm 30 days P. malariae
• Employ continuing cardiac and pulmonary • Period of communicability
monitoring o If not treated /inadequate – more than 3 yrs. P
• Assess the extent and location of the bite – biting malariae, 1-2 yrs. P. vivax, 1 yr- P. falciparum
incident/ status of the animal • Mode of transmission
o Severe exposure o Mosquito bite
o Mild exposure VECTOR – female Anopheles mosquito
• Wound treatment (local care)
o Cleanse thoroughly with soap and DIAGNOSTICS
water (or ammonium compounds, • Malarial smear – film of blood is placed on a slide, stained
betadine, or benzalkonium cl) and examined
o Anti rabies serum
 • Rapid diagnostic test (RDT) – done in field. 10 -15 mins • Is an acute febrile disease cause by infection with one of the
result blood test 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 Diagnostic Tests
o Severe headache • Torniquet test
• Platelet Count
o N/V
• Hematocrit
• Hemolytic
Manifestations
• Blackwater fever
• PRODROMAL symptoms
o Reddish to mahogany colored urine due to
o malaise and anorexia up to 12 hrs.
hemoglobinuria
o Fever and chills, head-ache, muscle pain
o Anuria – death
o N &V
• Malarial lung disease
• FEBRILE Phase
MANAGEMENT
o Fever persists (39-40 C)
• Antimalarial drugs – Chloroquine (all but P. Malarie),
quinine, Sulfadoxine (resistant P falciparum) o Rash - more prominent on the extremities and
Primaquine (relapse P vivax/ovale) trunk
• RBC replacement/ erythrocyte exchange transfusion o (+) torniquet test- petechia more than 10.
Nursing management: o Skin appears purple with blanched areas with
• Isolation of patient varied sizes ( Herman’s sign)
• Use mosquito nets o Generalized or abdominal pain
• Eradicate mosquitos o Hemorrhagic manifestations – epistaxis, gum
• Care of exposed persons – case finding bleeding
• I and O • CIRCULATORY Phase
• BUN & creatinine – dialysis could be life saving o Fall of temp on 3rd to 5th day
• ABG o Restless, cool clammy skin
• TSB, ice cap on head o Profound thrombocytopenia
• Hot drinks during chilling, lots of fluid o Bleeding and shock
• Monitoring of serum bilirubin o Pulse - rapid and weak
• Keep clothes dry, watch for signs of bleeding o Untreated shock --- coma – death
• PREVENTION o Treated – recovery in 2 days
o Mosquito breeding places should be CLASSIFICATION
destroyed • Grade 1
o Insecticides, insect repellant • Grade 2
o Blood donor screening • Grade 3
• Grade 4
DENGUE FEVER Treatment
• No specific antiviral therapy for dengue
• Analgesic – not aspirin for relief of pain
 • IV fluid o Convalescence – recovery
• BT as necessary MANAGEMENT
• O2 therapy 1. IV antibiotic
Pen G Na
NURSING MANAGEMENT Tetracycline
1. Kept in mosquito free environment Doxycycline
2. Keep pt. at rest 2. Dialysis – peritoneal
3. VS monitoring 3. IVF
4. Ice bag on the bridge of nose and forehead. 4. Supportive
5. Observe for signs of shock – VS (BP low), cold clammy skin 5. Symptomatic
PREVENTION Nursing Interventions
• Mosquito net o Isolation of patient – urine must properly
• Eradication of breeding places of mosquito- disposed
o house spraying o Care of exposed persons – keep under close
o change water of vases surveillance
o scrubbing vases once a week o Control measures
o cleaning the surroundings  Cleaning of the environment/ stagnant
o keep water containers covered water
o avoid too many hanging clothes inside the house  Eradicate rats
 Avoid bathing or wading in
contaminated pool of water
 vaccination of animals
LEPTOSPIROSIS (cattles,dogs,cats,pigs)
• Infectious bacterial disease carried by animals whose urine
contaminates water or food which is ingested or SCHISTOSOMIASIS
inoculated thru the skin. • Parasitic disease caused by Schistosoma japonicum, S.
