COMMUNICABLE DISEASE NURSING - An agent that prevents bacterial multiplication but does not kill

SUMMER REVIEW microorganisms

COMMUNICABLE DISEASE
■ Disease caused by an infectious agent that are transmitted CHAIN OF INFECTION
directly or indirectly to a well person through an agency, vector or
inanimate object

CONTAGIOUS DISEASE
■ Disease that is easily transmitted from one person to
another
INFECTIOUS DISEASE
■ Disease transmitted by direct inoculation through a break in
the skin

INFECTION
-Entry and multiplication of an infectious agent into the tissue of the
INFECTIOUS AGENT
host
■ Any microorganism capable of producing a disease
INFESTATION
RESERVOIR
- Lodgement and development of arthropods on the surface of the
■ Environment or object on which an organism can survive
body
and multiply
PORTAL OF EXIT
ASEPSIS
■ The venue or way in which the organism leaves the
- Absence of disease – producing microorganisms
reservoir
SEPSIS
MODE OF TRANSMISSION
- The presence of infection
■ The means by which the infectious agent passes from the
portal of exit from the reservoir to the susceptible host
MEDICAL ASEPSIS
PORTAL OF ENTRY
- Practices designed to reduce the number and transfer of
■ Permits the organism to gain entrance into the host
pathogens
SUSCEPTIBLE HOST
- Clean technique
■ A person at risk for infection, whose defense mechanisms
SURGICAL ASEPSIS
are unable to withstand invasion of pathogens
- Practices that render and keep objects and areas free from
microorganisms
STAGES OF THE INFECTIOUS PROCESS
- Sterile technique
■ Incubation Period – acquisition of pathogen to the onset of
signs and symptoms
■ CARRIER – an individual who harbors the organism and is
■ Prodromal Period – patient feels “bad” but not yet
capable of transmitting it without showing manifestations of the
experiencing actual symptoms of the disease
disease
■ Period of Illness – onset of typical or specific signs and
■ CASE – a person who is infected and manifesting the signs
symptoms of a disease
and symptoms of the disease
■ Convalescent Period – signs and symptoms start to abate
and client returns to normal health
■ SUSPECT – a person whose medical history and signs and
symptoms suggest that such person is suffering from that particular
MODE OF TRANSMISSION
disease
CONTACT TRANSMISSION
■ CONTACT – any person who had been in close association
■ Direct contact – involves immediate and direct transfer from
with an infected person
person-to-person (body surface-to-body surface)
■ Indirect contact – occurs when a susceptible host is
HOST
exposed to a contaminated object
- A person, animal or plant which harbors and provides nourishment
DROPLET TRANSMISSION
for a parasite
■ Occurs when the mucous membrane of the nose, mouth or
RESERVOIR
conjunctiva are exposed to secretions of an infected person within a
- Natural habitat for the growth, multiplication and reproduction of
distance of three feet
microorganism
VEHICLE TRANSMISSION
■ Transfer of microorganisms by way of vehicles or
ISOLATION
contaminated items that transmit pathogens
- The separation of persons with communicable diseases from other
AIRBORNE TRANSMISSION
persons
■ Occurs when fine particles are suspended in the air for a
QUARANTINE
long time or when dust particles contain pathogens
- The limitation of the freedom of movement of persons exposed to
VECTOR-BORNE TRANSMISSION
communicable diseases
■ Transmitted by biologic vectors like rats, snails and
mosquitoes
■ STERILIZATION – the process by which all microorganisms
including their spores are destroyed
TYPES OF IMMUNIZATION
■ DISINFECTION – the process by which pathogens but not
■ ACTIVE – antibodies produced by the body
their spores are destroyed from inanimate objects
■ NATURAL – antibodies are formed in the presence of
■ CLEANING – the physical removal of visible dirt and debris
active infection in the body; lifelong
by washing contaminated surfaces
■ ARTIFICIAL – antigens are administered to stimulate
antibody production
CONCURRENT
■ PASSIVE – antibodies are produced by another source
- Done immediately after the discharge of infectious materials /
■ NATURAL – transferred from mother to newborn through
secretions
placenta or colostrum
TERMINAL
■ ARTIFICIAL – immune serum (antibody) from an animal or
- Applied when the patient is no longer the source of infection
human is injected to a person
BACTERICIDAL
SEVEN CATEGORIES OF ISOLATION
- A chemical that kills microorganisms
■ STRICT- prevent highly contagious or virulent infections
BACTERIOSTATIC
■ Example: chickenpox, herpes zoster
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■ CONTACT – spread primarily by close or direct contact
■ Example: scabies, herpes simplex
■ RESPIRATORY – prevent transmission of infectious
distances over short distances through the air
■ Example: measles, mumps, meningitis
■ TUBERCULOSIS – indicated for patients with positive
smear or chest x-ray which strongly suggests tuberculosis
■ ENTERIC – prevent transmission through direct contact
with feces
■ Example: poliomyelitis, typhoid fever
■ DRAINAGE – prevent transmission by direct or indirect
contact with purulent materials or discharge
■ Ex. Burns
■ UNIVERSAL – prevent transmission of blood and body-fluid
borne pathogens
■ Example: AIDS, Hepatitis B
CENTRAL NERVOUS SYSTEM
THREE SIGNS OF MENINGEAL IRRITATION
OPISTHOTONUS
State of severe hyperextension and spasticity in which an individual’s
head, neck and spinal column enter into a complete arching position
BRUDZINSKI’S SIGN
Place the patient in a dorsal recumbent position and then put hands
behind the patient’s neck and bend it forward.
If the patient flexes the hips and knees in response to the
manipulation, positive for meningitis
KERNIG’S SIGN
Place the patient in a supine position, flex his leg at the hip and knee
then straighten the knee; pain and resistance indicates meningitis
DIAGNOSTIC EXAM
■ Informed consent
■ Empty bowel and bladder
■ Fetal, shrimp or “C” position
■ Spinal canal, subarachnoid space between L3-L4 or L4- L5
■ After: bedrest
■ Flat on bed to prevent spinal headache
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 ■ Headache
■ Sore throat
■ Recovery within 72 hours and the disease passes by
unnoticed
PRE-PARALYTIC OR MENINGETIC TYPE
■ Slight involvement of the CNS
■ Pain and spasm of muscles
■ Transient paresis
■ (+) Pandy’s test (increased protein in the CSF)
PARALYTIC TYPE
■ CNS involvement
■ Flaccid paralysis
■ Asymmetric
■ Affects lower extremities
■ Urine retention and constipation
■ (+) HOYNE’S SIGN (when in supine position, head will fall
back when shoulders are elevated)

