Communicable Disease Nursing (CDN)
from a disease and a new infection is set up
Communicable Disease
 Is any disease that can be transmitted directly
or indirectly from one person to another
Essential Elements in CD
 Agent
- Microorganism that is living and capable of
invading and multiplying in the body of the
host
a. Viruses
b. Bacteria
c. Fungi
d. Parasites
 Host
Types:
1. Infected body – which the infectious
agent has entered and multiply
2. Susceptible host – the one that don’t
possess resistance
 Environment
- Indirect
- Direct
- Reservoir on which an organism
survives and multiples
Terms
 Contagious – an illness which arises only
through direct transmission and is easily
transmitted
 Infectious – disease resulting from an
infection
 Infection – an invasion of the body by
pathogenic organisms that multiply and
produce injurious effects
Classification of Infections
 Primary infection – initial infection with an
organism in the host
 Reinfection – subsequent infection by the
same organism in a host (after recovery)
 Superinfection – infection by the same
organism in a host before recovery
 Secondary infection – when in a host whose
resistance is lowered by preexisting infectious
disease, a new organism may set up in
infection
 Focal infection – it is a condition where due
to infection at localized sites like the appendix
and tonsil, general effects are produced
 Cross infection – when a patient suffering
by another host or external source
 Nosocomial infection – cross infection
occurring in hospital
 Subclinical infection – is one where clinical
affects are not apparent
Types of Infectious Diseases
 Localized infections may be superficial or deep-
seated
 Circulation of bacteria in the blood is known as
bacteremia (viruses – virusemia)
 Septicemia is the condition where bacteria
circulate and multiply in the blood, form toxic
products and cause a swinging type of fever
 Pyemia is a condition where pyogenic bacteria
produce septicemia with multiple abscesses in
the internal organs such as the spleen, liver and
kidney
Depending on the spread of the infectious disease in
the community they may be classified into different
types
 Endemic diseases are one that are constantly
present in a particular area
Malaria is endemic in most parts of Palawan
 An epidemic disease is one that spreads
rapidly, involving many persons in an area at
the same time. Influenza causes annual winter
epidemics in the cold countries
 A pandemic is an epidemic that spreads
through many areas of the world involving
very large numbers of persons within a short
period (influenza, cholera, plaque)
 Epidemics vary in the rapidity of spread.
Waterborne disease such as cholera and
hepatitis may cause explosive outbreaks,
while disease which spreads by person-to-
person contact evolve more slowly
 Incubation period – no symptoms
 Prodromal period – mild and generalized
symptoms (fever, weakness, headache)
 Invasive stage – symptoms specific to the
disease
 Decline stage – symptoms subside
 Convalescence – no symptoms, health returns
to normal
 Isolation – separation of persons with CD
from other persons so that either direct or
 indirect transmission to susceptible persons is  Immune system – protection against antigen
prevented or diseases by a system of antibody
 Reverse isolation production
 Quarantine – limitation of the freedom of  Antibody – produced by lymphocytes in
movement equivalent longest IP of that response to antigen
disease  Antigen – triggering agent of the immune
system
The Chain of Infection

Etiologic/Infectious Agent: Immunoglobulins

(Bacteria, Fungi, Virus, Parasites)  IgG – most prevalent antibody 80% produce
later in the immune response, only Ig that can
Reservoir (source)
cross the placenta
Human beings, animals, inanimate objects, plants,
 IgA – found in colostrum, tears, saliva, sweat
general environments such as air, water and soil
 IgM – principal antibody of blood, quickly
Portal of Exit produced in response to an antigen, responds
Sputum, emesis, stool, blood to artificial immunization
 IgE – allergic reaction
Modes of transmission
 IgD – unknown antigen receptor, found in the
Contact, vehicle, airborne, vector-borne
surface of B cells
Portal of Entry
Mucous membrane, non-intact skin, GI tract, GU tract, Immunization
Respiratory  A process by which resistance to an infectious
disease is induced or augmented
Susceptible Host  Active and passive immunization
Immunosuppressed children, elderly, chronically ill,
those with trauma or surgery EPI (Expanded Program Immunization)
Infection  Hepa B 3 shots, 0-1-6 mos, IM, 0.5 ml, vastus
 Condition caused by the entry and lateralis
multiplication of pathogenic microorganisms  BCG 1 at birth, ID, 0.05 ml, left arm
within the host body  BCG 2 at 6 y/o, ID, 0.1 ml, left arm
 Invasion of organisms (bacteria, helminths,  DPT 3 shots, 6 weeks old, 4 weeks interval,
fungi, parasite, rickettsia, and prion) IM, 0.5 ml, vastus lateralis
 OPV 3x, same with DPT, oral drops 2-3-4
weeks interval
Factors Affecting Risk of Infection:  Measles 1x, 9 mos, SC, 0.5 ml, right arm
 Age
 Heredity Active Immunity
 Level of stress
 Antibodies are produced by the body in
 Nutritional status
response to infection
 Current medical therapy
 Antigen is introduced, long duration
 Pre-existing diseases
 Example:
 Immunization status
- Natural active = diseases
Immunity - Artificial active = vaccines
 The quality of being insusceptible to or
Artificial Active
unaffected by a particular disease
 Antigens (vaccines or toxoids)
Types:
- Are administered to stimulate antibody
 Innate – within the host
production.
Immune system
- Reinforced by booster dose to increase
 Acquired – inoculation and disease immunity
- Active
 Killed vaccines
- Passive
- Pertussis vaccine, typhoid vaccines
  Live vaccines Artificial Passive
- Attenuated, weakened sabin, measles  Immune serum (antibody) from animal or
 Toxoid human is injected
- Inactivated bacterial, Toxin-tetanus,  Provide immediate protection (Diphtheria
Diphtheria antitoxin, tetanus antitoxin)
- Skin-testing is a MUST!

