Polio Case Analysis1

A Case Analysis on
POLIOMYELITIS
In Partial Fulfillment of the
Requirements in NCM- 204 RLE
COMMUNITY HEALTH NURSING ROTATION
Submitted to:
BEVAN B. BALBUENA, RN, MN
Clinical Instructor
Submitted by:
Mary Justine N. Africa St. N
Anikka Dumandan St. N
Trianah Marie A. Ilagan St. N
October 14, 2020

Community Case Analysis Percentage Score
Introduction and Objectives 10%
Pathophysiology
 Etiology 10%
 Symptomatology 10%
15%
 Management
10%
 Prognosis
DOH Program 10%
Nursing Theory 15%
Reference 10%
Promptness 10%
Total: 100% Total:
Criteria:
Table of Contents
I. Introduction 4
2 | P o l i o m y e l i ti s
Objectives 7
II. Pathophysiology 8
A. Etiology 8
B. Symptomatology 10
C. Management 13
D. Prognosis 18
III. Department of Health Programs 19
IV. Nursing Theory 21
V. References 25
I. INTRODUCTION
Poliomyelitis is a highly infectious viral disease caused by the poliovirus, a
member of the genus Enterovirus, belonging to the Picornaviridae family. The word
poliomyelitis originated from the Greek word “polio” meaning “grey” and “myelon” which
means “marrow.” The etymology pertains to the effect of the poliomyelitis virus on the
spinal cord which can lead to its classic manifestation of paralysis.
Three wild types of poliovirus (WPV) are identified – type 1, type 2, and type 3.
Both the type 2 and type 3 strains have officially been confirmed as globally eradicated.
The last type 2 virus was detected in India in 1999, and on September 2015, the type 2
wild poliovirus was declared eradicated. Subsequently, the type 3 wild poliovirus, which
was last observed in November 2012 in Nigeria, was declared eradicated in October
2019. As of 2020, only the type 1 wild poliovirus remains, affecting the countries
Pakistan and Afghanistan.
Poliomyelitis mostly affects children under 5 years of age. The disease’s clinical
features are widely varied, ranging from mild cases of respiratory illness, malaise,
gastroenteritis, to completely debilitating paralysis. Hence, the severity of Poliomyelitis
have been categorized into abortive poliomyelitis (mild illness only), non-paralytic
poliomyelitis (aseptic meningitis), and paralytic poliomyelitis.
The poliovirus’ main mode of transmission is by person-to-person through the

faecal-oral route. However, it can also be spread via common vehicles such as in
contaminated food and water, although this is less frequent. After contracting the
poliovirus, it then enters the oropharynx and proliferates locally in the tonsils and the
lymph nodes of the neck. Subsequently, it multiplies in the Peyer’s patches and in the
small intestine, from which it can invade the nervous system and cause varying
severities of paralysis.
The incubation period of the poliovirus ranges from 3 to 30 days. At 3 to 5 days,

the poliovirus is commonly present in both the throat and the stool before the onset of
the illness. A week after the onset of the illness, the virus continues to be eliminated in
the stool for several weeks.
As of 2020, no cure for poliomyelitis still exists. The spread of the virus can only
be prevented via multiple doses of safe and effective polio vaccines. Two types of
vaccines are currently being used to protect communities against Poliomyelitis: the oral
polio vaccine (OPV) and the inactivated poliovirus vaccine (IPV).
The oral poliovirus vaccine (OPV) may contain one strain, a combination of two

(bivalent OPV), or all three strains (trivalent OPV) of attenuated poliovirus. Trivalent
OPVs were originally used, however, it has been switched to bivalent OPVs (containing
only the type 1 and type 3 wild poliovirus strains) after the eradication of the type 2 wild
poliovirus in 2015.
Protecting people against all three types of poliovirus, is the Inactivated poliovirus
vaccine (IPV). This type of vaccine does not contain live strains of the virus, therefore,
this vaccine cannot cause disease and people immunized with IPVs do not exuviate the
virus. Most countries use the IPV for routine immunization programs; however IPVs
cannot stop the transmission of the virus in communities. Hence, in countries where
polio outbreaks exist, OPVs are primarily used. After the polio outbreak has been
contained, the use of OPVs must be halted to prevent transmissions caused by vaccine-
derived poliovirus (VDPV).
Vaccine-derived polioviruses (VDPVs) are rarely occurring forms of the poliovirus

