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Communicable Diseases Nursing
Continuation of presentation (lecture)
Classification according to incidence:
• SPORADIC – disease that occur occasionally
and irregularly with no specific pattern
• ENDEMIC – those that are present in a
population or community at times
• EPIDEMIC – diseases that occur in a greater
number than what is expected in a specific area
over a specific time.
• PANDEMIC – is an epidemic that affects several
countries or continents
TWO TYPES OF COMMUNICABLE DISEASE
INFECTIOUS DISEASE
• Not easily transmitted by ordinary contact but
require a direct inoculation through a break in the
previously intact skin or mucous membrane
CONTAGIOUS DISEASE
• Easily transmitted from one person to another
through direct or indirect means
TERMINOLOGIES
• DISINFECTION –destruction of pathogenic
microorganism outside the body by directly
applying physical or chemical means
 Concurrent – method of disinfection done
immediately after the infected individual
discharges infectious material/secretions.
This method of disinfection is when the
patient is still the source of infection
 Terminal – applied when the patient is no
longer the source of infection.
• Disinfectant – chemical used on non-living
objects
• Antiseptic – chemical used on living things
• Bactericidal – kills microorganism
• Sterilization – complete destruction of all
microorganisms
General Principles
• Pathogens move through spaces or air current
• Pathogens are transferred from one surface to
another whenever objects touch
• Hand washing removes microorganism
• Pathogens are released into the air on droplet
nuclei when person speaks, breaths, sneezes
• Pathogens are transferred by virtue of gravity
• Pathogens move slowly on dry surface but very
quickly through moisture
INFECTION
• invasion and multiplication of microorganisms on
the tissues of the host resulting to signs and
symptoms as well as immunologic response
• injures the patient either by:
o competing with the host’s metabolism
o cellular damage produced by the
microbe’s intracellular multiplication
Factors of severity of infection
o disease producing ability
o the number of invading microorganisms
o The strength of the host’s defence and
some other factors.
Epidemiological triad:
o Agent
o Host
o Environment
Causes of INFECTION
• Some bacteria develop resistance to antibiotics
• Some microbes have so many strains that a
single vaccine can’t protect against all of them
ex. Influenza
• Most viruses resist antiviral drugs
• Opportunistic organisms can cause infection in
immunocompromised patients
• Most people have not received vaccinations
• Increased air travel can cause the spread of
virulent microorganism to heavily populated area
in hours
• Use of immunosuppressive drugs and invasive
procedures increase the risk of infection
• Problems with the body’s lines of defence
Three Lines of Defense
• FIRST LINE OF DEFENSE
o MECHANICAL BARRIERS
o CHEMICAL BARRIERS
o BODY’S OWN POP. OF
MICROORGANISM - “microbial
antagonism principle”
• SECOND – inflammatory response
o Phagocytic cells and WBC to destroy
invading microorganism manifesting the
cardinal signs
• THIRD – immune response - Natural/Acquired:
active/passive
RISK FACTORS
• Age, sex, and genes
• Nutritional status, fitness, environmental factors
• General condition, emotional and mental state
• Immune system
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• Underlying disease (diabetes mellitus, ➢ Poliomyelitis (give Oral Polio Vaccine or OPV)
leukaemia, transplant) ➢ Hepatitis B
• Treatment with certain antimicrobials (prone to ➢ Measles (give anti-measles vaccine)
fungal infection), steroids, immunosuppressive
drugs etc. IMPORTANT CONCEPT!
Emerging problems in infectious diseases There are only two (2) PERMANENT
• Developing resistance to antibiotics eg: anti tb CONTRAINDICATIONS to Immunization
drugs, MRSA, VRE ➢ Allergy
• Increasing numbers of immunosuppressed ➢ Encephalopathy without known cause or
patients. convulsions within seven (7) days after pertussis
• Use of indwelling lines and implanted foreign vaccine administration
bodies has increased.
There are four (4) TEMPORARY
Three (3) Factors to Know before taking care of CONTRAINDICATIONS for Immunization
Patients with Communicable Disease ➢ Pregnancy
➢ Know the CAUSATIVE AGENT o (i.e., MMR vaccine)
➢ Know what BODY SECRETION harbors the ➢ Recent receipt of blood products
microorganism o Wait two (2) to three (3) months
➢ Know the MODE OF TRANSMISSION ➢ Very severe disease
o Hospital confinement
GENERAL CARE FOR PATIENTS WITH o Hospital personnel will decide when
COMMUNICABLE DISEASES immunization would be given
➢ Immunocompromised situation
Two (2) Aspects ➢ Fever, diarrhea, and colds are NOT
➢ Preventive Aspect CONTRAINDICATIONS to Immunization.
➢ Control Aspect Immunization can still be given despite their
presence
1. PREVENTIVE ASPECT ➢ In a private setting, the physician can
➢ You do not have infection yet POSTPONE IMMUNIZATION in the presence of
1.1) Health Education fever, diarrhea, colds because patient is returned
➢ Main goal is to effect change in knowledge, skills by mother to the physician once these conditions
and attitude are resolved.
➢ Change in behavior towards health ➢ Current target group of Expanded Program on
1.2) Immunization Immunization of the Department of Health is
Three (3) Laws in Immunization composed of CHILDREN BELOW FIVE (5)
➢ Presidential Decree 996 – Compulsory YEARS OLD
Immunization for Children below Eight (8) years
old CDT VACCINE
➢ Proclamation No. 6 – United Nations’ Universal Cholera, Dysentery, Typhoid Vaccine
Child Immunization ➢ Given by DOH for free
➢ Proclamation No.46 of 2000 – National ➢ Adult dose is 0.5 cc
Immunization Day ➢ Adult injection site is the deltoid muscle
➢ Child dose is 0.25 cc
Common Goal is to prevent the seven (7) Childhood ➢ Child injection site is the vastus lateralis
Diseases ➢ Given INTRAMUSCULARLY (I.M.)
➢ Tuberculosis (give Bacillus Calmette Guerin or ➢ Given when there are outbreaks of epidemic
BCG) ➢ Immunity lasts only for six (6) months.
➢ Diphtheria Anti-Rabies Vaccine
➢ Pertussis ➢ Target group would be the animals
➢ Tetanus

➢ Animals are brought to the Barangay for free
immunization
➢ Barangay Captain is responsible for obtaining
vaccines from DOH
➢ Dogs must initially be registered before this
vaccine could be administered
1.3) Environmental Sanitation
➢ Objective:
o No proliferation of arthropods, rodents
(both of which are good vectors)
Presidential Decree 856
Sanitation Code
➢ Also includes submission of sex workers in
determination of sexually transmitted diseases
o For gonorrhea – two times a month
o For syphilis – once a month
o Physical Examination – once a month
Presidential Decree 825
➢ Anti-Littering Law
➢ Proper disposal of garbage
➢ Anyone caught littering would have a penalty of
Php2,000 to Php5,000 and imprisonment for one
(1) year.
1.4) Proper Supervision of Food Handlers
➢ A responsibility of the Department of Health
facilitated by its Sanitary Inspectors
➢ Also a responsibility of the Bureau of Food and
Drug
➢ Monitors food and drug sold to public to assure
that it is safe for consumption
2. CONTROL ASPECT
➢ Done when signs and symptoms are already
present
➢ There is already the presence of infection
➢ Goal is to limit the infection
2.1) Isolation
➢ Separation of an infected person during period of
communicability
Two (2) ways of Isolation
2.1.1) Strict Isolation
➢ Intended to protect other persons (not the
patient) from infection
➢ It intends to limit the microorganisms to be within
the patient
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2.1.2) Reverse Isolation
➢ Also called Protective Isolation
➢ Intended to protect the immunocompromised
patient from infection
➢ Intends to keep microorganisms out of the patient
Concepts:
Quarantine
➢ Limitation of freedom of movement of a well
person during the longest incubation period
➢ It involves the separation of persons who are
carriers
➢ These are persons who are not sick
➢ These are persons who do not manifest signs
and symptoms of the disease
Center for Disease Control’s two (2) Revised Isolation
Precautions
1) Standard Precaution
➢ Best strategy to prevent nosocomial infection
➢ Slowly taking place of Universal Precaution
➢ Applies to all patients regardless of their
diagnosis
➢ Applies to blood and all body fluids, excretions
and secretions except sweat.
➢ Applies to mucous membrane and non-intact skin
Concept:
Universal Precaution
➢ Has double standards
➢ Used only if patient is diagnosed or suspected of
having blood-borne diseases
Elements included in Standard Precautions
1. Practice hand washing for each patient care
➢ For contact with body fluids of patient
➢ Duration is 10 – 15 seconds
➢ Length of washing is not important
➢ What is important is the friction that is applied
Concepts:
For Medical Asepsis:
➢ Hand is lower than the elbow
➢ Hand is the dirtiest part
➢ Elbow is the cleaner part
For Surgical Asepsis:
➢ Hand is placed up and remains up
➢ Hand is the cleanest portion
➢ Elbow is less clean than the hands
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2. Use of Protective Barriers or Use of Personal

Protective Equipment (PPEs)
➢ If you wear them all, the correct sequence for Control Measures other than Isolation
wearing them would be: 1. Disinfection
o Mask ➢ Killing of pathogenic microorganisms by physical
o Goggles or chemical means (i.e., boiling, soaking)
o Cap / Bonnet
o Gown Types of Disinfection
o Gloves
➢ If you are about to remove them, the correct Concurrent Disinfection
sequence is: ➢ Done when the person is still a source of
o Gloves infection
o Do hand washing ➢ Example:
o Gown o When patient is still in the hospital
o Cap / Bonnet ➢ Boil all patient gowns
o Goggles
o Mask Terminal Disinfection
➢ Done when person is no longer a source of
3. Avoidance of Needle Stick or Sharps Injury infection
➢ Do not recap, bend or break needles ➢ Example:
➢ There must be puncture-resistant sharps o Room of patient is cleaned upon
collector discharge of patient using UV rays or
Lysol
IMPORTANT CONCEPT!!!
➢ If patient is diagnosed as having communicable
disease, practice both Standard Precaution and 2. Disinfestation
Transmission-based Precaution ➢ Killing of undesirable small animal forms such as
arthropods, rodents, insects by physical or
Transmission Based Precaution chemical means
Airborne Precaution
➢ Use of mask 3. Fumigation
➢ Special ultra-filterable mask ➢ Use of gaseous agents to kill arthropods, rodents
➢ Particulate mask and insects.
o For measles, chicken pox, TB
4. Medical Asepsis
Droplet Precaution ➢ Hand washing
➢ No contact to mucous membrane, nose, mouth ➢ Gloving
➢ Use mask – ordinary mask will do ➢ Gowning
➢ Use goggles ➢ Masking
o For meningitis, mumps, pertussis, ➢ Placarding
German measles, diphtheria o Placing “NO SMOKING” sign when there
is oxygen inhalation in progress.
Contact Precaution
➢ Avoid person to person contact Basic Concepts Related to Antimicrobial Therapy
➢ Use gloves
➢ Use gown Before we learn about medications that are used to treat
➢ For diarrheal diseases, typhoid, cholera, infections in our patients, we must first understand the
hepatitis, skin diseases like ringworm, scabies, basics of microbiology. Let’s begin with a review of
and pediculosis bacteria. Bacteria are found in nearly every habitat on
earth, including within and on humans. Most bacteria are

harmless or considered helpful, but some are pathogens.
A pathogen is defined as an organism causing disease
to its host. Pathogens, when overgrown, can cause
significant health problems or even death for your
patients.
Bacteria may be identified when a patient has an infection
by using a culture and sensitivity test or a gram stain test.
Antimicrobials may be classified as broad-spectrum or
narrow spectrum, based on the variety of bacteria they
effectively treat. Additionally, antibiotics may be
bacteriostatic or bactericidal in terms of how it targets the
bacteria. Finally, the mechanism of action is also
considered in the selection of an antibiotic.
In addition to antibiotics, antimicrobials also include
medications used to treat viruses and fungi. Each of
these topics will be discussed in more detail below, along
with the issue of drug resistance.
• Culture and Sensitivity
When a patient presents signs or symptoms of an
infection, healthcare providers will begin the detective
work needed to identify the source of the infection. A
culture is a test performed to examine different body
substances for the presence of bacteria or fungus. These
culture samples are commonly collected from a patient’s
blood, urine, sputum, wound bed, etc. Nurses are
commonly responsible for the collection of culture
samples and must be conscientious to collect the sample
prior to the administration of antibiotics. Antibiotic
administration prior to a culture can result in a delayed
identification of the organism and complicate the patient’s
recovery. Once culture samples are collected, they are
then incubated in a solution that promotes bacterial or
fungal growth and spread onto a special culture plate.
Clinical microbiologists subsequently monitor the culture
for signs of organism growth to aid in the diagnosis of the
infectious pathogen. A sensitivity analysis is often
performed to select an effective antibiotic to treat the
microorganism. If the organism shows resistance to the
antibiotics used in the test, those antibiotics will not
provide effective treatment for the patient’s infection.
Sometimes a patient may begin antibiotic treatment for an
infection, but will be switched to a different, more effective
antibiotic based on the culture and sensitivity results.
• Gram Positive vs. Gram Negative
A gram stain is another type of test that is used to assist
in classification of pathogens. Gram stains are useful for
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quickly identifying if bacteria are “gram positive” or “gram
negative,” based on the staining patterns of their cellular
walls. Utilizing gram stain allows microbiologists to look
for characteristic violet (Gram +) or red/pink (Gram -)
staining patterns when they examine the organisms
under a microscope. Identification of bacteria as gram
positive or gram negative assists the healthcare provider
in quickly selecting an appropriate antibiotic to treat the
infection.
• Broad-Spectrum vs.
Narrow-Spectrum Antimicrobials
Spectrum of activity is one of the factors that providers
use when selecting antibiotics to treat a patient’s
infection. A narrow-spectrum antimicrobial targets only
specific subsets of bacterial pathogens. For example,
some narrow-spectrum drugs only target gram positive
bacteria, but others target only gram-negative bacteria. If
the pathogen causing infection has been identified in a
culture and sensitivity test, it is best to use a narrow-
spectrum antimicrobial and minimize collateral damage to
the normal bacteria.
Broad-spectrum antimicrobial medications target a
wide variety of bacterial pathogens, including both gram
positive and gram-negative species, and is frequently
used to cover a wide range of potential pathogens while
waiting on the laboratory identification of the infecting
pathogen. Broad-spectrum antimicrobials are also used
for polymicrobial infections (a mixed infection with
multiple bacterial species) or as prophylactic prevention
of infections with surgery/invasive procedures. Finally,
broad-spectrum antimicrobials may be selected to treat
an infection when a narrow-spectrum drug fails because
of development of drug resistance by the target
pathogen.
One risk associated with using broad-spectrum
antimicrobials is that they will also target a broad
spectrum of the normal micro bacteria that can cause
diarrhea. They also increase the risk of a superinfection,
a secondary infection in a patient having a preexisting
infection. A superinfection develops when the
antibacterial intended for the preexisting infection kills the
protective microbiota, allowing another pathogen resistant
to the antibacterial to proliferate and cause a secondary
infection. Common examples of superinfections that
develop because of antimicrobial use include yeast
infections (candidiasis) and pseudomembranous colitis
caused by Clostridium difficile (C-diff), which can be fatal.
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Probiotics, such as lactobacillus, are commonly used for

individuals with C-diff to introduce normal bacteria into
the gastrointestinal system and improve bowel function.

At times, a broad-spectrum antibiotic may be

administered prior to receiving the culture report due to
the severity of the illness of the patient. Once the culture
is reported, the antibiotic therapy is tailored to the patient.
It is the nurse’s responsibility to review culture results and
ensure that the results have been communicated to the
prescribing provider.

• Antibacterial Actions
Bacteriostatic vs. Bactericidal COMMUNICABLE DISEASES OF THE RESPIRATORY
When a provider selects an antibacterial drug, it is SYSTEM
important to consider how and where the drug will Bacterial
ultimately target the bacteria. Antibacterial drugs can be ➢ Diphtheria
either bacteriostatic or bactericidal in their interactions ➢ Pertussis
with the offending bacteria. Bacteriostatic drugs cause ➢ Tuberculosis
bacteria to stop reproducing; however, they may not ➢ Pneumonia
ultimately kill the bacteria. In contrast, bactericidal drugs Viral
kill their target bacteria. ➢ Colds
➢ Influenza
The decision about whether to use a bacteriostatic or
bactericidal drug often depends on the type of infection DIPHTHERIA
and the overall immune status of the patient. In a healthy Causative Agent
patient with strong immune defenses, both bacteriostatic ➢ Corynebacterium diphtheriae
and bactericidal drugs can be effective in achieving ➢ (Klebs-Loeffler Bacillus)
clinical cure. However, when a patient is ➢ This bacteria does not only affect the respiratory
immunocompromised, a bactericidal drug is essential for tract
the successful treatment of infections. Regardless of the o If it affects the mucous membrane, this is
immune status of the patient, life-threatening infections called CUTANEOUS DIPHTHERIA
such as acute endocarditis require the use of a ➢ Types of Cutaneous Diphtheria
bactericidal drug to eliminate all offending bacteria.[14] o Conjunctival Diphtheria
▪ Conjuctiva is affected
• Mechanism of Action o Vaginal Diphtheria
Another consideration in the selection of an antibacterial ▪ Vaginal mucosa is affected
drug is the drug’s mechanism of action. Each class of o Diphtheria of the Prepuce
antibacterial drugs has a unique mechanism of action, the ▪ Affectation of the uncircumcised
way in which a drug affects microbes at the cellular level. prepuce of the male
For example, cephalosporins act on the integrity of the o Wound Diphtheria
cell wall. In contrast, aminoglycosides impact ribosome ▪ Affects wounds
function and inhibit protein synthesis, which stops the ▪ Especially of burn patients
proliferation of cells. See image below for a summary of
how various antibiotics affect the cell wall, the plasma Important Concepts!
membrane, the ribosomes, the metabolic pathways, or ➢ Respiratory Diphtheria
DNA synthesis of bacteria. o Is the more common type of diphtheria
➢ Wound Diphtheria
o Is the rare type of diphtheria