Conditions Before an Infection Develops

 Sufficient number of microorganisms
 Virulence of microorganisms
 Resistance of the host
 Immunity of the host
 Cycle of infection must be completed

Epidemiology
 Sporadic – occurs occasionally and irregularly
with no specific patterns
 Epidemic – occur in a greater number than
what is expected in a specific area over a
specific time
 Pandemic – epidemic that affects several
countries or continents
 Endemic – present in a population or
community at times

General Nursing Care in CD

1. Preventive Aspect
a) Health education
b) Immunization
c) Environmental sanitation
d) Proper supervision of food handlers
2. Control Aspect
 Isolation-separation for the period of
communicability of infected persons
 Quarantine-limitation of freedom of
movement of person exposed to CD
during the longest IP
 Disinfection-killing of pathogenic agents
by chemical or physical means

 Fumigation – process of killing of animal

forms accompanied by the employment of
Passive Immunity gaseous agent
 Practice of medical asepsis-gloving, gowning,
 antibodies are produced by another source
and handwashing, placarding, eye shields, eye
 antibodies are introduced, short duration
goggles
 example:
- Natural passive = mother Fundamentals of Standard Precaution
- Artificial passive = globulins
 Handwashing
 Gloves
 Masks, goggles, face shields
 Air filters
  Gowns
 Isolation
- It is necessary when a person is known or
suspected to be infected with pathogens
that can be transmitted by direct or indirect
contact
- The principle behind isolation technique is
to create a physical barrier that prevents
the transfer of infectious agents. To do this
you have to know how the organisms are
transmitted
 Strict isolation
 Contact isolation
 Tuberculosis isolation
 Enteric precaution
 Drainage/Secretion precaution
 Blood/Body fluids precaution
Transmission-Based precautions
 Contact transmission - Most common; direct,
indirect and droplet spread (3 ft/1 meter)
 Airborne transmission < 5 microns
 Vehicle transmission articles or substances
that harbor the organism until it is ingested or
inoculated
 Vector-borne transmission intermediate
carrier
Barrier protection
 Airborne private room – airflow or at least 6
air exchanges per hour
 Droplet-private room, mask within 3ft
 Contact private room, mask gown
Other types of Isolation
 AFB Isolation
- Visitors report to the nurses’ station before
entering the room
- Masks are to be worn in the patient’s room
- Gowns are indicated to prevent clothing
contamination
- Gloves are indicated for body fluids and
non-intact skin
- Handwashing after touching the patient or
potentially contaminated articles and after
removing gloves
- Articles should be discarded, cleaned or
sent for decontamination and reprocessing
- Room is to remain closed
- Patient is to wear a mask during transport
 Strict Isolation
- Visitors report to the nurses’ station before
entering the room
- Private room necessary, door must be kept
closed
- Gowns, masks, gloves must be worn by all
persons entering the room
- Handwashing
- Articles must be discarded or wrapped
before being sent to central supply for
disinfection or sterilization
 Respiratory Isolation
- Visitors report to the nurses’ station before
entering the room
- Private room necessary, the door must be
kept closed
- Gowns
- Masks must be worn by all persons entering
the room if susceptible diseases
- Handwashing
- Gloves
- Articles that are contaminated with
secretions must be disinfected
- Caution! All persons susceptible to the
specific disease should be excluded from
the area, susceptible, must wear masks
 Wound and Skin Isolation
- Visitors report to the nurses’ station before
entering the room
- Private room
- Gowns & gloves must be worn by all
persons having direct contact with the
patient
- Masks during dressing changes
- Handwashing
- Gloves must be worn by all persons having
direct contact with infected area
- Articles – instruments, dressing, linens
 Enteric Isolation
- Visitors report to the nurses’ station before
entering the room
- private room necessary FOR CHILDREN
ONLY
- Gowns must be worn by all persons having
direct contact with the patient
- Masks
- Handwashing
 - Gloves must be worn by all persons having Clinical manifestations:
direct contact with patient or articles  Trismus – lockjaw, neck and facial muscle last
contaminated with fecal material to disappear
- Articles – special precautions necessary for  Risus sardonicus – maskface; sardonic grin
articles contaminated with urine and feces,  Opisthotonos – arching of the back
must be disinfected or discarded  Rigidity of abdominal muscles and extremities
 Difficulty in swallowing and breathing
 Protective or Reverse Isolation  Urinary and bowel incontinence