RABIES
PRODROMAL/INVASION PHASE
■ Fever
■ Anorexia
■ Sore throat
■ Pain and tingling at the site of bite
■ Difficulty swallowing
EXCITEMENT OR NEUROLOGICAL PHASE
■ Hydrophobia (laryngospasm)
■ Aerophobia (bronchospasm)
■ Delirium
■ Maniacal behavior
■ Drooling
TERMINAL OR PARALYTIC PHASE
■ Patient becomes unconscious
■ Loss of urine and bowel control
■ Progressive paralysis
■ Death

POLIO
ABORTIVE TYPE
■ Does not invade the CNS
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RESPIRATORY SYSTEM

NURSING MANAGEMENT
BIRD FLU
WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD FLU
• Isolation
• Face mask on the patient
• Caregiver: use a face mask and eye goggles/glasses
• Distance of 1 meter from the patient
• Transport the patient to a DOH referral hospital

REFERRAL HOSPITALS
• National Referral Center – Research Institute for Tropical
Medicine (RITM) (Alabang, Muntinlupa)
• Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz,
Manila)
• Visayas – Vicente Sotto Memorial Medical Hospital
(Cebu City)
• Mindanao – Davao Medical Center (Bajada, Davao City)
SARS
SUSPECT CASE
1. A person presenting after 1 November 2002 with a history of:
▪ High fever >38 0C AND
▪ Cough or breathing difficulty AND

