EBOLA VIRUS DISEASE direct contact with blood or body fluids (urine,

 The first human outbreak of Ebola virus
disease occurred in 1976.
 For decades the virus maintained a pattern
of sporadic outbreaks in remote African
villages, followed by intervening without any
recognized cases worldwide.
 It usually initiated at the onset of chest pain
in an attempt to increase the amount of
oxygen delivered to the myocardium and to
decrease pain.
vomit, feces, saliva, sweat, semen, and breast
milk)
Ebola virus is only detected in blood after the
patient becomes symptomatic and viral levels rise
significantly as the disease progresses
2 to 21 days first symptoms ranges from
Clinical Manifestations

 West African countries Liberia  high fever

 Guinea  muscle aches
 Sierra Leone  fatigue
 Africa  severe diarrhea (5 L of liquid stool per day)

 Europe  abdominal pain

 United States  Vomiting

 bleeding or hemorrhage

Neurologic Symptoms
 Confusion
 Agitation
 Delirium
 encephalitis

*Patients who do not die during the first 2 weeks of

Pathophysiology
the disease are likely to survive
Infected bats or infected wild animals that are
sometimes hunted for food
Medical Management
 supportive maintenance of the circulatory
person who is ill from the virus and possibly from
system and respiratory systems
contact with semen of a man who has recovered
 ventilator
from Ebola
 dialysis
Nursing Management
 Health care workers are at increased risk for
acquiring Ebola because they may have
contact with body fluids or equipment
contaminated from exposure to body fluids
 The patient should be isolated in a private
room.
 Equipment used for the patient with Ebola
virus should be used solely for that patient
and should be disposed after use.
Transmission
Complications
 DHN
 AKD
 Hemorrhage
 Respiratory Failure
Middle East respiratory syndrome (MERS)
 is a viral respiratory disease caused by a
novel coronavirus (Middle East respiratory
syndrome coronavirus, or MERS‐CoV)
 The origins of the virus are not fully
understood but, according to the analysis of
different virus genomes, it is believed that it
may have originated in bats and was
transmitted to camels sometime in the
distant past.
 MERS-CoV is a zoonotic virus, which means
it is a virus that is transmitted between
animals and people.
 Non-human to human transmission
Dromedary camels are the major
reservoir host for MERS-CoV and an animal
source of infection in humans.
 Human-to-human transmission
The virus does not pass easily from
person to person unless there is close
contact, such as providing unprotected care
to an infected patient.

 first identified in Saudi Arabia in 2012

 Coronaviruses are a large family of viruses Since 2012, 27 countries have reported cases of

that can cause diseases ranging from the MERS including

common cold to Severe Acute Respiratory  Algeria

Syndrome (SARS).  Austria

 Bahrain
Symptoms (same as COVID-19)  China
 Fever  Egypt
 Cough  France
 shortness of breath  Germany
 diarrhoea  United States
 Yemen.
Source of the virus  Greece
 is a zoonotic virus – between animals and  Iran
human.  Italy
 Jordan
 Kuwait
 Lebanon
 Malaysia
 United Arab Emirates
 United Kingdom
 Netherlands,
 Oman
 Philippines
Prevention and treatment
 Qatar
 No vaccine or specific treatment is currently
 Republic of Korea
available.
 Kingdom of Saudi Arabia,
 Regular hand washing before and after
 Thailand
touching animals.
 Tunisia
 Treatment is supportive and based on the
 Turkey
patient’s clinical condition.
 Animal products that are processed
appropriately through cooking or
pasteurization are safe for consumption.
 Camel meat and camel milk are nutritious
products that can continue to be consumed
after pasteurization, cooking, or other heat
treatments.