- Visitors report to the nurses’ station before  Pain, redness, and swelling
entering the room  Dx exam: Wound History and wound culture
- Private room necessary, the door must be
kept closed Tetanus Neonatorum
- Gowns & mask must be worn by all persons
 Feeding and sucking abn
entering room
 Voiceless crying
- Handwashing
 Sucking – cyanosis
- Gloves must be worn by all persons having
 Dehydration
direct contact with patient
 Tonic or rigid muscular contraction
 Flaccidity – exhaustion – death
Diagnostic Tools Immunization
 Collection of specimens  DPT (0.5 ml IM)
 Principles 1 – 1 ½ mos old
 Types of specimen collection 2 – after 4 wks
 Blood 3 – after 4 wks
 Urine 1st booster – 18 mos
 Stool 2nd booster – 4 to 6 y.o
 Sputum Subsequent booster – every 10 yrs thereafter
 Wounds
 Throat  TT (0.5.ml IM)
TT1 – 6 mos preg
Laboratory tests
TT2 – 4 wks after
 Microscopy
TT3 – 6 mos after
 Culture
TT4 – at least 1 yr after TT3
 Antibiotic susceptibility testing TT5 – at least 1 yr after TT4
 White blood cell count TAT (horse) and TIG (human)
 Immunologic test
3 types of patients with skin wounds post exposure
CNS prophylaxis
Tetanus (Lockjaw) 1. (+) immunization as a child with boosters but
 Clostridium tetani – direct inoculation last shot > 10 yrs – give TT
resulting to tonic muscular spasms; anaerobic 2. (-) immunization – TT + TIG/TAT
bacteria gm+ 3. (+) tetanus – TIG/TAT + TT + ATBC + wound
 Toxins – tetanospasmin, tetanolysin cleansing + supportive therapy
 MOT – OM, tooth decay, Tet Neonat
 IP – 3 to 21 days Adult, 30 days NB
 Immunity Planning and Implementation
- Active = TT Preventive Measures
- Passive = TAT & TIG
- Natural = active none, passive (+) 1. Immunization
2. Proper wound care
3. Avoidance of wound
3 objectives of Medical Management
1. Neutralize toxins – antitetanus toxins;
epinephrine and corticosteroids present
2. Kill the bacteria – Penicillin, daily cleansing of
wound
3. Prevent muscle spasm – sedatives, muscle
relaxants to increase effect of sedatives
Nursing Care
 Avoid stimulation to avoid muscle spasm
 Proper oral hygiene
 Record intake and output
 Provide a quiet and well ventilated room
 Always have padded tongue depressor to
maintain patient airway
 Never leave the patient alone
Rabies/Lyssa (Hydrophobia)
 Rhabdovirus/filterable virus
 MOT – saliva of infected animal
 Canine (human) and sylvatic (animals)
 IP – 10 days to 15 years man; 7 days to 7 ½
mos for dogs
 Immunity
- Active = rabies vaccine
- Passive = HRG, ERIG
- Natural = active none, passive none
 Hydrophobia (fear of choking)
 Aerophobia (laryngospasm)
 Bite from warm blooded animals
 Encephalitis/meningitis/respiratory paralysis
Category of bites
 I – intact skin (lick)
 II – mucosal, non-bleeding wounds, abrasions
 III – bleeding bites and above neck, stray dogs,
laceration, multiple bites
Clinical Manifestations
Rabid animals
1. Dumb-form – complete change in disposition;
very affectionate and walking to and from;
paralysis and coping flow of saliva
2. Furious form – vicious, agitated, then become
paralyzed, emits excessive saliva and dies
For Man
A. Invasive stage – numbers on site of bite,
headache, malaise, restlessness, fever,
photosensitivity, apprehension
B. Excitement stage – hydrophobia, spasms of
laryngeal and pharyngeal muscle, maniacal
(climbing the wall and excessive salivation)
C. Paralytic stage – laryngospasm stopped, last
for how many seconds or hours
Diagnostic Exam
 10 days observation for maniacal, s/sx
 Brain biopsy of the animal
 Fluorescent rabies antibody – specimen blood
of individual
Planning and Implementation
 Provide a dim, quiet and non-stimulating
room for the patient
 Wear gown, mask and goggles
 All noises should be avoided
 Restrain the patient when needed
 Stimulation of any senses by fluids must be
avoided
 Anti-rabies vaccine
Preventive Measures
 Immunization
 Keep away from stray animals
After the Bite
 Wash with soap and water
 Give antibiotics and antitetanus
 Observe dog for 14 days, if it dies consult
doctor
 If dog shows suggestive of rabies, kill the dog
immediately and bring head for lab exam (+)
negri bodies. Submit for immunization while
waiting for results
 If dog is not available for observation submit
for immunization
Immunization - Autonomic involvement
 Rabies vaccine (5 shots)  IV- bulbar (encephalitis)
 IM (2 ml deltoid) - Facial, ocular and pharyngeal muscles-
 0,3,7,14, 28 days paralyzed
 ID (0.1 ml deltoid) - Respiratory and cardiac irregularities
 0,3,7 days (0.1 ml deltoid 2 shots) - Hypothalamic dysfunction
 30, 90 days (0.1 ml deltoid single shot)
 Rabies Ig single shot
Wound 40%
Deltoid 60%

Responsible Pet Ownership

 Have pet immunized at 3 mos and every year

after
 Never allow pets to roam in the street leashed
your dog
 Your pet action is your responsibility

