GI Infectious Diseases: Cholera, Typhoid & More

NCM112N INFECTIOUS INFLAMMATORY IMMUNOLOGICAL DISEASES OF THE GASTROINTESTINAL SYSTEM
OUTLINE
2. CHOLERA/ EL TOR
1. Background of Infectious Inflammatory
Immunologic Diseases of the Gastrointestinal
System
2. Cholera
2.1. Pathophysiology
2.2. Clinical Manifestations
2.3. Diagnosis
2.4. Prevention
2.5. Medical Management ● [$] causes severe vomiting and watery diarrhea (occurs
2.6. Nursing Diagnosis within 2 to 3 days of infection). Reproduces in the
2.7. Nursing Management mucous membranes. Produces localized infection
3. Typhoid Fever without spreading to other regions of the body
4. Amoebiasis ● [$] an acute diarrhoeal illness caused by strains of Vibrio
5. Botulism cholerae
6. Shigellosis ● Known as Asiatic cholera, Epidemic Cholera
7. Red Tide ● Acute bacterial endotoxin-mediated GI infection
8. Schistosomiasis ○ [@] endotoxins causes complication in patients
9. Ascariasis (may cause inflammation, scarring)
10. References
LEGEND
No logo - From PPT [@] - Prof’s Notes [$] - From Book
1. BACKGROUND OF INFECTIOUS INFLAMMATORY

IMMUNOLOGIC: GASTROINTESTINAL SYSTEM
● [@] Usually has manifestations like F&E imbalance and
diarrhea
Food and Waterborne Diseases in the Philippines (2018* vs
2017)
● 2, 743 cases of Acute bloody diarrhea
● 2,525 cases of Typhoid Fig. 1. Cholera Cases by Morbidity Week and Case
● 115 cases of Confirmed Rotavirus Classification
● 25 cases of Hepatitis A ● [@] there is high rate of Cholera on year 2017-2018
● 3 cases of Confirmed Cholera ● Acute bacterial enteric disease that results in profound,
Food/water 2018 2017 %
rapidly progressive dehydration and death
Borne Disease Difference ● [@] if not treated early, patient may undergo hypovolemic
Cases Deaths CFR % Cases *2018 vs shock d/t dehydration; shock can be fatal
2017 ● INFECTIOUS AGENT: Vibrio cholerae, non-invasive gram
negative bacillus
Acute Bloody 2,743 3 0,11 3814 ↓ -28.08 ○ [$] V. cholerae causes infections only in humans
Diarrhea
● Reservoir: Humans
Confirmed 3 0 0.00 13 ↓ -76.92
● MOT: Vehicle - Ingestion of infective dose of
Cholera contaminated food or water
○ [@] properly cook food and handle water
Confirmed 115 0 0.00 395 ↓ -70.89 ○ [@]promote hand washing especially to children
Rotavirus ● Incubation period: few hours to 5 days
● Period of communicability: as long as stools have a
Hepatitis A 25 0 0.00 104 ↓ -75.96 positive culture
○ [@] Rule of the thumb: "boil it, cook it, peel it or
Typhoid 2,525 4 0.16 4,207 ↓ -39.98
forget it"
Table 1. Food and Waterborne Diseases in the Philippines, ○ [@] Rectal swab or stool exam
2018* vs 2017 ○ Rapid antigen tesna
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This template was inspired and based on UERM College of Medicine 2023B’s Trans-Notes Template and was modified by Trisha Palmaria and the ADHARA
Trans-Notes Committee. Please do not remove this to give credit for their efforts and ideas.
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2.1 PATHOPHYSIOLOGY ● Metabolic Acidosis

Ingestion of contaminated water or food ○ [@] Kasi nareretain yung dapat finifilter ni kidney;
↓ oliguria occurs; can lead to renal failure
Organism reaches the human small bowel and produces CT ● Circulatory collapse - weak radial pulses, unobtainable
(cholera toxin) BP
↓ ○ [@] frequent fluids and electrolytes evacuation from
CT converts ATP into cyclic AMP which then accumulates the cells in the heart, the heart contractility weakens
○ [@] too much cyclic AMP will invite more Na and Cl leading to weak brachial pulse and unobtainable
(important na magsama to get enough fluids) to go blood pressure.
out of the cell to go inside the intestinal lumen ○ [@] Report immediately
wherein there is peristaltic movement resulting in a ○ [@] decreased Hgb → anemia/ glucose oxidation
big volume of fluid in the intestine ● Hypoglycemia
↓ ○ [@] Lack of insulin
Cyclic AMP inhibits the absorptive sodium transport system ● Renal Failure - Oliguria
and activated secretory chloride transport system ○ [@] Oliguria is d/t decreased NaCl and goes off the
↓ water in the interstitial lumen instead of filtering the
Accumulation of NaCl in the intestinal lumen (peristaltic waste product of the body.
movement) ○ [@] closely monitoring I&O during GI diseases is a
↓ given
Water is attracted to the lumen
[@] increased amount of water d/t attraction from Na 2.3 DIAGNOSIS
↓ ● Considered when patient develops severe dehydration or
Volume of isotonic fluid exceeds the capacity of the gut to develops acute watery diarrhea
resorb ○ [@] acute watery diarrhea: pathognomonic sign
[@] increased capacity of the small intestine to ● Rapid Antigen test using dipstick tool assays
accommodate the fluids ○ [@] prick of blood
↓ ● Positive culture on stool exam or rectal swab
Watery diarrhea ○ [@] To determine the growth or presence of Vibrio
↓ chlorae
Waster fluid and electrolytes
[@] decrease in fluids and electrolytes 2.4 PREVENTION
↓ ● Educate the public about the importance of proper
Shock and acidosis handwashing
[@] deadly ○ [@] Use friction rubbing because we can’t say those
little microorganisms sa mga singit singit
2.2 CLINICAL MANIFESTATIONS ○ [@] Public health teaching esp. Children (most
● Acute, profuse, watery diarrhea (pathognomonic sign) vulnerable)
● Rice water stool with fishy odor - may result to death ● Encourage use of sufficient toilet paper to minimize
within 6-12 hrs finger contamination
○ [@] Rice watery stool is the pathognomonic sign ○ [@] common route of GI diseases that are
○ [@} closely monitor otherwise patients might communicable are the oral-fecal route
undergo hypovolemic shock that may lead to death ○ [@] please properly wash your butt. Remaining feces
within 6-12 hours. may cause itchiness, children will scratch it with
● Nausea and profuse vomiting, ileus, muscle cramps their hands then touch their playmates or put their
○ [@] continuous journey hands in their mouth, touch their playmates or put
● Rapid dehydration - poor skin turgor, sunken eyes, their hands in their mouth.
washerwoman’s hand (pruney hands) ○ Wash with water AND SOAP or else u will get
○ [@] Washer woman’s hand is another cholera
pathognomonic sign. ● Disposal of human feces safely and maintain fly proof
○ [$] dehydration, with subsequent cardiopulmonary latrines
collapse, may cause rapid progression from onset ○ [@] not only for cholera but also other GI diseases
signs and symptoms to death. ○ [@] flies (langaw) are vectors for the transmission of
this disease
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● Protect, purify and chlorinate public water supplies

Severe Unconsciousness, lethargy,
○ [@] Nauso yung purification, water filtration system
or “floppiness”; weak or
dahil sa cholera outbreak
absent in pulse; inability to
○ [@] Every FIlipino has right to clean food and water
drink; sunken eyes (and, in
● Use of scrupulous cleanliness and food preparation and
infants, sunken fontanelles);
handling, refrigerate as appropriate
10% loss of total body weight
○ [@] For example: wasabi & calamansi can neutralize
bacteria
○ [$] safe food preparation- with special attention to TREATMENT OF CHOLERA, BASED ON DEGREE OF
meat preparation and cooking DEHYDRATION
■ [$] Ground beef should be thoroughly cooked
and all meat should be maintained at None or mild, but diarrhea
temperatures below 40°F or above 140°F (CDC,
2016) <2 years ¼ - ½ cup (50-100mL) of ORS, to a
■ [$] In planning events for groups of people, maximum of 0.5 L/d
adequate provision for storage and reheating to
Pasteurize or boil milk and dairy products 2-9 years ½ - 1 cup (100-200mL) of ORS, to a
○ [@] One of the reported cases for Cholera in GI maximum of 1L/d
cases is found in remote places (farm)
○ [@] Breastmilk is the best pasteurized or sterilized >10 years As much as ORS as desired, to a
milk. maximum of 2 L/d
○ [@] Natural sterilizer sa mammary gland
○ [@] Breast milk is well sterilized in the mammary Moderate
gland of the mother
<4 months 200 - 400 mL of ORS
2.5 MEDICAL MANAGEMENT
(<5 kg)
● Medical Management
○ Correcting basic abnormalities without delay 4 - 11 months 400 - 600 mL of ORS
■ IV Fluids (5-<8 kg)
■ Oral rehydration therapy
● [@] free in community health center 12 - 23 months 600 - 800 mL of ORS
● [@] Mixed with Clean boiled water (8-<11 kg)
● [@] Alternative: 1L of water with a pinch of
sugar and salt. 2 - 4 years (11-<16 800 - 1200 mL of ORS
■ Monitoring of F&E kg)
■ Intake and output should be recorded
○ Encourage breastfeeding throughout infancy (up to 5 - 14 years 1200 - 2200 mL of ORS
2 years old) (16-<30 kg)
○ Pasteurize
ASSESSING THE DEGREE OF DEHYDRATION IN PATIENTS >15 years 2200 - 4000 mal of ORS
WITH CHOLERA (>30 kg)
DEGREE OF DEHYDRATION CLINICAL FINDINGS Severe
None or mild, but diarrhea Thirst in some cases; <5% All ages and IV fluid replacement with Ringer's lactate
lost of total body weight. weights (or; if not available, normal saline): 100
mL/kg in first 3-h period for first 6-h
Moderate Thirst, postural hypotension, period for children <12 months old; start
weakness, tachycardia, rapidly, then slow down; total of 200
decreased skin turgor, dry mL/kg in first 24 h; continue until patient
mouth/ tongue, no tears; is awake, can ingest CRS, and no longer
5-10% loss of total body has a weak pulse.
weight ● [@] Client findings are the manifestations to be closely
monitored on the patient
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● [@] monitor fluids, I and O to monitor for fluid overload

Tetracycli Tetracyc 12.5 500 mg Antibiotic
● [@] If it is severe, fast dehydration is needed so just refer
nes line mg/kg/d qid x 3 resistance to all
to the table above for the treatment.
ose qid x days tetracyclines is
3 days common.
Antimicrobial Options for Treating Patients with Cholera Empirical use
often reserved
CLASS ANTIBIO PEDIATR ADULT COMMENTS for outbreaks
TIC IC DOSE DOSE Doxycyc 4-6 300 mg caused by
line mg/kg x x single documented
Macrolide Erythro 12.5 250 mg Single-dose single dose susceptible
s mycin mg/kg/d qid x 3 azithromycin is dose isolates.
ose qid x days often the Tetracyclines
3 days preferred are not
therapy, recommended
especially in for pregnant
children, and has women and
1 g x been shown to children.
Azithro 20 single be more
[@] Cholera toxin will still be released if bacteria does not die
mycin mg/kg dose effective than
d/t antibiotics use
bid x 3 ciprofloxacin in
days randomized 2.6 NURSING DIAGNOSES
trials in regions ● Altered Nutrition: Less than body requirements
where reduced ○ [@] low hemoglobin & frequent defecation
susceptibility to ○ [@] Loss of ATP
fluoroquinolones ● Altered tissue perfusion
are common. ○ [@] low hemoglobin and dilution of blood
Rare reports are ● Risk for Fluid Volume Deficit
of macrolide ○ [@] diarrhea= dehydration
resistance. ● Activity intolerance
○ [@]Because of dehydration
Fluoroqui Ciproflo 15 500 mg In highly ● Diarrhea
nolones xacin mg/kg/d bid x 3 susceptible ● Impaired skin integrity
ose bid x days strains, ○ [@] washer woman’s hands, poor skin turgor
3 days single-dose ○ [@] dehydration
ciprofloxacin 2.7 NURSING MANAGEMENT
compares
favorably ● Case reporting as indicated by government agencies
against ● Enteric precautions. Strict isolation not necessary
erythromycin ○ [@] wear gloves and 5 hygiene moments
and doxycycline ● Maintain hand washing and cleanliness
in randomized ● Concurrent disinfection of feces, vomitus and articles
trials. Reduced used by the patient
susceptibility to ● Accurate monitoring of intake and output
fluoroquinolones ○ [@] Encourage the patient to avoid eating oily food
has become and dark colored foods. Oily foods attract NaCl.
common in Dark colored foods increase peristaltic movement
endemic areas and alters urine color/ feces color d/t food coloring
and is such as cola and dark meat.
associated with ○ [@] Teach px how to measure fluid intake
treatment ● Provision of appropriate diet depending on stage of
failure. recovery
○ [@] Patient needs high calorie diet but limit the fats
or oily foods because it can stimulate peristaltic
movement of git
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3. TYPHOID FEVER ● [@] Due to ulceration, it will be easier for MO to

penetrate as well the lymphatic system. Spleen, and liver
(they like nutrients in the blood) → enlarged abdomen
d/t inflammation of spleen and liver → manifestation of
hepatitis, increase of enzymes bilirubin and alteration of
Hgb components and platelets → bleeding/ hemorrhage
3.2 CLINICAL MANIFESTATIONS

● Prolonged fever (38.8- 40.5 C) up to 4 weeks
● Headache, chills, cough, sweating, myalgias, malaise,
anorexia (inflammation response)
○ [@] d/t inflammation and cell mediated response of
the immune response of the body
● Abdominal pain, nausea, vomiting, diarrhea
○ [@] d/t peristalsis
● Also known as Typhoidal Salmonella, Enteric Fever ● Coated tongue, splenomegaly
● [$] A gram-negative anaerobic bacteria. Resistant from ○ [@] The inflammatory mediated response causes
being killed by granulocytes and can survive from being the coated tongue.
engulfed by macrophages ● ROSE SPOTS - faint, salmon-colored, blanching,
● Systemic disease characterized by fever, abdominal pain maculopapular rash on the trunk and chest [@]
→ INFECTIOUS AGENTS pathognomonic sign
● Enterobacteriaceae Salmonella ○ [@] maculopapular rash
● S. Typhi; S. Enterica ○ [@] d/t ruptured capillaries
● S. Typhosa ● Typhoid State
○ [@] - sa state ng typhoid fever na to, ito na yung
→ RESERVOIR medyo nakakatakot kasi dito yung px ay usually in
● Humans coma dahil sa sobrang dehydration etc.
→ MOT: ○ Can destroy or damage neurons that result to
● vehicle - ingestion of contaminated food and water neurological alterations
from feces and urine carriers. ● Staring blankly (coma vigil)
→ Incubation Period: ● Twitching of tendons -especially in the wrist (subsultus
● 5-40 days tendinum)
→ Period of Communicability ○ [@] Subsultus tendinum is the pathognomonic sign.
● as long as bacilli appear in excreta ○ [@] can ulcerate brain and alter neurological
function including the sympathetic and
3.1 PATHOPHYSIOLOGY parasympathetic system
● Mutters deliriously and “carphologia”
○ [@] carphologia- picking or grasping of imaginary
objects, may ginagawa siya pero unaware siya or
tulog siya pero comatose siya d/t altered
consciousness (ex. Buttoning the shirt)
● Tendency to slip down to the foot part of the bed
○ [@] d/t coma vigil
○ [@] Always raise the side rails.
● Severe cases, rambling delirium - ending in death
● [@] some bacteria are resistant ○ [@] lengthy time of delirium d/t decreased oxygen
● [@] Aside from releasing toxins for the supply on the oxygen. Within 5 minutes without
scarring/ulceration in the mucosal lining of intestine, oxygen → death
Salmonella typhi decreases stomach acidity → increase
chance to ulcerate further the stomach’s mucosal lining
→ microorganisms will easily penetrate the bacteria
mediated endocytosis and will be difficult for
macrophages to engulf or phagocytize the MO
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3.3 DIAGNOSIS nt Azithromycin 1g/d (PO) 5

1. Typhidot
● immunodot ELISA kit that detects production of IgM High dose
(recent infection) and IgG (indicates past infection’ ciprofloxacin 750 mg bid 10-14
meaning nagkasecondary infection si patient) (PO) or 400 mg
● [@] enzyme-linked immunoassay q8h (IV)
● [@] If there are build up of inflammation / antibodies
2. IgM ○ [@] for Diarrheal px: Wag agad iinom ng antimotility
● recent, IgG- remote infection drug, kasi suspected na may bacterial infection na
3. Widal Test nag cause ng diarrhea
● detects titers of antibodies present ○ [@] if 3 days may presence pa ng diarrhea, positive
● [@] detect if there have been antibody formation d/t for pathogens, consult the physician for stool exam
cell-mediated response to determine specific antibiotics
4. Rectal swab ○ [@] Drug of choice: ceftriaxone
● [@] Para determine kung anong microorganism yung 3.4 PREVENTION
nag invade ● Strict handwashing and medical asepsis
● [@] To determine the Salmonella Typhosa ● Disposal of human feces safely
○ [@] In the Philippines, they just pee or poop
anywhere (likod ng bahay or damuhan) because
MEDICAL TREATMENT
there is lack of water faucets and toilets
Antibiotic therapy for enteric (Typhoid) fever in adults
● Protect, purify and chlorinate public water supplies
● Cleanliness in food preparation and handling
Medication Agent Dosage(Route) Duration,
● Pasteurize or boil milk and dairy products
Days
● WHO recommends vaccination of people travelling to
endemic high risk areas
Empirical Ceftriaxone 1-2g/dL(IV) 7-14
○ [@] Prophylactic antibiotics and vaccination for
treatment
prevention
Azithromycin 1 g/dL (PO) 5
3.5 NURSING DIAGNOSES
Fully Ciprofloxacin 500 mg bid 5-7 ● Fluid volume deficit
susceptible (first line) (PO) or 400 mg ● Hyperthermia (d/t inflammatory process)
q12h (IV) ● High risk for injury (psychosis)
○ [@] because there might be MO invasion to brain
1g tid (PO) or 2 tissue, not because client is naturally psychotic
Amoxicillin g q6h (IV) 14 ● Self-care deficit
(second line) ○ [@] teach patient on how to be hygienic
25 mg/kg tid ● Constipation
Chloramphenicol (PO or IV) ○ [@] decreased peristaltic movement, weakened GIT
14-21 function
Trimethoprim-sulf 160/800 mg ● Anxiety (d/t treatment regimen)
amethoxazole bid (PO ● Knowledge deficit (d/t prevention and MOT)
5 3.6 NURSING MANAGEMENT
● Obligatory case reporting
Multidrug- Ciprofloxacin 500 mg bid 5-7 ● Enteric precautions, hospital care during acute illness
resistant (PO) or 400 mg ○ [@] wear gloves when handling the px
q12h (IV) ● Concurrent disinfection of feces, urine and articles
soiled
Ceftriaxone 2-3 g/d (IV) ● Search for carriers and sources of infection
7-14 ○ [@] To contact trace the community
Azithromycin 1g/d (PO) ● Monitor intake and output, fluid restoration as necessary
5 ● Prevent further injury if with psychosis
○ [@] because psychotic tendencies might happen d/t
Nalidixic Ceftriaxone 2-3 g/d (IV) 7-14 brain tissue penetration
acid-resista ● Personal hygiene and mouth care
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4. AMOEBIASIS [@] infectious agent looooove the liver because it is rich in

blood and nutrients; can result in low hemoglobin and low
platelet so big tendency to bleed and have anemia

ACUTE AMOEBIC DYSENTERY: MANIFESTATIONS
● Slight attack of diarrhea, periods of constipation with
tenesmus
○ [@] tenesmus- feeling of defecating even after you
defecate.
● Diarrhea, watery, foul-smelling stools often containing
blood-streaked foods.
○ [@] pathognomonic sign: bloody, mucoid stool
○ [@] don't let patient eat dark colored foods because
● Also known as acute bloody diarrhea it will be difficult for nurses to assess if there is
● A protozoan parasite infection blood
○ [@] It may invade other organs that cause ○ [@] ulceration may cause decrease in peristalsis →
hepatomegaly, splenomegaly and meningitis. constipation
● Varies from acute to fulminating dysentery with fever, ● Colic and gaseous distention - lower abdomen
chills and bloody or mucoid dysentery ● Nausea, flatulence, abdominal distention, and
○ [@] Pathognomonic sign: bloody or mucoid stool tenderness - right iliac region
→ INFECTIOUS AGENT:
● Entamoeba histolytica- either as a hardy infective CHRONIC AMOEBIC DYSENTERY
cyst or fragile pathogenic trophozoite, may result to
intestinal or extraintestinal disease
○ [@] E. histolytica reproduces trophozoites
○ [@] is found chiefly in the tropics and where
sanitation infrastructure is limited
→ RESERVOIR:
● Human
→ MOT
● Indirect- ingestion of fecal contaminated food or
water; Direct- oral-anal contact
→ INCUBATION PERIOD:
● 2-4 weeks but may extend to several months ● Prolonged amoebic dysentery
● [@] depending on resistance ● Anorexia, wt loss and weakness
→ PERIOD OF COMMUNICABILITY ● Abdominal distress
● If still with E. histolytica cyst (years) ● Constant fatigue
● [@] As long as this pathogen is still on the body ● Abdomen loss elasticity when picked up between fingers
● Amoebic Granulomata (AMOEBOMA)
4.1 PATHOPHYSIOLOGY ○ [@] ulcerations that can be found in the intestine d/t
Ingestion of cysts in food or water adhesins (refer to patho)
↓ AMOEBIC LIVER ABSCESS
Evolve to trophozoites and adheres to large bowel lumen ● Right upper quadrant pain
↓ ● Fever
Trophozoites produce adhesins, proteinases able to lyse ● Hepatic tenderness
cells and tissue which causes ulcerations ● Dullness and rales at the lung bases(hepatomegaly)
↓ ● Elevated alkaline phosphatase
Produces small ulcers, inflammatory response and mucosal ● Elevated ESR
hemorrhage ○ [@] Client will be prone to bleeding tendencies
↓ ○ [@] Elevated ESR disrupts the lifespan of platelets
Invade through the mucosa and into the bloodstream and hemoglobin
↓
Invade portal venous system - liver abscesses
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4.4 PREVENTION
● Methods of water treatment
● Boiling water should be brought to a rolling boil for at
least two minutes
○ [@] the count starts when the water is already
boiling → meaning it reaches the 100 degree boiling
point
● Disinfection- by using chlorine
○ Prepare a stock solution by dissolving 1 level of
powder. Chlorine compounds (65% to 76% available
chlorine) to 1 liter of water.
■ [@]Pwedeng inumin yung tubig-ulan, just
MUST RULE OUT FIRST! treat it with chlorine
● Amoebic colitis is often confused with IBDs ○ Add 2 teaspoons of stock solution to 5 gallons (20
[@] Need to know patient’s hx and ask if meron liters) of water. Mix thoroughly and let it stand for at
prolonged used of corticosteroids least 30 minutes before using.
● Use of corticosteroids may exacerbate amoebic colitis 4.5 MEDICAL MANAGEMENT
● Amoebic Granulomata may be mistaken for carcinoma
● Percutaneous drainage if with liver abscess
● Flask shaped ulcers
● [@] to drain abscesses formed, because if not drained
○ [@] Check if there’s any pathogens, specifically
liver won’t heal because there is lesion that blocks
mayroong entamoeba para ma-distinguish na hindi
● [@] they will insert a tube, place a camera, look for the
cancer
abscess and drain the necrotic tissue
Recommended Therapeutic Dosages of Antiamebic Drugs
Drug Dosage Duration, Days
Amebic Colitis or Amebic Liver Abscess
Tinidazole 2 g/d PO with food 3
750 mg tid PO or IV
Metronidazole 5-10
Entamoeba histolytica Luminal Infection
Paromomycin 30 mg/ kg qd PO in 3 5-10

4.3 DIAGNOSIS divided doses
● Stool ova and parasite exam- insensitive and non
650 mg PO tid
specific
Iodoquinol 20
● Fecal and antigen detection
● qPRC for fecal DNA
○ [@] Quantitative polymerase chain reaction: 4.6 NURSING DIAGNOSES
minemeasure yung DNA ng feces kung naging
● Alteration in bowel elimination
natural reservoir yung tiyan ng amoeba
○ [@]Constipation or Diarrhea
● Fecal and antigen detection
● Altered nutrition: less than body requirement
● Colonoscopy and abdominal imaging techniques
○ [@] low hgb
○ [@] To know the extent of ulceration of your patients
● High risk for infection
○ [@] to determine if there are ulcerations or
● Altered body temperature
amoebamata / amoeboma
○ [@]Due to inflammatory and hypothalamic activity
● Anxiety
○ [@]Because of the disease process and treatment
regimen.
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4.7 NURSING MANAGEMENT → MOT:

● Enteric precautions for feces, contaminated clothing and ● food without sufficient heat, may extending, lightly
bed linen preserved food, inadequately canned low acid foods
○ [@] Hygiene and comfort to prevent skin irritation ○ [@] part of health teaching is proper food
● Concurrent disinfection handling
● Health education about food and water management → INCUBATION PERIOD:
○ Regions in the country still don’t have proper water ● 12 - 36 hour may extend to days (the shorter the
sanitation duration, the more severe the disease.)
● Health education about food and water management →PERIOD OF COMMUNICABILITY:
● Oral and skin care ● Rare (kasi treatable naman especially if early
● Nutrition support treatment is given)
● Monitor I and O ACCURATELY 5.1 PATHOGENESIS
● Anemia Management Protocols Ingested, inhaled, or wound exposure to botulinum
○ Decreasing Hgb due to liver abscess neurotoxin
○ [@]Decreased platelet count can also occur [@] nagging bioweapon din nung world war
↓
5. BOTULISM Enters the vascular system
● [@] affects the neuromuscular junction ↓
● Serious but relatively rare intoxication cause by potent Reaches the peripheral cholinergic nerve (no CNS
toxins from the infectious agent involvement)
● [@] paralyze the smooth muscle of the intestine ↓
● [$] It is thought that the neurotoxin destroys or inhibits Inhibits Ach release
the neurotransmission of acetylcholine at the myoneural [@]ACH is responsible for blood vessel dilation, slowing of
junction, resulting in disturbed muscle innervation. heart rate, smooth muscle contraction and in increasing
● 4 types: bodily secretions
1. Food borne ↓
● [@] DO NOT eat canned goods if they have rust Flaccid Paralysis
(kalawang) or look inflated (lumobo) because it [@] common cause of death is respiratory illness due to
means it has an infection already. paralyzation of the muscles
2. Wound infection
● [@] common in injected drugs like heroin ● [@] Clostridium botulism: was used as bioweapon in
3. Infant botulism the war, infused in gunpowder in grenades with the
● [@] Cause in infant: fed/ingested raw honey infectious agent, so when they explode and air is
● [@] foods not pasteurized → GI irritation/ inhaled or wounds are exposed, they get botulism
disease → paralysis, delirium, susceptible to death
4. Adult intestinal toxemia
● produce toxins that lead to infection of
intestinal mucosa. TOXIN SEROTYPES
● [@] caused by raw and uncooked food (make 1. Type A
sure okay yung sushi or mga medium rare na ○ most severe- may require mechanical
meat) ventilation
→ INFECTIOUS AGENT ○ [@] because it depresses respiratory system
● Clostridium botulinum (muscle used for breathing)
○ Survive ordinary cooking procedures, 2. Type B
however ○ milder form of disease than type A
■ [@] boil foods and fry foods 3. Type E
appropriately ○ associated with foods of aquatic origin with
○ Toxin production occurs at anaerobic variable severity
atmosphere, ph >4.5, low salt and sugar, ● [@] can be found on
temperature 4-120C seafood
→ RESERVOIR: 4. Type F
● soil, agricultural products, honey, marine sediments, ○ rapid progression to respiratory failure but with
intestinal tract of animals rapid recovery
○ [@] even in milk ○ [@] Milder serotype of Clostridium
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5.2 CLINICAL MANIFESTATIONS 3. Electrophysiologic findings (heart rate, blood pressure)

● Symmetric cranial nerve palsies ○ Monitoring for cardiac / respiratory illnesses
○ [@] acetyl allele is lost ○ [@] uses cardiac monitors
○ [@]Inhibits the release of acetylcholine
● Symmetric descending flaccid paralysis 5.5 PREVENTION
○ [@] facial paralysis -> thoracic -> extremities ● [$] Correct processing of canned foods, boiling of
paralysis (downward) suspected canned foods for 15 min before serving
○ [@] look like GBS Guillain-Barré Syndrome 5.6 MEDICAL MANAGEMENT
● May progress to respiratory arrest and death ● [$] polyvalent antitoxin
○ [@] Monitor closely the patient ● [$] guanidine hydrochloric acid- enhances acetylcholine
○ [@] Emergency intubation on the bed side area release
● INFANT BOTULISM
○ Inability to suck and swallow (prone to malnutrition 5.7 NURSING DIAGNOSES
and dehydration) ● Alteration in comfort (Pain)
○ [@] d/t ACh stimulation ○ [@] pain kasi naiipit ang nerves
○ [@] Ptosis- drooping of the eyelid ○ [@] pain d/t paralysis
● FOOD BORNE ○ [@] If naging rigid muscles ni patient d/t release of
○ Nausea and vomiting prostaglandin
○ Abdominal pain ● Impaired physical mobility
■ [@]due to spasm / rigid mucosal lining ○ [@] d/t flaccid paralysis
■ [@]Paralytic ileus- constipation ○ d/t Absence of acetylcholine
■ [@] part of the mucosal layer is the smooth ● Altered bowel elimination
muscle → paralysis ○ [@] d/t paralysis
○ Urinary retention ● Altered Nutrition
■ [@] because the urinary bladder is a muscle, ○ [@]d/t Treatment and disease progression
loss of control/tone because of neurotoxin ● Anxiety
leads to urine retention → secondary infection ○ [@] d/t Treatment and disease progression
○ Extraocular muscle paralysis- blurred vision inability ● Risk for impairment of skin integrity
to accommodate ○ [@] due to paralysis -->schedule the turning and
○ Dizziness, dry mouth (d/t dehydration) positioning to prevent pressure ulcer
○ [@] also d/t dehydration
5.3 MEDICAL INTERVENTION 5.8 NURSING MANAGEMENT
● Botulinum antitoxin < 24 hours after onset ● Monitor V/S
○ [@] Immediate reporting of the case will have good ○ [@] Especially respiratory rate (can help determine
prognosis whether the patient is undergoing cardiac arrest),
○ [@] to control the neurotoxin made by the pathogen HR, BP
● Admitted to intensive care setting with monitoring of ● Wound botulism- wounds should be cleaned, debrided,
vital capacity. drained (soap with running water)
○ [@] vital capacity- capacity of lungs for air ● Standard precaution
○ [@]Especially if there are signs of respiratory failure ○ [@] especially when handling feces of patient
● Detoxification of implicated foods by boiling before
5.4 DIAGNOSIS discarding
● Sterilization of used utensils
1. Mouse bioassay- gold standard (lab rats) ○ [@] Place metal utensils in boiling water
○ [@] Blood exam then plasma then processed, then is ○ [@] Dispose if plastic
injected in diff. types of rats (healthy rats, rats with
antibiotics, etc.)
○ [@] They examine each rats’ reaction to the injected
substance, especially watching the reaction of the
rat with antibiotics.
○ [@] Gold standard kasi malalaman what type of
bacteria, serotype, if there is antibody formation, to
see if there is antibiotic resistance of antigen
2. Culture of serum, stool - low yield
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6. SHIGELLOSIS ● Rapid Dehydration and weight loss

● [$] may produce enterotoxins that are cytotoxic and alter ○ [@] d/t movement of the water to the intestinal
the permeability of intestinal cells leading to diarrheal lumen from intravascular compartment
diseases.
● Also called as Bacillary dysentery 6.3 DIAGNOSIS
● Acute bacterial disease involving the distal small ● Stool specimen culture via rectal swab
intestine characterized by loose stool of small volume ○ [@] Determines whether the pathogen is either an
● Most infectious bacterial enteropathogen amoeba or shigella
→ INFECTIOUS AGENT: ● Aggressive rehydration
● Genus Shigella ○ [@] aggressive because not only fluid loss but also
■ S. dysenteriae the bleeding
■ S. flexneri ○ [@] force-fluid intake may be implemented
■ S. boydii especially for children who are difficult to convince
■ S. sonnei to drink lots water
→ RESERVOIR: ○ [@] avoid dairy products in children*
○ humans ● Nutritional support
→ MOT: ● Nasogastric aspiration for colonic atony
○ Direct or indirect fecal- oral transmission ○ [@] only for cases with very weak colon
○ [@] closely supervise children’s hand washing ○ [@] Lavage to get rid of toxins
routine
→ INCUBATION PERIOD
○ 7 hours-7 days, average of 3-5 days
→ PERIOD OF COMMUNICABILITY:
○ Within 4 weeks after the onset of illness
6.1 PATHOGENESIS
Ingestion of MO
[@] oral-fecal route
↓
MO resistant to low pH condition
[@] gastric juices do not affect them
↓
Survives in the gastric barrier
↓
Produces enterotoxin that results to abnormal water
reabsorption
[@] parang nacombine yung typhoid fever and amoeba
↓
Watery diarrhea
↓
Mucosal inflammation - bloody-mucoid stool (dysentery) 6.4 MEDICAL MANAGEMENT
[@] enterotoxin can also ulcerate stomach lining → bleeding ● [$] Most cases of Shigellosis are mild and self-limiting,
→ looks like amoebiasis so are treated with oral rehydration therapy, rather than
May cause ulceration antibiotics.
6.2 CLINICAL MANIFESTATIONS ● [$] Antibiotics may be indicated in severe infections,
patients at extremes of age or immunocompromised.
● Fever
Also antibiotics are unlikely to reduce the period of
● Tenesmus, N/V, HA
excretion
● Colicky or abdominal pain associated with anorexia and
○ [$] Medications: Ciprofloxacin (drug of choice),
body weakness
ampicillin, co-trimoxazole, tetracycline or
○ [@] d/t ulceration in mucosal lining of intestines
cephalosporins.
● Diarrhea with bloody-mucoid stools
○ [@] Makikita lang talaga yung difference through
laboratory tests
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6.5 NURSING DIAGNOSES ● Begins 5 to 10 days after onset of diarrhea

● Pain and Discomfort ● Triad of symptoms
○ [@] d/t frequent motilit of abdomen ○ Hemolytic anemia with fragmented erythrocytes
● Altered bowel elimination ○ Thrombocytopenia
○ [@] d/t diarrhea ■ [@] Decrease platelets
● Altered body temperature ■ [@] may cause maculopapular rash or petechiae
○ [@] d/t inflammatory process ○ Acute kidney injury
● Risk for infection ■ [@] Damage of filtration because of bleeding
○ [@] d/t ulcerations present in intestines tendency
● Altered nutrition: less than body requirement ● [@] d/t frequent watery stool evacuation, nasisira
● Fear filtration function ng kidney*
○ [@] d/t disease progression and treatment regimen
○ [@] because of blood in the feces. 8. RED TIDE
● Anxiety ● Caused by “population explosion” of toxic, naturally
○ [@] Because of disease progression occurring microscopic phytoplanktons, esp. subgroup
6.6 NURSING MANAGEMENT known as dinoflagellates
● Enteric precautions to 10-100 microorganism needed to ● [@] seafoods that have openings ‘bukas ang bibig’
cause illness acquire the dinoflagellates (tahong etc.) when the food
● Concurrent disinfection is eaten → red tide poisoning
○ [@] Sterilization that the patient use ● [@] red tide usually happens during summer or hot
● Education on proper hygiene and washing weather season
● Monitor I&O STRICTLY, ACCURATELY ● [@] hot temperatures warm up the seas and oceans,
● Restrict food until N&V subsides causing phytoplanktons to float to the surface for
○ [@]it may become a waste product and not survival.
absorbed by the intestines ● Dinoflagellates are toxic can cause food poisoning when
○ [@] avoid dark color foods eaten
● Fly control → ETIOLOGIC AGENT
● Gonyaulax Protogonoyavlax & Gessnerium (all
presently known as Alexandrium sp.)
PAHINGA MUNA, ADHARA! ● Alexandrium tamarense - Atlantic coast
TULOG MUNA KAYO MGA ● Alexandrium catenella - Pacific west coast
● Ptychodiscus brevis - Gulf of Mexico
LODICAKES FOR 30 MINUTES ;)
Types of Shellfish that prone for toxin accumulation:
7. HEMOLYTIC UERMIC SYNDROME (HUS) ○ Quahogs
○ [@]are like small clams
○ Soft Shell Clamps
○ Oysters
○ Mussels
○ Scallops
○ Moon snails
● 4 Syndromes of Shellfish poisoning
○ Paralytic shellfish poisoning
■ [@] dinoflagellates can release satotoxins can
go to nervous system and cause paralysis ->
numbness and tingling sensation
○ Diarrheal shellfish poisoning
○ Amnestic shellfish
■ [@] Causes memory loss
● [$] One of the most common glomerular disorders in ○ Neurologic shellfish poisoning
children, caused by trauma to the erythrocyte. An acute ■ [@] causes paralysis to the patient , numbness
disorder characterized by microangiopathic hemolytic and tingling sensation rigidity of the muscles,
anemia, thrombocytopenia, and renal impairmentOften seizure, respiratory arrest and heart failure
follows hemorrhagic and diarrheal illness.
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8.1 PATHOPHYSIOLOGY 9. SCHISTOSOMIASIS

Ingestion of toxic shellfish
↓
Release of “satotoxin” produced by A. Catenella
↓
Acts by blocking sodium movement in muscle tissue
[@] Sodium is important for conducting ability of cells,
muscles, and tissues
↓
Conduction blocks primarily in the neurons and muscles
● [$] AKA Chronic cystitis, can cause granuloma
8.2 CLINICAL MANIFESTATIONS formation. Affects blood, GI, bladder, and generalized
● Initial sign- tingling of the lips which spreads to the face, symptoms. This is caused by deposition of eggs,
neck, fingertips and toes granuloma, and fibrosis.
● HA, dizziness, nausea and sometimes can be mistaken ● Also called as bilharziasis (kasi eto yung tawag dun sa
as drunken condition snail), snail fever
○ [@] attacking brain tissues causing delirium ● A blood fluke (trematode) with adult worms living in
● Symptoms are aggravated by alcohol consumption mesenteric and vesical veins of host for many years
● In severe cases- muscular paralysis and DOB in 5-12 ○ [@] characterized by big belly (clinical sign) kasi
hours bc of the paralysis of the diaphragm may mga worms
○ Early response= can survive with respirator ● [@] became endemic once in the Philippines
○ late=death ● Malaki ang tiyan dahil sa bulate
● With contact sa skin, pwede na magkasakit
→ INFECTIOUS AGENT: Schistosoma mansoni
● Modalities of treatment
● [@] adult worms
○ Induced to vomit
● S. haematobium - urinary manifestations bc affects
■ [@] may insert NGT to lavage
UT
■ [@] introduce negative air pressure → vomit to
● S. Japonicum - hepatic and intestinal
drain out toxins
manifestations
○ Charcoal hemoperfusion
● S. mansoni - intestinal tract
■ [@] Parang dina-dialysis (hemodialysis)
○ [@] common in PH
■ [@] The machine has this activated charcoal
→ RESERVOIR - humans
that sips and removes the blood
→ MOT - skin by penetration by cercariae released from
○ Alkaline fluids (sodium bicarbonate)
snails (Oncomelania quadrasi) or ingestion of contaminated
■ [@] Neutralize too much acid
water
○ Artificial respiration
→ INCUBATION PERIOD - 2-6 weeks after exposure
■ [@] and oxygen therapy to manage respiratory
→ PERIOD OF COMMUNICABILITY - may last until 10 years
function
for humans, snail the whole life span.
○ [@] there are people who can be resistant, or carrier
8.4 PREVENTION AND CONTROL but asymptomatic
● Monitoring program for shellfish producing area
○ [@] Community must be taught, to be aware and
prevent eating if there is red tide
● Year round testing of shellfish-growing area
● Seek medical attention if accidental ingestion of toxic
shellfish is suspected
● Pay attention to the warnings about red tide to the local
government unit.
○ [@] Avoid seafood like clams and oysters if there is
a red tide warning
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9.1 PATHOGENESIS ■ d[@]/t splenomegaly, hepatomegaly, and

1. Intact skin penetration with infective cercariae worms residing in stomach
(name of the snail) ○ Liver function deterioration
● [@] found in infectious agent’s saliva ■ [@]expect hepatitis like manifestation
2. Transform to schistosomula and reaches the liver
parenchyma 9.3 DIAGNOSIS
● [@] Invades because it’s very rich in nutrients ● Serology assay - FAST-ELISA and enzyme- linked
3. Humoral and cell mediated inflammatory response - immunoelectrotransfer blot technique (EITB)
Katayama fever ○ [@] kuha blood sample, study if there is
● [@] increased temperature, hepatomegaly, antigen/antibody formation
splenomegaly, rashes
4. Antigen excess and retained eggs in host tissues - ● Stool and urine analysis - kato thick smear
chronic schistosomiasis ○ [@] Kato thick smear - counts the number of eggs
● [@] Will be retained sa liver -> chronic that or helminths present in stool & urine of the patient
results to liver failure ● Circumoval Precipitin Test (COPT)- finger blood
5. Recruitment of inflammatory cells sampling
6. Lesion formation and enlargement -organomegaly ○ [@] To determine if there are antigen being
● [@]enlarged spleen, liver produced by these pathogens
● [@] Invades because it’s very rich in nutrients ● Liver and rectal biopsy
● [@] Inflammation or enlargement of an organ
7. Interruption of blood flow -portal hypertension
● [@] causes inflammation to the liver of the
patient
● [@] Hindi nafifilter ng maayos=renal failure
8. Fluid accumulation

I. Cercarial Invasion 9.4 PREVENTION
○ Dermatitis, Maculopapular rash - swimmer’s itch ● Improve irrigation and agriculture practices
■ [@] obtain patient history, saan naglagi ano ○ [@] Teach farmers for proper irrigation system for it
ang ginawa etc. not to become the habitat of the snails
■ [@] Nagkakapagputok ng capillaries, ● Prevent exposure to contaminated water (rubber boots)
develops macule and papule ● Exposure with contaminated water - towel dry the skin,
II. Acute Schistosomiasis - Katayama fever apply 70% alcohol to kill larva
○ Fever ○ [@] If there’s no alcohol, you can use soap and water
○ High degree of eosinophilia because they
cannot kill them because they are too big thus 9.5 MEDICAL MANAGEMENT
excess eosinophils will block
● Topical Ointment for dermatitis
○ Portal hypertension (due to blocked
● Glucocorticoid treatment (at the site of inoculation of
oxygenation)
the snail to prevent inflammation)
○ Colicly abdominal pain[@] Bloody diarrhea,
● [@] Praziquantel is an anti-helminthic
anemia
○ [@] hepatomegaly as well
○ [@] Ulcerations also occur 9.6 NURSING DIAGNOSIS
III. Hepatosplenic phase ● Altered urinary elimination
○ [@] Organs are enlarged which can cause ● Body image disturbance
rupture that may result to ascites n rupture ○ [@] d/t enlarged abdomen
(kaya din nagkakaascites) ● Impaired skin integrity (d/t dehydration)
○ Hepatomegaly -RUQ dragging pain ● Social isolation (d/t body image)
■ [@] parang hinihila yung liver na lumabas ● Altered role function
sa katawan ○ [@] If the patient gets sick, he/she will not be able to
○ Splenomegaly - LUQ pain do household chores anymore
○ Bleeding at the esophageal varices ● Self-esteem disturbance (r/t body image)
■ [@] Due to an abnormal platelet Ascites
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9.7 NURSING MANAGEMENT

● Regular treatment of praziquantel for endemic high-risk
groups
● Educate the public about seeking early treatment
● Concurrent disinfection of feces and urine
○ [@] wear gloves and standard precaution and 5
moments of hand hygiene
● No isolation technique necessary
● Fluid and electrolyte monitoring
○ [@] Because it dehydrates and the bowel elimination
is altered
● Check labs for liver function [@] cycle that can be controlled through handwashing,
● [@] increasing enzymes and bilirubin leading to health education is key
decreased hgb leading to anemia and bleeding → INCUBATION PERIOD
● Maintain comfort and skin integrity ● 4-8 weeks life cycle
○ [@] bed making, sponge bath, hydration etc. → PERIOD OF COMMUNICABILITY
● as long as mature fertilized female worms live in the
10. ASCARIASIS intestine 12-24 months
● [@] cycle will repeat if ova/eggs will stay there so
deworming will take months or even years
10.1 PATHOGENESIS
Ingestion of infective eggs
↓
Invade the mucosa, migrate to lungs
[@] proximity of thoracic cavity to entrance of GI
system=migration will occur sa lungs kaya may
manifestation na coughing
● [$] causes intestinal and bile duct obstruction ↓
● Also called as roundworm infection, ascaridiasis Ascend the bronchial tree and return to small intestines
● One of the STH (Soil-transmitted Helminth) diseases ↓
under surveillance by the DOH. Large bolus of entangled worms
○ [@] until now especially in endemic areas ↓
○ [@] Especially in communities that are unaware Small bowel obstruction, perforation, intussusception
about the disease and mga bata hindi natuturuan ng [@] dikit dikit yung bituka dahil sa bulate kaya
proper handwashing, also in areas na walang na-block na so they migrate to esophagus instead
sariling toilets [@] Pwede sumuka si patient ng bulate
● Helminthic infection of the small intestine generally ↓
associ with few or no overt clinical symptoms Migration to esophagus
○ [@] Bigger in size compared to schistomia* ↓
● [@] became endemic Oral expulsion of worms
→ INFECTIOUS AGENT 10.2 CLINICAL MANIFESTATIONS
● Ascaris Lumbricoides - largest nematode parasite of ● Non-productive cough, substantial discomfort
humans ○ [@] akala may phlegm, pero wala pala bulate pala
→ RESERVOIR ● Eosinophilia
● humans, ascarid eggs in soil ● Eosinophilic pneumonitis (Loffler’s syndrome)
→ MOT ○ [@] Worm attaches to lungs > increased eosinophils
● Indirect fecal- oral route (can be seen through stool (in order to engulf pathogen) = madaling mamatay
exam) na eosinophils so nadidislodge sila
● Pain
● Small bowel obstruction
● Biliary colic - large worm occludes the biliary tree
○ [@] colic - gas pain
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● Appendicitis 10.5 MEDICAL MANAGEMENT

○ [@] outpouching of appendix ● Anti-helminthic Therapy
○ [@] worms can swim into the appendix ● [@] Dosage depends ID
○ Mebendazole
10.3 DIAGNOSIS ○ Albendazole
● Direct fecal smear ○ Benzimidazole
○ [@] 10 cm or longer ● Nutritional Support
○ [@] Smear if may ova or egg growth ○ Iron, vitamin A
● Kato Katz Method - surveillance ○ [@] Bc they are also parasites that feed on nutrients
○ [@] Counts the worms and eggs sa poop ni patient of the cells
● Formalin ether/ethyl acetate concentration technique ○ [@] Nagiging malnourished yung bata kasi kumakain
(FECT) - food handlers din mga bulate
○ [@] smearing of the foods using ether to see in the ● Oral hydration therapy
microscope if there are eggs there especially for ○ [@] For patients that are sensitive for antihelminthic
those who work in the food industry medication
○ [@] Prone to dehydration
10.4 PREVENTION ● Antihistamine for hypersensitivity to medication
The WASHED Framework for comprehensive control of STH 10.6 NURSING MANAGEMENT
infections ● [@] How to Handle Expelled Worms from Mouth
○ Worms may be drenched in chlorine or salt, expect
Water ● Access to potable water they will convulse
● Drainage and disposal/reuse/recycling of ○ Usually are flushed down the toilet, make sure no
household water (gray water) worms are left on the toilet
● Monitos abdominal girth
Sanitation ● Access to safe and sanitary sanitation facilities ● Monitor for skin integrity d/t dehydration
● Safe collection, storage, treatment, and ● Pain management
disposal/reuse/recycling of human excreta ● Nutritional support
(feces or urine) ● Surveillance of high risk groups
● Management/reuse/recycling of solid waste ○ [@ ]check if may endemic sa community
● Concurrent disinfection
Hygiene/ ● Appropriate information regarding prevention ○ [@] baka may eggs nasasama sa hinihigaan ni px;
Education and treatment of STH these can die from chlorine
● Dissemination of key messages to promote the ● Zero Open Defecation Program (ZOD):- every household
following practices in the community should have a toilet
○ Safe water storage
PAHINGA MUNA, ADHARA!
○ Safe hand washing and bathing practices
○ Safe treatment of food stuffs
○ Latrine use
○ Wearing shoes
Deworming ● Regular mass drug administration
● [@] Health education is the key

