C.

Whooping Cough (Pertussis)

⮚ Description
o It is an acute infection of the respiratory tract characterized by repeated attack
of spasmodic coughing which consists of a series of explosive expirations.
Producing a crowing sound, “the whoop”, and usually followed by vomiting.
o Coughing may last for several weeks and occasionally 2-3 months
⮚ Etiologic Agent
o Haemophilus Pertussis
o Bordet Gengou Bacillus
o Bordetella pertussis or pertussis bacillus
⮚ Source of Infection
o Discharges from laryngeal and bronchial mucous membrane of infected persons
⮚ Mode of Transmission
o Direct spread through respiratory and salivary contacts
o Crowding and closed association with patients facilitate spread
⮚ Incubation Period
o 7-10 but not exceeding 21 days
⮚ Period of Communicability
o In early catarrhal stage, paroxysmal cough confirms provisional clinical diagnosis
7 days after exposure to 3 weeks after onset of typical paroxysms
⮚ Clinical Manifestation
o Violent coughing
o Nose bleeding
o Distended neck veins
o Periorbital edema
o Conjunctival hemorrhage
⮚ Complications
o Bronchopneumonia- most dangerous
o Convulsion
o Umbilical hernia
o Otitis media
o Severe malnutrition and starvation
⮚ Diagnostic Tests
o Nasopharyngeal swab (Positive for B. pertussis)
o Sputum culture
o CBC (Leukocytosis)
o Chest Radiography may reveal infiltrates or edema with atelectasis
⮚ Treatment Modalities
o Supportive therapy
✔ Fluid and electrolyte replacement
✔ Adequate nutrition
✔ Oxygen therapy
o Antibiotics
✔ Erythromycin
✔ Ampicillin
o Hyperimmune convalescent serum/ gamma globulin
⮚ Susceptibility, Resistance and Occurrence
o Susceptibility is general, predominantly a childhood disease, the incidence being
highest under 7 years of age and mortality highest in infants, particularly under
6 months of age.
o One attack confers definite and prolonged immunity.
o Second attack occasionally occurs
o A very prevalent and common disease among children everywhere regardless of
race, climate or geographic location.
⮚ Methods of Prevention and Control
o Routine DPT immunization of all infants which can be started at 1 ½ months of
life and given at monthly intervals in 3 consecutive months.

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 oThis constitutes the primary injections.
oBooster dose is to be given at the age of 2 years and again at 4 to 5 years of age
oThe patient should be segregated until after 3 weeks from the appearance of
paroxysmal cough.
⮚ PHN Responsibilities
o Explain clearly to parents the dangers of whooping cough and the need for
active immunization against the disease in infancy.
o Direct or guide parents to resources of the community where this service is
available as in health centers, private physicians and health clinics
o Observe patients for signs of complications and report immediately to physician
for desirable treatment
o Observe general nursing responsibilities in communicable disease care
⮚ Nursing Care
o Isolation and medical asepsis
o Suction equipment should be present at bedside
o Provide warm bath
o Keep the bed dry and free from soiled linens
o I and O should be closely monitored
o Care should be focused on prevention and other complications: special
attention to diet is needed if patient vomits after cough paroxysms
o Teach parents how to pick up the infant or child during paroxysmal cough, giving
abdominal support
o General care of nose and throat discharges

D. Influenza - (La Grippe)

⮚ Description
o Acute highly communicable disease characterized by abrupt onset with fever
which last 1 day to 6 days, chilly sensation or chills, aches or pains in the back
and limbs with prostrations.
o Respiratory symptoms include coryza, sore throat and cough
⮚ Etiological Agent
o Influenza A,B,C
⮚ Source of infection
o Discharges from the mouth and nose of infected persons
⮚ Mode of Transmission
o By direct contact, through droplet infection,
o by articles freshly soiled with discharged of nose and throat of infected person
o Airborne
⮚ Incubation Period
o Short, usually 24 to 72 hours
⮚ Period of Communicability
o Probably limited to 3 days from clinical onset
⮚ Clinical manifestations
o Chilly sensation
o Hyperpyrexia
o Severe aches and pains usually at the back associated with severe sweating
o Vomiting
o Sore throat
o Coryza and cough
⮚ Complications
o Hemorrhagic pneumonia
o Encephalitis
o Myocarditis
o Sudden infant death syndrome
⮚ Diagnostic Procedures
o Blood examination
✔ Usually normal but leucopenia has been noted