Mode of Transmission
➢ Droplet
Manifestations of Diphtheria
➢ Depends upon its classification
Three (3) Types of Respiratory Tract Infections
1. Nasal Type
➢ Nasal passages are affected
➢ With irritating nasal discharge
o Characterized by serosanguinous
secretion with foul mousy odor (whitish,
bloody, smells like a rat)
➢ Due to rubbing of nose, this results to upper lip and
nasal excoriation
➢ Pathognomonic Sign
o Presence of pseudomembrane
o However, not appreciable in the NASAL
TYPE
o This is found within the nasal septum
o Speculum is needed
o But is usually covered by irritating nasal
discharge
2. Pharyngeal Type or Faucial Type
➢ Affects the pharynx and the tonsils
➢ Patient complains of:
o Sore Throat
o Dysphagia
➢ Presence of pseudomembrane, which is visible
upon opening of the mouth
➢ Pseudomembrane is present on the following:
o Soft palate,
o Uvula
o Pillars of the tonsils
➢ The pseudomembrane can be described as:
o Grayish-white membrane
o Like cigarette ash
➢ Patient also has a BULL NECK appearance
o Enlargement of the neck
o Specifically of the anterior upper aspect of
the neck
o This is due to inflammation and
enlargement of cervical lymph nodes
o Anterior upper aspect of the neck is:
▪ Reddish
▪ Warm to touch
▪ There is pain
▪ Tenderness
➢ The difference between a person with Pharyngeal
Type of Diphtheria and a person with double chin
is that double chin people have on their necks:
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o Normal skin color
o Normal temperature
o No pain
3. Laryngeal Type
➢ Affects the larynx or the voice box
➢ With hoarseness of voice
➢ With loss of voice
o Aphonia but only temporary
➢ Larynx also serves as airway passage
o Therefore, there is:
▪ Dyspnea
• Difficulty of breathing
➢ Body compensates and uses accessory muscles
Important Concepts!
➢ Overuse of accessory muscles results to chest
retractions or chest indrawing
Important Concepts!!!
➢ Normally, when a person breathes in, the chest
expands
➢ But with over usage of accessory muscles, chest
wall does not expand, rather, it DRAWS IN!!!
➢ In order to detect chest indrawing, look at the
subcostal area (lower area of the chest region).
This elevates due to severe dyspnea
➢ Do not look at the sternum or at the intercostals
spaces
➢ Check for chest indrawing when:
o The patient is calm
o The patient is not crying
o The patient is not breast-feeding (chest
indrawing is NORMAL under this
condition)
o The patient is bottle-feeding (chest
indrawing is NORMAL under this
condition)
➢ Chest indrawing is constant in a patient with
diphtheria
➢ Chest indrawing is always present in any position
in a patient with diphtheria
Important Concepts!!!
➢ Pseudomembrane is also present
o Present in the larynx
o Laryngoscope is needed to see the
pseudomembranes
➢ Pseudomembranes may trigger cough
➢ Characteristics of cough:
o Barking cough
o Dry
o Metallic
o Croupy
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o Husky ➢ The toxin brings about systemic effects

➢ Due to hoarseness of voice ➢ Therefore, give anti-diphtheria toxin
Key Concept! o Do skin test first
➢ Laryngeal Type of Diphtheria may become severe o If positive for the skin test
▪ Give drug
LARNGEAL TYPE OF DIPHTHERIA ▪ Because there is no Diphtheria Ig
▼▼▼ ▪ But give in fractional doses
Laryngeal Edema ➢ Also have ready and handy the following:
▼▼▼ o Epinephrine
Airway Obstruction o Corticosteroid
▼▼▼ 2. Kill microorganism
Respiratory Obstruction ➢ Give anti-biotics
▼▼▼ ➢ Drug of Choice
Respiratory Distress o Penicillin
▼▼▼ ➢ Important Concept!
Death ➢ Scraping the pseudomembrane does not kill the
microorganism
➢ Therefore, management is EMERGENCY ➢ It only causes bleeding
TRACHEOSTOMY 3.Prevent Respiratory Obstruction
➢ Among the three types of Diphtheria, Laryngeal ➢ Performance of emergency tracheostomy
Diphtheria is the most fatal due to the possibility of
respiratory obstruction, which may lead to death. Nursing Management for Diphtheria
1. Place patient on complete bed rest until two (2)
Diagnostic Tests for Diphtheria weeks after recovery
➢ Rationale:
1. Schick’s Test o To prevent the number one complication
➢ Test for immunity or susceptibility to – MYOCARDITIS
diphtheria o Myocarditis leads to death
2. Moloney Test o Toxin released by microorganism has
➢ Test to determine hypersensitivity to diphtheria special affinity for heart muscles
toxin o Toxin released travels to the bloodstream
Nose and Throat Swab o Goes to the heart
➢ Most commonly done test o Waits for opportunities when heart’s
➢ Confirmatory Test resistance to go down:
o To identify the microorganism ▪ When the heart is overloaded
o To determine if patient is still with work
communicable ▪ When the heart is under stressful
➢ Important Concept! activities
o Patient is still communicable until ➢ Therefore, provide COMPLETE BED REST
three (3) consecutive results of
negative (-) nose and throat culture Signs and Symptoms of Myocarditis
are obtained ➢ Marked facial pallor
➢ Very irregular pulse rate
➢ Hypotension
➢ Chest pain or epigastric pain
Important Concept!
Medical Management for Diphtheria ➢ When the above signs and symptoms are
Three (3) Objectives: observed, immediately seek consultation
2. Maintenance of Patent Airway
1. Neutralize the toxin ➢ Proper position of patient
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o Upright ➢ Highly contagious

o Semi-Fowler’s ➢ Colds
➢ Encourage Deep Breathing Exercises and ➢ Nocturnal coughing
coughing exercises with pursed lip o Coughing is present at night
➢ Chest Physiotherapy ➢ Fever
➢ Increased oral fluid intake to liquefy the secretions ➢ Tiredness
➢ Frequent turning to sides to prevent pooling of ➢ Listlessness
secretions 2. Paroxysmal or Spasmodic Stage
➢ Do inhalation therapy with doctor’s order. ➢ With five (5) to ten (10) successive, forceful
o Nebulization coughings, which ends on a prolonged inspiratory
o Steam Inhalation phase or a WHOOF
➢ Perform Postural Drainage with doctor’s order ➢ To loosen mucous plug on airway (this causes the
➢ If patient cannot expectorate, suction secretions patient to cough)
as needed ➢ To loosen thick and tenacious secretions
3. Provide adequate nutritious diet ➢ Therefore, child coughs for five (5) to ten (10)
Soft diet due to the presence of dysphagia times
4. Other nursing managements are symptomatic and ➢ When patient is unsuccessful in expectorating
supportive narrow passageway requires long inhalation
Important Concept!!! ➢ If patient keeps on coughing
➢ An attack of diphtheria does not provide o He may choke on his mucous
permanent immunity since the causative agent is o This results to vomiting
a bacteria o Therefore, the patient is positive for
vomiting
Preventive Measures ➢ Due to pressure exerted on vomiting, there could
1. Immunization be
➢ DPT vaccine o Congested face (bloated face)
o Congested tongue
2.Proper disposal of nasopharyngeal secretions ▪ Purple in color
3. Cover the nose and the mouth when sneezing or ▪ Due to pressure exerted on the
coughing tongue by the teeth when
4. Never kiss the patient. coughing
➢ Diphtheria affects all ages o Teary-red eyes with protrusion due to
➢ Common in children pressure exerted when coughing
o Distention of face and neck veins
PERTUSSIS o Involuntary micturition and defecation
➢ Also called o Abdominal hernia due to pressure exerted
o Whoofing cough on abdominal wall when coughing
o Chin cough ➢ If patient is vomiting:
➢ Only affects children below six (6) years old o Metabolic alkalosis occurs
Causative Agent ➢ This will trigger convulsions due to electrolyte
➢ Cocobacillus imbalance
➢ Both aerobic and anaerobic Convalescent Stage
o Bordatella pertussis ➢ Patient is no longer communicable
o Haemophilus pertussis ➢ Signs and symptoms will now start to subside
Mode of Transmission ➢ Patient is now on the road to recovery
➢ Droplet
Manifestations of Pertussis Diagnostic Tests for Pertussis
Three (3) Stages
1. Nasal Swab
1. Catarrhal Stage 2. Bordet-Gengou Test
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➢ Specimen is nasopharyngeal secretion ➢ No permanent immunity from an attack of

3. Agar Plates Pertussis is acquired. However, second attacks
➢ Specimen is nasopharyngeal secretion are rare. Age decreases risks
4. Cough Plate Preventive Measures
➢ Specimen is nasopharyngeal secretion ➢ Same as for Diphtheria
Medical Management ➢ But you can kiss the patient because you (adults)
➢ Anti-biotic Treatment are above six (6) years old (in Diphtheria, all ages
o Drug of Choice are affected)
▪ Erythromycin
➢ Pertussis Immune Globulin TUBERCULOSIS
➢ For nocturnal cough ➢ Also called
o Give mild sedation o Koch’s infection
➢ Replace fluids and electrolytes lost due to o Phthisis
vomiting o Galloping Consumption
➢ Important Concept!!! o Pulmonary Tuberculosis
o No expectorant should be given to Causative Agent
pertussis patient ➢ Mycobacterium tuberculosis
o This stimulates coughing o Acid-fast bacteria
o Mucolytics are allowable o Also known as tubercle bacilli
Mode of Transmission
Nursing Management for Pertussis ➢ Airborne (most common)
Important Concept!
1. Complete Bed Rest ➢ Therefore, there is no need to separate eating
➢ To conserve the energy of the patient utensils!
➢ Decreases oxygen demand ➢ Tuberculosis is not acquired through shared
➢ Decreases oxygen consumption utensils.
2. Prevent Aspiration ➢ Tuberculosis is also acquired through ingestion of
➢ Proper position of patient contaminated milk
o Upright position in feeding o Causative agent is Mycobacterium bovis
➢ During spasmodic attacks of cough or Mycobacterium bovine
o Hold all feedings and keep patient on o Tuberculosis of Cattle
NPO (nothing per orem) o From improperly pasteurized or
➢ For children below six (6) years old: improperly boiled milk
o If bottle-fed ➢ Tuberculosis may also be acquired from birds
▪ Inform mother that nipples in o Mycobacterium avium is the causative
bottle should only have a SMALL agent
BORE to lessen chances of o Obtained when taking care of infected
aspiration bird
o Feed child with a medicine dropper o Eating of the bird is not necessary to get
infected
3. To manage vomiting: ➢ Mycobacterium avium Complex
➢ Monitor Intake and Output o Most common opportunistic infection for
➢ Assess for signs of dehydration AIDS patients in the United States
➢ Provide proper I.V. regulation Important Concept!
➢ Provide adequate fluids with extra aspiration ➢ Patients infected with Tuberculosis bacilli are most
precaution of the time asymptomatic
4.Application of Abdominal Binder ➢ Symptoms are usually seen after four (4) to eight
➢ To prevent abdominal hernia (8) weeks.
Important Concept!
Manifestations of Tuberculosis
 Page 11 of 56

➢ Afternoon low-grade fever with night sweats ➢ Positive ( + ) to TB exposure

➢ Anorexia ➢ Positive ( + ) to TB infection
➢ Weight loss ➢ Positive ( + ) to TB testing
➢ Fatigability ➢ Negative ( - ) to TB symptoms
➢ Body malaise ➢ Inactive PTB patients and carriers are under this
➢ Chest pain / back pain category
➢ Positive for productive cough ➢ They are given prophylactic management so that
➢ Hemoptysis they would not exhibit signs and symptoms
➢ Difficulty of Breathing ➢ Start on Anti-Tuberculosis drugs
➢ Anemia o INH
➢ Amenorrhea in females o Isoniazid
▪ The most effective TB drug
Three (3) Classifications of Patients ▪ Side Effect
• Peripheral Neuritis
1. According to Extent of Disease ➢ Give Vitamin B6 or pyridoxine to counteract INH
➢ Basis is on the CAVITATIONS IN THE LUNGS as side effect
seen through Chest X-ray ➢ Increase Vitamin B6 by intake of:
o Minimal Pulmonary Tuberculosis o Beans
o Moderately Advanced Pulmonary ▪ Mongo
Tuberculosis ▪ Red beans
o Far Advanced Pulmonary Tuberculosis ▪ White beans
2. According to CLINICAL MANIFESTATIONS ▪ Black beans
➢ Basis is the presence or absence of clinical o Prophylaxis is given for six (6) months
manifestations ➢ For children
o Active Pulmonary Tuberculosis o Prophylaxis is given for nine (9) months
▪ Infected; with signs and ➢ For Immunocompromised patients
symptoms o Prophylaxis is given for twelve (12)
o Inactive Pulmonary Tuberculosis months
▪ Infective; without signs and TB3
symptoms; with medication ➢ Positive ( + ) to TB exposure
3. According to American Pulmonary Society ➢ Positive ( + ) to TB infection
➢ Positive ( + ) to TB testing
TB0 ➢ Positive ( + ) to TB symptoms
➢ Negative ( - ) to TB exposure ➢ Active PTB patients are under this classification
➢ Negative ( - ) to TB infection ➢ They are given curative management
➢ Negative ( - ) to TB testing ➢ Combination of Anti-Tuberculosis drugs to prevent
➢ Newborns are under this classification drug resistance
➢ They are given preventive management in the ➢ Short-Course Chemotherapy
form of BCG vaccine immediately after birth o Composed of RIP(E)
TB1 ▪ Rifampicin
➢ Positive (+) to TB exposure ▪ Isoniazid
➢ Negative (-) to TB infection ▪ Pyrazinamide
➢ Negative (-) to TB testing ▪ Ethambutol
➢ Medical and other healthcare workers are under • May or may not be given
this classification ➢ Standard Regimen
➢ They are given preventive management in the o Composed of SI(E)
form of Personal Protective Equipment (PPEs); ▪ Streptomycin
and increased body resistance through vitamins, ▪ Isoniazid
adequate rest and adequate hand washing ▪ Ethambutol
TB2 • May or may not be given
 Page 12 of 56

Important Concepts!!! o No hepatotoxicity

➢ Short-Course Chemotherapy Side Effects o But causes RENAL TOXICITY
➢ Causes hepatotoxicity o Nursing Management
➢ Nursing Management o Monitor the following:
o Therefore, monitor liver enzyme tests ▪ Creatinine levels
➢ Advise patient to avoid alcoholic beverages, which ▪ Blood Urea Nitrogen (BUN)
increase hepatotoxic effects levels
▪ Monitor Intake and Output
Key Concept! o Also causes OTOTOXICITY
Rifampicin o Nursing Management
➢ Side effects are: o Assess patient for tinnitus or ringing of the
o Orange urine ears
o Orange tears o Assess patient for vertigo, which is
o Orange secretions and excretions another sign indicative of ototoxicity
o Orange saliva Key Concept!
o Orange sputum ➢ The American Pulmonary Society classification is
o Orange feces the best classification!!!
➢ Nursing Management
o Inform the patient that this normally Diagnostic Examinations for Tuberculosis
happens
o Therefore, remove soft contact lenses 1. Tubercullin Testing
▪ These may be permanently ➢ This is only a screening test for Tuberculosis
stained with orange color ➢ If result is positive ( + ), it does not mean that the
o Advise the patient to use eyeglasses person is infected but the person may have an
instead exposure
Isoniazid ➢ If result is CONSISTENTLY POSITIVE, it means
➢ Side effect is peripheral neuritis that the patient is sensitive to the organism
➢ Important Concepts!!!
➢ Nursing Management o This test uses Purified Protein Derivative
o Give Vitamin B6 or pyridoxine or PPD
Pyrazinamide o PPD is administered intradermally
PZA o Tubercullin testing is interpreted after
➢ Side effect is hyperuricemia forty-eight (48) to seventy-two (72) hours
➢ Patient is predisposed to stone formation o A positive result would give you an
➢ Therefore, make urine alkaline induration of greater than ten (10) mm.
➢ Nursing Management o If patient is positive for HIV, a positive
o To alkalinize the urine result would give the patient an induration
o Increase fluid intake of greater than five (5) mm
o Increase intake of vegetables Three (3) Ways of Performing Tubercullin Testing
Ethambutol 1.1) Mantoux Test
➢ Side effect is Optic Neuritis ➢ Just like a skin test
o Causes color blindness or inability to ➢ Utilizes the same technique as a skin test
distinguish red from green ➢ Uses PPD
➢ Nursing Management ➢ Interpreted after forty-eight (48) to seventy-two
o IMMEDIATELY STOP the medication (72) hours
because this side effect is ➢ Positive result is bigger wheal induration
IRREVERSIBLE 1.2) Tine Test or Multi-puncture Test
Important Concepts!!! ➢ Soak sterile needle in PPD for three (3) to four (4)
Standard Regimen hours
➢ Streptomycin ➢ Get arm
 Page 13 of 56

➢ Puncture for six (6) to eight (8) times in a circular ➢ Standard Regimen
manner Nursing Care for Pulmonary Tuberculosis
➢ This is commercially prepared ➢ Diet
➢ This utilizes a special syringe with four (4) small ➢ Drugs
needles for one simultaneous application o Most important
1.3) Vollmer and Pirquet Test ➢ Rest
➢ Skin scratch or skin patch test Important Concept!
➢ Get sterile needle ➢ Do not perform Chest Physiotherapy on PTB
➢ Get gauze containing PPD patient
➢ Apply this gauze over the scratch or tape this ➢ This can stimulate or aggravate the following:
gauze over the scratch o Hemoptysis
➢ Keep gauze on for seventy-two (72) to ninety-six o Frank Bleeding
(96) hours Key Concept!
➢ Remove after three (3) to four (4) days ➢ An attack of PTB only gives temporary immunity
➢ Results cannot be interpreted yet
➢ Wait for another forty-eight (48) to seventy-two Preventive Measures
(72) hours 1. Immunization
➢ Therefore, results could be obtained after five (5) ➢ Bacillus Calmette Guerin (BCG) vaccine
to seven (7) days!!! ➢ Number of Doses:
Important Concept! o Two
➢ Mantoux Test is the best type of test!!! ➢ When Given:
o Easier to perform o 1st Dose – At Birth
o Less pain to patient o 2nd Dose – Upon school entrance
o Most accurate results ➢ Dosage of First Dose
o 0.05 cc
2. Sputum Examination ➢ Route of First Dose
➢ This is the CONFIRMATORY TEST for o Intradermal
Tuberculosis ➢ Site of First Dose
➢ Done in the morning upon rising before oral care o Right deltoid muscle
➢ Collection of Sputum ➢ Important Concepts!!!
o Do deep breathing exercises for three (3) o Do not massage site of injection
times o Rationale:
o Open mouth widely ▪ It will spill the drug
o Put tongue at the back of the lower teeth o Child may experience fever
o As the back of tongue curves upon ➢ Nursing Management
spitting, phlegm goes out o Give paracetamol
➢ Key Concept!!! o On site of injection, there will be an
o Continuous receipt of anti-Tuberculosis abscess formation, which will develop into
drugs for two (2) weeks will give the a scar within two (2) to three (3) months
patient a negative ( - ) result o If after three (3) months, abscess is still
o Therefore, patient is no longer present, this is called an INDOLENT
communicable ABSCESS caused by:
o ▪ Wrong technique
3. Chest X-Ray • Given subcutaneously
➢ Shows extent of lung involvement instead of intradermally
➢ Does not reveal causative agent • Child’s exposure to a
➢ Not a confirmatory examination person with TB (i.e. mother who is
asymptomatic)
Medical Management for Tuberculosis ➢ Nursing Management
➢ Short-Course Chemotherapy
 Page 14 of 56

o Bring the child to the health center or clinic 2. Cover nose and mouth when sneezing and
for INCISION DRAINAGE coughing
o Then give prophylactic INH for nine (9)
months Important Concepts!
o When you transfer patient…
Additional Concepts!!! o Make the patient wear a mask so as
At school entrance not to infect people in the hallway,
➢ Give booster dose of BCG elevator, etc.
➢ When given: o Wear mask when you enter the
o About six (6) to seven (7) years old patient’s room
➢ Dosage of Booster Dose 3.Vaccine
o 0.01 cc o Hib vaccine for Haemophilus influenza
➢ Route of Booster Dose: 4. Proper pasteurization of milk
o Intradermal
➢ Site of Booster Dose PNEUMONIA
o Left Deltoid muscle ➢ Inflammation of the lung parenchyma
➢ Important Concepts!!! ➢ Caused by several organisms
o No abscess formation on site of booster Causative Agents:
dose ➢ Virus
o Site depends on preference of the mother o Cytomegalovirus
in a private setting ▪ Common opportunistic infection
in AIDS
Preventive Measures (continued) ➢ Protozoa
1.Proper disposal of nasopharyngeal secretions o Pneumocystis carinii Pneumonia
• Burning ▪ Also a common opportunistic
• Burying infection in AIDS
Proper procedure for disposal of nasopharyngeal ➢ Bacteria
secretions o Most common cause
✓ Use tissue paper o Can be caused by primary infection
✓ Put it in a plastic bag after use o Can be secondary to previous infection:
✓ Knot the plastic bag ▪ A complication
✓ Dispose plastic bag in a trashcan ▪ A debilitating disease
Important Concepts! Mode of Transmission
➢ The best and most economical way ➢ Droplet
preventing spread of infection is through Manifestations of Pneumonia
swallowing of nasopharyngeal secretions Five (5) Cardinal Signs of Pneumonia
➢ This brings the secretions to the stomach and ➢ 1. Fever
to the intestines and would then be eliminated ➢ 2. Shaking Chills
in the stool ➢ 3. Sputum Production
➢ Children have less chance of spreading o Rusty sputum
infection because they swallow o Depends on causative agent
nasopharyngeal secretions. o If sputum is creamy yellow
➢ This is contraindicated, however, for ▪ Causative agent is
tuberculosis patients Staphylococcus
➢ Thus, for TB patients, they must spit out o If sputum is currant jelly
nasopharyngeal secretions ▪ Causative agent is Klebsiella
➢ Swallowing is allowable for other respiratory o If sputum is clear
infections ▪ There is no infection
▪ This may also be brought about
by ASPIRATION PNEUMONIA
 Page 15 of 56