● [@] there still some PH regions that don’t have access
to clean water
● [@] Simple hand washing can prevent all of these.
● [@] Deworming by antihelminthic medication Complementary milk from Daturtle Section B !! Drink water
● [@]Access to water is a necessity too mga ka-puyat <3 us2 ko na lang maging turtle </3
REFERENCES
● Professor Lawrence. (2021). Infectious
Inflammatory Immunologic: Gastrointestinal System
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NCM112N INFECTIOUS RESPIRATORY DISEASES
days, treat with zanamivir, and test for
OUTLINE resistance.
1. Background of Infectious Respiratory Diseases ● [$] General measures—adequate hydration, antipyretics
2. Swine Flu (not aspirin in children), and decongestants.
2.2. Clinical Manifestations 3. PTB
2.3. Diagnosis ● Etiologic Agent: Mycobacterium Tuberculosis
2.4. Prevention ● [@] Acid fast aerobic organism (stays in the air)
2.5. Medical Management ● MOT: Airborne-droplet
2.6. Nursing Diagnosis ● As long as the bacillus is in the sputum
2.7. Nursing Management ● Incubation Period: 3-8 weeks
3. PTB ● [@] PC: as long as the MO is in the sputum
4. Whooping Cough ● [@] Wear ppe, mask, face shield and gloves
5. Avian Flu ● [@] anti-tb drugs: sometimes > 6 months usage
6. Diphtheria
7. Severe Acute Respiratory Syndrome 3.1 CLINICAL MANIFESTATIONS
8. Influenza ● Fatigue
9. COVID-19 ● Weight loss
10. Information ● Persistent low grade afternoon fever
10.1. General Format ○ [@] Pathogen becomes more aggressive during
10.2. Figure Inserts this time
10.3. Lists and Tables ● Night sweats
10.4. Citation ● Chills
10.5. References ● Hemoptysis (pathognomonic sign)
○ [@] Cough ng dugo d/t formation of a patchy
LEGEND
infiltration/ulceration of MO in lung parenchyma
No logo - From PPT [@] - Prof’s Notes [$] - From Book ● Productive cough
● Pleuritic chest pain
1. INFECTIOUS RESPIRATORY DISEASES ● [@] d/t infiltration in the lungs → O2 therapy
● [$] Dyspnea is a late symptom that may signify
● [@] most medical and nursing management focus on
considerable pulmonary disease or a pleural effusion
symptomatology (managing symptoms)
3.2 DIAGNOSIS
2. SWINE FLU ● Sputum specimen/sputum smear
○ [@] Wear PPE
● A-H1N1 virus
○ [@] Once the patient coughs and releases the
● Incubation Period: 24 - 72 hours
phlegm, the nurse will collect the specimen in a
● Period of Communicability: 7 days from onset of
sputum container and forward it to the laboratory
symptoms
for testing → to see the growth and presence of
● [@] originated from swine or pigs
TB
● [@] concurrent disinfection on materials used is
○ [$] Patients with sputum smear–positive TB are
important to prevent this disease
generally considered infectious for the first 2
2.1 CLINICAL MANIFESTATIONS weeks after starting treatment.
● Flu like symptoms ● Tuberculin test
● [@] fever 40 -41 C ○ [@] Like skin testing
2.2 MEDICAL MANAGEMENT ● Chest X ray
● Antiviral drugs: Oseltamivir, Zanamivir ○ [@] Reveals patchy infiltrates in the lungs
● [@] Swine flu is treatable for as long as px is given ○ [@] May itim itim sa may lungs
medications 3.3 PREVENTION
● [@] Strict isolation, quarantine necessary for px ● [$] Screening programs in known risk groups are of
2.3 NURSING MANAGEMENT value in detecting individuals with TB.
● [@] Supportive care, increase in F&E ○ [$] Individuals with a diagnosis of TB must be
● Strict Isolation / Quarantine reported to the public health authorities for
● Administration of Oseltamivir and Zanamivir identification and assessment of contacts
○ [$] If oseltamivir-resistant virus is suspected, or and risk to the community
a patient does not respond to therapy within 5
ADHARA 2023
This template was inspired and based on UERM College of Medicine 2023B’s Trans-Notes Template and was modified by Trisha Palmaria and the
ADHARA Trans-Notes Committee. Please do not remove this to give credit for their efforts and ideas.
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● [$] Teach patients to cover the nose and mouth meds, make sure they have isolated rooms and
with paper tissues every time they cough, sneeze, own utensils (utensils should be sterilized)
or produce sputum ○ [@] The prescription is dependent on the
● [$] The tissues should be thrown into a paper bag laboratory results of the sputum smear
and disposed of with the trash, burned, or flushed ○ [@] Observe for skin rashes d/t allergic reactions
down the toilet. ○ [@] Monitor if the px is having blurry vision (optic
● [$] Emphasize careful hand washing after handling neuritis)
sputum and soiled tissues 3.5 NURSING DIAGNOSIS
3.4 MEDICAL MANAGEMENT ● [$] Ineffective breathing pattern
● Isoniazid (INH) ● [$] Ineffective airway clearance
○ Take before meals ● [$] Noncompliance
○ Hepatic enzyme elevation, peripheral neuropathy ● [$] Ineffective self-health management
(side effects) 3.6 NURSING MANAGEMENT
○ [@] To increase drug absorption, should be taken ● Drug Therapy ( mainstay of TB treatment )
before meals ● Educating patient about how to take drugs and what to
○ [@] Monitor for peripheral neuropathy (tingling expect and monitor
sensation and altered senses) ● Monitor for peripheral neuropathy
○ [@] Monitor laboratory test especially for liver
function tests, as the liver produces several and
different enzymes during the detoxification of the 4. WHOOPING COUGH
drugs that might lead to toxicity ● [$] Caused by Bordetella Pertussis, a gram negative,
○ [@] Categorized as a chemotherapeutic drug so anaerobic bacteria. Vaccines for prevention changed
WOF toxicity: if nangangati balat, yellowish from a killed whole cell vaccine to an acellular vaccine
discoloration which would indicate liver toxicity that contained the pertussis toxin and additional
kaya monitor liver enzyme tests bacterial antigens.
● Rifampicin ● [@] Also called Pertussis
○ Taken with food ● [@] Almost eradicated in the PH, just make sure
○ [@] Sensitive to gastric juices of the stomach to far-flung areas receive the DPT vaccine as well
lessen irritation of GI walls ● [@] Highly preventable due to the development of DPT
○ Orange discoloration of secretion and urine (side vaccine
effects) ● [@] Whooping: pag inuubo, lengthy coughing because
○ [@] Advice/warn patient that urine/feces may be for as long as it is not coughed out, the px will continue
discolored (normal reaction to coating of the drug) coughing
● Pyrazinamide (PZA) ● [@] sometimes thick phlegm is swallowed and
○ Protect from light because the taste is “funky” or has “rustic” taste,
○ [@] It is wrapped in a blister-pack that’s which can cause vomiting
dark-colored ● Infectious disease characterized by repeated attacks
○ [@] Advise px to buy dark-colored medication of spasmodic coughing consists of a series of
containers bc serum levels of the meds may be explosive expirations, ending in a long drawn forced
broken when exposed to light inspiration producing a crowing sound “whoop” and
○ Hepatotoxic, ototoxic, nephrotoxic , GI upset (side usually followed by vomiting
effects) ○ [@] The sputum phlegm is difficult to cough out
○ [@] Hepatotoxic: check if the skin is having ● Etiologic agent
pruritus → if it is, then the bilirubin might be ○ Bordetella pertussis
increasing ● Mode of transmission
○ [@] Nephrotoxic: check if there is blood in the urine ○ Direct contact
○ [@] Ototoxic -> ringing of the ear that is frequent -> ○ Indirect contact
advise client to have checkups ○ Droplet
○ [@] Monitor if there are GI upset when taking the ○ [@] Face mask, face shield, gloves. Teach px about
drug so that it can be taken with food concurrent disinfection
● Ethambutol ○ [@] Teach family members about concurrent
○ Leads to optic neuritis, skin rash (side effects) disinfection as well
○ [@] Not much precautionary measure, but advice ● Period of Communicability
the px to assess and monitor during intake of ○ 7 days after exposure
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● Incubation period consistency which is difficult for the patient to
○ 7-14 days swallow
○ [@] Kung mapapansin nyo halos magkaka-range ● Paroxysmal coughing- induce nose bleeding. Increase
4.1 PATHOPHYSIOLOGY venous pressure, periorbital edema, conjunctival
Invasion of B. pertussis hemorrhage and bleeding in the anterior chamber of
↓ the eye.
Confined to the tracheobronchial mucosa which entangled ○ [@] Increased intrathoracic pressure due to
with the cilia coughing results in increased ICP
[@] Excessive production of mucus ○ [@] Increased intracranial pressure leads to
↓ symptoms like bleeding
Resulting to progressively tenacious mucus ● During Paroxysm - Cyanotic face, Veins on face and
↓ neck becomes distended, bulge eye or pop out eyeball,
Mucous is irritating to the mucosa tongue protrudes
↓ ○ [@] Pressure causes bleeding of micro blood
Initiates coughing vessels present in the cranium
↓ ● Profuse sweating, involuntary urination, lethargy and
Spasmodic because of its tenacious material-hard to expel exhaustion
[@] bc it is very very sticky and clingy, even more than your ○ [@] Higher thoracic pressure, higher UT pressure
ex ● Cough - provoked by crying, eating, drinking or physical
↓ exertion
Release of toxin from the organism that initiates coughing ○ [@] Recommend bed rest
and toxic effect to the central nervous system ○ [@] Give soft food to patient
○ [@] May result in aspiration
[@] If mucus stays in the lungs, it’s a toxic material and the ● Convulsions- intracranial hemorrhage
effect is on the nervous system (the toxin released by MO) ○ [@] d/t increased ICP
travels to the capillary membrane to the brain then can ● Between paroxysms, no signs
alter neurological function ● Lasts 4-6 weeks
[@] Hirap i-expel and impaired inspiration kaya patient 4.2.2 CONVALESCENT STAGE
becomes cyanotic. If may coughing man, it is lengthy. If ● [@] Doesn't mean naka recover ang pasyente
nalunok, patient may experience vomiting. ● [@] Patient may be in physical exhaustion during this
4.2 CLINICAL MANIFESTATIONS stage which can lead to death
● Gradual decrease of paroxysms of coughing vomiting
4.2.1 CATARRHAL STAGE ceases
● A non specific symptomatology - mucoid rhinorrhea, ● After 6 weeks, attack subsides until px is exhausted,
sneezing, lacrimation and dry bronchial cough. which may cause death
○ [@] Mucoid rhinorrhea - malapot ang sipon (as 4.3 DIAGNOSIS
compensatory mechanism) ● Nasopharyngeal swabs
● Irritating cough , hacking, nocturnal & more severe ○ [@] to determine presence of MO present
○ [@] Nocturnal kase usually sa gabi inaatake ng ● Sputum culture
manifestations ang px because of the activity of ● CBC
the MO in the body (MO are more aggressive at ○ [@] Clotting and platelet count may be low d/t
night) bleeding/hemorrhage
● Stage that is most communicable (wear PPE and ○ [@] Check for iron deficit, high WBC, to know if
gloves) there’s presence of secondary infection
● Lasts about 1-2 weeks ○ [@] Pwede magka-anemia si px
● If not early treated -> paroxysmal stage
4.4 PREVENTION
4.2.2 PAROXYSMAL STAGE
● Report any suspected case
● 7-14th day ● Immunized children (Provide DTP vaccine)
● Cough - Spasmodic and excessive, explosive in a rapid ● Isolation for 4-6 weeks after the onset (droplet
series (5-10 coughs in one expiration) precautions)
● Loud, crowing, inspiratory whoop, choking on mucus ● Public education for immunization and early diagnosis
that causes vomiting ○ [@] access to vaccines is still a problem d/t lack of
○ [@] The mucus can block bronchial tree and can healthcare professionals that have access to
also cause the patient to vomit due to it’s thick far-flunked places in the PH
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● Supportive therapy
○ F and E replacement
○ Adequate nutrition (NGT d/t risk for aspiration)
○ Oxygen therapy
○ [@] Humidifier to lessen thickness of mucous
● Erythromycin and Ampicillin
○ [@] drug of choice
● Hyperimmune convalescent serum or gammaglobulin
○ [@] Plasma transfusion
● [@] Advise the family members to wear their PPEs
● Major objective: prevent complication
● Isolation and medical asepsis
● During paroxysms - patient should be not left alone
(Suction equipment should be ready)
○ [@] PX should be monitored
● Sunshine and fresh air
○ Helps in the recovery
● Kept still and quiet as possible
● Warm bath and dry bed (free from soil)
● I and O Monitoring
5. AVIAN FLU
● Incubation period
● A1 VIRUSES- H1N1-H6N1, ○ 9-12 weeks
● Type A, B, C ● PC: May persist for 20 years for humans
● Mode of Transmission: Airborne, Direct Contact ● Mode of Transmission
● Incubation Period : 3-5 days ○ Ingestion of raw or insufficiently cooked crabs
○ [@] from birds, poultry ○ Contamination of foods or utensils with
○ [@] like in swine flu and influenza metacercariae
● Flu-like symptoms ○ Inadequately cooked meat of animal reservoir
● Antiviral ○ Drinking of contaminated water with infected
● [@] DOC: Same as swine flu larvae (metacercariae)
● [@] Nursing management will include providing ○ [@] Metacercariae - found in unsterilized
comfort, prevention, protection, and health education utensils
regarding avian flu
5.1 PATHOPHYSIOLOGY
Paragonimiasis Ingestion of raw infected crustaceans
● Also called Lung fluke ↓
○ Chronic parasitic infection contracted by the Larval flukes develop in the small intestine
consumption of fresh water infection crabs or ↓
crayfish (paragonimus) Flukes penetrate into the peritoneal cavity 30 mins to 48
○ [@] Related to the schistosomiasis hours after existing
● Causative agent ↓
○ Paragonimus westermani Flukes mature after 1 week
○ Subspecies ↓
■ P.philippinensis/ fillipinus- most Penetrate the diaphragm to reach the pleural the pleural
important causative agent space and lungs
● Intermediate host in the philippines ↓
○ Antemelania asperata (Brotia asperata) - Flukes develop fibrous cyst wall
freshwater snail ↓
○ Sundathelphusa philippina - crabs Egg deposition starts 5 - 6 weeks after infection
○ Varuna litterata - small, freshwater crabs
● Crayfish (cockroach of the sea) [@] Flukes will go up to the lung parenchyma
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5.2 CLINICAL MANIFESTATIONS 5.6 NURSING DIAGNOSIS

● Acute phase ● Ineffective airway clearance
○ Invasion and migration ○ [@] Blocks airway due to overproduction of phlegm
■ Diarrhea, abdominal pain, fever, cough, ● Alteration in comfort: pain
urticaria, hepatosplenomegaly, pulmonary ● Hyperthermia
abnormalities and eosinophilia ○ [@] d/t hypothalamic activity d/t inflammation
● [@] MO can enter from stomach to liver -> 5.7 NURSING MANAGEMENT
increased enzymes and bilirubin -> skin ● Same with Swine and Avian Flu
pruritus ● Treatment of infected person
● [@] Eosinophilia is d/t penetration of MO ● Disinfection
and accumulation of dead eosinophils to ● Sanitary disposal of excreta
the lungs ○ [@] If the person is located in a community where
● Chronic Phase there is no access to a proper toilet, the best thing
○ Pulmonary manifestations to do is treat it with chlorine solution and bury it in
■ Cough soil/underground
■ Expectoration of discolored sputum ● Health education - MOT
■ Hemoptysis ○ [@] Together with the LGU - Water Sanitation and
■ Abnormalities, infiltration in chest cavity irrigation system because MO thrive in farmlands
■ Chest Radiograph (lung scarring)
● [@] Due to eosinophilia that have died and 6. DIPHTHERIA
did not phagocyte flukes, which causes ● [$] A respiratory tract infection (Corynebacterium
bleeding in lung tissue diphtheriae) with systemic complications caused by
5.3 DIAGNOSIS toxin that inhibits messenger ribonucleic acid (mRNA)
● Acute bacterial disease involving the tonsils, pharynx,
● Sputum examination larynx, nose and occasionally other mucous membrane
○ [@] Examines presence or growth of ova of flukes or skin.
● Immunology ○ [@] They love mucosal layers
○ [@] Sample blood to determine the ○ [@] Easily preventable & is almost eradicated bc
antigen/antibody during the immune response DPT vaccine is included in DOH program for
● Cerebral paragonimiasis vaccination
○ [@] Can penetrate brain tissue ● Reservoir: Humans
● Effusion Fluid test or biopsy ● MOT: Contact with patient or carrier; raw milk has
○ [@] Biopsy of the lungs and liver to determine the served as a vehicle
presence of the larvae ○ [@] Ingestion of raw milk. Milk that was not boiled
5.4 PREVENTION ○ [@] depends on host resistance
● [@] When eating at restaurants with shellfish or ● Incubation Period - usually 2-5 days, occasionally
mollusks, make sure they are cooked well, even if the longer
slightly cooked versions are much more flavorful. ● Causative Agent: Corynebacterium Diphtheriae
Basically, eat well and die or eat meh and live. ○ Gram positive, unencapsulated, non-motile and
● Anti Mollusk campaigns non sporulating bacillus
○ [@] It was not stated whether it was edible or not. ■ [@] although it’s nonmotile,
Just make sure that it is cooked right and is not ○ Produces toxins that causes systemic activity,
eaten raw myocarditis and polyneuropathy
● Avoid infected foods ○ Toxigenic strains: Toxin allows formation of
● Avoid bathing in infected water pseudomembrane in the pharynx during the
5.5 MEDICAL MANAGEMENT respiratory diphtheria
● Drugs ○ Non-toxigenic strains: produces cutaneous
○ Praziquantil (Blitrizide) treatment of choice disease
○ Bithionol (BITIN)- alternative ■ [@] Skin diseases
○ Surgical removal ● TOX
■ For heterotopic cases ○ Diphtheria toxin, produced by toxigenic strains
● [@] dosage depends on age and severity of symptoms ○ Primary virulence factor the produce
pseudomembranous lesions and taken into the
bloodstream
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○ 1926- formulization of the toxin produces toxoid
(non-toxic but highly immunogenic)
○ Populations where the majority of individuals have
protective anti-toxins titers, the varier rate for
toxigenic strains decreases and overall risk is
reduced.
■ [@] d/t developed vaccines
● Bullneck Diphtheria
6.1 CLINICAL MANIFESTATIONS ○ Massive edema of the submandibular and
● Characteristic finding paratracheal region, foul breath, thick speech and
○ Mucosal ulcer with pseudomembranous coating strong stridorous breathing
with an inner band of fibrin and a luminal band of ○ [@] pathognomonic sign (bullneck)
neutrophils (pathognomonic sign) ○ [@] Smells like a strong fruity scent comparable to
■ [@] causes blockage in the airway which morning breath
poses risk for aspiration ○ [@] causes airway obstruction -> stridorous
○ Asymmetrical grayish white membrane with breathing
surrounding inflammation
○ Resulting from toxin induced necrosis of the

● Cutaneous Diphtheria
epithelium with edema, hyper edema and vascular
○ Usually caused by a nontoxic strain of C.
congestion of submucosal base
Diphtheriae
○ Initially white and adherent (advanced: adhesions
○ Variable dermatosis characterized by punched-out
turn grey/green/black as necrosis progresses)
ulcerative lesions with necrotic sloughing or
○ Expanding and sloughing of the
pseudomembrane formation
pseudomembranes result in fatal airway
○ Non-Healing, enlarging skin ulcers associated with
obstruction
pre existing wound or dermatoses (rarely exceeds
5 cm)
● Respiratory Diphtheria
○ [@] rings contain necrotic tissues but smooth in
○ Constellation of sore throat
the middle with an ulceration in the center, can go
■ [@] Ulceration formed by the toxin
deep into bones
○ Adherent tonsillar, pharyngeal, nasal
○ [@] cleanse with chlorine solution to remove or
pseudomembranous lesions
camouflage the odor bc betadine does not remove
○ Low-grade fever
odor
○ Weakness
● Complications
○ Dysphagia
● AIRWAY OBSTRUCTION
○ Headache
○ Children are more susceptible to this
○ Voice changes (Hoarseness)
complication r/t small airways
○ Difficulty swallowing
■ [@] px may be subjected to ET
○ Neck edema and difficulty in breathing
tube insertion
■ [@] px on soft diet
● SEPTIC ARTHRITIS
■ [@] Check the NGT if the ulcerations are
● POLYNEUROPATHY AND MYOCARDITIS
blocking the membranes
○ Late manifestations
■ [@] monitor px bc ulcerations are sloughing
○ Includes dysphagia, dysarthria with
off, they are scraped by doctors to avoid
cranial nerve involvement (facial
aspiration
numbness), ciliary paralysis can lead to
heart failure causing death
○ Ventricular tachycardia, atrial fibrillation,
complete heart block </3
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PAHINGA MUNA, ADHARA! 6.4 NURSING DIAGNOSIS

● Pain (Edema in the neck)
● Alteration in comfort (myalgia)
● Body image disturbance (especially if may bullneck si
px)
● Risk for infection (ulceration because of the secondary
infections)
● Impaired skin integrity
○ [@] Observe good hygiene and clean bedsheets
● Impaired physical mobility
● Altered role performance (d/t disease process)
● Case reporting and contact tracing
○ [@] To prevent infection transmission
● Isolation: strict isolation for pharyngeal diphtheria,
Rest your eyes from the paper for at least 5-10 minutes <3 contact isolation for cutaneous diphtheria until 2
A well deserved rest for being studious and good today cultures from nose and throat are clear
(Di ka aso ha!) ○ [@] If tested positive, isolate immediately
6.2 DIAGNOSIS ○ [@] Sterilize utensils used
● Based on clinical signs and laboratory confirmations ● Quarantine: adult contact whose occupation involved
● Culture from site of infection/local lesions using handling food or close association with
Loffler’s/Tinsdale’s selective medium (to determine this non-immunized children
certain type of pathogen ○ [@] quarantine to prevent transmission of infection
6.3 MEDICAL MANAGEMENT ● Widespread immunization recommended
○ [@] DPT vaccination campaign
● Diphtheria antitoxin - critical management
● Full bedrest for 2 weeks
○ Horse antiserum, effective in reducing extent of
● Soft diet
local disease and risk of complications
○ [@] to prevent aspiration
○ Associated with reduced mortality risk
○ [@] children may be given jell-o or fruit juices
● Antimicrobial therapy - prevent transmission
because it’s fun to eat
○ Procaine Pen G 600,000u IM q12h until patient can
● Fruit juices rich in Vitamin C
swallow ell followed by Pen V 250mg QID
○ [@] Freshly squeezed juices is most preferred
○ Erythromycin 500mg IB q6h
● Ice collar
○ [@] for the ulceration that is susceptible to
○ [@] To relieve client from neck pain and edema
secondary infection
● Nose and throat care
Vaccination
○ [@]Do not use alcohol-based antiseptic
● DTaP
mouthwashes
○ Full level diphtheria and tetanus toxoids and
○ [@] Plain NSS and saltwater can be given
acellular pertussis vaccine, adsorbed
● Complete bed rest for 2 weeks after recovery
● Tdap
● Maintain patent airway (suctioning an positioning)
○ Tetanus toxoid, reduced diphtheria toxoid, and
○ [@] Maintain suction equipment at bedside
acellular pertussis for booster
○ [@] closely monitor during feeding
Treatment modalities based on:
○
● Overall health and medical history
○ [@] to determine presence of pseudomembranes 7. SARS (Severe Acute Respiratory Syndrome)
● Continuous monitoring of cardiac and respiratory ● Severe respiratory infection with associated GI
function manifestations
● Cardiac work up to assess possibility of myocarditis ● [@] Before covid became a pandemic, SARS was once
○ [@ ]May Consult with anesthesiologist a pandemic (they belong to one genome family)
○ [@] Monitor cardiac enzymes ● [@] Concurrent disinfection, PPE, gloves
● With extensive pseudomembranes, consult with ● First recognized in 2003, though to have originated in
anesthesiologist or EENT specialist for possibility of Guandong, China
tracheostomy or intubation ● Infectious agent: SARS Coronavirus (SARS COV)
○ [@] to promote airway for the patient ● MOT: person to person contact, droplet, fomites
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○ [@] no studies prove that this 1st variation is 7.2 MEDICAL MANAGEMENT
airborne, but still consider it airborne to prevent ● Supportive therapy
community from acquiring this ○ [@] symptomatology
CORONAVIRUSES ● Ribavirin- frequently used but demonstrates no
● Pleomorphic, single stranded RNA viruses beneficial effect
● Accounts for 10-35% of common colds ○ [@] According to studies, it does not have
● Natural reservoir maybe horseshoe bats and outbreak beneficial effect, but most likely slows down
from human contact with palm civets progression of disease
○ [@] Horseshoe bats are cat-like or fox-like
○ [@] China’s traditions have contributed widely to 7.3 NURSING MANAGEMENT
medicine by studying plants and animals even ● Identify all suspects and probable cases
before vaccines were invented ● Persons who arrive at the ED who require SARS
○ [@] Their traditions also included eating exotic assessment must be rapidly diverted to triage nurses
animals such as those mentioned above. Proper to minimize transmission and given a face mask
food handling and cooking is needed especially for ● Triage nurse must
these rarely eaten animals ○ Wear a facemask (pref one that provides filtration
● Causes common cold that infect ciliated epithelial of exposed air)
cells in the nasopharynx ○ Wash hands before and after contact with patient
● Viral replication leads to damage of ciliated cells and ○ Soiled gloves,used equipment properly taken care
induction of chemokines and interleukins of
○ [@] Came from an animal, mutation process is ■ [@] place in infectious bag, drench in chlorine
heavy because if antigen is present in the human overnight, then bury in soil
body, it won't be detected, humoral response is ■ [@] DO NOT leave out infectious material in
weakened, then antigen is formed the open
○ [@] Virus has the ability to mutate and replicate, bc ○ [@] Triage nurse should be in full PPE
it adapts to antibodies present in the px’s body, ● ISOLATION OF PROBABLE CASES
such as DNA/RNA modification, which results to ○ Negative pressure room with doors closed or
various strains ○ Single room with own bathroom or
SARS-COV ■ [@] teach the janitorial services to close toilet
● Infect cells of the respiratory tract via ACE- 2 receptors before flushing twice, baka tumalsik ang water
● Stable in feces and urine at room temperature for 1-2 at pwede pumunta sa skin
days to 4 days if with diarrhea ○ Cohort placement with independent air supply,
○ [@] Seen in feces and urine exhaust system and bathroom if no air supply
● Causes systemic illness found in the bloodstream, available: turn off A/C and windows opened
urine and (up to 2 mos) in the feces ● Strict universal precaution: airborne, droplet and
contact
7.1 CLINICAL MANIFESTATIONS ● DURING EPIDEMIC OR WITH PROBABLE CASE
○ [@] contact tracers should have PPE as well, but if
● Starts 2-7 days but may range until 2 weeks scarce resources, use face masks and face shields
● Systemic illness with fever ● ALL STAFF MUST:
● Malaise, Headache, myalgia, non productive cough, ○ Practice strict universal precautions
dyspnea ○ Face mask with appropriate respiratory protection
● Diarrhea (25%) ○ Single pair of gloves
● CXR reveals areas of consolidation (peripheral and ○ Eye protection
lower lung fields) ○ Disposable gown
○ [@] presence of infiltration (itim itim) in lung fields ○ Apron
● Severe cases: worsening respiratory function to ○ Footwear that can be decontaminated
respiratory distress to multi-organ dysfunction ○ [@] Same management as COVID-19
○ [@] usually causes of death in px’s with SARS-COV
Risk Factors
● Age >50 years old
○ [@]weak immune response against infection
● Comorbidities: DM, cardiovascular diseases, hepatitis
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8. INFLUENZA ● Incubation period: 1-2 days