Poliomyelitis
Infantile Paralysis/Heine-Medin Disease
 Polio virus, Legio debilitans
- Legio Brunhilde (fatal) permanent
immunity
- Legio Lansing
- Legio Leon
 MOT= Fecal oral route (common) and
droplets
 IP= 7-21 days, repeated range 3-35 days
 Immunity
- Active- OPV
- Passive- Nonee
- Natural- Active (+), passive none
 Asymmetrical paralysis
 Hoyne’s sign- head drop
 Poker’s sign-opisthotonus
 Landry’s sign- ascending paralysis GIT
 Pandy’s test- increased in CSF CHON Schistosomias
 I- abortive or inapparent Bilharziasis/Snail Fever
- Does not invade CNS  Blood fluke
- Low lumbar pain  Schistosoma japonicum- infects the intestinal
- Recovers within 72 hours tract (katayama disease), endemic, “oriental
 II- meningitis (non-paralytic) schistosomiasis”
- Spasm of the hamstring  S. hematobium- affects intestinal tract
- Changes in deep and superficial reflexes  S. mansoni- affects urinary tract
- (+) pandy’s test  IP= at least 2 months
- Transient paresis  MOT= skin entry (larvae/cercaria) travel into
 III- paralytic (anterior horn of spinal cord) the bloodstream where they will infiltrate the
- (+) hoyne’s sign liver, from liver to intestines
- Less tendon reflexes  Intermediary host a tiny snail oncomelania
- (+) kernig and brudzinski sign quadrasi
 - Cerebral schistosomiasis- ICP, neurologic
signs

RESPIRATORY SYSTEM
Diphteria
 Corynebacterium diphtheria (Klebs-Loeffler
bacillus)
 Throat and skin
 Cycle- egg larvae (miracidium)- intermediary  MOT= droplets and airborne
host (oncomelania quadrasi-tiny snail)- o Highly contagious
cercaria
 IP= 2-5 days
 Itchiness at the site (“swimmers itch”)  Immunity
 RUQ pain (hepatomegaly)  Active- DPT
 Intestine infiltration- abd’l cramps, diarrhea  Passive- DAT
with blood (dysentery)
 Natural- xxx
 Praziquantel tablet for 6 months
 Dx COPT (stool exam) Strains
 Gravis (severe)
KEY POINTS!!
 Mitis (mild)- lesion extend to the larynx and
- Egg-miracidium-snail-cercaria-human
lungs
- Itchiness-liver-intestines
 Intermedius (intermediate)- tendency for
- Praziquantel
bleeding
- COPT
 Types
- Prevention
- Nasal
- Samar and Leyte
- Tonsillar
- Facial nasopharyngeal
 Prevention and Control
- Laryngeal- severe and fatal
- Have a stool exam
- Wound or cutaneous diphtheria
- Reduce snail density
Diphtheria
 Clearing vegetation
 Dx- throat swab, MOLONY, SCHICK
 Constructing drainage
 Pseudomembrane, bullneck
 Crop rotation
 Penicillin or erythromycin
- Diminish infection rate
 Resp. acidosis with hypoxemia
 Proper waste disposal
 Cx: myocarditis, septicemia
 Control of stray animals
 Prevent people bathing in infested
Nursing Consideration
streams
 Foot bridges  Observe CNS, cardiac and kidney
 Adequate water supply complications
 Complications  Pseudomembranous may lead to resp.
- Liver cirrhosis and portal hypertension obstruction
- Cor pulmonale and pulmonary  Isolation until 2 negative culture at 24 hour
hypotension interval
- Heart failure  F&E resuscitation
- Ascites  Parents or siblings who have never
- Hematemesis- rupture of esophageal immunized should receive a dose of diph.
varices Anti-toxin
- Renal failure  Attention to nasopharyngeal discharge
 Antibiotics- penicillin, erythromycin if allergic
to penicillin

 S/sx- sore throat, fever, “bull neck”
(pseudomembrane-gray exudate, foul breath,
massive swelling of tonsils and uvula, thick
speech, cervical lymphadenopathy, swelling
of submandibular and anterior neck.)
obstruction of respiratory tract
 Diagnostic test
- Schick test- susceptibility to diphtheria
toxin
- Molony- sensitivity to diphtheria toxoid
- Throat swab- (K tellurite and Loeffler’s
coagulated blood serum)
Management
- Diphtheria antitoxin (skin test)
- Penicillin, erythromycin, rifampicin,
clindamycin
Key Points!!
 Highly contagious
 Pseudomembrane and bullneck
 Immunization best intervention
 Prevention
- Obstruction and myocarditis
- Isolation technique
Pertussis (Whooping cough)
 Bordetella pertussis (bacteria)
 B. parapertussis
 B. bronchiseptica
 Hemophilus bacillus
 MOT= droplets and airborne
- Highly contagious
 IP= 7-14 days
 Immunity
- Active- DPT
- Passive- xxx
- One attack produces lifetime immunity
Clinical Manifestation
 Catarrhal (highly contagious)
- Last for 2 weeks, coryza, sneezing, dry
bronchial cough, fever, anorexia
 Paroxysmal
- Occurs 7th-14th day, severe violent
coughing attacks in clusters, that ends in
whoop (noisy spasm of inspiration)
resulting to cyanosis, vomiting, exhaustion,
last from 4 to 6 weeks
 Convalescent
- Gradual decrease in the paroxysms of
coughing both in frequency and severity;
vomiting ceases
 Ferrous iodide to liquefy thick secretions
 Erythromycin or Ampicillin
 Bordet gengou (agar for culture)
 Catarrhal stage (highly contagious)
 Clusters of cough that ends with a whoop
 Bronchopneumonia- dangerous complication
Key Points!!
- Highly contagious
- Thick secretions
- Cluster of cough
- Extreme exhaustion
- Hypoxia
- Prevention is still the best intervention
- Immunization
Tuberculosis (Koch’ disease/Phthisis/Consumption
disease)
 Mycobacterium tuberculosis and
 M. africanum in humans and M. bovis in cattle
 MOT= airborne/droplets
 IP= two to ten weeks
Risk factors:
- Decreased body resistance malnutrition,
poverty, overcrowding, steroid therapy,
chemotherapy
Pathogenesis:
- Transmission into the lungs
- Immune response macrophage (bacilli)
creating a lesion
- Tubercle formation scar or spot
- Dissemination
  CGFNS and NCLEX
 Usual dose
 RIE- 9 months to 12 months, 2-4 weeks non
infections
 Drug resistant tuberculosis
- RIE + (2nd line drug)
 Streptomycin
 Pyrazinamide
 Capreomycin
 Amikacin
 Cycloserine quinolone
 2 weeks after medications- non
communicable
 3 successive negative sputum, non-
communicable
 Rifampicin-prophylatic