➢ Important Concept! ➢ Purpose is to know what microorganism brought

o Lipid Pneumonia pneumonia
▪ Occurs when oil is used in 3. Auscultation
cleaning the nose ➢ For crackles
▪ Oil is not absorbed by the lungs ➢ For ronchi
➢ Therefore, do not use oil-based lubricants in o Decreased vocal fremitus
nasogastric tubes. ▪ ‘Ninety-nine’ verbalized
➢ 4, Productive Cough o Decreased breath sounds
➢ 5. Presence of Chest Pain or Pleuritic Pain 4. Percussion
o Aggravated when coughing ➢ Dullness upon percussion
o Use of chest binder is encouraged Medical Management
Important Concepts!!! ➢ Depends on causative agent
Presence of fast breathing is common in Pneumonia ➢ If viral
In Children: o Symptomatic management
➢ If two (2) weeks to two (2) months old (1 month ➢ If protozoal (PCP)
and 29 days) o Drug of choice is Pentamidine
o Cut off is sixty (60) breaths per minute ➢ If bacterial
o If respiratory rate is 61 breaths per minute o Administer anti-biotics
and above, this is indicative of Pneumonia o In the hospital setting, drug of choice is
➢ If two (2) months to twelve (12) months Penicillin
o Cut off is fifty (50) breaths per minute o In the community setting, drug of choice
o If respiratory rate is 51 breaths per minute is Cotrimoxazole (administered T.I.D.)
and above, this is indicative of Pneumonia
➢ If twelve (12) months to five (5) years Nursing Care for Pneumonia Patients
o Cut off is forty (40) breaths per minute ➢ Priority
o If respiratory rate is 41 breaths per minute o Ineffective airway clearance
and above, this is indicative of Pneumonia ➢ Management
➢ Therefore, if there is fast breathing, automatically, o Maintain patent airway
it is Pneumonia o Adequate rest
➢ Home management involves antibiotic therapy o Adequate nutrition
Important Concept! Preventive Measures
➢ Check for the presence of the following: 1. Immunization
o Chest Indrawing ➢ Pneumovax
o Stridor ➢ For prevention of secondary pneumonia
▪ Harsh breath sound heard during ➢ Given to adults
inspiration ➢ Given to the elderly with Community-Acquired
▪ To check, place ear on nose or Pneumonia (CAP)
mouth of patient
o Cough 2. Proper disposal of nasopharyngeal secretions
➢ If these three signs are present, then there is
SEVERE PNEUMONIA 3. Cover the nose and mouth while coughing or sneezing

Diagnostic Tests for Pneumonia COMMUNICABLE DISEASES OF THE

GENITOURINARY SYSTEM – SEXUALLY
1. Chest X-ray TRANSMITTED DISEASES
➢ Expect infiltrations
➢ Lung consolidation Bacterial
➢ This is the confirmatory examination ➢ Gonorrhea
2. Sputum Examination ➢ Syphilis
Viral
 Page 16 of 56

➢ HIV Infection o If there is no burning pain and no purulent

➢ AIDS discharge, the patient may not know that
she is infected
GONORRHEA o Presence of abscess formation on the
➢ Also called Bartholin’s Gland or the Skeene’s Gland
➢ Clap o When this abscess goes up, it gives rise
➢ Microorganism resembles hands clapping to ENDOCERVICITIS or
together ENDOMETRITIS
➢ Strain ➢ Hypogastric Pain
➢ Gleet o Due to presence of endocervicitis or
➢ Jack endometritis
➢ GC ➢ Important Concept!
➢ Morning Drop o Either of Endocervicitis or Endometritis
Causative Agent could give rise to Pelvic Inflammatory
➢ Neisseria gonorrhea Disease
Mode of Transmission o Pelvic Inflammatory Disease
➢ Sexual contact ▪ A systemic disease characterized
➢ Important Concepts! by:
o Most of the time, MALES are infected • Fever
▪ Urethra are affected leading to • Severe abdominal pain
urethritis • Nausea and Vomiting
➢ Females can also be infected • This is secondary to
o Cervix is affected gonococcal infections
o Signs and symptoms develop at a later ➢ Sterility and Ectopic Pregnancy
stage o If gonorrhea persists, it causes a
Manifestations of Gonorrhea narrowing of the Fallopian Tube
➢ Gonococcal Septicemia
In males: o Occurs when gonorrhea is already
➢ Burning pain, burning sensation upon urination systemic
o Due to redness and edema of urinary o Signs and symptoms would include:
meatus brought about by acidic urine ▪ Presence of Gonococcal Rashes
➢ Prostatitis ▪ Papular
o Abscess formation on the prostate gland • Elevated Rashes
➢ Purulent Discharges ▪ Pustular
o Mostly abundant in the morning • With pus
➢ If gonorrhea is persistent, a scar develops on the ▪ May be necrotic gonococcal
EPIDIDYMIS rashes
o Scar obstructs the flow of the sperm cells ➢ Polyarthritis develops
➢ Sterility ➢ Tenosynovitis
o Due to obstruction of sperm cell flow o Tendons and synovium are affected
➢ Important Concept!
In females: o Effect of disease to child of mother with
➢ Burning sensation upon urination if urinary meatus gonorrhea:
is involved ▪ Opthalmic neonatorum
o Urinary meatus is seldom involved in o Management:
gonorrhea. ▪ Give CREEDE’S PROPHYLAXIS
o Cervix is usually the one that is affected to prevent blindness in the
➢ Presence or absence of purulent discharges newborn
Diagnostic Tests for Gonorrhea
Important Concept!

1. Culture and Sensitivity
➢ Collect urethral discharges
➢ Done by scraping mucosa of the urethra
2. Papanicolau’s Smear or Vaginal Smear
➢ For females
Medical Management of Gonorrhea
1. Anti-biotics
➢ Drug of Choice
o Penicillin
o Benzathine Pen G (Penadur)
o Given also to Rheumatic Heart Disease
patients
➢ Important Concepts!!!
o Penicillin G is NEVER GIVEN PER I.V.
o For I.M. use only
o Rationale:
▪ If given per I.V., it will KILL THE
PATIENT!!!!
▪ It is oil based
▪ It forms into an EMBOLUS that
would kill the patient
o When given per I.M.
▪ Use big gauge needle
▪ Gauge 16 – 18
▪ This drug easily coagulates
▪ This drug easily clots
▪ Therefore, administer this drug
QUICKLY
▪ Dilute with one (1) cc of
LIDOCAINE
▪ One cubic centiliter (1cc) of
Lidocaine plus four (4) cubic
centiliters of Plain Normal Saline
Solution is used to provide less
pain
o Rationale:
▪ Due to the incorporation of an
anesthetic in the form of
Lidocaine
➢ Key Concept!
o If the patient is
▪ Pregnant
▪ Sensitive to Penicillin
o Administer SPECTINOMYCIN instead!!!
➢ Key Concept!
Page 17 of 56
o If patient with gonorrhea has chlamydial
infection or vice versa (Gonorrhea and
Chlamydia are TWIN SISTERS)
▪ Do not give Penicillin
▪ Do not give Spectinomycin
o Administer DOXYCYCLINE instead!!!
Nursing Care for Patients with Gonorrhea
➢ Gonorrhea patients are not confined
➢ They are treated on an outpatient basis
1. Psychological Aspect of Care
➢ STD patients have low self-esteem
2. Health Education and Patient Teaching
➢ To prevent recurrence of infection
Preventive Measures
➢ Safe Sex
➢ According to the Center for Disease Control, “safe
sex” means:
o No sex
o Mutual monogamous relationship
o Mutual masturbation without direct
contact
▪ Holding of body parts but no sex
➢ Important Concepts!
o Condom is not an example of safe sex
o Condom use is not 100% guaranteed in
preventing infection
o Best way to prevent spread of infection is
through BEHAVIOR MODIFICATION
o Also called LOW-RISK Behavior
SYPHILIS
➢ Also called:
o Pox
o Lues
o Sy
o Bad Blood Disease
Causative Agent
➢ Treponema pallidum
Mode of Transmission
➢ Sexual Contact
➢ May be transmitted vertically
o May pass placental barrier after sixteenth
(16th) week of pregnancy
➢ Rarely transmitted thorough Blood Transfusion
Manifestations of Syphilis
 Page 18 of 56

Three (3) Stages ▪ A transition period of one (1) to

Primary Stage of Syphilis two (2) years.
Patient exhibits: Tertiary Stage of Syphilis
➢ Chancre Patient exhibits:
o Characteristic lesion ➢ Gummatous Lesions or Gumma
o Painless popular lesions that heal o Characteristic lesion
spontaneously without treatment o Lesions that are found on deeper tissues
o Found on the: and organs of the body
▪ Genitals o Some are in the form of infiltrating tumors
▪ Face ➢ Other organs of the body are also affected
▪ Lips o Most affected is the HEART
▪ Tongue o This gives rise to CARDIOVASCULAR
▪ Under the breasts SYPHILIS
▪ On fingers ➢ Neurosyphilis
o If without treatment, chancre disappears, o Central Nervous System affectation
it will signal the start of the Secondary o Neurologic symptoms are present
Stage ▪ Lack of Balance
Secondary Stage of Syphilis ▪ Dementia
Patient exhibits:
➢ Flu-like symptoms Diagnostic Tests for Syphilis
o Sore throat
o Headache 1.5) Culture and Sensitivity
o Fever ➢ Done by mucosal scraping
➢ Several forms of dermatitis 1. Dark Field Microscopy
o Rashes (Kulugo) 3. Blood Examination
▪ All over the body 3.1) FTA-ABS
o Presence of dry, hard wart-like lesions ➢ Fluorescent Treponema Antibody Absorption Test
➢ Condylomalata o This is the confirmatory test for syphilis
o Infectious lesions that are fused together 3.2) VDRL
o Found under the breast and on the ➢ Venereal Disease Research Laboratory
genitals o This is not a definitive test
o Highly infectious lesions 3.3) RPR
➢ Key Concept! ➢ Reactive Plasma Reagent
o Secondary Stage is highly infectious o Non-definitive test for syphilis
o Also called Infectious Stage
➢ Changes in hair growth Medical Management of Syphilis
o Patchy Alopecia all over
o Patient has MOTH-EATEN 1.6) Anti-biotics
APPEARANCE ➢ Drug of Choice
➢ Affects growth of pubic hair o Penicillin
o Thinning of pubic hair ➢ If patient is sensitive to Penicillin
o Management: o Administer a Cephalosporin instead
▪ Patient uses aloe vera o Choice of Cephalosporin
▪ Patient uses Mane and Tail ▪ Ceptriaxone or Rocephin
➢ Key Concept!!! ▪ Given per I.M. or per I.V.
o Before the Tertiary Stage of Syphilis o Different diluents are used:
occurs, the patient becomes o When given I.V.
ASYMPTOMATIC ▪ Diluent used is Sterile Water
o This may be called the LATENT PHASE o When given I.M.
▪ Diluent used is Xylocaine

➢ Important Concepts!!!
o Do NOT INTERCHANGE diluents!
o If I.M. preparation is given via I.V.
▪ Patient dies due to dysrhythmias
o If I.V. preparation is given via I.M.
▪ Viscous medication would give
rise to pain upon administration
Nursing Management in Syphilis
➢ Same as in gonorrhea
Preventive Management of Syphilis
➢ Same as in gonorrhea
Important Concepts!!!
➢ Effect of syphilis to child whose mother developed
syphilis during pregnancy:
o Still Birth (baby dies)
o Syphilitic Baby
▪ Placenta is bigger than the baby
▪ Baby resembles the appearance
of an old man
▪ Baby has linear scars at angles of
the mouth
▪ Baby has persistent vesicular
eruptions or blisters
▪ Baby has nasal discharges
➢ Mother may NOT give birth to a child with syphilis
but may give birth to a child with LATE SYPHILIS
o Two (2) years after birth, the child will
manifest:
▪ Hutchinson’s Teeth
• Saw-like teeth
▪ Anterior Bowing of the Tibia
• Fractured Tibia
• Backward Tibial growth
▪ Saddle nose with high palate
▪ Deafness
▪ Persistence of dactylitis
o If child with Late Syphilis is not given
prophylaxis upon adolescence
▪ Child develops neurosyphilis
▪ Child will eventually die
➢ Mother may NOT give birth to a child with syphilis
o Child may be born NORMAL
o Child may be ALIVE and NORMAL
o But wait for two (2) years to really declare
that child is normal
Important Concepts!!!
➢ If you are pregnant, do not be infected with syphilis
Page 19 of 56
➢ Do not get infected with syphilis, particularly in the
third (3rd) trimester of pregnancy.
➢ The nearer you give birth to a child, the greater is
the chance that the child would develop congenital
anomalies
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
Important Concept!!!
➢ Acquired Immune Deficiency Syndrome (AIDS) is
DIFFERENT from HIV Infection
HIV Infection
➢ Means that you are infected with the virus
➢ Initial stage of AIDS
AIDS
➢ Means that you are infected
➢ You manifest a group of signs and symptoms
➢ With decreased or weakened immune system
➢ This is the end-stage of HIV infection
Key Concepts!
➢ All patients with HIV infection will develop into
AIDS
➢ All AIDS patients have passed through the HIV
stage
Causative Agent
Human Immuno-Deficiency Virus
➢ A Retrovirus
➢ A very fragile virus
➢ Can easily be destroyed by:
o Seventy percent (70%) alcohol
o A temperature of fifty-six degrees Celsius
(56°C)
o Chlorine
▪ Therefore, AIDS cannot be
acquired through the swimming
pool
o By Ordinary House Bleaching Soap with
Sodium Hypochlorite
▪ Zonrox
▪ Chlorox
▪ Purex
▪ Domex
▪ Proportion of bleaching soap to
water is 1:10
➢ Important Concepts!
o If virus leaves the body of an individual
infected with AIDS (i.e. through the
semen), the virus will survive for only four
(4) hours
 Page 20 of 56

o If it does not penetrate another person, o If child is still positive for HIV testing after
the virus WILL DIE eighteen (18) months, then the child is
o But if the virus goes out with blood, the REALLY INFECTED!!!
VIRUS WILL REMAIN ALIVE, as long as
the BLOOD IS FRESH!!! NORMAL IMMUNE RESPONSE
o Once a person dies with AIDS, the virus
remains in the body of the individual, as Microorganism
long as, the body is HUMID ▼▼▼
o Therefore, the body of an AIDS victim Detected by the Macrophages
should be cremated within twenty-four ▼▼▼
hours after death or sealed in a metal Macrophages will alert T cells
coffin, also within twenty-four (24) hours ▼▼▼
from death. Alerted T cells reproduce and multiply
o The body of an AIDS victim COULD NOT ▼▼▼
BE EMBALMED T cells stimulate the B cells
▪ The virus will INFECT THE ▼▼▼
EMBALMERS B cells reproduce and multiply
▼▼▼
Modes of Transmission B cells release the antibody
▼▼▼
Blood Transfusion per Single Exposure Antibody produced attacks the invading microorganism
➢ Single Blood Transfusion ▼▼▼
o Provides 90% chance of infection Antigen-Antibody reaction occurs
Sexual Contact ▼▼▼
➢ Pandemically, the number one mode of Manifestation of Disease will be present
transmission
o Single exposure gives 0.1% to 1.0% Important Concept!
chance of infection ➢ In HIV Infection, there is an alteration in the
o However, due to repeated sexual NORMAL Immune Response
encounters, chance of infection increases
Contaminated Sharps and Needles HIV (Retrovirus)
➢ Single exposure gives 0.1% to 0.5% chance of Has special affinity for T cells
infection ▼▼▼
Vertical Transmission Retrovirus is NOT DETECTED by the Macrophages
➢ From the infected mother to the unborn fetus ▼▼▼
o Gives 30% chance of infection Macrophages will NOT BE ABLE TO ALERT the T cells
Important Concepts!!! ▼▼▼
➢ If a child is born to a mother who is HIV positive, Retrovirus ENTERS the T cell
the child would ALWAYS have a POSITIVE ▼▼▼
RESULT for HIV TESTING Retrovirus releases the enzyme
o HIV testing identifies the presence of REVERSE TRANSCRIPTASE
antibodies in the blood This resembles the genetic make-up of the T cell
➢ Child possesses maternal antibodies ▼▼▼
o Therefore, child is positive for HIV but T cell does not destroy the virus
may this may not mean the child is ▼▼▼
infected T cell BECOMES a PRO-VIRUS
➢ Child is given up to eighteen (18) months for HIV ▼▼▼
testing Virus multiplies within the T cell
o After eighteen (18) months, child must be ▼▼▼
negative for HIV testing T cell is DAMAGED
 Page 21 of 56