● Acute viral diseases of the respiratory tract ● Systemic: fever 38-41 C, chills, HA, myalgia, malaise
● Infectious agent: influenza Viruses medium sized and anorexia
enveloped viruses with segmented RNA genome with ● Dry cough, nasal discharge, nasal obstruction,
two glycoproteins (H) hemagglutinin and (N) hoarseness, dry/sore throat
neuraminidase ● Respiratory: dry cough, nasal discharge, hoarseness,
● Reservoir: Humans, can be birds and mammals such dry/sore throat
as swine ○ [@] Influenza/flu - Continuous inflammatory
● MOT: Airborne spread response
○ [@] and droplets ○ [@] Nasal discharge coming from lacrimal duct of
patient
○ [@] Sore throat d/t scarring of throat or larynx
8.1 CLINICAL MANIFESTATIONS tissue
● [@] cold is usually a natural reaction to weather for ● Ocular: photophobia, tearing, burning and pain
example ○ [@] d/t hypothalamic activity because of
DIFFERENTIATING COLD AND FLU inflammation
Signs and Cold Flu ● Symptomatic treatment
symptoms ● Salicylates and salicylate-containing medications are
not advised for children
Symptoms onset Gradual Abrupt ○ [@] to control pain and fever but in children they
develop hypersensitivity reactions that may cause
Fever Rare Usual Reye syndrome
● Antiviral agents- oseltamivir and zanamivir
Aches Slight Usual ○ [@] Help fight influenza
● No antibiotic use - may use secondary infections
Chills Slight Unusual ○ [@] NOT a bacteria
○ [@] may develop antibiotic resistance
Fatigue, Uncommon Common
weakness REYE SYNDROME
● [@] delirium or amnesia during childhood
Sneezing Common Sometimes ● Encephalopathy, Hepatomegaly, VZV Infection
● NEEDS TWO CONDITIONS
Chest Mild to Moderate Common ○ Ongoing or post infection with influenza A or
Discomfort, varicella
Cough ○ Use of aspirin (salicylates) during illness
● S/Sx initial viral symptoms followed by
Stuffy nose Common Sometime ○ nausea and vomiting
○ change in mental status (amnesia, weakness,
Sore throat Common Sometimes vision and hearing changes which may progress to
coma) and liver damage (hepatomegaly may also
Headache Rare Common occur)
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9. COVID-19 9.1 CLINICAL MANIFESTATIONS

● COVID -19 is the diseases caused by a new ● Fever
coronavirus called SARS-COV-2 ● Dry Cough
○ [@] If invades the body, it can mutate into a new ● Fatigue
variant ● Other symptoms that are less common and may affect
● WHO first learned of this new virus on Dec. 31, 2019, some patient include
following a report of a cluster of cases of “viral ○ Loss of taste or smell
pneumonia in Wuhan, People’s Republic of China ○ Nasal congestion
○ [@] Aug-Oct 2019, there were cases of people in ○ Conjunctivitis (also known as red eyes)
China that abruptly faint out of nowhere, which ○ Sore Throat
they called back then “unknown disease” ○ Headache
○ [@] Storytime w/ sir law : ppl from China to HK, ○ Muscle or joint pain
nung nag-hotel siya, itong virus na to hindi pa nila ○ Different types of skin rash
MOT, di sila naka-face mask or face shield, kaya ○ Nausea or vomiting
nag spread. Pumunta sa london, america, kumalat ○ Diarrhea
na ○ Chills or Dizziness
● Incubation period ○ Irritability
○ The incubation period of covid-19 is though to ○ Confusion
extend to 14 days with a median time of 4-5 days ○ Reduced consciousness
from exposure to symptoms onset ○ Anxiety
○ Depression
Mode of Transmission ○ Sleep Disorders
● Droplets, airborne, direct contact ○ More severe and rare neurological complications
such as strokes, brain inflammation, delirium and
nerve damage
● Symptoms of severe COVID-19 disease include
○ Shortness of Appetite
○ Confusion
○ Persistent pain or pressure in the chest
○ High temperature (above 38 degrees)
● Among those who develop symptoms, most (about
80%) recover from the disease without needing
hospital treatment. About 15% become seriously ill and
require oxygen and 5% become critically ill and may
need intensive care.
● Complications leading to death may include
○ Respiratory failure
○ ARDS
○ Sepsis and Septic Shock
○ Thromboembolism
○ Multiorgan Failure(including injury of heart, liver, or
kidneys
Variants ● In rare situations, children can develop a severe
● Alpha B117 inflammatory syndrome a few weeks after infection
● BETA B1351
● GAMMA P1 9.2 DIAGNOSIS
● DELTA B16172 ● RT-PCR
○ [@] Highly transmissible ● Rapid antigen test
● LAMBDA ● Saliva test
● P.3 ○ [@] Quite controversial still because it still under
study
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9.3 MEDICAL MANAGEMENT You may be able to shorten your quarantine

● Minimum health protocol ● local , public health authorities make the final
● Case reporting / Contact tracing decisions about how long quarantine should last,
● Isolation/quarantine based on local conditions and needs. Follow the
● Intravenous (IV)Fluid recommendations of your local public health
● Oxygen therapy department if you need to quarantine. Options they will
● Fluid and electrolyte consider include stopping quarantine
● Corticosteroids ○ After day 10 without testing
● Vaccines ○ After day 7 after receiving a negative test result
● From DOH (test must occur on day 5 or later)
○ B-awal ang walang mask
○ I-sanitize ang mga kamay CITATION
○ D-umistansya ng isang metro ● (Professor Lawrence, August 2021)
○ A-lamin ang totoong impormasyon
9.4 NURSING DIAGNOSIS REFERENCES
● Same as influenza ● APA citation guide. (2016).
● [@] Manifestations http://www.bibme.org/citation-guide/apa/
QUARANTINE
● Quarantine if
○ you have been in close contact within 6 feet of
someone for a cumulative total of 15 minutes or
more over a 24 hour period with someone who has
Covid-19, unless you have been fully vaccinated
● People who are fully vaccinated do not need to
quarantine after they had contact with someone who
has Covid-19, unless they have symptoms should get
tested 3-5 days after exposure even without symptoms
wear a mask indoors in public for 14 days following
exposure or until test result is negative
WHAT TO DO
● Stay home 14 days after your last contact with a
person who has COVID-19.
● Watch out for fever (38 degrees) , cough, shortness of
breath, or other symptoms of covid- 19
● If possible, stay away from people you live with,
especially people who are at higher risk of getting very
sick from COVID 19
AFTER QUARANTINE
● Watch out for symptoms until 14 days after exposure
● If you have symptoms, immediately self isolate and
contact your local public health authority or healthcare
provider
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NCM112 SEXUALLY TRANSMITTED DISEASES
0w
OUTLINE
1. SEXUALLY TRANSMITTED DISEASES
1. Sexually Transmitted Diseases
1.1. Things to Consider ● The sexually transmitted diseases (STDs) are grouped
2. Gonorrhea together because sexual contact is epidemiologically
2.1. Pathophysiology significant, although it is not the only mechanism
2.1.1. Gonorrheal Ophthalmia Neonatorum through which the diseases are acquired.
2.2. Clinical Manifestation ○ [@] possible that a patient who has gonorrhea can
2.3. Diagnosis have other std since STD is a cluster of disease
2.4. Prevention because fighting cells are weak
2.5. Management ● [@] opportunistic = “madaling makapasok”
2.5.1. Medical
2.5.2. Nursing
2.6. Nursing Diagnosis 1.1 THINGS TO CONSIDER
3. Syphilis ● Patients with one diagnosis with STD are significantly
3.1. Pathophysiology likely to have others
3.1.1. Congenital Syphilis
● Patient education for risk reduction
3.3. Diagnosis ● Sexual partners of patients with STD are at high risk of
3.4. Prevention infection and are always evaluated
3.5. Management ○ [@] Partner must be honest since transmissible
3.5.1. Medical ● All patients must have completed treatment before
3.5.2. Nursing resuming unprotected sexual contact
3.6. Nursing Diagnosis ○ [@] Control sexual activity until treatment is done.
4. AIDS
● Always take a careful and complete sexual history
4.1.1. HIV Life Cycle ○ [@] You need to extract information from the
4.1.2. Common Opportunistic patient.
Microorganisms ● Never make assumptions regarding sexual orientation
4.2. Clinical Manifestations ● [@] “ABC, how would you like me to address you?”
4.2.1. Modified Classification (Stages Of ● [@] Never assume gender.
HIV Infection (US CDC) ● Assess for recent antibiotic use
4.3. Diagnosis
○ [@] to assess antibiotic resistance
4.4. Prevention
4.5. Management ○ [@] prophylaxis = need preventive measure
4.5.1. Medical [@]Those in higher income are more likely to have an STD
4.5.2. Nursing due to their lifestyle.
4.6. Nursing Diagnosis
5. Herpes
5.2.1. Modalities & Treatment
5.3. Diagnosis
5.4. Prevention
5.5. Management
5.5.1. Medical
5.5.2. Nursing
LEGEND
No logo - From [@] - Prof’s Notes [$] - From Book
PPT
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[@]STDs are also ↑ in low income because of prostitution.
2. GONORRHEA
● [@] known as “tulo”, with pus 2.1 PATHOPHYSIOLOGY
● A sexually transmitted infection (STI) of epithelium & ● ln about 20%; Uterine inversion happens
commonly manifests as cervicitis, urethritis, proctitis, & ○ During menstrual period, endometritis, salpingitis
conjunctivitis or pelvic peritonitis can risk infertility and ectopic
● [@] Found in moist areas pregnancy
● ln children over 1 year, considered as indicator of sexual ○ Septicemia occurs in 0.5-1%
abuse ○ Rarely the bacteria can enter the heart,
○ [@] A thorough interview is a must endocarditis, meningitis and arthritis
○ [@] If you interview children, always have a social
worker for legal action to happen 2.1.1 GONORRHEAL OPHTHALMIA NEONATORUM
○ [@] If you cannot extract information from child ask ● [@] Can be permanent if no treatment, kasi may scarring
help from your supervisor ● Acute redness and swelling of conjunctiva with
● Resistance to penicillin, quinolones and tetracycline is mucopurulent discharge
widespread ● May progress to corneal ulcer, perforation and
○ [@] Early to kill, but needs early treatment. blindness if not treated promptly
➔ CAUSATIVE AGENT: Neisseria gonorrhoeae ➔ MOT:
◆ Gram-negative, non-motile, non-spore forming ◆ Contact with infected birth canal during childbirth
◆ Exclusively a human pathogen ➔ RESERVOIR: Infection of maternal cervix
○ [@] mahilig sa basa since walang spore para sa ➔ INCUBATION PERIOD: 1-5 days
lubrication to evade
➔ MOT: 2.2 CLINICAL MANIFESTATIONS
◆ Contact with exudates from mucous membranes of MEN
infected people ● Acute Urethritis
○ [@] Wear gloves during procedures
◆ Transmitted (40-60% during unprotected sex);
↑ transmissions because of asymptomatic carriers
● [@]Not limited to wearing condom but also
those who do not know proper disposal of
condom
◆ Oropharyngeal gonorrhea occurs in 20% of women ● Urethral discharge - starts scant and mucoid then
who practice fellatio becomes profuse and purulent
● [@] Fellatio - Oral sex ● Dysuria
◆ Increased transmission because of asymptomatic Figure 2. “Example of Dysuria”
carriers FEMALE
● [@] Only way to know if the patient has this is ● Cervicitis
to assess the genitalia. ○ Vaginal discharge - mucopurulent
➔ RESERVOIR: Humans ○ [@]pathognomonic sign
➔ INCUBATION PERIOD: 2-7 Days ○ Dysuria
➔ PERIOD OF COMMUNICABILITY: ○ Dyspareunia, abnormal vaginal bleeding due to
[@]Until it is treated because it stays in the blood scarring
[@]Blood test is done to see if antigen is present ○ [@] Can be thought of us menstrual blood
◆ Extend for months if untreated; effective treatment ○ Lower abdominal and back pain
ends communicability within hours ○ [@] Means that bacteria has ascended to
the kidney.
○ Pyuria
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○ Urethritis ■ [@] Gently remove it from the penis and tie it
then dispose in infectious bin or somewhere
children cannot have access to it
● Intensive case finding
○ [@] Thorough case finding and tracing because
some patients are not open about disclosing sexual
history.
○ [@] Highly preventable
○ [@] Explain to the patient so they can open up
Figure 3. “Example of Urethritis”
● Vaginitis 2.5 MANAGEMENT
○ @] If left untreated, can lead to vaginitis ● TREATMENT
○ May occurs in an estrogenic women (prepuberty/ ○ Case reporting
menopausal) ○ Contact isolation for all newborn infants and
■ [@] Because there’s no lubrication yet that can prepubertal children until effective parenteral
cause scarring antimicrobial therapy for 24 hours
■ [@]The bacteria prevents lubrication ○ Concurrent disinfection
○ Painful, edematous, reddish vaginal mucosa ○ [@] Especially the underwear of patients. Teach
○ May be accompanied by Skene's and Bartholin's them to clean it properly by soaking it in
glands infection detergent and chlorine for 15 minutes. Properly
○ Cervical erosion and abscesses dry it off.
○ Quarantine and immunizations are not applicable
2.3 DIAGNOSTIC TESTS
● Gram stain of discharges (urethral & cervical smears
with 90-97% specificity)
● Bacteriological culture (Thayer Martin agar)
○ [@] Kinukuhanan ng pus and smear
2.4 PREVENTION
GONORRHEAL OPHTHALMIA NEONATORUM
● Emphasis on early detection and effective treatment
● Provision of health and sex instruction
■ [@] Health teaching about this.
Figure No. 4. “Maternal STI Risk Assessment (DOH)”
○ Delays sexual activity until the onset of sexual ● [@] to determine if patient has a chance to have STD or
maturity. can pass STD to child
■ [@] Teach children especially teenagers = do
not engage for sexual activities
2.5.1 MEDICAL
○ Mutually monogamous relationship/ reduction of
● TREATMENT OF CHOICE
sexual partners
○ GENERAL (2010 CDC)
■ [@] The couple must be honest and faithful to ■ Ceftriaxone 250mg IM
prevent such infection ■ Cefixime 400 mg PO
○ Methods of personal prophylaxis for sex workers ○ PREGNANT WOMEN (DOH)
■ [@] Some countries legalised prostitution ■ Cefixime 400 mg PO
■ [@] In the form of antibiotics. ■ Ceftriaxone 250 mg IM + Amoxicillin 500 mg
○ Correct and consistent use of condoms TID PO
○ NEWBORN
■ [@]Teach how to dispose of it properly.
■ 1% silver nitrate solution
● [@]Drop in eyes of baby
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■ Erythromycin/Tetracycline ointments ➔ PERIOD OF COMMUNICABILITY: Present until with
● [@] Apply on the inner to outer canthus of moist mucocutaneous lesions (primary or secondary)
the newborn’s eye ● [@]Until bacteria is present in the body.
2.6 NURSING DIAGNOSIS

● Altered sexuality pattern
○ [@] Di mageengage sa sexual activities until 3.1 PATHOPHYSIOLOGY
matapos ang course of treatment Syphilis organisms rapidly penetrates intact Mucous
● Social isolation membranes or microscopic dermant abrasion
● Knowledge deficit
↓
○ [@] Deficient knowledge about treatment and
management. Enters the lymphatics and blood
● Altered urinary elimination ↓
○ [@] Since painful ang urination. Include in health
educ to increase fluids to help in elimination Produce systemic infection
● Risk for infection ↓
○ [@]Risk for transmitting the infection to others.
CNS is invaded early in the infection; abnormal finding in
CSF
3. SYPHILIS/ VENEREAL SYPHILIS
● Chronic systemic infection caused by Treponema ↓
pallidum subspecies pallidum, is usually sexually 5-10 yrs after the onset of untreated primary infection
transmitted and is characterized by episodes of active
disease interrupted by periods of latency
↓
Involves the meninges and blood vessel
↓
Meningovascular neurosyphilis
● [@]Also became prevalent in the Philippines. ↓

● [@]Symptoms may stop from occurring which may Later stage, parenchymatous neurosyphilis
lead the patient to think that s/he is healed. ________________________________________________________
➔ CAUSATIVE AGENT: Spirochete (Treponema pallidum)
◆ Thin spiral organism, motile
Stage Onset of Signs & Duration of
◆ [@] The MO can travel inside the body as far as the infection Symptoms symptoms
meninges.
➔ MOT: Primary 21 days Painless 2-6 weeks
◆ Direct contact with infectious exudates from early (range 10-90 genital ulcer
lesions of skin and mucous membranes; days)
Transplacental injection; Blood transfusion
Secondary 3 weeks - 3 Skin rash 2-6 weeks
◆ [@] wear gloves during procedures months Fever
➔ RESERVOIR: Humans Muscle pain
➔ INCUBATION PERIOD: 10 days-3 mos, usually 3 weeks Latent phase:
no symptoms
Tertiary Several years Neurosyphilis Years

Scan me to several (brain and
decades after spinal cord)
→ infection Cardiac
syphilis
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(heart)
Late Benign
syphilis
(skin)
Table No. 1. “Stages of Syphilis Infection”
3.1.1 CONGENITAL SYPHILIS Figure No. 6. “Chancre”

● Transmits across the placenta from a syphilitic woman ● PRIMARY
to her fetus ○ Single painless papule (chancre) usually found in
● Fetal damage occurs starting on the 2nd trimester (4th penis, and canal, cervix, labia- indurated with
month) serous exudate
■ [@] chancre: pathognomonic sign
3.2 CLINICAL MANIFESTATIONS ○ Followed by firm non fluctuant painless satellite
● CONGENITAL lymph node (bubo)
○ Early: (within 2 years) rhinitis, mucocutaneous ● SECONDARY
lesions, bone changes, hepatosplenomegaly, ○ Mucocutaneous lesions
lymphadenopathy, anemia, jaundice, ○ Generalized lymphadenopathy
thrombocytopenia, leukocytosis ○ Skin rash
■ [@] May occur in any epithelial cells ■ symmetrical maculopapular rash involving the
○ Late: interstitial keratitis, CN VIII deafness, palms and soles
recurrent arthropathy ○ Rare: lues maligna
○ Classic Stigmata: Hutchinson's teeth, mulberry ■ [@] Happens when the patient has HIV
molars, saddle nose and saber shins ■ Severe necrotic lesions (common in HIV
■ [@] Destroys bone formation of the baby. patients)
■ [@] Saber shins can still be corrected as long ■ [@] Can be a secondary infection
as it is still early and the bone is not yet fully ■ [@] Opportunistic infection
grown. ○ Papules may enlarge to produce moist, pink to
gray-white highly infectious lesions - condylomata
lata
■ [@] Also likes moist surfaces.
○ Mucous patches
■ Superficial mucosal erosions painless and
silver gray with red periphery
● LATENT
○ (+) serologic test + normal CSF + NO CLINICAL
Figure No. 5. “Congenital Syphilis”
MANIFESTATION
○ EARLY LATENT - within the first year of infection
○ LATE BENIGN (Gumma) - lesion of more than 1 year
duration
○ [@] Can reoccur, may require a higher dosage of
medications
● LATE
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○ Neurosyphilis
■ Asymptomatic
- CSF abnormalities
- Mononuclear pleocytosis (increased
leukocytes), increased protein, CSF
reactivity
■ Symptomatic
● Meningeal
- Headache, nausea, vomiting, neck
stiffness, cranial nerve involvement, Figure No. 7. “Signs & Symptoms of Syphilis”
seizures, changes in mental status
- [@]Expect for meningeal irritation. “EASY WAY OUT”
● Meningovascular “PARESIS” for neurosyphilis
- meningitis + inflammatory vasculitis P - Personality (mood swings)
(stroke syndrome - MCA of sa young A - Affect (facial expressions doesn’t match the patient’s
adult) emotions)
- [@] since malapit yung utak sa heart R - Reflexes (HYPERACTIVE)
● [@] because of loss of myelin sheath that causes
● Parenchymatous surge in impulses
○ General paresis E - Eye (ARGYLL ROBERTSON PUPILS - pupils are not
○ Tabes Dorsalis reactive to light, do not constrict)
➔ Demyelination of ganglia S - Sensorium
➔ Ataxic wide-based gait (parang ● [@] altered = patient can be in comatose; patient is
sakang; lasing mag walk) disoriented; patient may have hallucinations,
➔ Foot drop (loss of foot function) confusions)
➔ [@]Parang nawalan ng joint or I - Intellect
bone yung foot S - Speech (slurred speech, unable to talk due to a
➔ Paresthesia (numbness to loss of dysfunction on the glossopharyngeal nerve)
sensation) ○ Cardiovascular Syphilis
➔ Bladder disturbance (altered
urination)
➔ Impotence (absence of genitalia
sensation)
➔ Areflexia (absence of reflexes)
➔ Loss of positional and deep pain
and temperature sensations (risk
for injury)
■ Appears 10-40 years after infection
● [@] May destroy/block valves of the heart
which can cause regurgitation of blood to
lungs which can cause pulmonary
congestion
● [@] Listen to abnormal heart sounds.
■ s/sx: endarteritis obliterans, uncomplicated
aortitis, aortic regurgitation, saccular
aneurysm, coronary ostial stenosis
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Primary, Pen G Benzathine Tetracycline HCI

3.3 DIAGNOSIS secondary, early (single dose Doxycycline for 2
CASE DEFINITION: DOH latent 2.4mU IM) weeks
● PROBABLE CASE
Late latent. Pen G. Benzathine Tetracycline HCI
○ Infant whose mother had untreated/ inadequately
Cardiovascular. (2.4 mU IM weekly Doxycycline for 4
treated syphilis Benign tertiary for 3 weeks) weeks
○ Infant with a reactive treponemal test and any of the
ff: with manifestations, long bone x-rays, VDRL- Neurosyphilis Aqueous Desensitization and
CSF, reactive IgM ELISA (with abnormal crystalline Pen G treatment with Pen
CSF findings) for 10-14 days G
Aqueous procaine
● CONFIRMED:
pen G
○ Demonstration of T. Pallidum by darkfield
microscopy, fluorescent antibody. specimen stains Syphillic Mother Benzathine Erythromycin 500
from lesions, placenta, umbilical cord, autopsy and partner Penicillin, 2.4 mU mg QID for 15 days
material IM, SD
○ [@] Looks neon light under the microscope Table No. 2. “Specific Treatment of Each Stage”
○ [@] Placenta and umbilical cord can also be used
for culture of specimens. 3.5.2. NURSING MANAGEMENT
● Stress the importance of completing the treatment
3.4 PREVENTION
● Instruct infected individual to inform their partner for
● The only way to avoid STDs is to not have vaginal, anal, possible treatment
or oral sex.
○ [@] Encourage them to be honest to their partner
● If sexually active, the following lowers the chances of
getting syphilis: because they also need to be treated.
○ Being in a long-term mutually monogamous ● Universal precaution
relationship with a partner who has been tested for ● Secondary syphilis - keep lesions dry and clean
syphilis and does not have syphilis; ● Cardiovascular syphilis - check for signs of decrease
○ Using latex condoms the right way; sometimes CO & pulmonary congestion (may cause pulmonary
sores occur in areas not covered by a condom.
arrest leading to death; to prevent blood
Contact with these sores can still transmit syphilis.
regurgitation/backflow of blood in the heart)
3.5 MANAGEMENT
● [@]Check for riles.
● TREATMENT
○ Case reporting
○ Isolation: avoid intimate contact and contamination
● Altered sexual pattern
of environment until lesions healed
● Self-esteem disturbance
○ [@] Even hugging and kissing
● Social isolation
○ Concurrent disinfection
○ [@] Especially underwear
○ Quarantine and immunization not applicable
● Anxiety
○ Treat all family contacts
● [@] same with gonorrhea
○ [@] For possible direct transmission d/t the
lesion
3.5.1 MEDICAL
STAGES WITHOUT WITH ALLERGY TO

ALLERGY PENICILLIN
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Figure No. 7. “Modes of Transmission Among Newly

Diagnosed Cases, January 2019”
Photo Credit: Art by Alyssa Adasa on FB
4. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