VIRAL HEPATITIS
 Viral infection in which necrosis and
inflammation of liver cells produce a
characteristic cluster of clinical, biochemical,
and cellular changes
 5 definitive types of viral hepatitis
o Hepatitis A
o Hepatitis C
o Hepatitis D
o Hepatitis E
o Hepatitis A Virus
Hepatitis A and E are similar in mode of  hand-to-mouth contact
transmission (fecal–oral route), whereas hepatitis B,  or other close contact
C, and D share many other characteristics.  Hepatitis A can be transmitted during sexual
activity
HEPATITIS A Virus
 Hepatitis A, formerly called infectious Incubation period
hepatitis, is caused by an RNA virus of the  2 and 6 weeks
enterovirus family  The illness may be prolonged, lasting 4 to 8
weeks.
Prevalence:  It usually lasts longer and is more severe in
 countries with overcrowding those older than 40 years
 poor sanitation
 poor hygiene

 Nausea
Clinical Manifestations  Heartburn
 flu-like upper respiratory tract infection  flatulence.
 low-grade fever
 Anorexia Assessment and Diagnostic Findings
 Jaundice  Hepatomegaly
 dark urine  Spleenomegaly
 Indigestion
 vague epigastric distress
  An HAV antigen may be found in the stool 7 environmental sanitation (safe food and
to 10 days before illness and for 2 to 3 weeks water supply, effective sewage disposal).
after symptoms appear
 HAV antibodies are detectable in the serum, H1N1 flu
although usually not until symptoms appear.  commonly known as swine flu
 primarily caused by the
Prevention  one of several flu virus strains that can cause
 Scrupulous hand hygiene, safe water the seasonal flu.
supplies, and proper control of sewage  2009 WHO pandemic
disposal are just a few of these prevention
strategies. Symptoms
 two-dose vaccine be given to adults 18 years  Fever, but not always
of age or older, with the second dose given  Chills
6 to 12 months after the first.  Cough
 Immune globulin is also recommended for  Sore throat
household members and sexual contacts of  Runny or stuffy nose
people with HAV  Watery, red eyes
 Body aches
Medical Management  Headache
 Bed rest  Fatigue
 Nutritious diet  Diarrhea
 Anorexia  Nausea and vomiting
 Gradual but progressive ambulation hastens
recovery Complications
Influenza complications include:
Nursing Management  Worsening of chronic conditions, such as
 The nurse assists the patient and family in heart disease and asthma
coping.  Pneumonia
 Educates them to seek additional health  Neurological signs and symptoms, ranging
care if the symptoms persist or worsen. from confusion to seizures
 The patient and family also need specific  Respiratory failure
guidelines about diet, rest, follow-up blood
work, avoiding alcohol, as well as sanitation Prevention
and hygiene measures.
 The Centers for Disease Control and
 Stressing careful hand hygiene (after bowel Prevention (CDC) recommends annual flu
movements and before eating) and
 vaccination for everyone age 6 months or Several types of GBS
older. 1. The patient experiences weakness in the
 Wash your hands thoroughly and lower extremities, which progresses upward
frequently. Use soap and water, or if they're and has the potential for respiratory failure.
unavailable, use an alcohol-based hand 2. The second type is purely motor with no
sanitizer. altered sensation.
 Cover your coughs and sneezes. Cough 3. Descending GBS, is much more difficult to
or sneeze into a tissue or your elbow. Then diagnose; it mostly affects the head and
wash your hands. neck muscles.
 Avoid touching your face. Avoid touching 4. The rarest type, the Miller–Fisher variant,
your eyes, nose and mouth. presents with ataxia, areflexia, and
 Clean surfaces. Regularly clean often- ophthalmoplegia.
touched surfaces to prevent spread of
infection from a surface with the virus on it to Pathophysiology
your body.
 Avoid contact.

