HEMATOLOGY

FUCTION OF BLOOD

 Transport of gas, nutrients, waste

 Regulation of pH and osmosis (normal range:
7.35 (↓= acidosis) – 7.45 (↑= alkalosis))
 Thermoregulation
 Protection against foreign substances
 Clot formation
HEMATOLOGIC SYSTEM

 The blood and the blood forming sites:  It serves as electrolytes (sodium, hormones,
- Bone marrow respiratory gases, nutrients, waste products)
- Reticuloendothelial system  Serum – minus clotting factor in plasma
 Blood 45% - RBC (44% is the RBC and the remaining 1% is the
- Plasma “buffy coat” that composed of platelets and leukocytes)
- Blood cells
WBC (WHITE BLOOD CELLS)

NOTE: CBC READING

Erythropoiesis – production of RBC is happen that in yolk  HGB (Hemoglobin) – carries oxygen
sac after the 2nd/3rd intrauterine life it is taken by the
- ↓ HGB = Anemia
liver from there it will be taken by bone marrow.
 HCT (Hematocrit) – parameter that reflects the
90-120 days – lifespan of RBC hydration level
 RBC
55 % - Plasma (serum of blood; clear fluid of blood)
(91% water and 7% protein) - ↓ RBC = Anemia; ↑ = Polycythemia Vera
 WBC – Infection
 Protein metabolized by liver which produces- - ↑ = Infection
albumin, globulin (oncotic pressure= COP DIFFERENTIAL:
colloidal osmotic pressure, they are colloids, they  Basophil: allergy
have the capacity to hold water and fibrinogen  Eosinophil: parasites
(will form into fibrin then clot)  Neutrophil: ↑ Bacterial Infection
 Osmotic pressure - pull or hold the water  Lymphocytes: ↑ Viral Infection; self-
 Hydrostatic pressure - push the water limiting
 ↓ Plasma; Colloids in intravascular – it can shift  Monocytes: bacterial
into interstitial space that can cause edema.  Platelets: ↓ = dengue

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  ↑ RBD destruction
 Acute or Chronic blood loss
TYPES OF ANEMIA
 IRON-DEFICIENCY ANEMIA
 Inadequate intake of iron
 Most common type of anemia
 May occur with the removal of duodenum
 Associated also with chronic blood loss
NOTE:
o Iron is the major production of RBC
o Dietary problem is the main problem for iron
deficiency
o 1 mg of iron is lost in our body every day
o 1.5 mg per day is lost during regular
menstruation
o 500 mg total loss of iron in pregnancy
ETIOLOGIC FACTOR:

 Bleeding
 Malabsorption
ERYTHROPOIESIS  Malnutrition
 Happens in the RBM  Alcoholism
 Stimulated by the hormone erythropoietin PATHOGENESIS:
 Process requires B9 and B12 (for DNA synthesis)
Dec iron
 Iron is required for hemoglobin production
 Triggered by low oxygen level ↓
HEMATOPOIESIS Dec hemoglobin
 Process of blood cell production ↓
 Fetus
Dec oxygen
- Liver, thymus, spleen, lymph nodes, RBM
 After birth ↓
- RBM
= tissue hypoxia
BLOOD DISORDERS ASSESSMENT FINDINGS:
 ANEMIA 1. Pallor of skin and mucous membrane
 Reduction in the normal number of RBC 2. Weakness and fatigue
particularly the quantity of hemoglobin and its 3. General malaise
volume (hematocrit) 4. Pica (eating disorder)
 Occurs when the rate of RBC Production falls 5. Brittle nails
below that of cell destruction, or when there is 6. Smooth and sore tongue
loss of RBCs, causing their number and the
hemoglobin level to fall below that of production
NOTE: decrease oxygen there is tissue hypoxia
RESULTS FROM:

 ↓ RBC Production
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 - Liquid Preparation:
Stain teeth
Drink with a straw
 + Stool may turn black/dark in color
 Advice to eat high fiber diet and 1 fluid intake
to counteract constipation
 Iron should be taken for 2-3 months to have
effective return of hemoglobin to normal
 Administration of packed RBC if patient is
symptomatic
- Usually a Hgb of <7g/dl or 70 mg/dl

 APLASTIC ANEMIA
 Life-threatening stem cell disorder
 Can be accompanied by ↓ WBC as well as
platelets
LABORATORIES:  Characterized as:
- Hypoplastic: lumiit yung bone marrow
 CBC - Pancytopenia: ↓ RBC, WBC, and Platelets
 Iron studies - Fatty bone marrow
 BMA: Bone Marrow Aspiration
CAUSATIVE FACTORS:
NOTE:
 Environmental toxins such as pesticides
o People with iron deficiency anemia may  Certain drugs:
experience itchy skin (Pruritus) that can become - Chemo
red, bumpy and sore when scratched. Rashes - Chloramphenicol
associated with aplastic anemia usually appear - Sulfonamides
as tiny red or purple dots under your skin  Heavy metals
(petechial). The dots can form large patches but  Radiation
aren't usually itchy or painful.
o Cheilosis – a condition where the corners of the PATHOPHYSIOLOGY:
mouth become inflamed, which can lead to
Toxins directly attack the BM
cracking and pain at the corners of the mouth
MANAGEMENT: ↓
BM becomes acellular (di makapag produce ng mga
 Iron replacement
WBC, RBC, platelets)
- Taken without meals
- Oral: Ferrous sulfate (after meals; use of straw ↓
when giving this medication; Do not administer
with tea, milk, and antacid) Decrease production of cells
- Parenteral: IM (Z-track administration to avoid ASSESSMENT
leaking of medication)
 Blood Transfusion 1. Fatigue
2. Pallor
NURSING MANAGEMENT 3. Dyspnea
4. Bruising
 Provide Iron rich foods
5. Splenomegaly
- Organ meats
- Beans 6. Retinal hemorrhages: ↓ WBC
- Green leafy vegetables LABORATORIES:
 Administration of iron
- Oral preparation tablets  CBC
- Take it with vitamin C
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  BMA  Abnormally large RBC
 Biopsy
TYPES:
 Folic Acid Deficiency
NORMAL BM
 Folate is required for DNA synthesis in RBC
formation
 Decrease B9
 No neurologic involvement
 CAUSES:
- Alcoholism
- Malabsorption
 Diet deficient in uncooked vegetables
 Use of oral contraception
PATHOPHYSIOLOGY:

Aplastic Anemia ↓ Folate

↓
Impaired DNA synthesis
↓
Impaired RBC development
↓
Impaired Nuclear maturation
↓
Cytoplasmic maturation
MEDICAL MANAGEMENT
↓
 Bone marrow transplant
 Immunosuppressant drugs = Large size
 Steroids NURSING MANAGEMENT
 Blood transfusion
 Promote compliance with replacement therapy
NURSING MANAGEMENT  Administration of vitamins (pregnancy)
 Assess for signs of bleeding and infection  Instruction on food high in folate:
 Pancytopenia plan of care - Green leafy
- Private room - Liver
- Strict hand washing - Citrus fruits
- Minimize invasive procedures - Nuts and grains
 Client and family support NOTE:
NOTE: o B9 – no neurologic manifestation
o B12 – has neurologic manifestation
o Restrain/restrict the pt for activity to prevent
oxygen demand
 PERNICIOUS ANEMIA
 MEGALOBASTIC ANEMIA  Anemia due to deficiency of vitamin B12
 CAUSES:
Defective erythrocytes (megaloblast) structure caused by 1. Strict vegetarian diet
impaired DNA synthesis due to B12 or B9 defiency 2. Gastrointestinal malabsorption
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 3. Cohn’s Disease  Increase in the three types of blood cells
4. Chronic gastritis  UNKNOWN cause
5. Gastrectomy
ASSESSMENT:
NOTE:
 Reddish skin/ some areas
o Intrinsic factor is a protein that helps your
 Splenomegaly
intestines absorb vitamin B12.
o Parietal cell of stomach – production of intrinsic  Headaches
factor  Dizziness
↓ Production of intrinsic factor  Blurred vision
↓  Angina
↓ Absorption of Vitamin B12  Intermittent claudication
↓
PATHOPHYSIOLOGY:
↓ RBC
INCREASE ALL BLOOD COMPONENTS
ASSESSMENT FINDINGS:
↓
 Weakness and fatigue
 Neurologic Manifestations: ↑ Blood viscosity
- Paresthesia of extremities
- Impaired though process ↓
 Beefy red swollen tongue Thromboembolism
↓
Blood cell will flow into blood vessels then will cause
organ infiltration (stagnant)
↓
Liver: Hepatomegaly
Spleen: Splenomegaly
Joints: Arthralgia
Brain (between): Cerebral Hypoxia
It is possible to have Hyperuricemia?
-
LABORATORIES:
It is possible na mag karoon ng MI ang pt?
 Blood smear
 Schilling’s Test: most definitive test - Yes, because of thromboembolism
- Radioactive Vit B12 is secreted in urine
LABORATORY FINDINGS:
- Confirms absence of IF
NOTE:  Elevated blood cells
 Hemoconcentration
o It is a LIFETIME monthly injection of Vitamin B12  Plethora
NURSING MANAGEMENT:
 POLYCYTHEMIA VERA  Primarily we are educators
 Refers of increase in the volume of RBCs  Regular assessment of complications
(polycythemia)
 Avoid alcohol and aspirin medications
 Proliferative disorder in which the myeloid stem
cells become uncontrolled
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  SICKLE CELL ANEMIA  Blood replacement
CAUSES:  Antibiotics
 Genetic Transmission, 2 parents with the trait  Oxygen Therapy
have 25% chance of having child with SCD,
found primaly in blacks, occ Hispanics NURSING CARE:
 HgB A is partly or completely replaced by HgB
 Minimize tissue deoxygenation
S
 Promote hydration
 With dehydration, acidosis, hypoxia, and
temperature elevations, HgB S “sickles”  Minimize crises
 Pain management
PATHOPHYSIOLOGY  Administering blood transfusions
Vaso-occulusion from sickled RBCs  Encourage screening and genetic counseling
 Parent education
↓
Increased RBC destruction  HEMOPHILIA - platelet
Factor 8 or factor 9 deficiency – prolonged bleeding
↓
any where in the body!
Splenic congestion and enlargement
CAUSE:
↓
 X – linked recessive disorder
Hepatomegaly, liver failure  Defects in platelets
 Clotting factors
↓
DIAGNOSIS:
Renal ischemia, hematuria
↓  History of bleeding episodes
 Evidence of x-linked inheritance, labs
Cardiomegaly, heart failure, stroke
MEDICAL MANAGEMENT:
SIGNS AND SYMPTOMS
 Factor 8 concentrate
 Exercise intolerance  DDAVP (vasopressin)
 Anorexia
 Jaundiced sclera NURSING CARE:
 Chronic leg ulcers  Prevent bleeding
 Growth retardation  Recognize and control bleeding (RICE)
DIAGNOSIS - Rest
- ICe
 Peripheral Blood Smear - Compression
 Vaso-occlusive crisis - Flevation
- Mild to sever pain  Prevent crippling effects of bleeding
- Acute abdominal pain  Client education
- Priapism
- Asthralgia  IDIOPATHIC THROMBOCYTOPENIC PURPURA
MEDICAL MANAGEMENT CAUSES: acquired hemorrhagic disorder of unknown
origin, probably an autoimmune response to disease-
Supportive/symptomatic tx of crises:
related antigens
 Bed rest DIAGNOSIS: platelet count < 20,000, abnl bleeding
 Hydration time and clot retraction
 Electrolyte replacement
 Analgesics for pain