which originates from the genetic mutation of the attenuated viruses found in oral polio
vaccines. This type of poliovirus only emerges in underimmunized communities with
high population densities and poor sanitation and hygiene.
On September 19, 2019, the Department of Health (DOH) confirmed that Polio
has re- emerged in the Philippines, 19 years after World Health Organization (WHO)
declared the country as polio- free in 2000. Two cases were reported in September
2019, both of which were caused by vaccine-derived poliovirus type 2 (VDPV2).
However, as of January 27, 2020, 13 cases of Circulating vaccine-derived poliovirus
type 2 (cVDPV2), one case of cVDPV1; one case of VDPV1; and one case with
immunodeficiency-related VDPV type 2 (iVDPV2) have been confirmed in the country.
In line with this, the alarming outbreak of such cases in a once polio- free country
have highlighted the importance of strengthening polio surveillance systems and the
significance of ensuring high vaccination coverage in communities to contain the
outbreak and eradicate the possibility of re-transmission via various types of VDPVs.
As members of the healthcare team, we must be one with the Global Polio
Eradication Initiative (GPEI), a public-private partnership led by various organizations
such as World Health Organization (WHO), the US Centers for Disease Control and
Prevention (CDC), the United Nations Children’s Fund (UNICEF), and the Bill & Melinda
Gates Foundation in their new Endgame Strategy (2019-2023) for Poliomyelitis, which
focuses on implementing strategies to address circulating vaccine- derived polioviruses
(cVDPVs) and on the continuation of providing polio vaccines to every child in the world,
most especially those living in high- risk communities.
Lastly, as student nurses, it is important for us to be aware of the current

situation regarding Poliomyelitis for us to know the information that we can relay and the
interventions that we can do in our communities to help completely eradicate this highly
infectious disease.
OBJECTIVES
General Objective:
The main objective of this case analysis is to provide knowledge about the
disease process and mitigation of poliomyelitis and to enable the student nurses to gain
insights about how to apply this knowledge in delivering nursing services to
communities with active poliomyelitis cases.
Specific Objective:
Upon completion of the case analysis, the student nurses should achieve the
following:
1. Obtain and describe data about Poliomyelitis;

2. Trace its Etiology;
3. Enumerate symptoms related to the disease as well as the possible medical
management;
4. Provide the prognosis for the disease;
5. Provide a list of existing Department of Health programs related to the mitigation
of Poliomyelitis;
6. Relate the management of the disease to an appropriate Nursing Theory and;
7. Apply the knowledge of Poliomyelitis combined with the Nursing theory to
formulate significant nursing interventions for possible nursing diagnoses and
apply it to health teachings for families affected by the disease.
II. PATHOPHYSIOLOGY
A. Etiology
Poliomyelitis is caused by the poliovirus, a highly contagious RNA virus that can
be transmitted through direct contact via the fecal- oral route and indirectly via
Ingestion. The virus belongs in the Enterovirus genus of the Picornaviridae family, which
is a single-stranded RNA that is surrounded by a capsid without lipid envelope making
the virus resilient to lipid solvents. The incubation period varies from 3 days to 30 days,
and the virus can be excreted from the gastrointestinal tract for up to 6 weeks. The virus
replicates in the oropharynx and proliferates locally in the tonsils and the lymph nodes
of the neck. Subsequently, it also replicates in the Gastrointestinal tract, and may
spread via the bloodstream to the lymph nodes and, rarely, to the central nervous
system, where it affects the motor neurons in the anterior horn and brainstem. It is the
destruction of motor neurons that leads to the development of acute flaccid paralysis.
Most of the virus is spread from fecal and oral contact with an infected person. It
shelters on oral secretions for several weeks and it stays in the feces for several
months. Usually, this occurs due to poor hygiene such as improper hand washing or
from sneezing and coughing. However, infected people who do not have symptoms can
still transmit the virus to others. Furthermore, the poliovirus can also be passed through
the ingestion of contaminated food or water. Poliovirus-endemic areas are usually the
places with particular factors that inhibit vaccination, such as remote location, war-torn
environments, and cultural barriers to vaccination. Thus, residence in one of these
areas confers the risk of not being immunized, and consequently being at risk of
contracting poliomyelitis.
Predisposing Factors Rationale

1. Environmental *persisting practice of open defecation and poor sanitation in
low- resource communities increases the probability of polio
virus transmission via the fecal- oral route
2. Unvaccinated status *Vaccination is required to enable our bodies to create
antibodies specific to the poliovirus which can then protect
us from acquiring Poliomyelitis.
3. Immunodeficiency Persons with primary immunodeficiencies may have an
inability to mount an adequate immune response after
vaccination, prolonging viral shedding and the persistence of
intestinal vaccine virus infection. (Centers for Disease
Control and Prevention, July 16, 2020)
https://www.cdc.gov/mmwr/volumes/69/wr/mm6928a4.htm
4. Malnutrition The immune response to polio vaccinations on
malnourished children is approximately four percent lower
compared to nourished children, impacting the overall
effectivity of the poliovirus vaccine.
(https://www.thenewhumanitarian.org/report/94700/pakistan-
malnutrition-undermining-battle-against-polio)
5. Age Although Poliomyelitis can affect people of all ages, infants,
children, and older people are more vulnerable to
poliomyelitis infection. In line with this, Poliomyelitis mostly
affects children under 5 years of age.
https://www.healthhub.sg/a-z/diseases-and-
conditions/72/polio
Precipitating Factors Rationale

