COMMUNICABLE DISEASE

MODULE 1

DEFINITION OF COMMUNICABLE DISEASE

At the end of the course the student will be able to

understand:
1. The overview and purpose of the diagnostic procedure

2. The definition of communicable diseases, different

terminologies important in its process

3. The types of communicable diseases, pattern of diseases,

occurrence and immunity

4. Process of chain of infection, mode of transmissions

5. The different infection control measures

6. The isolation technique and the transmission based

precautions

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 COMMUNICABLE DISEASE
DEFINITION OF COMMUNICABLE
DISEASE
COMMUNICABLE DISEASE NURSING
AND ITS
DIFFERENT TERMINOLOGIES
 Disease caused by an infectious
agent from an infected individual
and transmitted to a susceptible
host either by direct/ indirect
contact or through direct
inoculation into a broken skin.
 Is an illness caused by an
infectious agent or its toxic
product that are transmitted
directly or indirectly to a well
person through an agency, and a
vector or an inanimate object.
COMMON TERMINOLOGIES
INFECTION – is the implantation and
successful replication of an organism in
the tissue of the host resulting to signs
and symptoms as well as immunologic
response.
CARRIER – is an individual who
harbors the organisms and is capable of
transmitting it to a susceptible host
without showing manifestations of the
disease.
CONTACT – is any person or animal, or
freshly soiled materials.
2
DISINFECTION – is the destruction of
pathogenic microorganism outside the
body by directly applying physical or
chemical means.
a. Concurrent disinfection
b. Terminal disinfection
HABITAT – is the place where an
organism lives or where an organism is
usually found.
HOST – is a person, animal or plant on
which a parasite depends for its
survival.
ISOLATION – is the separation from
other persons of an individual suffering
from a communicable disease.
QUARANTINE – is the limitation of
freedom of movement of persons or
animals which have been exposed to
CD/s for a period of that disease.
RESERVOIR – is composed of one or
more species of animal or plant in which
an infectious agent lives and multiplies
for survival and reproduces itself in such
a manner that it can be transmitted to
man.
SURVEILLANCE – is the act of
watching.
TYPES OF COMMUNICABLE
DISEASE
 COMMUNICABLE DISEASE
 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
spread and is directly transmitted
from person to person
3. Intracellular multiplication
Severity of Infection
 Varies with the;
a. Disease producing ability
b. Number of invading organism
c. The strength of the host’s
defense
d. Some other factors

Why infections occur?

PATTERNS OF DISEASE/ INCIDENCE  Some bacteria develop
OF THE DISEASE resistance to antibiotics
 Some microbes such as influenza
SPORADIC - intermittent occurrence of have so many different strains
that a single vaccine cannot
a disease./ Occasionally and irregularly
protect against all of them.
with no specific pattern.  Most viruses resist antiviral drugs
 New infectious agents
ENDEMIC – continuous or constant occasionally arise such as HIV
occurrence of a disease in a certain and Corona Viruses.
area
Some microbes localize in areas of the
EPIDEMIC –sudden increase in the body that make treatment difficult
number of cases of a disease in a short
period of time/ occur in a greater ASPECTS OF CARE OF PATIENTS
number than what is expected in a WITH COMMUNICABLE DISEASE
specific area over a specific time.
A. PREVENTION
PANDEMIC -worldwide epidemic/ 1. HEALTH EDUCATION
affects several countries or continents Educate the family and the client
with respect to:
INFECTION AND THE ASPECTS OF  Availability and importance of
CARE OF PATIENTS WITH prophylactic immunization
COMMUNICABLE DISEASE  Manner in which infectious
illness is spread and methods
What is infection? of avoiding the spread
 The production of  Importance of seeking
microorganisms injures the
medical advice for any sign of
patient by;
1. Competing with the host health problem
metabolism,  Importance of environmental
2. Cellular damage produced by the cleanliness and personal
microbes, hygiene
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 COMMUNICABLE DISEASE
 Means of preventing
contamination of food and
water supply
2. IMMUNIZATION – induction or
introduction of specific protective
antibodies in a susceptible
person for the purpose of
producing cellular immunity.
 Expanded Program of
Immunization (EPI)
Proclamation No. 6: Prevent
the seven childhood diseases,
TB, DPT, polio, measles,
hepatitis B
 U.N. goal: universal child
immunization
IMMUNITY
 Immunity is the process of
rendering an individual resistance
or immunity to a specific
disease.
TYPES OF IMMUNITY
1. Natural Immunity: innate;
inherent; inborn
A. Natural
* Natural Active: Through exposure
or having disease itself
*Natural Passive: Maternal
antibodies received by the baby
through placental transmission.
2. Acquired Immunity
B. Artificial
* Artificial Active: Introduction of
antigens that will stimulate the
body to produce antibodies, e.g.
live attenuated vaccine
*Artificial Passive: Introduction of
antibodies, e.g. Immunoglobulin
3. ENVIRONMENTAL SANITATION
– P.D. 856
 Anti-littering: P.D. 825
 Proper supervision of food
handlers
/ B. CONTROL – LIMIT THE SPREAD
OF INFECTION BY MEANS OF:
1. Isolation – separation of infected
persons from other persons
during the period of
communicability in order to
prevent the direct or indirect
transmission of the infectious
agent from infected persons to
other person who are susceptible
or who may spread the disease
to others.
Purpose of Isolation
• Is to confine the infectious
agent to a circumscribed area
and to prevent the escape of
infection from that area.
7 Categories Recommended In
Isolation
1. Strict Isolation – to prevent
highly contagious or virulent
infections
2. Contact Isolation – to
prevent the spread of infection
primarily by close or direct
contact.
3. Respiratory Isolation – to
prevent transmission of
infectious diseases over short
distances through the air.
4. TB isolation – for TB patients
with smear or with chest X-ray
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 COMMUNICABLE DISEASE
which strongly suggest active
tuberculosis.
5. Enteric Isolation – is for
infections with direct contact
with feces
6. Drainage/Secretion
Precaution – to prevent
infections that are transmitted
by direct or indirect contact
with purulent materials or
drainage from an infected
body site.
Universal Precaution –is
applied when handling blood
and body fluids
a. Applied to patients with
HIV/HBC
b. Intended to prevent
parenteral, mucous
membrane, and non-intact
skin exposure of health
care workers to blood-
borne pathogens.
c. The isolation is necessary
to prevent infections that
are transmitted by direct
contact with infected blood
or body fluids.
d. This applied to blood,
semen, vaginal secretions,
and other body fluids,
(CSF, synovial fluid,
pleural fluid, peritoneal
fluid, pericardial fluid,
amniotic fluid), and tissues
containing visible blood.
2. Quarantine – limitation of
freedom of movement of persons
or animals who have been
exposed to a communicable
disease for a period of time equal
to the longest usual incubation
period of the diseases so as to
prevent effective contact with
5
those who are not exposed. May
either be complete or modified.
3. Fumigation – any process by
which the killing of animal forms
is accomplished with the use of
gaseous agents.
4. Disinfection – any physical or
chemical process to destroy
undesired animal forms present
in the person, clothing or
environment.
 Concurrent – the application
of disinfection as rapidly as
possible after the discharge of
infectious material from the
body of an infected person or
as after the soiling of articles
with such infectious
discharges.
 Terminal – the process of
rendering the personal
clothing and immediate
physical environment of the
patient free from the
possibility of conveying the
infection to others at the time
when the patient is no longer
a source of infection.
5. Asepsis – the state or condition
of being free from infection.
A. CHAIN OF INFECTION
1. Describes the development of
an infectious process
2. An interactive process
involving an agent, host, and
environment is required
The six essential links (elements) in
the chain of infection:
1. AGENT
 COMMUNICABLE DISEASE
 An entity that is capable of
causing disease.
 Agents that cause disease may
be as follows:
Biological Agents: Living organisms
that invade the host, causing disease.
a. Bacteria
 Simple, one-celled microbes
with double-celled membranes
that protect them from harm
 Produce rapidly and are
considered the most common
cause of fatal infectious disease
 Classified according to:
 Shape (cocci, bacilli,
spirillae)
 Need of oxygen (aerobic,
anaerobic)
 Response of staining (gram-
positive or negative; acid
fast or non-acid fast)
 Motility (motile, non-motile)
 Tendency to capsulate
(encapsulated, capsulated)
 Capacity to form spores
(spore-forming, non-spore-
forming)
b. Viruses
 Smallest known microbes
 Cannot replicate independently
in the host’s cells; rather, they
invade and stimulate the host’s
cells to participate in the
formation of additional viruses
c. Fungi
 Found almost everywhere on
earth
 Live in organic matter, soil,
water, animals and plants
 Can also live inside and outside
the body
 May be harmful or beneficial
d. Protozoa
 Larger than bacteria
 Absorb nutrients from the body
of the host
e. Rickettsia
 Small, gram-negative bacteria-
like microbes that can induce
life-threatening infections
 Like viruses, they require a host
cell for replication
 Usually transmitted through a
bite of arthropod carriers like
lice, fleas, ticks as well as
through waste products
f. Spirochete
 A bacterium with flexible,
slender, undulating spiral rods
that possess cell wall.
 Three forms of spirochete that
cause a disease:
 Treponema
 Leptospira
 Borilia
g. Parasites
 Live on or without other
organisms
 Live at the expenses of others
 Don’t usually kill their host but
take only the nutrients they
need.