Guillain–Barré Syndrome (GBS) INFLAMMATORY BOWEL DISEASE

 Also known as acute idiopathic polyneuritis Inflammatory bowel disease (IBD) is a group of

 is an autoimmune attack on the peripheral chronic disorders:

nerve myelin. 1. Crohn’s disease (i.e., regional enteritis)

2. Ulcerative colitis that result in inflammation
 acute, rapid segmental demyelination of
or ulceration (or both) of the bowel
peripheral nerves and some cranial nerves,
producing ascending weakness with
Nursing Interventions
dyskinesia (inability to execute voluntary
movements), hyporeflexia, and paresthesias  MAINTAINING NORMAL ELIMINATION

(a sensation of numbness, tingling, or a “pins PATTERNS

and needles” sensation).  RELIEVING PAIN

 MAINTAINING FLUID INTAKE

Antecedent event (most often a viral infection)  MAINTAINING OPTIMAL NUTRITION

 Campylobacter jejuni  PROMOTING REST

 Cytomegalovirus  REDUCING ANXIETY

 Epstein–Barr virus  ENHANCING COPING MEASURES

 Mycoplasma pneumoniae  PREVENTING SKIN BREAKDOWN

 H. influenzae  MONITORING AND MANAGING

 HIV POTENTIAL COMPLICATIONS

 volvulus of the colon ,and
 The nurse assists the patient in determining strangulation of the small intestine.
if there is a relationship between diarrhea  Tertiary peritonitis occurs as a result of a
and certain foods, activities, or emotional suprainfection in a patient who is
stressors. immunocompromised.
o Tuberculous peritonitis in a patient
 Position changes, local application of heat
with AIDS is an example of tertiary
(as prescribed), diversional activities, and
peritonitis; these are rare causes of
prevention of fatigue also are helpful for
peritonitis.
reducing pain

Peritonitis Pathophysiology
 Is inflammation of the peritoneum, which is inflammation, infection, ischemia, trauma, or tumor
the serous membrane lining the abdominal perforation
cavity and covering the viscera.
 it is a result of bacterial infection but may leakage of contents from abdominal organs into the
occur secondary to a fungal or mycobacterial abdominal cavity
infection; the organisms come from diseases
or disorders of the GI tract or, in women, Bacterial proliferation
from the internal reproductive organs (e.g.,
fallopian tube). develops edema of the tissues results, and
 Escherichia coli and Klebsiella, Proteus, exudation of fluid
Pseudomonas, and Streptococcus species.
Fluid in the peritoneal cavity becomes turbid with
Peritonitis can be categorized as: increasing amounts of protein, white blood cells,
 Primary peritonitis, also called cellular debris, and blood
spontaneous bacterial peritonitis (SBP),
occurs as a spontaneous bacterial infection Hypermotility paralytic ileus with an
of ascitic fluid. accumulation of air and fluid in the bowel
o with liver failure
 Secondary peritonitis occurs secondary to Clinical Manifestations
perforation of abdominal organs with  Fever
spillage that infects the serous peritoneum.  Abdominal
o perforated appendix, perforated  Pain
peptic ulcer perforated sigmoid colon  Loss of Appetite
caused by severe diverticulitis,  Dry Mouth
 Tenderness
  Chills
 Severe weight loss
 Board-like abdomen

Assessment and Diagnostic Findings

 CBC
 abdominal x-ray
 computed tomography (CT)
 MRI

Medical Management
 Fluid, colloid, and electrolyte replacement is
the major focus of medical management.
 Analgesic
 Antibiotic therapy

Nursing Management
 Intensive care is needed for the patient with
septic shock.
 The nurse increases fluid and food intake
gradually and reduces parenteral fluids as
prescribed
 The nurse must prepare the patient for
emergency surgery  The appendix fills with by products of
digestion and empties regularly into the

Note: A worsening clinical condition may indicate a cecum.

complication, and the nurse must prepare the  It empties inefficiently and its lumen is small,

patient for emergency surgery. the appendix is prone to obstruction and is

particularly vulnerable to infection

Appendicitis
Pathophysiology
 Is a small, vermiform (i.e., wormlike)
inflamed and edematous as a result of becoming
appendage about 8 to 10 cm (3 to 4 inches)
kinked or occluded by a fecalith (i.e., hardened
long that is attached to the cecum just below
mass of stool), lymphoid hyperplasia (secondary to
the ileocecal valve.
inflammation or infection), or rarely, foreign bodies
(e.g., fruit seeds) or tumors
 The inflammatory process increases intraluminal Assessment and Diagnostic Findings
pressure, causing edema and obstruction of the  Rovsing
orifice.  Psoas
 Obturator
Once obstructed, the appendix becomes ischemic,
bacterial overgrowth occurs Medical and Surgical Management
 Appendectomy
gangrene or perforation occurs