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SIGNS AND SYMPTOMS: petechia, bruising, bleeding ROLES OF THE IMMUNE SYSTEM
from mucous membranes, prolonged bleeding from
abrasions  defense against infections
 defense against tumor
MEDICAL MANAGEMENT: supportive, steroids, Anti-D  recognize and respond to tissue grafts & newly
antibody, splenectomy introduced proteins
NURSING CONSIDERATIONS:  Wound repair and tissue clean up
 can inure cells and induce inflammation
 Client/Parent teaching
 No contact sports
 No aspirin
 Prevent infection

IMMUNOLOGY SYSTEM
- resistance from disease
VOCABULARY
Immunology – study of the immune system response to
pathogen and damaged tissue (injury)
Immune system – collection of cells, tissues and
molecules that mediate resistance to infection
SECONDARY LYMPHOID ORGANS:
Immune response – coordinated reaction of the immune
cells to infectious microbes Lymph Nodes

Immunity – free from disease  Acts as filters

 Immune cells trap germs in LN
Immune tolerance – ability if the immune system to
 Painful and swollen are signs that IS is actively
determine friend from a foe
fighting an infection
DEFINITION OF TERM
Spleen
Antigen (Ag): substance either within or outside the body
that triggers the immune system to produce antibody  Stores various immune cells
against it  Scavengers
 Filter germs
Antibody (Ab): family of defensive proteins the body  Break down RBC (hemolysis)
makes when stimulated by Ag
 Stores and break down platelet
- secreted by plasma cells
TONSILS
- AKA, immunoglobulins
- identify and neutralize target cells  Stop and filter germs passing thru mouth and
Cytokines: proteins secreted by cells communicating with nose
nearby cells  Contains WBC > kills
 TYPES: Palatine, Adenoid, Lingual
ANATOMY AND PHYSIOLOGY
INNATE IMMUNE ADAPTIVE IMMUNE
SYSTEM SYSTEM

Non-specific Specific
Immediate response Slow response
No memory Has memory

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BARRIER IMMUNITY: Mast Cells

 Physical barrier  Early recognition of pathogen

 Chemical barrier  Release of histamine, tryptase, chymase, TNF-a,
 Biological barrier leukotriene
 Wound healing
CELLS OF THE INNATE IMMUNITY
 Have HISTAMINE and HEPARIN
Neutrophils
INFLAMMATION
 Most abundant
 First cell to migrate to infection site
 Phagocytosis Bradykinin
Arachidonic acid

Monocyte

 Ability to destroy invaders

 Facilitates healing and repair
 Phagocytosis
Eosinophil

 Cytokines
 Fights multicellular parasites and some bacteria
 Allergic reaction COMMUNICABLE DISEASES
Dendritic Cell TWO TYPES OF COMMUNICABLE DISEASE:

 Ag presenting cell (to lymphocytes)  Infectious Diseases

 Activates to become macrophage - It can be transmitted
 Secrete Interferon viru  Contagious Diseases
- Easily Transmitted (e.g., flu, colds, covid [highly
“20 proteins” contagious])
 Complement the action of Ab and other cells in SPORADIC (S – seasonal) – occurring occasionally,
destroying the bacteria singly, or in irregular or random instances; Uncommon,
 Activated by Ag + Ab binding unusual, isolated (e.g., Hansen's disease (also known as
leprosy))
NK Cells
ENDEMIC (E – Endito lang yung sakit) – is something
 Recognizes virally infected changes on the that commonly occurring to a particular people or
surface of cells country; constant, usual (predictable) (e.g., cough and
 Apoptosis colds, dengue)
 Cytotoxicity
EPIDEMIC (E – Epiglang Taas) – outbreak of disease that
 Attack our own cells that has become defective affects a large number of people within a community,
 Tumor cells and virally infected cells population, or region; greater than 50% of the previous
Macrophage cases consider as epidemic
PANDEMIC (PA – Pandaigdigan) – is an epidemic that’s
 Phagocytosis
spread over multiple countries or continents; worldwide
 Release of cytokines > cell signaling (e.g., STD, Covid-19, HIV/AIDS)
 Inflammation
 Migrate from blood to tissue spaces for invading
pathogens
 Release CHEMOKINES > attract other immune
cells