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 COMMUNICABLE DISEASE

THE CHAIN OF INFECTION

BIOLOGICAL
Intact immune AGENT
Disinfection
system

Exercise Cleaning

Immunization
Sterilization
Proper nutrition

SUSCEPTIBLE HOST RESERVOIR OR

SOURCE

Skin integrity Proper hygiene

Sterile technique Change of

dressing

Proper disposal of Cleaning of

needle or sharps equipment

Sterilization
PORTAL OF
ENTRY TO HOST
PORTAL OF EXIT
FROM RESERVOIR
Wearing of gloves
masks gowns
Clean dressing
goggles (APPEs)
over wounds
Medical or
surgical asepsis Covering mouth
and nose when
Proper disposal of 7 coughing or
contaminated sneezing
object

Hard hygiene
 COMMUNICABLE DISEASE
FIGURE 1.1 THE CHAIN OF INFECTION
Chemical agents. Substances that can interact
with the body, causing disease, such as food
additives, medications, pesticides, and industrial
chemicals
Physical agents. Factors in the environment that
are capable of causing disease, such as heat,
light, noise, and radiation
2. RESERVOIR
 A place or environment where the
agent can survive and multiply
 The most common reservoirs are:
 Humans
 Animals
 Physical environment
 Fomites
3. PORTAL OF EXIT
 Route, path or way by which an
infectious agent leaves the reservoir to
be transferred to a susceptible host.
 The agent leaves the reservoir through
body secretions including:
 Sputum (from the respiratory tract)
 Semen, vaginal secretions, or
urine (from the genitourinary tract)
 Saliva and feces (from the
gastrointestinal tract)
 Blood
 Draining wounds
 Tears
 HORIZONTAL TRANSMISSION
4. MODES OF TRANSMISSION
8
 The process of the infectious agent
moving from the reservoir or source
through the portal of exit to the portal
of entry of the susceptible “new” host.
Most infectious agents have a usual
primary mode of transmission, but
some microorganisms may be
transmitted by more than one
mode/depending on the agent. Almost
anything in the environment can
become a potential mode of
transmission.
Contact Transmission
This involves the transfer of an agent
from an infected person through a
fomite, or close contact with
contaminated secretions. Sexually
transmitted diseases are spread by
direct contact. Common viral infections
(cold, measles, and flu) are spread by
close contact with contaminated
secretions.
 Direct Contact – person to person
 Indirect Contact – inanimate
objects or personal things
 Droplet Contact – contact with
discharges from coughing,
sneezing or talking with infected
person
 COMMUNICABLE DISEASE
Droplets that do not remain airborne or
settle out are excluded from this category.
Figure 1.3 Airborne Transmission

Vehicle Transmission
 Occurs when an agent is transferred to a
susceptible host by contaminated
inanimate objects such as water, food,
milk, drugs, and blood. Cholera is
transmitted through drinking water and
salmonellosis is transmitted through
contaminated meat.

Vectorborne Transmission
 Occurs when an agent is transferred to a
susceptible host by animate means such
as mosquitoes, fleas, ticks, lice, and
other animals. Lyme disease, malaria,
and West Nile virus are examples of
diseases spread by vectors.
Figur
Figure 1.2
Horizontal Transmission (Direct Contact) e 1.4

DIRECT CONTACT

Airborne Transmission
 Occurs when a susceptible host contacts
droplet nuclei or dust particles that are
suspended in the air. Contaminated
droplets containing the measles virus are Vectorborne Transmissions (Mosquitoes)
in the spray from sneezing. The droplet
can find a portal of entry through the Vertical Transmission
mucous membranes or conjunctiva.
 Refers to the mother-to-child
transmission through the placental
barrier or breastfeeding

9
COMMUNICABLE DISEASE

Figure 1.5
Verticaltransmissions through breastfeeding and
placental barrier

5. Portal of Entry
 The route by which an infectious agent
enters the host

6. Host

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 COMMUNICABLE DISEASE
 A host is an organism that can be
affected by an agent.
 A human being is usually considered a
host.
 Susceptible host is a person who has no
resistance to an agent and thus is
vulnerable to disease. For example, an
individual who has not received the
measles vaccine is more likely to
FIGURE 1.6 BREAKING THE CHAIN OF INFECTION
11
contract the infection because of the lack
of immunity o the infectious agent.
 Compromised host is a person whose
normal body defense is impaired and is
therefore susceptible to infection. For
example, a person with a common cold
or superficial burns is at greater risk for
infection because of the impaired state of
the body system mechanisms.
 COMMUNICABLE DISEASE
1. Infection Control: First Line of
Defense
Hand hygiene is the first line of
defense against infection and is the
single most important practice in
preventing the spread of infection.
 Between Agent and Reservoir
The first link in the chain of
infection is between the agent
and the reservoir.
 Between Reservoir and Portal
of Exit
Promoting proper hygiene,
changing dressings and linens,
and ensuring that clean
equipment is used in client care
ways to break the chain of
infection between the reservoir
and the portal of exit
The goal is to eliminate the
reservoir for the microorganism
before a pathogen can escape
to a susceptible host.
 Between Portal of Exit and
Mode of Transmission
The goal in breaking the chain
of infection between the portal
of exit and the mode of
transmission is to prevent the
exit of the infectious agents.
Clean dressings must be
maintained on all wounds.
Clients should be encouraged to
cover their mouths and noses
when sneezing or coughing, and
the nurse must do so as well.
Gloves must be worn when
caring for a client who may have
infectious secretions, and care
12
must be taken to properly
dispose of any contaminated
article.
 Between Mode of
Transmission and Portal of
Entry
Asepsis must be ensured and
barrier protection worn when the
care of clients involves contact
with the body secretions.
Gloves, masks, gowns, and
goggles are barrier protection
that can be used. Proper hand
hygiene and proper disposal of
contaminated equipment and
linens are ways to prevent
transmission of microorganisms
to other clients and health care
workers.
 Between Portal of Entry and
Host
Maintaining skin integrity and
using sterile technique or client
contacts are methods of
breaking the chain of infection
between portal of entry and
host. Avoiding needle sticks by
properly disposing of sharps
also reduces the potential for
infection by denying a portal of
entry. The goal at this point in
the chain is to prevent the
transmission of infection to a
client or health care worker who
is not infected.
 Between Host and Agent
Breaking the chain of infection
between host and agent means
eliminating infection before it
 COMMUNICABLE DISEASE
begins. There are many ways to sterilization are moist heat
reduce the risk of acquiring (steam), dry heat, and ethylene
infection: oxide gas. The method of
sterilization depends on the
Proper nutrition, exercise, and object to be sterilized and the
immunizations allow an kind and amount of
contamination.
individual to maintain an intact
immune system, thus preventing
 Autoclaving sterilization,
infection. which uses moist heat or steam,
is the most common sterilization
technique used in the hospital
2. Infection Control: Cleansing setting. Boiling water is not an
effective sterilization measure,
Cleansing is a potential hazard to because some viruses and
the nurse from the splashing of spores can survive boiling
contaminated material onto the water. Objects that have been
body. Nurses should wear gloves, boiled in water for 15 to 20
masks, and goggles during minutes at 121ºC (249.8ºF) are
considered clean but not sterile
cleansing.
(Department of Labor, 1991)
 Promoting proper hygiene,
 Disinfection is the elimination changing dressings and linens,
of pathogens, except spores, and ensuring that clean
from inanimate objects. equipment is used in client care
Disinfectants are chemical are ways to break the chain of
solutions used to clean infection between the reservoir
inanimate objects. Common and the portal of exit. The goal
disinfectants are alcohol, is to eliminate the reservoir for
sodium hypochlorite, quaternary the microorganism before a
ammonium, phenolic solutions, pathogen can escape to a
and glutaraldehyde. susceptible host.
 A germicide is a chemical that B. TYPES AND STAGES OF
can be applied to both animate
INFECTIONS
(living) and inanimate objects to
eliminate pathogens. Antiseptic
preparations such as alcohol 1. Types of Infections
and silver sulfadiazine are  Localized infections are
germicides. limited to a defined area or
single organ with symptoms
 Sterilization is destroying all that resemble inflammation
microorganisms including (redness, tenderness, and
spores. Equipment that enters
swelling), such as a cold
normally sterile tissue or blood
vessels must be sterilized. sore.
Methods of achieving
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 COMMUNICABLE DISEASE
 Systemic infections affect
the entire body and involve
multiple organs, such as
AIDS.
2. Stages of Infection
 Incubation Stage. The
incubation period is the time
between entry of infectious
agent in the host and the
onset of symptoms. During
this time, the infectious
agent invades the tissue and
multiplies to produce an
infection. The client is
typically infectious to others
during the latter part of this
stage. For example, the
incubation period for
varicella (chicken pox) is 2 to
3 weeks. The infected
person is contagious from 5
days before any skin
eruptions to no more than 6
days after the skin eruptions
appear.
Safety
Always verify the incubation
period of a suspected
infection. Remember that a
client may be able to
transmit the infection to
another person before the
onset of symptoms.
 Prodromal Stage. The
prodromal stage is the time
from the onset of non-
specific symptoms until
specific symptoms begin to
14
manifest. The infectious
agent continues to invade
and multiply in the host. A
client may also be infectious
to other persons during this
time period. In the client with
chickenpox, a slight
elevation in temperature will
occur during this stage,
followed within 24 hours by
eruptions on the skin.
 Illness Stage. The illness
stage is the time when the
client has specific signs and
symptoms of an infectious
process. The client with
chickenpox will experience a
further rise in temperature
and continued outbreak of
skin eruptions for at least 2
to 3 more days.
 Convalescent Stage. From
the beginning of the
disappearance of acute
symptoms until the client
returns to the previous state
of health. The client with
chickenpox will see the skin
eruptions and irritations
begin to resolve during this
stage.
C. NOSOCOMIAL INFECTION
A nosocomial infection is
an infection acquired in a
hospital or other health care
facility that was not present
or incubating at the time of
the client’s admission. They
 COMMUNICABLE DISEASE
also include those infections surgical wounds, pneumonia,
that become symptomatic and septicemia.
after the client is discharged
and infections passed Most nosocomial infections
among medical personnel. are transmitted by health
Nosocomial infections are care personnel who fail to
also called hospital-acquired practice proper hand hygiene
infections. These types of or who fail to change gloves
infections typically fall into between client contacts.
four categories: urinary tract,