▼▼▼ ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

Virus will retrovert before leaving the T cell ▼▼▼
▼▼▼ ▼▼▼
Virus leaves T cell ▼▼▼ Months to years
▼▼▼ ▼▼▼
Virus attacks another T cell ▼▼▼
▼▼▼ DEATH occurs
Net effect: No T cells will be present to stimulate the B
cells Important Concepts!
▼▼▼ AIDS Related Complex Symptoms include the following:
No B cell stimulation ➢ Fever with night sweats without a cause
▼▼▼ o All laboratory works are negative
No antibody production ➢ Enlargement of lymph nodes without a cause
▼▼▼ o All laboratory works are negative
No antigen-antibody reaction occurs ➢ Fatigability
▼▼▼ ➢ Weight Loss
Person is infected but remains asymptomatic ➢ Altered Sleeping Patterns
➢ Temporary Memory Loss
Important Concept! ➢ Altered Gait
➢ During the HIV infection, the macrophages
CANNOT IDENTIFY the HIV Manifestations of AIDS
➢ As the body takes more time to develop antibodies ➢ For adults
to the HIV, the person BECOMES INFECTED but o Two (2) major symptoms
REMAINS ASYMPTOMATIC o One (1) minor symptom
➢ For Children
A WELL-WORRIED INDIVIDUAL o Two (2) major symptoms
▼▼▼ o Two (2) minor symptoms
▼▼▼ Major Symptoms
▼▼▼ ➢ Fever: One (1) month and above in duration and
Infected with HIV but is ASYMPTOMATIC is recurrent
▼▼▼ ➢ Diarrhea: One (1) month and above
▼▼▼ ➢ Ten percent (10%) weight loss
▼▼▼ After six (6) weeks to six (6) o Staunted growth in children
▼▼▼ months (called the WINDOW Minor Symptoms
▼▼▼ PERIOD or the time interval ➢ Persistent generalized lymphadenopathy
▼▼▼ between the infection of the ➢ Generalized pruritic dermatitis
▼▼▼ individual to the production of ➢ Persistent cough: One (1) month and above
▼▼▼ the antibodies), where the ➢ Oropharyngeal Candidiasis
▼▼▼ body produces antibodies ➢ Recurrent Herpes Zoster
▼▼▼ ➢ Progressive Disseminated Herpes Simplex
▼▼▼ ➢ Continually multiplying and continually growing
▼▼▼ mouth sores
▼▼▼ Important Concepts!
( + ) for HIV infection ➢ False-Negative Result for AIDS
With AID Related Complex (ARC) Symptoms o No antibodies are identified but patient is
▼▼▼ already infected
▼▼▼ o This occurs during the WINDOW PERIOD
▼▼▼ Months to years ➢ The person who undergoes HIV testing undergoes
▼▼▼ counseling
▼▼▼

o This person should not engage in any of
the modes of transmission of AIDS before
the window period ends
➢ The ACTIVE PARTNER
o Considered the GIVER
o Has less chances of becoming infected
➢ The PASSIVE PARTNER
o Considered the RECEIVER
o Has greater chances of being infected
➢ AGAIN, DO NOT ENGAGE in any of the modes of
transmission of AIDS DURING the WINDOW
PERIOD!!!
Important Concepts!!!
➢ If an adult manifests the following:
o Two (2) major symptoms
o One (1) minor symptom
o Then, that adult is AIDS BONAFIDE
➢ If a child manifests the following:
o Two (2) major symptoms
o Two (2) minor symptoms
o Then, that child is AIDS BONAFIDE
Key Concepts!
➢ When a person has AIDS, all microorganisms
entering his body gives rise to infections
➢ These are called OPPORTUNISTIC INFECTIONS
➢ In the Philippines, the Number One Opportunistic
Infection is TUBERCULOSIS
Important Concepts!!!
➢ Cancers Associated with AIDS
o Caposi Sarcoma
▪ A malignancy of blood vessel wall
or the vascular endothelium
▪ Manifested through the skin
▪ With pink or purple, painless
spots on the skin
▪ Gives rise to a “LEOPARD-
LOOK”
o Non-Hodgkin’s Disease
▪ Cancer of the lymph nodes
Diagnostic Tests for AIDS
1. ELISA
➢ Enzyme-Linked Immunosorbent Assay
o This is only a SCREENING TEST for
AIDS
2. PCR Test
➢ Polymerase Chain Reaction Test
o Likewise, a SCREENING TEST for AIDS
o Relatively expensive
Page 22 of 56
o Costs approximately Php5,000 to
Php7,000 per test
o Results are known within two (2) to three
(3) hours
Important Concept!
➢ If a person
o Has been twice positive for ELISA and;
o Has been positive once for PCR
➢ Then confirm the results by doing the next test…
3. Western Blot
If a person is diagnosed with HIV
➢ Tests continue
➢ Monitor the following:
o 3.1) Viral Load
o Monitors replicating activity of the virus
o Negative ( - ) Viral Load
▪ Means virus is not actively
multiplying but is still present
o 3.2) CD4 and T cell Count
o Establishes STAGE OF INFECTION,
whether it is HIV or AIDS
▪ Indicates HIV infection
• If greater than or equal to
200
▪ Indicates AIDS
• If less than 200
Medical Management for AIDS
➢ Symptomatic management as virus is the
causative agent
➢ Latest Trend in Pharmacologic Management of
AIDS
o COCKTAIL DRUGS
▪ Patient must take medication
composed of at least twenty-one
(21) tablets per day
▪ Patient spends approximately
Php1,000 per day on drugs
▪ Prevents multiplication of the
virus but DOES NOT KILL THE
VIRUS
1.Nucleoside Reverse Transcriptase Inhibitors
➢ NRTIs
o AZT Azidothymidine
▪ Retrovir
▪ Zidovudine
o ddc
▪ Dideoxycitidine
▪ Zalcitadine
o ddI
▪ Dideoxyinosine
 Page 23 of 56

▪ Didanosine COMMUNICABLE DISEASES OF THE CENTRAL

• Tastes sour NERVOUS SYSTEM
• Give together with fruit
juice Bacterial infections
o Lamivudine ➢ Tetanus
o Stavudine ➢ Meningitis
Viral Infections
2.Non-nucleoside Reverse Transcriptase Inhibitors ➢ Encephalitis
➢ Non-NRTIs ➢ Poliomyelitis
o Delavirdine ➢ Rabies
o Nevirapine
TETANUS
3. Protease Inhibitors ➢ Also called LOCKJAW
➢ PIs ➢ With painful muscular spasms
o Saquinavir ➢ Ten times more painful than leg cramps
o Indinavir
o Pitonavir ➢ Clostridium tetani
o Delfinavir o Causative agent of Tetanus
o Anaerobic microorganism
o Abundant in soil, dust, clothing
Important Concept! o It exists in the form of a SPORE outside
➢ All the above-mentioned drugs inhibit the human body
multiplication of the virus but DOES NOT KILL o That is why it survives outside the human
THE VIRUS body even in the presence of oxygen
o Sterilization is needed to kill the
Nursing Care for AIDS microorganism
➢ Symptomatic as causative agent is a virus
➢ Psychological Care Important Concepts:
➢ Promotion of Homeostasis ➢ When inside the human being, the spore
transforms into a VEGETATIVE FORM, which can
Important Concept! be destroyed by the presence of oxygen
➢ Role of the Nurse in AIDS ➢ Why is Clostridium tetani abundant in soil?
o A counselor o Normal habitat of C. tetani is in the
intestines of herbivorous animals (i.e.
Preventive Measures cows, carabaos, goats, sheep, horses)
➢ A for Abstinence o Manure of these animals is used as
➢ B for Be Truthful fertilizer
➢ C for Condom use ➢ Mode of Transmission of C. tetani
➢ D for Do not use Drugs o Break in skin integrity
➢ Person is at risk for infection when there is any
Important Concept! kind of would (i.e. splinter or salubsob, tooth
➢ Virus can be found on all body fluids but will not decay, otitis media)
be enough to cause infections
➢ Example: Important Concepts!
o Six (6) to eight (8) gallons of saliva are ➢ You need not be wounded by a RUSTY OBJECT
needed to transmit HIV to acquire tetanus
➢ In the newborn, tetanus neonatorum is caused by
poor cord care.
➢ When C. tetani enters the body, it seldom migrates
to the bloodstream where oxygen is present

➢ C. tetani remains in the wound but the effects are
systemic
IMPORTANT CONCEPT!
➢ Toxin is released to the blood and is responsible
for the manifesting signs and symptoms of the
disease
Two (2) Types of Toxins in Tetanus
1. Tetanolysin
➢ Dissolves red blood cells
➢ Results to anemia
➢ Thus, patient is pale-looking
2. Tetanospasmin
➢ Causes muscle spasm
➢ Acts on MYONEURAL JUNCTION of the muscles
and on the INTERNUNCIAL FIBERS of the spinal
cord and the brain.
➢ Results into multiple muscle spasms
➢ Inhibits the spastic muscle from sending
transmissions to the brain, which would inhibit
progression of spasms. Due to this, adjacent
muscles will also undergo spasm similar to a chain
reaction or a domino reaction.
In the wound, there would be an inflammatory
response:
➢ Rubor - rednes
➢ Calor - heat
➢ Tumor - swelling
➢ Dolor - pain
➢ Functiolaesa – loss of function
Signs and Symptoms of Tetanus
➢ The patient manifests:
o Restlessness
o Fever
o Profuse Sweating
IMPORTANT CONCEPTS!!!
➢ Masseter muscle is involved
o It functions for mastication, for opening
and closing of the mouth
o Tetanus affects strong muscles
o Therefore, it affects the closing of the
mouth muscle
o This is called LOCKJAW or TRISMUS
➢ Facial muscle is affected
o Gives rise to “risus sardonicus”
Page 24 of 56
o Known as the “Sardonic Smile”
o Also known as “Ngiting Aso”
o Patient is smiling but his eyebrows are
raised.
➢ Spinal muscle is affected
o Resulting into the Ophistotonus position
o This is the arching of the back
o In the vernacular, it is called “LIAD”
➢ Respiratory muscles are affected
o Results to difficulty of breathing, dyspnea
and chest heaviness
➢ Genitourinary tract muscles are affected
o Results into urinary retention
o Intervention would involve catheterization
➢ Gastrointestinal muscles are affected
o Resulting into constipation
➢ Abdominal muscles are affected
o Results into abdominal rigidity
o Abdomen is hard as a board
o This sign serves as a basis for recovery
o If abdominal rigidity decreases, it means
that the patient is on his way to recovery
➢ Extremity muscles are affected
o Results into stiffness of extremities
o There is difficulty in flexing
o Robot gait is evident
Concept!
➢ Thus, almost all of the muscles are rigid and stiff
in Tetanus!
Diagnostics for Tetanus:
1. Clinical Observation
➢ Assess patient physically
➢ Assess for the presence of lockjaw
➢ If this is positive, a logical question would be – “Do
you have a wound”
2. Obtain history of wound
➢ Wound Culture
➢ If there is a fresh wound, microorganism is still
present there
Concept:
➢ The shorter the incubation period, the poorer the
prognosis
➢ Shortest incubation period is 2 – 3 days.
➢ An incubation period of one month has a better
prognosis than an incubation period of 2 – 3 days.
 Page 25 of 56

3. Prevent and Control Spasm

Three (3) Objectives of Medical Management ➢ Give muscle relaxant
o Given during the acute phase of tetanus
Neutralize the toxin o Done via the I.V. route
➢ This is the top priority ➢ Give Diazepam / Valium
➢ The toxin is responsible for the signs and o Use I.V. push or I.V. drip
symptoms of the disease and the systemic Concepts:
infection ➢ I.V. drip regulation is titrated based on the
➢ Give anti-tetanus serum or tetanus anti-toxin frequency of the spasm.
o It comes from a horse serum o The more frequent the spasm, the faster
o Do skin testing first the rate of the titration
o If (+) for skin testing, DO NOT GIVE the
drug. ➢ When the patient is on his way to recovery, muscle
▪ Resort to human serum – tetanus relaxants per orem may be used:
immunoglobulin o Methocarbamol or Robaxin
Concept: o Lionesal or Baclofen
➢ In the Philippine setting, the horse serum is still o Eperison or Myonal
given despite a positive skin test.
➢ This is done by giving fractional doses. Proceed with other supportive management
➢ Example: ➢ For urinary retention, do catheterization
o Initial administration of 0.01 of drug and ➢ For constipation, administer laxatives as ordered
0.99 PNSS Nursing Management in tetanus
o After 30 minutes, 0.05 of the drug and ➢ Muscle spasms are the first concern
0.95 of PNSS Concept:
o After another 30 minutes, another ➢ Stimuli trigger spasms.
increase in the dose of the drug Types of Stimuli:

IMPORTANT CONCEPT!!! 1. Exteroceptive

➢ When administering tetanus horse serum, always ➢ Comes from outside environment of the patient
have ready the following: ➢ Examples are bright light and noise
o EPINEPHRINE ➢ Place the patient in dim and quiet environment
o CORTICOSTEROID 2. Interoceptive
➢ These would be necessary to counteract any ➢ Comes from inside or within the patient
delayed reaction, which may cause ➢ Examples are stress, pain, coughing, passage of
hypersensitivity reactions leading to anaphylaxis flatus
and eventually the death of the patient. 3. Proprioceptive
2. Kill the Microorganism ➢ There is participation of patient and other persons
➢ Give Penicillin ➢ Examples are touching, turning, jarring the bed of
o This is the drug of choice to kill the the patient
bacteria Nursing Care in Tetanus
➢ In the fresh wound, do daily cleansing with the use ➢ Done to prevent patient from having spasms
of hydrogen peroxide ➢ Place the patient in a dim and quiet environment
➢ Then apply antiseptic solution like Betadine or ➢ Practice minimal handling of the patient
Povidone o Avoid unnecessary disturbance of the
➢ Then cover wound with THIN DRESSING to allow patient
air to circulate through the wound. ➢ Practice Cluster Care
➢ It may also be good to expose the wound but avoid o Do all nursing care activities in one setting
contact with flies. o Do other nursing care activities with vital
signs taking
➢ Gentle handling of the patient
 Page 26 of 56

➢ Touching is not contraindicated o 1st Dose:6 weeks after birth; 0.5 ml

➢ Turning is not contraindicated o 2nd Dose:10 weeks after birth; 0.5 ml
o However, do these as gently as possible o 3rd Dose:14 weeks after birth; 0.5 ml
o Inform the patient before proceeding with ➢ Number of Doses:
any procedure o Three (3)
➢ Concept: ➢ Interval between Doses:
o Tetanus patients are isolated so as not to o Four (4) weeks
be exposed to stimuli ➢ Administration Site:
o Vastus lateralis muscle
Prevent injury: ➢ Route:
Respiratory injury o Intramuscular
➢ Airway obstruction
➢ Tongue could be drawn back and cause blockage IMPORTANT CONCEPTS!!!
or obstruction ➢ Expect fever to set in after administration of DPT
➢ Use padded tongue depressor for retaining vaccine
patency of the airway o Give paracetamol
Respiratory Infection o Apply warm compress for better drug
➢ Turning to side is usually not done absorption
o This results to pooling of respiratory o Immediately follow up with cold compress
secretions in the lungs to avoid soreness
o This leads to pulmonary infection ➢ If tenderness or swelling on site of injection is
➢ Profuse sweating and draft exposure also leads to present:
pulmonary infection o Do cold compress within twenty-four (24)
➢ Therefore, always keep patient dry; especially at hours
the back. o Then do warm compress
➢ Observe for signs of convulsions within seven (7)
Physical Injury days after DPT immunization
➢ For falls: o This indicates that child has reaction with
o Never leave the patient alone the pertussis component of the drug
o If you do leave the patient, keep the o Therefore, succeeding doses of DPT will
padded side rails up NOT BE GIVEN
o Keep call light within the reach of the o Give ONLY the DT components
patient o If DPT is given again, this predisposes the
➢ Fractures due to spasm: child to neurologic disorders
o Caused by restraining by relatives ➢ Observe if child cries uncontrollably
▪ This is an indication of
Provide Patient with Comfort Measures development of neurologic
➢ Oral care disorders.
o To prevent mouth sores
o Cotton swab used on inner and outer DPT Immunization for Pregnant Individuals
chick ➢ Dose: 0.5 ml
o Do not use toothbrush ➢ Route: Intramuscular
➢ Number of Doses given:
IMPORTANT CONCEPT!!! o Two (2) doses with three (3) booster
➢ Attack of tetanus does not give permanent doses or;
immunity o Two (2) doses with booster dose given
every pregnancy
Vaccine Given: ➢ When given:
Diphtheria Pertussis Tetanus Vaccine or DPT vaccine o 1st Dose: Anytime during second
➢ When given: trimester of pregnancy
 Page 27 of 56

o 2nd Dose: With one (1) month o Pia mater

interval ➢ Cerebrospinal Fluid or CSF is found in the
o Booster Dose: Given with successive SUBARACHNOID SPACE
pregnancy/ies
Causative Agents in Meningitis
For High-Risk Individual ➢ Viral
➢ 1st Dose given: o CMV – Cytomegalovirus
o 03-05-2005 ▪ Opportunistic infection for AIDS
➢ 2nd Dose given: ➢ Fungal
o 04-05-2005 o Cryptococcal Meningitis
➢ 3rd Dose given: ▪ Source is excreta of fowls and
o 10-05-2005 (six months after the LAST feathered animals
dose) ▪ Another form of opportunistic
➢ 4th Dose given: infection for AIDS
o 10-05-2006 (After one (1) year from the ➢ Bacterial
LAST dose) o Tubercle Bacilli
➢ 5 Dose given:
th ▪ TB meningitis
o 10-05-2007 (After one (1) year from the ➢ Staphylococcal meningitis
LAST dose) o Secondary to skin infection
➢ Hemophilus influenzae bacilli
IMPORTANT CONCEPTS!!! o Common cause of meningitis in the
➢ Succeeding doses of Tetanus Toxoid are given United States
based on DATE OF LAST DOSE ➢ Meningococcemia
➢ If a person is high-risk, give booster dose every o Meningococcemia meningitis
five (5) years o Spotted Fever Disease
➢ If a person is low risk, give booster dose every ten o Most fatal
(10) years o The only type of meningitis where the
➢ Effect of Tetanus Toxoid administration on the VASCULAR SYSTEM is affected
mother o Bleeding is triggered
➢ Slight soreness or heaviness on site of injection o Disseminated Intravascular Coagulation
occurs and leads to vascular collapse
Wound Care o Vascular collapse leads to death in ten
➢ Wash wound with soap and running water percent (10%) of patients
➢ Place antiseptic solution on wound o This ten percent (10%) has the
➢ Use thin dressing FULMINANT TYPE or the Waterhouse-
➢ Band Aid Plastic Strips are allowable as they have Friedrichsen Syndrome (characterized by
air ventilation holes vascular collapse)
➢ Do not use plaster o Causative agent is Neisseria meningitides
➢ Use only those types of plasters with air ventilation
holes to introduce oxygen to the wound Important Concept!
Key Concept!!! ➢ In children below four (4) years old, Neisseria
➢ Avoid Wounds meningitidis is a normal flora in the nasopharynx.
➢ If resistance goes down, these children become
MENINGITIS prone to infection
➢ Inflammation of the meninges (covering of the Mode of Transmission
brain and spinal cord) ➢ Droplet transmission
Concepts! ➢ In cryptococcal meningitis:
➢ Meninges are composed of: o Inhalation of spores
o Dura mater Portal of Entry
o Arachnoid mater ➢ Respiratory system via the nasopharynx

