ANG, AILA QUEEN C.

BSN2 NCM-109 ASSIGNMENT JANUARY 20, 2020

1) What is the portal of entry and the name of the causative agent?
 SARS
Severe acute respiratory syndrome (SARS) is a viral respiratory infection caused by
SARS-coronavirus (SARS-CoV). The virus that causes SARS is thought to be
transmitted most readily by respiratory droplets (droplet spread) produced when an
infected person coughs or sneezes. The virus also can spread when a person touches a
surface or object contaminated with infectious droplets and then touches his or her
mouth, nose or eye(s).
 AIDS
Human immunodeficiency virus (HIV) is the causative agent for AIDS. The most
common type is known as HIV-1 and is the infectious agent that has led to the
worldwide AIDS epidemic. Transmission only occurs when the virus leaves the body
of an infected person via blood, semen or vaginal fluids.
 TUBERCULOSIS
Mycobacterium tuberculosis is the organism that is the causative agent for tuberculosis
(TB). There are other "atypical" mycobacteria such as M. kansasii that may produced
a similar clincal and pathologic appearance of disease. M. tuberculosis is carried in
airborne particles, called droplet nuclei, of 1– 5 microns in diameter. Infectious droplet
nuclei are generated when persons who have pulmonary or laryngeal TB disease cough,
sneeze, shout, or sing. TB is spread from person to person through the air.
 LEPROSY
Leprosy (Hansen's Disease) is a chronic infectious disease that primarily affects the
peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa (lining of the
nose). The disease is caused by a bacillus (rod-shaped) bacterium known as
Mycobacterium leprae. The portal of entry of M. leprae into the human body is not
definitely known. However, the two portals of entry seriously considered are the skin
and the upper respiratory tract.
 SCHISTOSOMIASIS
Schistosomiasis (Bilharziasis) is caused by some species of blood trematodes (flukes)
in the genus Schistosoma. The three main species infecting humans are Schistosoma
haematobium, S. japonicum, and S. mansoni. Schistosoma parasites can penetrate the
skin of persons who are wading, swimming, bathing, or washing in contaminated water.
Within several weeks, the parasites mature into adult worms and live in the blood
vessels of the body where the females produce eggs.
 RABIES
Rabies is a zoonotic disease that remains an important public health problem worldwide
and causes more than 70,000 human deaths each year. The causative agent of rabies is
rabies virus (RV), a negative-stranded RNA virus of the rhabdovirus family. Rabies
virus is transmitted through direct contact (such as through broken skin or mucous
membranes in the eyes, nose, or mouth) with saliva or brain/nervous system tissue from
an infected animal.
 HEPATITIS B
Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from
person to person through blood, semen or other body fluids. It does not spread by
sneezing or coughing.
 MALARIA
Malaria is caused by protozoa of the genus Plasmodium. Four species cause disease in
humans: P falciparum, P vivax, P ovale and P malariae. Malaria enters its human hosts
via the bite of mosquitoes of the genus Anopheles. The malaria parasites are present in
the mosquitoes saliva, and enter into the human bloodstream when the mosquito bites
to take a blood meal.
 FILARIASIS
Lymphatic filariasis is caused by the worms Wuchereria bancrofti, Brugia malayi, and
Brugia timori. These worms occupy the lymphatic system, including the lymph nodes;
in chronic cases, these worms lead to the syndrome of elephantiasis. When a mosquito
bites a person who has lymphatic filariasis, microscopic worms circulating in the
person's blood enter and infect the mosquito. When the infected mosquito bites another
person, the microscopic worms pass from the mosquito through the skin, and travel to
the lymph vessels.
  DENGUE FEVER
Dengue fever is among the most common mosquito-borne virus infections. Causative
agent of the disease is the Dengue virus, of which four different types are known. The
virus cannot be transmitted from human to human. In order to spread the disease needs
a mosquito as alternate host. A reservoir such as a human and an agent such as an
amoeba. The mode of transmission can include direct contact, droplets, a vector such
as a mosquito, a vehicle such as food, or the airborne route. The susceptible host has
multiple portals of entry such as the mouth or a syringe.

