NCM 104 LEC Notes from sir dizon Prelims

COMMUNICABLE DISEASE
- Disease caused by an infectious agent that are
transmitted directly or indirectly to a well person
through an agency, vector or inanimate object

CONTAGIOUS DISEASE
-
Disease that is easily transmitted from one person to
another
INFECTIOUS DISEASE
- Disease transmitted by direct inoculation through a
break in the skin
INFECTION INFECTIOUS AGENT
- -Entry and multiplication of an infectious agent into - Any microorganism capable of producing a disease
the tissue of the host RESERVOIR
INFESTATION - Environment or object on which an organism can survive
- Lodgement and development of arthropods on the and multiply
surface of the body PORTAL OF EXIT
ASEPSIS - The venue or way in which the organism leaves the
- Absence of disease reservoir
- producing microorganisms MODE OF TRANSMISSION
SEPSIS - The means by which the infectious agent passes from the
- The presence of infection portal of exit from the reservoir to the susceptible host
PORTAL OF ENTRY
MEDICAL ASEPSIS - Permits the organism to gain entrance into the host
- Practices designed to reduce the number and SUSCEPTIBLE HOST
transfer of pathogens - A person at risk for infection, whose defense mechanisms
- Clean technique are unable to withstand invasion of pathogens

SURGICAL ASEPSIS STAGES OF THE INFECTIOUS PROCESS

- Practices that render and keep objects and areas free - Incubation Period – acquisition of pathogen to the onset
from microorganisms of signs and symptoms
- Sterile technique - Prodromal Period – patient feels “bad” but not yet
experiencing actual symptoms of the disease
CARRIER – an individual who harbors the organism and is - Period of Illness – onset of typical or specific signs and
capable of transmitting it without showing manifestations of symptoms of a disease
the disease
- Convalescent Period – signs and symptoms start to abate
CASE – a person who is infected and manifesting the signs
and client returns to normal health
and symptoms of the disease
MODE OF TRANSMISSION
o SUSPECT – a person whose medical history and signs
CONTACT TRANSMISSION
and symptoms suggest that such person is suffering
from that particular disease - Direct contact
o CONTACT – any person who had been in close involves immediate and direct transfer from
association with an infected person person-to-person (body surface-to-body surface)
- Indirect contact
HOST
occurs when a susceptible host is exposed to a
- A person, animal or plant which harbors and provides contaminated object
nourishment for a parasite DROPLET TRANSMISSION
RESERVOIR
- Occurs when the mucous membrane of the nose, mouth
- Natural habitat for the growth, multiplication and or conjunctiva are exposed to secretions of an infected
reproduction of microorganism person within a distance of three feet
VEHICLE TRANSMISSION
ISOLATION
- Transfer of microorganisms by way of vehicles or
-
The separation of persons with communicable diseases contaminated items that transmit pathogens
from other persons
QUARANTINE AIRBORNE TRANSMISSION
- The limitation of the freedom of movement of persons - Occurs when fine particles are suspended in the air for a
exposed to communicable diseases long time or when dust particles contain pathogens
VECTOR-BORNE TRANSMISSION
STERILIZATION - Transmitted by biologic vectors like rats, snails and
-
the process by which all microorganisms mosquitoes
including their spores are destroyed
DISINFECTION TYPES OF IMMUNIZATION
- the process by which pathogens but not their ACTIVE – antibodies produced by the body
spores are destroyed from inanimate objects NATURAL
CLEANING – antibodies are formed in the presence of active
infection in the body; lifelong
- the physical removal of visible dirt and debris
by washing contaminated surfaces ARTIFICIAL
– antigens are administered to stimulate antibody
CONCURRENT production
PASSIVE
- Done immediately after the discharge of infectious
– antibodies are produced by another source
materials / secretions
NATURAL
– transferred from mother to newborn through placenta
TERMINAL
or colostrum
- Applied when the patient is no longer the source of ARTIFICIAL
infection – immune serum (antibody) from an animal or human is
BACTERICIDAL injected to a person
- A chemical that kills microorganisms
BACTERIOSTATIC SEVEN CATEGORIES OF ISOLATION
- An agent that prevents bacterial multiplication but does 1. STRIC0T
not kill microorganisms - prevent highly contagious or virulent infections
Example: chickenpox, herpes zoster
CHAIN OF INFECTION
2. CONTACT

CD-Bucud 1
 NCM 104 LEC Notes from sir dizon Prelims

– spread primarily by close or direct contact 2. BRUDZINSKI’S SIGN

Example: scabies, herpes simplex
- Place the patient in a dorsal recumbent position and then
3. RESPIRATORY put hands behind the patient’s neck and bend it forward.
– prevent transmission of infectious distances
over short distances through the air - If the patient flexes the hips and knees in response to the
Example: measles, mumps, meningitis. manipulation, positive for meningitis
TUBERCULOSIS – indicated for patients with positive smear or 3. KERNIG’S SIGN
chest x-ray which strongly suggests tuberculosis - Place the patient in a supine position, flex his leg at the
ENTERIC – prevent transmission through direct contact with hip and knee then straighten the knee; pain and
feces resistance indicates meningitis
Example: poliomyelitis, typhoid fever
DRAINAGE – prevent transmission by direct or indirect contact
with purulent materials or discharge SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA
Ex. Burns
UNIVERSAL – prevent transmission of blood and body-fluid
borne pathogens
DIC
Example: AIDS, Hepatitis B
URTI: Micro-
Vasculitis:
CENTRAL NERVOUS SYSTEM cough, sore thrombosis
petechial
throat,
ENCEPHALITIS MENINGITIS MENINGO- rash in the Purpura
fever,
COCCEMIA trunk and
headache, Hypotension
extremities
MAIN PROBLEM
nausea and
- Acute infection of vomiting Shock
- Inflammation of - Inflammation of the bloodstream and
the brain the meninges Death
developing vasculitis
ETIOLOGIC AGENT - Streptococcus
- Arboviruses - Staphylococcus ENCEPHALITIS MENINGITIS MENINGO-
- Pneumococcus
COCCEMIA
- Tubercle bacillus
- Neisseria meningitides SIGNS AND SYMPTOMS Vasculitis
INCUBATION PERIOD

