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MUMPS (Epidemic Parotitis) Definition: It is an acute contagious disease, the characteristic feature of which is the swelling of one or both

of the parotid glands, usually occurring in epidemic form. Mode of Transmission: It is spread by direct contact with a person who has the disease or by contact with articles in his/her immediate environment which have become freshly soiled with secretion from the nasopharynx. The period of communicability begins before the glands are swollen and remains for an unknown length of time, but is presumed to last as long as any localized glandular swelling remains. Incubation period is from 12-26 days, usually 18 days. Pathophysiology:

Causes: Mumps virus, a member of the family Paramyxomviridae, genus Paramyxovirus is antigenically related to the parainfluenza viruses. Signs and Symptoms: Painful swelling on front of ear, angle of jaws and down the neck. Fever Malaise Loss of appetite Swelling of one or both testicles (orchitis) in some boys

Encephalitis may complicate mumps. Sudden rise in temperature, stiff neck, headache, malaise, nausea and vomiting, delirium and double vision should be watched for since they are the symptoms of this complication. These symptoms usually subside spontaneously within 10-14 days. Management/treatment: Active Treatment- The average case before the age puberty requires little attention. After the Age of Puberty- All patients, particularly adults, should remain quiet in bed until all fever and swelling have been absent for at least four days because of the danger of glandular complications. In males, the scrotum should be supported by a properly fitted suspensory, pillow or a sling between thighs, thus relieving the pull of gravity on the testes and blood vessels and minimizing the dangers of orchitis, edema and atrophy. When orchitis occurs, it may require the use if sedatives to

relieve pain. Present treatment in adults consists of giving an immediate oral dose of 300-400 mg. of cortisone, followed by 100 mg. every 6 hours. Response is immediate and spectacular. Smaller doses do not do so well. In children, in whom this complication is common, the dose must be adjusted accordingly. It is continued for 3 or days. A nick in the membrane enclosing testes, made under aseptic precautions through scrotum with a large needle or a sharp pointed knife, may relieve fluid under pressure by swallowing it to drain into the scrotum. This procedure, formerly widely employed, unquestionably saved many testicles from atrophy, but it is now outdated and so is the hypodermic administration of stilbestrol. The diet should be soft or liquid as tolerated and is suitable for his age. Sour foods or fruit juices are disliked because of the burning or stinging sensation they elicit. Either sweet or acid foods may cause pain. Some patients are unable to tolerate cold foods; others are unable to swallow hot foods. Encourage control of scratching to prevent local infections and scars. Medication includes aspirin for fever and generalized discomfort. Elevated temperatures seldom present a nursing problem in uncomplicated mumps. Alcohol rub and tepid sponge bath may also be done to reduce fever. The patient should remain in bed to prevent complications. In mild cases, children may be allowed out of bed, at least for toilet privileges. For the comfort of patient, either hot or cold applications may be used on the swollen jaws to alleviate the discomfort. Skin care and oral hygiene- A daily bath should be given. Frequent antiseptic mouth washes may be helpful in addition to regular oral hygiene and brushing teeth. Eye care- Rarely, inflammation of the lachrymal glands, or conjunctivitis may occur. The doctor may prescribe cold compresses or a collyrium. If the eyes required protection from light, dark glasses may be used. Prevention: Prophylactic- a vaccine exists for the active immunization of patient against mumps. However, it is of no avail after a non-immune patient has been actively exposed to the disease. The immunity granted by inoculation with mumps vaccine is relatively short duration of passive immunization against the disease. Isolation-Mumps cases should be isolated to prevent spread to susceptible. Disinfection- The usual methods or procedures in the care of contaminated articles should be used. Since the disease is spread by secretions of the nose and mouth, all materials contaminated by these secretions should be carefully cleansed by boiling. Paper handkerchiefs should be burned.

Terminal Disinfection- The usual cleaning a room or unit should be used. If the patient has been at home, the room should be aired for 6-8 hours.

PARAYTIC SHELFISH POISONING (PSP I Red Tide Poisoning) Definition: It is a syndrome of characteristic symptoms predominantly neurologic which occur within minutes or several hours after ingestion of poisonous shellfish. Mode of Transmission: Ingestion of raw or inadequately cooked seafood usually bi valve shellfish or molluscs during red tide season. Incubation period varies from about 30 minutes to several hours after ingestion of poisonous shefish. Pathophysiology:

Causes: Single celled organism called dinoflagellates (less than 30 kinds out of about 2000 varieties become poisonous after heavy rainfall preceded by prolonged summer.) It is commonly referred to as plankton. The organism that causes red tide in the seas around Manila Bay, Samar, Bataan, and Zambales is the Pyromidium bahamense var. Compressum. Signs and Symptoms: Numbness of the face especially around the mouth Vomiting and dizziness Headache Tingling sensation, paresthesia and eventual paralysis of hands and feet Floating sensation and weakness Rapid pulse Difficulty of speech (ataxia) and difficulty of swallowing (dysphagia) Total muscle paralysis with respiratory arrest and death occur in severe cases

Poison victims who survive the first twelve hours after ingestion of the toxic shefish have a greater chance of survival. Management/treatment: No definite medication indicated Induce vomiting

Drinking pure coconut milk weakens the toxic effect of red tide, sodium bicarbonate solution (25 grams in glass of water may be taken.) Drinking of coconut milk and bicarbonate solution is advised during early stage of poisoning only. If given during the late stage, they may make the condition of the patient worse. Prevention: Shellfish affected by red tide must not be cooked with vinegar as the toxin of Pyromidium increases (15 times greater) when mixed with acid Toxin of red tide is not totally destroyed upon cooking hence consumers must be educated to avoid bi-valve molluscs such as tahong, talaba, halaan, kabiya, abaniko (sun and moon shel or Asian scallop) when the red tide warning has been issued by the proper authorities.