Manifestation Category I
 Early - (new PTB (+) sputum)
- Weight loss, listlessness, vague chest pain, - Give ripe 2 months, maintenance or ri 4
pleurisy, anorexia, fever, night sweat months
 Late Category II (relapsed)
- Pulmonary hemorrhage - Previously treated with relapses give
- Expectoration of purulent sputum, ripes 1st 2 months, reps 1 month,
dyspnea, hemoptysis (cavitary spread) maintenance rie 5 months
 Diagnostic Category III
- PPD exposure - (PTB case (-) sputum for 3x
 0-4mm (negative) - Give rip 2 months, maintenance ri 2
 5mm variable months
 10mm (positive) - Short course- 6-9 months
 Chest Xray- cavitary lesion - Long course- 9-12 months
 Sputum- confirmatory
DOTS- direct observe treatment short course
 Case finding
 Home meds (members of the family)
 Referrals
 Follow-ups

Blood Borne Diseases

Dengue fever, H-fever, Dandy fever, Breakbone
Disease
Management:
 Acute Febrile Disease
- R- orange urine
 Causative agent-filtable virus
- I-ineuritis and hepatitis
- Dengue virus type 1,2,3,4
- P- hyperuricemia
- Chikungunya virus
- E- impairment of vision
- Onyong-yong virus
- S- 8th cranial nerve damage
 MOT= bite from: aedas aegypti; aedas
albopticus, culex fatigans
 IP= 3-14 days (7-10 days)
  Hyperpyrexia without focal of infection
 TRIAD- fever, rashes and muscle pain
 Bleeding to hypovolemic shock
 Watch out for bleeding
 Platelet is being attacked
Diagnostic Test
 Tourniquet test or rumpel leede test- crude
test of capillary fragility
 Hematocrit level- increased
 Platelet count determination
1st stage, first 4 days
- Non-specific s/sx epistaxis
2nd stage, 4-7 days
- Toxic or hgic stage
- Lowering of body temp., severe abdominal
pain, vomiting, GIT bleeding-hematemesis,
melena, narrow BP, shock
rd
3 stage, 7-10 days
- Convalescent or recovery stage
 Sign of plasma leakage
 Pleural effusion, ascites,
hypoproteinemia
 Herman’s sign
 Grade 1
- (+) tourniquet test, no bleeding
 Grade 2
- Spontaneous bleeding, (+) grade 1
 Grade 3
- Circulatory failure, decrease BP, rapid
weak pulse, narrowing PP, cold clammy
skin, restlessness
 Grade 4
- Profound shock, undetectable BP and
pulse
Symptoms
 Mild symptoms of dengue can be confused
with other illnesses that cause fever, aches
and pains, or a rash
 Graphic of human body showing most
common symptom of dengue is fever with any
of the following: eye pain, headache, muscle
pain, rash, bone pain, nausea/vomiting, joint
pain
 The most common symptom of dengue is
fever with any of the following:
- Nausea and vomiting
- Rash
- Aches and pains
- Any warning sings
- Symptoms of dengue typically last 2-7
days. Most people will recover after about
a week
Severe Dengue
 About 1 in 20 people who got sick with
dengue will develop severe dengue
 Severe dengue can result in shock, internal
bleeding, and even death
 If you have had dengue in the past, you are
more likely to develop severe dengue
 Infants and pregnant women are at higher risk
for developing severe dengue
Warning signs for severe dengue
 Watch for signs and symptoms of severe
dengue. Warning signs usually begin in the 24-
48 hours after your fever has gone away
 Immediately go to a local clinic or emergency
room if you or a family member has any of the
following symptoms:
o Belly pain, tenderness
o Vomiting (at least 3 times in 24 hours)
o Bleeding from the nose or gums
o Vomiting blood, or blood in the stool
o Feeling tired, restless, or irritable
Nursing Consideration
 Any condition associated with bleeding is
enough cause for alarm
 Rapid replacements of fluids is the most
important treatment
 Give oresol/hydrite
 Vit. C promote capillary integrity
 Blood transfusion
- IV crystalloids (plain LRS, plain 0.9 NSS)
- Dextran (colloids)
- Platelets
- Fresh frozen plasma
- Cryoprecipitate
- Whole blood
 No known immunization (vaccine currently
underway)
Planning and Implementation
 Provide a comfortable and quiet room
 Provide adequate rest
  Ice packs to relieve constant headache
 Protect the eyes
Key Points!!
 Day biting aedas aegypti, stagnant
 Fever with no focal of infection
 Bleeding is imminent when fever subsides
 Fluid replacement
 BT
 Platelets
Malaria, King of Tropical Disease (AGUE)
 Protozoan plasmodium
- Plasmodium ovale- dormant (liver)
- Plasmodium vivax- benign tertian
- Plasmodium malariae- mild but resistant,
quartan malaria
- Plasmodium falciparum- malignant
tertian (cerebral malaria)
- P. Vivax and ovale may have recurrence
of symptoms
 Tertian-febrile paroxysm- q24H-
48H
 Quartan-febrile paroxysm- q48H-
72H
MOT
 Bite from infected anopheles mosquito or
minimus flavire (night biting)
 Blood transfusion
 Mosquito or sexual cycle
- Sporogony
- Gametes is the infective stage
 Human or asexual cycle
- Schizogony
 IP= 10-12 days
Life Cycle
 When certain forms of blood stage parasites
(gametocytes, which occur in male and
female forms) are ingested during blood
feeding by a female anopheles mosquito, they
mate in the gut of the mosquito and begin a
cycle of growth and multiplication in the
mosquito
 After 8-10 days, a form of the parasite called a
sporozoite migrates to the mosquito’s salivary
glands
 When the anopheles mosquito takes a blood
meal on another human, anticoagulant saliva
is injected together with the sporozoites,
which migrate to the liver, thereby beginning
a new cycle
 In humans, the parasites grow and multiply
first in the liver cells and then in the red cells
of the blood
 In the blood, successive broods of parasites
grow inside the red cells and destroy them
releasing daughter parasites (“merozoites”)
that continue the cycle by invading other red
cells
Clinical Manifestations
 Cold stage last for 10 to 15 minutes, presence
of chills
 Hot stage last for 4 to 6 hours, nauseas and
vomiting, fever, diarrhea, nose bleeding,
headache
 Diaphoretic stage- generalized weakness,