5-15 days 1-10 days 3-4 days Stiff neck Nuchal rigidity Waterhouse-
MODE OF TRANSMISSION
Photophobia Opisthotonus Friderichsen
Bite of infected syndrome
Respiratory droplets
mosquito Lethargy Brudzinski’s
Petechiae with
SIGNS AND SYMPTOMS OF ENCEPHALITIS Convulsions Kernig’s sign the development
of hemorrhage
Virus enters neural cells
INCIDENCE

5-10 years old < 5 years old 6 months–5

Disruption in Perivascular Inflammatory years old
cellular congestion reaction
DIAGNOSTIC EXAM
functioning  Informed consent
 Empty bowel and bladder
Lethargy Fever  Fetal, shrimp or “C” position
Headache  Spinal canal, subarachnoid space between L3-L4 or L4- L5
Convulsions Photophobia Sore throat  After: bedrest
Seizures Vomiting  Flat on bed to prevent spinal headache
Stiff neck ENCEPHALITIS MENINGITIS MENINGO-
COCCEMIA
TREATMENT MODALITIES

Dexamethasone Ceftriaxone
SIGNS AND SYMPTOMS OF MENINGITIS
Mannitol Penicillin
Anticonvulsants Chloramphenicol
Antipyretics

PREVENTION

1. Japanese 1. HiB vaccine Rifampicin

encephalitis
Ciprofloxacin
VAX

THREE SIGNS OF MENINGEAL IRRITATION

1. OPISTHOTONUS
- State of severe hyperextension and spasticity in which an
individual’s head, neck and spinal column enter into a
complete arching position

CD-Bucud 2
 NCM 104 LEC Notes from sir dizon Prelims

ENCEPHALITIS MENINGITIS MENINGO- ABORTIVE TYPE

 Does not invade the CNS
COCCEMIA  Headache
NURSING MANAGEMENT  Sore throat
1. Side boards  Recovery within 72 hours and the disease passes by
1. Comfort: quiet, 1. Respiratory unnoticed
2. Close contacts
well-ventilated isolation 24-72
room hours after onset H – ouse PRE-PARALYTIC OR MENINGETIC TYPE
of antibiotic I – nfected person  Slight involvement of the CNS
2. Skin care:  Pain and spasm of muscles
therapy kissing
cleansing bath,  Transient paresis
change in 2. Room protected S – ame daycare  (+) Pandy’s test (increased protein in the CSF)
position against bright center PARALYTIC TYPE
lights  CNS involvement
3. Eliminate S – hare mouth  Flaccid paralysis
mosquito instruments  Asymmetric
3. Safety: side-lying
breeding sites:  Affects lower extremities
position and 3. Antibiotics as
CULEX  Urine retention and constipation
raised side rails prophylaxis  (+) HOYNE’S SIGN (when in supine position, head will fall
mosquito
back when shoulders are elevated)

RABIES
POLIOMYELITIS RABIES TETANUS
PRODROMAL/INVASION PHASE
 Fever
 Anorexia
MAIN PROBLEM
 Sore throat
Acute infection of Acute viral disease Acute infectious  Pain and tingling at the site of bite
the CNS – muscle of the CNS – by disease with systemic  Difficulty swallowing
spasm, paresis and saliva of infected neuromuscular EXCITEMENT OR NEUROLOGICAL PHASE
paralysis animals effects  Hydrophobia (laryngospasm)
 Aerophobia (bronchospasm)
ETIOLOGIC AGENT Rhabdovirus  Delirium
Clostridium tetani
 Maniacal behavior
Legio debilitans Bullet-shaped Anaerobic  Drooling
Affinity to CNS TERMINAL OR PARALYTIC PHASE
Gram positive  Patient becomes unconscious
Killed by sunlight, Drumstick  Loss of urine and bowel control
UV light, formalin appearance  Progressive paralysis
 Death
Resistant to
antibiotics
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
COMPLICATION
INCUBATION PERIOD
2-8 weeks Paralysis of RESPIRATORY DEATH
respiratory muscles FAILURE
7-21 days Distance of bite to Adult: 3 days-3
brain weeks
DIAGNOSTIC PROCEDURES
Extensiveness of the Neonate: 3-30 days
bite 1. Throat washings 1. Blood exam
1. Stool culture
Resistance of the 2. Flourescent rabies
2. CSF culture antibody (FRA)
host
MODE OF TRANSMISSION 3. Negri bodies
- Direct contact with ISOLATION PRECAUTION
infected feces
Bite of an infected Direct inoculation Enteric isolation Respiratory
- Direct contact with
respiratory secretions
animal through a broken isolation
skin
- Indirect with soiled
linens and articles
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
TREATMENT MODALITIES 1. Tetanus immune
1. Analgesics 1. Local globulin (TIG)
SIGNS AND SYMPTOMS R – isus sardonicus
treatment of 2. Tetanus antitoxin
1. Abortive type 1. Prodromal / O – pistothonus 2. Morphine (TAT)
wound
invasion 3. Moist heat
2. Pre-paralytic phase 2. Active 3. Penicillin G
T – rismus application
or meningetic immunization 4. Tetracycline
type 2. Excitement / C – onvulsions 4. Bed rest
Lyssavac 5. Diazepam
neurological
3. Paralytic type H – eadache 5. Rehabilitation 6. Phenobarbital
phase Imovax
7. Tracheostomy
3. Terminal / I – rritability Antirabies vax
8. NGT feeding
paralytic type 2. Passive
L – aryngeal
spasm immunization

