LESSON PLAN

Course: M.Sc Nursing

Name of the student teacher: Prabha Krishnan
Year: First year
Time: 30min on 18/2/2020
Subject: Community Health Nursing
Venue: Mukkam CHC
Topic: Rabies
Group: 2nd B. Sc Nursing
Method of Teaching: Lecture cum Discussion
No. of participants: 10
Previous Knowledge: Students have some knowledge about Rabies

AV Aids: Powerpoint presentation

CENTRAL OBJECTIVES
On the completion of the class the group will be able to explain Rabies, its pathogenesis, management and pre and post
prophylaxis regimen in India and apply this knowledge in their day to day life with positive attittude.

SPECIFIC OBJECTIVES: At the end of the class , students will be able to:
1. define rabies
2. identify the agent, host, reservoir and mode of transmission
3. explain the pathogenesis
4. enlist the sign and symptoms of rabies
5. describe the preventive measures of rabies
6. describe the preventive measures of rabies
Time Specific Content Teacher Learners AV aids Evaluation
Objectives Activity Activity
2min introduce the INTRODUCTION Introduces listen
topic Rabies is almost always fatal. However, following a carefully
rabies exposure the disease is practically 100%
preventable by timely post-exposure prophylaxis (PEP)
and correct use of rabies vaccines & immunoglobulins
(RIG). About 55,000 – 60,000 human rabies deaths are
known to occur globally each year of which 20,000, i.e.
about one-third is from India alone.

2min define rabies DEFINITION:

Rabies is a viral disease that causes acute encephalitis explain the listens
(inflammation of the brain) in warm blooded animals. definition carefully
Rabies is a zoonotic disease (a disease that is
transmitted to humans from animals) that is caused by
a virus

identify the AGENT,HOST, RESERVOIR,SOURCE OF INFECTION AND discuss actively Whether rats
3min agent, host, MODE OF TRANSMISSION about the participates can cause
reservoir and AGENT: agent , host with the rabies?
mode of Rabies virus. a member of the Lyssavirus genus, in the and mode of discussion
transmission family Rhabdoviridae transmission
HOST:
Humans, and many mammals
RESERVOIR:
Carnivorous animals

SOURCE OF INFECTION
The source of infection to man is the saliva of
rabid animals. In dogs & cats, the virus may be present
in the saliva for 3-4 days before the clinical
onset & during the course of illness till death
 INCUBATION PERIOD
It is highly variable in man, commonly 3-8
weeks following exposure.
The closer the bite to the brain, the shorter the
incubation.
Rabies virus travels 1 cm per day

MODE OF TRANSMISSON:
 Man to man
 Licks
 Aerosol
 Animal bites

PATHOGENESIS
explain the Live virus (Epidermis, Mucus membrane)
2min pathogenesis
Peripheral nerve explains the understand
pathogenesis the
CNS ( gray matter ) with the help pathogenesis
of ppt
Other tissue (salivary glands,…)

SIGN AND SYMPTOMS Why do

enlist the sign  Bizarre behavior. list down the recognize patient hav e
3min and symptoms  Agitation sign and the signs and hydrophobia?
of rabies  Seizures. symptoms symptoms
 Difficulty in drinking
 Patients will be able to eat solids
 Hydrophobia.
 Spasms of Pharynx produces choking
 Death in 1 -6 days.
 Respiratory arrest / Death / Some may survive.
 Headache, fever, sore throat
 Nervousness, confusion
  Pain or tingling at the site of the bite
 Hallucinations
 Paralysis
 Coma and death
PREVENTION
 PRE EXPOSURE PROPHYLAXIS
 Provided to subjects at risk before
occupational or vocational exposure to rabies.
describe the  Subjects include diagnosticians, laboratory &
5min preventive vaccine workers, veterinarians, cavers, etc. explain the actively
measures of  Simplifies post exposure management. preventive responds
rabies  Only vaccines used measures with the
explanation
 POST EXPOSURE PROPHYLAXIS
 Provided to subjects after rabies
 exposure.
 Consists of wound care, rabies immuno
globulin, and vaccine.
 Cleansing
 Chemical Treatment
 Suturing
 Anti-Rabies Serum
 Antibiotics & anti-tetanus measure
 Observe the animal for 10 days
VACCINATION
(INTRADERMAL SCHEDULE)
Day Dose Site
DAY 0 0.1 ml L & R deltoids/anterolateral
thighs of infants
DAY 3 0.1 ml L & R deltoids anterolateral
thighs of infants
DAY 7 0.1 ml 7 L & R deltoids /anterolateral
thighs of infants
 DAY 28 0.1 ml L & R deltoids/ anterolateral
thighs of infants

INTRAMUSCULAR SCHEDULE
day dose site
Day 0 0.5 ml deltoid/anterolateral
thigh of infants
Day 3 0.5 ml same
Day7 0.5 ml same
Day 14 0.5 ml same
Day 28 0.5 ml same

MANAGEMENT OF RABIES PATIENT

Once symptoms start, treatment should center
on comfort care, using sedation & avoidance of
intubation & life support measures once
diagnosis is certain explains the
explain the 1. MEDICATIONS management Understand
4min management a. Diazepam the
of rabies b. Midazolam management
paient c. Haloperidol + Dipenhydramine of a rabies
patient
2. SUPPORTIVE CARE
- Pts w/ confirmed rabies should receive adequate
sedation & comfort care in an appropriate medical
facility.
a. Once rabies diagnosis has been confirmed,invasive
procedures must be avoided
b. Provide suitable emotional and physical support
c. Discuss & provide important info. To relatives
concerning transmission of disease. & indication for
PET of contacts
d. Honest gentle communication concerning prognosis
should be provided to relatives of patient
 3.INFECTION CONTROL
a. Patient should be admitted in a quiet, draft-free,
isolation room
b. HLCR workers & relatives in contact w/pt should
wear proper personal protective equipment (gown,
gloves,mask, goggles)
4. DISPOSAL OF DEAD BODIES
CONCLUSION:
it is important to provide free rabies PEP to all animal
bite victims on a continual basis to ensure dog
mediated human rabies free HP by 2025. In a resource
2min limited setting like India, high cost of vaccine is a major
limiting factor
RECAPTULISATION
1. What are the signs of rabies in a man?
2. If a person has missed a dose of vaccination,is
it required to restart the vaccination?
2 min
BIBLIOGRAPHY
1.Government of India,National guidelines on rabies
prophylaxis, National Centre for Disease Control, 2015.
2. WHO, WHO expert consultation on rabies, Technical
Report Series, 1012, 2018, Geneva, Switzerland
3. Park K, Preventive and social medicine, 21st edition,
Jabalpur: M/s BanarasiDas Bhanot Publisher,2011,
p(226-234)
4. Gulani K. K., Community health nursing,second
edition,Delhi: Kumar publishing house,2012