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 o Viral culture (oropharyngeal washing or swabbing during the first few days of
illness
o Viral serology
o Complement Fixation Test
✔ It is an immunological medical test that can be used to detect the
presence of either specific antibody or specific antigen in a patient’s
serum
o Chest Radiography may reveal bilateral symmetrical interstitial infiltrates
indicative of pneumonia
o Arterial blood Gas testing may reveal hypoxemia in severe cases
o Laboratory Tests may reveal leucopenia, lymphopenia and thrombocytopenia
⮚ Susceptibility, Resistance and Occurrence
o Universal but of varying degrees as shown by frequent unapparent and typical
infection during epidemics
o Occurrence is variable, in pandemics, local epidemics and as sporadic cases,
often unrecognized by reason of indefinite clinical symptoms
o Infection produces immunity of unknown duration to the type and subtype of
infecting virus

⮚ Methods of Prevention and Control

o Education of the public as to sanitary hazard from spitting, sneezing and
coughing
o Avoid use of common towels, glasses and eating utensils
o Active immunization with influenza vaccine
o Avoid crowded places
⮚ PHN Responsibilities
o Isolate patient during the acute stage
o Report cases to local health officer
o During epidemics, patients should be instructed to go to bed at the beginning of
the attack and not to return to work without the approval of the physician
⮚ Nursing Care
o Keep patient warm and free from drafts in bed
o Keep patient away from persons suffering from respiratory tract infections to
prevent pneumonia
o TSB fro fever
o Cover the nose and mouth while sneezing and coughing
o Teach the burning method or disposal of contaminated tissues and newspaper
o Clothing soiled with throat and nose discharges should be boiled for 30 minutes
before laundering
E. Pneumonia
⮚ Description
o An acute infectious disease of the lungs usually caused by the pneumoccocus
resulting in the consolidation of one or more lobes of either one or both lungs
⮚ Etiologic Agents
o Streptococcus pneumonia
o Staphylococcus aureus
o Haemophilus influenza
o Pneumococcus of Friedlander
o Majority of cases due to Diploccocus pneumoniae
o Viruses
⮚ Predisposing Causes
o Fatigue
o Overexposure to inclement weather (extreme heat or cold)
o Exposure to polluted air
o Malnutrition
⮚ Incubation Period
o 2 to 3 days

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 ⮚ Mode of Transmission
o Droplet infection
o Indirect contact (fomites)
⮚ Signs and Symptoms
o Rhinitis/ common cold
o Chest indrawing
o Rusty sputum
o Productive cough
o Fast respiration
o High fever
o Vomiting at times
o Convulsions may occur
o Flushed face
o Dilated pupils
o Severe chill in young children
o Pain over affected lung
o Highly colored urine with reduced chlorides and increased urates
⮚ Complications
o Emphysema- a condition in which the air sacs of the lungs are damaged and
enlarged, causing breathlessness
o Endocarditis or pericarditis
o Pneumococcal meningitis
o Otitis media in children
o Jaundice
o Abortion
⮚ Diagnostic Test
o Based on history and clinical s/s
o Dull percussion noted on affected side (lung)
o Chest X-ray
o Sputum analysis
o Blood/ serologic exam
⮚ Management
o Bed rest
o Adequate salt, fluid, calorie, and vitamin intake
o TSB for fever
o Frequent turning from side to side
o Antibiotics based on Care of Acute Respiratory Infection (CARI) of the DOH
⮚ Prevention and Control
o Prevent common colds, influenza and other respiratory infections
o Immunization with pneumonia vaccine
o Eliminate contributory factors such as exposure to cold, pollution, and physical
conditions of fatigue or alcoholism

F. Anthrax
⮚ Other Terms
o Wool sorter’s Disease- a pulmonary form of anthrax that results from the
inhalation of spores of the bacterium Bacillus anthracis in the wool of
contaminated sheep
o Ragpicker’s disease-
o Malignant pustule
o Malignant edemia
⮚ Description
o It is an acute bacterial disease usually affecting the skin but which may very
rarely involve the oropharynx, lower respiratory tract, mediastinum or intestinal
tract
⮚ Etiologic Agent
o Bacillus anthracis