1. Excessive exercise Excessive exercise amongst Polio patients heightens their risk
of increased chronic fatigue levels and muscle weakness,
thereby, decreasing their functional level and increasing their
risk of post- polio syndrome.
(https://www.svhm.org.au/ArticleDocuments/2075/Exercise-
Brochure-physios.pdf.aspx?embed=y and
https://www.mayoclinic.org/diseases-conditions/post-polio-
syndrome/symptoms-causes/syc-20355669)
2. B-cell Persons with B-cell immunodeficiencies are at significantly
immunodeficiency increased risk of paralytic poliomyelitis and can manifest long-
term poliovirus excretion. B cells are specialized lymphocytes
whose primary function is to produce antibodies specific to
foreign antigens such as the poliovirus.
(https://academic.oup.com/jid/article/210/suppl_1/S368/219434
9 and https://primaryimmune.org/immune-system-and-primary-
immunodeficiency)
B. Symptomatology
Most poliovirus- infected patients are asymptomatic. When they do acquire

symptoms, the manifestation is usually as a minor illness characterized by
gastrointestinal disturbances, which is usually mistaken for a typical gastroenteritis.
Abortive Poliomyelitis:
Signs and Symptoms:
 generalized, non-throbbing headache

 fever of 38-40 º C
 Malaise
 Sore throat
 Nausea and/ or vomiting
 Decreased appetite
 Gastrointestinal disturbances
The signs and symptoms observed in abortive poliomyelitis is related to immune

responses against the virus’ circulation. Moreover, the virus is acquired via the fecal-
oral route, from which it replicates mainly in the throat and gastrointestinal tract, causing
disturbances in these areas.
Non- paralytic Poliomyelitis (aseptic meningitis):
Symptoms of non- paralytic poliomyelitis may include those found in abortive

poliomyelitis with the addition of:
 Worsened headache, Nausea and/ or vomiting

 stiffness of the neck and back (along the spine)
 pain of the muscles in the neck, trunk, arms, and legs
 areas of hyperesthesia (increased sensation) and paresthesia (altered sensation)
Aseptic meningitis is the inflammation of the meninges, the membranes covering

the brain and spinal cord which is caused by viruses. The poliovirus is able to penetrate
and subsequently spread in the central nervous system, from which it causes the
above-mentioned symptoms. In rare cases, some patients may also experience
photophobia, which is a manifestation of meningeal irritation.
Paralytic poliomyelitis:
Symptoms of paralytic poliomyelitis may include those found in non- paralytic

poliomyelitis with the addition of:
 Severe muscle pain and spasms

 Flaccid muscle tone
 assymetrical weakness
 muscle wasting
 reflexes initially are brisk but then become absent
 Muscle paralysis
 Weakened breathing
 Bladder paralysis
Only a few population of people infected with poliomyelitis progress to the major
paralytic illness, which involves acute flaccid paralysis (AFP). The poliovirus is able to
replicate in the nervous system, subsequently destroying motor neurons that activate
the skeletal muscles. The affected muscles then lose their functions due to lack of
innervation, causing the condition AFP.
Paralytic poliomyelitis with Bulbar involvement (Bulbar Poliomyelitis):
Symptoms of paralytic poliomyelitis with bulbar involvement may include those

found in paralytic poliomyelitis with the addition of:
 Dyspnea
 Dysphagia
Although rare, Poliomyelitis can also affect the brainstem. The brainstem houses
the medulla oblongata, the part of the brain in charge of swallowing. Moreover, the
brainstem also coordinates breathing, thus damage in these areas of the brain cause
breathing and swallowing problems.
Post- poliomyelitis syndrome:
 Progressive weakness
 Muscle and joint pain
 Fatigue
 Muscle Atrophy
 Dysphagia
 Breathing difficulties
 Sleep disorders
 Sensitivity to cold temperatures
Post-poliomyelitis syndrome (PPS) may develop years or even decades following

acute poliomyelitis. PPS is not contagious and usually involve the muscle groups
previously affected in the original illness. The cause of PPS is currently unknown.
However, the leading theory suggests that it is due to the gradual deterioration of the
muscles previously affected by the poliovirus, which can account for why this condition
takes several years to manifest.
C. Management
Medical:
There is no cure for Poliomyelitis or post-poliomyelitis syndrome. It can only be