The hospital environment Therefore, the client has no

provides exposure to a resistance to these
variety of organisms to which organisms, illness impairs
the client has not typically the body defenses.
been exposed in the past.

STANDARD PRECAUTIONS FOR INFECTION

CONTROL (Use for all clients)

Handwashing Wear Gloves

Wash hands before Figure 1.8
contact with each
client, during care as Wear gloves (clean, nonsterile adequate) whenever
needed (even if contact is expected
wearing gloves) to with blood, body
prevent cross fluids, secretions,
contamination of excretions, mucous
body sites, and after membranes and
touching blood, body non-intact skin and
fluids, secretions, contaminated items.
excretions, and
contaminated items Always change
(with or without gloves between
gloves). clients and between
Figure 1.7 tasks and
Use a plan (non-antimicrobial) soap during routine procedures on the
handwashing: Use a antimicrobial agent or a same client after
waterless antiseptic agent as per agency policy. contact with material that may contain a high
concentration of microorganisms.

15
 COMMUNICABLE DISEASE
Remove gloves promptly after use, before touching
non-contaminated items and environment surfaces,
and before going to another client, wash hands.

Face Protection (mask, goggles, face shield)

Figure 1.9

Wear a face shield, or wear goggles and

a mask thatcovers both the nose and the
mouth during proceduresand client care
activities that are likely to generate
splashes or sprays of blood, body fluids,
secretions or excretions to provide
protection of the mucousmembranes of
the eyes, nose and mouth. Wear Gown and other protective
apparel

Figure 1.10

Wear a gown to prevent

contamination of clothing and skin
from blood and body fluids
exposures. Gowns especially treated
to make them permeable to liquids
and leg/shoe covers provide greater
Patient-Care Equipment skin

Figure 1.11 protection when splashes or large

Handle used patient – care equipment soiled with quantities of ineffective material are
blood, body fluids, secretions or excretions in a present or anticipated. Remove
manner that prevents skin and mucous membrane soiled gown as soon as possible;
exposures, contamination of clothing and transfer
wash hands to avoid transfer of
of microorganism, to other patients and
environments. Ensure that reusable equipment is microorganisms.
16
not used for the care of another patient until it has
been appropriately cleaned and reprocessed and
single use items are properly discarded.
 COMMUNICABLE DISEASE
Environmental Control
Figure 1.12
Follow hospital procedures for routine
care, cleaning, and disinfection of
environment surfaces, beds, and
bedrails, bedside equipment and
other frequently touched surfaces.
Linen
Figure 1.13
Handle, transport, and process used linen
soiled with blood, body fluids, secretions or 17
excretions in a manner that prevents
exposures and contamination of clothing and
avoids transfer of microorganisms to other
Never recap used needles using both hands
and any other technique that involves
directing the point of a needle toward any
part of the body; rather, use either a one-
handed “scoop” technique or a mechanical
device assist in maintaining appropriate
hygiene or environment control. Consult
Infection Control if a private room is not
available.
Figure 1.14
Occupational Health and Bloodborne
Pathogens
Prevent injuries when using needles,
scalpels and other sharp instruments or
devices, when handling sharp instruments
after procedures; when cleaning used
instruments and when disposing of used
needles. Handle, transport, and process
used linen soiled with blood, body fluids,
secretions or excretions in a manner that
prevents exposures and contamination of
clothing and avoids transfer of
 COMMUNICABLE DISEASE

Figure 1.16

Patient Placement

Use a private room for a patient who

contaminates the environment or who does
Figure 1.15
not (or cannot be expected to)
Use Resuscitation devices as in alternative to
mouth-to-mouth resuscitation.

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 COMMUNICABLE DISEASE

Table 1.1 TRANSMISSION BASED PRECAUTIONS (use when indicated)

Airborne Precautions Observe standard precautions.

Use when small (<5 um) pathogen-infected
droplet nuclei may remain suspended in air
over time and travel distances greater than 3
feet.
Examples, varicella, measles, tuberculosis
Droplets Precautions
Use with large (>5 um) pathogen-infected
droplets that travel 3 feet or less via
coughing, sneezing, etc. or during
procedures (sunctioning)
Examples: hemophilis influenza, Neisseria
meningitides, others
Place client in private room or with another client having the same infection
but not other infections (cohorting).
If possible, use room equipped with negative pressure ventilation, outside
venting, and 6-12 air exchanges per hour.
Keep the door to the room closed.
Wear a special approved particulate filter mask (N95) whenever entering
room of all clients with tuberculosis or when staff or visitors not exposed to
rubella or varicella must enter room.
Limits visitors and caretakers to those already immune if chicken pox
(varicella) or measles are involved.
Keep client in room. Place surgical mask on client if transport is necessary.
Follow additional agency guidelines.
Observe standard precautions.
Place client in private room or with another client having the same infection,
but no other infections (cohorting).
When private room or cohorting is unavailable, keep a distance of 3 feet or
more between the infected client and other clients or visitors.
Special ventilation is not necessary and the door may remain open.
Wear a mask when working within 3 feet of the client or entering the room
according to agency policy.
Limit the transport of the client from the room and then mask the client, if
possible.

Additional recommendations for specific pathogens may also apply.

Contact Precautions: Observe standard precautions.
Use with known or suspected Place client in private room or use cohorting, consult agency infectious
microorganisms transmitted by direct hand- disease department as needed.
to-skin client contact or indirect contact with
surfaces or care items in the environment. Wear gloves when entering the room, change gloves after contact with
Examples: Clostridium difficile, diphtheria infected material, remove gloves before leaving room and wash hands
(cutaneous), herpes simplex immediately with antimicrobial agent or waterless antiseptic agent, then
(mucocutaneous or neonatal), impetigo, ensure that hands do not touch potentially contaminated room surfaces or
pediculosis, scabies, zoster (disseminated, items.
immunocompromised host), (Ebola, Lassa, Wear a clean, non-sterile gown when entering room is clothing may have
Marburg), others substantial contact with client, environmental surfaces or items, or if client is
incontinent, or has diarrhea, ileostomy, colostomy or wound drainage not
contained by a dressing. Remove gown before leaving the room, then ensure
that clothing does not contact potentially contaminated environmental
surfaces.
Limit to essential purposes client transport from room. If transport is needed,
maintain precautions to minimize the risk of pathogen transmission to other
clients and environmental surfaces or equipment.

19
 COMMUNICABLE DISEASE
When possible, dedicate the use of non-critical client-care equipment to a
single client or cohort colonized with the same pathogen; if use of common
equipment or items is unavoidable, adequately clean and disinfect them
before use on another client.
Additional recommendations for specific pathogens may also apply.

PRACTICE TO PASS:

Answer the puzzle below:

20
 COMMUNICABLE DISEASE

MODULE 2

DISEASES AFFECTING GASTROINTESTINAL SYSTEM

LEARNING OBJECTIVES
At the end of the course the student will be able to understand:

1. The different communicable diseases occur, other names, and

etiologic agents

2. The incubation period, period of communicability and transmission of

different communicable diseases

3. The different diagnostic procedures, signs and symptoms and

treatment

4. The process, prevention and control and management of every

communicable diseases.