● HIV is a virus spread through certain body fluids that
attacks the body's immune system, specifically the CD4
cells, often called T cells
[@] CD4- directly attacked by the virus soldiers of
the body, which fights antigens (cluster of
differentiation #4)
- [@] Consider the virus as a hacker and
copies the information then integrate it
and readies to transform into a normal cell
(IMPOSTER)
- [@] Body can no longer recognize the Table No. 2. “Summary of HIV Diagnoses & Deaths”
normal cells due to the mutilated
replicated CD4+
● Untreated, HIV reduces the number of CD4 cells (T
cells) in the body. This damage to the immune system
makes it harder and harder for the body to fight off
infections and some other diseases.
● Opportunistic infections or cancers take advantage of a
very weak immune system and signal that the person
has AIDS
➔ CAUSATIVE AGENT: Human Immunodeficiency Virus,

retrovirus
➔ MOT:
◆ Direct contact (unprotected intercourse, contact
with body secretions, sharing needles, Figure No. 8. “1993 Revised Classification System For Hiv
transplantation, vertical transmission (which is Infection And Expanded Aids Surveillance Case Definition
blood transfusion) For Adolescents And Adults”
➔ EPIDEMIOLOGY
◆ RESERVOIR: Humans 4.1 PATHOPHYSIOLOGY
◆ INCUBATION PERIOD: <1 to 15+ years (CDC, 2012)
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a. [@] The HIV is introduced to the body
2. Fusion
a. [@] Will directly fuse itself to the CD4 cells
ignoring the macrophages
3. Reverse transcription
a. [@] Hacker - will inject protease and
transcriptase in the RNA of CD4
4. Integration
a. [@] If the virus has captured the data inside
the RNA and DNA it will apply it to itself
(IMPOSTER or like Mystique from X-Men)
5. Transcription
a. [@] Copy the normal cell of the patient
6. Translation
a. [@] Repeat the process of reverse
transcription
7. Cleavage
a. [@] Preparation to multiply, splitting into
two cells
8. Assembly and Release
a. [@] It will now be distributed in the different
organs of the body like the heart and brain
** GP41 attaches itself to the CD4 b. [@] There is no way to increase the body’s
immune system with the virus present, so
treatments are more of trying to slow down
the transcription - translation phase.
4.1.2. COMMON OPPORTUNISTIC MICROORGANISMS

4.1.1.HIV LIFE CYCLE ● Bacterial
○ mycobacterium avium complex (MAC)
■ TB manifestation - CD4 is less than 50
○ Tuberculosis
○ salmonellosis
● Viral
○ Herpes
○ Hepatitis
○ genital warts
○ cytomegalovirus (CMV) - retinitis, pain on
swallowing, numbness of legs, can be transmitted
to semen, vagina, secretions, blood & breast milk
○ molluscum contagiosum
● Fungal
○ Candidiasis
1. Attachment ○ cryptococcal meningitis
■ [@] Fungal infection of meninges
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○ histoplasmosis - skin lesion (direct contact) ○ Persistent cough for 1 month
■ [@] Wear gloves upon checking the skin ○ Generalized pruritic dermatitis
○ Recurrent herpes zoster
● Pneumonias ○ Oropharyngeal candidiasis
○ Bacterial ○ Chronic disseminated herpes simplex
○ pneumocystis carinii pneumonia (PCP) ○ Generalized lymphadenopathy
■ [@] Parasitic pneumonia
● MAJOR SIGNS:
● Cancers ○ More than 10% loss of weight
○ kaposi's sarcoma - cancerous lesion ○ More than 1 month diarrhea
○ Cervical dysplasia & cancer - associated w/ Human
Papilloma virus (HPV)
○ Non-Hodgkin's lymphoma - cancerous tumor in
lymph nodes, late manifestation of HIV infection
Figure No. 9. “Kaposi’s Sarcoma”
● Parasitic ○ Fever for 1 month

○ toxoplasmosis - parasitic infection that causes ■ [@] If CD4 is already 50, it is on the severe
neurological symptoms stage.
■ [@] administer antiparasitic agents
○ Cryptosporidiosis - parasite Cryptosporidium 4.2.1. MODIFIED CLASSIFICATION (STAGES OF HIV
"crypto" INFECTION (US CDC)
4.2 CLINICAL MANIFESTATIONS Clinical stage I: Asymptomatic
● May exhibit neurological symptoms; memory loss, ● acute HIV infection characterized by general
altered gait, depression, sleep disorders & GIT lymphadenopathy
symptoms - often called AIDS-related complex (ARC)
○ Px CD4 counts have dropped to become CD4 count: Clinical Stage 2: Early (Mild)
500-1500 (this is already the normal range for the ● weight loss greater than 10%
infected px) ○ [@] Excessive consumption of ATP
○ Normal viral load: less than 10,000 Clinical Stage 3: Intermediate (Moderate):
● weight loss (greater than 10%)
● MINOR MUCOCUTANEOUS MANIFESTATIONS: ● diarrhea (more than a month)
○ Seborrheic dermatitis ○ [@] Indicative of GIT infection
○ Fungal nail infection ● oral candidiasis (thrush)
○ Recurrent oral infection ○ [@] Mouth sores that are ulcerated already
○ [@] mouth sores ● oral hairy leukoplakia
○ Angular cheilitis ○ [@] Caused by a fungus; white hair on the
○ [@] Bleeding mouth sores tongue
○ Recurrent respiratory infection ● severe bacterial infection (e.g. Pneumonia)
○ [@] prone to colds
○ [@] Due to low CD4+ Clinical stage 4: Late (severe) AIDS:
● HIV wasting syndrome
● SIGNS AND SYMPTOMS (Cryptosporidiosis) ○ [@] Px that have diarrhea, and other
○ watery diarrhea, abdominal cramps, low grade neurologic deficits, or the changes in
○ fever, weight loss personality
● MINOR SIGNS: ● Pneumonia
[@] opportunistic infection due to decreased CD4 counts in ○ [@] Can be viral or bacterial pneumonia
the body) ● toxoplasmosis of the brain
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○ [@] Infection in the neurons ● HIV antibody test
○ Caused of ARC (age-related complex) ○ HIV not detectable "negative (-) antibody test"
○ HIV detectable "positive (+) antibody test-HIV
● cryptosporidiosis w/ diarrhea for more a month positive"
● herpes simplex
● multifocal leukoencephalopathy 4.4 PREVENTION
○ [@] Can cause altered sensation, amnesia ● avoid accidental pricks
● disseminated endemic mycoses ● gloves-in handling blood specimen & other secretions
○ [@] Fungus infection ● labeled specimen w/ AIDS precaution
● don't clean spilled blood w/ household disinfectants
● dispose needle in to puncture-resistant container
4.5 MANAGEMENT
● Case reporting
● isolation: unnecessary and ineffective
○ [@] Unless airborne or droplets then we will now
provide isolation
● Quarantine and immunization not applicable
4 CS IN THE MANAGEMENT OF HIV/AIDS:

Figure No. 10. “Immune Response by White Blood Cells” ● Compliance - client sticks w/ the program
● Counseling/education
a. instructions about treatment
b. disseminating information about the disease
c. guidance to avoid STD
d. sharing facts about HIV & AIDS
● Contact tracing - providing treatment to partners
● Condoms - providing information about the proper use
and disposal of the used condom
4.5.1 MEDICAL
● ANTIRETROVIRAL THERAPY Targets and inhibits HIV
specific enzymes.
Figure No. 11. “Stages of Infection” (GOAL: suppress viral load to undetectable levels)
○ Reverse-transcriptase inhibitors
4.3 DIAGNOSIS ○ Protease inhibitors
● EIA or ELISA ○ Integrase inhibitors
○ [@] If tested negative, patient does not need to do ● CCR5 antagonists
Western blot analysis ○ Entry inhibitors
● Particle agglutination (PA) test ■ Maraviroc
● Western blot analysis - confirmatory ■ Enfuvirtide
● Immunofluorescent test ■ Raltegravir
● Radio immuno-precipitation assay (RIPA) ● REVERSE TRANSCRIPTASE (Depends on the severity of
○ Given to identify what type of opportunistic the infection)
MO is present ○ Zidovudine
○ Similar to Finger Prick ○ Stavudine
○ Tenofovir
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● PROTEASE INHIBITORS ● Knowledge deficit
■ Saquinavir ● Anxiety
■ Ritonavir ● Altered role performance
■ Tipranavir
GOAL: IS TO SLOW DOWN THE TRANSCRIPTION PHASE PAHINGA MUNA, ADHARA!
4.5.2. NURSING 5. HERPES

1. Health education HERPES SIMPLEX (simple lesions)
○ practical advise ● viral disease characterized by the appearance of sores
○ health teaching about MOT & blisters anywhere on the skin "virus of love"
○ emphasize the "AIDS Awareness Program" ○ [@] also known as kissing disease since
○ avoid judgmental & moralistic messages commonly transmitted via kissing
○ consistent & concise in giving instructions ● related to the viruses that cause infectious
○ Use positive statement mononucleosis (Epstein-Barr virus), chicken pox &
i. [@] But not false reassurance shingles
○ Proper management for previous contacts ➔ CAUSATIVE AGENT: herpes simplex virus (HSV)
i. [@] Handwashing and good hygiene ➔ MOT: Direct Contact, Through droplet, Airborne
2. Practice universal/standard precaution ➔ RESERVOIR: Humans
○ thorough medical hand washing before & after ➔ INCUBATION PERIOD: initial herpes infection is 4 days
handling/entering room of the suspected patient (range, 2 to 12) after exposure (CDC, 2021)
○ Universal barriers or PPE's ➔ PERIOD OF COMMUNICABILITY: [$] transmission of
3. Prevention HSV takes place mainly during the active phase but
occasionally may occur during the latent phase due to
Scan me subclinical virus shredding.
→ ● [$] Condoms and antiviral therapies reduce the risk
of transmission, BUT do not prevent it completely
➔ PATHOGNOMONIC SIGN: Cold sores
○ Avoid accidental pricks
HERPES ZOSTER (Shingles)
○ Gloves - in handling blood specimen and other
➔ CAUSATIVE AGENT: caused by the same virus caused
secretions
by chickenpox (varicella-zoster virus)
○ Labeled specimen with AIDS precaution
[@] With shingles, blisters are unilateral while with
○ Don’t clean spilled blood with household
chickenpox, it is scattered all over the body
disinfectants
➔ MOT: DIRECT CONTACT, Droplet, Airborne
○ Dispose needle in to puncture-resistant container
➔ RESERVOIR:
○ Do not share personal belongings
➔ INCUBATION PERIOD: unknown, believed to 13-17days
○ Isolation
➔ PERIOD OF COMMUNICABILITY:
○ Risk for HIV - no blood donation or organ donor
◆ A day before the appearance of the first rash until
○ Encourage monogamous relationship
5-6 days after the last crust disappears
○ HIV-infected pregnant women - regular prenatal,
◆ [@] Highly communicable
intrapartal and postpartal care
○ Speaks openly with partners about safer sex
techniques and HIV status

● Risk for infection
● Self-esteem disturbance
5.1 PATHOPHYSIOLOGY
● Social isolation
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● HERPES SIMPLEX ■ vesicular & ulcerative lesion- buccal mucosa &
- Herpes lesion: Found on the penile shaft (male), tongue
vagina, vulva, cervix (female) & around anus ■ inflammation of gums, cervical adenopathy &
fever
■ excessive salivation
■ painful feeding & poor fluid intake
2. Labial herpes
○ "cold sores" or fever blisters"
Type 1 virus:
3. Ocular herpes
○ Herpetic keratitis may lead to loss of vision
○ More serious if the stoma is involved or
irridocyclitis
○ Cause cold sores to infant & childhood (tiny, clear,

fluid-filled blisters), affects the lips, mouth, nose,
chin or cheeks shortly after exposure
4. Cutaneous herpes
○ May barely notice the symptoms or need medical
○ deep burning pain, fever, skin edema,
attention
○ ascending lymphangitis & regional
○ Transmitted by kissing & sharing kitchen utensils &
○ lymphadenopathy
towels
○ Sores (primary infection appear) 2-20 days after
5. Erythema multiform
contact
○ allergic reaction - complication of HSV infection
Type 2 virus:
○ [@] Unnoticeable
6. Genital herpes
○ Causes genital sores - buttocks, penis, vagina or
○ most common sexually transmitted disease
cervix (2-20 days)
7. Severe to fatal disease:
○ Through sexual contact
○ Newborns - acquired from maternal infection
○ Also spread by touching herpes lesion
○ Eczema varicelliform eruption
○ Minor rash, itching & painful sores, fever, muscular
○ Encephalitis - most common non-epidemic forms
pain & burning sensation during urination
● HERPES ZOSTER (Shingles)

○ Thoracic segment commonly involved
○ May affect the extremities & branches to the 5th
(Trigeminal) & 7th (Facial) cranial nerves
■ [@] May result to paralysis

● HERPES SIMPLEX
1. Mild to moderate
○ Oral herpes
■ gingivostomatitis - most common to young
children
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○ Affects the ganglion of the posterior nerve roots or 5.3 DIAGNOSIS
extramedullary cranial nerve ganglion ● Characteristic of the skin may be diagnostic
○ Erythematous skin, followed by appearance of ● Tissue culture technique
vesicles w/in 24hours (may lasts 1-2 weeks) ○ [@] To determine where the infection came from
○ Pain - 5 days prior development of rash & is ● Smear of vesicle fluid
neuralgic & paroxysmal in type (burning & ● Microscopy
stabbing), worse at night & intensified by
movement
5.4 PREVENTION
● Personal Hygiene
● Universal Precaution
● Restoration of F&E
5.5 MANAGEMENT
● Isolation - esp. eczema herpeticum or neonatal herpes
○ fever, malaise, anorexia and HA brought about by 5.5.1 MEDICAL

inflammatory process (1 or more days) ● HERPES ZOSTER (Shingles)
○ Regional lymph nodes (early stage of the disease) Modalities of treatment:
○ Ophthalmic (5th cranial nerve) is affected, with 1. Symptomatic
"Gasserian ganglionitis" 2. Oral antiviral drugs (acyclovir, famciclovir or
■ [@] inflammation of ganglion valacyclovir)
○ Paralysis of the facial nerve & vesicles affects 7th 3. Analgesics (for pain)
cranial nerve "Ramsay -Hunt Syndrome" a. [@] diversional therapy for children
4. Anti-inflammatory
5.5.2. NURSING MANAGEMENT

● Keep comfortable
5.2.1 MODALITIES AND TREATMENT (HERPES)
○ [@] Teach the patient to shower regularly
HERPES SIMPLEX
○ [@] Bed making is done to avoid wrinkled sheets
● Oral antiviral drugs
since this may irritate patient’s skin
○ Acyclovir
● Meticulous skin care
○ Famciclovir
○ No need for alcohol based skin care products
○ Valacyclovir
● Apply cool, wet dressings w/ NSS to pruritic lesions
● Personal hygiene
● Prevent secondary infection
○ Soap and water is enough; no need to use
○ [@] by keeping skin clean and dry
alcohol based products
● Prevent entrance of microorganism into the lesion
● Restoration of F&E
● Pain reliever
● Isolation - esp. Eczema Herpeticum or Neonatal
● Bed rest
Herpes
● Diversional activities
● Universal precaution
○ [@] Especially for children feeling pain, give play
therapy.
HERPES ZOSTER (SHINGLES)
○ [@] Relaxation technique, guided imagery for
● Symptomatic
adults.
● Antiviral drugs
● Analgesics
● Anti-inflammatory
ADHARA 2023
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REFERENCES
● Flores, L. (August, 2021). Sexually Transmitted
Disease [PowerPoint slides]. College of Nursing,
UERMMMCI
● Kumar, V., Abbas, A. K., & Aster, J. C. (2017).
Robbins Basic Pathology (10th ed.). Elsevier -
Health Sciences Division.
● Centers for Disease Control and Prevention. (2021,
July 22). STD facts - genital herpes (detailed
version). Centers for Disease Control and
Prevention.https://www.cdc.gov/std/herpes/stdfa
ct-herpes-detailed.htm.
● Centers for Disease Control and Prevention. (2012,
May 18). Principles of epidemiology. Centers for
Disease Control and Prevention.
https://www.cdc.gov/csels/dsepd/ss1978/lesson
1/section9.html.
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INTRODUCTION TO INFECTIOUS, INFLAMMATORY, AND IMMUNOLOGIC RESPONSE
NCM 112 MEDICAL SURGICAL NURSING

filter air that we inhale. Forms
“The human body is continually exposed to a large mucus then cough reflex happens
variety of conditions that result in damage.” para malabas yung MOs. inhaled.
Collect MOs → cough
PART I: HUMAN DEFENSE MECHANISM
■ NORMAL MICROBIOME
● Colonies of MOs found in each
Types
surface of the mucous membrane
● INNATE IMMUNITY - natural/ native
● Do not normally cause disease
immunity ; what we have na from
● Normal flora
conception pa lang (while living sa tiyan ng
● Functions
nanay natin)
○ GI - facilitates digestion,
○ Form the first line of defense at the
production of vitamins K and B
body’s surface and in place at birth
○ Production of chemicals toxic to
○ Includes physical, mechanical and
pathogens
biochemical barriers and inflammation
○ Compete with pathogens and
● ADAPTIVE IMMUNITY - acquired/ specific
block attachment to skin
immunity; Example: Body has formed
■ Sloughing of the skin, it's not
antibodies to fight off the disease in case na
just old skin cell but with
magkaroon ulit nung certain na sakit.
killed pathogens
■ Relative slower and targets specific
○ INFLAMMATION
invading MOs
■ Second line of defense
● INNATE IMMUNITY cont.
■ Programmed to respond to cellular or
○ PHYSICAL & MECHANICAL BARRIERS
tissue damage
■ Cover the external parts of the human
■ Inflammatory response is a rapid
body
initiation of an interactive system of
■ First line of defense
humoral and cellular systems
■ Includes
■ Occurs in a vascular tissues,
● Tightly associated epithelial cells of
nonspecific and rapid
the skin
● Linings of the GI, GU and
respiratory tracts
■ EPITHELIAL CELL -derived chemicals
that kill or inhibit growth of MOs
● LYSOZYME - found in sweat, saliva
and tears
● CATHELICIDINS and DEFENSINS -
found in epithelial cells
● COLLECTINS - family of
glycoproteins in the lungs; Helps
ADHARA 2023 1

*Prostaglandin - dolor - prescribe NSAID,
Macrophage and mast cells stimulate RBC to salicylates
go to the injured tissue to bring important *Arachidonic acid - if there is massive response in
chemical that is important for clotting the px - corticosteroid
mechanism → vasodilation → clotting

factors, collagen special proteins and
We will only give drugs if there is massive or
chemical release of chemokine to kill and
aggressive inflammatory response because
engulf the MO (phagocytosis) → neutrophils otherwise, autoimmune response (?)
and macrophages to further phagocyte and
heal the injured tissue INFLAMMATORY EXUDATES Mga napatay na
pathogens forming into diff kinds of exudates
below:
● Serous → clean water
● Fibrinous → amount of fibrinogen
○ Yellow pigment afterdun sa mga
sugat (undergo healing)
● Catarrhal → cloudy mucus
○ phlegm, sipon, tenga
● Purulent → yellow or green/ opaque
discharge
● Hemorrhagic → presence of RBCs
(hemorrhagic exudate - black pag
natuyo)
TYPES OF INFLAMMATION
● ACUTE - self limiting, continue until
threats to the host is eliminated, 8-10
days duration
● CHRONIC - may persist to 2 weeks or
months
(saan pwede magwork yung medicines na

CARDINAL SIGNS OF INFLAMMATION
piniprescribe ng doctor)
Pain heat redness swelling loss o f function
*Histamine - promote capillary permeability - if
aggressive react - antihistamine
ACUTE INFLAMMATION
*Vasodilation - increase blood flow and heat
● PRIMARY SYSTEMIC CHANGES
production
(Calor - heat)
ADHARA 2023 2

○ Fever - induced by cytokines and ○ Primary intention - wound
chemical mediators margins are neatly approximated
○ Leukocytosis (Increased production (Ex:Namuong dugo sa sugat)
of WBC) ○ Secondary intention - irregular
○ Increased levels of circulation wound margins and extensive
plasma proteins for clotting tissue loss
process helping in tissue healing ■ Burnt px
○ Tertiary intention - two layers of
granulation tissue together
■ Medical intervention
■ Surgical intervention
*Strengthening of scar
PHASE OF PRIMARY INTENTION
Phases Duration Description
Initial 3-5 days Approximatio

CHRONIC INFLAMMATION n of incision
● Preceded by unsuccessful acute edges,
inflammatory response migration of
● characterized by epithelial
○ Pus formation cells, clot of
○ Suppuration [purulent discharge] starting
capillary
○ Incomplete wound healing
growth, -
○ Granuloma formation SCAB
● Common in burnt px, if the debris is
Granulation 5 days to 4 Migration of
not completely removed → incomplete
weeks fibroblast,
wound healing → pus → complication secretion of
collagen (like
HEALING PROCESS fish), clotting
● Final phase of the inflammatory process mechanism
● COMPONENTS
Maturation / 7 days to Remodeling
○ Regeneration - replacement of lost scar several of collagen,
cells and tissues formation months strengthening
○ Repair - results in scar formation of scar
● REPAIR HEALING TYPES
If
inadequate
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● ANTIBODIES - circulate the blood and
collagen →
defend against extracellular microbes and
it may last
toxins (nirerelease ng katawan)
longer
Depends on ● T-LYMPHOCYTES (thymus derived) -
clotting develops into subsets
factor, ○ T-cytotoxic cells from CD8 -
proteins, identify and kill target cells
amino acids ○ T-helper cells from CD4 -
etc.
regulate immune response, ilang
cytotoxic cells lang ang
***During sleeping → increase immunologic
palalabasin para i combat and
response
infection. Otherwise →
autoimmune response →
ADAPTIVE IMMUNITY
(dito nakuha yung concept ng vaccine kasi it helps detrimental → complication
the body system to remember na nakapasok na siya dahil nakikisanib na sila sa
sa katawan) antigen to fight their own
● Third line of defense family of lymphocyte
● Called the immune response and consists ○ T-regulatory -suppress
mainly of Lymphocytes and antibodies inappropriate immune responses
○ Presence of pathogen stimulate (regulates kapag nagwawala na
release of antigen si T-cytotoxic cells para di
■ Related to how vaccines mamatay yung healthy body
work
cells) otherwise → autoimmune
● Augments the initial defenses against
response
infection and provides long term security
● B-LYMPHOCYTES (bone marrow derived)
against reinfection
- derived from plasma cells that become
● Do not pre-exist unlike innate immunity
factories for antibodies
● Develops slowly and specific
● Nagttraining sila sa bone marrow to
● Effectors are long-lived and systemic
combat COVID 19
● Has memory (helps the body system to
remember) Because of the antibodies,
T and B LYMPHOCYTES
marerecognize na nila kapag nagkaroon
● T-LYMPHOCYTES
ka ulit ng same na sakit.
○ Responsible for cell-mediated
immunity
TERMS
○ Kills targets directly or stimulate
● ANTIGEN - molecular targets of
activity of other WBC
antibodies and lymphocytes (released by
● B-LYMPHOCYTES
pathogens)
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○ Responsible for humoral immunity ● IgE
(because it contains ○ Mediator of common allergic
immunoglobulins) responses and defense of parasitic
○ Mediates circulating antibodies/ infections
immunoglobulins
○ IgE - antibody against TYPES OF ACQUIRED IMMUNITY
environmental antigens r/t ● Active Acquired- tayo ang gumawa
allergies ○ Exposure to an infectious agent
(natural) (Ex: nagkaroon ka na ng
IMMUNOGLOBULINS COVID, pero nasurvive mo so may
● IgG antibodies ka na) (chicken pox)
○ Most abundant, 80-85% ○ Vaccination - induced (artificial) -
○ Accounts for most of the protective ibinigay (Thru vaccines na may live
activity against infection attenuated/weakened virus para
○ Maternal IgG protects the infant makabuo ng antibodies sa katawan
during the first 6 months of life natin)
○ Transplacental ● Passive Acquired - binigay sa atin/
● IgA (seen on sweat) transfer
○ Lines mucosal membranes for ○ Maternal transfer (natural)
protection ○ Injection of pre-formed antibodies
○ Found in sweat, tears, saliva, (artificial)
mucus and GI ○ Ex. There are certain
● IgM sila ang unang nakapunta sa site of microorganism na nag iiwan ng
tissue injury/wound (M for malaki) toxins kaya may naiimbentong
○ Largest Ig toxoids or free form antibodies
○ First antibody produced during ○ Booster shot
primary response to antigens ○ Kasi mahihirapan ang body na
● IgD gumawa ng sariling antibodies so it
○ Functions as an antigen receptor on will help
the surface of B cells
○ Pag narelease ng certain antigen, SIDE BAR: READING HEPATITIS B PROFILES
ineenvelope niya itong mga antigen ● HEPATITIS B SURFACE ANTIGEN
para di na magcause ng further (HBsAG)
antigen ○ Protein found on the surface of the
○ IgD (magnet or attach) (traffic virus
enforcer) “bakit ka nagccause ○ Indicates that the person is
ng traffic dyan” → pupunta infectious
niyasa Lymphocytes → lymphocyte

will kill it
ADHARA 2023 5

○ Positive result: patient is
HBsAg Negative Immune na
infectious/may manifestation ng Anti-HBc Positive yung patient
sakit Anti-HBs Positive dahil
● HEPATITIS B SURFACE ANTIBODY (anti- recovered na
HBs) siya from
○ Indicating recovery and immunity hepatitis
from the virus infection HBsAg Negative Immune na;
○ Either past exposure or successful Anti-HBc Negative protected bc
vaccination Anti-HBs Positive may vaccine
○ Positive result: protected siya
against an infection/
recovering. Of nagkaroon ka na
dati → recovered → natural SIDE BAR: READING HEPATITIS B PROFILE
immunity ● IgM Antibody to HEPATITIS B CORE
● TOTAL HEPATITIS B CORE ANTIBODY ANTIGEN (Igm anti-HBc)
(anti-HBc) ○ Indicates recent infection in less
○ Appears at the onset in acute than 6 months from the virus
infection and persist for life ○ Acute infection
○ Indicates previous exposure or ○ History taking
ongoing infection ● HEPATITIS B e ANTIGEN (HBeAg)
○ DIFFERENCE WITH antiHbs → ○ Present only in person positive for
HBsAg
ongoing protection
○ Indicates that person is highly
○ Susceptible in needle prick
infectious
■ Pag positive, it only means
na meron sa katawan ninyo
na nagpprocess ng hepatitis
or di pa nareresolve itong
hepatitis sa katawan ninyo
so pwede kayong maging
carrier
■ Pag negative = natapos sa
inyong infection
Profile Results Interpretation
HBsAg Negative Susceptible Profile Results Interpretation