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 ▪ One or more of the following exposures during the 10 days • Membrane lining thickens 🡪 airway obstruction
prior to the onset of symptoms: • Suffocation, cyanosis or death
⮚ Close contact, with a person who is a suspect or WOUND OR CUTANEOUS DIPHTHERIA
probable case of SARS • Yellow spots or sores in the skin
⮚ History of travel, to an area with recent local
transmission of SARS PERTUSSIS
⮚ Residing in an area with recent local transmission of CATARRHAL STAGE
SARS • Lasts for 1 to 2 weeks
2. A person with an unexplained acute respiratory illness resulting • Most communicable stage
in death after 1 November 2002, but on whom no autopsy has • Begins with respiratory infection, sneezing, cough and
been performed : fever
AND • Cough becomes more frequent at night
▪ One or more of the following exposures during the 10 days PAROXYSMAL STAGE
prior to the onset of symptoms: • Lasts for 4 to 6 weeks
⮚ Close contact, with a person who is a suspect or • Aura: sneezing, tickling, itching of throat
probable case of SARS • Cough, explosive outburst ending in “whoop”
⮚ History of travel, to an area with recent local • Mucus is thick, ends in vomiting
transmission of SARS • Becomes cyanotic
⮚ Residing in an area with recent local transmission of • With profuse sweating, involuntary urination and
SARS exhaustion
PROBABLE CASE CONVALESCENT STAGE
1. A suspect case with radiographic evidence of infiltrates • End of 4th-6th week
consistent with pneumonia or respiratory distress syndrome on Chest • Decrease in paroxysms
x-ray.

2. A suspect case of SARS that is positive for SARS coronavirus by

one or more assays.

3. A suspect case with autopsy findings consistent with the

pathology of SARS without an identifiable cause.

NASAL DIPHTHERIA
• Bloody discharge from the nose
• Excoriated nares and upper lip
TONSILOPHARYNGEAL DIPHTHERIA
• Low grade fever
• Sore throat
• Bull-neck appearance
• Pseudomembrane- Group of pale yellow membrane over
tonsils and at the back of the throat as an inflammatory
response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA
• Hoarseness
• Croupy cough
• Aphonia
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MUMPS
MAIN PROBLEM
An acute contagious disease, with swelling of one or both of the
parotid glands
ETIOLOGIC AGENT
Filterable virus of paramyxovirus group
INCUBATION PERIOD
12-26 days
MODE OF TRANSMISSION
Respiratory droplets
PERIOD OF COMMUNICABILITY
6 days before and 9 days after onset of parotid swelling
SIGNS AND SYMPTOMS

PRODROMAL PHASE
F-ever (low grade)
H-eadache
M-alaise

PAROTITIS
F-ace pain
E-arache
S-welling of the parotid glands

COMPLICATIONS
• Orchitis – the most notorious complication of mumps
• Oophoritis – manifested by pain and tenderness of the
abdomen
• CNS involvement – manifested by headache, stiff neck,
delirium, double vision
• Deafness as a result of mumps
NURSING MANAGEMENT
1. Prevent complications
− Scrotum supported by suspensory
− Use of sedatives to relieve pain
− Treatment: oral dose of 300-400 mg cortisone followed by 100
mg every 6 hours
− Nick in the membrane
2. Diet
- Soft or liquid diet
- Sour foods or fruit juices are disliked
3. Respiratory isolation
4. Comfort: ice collar or cold applications over the parotid glands may
relieve pain
5. Fever: aspirin, tepid sponge bath
6. Concurrent disinfection: all materials contaminated by these
secretions should be cleansed by boiling
7. Terminal disinfection: room should be aired for six to eight hours