21
 COMMUNICABLE DISEASE

• Antigen H – has been

DISEASES AFFECTING exposed before or has
GASTROINTESTINAL SYSTEM received toxin
• Typhidot
(Bacterial in Origin) 2. Urine culture
3. Stool culture

TYPHOID FEVER

A. AKA: Enteric Fever

B. Causative agent – Salmonelia

typhosa

C. Incubation period – usually

between 7-14 days

D. Period of communicability – for

as long as the bacteria are in the
stools
Figure 2.1 Diagnostic Features of
E. Mode of transmission – by food Typhoid Fever
and water contaminated by stools
and urine of patients or carriers.
The vehicles are the 5 Fs: G. Signs and symptoms
1. Feces 1. Prodromal stage – for 3-4
2. Food days
3. Flies 1.1. Dull headache; malaise
4. Fomites 1.2. Chills; fever; body aches
5. Fingers 1.3. Vomiting or
diarrhea.
F. Diagnostic/laboratory exams 2. Fastigeal/pyrexial stage –
1. Blood culture – during the during the second week
prodromal stage 2.1. Exanthema rose spots –
Widal Test to determine the 4 to 5 peculiar rose-
antigen left by the colored macules or
microorganism meculopapules seen on
• Antigen O – presently the 7th to the 12th day on
infected

22
 COMMUNICABLE DISEASE
the abdomen and chest (in 4. Lysis/convalescence stage
adult) or on the face (in – although signs and
infants) symptoms subsides, patient
2.2. Ladder-like fever should still be observed for
2.3. Enlarged spleen relapses which could be fatal.
2.4. Typhoid psychosis
2.4.1. Coma-vigil H. Management
look – pupils dilate
and patient appears 1. Prevention
to have blank stares 1.1. Immunization –
or staring without CDT (Cholera,
seeing. Dysentery, Typhoid)
2.4.2. Difficulty 1.1.1. Given IM at
putting out the the deltoid
tongue. 1.1.2. Children –
2.4.3. Carphologia 0.25 ml, Adults
– involuntary and – 0.5 ml
aimless picking of 1.1.3. 6 months
linen immunity
2.4.4. Subsultus
tendinum – 1.2. Vivotif
involuntary twitching 1.2.1. Capsule form
of the tendon of the 1.2.2. Given 1 hour
wrists. before meal
2.4.5. Constant every other day
tendency to slip down for 3 doses
toward the foot of the 1.2.3. 3 years
bed. immunity
2. Control
3. Deferenscence stage – 3rd 2.1. Proper handwashing;
week clean environment
Intestinal 2.2. Boil drinking water
hemorrhage – 2.3. Avoid street foods
microorganism produces and improperly
ulcers in the intestine washed or improperly
Intestinal cooked food
perforation – spillage of
fecal material in the 3. Treatment
peritoneum, causing 3.1. Medical care – the
peritonitis drug of choice is
Cough and hypostatic Chloromycetin
congestion of the lungs; 3.2. Nursing care
pneumonia 3.2.1. Regulation of
Leukopenia the diet
3.2.2. Regulation of
dehydration

23
 COMMUNICABLE DISEASE
3.2.3. hygiene and  Commonly 5-10 days but
control may vary from 2 days to
TETANUS several weeks or longer,
 Important information depending on the extent,
 Infectious but not contagious location and characteristics of
 Brought about by direct the wound.
inoculation of material  A short incubation period
containing the causative gives a bad prognosis
agent  The longer the incubation the
 Always a serious disease greater the probability of
recovery
 AKA: lockjaw
 Causative agent: clostridium  Mode of Transmission
tetani  Normally mode of
 A common inhabitant of the transmission is through
soil specially if fertilized with punctured wound that is
manure contaminated by dust, soil, or
 Long, slender, gram-positive animal excreta containing C.
bacillus tentani
 Forms spores which are • Rugged traumatic wounds
extremely resistant to heat and burns
and ordinary antiseptics • Umbilical stump in
 Extremely anaerobic (does newborn especially for
not grow in the presence of babies delivered at home
free oxygen) with faulty cord dressing;
 Multiplies only at the site of babies delivered to
the wound mothers without tetanus
 Produces its deadly effect by toxoid immunization
releasing a true soluble toxin • Unrecognized wounds
(tetanospasmin) which (cleaning of the ears with
reaches the brain and spinal sharp materials)
cord and responsible for • Dental extraction,
muscle spasm circumcision, ear piercing

 Predisposing factors  Signs and Symptoms

 Newborns whose method of
delivery and umbilical cord
care are not aseptic
 Following surgeries, infected
wounds
 Women are poorer risks than
men, so are the very young
and the very old.
 Incubation Period
 Stiffness in the neck, jaw
muscles (trismus), abdomen
or limbs which either rapidly
or gradually increases until
the jaws are locked (trismus)
and cannot be opened.
Masseter muscle is dominant.
 The lips protrude and the
corners of the mouth are
drawn out of shape, giving

24
 COMMUNICABLE DISEASE
rise to rise to the sardonic grin after birth, 0.5ml for 3 doses –
(risus sardonicus). (4-6 weeks interval)
Heightened by simultaneous b. Tetanus toxoid for non-pregnant
women
elevation of the eyebrows and
 1st dose given anytime –
wrinkling of the forehead, the 0.5ml
eyes remain partially closed  2nd dose after one month
 The head retract, other  3rd dose after 6 months
muscles of the body become  4th dose after 1 year
spastic, the back become  5th dose after another year
bowed and the stiffened c. Antitoxin – is used for the
treatment of clinical tetanus and
patient rests on his head and
for passive immunization or
heels (opisthotonos) prophylaxis in recently wounded
 Slightest stimulation of the individuals never previously
patient causes frightful immunized with tetanus toxoid.
convulsions and causes
unbearable pain. Voluntary 2. Control
movements are not possible. a. Medical aseptic technique
Convulsion last from a few to b. Concurrent (All materials
contaminated with secretions
an almost continuous seizure
should be wrapped in paper
during the 24-hour period and burned ASAP)
Types of Stimuli c. Terminal disinfection (walls and
1. Exteroceptives – outside the furniture washed with soap and
patient, bright lights, loud noise water , room thoroughly aired
2. Interoceptives – from the patient mattress and pillows autoclave
himself’ flatus or aired/sunned for 6-8 hours
3. Proprioceptives – touching the Treatment
patient, jamming the bed, turning MEDICAL CARE
the patient 1. ATS, (ANST),
 Low grade fever, profuse 2. TAT 0.01 ml Neutralizes the toxin
sweating 3. and 0.09 ml NSS
 Difficulty in breathing and 4. Epinephrine or steroid to counteract
swallowing anaphylaxis
 Difficulty in breathing and 5. Antibiotics – Penicillin , destroy the
swallowing microorganism
 Cyanosis 6. Prevent and control spasm
 Urinary retention and a. muscle relaxants –
Constipation methocarbamol (Robaxin,
Robaxisal) Baclofen
MANAGEMENT b. Sedatives –Valium (diazepam)
c. Tranguilizers – Thorazine
1. Prevention
7. Tracheostomy, if needed
a. Active Immunization with
tetanus toxoid – DPT 6 weeks
NURSING CARE

25
 COMMUNICABLE DISEASE
1. Patient should be in a quiet, 4. Prevent injury
darkened, well ventilated and non- a. do not leave the patient alone
stimulating environment b. siderails of the bed always raised
2. Minimal gentle handling of patient- c. padded tongue blades or metal
proper scheduling of nursing care spoon to guard against
activities so as not to disturb patient respiratory obstruction
very often, daily cleansing bath with 5. Proper wound care – wash with
warm water, change position, oral flowing water, then rinse with
hygiene antiseptic solution and cover with
3. Liquid diet of 3000-4000 calories via thin dressing.
tube feedings if indicated

Figure 3.1 Manifestations of Tetanus

Hookworm Disease l Ancylostomiasis, Miner’s

Disease, Egyptian Chlorosis
26
 COMMUNICABLE DISEASE
l An intestinal parasite of humans
that usually causes diarrhea or
cramps.
Occurs mostly in tropical and
subtropical countries
 Incidence:
o Most important helminth infection of
man
 All persons are susceptible
 15-25 years of age (common)
 Tropical and subtropical countries
(common)

Clinical Manifestations
Etiologic Agent
 Small lesion of the intestinal mucosa
 Cyclostome duodenale – prevalent in  Iron deficiency anemia
Europe and Asia
 Abdominal pain, diarrhea, allergic
 Necator americanus – Central and reactions like urticaria
South America and West Africa
 Mentally and physically
o Both are pathogenic to man
underdeveloped (children)
o Source of infection is the soil
 Protruding abdomens and lethargic
contaminated with feces (child)
o Female hookworm – 10,000 to  Malnourished and undernourished
20,000 eggs (child)
o Eggs in moist and oxygen-rich soil  Lazy, have no energy, lack ambition
will develop into embryos within 24- (child)
72 hrs.  Pupils are dilated
o Larvae take about 6 weeks to
 Perverted appetite
develop into a mature larvae that can
 Pedal edema and edema in other
cause human infection.
portions of the body maybe present
o It remains alive in the soil for several
weeks under favorable condition. Diagnostics
 Microscopic exam of feces for the
Incubation Period
eggs
o Hookworm ova appear in the stool
 Blood exam reveals eosinophilia
about 4-6 weeks after the larvae
 Treatment Modalities:
penetrate the skin
o Pyrantel embonate (Quantrel)
o 40-100 days or 2-8 weeks
o Tetrachloroethylene
 Period of Communicability
o Carbon tetrachloride
o Person remains spreaders of
infection as long as they remain
Nursing Management
infected

Mode of Transmission  Isolation not necessary

 Diet high in calories, vitamins, and
 Directly through the skin of the foot minerals
(ground itch)  Personal hygiene should be
 Ingestion of contaminated drinking maintained
water and food  Prevention:
 Health education

