COMMUNICABLE & INFECTIOUS DISEASES (LEAP) ✔ In this stage, the client is prone for

secondary infection due to their

EPIDEMIOLOGIC PATTERNS temporary suppressed immune
1) SPORADIC system.
✔ Intermittent Occurrence 5) CONVALESCENT/DEFERVESCENT
✔ Irregular interval ✔ CONVALESCENT = Recovery
✔ Random locations ✔ DEFERVESCENT = Complication/
✔ Scattered cases Death
✔ E.g. rabies
2) ENDEMIC CHAIN OF INFECTION
✔ Continuous occurrence 1) INFECTIOUS AGENT
✔ Steady frequency ❒ Bacteria, Virus, Fungi, Protozoa
✔ Over a period of time ❒ How to break the CHAIN?
✔ Inherent in that locality a) Rapid organism identification
✔ E.g. Schistosomiasis in Leyte, Malaria (DIAGNOSIS)
in Palawan b) Prompt treatment
3) EPIDEMIC c) Decontamination
✔ Outbreak VIRULENCE ✔ Ability to cause a disease
✔ Greater than usual ✔ Overall strength to cause a
✔ Short period of time disease
4) PANDEMIC
✔ Concurrent occurrence INFECTIVITY ✔ Capacity of agent to enter and
✔ Same disease
multiply in a susceptible host
✔ Different countries
INVASIVENESS ✔ Ability to penetrate an intact
DIFFERENCE of NOSOCOMIAL and COMMUNITY
ACQUIRED INFECTION skin
NOSOCOMIAL/HOSPITAL COMMUNITY ACQUIRED
PATHOGENICITY ✔ Capacity if agent to cause a
ACQUIRED
Infection that is acquired Infection that is acquired clinical disease in the infected
after 48-72 hours of within 48-72 hours of host
hospital stay hospital stay
TOXIGENICITY ✔ Capacity of agent to produce a
toxin or poison
STAGES OF ILLNESS:
1) INCUBATION PERIOD ANTIGENICITY ✔ Ability to combine specifically
✔ When the pathogen enters, no signs with the final products of the
and symptoms yet mention responses (i.e.
✔ Insufficient number of pathogens antibodies and/or cell-surface
2) PRODROMAL PERIOD
receptors)
✔ Appearance of initial signs and
symptoms (fever, sore throat)
✔ Pathogens continues to multiply
2) RESERVOIR (any site where the pathogen can
3) PERIOD OF ILLNESS/ACUTE STAGE
multiply or merely survive until it is
✔ All signs and symptoms appears
transferred to a host)
✔ Signs and symptoms are MOST
❒ Human Reservoirs
OBVIOUS and SEVERE
❒ Animal Reservoirs
✔ Pathognomonic signs appears
❒ Environmental Reservoirs (plants, soil
(characteristic signs of a specific
and water)
disease)
❒ How to break the CHAIN?
4) PERIOD OF DECLINE
a) Environmental sanitation
✔ Number of pathogens begins to
b) Good health & hygiene
decrease
c) Decontamination/ Sterilization
✔ Sign and symptoms of illness begin
d) Dressing change
to decline
e) Appropriate linen disposal
 f) Proper feces and urine disposal
3) PORTAL OF EXIT (path by which the organism
leaves the reservoir)
❒ Mouth (vomit, saliva)
❒ Cuts in the skin (blood)
❒ During diapering and toileting (stool)
❒ How to break the CHAIN?
a) Control of secretions
b) Hand hygiene
c) Proper waste disposal
d) Avoid taking, coughing
sneezing over
wounds/sterile fields
e) Cover mouth and nose when
coughing/sneezing
4) MODE OF TRANSMISSION (means by which
the agent passes through from the portal of
exit of the reservoir to the host)
DIRECT CONTACT INDIRACT CONTACT
CONTACT VEHICLE
❒ How to break the CHAIN?
a) Hand Hygiene
b) Aseptic Technique
c) Wound Care
d) Puncture-Resistant Containers
6) SUSCEPTIBLE HOST
❒ How to break the CHAIN?
a) Recognize High-Risk Patients
or b) Prompt Treatment
open c) Maintain Skin Integrity
d) Balanced Diet
e) Immunization
❒ RISK FACTORS OF A SUSCEPTIBLE HOST
a) Children
b) Elderly
c) People with a weakened immune
system
d) Unimmunized people