Pathophysiology of Meningitis
➢ From the nasopharynx, the microorganism goes to
the bloodstream
➢ Once in the bloodstream, the microorganism
causes petechiae formation (pinpoint red spots on
the skin)
➢ From the bloodstream, microorganism goes to the
meninges and irritates them
o There is inflammation of the meninges
and accumulation of substances in the
meninges
➢ This results into increased Intracranial Pressure
(ICP)
o Increased ICP leads to:
▪ Severe headache
▪ Projectile Vomiting
▪ Two (2) to three (3) feet away
from patient
o Management involves turning patient to
side
▪ Position kidney basin about two
(2) to three (3) feet away
➢ Altered Vital Signs
o Increased Temperature
o Decreased Pulse Rate
o Decreased Respiratory Rate
o Increase in Systolic Blood Pressure and
Normal Diastolic Pressure
▪ This results in the widening of the
Pulse Pressure
➢ Convulsions (seizures)
➢ Diplopia
o Due to choking of optic discs
o Double vision but not crossed eyed
o Determined by finger counting
➢ Altered level of consciousness
Pathophysiology of Meningococcemia
➢ Portal of entry of Neisseria meningitidis is also the
nasopharynx
➢ The bacteria then go to the bloodstream
➢ Presence of bacteria in the bloodstream causes
ecchymosis
o These ecchymoses are blotchy (pantal-
pantal) purpuric lesions
o They are purplish in color
o Usually found on the wrist and the ankles
➢ From the bloodstream, they go to the meninges
and irritate them.
Page 28 of 56
➢ Same sequence of events follows as mentioned
above
Signs and Symptoms of Meningitis
➢ Once the microorganism is at the nasopharynx:
o Fever
o Headache
o Sore throat
o Cough
o Colds
➢ Other signs and symptoms present as discussed
in the pathophysiology
Pathognomonic Sign of Meningitis
➢ Nuchal Rigidity
➢ Stiffening of the neck
o No flexing of the neck
o No hyperextending of the neck
o No turning from side to side
➢ Abnormal Reflexes
o Positive for Kernig’s Sign
▪ Place patient in supine position
▪ Flex both knees toward the
abdomen
▪ Then ask the patient to extend
the legs
▪ If pain is present, the patient is
said to be positive (+) for Kernig’s
Sign or difficulty of extending the
leg
➢ Positive for Brudzinski’s Sign
o Place the patient in supine position
o Flex the neck
o If there is no reaction, the patient is said
to be negative (-) for Brudzinski’s Sign.
o If there is INVOLUNTARY DRAWING UP
of the LEGS / HIP upon flexion of the
neck, the patient is said to be positive (+)
for Brudzinski’s Sign
Diagnostic Tests for Meningitis
1. Lumbar Puncture
➢ Cerebrospinal Fluid (CSF) is the specimen used
o Assess for the color of the CSF
➢ Bacterial infection is present if:
o CSF is yellowish, turbid, cloudy
➢ Viral infection is present if:
o CSF is clear
 Page 29 of 56

➢ No infection is present if: ➢ If with excess CSF

o CSF is clear o Give osmotic diuretic in the form of
Send CSF for Laboratory Examination MANNITOL
➢ Laboratory findings would show: o Check blood pressure before
o Increased protein levels administration as it causes hypotension
o Increased White Blood Cell levels o Monitor the intake and output to evaluate
o Decreased Sugar content the effectiveness of Mannitol
Concepts o Expect that after two (2) to three (3) hours,
➢ If caused by bacteria, do Culture and Sensitivity the urine output must increase by thirty
test (30) to fifty (50) ml.
o This is done to know what bacteria o If no changes in urine output occurs, then
caused the infection Mannitol is not effective
o This is also done to determine what drug o Refer this to the physician
will be used to kill the offending ➢ If there are convulsions due to CNS infection
microorganism o Give anti-convulsants
▪ Dilantin
➢ If CSF is clear, it is subjected to Counter Immuno- ▪ Phenytoin
Electrophoresis (CIE) ➢ Routes of Administration of Dilantin
➢ This is done to determine if causative agent or a o Per Intravenous
protozoa ▪ Nursing Care for I.V.
➢ IMPORTANT CONCEPT!!! administration of Dilantin
In patients with HIGHLY INCREASED • Sandwich Dilantin with
INTRACRANIAL PRESSURE due to CNS NSS
infection, lumbar puncture or aspiration of the CSF • NSS – Dilantin – NSS
is CONTRAINDICATED ▪ Rationale:
o This will bring about HERNIATION OF • Dilantin would crystallize
THE BRAIN and would eventually lead to o Per Orem
death ▪ Nursing Care for P.O.
➢ Therefore, it is important that the nurse performs administration of Dilantin
Physical Assessment before doing a lumbar tap. • Do frequent oral care
2. Blood Culture • Do gum massage
➢ Done because microorganism can travel to the o Rationale:
bloodstream ▪ Dilantin causes gingival
Medical Management of Meningitis hyperplasia or overgrowth of the
➢ If bacterial gums
o Give anti-bacterial agent in the form of
antibiotics Important Concept!
➢ If viral ➢ Dilantin is never given Intramuscularly
o Symptomatic o This is irritating to the tissues
➢ If fungal o This has an erratic effect
o Give Amphotericin B
➢ If with inflammation Nursing Care
o Give corticosteroids in the form of ➢ Symptomatic
DEXAMETHASONE ➢ Supportive
o Never give PREDNISONE
▪ Prednisone does not cross the Nursing Diagnoses
Blood-Brain barrier
▪ Prednisone causes sodium 1. Alteration in body temperature related to infection
retention ➢ Priority is to lower body temperature
▪ Retains CSF o Do TSB
 Page 30 of 56

o Provide cold compress o Difficult to awaken

o Provide loose clothing o Patient is abnormally sleepy
2. Pain: Alteration in comfort related to increased ➢ With behavioral changes
Intracranial Pressure ➢ Brain is immediately affected relative to meningitis
➢ Priority is to relieve headache within thirty (30)
minutes Diagnostic Tests
o Provide diversion 1. Lumbar Puncture
o Provide proper positioning ➢ Specimen is cerebrospinal fluid (CSF)
▪ Low-Fowler’s position (30° ➢ Laboratory Results would indicate:
incline) o Increased Proteins
o Provide comfort measures o Increased White Blood Cells
o Massage the forehead o Normal Sugar Content
o Do petrissage with circular action
3. Potential for injury related to altered level of 2. Electroencephalogram (EEG)
consciousness ➢ To assess extent of brain damage
➢ Never leave the patient alone ➢ Patient recovers but because he is epileptic, he
➢ Place call switch and light within reach of patient develops irreversible brain damage
4. Potential for fluid and electrolyte imbalance due to Medical Management
projectile vomiting ➢ Symptomatic due to viral cause
➢ Monitor intake and output Concepts!
➢ Provide fluids per orem ➢ No permanent immunity is obtained from attack of
Important Concept encephalitis, only temporary immunity, due to
➢ An attack of meningitis does not provide causation by various viruses
permanent immunity
➢ Source of infection is mosquito
BRAIN FEVER
➢ Arbovirus Preventive Management:
➢ Arthropod-borne Virus ➢ CLEAN PROGRAM
Primary cause o C – Chemically Treated Mosquito Net
➢ St. Louise o L – Lavivorous fishes
➢ Japan B o E – Environmental Sanitation
➢ Australian X: Equine (E-W) o A – Anti-mosquito Soap (Basic Soap)
Mode of Transmission o N – Neem Trees or Eucalyptus Tree
➢ Mosquito bites (draws away mosquitoes)
o Aedes Sollicitans Concepts!
o Culex tarsalis ➢ To kill mosquitoes in canal, pour oil or gas in canal
▪ Ticks of horse o This depletes oxygen present in the canal
▪ Migratory birds o There is no need to light it up
Secondary cause
➢ Post racene encephalitis POLIOMYELITIS
Toxic ➢ Also called:
➢ Metal poisoning o Infantile Paralysis
o Lead poisoning o Heine-Medin Disease
o Mercury poisoning ➢ Affects children below ten (10) years of age
➢ Less risk for people above ten (10) years Old
ENCEPHALITIS

Signs and Symptoms

➢ With altered level of consciousness
➢ With lethargy
 Page 31 of 56

Causative Agent ➢ But there will be instances when disease process

➢ Virus will not be aborted
o Legio debilitans
▪ Type 1 – Brunhilde Tonsils Peyer’s Patches
▪ Type 2 – Lansing ▼ ▼
▪ Type 3 – Leon Cervical Mesenteric
➢ If Brunhilde Lymph Lymph
o Gives permanent immunity Nodes Nodes
➢ If Lansing or Leon ▼▼▼ ▼▼▼
o Gives temporary immunity BLOODSTREAM
▼▼▼
Important Concepts! Central Nervous System
➢ When Brunhilde infects you, Leon or Lansing will
no longer affect you! 2nd Stage: Pre-paralytic Stage of Poliomyelitis
➢ Central Nervous System is already involved but
➢ In the Philippines, the most prominent type is there will be no paralysis
Brunhilde!
Mode of Transmission Signs and Symptoms:
➢ Droplet ➢ Once in the CNS, microorganism will cause:
o In early stage of infection, virus if found at o Sever muscle pain
nasopharyngeal secretions ▪ Do not keep on turning or holding
➢ Fecal-Oral Route patient
o In late stage of transmission, virus is ▪ Do not do massage
found at the mouth ▪ No positioning will relieve patient
o Instead, what would relieve the patient
Portal of Entry would be:
➢ Gastrointestinal Tract ▪ Application of warm packs
Pathophysiology ▪ Analgesics
➢ Legio debilitans goes to the nasopharynx or the o Never administer Morphine
mouth ▪ It is a narcotic analgesic that
➢ If in the nasopharynx, it goes to the tonsils and would cause respiratory
causes: depression
o Sore throat
o Fever and chills ➢ Once in the CNS, the microorganism will also
o Headache with body malaise cause:
➢ If at the mouth, it goes to the Peyer’s patches and o Stiffness of the hamstring
causes: o Patient will be positive for HOYNE’S Sign
o Abdominal pain and exhibit a HEAD DROP
o Anorexia o To check for Hoyne’s Sign
o Nausea and Vomiting ▪ Lift shoulders of patient when
o Diarrhea or Constipation lying supine or extend head of
patient beyond the edge of the
STAGES of POLIOMYELITIS bed
▪ If head of patient drops, he is said
1ST Stage: Invasive Stage or Abortive Stage to be positive (+) for Hoyne’s Sign
➢ All the abovementioned signs and symptoms will
appear ➢ Once in the microorganism is in the CNS, the
➢ Patient recovers patient would elicit a POKER SPINE
➢ Disease process is aborted o Opisthotonos with head retraction
o Sitting position cannot be assumed
 Page 32 of 56

o Therefore, patient will assume a TRIPOD

POSITION Diagnostic Tests
1. Lumbar Puncture
Central Nervous System ➢ Laboratory results would reveal:
▼▼▼ o Increased White Blood Cell levels
Paralysis o Increased Protein levels
Concept! o Normal Sugar levels
➢ From the CNS, the patient will experience 2. Muscle Testing
paralysis. ➢ To determine what specific muscle is affected
➢ This leads to the third (3rd) stage of the disease 3. Electromyelogram
3 Stage: Paralytic Stage
rd ➢ To determine extent of muscle involvement
➢ Presence of paralysis 4. Stool Examination
➢ Characteristics of Paralysis: ➢ Perfomed at the late stage
o Flaccid ➢ About ten (10) days after being affected
▪ Soft 5. Nasopharyngeal Examination
▪ Flabby ➢ Performed at the early stage
▪ Limp Medical Management
Important Concept! ➢ Symptomatic
➢ Flaccid Paralysis is PATHOGNOMONIC SIGN of ➢ Causative agent is viral
Poliomyelitis If there is respiratory paralysis
➢ Place patient in a MECHANICAL VENTILATOR
Three (3) Types of Paralysis ➢ Use the IRON LUNG MACHING
o This works on the principle of Negative
1. Bulbar Type Pressure Breathing
➢ Cranial nerves are affected o No tracheostomy tube needed
➢ 9Th cranial nerve (Glossopharyngeal Nerve) and (tracheostomy tube or endotracheal tube
10th cranial nerve (Vagus Nerve) affectations give work on the principle of Positive Pressure
rise to: Breathing)
o Respiratory problems o Capsular in shape
o Vocal cord swelling / paralysis o With glass windows
o Excessive salivation o With metal plate
o Aspiration o Works on electricity
o Regurgitation o During brownout or power shortages,
2. Spinal Type operate the machine manually
➢ Most common type of paralysis o It has a steering wheel, which can be
➢ Affects ANTERIOR HORN CELLS manipulated manually
➢ Affects MOTOR FUNCTION o Patient stays in the Iron Lung Machine for
o Paralysis of extremities months
o Paralysis of intercostal muscles leads to
DIFFICULTY OF BREATHING Nursing Care for Poliomyelitis
➢ Symptomatic and Supportive
3. Bulbo-Spinal Type ➢ Psychological Aspect of Care
➢ Combination of Bulbar and Spinal types o Use empathy
➢ Patient has cranial nerve affectations and anterior
horn cell affectations Preventive Measures
1. Immunization
Important Concepts!!! ➢ Vaccine given:
Not all patients will develop paralysis o Oral Polio Vaccine (OPV) or Sabin
➢ If patient is non-paralytic,
o He has GOOD PROGNOSIS o Dose:
 Page 33 of 56

▪ Two (2) to three (3) drops ▪ 3rd Dose – at fourteen (14) weeks
o Route: old
▪ Oral o Rationale:
o Number of Doses: ▪ Because stool of child may
▪ Three (3) contain the virus if OPV is given
o Interval:
▪ Four (4) weeks 2. Avoid mode of transmission
o When given: ➢ Proper disposal of nasopharyngeal secretions
▪ 1st Dose – at six (6) weeks old ➢ Cover mouth when coughing
▪ 2nd Dose – at ten (10) weeks old ➢ Do not put anything through the mouth
▪ 3rd Dose – at fourteen (14) weeks
old RABIES
o Important Concepts!!! ➢ Also called:
▪ Do not feed child for thirty (30) o Hydrophobia
minutes after administration of o Lyssa
OPV o La Rage
o Rationale: ➢ A disease of a low form of animal
▪ For better absorption o Not a human infection
o If child vomits, REPEAT!!! o Only accidentally transmitted to man
o If child has diarrhea ➢ Occurs in canine animals or animals with fangs:
▪ Give OPV o Fox
▪ But do not record it o Wolves
▪ Not all of the vaccine may be o Boar
absorbed properly o Monkeys
▪ When OPV 3 is given four weeks o Bats
after, record it as OPV 2 o Cats
o Dogs
➢ Integrated Management of Childhood Illnesses
(IMCI) Causative Agent:
o Tell mother also that she should be very ➢ Rhabdovirus
careful in handling stool of child because o A neurotropic virus
this vaccine eliminates virus to the stool o Has special affinity to neurons and the
o If significant others at home are Central Nervous System
immunocompromised
o Do not administer OPV R H A B D O V I R U S
o Due to feces of child ▼▼▼ ▼▼▼
o Rather give, IPV or Inactivated Polio Peripheral Efferent
Vaccine / SALK Nerves Nerves
o Dose: ▼▼▼ ▼▼▼
▪ 0.5 cc CNS Salivary
o Route: Pathologic Gland
▪ Intramuscular Lesions of Rabid
o Number of Doses: (negri bodies) Animal
▪ Three (3)
o Interval:
▪ Four (4) weeks Important Concept!
o When given: ➢ Pathologic lesions that are formed as
▪ 1st Dose – at six (6) weeks old microorganism multiplies
▪ 2nd Dose – at ten (10) weeks old
 Page 34 of 56

➢ If there is no multiplication of the microorganisms incubation period recorded in the

at the Central Nervous System, there will be NO Philippines)
negri bodies. Stage 1 – Invasive Stage
Mode of Transmission ➢ Numbness on the site of the bite
➢ Contact with saliva of a rabid animal ➢ Itchiness on the site of the bite
➢ Flu-like symptoms
Important Concept! o Fever
➢ Therefore, you need not be bitten o Headache
➢ Even a scratch could cause rabies as animals lick o Sore throat
their paws ➢ Marked Insomnia
➢ Infection may occur through: ➢ Restless
o Corneal transplantation ➢ Irritable
o Kissing animal ➢ Apprehensive
o Dog licking wounds ➢ Slight photosensitivity
➢ Vague symptoms
Manifestation:
➢ In Animals Important Concept!
o Incubation Period ➢ When a family member at home is bitten by a rabid
▪ Three (3) to eight (8) weeks animal, vaccinate all people at home because
patient has virus at saliva
Stages of Manifestations in Animals
Stage 2 – Excitement Stage
Stage 1 – Dumb Stage ➢ Acrophobia
➢ Animal will have complete change in disposition o Fear of Air
➢ May show any of the following behaviors: ➢ Hydrophobia
o Withdrawn o Fear of Water
o Stays in one corner Important Concept!
o Depressed ➢ Air and Water both cause
o May be overly affectionate PHARYNGOLARYNGEAL SPASM
▪ Can lick wounds ➢ This is characterized by:
o May be walking to and from o A drowning sensation
o Hyperactive o Strangulation to death syndrome
o Manic o Like breathing in thick smoke
➢ It is better if the animal is withdrawn as it is easy ➢ Other signs and symptoms
to note o Photosensitivity
o Maniacal behavior
Stage 2 – Furious Stage o Resembles attitude of a rabid animal
➢ Easily agitated o Easily agitated
➢ Easily bites o Runs after people
➢ With vicious look o Violent
➢ With drooling of the saliva o Club walls
➢ Expect the animal to die o Jumps out of window
➢ Dying and biting happens on this stage Important Concepts!
➢ Animal can die without biting ➢ Before, THORAZINE and BENADRYL were given
for maniacal behavior but had proven to be
Manifestation: ineffective
➢ In Humans ➢ Now, HALOPERIDOL and BENADRYL are
o Incubation Period administered and are very effective against
▪ Ten (10) days to twenty one (21) maniacal behavior
years (this is the longest
 Page 35 of 56