27
 COMMUNICABLE DISEASE
 Prevent pollution of streams and
lakes with human excreta
 In endemic areas, avoid walking
barefoot
 Good hygiene is important
 Animals should not be allowed to
defecate on the streets or beaches
where most people likely linger
 Purified or boiled water must be used
for drinking
 Vegetables should not be eaten raw
Hydatid Disease
 Cystic echinocccosis (CE), also
known as hydatid disease, is caused
by infection with the larval stage of
Echinococcus granulosus, a ~2-7
millimeter long tapeworm found in
dogs (definitive host) and sheep,
cattle, goats, and pigs (intermediate
hosts). Although most infections in
humans are asymptomatic, CE
causes harmful, slowly enlarging
cysts in the liver, lungs, and other
organs that often grow unnoticed and
neglected for years.
Mode of Transmission
 Humans can be exposed to these
eggs by "hand-to-mouth" transfer or
contamination.
o By ingesting food, water or soil
contaminated with stool from
infected dogs.
o By petting or handling dogs infected
with the Echinococcus granulosus
tapeworm. These dogs may shed
the tapeworm eggs in their stool,
and their fur may be contaminated.
 Risk factors for human infection
include uncontrolled dogs living
closely with people, uncontrolled
28
slaughter of livestock, and
unsanitary living conditions.
Clinical Manifestations
 Pain or discomfort in the upper
abdominal region or chest, nausea,
vomiting, or coughing may occur as a
result of the growing cysts. Rupture of
cyst fluid can lead to allergic
reactions or even death.
Diagnostics
 X-rays or MRI scans
 Blood tests
 Treatment:
o Surgical removal of the cyst
o modified surgical procedure
(aspiration)
o Medication
Prevention
 Prevent dogs from feeding on the
carcasses of infected sheep.
 Control stray dog populations.
 Restrict home slaughter of sheep
and other livestock.
 Do not consume any food or water
that may have been contaminated
by fecal matter from dogs.
 Wash your hands with soap and
warm water after handling dogs, and
before handling food.
 Teach children the importance of
washing hands to prevent infection.
Leptospirosis is a bacterial disease
that affects both humans and animals.
Humans become infected through direct
contact with the urine of infected
animals or with a urine-contaminated
 COMMUNICABLE DISEASE
environment. The bacteria enter the
body through cuts or abrasions on the
skin, or through the mucous membranes
of the mouth, nose and eyes. Person-to-
person transmission is rare.  Patients with severe leptospirosis will
In the early stages of the disease,
symptoms include high fever, severe
headache, muscle pain, chills, redness
of the eyes, abdominal pain, jaundice,
hemorrhages’ in the skin and mucous
membranes, vomiting, diarrhea, and
rash.
Synonyms
o Weil’s Disease, Canicola Fever,
Hemorrhagic Jaundice, Mud
Fever, Swine Herd Disease
For mild cases, the doctor may
prescribe antibiotics, such as
doxycycline or penicillin.
need to spend time in the hospital. They
will receive antibiotics intravenously.
Depending on which organs
leptospirosis affects, the individual may
need a ventilator to help them breathe.
If it affects the kidneys, dialysis may be
necessary.
Intravenous fluids can provide hydration
and essential nutrients.
Hospital stays may range from a few
weeks to several months. This mostly
depends on how the patient responds to
antibiotic treatment, and how severely
the infection damages their organs.

During pregnancy, leptospirosis can

affect the fetus. Anyone who has the
infection during pregnancy will need to
spend time in the hospital for
monitoring.

Symptoms
The signs and symptoms of
leptospirosis usually appear suddenly,
about 5 to 14 days after infection.
However, the incubation period can
range from 2 to 30 days, according to
the CDC.

Mild leptospirosis

Signs and symptoms of mild

leptospirosis include:

o a fever and chills

o coughing
o diarrhea, vomiting, or both

29
 COMMUNICABLE DISEASE
o headache
o muscle pain, particularly lower back
and calves
o a rash
o red and irritated eyes
o jaundice
o Most people recover within a week
without treatment, but around 10
percent go on to develop severe
leptospirosis.
Severe leptospirosis
Signs and symptoms of severe
leptospirosis will appear a few days after
mild leptospirosis symptoms have
disappeared.
Symptoms depend on which vital organs
are involved. It can lead to kidney or
liver failure, respiratory distress, and
meningitis. These can be fatal.
The heart, liver, and kidneys
If leptospirosis affects the heart, liver,
and kidneys, the person will experience:
o fatigue
o irregular, often fast, heartbeat
o muscle pains
o nausea
o nosebleeds
o pain in the chest
o panting
o poor appetite
o swelling of the hands, feet, or ankles
o unexplained weight loss
o jaundice, seen in a yellowing of the
whites of the eyes, tongue, and skin
o Without treatment, this can lead to
life-threatening kidney failure.
The brain
30
If it affects the brain or spinal cord,
meningitis, encephalitis, or both may
develop.
Meningitis is an infection of the
membrane covering the brain and spinal
cord, while encephalitis refers to
infection of brain tissue. Both conditions
have similar signs and symptoms.
These may include:
confusion or disorientation
drowsiness
fits or seizures
high fever
nausea
photophobia, or sensitivity to light
problems with physical movements
stiff neck
inability to speak
vomiting
aggressive or unusual behavior
Untreated meningitis or encephalitis can
result in serious brain damage, and it
may be life-threatening.
The lungs
If it affects the lungs, the person cannot
breathe.
Signs and symptoms include:
o high fever
o panting
o coughing up blood
o In severe cases, there may be so
much blood that the person
suffocates.
Diagnosis
Early-stage, mild leptospirosis is hard to
diagnose, because the symptoms can
resemble those of flu and other common
infections.
 COMMUNICABLE DISEASE

If a physician suspects severe The Centers for Disease Control and

leptospirosis, the patient may undergo Prevention (CDC) puts the fatality rate
specific diagnostic tests. Various tests between 5 and 15 percent among those
are available. In some cases, tests may with severe illness.
need repeating to confirm the result.
With effective and timely treatment,
The doctor will ask about any recent leptospirosis is less likely to become
travel, especially to areas where severe.
leptospirosis is common.
Those more likely to develop severe
They may ask if the person: leptospirosis tend to be those who are
already sick, for example, with
has been swimming in a lake, pond, pneumonia, those under the age of 5
canal, or river years, and those in older age.
has had contact with any activities that
occurred in a slaughterhouse, on a farm, PARALYTIC SHELLFISH POISONING
or relating to animal care
may have had contact with animal urine A. Important Information
or blood 1. A syndrome of
A number of blood and urine tests can characteristics symptoms
confirm or rule out leptospirosis. predominantly neurologic
which occur within minutes
or several hours after
ingestion of poisonous
In the United States, leptospirosis is a shellfish
notifiable disease. The doctor must 2. Victims who survive the
inform the relevant health authorities if a first 12 hours after
person’s diagnosis confirms an ingestion have a greater
infection. chance of survival

Types B. AKA: Red Tide

There are two main types of
leptospirosis.

Mild leptospirosis: This accounts for

90 percent of cases. Symptoms include
muscle pain, chills, and possibly a
headache.

Severe leptospirosis: Between 5 and

15 percent of cases can progress to
severe leptospirosis. Organ failure,
internal haemorrhaging, and death can
result if the bacterium infects the liver,
kidneys, and other major organs.

31
 COMMUNICABLE DISEASE
shellfish or mollusk during red
tide season

F. Signs and Symptoms

1. Numbness of the face
specially around the mouth
2. Dizziness, floating
sensation, weakness
3. Headache; rapid pulse;
vomiting
4. Difficulty of speech
(ataxia) and difficulty of
swallowing (dysphagia)
5. Tingling sensation,
paresthesia and eventual
paralysis of the hands and
feet

G. Management
1. Induce vomiting
2. To weaken the effect of
Figure 2.3 Paralytic Shellfish toxic effect of Red tide,
Poisoning give coconut milk and
sodium bicarbonate
C. Causative agent – single celled solution during the early
dinoflagellates, specifically stage. If given the last
Pyromidium bahamenvar stage the condition will get
compressum worst.
1. There are 2000 varieties,
30 of which become DYSENTERY/ CHOLERA
poisonous after heavy
rainfall preceded by A. Important Information
prolonged summer 1. Protozoa in origin
2. Commonly called 2. Name used in connection with
planktons various-intestinal disturbances
3. Toxins are not totally with such common symptoms
destroyed by cooking as severe abdominal pain
(griping), tenesmus and
D. Incubation period – 30 minutes frequent mucoid or bloody
to several hours after ingestion of stools.
poisonous shellfish (tahong, 3. More common and more
talaba, halaan, etc.) severe in children than in
adults
E. Mode of transmission –
Ingestion of raw or inadequately B. AKA
cooked seafood: specially bivalve