POLIO

CD-Bucud 3
 NCM 104 LEC Notes from sir dizon Prelims

POLIOMYELITIS RABIES TETANUS BIRD FLU SARS

COMPLICATIONS
NURSING MANAGEMENT Severe viral pneumonia Severe viral
1. Adequate airway pneumonia
1. Enteric isolation 1. Isolation Acute respiratory distress
syndrome
2. Proper disposal 2. Optimum 2. Quiet, semi-dark
of secretions comfort environment Hypoxemia
Fluid accumulation in
3. Moist hot packs 3. Restful 3. Avoid sudden alveolar sacs
4. Firm / environment stimuli and light Respiratory failure
nonsagging bed 4. Emotional Severe breathing difficulties
5. Suitable body support
alignment 5. Concurrent Multiple organ failure
6. Comfort and and terminal
safety disinfection
DEATH
POLIOMYELITIS RABIES TETANUS BIRD FLU SARS
PREVENTION
PREVENTION 1. If the dog is 1. Aseptic
Salk vaccine healthy handling of 1.Culling – killing of 1.Quarantine
2. If the dog dies or umbilical cord sick or exposed
- Inactivated shows signs
2. Tetanus toxoid
birds 2. Isolation
polio vaccine suggestive of
- Intramuscular
rabies immunization 2. Banning of 3. WHO alert
3. If dog is not 3. Antibiotic importation of on SARS
Sabin vaccine available for prophylaxis birds (Executive
- Oral polio
observation
order # 280)
(March 12,
- Penicillin
vaccine 4. Have domestic 2003)
dog 3 months to - Erythromycin 3. Cook chicken
- Per orem 1 year old
immunized - Tetracycline thoroughly
NURSING MANAGEMENT
BIRD FLU
RESPIRATORY SYSTEM WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD
FLU
• Isolation
BIRD FLU SARS • Face mask on the patient
• Caregiver: use a face mask and eye goggles/glasses
MAIN PROBLEM
• Distance of 1 meter from the patient
Flu infection in birds that A new type of atypical pneumonia • Transport the patient to a DOH referral hospital
affects humans that infects the lungs
REFERRAL HOSPITALS
ETIOLOGIC AGENT • National Referral Center – Research Institute for
Tropical Medicine (RITM) (Alabang, Muntinlupa)
Avian influenza virus, H5N1 Corona virus • Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz,
Manila)
INCUBATION PERIOD • Visayas – Vicente Sotto Memorial Medical Hospital
(Cebu City)
3-5 days 2-8 days • Mindanao – Davao Medical Center (Bajada, Davao
City)
MODE OF TRANSMISSION SARS
Inhalation of feces and Respiratory droplets SUSPECT CASE
discharge of an infected bird 1. A person presenting after 1 November 2002 with a history of:
 High fever >38 0C AND
 Cough or breathing difficulty AND
 One or more of the following exposures during the 10 days
BIRD FLU SARS prior to the onset of symptoms:
 Close contact, with a person who is a suspect or
SIGNS AND SYMPTOMS probable case of SARS
 History of travel, to an area with recent local
Body weakness or muscle transmission of SARS
pain  Residing in an area with recent local transmission of
SARS
Cough 2. A person with an unexplained acute respiratory illness
resulting in death after 1 November 2002, but on whom no
Difficulty breathing autopsy has been performed :
AND
Episodes of sore throat  One or more of the following exposures during the 10 days
prior to the onset of symptoms:
Fever  Close contact, with a person who is a suspect or
probable case of SARS
 History of travel, to an area with recent local
High fever >38’Celsius transmission of SARS
 Residing in an area with recent local transmission of
Chills SARS

PROBABLE CASE

CD-Bucud 4
 NCM 104 LEC Notes from sir dizon Prelims

1. A suspect case with radiographic evidence of infiltrates

consistent with pneumonia or respiratory distress syndrome on
DIPHTHERIA PERTUSSIS
Chest x-ray.
DIAGNOSTIC PROCEDURES
2. A suspect case of SARS that is positive for SARS coronavirus  SCHICK’S TESTS  CBC– increase in
by one or more assays. - Susceptibility and immunity to lymphocytes
diphtheria
3. A suspect case with autopsy findings consistent with the -ID of dilute diphtheria toxin (0.1
pathology of SARS without an identifiable cause. cc)
(+) local circumscribed area of
redness, 1-3 cm
DIPHTHERIA PERTUSSIS
MALONEY’S TEST
MAIN PROBLEM
-Determines hypersensitivity to
Acute bacterial disease Repeated attacks of spasmodic diphtheria anti-toxin
characterized by the elaboration coughing -ID of 0.1 cc fluid toxoid
of an exotoxin
-(+) area of erythema in 24 hours
ETIOLOGIC AGENT