Skin to skin contact, Indirectly transmit an INFECTION CONTROL

sexual contact infectious agent 1) Aseptic Technique
2) Standard Precaution
5 F’s: 3) Transmission-based Precaution
Feces, Food, Fluids, 4) Isolation Technique
Fingers, Flies, Fomites
CDC and Prevention Isolation Guidelines
NO DEVELOPMENT of A. TIER ONE
agent 1) STANDARD PRECAUTIONS
AIRBORNE ✔ Designated for the care of ALL
hospital patients.
Suspended longer ✔ Hand Hygiene
Travels more than 3 ft. VECTOR ✔ PPE (depending on the care rendered
DROPLET to a patient)
Animals/insects that can ✔ Respiratory Hygiene
Travels less than 3 ft. transmit the disease ✔ Puncture-Resistant Containers
AEROSOL ❖ In PPE:
DEVELOPMENT of agent ✔ Upon WEARING in SEQUENCE:
Tuberculosis, Measles, GoMEGlo
Chickenpox e.g. Mosquitoes, Fleas, a) Gown
Ticks b) Mask
DROPLET OF SALIVA c) Eyewear
d) Gloves
Mumps, Rabies, Infectious ✔ Upon REMOVING in SEQUENCE
mononucleosis (GlEGoMa)
a) Gloves
❒ How to break the CHAIN? b) Eyewear
a) Hand Hygiene c) Gown
b) Isolation Precautions d) Mask
c) Disinfection/Sterilization B. TIER TWO
d) Use Of PPE 1) TRANSMISSION-BASED PRECAUTIONS
e) Aseptic Technique ✔ AIRBORNE-PRECAUTIONS
5) PORTAL OF ENTRY 1. Isolate
❒ Mouth, Cuts in the skin, Eyes 2. Negative Air Pressure Room
 3. N95 Mask
✔ DROPLET PRECAUTIONS
1. Isolate
2. Mask (Not Necessarily N95)
3. Maintain 3 Ft Distance
✔ CONTACT PRECAUTIONS
1. Isolate
2. Wear PPE MEDICAL ASEPSIS SURGICAL ASEPSIS
✔ Protective Environment REDUCES number of ELIMINATES ALL
1. People underground gene pathogens pathogens
therapy, organ transplant CLEAN TECHNIQUE STERILE TECHNIQUE
2. Administered drugs that cause USES FOR:
immunosuppression Administration of DRESSING CHANGES
✔ Hand hygiene MEDICATIONS
✔ PPE (depending on the care rendered ENEMAS CATHETERIZATIONS
to a patient) TUBE FEEDING SURGICAL PROCEDURES
✔ Respiratory Hygiene
DAILY HYGIENE Operating Room
✔ Puncture-Resistant Containers
Proper Cleaning of Labor & Delivery Room
supplies and equipment
CATEGORIES RECOMMENDED IN ISOLATION
1) STRICT ISOLATION Proper Disposal Of Special Diagnostic Areas
a) COVID-19 Needles, Contaminated
b) Measles Materials And Infectious
c) Chickenpox Wastes
2) CONTACT ISOLATION Disinfection
a) Herpes Simplex Virus
b) Impetigo BLACK ❒ Dry
c) Parasitic Mites ❒ Non-Infectious Waste
d) Chickenpox/Shingles (if ruptured
vesicles) GREEN ❒ Wet
3) RESPIRATORY ISOLATION ❒ Non-Infectious Waste
a) COVID-19
b) Measles YELLOW ❒ Infectious
4) TB ISOLATION ❒ Pathologic Waste
5) ENTERIC ISOLATION
a) Hepatitis A ❒ Chemical Waste
b) Cholera YELLOW WITH BLACK ❒ Heavy Metal
c) Diarrheal Diseases BAND
6) DRAINAGE/SECRETION ISOLATION ORANGE ❒ Radioactive Waste
a) Jackson-Pratt Drainage of Patients
having Brain Abscess RED ❒ Sharps
b) Burn Patients
7) BLOOD & BODY FLUIDS ISOLATION
a) AIDS CONSIDERATIONS FOR COHORTING
b) Hepatitis B ❒ Placement and care of individuals who are
c) Malaria infected or colonized with the same
d) Syphilis microorganism in the same room.
8) REVERSE ISOLATION/PROTECTIVE OR 1) Client’s Diagnosis
NEUTROPENIC ISOLATION 2) Presence Or Absence Of Infection
a) Leukemia 3) Infectious clients are considered DIRTY
b) Neutropenia 4) Postoperative clients are considered
CLEAN

ISOLATION TECHNIQUE
SOURCE PROTECTIVE
 ROOM - +
PRESSURE VECTOR-BORNE & ZOONOTIC DISEASES
PROTECTED OTHERS PATIENT A. DENGUE FEVER
PERSON ⮚ Acute febrile disease transmitted by a
MOVEMENT OF IN OUT mosquito
AIR ⮚ CAUSATIVE AGENT: Aedes aegypti
⮚ It is a DAY-BITING mosquito
⮚ It breeds on STAGNANT water
⮚ DF can be infected 4 times
⮚ 3 CLASSIFICATIONS:
1) Dengue Fever
✔ VIRUSES:
a) Dengue Virus 1, 2, 3, 4
TRANSMISSION-BASED PRECAUTIONS
b) Chikungunya Virus
AIRBORNE
c) Arboviruses
PATIENT ❒ Chickenpox ✔ Pregnant women can pass DF to
❒ Measles their child (crosses placental
❒ TB barrier).
2) Dengue Hemorrhagic Fever
PLACEMENT NEGATIVE PRESSURE ● A severe form of DF that cause
PRIVATE ROOM severe bleeding.
PPE ❒ N95 (95% of air 3) Dengue Shock Syndrome
particular filter
respirator) DAYS
1-3 FEBRILE ❒ FEVER typically lasts
TRANSPORT ❒ Limited to essential DAYS 2-7 days can be
purpose biphasic.
❒ Place a surgical mask ❒ S/Sx:
a) Severe headache
b) Retro-orbital eye
DROPLET
pain
PATIENT ❒ Diphtheria
c) Muscle, joint, and
❒ Meningitis
bone pain
❒ Pertussis
d) Macular or
PLACEMENT PRIVATE ROOM maculopapular
PPE ❒ Mask rash
e) Minor
TRANSPORT ❒ Limited to essential hemorrhagic
purpose manifestations
❒ Place a surgical mask (petechial,
ecchymosis,
purpura, epistaxis,
CONTACT
bleeding gums,
PATIENT ❒ Decubitus ulcer
hematuria, (+)
❒ Discharges
tourniquet test)
PLACEMENT PRIVATE ROOM ❒ Dehydration: High
PPE ❒ Gloves fever may cause
❒ Gown neurological
disturbances and
TRANSPORT ❒ Limited to essential
purpose
 febrile seizures in ❒ Convalescent phase
young children. rash desquamates ad
be pruritic.
4-7 CIRCULATORY ❒ CRITICAL PHASE of ❒ Hypervolaemia (only
DAYS dengue begins at IV therapy has been
DEFERVESCENCE and excessive and/or has
typically lasts 24-48 extended into this
hours period)
❒ Most patient clinically
improve during this
phase DF GRADING
❒ Can develop severe GRADE I ❒ Non-specific
dengue to those symptoms
having substantial ❒ (+) Tourniquet test
plasma leakage
GRADE II ❒ Grade 1 symptoms
resulting a marked
❒ Spontaneous
increase in vascular
bleeding
permeability
a) Shock from GRADE III ❒ Grade 2 symptoms
plasma ❒ Circulatory failure
leakage
b) Severe GRADE IV ❒ Grade 3 symptoms
hemorrhage ❒ Profound shock
c) Organ
impairment
WHO DEFINITION OF DHF:
8-10 RECOVERY ❒ As plasma leakage 1) Fever
DAYS 2) Hemorrhagic Episode
subsides, patient
3) Platelet (<100,00/m3)
enters the 4) Increased vascular permeability
convalescent phase
❒ Begins to reabsorb DIAGNOSIS OF DF
extravasated IV fluids 1) Tourniquet Test (Rumple Leeds Test)
and pleural and a) Take the patient’s blood pressure and
abdominal effusions record it
o e.g. 100/70 mmHg
❒ Hemodynamic status
b) Inflate the cuff to appoint midway
stabilizes (may between SBP and DBP and maintain
manifest bradycardia), for 5 minutes.
and diuresis ensues. o (100 + 70)/2 = 85 mmHg
❒ Hematocrit stabilizes c) Reduce and wait 2 minutes
or may fall because of d) Count petechiae below antecubital
the dilutional effect of fossa
e) (+) Tourniquet test: 10 or more
the reabsorbed fluid
petechiae per 1 square inch.
❒ WBC count usually
starts to rise MANAGEMENT OF DF
❒ Platelet count 1) Hydration
recovery 2) Analgesics
3) Antipyretics
4) Administer Blood Transfusions
5) Environmental Control
 6) Encourage Bed Rest
7) O2 therapy
8) On Trendelenburg Position
9) Oral Rehydration Solution (ORS)
10) Use Sedatives

