NURSING CARE OF PATIENTS WITH

RESPIRATORY COMUNICABLE DISEASES

 Lecture Outline

n Measles
n German measles
n Chicken Pox
n Herpes Zoster
n influenza
n COVID-19
 Measles description
n is one of the most contagious infectious
diseases, with at least a 90% secondary
infection rate in susceptible domestic
contacts.
n Despite being considered primarily a
childhood illness, measles can affect
people of all ages.
 pathophysio
n Infection is transmitted via respiratory
droplets, which can remain active and
contagious, either airborne or on surfaces,
for up to 2 hours.
n Initial infection and viral replication occur
locally in tracheal and bronchial epithelial
cells.
n After 2-4 days, measles virus infects local
lymphatic tissues, perhaps carried by
pulmonary macrophages.
n Following the amplification of measles
virus in regional lymph nodes, a
predominantly cell-associated viremia
disseminates the virus to various organs
prior to the appearance of a rash.
 Measles
n Synonyms: Rubeola; First disease, Little
red disease
n Causative agent: Paramyxovirus
n Incubation: 7-14 days (average 10-14
days)
n MOT: droplet -spread by coughing and
sneezing via close personal contact or
direct contact with secretions.
n * Period of communicability: 4days before
to 5 days after the appearance of rashes
Signs and symptoms
1. Prodromal -Pre-eruptive:
>fever 3-4days, malaise, anorexia
> 3 Cs:
Cough, coryza, conjunctivitis
Enanthem phase> Pathognomonic
sign- Koplik spots – fine red spots with
bluish-white spot at center found in
the inner cheek
Koplik spot
2. Exanthem- Eruptive:

> Rashes – cephalocaudal appearance

of maculopapular rash ; appears on
the 3rd day of illness
3. Post-eruptive:
> rashes begin to disappear leaving a fine
branny desquamation
 Most contagious stage
n Last
day of incubation to prodromal
exanthem phase- 4 days before and 4
days after onset of the rash
Complications
Complications
Diagnosis: Clinical signs & symptoms
Treatment: Symptomatic
Nursing care:
>isolation
> Complete bed rest
> Adequate nutrition; no food
restriction
> Increase fluid intake
> Increase vitamin C & A
> Keep patient warm & dry
> Photophobia – darken the room
n Antibody assays. The measles virus
sandwich-capture IgM antibody assay- is
the quickest method of confirming acute
measles
n Viral culture-Throat and nasal swabs
n Reverse-transcription polymerase chain
reaction (PCR)- highly sensitive at
visualizing measles virus RNA in blood,
throat, nasopharyngeal, or urine
specimens
Prevention:
1. Immunization – 0.5 ml SC deltoid
Precaution: fever, mild rash
MCV1- 9 months
MMR- given at 12- 15 months
- check for allergy to eggs
2ND Dose- 4-6 years old
2. Proper disposal of nasal secretions
 German Measles

n Synonyms: Rubella, 3 day measles, Third

disease
n Causative agent: Togavirus- Rubivirus
n MOT: droplet/ aerosol
n Incubation period: 14-21 days
n Can spread transplacentally- 1 st trimester
n Period of communicability – entire course of the
disease
Stages:
1. Pre-eruptive – low grade fever, headache,
sore throat (1-2 days)
Forscheimer spots (fine red spots found on
soft palate)

2. Eruptive
> rashes (exanthem)– maculopapular
(smaller than measles) ; cephalocaudal; lasts
for 2-3 days & leave no desquamation nor
pigmentation
> enlargement of lymph nodes: sub-occipital,
post. Auricular, post. Cervical
Forscheimer spots
3. Post-eruptive:
> rash disappears
> enlargement of lymph nodes begin to
disappear

n Congenital anomalies
– Microcephaly
– Heart defect
– Cataract
– Deaf-mutism
n Theclient should avoid pregnancy for 1 to
3 months after immunization with rubella
vaccine
 Chicken pox

n Synonyms: Varicella; Bulutong

n Causative agent: Varicella Zoster virus
n MOT: Airborn
n Incubation Period: 2-3 Weeks
n Period of Communicability: Until the last
crust has fallen off
1. Pre-eruptive
> fever, headache, body malaise, muscle pain
> symptoms occur within 24 hours
2. Eruptive phase
described as vesiculo-pustular, more abundant
in covered parts of the body
> unilocular appearance of lesions
3. Post-eruptive
> lesions start to crust leaving a scar that is
superficial, depigmented, and take years to
fade
Complications:
> secondary bacterial infection of the
lesions: impetigo, furuncles, cellulitis
Diagnosis: Clinical
Treatment: Symptomatic
antiviral (acyclovir) – reduce the
number of lesions and shorten the
course of illness
if used, px will not develop permanent
immunity
Nursing priority:
> prevention of secondary infection of
the skin lesions through hygienic care of
the patient
> cut fingernails short & wash hands to
minimize bacterial infections that may
be introduced during scratching
> isolation of patient
> Cool soda bath/ baking soda paste
reduce itchiness
Preventive Measures:
> Immunization
Varivax
2 doses in adult, 1 month interval
1 dose in child
 Herpes-Zoster
(Shingles)