Sources: http://www.idph.state.il.us/public/hb/hbsars_hcp.htm
https://webpath.med.utah.edu/TUTORIAL/AIDS/AIDS.html
https://www.skillsportal.co.za/content/how-hivaids-spread
https://webpath.med.utah.edu/TUTORIAL/MTB/MTB.html
https://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf
https://en.m.wikipedia.org/wiki/Leprosy
https://www.who.int/lep/transmission/en/index3.html
https://www.cdc.gov/parasites/schistosomiasis/biology.html
https://www.cdc.gov/parasites/schistosomiasis/gen_info/faqs.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600441/
https://www.cdc.gov/rabies/transmission/index.html
https://www.mayoclinic.org/diseases-conditions/hepatitis-b/symptoms-causes/syc-
20366802
https://www.ncbi.nlm.nih.gov/books/NBK8584/
http://www.malaria.com/questions/how-malaria-enters-body
https://en.m.wikipedia.org/wiki/Filariasis
https://www.cdc.gov/parasites/lymphaticfilariasis/gen_info/faqs.html
http://saltidin.com/uploads/tx_lxsmatrix/denguefever.pdf
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html

2) Give the signs and symptoms.

 SARS
Fever over 100.4F, dry cough, sore throat, problems breathing, headache, body aches,
loss of appetite, malaise
 AIDS
Fevers and chills, night sweats, muscle aches, rashes, a sore throat, general fatigue,
swollen lymph nodes, mouth ulcers
 TUBERCULOSIS
low-grade fever, night sweats, weakness or tiredness, weight loss, cough, have chest
pain, shortness of breath or might be coughing up blood.
 LEPROSY
painless ulcers, skin lesions of hypopigmented macules (flat, pale areas of skin), and
eye damage (dryness, reduced blinking).
 SCHISTOSOMIASIS
Within days after becoming infected, you may develop a rash or itchy skin. Fever, chills,
cough, and muscle aches can begin within 1-2 months of infection. Most people have
no symptoms at this early phase of infection.
 RABIES
The first symptoms of rabies may be very similar to those of the flu including general
weakness or discomfort, fever, or headache. These symptoms may last for days.There
may be also discomfort or a prickling or itching sensation at the site of the bite,
progressing within days to acute symptoms of cerebral dysfunction, anxiety, confusion,
and agitation. As the disease progresses, the person may experience delirium, abnormal
behavior, hallucinations, hydrophobia (fear of water), and insomnia.
 HEPATITIS B
Most people do not experience any symptoms when newly infected. However, some
people have acute illness with symptoms that last several weeks, including yellowing
of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and
abdominal pain. A small subset of persons with acute hepatitis can develop acute liver
failure, which can lead to death.
 MALARIA
 An attack usually starts with shivering and chills, followed by a high fever, followed
by sweating and a return to normal temperature. Malaria signs and symptoms typically
begin within a few weeks after being bitten by an infected mosquito.
 FILARIASIS
Lymphatic filariasis infection involves asymptomatic, acute, and chronic conditions.
The majority of infections are asymptomatic, showing no external signs of infection,
although their blood is positive for microfilaria. This stage may lasts for months.
Acute episodes of local inflammation involving skin, lymph nodes and lymphatic
vessels.
Chronic condition shows oedema with thickening of the skin and underlying tissues
(the classical symptom of filarasis).
It usually affects the lower extremities. However, the arms, vulva, breasts and scrotum
(causing hydrocele formation) can also be affected.The oedema in the extremities,
breast or genital area can result in the part becoming several times its normal size and
is due to blockage of the vessels of the lymphatic system.
 DENGUE FEVER
Symptoms of dengue fever include severe joint and muscle pain, swollen lymph nodes,
headache, fever, exhaustion, and rash. The presence of fever, rash, and headache (the
"dengue triad") is characteristic of dengue fever.

Source: https://www.healthline.com/health/severe-acute-respiratory-syndrome-sars
https://www.medicalnewstoday.com/articles/315928.php#early-symptoms
https://www.health.ny.gov/diseases/communicable/tuberculosis/fact_sheet.htm
https://www.medicinenet.com/leprosy/article.html
https://www.cdc.gov/parasites/schistosomiasis/gen_info/faqs.html
https://www.cdc.gov/rabies/symptoms/index.html
https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
https://www.mayoclinic.org/diseases-conditions/malaria/symptoms-causes/syc-
20351184
https://www.aimu.us/2017/07/15/filariasis-symptoms-causes-and-management/
https://www.medicinenet.com/dengue_fever/article.htm

3) What are the nursing interventions and give the medications.