Corynebacterium diphtheriae or Bordetella pertussis

Klebs-Loeffler bacillus DIPHTHERIA PERTUSSIS
INCUBATION PERIOD
COMPLICATIONS Convulsions (brain
2-5 days 7-14 days
Toxins in the bloodstream
damage from
MODE OF TRANSMISSION
asphyxia)
1. Respiratory droplets Myocarditis Peripheral Broncho-
2. Direct contact with respiratory secretions
(epigastric
or chest
paralysis
(tingling,
pneumonia
(fever,
Otitis media
3. Indirect contact with articles
pain) numbness, cough) (invading
paresis)
organisms)
DIPHTHERIA PERTUSSIS
Heart Respirat Bronchopneumonia
SIGNS AND SYMPTOMS Decreased
failure in ory
respiratory arrest
(most dangerous
Types: Stages: rate complication)
1.Nasal 1. Catarrhal DEATH
2.Tonsilopharyngeal
2. Paroxysmal DIPHTHERIA PERTUSSIS
3.Laryngeal
3. Convalescent
4.Wound or TREATMENT MODALITIES

cutaneous 1. Diphtheria anti-toxin 1. Erythromycin – drug of

- Requires skin testing choice
- Early administration 2. Ampicillin – if resistant
aimed at neutralizing the to erythromycin
NASAL DIPHTHERIA toxin present in the
• Bloody discharge from the nose 3. Betamethasone
circulation before it is (corticosteroid) –
• Excoriated nares and upper lip absorbed by the tissues
TONSILOPHARYNGEAL DIPHTHERIA decrease severity and
• Low grade fever 2. Antibiotic therapy length of paroxysms
• Sore throat
- Penicillin G 4. Albuterol
• Bull-neck appearance
• Pseudomembrane- Group of pale yellow membrane (bronchodilator)
- Erythromycin
over tonsils and at the back of the throat as an
inflammatory response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA
• Hoarseness DIPHTHERIA PERTUSSIS
• Croupy cough
• Aphonia NURSING MANAGEMENT
1. Isolation: 4-6 weeks from
• Membrane lining thickens à airway obstruction 1. Isolation: 14 days (until
• Suffocation, cyanosis or death
onset of illness
2-3 cultures, 24 hours
WOUND OR CUTANEOUS DIPHTHERIA apart) 2. Supportive measures
• Yellow spots or sores in the skin (bedrest, avoid
2. Bedrest for 2 weeks excitement, dust, smoke
PERTUSSIS and warm baths)
CATARRHAL STAGE
3. Care for nose and
• Lasts for 1 to 2 weeks throat (gentle swabbing) 3. Safety (during
• Most communicable stage 4. Ice collar (decrease pain paroxysms, patient
• Begins with respiratory infection, sneezing, cough of sore throat) should not be left alone)
and fever
• Cough becomes more frequent at night 5. Diet (soft food, small 4. Suctioning (kept at
PAROXYSMAL STAGE frequent feedings) bedside for emergency
• Lasts for 4 to 6 weeks use)
• Aura: sneezing, tickling, itching of throat
• Cough, explosive outburst ending in “whoop”
• Mucus is thick, ends in vomiting MUMPS
• Becomes cyanotic MAIN PROBLEM
• With profuse sweating, involuntary urination and - An acute contagious disease, with swelling of one or both
exhaustion of the parotid glands
CONVALESCENT STAGE ETIOLOGIC AGENT
• End of 4th-6th week
• Decrease in paroxysms - Filterable virus of paramyxovirus group
INCUBATION PERIOD
- 12-26 days
MODE OF TRANSMISSION
- Respiratory droplets
PERIOD OF COMMUNICABILITY
- 6 days before and 9 days after onset of parotid swelling

CD-Bucud 5
 NCM 104 LEC Notes from sir dizon Prelims

SIGNS AND SYMPTOMS

AMOEBIASIS SHIGELLOSIS
DIAGNOSTIC TESTS
PRODROMAL PHASE
F-ever (low grade) 1. Stool exam
H-eadache
M-alaise 2. Blood exam
3. Sigmoidoscopy
PAROTITIS
F-ace pain
E-arache TREATMENT MODALITIES
S-welling of the parotid glands
1. Metronidazole – drug 1. Cotrimoxazole – drug
COMPLICATIONS of choice of choice
• Orchitis – the most notorious complication of mumps
• Oophoritis – manifested by pain and tenderness of the 2. Tetracycline
abdomen
• CNS involvement – manifested by headache, stiff neck, 3. Chloramphenicol
delirium, double vision
• Deafness as a result of mumps
NURSING MANAGEMENT AMOEBIASIS SHIGELLOSIS
1. Prevent complications
 Scrotum supported by suspensory NURSING MANAGEMENT
 Use of sedatives to relieve pain
 Treatment: oral dose of 300-400 mg cortisone followed by
1.Enteric isolation
100 mg every 6 hours 2. Boil water for
 Nick in the membrane
2. Diet drinking
- Soft or liquid diet
- Sour foods or fruit juices are disliked 3. Handwashing
3. Respiratory isolation
4. Comfort: ice collar or cold applications over the parotid glands 4. Sexual activity
may relieve pain
5. Fever: aspirin, tepid sponge bath
5. Avoid eating
6. Concurrent disinfection: all materials contaminated by these uncooked leafy
secretions should be cleansed by boiling vegetables
7. Terminal disinfection: room should be aired for six to eight
hours