32
 COMMUNICABLE DISEASE
1. Bacillary – Shigellosis, Bloody bowels must move; yet
Flux when thay do, no relief is
2. Cholera – El Tor left)
3. Amoebic – Amoebiasis 1.3 Severe diarrhea at first
mucoid and later bloody,
C. Causative agent – gram- alternating with
negative, nonsporulating, constipation
nonmotile bacteria 1.4 Bowek movements may
1. Bacillary – shigella be 30-40 times or more in
Dysenteriae; Flexnar; Boyclii; 24 hours
Sonne 1.5 Extreme thirst and rapid
2. Cholera – Vibrio comma; dehydration
Ogawa; Inaba; El Tor
3. Amebic – Entamoeba 2. Cholera
histolytica 2.1. Starts with acute colicky
pains in the abdomen,
D. Incubation period – 4-7 days accompanied by mild
diarrhea in which stools
E. Period of communicability – are at first yellowish
during acute infection and until becoming grayish-white
the infectious agent is no longer (“rice-watery”). Use of
present in the stools, usually water bed is necessary
within 4 weeks after illness because bowel
movements are very
F. Mode of transmission – by frequent
direct or indirect fecal-oral 2.2. Marked mental
transmission from a patient or depression, headache,
carrier vomiting, fever may or
may not be present
2.3 Extreme thirst, thickly
G. Diagnostic/laboratory exams furred tongue, severe or
1. Stool exam – fresh stool violent cramps in the legs
within 30 minutes to one and feet
hour should be examined 2.4. Face appears shriveled,
for the presence of eyes sunken and the skin
trophozoites an ash-gray color
2. Rectal swab 2.5. Washerwoman’s hands –
because of rapid
H. Signs and symptoms dehydration
1. Bacillary
1.1 Ushered by chills followed
by fever
1.2 Nausea, vomiting,
tenesmus (constant
bearing down sensation in
the rectum as though the

33
 COMMUNICABLE DISEASE
I. Medical Management –
basically IV therapy
1. Bacillary and Cholera –
antibiotics
2. Amoebic – antiprotozoan
agent, e.g. Araien

HEPATITIS

A. Causative agents
1. Microorganisms – bacteria,
viruses, protozoa, spirochetes
2. Too much alcohol
3. Drug intoxication
4. Chemical intoxication

B. Types
1. Hepatitis A
1.1 Synonyms: Infectious
hepatitis; Catarrhal
hepatitis; Epidemic
Hepatitis
1.2 Causative agent – RNA-
containing virus
1.3 Mode of transmission –
food and water
Figure 2.4 Cholera Control
contaminated with feces
and saliva of patient with
Hepatitis A
3. Amoebic
1.3.1 Fecal-oral
3.1 Primary or intestinal
1.3.2 Oral-oral
3.1.1. Vomiting, tenesmus,
1.4 Predisposing factor
severe abdominal
1.4.1 Food handlers
cramps
1.4.2 Unsanitary
3.1.2. Diarrhea alternating
living conditions
with constipation;
1.4.3 Oral-anal sex
stools are
mucopurulent, foul-
1.5 Incubation period 2 – 7
smelling and with
weeks
bloody streaks
3.2 Secondary – incident to
the migration of amoeba to
2. Hepatitis B – most fatal
other organs, usually the
2.1. AKA: Serum
liver (hepatitis) and the
hepatitis; Homologous
brain
hepatitis; Viral hepatitis

34
 COMMUNICABLE DISEASE
2.2. Causative agent – DNA- 4.2. Can be acquired
containing virus only if with Hepatitis
2.3. Mode of transmission – B
blood and other body 4.3. Same mode of
fluids; transmission,
percutaneous/inoculation predisposing factors
2.3.1 Use of contaminated and incubation period
needles as Hepatitis B
2.3.2 Blood transfusion
2.3.3 Oral-oral 5. Hepatitis E
transmission  Important information – if
2.3.4 Sexual transmission hepatitis recons at age 20-
2.3.5 Vertical / 30, it can lead to cancer of
transplacental the liver
transmission  AKA: Enteric hepatitis
2.4 Predisposing factors  Causative agent –
2.4.1 Health workers Hepatitis E virus
2.4.2 Blood recipients  Mode of transmission –
2.4.3 Drug addicts fecal-oral
2.4.4 Promiscuous  Predisposing factors and
individual/multiple sex incubation – same as
partners Hepatitis
2.5 Incubation period – 6
weeks to 6 months Manifestation/Signs and
Symptoms

3. Hepatitis C Pre-icteric stage

3.1 AKA: Past-transfusion  Fever, body malaise (due to
hepatitis irritability of the liver to convert
3.2 Causative agent – glucose to glycogen)
Hepatitis C virus  Weight loss
3.3 Mode of transmission  Anorexia and vomiting (due to
– percutaneous, inability of the liver to deaminase
particularly blood protein)
transfusion  Right upper quadrant pain (due to
3.4 Predisposing factors infiltration and liver inflammation)
3.4.1 Paramedical team  Anemia (due to decreased life
3.4.2 Blood recipients span of RBCs – normal life span
3.5 Incubation Period – 2 of RBCs is 120 days)
weeks to 6 months
Icteric stage
4. Hepatitis D  Jaundice – due to excessive
4.1. Dormant type of bilirubin in the blood
hepatitis  Pruritus (itchiness) – due to bile
salts in the sweat

35
 COMMUNICABLE DISEASE
 Tea-colored urine – due to  Immunization for Hepatitis
excess bilirubin in the kidneys A and B
 Acholic (gray-colored) stools  Monogamy
 Hepatomegaly
2. Control
Post-icteric stage  avoid mode of
 Signs and symptoms subside transmission
 Takes 3-4 months for the liver to  handwashing
regenerate  standard precaution

3. Nursing care
C. Diagnostic/laboratory exams 3.1 Complete bed rest – to
1. Liver Functions Test. Liver facilitate liver regeneration
Enzyme Test – to determine 3.2 Diet – to promote
the extent of liver damage tissue repair
1.1 Alanine Amino 3.2.1 decrease fat,
Transferase (ALT) – 1st carbohydrates
to increase when there is increases
liver damage (CHO), protein
1.2 Aspartate Amino (CHON) – if with
Tranferase (AST) – simple hepatitis
SGOT 3.2.2 decrease fat,
1.3 Alkaline Phosphatase increase CHO,
(ALP) decrease
CHON – if with
2. Serum Antigen Antibody Test severe hepatitis
– for hepatitis
2.1 HasAg-surface
AntiHAV
2.1.1 IgG
2.1.2 IgM
2.2 HbsAg-surface
AntiHBs
2.3 HbeAg-Protein
Independent AntiHBe
2.4 HbcAg-Care
Independent AntiHBc
2.5 HcsAg-Surface
Independent AntiHCs

3. Ultrasound
4. Liver biopsy
5. Urinalysis

D. Management
1. Prevention Figure 2.6 Viral Hepatitis Overview

36
 COMMUNICABLE DISEASE
 Period of communicability – as
long as gravid females are
discharging eggs on the perineal
skin.

PINWORM-INFESTATION  Mode of transmission – direct

transfer of infective eggs by hand
 Important Information from anus to mouth of the same
An intestinal roundworm or another person, or indirectly
which infects only man. through contaminated clothing,
If found in one family member, linen, food, etc. Dustborne
there are most probably infection is also possible.
infected also

 AKA : Nocturnal Ani;

Enterobiasis, Oxyurasis,
seatworm or threadworm

 Causative agent – Enterobius

vermicularis, (a nematode)
1. Lives and breads in the
small intestine.
2. When eggs are swallowed,
they hatch in the stomach
and small intestine.
3. Gravid worms migrate
during the night down the
rectum and even the
perianal area to lay their Figure 2.8 Pinworm Cycle
eggs, causing severe
itching.  Diagnostic exam – Test tape
4. May enter the vagina and  Best done upon waking up in
into the peritoneal cavity. the morning before bathing or
5. Eggs are infective within a bowel movement.
few hours after leaving the  Scotch tape placed against
GIT. the anus and then examined
6. Eggs are easily blown microscopically for eggs.
around by mild breezes
and are very infectious.  Management
7. Eggs are not destroyed by 1. Handwashing
ordinary laundering. 2. Wear well-fitting
underwear
 Incubation period – the life 3. all members of the
cycle of the worm requires 2-6 household should be treated
weeks to be completed. with Piperazine hexahydrate
(500 mg/tsp) for 1 week