Stage 3 – Paralytic Sage ▪ Submit yourself for treatment at

➢ Patient’s spasms will stop once if:
➢ He can be fed, etc., • You have multiple bites
➢ Paralysis sets in from toes going upwards • You have a deep bite
➢ If respiratory system is affected, the patient will die o Reason for the Bite
➢ Manifestation of signs and symptoms sets within ▪ If bite is provoked
24 hours and death follows ▪ Example:
Important Concept!!! • You stepped on the
➢ Rabies is a preventable but not a curable disease dog’s tail
➢ Maximum time before death occurs is seventy-two • Do not worry
(72) hours. ▪ If unprovoked
▪ Example:
Diagnostic Tests Done Before Patient Manifests Signs • There is no reason
and Symptoms • Then, WORRY, because
IT IS A RABID DOG!!!
Important Concept! Medical Management
➢ There is no diagnostic examination done to Post-Exposure Prophylaxis Vaccines
humans, ONLY TO ANIMALS
Brain Biopsy of the Animal Active Form of Vaccine
➢ Identifies presence of negri bodies ➢ Made up of microorganisms
➢ 10% of animals have rabies but are negative for ➢ Purified Vero Cell Vaccine
negri bodies o PVCV
o Because virus may travel through efferent o One of the more common types
nerves and may not have reached the o Verorab
CNS before death o Stock dose is 0.5 cc / vial
➢ Therefore, do the next test…
➢ Purified Duck Embryo Virus
Direct Fluorescent Antibody Test (DFA Test) o PDEV
➢ Confirmatory test for rabies o Lyssavac
Observation of the Animal o Stock dose is 1.0 cc / vial
➢ Done for ten (10) days
➢ Important Concept! ➢ Purified Chick Embryo Cell
o Submit yourself for treatment if, within ten o PCEC
(10) days: o Also one of the more common types
▪ Animal dies o Rabipur
▪ Animal shows behavioral o Stock dose is 1.0 cc / vial
changes
➢ Consider the following: Important Concepts!!!
o Site of Bite ➢ If given intramuscularly (I.M.)
▪ If above waist o Do skin testing first
• Submit yourself for ➢ If given intradermally (I.D.)
treatment as soon as o No skin testing is done
possible ➢ Site
• This is due to the o Deltoid
proximity of the bite to o Vastus lateralis
the brain Important Concepts!!!
o Velocity of Virus If active form of vaccine
▪ Three millimeters per hour If via I.M.
(3mm/hr) ➢ Schedule is:
o Extent of Bite Dose Day Example Dosage Remarks
 Page 36 of 56

1st 00 03/05/ 2 vials 1 cc on 3rd 07 3/12/ 0.1 cc if Given on

2005 each 2005 Verorab each
site; One or site:
on the 0.2 cc if Right
left and Lyssavac and Left
one on Or
the right Rabipur
2nd 07 3/12/ 1 vial One site 4th 28 04/01/ 0.1 cc if Given on
2005 only to 2005 Verorab one site
3rd 21 3/26/ 1 vial One site 30 to or only
2005 only 04/03/ 0.2 cc if
Important Concepts!!! 2005 Lyssavac
➢ Counting is ALWAYS BASED on the FIRST Or
DOSE!!! Rabipur
➢ You can afford not to continue vaccine if dog does 5th 90 06/03/ 0.1 cc if Given on
not die after ten (10) days 2005 Verorab one site
➢ However, continuance is encouraged because or only
doing so would give three (3) years of immunity 0.2 cc if
➢ If you abort vaccination, you will not get three (3) Lyssavac
years of immunity Or
➢ When you get bitten again, you start all over again Rabipur
➢ In case the dog: Important Concepts!!!
o Died ➢ Verorab
o Disappeared o Once reconstituted is only potent for eight
o Was killed within (3) days (8) hours
➢ Avail of complete doses plus a BOOSTER DOSE ➢ Antibodies are produced in about seven (7) days
o Booster Dose ➢ Therefore, also give passive form of vaccine.
▪ Given at DAY 91 Passive Forms
▪ In the tabulated example Temporary antibodies
• Schedule would be at
6/05/2005 Animal Serum
• Dosage is one vial ➢ Equine Rabies Immunoglobulin (ERIG)
o Anti-rabies serum
If via I.D. o HyperRab
➢ Schedule is: o FaviRab
Dose Day Example Dosage Remarks Important Concepts!
1st 00 03/05/ 0.1 cc if Given on ➢ Do skin test first
2005 Verorab each o If negative for skin test, give drug
or site: ▪ Dosage is based on body weight
0.2 cc if Right and is provided in direct
Lyssavac and Left proportion
Or ▪ 0.2 cc / kg body weight is the
Rabipur standard
2nd 03 3/08/ 0.1 cc if Given on ▪ Example:
2005 Verorab each • A 50 kg person would
or site: receive 10 ml of ERIG
0.2 cc if Right • Cost is approximately
Lyssavac and Left Php1,800 / 5.0 cc
Or o If positive for skin test, give HRIG or
Rabipur Human Rabies Immunolobulin
 Page 37 of 56

▪ Imogam ➢ Dengue Fever is different from Dengue

▪ Rabuman Hemorrhagic Fever!
▪ 0.133 cc / kg body weight is the ➢ Dengue fever is an affectation of the circulatory
standard dose system without bleeding
▪ Example: o It is a mild form of hemorrhagic fever
• A 50 kg person would Causative Agent:
receive 6.65 cc of HRIG ➢ Arbovirus
▪ Cost is approximately Php4,500 / ➢ Carried from one person to another by an
2.0 cc Arthropod
o This is given as a single dose within seven Types of Dengue Viruses
(7) days from the date of the bite ➢ Type 1 – Onyong-nyong virus
o After seven days, patient already has ➢ Type 2 – Chikungunya
antibodies ➢ Type 3 – West Nile
o Computed Dosage is divided in two ➢ Type 4 – Flavivirus
▪ Half is given Intramuscular o Brought epidemics in several areas in the
▪ On the ventrogluteal muscle or at Philippines
the side of the buttocks Mode of Transmission
o Other half is... ➢ Mosquito Bite
▪ Infiltrated around site of bite ➢ Biological Transmitters
using four distinct points or o Aedes aegypti
▪ Given inside the wound of the o Aedes albopectus
patient ➢ Mechanical Transmitter
o This is prophylactic and is not considered o Culex fatigans
as a treatment Biological Transmitter
➢ After this mosquito has bitten an infected person,
Nursing Care after eight (8) to ten (10) days, it can transfer virus
➢ Place patient in a dim and quiet environment to other people
➢ Keep patient away from sub-utility room ➢ Virus becomes a part of the system of the
➢ Restrain the patient before he exhibits maniacal mosquito as long as it is alive
behavior ➢ Life span of these types of mosquitoes is four (4)
➢ Wear all Personal Protective Equipment when you months
enter the room because patient continues to spit Mechanical Transmitter
Preventive Measures ➢ After this mosquito bites an infected person, the
➢ Be a responsible pet owner very next person it bites is the only person who
o Have pets immunized gets the virus.
➢ Wash wound with soap, water and antiseptic ➢ One is to one
➢ Then observe the dog ➢ Immediate transfer of virus
Important Concept!!! Aedes aegypti
➢ Virus rabies is destroyed by 60°C heat for thirty- ➢ More common in the Philippines
five (35) seconds ➢ Day-biting
➢ Therefore, you will not acquire rabies from eating ➢ Low-flying
dog meat ➢ Low-extremity biting
➢ Breeds on clear, stagnant water usually in urban
area
COMMUNICABLE DISEASES OF THE CIRCULATORY o Old tires
SYSTEM o Flower vases
o Plant cans
DENGUE HEMORRHAGIC FEVER ➢ In the Philippines, any area is a dengue risk area
Important Concept! ➢ Other information:
 Page 38 of 56

o When it lands on a surface, body of Important Concept!

mosquito is on a PARALLEL POSITION ➢ If patient recovers, he only has Dengue Fever
and two (2) legs are raised (and not Dengue Hemorrhagic Fever)
o It has white stripes on legs ➢ Dengue Fever is also called:
o It has a gray-millennium color o Dandy Fever
o Breakbone Fever
Four Classifications of Dengue Hemorrhagic Fever
DHF Grade 2
DHF Grade 1 ➢ If there is persistence of signs and symptoms of
➢ Increased grade fever (lasts 3 – 5 days) DHF Grade 1
o Even if antipyretics are given, fever will ➢ If there is bleeding from:
persist o Nose – epistaxis
o Fever will come down but the patient is o Gums – gum bleeding
still febrile o Vomiting of blood – Hematamesis (coffee
o Important Concept! ground appearance from the stomach)
▪ Therefore, give antipyretic round ➢ Upper Gastro-Intestinal Tract Bleeding
the clock o Melena
➢ Pain is present ▪ Passing of black tarry stool
o Headache ▪ Acted upon by digestive enzymes
o Periorbital pain ➢ Lower Gastro-Intestinal Tract Bleeding
o Pain behind the eyes o Hematochezia
o Joint and bone pain ▪ Passing of fresh blood in the stool
o Abdominal Pain ➢ Then, these signs and symptoms indicate the
▪ Nausea and Vomiting START OF HEMORRHAGIC FEVER
➢ Presence of Pathological Vascular Changes
o Petechiae DHF Grade 3
o Herman’s Sign ➢ Persistence of signs and symptoms of DHF Grade
▪ Generalized redness 2
➢ Flushing of the skin ➢ With signs of circulatory collapse or failure
➢ With cold clammy skin
➢ Nursing Alert!
INFECTED MOSQUITO o Check for capillary refill
▼▼▼ o How?
BLOODSTREAM (multiplies) ▪ Apply pressure on nailbeds
▼▼▼ ▪ Normal capillary refill time is
Multiple lesions in the bloodstream about one (1) to two (2) seconds
▼▼▼▼ ▼▼▼▼ ▪ If capillary refill time is about
Increased Increased three (3) seconds or more, blood
Capillary Capillary flow is sluggish due to circulatory
Fragility Permeability failure
(causes easy (allows shifting ➢ Check Vital Signs
bleeding; of fluid from o Indicators of Circulatory Failure:
difficult to stop one ▪ Hypotension or decreased blood
due to compartment pressure
thrombocytopenia; to ▪ Rapid but weak pulse
poor clotting another leads ▪ Rapid respiration
to ascites; DHF Grade 4
hemo- ➢ With signs and symptoms of DHF Grade 3
concentration ➢ With shock
 Page 39 of 56

➢ Hypovolemic shock due to excessive blood loss Medical Management

due to uncontrolled bleeding ➢ Symptomatic
➢ No specific treatment
Diagnostic Tests for Dengue Hemorrhagic Fever Important Concepts!
➢ If patient is febrile
1. Tourniquet or Rumpel Leede’s Test o Administer antipyretic
➢ Test for capillary fragility o But never use aspirin
➢ Concept! ▪ Potentiates clumping of platelets
o This is only a presumptive test for DHF ▪ Results to bleeding
(not a confirmatory test) o ASA is not given to children below twelve
o Not all patients are subjected to this test (12) years old and when cause of disease
➢ Three (3) criteria that must be present before you is unknown.
perform the tourniquet test: ▪ Side effect is Reye’s Syndrome
o Person must be at least six (6) months old •A neurologic disorder
o Fever should be more than three (3) days associated with viral infection
o No other signs of DHF are present ➢ If there is bleeding
▪ Patient only feels fever o Give coagulants
➢ If there are other manifestations (i.e. ▪ Vitamin K
stomachache), do not do tourniquet test • Aquamephyton
➢ How is it done? • Konakion
o Get the blood pressure of the patient ➢ Vitamin C
o Add systolic and diastolic pressures To increase capillary resistance
o Divide the sum by two ➢ Provide blood transfusion
o Apply that pressure on the cuff. . . Nursing Management
▪ For five (5) minutes if the patient ➢ Prioritize bleeding prevention and control
is pediatric ➢ For gum bleeding
▪ For ten (10) minutes if the patient o Use cotton swab
is an adult o This is softer than any toothbrush
o Deflate the Blood Pressure Cuff ➢ Provide ice chips
o Check for the presence of petechial ➢ Advise patient to gargle
formation o It will not cause injury
o If greater than or equal to petechial o Use mouthwash
formations per square inch, then patient is ➢ Use soft-bristled toothbrush
positive (+) to Tourniquet Test o Consider this as the last measure to be
o Therefore, patient is probably suffering taken compared with the three others
from Dengue Hemorrhagic Fever above
➢ To confirm the diagnosis, do the next test. . . ➢ Keep patient on NPO if patient vomits blood
2. Blood Examination ➢ Apply ice pack over epigastric region of patient
➢ Platelet Count ➢ Doctor may order NGT insertion
o Normal value is 150,000 to 400,000 ➢ For gastric lavage, use ice cold NSS or coagulant
platelets per cubic millimeter ➢ Provide adequate nutrition
o Values lower than the normal indicate that ➢ Avoid dark colored foods
patient is positive (+) for Dengue Important Concept!
Hemorrhagic Fever ➢ Attack of Dengue Hemorrhagic Fever does not
➢ Hematocrit Determination give permanent immunity
o Measures degree of hemoconcentration Prevention:
o Normal value is 37% to 54% ➢ Practice CLEAN PROGRAM of the DOH
o Values higher than the normal indicate
that patient is positive (+) for Dengue MALARIA
Hemorrhagic Fever ➢ Also called Ague
 Page 40 of 56

➢ King of tropical diseases liver to release

➢ Manifested by indefinite periods of chills and fever the RBC for
Important Concepts! them to
➢ Microorganism is a PROTOZOA penetrate other
➢ Plasmodium has four species RBC
o Plasmodium malariae ▼▼▼
o Plasmodium ovale Inside RBC
o Plasmodium vivax
▪ One of the most common in the Important Concepts!!!
Philippines ➢ Once inside the Red Blood Cells (RBC), the
o Plasmodium falciparum microorganism multiplies and destroys the RBC.
▪ Another of the most common in ➢ This leads to ANEMIA!
the Philippines ➢ Rupturing of membranes of Plasmodium
o The most fatal due to its tendency to coincides with the presence of CHILLS in the
multiply rapidly patient
➢ Plasmodium is acquired through a mosquito bite – ➢ Presence of more or new microorganisms in the
Anopheles mosquito bloodstream causes FEVER!
➢ Blood is needed by the female Anopheles Important Concepts!
mosquito for the fertilization of its eggs ➢ If you have malaria and your last attack is more
Important Concepts! than five (5) years ago, then you can be a blood
➢ Anopheles mosquito is donor
o A NIGHT biting mosquito ➢ If your last attack is less than five (5) years ago,
▪ It bites from sunset to sunrise or you CANNOT BE A BLOOD DONOR
from dusk to dawn ➢ Malaria can also be obtained by BLOOD
o It breeds in CLEAR, SLOW FLOWING TRANSFUSION
WATER Manifestations of Malaria
o It is common in
▪ Rural Areas Stage 1 – Cold Stage
▪ Mountainous Areas ➢ Lasts for ten (10) to fifteen (15) minutes
▪ Forested Areas ➢ Chilling sensation is present
• Palawan ➢ Shaking, chattering of the lips is present
• Dumaguete ➢ Nursing Responsibilities
• Surigao o Provide warmth
o It lands on the surface on a forty-five (45) o Blankets
degree angle or in a slanting position o Warm drinks
o Not warm compress
Pathophysiology of Malaria o Hot water bag on soles of the feet
o Expose to heat lamp or droplight
PLASMODIUM Stage 2 – Hot Stage
▼▼▼ ➢ Last for four (4) to six (6) hours
BLOODSTREAM ➢ The patient has:
▼▼▼▼ ▼▼▼▼ o Fever
Inside RBC (for Those that don’t o Headache
reproduction) penetrate RBC o Abdominal Pain
go to the LIVER. o Vomiting
They do nothing ➢ Nursing Responsibilities
and may remain o Lower the body temperature
dormant for o Provide tepid sponge bath
3 – 5 years. o Provide cold compress
They wait for the o Increase fluid intake
 Page 41 of 56

o Provide light, loose clothing
o Provide antipyretic as ordered
Stage 3 – Wet Stage
➢ Patient exhibits:
o Profuse sweating
o Feeling of weakness
➢ Nursing Responsibilities
o Make patient comfortable
o Keep patient dry and warm
o Provide fluids to prevent dehydration
o Make patient rest comfortably in bed
Important Concepts!!!
➢ In other types of sicknesses or disorders, chills
occur before fever
➢ This is due to body’s response to heat loss
➢ In ordinary infections, higher temperatures are
seen during CHILLS because patient is trying to
retain heat
➢ In malaria, increased temperature occurs on
FEVER or HOT STAGE
➢ There is no fever during the cold stage
➢ Chills occur due to the release of Plasmodium
Key Concept!
➢ If causative agent is P. falciparum, its rapid
multiplication and RBC destruction would lead
to…
o Anemia
o Liver then compensates and results to
HEPATOMEGALY
o Splenomegaly
o Mild jaundice sometimes occurs
o Cerebral Hypoxia
▪ Restlessness
▪ Confusion
▪ Delirium
▪ Convulsions
▪ Loss of consciousness
▪ Coma
o Black Water Fever
▪ Passing out black urine or dark
red urine due to rapid RBC
destruction
▪ This may lead to death
Diagnostic Tests for Malaria
Blood Smear or Malarial Smear
➢ Best time to collect
o At the HOT STAGE
o At the peak of fever (this is when the
microorganism is in the blood stream)
Concepts!
➢ During the Hot Stage, the microorganism is in the
bloodstream
➢ During the Cold Stage, the microorganism is
inside the red blood cells
Quantitative Buffy Coat (QBC)
➢ This is seldom done
➢ This test is expensive
➢ Specimen used is blood
➢ A rapid test for malaria
➢ You do not have to wait for fever to set in to
undergo this test
➢ You can extract blood earlier
Medical Management of Malaria
➢ Anti-malarial Agents
➢ Drug of Choice
o Chloroquine
➢ Other Drugs used:
o Primaquine
o Atabrine
o Pancidar
o Quinine
▪ A reserve drug for severe type of
malaria
Important Concepts!
➢ Anti-malarial agents are cautiously used in
pregnant women
➢ They are considered as ABOTIFACIENT
AGENTS
o They can cause ABORTION
➢ However, this is NOT CONTRAINDICATED
because if mother (infected with malaria) is not
treated, the child may be born with NEONATAL
MALARIA
➢ Child with Neonatal Malaria exhibits the following:
o Decreased levels of RBC
o Immature liver
o Severe anemia
➢ Child may die
Key Concepts!
➢ Malaria may be acquired through:
o Blood Transfusion
o Vertical Transfusion
▪ RBC passes through the
placenta (not the microorganism)
Important Concept!
 Page 42 of 56

➢ An attack of Malaria does not provide permanent ➢ Fine, branny desquamation appears
immunity ➢ Then the desquamation peels off
➢ A repeat bite from a malaria mosquito is not ➢ Peeling off proceeds in a cephalocaudal manner
needed because the microorganism may be ➢ It is only the rashes that will be peeling off, NOT
dormant in the liver THE SKIN of the patient
Prevention ➢ Concept!
➢ Practice the CLEAN PROGRAM of the DOH o Use of Colantro
o Has a burning effect
COMMUNICABLE DISEASES OF THE o Causes skin to likewise peel off
INTEGUMENTARY SYSTEM o Use of colantro is now discouraged