sweating, decreased pulse rate, temperature
and respiratory rate
Female Anopheles Mosquito
 Breeds in clear, flowing, and shades stream
usually in the mountains
 Bigger in size
 Brown
 Night biting
 Not bite a person in motion
Nursing Consideration
Dx
 Blood extraction (extract blood at the height
of fever)
 Fever, chills, profuse sweating-convulsion
 Anemia and fluid and electrolytes imbalance,
hepatomegaly, splenomegaly, rigor,
headache, and diarrhea
 Chloroquine and primaquine drug of choice
 Chloroquine for pregnant women
 For resistant plasmodium-use chemo drug
 Sulfadoxine- resistant P. falciparum
 Primaquine- for relapse of P. vivax and ovale
 IV Fluids and Electrolytes
 - Blackwater fever- hemolysis and
hemoglobinuria
- Sickle cell trait- provides natural
resistance
- Decrease fluids in cerebral edema
- Assisted ventilation in pulmonary edema
- Dialysis in renal failure
- BT in anemia
 Travelers to malaria endemic area should
follow preventive measures
- (chemoprophylaxis chloroquine may be
taken 1 week before entering endemic
area)
- Soaking of mosquito net in an insecticide
solution
- Bio ponds for fish
- On stream clearing (to expose the
breeding stream to sunlight)
- Vectors peak biting at night 9pm-3am
- Planting if neem tree (repellent effect)
- Zooprohylaxis (deviate mosquito bites
from man to animals)
- Infected mother can still continue breast
feeding
Planning and Implementation
 Tepid to cool sponges for fever
 Provide adequate fluids
 Monitor VS especially temperature
 Provide diet high in calories, vitamins and
minerals
 Maintain fluid and electrolyte balance
 Oral hygiene should be maintained
 Iron rich foods for anemia
 Drugs
Leptospirosis, Weil’s disease (Zoonotic)
 Spirochete-Leptospira interrogans
 IP= 5-6 days
 MOT
- Skin penetration= flood
- Ingestion of contaminated food
- Skin, mucus membrane, abraded skin,
conjunctiva
- After penetration leptospirosis enter the
blood stream and are carried to all parts of
the body including liver, kidneys, and CSF
Clinical Manifestation
 Sudden onset with chills, vomiting and
headache followed by severe fever and pain
in the extremities
 intense itching of the conjuctivae
 severe jaundice with hemorrhage in the skin
and mucus membrane
 hematemesis, hematuria and hepatomegaly
for severe cases
 convalescence occurs in the third week unless
there is complications
 EARLY= fever and headache
o Leptospiremic phase= vasculitis
- Hepatitis, jaundice, skin hemorrhage,
fever, chills, renal failure, meningitis
with mental status change, muscular
pain, nausea and vomiting, cough and
chest pain
o Immune phase
- Appearance of circulating IgM
Dx
 culture of microorganisms
 blood and CSF examination (first week)
 urine exam- after 10 days
 microscopic agglutination test (mat) a rise in
antibody titer
Prevention
 eradication of rats
 environmental sanitation
 avoidance of exposure to urine and tissues
from infected animals (flood)
 rodent control
 vaccination of animals
 hygienic conditions in slaughterhouses, farm
yard buildings and bathing pools
 use of protective clothing and boots
 chemoprophylaxis (doxycycline 200 mg PO
once a week)
 supportive management
 all patient suspected to have lepto, mild or
severe should be admitted
Nursing Consideration
 Penicillin or doxycycline (Immediately)
 Fluid and electrolyte balance
 Adequate renal perfusion
  If azotemia is severe or prolonged (consider
dialysis)
 Disease is usually short lived and mild but
severe infection can damage kidneys, liver,
CNS, and respiratory system
 Most serious form is called Weil’s Disease
 Primarily a disease of domesticated and wild
animals
Key Points!!
 Spirochette, rat, urine, and feces
 Skin penetration, ingestion
 Fever and headache
 Liver, kidneys, and CSF
 Doxycycline
Cholera
 Main problem: acute bacterial disease of the
GIT characterized by profuse secretory
diarrhea, vomiting, massive loss of fluid and
electrolytes
 Etiologic agent: Vibrio cholera/Vibrio coma
 Incubation Period: 5 to 3 days
 Period of communicability: during the stool-
positive stage, usually a few days after
recovery
 MOT: fecal-oral transmission; 5 F’s
Signs and Symptoms
 Rice water stool- pathognomonic sign
 Abdominal cramps
 Vomiting
 Intravascular Dehydration
 Shock
Treatment Modalities
 Lactated ringer’s solution
 Oral rehydration therapy
 Antibiotic therapy
- Tetracycline- drug of choice
- Cotrimoxazole
- Chloramphenicol
Nursing Management
 Maintain and restore the fluid and electrolyte
balance
 Enteric isolation
 Sanitary disposal of excreta
 Adequate provision of safe drinking water
 Good personal hygiene
Typhoid Fever
 Main problem: An infection affecting the
Peyer’s patches of the small intestines
 Etiologic agent: Salmonella typhi
 Incubation Period: 5-40 days, mean 10-20
days
 Period of communicability: is variable, as long
as the patient is excreting the microorganism,
he is capable of infecting others
 MOT: fecal oral transmission, 5 F’s
 Complication: hemorrhage or perforation
Signs and Symptoms
Onset
 Fever
 Rose spots- abdominal wall on 7th to 9th days,
pathognomonic sign
 Diarrhea
Typhoid state/Fastigial Stage
 Sordes- teeth and lips accumulate a dirty
brown collection of dried mucus and bacteria
 Subsultus Tendinum- twitching of the
tendons especially of the wirst
 Coma vigil- staring blankly
 Carphologia- picks bedclothes with his fingers
 Diagnostic procedure- typhidot
(confirmatory)
Treatment Modalities
 Chloramphenicol- DOC (drug of choice)
 Ampicillin/Amoxicillin- for typhoid carriers
 Cotrimoxazole- for severe cases with relapse
Nursing Management
 Maintain and restore the fluid and electrolyte
balance
 Enteric isolation
 Sanitary disposal of excreta
 Adequate provision of safe drinking water
 Good personal hygiene
Diseases caused by parasites
 Amoebias
 Ascariasis
 Capillariasis
 Enterobiasis