prevented by the use of oral polio vaccines and/or inactivated polio virus vaccine
administered according to the routine immunization schedule:
Vaccine Minimum Number Dosage Interval Route Site
Age of of Doses Between
First Dose Doses
OPV 6 weeks 3 2 drops 4 weeks Oral Mouth
Intramuscula Vastus
IPV 14 weeks 1 0.5 ml -
r Lateralis
Treatment for the minor illness, the major paralytic illness, and the respiratory
and post-poliomyelitis syndromes is supportive, with the aim of preventing or limiting
disability and disease progression.
Abortive Poliomyelitis (Gastrointestinal Illnesses):
The treatment is similar to that for any pediatric gastrointestinal illness.
Management: Rationale
Oral rehydration and/or intravenous fluids to prevent volume depletion
Monitor for acute flaccid paralysis (AFP) indicates progression to paralytic
poliomyelitis
Non- paralytic poliomyelitis:
Treatment is the same for symptoms similar to Abortive myelitis.
Paralytic poliomyelitis (acute flaccid paralysis):
There are no specific treatments for paralytic poliomyelitis. Vaccine-associated

paralytic poliomyelitis (VAPP) and circulating vaccine-derived poliovirus (CVDPV) are
rare occurrences following the use of oral attenuated poliovirus vaccine (OPV). OPV
should not be administered to children who are immunocompromised.
Physiotherapy (e.g. mobilizing the affected to minimize subsequent handicaps
limb(s) early
Supportive treatment (e.g. Corrective to help with walking and mobilization
braces)
Antispasmodic drugs to relax muscles
Bulbar Poliomyelitis (respiratory paralysis):
Patients should be monitored for progression of limb paralysis to respiratory

paralysis, a life-threatening condition requiring immediate expert medical assistance. No
experimental or alternative treatments have been demonstrated as effective to date.
Immediate transport to a specialized center is required for treatment.
Respiratory support measures (e.g. to support the process of air flowing in and
intubation and ventilation) as needed out of the lungs
Pulmonary Rehabilitation to increase lung endurance
Post-poliomyelitis syndrome (PPS):
This syndrome may develop many years or even decades following paralytic
poliomyelitis, and is characterized by fatigue, weakness, and wasting of affected
muscles.
Management Rationale
Low-intensity muscle-strengthening help muscle function and prevent
exercise programs (non-fatiguing contractures and muscle waste
exercises)
Use of assistive devices (e.g. lightweight to preserve energy and muscle strength
braces, canes, walkers, scooters, and
wheelchairs)
Pain relievers (e.g. aspirin, to ease muscle and joint pain
acetaminophen, ibuprofen)
Speech therapy (specifically designed for To help mitigate swallowing difficulties

Dysphagia)
Assisted breathing with a positive-pressure To ensure proper breathing pattern during
breathing machine sleep
While some existing medications have been proposed to help with paralytic
poliomyelitis and/or post-poliomyelitis syndrome, such as pyridostigmine,
corticosteroids, amantadine, lamotrigine, etc., there have been no trials of sufficient
quality or size to recommend the use of these agents. Patients are advised to continue
with physiotherapy on an outpatient basis to help muscle function. The duration of such
therapy should be individualized based on clinical progression and improvement.
Nursing Diagnosis #1
Nursing Goals: Nursing Interventions

Diagnosis
Ineffective 1. Patient  Assess respiratory rate, rhythm, depth, effort,
breathing maintains an and breath sounds; and elevate the head of
pattern effective breathing the bed to promote the optimum level of
related to pattern, as activity for best possible lung expansion.
respiratory evidenced by
 Encourage diaphragmatic breathing to relax
muscle relaxed breathing
muscles and increases the patient’s oxygen
fatigue as at normal rate and
level.
evidenced depth and
by dyspnea absence of  Provide respiratory medications and oxygen,
dyspnea. per doctor’s orders.
2. Patient’s
 Encourage frequent rest periods and teach
respiratory rate
patient to pace activity.
remains within
established limits.  Assist with Respiratory support measures
(e.g. intubation and ventilation) as needed
3. Patient performs
 Teach patient about:
diaphragmatic
pursed-lip pursed lip breathing
breathing.
performing relaxation techniques
diaphragmatic deep breathing
Nursing Goals: Nursing Interventions