Clinical Manifestations
 Vague periumbilical pain (i.e., visceral pain
that is dull and poorly localized)
 anorexia progresses to right lower quadrant Cholecystectomy
pain (i.e., parietal pain that is sharp, discrete,
and well localized)
 Nausea
 Fever
 . Local tenderness may be elicited at
McBurney point when pressure is applied
 Rebound tenderness (i.e., production or
intensification of pain when pressure is
released) may be present. Rovsing sign may
be elicited by palpating the left lower
quadrant; this paradoxically causes pain to
be felt in the right lower quadrant
Acute Pancreatitis but may be attributed to a virus, fungus, or
 80% are the result of cholelithiasis or parasite.
sustained alcohol abuse
 Acute pancreatitis ranges from a mild,
self-limited disorder to a severe, rapidly
fatal disease that does not respond to
any treatment

Causes
 Gonorrheal
 chlamydial organisms
 polymicrobial

Risk factors
 early age at first intercourse
 multiple sexual partners
 frequent intercourse
Pelvic Inflammatory Disease  intercourse without condoms

• an inflammatory condition of the pelvic

 sex with a partner with an STI
 a history of STIs or previous pelvic
cavity that may begin with cervicitis and
infection
involve the uterus (endometritis), fallopian
tubes (salpingitis), ovaries (oophoritis),
*One of the most common causes of salpingitis
pelvic peritoneum, or pelvic vascular
(inflammation of the fallopian tube) is
system.
chlamydia, possibly accompanied by
• Infection, which may be acute, subacute, gonorrhea
recurrent, or chronic and localized or
widespread, is usually caused by bacteria
  Dyspareunia
Pathophysiology

Bacterial vaginosis, STI, endometrial biopsy,

abortion, hysteroscopy, or insertion of an
intrauterine device
organisms usually enter the body through the
vagina
pass through the cervical canal, colonize the
endocervix
move upward into the uterus
organisms may proceed to one or both
fallopian tubes and ovaries and into the pelvis
In bacterial infections that occur after childbirth
or abortion, pathogens are disseminated
directly through the tissues that support the
uterus by way of the lymphatics and blood
vessels (see Fig. 57-1A). In pregnancy, the
increased blood supply required by the
placenta provides a wider pathway for infection.
These postpartum and postabortion infections
tend to be unilateral. Infections can cause
perihepatic inflammation when the organism
invades the peritoneum.

Complications
Clinical Manifestations  Pelvic or generalized peritonitis
 vaginal discharge  Abscesses
 dyspareu nia  Strictures
 Dysuria  fallopian tube obstruction
 pelvic or lower abdominal pain  ectopic pregnancy
 tenderness that occurs  Sterility
 after menses  Adhesions
 postcoital bleeding
Note: Obstruction may cause an ectopic
S/SX: pregnancy in the future if a fertilized egg cannot
 Foul smell vagina pass a tubal stricture, or scar tissue may
 Fever occlude the tubes, resulting in sterility.