• Etiologic agent: spirochete Leptospira interrogans mansoni, S. Hematobium
o found in river, sewerage, floods • AKA: Bilharziasis, Snail fever
• AKA: Weil’s disease, mud fever, Swineherd’s disease • Incubation period: 2-6 weeks
• Incubation Period: 6 -15 days • MOT: bathing, swimming, wading in water
• Period of Communicability – found in urine between 10-20 • Vector: Oncomelania quadrasi
days o Cercariae: most infective stage
• MOT – contact with skin of infected urine or feces of • Diagnostic test: ova seen in fecalysis
wild/domestic animals; ingestion, inoculation • Diagnostic procedures
• Diagnostic tests:  Fecalysis
o Clinical manifestations  Identification of eggs
o Culture  Liver and rectal biosy
 Immunodiagnostic tests / circumoval
precipitin test and cercarial envelope
reactions

SOURCE OF INFECTION
o Rats, dogs, mice
MANIFESTATIONS
o Septic Stage
 Early
 Fever (40 ‘C), tachycardia, skin flushed,
warm, petechiae
 Severe
 Multiorgan S/s
 Conjunctival affectation, jaundice, o Swimmers itch
purpura, ARF, Hemoptysis, head-ache,  Itchiness
abdominal pain, jaundice  Redness and pustule formation at site of entry of
o Toxic stage – with or w/o jaundice, meningeal irritation, cercariae
oliguria– shock, coma , CHF  Diarrhea
  Abdominal pain • Raised large erythemathous plaques appear on skin with
 hepatosplenomegaly clearly defined borders. – rough hairless and
CLINICAL MANIFESTATIONS: hypopigmented – leaves an anesthetic scar.
• Abdominal pain • Loss of eyebrows/eyelashes
• Cough • Loss of function of sweat and sebaceous glands
• Diarrhea • Epistaxis
• 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 TREATMENT
o Portal cirrhosis • multiple drug therapy
Treatment: • sulfone
• Trivalent antimony • rehab
o Tartar emetic – administered thru vein • occupational Health
o Stibophen (FUADIN) – given per IM • isolation
• PRAZIQUANTEL – per orem • moral support
• Niridazole PREVENTION
• Nursing Interventions: 1. Report cases and suspects of leprosy
o Administer prescribed drugs as ordered 2. BCG vaccine may be protective if given during the first 6
o Prevent contact with cercaria-laden waters in months.
3. Nursing Interventions:
endemic areas like streams
1. Isolation of patient – until causative agent is still
o Proper sanitation or disposal of feces
present
o Creation of a program on snail control – chemical
2. Care of exposed persons
or changing snail environment
1. Household contact –
Diaminodiphenylsulfone for 2 years
LEPROSY 2. Observe carefully for symptoms of the
• Chronic systemic infection characterized by progressive disease
cutaneous lesions
• Etiologic agent: Mycobacterium leprae Diseases Acquired Thru Sexual Contact
o Acid fast bacilli that attack cutaneous tissues,
peripheral nerves producing skin lesions,
HIV /AIDS
anesthesia, infection and deformities.
• Chronic disease that depresses immune function
• Incubation period – 5 1/2 mo - eight years.
• Characterized by opportunistic infections when T4/CD4
• MOT – respiratory droplet, inoculation thru break in skin
count drops <200
and mucous membrane.