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 CHAIN OF INFECTION
SUSPCEPTIBLE HOST – human being
AGENT – cause of disease condition (bacteria, virus,
fungi, parasite, and protozoa)
RESORVOIR – carrier of disease (human, animal, insect)
EXIT – where the agent comes out (GIT, mouth)
MODE OF TRANSMISSION (MOT) – how to pass on to
others; here it will be cut so as not to infect others;
weakest link; hand washing, PPE, facemask
PORTAL OF ENTRY – manner in which a pathogen enters
a susceptible host
STAGES OF INFECTION
 INCUBATION PERIOD – entry of bacteria in the
body of the patient until the first S/SX appears.
 PRODROMAL PERIOD – nasa body na yung
bacteria pero non-specific S/SX (e.g., flu like
symptoms: cough, colds)
 ACUTE PERIOD – specific S/SX to know the
illness of the pt. (e.g., Tetanus: Lock Jaw; Dengue:
Petechiae)
 CONVALESCENT PERIOD – S/SX start to
disappear; recovery stage
 RESOLUTION PERIOD – the pt becomes healthy
IMMUNITY – resistance
 Antigen (Ag) – foreign bodies (bacteria, virus)
 Antibody (Ab) – destroy familiar antigen
IMMUNOGLOBULINS: GAMED
- IgG (Gammaglobulin) – most abundant; Trans
placental: so the child will not get sick right away
even if it is inside the womb it will be given in the
2nd to 3rd trimester of pregnancy; next
antibody to respond after IgM (secondary
response of the body; for convalescence or
recovery
- IgA – breastmilk
- IgM – first antibody for acute infection; found
in intravascular serum
- IgE – responsible for allergens → allergic
reaction
IMMUE RESPONSE
NATURAL IMMUNITY – Inherent in the body; Species
specific antibody
ACQUIRED IMMUNITY– environment exposure
TWO TYPES OF ACQUIRED IMMUNITY:
 Active Acquired Immunity (A – Ako) –
antibody produced by himself; long-term
2 TYPES:
 NATURAL ACTIVE – recovery from a
disease
“NARD” – Natural Active Recovery from
Disease
 ARTIFICIAL ACTIVE – antigen yung
inienject; vaccines
L – Live Attenuated Vaccine (weakened
vaccine; delikado dahil
immunocompromised)
I – Inactivated (killed vaccine)
T – modified Toxins (binago; tetanus
toxoids and TD: Diphteria Tetanus)
EXAMPLE: BGC, Hepa B (nag rereact sa
katawan; S/SX)
 Passive Acquired Immunity (P – Pasa) –
antibody given to individual; short-term
(vaccines)
2 TYPES:
 NATURAL PASSIVE – breastmilk
 ARTIFICIAL PASSIVE – antibody yung
inenject; immunoglobulin vaccines (they
are already antibodies)
NOTE:
ETI Vaccines – they are all Artificial Active
 DENGUE FEVER
 AKA: Breakbone Fever, Dandy Fever, and
Infectious Thrombocytopenic Purpura
 Severe arthralgia (joint pain) and myalgia
(muscle pain)
 Dengue Hemorrhagic Fever – severe and fatal
manifestation of dengue > bleeding and
hypovolemic shock
 Dengue Shock Syndrome – most lethal form of
dengue > severe drop in BP with profound shock
(mas intense yung shock lahat na affected that
causes multiple damage of organs)
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 CAUSATIVE AGENT: 2. CONVALESCENT (+ Ab)
 Dengue Spot Test
 Flavivirus or Abrovirus - IgG and IgM antibodies dengue virus (dengue
RESERVOIR: duo)
- Here you can see if the pt was exposed to
 Mosquito (Aedes Aegypti) dengue before
 Humans  Dengue Duo: confirmatory (dahil mabilis)
- Rapid agglutination test: 2 Ab is being tested
MODE OF TRANSMISSION: (IgM and IgG)
 Mosquito bites -

CHARACTERISTIC OF AEDES AEGYPTI SIGN AND SYMPTOMS:

D - aybiting  Dengue fever

Prodromal Stage:
L – ow flying - Sudden onset of fever – 39 to 40 degree C
then accompanied by chills
S – tagnant water
- Frontal headache, ocular pain, myalgia with
U – rban severe back ache
- Malaise at walang ganang kumain
4 o’clock habit – nag lilinis to destroy the breeding sites - Rashes: Macupapular rash/petechial rash
INCUBATION PERIOD: - Abdominal pain and tenderness (decreased
platelet that causes hepatic involvement
 3 to 14 days, commonly 7 to 10 days  DENGUE HEMORRHAGIC FEVER
 Second dengue infection
PERIOD OF COMMUNICABILITY:
SIGN AND SYMPTOMS:
 Day before the febrile period until the end
 Febrile Period: 1 to 3 days fever - Epistaxis
 4,5,6 day – critical stage; bleeding stage - Bleeding of gums
 7,8 day – recovery stage - Melena
- Hematochezia
DIAGNOSTIC PROCEDURES: - Hematemesis
- Ecchymosis
 Rumpel Leed Test/Tourniquet Test
- vascular resistance NOTE:
- +20 or more petichiae per square inch; count
petichiae below the antecubital fossa  Bright Red Bleeding – lower GI tract
- Indicated to 6 months and older  Dark Red Bleeding – upper GI Tract
- Fever for 3 days or more *** HERMANS SIGNS – pathognomic sign
- No sign of bleeding fever
- Presumptive Screening Test: Tourniquet Test WHO GUIDELINES
- Confirmatory Test: Platelet Count (decreased)
I. – no shock (+) tourniquet test (butlig at lagnat)
– 150-450k
NOTE: Wag kang mag tetest kapag may II. – no shock, spontaneous bleeding, (+) tourniquet
bleeding and dehydrate yung pt. test (dugo-dugo)
When you are doing tourniquet test: III. – Shock (low BP)
- Add systole and diastole then divide it into 2 = IV. – profound shock, unmeasurable blood pressure
Inflate the cuff at least 5 mins (no BP at all)
 BLOOD TEST MEDICAL MANAGEMENT:
- DEC WBC
- INC HCT  Analgesics – fever (Paracetamol), never use
 SEROLOGICAL TEST aspirin (anti-platelet) and ibuprofen because it
- Elisa/Eia = (+Antibody) may lead to bleeding
1. ACUTE DISEASE (+ Ab)  Blood Transfusion – FFP (Fresh Frozen Plasma)