PREVENTION OF DF: MAG 4S KONTRA DENGUE

1) SEARCH & DESTROY
2) SELF-PROTECTION MEASURES
3) SEEK EARLY CONSULTATION
4) SAY NO TO INDISCRIMINATE FOGGING

B. FILARIASIS
⮚ Parasitic disease which causes an extremely
debilitating and stigmatizing disease
⮚ CAUSATIVE AGENTS:
a) Wuchereria bencrofti
b) Lymph vessels
c) Cules or Anopheles
MANIFESTATIONS OF FILARIASIS
1) ASYMPTOMATIC
2) ACUTE
3) CHRONIC

DIAGNOSIS OF FILARIASIS
1) NOCTURNAL BLOOD EXAMINATION
2) IMMUNOCHROMATOGRAPHIC TEST

MANAGEMENT OF FILARIASIS
1) SURGERY
2) HYGIENE
3) ON DEC or HERTRAZAN ⮚ SIGNS & SYMPTOMS: CHASE
4) ELASTIC BANDAGE a) CHILLS
5) START ANTIBIOTICS/ANTIFUNGALS b) HEPATOMEGALY
c) ANEMIA
PREVENTION OF FILARIASIS ❒ Lysis of infected and uninfected
1) DAY RBCs
a) Environmental sanitation ❒ Suppression of hematopoiesis
b) House spraying ❒ Increased clearance of RBCs by
2) NIGHT spleen
a) Use of mosquito net d) SWEATING (PROFUSE)
b) Long sleeves and pants e) ELEVATED TEMPERATURE
⮚ PREVENTION: CLEAN
C. MALARIA a) Chemoprophylaxis
⮚ Acute and chronic parasitic disease b) Larva-eating fish
transmitted by the bite of infected mosquitos c) Environmental sanitation
⮚ CAUSATIVE AGENTS: d) Anti-mosquito repellents
a) Plasmodium falciparum e) Neem Tree/ Oregano Tree
b) Plasmodium malariae ⮚ CONTROL: Sustainable preventive and vector
c) Plasmodium vivax control measures
d) Plasmodium ovale a) Insecticide Treatment
⮚ VECTORS: b) On Stream Seeding
a) Breeds in clear, flowing, shaded c) House Spraying
streams d) On Stream Clearing
b) Brown in color e) Zooprophylaxis
c) Assumes a 36 degrees position when f) Chemoprophylaxis
it alights g) Avoiding outdoor nighttime activities
d) NIGHT BITING h) Using of mosquito repellents
⮚ MOT: i) Planting Neem Trees
a) Bite of an infected mosquito j) Wearing Long sleeved clothes
b) Parenterally through BT
c) Shared contaminated needles D. SCHISTOSMIASIS
d) Transplacental transmission ⮚ Known also as:
⮚ PATHOPHYSIOLOGY a) SNAIL FEVER
b) BILHARZIA
c) KAYTMA FEVER
⮚ CAUSATIVE AGENTS:
a) Schistosoma japonicum
b) Schistosoma mansoni
c) Schistosoma haematobium
d) Oncomelania quadrasi
⮚ MOT:
⮚ DIAGNOSTIC TEST:
a) CERCUM OVA PRECIPETIN TEST
⮚ PREVENTION:
1) REDUCE SNAIL DENSITY
a) Clearing vegetation
b) Constructing drainage
c) Improving farming
2) DIMINISH INFECTION RATE
a) Disposing of urine and feces
properly
b) Avoiding bathing in infected
streams
c) Building foot bridges over
streams
d) Providing water supply
3) PREVENT EXPOSURE
a) Using rubber boots
b) Towel-drying
c) Applying alcohol
E. LEPTOSPIROSIS
⮚ Zoonotic infectious bacterial disease carried
by animals whose urine contaminates food
and water.
⮚ CAUSATIVE AGENT: Leptospira interrogans
⮚ DIAGNOSIS:
 a) Clinical c) Skin is cold and clammy
b) Culture & Sensitivity d) Severe and painful spasm of
c) Serologic Test the mouth, pharynx, and
⮚ MANAGEMENT: larynx
1) ANTIBIOTICS e) Profuse drooling of saliva
a) PENICILLIN G (SEVERE) f) Tonic-clonic contractions of
b) DOXYCYCLINE (MILD) muscles
c) CEFTRIAXONE (MILD) 3) TERMINAL/PARALYTIC PHASE
2) BLOOD TRANSFUSION a) Patient becomes quiet and
3) CONFRONT AND CONTROL unconscious
4) DALYSIS IF NECESSARY b) Loss of bowel and urinary
5) ELECTROLYTES control
c) Spasm ceases with
⮚ PREVENTION progressive paralysis
a) Protective clothing, boots and gloves d) DEATH:
b) Educate people at risk 1. Respiratory failure
c) Rat eradication program 2. Circulatory collapse
d) Segregate domestic animals 3. Heart failure
e) Chemoprophylaxis (DOXYCYCLINE) ⮚ MANAGEMENT:
1) Immunize household dogs and cats at
F. RABIES 3 mos. Of age
⮚ CAUSATIVE AGENT: Rhabdovirus 2) Immunize people who are expose to
⮚ CARRIERS: animals
a) Bats 3) Carefully and thoroughly clean and
b) Skunks flesh wounds with soap and water
c) Raccoons 4) Povidone iodine or alcohol may be
d) Cats used
e) Dogs 5) Patients may be given antibiotics,
⮚ FACTORS AFFECTING INCUBATION PERIOD: Tetanus toxoid, or ATS
1) Distance of the bite to the brain 6) Animals that bite are observed for
2) Extensiveness of the bite 10-14 days;
3) Specie of the animal a) If SICK: should be euthanized
4) Richness of nerve supply and their brains examined