Anti-HBc Negative
Anti-HBs Negative HBsAg Positive Patient has an
Anti-HBc Positive acute
ADHARA 2023 6

○ The signs and symptoms of
IgM Anti-HBc Positive infection
Anti-HBs Negative infection are a result of specific
pathogen activity, which triggers
HBsAg Positive Patient has a ■ Inflammation
Anti-HBc Positive chronic ■ Immune response
IgM Anti-HBc Negative infection and
Anti-HBs Negative it is infectious
During an infection, the MO injures the host by:
HBsAg Negative Resolved ● Competing with the host cell for
Anti-HBc Positive infection metabolism
Anti-HBs Negative False-positive ● Cellular damage produced by microbial
Low-level
toxins
chronic
infection ● Intracellular multiplication
● (Itong mga bacteria nagrrelease sila ng
toxins sa katawan na kahit magresolve na
PART II: COMMUNICABLE DISEASE
sila, pwede mag-iwan ng mark or scar.
These toxins can lead to cancer)
● Caused by pathogenic microorganisms,
such as bacteria, viruses, parasites or
DISEASE INCIDENCE
fungi;
● SPORADIC - occurs occasionally and
● The diseases can spread , directly or
irregularly with no specific pattern
indirectly, from one person to another
○ "Pabugso-bugso lang" it takes years
pa bago magkaroon ulit ng sakit
○ Neighborhood lang
● ENDEMIC - refers to the constant
presence and/ or usual prevalence of
disease or infectious agent in a population
within a geographic area (isang
lugar/bansa lang. ex: Malaria in Puerto
Prinsesa) with pattern
● HYPERENDEMIC - persistent, high levels
of disease occurrence
SOUTHEAST-ASIAN 2004 CD STATISTICS ○ Sa lugar na yun sa puerto prinsesa,
libo ng mga tao ang nagkakaroon ng
INFECTION malaria. Hindi siya epidemic kasi
● Occurs when a pathogen (a kung epidemic dapat kumalat siya sa
microorganism that causes disease) region ng visayas or region ng luzon.
○ Invades the body > begins to Pag kumalat sa indonesia or other
multiply > produces disease > countries, it is called pandemic
causing harm to the host
ADHARA 2023 7

● EPIDEMIC - refers to an increase, often ● HOST - human who can get the disease
sudden, in the number of cases of a ● ENVIRONMENT - extrinsic factors that
disease above what is normally expected affect the agent and opportunity for
in that population in that area / scattered exposure
in not nearby areas ex. Dengue in quezon,
bohol, ilocos. EPIDEMIOLOGICAL TERMS
● PANDEMIC - refers to an epidemic that ● INCIDENCE - measure of the frequency
has spread over several countries or with which new cases of illness, injury or
continents, usually affecting large other health condition occurs among a
number of people (worldwide) population
● PATHOGENICITY -ability of an agent to
cause disease after an infection- Yung
effect niya sa body (multisystem, like
covid nakakaaffect din sa may cardio)
asiode for manifestations there are also
complications caused by MO
● PREVALENCE - number of cases or events
among a given population
● VIRULENCE - relative capacity of a
pathogen to overcome body defenses and
cause severe disease- Gaano katindi ang
CHECKPOINT ANSWERS:
effect ng isang pathogen
1. Epidemic
● SPECIFICITY - attraction of a microbe to a
2. Hyperendemic
specific host or range of host, bakti siya
3. Pandemic
lang ang nagkaroon sa family nila if
4. Sporadic
communicable disease siya, it depend on
5. Endemic
the resistance or immune response of the
person
EPIDEMIOLOGIC TRIAD
● TOXIGENICITY - ability to produce
soluble toxins or endotoxins which can
influence virulence
● AGENT -must be present for disease to

occur; can be any MO or pathogen
○ Ex: COVID-19 virus
ADHARA 2023 8
Class Site of Example

reproduction
virus intracellular poliomyelitis
chlamydiae intracellular urethritis
rickettsiae intracellular spotted fever
mycoplasma extracellular atypical

pneumonia
bacteria various cholera
fungi various candidiasis
protozoa mucosal / giardiasis

intracellular
helminths intracellular/ filariasis

extracellular
RESERVOIR
● Refers the habitat in which an infectious
agent normally lives, grows, and
multiplies, which can include:
○ HUMAN RESERVOIR
(This diagram means it is a cycle kasi a person ■ Carrier - a person with
can be carrier to a certain type of disease kahit inapparent infection who is
siya ay recovered) capable of transmitting
pathogens to others
CHAIN OF INFECTION ○ ANIMAL RESERVOIR
● The progression of an infectious agent ■ Zoonosis - infectious disease
that leaves its reservoir through a portal transmissible under natural
of exit, is conveyed by a mode of conditions from animal to
transmission and then enters through an humans
appropriate portal of entry to infect a ○ ENVIRONMENTAL RESERVOIR
susceptible host ■ May include plants, soil
(tetanus: not the rust; it is
CAUSATIVE INFECTION - microbe capable of the clostridium tetani in the
producing a disease soil not the rust itself :P) ,
and water
ADHARA 2023 9

○ skin to skin contact, kissing, sexual
PORTAL OF EXIT intercourse, maternal transmission
● Path by which a pathogen leaves its host ■ You can wear gloves and
○ Ex: feces, vomitus, saliva proper dispolar should be
○ Make sure to wear gloves and wash practice
hands ■ It can be transfer to another
PORTAL OF ENTRY person
● Manner by which a pathogen enters a ● Droplet spread
susceptible host ○ large droplets carry the infectious
○ Eyes, nose, open wound etc. agent (>5 micrometer in diameter;
carry a few feet), sneezing,
coughing
○ Karamihan sa pathogen,
HOST napakadaan = can be carried by the
● A person or other living organism that is air
susceptible to or harbors an infectious
agent under natural conditions MODE OF TRANSMISSION: INDIRECT
● SUSCEPTIBILITY - depends on genetic or ● Refers to an infectious agent from a
constitutional factors (intrinsic factors) reservoir to a host by intermediaries
that affect a person’s ability to resist ○ AIRBORNE
infection ■ Occurs by respiratory route
○ Ability to fight or not fight with the agent present in
pathogens/microorganisms aerosols (<5 micrometer in
diameter, carried in
MODE OF TRANSMISSION suspended air particles)
● Direct ■ Suspended in the air for
○ Direct contact hours
○ Droplet spread ○ VEHICLE
● Indirect ■ Includes food, water,
○ Airborne biologic products, fomites
○ Vehicleborne (food, medication, IV ■ When eating/drinking, make
fluids) sure that it is clean
○ Vectorborne (mechanical or ○ VECTORS
biologic) ■ small animate
intermediaries, mosquitoes,
MODE OF TRANSMISSION: DIRECT fleas, ticks
● Infectious agent is transferred from a ■ Dapat pinapalitan yung mga
reservoir to a susceptible host by hinihigaan (matress) na
● Direct contact kama kasi pinapangayan ng
ADHARA 2023 10

mga vectors (ex. 10 years or ● Single patient room/ possible cohorting
5 yrs) with >3 feet spatial separation between
beds
UNIVERSAL PRECAUTIONS ● HCP wear gown and gloves for all
● Hand hygiene - 5 moments interactions
○ Before touching patient
○ Before procedure DROPLET PRECAUTION
○ After touching patient’s ● Prevent transmission of pathogens spread
surrounding through close respiratory or mucous
○ After a procedure or body fluid membrane contact with respiratory
exposure risk secretions
○ After touching a patient ● Single room is preferred/ possible
● PPE - based on anticipated exposure cohorting with >3 feet spatial separation
○ It is a must for a nurse to wear in a and drawing of curtains
covid-19 patients ward ● HCP wears mask for close contact upon
● Respiratory hygiene/ Cough Etiquette - room entry
tissues and no touch receptacles; offer ● Patient during transport should wear a
masks during high incidence mask
● Patient Placement
AIRBORNE PRECAUTION
STANDARD PRECAUTIONS ● Prevents transmission of MOs that remain
● Combines universal precautions and body infectious over distances
substance isolation ● Preferred patient placement on Airborne
● All blood, body fluids, secretions, Infection Isolation Room (AIIR) -
excretions except sweat, non-intact skin negative pressure, 12 air exchanges per
and mucous membranes may contain hour, air filtration before return)
transmissible infectious agents ● HCP wear masks/ respirator as
○ This is why you should always wear appropriate
GLOVES
● Apply to all patients, regardless of
infection status
CONTACT PRECAUTIONS
● Applies to MOs spread by direct or indirect
contact
● Applies during presence of excessive
wound drainage, fecal incontinence, other
discharges from the body
ADHARA 2023 11

○ Methyl - weakest bactericidal
action
○ Ethyl (60-80%) potent virucidal
agent
○ Isopropyl - not active against
nonlipid enteroviruses
○ Ethyl or isopropyl better than
methyl *
LEVEL OF PREVENTATIVE CARE

● PRIMARY PREVENTION
○ Clients are considered physically/
mentally healthy
○ Aims at health promotion including
PROTECTING THE PUBLIC health education, immunization
● Isolation separates sick people with a and physical and nutritional fitness
contagious disease from people who are ■ Ex. Vaccination is very
not sick important to prevent severe
● Quarantine separates and restricts the conditions
movement of people who were exposed to ● SECONDARY PREVENTION
a contagious disease to see if they become ○ Clients are experiencing health
sick problems/ illness who are at risk of
developing complications
○ To prevent complications it is
DISINFECTION important to interview the px agad.
● CONCURRENT - done immediately after ■ Aims to return the patient to
use with the patient a normal level of health
○ The patient is in bed for 48 hours. ● TERTIARY PREVENTION
Dapat after 48 hours, we should ○ Clients with permanent disability
disinfect the bed. Bedsheets, gowns ○ Aims to minimize the effect of long
and pillowcases = dapat naka- term disease or disability
autoclave or pinapasikatan sa araw ■ Ex. The patient should be
pero dapat 24 hrs talaga able to engage in exercises,
● TERMINAL - done when patient has been rehabilitation or physical
discharged door, floor, door knob, chair, therapy
ALL
PART III: GENERAL NURSING CARE
SIDE BAR: ALCOHOL
● ALCOHOL ASSESSMENT
ADHARA 2023 12

● Early detection can prevent major ○ Organisms are cultured for 24-48
complications hours
● RESPIRATORY INFECTIONS ○ Sensitivity exam to expose
○ Lung sounds: wheezing, crackles, organisms to various antibiotics to
rhonchi determine effectiveness
○ Inflammation of tonsils ● SERUM ANTIBODY TEST
○ Presence of cough, colds, runny ○ Measures reaction to certain
nose, sore throat, chest congestion, antigen
chest pain ● CBC
○ Sputum culture ○ Identifies 5 different leukocytes
○ RTPCR ○ Erythrocytes sedimentation rate
● GENITO-URINARY INFECTIONS (ESR) screening for inflammation
○ Assess for: ■ To check for signs of
■ Voiding urgency and inflammation or infection
frequency processes
■ Burning
■ Flank pain
■ Change in color of urine, foul NURSING DIAGNOSIS
odor ● Risk for infection related to external
■ Change in mental status factors
;kapag nasira yung filtration ● Imbalanced nutrition: less than body
process, natitira yung requirements related to problems eating
urea/uric acid that is toxic or digesting food; some dx alters
and passes thru the blood swallowing reflex
brain barrier kaya ● Deficient knowledge related to disease
nagchchange mental status process and treatment
■ Urinalysis/ urine culture as
appropriate INTERVENTIONS
● GASTROINTESTINAL INFECTIONS ● Follow current hand hygiene guidelines to
○ Assess for: reduce spread of infection
■ Nausea, vomiting, diarrhea ● Use standard precautions and
■ abdominal cramps transmission-based precautions to
■ Anorexia prevent the transmission of organisms
■ Signs of dehydration ● Observe and report signs of infection such
■ Stool cultures as ordered as redness, warmth, and fever, especially
for neutropenic patients as they do not
LABORATORY ASSESSMENT have normal inflammatory response and
● CULTURE AND SENSITIVITY low-grade fever is often the only sign
ADHARA 2023 13

● Monitor laboratory values of white blood
cell counts and cultures as they correlate MESSENGER RNA VACCINES
to patient's immune function for planning ● Researchers have been studying and
care working with mRNA vaccines for decades
● Recommend responsible use of antibiotics and this technology was used to make
to prevent resistant organism ; always some of the COVID-19 vaccines. mRNA
teach px na antibiotics is not OTC, dapat vaccines make proteins in order to trigger
always prescribed an immune response. mRNA vaccines
● Explain medications, side effects and have several benefits compared to other
symptoms to report to promote types of vaccines, including shorter
compliance with treatment and safe manufacturing times and, because they do
medication use not contain a live virus, no risk of causing
● Teach patients how to participate in their disease in the person getting vaccinated
own care and have them assist in the
development of their plan of care to VIRAL VECTOR VACCINES
promote compliance with treatment ● For decades, scientists studied viral vector
vaccines. Some vaccines recently used for
VACCINATIONS Ebola outbreaks have used viral vector
technology, and a number of studies have
Vaccines focused on viral vector vaccines against
● Preparation with whole or fractionated other infectious diseases such as Zika, flu
MOs and HIV. Scientist used this technology to
● Administration leads to the recipient's make COVID-19 vaccines as well
immune system to make antibodies ● Viral vector vaccines use a modified
version of a different virus as a vector to
TYPES OF VACCINES deliver protection. Several different
● Killed vaccines viruses have been used as vectors,
○ Whole, killed or isolated MO including influenza, vesicular stomatitis
components [hep B, H. influenza virus (VSV), measles virus, and
type B vaccine] adenovirus, which causes the common
● Live attenuated cold. Adenovirus is one of the viral vectors
○ Life MOs that have been weakened used in some COVID-19 vaccines being
or rendered avirulent; dangerous to studied in clinical trials
those who are ● Ebola virus from monkey
immunocompromised
● TOXOID THE FUTURE OF VACCINES
○ Bacterial toxin changed to a ● Did you know that scientists are still
nontoxic form - antitoxins working to create new types of vaccines?
Here are 2 exciting examples
ADHARA 2023 14

○ DNA vaccines are easy and ● Parasitic infestation of the skin caused by
inexpensive to make - and they a mite whose penetration is visible as
produce strong, long term papules, vesicles, or tiny linear burrows
immunity containing mites and eggs
○ Recombinant vector vaccines ● Etiologic Agent: Sarcoptes scabiei; mite
(platform-based vaccines) act like (female mite)
a natural infection, so they’re ● Reservoir: Humans
especially good at teaching the ● MOT: Prolonged direct contact; sexual
immune system how to fight germs contact; transfer from undergarments and
bedclothes
● Incubation: 2 to 6 weeks if without
previous exposures takes 1-4 days
● If you're going to take care of a patient
with scabies, what would be the
precautionary measure?
○ Gloves
○ Handwashing
NURSING PROCESS
● Do not use to treat acute infection
● Do not administer if infection and
immunodeficiency are present
● Do not give if patient has received blood,
blood products, or immune globulin
within the 3 months
● Observe proper preparations and
administration
● Comfort measures
PART 2: INFECTIOUS INTEGUMENTARY

DISEASES
PATHOGNOMONIC SIGN
● Specific sign to identify that type of PATHOGENESIS:
disease 1. Transfer of mites
● Landmark pag nakita mo yung patient, 2. Superficial burrowing beneath the
you will know kung anong sakit stratum corneum -reddish brown lesions
3. Deposition of 3 less eggs per day
SCABIES/ SARCOPTIC ITCH/ ACARIASIS 4. Nymphs mature and emerge on the
surface of the skin
ADHARA 2023 15

5. Mate and transfer to another site ● ISOLATION: exclude infected individuals
6. Adult mite release fecal material until the day after treatment, contact
7. Pruritus and excoriation isolation for 24 hours after treatment
● Concurrent disinfection: laundering
MANIFESTATIONS underwear, clothing and bedsheet word or
● Burrows surrounded by eosinophils, used within 48 hours ; using hot cycles of
lymphocytes and general rash develops, washer and dryer
dark wavy lines in epidermis ● Permethrin Cream (5%) - scabicide
(Pathognomonic Sign) applied behind the ears and from the neck
● Intense itching (worsens at night down after bathing, removed 8 hours
after a hot shower) -because mite later with soap and water
become aligaga → sleep disturbance ○ Sometimes causes burn
● Lesions occur frequently in volar wrists, sensation/ tingling → manipis
between the fingers, on the penis and lang iapply then sa may scabies
elbows lang ilagay
● Small papules with symmetrical ● Crotamiton cream or Neosporin ointment
distribution - scabicide topical application
● Antihistamine, salicylates, calamine
DIAGNOSTIC TEST lotion to relieve itching
● Recovery of mite from a burrow and
microscopic identification NURSING DIAGNOSES
● Application of mineral oil may facilitate in ● Alteration in comfort (itchiness)
collecting the scrapings and examining ● Impaired skin integrity
under a cover slip ● Altered role performance
● Applying ink and washing it off may ● Knowledge deficit
disclose the burrows ● Social isolation
● Body image disturbance
LOUSE INFESTATIONS (loves hairy part of body)

● Infectious Agent: Ectoparasites
○ PEDICULUS CAPITIS - head lice
(mainly on the hair of the scalp
○ PTHIRUS PUBIS - or crab lice, hair
of the pubis
○ PEDICULUS CORPORIS - body lice;
infest on the seams of clothing
MANAGEMENT ● Can survive for a whole week without food
source: blood of host because they eat our
blood instead
ADHARA 2023 16

● Lice leaves a febrile host: fever and over CLINICAL MANIFESTATIONS
crowding increases transmission ● Vagabond’s disease -chronic infestation
● EPIDEMIOLOGY with postinflammatory
❖ Reservoir: Humans hyperpigmentation and thickening of the
❖ P.Capitis and P.Corporis MOT: skin
direct contact with infected person ➢ Halos nagddry na yung skin ng
and objects; indirect contact with patient
personal belonging (shared ● Plica polonica - foul smelling mass r/t
clothing/ headgear) crusting excoriation of chronic infestation
❖ P. pubis Includes sexual contact ➢ Naiwan na hatched na nymph
● Crab lice - intensely pruritic lesion and
blue
● May lead to secondary bacterial infection
➢ Bumaba ang physical immune
barrier ng skin ng patient
➢ Example pag masyadong
nagkakamot
CLINICAL MANAGEMENT
● Educate the public on the value of
destroying eggs and lice through early
detection
● Contact isolation from 24 hrs. until
application of pediculocide
● Concurrent disinfection: clothing,
bedding and fomites should be treatment
by laundering in hot water, dry cleaning
or applying chemical insecticide / bilad sa
araw
INFESTATION ● Eyelid infestation- apply petrolatum for
● Female lice lay egg and cement them into 3-4 days
hair or clothing ● Treat only if with presence of live lice
● A nymph hatches around 10 days, empty ➢ Pwede makasunog ng balat
eggs (nit) affixed for months ● Mechanical removal by means of fine-
● Head and body lice: hypersensitivity to toothed louse or nit comb - not effective
lice saliva produces pruritus otherwise ● 1% permethrin for 10 mins, second
asymptomatic application 10 days later (matapang for
● Body Lice - maybe vectors for typhus kids)
ADHARA 2023 17

● 0.5% malathion, dimethicone,spinosad ↓
alternatives Placental infection and virus replication
↓
NURSING DIAGNOSIS Infection of fetal organs
● Alterations in comfort
● Impaired skin integrity CONGENITAL RUBELLA SYNDROME (CRS)
● Risk for infection
TRANSIENT PERMANENT
● Sleep disturbance
MANIFESTATIONS MANIFESTATIONS
RUBELLA/ GERMAN MEASLES Hepatosplenomegaly Hearing impairment/

● Infectious agent: Togaviridae from genus Pneumonitis deafness
Rubivirus - single-stranded RNA Thrombocytopenia Congenital heart
with purpura defects (patent ductus
enveloped virus
Adenopathy arteriosus, pulmonary
● Reservoir: humans Hemolytic anemia arterial stenosis)
● MOT: contact with nasopharyngeal Eye defects (cataracts,
secretions, droplet or contact spread congenital glaucoma,
● Incubation period: 14-17 days microphthalmos,
● Pregnant mother (early pregnancy) may retinopathy)
Microcephaly
infect and produce congenital cataracts
Mental/motor delay,
(Congenital Rubella Syndrome) or
autism
permanent blindness
● Precautionary measure: facemask, gloves,
handwashing, and explain to patient the
purpose
PATHOGENESIS
● Pregnant mothers (early pregnancy) may
infect infants and produced congenital
cataracts (Congenital Rubella Syndrome:
baby may have permanent blindness due
to cataract; stunted growth)
Primary implantation and replication in the

nasopharynx
↓
Secondary spread to lymph nodes
↓
Viremia occurs
ADHARA 2023 18

○ Supportive treatment with anti-
pyretics
○ Mothers may opt for:
Immunoglobulin Im adm within 72
hrs post exposure to rubella (does
not eliminates risks)
○ Symptomotology
NURSING MANAGEMENT
1. Encourage females to be vaccinated
ACQUIRED RUBELLA MANIFESTATIONS
against rubella
● Rash (exanthem) on the face which
2. TSB - fever control
spreads to the trunk and limbs (fades
3. Diversional activity
after 3 days) →acquire via history 4. Avoid exposure to affected individual
taking 5. Treat only if with presence of live lice
● Low grade fever, swollen glands (sub 6. Antibiotic if the disease is aggreseive
occipital & posterior cervical
lymphadenopathy) - persists to a week NURSING DIAGNOSIS
● Joint pains, headache and conjunctivitis ● Altered thermoregulation: Hyperthermia
● Forchheimer’s sign - small, red papules ○ Because of the inflammatory
on the area of the soft palate - process
pathognomonic sign ● Alteration in comfort: Pain
● Body Image disturbance
○ Because of rashes formation lalo na
pag mga bata baka ibully ng mga
kalaro niya
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

● Lupus- because the face of the patients
looks like a wolf “lobo”
DIAGNOSIS AND TREATMENT
● Chronic multisystem inflammatory
● Diagnostic
autoimmune disease
○ IgM specific antibodies for 6 weeks
● Associated with abnormalities of immune
○ 4-fold rise (48-72 hours) in IgG
system
within 7-10 days (once na
● Results from interactions among genetic,
nagkafever the immunoglobulins
hormonal, environmental, and
rise)
immunologic factors
○ Rubella RT-PCR
● SLE affects 2 to 8 persons per 100,000 in
● Treatment
United States
ADHARA 2023 19

● Most cases occur in women of child
bearing years
○ Kasi doon nagbabago ang
hormones ng mga babae. Before
getting into pregnancy, mag-
prenatal check up muna
● African, Asian, Hispanic, and Native
Americans 3 times more likely to develop
than whites
● Etiology is unknown
○ Consult physician first para
mabigyan ng right dose and
medicines
● Most probable causes
○ Genetic influence
○ Hormones
○ Environmental factors
○ Certain medication
● Autoimmune reactions directed against
constituents of cell nucleus, DNA CLINICAL MANIFESTATION
● Antibody response related to B and T cell Dermatologic
hyperactivity ● Cutaneous vascular lesions
○ Can cause auto-immune disorder ● Butterfly rash (pathognomonic sign)
○ Common in face but can be found in
CLINICAL MANIFESTATION other parts of the body
● Ranges from a relatively mild disorder to ● Oral/ nasopharyngeal ulcers
rapidly progressing, affecting many body ● Alopecia
systems ○ Because of massive auto-immune
● Most commonly affects the skin/ muscles, response in the body
lining of lungs, heart, nervous tissue and Musculoskeletal
kidneys ● Polyarthralgia with morning stiffness
○ Nervous tissue - meningitis ● Arthritis
● Flu like symptoms -history taking ○ Swan neck deformity
○ Ulnar deviation
Multisystem Involvement of SLE ○ Subluxation with hyperlaxity of
joints
○ Uric acid → prostaglandin →
pain
ADHARA 2023 20

○ Pwede mabulok yung kidney ng
patient so tatanggalin yung isang
kidney
Nervous system
● Generalized focal seizure
● Peripheral neuropathy
● Cognitive dysfunction
○ Disorientation
○ Memory deficits
*SWAN NECK DEFORMITY- PATHOGNOMONIC ○ Psychiatric symptoms
SIGN Hematologic
● Formation of antibodies against blood
Cardiopulmonary cells
● Tachypnea ● Anemia
● Pleurisy ● Leukopenia
● Dysrhythmias ● Thrombocytopenia
● Accelerated CAD (Coronary Artery Infection
Disease) ● Increased susceptibility to infection
● Pericarditis ● Fever should be considered serious
○ Very dangerous; may be cause of
death DIAGNOSTIC STUDIES
Management: Symptomatology controlling the ● No specific test
inflammation going on the system and is ● SLE diagnosed primarily on criteria
treatable but if late diagnosis with complications r/t patient history, physical
on other organs it will be hard :< examination and laboratory findings →
explain to px why it is expensive
CLINICAL MANIFESTATIONS
Renal COLLABORATIVE CARE
● Lupus nephritis ● Drug therapy (supportive drugs to
○ Infected and inflamed suppress secondary infection/
○ Ranging from mild proteinuria complication)
to glomerulonephritis → ○ NSAIDS
retention of metabolic waste ■ For pain
product → multi organ failure ○ Antimalarial drugs
○ Primary goal in treatment is ■ To suppress secondary ?
slowing the progression (pwede ○ Steroid-sparing drugs
masubmit into dialysis) ○ Corticosteroids
○ Immunosuppressive drugs
ADHARA 2023 21

