NURSING CARE OF CLIENTS WITH INFECTIOUS & INFLAMMATORY DISORDERS
INFECTIOUS DISORDERS
EBOLA VIRUS DISEASE
The 1st human outbreak occurred in 1976 then
in 2014
 Ebola is spread through direct contact with
blood or body fluids (urine, vomitus, feces,
saliva, sweat, semen, and breast milk), from
the person who is ill from ebola and from
contact with semen of a man who has
recovered from ebola.
 Ebola virus is only detected in blood after
the patient becomes symptomatic and viral
levels rise significantly as the disease
progresses.
 Incubation period ranges from 2-21 days.
 If there are no symptoms 21 days after
exposure, there is no risk of developing the
disease
Clinical manifestations
1. Initial, high fever, muscle aches and
fatigue
2. By the 3rd and 5th symptomatic days,
patient develops severe diarrhea,
abdominal pain & vomiting which can
last for a weekor more.
3. Neurologic symptoms susch as
confusion, agitation, delirium or
encephalitis
4. 5% of cases will develop bleeding , a
very poor prognosis indicator.
5. Those who do not die during the first 2
weeks of the disease are likely to
survive
Ebola virus disease
Management:
 Management is supportive maintenance of
cardio-respiratory systems.
 Mechanical ventilator
 Dialysis
Nursing management:
 Patient should be isolated and in a private
room away from other patients.
 HCW must wear complete PPE and careful
doffing (removal) of PPE
 Equipment used for this patient should be
sterilized or cleaned with bleached-base
solution
MERS CoV
Middle East Respiratory Syndrome-
related coronavirus
 It is a zoonotic virus, which means it is
transmitted between animals and people by
direct or indirect contact.
 It was 1st reported in Saudi Arabia in
September 2012 and spread from several
other countries but the 1st known cases of
MERS occurred in Jordan in April 2012
 MERS is a viral respiratory illness caused by
MERS CoV
 Clinical symptoms include fever, cough and
shortness of breath
 Other manifestations include diarrhea and
nausea/vomiting
 Severe complications are Pneumonia and
Kidney failure
Risk factors/ Pre-existing conditions:
 Diabetes
 Cancer
 Chronic lung disease
 Chronic heart disease
 Chronic kidney disease
* Incubation period: 2 -14 days but symptoms
start to appear about 5-6 days after exposure
Transmission:
 From the respiratory secretions such as
through coughing
 Close contact such as caring for or living
with an infected person
 Recent travel to the Arabian Peninsula
Prevention:
 frequent handwashing with soap and water
 cover nose and mouth with tissue when you
cough or sneeze
 avoid touching M E N with unwashed hands
 avoid personal contact, such as kissing or
sharing cups or eating utensils with sick
people
 clean and disinfect frequently touched
surfaces and objects such as doorknobs
Treatment:
 no specific antiviral treatment
 symptomatic treatment
 NURSING CARE OF CLIENTS WITH INFECTIOUS & INFLAMMATORY DISORDERS
At-risk for MERS
1. Recent travelers from the Arabian
Peninsula( if you develop respiratory
symptoms of cough, SOB, and fever
within 14 days after traveling, you
should seek health care)
2. Close contacts of an ill traveler from the
Arabian Peninsula
3. Close contacts of a confirmed case of
MERS
4. HCP not using recommended Infection-
control precautions
5. People with exposure to camels
INFLUENZA A virus subtype H1N1 or
A/H1N1 or H1N1 Flu aka swine flu
 It is called swine flu because before people
afflicted with this disease had direct contact
with pigs.
 It became pandemic in 2009
 A highly contagious respiratory disease in
pigs caused by one of several swine
influenza A viruses
 S/S: cough, fever, chills, sore throat, stuffy
nose, body aches, fatigue, decreased
appetite
 Can lead to pneumonia, lung infection
 1957-1968 H2N2Influenza A
 HPAI H5N1 virus-Highly Pathogenic Avian
Influenza A H5N1-an influenza A virus that
occurs mainly in birds, highly contagious
among birds and can be deadly to them. It
does not usually infect people but infections
have occurred in humans
 2003-outbreaks in Asia and parts of Europe
in 2005, the Near East & Africa 2006 with
60% death
 In January 2012, China reported the 2nd
human death; Canadian case death in 2014
Treatment H1N1 Influenza A
 It is resistant to AMANTADINE &
RIMANTADINE,2 antiviral agents licensed
for Influenza A
 OSELTAMIVIR & ZANAMIVIR, PERAMIVIR
can be used to treat HPAI H5N1; WHO
preferred the former
 Subtypes in humans:
o H5N1
o H7N3
o H7N7
o H7N9
o H9N2
o H10N8= (1) human death in Jiangxi
Prov., China from Pneumonia
caused by this strain
 The subtypes are based on differences in 2
main proteins on the surface of the
influenza A virus:
 Hemagglutinin (HA) protein 16 known
HA subtypes
 Neuraminidase (NA) protein 9 known
NA subtypes
VIRAL HEPATITIS
a systemic viral infection in which necrosis and
inflammation of liver cells produce a
characteristic cluster of clinical, biochemical and
cellular changes.