5) Resistance of the host ⮚ PREVENTION
⮚ DIAGNOSIS 1) PRE-EXPOSURE VACCINE
1) Virus isolation from the patient’s a) IM administration in the deltoid
saliva b) Days 0, 7, and 21 or 28
2) Fluorescent Rabies Antibody Test 2) POST EXPOSURE VACCINE
3) Presence of Negri bodies a) Previously unimmunized
⮚ PHASES: 1. 1 mL vaccine IM on days
1) PRODROMAL/INVASION PHASE 0, 3, 7, 14, 28
a) 1ST SYMPTOM: Flu-like 2. Administer HRIG
symptoms b) Previously immunized
b) Pain at the original site of bite 1. 1 mL vaccine IM on days
c) Sensitivity to light, sound, 0 and day 3
temperature 2. Do not administer HRIG
d) Pain and aches in different
body part
e) Mild difficulty swallowing GASTROINTESTINAL DISEASES
f) Numbness, tingling, burning A. PARALYTIC SHELLFISH POISONING
sensation ⮚ Food borne marine toxin disease with both GI
2) EXCITEMENT/NEUROLOGICAL and Neurologic symptoms
PHASE Occurs within minutes or several hours after
a) Marked excitation ingestion of poisonous shellfish
b) Eyes become fixed and glossy ⮚ CAUSATIVE AGENT: Dinoflagellates
 ✔ Become poisonous after a heavy 4) Hydration And Food
rainfall preceded by prolonged 5) Oral Care
summer 6) Safety Is A Priority
⮚ MOT: through INGESTION 7) Antibiotics: Chloramphenicol
⮚ CLINICAL MANIFESTATION :
a) Tingling of lips and tongue C. CHOLERA
b) Tingling of the face, neck ⮚ Acute bacterial enteric disease
c) Tingling of fingertips and toes ⮚ CAUSATIVE AGENT: Vibrio cholerae
d) Dysphagia ⮚ MOT: FECAL-ORAL ROUTE
e) Headache, Dizziness, Nausea a) Flies
f) Muscular Paralysis b) Food
g) Respiratory Difficulty c) Fingers
⮚ DIAGNOSTICS: d) Fomites
a) Clinical e) Feces
b) Urine test ⮚ CLINICAL MANIFESTATIONS: HARD
⮚ PREVENTION: a) Hypovolemic Shock
a) Monitoring program to test water b) Acidosis
b) Avoid eating shellfish during red tide c) Rice Watery Stool
⮚ MANAGEMENT: 4 A’s d) Diarrhea
a) Allow/induce vomiting ⮚ DIAGNOSTIC:
b) Alkaline fluids are given a) Culture & Sensitivity (Gold Standard)
✔ E.g. Coconut water b) Dip Stick Test
c) Activated charcoal c) Stool examination
d) Artificial respiration ⮚ PREVENTION: BREAK THE CHAIN of fecal, hand
and oral route
B. TYPHOID FEVER ⮚ MANAGEMENT:
⮚ Bacterial infection of the GIT affecting the 1) High Calorie, Low Fiber Diet
⮚ CAUSATIVE AGENT: Salmonella typhi 2) IV Treatment
⮚ MOT: FECAL-ORAL ROUTE 3) Antibiotics (Tetracycline)
a) Flies 4) Monitor I&O with VS
b) Food 5) Oral Rehydration Therapy
c) Fingers
d) Fomites LEPROSY (HANSEN’S DISEASE)
e) Feces ⮚ Chronic systemic infection characterized by
⮚ CLINICAL MANIFESTATIONS progressive cutaneous lesion
a) Neurological Changes ⮚ CAUSATIVE AGENT: Mycobacterium leprae
b) Pea-Soup Diarrhea ⮚ AFFECTED ORGANS:
c) Rose Spots (Rash) a) Skin
⮚ DIAGNOSTIC: TyphiDot b) Peripheral nerves
✔ Presence of Salmonella typhi c) Eyes
⮚ COMPLICATION: d) Testes
❒ It can spread VASCULARLY e) Mucosa of the URT
a) Meningitis ⮚ MOT:
b) Waterhouse-Friderichsen a) Aerosol spread from infected nasal
Syndrome and oral mucosa
c) Skin lesions b) Prolonged skin to skin contact
d) Vascular collapse ⮚ CLINICAL MANIFESTATIONS
e) Pulmonary insufficiency 1) FINE NERVES
f) Adrenal necrosis a) Anesthesia
⮚ PREVENTION: BREAK THE CHAIN of fecal, hand b) Anhidrosis
and oral route c) Dryness
⮚ MANAGEMENT: TYPHOSA 2) LARGE NERVES
1) TSB a) Pain then anesthesia
2) You have to monitor S/Sx closely b) Paralysis
3) Position Changes c) Atrophy
 3) Changes in skin color b) Renders patients non-infectious 1 week
4) Loss of sensation on the lesion after initiation of therapy
5) Decrease or loss of sweating 1) RIFAMPICIN
6) Thickened or painful nerves ❒ 600 mg once a month
7) Muscle weakness 2) DAPSONE
8) Pain and redness of the eyes ❒ 100 mf daily
9) Nasal obstruction or bleeding 3) CLOFAZIMINE
10) Ulcers that do not heal ❒ 50 mg daily
11) LEONINE FACIES (Pathognomonic) ❒ S/E: skin discoloration
12) Madarosis (loss of eyebrows) ⮚ NURSING MANAGEMENT:
13) Lagopthalmos (inability to close a) Moral support and encouragement
eyelids) b) Diet should be wholesome
14) Clawing of fingers and toes c) Terminal disinfection
15) Contractures ⮚ PREVENTION AND CONTROL