GASTROINTESTINAL TRACT
CHOLERA TYPHOID FEVER
AMOEBIASIS SHIGELLOSIS MAIN PROBLEM

MAIN PROBLEM Acute bacterial disease of the An infection affecting the

Protozoal infection of the large
intestine
ETIOLOGIC AGENT
Entamoeba histolytica
- Prevalent in areas with ill
sanitation
-Acquired by swallowing
Acute infection of the lining GIT characterized by profuse Peyer’s patches of the small
of the small intestine secretory diarrhea intestines
ETIOLOGIC AGENT
Vibrio cholerae Salmonella typhi
Shigella group
INCUBATION PERIOD
1. Shigella flesneri – most
common in the Philippines 1 to 3 days 1 to 3 weeks
2. Shigella connei MODE OF TRANSMISSION

- Trophozoites: vegetative form 3. Shigella boydii

1. Fecal-oral transmission
- Cyst: infective stage 4. Shigella dysenterae – most
infectious type 2. 5 F’s

CHOLERA TYPHOID FEVER

AMOEBIASIS SHIGELLOSIS
SIGNS AND SYMPTOMS
SIGNS AND SYMPTOMS Fever (ladder-like)
1. Acute amoebic dysentery Rice-water stool
Fever Rose spots
- Diarrhea alternated with Abdominal cramps
Diarrhea
constipation Abdominal pain
- Tenesmus Vomiting TYPHOID STATE
- Bloody mucoid stools Diarrhea and Intravascular Sordes
2. Chronic amoebic tenesmus Dehydration
dysentery Subsultus Tendinum
- Enlarged liver Bloody mucoid Shock Coma vigil
- Large sloughs of intestinal stool
tissues accompanied by Carphologia
hemorrhage

CD-Bucud 6
 NCM 104 LEC Notes from sir dizon Prelims

CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER

TREATMENT MODALITIES • Rashes
SIGNS AND SYMPTOMS
1.Chloramphenicol –
1.Lactated Ringer’s -Unilateral, band-like
drug of choice • Rashes : Centrifugal distribution
solution distribution -Dermatomal
2. Ampicillin/
2. Oral rehydration Amoxicillin – for •Rash stages: macule - Erythematous base
therapy typhoid carriers papule vesicle - Vesicular, pustular or
3. Antibiotic therapy pustule crust crusting
3. Cotrimoxazole – for •Regional
- Tetracycline – drug severe cases with lymphadenopathy
• Pruritus
of choice relapses •Pruritus
- Cotrimoxazole •Pain – stabbing or
burning
- Chloramphenicol
CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
NURSING MANAGEMENT
COMPLICATIONS
RAMSAY-HUNT
1. Maintain and restore the fluid SYNDROME - Involvement of
SCARRING – most common
and electrolyte balance complication; associated with
the facial nerve in herpes zoster
with facial paralysis, hearing
staphylococcal or streptococcal
2. Enteric isolation infections from scratching
loss, loss of taste in half of the
tongue
3. Sanitary disposal of excreta NECROTIZING FASCIITIS –
GASSERIAN
most severe complication
GANGLIONITIS –
4. Adequate provision of safe Involvement of the optic nerve
REYE SYNDROME –
drinking water abnormal accumulation of fat in resulting to corneal anesthesia
the liver plus increase of
ENCEPHALITIS – acute
5. Good personal hygiene pressure in the brain resulting to
inflammatory condition of the
coma, therefore leading to
brain
DEATH

CHICKENPOX HERPES ZOSTER

INTEGUMENTARY SYSTEM
TREATMENT MODALITIES

CHICKENPOX HERPES ZOSTER 1. Antihistamines – 4. Corticosteroids – anti-

symptomatic relief of itching inflammatory and decreased
pain
MAIN PROBLEM Ex. Diphenhydramine
(Benadryl) Ex. Prednisone
A highly contagious disease An acute viral infection of
characterized by vesicular the sensory nerve
eruptions on the skin and 2. Analgesics and antipyretics
mucous membranes Ex. Acetaminophen
ETIOLOGIC AGENT
Varicella zoster virus 3. Antiviral agents – for patient to
INCUBATION PERIOD
experience less pain and faster
resolution of lesions when used within
10-21 days 13-17 days 48 hours of rash onset
MODE OF TRANSMISSION Ex. Acyclovir (Zovirax)
1. Droplet method
2. Direct contact CHICKENPOX HERPES ZOSTER
3. Indirect contact
NURSING MANAGEMENT

CHICKENPOX HERPES ZOSTER Strict isolation

Prevent secondary infection (cut
PERIOD OF COMMUNICABILITY
fingernails short, wear mittens)
One day before eruption
One day before eruption Eliminate itching: calamine
of 1st lesion and five days lotions, warm baths, baking soda
of 1st rash and five to six
after appearance of last paste
days after the last crust
crop
Encourage not going to school:
SIGNS AND SYMPTOMS usually 7 days
PRODROMAL Disinfection of clothes and linen
PERIOD with nasopharyngeal discharges
- Fever (low-grade) by sunlight or boiling

- Headache
- Malaise

CD-Bucud 7
 NCM 104 LEC Notes from sir dizon Prelims

MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES

MAIN PROBLEM TREATMENT MODALITIES

A contagious exanthematous A benign communicable 1.Vitamin A – helps 1.Aspirin – help reduce

disease with chief symptoms to exanthematous disease caused prevent eye damage inflammation and
the upper respiratory tract by rubella virus and blindness fever
ETIOLOGIC AGENT
2. Antipyretics – for
Filterable virus of Rubella virus fever
paramyxoviridae
3. Penicillin – given
INCUBATION PERIOD
only when secondary
10-12 days 14-21 days
infection sets in
MODE OF TRANSMISSION
1. Droplet method
2. Direct contact with respiratory discharges
3. Indirect with soiled linens and articles

MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES

PERIOD OF COMMUNICABILITY NURSING MANAGEMENT

4 days before and 5 days after
the appearance of rashes
SIGNS AND SYMPTOMS
PRE-ERUPTIVE STAGE
Cough
Coryza
Conjunctivitis
Fever (high-grade)
Photophobia
One week before and four days 1. Darkened room to relieve photophobia
after the appearance of rashes 2. Diet: should be liquid but nourishing
3. Warm saline solution for eyes to relieve
eye irritation
PRE-ERUPTIVE STAGE
Fever 4. For fever: tepid sponge bath and anti-
pyretics
Headache
5. Skin care: during eruptive stage, soap is
Malaise omitted; bicarbonate of soda in water or
lotion to relieve itchiness
Coryza
6. Prevent spread of infection: respiratory
Conjunctivitis isolation

KOPLIK’S SPOT (Rubeola)

- Bluish white spots surrounded by a red halo SCABIES
- Appear on the buccal mucosa opposite the premolar teeth MAIN PROBLEM
FORCHEIMER’S SPOTS (Rubella) - Infestation of the skin produced by the burrowing action
- small, red lesions of a parasite mite resulting in skin irritation and formation
- Soft palate to mucus membrane of vesicles and pustules
MEASLES GERMAN MEASLES ETIOLOGIC AGENT
- Sarcoptes scabiei
INCUBATION PERIOD
SIGNS AND SYMPTOMS ERUPTIVE STAGE
2. ERUPTIVE STAGE
- Within 24 hours
1. Rash MODE OF TRANSMISSION
Rashes - pinkish, maculopapular Direct contact
- Elevated papules Indirect contact
- Begins on the face
- Begin on the face and behind
the ears - Spread to trunk or limbs Sarcoptes scabiei
- Spread to trunk and 1. Yellowish white in color
extremities - No pigmentation or
desquamation 2. Barely seen by the unaided eye
Color: Dark red – purplish hue
– yellow brown 3. Female parasite burrows beneath the epidermis to lay
2. Posterior auricular and eggs
3. Stage of Convalescence suboccipital
lymphadenopathy 4. Males are smaller and reside on the surface of the skin
- Desquamation SIGNS AND SYMPTOMS
- Rashes fade from the face • Thin, pencil-mark lines on the skin
downwards • Itching, especially at night
• Rashes and abrasions on the skin
PRIMARY LESIONS
NODULAR LESIONS
MEASLES GERMAN MEASLES SECONDARY LESIONS
TREATMENT MODALITIES
• SCABICIDE : Eurax ointment (Crotamiton)
COMPLICATIONS 1. Encephalitis
• PEDICULICIDE : Kwell lotion (Gamma Benzene
2. Congenital rubella syndrome Hexachloride) – contraindicated in young children and
Pneumonia - Spontaneous abortion pregnant women
- Intrauterine growth retardation • Topical steroids
Otitis media (IUGR) • Hydrogen peroxide : cleanliness of wound
- Thrombocytopenia purpura • Lindane Lotion
Severe diarrhea (leading “blueberry muffin skin”
- Cleft lip, cleft palate, club foot
NURSING MANAGEMENT
• Apply cream at bedtime, from neck to toes
to dehydration) • Instruct patient to avoid bathing for 8 to 12 hours
- Heart defects (PDA, VSD)
• Dry-clean or boil bedclothes
Encephalitis - Eye defects (Cataract,
glaucoma) • Report any skin irritation
• Family members and close contact treatment
- Ear defects (Deafness) • Good handwashing
- Neurologic (microcephaly, • Terminal disinfection
mental retardation, behavioral
disturbances SEXUALLY TRANSMITTED DISEASES

CD-Bucud 8
 NCM 104 LEC Notes from sir dizon Prelims

AIDS SYPHILIS AIDS SYPHILIS

SIGNS AND SYMPTOMS 2. SECONDARY SYPHILIS

MAIN PROBLEM
- Skin rash
Final and most serious stage Infectious disease caused
of HIV disease, which causes - Mucous patches
severe damage to the immune
by a spirochete
system - Hair loss

ETIOLOGIC AGENT - CONDYLOMATA LATA:

Retrovirus – Human T-cell
lymphotropic virus III
(HTLV-3)
coalescing papules which
form a gray-white plaque
Treponema pallidum
frequently in skin folds

INCUBATION PERIOD

3 to 6 months to 8 to 10 years 10-90 days

AIDS SYPHILIS AIDS SYPHILIS

MODE OF TRANSMISSION SIGNS AND SYMPTOMS 3. TERTIARY SYPHILIS
• Sexual contact – oral, anal or - 1 to 10 years after infection
vaginal sex
- Appear on the skin, bones,
•Blood transfusion mucus membrane, URT, liver
and stomach
•Mother-to-child - GUMMA: chronic, superficial
nodule or deep
•Indirect contact through soiled granulomatous lesion that is
articles solitary, painless, indurated