 SARS
Currently, no definitive medication protocol specific to SARS has been developed,
although various treatment regimens have been tried without proven success. The CDC
recommends that patients suspected of or confirmed as having SARS receive the same
treatment that would be administered if they had any serious, community-acquired
pneumonia.
 AIDS
INTERVENTIONS. Infection control; Infection protection; Respiratory monitoring;
Temperature regulation. AIDS Drugs” are medicines used to treat but not to cure HIV
infection.
These drugs are sometimes referred to as “anteroviral drugs.”
These work by inhibiting the reproduction of the virus.
 TUBERCULOSIS
TB is a curable disease. Treatment should be started as soon as possible, particularly in
infectious cases to prevent further spread of the disease. It consists of combination anti-
TB drugs. TB cannot be treated with a solitary agent, as it easily becomes resistant.
There are two phases of treatment - an initial phase lasting two months and a
continuation phase lasting four months (Box 2). Patients with TB should be monitored
regularly to ensure that:
(1) No interruptions occur in treatment;(2) Serious side-effects from the treatment are
quickly identified;(3) There is improvement in the patient’s condition, although this
is often very gradual.
 LEPROSY
In response to the increased incidence of dapsone resistance, the WHO introduced a
multidrug regimen in 1981 that includes rifampicin, dapsone, and clofazimine. Some
clinical studies have also shown that certain quinolones, minocycline, and azithromycin
have activity against M leprae. The WHO recently recommended single-dose treatment
with rifampin, minocycline, or ofloxacin in patients with paucibacillary leprosy who
 have a single skin lesion. However, the WHO still recommends the use of the long-
term multidrug regimens whenever possible because they have been found to be more
efficacious.
 SCHISTOSOMIASIS
Praziquantel is the drug of choice. However, it will only treat mature worms (they can
take 40 days to reach maturity), so taking the drug immediately after swimming is
unlikely to be effective.
 RABIES
Once symptoms for rabies appear, there is no treatment. However, a vaccine can be
administered after an exposure (postexposure prophylaxis). The indication of
vaccination depends on type of contact with the rabid animal.
Rabies Nursing Management:
Provide patient Isolation
Wash hands before and after patient contact to prevent self-contamination and spread
of disease
Give emotional and spiritual support to family by helping them cope with patient’s
symptoms and probable death
Darken the room,provide a quiet environment
Patient should not be bathed and must not have any running water in the room.
Continously monitor cardiac and respiratory function
 HEPATITIS B
Initiate bleeding precautions per facility protocol, Monitor fluid and electrolyte balance,
Provide routine oral care before meals with soft toothbrush, Administer medications
appropriately and monitor for effectiveness and adverse reactions. Monitor lab values
prior to administration. Medications may be given to manage electrolytes, and
symptoms of nausea or to assist with alcohol or drug detox.
Avoid giving acetaminophen.
Antiviral medications may be given to treat certain types of hepatitis.
 MALARIA
1. Assess nutritional history, including a preferred food. Observation and record food
intake.
2. Give a little and eat the right foods of little extras.
3. Maintain a schedule of regular weighing.
4. Discuss the food and input in a pure diet.
5. Observation and record the occurrence of nausea / vomiting, and other symptoms
associated.
6. Collaboration for referral to a dietitian.
The artemisinin derivatives are the most exciting recent development in the treatment
of severe malaria. They are rapidly parasitocidal, and—crucially unlike quinine—they
kill young circulating parasites before they sequester in the deep microvasculature.
 FILARIASIS
Treatment:
Ivermectine – drug of choice for W. bancrofti
Doxycycline – used to reduce tissue swelling
Suramin –effective against adult roundworms
Diethylcarbamazine (DEC) – treatment for W. bancrofti
Albendazole and Flubendazole – eliminate roundworms easily
Nursing Management:
Monitor client’s vital signs, particularly the temperature.
Assess skin color and integrity. Note for wounds, bleeding or any skin changes.
Assess for any discomfort and pain.
Provide wound care.
Elevate affected body area to reduce swelling.
Administer medications if ordered and discuss them to the client.
Provide support to perform basic activities.
Encourage range of motion and simple exercises of the affected extremities to stimulate
lymphatic flow.
Recognize client’s self-esteem needs.
Provide health teaching and information for continuity of care.
 DENGUE
Nursing Assessment
Assessment of a patient with DHF should include:
 Evaluation of the patient’s heart rate, temperature, and blood pressure.
Evaluation of capillary refill, skin color and pulse pressure.
Assessment of evidence of bleeding in the skin and other sites.
Assessment of increased capillary permeability.
Measurement and assessment of the urine output.
Medical Management
The management of DHF is actually simple as long as it is detected early.
Oral rehydration therapy. Oral rehydration therapy is recommended for patients with
moderate dehydration caused by high fever and vomiting.
IV fluids. IVF administration is indicated for patients with dehydration.
Blood transfusion and blood products. Patients with internal or gastrointestinal
bleeding may require transfusion, and patients with coagulopathy may require fresh
frozen plasma.
Oral fluids. Increase in oral fluids is also helpful.
Avoid aspirins. Aspirin can thin the blood. Warn patients to avoid aspirins and other
NSAIDs as they increase the risk for hemorrhage.