16) Gynecomastia a) Reporting of all cases and suspects
17) Chronic ulcers b) Separating newborns from leprous
⮚ DIAGNOSIS mothers
a) Presence of signs and symptoms c) BCG vaccination
b) History contact of People with leprosy d) Adequate nutrition
c) 1 of the 3 symptoms: e) Health education on the MOT
1. Hypopigmented or reddish
patches with definite loss of HEPATITIS
sensation ⮚ CLASSIFICATION:
2. Damaged peripheral nerves 1) HEPATITIS A
3. Acid Fast Bacilli on Skin Slit ✔ CAUSATIVE AGENT: Hepatitis A virus
Smear ✔ May be Asymptomatic
✔ MOT: Fecal-Oral Route
BACTERIAL CLASSIFICATION ✔ Vaccine Preventable
PAUCIBACILLARY MULTIBACILLARY ✔ Curable
NON-INFECTIOUS/TUBERCU INFECTIOUS/ ✔ Contagious before they feel sick
LOID LEPROMATOUS 2) HEPATITIS B (Serum Hepatitis)
Incubation period of 2-5 Incubation period of 8-12 ✔ CAUSATIVE AGENT: Hepatitis B virus
years years ✔ Usually no symptoms
<5 Lesions >5 Lesions ✔ MOT:
Normal Cell-mediated Deficient CMI a) Sexual Contact
Immunity (CMI)/ Partially b) Contaminated Needles
deficient CMI c) Body fluids (Blood or Semen)
Rapid peripheral nerve Rapid peripheral nerve ✔ Vaccine preventable
involvement involvement ✔ Can become CHRONIC
✔ Treatable but no cure exists
(+) LEPROMIN (Skin test) (-) LEPROMIN (Skin test) 3) HEPATITIS C
Few Bacilli Numerous Bacilli ✔ CAUSATIVE AGENT: Hepatitis C virus
✔ Usually no symptoms
PHARMACOLOGIC MANAGEMENT
✔ MOT: Blood-blood transmission
1) RIFAMPICIN 1) RIFAMPICIN
✔ NO VACCINE
2) DAPSONE 2) DAPSONE ✔ Usually become chronic
3) CLOFAZIMINE ✔ Curable
4) HEPATITIS D (Delta Hepatitis)
✔ CAUSATIVE AGENT: Hepatitis D virus
⮚ MODALITIES OF TREATMENT: ✔ MOT:
a) MDT a) Sexual Contact
b) Rehabilitation b) Contaminated Needles
c) Sulfone Therapy ✔ Can only be infected if have current
⮚ TREATMENT: MULTIDRUG THERAPY Hepatitis B
a) Use of two or more drugs for the ✔ Hepatitis D resides inside Hepatitis B
treatment of leprosy
 ✔ HREATER RISK of Liver failure
✔ Increased risk + Progression to liver
cirrhosis
5) HEPATITIS E
✔ CAUSATIVE AGENT: Hepatitis E virus
✔ MOT: Fecal-Oral Route
✔ INCUBATIONPERIOD: 2-8 weeks
✔ CLINICAL SYMPTOMS:
a) Jaundice
b) Nausea
c) Fatigue
✔ CHRONIC STAGE:
a) Weak immune system
b) Pregnancy
✔ GREATER RISK:
a) Fulminant liver failure
b) Cirrhosis
⮚ RA 7846
✔ An Act Requiring Compulsory
Immunization Against Hepatitis B For
Infants And Children Below 8 Years
Old.
⮚ MANIFESTATIONS: PHASES
1) PREICTERIC PHASE
a) Flu-like symptoms:
❒ Malaise
❒ Fatigue
❒ Fever
b) GI symptoms
❒ Anorexia
❒ Nausea
❒ Vomiting
❒ Diarrhea/Constipation
c) Muscle aches
d) Mild RUQ pain and tenderness
2) ICTERIC PHASE
a) Jaundice
b) Pruritus
c) Clay-colored stool
d) Brown or tea-colored urine
e) Decrease in PREICTERIC
PHASE symptoms
3) POSTICTERIC OR RECOVERY
a) Disappearance of Jaundice
b) Urine & stool color become
NORMAL
c) Appetite improves
d) GI symptoms disappears
e) COMPLETE RECOVERY of liver
may take up to 6 months
⮚ NURSING INTERVENTIONS
1) Use Standard Precautions
2) Encourage planned rest periods
3) Diet:
a) Moderate Fat
b) High Caloric
c) High Carbohydrates
d) High Proteins
4) Small frequent feedings
5) Majority of caloric intake should be
scheduled in the morning
6) Avoid alcohol intake and diet drinks
7) Use warm water when bathing,
8) Use mild soap or no soap
9) Limit duration of baths and shower
10) Keep fingernails short and wear
cotton mittens
TREATMENT
HEPATITIS 1) INTERFERON ALPHA
B ❒ Interferes with viral
replication
❒ Given IM or SC
❒ S/E: flu-like symptoms
2) LAMIVUDINE
❒ Reduces liver inflammation
HEPATITIS 1) INTERFERON ALPHA + RIBAVIRIN
C ❒ Ribavirin adverse effects:
a) Hemolytic anemia
b) Birth defects
PREVENTION AND CONTROL
HEPATITIS A AND E
1) HANDWASHING
2) TRAVELERS SHOULD AVOID WATER AND
ICE IF UNSURE OF THEIR PURITY
3) FOOD HANDLERS SHOULD BE CAREFULLY
SCREENED
4) SAFE FOOD PREPARATION AND HANDLING
5) PUBLIC SHOULD BE EDUCATED ON THE
MODE OF TRANSMISSION
PREVENTION AND CONTROL
HEPATITIS B, C, AND D
1) AVOID SHARING NEEDLES
2) CAUTIOUS USE OF SHARPS BY HEALTH
WORKERS
3) SCREENING OF BLOOD AND BLOOD
PRODUCTS
4) ABSTINENCE
5) CONDOM
 Td (2): 4
weeks after
Td (1)

