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Polio
Polio
INTRODUCTION
DEFINITION:
Types of Poliomyelitis
1) Spinal
Cervical
Thoracic
Lumbar
2) Bulbar
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Cranial nerves
Circular System
Respiratory System
3) Bulbo-spinal
4) Polioencephalitis
PERIOD OF COMMUNICABILITY:
Most contagious a few days before and after the onset of symptom when the virus is
found in the oropharynx for about a week, and in large quantities in the small bowel, and
continues to be in feces up to about 3 months.
Modes of Transmission:
- virus is harbored in GIT and is transmitted through saliva, vomitus and feces
1) Direct contact – from one person to another person through healthy carriers via the
intestinal/oral pathways.
- it has been shown that poliovirus excretors are much more commonly found among
household or family contacts than among noncontact.
2) Indirect contact – fecal-oral through food, water, utensils and objects contaminated
by human exreta.
- occasionally, the virus may be implanted through the oropharynx and in very rare
instances by parenteral.
INCUBATION PERIOD:
Usually 7-14 days, with a range of 5-35 days, for paralytic and non-paralytic
forms; 3-5 days for the minor illness.
PATHOGENESIS:
Polio virus reaches the intestinal tract through the mouth, enters the
intestinal mucosa and lodges and multiplies in undetermined sites,
possibly reticuloendothelial system. This is known as the Intestinal Phase.
The organism may then reach the blood (viremic phase) and then proceed
to CSN (neural phase)
In each of these stages the body defences respond and resist the invading
organisms.
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The disease may stop in any of this sites, depending on the promptness
and effectiveness of the host’s antibody response at that particular phase.
The milder manifestations constitute the Abortive type of the disease and
the more severe manifestations; the Meningitic or preparalytic Type.
Unchecked, the organism proceed via nerve pathways to the CNS and
again depending on the site they invade, manifestations may
correspondingly be Spinal, Bulbospinal or Encephalitic.
CLINICAL MANIFESTATIONS:
1) Inapparent/Subclinical/Asymptomatic/Silent Type
Person who are expose to poliomyelitis ward like the nurses and other
members of the health team. But not all polio victim has small leg or both.
Then the second febrile stage is observe, this time with higher temperature,
headache, vomiting, restlessness, anorexia, lethargy and pain in the neck and back, arms,
legs, and abdomen.
- It cause also muscle spasms and tenderness in the extension or extensora of neck and
back.
- Is usually lasts about a week with meningeal irritation persisting for about 2 weeks.
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4) Paralytic Type
Early manifestations are pain and some degree of stiffness followed by twitching and
diminished deep tendon reflexes.
- Positive Hoyne’s Signs- his head will fall back when he is in supine and
his shoulders are elevated. He won’t be able to raise his legs at full 90
degrees.
DIAGNOSIS
Blood- by the end of the 1st week, WBC count may be normal or slightly
increased.
Throat- by the end of the 1st week until the 2nd week
Fecal/stool- by the end of the 1st week until the 3rd or throughout the disease and
even up o 3 months.
CSF- is not a path gnomonic but may be help when considered with other
manifestations and the course of the disease.
2) SEROLOGIC DIAGNOSIS
It is of value when there is at least a 4 rise of antibody titer from the acute to the
acute to the convalescent stage, as determined by neutralization or complement fixation
tests.
TREATMENT:
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1.Abortive Type/Minor Illness
Bed rest
Analgesic-to ease headache, back pains and muscle spasm
Moist hot packs for 15-30 min every 2-4 hrs over the affected muscles
Anxiety and fear should be allayed
Suitable body alignment; feet at the right angle, knees slightly flexed, hips and
spine straight, with the use of board, sand bags, and occasionally light splint shells
Active and passive movements as soon as pain disappears
Make bed with cotton or woollen blanket both under and over the pt.
PREVENTION:
COMPLICATION
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Respiratory paralysis- which includes the diaphragm and the inter costal muscle
Pneumonia
Myocarditis
Atelectasis
Pulmonary edema
Hypertension
8. Renal calculi
PROGNOSIS
- Muscles which are paralyzed in 1 month after the onset of illness recover
completely only in less than 2% of the cases.
PREVENTION
NURSING INTERVENTIONS:
enteric precautions
Apply moist hot packs to the affected muscle and to relieve muscle shortening.
Maintain good body alignment by using board, sandbags, etc.
Make bed with cotton or woolen blanket both under and over the patient
Nasal and oral hygiene such as mouth and teeth must be clean, nose should be
cleansed for easily passage of air; moisten the mucus membrane with some
prescribed lubricant.
5. Children’s activities should be reduced to avoid physical exertion and fatigue and
chilling should not be overlooked.
6. Sanitation of the premises and proper food handling to avoid contamination by flies
should be overlooked.
Operation of Tendons
fasciotomy- operation on deep fascia the most useful procedure in the surgical
treatment of poliomyelitis are operations that restore stability to failed joints.
CONCLUSION