Viral Diseases
Measles (Rubeola/Morbili)
 Main problem: acute, contagious and
exanthematous disease with chief symptoms
to the upper respiratory tract
 Etiologic agent: filterable virus of the family
paramyxoviridae
 Incubation Period: 10-21 days; a single attack
coveys and lifelong immunity
 Period of Communicability: 4 days before and
5 days after the appearance of rashes
 MOT
o Droplet method
o Direct contact with respiratory discharges
o Indirect with soiled linens and articles
 Pathognomonic sign: Koplik’s spots “grain of
salt” of the buccal mucosa
Signs and Symptoms
1. Pre eruptive stage
 Cough
 Coryza
 Conjunctivitis
 Fever (high-grade)
 Photophobia
2. Eruptive stage
 Rashes
 Elevated papules
 Begin on the face and behind the ears
 Spread to trunk and extremities
 Color: dark red purplish hue yellow hue
3. Stage of Convalescence
 Branny desquamation
 Rashes fade from face downwards
Treatment Modalities
 Vitamin A- 100,000-200,000 IU; helps prevent
eye damage and blindness
 Antipyretics- for fever
 Penicillin- given only when secondary
infection sets in
Nursing Management
 Darkened room to relieve photophobia
 Diet: liquid but nourishing
 Warm saline solution for eyes to relieve eye
irritation
 For fever: tepid sponge and anti pyretics
 Skin care: during eruptive stage, soap is
omitted; bicarbonate of soda in water or
lotion to relieve itchiness
Complications
 Pneumonia
 Otitis Media
 Severe diarrhea (leading to dehydration)
 Encephalitis
Preventive Measures
 Immunization with anti-measles at 9 months
as a single dose
 The first dose of MMR vaccine is given at 15
months old, with the 2nd dose at 11 to 12
years
 Measles vaccine should be not given to
pregnant women or to persons with active
tuberculosis, leukemia, or lymphoma, or
those with depressed immune systems
 Avoid overcrowded place to lessen the
chances of contracting the virus
German measles (Rubella/Three day measles)
 Main Problem: a contagious communicable
exanthematous disease caused by rubella
virus
 Etiologic agent: rubella virus
 Incubation period: 14-21 days
 MOT
- Direct contact with nasopharyngeal
secretions
- Air droplets
- Transplacental transmission in congenital
rubella
 - Infants with congenital rubella shed large
quantities of the virus through their
pharyngeal secretions and urine, which
serve as sources of infection to other
contacts
Clinical Manifestations
Prodromal Period
 Low grade fever
 Headache
 Malaise
 Mild coryza
 Conjunctivitis
 Post-auricular, sub-occipital, and posterior
cervical lymphadenopathy which occurs on
the 3rd day to 4th day after the onset
Eruptive Period
 A pinkish rash or the soft palate
(forscheimer’s spot), an exanthematous rash
that appears first on the face, spreading to
the neck, the arms, trunk and legs
 Eruption appears after the onset of
adenopathy
 The rash may last for 1 to 5 days and leaves
no pigmentation nor desquamation
 Testicular pain in young adults
 Transient polyarthralgia and polyarthritis may
occur in adults and occasionally in children
Treatment Modalities
 Very little treatment is necessary; treatment
is essentially symptomatic
Nursing Management
 Darkened room to relieve photophobia
 Diet: liquid but nourishing
 Warm saline solution for eyes to relieve eye
irritation
 For fever: tepid sponge and anti pyretics
 Skin care: during eruptive stage, soap is
omitted; bicarbonate of soda in water or
lotion to relieve itchiness
Complications
 Encephalitis
 Congenital rubella syndrome
- Spontaneous abortion
- Intrauterine growth retardation (IUGR)
- Thrombocytopenia purpura “blueberry
muffin skin”
- Cleft lip, cleft palate, club foot
- Heart defects (PDA, VSD)
- Eye defects (cataract, glaucoma)
- Ear defects (deafness)
- Neurologic (microcephaly, mental
retardation behavioral disturbances)
Prevention
 Live attenuated vaccine 12-15 months 1st
dose; 4 years not later 11-12 years old 2nd
dose
 Pregnant women should avoid exposure to
patients infected with the rubella virus
 Administration of immune serum globulin one
week after exposure to rubella
 Prevent spread of infection by minimizing
contact with visitors
Chicken Pox (Varicella)
 Main Problem: a highly contagious disease
characterized by vesicular eruptions on the
skin and mucous membranes
 Etiologic agent: varicella zoster virus
 IP= 10-21 days
 MOP
- Droplet method
- Direct contact
- Indirect contact
 Period of Communicability: one day before
eruption of 1st lesion and five days after
appearance of last crop
Signs and Symptoms
Prodromal Stage
 Fever (low grade)
 Headache
 Malaise
Eruptive Stage
 Rash starts on the trunk, then spreads to
other parts of the body
 Initial lesions are distinctively red papules
whose contents become milky and pus- like
within 4 days
 Rapid progression so that transition is
completed in 6 to 8 hrs
 Vesicular lesions are very pruritic
  All stage are present simultaneously before all  MOP
are covered with scrabs, leading to the - Droplet method
appearance known as “celestial map” - Direct contact
 Rashes: centrifugal distribution - Indirect contact
 Rash stages:  Period of Communicability: one day before
maculepapulevesiclepustulecrust eruption of 1st rash until 5-6 days after the last
 Pruritus crust disappears