Diagnosis
Imbalanced 1. Patient will  Encourage small frequent meals to promote
nutrition: declare increased nutritional and fluid intake and decrease
less than desire for stimulus to vomit
body nutritional and fluid
 maintain nasogastric tube feeding, if ordered;
requiremen intake.
ts related 2. Patient will  hyperalimentation may be necessary to
to verbalize less ensure adequate nutrition
insufficient feeling of nausea/
 eliminate unpleasant odors from the
dietary stimulus to vomit
environment during meals.
intake as 3. Patient will
evidenced demonstrate  If patient lacks strength, schedule rest periods
by proper use of before meals and open packages and cut up
weakness adaptive feeding food for patient.
of muscles devices as  Make adjustments to the thickness and

required for tolerated consistency of foods to improve nutritional
swallowing intake as recommended by a speech
and therapist.
insufficient
 Assist patient with the use of adaptive feeding
interest in
devices as recommended by an occupational
food.
therapist.
Nursing Goals: Nursing Interventions:

Diagnosis
Impaired 1. Patient will experience  Administer analgesics as prescribed

physical reduced pain and identify by a physician, and educate the
mobility relat diversional activities to patient on diversional activities to
ed to reduce pain. reduce the pain.
paralysis as 2. Patient is free from
 Reduce or eliminate the sources of
evidenced by complications of
heat loss in infants, and monitor the
inability to immobility, as evidenced
body temperature. Establish
move by intact skin, absence
measures to prevent skin breakdown
purposefully of thrombophlebitis.
and thrombophlebitis from prolonged
in the 3. Patient demonstrates
immobility.
physical the use of adaptive
environment devices to increase  Assist patient in the use of assistive
mobility devices aimed at increasing their
4. Patient demonstrates mobility.
measures to increase
 Assist patient for muscle exercises as
mobility
able or when allowed out of bed;
5. Patient uses safety
execute abdominal-tightening
measures to minimize
exercises and knee bends; hop on
potential for injury
foot; stand on toes.
 Let the patient accomplish tasks at

his or her own pace. Encourage
independent activity as able and safe.
Give positive reinforcement during
activity. Patients may be unwilling to
move or initiate new activity because
of fear of falling.
 Teach patient or family in maintaining
home atmosphere hazard-free and
safe. A safe environment will help
prevent injury related to falls. Home
modification can help the patient
maintain a desired level of functional
independence and reduce fatigue
with activity.
D. Prognosis
The prognosis of poliomyelitis is relative to the severity of the case and

subsequently, the extent of the damages caused by the disease. For patients with
abortive and non- paralytic poliomyelitis, prognosis is excellent and recovery is
complete. However, for patients who develop more severe symptoms such as in the
case of paralytic and bulbar poliomyelitis, patients usually develop lifelong disabilities
and even death. (https://www.medicinenet.com/polio_facts/article.htm)
Paralytic poliomyelitis has no definitive treatment. In patients with this case,

about 50% recover with no residual paralysis, and approximately 25% are left with
residual deficits of limb weakness and/or paralysis. The remaining patients are left with
severe permanent disabilities. With early and appropriate physiotherapy, some
functions can usually be restored.
Respiratory failure due to bulbar paralytic poliomyelitis is a medical emergency

and may develop in patients with paralysis, which has a high mortality rate. For patients
who survive, complete recovery is unusual and respiratory compromise usually remains.
Undergoing chest physiotherapy may bring minimal improvement on the residual
condition.
DEPARTMENT OF HEALTH PROGRAMS
On the 19th of September 2019, the Department of Health declared a polio

outbreak in the Philippines after two vaccine-deprived poliovirus type 2 (VDPV2) polio
cases from Lanao del Sur and Laguna Province have been recorded, almost 19 years
after the country has been declared polio-free since October 2000. Moreover,
environmental samples taken from waterways in Manila and Davao have confirmed the
circulation of VDPV2.
In line with this, the country is currently at a high-risk for poliovirus transmission
due to the persisting practice of open defecation and poor sanitation in communities.
Furthermore, the DOH also reported the decrease of vaccination coverage for the third
dose of the Oral Polio Vaccine (OPV) to the targeted population. This caused alarm and
an immediate response, along with the existing programs from the Department of
Health with support from the Global Polio Eradication Initiative (GPEI) was carried out,
which includes:
Before the 2019 outbreak:
1. Polio immunization campaign for all children under five years old and a
strengthened surveillance to children who appeared to have muscle weakness of
the upper and lower extremities;
2. Implementation of the Zero Open Defecation Program (ZODP) and to intensify
the education for environmental sanitation and personal hygiene, such as
frequent hand-washing;
Zero Open Defecation Program (ZOPD):
- The ZOPD is an advocacy and health education campaign which utilizes the
approaches and strategies of Community-Led Total Sanitation (CLTS) which includes
the promotion of total sanitation concepts such as ceasing open defecation practices,
ensuring the use of sanitary toilets, and frequent and proper hand washing aimed at
creating and maintaining a safe and clean environment. In select rural communities, a
communication campaign called “Goodbye, Dumi! Hello, Healthy!” was launched to
promote the ZOPD program. (https://www.doh.gov.ph/node/11787)
After the 2019 outbreak:
1. The Sabayang Patak Kontra Polio (SPKP) campaign started in July 2019 after
the detection of polioviruses from infected waterways. SPKP started with an aim
to at least immunize more than 95% of the target children for vaccination;
2. After the declaration of the polio epidemic, The Department of Health mandated
foreign nationals and returning Filipinos of all ages to receive a single dose of
inactivated poliovirus vaccine (IPV), this is the same for departing individuals.
Sabayang Patak Kontra Polio
- The SPKP is a campaign aimed at boosting the country’s immunization coverage