Td (3): 6
months after
Td (2)

Td (4): 1 year
after Td (3)

Td (5): 1 year
after Td (4)
JE SC Upper arm 9 months
HPV IM Outer Female: 9-10
upper arm years old
Influenza IM Outer 60 years old
Vaccine upper arm and above
annually
EPI-PREVENTABLE COMMUNICABLE AND (every year)
INFECTIOUS DISEASES PULMONARY TUBERCULOSIS (KOCH’S DISEASE)
⮚ CAUSATIVE AGENTS:
VACCINE ROUTE INJECTION SCHEDULE 1) Mycobacterium tuberculosis
SITE 2) Mycobacterium avium
BCG ID Upper right At birth 3) Mycobacterium africanum
arm 4) Mycobacterium bovis
HepB IM Outer At birth ⮚ INCUBATION PERIOD: 2-10 weeks
mid-thigh ⮚ SOURCES OF INFECTION
OPV PO Mouth 6-10-14 weeks 1) Saliva
IPV IM Outer left 14 weeks 2) Sputum
upper thigh 3) Nasal Discharge
PENTA IM Outer right 6-10-14 weeks 4) Blood from Hemoptysis
upper thigh ⮚ MOT:
1) Airborne (Coughing, Singing, Sneezing)
PCV IM Outer left 6-10-14 weeks
upper thigh 2) Direct invasion through mucous
membranes or breaks in the skin
PPV IM Upper right Adults 60 and
3) Ingestion of unpasteurized milk
arm 65 years old
4) Contact with contaminated eating or
Rotavirus PO Mouth 6-10 weeks
drinking utensils
Vaccine
⮚ CLINICAL MANIFESTATIONS:
MMR SC Upper right 9 months and
1) Cough for 2 weeks
arm 12 months
2) tiredness
MR SC Upper right Grade 1 and 7
3) Loss Of Appetite
arm
4) Weight Loss
Td IM Outer left Grade 1 and 7
5) Fever
upper arm for children.
6) Night Sweats
⮚ SCREENING:
Pregnant
1) Intradermal PPD: MANTOUX TEST
Mothers:
a) 0.1 mL of PPD injected ID into the
Td (1): As forearm
early as MANTOUX TEST POSITIVE RESULTS IMPLICATION
possible in > 5 mm ❒ HIV Positive
pregnancy. ❒ Recent contact with an
active TB patient
 ❒ Nodular or fibrotic changes 1. Sweating
on CXR 2. Fatigue
❒ Organ transplant 3. Body malaise
4. SOB
>10 mm ❒ Recent arrivals (<5 years) 2) Acid Fast Bacilli: RED
from high-prevalence
countries
❒ IV drug users
❒ Resident/employee of high
risk congregate settings
❒ Mycobacteriology lab
personnel
❒ Comorbid conditions
❒ Children <4 years old
❒ Infants, children, &
adolescents exposed to
high risk categories