* 5 definitive types:
1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D
5. Hepatitis E
* Hepatitis A & E are similar in mode of
transmission (fecal-oral route)
*Hepatitis B, C, D have the same characteristics
Hepatitis A virus (HAV)
 Formerly called infectious Hepatitis, is
caused by an RNA virus of the enterovirus
family.
 Transmitted primarily through oral-fecal
route, by the ingestion of foods or liquids
infected with the virus.
 Prevalent in countries with overcrowding
and poor sanitation
 HAV can also be transmitted during sexual
activity through oral-anal contact or anal
intercourse and with multiple sex partners.
 Hepatitis A or Infectious Hepatitis is caused
by Hepatitis A virus (HAV)
 Immunity is 30 days average
 S/S: may occur with or without symptoms,
flu-like illness
 Pre-icteric phase: headache, malaise,
fatigue, anorexia, fever
 Icteric phase: dark urine, icteric sclerae and
skin, tender liver
 Outcome: Usually mild with recovery
 No carrier state or increased risk of chronic
hepatitis, cirrhosis or hepatic cancer
 NURSING CARE OF CLIENTS WITH INFECTIOUS & INFLAMMATORY DISORDERS
Hepatitis B (Serum Hepatitis)
 Etiologic agent: Hepatitis B virus (HBV)
 Transmission: through blood (percutaneous
& permucosal routes); can be found in
blood, saliva, semen & vaginal secretions &
through mucous membrane and breaks in
the skin. Can also be from carrier mother to
infants
 Immunity: average: 70-80 days
 Risk Factors: close contact with carrier,
frequent exposure to blood, blood
products, other body fluids, HCW,
Hemodialysis, needlesticks, IV injection drug
use, homosexual & bisexual activity,
multiple partners, recent history of STDs,
Tattooing, Unsanitary condition
 S/S: may occur without symptoms; fever &
respiratory symptoms are rare
o may develop arthralgias, rash,
anorexia, dyspepsia, abdominal
pain, generalized
o aching, malaise, weakness.
o if jaundice occurs, light colored
stools and dark urine may
accompany it
o tender liver & enlarged to 12-14
cm; splenomegaly, enlarged
posterior cervical lymph node
 Outcome: may be severe, carrier state
possible, increased risk of chronic hepatitis,
cirrhosis, or hepatic cancer
 Treatment: alpha-interferon @ 5M units
daily for 16-24 weeks
 anti-viral agents – Entecavir (ETV) and
Tenofovir (TDF) oral nucleoside analogs for
chronic Hepatitis B
Hepatitis C (non-A, non-B Hepatitis)
 Etiology: Hepatitis C virus (HCV)
 Immunity: average: 50 days; second attack
may indicate weak immunity or infection
with another agent
 S/S: same as in HBV; less severe and
anicteric
 Outcome: frequent occurrence of chronic
carrier state, and chronic liver disease.
Increased risk of hepatic cancer
Hepatitis D
 Etiology: Hepatitis D virus (HDV)
 Immunity: average: 35 days
 S/S: similar to HBV
 Outcome: similar to HBV but greater
likelihood of carrier state, chronic active
hepatitis, and cirrhosis
Hepatitis E
 Etiology: Hepatitis E virus (HEV)
 Immunity: Average: 31 days
 S/S: similar to HAV; very severe in pregnant
women
 Outcome: similar to HAV except very severe
in pregnant women
INFLAMMATORY DISORDERS
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE (refers to 2
chronic inflammatory GI disorders
1. Crohn’s disease- (Regional enteritis)
can occur anywhere between the
mouth and the anus
2. Ulcerative colitis-is limited to the colon
CROHN’S DISEASE
 a subacute and chronic inflammation of the
GIT wall that extends through all layers (ie.
Transmural lesion)
 it most commonly occurs in the distal ileum
and to a lesser degree, the ascending colon
 characterized by periods of remission and
exacerbation
Pathophysiology:
 begins with edema and thickening of the
mucosa
 the lesions are not in continuous contact
with one another and are separated by
normal tissue. Therefore, these clusters of
ulcers tend to take on a classic
“cobblestone” appearance
 fistulas, fissures and abscesses form as the
inflammation extends into the perineum
 granulomas occur in 50% of patients
 as the disease advances, the bowel wall
thickens and becomes fibrotic
Crohn’s disease
S/S insidious
 prominent RLQ pain
 diarrhea unrelieved by defecation
 abdominal tenderness and spasm
 crampy pain after meals
 weight loss, malnutrition, secondary anemia
 emaciated from inadequate food intake and
constant fluid loss
 fever with leukocytosis
 NURSING CARE OF CLIENTS WITH INFECTIOUS & INFLAMMATORY DISORDERS
 chronic symptoms of diarrhea, abdominal
pain, steatorrhea (excessive fat in the
feces), anorexia, weight loss and nutritional
deficiencies
 may extend beyond GIT and include joint
disorders, skin lesions (erythema nodosum),
ocular disorders (conjunctivitis) & oral
ulcers
Diagnostics
Proctosigmoidoscopy
 Stool examination (+ for occult blood and
steatorrhea)
 Barium study-most conclusive test-shows
the classic “string sign” on an X-ray film of
the terminal ileum, indicating the
constriction of a segment of intestine.