against polio by providing three doses of the OPV to all children under 5 years of age,
regardless of their immunization status. (http://ritm.gov.ph/ritm-supports-sabayang-
patak-kontra-polio/)
Sabayang Patak Kontra Polio Activities:
1. In August 2019, synchronized polio immunization programs with several

vaccination rounds was successfully conducted in the city of Manila and was
expanded to the National Capital Region (NCR) and to other priority regions;
2. In the months of January to April 2020, extended additional rounds of
immunization were conducted in NCR and all regions of Mindanao;
3. Amidst the start of the pandemic, the SPKP was put on hold and orientations on
polio vaccination and infection prevention as well as control guidelines and
meticulous planning with field teams were held online to ensure a safe campaign
once resumed. Due to the high demand of health care workers, volunteers were
trained to do vaccinations against polio in close coordination with local
community leaders in order to synchronize efforts for both polio and COVID;
4. In July to August 2020, the campaign resumed after being put on hold because
of the COVID-19 pandemic and had given vaccinations to children under 5 years
old as well as polio drops to children under 10 years old in selected areas in
Mindanao, and lastly;
5. As of September 2020, the aim for 95% of the target children to be immunized
had been reached. Since the resumption of the SPKP campaign, 3,408,241
children were vaccinated in Mindanao, 1,093,317 in Central Luzon. 250,577 in
CALABARZON excluding Calamba City. Round 2 of the SPKP will be targeting
the same region with an aim of 1,185,005 children in Laguna, Cavite, and Rizal.
Related Nursing Theory
“Dorothea Orem’s Self- Care Deficit Theory”
Dorothea Orem’s Self- Care Deficit Theory is a goal- oriented theory aimed at
encouraging patients to maximize their ability to perform “self- care” despite being in an
illness state. Orem’s theory defines self- care as the activities that individuals initiate
and perform independently throughout life to perform and maintain health and well-
being. Moreover, it defined Nursing as “The act of assisting others in the provision and
management of self-care to maintain or improve human functioning at home level of
effectiveness.” In line with this, our goal as student nurses is to be able to improve the
Poliomyelitis patient’s ability to perform self- care despite their existing condition.
Furthermore, Orem’s theory also defined the concept of Dependent- care, which
refers to the care that is provided to persons who, because of factors such as paralysis,
are unable to independently perform self- care. In line with this concept, Orem’s theory
also elaborated three basic Nursing systems, which are: Wholly compensatory nursing
system; partially compensatory nursing system; and supportive- educative nursing
system. These nursing systems describe the series of deliberate practical nursing
actions to be performed relative to the patient’s ability and self- care demands. For
Poliomyelitis patients, all three of these nursing systems can be used, in accordance to
the severity of the patients’ symptoms. However, for paralytic poliomyelitis patients, they
either fall under the partly or wholly compensatory system.
Orem’s theory also identified the concept of Universal Self- Care Requisites,
which are universally- required goals to be met through self- care or dependent care.
The first Universal Self- Care Requisite is the Maintenance of a sufficient intake
of air. Some patients affected with Poliomyelitis experience dyspnea due to damages
made in their brainstem by the poliovirus, thus affecting their ability to meet the first
Universal need. This aspect of Orem’s theory will be a beneficial guide in formulating
the nursing interventions for the first nursing diagnosis, the Ineffective airway clearance.
The second and third Universal Self- Care Requisite is the Maintenance of a
sufficient intake of food and water. Abortive Poliomyelitis patients experience nausea
and/ or vomiting as well as gastrointestinal disturbances, which can decrease their
appetite. Moreover, some Paralytic Poliomyelitis patients experience dysphagia
because of the poliovirus’ damage to the medulla oblongata, thus, can partially or
completely obstruct their ability to independently meet these two requisites. The nursing
interventions for the second nursing diagnosis Inadequate Nutrition is based on these 2
Universal requisites.
Lastly, the fifth Universal Self- Care Requisite is the Maintenance of balance
between activity and rest. For Paralytic Poliomyelitis patients, this aspect of the Self-
Care Deficit theory is crucial for the mitigation of their symptoms. Physiotherapy,
specifically early mobilization of the affected limbs, is required to minimize subsequent
handicaps. However, as student nurses, we need to ensure that the patient does not
excessively exercise because this exacerbates muscle weakness and heightens their
fatigue levels. Thus, emphasis on the balance between activity and rest is an essential
factor to consider for our nursing interventions for the third nursing diagnosis, the
impaired physical mobility as evidenced by inability to move purposefully in the physical
environment.
“Florence Nightingale‘s Environmental Theory”
Florence Nightingale, also known as “The Lady with the Lamp” is the founder of
modern nursing and the first nursing theorist. She believed that healthy surroundings
were necessary for proper nursing care and for the restoration and maintenance of
health.
Nightingale’s Environmental Theory defined Nursing as “the act of utilizing the