Viral Communicable Diseases Diagnostic Tests for Measles

➢ Measles
➢ German Measles Concept!
➢ Chicken Pox ➢ There is no specific diagnostic test for measles
➢ Herpes Zoster 1.Clinical Observation
Medical Management for Measles
MEASLES ➢ Symptomatic Management
Causative Agent ➢ Recovery dependent on Nursing Care
➢ Morbilli Nursing Care
o Paramyxovirus ➢ Maintain and increase body resistance of the
➢ Rubeola Virus patient
Manifestations of Measles ➢ Provide the following:
1. Pre-eruptive Stage ➢ Adequate rest
➢ Three (3) C’s ➢ Adequate nutrition
o Coryza o No diet restrictions
o Cough o Provided that patient is not a
o Conjunctivitis hypersentitive individual (i.e. prone to
➢ Kuplick Spots allergies)
o Fine red spots with bluish white spot at the o Seafood or poultry products are
center contraindicated if the patient is allergic to
o Found at the inner cheeks these foods
o This is the PATHOGNOMONIC SIGN of o Increase oral fluid intake
Measles o Especially those rich in Vitamin C
Eruptive Stage ➢ Keep patient’s back dry and warm
➢ Rashes are now present o Rationale
➢ Maculopapular Rashes ▪ Exposure to draft gives rise to
o Flat to elevated cough and cold
o Reddish in color ▪ It gives rise to a good medium for
o With blotchy appearance growth of microorganisms
o In the vernacular, pantal-pantal ▪ Leads to pulmonary
o Face of the patient looks bloated complications like pneumonia,
o Cephalocaudal distribution which could lead to death
▪ Appears first on the hairline ➢ Provide hygienic measures
▪ Head to toe distribution o Eye care
o Appears on the 3RD DAY of illness ▪ Measles patients have much
o Within two (2) to three (3) days, the entire “MUTA”
body will be covered with rashes ▪ To prevent eye complications
3. Post-eruptive Stage o Ear care
➢ Time when rashes start to disappear ▪ To prevent otitis media
 Page 43 of 56

o Mouth care ➢ Site:

o Nasal care o Deltoid muscle
o Skin care ➢ Ask mother if the child has allergies to egg and
▪ Taking a bath or taking a sponge neomycin
bath is not contraindicated o MMR is made up of duck embryo and
▪ However, do not expose the neomycin
patient to draft o If patient is allergic to egg
Other Nursing Care ▪ Give vaccine
➢ Symptomatic nursing care ▪ But observe for signs and
➢ Patient is photophobic symptoms of allergies
o Provide dim and quiet environment o If patient is allergic to neomycin
▪ Do NOT give MMR vaccine
Important Concept! ▪ It may cause anaphylaxis
➢ Attack of measles gives permanent immunity to
the disease
Key Concept! Important Concept!
➢ When is the patient communicable? ➢ DOH Program on Measles
➢ Patient is communicable before rashes appear or o Ligtas Tigdas Immunization Program in
during the pre-eruptive stage. 2004
Preventive Measures
1. Immunization Mode of Transmission
➢ Anti-measles vaccine (AMV) ➢ Airborne
➢ When given:
o Age of nine (9) months Prevention
➢ Dosage: ➢ Proper disposal of nasopharyngeal secretions
o 0.5 cc ➢ Cover the mouth when coughing or sneezing
➢ Route: Key Concepts!!!
o Subcutaneous ➢ Measles is not fatal by itself
➢ Site: ➢ Common complications
o Deltoid muscle o Bronchopneumonia
➢ Important Instructions to be given to the mother of o Encephalitis
the patient!
o Child may experience fever GERMAN MEASLES
o Give paracetamol to lower the body ➢ Also called:
temperature o Rubella
o After three (3) to four (4) days, child will o Three (3) day disease
have a rash formation. This is a NORMAL o Poteln
REACTION to the vaccine Causative Agent
o In fact, it is a good reaction, indicating that ➢ Pseudoparamyxovirus
the patient’s body has produced anti- o Rubella Virus
bodies to measles ▪ Togavirus
Mode of Transmission
Important Concepts! ➢ Droplet (not airborne)
➢ In the private setting, MMR vaccine is given…
➢ When: Manifestations of German Measles
o Age of fifteen (15) months 1. Pre-eruptive Stage
➢ Dosage: ➢ Fever may be present or absent
o 0.5 cc ➢ If patient has fever, it lasts only for one (1) to two
➢ Route: (2) days
o Subcutaneous ➢ Patient has mild cough and mild cold

➢ NO CONJUNCTIVITIS
o Therefore, he only has two (2) C’s.
➢ Important Concept!
o Enanthem of German Measles are called
FORSCHEIMER SPOTS
▪ Fine red spots
▪ Also called petechial spots
▪ Appears on the soft palate
2nd Stage – Eruptive Stage
➢ With maculopapular rashes
o Not reddish but pinkish
o Not blotchy but discreet
o Appearance is fine
o Slightly unnoticeable
o Rashes are smaller compared with those
of measles
o Also has cephalocaudal distribution
o Appears first at the head
➢ Important Concept!
o Once the rashes appear, within twenty-
four (24) hours, the entire body is filled
with rashes
o However, head-to-toe distribution is not
as distinct as in measles
➢ Key Concepts!
o Patient is positive for enlargement of
lymph nodes
▪ Suboccipital lymph nodes
▪ Posterior auricular lymph nodes
▪ Posterior cervical lymph nodes
o This is a differentiating factor between
German Measles (positive for
enlargement of lymph nodes) and
Measles (negative for enlargement of
lymph nodes).
3rd Stage – Post-Eruptive Stage
➢ Rashes now start to disappear
➢ But they disappear at the third (3rd) day of illness
➢ Important Concept!
o In measles, rashes just start to manifest
themselves by the third (3rd) day of the
illness
o Enlarged lymph nodes will gradually
subside
Diagnostic Tests, Medical Management, Nursing
Management and Preventive Measures for German
Measles are THE SAME AS THAT FOR MEASLES
Page 44 of 56
Important Concepts!
➢ An attack of German Measles gives permanent
immunity
➢ When is German Measles communicable?
o During the entire course of the disease.
o Until enlarged lymph nodes return to
normal
➢ German Measles is NOT FATAL
➢ It can become fatal if patient is on her first
trimester of pregnancy due to chances of giving
birth to a child with congenital anomalies:
o Microcephaly
o Congenital Defect (Tetralogy of Fallot,
etc.)
o Cataract leading to blindness
o Deafness and mutism
➢ Mere exposure of pregnant woman to German
Measles MUST BE AVOIDED
o If exposed during the first trimester of
pregnancy, pregnant mother must
immediately receive immunoglobulin or
gamma globulin within seventy-two (72)
hours.
➢ After three (3) days, the virus has already passed
through the placenta
o Therefore, once pregnant, women should
be already given gamma globulin
➢ German Measles is more fatal to pregnant women
relative to Measles
➢ All people have been exposed to measles,
therefore, anti-bodies to measles have already
been developed.
➢ Not all have been exposed to German Measles,
therefore, not all have developed anti-bodies to
German Measles
➢ MMR vaccine
o Measles, Mumps, Rubella vaccine
o If you are an adolescent, you can receive
this but do not be pregnant within the next
three (3) months because you may give
birth to a child with congenital anomalies
CHICKEN POX
➢ Also called Varicella
Causative Agent
➢ Varicella Zoster Virus
o Can be found both on:
▪ Nasopharyngeal Secretions
▪ Secretions of rashes
o But only causes infection if. . .
 Page 45 of 56

▪ It enters the nasopharynx

o Does NOT cause infection by skin-to-skin SCRATCHING WHILE ASLEEP
contact ▼▼▼
Mode of Transmission RUPTURES THE VESICLES
➢ Airborne ▼▼▼ ▼▼▼
Leads to skin Permanent
Three (3) Stages of Manifestation Infection Scar
▼▼▼ (Pox mark)
Stage 1 – Pre-Eruptive Stage Becomes a
➢ Presence or absence of low-grade fever Boil,
➢ Headache or a Furuncle
➢ Body malaise (big Boil),
➢ Muscle pain or a Carbuncle
➢ Lasts for twenty-four (24) to forty-eight (48) hours (several boils
Stage 2 – Eruptive Stage attached to one
➢ Presence of rashes another)
o Vesiculopustular rashes ▼▼▼
➢ Development of Vesiculopustular Rashes: Results to cellulitis
o Initially, these rashes are macules – FLAT or gangrene
RASHES Important Concepts:
o They will become elevated or become ➢ The distribution of the rashes are:
PAPULES o Generalized
o Then, another set of macules appear o Found all over the body
o The original rashes (now papules) will ➢ Found first on the trunk
become vesicles ➢ Found on the covered parts of the body
o Pus then develops ➢ Then found on the scalp
➢ Important Concept! ➢ Abundantly found on the covered parts of the body
o It is only during the eruptive fever stage and then on the exposed parts of the body
that you can see all the following: Key Concept!
▪ Macules ➢ Period of Communicability
▪ Papules o Until the LAST RASH has crusted!!!
▪ Vesicle o Easily and highly-contagious upon the
▪ Vesiculopustular Rashes appearance of rashes
Additional Concepts!!! Important Concepts!
➢ These rashes are itchy ➢ During the summer season, if you have not had
➢ Therefore, it is a MUST that the patient takes a chicken pox and if you are immunocompromised,
bath DAILY DO NOT GO OUT
➢ If the patient does not take a bath. . . ➢ Duration of the Disease
o Patient will perspire o Two (2) weeks
o Patient will accumulate dirt Important Characteristic of Chicken Pox Rashes
o Dirt + Wetness + Itchy rashes will lead to ➢ Rashes have UNIFOCULAR appearance
greater itching and would eventually ➢ They have one focus
result into SCRATCHING ➢ Rashes appear one at a time and they NEVER
➢ Scratching may be avoided while the patient is FUSE TOGETHER
awake ➢ There is always a gap between one rash to
➢ However, scratching during sleep is common another rash
among Chicken Pox patients o If rashes get into contact with each other,
Key Concept! it is no longer Chicken Pox.
➢ Do not scratch rashes o It is HERPES ZOSTER
➢ Scratching results to infection or pox marks!!!
 Page 46 of 56

3rd Stage – Post-Eruptive Stage o Subcutaneous

➢ Rashes now start to crust ➢ For children below thirteen (13) years old
➢ They start to dry o Single dose is given
➢ They start to peel off o Site of administration is the deltoid muscle
➢ If rashes start to dry, let them peel off by ➢ For those thirteen (13) years old and above
themselves o Two doses are given
➢ If allowed to dry and peel off, there will be no o With one (1) month interval
infection
➢ However, it leaves a pox mark 2.Proper disposal of nasopharyngeal secretions

Diagnostic Test for Chicken Pox 3.Cover nose and mouth when sneezing or when
➢ Clinical Observation coughing
Important Concepts!
Medical Management of Chicken Pox ➢ Not all of the Chicken Pox virus would leave your
➢ Symptomatic management as causative agent is body. Some are left behind, travel to the nerve
a virus and become dormant
Additional Concepts! ➢ Therefore, next exposure to it will not give you
➢ Zovirax or Acyclovir Chicken Pox
o Not a treatment for chicken pox ➢ New Varicella Zoster Virus will go to the nerve and
o Virus is not always responsive to this drug activate dormant virus to give you Herpes Zoster
o Some viruses are resistant (drug has no ➢ Herpes Zoster is the dormant or inactive type of
effect) while some are sensitive to it and Chicken Pox
patient will heal within three (3) days ➢ You CANNOT have Herpes Zoster until you have
o Dosage is four (4) to five (5) tablets per obtained Chicken Pox
day for one week ➢ Adults usually affected by Herpes Zoster because
➢ Zovirax Cream what is affected is the ganglion of posterior nerve
o Protects skin from infection but does not root
protect against pox marks
➢ Zovirax may be effective but it does not allow the HERPES ZOSTER
patient to produce antibodies. ➢ Also called
➢ Therefore, let the normal course of Chicken Pox o Shingles
occur o Zone
o Acute Posterior Ganglionitis
Nursing Care for Chicken Pox Causative Agent
➢ Same as in measles ➢ Varicella Zoster Virus
➢ But more focus should be given on SKIN CARE Mode of Transmission
o Rationale: ➢ Droplet
▪ To prevent skin infection Manifestations of Herpes Zoster
▪ Complication is encephalitis ➢ Same as those of Chicken Pox
Important Concepts! ➢ Rashes are also vesiculopustular
➢ Attack of Chicken Pox gives permanent immunity ➢ However, there are differences in the
➢ Period of Communicability characteristics of rashes
o Until last rash has crusted ➢ Herpes Zoster rashes are:
Preventive Measures o Not itchy
1. Immunization o More of painful because nerves are
➢ Varivax affected
o Varicella Vaccine o Even if patient has recovered and rashes
➢ Dosage are long gone, pain may be persistent up
o 0.5 cc to two (2) months. This is NORMAL
➢ Route
 Page 47 of 56

o Rashes do not have generalized

distribution GASTROENTERITIS
o Has a unilateral distribution because it Key Concepts!
follows the nerve pathway ➢ Main Sign and Symptom of Gastroenteritis is
o Always vertical or longitudinal (on one diarrhea
side) ➢ Diarrhea is a general term caused by various
o Rashes do not have unifocular microorganisms
appearance but APPEARS IN Causative Agents:
CLUSTERS ➢ Salmonella typhosa
Diagnostic Test and Medical Management for Herpes o For typhoid fever
Zoster ➢ Salmonella Newport
➢ Same as in Chicken Pox o For food poisoning or salmonellosis
Additional Medical Management ➢ Staphylococcus enterococcus
➢ Application of Potassium Permanganate (KMnO4) o For staphylococcal food poisoning
compress over the rashes of the patient ➢ Clostridium botulinum
➢ Rationale: o For botulism
o To obtain three-fold effect ➢ Shigella dysenterieae
▪ Astringent effect o For shigellosis
• To dry the rashes o For bloody flax
▪ Bactericidal effect o For bacillary dysentery
• To decrease chances of ➢ Vibrio coma or Vibrio cholera
skin infection o Coma-shaped
▪ Oxidizing effect o Cholera or El tor
• To deodorize the rashes o Give rise to violent dysentery due to
and remove the fishy violent diarrhea (which occurs
odor continuously)
Important Concept! Mode of Transmission
➢ An attack of Herpes Zoster does not give ➢ Fecal – Oral route
permanent immunity Source of Infection
➢ Most common complications of Herpes Zoster ➢ Food
o Skin infection ➢ Water
o Encephalitis If food poisoning:
Preventive Measures ➢ Salmonellosis
➢ Same as that of Chicken Pox o Foods rich in protein
Important Concepts!!! ▪ Meat products
➢ Children are mostly affected in: ▪ Poultry
o German Measles ▪ Eggs
o Measles ▪ Cheese
o Chicken Pox ▪ Milk
➢ Adults are mostly affected in: o Incubation Period
o Herpes Zoster ▪ Six (6) to eight (8) hours
o Then you manifest the symptoms
➢ Staphylococcal
COMMUNICABLE DISEASES OF THE o Carbohydrate-rich foods
GASTROINTESTINAL TRACT ▪ Cereals
▪ Rice
Bacterial ▪ Pastries
➢ Gastroenteritis ▪ Bread
➢ Inflammation of the gastric mucosa and the ▪ Cakes
mucosa of the intestines ▪ Pasta
 Page 48 of 56

▪ Noodles ➢ Number 1 indicator of dehydration in a patient with

o Incubation Period
▪ Two (2) to six (6) hours
o Then you manifest the symptoms
➢ Botulism
o Caused by canned or preserved foods
o Incubation Period
▪ Eight (8) to twenty-four (24) hours
o General manifestation is diarrhea
o Borborygmi is present
▪ Gurgling sound on the abdomen
➢ Typhoid Fever
o Three (3) Clinical Features
o 1. Rose spots
▪ This is the PATHOGNOMONIC
SIGN for typhoid fever
o 2. Ladder-like fever
o 3. Splenomegaly
➢ Dysentery
o Characteristics of Stool
o If Bacillary Dysentery
▪ Mucoid Stool
▪ Which could become blood
streaked if severe
▪ Microorganism’s endotoxin
destroys the intestinal wall
o If Cholera
▪ Rice-watery stool, which is one
after the other
▪ The microorganisms do not
destroy the intestinal wall
▪ They only stimulate peristalsis
➢ Rapid dehydration occurs
o Manifested by washer woman’s hand
▪ Decreased skin integrity
▪ Poor skin turgor
▪ Very dry
diarrhea is LOSS OF WEIGHT
o This occurs within or before forty-eight
(48) hours
➢ Other manifestations of dehydration, which are
seen after forty-eight (48) hours are:
o Thirst
o Sunken eyes
o Sunken fontanelles
o Poor skin turgor
Diagnostic Tests for Patients with Gastroenteritis
1. Stool Examination
➢ Most common diagnostic examination
➢ For Typhoid Fever
o Stool examination is not a good test
o Blood examinations are done
o Blood culture is also done to identify the
microorganism
o Done during initial manifestation of the
disease
➢ In the Philippines, the WIDAL TEST is done for
Typhoid Fever
o The antigen is detected
o Antigen O
▪ Somatic antigen
▪ If present, the patient is positive
for infection
o Antigen H
▪ Flagellar antigen
▪ If present, patient has been
previously exposed to typhoid
fever or immunization
➢ In TYPHIDOT, a blood examination is conducted,
and an antibody is detected
2. Rectal Swab
➢ If patient is positive for gastroenteritis

➢ Nursing Management Medical Management for Gastroenteritis

o Patient is placed on a special bed called
the WATEN BED – bed with a hole 1. Fluid and electrolyte replacement
o Pail is positioned underneath the hole on ➢ Oresol
the bed ➢ I.V. fluid
o Bed pan is not advised ➢ Gatorade
o Continuous diarrhea makes the bedpan 2. Antibiotics
inadequate in containing all the fecal ➢ In typhoid fever, the drug of choice is
material CHLORAMPHENICOL
o Vomiting also contributes to dehydration
 Page 49 of 56

o This drug gives rise to bone marrow o Environmental Sanitation

depression, which leads to anemia and o Insecticide
even leukemia o Screening
➢ In dysentery, particularly bacillary dysentery, the ➢ Fomites
drug of choice is COTRIMOXAZOLE o Do not put anything into your mouth
➢ In cholera, the drug of choice is TETRACYCLINE o Most common is the ball pen
Important Concepts on the Administration of
Tetracycline LEPTOSPIROSIS
➢ Tetracycline should not be given with the ➢ Also called
following: o Mud Fever
o Milk or calcium-rich foods o Swamp Fever
o Antacids o Canicola Fever
o Iron-preparation medication o Pre-tibia
➢ For better Tetracycline absorption o Weil’s Disease
o Give Tetracycline with one full glass of o Swine Herd’s Disease
water o Ictero-hemorrhagic disease
➢ This drug should not be given to children below ➢ A disease of a low form of animal found in the farm
eight (8) years of age because it causes staining
of teeth RATS
➢ This drug is not given to pregnant women ▼▼▼
o It is TERATOGENIC to bone growth of the Source of Infection
fetus because it binds to calcium Excreta of Rats
➢ Once Tetracycline is expired, discard it because it Urine of Rats
will increase the toxic effect of the drug ▼▼▼
➢ It must be kept away from sunlight Causative Agent (Spirochetes)
➢ It must be placed in an amber bottle Leptospira canicola
➢ Sunlight destroys component of tetracycline Leptospira interrogans
Important Concept! (most common in the Philippines – infects rats)
➢ Gastroenteritis attack does not give permanent Leptospira hemorragica
immunity
Mode of Transmission
Preventive Management ➢ Skin penetration
1. Immunization Important Concept!
➢ CDT immunization ➢ No need to have a break in the skin or to have a
➢ Given only free during epidemic wound to have leptospirosis
➢ Provides six (6) months immunity
Individuals who are High-Risk for Leptospirosis:
2. Avoid the five (5) Fs ➢ Sewage Workers
➢ Usual source of infection are the Five (5) Fs: o Those working in drainage systems
➢ Feces ➢ Farmers
o Proper excreta disposal ➢ Miners
➢ Food ➢ Slaughterhouse workers (pigs, cattle are sources
o Proper food preparation of infection)
o Proper food handling ➢ Manilenos
o Proper food storage o Due to flooding
o Avoid eating in unsanitary places ➢ Incidence of leptospirosis increases during the
➢ Fingers rainy season
o Hand washing
➢ Flies Key Concepts!
o Eradicate
 Page 50 of 56