37
 COMMUNICABLE DISEASE
 ½ tsp OO for children
 tsps BID for adults
ASCARIASIS
 Important information
 A chronic condition often
producing no symptoms.
 More prevalent in tropical
countries like the Philippines
 Causative agent – Ascaris
lumbricoides
 A large roundworm
 Eggs hatch in the intestinal
canal and release larva →
intestinal wall → lymphatic
and circulatory systems →
lungs → bronchioles →
bronchi → pharynx → back to
the small intestines where
they mature.
 Female produces around
20,000 eggs/day.
38
Figure 2.9 Ascariasis
 Incubation period – reach
maturity about 2 months after
ingestion
 Period of communicability – as
long as mature gravid worms are
in the intestines.
 Signs and symptoms – seen
only when with heavy infestation
- Abdominal pain; marked
disturbances of digestion
- Insomnia; restlessness
 Sequela – destruction of the
bowel when there is a bolus of
worms
 Management – anthelminthics
e.g., Antiox
POLIOMYELITIS
 Disease of the lower motor
neuron involving the anterior horn
cells, characterized by changes
in the CNS
 An acute paralytic condition
which is very contagious and
infectious.
 Characterize by changes in the
central nervous system
 Disease of the lower motor
neuron involving the anterior horn
cells
 No patient dies except if
respiration is affected by
involvement of the spinal cord.
No matter how severely
paralyzed, if respiration is not
involved the prognosis is good.
Synonym: Infantile paralysis, Heine
medin disease
 COMMUNICABLE DISEASE
Causative Agents: Legio debilitants
Characteristics:
1. Three stains: Brunhilde (provides
permanent immunity) Lansing
and Leon (give temporary
immunity)
2. Small filterable virus introduced
through the oropharynx and
which leaves the body via
discharges from the throat and
the gastrointestinal tract (virus
found in +stools 2 weeks before
appearance of symptoms
3. May exist in contaminated water
supplies and sewage or infected
milk
4. Can survive in body secretions at
ordinary temperature outside the
body for long periods.
5. Multiplies in the tonsils an
2. male more often affected
3. poor environmental and hygienic
conditions – flies may act as
mechanical vectors
Incubation Period: usually 12 days,
may vary from 7-21 days
Mode of Transmission
1. droplet infection – in early
infection
2. body secretions –
nasopharyngeal
3. fecal-oral –during late stage
Diagnostic /Laboratory Exams
1. Lumbar tap –(+) Pandy test
(increased protein in CSF)
2. Muscle wasting
3. Stool exam – 10 days after being infested
(late stage)
Pathophysiology
Legio debilitants

Children below 10 years of age

Droplets
Nasopharyngeal secretions

Abortive Stage
Multiplies in tonsils and Payer’s patches

Sore throat
Fever, headache, body malaise
Anorexia, abdominal pain, nausea and vomiting
Low lumbar pains
Diarrhea/constipation

Lymphatic system

Prepalytic Stage
Blood stream

Muscle tightness/spasm
Peyer’s patches before it enters Stiffneck
the blood stream Paresthesia
Hoyne sign
Figure 2.10 Poliomyelitis Pover sign
Predisposing Factors
1. children below 10 years old CNS

39
 COMMUNICABLE DISEASE
Paralytic stage
(Flabby, flaccid and soft muscle)
1. bulbar
2. spinal
3. bulbospinal
Figure 2.11 Pathophysiology of Poliomyelitis
Signs and Symptoms
1. Abortive stage – headache sore throat,
slight or moderate, occasional vomiting
2. Preparalytic stage – signs of infection
a. tightness/spasm of the back muscle
and hamstrings
b. stiff neck
c. paresthesias
d. Hoynes signs – in supine lift patient
shoulder, if head drops abnornal
e. Pofer sign – opisthotonos with head
refraction
3. Paralytic Stage –classified according to
the site involved and the resulting clinical
picture
a. actual paralysis is commonly the first
presenting sign
b. persistent headache
c. biphasic pattern
1. first phase is similar to signs of
the abortive type, then a few
days of remission of symptoms
wherein patient appears to have
recovered
2. Second phase starts when
patient develops weakness or
paralysis, which appears more
often on the 2nd day and then
reaches its maximum by the 6th
day.
a. Constipation; vomiting
b. Irritability, lethargy
c. Pinched, poison affording
maximum comfort to
painful muscle
diagnostic
d. Profuse sweating usually
over areas in which the
muscles are involved
e. Changing deep tendon
reflexes, hyperactive at
the start and then
diminution or loss.
Management
 Prevention
 Passive Immunization – gamma
globulin IM may protect a person
who has had intimate contact with a
fresh case of active poliomyelitis for
2-3 weeks
 Active immunization – oral polio
vaccine (Sabin), 2-3 drops p. o. 4-6
weeks after birth for 3 doses (infant
should not be fed for at least 30
minutes after to promote absorption
of the vaccine)
 Control
 Aseptic techniques and avoiding
infected discharges
 Treatment: generally symptomatic and
supportive
 Medical care
 Iron lung machine – if with
respiratory paralysis
 Tracheostomy if necessary
 Physiotherapy
 Nursing Care
 Comfort and hygiene measures
 Do not touch or massage painful
areas
 Apply warm packs to relieve
muscle shortening, pain and
tenderness
 Diet – bland, high protein
 Tracheostomy care
is Types of paralysis
a. bulbar – cranial nerve are affected
40
 COMMUNICABLE DISEASE
b. spinal – anterior horn cells are Figure 2.12 Muscles Commonly
affected, causing paralysis of the weakened by Polio
affected extremities
c. bulbospinal – combination of both

PRACTICE TO PASS:

Answer the puzzle below, refer to the next page for the questions/items:

41
 COMMUNICABLE DISEASE

PRACTICE TO PASS:

Questions/Items for puzzle on page 57

42
COMMUNICABLE DISEASE

PRACTICE QUESTIONS:
Situation: Malaria is said to be
endemic in Tropical countries
1. A client is concerned about
contracting malaria while visiting
relatives in Palawan. The nurse
explains that the best way to prevent
malaria is to avoid;
A. Mosquito bites
B. Untreated water
C. Undercooked food
D. Over-populated areas

2. When teaching a client about drug

therapy against plasmodium
falcifarum, the nurse should indicate
the fact that;
A. The infection are controlled
B. Immunity will prevent
immunization
C. The infection can generally be
eliminated
D. Transmission by the anophelies
mosquito can occur

3. When caring for a client who is

HIV positive, the primary
responsibility of the nurse is to
explain how the client can prevent;
A. AIDS
B. Social isolation
C. Other infections
D. Kaposi’s sarcoma

4. A home health care nurse begins

caring for a 25 year old female client
who has just been diagnosed with
the human immunodeficiency virus
infection. The client asks the nurse,

43
 COMMUNICABLE DISEASE
“How could this have happened”?
The nurse responds to the question 8. The nurse is planning a
based on the most frequent mode of community education program on
HIV transmission which is; how to prevent the transmission of
A. hugging with HIV positive viral hepatitis. Which of the following
sexual partner without using types of hepatitis is considered to be
barrier protection primarily a sexually transmitted
B. inhaling cocaine disease?
C. sharing food utensils with A. Hepatitis A
an HIV positive person without B. Hepatitis B
proper cleansing of the utensils C. Hepatitis C
D. having sexual intercourse D. Hepatitis D
with a HIV positive person
without using a condom 9. When caring for a client with
scabies, the nurse should be aware
5. A client with HIV is taking that scabies is;
Zidovodine (AZT). AZT is the drug A. highly contagious
that acts to; B. a chronic problem
A. destroys the virus C. caused by a fungus
B. enhance the body’s D. associated with other
antibody production allergies
C. slow replication of the
virus 10. The term Condylomata
D. neutralizes the toxins acuminate refers to;
produces by the virus A. scabies
B. herpes zoster
6. The nurse is instructing a group C. venereal warts
about food preparation. They are told D. cancer of the epididymis
to avoid using products in damaged
cans because they might contain the 11. Client’s who develop general
anaerobic spore-forming rod; paresis as a complication of syphilis
A. Escheria coli are usually treated with;
B. Clostridium tetani A. Penicillin
C. Salmonella typhosa B. Major tranquilizers
D. Clostridium botulism C. Behavioural modification
7. When caring for a client with D. Electroconvulsive therapy
Hepatitis A the nurse should take
special precautions to; 12. When educating a female client
A. prevent droplet spread of about gonorrhea, the nurse should
infection emphasize that for women
B. use caution when bringing gonorrhea;
food to the client A. is often marked by dysuria
C. use gloves when removing and vaginal discharge
the client’s bedpan B. does not lead to serious
D. wear mask and gown complications
before entering the client’s room

44
 COMMUNICABLE DISEASE
C. can be treated but not 17. A mother ask the nurse how to
cured tell the difference between measles
D. may not cause symptoms and a German measles . The nurse
until serious complications occur tells the mother that with measles
the child has;
13. A female client with gonorrhea A. a high fever and koplik’s
informs the nurse that she has had spots
sexual intercourse with her boyfriend B. a rash on the trunk with
and asks the nurse, “Would he have pruritus
other symptoms?” The nurse C. nausea, vomiting and
responds that in men the symptoms abdominal cramps
of gonorrhea includes; D. symptoms similar to a
A. impotence cold, followed by a rash
B. scrotal swelling and
dysuria 18. Chicken pox can sometimes be
C. urinary retention fatal to children who are receiving;
D. Dribbling of urine A. insulin
B. steroids
14. The nurse understand that C. antibiotics
organism that causes a trichonomal D. anti-convulsants
infection is a;
A. yeast 19. The nurse obtains a sputum
B. fungus specimen from a client with
C. protozoa suspected tuberculosis for laboratory
D. spirochete study. Which of the following
laboratory techniques is most
commonly used to identify tubercle
15. The oral drug that is likely to be bacilli sputum?
prescribed for treatment of A. acid fast staining
trichonomas vaginalis is B. sensitivity testing
A. penicillin C. agglutination testing
B. Gentian violet D. dark field illumination
C. Nystatin (mycostatin)
D. Metronidazole (flagyl) 20. The nurse should include which
of the following instruction when
16. When teaching parents at the developing a teaching plan for clients
school about communicable who are receiving INH and
diseases, the nurse reminds them Rifampicin for treatment of
that these diseases are serious and tuberculosis
that encephalitis can be a A. take the medication with
complication of; antacid
A. pertussis B. double the dose if a drug
B. chicken pox dose is forgotten
C. poliomyelitis C. increase intake of dairy
D. scarlet fever products
D. limit alcohol intake