Sources: https://emedicine.medscape.com/article/237755-treatment#d1
https://www.rnpedia.com/nursing-notes/communicable-diseases-notes/hivaids/
https://www.nursingtimes.net/archive/the-treatment-of-patients-with-tb-and-the-role-
of-the-nurse-07-09-2004/
https://emedicine.medscape.com/article/220455-treatment
https://www.nursingtimes.net/archive/schistosomiasis-05-04-2005/
https://www.rnspeak.com/rabies-nursing-management/
https://nursing.com/lesson/nursing-care-plan-for-hepatitis/
https://screware.blogspot.com/2013/06/malaria-5-nursing-interventions.html?m=1
https://www.ncbi.nlm.nih.gov/books/NBK1704/
https://www.rnspeak.com/filariasis-nursing-management/
https://nurseslabs.com/dengue-hemorrhagic-fever/

4) What is the portal of exit?

 SARS
The main way that SARS seems to spread is by close person-to-person contact. The
virus that causes SARS is thought to be transmitted most readily by respiratory droplets
(droplet spread) produced when an infected person coughs or sneezes.
 AIDS
Transmission only occurs when the virus leaves the body of an infected person via
blood, semen or vaginal fluids. These are known as "exit portals", the way the virus has
of getting out or leaving the body. Finally it is necessary for the virus to be able to gain
entry into the body of the uninfected person.
 TUBERCULOSIS
Mycobacterium tuberculosis exit the respiratory tract
 LEPROSY
Researchers suggest that M. leprae spreads person to person by nasal secretions or
droplets from the upper respiratory tract and nasal mucosa. However, the disease is not
highly contagious like the flu. They speculate that infected droplets reach other peoples'
nasal passages and begin the infection there.
 SCHISTOSOMIASIS
Transmission occurs when people suffering from schistosomiasis contaminate
freshwater sources with their excreta containing parasite eggs, which hatch in water.
 RABIES
The olfactory mucosa is a potential portal of entry and exit for airborne rabies virus in
bat caves.
 HEPATITIS B
exit through cuts or needles in the skin
 MALARIA
Exit by blood-sucking arthropods
 FILARIASIS
These are spread by blood-feeding diptera such as black flies and mosquitoes.
 DENGUE FEVER
Skin (when a mosquito bites and it takes the virus from the infected)

Sources: https://www.cdc.gov/sars/about/fs-sars.html
https://www.skillsportal.co.za/content/how-hivaids-spread
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
https://www.medicinenet.com/leprosy/article.htm
https://www.who.int/news-room/fact-sheets/detail/schistosomiasis
https://www.ncbi.nlm.nih.gov/m/pubmed/4551426/
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
https://en.m.wikipedia.org/wiki/Filariasis
https://deguefever17.weebly.com/chain-of-infection.html