>15 mm ❒ Persons with no known

risk factors for TB

2) CHEST X-RAY

⮚ DIAGNOSIS: ⮚ SPUTUM SPECIMEN

1) Direct Smear Sputum Microscopy a) SPOT SPECIMEN
✔ Primary diagnostic tool in NTP case b) SPOT/EARLY MORNING SPECIMEN
finding prescribed to all TB ⮚ OTHER DIAGNOSTIC TESTS:
symptomatic a) VISION EXAMINATION
✔ 3/6 Symptoms: (+) b) LIVER FUNCTION TESTS
a) Coughing or wheezing for 2 weeks c) AUDIOMETRIC TESTING
b) Unexplained fever of 2 weeks or ⮚ PREVENTION: PROPHYLAXIS
more a) ISONIAZID (INH) 300 mg/day for 6-12
c) Failure to respond to 2 weeks of months
antibiotic for LRTI ⮚ TREATMENT: DOTS
d) Loss of appetite/weight or failure a) RIFAMPICIN (R)
to gain weight ✔ Adverse effect: HEPATOTOXIC
e) Failure to regain previous state of ✔ Contact lenses should not be worn
health 2 weeks after viral ✔ With meals
infection b) ISONIAZID (H)
f) Fatigue, reduced playfulness or ✔ HEPATOTOXIC\Avoid alcohol
lethargy ✔ Peripheral neuropathy
✔ Any person with cough for 2 or more ✔ Take with Vitamin B6 (Pyridoxine)
weeks with or without the following ✔ Take on empty stomach
symptoms: ✔ CONTRAINDICATION: Pregnancy
a) Fever c) PYRAZINAMIDE (Z)
b) Chest and/back pains not ✔ Hyperuricemia
referable to any musculoskeletal ✔ HEPATOTOXIC
disorder ✔ Avoid using alcohol
c) Hemoptysis or recurrent ✔ Administer with meals
blood-streaked sputum d) ETHAMBUTOL (E)
d) Significant weight loss ✔ Optic neuritis
e) Other symptoms: ✔ Monitor vision daily
 ✔ Schedule visual examination 3) RESPIRATORY ISOLATION
e) STREPTOMYCIN (S) 4) ADMINSTER MEDICATION AS ORDERED
✔ Administered IM 5) PATIENT EDUCATION
✔ Sites are rotated a) COUGH ETIQUETTE
✔ Maintain fluid intake of 2-3 L/day b) SIGNS OF DRUG REACTION
✔ Monitor urine output, BUN, Creatinine
✔ Assess balance BACILLE-CALMETTE-GUERIN (BCG) VACCINE
✔ Reinforce safety ⮚ Minimum age at 1st dose: AT BIRTH
⮚ Dosage: 0.05 mL
SIDE EFFECTS DRUG(S) WHAT TO DO ⮚ Number of doses: 1 dose
RESPONSIBLE ⮚ Interval between doses: None
MAJOR SIDE EFFECTS: DISCONTINUE TAKING ⮚ Route: Intradermal (ID)
MEDICINES AND REFER TO MHO/CHO/PHYSICIAN ⮚ Site: Deltoid
IMMEDIATELY ⮚ Vaccine type: Attenuated
Severe Skin Any kind of Discontinue and
Rash drug (especially, refer PREVENTION AND CONTROL
Streptomycin) 1) Submit all babies for BCG
Jaundice Due To Any kind of Discontinue and 2) Avoid overcrowding
Hepatitis drug (especially, refer 3) Improve health status
HRZ) 4) CONTRAINDICATION:
If symptoms a) Patients who have compromised
subside, resume immune system
treatment and
monitor
Impairment Of Ethambutol Discontinue and
Visual Acuity refer A. MEASLES (RUBEOLA)
And Color ophthalmologist ⮚ Acute highly communicable infection
Vision characterized by fever, rash and respiratory
Hearing Streptomycin Discontinue and symptoms
Impairment refer ⮚ CAUSATIVE AGENT: Morbilli Paramyxoviridae;
an RNA virus
⮚ INCUBATION PERIOD: 8-12 days
CATEGORY 1st Sputum 2nd Sputum 3rd Sputum
⮚ MOT:
Follow-up Follow-up Follow-up
a) DIRECT (DROPLETS, AIRBORNE)
Exam Exam Exam
b) INDIRECT (FOMITES)
I Towards Towards End of 6th
⮚ PERIOD OF COMMUNICABILITY
end of 2nd end of 5th month
a) CONTAGIOUS 4 days before
month month
appearance of rash
II Towards Towards End of 8th b) CONTAGIOUS 4 days after appearance
end of 3rd end of 5th month of rash
month month ⮚ CLINICAL MANIFESTATIONS: STAGES
a) PRE-ERUPTIVE STAGE
5 ELEMENTS OF DOTS ❒ Flu-like symptoms
1) SUSTAINED POLITICAL COMMITMENT ❒ Cough
2) ACCESS TO QUALITY-ASSURED SPUTUM ❒ Conjunctivitis
MICROSCOPY ❒ Body ache
3) UNINTERRUPTED OR REGULAR SUPPLY OF ❒ KOPLIK’S SPOTS (Pathognomonic)
QUALITY-ASSURED DRUGS − Bluish-whitish spots on
4) STANDARDIZED RECORDING AND soft palate or buccal
REPORTING SYSTEM mucosa
5) STANDARDIZED TREATMENT WITH b) ERUPTIVE STAGE
SHORT-COURSE CHEMOTHERAPY ❒ Maculopapular Rashes (starts
form the hairline down to behind
PTB - NURSING MANAGEMENT the ears to trunk and limbs)
1) COVER NOSE WHEN COUGHING OR SNEEZING ❒ Pruritus
2) HAND WASHING
 c) STAGE OF CONVALESCENCE 2) DISINFECTION
❒ Rashes desquamates (peeling) 3) VACCINATION
❒ Fever dissipates
⮚ MANAGEMENT: MEASLES – NURSING MANAGEMENT
a) Active Immunity (MMR & Measles 1) ISOLATE PATIENT
Vaccine) 2) TSB FOR FEVER
b) Passive Immunity (Measles 3) SKIN HYGIENE
Immunoglobulin) 4) ORAL & NASAL HYGIENE
c) Lifetime Immunity for primary 5) RESTRICT TO QUIET ENVIRONMENT
infection (Active Natural) 6) DIM LIGHT
⮚ OTHER FACTS OF MEASLES: 7) ANTIPYRETICS
a) It is EXTREMELY CONTAGIOUS
b) Breastfed babies of mothers have 3 MEASLES – MANAGEMENT
month immunity for measles 1) MOUTH AND NOSE CARE
c) MOST COMMON COMPLICATION: 2) APPETITE IS CONCERN
❒ Otitis Media 3) HYDRATION STATUS
d) MOST SERIOUS COMPLICATIONS 4) IN HEAT/FEBRILE
❒ Pneumonia 5) YES, RASHES WILL FADE
❒ Encephalitis 6) A (VITAMINS)
⮚ DIAGNOSTICS:
a) Physical Examination (CLINICAL) MEASLES VACCINE
b) Nose & Throat Swab (not routinely ⮚ Minimum age at 1st dose: 9 MONTHS
done) ⮚ Dosage: 0.5 mL
c) U/A ⮚ Number of doses: 1 dose
d) CBC ⮚ Interval between doses: None
DAY 0-1 PRODROME ⮚ Route: SUBCUTANEOUS
COUGH ⮚ Site: OUTER PART OF UPPER ARM
CORYZA ⮚ Vaccine type: Attenuated
CONJUNCTIVITIS