 Endoscopy , colonoscopy and intestinal
biopsy to confirm the diagnosis
 Barium enema may show ulcerations (the
cobblestone appearance), fissures and
fistulas
 CT scan may show bowel wall thickening
with fistula formation
 CBC , with hemoglobin & hematocrit
decreased and WBC elevated
 ESR is elevated
 Albumin and Protein levels may be
decreased indicating malnutrition
Complications:
 intestinal obstruction or stricture formation
 Perianal disease
 Fluid and electrolyte imbalances
 Malnutrition from malabsorption
 Fistula (Enterocutaneous fistula-abnormal
opening between the bowel and the skin)
 Abscess formation (resulting from fluid
accumulation and infection
 Increased risk for colon cancer
Ulcerative colitis
a recurrent ulcerative & inflammatory disease
of the mucosal & submucosal layers of the
colon & rectum
 Highest in Caucasian and people of Jewish
heritage
 Accompanied by systemic complications
and a high mortality rate
 Approximately 5% of patients develop colon
cancer
Pathophysiology:
 affects the superficial mucosa of the colon
 characterized by multiple ulcerations,
diffuse inflammations and desquamation or
shedding of the colonic epithelium
 bleeding occurs as a result of the
ulcerations
 mucosa becomes edematous and inflamed
 the lesions are contiguous (same border),
occurring one after the other
 abscesses form and an infiltrate is seen in
the mucosa & submucosa with clumps of
neutrophils along the lumen of the abscess
 begins in the rectum and spreads proximally
to involve the entire colon
 bowel narrows, shortens and thickens
Clinical manifestations
 Diarrhea, passage of mucus and pus
 LLQ pain
 Intermittent tenesmus (cramping rectal
pain)
 Rectal bleeding= resulting to pallor,
anemia and fatigue
 Anorexia, vomiting, weight loss
 Fever, dehydration
 Passage of 10-20 liquid stools per day
 Hypocalcemia
 Rebound tenderness on the RLQ
 Extraintestinal manifestations include
skin lesions (erythema nodosum), eye
lesions (uveitis), joint abnormalities
(arthritis) & liver disease
Diagnostics
 Fecal occult blood test (+)
 Low hemoglobin and hematocrit levels,
elevated WBC count
 Low albumin levels and electrolyte
imbalance
 Elevated antineutrophil cytoplasmic
antibody levels
 Abdominal X-ray to determine the cause of
symptoms
 Sigmoidoscopy/colonoscopy/barium enema
to distinguish ulcerative colitis from other
diseases
 Barium enema may show mucosal
irregularities, focal strictures, or fistulas,
shortening of the colon, dilation of bowel
loops
 Colonoscopy may reveal friable, inflamed
mucosa with exudate & ulcerations
 Leukocyte tagging is useful when severe
colitis prohibits the use of colonoscopy to
determine the extent of inflammation (WBC
scan)
 NURSING CARE OF CLIENTS WITH INFECTIOUS & INFLAMMATORY DISORDERS

Complications affected GIT, it can only to the

cause large
 Toxic megacolon- the inflammation extends problems in bowel
to the muscularis, inhibiting its ability to some areas as
contract resulting in colonic distention. If mouth (sores
patient does not respond to medical between the
management within 24-72 hours, total gums & lower
colectomy is indicated with ileostomy lip, bottom of
 Perforation; Bleeding as result of ulceration tongue, anal
 Vascular engorgement tears
 Highly vascular granulation tissue (fissures),
ulcers,
Nursing management with IBD infections or
narrowing
 maintaining normal elimination patterns
S/Sx Abdominal Abdominal
(administer anti-diarrheal medications, pain anywhere pain is
record frequency and consistency of stools, in the often
bed rest to decrease peristalsis) abdomen confined
 Relieving pain (dull, burning, crampy)- to the left
administer anticholinergic drug 30 minutes side of the
before a meal (to decrease intestinal abdomen
motility), administer analgesic for pain, Endoscopic
position changes, local heat application, findings
diversional activities, prevention of fatigue
 maintaining fluid intake (record I & O, daily
weights, increase fluid intake, monitor IVF)
 Maintaining optimal nutrition (TPN, I & O,
daily weight, blood glucose level q6H,
elemental feedings after TPN (high in CHON
low in fat and residue)
 Promoting rest; Reducing anxiety
 Enhancing coping measures (relaxation
techniques, visualization, breathing
exercises, biofeedback, professional
counselling)
 Preventing skin breakdown( use skin barrier
(petroleum ointment), pressure-relieving
devices
 Monitoring and managing potential
complications

Crohn’s vs. Ulcerative Colitis

Characteristics Chron’s Ulcerative
disease colitis
Location Inflammation Affects
can occur only the
anywhere in large
the digestive intestine
tract, from
the mouth to
the anus
Continous PT c Chron’s There are
inflammation often have no
healthy areas healthy
in between areas in
inflamed between
spots inflamed
spots
Layers Affects more Confined