environment of the patient to assist him in his recovery.” In this theory, she identified 5
environmental factors that affect health: fresh air, pure water, efficient
drainage, cleanliness or sanitation, and light or direct sunlight. In line with this,
Nightingale’s environmental theory is a suitable basis for nursing interventions i.e.
health promotion, needed in the mitigation of poliomyelitis in the community setting.
For Poliomyelitis, much emphasis will be given to Nightingale’s elaboration on

the importance of the Cleanliness or Sanitation factor. She noted that an unsanitary
environment was a source of infection through the organic matter it contained.
Poliomyelitis is endemic in low- resource communities with poor sanitation, thus, this
aspect of the Environmental theory is crucial for the mitigation of this highly- infectious
disease.
Moreover, Efficient Drainage, which Nightingale described as appropriate

handling and disposal of bodily secretions and sewage, are required to prevent
contamination of the environment. Poliomyelitis is mainly spread through the fecal- oral
route, thus, emphasis on the proper use of toilets and sewage maintenance is
necessary to prevent the spread of polio virus- containing fecal matter to the
community.
Furthermore, Pure Water is also a critical factor that needs to be put in

consideration to improve the health status of the residents living in crowded,
environmentally inferior conditions. Pure water is an essential commodity for all, and is
required for people to practice proper hygiene such as bathing and hand-washing; in
cleaning their respective homes; and in preparing and cooking food. Hence, if water in
the community is contaminated, it can serve as an additional mode of contracting
diseases instead of preventing them.
In conclusion, utilizing the concepts of Nightingale’s Environmental theory,

specifically the Environmental factors Cleanliness or Sanitation, Efficient Drainage, and
Pure Water, is essential in controlling the spread of poliomyelitis. As per Health
Secretary Francisco Duque III, “Aside from immunization, we remind the public to
practice good personal hygiene, wash their hands regularly, use toilets, drink safe
water, and cook food thoroughly”.
References:
Mehndiratta, M. M., Mehndiratta, P., & Pande, R. (2014). Poliomyelitis: historical facts,
epidemiology, and current challenges in eradication. The Neurohospitalist, 4(4), 223–
229. https://doi.org/10.1177/1941874414533352
Ashish S Ranade, M. (2020, July 21). Poliomyelitis. Retrieved October 06, 2020, from
https://emedicine.medscape.com/article/1259213-overview
Johnson, S. (2018, September 17). Polio: Types, Causes, & Symptoms. Retrieved
September 21, 2020, from https://www.healthline.com/health/poliomyelitis
Khan, O., & Heymann, D. (2020, June 26). Poliovirus infection. Retrieved October 06,
2020, from https://bestpractice.bmj.com/topics/en-gb/902?q=Poliovirus+infection
Department of Health, (2019). DOH Intensifies Efforts to Prevent Polio. Retrieved on:
October 5, 2020 from https://www.doh.gov.ph/press-release/DOH-INTENSIFIES-
EFFORTS-TO-PREVENT-POLIO
Department of Health, (2019). Advisory: Polio Vaccination for Travellers Coming

to the Philippines. Retrieved on: October 5, 2020 from
https://www.doh.gov.ph/advisories/Polio-Vaccination-for-Travelers-coming-to-the-
Philippines
Department of Health, (2020).DOH Extends Polio Campaign Until April.