 Burning dysuria Adhesions are common and often result in

chronic pelvic pain; they eventually may require bleeding, delayed menses, faintness,
removal of the uterus, fallopian tubes, and dizziness, and shoulder pain)
ovaries.
Medical Management Benign Prostatic Hyperplasia (Enlarged
Broad-spectrum antibiotic therapy Prostate)
 combination of ceftriaxone (Rocephin),  a noncancerous enlargement or
doxycycline, and metronidazole (Flagyl) hypertrophy of the prostate, is one of the
most common diseases in aging men.
Indications for hospitalization include  BP typically occurs in men older than 40
 surgical emergencies years.
 Pregnancy
 no clinical response to oral antimicrobial
therapy
 inability to follow or tolerate an
outpatient oral regimen
 severe illness (i.e., nausea, vomiting, or
high fever)
 tubo-ovarian abscess
 Treatment of sexual partners is
necessary to prevent reinfection.
Risk Factors
 Smoking
Nursing Management
 heavy alcohol consumption
 State the importance of completing the
 Obesity
course of antibiotic therapy.
 reduced activity level
 Describe proper perineal care
 Hypertension
procedures (wiping from front to back
 heart disease
after defecation or urination).
 diabetes,
 Discuss the importance of following
health practices and safer sex practices  Western diet (high in animal fat and
protein and refined carbohydrates, low
 All patients who have had PID need to
in fiber)
be informed of the signs and symptoms
of ectopic pregnancy (pain, abnormal
Pathophysiology
elevated estrogen levels and when prostate
tissue becomes more sensitive to estrogens
and less responsive to DHT
(Dihydrotestosterone)
complex interactions involving resistance in
the prostatic urethra to mechanical and
spastic effects, bladder pressure during
voiding, detrusor muscle strength, neurologic
functioning, and general physical health
hypertrophied lobes of the prostate obstruct
the bladder neck or urethra
incomplete emptying of the bladder and
urinary retention
gradual dilation of the ureters (hydroureter)
and kidneys (hydronephrosis), UTI
Clinical Manifestations
 urinary frequency
 Urgency
 Nocturia
 hesitancy in starting urination
 decreased and intermittent force of
stream
 the sensation of incomplete bladder
emptying
 abdominal straining with urination
 decrease in the volume and force of the
urinary stream
 dribbling
Assessment and Diagnostic Findings
 DRE
 Urinalysis
 PSA
 Urethrocystoscopy
 ultrasound
Medical Management
 improve quality of life
 improve urine flow
 relieve obstruction
 prevent disease progression
 minimize complications
 immediately catheterization
 Pharmacologic Therapy
 Alphaadrenergic blockers
 alfuzosin (Uroxatral)
 terazosin (Hytrin)
 doxazosin (Cardura)
 Tamsulosin
relax the smooth muscle of the bladder neck
and prostate. This improves urine flow and
relieves symptoms of BPH. Side effects include
dizziness, headache, asthenia/fatigue, postural
hypotension, rhinitis, and sexual dysfunction.
Pharmacologic Therapy  The body then reabsorbs the dead
The 5-alpha-reductase inhibitors tissue
 finasteride (Proscar)
 dutasteride (Avodart) TUNA
are used to prevent the conversion of
testosterone to DHT and decrease prostate Systemic Lupus Erythematosus
size. Side effects include decreased libido,
ejaculatory dysfunction, erectile dysfunction,
4642 gynecomastia (breast enlargement), and
flushing

Transurethral microwave thermotherapy

Transurethral resection of the prostate

(TURP)

Criteria for Classifying Systemic Lupus

Erythematosus
 Malar rash
Transurethral needle ablation  Discoid rash
 minimally invasive treatment by  Photosensitivity
radiofrequency energy and the  Oral ulcers
UroLume stent. TUNA uses low-level  Nonerosive arthritis
radiofrequencies delivered by thin  Pleuritis or pericarditis
needles placed in the prostate gland to  Kidney disease
produce localized heat that destroys  Neurologic disease
prostate tissue while sparing other  Hematologic disorder
tissues.  Immunologic disorder
 Positive antinuclear antibody
 Multiple Sclerosis
*Based on the 11 criteria above, a person is
diagnosed with systemic lupus erythematosus
if any 4 or more of the criteria are met at any
time.