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⮚ Mode of Transmission
o Cutaneous infection is by contact with:
✔ Tissues of animals (cattle, sheep, goats, horses, pigs and others) dying of
the disease
✔ Contaminated hair, wool or products made from them such as drums or
brushes
✔ Soil associated with infected animals or contaminated bone meal used
in gardening
⮚ Incubation Period
o Inhalation anthrax (1 to 7 days) usually within 48 hours
o Cutaneous anthrax 1 to 7 days rarely up to 7 weeks
o Ingestion (1 to 7 days)
⮚ Clinical Manifestations
o Cutaneous anthrax
✔ Most common (over 90% of cases)
✔ Infection through skin
✔ Over a few days a sore, which begins as a pimple, grows, ulcerates and
forms a black scab, around which are purplish vesicles
✔ Systemic symptoms may include rigors, headache and vomiting
✔ The sore is usually diagnostic; 20% of cases are fatal
o Inhalational Anthrax
✔ Spores are inhaled, with subsequent invasion of mediastinal lymph
nodes
✔ Abrupt onset of the flu-like illness, rigors, dyspnea and cyanosis
followed by shock and usually death over the next 2 to 6 days.
o Intestinal Anthrax
✔ Occurs following ingestion of meat from infected animals and is
manifested as violent gastroenteritis with fever, vomiting, bloody stools
and then septicemia. Prognosis is poor
⮚ Diagnostic Tests
o Polymerase Chain Reaction (PCR) – Definitive test for B. Anthracis
o Swabs from cutaneous lesions
o Nasal swabs (inhalational anthrax)
o Blood cultures
o Lymph nodes or spleen aspirates
o CSF shows characteristic bacilli on staining with polychrome methylene blue.
o Chest radiography may show fluid surrounding the lungs or widening of the
mediastinum
⮚ Treatment Modalities
o Antibiotics
✔ Doxycycline
✔ Ciprofloxacin
✔ Penicillin
o Treatment of cutaneous anthrax is oral antibiotics for 7 to 10 days
o Length of treatment for GI anthrax is 60 days, but safety has not been evaluated
beyond 14 days.
⮚ Complications
o Cutaneous anthrax
✔ Septicemia
o Inhalational anthrax
✔ Hemorrhagic meningitis
✔ Pleural effusion
✔ Mediastinitis
✔ Shock
✔ Acute respiratory distress syndrome
o GI anthrax
✔ Hemorrhage
✔ Shock

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 ⮚ Nursing Considerations
o Obtain culture specimen before starting antibiotic therapy
o Supportive measures are geared toward the type of anthrax exposure
o Teach the patient and family that anyone who has been exposed to anthrax
must see a doctor immediately
o Instruct the patient to take antibiotics as prescribed and until co9mpleted
o Instruct the patient with cutaneous anthrax not to scratch at the lesions
o Alcohol-based hand sanitizers do not kill anthrax spores, wash hands with soap
and water
⮚ Prevention
o Pretreatment of animal products and good occupational health cover are the
mainstays of control
o Animals believed to have died of anthrax should be disposed of under
supervision
o Mass vaccination of animals may reduce diseases spread
o Non- cellular vaccines for human use are available for individuals at risk from
occupational exposure
o Workers handling potentially infectious raw material should be aware of the
risks

G. Bird Flu (Avian Influenza)

⮚ Description
o It is an infectious disease of birds ranging from mild to severe form of illness
⮚ Sources of Infection
o Viruses that normally infect only birds and less commonly pigs
⮚ Incubation Period
o 3 to 5 days
⮚ Clinical manifestations
o Fever
o Body weakness/ muscle pain
o Cough
o Sore throat
o May have difficulty of breathing in severe cases
o Sore eyes
⮚ Susceptibility, Resistance and Occurrence
o All birds are susceptible to infection but domestic poultry flocks are especially
vulnerable to infections that can rapidly reach epidemic population
⮚ Control measures
o Rapid destruction, proper disposal of carcasses and quarantining and rigorous
disinfection of farms
o Restrictions on the movement of live poultry
⮚ Nursing Care
o Isolation precaution
o Infection control
o Early recognition of cases of highly pathogenic avian influenza during outbreak
among poultry

H. Severe Acute Respiratory Syndrome (SARS)

⮚ Earliest known case (Guangdong Province, China, November 2002
⮚ Outbreak and worldwide surveillance (March 12, 2003)
⮚ First case in the Philippines (April 11, 2003)
⮚ Etiologic Agent
o Human coronavirus
⮚ Mode of Transmission
o Droplet contact
⮚ Incubation period

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 o Mean incubation period is 5 days(range 2-10 days) and may reach up to 14 days
⮚ Clinical Manifestations
o Prodromal Phase
✔ Fever >_ 38 degrees Celsius
✔ Chills
✔ Malaise
✔ Myalgia
✔ Headache
o Respiratory Phase
✔ Dry, non-productive cough with or without respiratory distress
✔ Hypoxia
✔ Crackles
✔ Dullness on percussion
✔ Decreased breath sounds on physical examination
⮚ Preventive Measures and Control
o Screen patients for travel history, symptoms or close contact with cases
o Isolation of suspected probable case
o Barrier nursing technique for suspected and probable case
⮚ Nursing care
o Maintain isolation measures
o Utilize personal protective equipment (PPE)
o Apply principles of hand wash