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  Fluid replacement – most important management  Elephantiasis
- Conscious: ORS (Oral rehydration solution -
Orisol), Gatorade, Pocari Sweat
- Unconscious: IVF (LR, NSS),
NOTE: D5LR: hindi plain; LR: plain
 Plasma Expander (Albumin, Dextran, Starch)
 Oxygen Therapy
 Sedatives – for severe anxiety and pain
NURSING MANAGEMENT:

 Defervescence period – nag susubside na yung

fever
 Mosquito free environment – maintain the
cleanliness of the surroundings  Headache
 Increase body resistance  Chills and fever
 Monitor vital signs especially BP  Pain (dolor)
 Prevent and control bleeding  Tumor (swelling)
 Chemically treated mosquito  Rubor (Redness is arms, legs, and scrotum)
 Neem tree DIAGNOSTIC PROCEDURE:
 Larvae eating
 Environmental sanitation  Circulating Filarial Antigen – finger prick blood
droplet
 Antimosquito repellant
 NBE= Nocturnal blood examination= Post 8pm
 Zooprophylaxis – carabao dahil mas attracted
sa dark color  ICT= Immuno chromatographic test = daytime
 Search and destroy
DIET:  Self- protection
 No dark colored foods and drinks  Seek early consult
 Say no to indiscriminate fogging
 FILARIASIS MANAGEMENT:
 AKA: Elephantiasis
 Hetrazan
3 STAGES:
 SURGERY – for scrotal enlargement
1. Asymptomatic = 8 to 16 mons  Decrease fortified salt
2. Acute Stage
- Lymphadenitis
- Lymphagitis  PERTUSSIS
- Funiculitis (Spermatic Cord)  AKA: Whooping cough
- Orchitis (Inflammation of the testicles)
 INCUBATION PERIOD: 7-14 days
- Epididymitis
3. Chronic Stage (10-15 years)  MOT: droplet, direct contact
- Hydrocele  S/SX:
- Elephantiasis - Catarrhal Stage – stage of increase
- Lymphedema communicability; Flulike symptoms
- Paroxysmal Stage – paroxysms of cough
CAUSATIVE AGENT: Wuchareria Bancrofti (pathognomonic/hallmark sign)
- Convalescent Stage – recovery and healing
MOT: Mosquito Bite (Aedes Poecillus)
 MEDICAL MANAGEMENT:
S/SX: - Oxygen Therapy
- Fluid and Electrolytes replacement and
Ampicillin – finish duration
- Antibiotics – erythromycin
- Provide bed rest
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  NURSING MANAGEMENT  CORYZA- “colds”
- Isolation (reverse isolation)  CONJUNCTIVITIS
- Medical asepsis
- If madaming phlegm i suction si patient ERUPTIVE STAGE (lalabas na yung rash) presence of
- Sunshine and fresh air rashes called Maculopapular rash, Intermittent fever on
- Warm bath and off fever

SUCTION: CONVALESCENT STAGE - recover stage and healing

stage
- for infant: 3-5 secs
- Adult: 10-15 secs MEDICAL MANAGEMENT:

 Antiviral drugs ( isoPRENOsine) to stop virus

 Give antibiotics if with Complication
 DIPHTHERIA
NURSING MANAGEMENT:
CAUSATIVE AGENT: Corynebacterium Diphtheriae
 isolate patient (reverse)
INCUBATION PERIOD: 1-5 Days
 dark room and dim light
MOT: Droplets, Direct Contact and soiled linens (Fomites)  tepid sponge bath
TYPES OF DIPHTHERIA  increased oral fluid intake
 give vaccines like mmr vaccine
Nasal – white membrane in nasal septum
Nasopharyngeal – bulls neck/ namamaga ang leeg that
developmed called pseudomembrane na natratrap sa  GERMAN MEASLES (Rubella)
leeg (most dangerous) AKA: RUBELLA (3-day measles)
PATHOGNOMONIC - Pseudomembranes INCUBATION PERIOD: 14-21 days
Cutaneous - yellow spot in the skin CAUSATIVE AGENT: RUBELLA VIRUS
MEDICAL MANAGEMENT PATHOGNOMONIC SIGNS- Forscheimers spot (pinkish
 Penicillin rash on soft palate)
 Diphtheria antitoxin MOT: Droplets, Airborne and Transplacental (pwede
 Apply ice collar in neck mahawa baby habang nasa tyan during 1st trimester
 Oxygen inhalation (organogenesis)
 Bed rest SIGNS AND SYMPTOMS:
 ** Tracheostomy set** at the bedside of pt
 MEASLES PRODROMAL STAGE- Low grade fever, Mild coryza
(colds), Lymphadenopathy,
AKA: RUBEOLA/MORBILLI
ERUPTIVE STAGE - Forscheimers spots, Testicular pain,
CAUSATIVE AGENT: Rubeola Virus polyarthralgia
MODE OF TRANSMISSION: Airborne (more than 3 feet) MEDICAL MANAGEMENT:
and Droplets (less than 3 feet)
SYMPTOMATIC - give paracetamol and antihistamine
PATHOGNOMONIC SIGN: Koplik's Spot - inflammatory
lesion inner mouth ba? NURSING MANAGEMENT:

SIGNS AND SYMPTOMS:  Tepid sponge bath

 Isolation
PRE- ERUPTIVE (bago lumabas ang mga measles)
 Mild liquid BUT nourishing diet (Small Frequent
CATARRHAL STAGE: 3 c’s Feeding (SFF)
 Dim light- photophobia
 COUGH
 Good ventilation
SAA
  Give vaccine MMR 3. Tetanus Neonatorum- tetanus for baby >>
 Immune serum globulin IF patient has positive usually for Home Delivery
exposure (esp pregnant) SIGNS AND SYMPTOMS:
 Lotion with calamine, oat and starch
 Soap unscented, hypoallergenic  TRISMUS >> (CN 5) Trigeminal Nerve >>
Lockjaw
 OPISTHOTONUS>> Arching of the back
 CHICKEN POX  RISUS SARDINICUS>> Sardonic smile or Grin -
ngiting aso
AKA: VARICELLA
PATHOGNOMONIC SIGN: Sardonic Smile
CA: HERPESVIRUS VARICELLAE
IP: 14-21 DAYS
MEDICAL MANAGEMENT:
MOT: DIRECT CONTACT AND FOMITES,
TRANSPLACENTAL (IT DEPENDS)  Diazepam
 Antibiotic
SIGNS AND SYMPTOMS:
 Penicillin: ginagamit before but it has Side
 Rash- (unexposed part trunk) effects: Potentiate the toxin (kaya Metronidazole
 Macule-papule-vesicle (fluid filled) - pustule (pus) (Flagyl)
- crust/ scab  Side effects: never take alcohol (any kind of
 Celestial maps - scabs/crust that has alcohol content)
 Adverse effects: Disulfiram like reaction (severe
MEDICAL MANAGEMENT: vomit and dehydration)
 Take zoverax, acyclovir, antihistamines (bilastine  Antabuse - tinetake ng adik sa alak pero dapat
(bilaxten) 20mg) bili naaa hahaha wag na uminom ng alak kasi magkakaroon ng
Disulfiram like reaction
 Calamine lotion
 Avoid salicylates- antipyretic (if fever occur) PREVENTION:
NURSING MANAGEMENT  Avoidance of wound
 Give tetanus toxoid (tetanus diphtheria)
 Respiratory isolation until ALL vesicles had
crusted  First Aid:
 Disinfect linens under sunlight/boiling POST EXPOSURE = Tetanus Toxoid (artificial active) +
 Cut fingernails Tetanus Immunoglobulin ( artificial passive)
 use mittens
(+) History of tetanus vaccination>> they give you
Tetanus toxoid (booster dose)