• MOT – sexual contact with infected – unprotected,
Diagnosis
injection of blood/products, placental transmission
• 1. Identification of S/s
• 2. Tissue biopsy
• 3. Tissue smear
• 4. Bloods – inc. ESR History of HIV / AIDS
• 5. Lepromin skin test • 1959 - African man
• 6. Mitsuda reaction • 1981- 5 homosexual men
• 1982-Designated as disease by CDC
MANIFESTATIONS • 1983- HIV 1 discovered
• Corneal ulceration, photophobia –blindness • 1987- 1.5 million HIV-infected in USA
• Lesions are multiple, symmetrical and erythematous– • 1994- WHO reports 8-10 mil. Worldwide & protease
macules and papules inhibitors introduced
• Later lesions enlarge and form plaques on nodules on • 1999-First clinical trials for HIV vaccine
earlobes, nose eyebrows and forehead The immune system
• Foot drop o Macrophages
 Humoral response
  Cell-mediated response 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
o Progressive multifocal leukoencepalopathy
o Salmonella septicemia
o Toxoplasmosis
o 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
Diagnostic Tests • Acts by binding directly to the reverse transcriptase
• ELISA enzyme
• Western Blot • Not used alone
• CD4 count • Rapid development of resistance
• Viral load testing
• Home test kits Generic Trade Dose Notes
Manifestations Zidovudine AZT, ZDV, 300 mg. Bid Taken with food
o Minor signs – cough for one month, general Retrovir
pruritus, recurrent herpes zoster, oral
candidiasis, generalized lymphadenopathy Didanosine ddI, Videx 200 mg bid Peripheral
o Major signs – loss of weight 10% BW, chronic neuropathy
diarrhea 1month up, prolonged fever one month
up. Zalcitibine ddC,Hivid .75 mg TID No antacids
• Persistent lymphadenopathy
• Cytopenias (low) Stavudine d4T, Zerit 400 mg bid Peripheral
• PCP neuropathy
• Kaposis sarcoma
Lamivudine 3TC, Epivir 150 mg bid Used as resistance
• Localized candida
develops
• Bacterial infections
• TB
• STD Lamiduvine/Zido Combivir 150/300 Bone marrow
 Neurologic symptoms vudine mg toxicity
Criteria for Diagnosis of AIDS
• CD4 counts of 200 or less
Protease Inhibitors
• Evidence of HIV infection and any of
• Introduced in 1995
o Thrush
• Acts by blocking protease enzyme
o Bacillary angiomatosis • Indinavir (Crixivan)
o Oral hairy leukoplakia
o Peripheral neuropathy CDC Guidelines
o Vulvovaginal candidiasis
 o Combination of 2 NRTI + PI • Etiologic agent: Treponema pallidum
• Nursing Management • AKA: Lues, The pox, Bad blood
o Administer Antiviral meds as ordered • Type of Infection: Bacterial
o Universal precaution • Modes of transmission :
o Reverse isolation o Through sexual contact/ intercourse, kissing
 gloves, needle stick injury prevention o abrasions
o Assist in early diagnosis and management of o Can be passed from infected mother to unborn
complications child (transplacental)
• 4 C’s Symptoms
o Compliance – info, + drugs o Primary syphilis (10 – 90 days after infection)
o Counselling – education  Chancre – a firm, painless skin
o Contact tracing – tracing out and tx for partners ulceration localized at the point of
o Condoms – safe sex initial exposure to the bacterium
appear on the genitals
GONORRHEA  can also appear on the lips,
• A curable infection caused by the bacteria Neisseria gonorrhoea tongue, and other body parts
• AKA: Clap, Drip, G. vulvovaginitis o Secondary syphilis (last 2 – 6 weeks)
• MOT: transmitted during vaginal, anal, and oral sex  syphilis rash - an infectious brown skin
• Incubation period: 3-10 days initial manifestations rash that typically occurs on the
• Period of communicability: considered infectious from the time bottom of the feet and the palms of
of exposure until treatment is successful the hand
Manifestations:  condylomata lata - flat broad whitish
• Urethritis – both male and female lesions
• S/S: dysuria and purulent discharge  Fever, sore throat, swollen glands, and
• Cervicitis hair loss can also be experienced
• Upper Genital Tract – females (PID) • Third stage
Endometritis, Salpingitis, o Will manifest 1 – 10 years after the infection
Pelvic Abscess o characterised by gummas - soft, tumor-like
• Complications : growths
• PID  seen in the skin and mucous
• Infertility membranes – occurs in bones
Complications: o joint and bone damage
• Upper Genital Tract – male o increasing blindness
o Epididymitis, Prostatitis, Seminal Vesiculitis o Numbness in the extremities, or difficulty in
• Disseminated Gonococcal Infection (DGI) coordinating movements.
o Tenosynovitis or Polyarthritis, skin lesions and
fever Neurosyphilis
• Anorectal Infection • generalized paresis of the insane which
• Pharyngeal Infection results in personality changes, changes in
• Gonococcal Conjuctivitis emotional affect, hyperactive reflexes
o Opthalmia Neonatorum • cardiovascular syphilis
• Meningitis, Endocarditis • aortitis, aortic aneurysm, Aneurysm of sinus
Diagnosis: of valsalva and aortic regurgitation, - death
• Culture & Sensitivity Consequences in Infants
• Blood tests for N. gonorrhoeae antibodies • Congenital syphilis
Treatment: • extremely dangerous
• ANTIBIOTICS • Deformities
• Penicillin • Seizures
• Single dose Ceftriaxone IM + doxycycline PO BID for 1 week • Blindness
• Prophylaxis: Silver nitrate, Tetracycline, Erythromycin • Damage to the brain, bones, teeth, and ears.