➢ When the microorganism enters, it travels along

the bloodstream Important Concepts on Penicillin
➢ It affects other organs If given per orem:
o Striated Muscles ➢ Give one (1) hour before meals or two (2) hours
o Liver after meals
o Kidneys o It binds with food and becomes digested
▪ Spirochetes have a special o When this happens, it will be metabolized
affinity here and would have no effect
▪ They destroy the nephrons o Therefore, it is best to give Penicillin on an
o Most common complication of empty stomach
Leptospirosis, which brings about death is ➢ Do not give with fruit juices or citrus juices
Kidney Failure o These juices destroy the component of
Penicillin
Manifestations of Leptospirosis o Therefore, give with a full glass of water!!!
➢ Fever with chills
➢ Presence of intense itchiness of the conjunctiva Nursing Management for Leptospirosis
➢ Abdominal Pain ➢ Symptomatic and supportive
➢ Nausea and Vomiting ➢ Monitor urine output due to possible kidney failure
➢ Muscle tenderness and pain on the calf muscle ➢ Immediately refer to doctor for any signs and
(gastrocnemius) symptoms of kidney failure
o Therefore, the patient does not like to
walk or stand Preventive Measures
➢ For ictero-hemorrhagic type of leptospirosis: ➢ Eradicate rats by environmental sanitation
o Jaundice o Use of rat poison
o Hemorrhages on skin and mucous ➢ Avoid walking through flooded areas
membrane o Wash with soap and running water after
walking in floods
Important Concept!
➢ Pathognomonic sign of leptospirosis are the MUMPS
orange eyes or orange sclera of the eyes ➢ Infectious parotitis

Important Concept! Causative Agent

➢ If the kidney is affected, there would be signs and ➢ Paramyxovirus
symptoms of kidney failure: o Found on the saliva of the infected
o Decreased urine output individual
o Leading to anuria Mode of Transmission
➢ Droplet
Diagnostic Tests for Leptospirosis Manifestations of Mumps
➢ Blood Examinations ➢ High-grade fever
o Leptospira Agglutination Test (LAT) ➢ Earache
o Leptospira Antigen-Antibody Test (LAAT) o Ear pain
o Microscopic Agglutination Test (MAT) ➢ Pain upon mastication or chewing
▪ Reveals the microorganism ➢ Swelling of the parotid glands
Diagnostic Tests for Mumps
Medical Management of Leptospirosis ➢ Clinical Observation
Medical Management for Mumps
Anti-biotics ➢ Symptomatic as the causative organism is viral
➢ Drug of Choice is TETRACYCLINE ➢ Recovery depends on nursing care provided
➢ If patient does not tolerate Tetracycline, give
Penicillin instead Nursing Care for Mumps Patients
 Page 51 of 56

4. Apply ice cap or ice cooler to relieve pain

1. Provide Complete Bed Rest (CBR) until swelling ➢ Cold application deadens the nerve endings
subsides temporarily
➢ Rationale: ➢ This results to numbness
o To prevent glandular complications: Important Concept!
o In Females: ➢ Aniel (composed of vinegar and dye) has a cold
▪ Oophoresis or inflammation of effect that decreases pain
the ovaries ➢ This is colored blue so that the person with mumps
o In Males: could be easily identified while he is still far away
▪ Orchitis or inflammation of the Key Concept!
testes ➢ Mumps attack gives permanent immunity
2. For males, wear well-fitted supporters to prevent ➢ When is the person with Mumps communicable?
pulling of gravity on the testes and blood vessels. o He is communicable until swelling
➢ Rationale: subsides
o This predisposes the patient to orchitis o Highly-contagious two (2) days after
and atrophy leading to sterility onset of swelling
Important Concepts! Preventive Measures
➢ Glandular complications are manifested only by: ➢ Immunization
o Adolescents o MMR vaccine
o Adults ➢ Proper disposal of salivary secretions
➢ In people twelve (12) years old and above, there ➢ Cover nose and mouth while coughing and
is complete descent of the testes into the scrotal sneezing
sac
➢ Therefore, there is greater pull of gravity on the COMMUNICABLE DISEASES OF THE
patient GASTROINTESTINAL TRACT AND ITS ACCESSORY
➢ Glandular complications are absent among ORGANS
Children
➢ If orchitis is positive, its location depends on the HEPATITIS
location of the mumps ➢ Inflammation of the liver
o If mumps is on the right side, orchitis is ➢ Brought about by several causes:
also on the right side o Alcoholism
o If mumps is on the left side, orchitis is also o Drug intoxication
on the left side ▪ Hepatotoxic Drugs
o If mumps is bilateral, orchitis is also ▪ Anti-Tuberculosis drugs
bilateral ▪ Tylenol
3. Provide adequate nutrition ▪ Acetaminophen
➢ Provide the following types of diet: o Chemical Intoxication
o Soft diet ▪ Arsenic
▪ Because there is pain upon o Microorganisms
chewing ▪ Viral
o Bland diet ▪ Communicable microorganisms
▪ Sour and spicy foods are irritating Important Concept!
▪ They increase salivation and Current Number of Viruses causing Hepatitis
increase pain ➢ Capable of Infecting Humans
▪ Thus, kalamansi is o Hepatitis A virus
contraindicated for mumps o Hepatitis B virus
patients o Hepatitis C virus
o Apple juice and water are allowed in o Hepatitis D virus
mumps patients o Hepatitis E virus
o Hepatitis G virus
 Page 52 of 56

➢ Non-pathogenic in Man ▪ Milk

o Hepatitis H ▪ Urine
▪ Semen
HEPATITIS A o In fact, all fluids
➢ Also called: ▪ Harbor the microorganism
o Infectious Hepatitis
o Catarrhal Jaundice Hepatitis Mode of Transmission
o Epidemic hepatitis ➢ Percutaneous
▪ Incidence is in epidemic o Use of contaminated sharps and needles
proportions o Blood Transfusion
Causative Agent ➢ Oral to oral Transmission
➢ Hepatitis A virus o In saliva
o RNA-containing virus ➢ Sexual Transmission
Important Concepts! o Seminal fluid
➢ In Hepatitis A infected individuals: o Cervical fluid
o The feces ➢ Vertical Transmission
▪ Harbors the microorganism in ➢ Swallowing of amniotic fluid by the baby
abundant amounts Individuals AT RISK for Hepatitis B:
o The blood ➢ Healthcare workers
▪ Harbors the microorganism in o All who are in contact with body fluids of
minimal amounts patients
Mode of Transmission ➢ Blood recipients
➢ Fecal – Oral Transmission ➢ Hemodialyzing patients
➢ Rarely percutaneous or by blood transmission ➢ Drug addicts
Individuals AT RISK for Hepatitis A: ➢ Promiscuous individuals with multiple sex partners
➢ Those living in unsanitary conditions Incubation Period
➢ Those who practice anal – oral sex ➢ Six (6) weeks to six (6) months
Incubation Period:
➢ Two (2) to six (6) weeks HEPATITIS C
➢ Also called:
HEPATITIS B o Post-transfusion Hepatitis
➢ Also called: ➢ Rationale:
o Serum Hepatitis o Because people who develop this are
o Homologous Hepatitis those who have undergone blood
o Viral Hepatitis transfusion
Causative Agent
➢ The most fatal form of hepatitis ➢ Hepatitis C virus
➢ The most fulminant form of hepatitis Important Concept!
Causative Agent ➢ In Hepatitis C infected individuals
➢ Hepatitis B virus ➢ Blood
o DNA-containing virus ➢ Harbors the microorganism
Important Concept! Mode of Transmission
➢ In Hepatitis B infected individuals ➢ Percutaneous
o The Blood Individuals AT RISK for Hepatitis C:
▪ Harbors the microorganism ➢ Hemodialyzing patients
o Other body fluids ➢ Healthcare workers
▪ Tears ➢ Drug addicts
▪ Saliva ➢ Blood Recipients
▪ Sweat Incubation Period
▪ Cerebrospinal Fluid ➢ Five (5) to twelve (12) weeks
 Page 53 of 56

Incubation Period
HEPATITIS D ➢ Three (3) weeks to twelve (12) weeks
➢ Also called
➢ Dormant Type of Hepatitis B HEPATITIS E
Important Concepts! ➢ Also called
➢ A person must have Hepatitis B before he could o Enteric Hepatitis
be infected with Hepatitis D Causative Agent
➢ Hepatitis D cannot multiply by itself ➢ Hepatitis E virus
➢ It cannot bring about infection Important Concept!
➢ If Hepatitis B is present in the body, Delta virus ➢ In individuals with Hepatitis E
activates Hepatitis B virus to help the Delta virus o The Feces
multiply ▪ Harbors the microorganism
Mode of Transmission
Causative Agent ➢ Fecal – Oral route
➢ Hepatitis D virus Individuals AT RISK for Hepatitis E:
➢ Delta virus ➢ Those living in unsanitary conditions
Important Concept! ➢ Those who practice anal – oral sex
➢ In Hepatitis D infected individuals
o Blood Incubation Period:
▪ Harbors the microorganism ➢ Two (2) to six (6) weeks
o Other body fluids
▪ Tears HEPATITIS G
▪ Saliva ➢ No synonyms
▪ Sweat Causative Agent
▪ Cerebrospinal Fluid ➢ Hepatitis G virus
▪ Milk Important Concept!
▪ Urine ➢ In individuals with Hepatitis G
▪ Semen o The Blood
o In fact, all fluids ▪ Harbors the microorganism
▪ Harbor the microorganism Mode of Transmission
Mode of Transmission ➢ Percutaneous
➢ Percutaneous
o Use of contaminated sharps and needles Individuals AT RISK for Hepatitis G:
o Blood Transfusion ➢ Hemodialyzing patients
➢ Oral to oral Transmission ➢ Healthcare workers
o In saliva ➢ Drug addicts
➢ Sexual Transmission ➢ Blood Recipients
o Seminal fluid Incubation Period
o Cervical fluid ➢ Unknown
➢ Vertical Transmission IMPORTANT CONCEPTS!!!
➢ Swallowing of amniotic fluid by the baby Similar Types or Partner Types
Individuals AT RISK for Hepatitis D: ➢ Hepatitis A and Hepatitis E
➢ Healthcare workers ➢ Hepatitis B and Hepatitis D
o All who are in contact with body fluids of ➢ Hepatitis C and Hepatitis G
patients
➢ Blood recipients Manifestations of Hepatitis
➢ Hemodialyzing patients Three (3) Stages
➢ Drug addicts
➢ Promiscuous individuals with multiple sex partners 1st Stage – Pre-Icteric Stage
This occurs before jaundice arises
 Page 54 of 56

The patient experiences: ➢ Acholic Stool or Clay-colored Stool

➢ 1. Fever
o Due to infection
➢ 2. Right Upper Quadrant pain
o Due to inflammation and infiltration of the
liver
➢ 3. Fatigability
➢ 4. Weight Loss
➢ 5. Body Malaise
o The three (3) manifestations above are
due to the inability of the liver to convert
glucose to glycogen
o Body compensates by breaking down
protein
o End-product of protein breakdown would
be amino acids
o Amino acids are normally deaminated by
the liver so that they could be eliminated
➢ 6. Anorexia
➢ 7. Nausea
➢ 8. Vomiting
o Above three (3) manifestations are due to
inability of the liver to deaminase proteins
➢ Anemia
➢ Paleness
➢ Pallor
o The above three (3) manifestations are
due to decreased life span of Red Blood
Cells (RBC)
o Normal live span of RBCs is one hundred
twenty (120) days
o In hepatitis patients, RBCs live for less
than one hundred twenty (120) days
➢ End-product of RBC breakdown is bilirubin
o Accumulation of bilirubin into the system
leads to the 2nd Stage – Icteric Stage
2nd Stage – Icteric Stage
Patient exhibits:
➢ Jaundice
o Due to inability of the liver to eliminate
normal amounts of bilirubin
o Body compensates by eliminating
bilirubin through sweat
➢ Pruritus
o Due to accumulation of bile salts in the
skin
➢ Tea-colored Urine or Brown-colored Urine
o Due to excess bilirubin thrown out by the
kidney in the urine
o Due to absence of bilirubin (conjugated
bilirubin) that normally goes to the
duodenum to color the stool
➢ Hepatomegaly
o Enlargement of the liver
o Due to an overworked liver
➢ Important Concept!
o Viral infections are self-limiting
➢ If no complication arises, this would lead to the 3rd
Stage – Post-Icteric Stage
3rd Stage – Post-Icteric Stage
➢ Jaundice disappears
➢ Signs and symptoms subside
➢ Energy level increases
➢ Patient is on the road to recovery
➢ Important Concept!
o It takes three (3) to four (4) months for the
liver to regenerate or recover
o Physician usually advices rest for
complete liver recovery or regeneration
➢ Most important Health Teaching:
o Avoid alcohol for a period of one (1) year
o Avoid over the counter drugs (OTCs) that
are hepatotoxic for one (1) year
o Consult physician prior to use of over the
counter drugs.
Diagnostic Tests for Hepatitis
1. Liver Enzyme Tests
➢ Tests for extent of liver damage
1.1) ALT
Alanine Aminotransferase
➢
Formerly SGPT
➢
Serum Glutamic-Pyruvic Transaminase
➢
If increased, there is a liver problem
➢
First enzyme to increase in the presence of a liver
➢
problem
1.2) AST
➢ Aspartate Transaminase
➢ Formerly SGOT
➢ Serum Glutamic-Oxaloacetic Transaminase
➢ Increases only upon the onset of jaundice
1.3) ALP
➢ Alkaline Phosphatase
➢ Increase indicates:
o Obstructive Jaundice
 Page 55 of 56

o Obstructive Hepatitis Latest Trend in Pharmacological Management of

o Obstruction in the Biliary Tract Hepatitis
1.4) GGT Utilizes a combination of:
➢ Gamma Glutamyl Transferase ➢ 1) Lamivudine
➢ When increased o Anti-viral drug
o Patient is experiencing TOXIC o Dosage:
HEPATITIS ▪ Once daily for one year
▪ Due to toxic substances o Action:
▪ Alcohol ▪ Inhibits multiplication of the virus
▪ Hepatotoxic agents o Cost:
1.5) LDH ▪ Approximately Php200 / tablet
➢ Lactate Dehydrogenase ➢ 2) BRM
➢ When identified, it indicates liver organ damage o Biologic Response Modifiers
o An immunomodulating drug
2. Serum Antigen-Antibody Test for Hepatitis o Interferons
2.1) For Hepatitis A ▪ Injectable form of BRM
➢ HAsAg ▪ Normal substance produced by
➢ Hepatitis A Surface Antigen the body when virus enters the
➢ Anti-HAV human cell
➢ Presence of IgG o Dosage:
➢ Presence of IgM ▪ Two (2) to three (3) times a week
2.2) For Hepatitis B for six (6) months
➢ HBsAg o Action:
➢ Hepatitis B Surface Antigen ▪ Kills the virus
➢ Anti-HBs o Cost:
2.3) For Hepatitis E ▪ Approximately Php85,000!!!
➢ HBeAg Nursing Care for Hepatitis
➢ Protein-independent Antigen Two (2) Important Aspects
➢ Anti-HBe
2.4) For Hepatitis C 1. Provide Complete Bed Rest (CBR)
➢ HCsAg ➢ To promote liver regeneration and recovery
➢ Hepatitis C Surface Antigen ➢ When rested, there is decreased metabolism
➢ Anti-HCs ➢ Less metabolism leads to decreased liver load
Medical Management of Hepatitis ➢ Liver relaxes and liver recovers
➢ No specific treatment 2. Diet
➢ Treatment is symptomatic as causative agent is a ➢ Low fat diet
virus o Because there is not enough bile released
or produced by the liver
Most Common Drugs used in Hepatitis: ➢ Increased Carbohydrate Intake
➢ Essentiale o To spare protein metabolism
➢ Jetipar o To decrease amino acids
➢ Silymarine o Accumulation of protein breakdown
o The above three (3) drugs are: products like ammonia would lead to
▪ Hepatic protectors hepatic encephalopathy
▪ Composed of multivitamins,
phospholipids and nutrients ➢ Butterball Diet
needed by the body so that the o Produces energy
liver would not be overworked o These are hard candies
and be relaxed, and thus, recover o Chocolates are contraindicated
▪ They contain fat
 Page 56 of 56

➢ Protein Intake
o Depends on the situation
o If the patient is infected
▪ Provide moderate protein intake
o If the patient is in the recovery stage
▪ Provide increased protein intake
o If complications arise
▪ Provide decreased protein intake
Key Concept!
➢ The most fatal form of hepatitis is HEPATITIS B!
➢ Even if patient recovers, after twenty (20) or thirty
(30) years, the patient would develop cancer of the
liver or cirrhosis of the liver

Preventive Measures for Hepatitis

1. Immunization
➢ Hepatitis B vaccine
➢ Number of Doses:
o Three (3)
➢ Interval between doses:
o Four (4) weeks
➢ When given:
o 1st Dose – Six (6) weeks from birth
o 2nd Dose – Ten (10) weeks from birth
o 3rd Dose – Fourteen (14) weeks from birth
➢ Dosage:
o 0.5 cc
➢ Route:
o Intramuscular
➢ Site:
o Vastus lateralis
➢ Important Concepts!!!
o Inform the mother that there would be
pain and soreness on the injection site
o A slight elevation on liver enzyme tests is
a NORMAL REACTION to the vaccine
2. Avoid the different modes of transmission
➢ For Hepatitis B, C, and D
o Blood-borne diseases
➢ There is a Needle-exchange Program in the
United States and in Australia
o Every 6:00 PM a healthcare worker is
given a knapsack with needles and
sharps
o He then proceed to areas of distribution –
alleys
o Exchanges new syringes with old
syringes used by drug addicts.