Retrieved on: October 5, 2020 from https://www.doh.gov.ph/doh-press-release/doh-
extends-polio-campaign-until-april
Department of Health, (2020). DOH, WHO, and UNICEF Resume Polio

Campaign. Retrieved on: October 5, 2020 from https://www.doh.gov.ph/press-
release/DOH-WHO-and-UNICEF-Resume-Polio-Campaign
Department of Health, (2020). DOH: 95% of Target for the SabayangPatakKontra

Polio Reached; Successful LGU-led Campaign Basis for COVID Strategy. Retrieved on:
October 5, 2020 from https://www.doh.gov.ph/press-release/DOH-95%25-OF-TARGET-
FOR-THE-SABAYANG-PATAK-KONTRA-POLIO-REACHED-SUCCESSFUL-LGU-
LED-CAMPAIGN-BASIS-FOR-COVID-STRATEGY
Department of Health, (2020). DOH Conducts 2 nd Round of

SabayangPatakKontra PolioIn Central Luzon and Calabarzon. Retrieved on: October 5,
2020 from http://www.doh.gov.ph/press-release/DOH-CONDUCTS-2ND-ROUND-OF-
SABAYANG-PATAK-KONTRA-POLIO-IN-CENTRAL-LUZON-AND-CALABARZON
Disease Outbreak News, (2019).Polio outbreak– The Philippines.Retrieved on:

October 5, 2020 from https://www.who.int/csr/don/24-september-2019-polio-outbreak-
thephilippines/en/#:~:text=On%2019%20September%202019%2C%20the,also
%20tested%20positive%20for%20VDPV2.
World Health Organization, (n.d.).Polio Outbreak in the Philippines. Retrieved on:

October 5, 2020 from https://www.who.int/westernpacific/emergencies/polio-outbreak-
in-the-philippines

Polio Case Analysis1

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Polio Case Analysis1

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A Case Analysis on

In Partial Fulfillment of the

Requirements in NCM- 204 RLE

COMMUNITY HEALTH NURSING ROTATION

BEVAN B. BALBUENA, RN, MN

Mary Justine N. Africa St. N

Anikka Dumandan St. N

Trianah Marie A. Ilagan St. N

October 14, 2020

III. Department of Health Programs 19

IV. Nursing Theory 21

The poliovirus’ main mode of transmission is by person-to-person through the

The incubation period of the poliovirus ranges from 3 to 30 days. At 3 to 5 days,

The oral poliovirus vaccine (OPV) may contain one strain, a combination of two

Vaccine-derived polioviruses (VDPVs) are rarely occurring forms of the poliovirus

Lastly, as student nurses, it is important for us to be aware of the current

1. Obtain and describe data about Poliomyelitis;

Predisposing Factors Rationale

Precipitating Factors Rationale

Most poliovirus- infected patients are asymptomatic. When they do acquire

Signs and Symptoms:

 generalized, non-throbbing headache

The signs and symptoms observed in abortive poliomyelitis is related to immune

Non- paralytic Poliomyelitis (aseptic meningitis):

Symptoms of non- paralytic poliomyelitis may include those found in abortive

 Worsened headache, Nausea and/ or vomiting

Aseptic meningitis is the inflammation of the meninges, the membranes covering

Symptoms of paralytic poliomyelitis may include those found in non- paralytic

 Severe muscle pain and spasms

Paralytic poliomyelitis with Bulbar involvement (Bulbar Poliomyelitis):

Symptoms of paralytic poliomyelitis with bulbar involvement may include those

Post- poliomyelitis syndrome:

Post-poliomyelitis syndrome (PPS) may develop years or even decades following

There is no cure for Poliomyelitis or post-poliomyelitis syndrome. It can only be

Abortive Poliomyelitis (Gastrointestinal Illnesses):

The treatment is similar to that for any pediatric gastrointestinal illness.

Non- paralytic poliomyelitis:

Treatment is the same for symptoms similar to Abortive myelitis.

Paralytic poliomyelitis (acute flaccid paralysis):

There are no specific treatments for paralytic poliomyelitis. Vaccine-associated

Bulbar Poliomyelitis (respiratory paralysis):

Patients should be monitored for progression of limb paralysis to respiratory

Post-poliomyelitis syndrome (PPS):

Speech therapy (specifically designed for To help mitigate swallowing difficulties

Nursing Goals: Nursing Interventions

diaphragmatic deep breathing

Nursing Goals: Nursing Interventions

by proper use of before meals and open packages and cut up

weakness adaptive feeding food for patient.

of muscles devices as  Make adjustments to the thickness and

Nursing Goals: Nursing Interventions:

Impaired 1. Patient will experience  Administer analgesics as prescribed

 Let the patient accomplish tasks at

The prognosis of poliomyelitis is relative to the severity of the case and

Paralytic poliomyelitis has no definitive treatment. In patients with this case,

Respiratory failure due to bulbar paralytic poliomyelitis is a medical emergency

On the 19th of September 2019, the Department of Health declared a polio

Before the 2019 outbreak:

Zero Open Defecation Program (ZOPD):

After the 2019 outbreak:

Sabayang Patak Kontra Polio

- The SPKP is a campaign aimed at boosting the country’s immunization coverage

Sabayang Patak Kontra Polio Activities:

1. In August 2019, synchronized polio immunization programs with several