Nursing Interventions: Test and diagnosis
o Case finding • Venereal Disease Research Laboratory (VDRL)
o Health teaching on importance of monogamous test
sexual relationship • Flourescent treponemal antibody absorption
o Treatment should be both partners to prevent (FTA – Abs)
reinfection • Micro hemagglutination test (MHA - TP)
o Instruct possible complications like infertility • CSF examination
o Educate about s/s and importance of taking Treatment
antibiotic for the entire therapy • Syphilis is easily treatable when early detected
• Penicillin & other antibiotics
SYPHILIS
• a curable, bacterial infection, that left untreated will
Prevention
progress through four stages with increasingly serious
• Abstinence
symptoms
• Mutual monogamy
 • Latex condoms for vaginal and anal sex • An acute and highly contagious respiratory disease in
• Nursing interventions humans
o Case finding • Etiologic agent: SARS coronavirus
o Health teaching and guidance along preventive • November 2002 and July 2003, with 8,096 known infected
measures cases and 774 deaths
o Utilization of community health facilities • Incubation period: 2-3days
o Assist in interpretation and diagnosis • MOT: Airborne
o Reinforce ff up treatment S/s
o VD control program participation o flu like: fever, myalgia, lethargy, gastrointestinal
o Medical examination of patient’s contacts symptoms, cough, sore throat
o fever above 38 °C (100.4 °F)
HEPATITIS B o Shortness of breath
• serious disease caused by a virus that attacks the liver o Symptoms usually appear 2–10 days following
• Etiologic agent: hepatitis B virus (HBV) exposure
• Source of infections: Blood and body secretions o require mechanical ventilation
Risk factors Diagnostic Test:
• multiple sex partners or diagnosis of a sexually transmitted • Chest X-ray (CXR)- abnormal with patchy infiltrates
disease • WBC and PLT CT. - LOW
• Sex contacts of infected persons • ELISA test detects antibodies to SARS
• Injection-drug users o but only 21 days after the onset of symptoms
• Household contacts of chronically infected persons • Immunofluorescence assay, can detect antibodies 10 days
• Infants born to infected mothers after the onset of the disease
• Infants/children of immigrants from areas with high rates o labour and time intensive test
of HBV infection • Polymerase chain reaction (PCR) test that can detect
• Health-care and public safety workerr genetic material of the SARS virus in specimens ranging
• Hemodialysis patients from blood, sputum, tissue samples and stools
Complications: • CXR - increased opacity in both lungs, indicative of
• Lifelong infection pneumonia
• Liver cirrhosis • SARS may be suspected
• Liver cancer • fever of 38 °C (100.4 °F) or more AND
• Liver failure • Either a history of:
• Death o Contact (sexual or casual) with someone with a
S/s: diagnosis of SARS within the last 10 days OR
• Jaundice o Travel to any of the regions identified by the
• Pruritus WHO as areas with recent local transmission of
• Fatigue SARS (affected regions as of 10 May 2003 were
• RUQ - Abdominal pain parts of China, Hong Kong, Singapore and the
• Loss of appetite province of Ontario, Canada).
• Nausea, vomiting • probable case of SARS has the above findings plus positive
• Joint pain chest x-ray findings of atypical pneumonia or respiratory
Prevention: distress syndrome
• Hepatitis B vaccine has been available since 1982. Treatment
o Routine vaccination of 0-18 year olds • Supportive with antipyretics, supplemental oxygen and
o Vaccination of risk groups of all ages ventilatory support as needed.
• Immune globulin if exposed • Suspected cases of SARS must be isolated, preferably in
MEDICAL MANAGEMENT negative pressure rooms, with full barrier nursing
• Interferon alfa-2b precautions taken for any necessary contact with these
• Lamivudine patients
• Telbivudine • steroids
• Entecavir • antiviral drug
• Adefovir dipivoxil • SARS vaccine
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
o WOF s/s bleeding, edema
o Health education on safe sex

SEVERE OF ACUTE RESPIRATORY SYNDROME