■ Control temporarily the ■ Log exacerbation otk now
inflammation the prime cause of the
symptoms/ signs
NURSING MANAGEMENT ○ Maintain optimal role function and
a positive self image
NURSING ASSESSMENT ■ Teenagers - they feel
● Assess patient’s physical, psychologic, isolated because of body
and sociocultural problems with long- disturbance
term management of SLE
● Assess pain and fatigue daily IMPLEMENTATION
○ There could be time na pwede ● Health Promotion
siyang maging "lantang gulay" ○ Prevention of SLE is not possible
dahil sa sobrang fatigue ng ■ Kasi di natin alam kung
kanyang katawan (due to diarrhea, kailan o paano nakukuha ito
vomiting etc) ng patient (ex. Laging
● Log input and output. nanghihina/weakness,
● Monitor and frequent follow up because magpaconsult na agad sa
she cant stay forever on the hospital doctor for possible SLE)
○ Promote early diagnosis and
NURSING DIAGNOSES treatment
● Fatigue ● Acute intervention
● Acute pain ○ During exacerbation, patient will
● Impaired skin integrity become abruptly dramatically ill
● Etc ○ Record severity of symptoms and
response therapy
PLANNING ■ Lalo na pag corticosteroid
● Overall goals drugs
○ Have satisfactory pain relief ■ Ask kung ano naramdaman
○ Comply with therapeutic regimen ng patient (medication log)
to achieve maximum symptom ○ Observe for
management ■ Fever pattern -Baka may
■ It is a symptomatology opportunistic infection na
approach like TB.
■ Very collaborative function ● Monitor temperature
○ Demonstrate awareness of and and record to
avoid activities that cause, disease determine the type of
exacerbation infection ang meron
ang patient with SLE
● Log pattern of fever
ADHARA 2023 22

■ Joint inflammation ; uric ■ Neonatal lupus
acid on bony prominences erythematosus (NLE) may
kapag may SLE occur in infant born of
■ Limitation of motion women with SLE
■ Location and degree of ● Encourage
discomfort pre/postnatal care to
■ Fatigability monitor if nakuha ng
○ Monitor weight and I&O anak yung SLE and
■ Using a measuring cup help manage the
○ Collect 24 hr. Urine sample symptoms.
○ Assess neurologic status
○ Explain nature of disease ○ Psychosocial issues
○ Provide support (family, significant ■ Counsel patient and family
others) that LSE has good prognosis
○ Ambulatory and home care ■ Physical effects can lead to
■ Emphasize health teaching isolation, self-esteem, and
■ Reiterate that adherence to body image disturbances
treatment does not ■ Assists patient in developing
necessary halt progression goals
● Do not give false ● Expected Outcomes
assurance to the ○ Completion of priority activities
patient. Just ■ We can teach them
teach/educate them scheduling of activities
■ Minimize exposure to called activity log (ex. 7am
precipitating factors gigising siya, 8am will go to
● Avoiding stress, too work etc. then imonitor pa
much emotion, rin niya yung dapat imonitor
strenuous activity esp. if may kidney problems)
○ Lupus and pregnancy ○ Verbalization of having more
■ Infertility can result form energy
SLE’ regimen ■ Engage in physical activities
■ Women with serious SLE but not too much
should be consumed against ○ Expression of satisfaction with pain
pregnancy relief measures
● Genetic counseling ○ Performance of activities of daily
● Do not give false living without pain
assurance. Tell them ○ Limitation of direct exposure to
the risk/s sun and use of sunscreen
ADHARA 2023 23

■ Prescribed by a
dermatologist
○ No open skin lesions
○ Expression of satisfaction with
activity level
○ Pacing of activities to match level
of tolerance
■ Turuan gumawa ng activity
log
○ Expression of confidence in ability
to manage SLE over time and in
home environment
■ Support of family and
significant others
■ Ex. Fund-raising activities
ADHARA 2023 24
VECTOR BORNE DISEASE
NCM 112 MEDICAL SURGICAL NURSING August 17, 2021

○ Mosquito bites human then injects
the parasites (two phases of
Malaria (Ague)
asexual cycle within human)
● Erythrocytic- causes pathologic findings
● Acute or chronic parasitic disease to human host
transmitted by bite of infected mosquitoes ● When sporozoites inoculated to human
& is confined mainly to tropical and blood
subtropical areas ○ Changed form into
→ Etiologic Agent & Incubation Period “exoerythrocytic” and carried to
○ Plasmodium falciparum (most the liver
dangerous/deadly ) - 12 days ○ They invade hepatocyte (kung saan
○ P. vivax - 14 days mapunta ang blood dun pupunta
○ P. malariae - 30 days ang parasite)
○ P. ovale - 14 days
○ Liver → Hepatomegaly → yellow
● Symptomatology approach
skin d/t production of bile
→ Mode of Transmission
○ Spleen → splenomegaly
1. Bite of an infected female Anopheles
mosquito ○ Kidney → renal failure
○ female mosquitoes carries risk ○ Brain → coma or decrease
agents sensory
2. Blood transfusion
3. Rare occasions, shared
contaminated needles
4. Transplacental transmission of
congenital malaria
*Pregnant mothers should be healthy →
congenital malaria
*And should keep away from mosquitoes, flies,
etc.
→ Pathophysiology
○ Anopheles mosquito gets the
parasite from an infected person
○ Parasites multiple in the intestine
of the mosquito(producing
sporozoites- baby parasites)
○ Sporozoites discharged into the
saliva of the mosquito
ADHARA 2023 1

○ Continuous fever
○ Convulsions and GI symptoms
○ Splenomegaly
○ In cerebral malaria
○ Severe HA, vomiting,
changes in sensorium
○ Jacksonian or grand mal
seizure
■ Buong katawan
nagkaroon ng
panginginig/
naninigas / spasm
○ Increase ICP d/t increase
CSF → headache and
trigger medulla oblongata
→ nausea and vomiting
→ Diagnostic Procedure
○ Malaria smear
○ Blood na nilalagay sa petri
dish
Note: it can cause anemia and alteration of ○ Makikita yung parasite sa
clotting mechanism because plasmodia eats Hgb dugo ng patient
● Rapid diagnostic test
→ Clinical Manifestations ○ give results 10-15 minutes
○ Paroxysms (spiking fever) with ○ Mukhang pregnancy test
shaking chills tool pero blood ang
○ Rapidly rising fever with HA specimen
(headache)
○ Know pattern of fever to differ with → Management
other illnesses ● Medical
○ Profuse sweating (bc rapid yung ○ Anti-malarial drugs (means
ATP during chills) pinatay yung
○ Myalgia parasites/plasmodium; hindi
○ Splenomegaly, hepatomegaly mosquito)
○ Orthostatic hypotension ■ Chloroquine
○ Paroxysms may last for 12 hours ■ Quinine
and may attack every 2 days ■ Sulfadoxine
○ In Children: ■ Primaquine
ADHARA 2023 2

○ Erythrocyte exchange ○ Hemoglobin female: 12-16
transfusion gm
○ Hemoglobin male: 14- 18 gm
→ Nursing Management ● Watch out for signs of abnormal
○ Closely monitored bleeding
(frequent/paroxysmal fever and ● Consider malaria as medical
inflammation and possible emergency (If there is bleeding of
gums, nose, fever and chills)
seizure attack because it is
dangerous) → coma
→ Prevention and Control
○ I&O monitoring (as this might lead
1. All cases should be reported
to dehydration)
○ Important to assess the
○ Serum bilirubin (kasi naapektuhan
patient (pattern, know
ang bilirubin since it helps in
temperature reading)
breakdown of fats), BUN, creatinine
2. Screening of all infected persons
& parasitic count- daily monitoring
from mosquitoes 🦟
(Explain na everyday kukunan ang
3. Breeding places must be destroyed
patient ng dugo for monitoring
4. Use spray with effective
because some patients might refuse)
insecticides
(pag di naagapan = renal failure)
○ Pwedeng gumamit ng
○ Monitor Hgb level
citronella plants/oil
● If respiratory and renal symptoms
5. Use mosquito net
are present - determine ABGs (to
6. Insect repellants
determine if oxygen level is low-
7. No blood donations at least 3 years
Hypoxia) and plasma electrolyte
for people living in malaria-
○ Plasma electrolyte - To
infested area
correct dehydration of the
○ Pwedeng may parasite pa
patient
doon sa blood and mapasa pa
○ Pwede ring araw-araw kunin
sa iba
● TSB (Tepid Sponge Bath)
8. Screened blood 🦟 donors
○ Help patient to lower down
the fever
→ Nursing Diagnoses
● Plenty of fluids
● Kept clothing and bed dry ● Altered body temperature
● Watch out for neurotoxicity ● Activity intolerance
○ Convulsions ● Risk for F&E imbalance
○ Hallucinations (dehydration)
○ Sensorium, HA ● Altered nutrition: less than body
● Evaluate degree of anemia requirement (bc invasion of parasite
in hemoglobin)
ADHARA 2023 3

● Knowledge deficit ○ Day-biting mosquito (2
○ Kasi when we talk to hours after sunrise and 2
communicable disease, we hours before sunset)
should teach the public ○ Breeds in stagnant water
○ Cleaning the environment is ○ Limited, low-flying
very important movement
○ Fine white dots at the base of
the wings and white bands
on legs
DENGUE
○ Aedes Albopictus
○ May contribute to
● Breakbone fever/Hemorrhagic transmission of dengue virus
fever/Dandy fever/Infectious - rural area
thrombocytopenia purpura ○ Other contributory mosquitoes:
○ affects the bones and joints of px/ ○ Aedes polynesiensis
affects bleeding/ has rashes ○ Aedes scutellaris simplex
● Acute febrile disease caused by infection
with one of the serotypes of dengue virus
→ Incubation Period:
● Also alter the synovial fluid →
○ 3 - 14 days; commonly 7-10 days
prostaglandin → joint pain → Period of Communicability
● Dengue Hemorrhagic Fever - severe, ● A day before the febrile period to
sometimes fatal (bleeding diathesis & the end
hypovolemic shock cause of death ng px) ● Mosquito - infective from day 8-12
○ Fatal lalo na sa mga bata na di after the blood meal throughout life
naagapan ● Source of Infection:
○ <platelets ○ Infected persons
○ Also called dandy fever - kuba and ○ Standing/stagnant water
cross arms over the shoulders ○ Incidence:
○ Melena → no dark colored food ○ Age
→ Etiologic Agents: ■ any age, common
1. Flaviviruses 1,2,3,4 a family of among children &
Togaviridae, small viruses that peaks between 4-9
contain single-stranded RNA years old
2. Arbovirus ○ Sex
■ both
→ Mode of Transmission: ○ Season
● Bite of Aedes aegypti (parang tiger ■ More frequent during
na may stripe) (most common rainy seasons
mosquito) ○ Location
ADHARA 2023 4

■ More prevalent in ■ Bibigyan ng
urban communities paracetamol IM
■ Patient at the bedside
→ Clinical Manifestations ■ Order blood transfusion
● Dengue fever ■ Signs: Fever, Nose
○ Prodromal (beginning Bleeding, sudden
symptoms) defecate (blood) of the
■ Malaise & anorexia ( patient, yellowish
up to 12 hrs) discoloration of the skin
■ Fever and chills w/ (lalo na pag tumaas
frontal Headache, yung bilirubin)
ocular pain, myalgia, ● Phases of Illness:
w/ severe back ache 1. Initial febrile Phase 2-3 days
and arthralgia ○ Fever (38-40C) w/ HA
■ N/V ○ Febrile convulsions tumitirik
■ Non remitting fever ang mata
and persists for 3- ○ Flushed palms and soles
7days (namumula)
■ Rash ○ Positive Tourniquet test
● More ■ Lalagyan ng band sa
prominent on kanyang arm or
the extremities usually pag walang
and trunk (face band, bp cuff ang
- some isolated gamit
cases) ■ After a minute, pag
■ Petechiae may nakitang petique,
● Near the end of then we can suspect
the febrile the patient has a
period (more dengue
common on the ■ d/t inflammatory
lower response of the
extremities) blood vessels d/t
1. Dengue Hemorrhagic fever (DHF) increase temp →
○ Severe form- fever,
bleeds as well →
hemorrhage, diathesis,
petechiae
hepatomegaly &
○ Anorexia, vomiting, myalgia
hypovolemic shock
■ Sira and clotting
mechanism = bleeding
ADHARA 2023 5

■ Sumasakit ang mga ○ Shock - loss of plasma from
buto-buto or muscles intravascular changes,
ng patient hemoconcentration -
○ Maculopapular or petechial elevated hematocrit
rash ○ Rapid, weak pulse; narrow
■ Starts in the distal pulse pressure; BP may drop
portion of the to unobtainable level
extremities (sparing ○ Untreated shock - coma,
the axilla and chest), metabolic acidosis and death
purple skin with ○ Effective therapy - recovery
blanched areas of may follow
varying size ● Classification According to
■ (Herman’s sign Severity:
considered ○ Grade I
pathognomonic to ■ Fever with non
the disease) - specific constitutional
symptoms and (+)
fever → petechiae
only to tourniquet test
all over the body
○ Grade II
○ Generalized or abdominal
■ All signs in grade I,
pain → suspect GI plus spontaneous
bleeding , assess PQRST bleeding from the
○ Hemorrhagic manifestation nose, gums and GIT
- (+) tourniquet test, ○ Grade III
purpura, epistaxis & gum ■ Presence of
bleeding) circulatory failure
2. Circulatory phase (Weak, pulse, narrow
○ Fall of temp with profound pulse pressure,
circulatory changes (3-5th hypotension, cold,
day) clammy skin and
○ Restless, cool, clammy skin restlessness
d/t decreased Hgb level (d/t ○ Grade IV
decrease glucose oxidation) ■ Profound shock,
○ Cyanosis undetectable BP and
○ Profound thrombocytopenia PR
with onset of shock ■ Low blood
○ Bleeding diathesis - more pressure means
severe & lead to GIT meron ng
hemorrhage massive shock
ADHARA 2023 6

dun sa brain ○ Hemoconcentration- increase of
niya pwedeng 20% in hct or a steady rise ( means
mamatay ang prone for dehydration_
patient ○ Occult blood (seen in feces)
○ Hgb determination ( para malaman
● Complications: kung mababa ang hemoglobin)
○ Dengue fever
■ Epistaxis, ● Treatment modalities:
menorrhagia ○ No effective anti-viral
■ GIT bleeding therapy for dengue (entirely
■ Concomitant GIT symptomatic)
disorder (peptic ulcer) ○ Analgesic drugs - HA, ocular pain,
■ d/t altered platelet myalgia
count ○ IV infusion to prevent dehydration
○ DHF and replacement of plasma
■ Metabolic acidosis ○ Blood transfusion - severe bleeding
■ Hyperkalemia ○ O2 therapy - all pxs in shock
■ Tissue anoxia (low ○ Sedatives- for anxious and restless
hemoglobin) px
■ Hemorrhage into CNS
or adrenal glands ● Nursing Management
■ Uterine bleeding ○ Mosquito-free environment
■ Myocarditis ○ Rest during bleeding periods
○ Severe manifestations ○ VS must be promptly monitored
■ Dengue ○ Nose bleeding - trunk elevated,
encephalopathy apply ice bag
■ Increasing
restlessness,
anxiety,
disturbed
sensorium,
convulsions,
spacity and
hyporeflexia
■ Increase CSF ● Observe for signs of shock
increased ICP ● Restore blood volume-
● Diagnostic Procedure trendelenburg’s position (restore
○ Tourniquet test - screening test circulation in upper extremities)
○ Platelet count - confirmatory test
ADHARA 2023 7

● Patient w/ dengue is not infectious
- isolation is not required
→ Prevention & Control:

● Health education
● Early detection and treatment
● Treat mosquito nets with
insecticide
● House spray
● Eliminate mosquitoes - destroy
breeding places, keeping
containers
● Avoid hanging too many clothes
● Case finding
→ Nursing Diagnosis
● Altered body temperature
● Risk for fluid volume deficit
● Fear
● Anxiety
● Activity intolerance
● It will attack other organs of the body

FILARIASIS
(mostly lymphatic vessels)
○ Liver
● Parasitic disease caused by nematode, ○ Heart lead to myocarditis
microscopic, threadlike African eye worm ○ Lungs
● Causative Agent: ● It will promote dehydration (may
○ Wuchereria bancrofti lead to shock, coma or even death if
untreated)
→ Mode of Transmission ● Lymphatic system → enlarged
● Mosquito bites lymph nodes
→ Pathophysiology of Filariasis → Pathognomonic sign: Elephantiasis

● Thickening or hardening of the
skin
○ Site: can be in genital area
● Symptoms:
ADHARA 2023 8

○ Begin with on and off chills, ○ It will take months to years
HA and fever that lasts to completely deworm the
between 3 months and one body of the px
year after the insect bite ● Surgery
○ Swelling, redness, pain in ○ To remove surplus tissue,
the arms, legs or scrotum drainage of fluid, remove
■ Because of secondary surplus tissue, drainage of
bacterial infection fluid, minimize massive
■ May lead to edema enlargement of scrotum
○ Areas of abscesses may ● Elephantiasis of the legs
appear as a result of dying ○ Elevation of legs and elastic
worms or secondary bandage
bacterial infection ○ Pathognomonic sign - bite
■ Kapag namatay ang of the mosquito
bulate, di siya agad ● DEC-fortified salt is helpful
matanggal so mag- ○ Pwede ilagay sa water o kaya
accumulate siya sa sa mga pagkain
lymphatic cells
→ Nursing Management:
→ Diagnostic Procedures: ● Health education- MOT
● Circulating filarial antigen (CFA) ● Destruction of breeding places of
● Larvae can also be found in the mosquitoes
blood ● Psychological and emotional
● Patient’s hx: pattern of support
inflammation & signs of lymphatic ● Personal hygiene
obstruction ● Course of the disease must be
○ Kailan niya unang nakita yung explained to client/family
pamamaga
○ Nakagat ba siya ng lamok // → Prevention and Control
check dun sa paligid niya ● Use mosquito net
(environment) ● Mosquito repellant in the hours
→ Modalities of Treatment: between dusk and dawn
● Ivermectin, albendazole or ● Yearly dose of medicine that kills
diethylcarbamazine (DEC) are used worms circulating in the blood
to treat and act by:
○ Eliminating the larvae → Nursing Diagnosis
○ Impairing the adults worm ● Impaired physical mobility
to reproduce ● Impaired skin integrity
○ Killing the adult worm ● Activity intolerance
ADHARA 2023 9

● Altered health maintenance
Leptospirosis
● (Weil’s diseases; Canicola fever; ● Organs of the body invaded by

hemorrhage Jaundice; Mud Fever; Swine microorganisms
herd disease) ○ After gaining entrance, it
● A zoonotic infectious bacterial disease multiplies in the
carried by animals, both domestic and bloodstream & invades the
wild, whose urine contaminates water or liver - jaundice, Icteric that
food which is ingested or inoculated gives orange-colored sclera
through the skin or mucous membranes ○ Differ leptospirosis from
(usually rat’s urine or saliva but can be other hepatitis by history taking
animals such as cattles, cats, bats, and dogs). ○ Kidneys
■ Inflammation of the
→ Etiologic Agent nephrons and tubular
● Leptospira interrogans necrosis - renal
○ A spirochete of genus failure
● Incubation period: ○ It may affect muscles - pain
○ 6-15 days and sometimes edema
○ Eyes - conjunctivitis
→ Mode of Transmission:
● Direct contact → Clinical Manifestations:
● Septicemic Stage
→ Period of Communicability ○ Febrile (4-7 days)
● Found in urine between 10-20 days after ○ Abrupt high remittent fever,
onset N/V, HA, anorexia,
abdominal, joint, muscle
→ Source of Infection: pains, myalgia and severe
● Rats (L. leterohemoragiae) prostration
● Dogs (L. canicola) ● Immune or Toxic Stage
● Mice (L. grippotyposa) ○ With or without jaundice, 4-
● Rats (L. batavia) 30 days; if severe - death
between 9th and 16th day
→ Pathophysiology: Leptospirosis ● Anicteric phase (w/o jaundice)
ADHARA 2023 10

○ Low grade fever/ rash, ■ Indirect
conjunctival infection, HA, Hemagglutination
meningal manifestations - ● Impaired liver and kidney function
disorientation, convulsions test with urinary findings of
and signs of meningeal albumineria, hematuria and
irritation - CSF: aseptic cylindruria
meningitis d/t penetration
of MO in the CSF → Treatment
○ Iritis or iridocyclitis ● Suppressing the causative agents
○ Leptospiruria ● Fighting the possible complications
● Icteric phase (with jaundice) ○ Autotropic drugs -
○ AKA Weil syndrome penicillin, doxycycline,
○ Hepatic and renal ampicillin, amoxicillin
manifestation (prominent) ● For prophylaxis- doxycycline 100
○ Hemorrhages, mg/tab q12 for 1 week
hepatomegaly, ○ Binibigay sa medical
hyperbilirubinemia mostly professional kapag pupunta sa
the direct fraction and mga lugar na may endemic
slightly elevation on infection
transaminase level ● Peritoneal Dialysis
○ Renal involvement ● Administration of F&E and blood,
○ Shock, coma, and CHF - as indicated
severe cases
● Convalescence → Nursing Management
○ Relapse (4th and 5th week) ● Isolate patient (dispose urine
properly)
→ Medical Management: ○ nursing intervention: always
● Culture wear gloves, flush at toilet
○ Blood: during 1st week bowl, clean urinal and bedpan,
○ CSF: 5th - 12th day handwashing
○ Urine: after 1st week until ● Darken room (to avoid irritation of
the period of convalescence eye)
● Agglutination ○ Prone at photosensitivity
○ Test done after 2nd or 3rd ● Skin care to ease pruritus
week ○ Due to jaundice you can do
■ Microscopic sponge bath or can give
agglutination calamine lotion as prescribed
■ Macroscopic ● Close surveillance
Agglutination ○ Report cases
ADHARA 2023 11

○ Kung tumataas baka ● Multisystem illness caused by a tick borne
kailangan na magkaroon ng spirochete (closely mimics other
pampatay ng daga/ rheumatic diseases)
exterminator/ massive ● Causative agent:
education about leptospirosis ○ Borrelia burgdorferi
● Keep homes clean
● Eradicate rats and rodents → Incubation Period:
● Health education on MOT (mode of ● 3-32 days
transmission)
○ Wear high boots kapag may → Mode of Transmission:
baha ● Tick bite or contact with tick feces -pulgas
● Oral fluid intake
→ Period of Communicability
→ Prevention and Control ● Not communicable from person to person
● Sanitation in homes, workplaces
and farm → Pathophysiology *insert pic*
● Need for proper drainage system &
control of rodents (40-60%
infected)
● Animals must be vaccinated
● Infected humans and pets should
be treated
● Information dissemination
→ Nursing Diagnoses
● High risk for injury
● anxiety
● Altered nutrition: less than body
requirement
● Impaired physical mobility
○ Because of jaundice and
B cell → destruction
dryness of the skin
Endotoxins → Leave scar in tissue organ →
autoimmune response
B cell hyperactivity → autoimmune response
LYME DISEASE
→ corticosteroid or antiinflammatory meds
ADHARA 2023 12

→ Clinical Manifestations Rocky Mountain Spotted Fever
● Erythema migrans, annular skin lesions
● Acute rickettsial infectious disease
for a period of days to weeks & develops
transmitted to humans by infected ticks
central clearing
and manifested by severe symptoms and
● Lesion- warm to touch not painful
a macular or papular rash
● Flu-like symptoms
● Inflamed, painful; arthritis in large joints
→ Causative Agent:
○ Synovial and artholvial fluid
increases ● Rickettsia rickettsii
● Limb weakness, sensory loss
● Confusion, memory loss d/t → Incubation Period:
● 3-14 days
penetration of endotoxins in the
brain → scar in tissue organ
→ Mode of Transmission
● Bell’s palsy one side of face is paralyzed
● Bite from tick, contamination w/tick’s
d/t endotoxin that is in the brain
feces
peripheral and CNS
→ Prevention and Control