AIDS SYPHILIS
AIDS SYPHILIS
SIGNS AND SYMPTOMS
OPPORTUNISTIC INFECTIONS DIAGNOSTIC PROCEDURES
1. Pneumocystis carinni
pneumonia
1.ELISA 1.Dark Field
Illumination test
2. Oral candidiasis 2. Western blot
3. Toxoplasmosis
3. RIPA 2. Flourescent
4. Acute/chronic diarrhea
Treponemal
5. Pulmonary tuberculosis
4. PCR Antibody
MALIGNANCIES
Absorption Test
1. Kaposi’s sarcoma
2. Non-Hodgkin’s lymphoma 3. VDRL
AIDS SYPHILIS
1. PRIMARY SYPHILIS
AIDS SYPHILIS
SIGNS AND SYMPTOMS
- CHANCRE: small, painless, TREATMENT MODALITIES
pimple-like ulceration on the 1. Penicillin G Benzathine
penis, labia majora, minora 1. Antivirals - Disease < 1 year: 2.4 M units
and lips once in two injection sites
- Shorten the clinical
- May erupt in the genitalia, - Disease > 1 year: 2.4 M units
anus, nipple, tonsils or eyelids course, prevent
in 2 injection sites x 3 doses
- Lymphadenopathy
complications, prevent
2. Doxycycline – if allergic to
development of
penicillin
latency, decrease
3. Tetracycline
transmission
- if allergic to penicillin
- Example: Zidovudine - Contraindicated for
(Retrovir) pregnant women

CD-Bucud 9
 NCM 104 LEC Notes from sir dizon Prelims

CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

MAIN PROBLEM MAIN PROBLEM

A viral disease
Sexually transmitted disease caused by a bacteria
Mild superficial fungal characterized by the
Purulent inflammation of mucous appearance of sores and
membrane surfaces infection
blisters on the skin
ETIOLOGIC AGENT

Chlamydia trachomatis Neisseria gonorrhea ETIOLOGIC AGENT

INCUBATION PERIOD Herpes simplex virus
Candida albicans types 1 and 2
2-3 weeks (males)
2-10 days
Asymptomatic (females) INCUBATION PERIOD
MODE OF TRANSMISSION
2-3 weeks 2-12 days
Sexual contact: Oral, vaginal or anal sex

CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

SIGNS AND SYMPTOMS Women MODE OF TRANSMISSION
Women Bleeding after intercourse 1. Rise in glucose as in TYPE 1
Abdominal or pelvic pain Burning sensation during diabetes mellitus - Respiratory droplets
Bleeding after intercourse and urination
in-between menses Yellow or bloody vaginal
2. Lowered body - Direct exposure to
discharge resistance as in cancer infected saliva
Unusual vaginal discharge
3. Increase in estrogen - Kissing and sharing
Men level in pregnant women utensils
Burning with urination
4. Broad-spectrum TYPE 2
Swollen, painful testicles antibiotics are used
White, yellow or - Sexual or genital
Discharge from the penis green pus from the
penis
contact

SIGNS AND SYMPTOMS (Candidiasis)

CHLAMYDIA GONORRHEA ONYCHOMYCOSIS
• Red, swollen darkened nailbeds
COMPLICATIONS • Purulent discharge
Women
• Separation of pruritic nails from nailbeds
Pelvic inflammatory DIAPER RASH
disease • Scaly, erythematous, papular rash
Ectopic pregnancy • Covered with exudates
Sterility
• Appears below the breasts, between fingers, axilla, groin
and umbilicus
THRUSH
Men • Cream-colored or bluish-white patches on the tongue,
Epididymitis mouth or pharynx
• Bloody engorgement when scraped
Newborn
Sterility MONILIASIS
• White or yellow discharge
Conjunctivitis Newborn • Pruritus
Otitis media Gonococcal ophthalmia • Local excoriation
Pneumonia • White or gray raised patches on vaginal walls with local
inflammation

CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

TREATMENT MODALITIES TREATMENT MODALITIES

1. Cefixime 1. Antifungals 1. Antivirals

1. Azithromycin
(Zithromax) - Drug of choice - Fluconazole (Diflucan) - Acyclovir (Zovirax)
because of oral - Ketoconazole (Nizoral)
- Drug of choice because
efficacy, single dose
of single-dose treatment - Imidazole (Nystatin)
effectiveness and lower 2. Ciprofloxacin
cost - Used for oral thrush
3. Ceftriaxone - 48 hours until
2. Doxycycline
symptoms disappear
- Secondary drug of 4. Erythromycin
- Cotrimoxazole
choice

CD-Bucud 10
 NCM 104 LEC Notes from sir dizon Prelims

VECTOR-BORNE DISEASES
DENGUE MALARIA
DENGUE MALARIA
DIAGNOSTIC PROCEDURES 1. CLINICAL DIAGNOSIS

1. TORNIQUET TEST - Based on triad symptoms, 50%

MAIN PROBLEM
An acute febrile disease
The most common arboviral
illness transmitted globally
ETIOLOGIC AGENT
Dengue virus types 1, 2, 3 and 4
Chikungunya virus
O’nyong’nyong virus
- Screening test for dengue
An acute and chronic parasitic
- A test for the tendency for blood
disease capillaries to break down or produce
petechial hemorrhage
The most deadly vector-borne
- Performed by examining the skin of
disease in the world the forearms after the arm veins
have been occluded for 5 minutes
Plasmodium falciparum - To detect unusual capillary fragility
2. PLATELET COUNT
Plasmodium vivax
- Confirmatory test for dengue
Plasmodium ovale
- Decreased count is confirmatory
accuracy
2. BLOOD SMEAR
- Definitive diagnosis of infection is
based on demonstration of malaria
parasites in blood film
3. RAPID DIAGNOSTIC TEST
- Uses immunochromatographic
methods to detect Plasmodium-
specific antigens
- Takes about 7 to 15 minutes
- Sensitivity and specificity > 90%