45
 COMMUNICABLE DISEASE
21. A nurse provides instructions to a
mother of a child with mumps
regarding respiratory precautions.
The mother asked the nurse about
the length of time required for the
respiratory precautions. The nurse
most appropriately responds that;
A. “respiratory precautions
are necessary for the entire time
of illness”
B. “respiratory precautions
are necessary until swelling is
gone”
C. “Respiratory precautions
are indicated during the period of
communicability”
D. “Respiratory precautions
are indicated for 18 days after the
onset of parotid swelling”
Situation: Isadora, age 9 was bitten by
a dog on his way home from school.
When his father knew about this, he
wanted the dog killed once.
22. When Isadora was brought to the
health center you interviewed
Isadora and his father. You told
Isadora’s father not to kill the dog….
A. observe the dog for 24 hours
B. must be confined in a cage
C. should be experimented for
negri bodies
D. has to be observed for 10
days
23. Sight and sound of water as well as
drip of the faucet disturb a patient
with rabies, which one should you do
first?
A. place patient near window
B. cover the IV bottle with brown
paper
C. sponge only with warm face
cloth
46
D. keep patient clean and quiet
24. Immunization with tetanus toxoid is
an example of;
A. naturally acquired immunity
B. naturally acquired passive
immunity
C. artificially induced active
immunity
D. artificially acquire passive
immunity
25. An example of active naturally
acquired immunity is;
A. Gamma globulins injection
B. Measles vaccination
C. Chicken pox
D. Placental transfer of maternal
antibodies
26. Measles (Rubeola) is a viral
disease, which is large contributor to
pneumonia deaths in young children.
Which of these are characteristics
signs of measles?
A. Vomiting, headache, fine
petecheal rashes and epistaxis
B. Sudden onset of slight fever,
skin eruptions which are
abundant of the face and
extremities
C. Rash which spreads from face
to trunk and limbs, conjunctivitis,
high fever and tiny white spots in
the mucosa inside the check.
D. Sudden onset of slight fever
and skin eruptions which are
more abundant on covered than
on exposed parts of the body
27. What statement made by a pregnant
mother whose niece has German
measles best indicates an
understanding of the implications of
viral infections like rubeola and
more importantly rubella?
 COMMUNICABLE DISEASE
A. “I’ll remember to give my D. Elephantiasis, parotitis,
niece aspirin for the fever” impetigo contagiosa
B. “I’ll ring my niece to wish her
well and explain why I cannot go 32. Etiologic agent of diphtheria
and visit” A. staphylococcus aureus
C. “if I catch the infection, I need B. klebs loefflers bacillus
not worry for the virus won’t harm C. bordet-Gengao bacillus
my unborn child” D. alpha-hemolytic streptococcus
D. “If I catch the infection, I will
need to be vaccinated against 33. Characteristic sign of diphtheria;
measles immediately”. A. bullneck appearance
B. Aerosangenous discharge
28. School children with chicken pox C. Pseudomembrane
should be kept out of control for at least; D. Inflamed tonsils
A. 1 week before appearance of
rashes Situation: Roger 8 years old was
B. 1 week after eruption appears referred to the hospital because of low
or until vesicles becomes dry grade fever, general malaise and loss of
C. 1 week before recovery appetite. On PE there is a whitest-gray
D. 2-3 weeks after 1st eruption 1st membrane patch on his tonsils, soft
appeared palate and ovula. Diagnosis: Diphtheria

34. Diphtheria is characterized by;

A. acute nasopharyngitis
29. Characteristics eruption in chicken B. persistent cough for 2 weeks
pox C. acute pharyngitis and
A. macular laryngitis with pseudomembrane
B. popular D. catarrhal symptoms with
C. pustular paroxysmal cough
D. vesicular
35. Bacterial conjunctivitis is common
30. Which of the following usually during summer months.
communicable diseases cannot be Conjunctivitis is transmitted through;
transferred through droplet infection? except;
A. Malaria A. contact with discharges from the
B. Mumps conjunctivitis of infected persons
C. Tuberculosis B. mechanical transmission by
D. Measles vectors such as flies
C. contact with discharges from the
upper respiratory tract of infected
31. Which of the following are persons through contaminate
respiratory diseases? finger articles
A. pertussis, pneumonia, malaria D. all these mode of transmission
B. diphtheria, leprosy, shingles
C. PTB, coryza, pertussis

47
 COMMUNICABLE DISEASE
Situation: Leprosy is chronic skin and with hemoptysis and fever, cough for
peripheral nerves disease caused by a month but with stable vital signs.
Mycobacterium leprae. Which kind of precautions should
you employ?
36. A nurse role in the prevention of A. Contact precautions
spread of leprosy is through; B. Enteric precautions
A. health education C. Droplet precautions
B. proper nutrition D. Airborne Precautions
C. Personal hygiene
D. BCG vaccination 41. The receiving nurse in the Medical
surgical ward will expect which
Situation: Mrs. Escudero lives in an isolation technique upon the arrival
urbanized community. She is positive to of the patient?
syphilis so she goes to the health center A. respiratory isolation
for proper management. B. strict isolation
C. TB isolation
29. The causative agent of Syphilis is: D. Enteric Isolation
A. Treponema Pallidum
B. HIV Situation: Knowledge of the basic
C. Neisseria group concepts and principles related to care
D. Treponema Pertenue of patients with communicable disease
is vital in the performance of the nurse
38. The primary lesion of Syphilis is: role as health educator.
A. Chancre
B. Gummas 42. Air, water and food can serve as:
C. Condylamata Lata A. Vehicle of transmission of
D. Maculopapular rashes infectious agents
B. Reservoirs of microorganism
39. Prevention and control of syphilis C. Entry routes for infectious agents
will be one of the agenda in your D. Vehicles for exit of infectious
conference with the midwives. Which of sperm
these is not relevant?
A. Immunization of contacts 43. As you made your home visits, you
B. Need to immediate report cases see mothers preparing food at home.
found and their contacts to health Conscious of the principles
authority underlying hand washing, you
C. Need for early diagnosis and remind them to wash their hands
treatment before handling foods for the simple
D. Symptoms of syphilis and its reasons that:
mode of transmission A. Hands can be sterile by
thoroughly scrubbing with soap
Situation: One of the responsibilities of and water.
a nurse is to protect self and patient B. Soap used in hand washing acts
from acquiring infections. as a disinfectant.
40. A nurse is assigned in the C. transient bacteria can be reduced
emergency room, admitted a patient by mechanical cleansing

48
 COMMUNICABLE DISEASE
D. through hand washing, heat
coagulates protein
44. The incidence of ascariasis can be
reduced by preventing other children
from acquiring the disease. This can be
done through:
A. Teaching the children to cut
fingernails and was hands before
putting anything into the mouth
B. Avoiding overcrowded places
C. Teaching children to use slippers
while playing on the soil.
D. Avoiding direct contact with
children suffering from parasitism
45. The first line of defense of the body
against disease is:
A. an intact skin
B. personal hygiene
C. complete immunization
D. physical stamma
46. When “breaking the chain of
infection” which of the following is
TRUE?
A. a virulent agent can resist
disinfectant
B. an appropriate portal of entry will
not cause infection
C. mode of entry of harmful
organisms is direct entry
D. every link in the chain of infection
can be interrupted
Situation: Pneumonia remains to be
one of the leading causes of deaths.
Hence, this was discussed in the one
conferences at the Rural Health Unit.
47. This disease is characterized by:
A. sudden onset with chills, fever,
pleural pain and cough
productive of “rusty” sputum
49
B. fever, headache, malaise,
anorexia, and non productive
cough
C. fever, fatigue, cough chest pain
and loss of weight
D. fever, cough, hoarseness and
hemoptysis
48. Pneumonia is transmitted through
which of these modes:
A. through articles freshly soiled
with respiratory discharges
B. by direct oral contact
C. by droplet spread
D. any of these mode of
transmission
Situation: Rainy season is evident
again and dengue hemorrhagic fever is
one of the locally endemic diseases in
the community.
49. Capillary fragility test was done to a
patient suspected of DHF. It can be
achieved by doing:
A. schick's test
B. rumple needle test
C. tine test
D. dick's test
50. Hematology report on platelet count
revealed 250, 000 mm3. From the
nurses knowledge of the lab she
would:
A. call the physician's attention to
this value and anticipate
transfusion of the whole blood
B. have vitamin K available for IV
infusion
C. call the physician's attention and
call laboratory to order the
platelet transfusion
D. realize that this is a normal value
 COMMUNICABLE DISEASE

References:
David L. Heymann, Control of
Communicable Disease Manual 19th
Edition

Dionesia Mondejar – Navales,

Handbook of Common Communicable
and Infectious Diseases. Copyright
20008

50