Nursing Management
 Patients should be instructed to avoid
exposure or to protect themselves with
sunscreen and clothing
 The patient may benefit from
participation in support groups, which
can provide disease information, daily
management tips, and social support
Complications
 Patients should understand the need
 an immune-mediated, progressive
for routine periodic screenings as well
demyelinating disease of the CNS
as health promotion activities
 Demyelination refers to the destruction
 Smoking cessation programs should
of myelin—the fatty and protein material
be offered to all patients who report
that surrounds certain nerve fibers in the
smoking habits
brain and spinal cord; it results in
 The nurse educates the patient about
impaired transmission of nerve impulses
the importance of continuing
prescribed medications and addresses
the changes and potential side effects
 The nurse should also screen the
patient for osteoporosis, because
longterm use of corticosteroids
increases the incidence of
osteoporosis
 Diabetes Mellitus
 I – juvenile
 II – Gestational DM

Nursing Management of DM

Nursing Interventions
 PROMOTING PHYSICAL MOBILITY
 PREVENTING INJURY
 ENHANCING BLADDER AND BOWEL
CONTROL
 ENHANCING COMMUNICATION AND
MANAGING SWALLOWING
DIFFICULTIES
 IMPROVING COGNITIVE FUNCTION
 STRENGTHENING COPING
MECHANISMS
 IMPROVING HOME MANAGEMENT
 PROMOTING SEXUAL FUNCTIONING

Criteria for the Diagnosis of Diabetes
 Symptoms of diabetes plus casual
plasma glucose concentration equal to
or greater than 200 mg/dL
 Fasting plasma glucose greater than or
equal to 126 mg/dL (7.0 mmol/L).
Fasting is defined as no caloric intake for
at least 8 hours
 Two-hour postload glucose equal to or
greater than 200 mg/dL (11.1 mmol/L)
during an oral glucose tolerance test.
 A1C ≥6.5% (48 mmol/mol)
Allergy
(hypersensitivity)
Rheumatoid Arthritis
 an autoimmune disease of unknown
origin that affects 1% of the population
worldwide
 females having a 2.5 times greater
incidence than males.
 Cigarette smoking is one modifiable risk
factor that has been shown to be highly
related to RA
Pathophysiology
environmental factors, such as cigarette
smoking, and genetic factors coalesce
produce inflammatory and destructive synovial
fluid, starting in the more distal joints.
RA synovium breaks down collagen
edema, proliferation of the synovial
membrane, and ultimately pannus formation
Pannus destroys cartilage and erodes the
bone
loss of articular surfaces and joint motion
Muscle fibers undergo degenerative changes.
Tendon and ligament elasticity and contractile
power are loss
 2. serology (low positive or high positive
rheumatoid factor [RF] or anti-
citrullinated peptide antibody [ACPA])
3. abnormal results of the acute phase
reactants (erythrocyte sedimentation
rate [ESR] or C- reactive protein [CRP])
4. duration of symptoms greater than 6
weeks.

Patients diagnosed with RA who are excluded

from these diagnostic criteria include: (1)
patients who have one joint with synovitis that
is not related to any other clinical disease and
who also score at least 6 to 10 points on the
scale, and (2) patients diagnosed with bony
erosions on X-ray (Aletaha, Neogi, Silman, et
Clinical Manifestations
al. 2010).

• The American College of Rheumatology

and the European League Against Clinical Manifestation

Rheumatism have collaborated and

established new criteria for classifying
• Symmetric joint pain
RA. • Swelling
• These criteria are based on a point • Warmth
system where a total score of 6 or
greater is required for the diagnosis of • erythema
RA
• lack of function are classic symptoms
The scoring system is based on
1. joint involvement (number of joints
• Palpation of the joints reveals spongy or
boggy tissue.
affected)
Medical Management 1. routine blood testing for liver and kidney
The goal of treatment at all phases of the RA function
disease process is t: 2. monitoring the CBC for anemia
1. decrease joint pain and swelling 3. Dosage may need to be modified for
2. achieve clinical remission patients with renal impairment.
3. decrease the likelihood of joint deformity 4. Annual eye examinations are also
4. minimize disability recommended with the use of sulfasalazine
and hydroxychloroquine
Recommended treatment guidelines
include beginning with: Nursing Management
The most common issues for the patient with
1. nonbiologic DMARDs (methotrexate RA include
[Rheumatrex] 1. pain
2. leflunomide [Arava] 2. sleep disturbance
3. sulfasalazine [Azulfidine]) 3. fatigue
4. hydroxychlorotquine (Plaquenil) 4. altered mood
5. limited mobility.