West Nile virus Plasmodium malariae

DENGUE MALARIA
DENGUE MALARIA
TREATMENT MODALITIES 1. Chloroquine
INCUBATION PERIOD P. Falciparum – 12 days 1. Analgesics and antipyretics
2. Primaquine
- acetaminophen
P. Vivax – 14 days 3. Pyrimethamine
3-14 days 2. Volume expanders
P. Ovale – 14 days - Used in the treatment of 4. Sulfadoxine
intravascular volume deficits
P. Malariae – 30 days 5. Quinine
MODE OF TRANSMISSION - Example: Lactated Ringers
6. Quinidine
3. Blood transfusion – for severe
Bite of an infected mosquito bleeding
Blood transfusion, contaminated 4. Oxygen therapy
syringe or needle
5. Sedatives
Trans-placentally

DENGUE
VECTOR
Aedes aegypti
(Aedes albopictus)
White stripes on the back and
legs (Tiger mosquito)
Day biting (2 hours after sunrise
and 2 hours before sunset)
Breeds on clear stagnant water
Urban-based
SCHISTOSOMIASIS LEPTOSPIROSIS
MALARIA
MAIN PROBLEM
A slowly progressive disease A zoonotic infectious disease
Anopheles flavirostris caused by a blood fluke
ETIOLOGIC AGENT
Brown in color 1. SCHISTOSOMA JAPONICUM Leptospira interrogans
- Intestinal tract, endemic in the
Philippines
Night biting (9 PM-3 AM) 2. SCHISTOSOMA MANSONI
- Africa
Breeds on clear, flowing and
shaded streams 3. SCHISTOSOMA HAEMATOBIUM
- Middle East countries like Iran and Iraq
Rural-based

SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
INCUBATION PERIOD
SIGNS AND SYMPTOMS
At least 2 months 7 to 19 days
FEVER FEVER
MODE OF TRANSMISSION
HEADACHE CHILLS
Ingestion
MALAISE PROFUSE SWEATING
Skin penetration
RASH
Contact with the skin
EPISODES OF
BLEEDING

CD-Bucud 11
 NCM 104 LEC Notes from sir dizon Prelims

SCHISTOSOMIASIS LEPTOSPIROSIS SCHISTOSOMIASIS LEPTOSPIROSIS

VECTOR TREATMENT MODALITIES

1st line drugs
Oncomelania quadrasi 1. Praziquantel (Biltricide)
1. Penicillin G – drug of choice
1. Thrives in fresh water - Taken for 6 months
stream 2. Doxycycline
- 1 tablet BID for 3 months
2. Clings to grasses and leaves 2nd line drugs
- 1 tablet OD for 3 months
3. Greenish brown in color 3. Ampicillin
4. Size is as big as the smallest 4. Amoxicillin
grain of palay

FILARIASIS
SCHISTOSOMIASIS LEPTOSPIROSIS MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
SIGNS AND SYMPTOMS Septic or Leptospiremic Stage Wuchereria bancrofti
Brugia malayi
ACUTE STAGE F – ever (remittent Brugia timori
INCUBATION PERIOD
1. Cercarial dermatitis H – eadache 8 to 16 months
(swimmer’s itch) MODE OF TRANSMISSION
M – yalgia
Person-to-person by mosquito bites
2. Katayama syndrome
N – ausea ACUTE STAGE
C - ough V – omiting • Lymphadenitis (inflammation of lymph nodes)
• Lymphangitis (inflammation of lymph vessels)
H – eadache and fever • Male genitalia affected leading to funiculitis, epididymitis
C – ough
A – norexia and lethargy and orchitis (redness, painful and tender scrotum)
C – hest pain CHRONIC STAGE
R – ash • Develop 10-15 years from onset of first attack
• Hydrocele (swelling of the scrotum)
M - yalgia
• Lymphedema (temporary swelling of the upper and
lower extremities)
SCHISTOSOMIASIS LEPTOSPIROSIS • Elephantiasis (enlargement and thickening of the skin
of the upper and lower extremities, scrotum and breast

SIGNS AND SYMPTOMS Immune or Toxic Stage LABORATORY EXAMINATIONS

• Nocturnal blood examination (NBE) – taken at
CHRONIC STAGE - Lasts for 4 to 30 days patient’s residence/hospital after 8PM
• Immunochromatographic test (ICT) – rapid
1. Hepatic: pain, abdominal - Iritis, headache, meningeal assessment method; an antigen test done at daytime
distension, hematemesis, melena manifestations TREATMENT
2. Intestinal: fatigue, abdominal pain, • Diethylcarbamazine Citrate (DEC) or HETRAZAN –
- Oliguria, anuria with renal an individual treatment kills almost all microfilaria and a
dysentery
failure good proportion of adult worms.
3. Urinary: dysuria, urinary PREVENTION AND CONTROL
frequency, hematuria - Shock, coma and congestive
• Measures aimed to control vectors
heart failure
4. Cardiopulmonary: palpitations, • Environmental sanitation such as proper drainage and
dyspnea on exertion cleanliness of surroundings
• Spraying with insecticides
5. CNS: seizures, headache, back PREVENTION AND CONTROL
pain and paresthesia • Measures aimed to protect individuals and families:
• Use of mosquito nets
SCHISTOSOMIASIS LEPTOSPIROSIS • Use of long sleeves, long pants and socks
• Application of insect repellants
• Screening of houses
DIAGNOSTIC PROCEDURES
1. Fecalysis

2. Kato-Katz Technique

3. Cercum ova precipitin test

(COPT)
- Confirmatory test for
schistosomiasis

CD-Bucud 12