Treatment Modalities Signs and Symptoms

 Antihistamines- symptomatic relief of itching Prodromal Period
 Analgesics and antipyretics  Fever (low grade)
 Antiviral agents- for patient to experience less  Headache
pain and faster resolution of lesions when  Malaise
used within 48 hours of a rash onset; oral  Rashes
acyclovir 800mg 3 a day for 5 days - Erythematous base of the skin lesion
 Corticosteroids- anti-inflammatory and appears first; vesicles within 24 hours
decreased pain - Irregular, band aid like distribution along
 Preventive measures- live attenuated varicella the course of involve dermatomes
vaccine - Eruptions are unilateral
- Vesicles become pustule, breakdown,
Nursing Management and form crusts
 Strict isolation - Lesion last 1 to 2 weeks
 Prevent secondary infection (cut fingernails  Regional lymphadenopathy
short, wear mittens)  Pruritus
 Eliminate itching: calamine lotion, warm  Pain stabbing or burning
baths, baking soda paste  5th CN, corneal anesthesia- Gasserian
 Encourage not going to school: 7 days ganglionitis
 Disinfection of clothes and linen with  7th CN, paralysis and vesicles eternal auditory
nasopharyngeal discharges by sunlight or canal- ramsay hunt syndrome
boiling
Treatment Modalities
Complications  Antihistamines- symptomatic relief of itching
 Scarring- most common complication;  Analgesics and antipyretics
associated with staphylococcal or  Antiviral agents- for patient to experience less
streptococcal infections from scratching pain and faster resolution of lesions when
 Necrotizing Fasciitis- most severe used within 48 hours of a rash onset; oral
complication acyclovir 800mg 3 a day for 5 days
 Reye syndrome- abnormal accumulation of  Corticosteroids- anti-inflammatory and
fat in the liver plus increase of pressure in the decreased pain
brain resulting to coma, therefore leading to
death

Herpes Zoster (Shingles/Acute Posterior Ganglionitis)

 Main problem: an acute viral infection of the
sensory nerve; reactivation of latent VZV
whose genomes persist in sensory root
ganglia of the brainstem and spinal cord
 Etiologic agent: varicella zoster virus
 IP= 13-17 days