→ Diagnostic Procedures:
● Rapid
● Blood, skin CSF & joint fluid culture
● Observation of skin, myocardial, retinal &
→ Period of Communicable
synovial lesions
● Not communicable from person to person
→ Medical Treatment
● Antiinfective Drugs
→ Pathophysiology:
○ Tetracycline (Achromycin)
○ Chloramphenicol (Chloromycetin)
→ General Management:
● IV Fluids & electrolytes
● Sedation- paraldehyde or chloral hydrate
● High protein, high calorie diet
● Serum albumin transfusion
● Packed RBC for anemia
● O2 for pulmonary complications
● Fever Control
ADHARA 2023 13
Producing:
● Rapid progressive systemic angiitis
INFECTIOUS DISEASE CNS
w/severe systemic manifestations
● Vascular endothelial edema
● Fibrin and platelet deposition TETANUS (LOCKJAW)
● Microthrombi development - obstruction
● caused by Clostridium tetani which
& occlusion of small vessels
produces potent exotoxin with prominent
● Tissue infarction
systemic neuromuscular efforts
● Necrosis
manifested by generalized spasmodic
contractions of the skeletal musculator
→ Clinical Manifestations:
● Fatal up to 60% of unimmunized persons,
● Petechial skin rash that becomes purpuric
usually within 10 days of onset
● Clouded sensorium
● When symptoms develop within 3 days,
● Edema
the prognosis is poor
● Hypotension d/t bleeding
● DPT vaccine is free (educate patient and
● Peripheral vascular circulatory collapse
family)
● myocardial involvement; myocarditis -
focal vascular lesions plus mononuclear
→ Incubation Period
cell infiltration
● 3 days to 3 weeks in adult
● 3-30 days in neonate
→ Diagnostic procedure
● Immunofluorescence of skin tissue -
→ Etiologic agent
medical ink → shows lesion / necrosis
● CI. Tetani
of the tissue
○ Anaerobic, gram (+) with round
● Serology terminal spore with slender body
● Confirmatory: indirect fluorescent giving a drumstick appearance
antibody ■ Tetanospasmin- responsible
● Complement fixation for muscle spasm
● Blood components ■ Tetanolysin- responsible for
destruction of RBC
→ Medical & General Management: ● May lead to tissue
● Same w/ Lyme disease
hypoxia → necrosis
● Prone to bleeding →
hypovolemic shock →
death
ADHARA 2023 14

○ An attempt to suck results in spasm
and cyanosis
○ Fever due to infection and
→ Sources of infection dehydration → OGT or NGT
● Animal and human feces. Organism that ○ Jaw becomes so stiff that the baby
are found in the intestinal wall of cannot suck or swallow
herbivorous animals, including man ○ Tonic or rigid muscular contraction
● Soil and dust l, spasm or convulsions provoked
● Plaster of paris, unsterile sutures, pins, by stimuli
rusty materials, scissors ○ Cyanosis and pallor
○ May end with flaccidity, exhaustion
→ Mode of Transmission and death
● Direct inoculation - dust, soil or animal 2. Older children and Adult
excreta containing CI. Tetani ○ If tetanus remains localized, signs
of onset are spasm and increase
→ Avenues for entrance of the organism muscle tone near the wound
● Rugged traumatic wounds and burns ○ If it becomes systemic
● Umbilical stump in newborn - home indications include
deliveries (mothers without tetanus ● Hypertonicity, hyperactive deep
toxoid immunizations) tendon reflexes, tachycardia,
● Unrecognized wounds (cleaning of the profuse sweating, low grade fever,
ears with sharp materials and painful involuntary muscle
● Dental extraction, circumcision and ear contractions
piercing ● Neck and facial muscle rigidity
● Farmers are susceptible (trismus) pathognomonic sign
● Sometimes in newborn, they use ● Grinning expression (risus
unsterile scissors to cut the sardonicus) - pathognomonic to
the disease
umbilical cord. → tetanus → voiceless
● Boardlike abdomen/ abdominal
cry d/t spasm in the larynx
rigidity
● Di nahugasan na sugat is also susceptible
● Opisthotonos -pathognomonic
for tetanus
sign - arching of the back
● Circumcision
● Tonic convulsion for several
minutes-may result in cyanosis
→ Clinical Manifestations
and sudden death due to
1. Neonate asphyxiation d/t difficulty of
○ Feeding and sucking difficulty diaphragm and
○ Excessive crying, most of the time
sternocleidomastoid to inhale
voiceless crying
ADHARA 2023 15

● Laryngospasm - accumulation of ○ Intramuscular hematoma
secretions in the lower airway ○ Fracture of the spine and ribs dt
resulting to respiratory distress ( prolong opisthotonos
involvement of respiratory
muscles) ● Septicemia or generalized infection
● Fracture of the vertebrae - severe
spasm, yielding to coma and death → Modalities of treatment
■ In mild cases, after weeks, ● Specific
spasm gradually diminish in ○ Within 72 hrs after punctures
frequency and severity with wound, the patient should receive
trismus (last symptoms to ATS, TAT or TIG especially if he
disappear) dahan dahan nag don't have any previous
ggrin immunization
■ In fatal cases, death usually ○ Tetanus toxoid, 0.55 cc IM given in
occurs during the first 10 standard schedule
days of the disease ○ Pen G Na to control infection broad
spectrum antibiotic
→ Complications ○ Muscle relaxant to control muscle
● Laryngospasm and involvement of spasm and muscle rigidity (PO
respiratory muscle maintenance)
○ Hypostatic pneumonia dahil di ○ With or without DPT, if the
malabas ang secretions tetanus manifestation is there
○ Hypoxia d/t laryngospasm → give tetanus toxoid for
decreased o2 supply to tissue
prophylaxis as well
○ Atelectasis
● Non specific
○ Pneumothorax dahil puro na
○ O2 inhalation
secretions → suction but be ○ Feed thru NGT
careful because external ○ Tracheostomy
stimuli can stimuli spasm → do ○ Adequate F&E and caloric intake
not pull out the tube
○ During feeding and nag trismus → Good Nursing Care
→ kink the tubing (call bell to ● Avoidance of external stimulation
give sedatives) to prevent ● Prevention from further injury
● Maintain adequate airway
aspiration
● Provide cardiac monitoring
● Maintain IV line for medication and
● Due to trauma
emergency care (IM meds is limited and is
○ Laceration of tongue and buccal
often not prescribed/ avoided)
mucosa
ADHARA 2023 16

● Carry out efficient wound care ○ Extensiveness (if deep → IM
● Avoid contractures and pressure will not suffice but IV may)
● WOF urinary retention ○ Species of the animal
● Close monitoring on VS and muscle tone ○ Richness to blood supply
● Provision of optimum comfort measure ○ Resistance - host
→ Period of Communicability
→ Prevent and Control ● The patient is communicable 3-5 days
● Active immunization with tetanus toxoid before onset of the symptoms until the
for adult entire course of illness that is why the
● DPT babies and children patient is isolated all throughout the course
● Early consultation and adequate wound of illness. Otherwise the patient might bite
care after injury other person and will infect them as well.
● Iniiwanan lang ang pagkain or binibigyan
RABIES (HYDROPHOBIA; LYSSA) ng sedative bago pakainin
● A specific, acute, viral infection

→Clinical Manifestation
communicated to a man by the saliva of
● Prodromal/ Invasion phase
an infected animal
○ Fever, anorexia, boy malaise, sore
● Lyssa - rage and fury
throat, copious salivation,
lacrimation, perspiration,
→ Etiologic Agent
irritability, hyperexcitability,
● Rhabdovirus
apprehensiveness, restlessness,
○ A bullet shape filterable virus with
drowsy, mental depression,
strong affinity to the CNS
melancholia and marked insomnia
○ Sensitive to sunlight, UV light,
(d/t speed of the virus to penetrate
ether, formalin, mercury and nitric
the brain like a bullet)
acid
○ Pain or tingling sensation at the
○ Resistant to phenol, merthiolate
original site and diff body parts,
and common antibacterial agents
HA, nausea
○ If you cannot outrun the animal ○ Sensitive to light, sound and
→ give your foot → because the temperatures
closer the bite from the brain, ○ Anesthesia, numbness, burning
the lesser the survival will be and cold sensation maybe felt the
peripheral nerves involved
→ Incubation Period ○ Mild difficult in swallowing
● 1 week - 7 ½ mos in dogs depending on the severity (d/t
● 10 days - 15 yrs. In human spasm)
● Depends upon the ff factors ● Excitement/ Neurological Phase
○ Distance of the bite to the brain
ADHARA 2023 17

○ Marked excitation, apprehension ○ Death occurs dt respiratory
and even terros may occur paralysis, circulatory collapse or
○ Delirium associated with nuchal heart failure
rigidity, involuntary twitching
or generalized convulsions → → Diagnostic Procedure
prone to injury ● Virus from the patient’s saliva or throat
○ Maniacal behavior, eyes are fixed ● Fluorescent rabies antibody (FRA) -
and glossy, skin is cold and clammy the most definitive diagnosis - we
d/t absence of Hgb will open the brain → post mortem →
○ Severe and painful spasm of the pinapatay yung aso beheaded and the
muscle of the mouth, pharynx and brain of it will be studied.
larynx, on attempt to swallow ● Presence of negri bodies in the dogs brain
water or food or even at the mere ● RT PCR
sight of them
○ Aerophobia or fear of air (some → Modalities of treatment
of them literally pinipigilan ● Wash wounds and scratches with soap and
huminga → death) running water for athletes 3 mins as first
○ Difficulty in swallowing causes aid
frothy saliva to drool from the ● Immunization status (Tetanus toxoid if
patient's mouth needed)
○ Marked restlessness, anxiety, ● Tetanus antiserum infiltrated around the
apprehension, CN dysfunction that wound or given IM after a negative skin
causes ocular palsies, strabismus test
○ Death may occur during the ● Anti-rabies vaccine
episode of spasm or ● Bawal isa lang, package na silang lahat ng
cardiac/respiratory failure mga turok
○ If patient survives during this
phase, patient deteriorates rapidly → Nursing Management
and enters to the terminal phase ● Isolate the patients no visitors
● Terminal/ paralytic phase ● Emotional and spiritual support to the
○ Patient becomes quite and patient and the family to help them cope
unconscious (ATP loss) with patient’s symptoms and probable
○ Loss of bowel and urinary control death
○ Spasm ceases with progressive ● Provide optimum comfort
paralysis ● Darken the room, provide quiet
○ Tachycardia, labored , irregular environment
respirations
ADHARA 2023 18

● Patient should not be bathed, no running ○ Tubercle bacillus
water in the room or within the hearing ○ Neisseria meningitides
distance of the patient (meningococcus) - most of the
● If IV fluids - wrapped and needle should epidemics of meningitis, also
be securely anchored in the vein to avoid
cause primary pneumonia,
dislodging in times of restlessness
purulent conjunctivitis,
● Concurrent and terminal disinfection
endocarditis, sinusitis and
● Continuously monitor cardiac and
respiratory function genital infections ( if patient
experiences these infections,
alamin if ang cause ay
→ Prevention and control meningitides to prevent
● Vaccination of all dogs penetration to brain →
● Confinement for 10-14 days of any dog meningitis or penetration to
that has bitten a person heart → endocarditis)
● Laboratory facilities for observation and
diagnosis
→ Incubation period
● Public education especially children in
● Incubation period is variable, the extreme
avoiding and reporting all animals that
limits being set from 1-10 days
appears sick
→ Mode of transmission
MENINGOCOCCAL INFECTIONS (2 types) ● Respiratory droplets
● Direct invasion through otitis media
○ If the child has otitis media →
MENINGITIS (CEREBROSPINAL FEVER)
blood test → know if it is
● Inflammation of the meninges of the neisseria meningitidis for
brain and spinal cord as a result or viral early detection and prevention
bacterial infection
of meningitis
● Such inflammation may involve the three
● May also follow skull fracture,
meningeal membranes; the dura matter,
penetrating head wound, lumbar puncture
the arachnoid and the pia matter - altered
or ventricular shunting procedures
CSF with bacteria/ virus
○ Kaya tinuturukan yung mga px
from vehicular accidents
→Etiologic Agent
● Viral meningitis - a complication of an
● Several kinds of organism existing viral infection
○ Pneumococcus
○ Staphylococcus
→ Diagnostic Procedures
○ Streptococcus
● Lumbar puncture (CSF analysis)
ADHARA 2023 19

○ Diagnostic purposes: ■ Exaggerated and
■ To obtain specimen, the CSF symmetrical deep tendon
■ To take x- ray of the spinal reflexes
canal and cord ■ Sinus arrhythmia,
○ Therapeutic purposes irritability,
■ To reduce ICP photophobia, diplopia and
■ To introduce serum and
other visual problems
other medications
(Herniation → optic
■ To inject an anesthetic agent
chiasm ay naiipit)
● Gram Staining
● Smear and blood culture ■ Delirium, deep stupor and
coma
● Smear form petechiae
● Urine culture ■ Signs of ICP
● Bulging fontanel in
infants
● Nausea and vomiting
→ Types of meningitis
(projectile)
● Aseptic
● Severe frontal
○ A benign syndrome characterized
headache
by HA, fever, vomiting and
● Blurring of vision
meningeal symptoms
● Alteration in
○ Projectile vomiting
sensorium
○ Begins with a fever up to 40 C,
→ Complications
alteration in consciousness
(drowsiness, confusion, stupor), ● Subdural effusion
● Hydrocephalus
neck and spine stiffness, which is
slight at first ● Deaf- mutism
● Blindness of either one or both eyes
○ Characteristic sign of meningeal
irritation ● Otitis media and mastoiditis
■ Stiff neck or nuchal rigidity ● Pneumonia and bronchitis
■ Opisthotonos
■ (+) Brudzinski’s sign lie → Modalities of treatment
● If left untreated it has a mortality rate of
flat → lift head → if the
70-100%
legs flex → positive
● Treatment includes appropriate antibiotic
■ (+) Kernig’s sign lie
therapy and supportive care management
flat → lift the legs → if ● Usually IV antibiotics are given for 2
the px flexed → positive weeks and followed by oral antibiotics
such as:
○ Ampicillin
ADHARA 2023 20

○ Cephalosporin (Ceftriaxone) purpuric & ecchymotic spots associated
○ Aminoglycosides with shock
● Digitalis glycoside (digoxin) to control ● The condition runs short course and is
arrhythmias usually fatal. This frequently occurs in
● Mannitol to decrease cerebral edema → fulminant type of meningococcemia
monitor intake and output d/t >urine
● Anticonvulsant/sedative to reduce → Nursing management for aseptic meningitis
restlessness and convulsions ● Asses neurologic condition of the patient
● Acetaminophen to relieve to relieve to ○ Observe the patient's LOC and
relieve HA and fever check for signs of increased ICP
manifested by:
■ Plucking at bed covers
ACUTE MENINGOCOCCEMIA
■ Projectile vomiting
● Most common among children, ages 6 ■ Seizures, changes in motor
mos to 5 years functions and VS
● Following the incubation period of 3-4 ■ They are isolated because
days, invades the bloodstream, the joints, it is contagious → PPE
the skin, the adrenal glands, the lungs, ○ WOF deterioration of patients
without involving the meninges condition, which maybe signal for
● Starts with nasopharyngitis followed by an impending crisis
sudden onset of spiking grade fever with ○ WOF adverse reaction of antibiotics
chills, nausea, vomiting, malaise and HA and other drugs. Avoid IV
● Petechial, purpuric, or ecchymotic infiltration and phlebitis
hemorrhages scattered over the entire ○ Maintain adequate nutrition and
body and mucous membrane, which could elimination (avoid dark colored
be due to acute vasculitis followed by food for possible melena)
supprative necrosis and hemorrhage into ○ Ensure patient’s comfort
the dermal connective tissues ○ Monitor fluid balance
● Adrenal lesions starts to bleeds into the
■ Maintain adequate fluid
medulla which extends to the cortex
intake to avoid
● The combination of the dermal
dehydration, but avoid
manifestations and adrenal medullary
hemorrhage is known as the waterhouse- fluid overload because of
friderichsen syndrome pathognomonic the danger of cerebral
sign - bleeding of adrenal medulla d/t too edema → Mannitol d/t
much inflammation <urine output
● Waterhouse-friderichsen syndrome - ■ Measure central venous
rapid development of petechiae to pressure and intake and
output
ADHARA 2023 21

○ Position the patient carefully to ● 3 strains of viruses, and as far as it is
prevent joint stiffness and neck known, the disease affects man alone:
pain ○ Brunhilde
■ Turn him often to sides to ○ Lansing
avoid pressure sores and ○ Leon
respiratory complications
■ Assists with ROM, passive →Incubation period
and active range of motion ● 7-21 days for paralytic cases with a
○ Provide reassurance and support to repeated range of 3-35 days
the patient and the family
○ Follow strict aseptic technique → Period of communicability
when treating patients with head ● First 3 days- 3 months. Of illness
wounds or skull fractures ● Most contagious during the first few days
○ Isolation is necessary especially of of active disease, and possibly for 3-4
nasal culture is positive days before
● Isolation
→ Prevention
● Vaccines available to protect against → Mode of transmission
certain types of meningitis. Pneumococcal ● Direct contact
vax ● Person to person transmission
● Chronic sinusitis - importance of proper ● Indirectly through contaminated articles
and prompt medical treatment and and flies-contaminated water, food and
diagnosis utensils
POLIOMYELITIS (INFANTILE PARALYSIS; →Predisposing causes of Poliomyelitis :

HEINE-AMEDIN DISEASE) ● Age. about 60% of patients are under 10
years of age
● Characterized by changes in CNS which
● Sex. Males are more prone than female
may result in pathologic reflexes, muscle
(ratio of 3:2 ) death- higher in males
spasm and paresis or paralysis
● Heredity. Poliomyelitis is not heredity
● Lower motor neurons and it is because of
● Environment and hygienic conditions.
anterior horn involvement that is named “
The rich are more often to spread than the
Anterior poliomyelitis”
poor. Excessive work, strain, marked
● Decrease myelin sheath → decreased
overexertion
sensation → etc.
→Types of Poliomyelitis
→ Etiologic agent ● Abortive type accounts to about 4-8% of
● Caused by a filterable virus, polio virtual all causes
“legio debilitans”
ADHARA 2023 22

○ Does not invade the central nervous ○ There is usually urine
system retention, constipation and
○ Headache and sore throat abdominal discomfort d/t
○ Slight or moderate fever
paralytic activity → high fiber
○ Occasional vomiting
diet
○ Lower lumbar pain
■ Spinal Paralytic
○ The patient usually recovers within
● Paralysis occurs in
72 hours and in most cases, the
muscle innervated by
disease passes unnoticed
motor neurons of the
● Pre-Paralytic or meningetic type
spinal cord
○ Usual type
● Characterized by as
○ All the above signs
asymmetry, scattered
○ Patient manifest higher
flaccid paralysis on
temperature, more severe
one or both lower
headache, restlessness, vomiting,
extremities
anorexia, lethargy
● Autonomic
○ Pain and spasm of the muscle of the
involvement
hamstring, pain at the neck and
manifested by
back
excessive sweating
○ Changes in deep and superficial
● Respiratory
reflexes
○ Pain in the neck, back, arms, difficulty → prone
to death
legs and abdomen, tatapikin →
■ Bulbar Paralytic
spasm maninigas via reflex
● Usually has a rapid
hammer
development and
○ Inability to place the head in
more serious type
between the knees
● Attacked motor
○ Positive pandy’s test
neuron, affecting the
○ Transient paresis may occur
medulla. It weakens
○ Lasts for about a week, with
the muscles supplied
meningeal irritation persisting for
by the cranial nerves
about 2 weeks
especially the 9th
● Paralytic
(glossopharyngeal)
○ The above signs and symptoms
and the 10th (vagus)
○ Paralysis occur
● Naninigas na ang face
○ Less tendon reflexes
and impaired voice
○ (+) kernig and Brudzinski
and swallowing
○ Weakness of the muscles
○ Hypersensitivity to touch
ADHARA 2023 23

● Paralysis of the facial, ● Isolation of the virus from throat
pharyngeal and ocular washings or swab early in the disease
muscles ● Stool culture throughout the disease
● Hypothalamic ● Culture form the cerebrospinal fluid (CSF)
dysfunction as
manifested by → Modalities of treatment
impaired temperature ● Analgesics - HA, back pain and leg spasm.
regulation Morphine is contraindicated- respiratory
● Encephalitic suppression
manifestation - ● Moist heat application- reduce muscle
30%of patients spasm and pain
manifested by facial ● Bed rest is necessary
weakness, dysphagia, ● Paralytic polio requires rehabilitation
difficulty in chewing, using physical therapy, brace, corrective
inability to swallow or shoes and in some cases, orthopedic
expel saliva, surgery
regurgitation of food
through nasal → Nursing management
passages and dyspnea ● Carry out enteric isolation
■ Bubospinal paralytic ● Observe the patient carefully for signs of
● Involvement of the paralysis and other neurologic da,a e
neurons both the ● Perform a neurological assessment at
brainstem and the least once a day, but don’t demand any
spinal cord vigorous muscular activity bc pagod si
patient, baka mag cause ng complications,
→ Complications need to schedule
● Respiratory failure ● Flush toilet twice with cover closed
● Circulatory collapse ● Check BP regularly especially in bulbar
● Electrolyte imbalance poliomyelitis
● Bacterial infection ● WOF fecal impaction d/t dehydration and
● Urinary problems r/t retention or immobility, give sufficient fluids and high
paralysis of the urinary bladder iber to ensure adequate diet
(increase ATP requirement → shift ● Prevention of pressure sores. Provide
body fluids → decrease urine output) good skin care. Reposition the patient
● Abdominal distention d/t spasm frequently, and keep the bed dry
● To prevent the spread to the disease, wash
hands alevery after contact with patient
→ Diagnostic Procedure
● Apply hot packs affected limb to relieve
pain and muscle shortening
ADHARA 2023 24

● Dispose excreta and vomits properly
● Provide emotional support for the px and
family
● Maintain good personal hygiene,
particularly oral and skin care
→ Prevention and control

● Immunization, oral polio vaccine
● Proper disposal of GIT secretions
● Proper food handling and pooping
● Enteric isolation
● Implementation of standard precautions
● Sanitation of the premises and proper
food handling to avoid contamination by
flies should be strictly observed
● Avoid overcrowding
ADHARA 2023 25

GI Infectious Diseases: Cholera, Typhoid & More

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GI Infectious Diseases: Cholera, Typhoid & More

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NCM112N INFECTIOUS INFLAMMATORY IMMUNOLOGICAL DISEASES OF THE GASTROINTESTINAL SYSTEM

1. BACKGROUND OF INFECTIOUS INFLAMMATORY

2.1 PATHOPHYSIOLOGY ● Metabolic Acidosis

● Protect, purify and chlorinate public water supplies

DEGREE OF DEHYDRATION CLINICAL FINDINGS Severe

● [@] monitor fluids, I and O to monitor for fluid overload

3. TYPHOID FEVER ● [@] Due to ulceration, it will be easier for MO to

3.2 CLINICAL MANIFESTATIONS

3.3 DIAGNOSIS nt Azithromycin 1g/d (PO) 5

4. AMOEBIASIS [@] infectious agent looooove the liver because it is rich in

4.2 CLINICAL MANIFESTATIONS

Drug Dosage Duration, Days

Amebic Colitis or Amebic Liver Abscess

Tinidazole 2 g/d PO with food 3

Entamoeba histolytica Luminal Infection

Paromomycin 30 mg/ kg qd PO in 3 5-10

4.7 NURSING MANAGEMENT → MOT:

5.2 CLINICAL MANIFESTATIONS 3. Electrophysiologic findings (heart rate, blood pressure)

6. SHIGELLOSIS ● Rapid Dehydration and weight loss

6.5 NURSING DIAGNOSES ● Begins 5 to 10 days after onset of diarrhea

8.1 PATHOPHYSIOLOGY 9. SCHISTOSOMIASIS

9.1 PATHOGENESIS ■ d[@]/t splenomegaly, hepatomegaly, and

9.2 CLINICAL MANIFESTATIONS

9.7 NURSING MANAGEMENT

● Appendicitis 10.5 MEDICAL MANAGEMENT

Deworming ● Regular mass drug administration

● [@] Health education is the key

4.5 MEDICAL MANAGEMENT

5.2 CLINICAL MANIFESTATIONS 5.6 NURSING DIAGNOSIS

○ Resulting from toxin induced necrosis of the

PAHINGA MUNA, ADHARA! 6.4 NURSING DIAGNOSIS

8. INFLUENZA ● Incubation period: 1-2 days

9. COVID-19 9.1 CLINICAL MANIFESTATIONS

9.3 MEDICAL MANAGEMENT You may be able to shorten your quarantine

2.6 NURSING DIAGNOSIS

● [@]Also became prevalent in the Philippines. ↓

Tertiary Several years Neurosyphilis Years

3.1.1 CONGENITAL SYPHILIS Figure No. 6. “Chancre”

Primary, Pen G Benzathine Tetracycline HCI

STAGES WITHOUT WITH ALLERGY TO

Figure No. 7. “Modes of Transmission Among Newly

4. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

➔ CAUSATIVE AGENT: Human Immunodeficiency Virus,

4.1.2. COMMON OPPORTUNISTIC MICROORGANISMS

● Parasitic ○ Fever for 1 month

4 CS IN THE MANAGEMENT OF HIV/AIDS:

4.5.2. NURSING 5. HERPES

4.6 NURSING DIAGNOSIS

○ Cause cold sores to infant & childhood (tiny, clear,

● HERPES ZOSTER (Shingles)

5.2 CLINICAL MANIFESTATIONS

○ fever, malaise, anorexia and HA brought about by 5.5.1 MEDICAL

5.5.2. NURSING MANAGEMENT

NCM 112 MEDICAL SURGICAL NURSING

NCM 112 MEDICAL SURGICAL NURSING

mechanism → vasodilation → clotting

(saan pwede magwork yung medicines na

NCM 112 MEDICAL SURGICAL NURSING

PHASE OF PRIMARY INTENTION

Phases Duration Description

Initial 3-5 days Approximatio

NCM 112 MEDICAL SURGICAL NURSING