 TETANUS Pag no history of TT - give TT and TIg

AKA: LOCKJAW Pag nakalimutan- give 2 dose

CAUSATIVE AGENT: Clostridium tetani- Anaerobic (no

need oxygen/ without oxygen)
 RABIES: (LYSSA)
 Sa Deep wound mas gusto nila mabuhay. CAUSATIVE AGENT: Rhabdovirus = bullet
TOXIGENIC - (+) Contagious
1. Tetanolysin - lysis (destruction of blood cells - (+) s/sx
2. Tetanospasmin - neurotoxin>> muscle spasm>> - (+) death
Airway (Laryngospasm) which cause blockage of S/SX: (pag nasa brain na)
airway
Bedside ng patient: Must have TRACHEOSTOMY  Invasive stage
Cardiac Dysrhythmias - ECG
SAA
 - Fever MANAGEMENT:
- Headache
- Numbness  Supportive
- Photophobia  Strict Isolation
 Excitement Stage (acute stage)  Restraint
- Hydrophobia  Avoid stimulation of Fluid (takot sa tubig-parang
- Aerophobia nalulunod)
- Maniacal Behavior  Cover the IVF
 Paralytic Stage
DENGUE MALARIA FILARIASIS
- Generalized paralysis can cause respiratory
paralysis that can lead to death
 High 
Marsh  Elepha
MODE OF TRANSMISSION: Fever Fever ntiasis
 CA:  Protozo  Parasit
 DOG- 99% (bite and scratch= laway) Dengue al e
 CAT Virus Parasite (Wuch
 BAT (1,2,3,4 (Plasmo areria
classes) dium:) Bancrof
*All mammals have rabies except RAT  Onyong- 1. Falcifar ti)
yong um  Brugia
 Animal bite Virus (madal Malayi
 Scratch (rare)  Chikungu as)  Bruguia
 Tissue transplant (rare) nyang 2. Vivax Timori
Virus 3. Ovale 
 Airborne or droplet (rare) 4. Malaria
MOT:
 MOT: Mosqui
DIAGNOSTIC: Mosquito e to bites
bites  MOT:  Aedes
 Observe 10-14 days= 15 DAYS, 20 DAYS  Aedes Mosquit Poecill
 Brain Biopsy (Negri Bodies discovered by Italian) Egyptii o bite us
 Fluorescent (confirmatory test for rabies)  Anophe
- Rabies les
Mosqui
- Antibody
to
- Test
NOTE: Vector is a MOT (Mosquito bite)
MANAGEMENT:
SAMPLE QUESTION:
GOAL: To prevent the virus from reaching the brain
With the onset of rainy seasons, Nurse case of dengue
1) First Aid (clean running water with soap and put fever. Identify the causative agent of dengue fever.
povidone iodine)
A. Fomite (MOT)
2) Tetanus prophylaxis
B. Vector (MOT)
3) Rabies immunization
C. Bacteria
ACTIVE Immunization
D. Virus
- 5 doses (inactivated virus)
- Verorab/ Imurab safe for pregnant women Bleeding is the most serious complication of dengue
(IM: Day 0,3,7,14 and 28 ) and IV infection. When is the pt be watched for symptoms of
PASSIVE Immunization bleeding?
-IIM in opposite site pag sabay sa active and
passive A. 4th to 7days (dito na nag kakaroon ng
- ½ wound site ½ IM vaccine bleeding)
- ERig (Equine Rabies Immunoglobulin) B. At the onset symptoms
- HRIg (Human Rabies Immunoglobulin) - mas C. 2nd to 3rd day
mahal and mas maganda yung vaccine ang D. 1st day
vaccine na to Which diagnostic test could be useful in confirming the
* Active and passive vaccine pwede magsabay itusok diagnosis of Dengue Fever?
pero opposite site dapat
SAA
 A. Rumpell- Lead (not confirmatory)  Diaphoretic Stage (pwede madehydrate yung
B. Mantoux pt)
C. Elisa
D. Widal SPOROZOITES: they are immature parasites that enter in
liver to mature
o DENGUE FEVER MILD MEROZOITES: matured parasites; they will enter to
MANIFESTATION: blood to destroy RBC

1. High Fever (High 2 to 4 days, another 1 to 2  Anemia

days baba then tataas ulit called BIPHASIC)  Severe Anemia
2. Breakbone – pain: headache, retroorbital pain,  Malarial Cachexia
bone, muscle pain/joint pain
- Due to INC chemical mediator (INC Bradykinin, DIAGNOSTIC TEST:
Prostaglandin, Histamine)
 Blood Smear/Malarial Smear
3. Conjunctivitis, Epistaxis, Gem bleeding due to INC
histamine  BEST TIME TO TAKE: High Fever
4. Herman’s Sign – petichiae (capillaries bumibigay) MEDICAL MANAGEMENT:
WARNING SIGNS: (ACCORDING TO MEDSCAPE)  First Line Drug: Artemether-Lumefantrine
 Abdominal pain and tenderness – there is bleeding  Second Line Drug: Quinine
(hematemesis: vomiting of blood; Melena: black
stools that occur as a result of gastrointestinal SEXYALLY TRANSMITTED
bleeding) DISEASES/INFECTION (STD/STI)
 Persistent Vomiting – >3x/24
 Clinical Fluid Accumulation – shifting of fluids in  Sexually transmitted infections are infectious
lungs (pleural effusion), shifting of fluids in diseases that are transmitted from person to
abdomen (Ascites) person during sex contact, not necessary vaginal
 Lethargy or Restlessness – decrease of oxygen intercourse.
results from active bleeding  Often these patients or female sex workers are
 Mucosal Bleeding – epistaxis; gumbleeding very reluctant to consult regular or routine
 Liver enlargement – >2cm checkup because they are often badly treated,
stigmatizes or rejected.
LABORATORY FINDINGS:  Most patients seeking STI care, feel ashamed to
 Increasing Hematocrit – hemoconcentration have contracted an STI. Patients with STI should
be treated like any other patients seeking care
 Concurrent rapid decrease of platelet
and should not be blamed for their work or bad
behavior.
o SEVERE DENGUE
 The health care worker should avoid being
 There is bleeding
negatively judgmental or moralistic.
SIGN AND SYMPTOMS:
MOT SEX/ INITIMATE CONTACT
 Hypotension SOURCE:
 Tachycardia
 Tachypnea  Discharges
 Blood
 MALARIA
 Semen
SIGN AND SYMPTOMS:
 Surface lesions
 Every 2 or 3 days
 Cold stage: Chills or clatter teeth (10-15 mins? S/SX:
 Hot stage: High Fever (4-6 hours) PRIMARY:

SAA
  Chancres (painless lesion) DIAGNOSIS
SECONDARY:  Viral culture
 Pap smear (shows cellular changes)
 Condylomata lata and graying white lesion
 Tzanck smear (scraping of ulcer for staining)
LATENT - Asymptomatic
LATE - Gumma deep
 GENITAL HERPES
CA: Herpes Simplex Virus
 SYPHILIS
MOT: SEX
 Treponema pallidum, spirochete
 “Beautiful” fast moving but delicate spinal thread S/SX: Genital Sore, Painful sore, fever, muscular pun,
 INCUBATION PERIOD: 10-90 days burning sensation

MEDICAL MANAGEMENT
MGMT:
 Penicillin
 Tetracycline  Anti viral- acyclovir (zovirax)

NURSING MANAGEMENT CX:

 Stress importance of continuing tx  Meningitis

 Contact tracing  Neonatal infection
 Universal precautions: using contraceptives and
handwashing
 Keep the lesions dry  GONORRHEA, MORNING DROP, CLAP, JACK
- Neisseria gonorrheae, fram (+)

 HERPES GENITALIS IP: 3-7 Days

- HSV 2 S/ SX:
S/Sx: Painful sexual intercourse, Painful vesicle (cervix,
vagina, perinium, glans penis)
SAA
  Females: usually asymptomatic or minimal
urethral discharge with longer abdominal pain
 TRICHOMONIASIS
- Sterility or ectopic pregnancy
 Male: Mucopurulent discharge, painful urination CA: Trichomonas vaginalis
- Decreased sperm count
MOT: Sex
MEDICAL MANAGEMENT:
SIGNS AND SYMPTOMS:
 ceftriaxone - IM with lido to ease pain (1gram
for adult))  Cervicitis
 Penicillin  Vaginitis
 Infants born to mothers with gonorrhea  Urethritis
 Erythromycin (crede's prophylaxis ) to prevent  Dyspareunia
ophthalmia neonatorum  Syroniua

NURSING MANAGEMENT: MEDICAL MANAGEMENT:

 isolation  Metronidazole 500mg

 Sex education NURSING MANAGEMENT:
 Contact tracing
 (All info must confidential)  universal precaution
 Practice safe sex
DIAGNOSIS:

 Gram stain and culture of cervical secretions on

thayer martin VCN medium  TUBERCULOSIS (KOCH’S DISEASE)

MANAGEMENT: TOP DISEASE >> commonly affects LUNGS >>(

TUBERCLES)
 Single dose only
>> NECROSIS>> CALCIFICATION
 Ceftriaxone (Rochephin) 125 mg IM
 Ofloxacin (Floxin) 400 mg orally CA: Mycobacterium Tuberculosis
 Treat concurrently with Doxycycline or
MOT: Airborne
Azithromyucin for 50% infected w/ Chlamydia
CLASSIFICATION:
CS: PID, ectopic pregnancy and infertility peritonitis,
perihepatitis, ophthalmia, neonatorum, sepsis and arthritis 1) PTB Minimal - if has positive sputum exam (early
in the morning) (don't use mouthwash or
antiseptic) (3 consecutive days collection of
 CHLAMYDIA sputum
- there's no apparent signs and symptoms
CA: Chlamydia Trichomatis - Lungs are not clear in x-ray
SIGN AND SYMPTOMS: - Slights lesions no excavation
2) PTB Moderately Advanced
 Cervicitis- - positive sputum examination of patient
 Dyspareunia- - Positive signs and symptoms
 Pyuria- Pus in urine - With cavitation less than 4 cm
- With hemoptysis ( fresh blood )
 Scrotal swelling-
- Volume affected does extent to the other lobe
 Tenesmus- urge to defecate 3) PTB FAR ADVANCED
MEDICAL MANAGEMENT: - positive sputum test
- Positive signs and symptoms
 Doxycycline for 7 days - Respiratory distress (DOB, Restlessness)
 Azithromycin 1 day only - Cavitation more than 4 cm
SAA
 - Severe hemoptysis

HOW TO READ X-RAY

 see if has pleural effusion

 See if has complete ribs
 Look if anterior posterior ribs is complete
 Check for bronchioles
 Check for heart for any signs of cardiomegaly
 Check for costophrenic angle if may puti puti na
madmai may pleural effusion
NOTE:
DIAGNOSTIC PROCEDURE:
 DRUGS and SE
 sputum exam or AFB smear ( Acid fast bacilli) for  Madalas IRE binibigay
CONFIRMATORY  Rifampicin- red orange discoloration urine, 400-
 Early in the morning>>>3 consecutive mornings 450 mg
before toothbrush  Isoniazid- peripheral nueritis, take with vb6
 Rinse mouth with plain water  PZA- hyperuricemia
 *Use sterile container  Ethambutol- optic neuritis
 X-ray- entent lung involvement  Streptomycin- oto, nephrotoxic
 Location of infection, cavity formation scar tissue  Primary complex= TB sa baby hindi naman sya
and calcium deposits nakakahawa
 Tuberculin test (screening test) if nag positive
exposed ka sa bacteria, pag positive mag skin
test 2- 3 days pag 10- 15 mm positive yun
 Mantoux test (commonly accurate)
 Multi puncture test/ heaf test
 Skin scratch test and pirquet test
S/ SX:

 Low grade fever- virulence of bacteria

 Chills sweat
 Dry to productive cough
 Fatigue, anorexia, weight loss (kulang sa
oxygen)
 Dyspnea
MGT:

 MDT: multiple drugs therapy

 DOTS: Direct observed treatment short course
(non compliance px= di gagana yung gamot)

SAA