GASTROINTESTINAL TRACT

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INTEGUMENTARY SYSTEM

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 FORCHEIMER’S SPOTS (Rubella)
- small, red lesions
- Soft palate to mucus membrane

KOPLIK’S SPOT (Rubeola)

- Bluish white spots surrounded by a red halo
- Appear on the buccal mucosa opposite the premolar teeth

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SCABIES
MAIN PROBLEM
Infestation of the skin produced by the burrowing action of a parasite
mite resulting in skin irritation and formation of vesicles and pustules
ETIOLOGIC AGENT
Sarcoptes scabiei
INCUBATION PERIOD
Within 24 hours
MODE OF TRANSMISSION
Direct contact
Indirect contact

Sarcoptes scabiei
1. Yellowish white in color
2. Barely seen by the unaided eye
3. Female parasite burrows beneath the epidermis to lay eggs
4. Males are smaller and reside on the surface of the skin
SIGNS AND SYMPTOMS
• Thin, pencil-mark lines on the skin
• Itching, especially at night
• Rashes and abrasions on the skin
PRIMARY LESIONS
NODULAR LESIONS
SECONDARY LESIONS
TREATMENT MODALITIES
• SCABICIDE : Eurax ointment (Crotamiton)
• PEDICULICIDE : Kwell lotion (Gamma Benzene
Hexachloride) – contraindicated in young children and
pregnant women
• Topical steroids
• Hydrogen peroxide : cleanliness of wound
• Lindane Lotion
NURSING MANAGEMENT
• Apply cream at bedtime, from neck to toes
• Instruct patient to avoid bathing for 8 to 12 hours
• Dry-clean or boil bedclothes
• Report any skin irritation
• Family members and close contact treatment
• Good handwashing
• Terminal disinfection

SEXUALLY TRANSMITTED DISEASES

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SIGNS AND SYMPTOMS (Candidiasis)
ONYCHOMYCOSIS
• Red, swollen darkened nailbeds
• Purulent discharge
• Separation of pruritic nails from nailbeds
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DIAPER RASH
• Scaly, erythematous, papular rash
• Covered with exudates
• Appears below the breasts, between fingers, axilla, groin
and umbilicus
THRUSH
• Cream-colored or bluish-white patches on the tongue,
mouth or pharynx
• Bloody engorgement when scraped
MONILIASIS
• White or yellow discharge
• Pruritus
• Local excoriation
• White or gray raised patches on vaginal walls with local
inflammation

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VECTOR-BORNE DISEASES

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FILARIASIS
MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
Wuchereria bancrofti
Brugia malayi
Brugia timori
INCUBATION PERIOD
8 to 16 months
MODE OF TRANSMISSION
Person-to-person by mosquito bites
ACUTE STAGE
• Lymphadenitis (inflammation of lymph nodes)
• Lymphangitis (inflammation of lymph vessels)
• Male genitalia affected leading to funiculitis, epididymitis
and orchitis (redness, painful and tender scrotum)
CHRONIC STAGE
• Develop 10-15 years from onset of first attack
• Hydrocele (swelling of the scrotum)
• Lymphedema (temporary swelling of the upper and lower
extremities)
• Elephantiasis (enlargement and thickening of the skin of
the upper and lower extremities, scrotum and breast

LABORATORY EXAMINATIONS
• Nocturnal blood examination (NBE) – taken at patient’s
residence/hospital after 8PM
• Immunochromatographic test (ICT) – rapid assessment
method; an antigen test done at daytime
TREATMENT
• Diethylcarbamazine Citrate (DEC) or HETRAZAN – an
individual treatment kills almost all microfilaria and a good
proportion of adult worms.
PREVENTION AND CONTROL
• Measures aimed to control vectors
• Environmental sanitation such as proper drainage and
cleanliness of surroundings
• Spraying with insecticides
PREVENTION AND CONTROL
• Measures aimed to protect individuals and families:
• Use of mosquito nets
• Use of long sleeves, long pants and socks
• Application of insect repellants
• Screening of houses

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