DAY 2-3 KOPLIK SPOTS APPEAR B. GERMAN MEASLES (RUBELLA)
DAY 4-5 MORBILLIFORM RASH ⮚ POST NATAL: an infection that primarily
APPEARS affects the skin and lymph nodes
DAY 6 KOPLIK SPOTS REGRESS ⮚ CONGENITAL: fetal infection which results to
DAY 7-8 RASH IS MOST INTENSE congenital abnormalities
DAY 10 RASH BEGINS TO ⮚ Known as 3 DAY MEASLES (After 3 days,
RESOLVE measles disappears)
3 C’S OF MEASLES ⮚ CAUSATIVE AGENT: Rubi Togaviridae; a
❒ FIRST SIGN: Mild-Moderate Fever rubella virus; RNA
1) CORYZA ⮚ INCUBATION PERIOD: 14-21 days
2) COUGH ⮚ MOT:
3) CONJUNCTIVITIS a) DIRECT
− DROPLETS spread through
MEASLES – MANAGEMENT: the nasopharynx
1) OBSERVE RESPIRATORY ISOLATION b) INDIRECT:
2) SUPPORTIVE MANAGEMENT OF SYMPTOMS − TRANSPLACENTAL
3) HYDRATION ⮚ CLINICAL MANIFESTATIONS:
4) PROPER NUTRITION a) Maculopapular Rashes (diffuse/
5) VITAMIN A non-confluent, no desquamation,
6) ANTIBIOTICS (if with secondary bacterial spreads from face downwards)
infection) b) Blueberry Muffin Appearance
7) MEASLE VACCINE at 9 MONTHS c) FORSCHEIMER’S SPOTS
8) MMR VACCINE at 12-15 MONTHS (Pathognomonic)
− Petechial reddish spots on soft
MEASLES – PREVENTION palate or buccal mucosa
1) ISOLATION
 d) Cervical lymphadenopathy (swelling 3) ANTIHISTAMINE
of cervical lymph nodes)
e) Low-grade fever compared to measles C. CHICKENPOX (VARICELLA)
⮚ DIAGNOSTICS: ⮚ Acute & highly CONTAGIOUS characterized by
a) CLINICAL vesicular eruptions
b) Serologic testing ⮚ Childhood disease & adolescents
⮚ COMPLICATIONS: ⮚ Human beings are the only source of infection
a) Pneumonia ⮚ CAUSATIVE AGENT: Varicella Zoster Virus
b) Meningoencephalitis ⮚ INCUBATION PERIOD: 10-21 days
c) Congenital Rubella Syndrome: ⮚ MOT: DROPLETS spread
1. Deafness a) Nose & throat secretions
2. Cataracts b) INDIRECT CONTACT
3. Heart defects c) Vesicles (contagious in early stage of
4. Microcephaly eruption)
5. Mental retardation d) Airborne
6. Bone alterations ⮚ CLINICAL MANIFESTATIONS:
7. Liver and spleen damage a) PRODROMAL PERIOD:
⮚ COMPLICATIONS TO PREGNANT WOMEN: ❒ Headache
a) Severe birth defects (acquired German ❒ Vomiting
measles on 1st trimester) ❒ Anorexia
b) Abortion (acquired German measles on ❒ Malaise
2nd trimester) ❒ Mild Fever
c) Premature baby (acquired German ❒ Papulovesicular Rashes
measles on 3rd trimester) appear on trunk (spreads to
d) 100% = 1st trimester the face and extremities –
e) 4% = 2nd and 3rd trimester CENTRIFUGAL)
f) 90% = excretion o virus at birth
g) 10% = contagious until 1 year
⮚ MANAGEMENT:
a) Active Natural Immunity
(PERMANENT or Lifetime after
primary infection)
b) Active Immunity (MMR & Rubella
Vaccine)
c) Passive Immunity (Gamma globulin)
⮚ PERIOD OF COMMUNICABILITY
a) CONTAGIOUS for 7 DAYS BEFORE
appearance of rash
b) CONTAGIOUS for 7 DAYS AFTER
appearance of rash
c) During Catarrhal Stage
⮚ NURSING CONSIDERATIONS:
a) MMR immunization ⮚ PERIOD OF COMMUNICABILITY
b) Use of Immunoglobulin a) CONTAGIOUS for 5 DAYS BEFORE
c) Prevention of congenital measles appearance of rash
d) Avoid exposure b) CONTAGIOUS for 5 DAYS AFTER
appearance of rash (Crusting)
RUBELLA – PREVENTION: c) CONTAGIOUS a DAY BEFORE the
1) DISINFECTION eruption of first lesion
2) ISOLATION ⮚ COMPLICATIONS:
3) DROPLET PRECAUTION a) Pneumonia
b) Meningoencephalitis (rare)
RUBELLA – MANAGEMENT (POST NATAL) c) Hepatitis
1) BED REST d) Skin lesions may develop secondary
2) STARCH BATH bacterial infections
 e) Reye’s Syndrome (associated with a) CONTACT
Aspirin use) b) IINDIRECT CONTACT
⮚ DORMANT: ⮚ PERIOD OF COMMUNICABILITY
a) Remain at the dorsal root ganglion a) CONTAGIOUS for 3 days before the
and may recur as SHINGLES. onset
⮚ MANAGEMENT: b) CONTAGIOUS for 4 days after the start
a) ANTIVIRALS of parotitis
b) ANTIHISTAMINES ⮚ COMPLICATIONS:
c) ANTIPRURITIC LOTIONS a) Meningitis
d) ANTIPYRETICS b) Encephalitis
e) Mild/bland, soft foods c) Pancreatitis
f) Acyclovir, Antihistamines d) Oophoritis
g) Nasal and Oral care e) Orchitis
h) Observe proper hygiene ⮚ DIAGNOSIS : CLINICAL
i) Keep fingernails short ⮚ PREVENTION:
⮚ NURSING CONSIDERATIONS: 1) Isolation
a) If itchy, give antihistamines PO or 2) Disinfection
local 3) Distance
b) Avoid rupture of lesions ⮚ MANAGEMENT: SADAACO
c) Cut nails short 1) Soft diet
d) Pay attention to nasopharyngeal 2) Aqua therapy
secretions/discharges 3) Discharges
e) Prophylactic antibiotics 4) Aspirin
f) Exclusion from school for 1 week after 5) Allow Bed Rest
eruption appears 6) Control scratching
g) An attack gives lifetime immunity 7) Oral Antiseptics
(Active Natural) 8) Orchitis
h) DOC: Acyclovir (topical cream applied
to crusts)
⮚ PREVENTIVE MEASURES:
a) Active Immunization with LIVE
ATTENUATED VARICELLA VACCINE
b) Avoid exposure as much as possible to
infected person

CHICKENPOX HERPES ZOSTER

(SHINGLES)
DISTRIBUTION GENERALIZED UNILATERAL
MAIN ITCHINESS BURNING PAIN
CONCERN
MANAGEMENT ACYCLOVIR ACYCLOVIR
ANTIPYRETIC ANALGESIC
ANTIPRURITIC ANTI-INFLAMM
ATORY
PREVENTION ❒ IMMUNIZATION
❒ AVOIDING EXPOSURE
❒ DISINFECTION
❒ WEARING PPE

D. MUMPS (PAROTITIS)
⮚ Inflammation of the parotid glands
⮚ Human beings are the only RESERVOIR
⮚ CAUSATIVE AGENT: Paramyxovirus
⮚ MOT: DROPLETS spread