Etiologic agent: Varicella zoster virus

> occurs in a partially immune individual due
to a previous varicella infection
> rashes are clustered, follows a nerve
pathway (unilateral), itchy, painful
Diagnosis: Clinical
Complications:
> can lead to blindness because it can
damage the ophthalmic division of the 5 th
cranial nerve
Treatment: Symptomatic
> acyclovir (anti-viral)
> KMnO4 –
A: astringent effect – dries rashes
B: bactericidal – minimizes infection
> analgesics are necessary for weeks or even
months after blisters have dried up because it
may cause neuralgia
Preventive measures:
> use of mask, gown, proper disposal of
nasopharyngeal secretions
 INFLUENZA
q Synonym: Flu
q Highly contagious characterized
respiratory and constitutional symptoms
q Causative agent: Myxovirus
Influenza virus A, B, C
q MOT- Droplet, contact with
nasopharyngeal secretions
q Incubation: 1-5 days
 INFLUENZA A
2 Antigens
Hemaglutinin
Neuraminidase
Past Pandemic Influenza
1918 (H1N1) – Spanish influenza
1957 (H2N2) – Asian influenza
1968 (H3N2) – Asian influenza
1977 (H1N1) – Russian Influenza
Assessment
Clinical Manifestation
a. Respiratory – most common
Fever
Anorexia
Chills
Sore throat
Bitter taste
Pain behind the eyeballs
b. Intestinal
Nausea and vomiting
Severe abdominal pain
Fever
Constipation
Severe diarrhea
c. Nervous
Headache
Muscle and joint pain
Fever
Planning and Implementation
a. Adequate rest and good ventilation
b. TSB
c. Monitor vital signs
d. Adequate nutrition

Prevention
Annual vaccination for high risk people or
for individuals who wish to reduce
chances of getting flu
 Avian Influenza
Synonym: Bird flu, AI
Causative agent: Influenza A H5N1 virus
MOT: Direct contact with droppings of infected
bird
Signs and symptoms: Fever, body weakness or
muscle pain, cough, sore throat, sore eyes, DOB
Management: Same as influenza
Prevention: No vaccine available yet, avoid
migratory birds, Thorough cooking of poultry
meat
 How long will it stay on the
surface?
n Feces and urine in room temp-2 days
n Paper and plastered wall- 36 hrs
n Stainless=72 hrs
n Glass slides-96 hrs
n Loses its infectivity when expose to
disinfectants.
n Heat at 56 c rapidly to kill the virus
 COVID-19
n Coronavirus disease (COVID-19) is an
infectious disease caused by a newly
discovered coronavirus.
n spreads primarily through droplets of
saliva or discharge from the nose when an
infected person coughs or sneezes
n highly transmittable and pathogenic viral
infection caused by severe acute
respiratory syndrome coronavirus 2 (SARS
-CoV-2), which emerged in Wuhan, China
and spread around the world.
n Genomic analysis revealed that SARS-CoV-
2 is phylogenetically related to severe
acute respiratory syndrome-like (SARS-
like) bat viruses, therefore bats could be
the possible primary reservoir.
n mildto moderate respiratory illness and
recover without requiring special
treatment.
n Older people, and those with underlying
medical problems like cardiovascular
disease, diabetes, chronic respiratory
disease, and cancer are more likely to
develop serious illness.
n On average it takes 5–6 days from when
someone is infected with the virus for
symptoms to show, however it can take
up to 14 days.
n The incubation period for COVID-19 is
thought to extend to 14 days, with a
median time of 4-5 days from exposure to
symptoms onset.
 Signs and symptoms
n Most common symptoms:
n Fever, dry cough, tiredness.

n Less common symptoms:

aches and pains, sore throat, diarrhea
n Conjunctivitis, headache,loss of taste or
smell.
n a rash on skin, or discolouration of fingers
or toes.
n Serious symptoms:
n difficulty breathing or shortness of breath.
n chest pain or pressure.
n loss of speech or movement.
 Illness Severity
n Mild to moderate (mild symptoms up to
mild pneumonia): 81%
n Severe (dyspnea, hypoxia, or >50% lung
involvement on imaging): 14%
n Critical (respiratory failure, shock, or
multiorgan system dysfunction): 5%
Diagnostics
n CXR- bilateral air space consolidation
n CT SCAN
n CBC- Lymphopenia is the most common
laboratory finding and is found in as many
as 83% of hospitalized patients.
n may develop signs of a hypercoagulable
state and be at increased risk for venous
and arterial thrombosis of large and small
vessels.
 prevention
Wash your hands regularly with soap and
water, or clean them with alcohol-based
hand rub.
n Maintain at least 1 metre distance
between you and people coughing or
sneezing.
n Avoid touching your face.
n Cover your mouth and nose when
coughing or sneezing.
n Stay home if you feel unwell.
n Refrain from smoking and other activities
that weaken the lungs.
n Practice physical distancing by avoiding
unnecessary travel and staying away from
large groups of people.