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Communicable disease
Sir JV Gasmin

• Principals of infec.on and infec.on control

o Infec.on
§ The growth of microorganism in body 7ssue where they are not usually
found. It causes abnormali4es.
o Disease
§ Detectable altera7on in normal 7ssue func7on.
o Communicable disease
§ The infec7ous agent can be transmi:ed to a individual direct or indirect
contact or as an airborne
§ not all infec4ous becomes diseases.
§ Not all disease come from infec4on.
§ Not all disease is communicable.
§ All communicable disease are infec4ous
o Types of infec.on
§ Local – limited to the specific part of the body where the microorganism
remains. At least two or more body parts in the body.
• Example: sore eyes
§ Systemic – the microorganism spread and damage different parts of the
body.
• Example:
o “Pigsa” these can start from local à systemic.
o Tetanus
§ Acute – appear suddenly or last a short 7me.
• Dura.on: 6 months and below
§ Chronic – occur slowly, over a very long period, and may last months or
years.
• Dura.on: 7 months and up
• Types of health care associated infec.on
o Nosocomial
§ Can either develop during a client stay in a facility or manifest other
discharge. It means it is an infec4on caused by staying in the hospital.
§ 48 hours aGer admission, and 48 hours aGer discharge
§ Example: pneumonia
§ Types of nosocomial infec.on
• Endogenous:
o comes from the pa7ent.
o Usually occurs when there is immunocompromised.
• Exogenous:
o comes from the environment.
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o The health care, u7lity, and usually anything that is not

clean or sterilized can cause exogenous infec7on.
o Iatrogenic
§ The direct result of diagnos7c or therapeu7c procedures.
• Health care associated infec.on (HAI)
o Iatrogenic infec.on
§ Most common: staphylococcus aureus
§ Other pathogens:
• Escherichia coli
• Enterococci
• candida
o Central-line associated blood stream infec.on (CLABSI)
§ Select op7mal catheter site.
§ Use maximal barrier precau7on.
§ Assess need for con7nuing central line access.
§ Replace administra7on sets regularly.
• Admin set/needleless component – 96 hours or 4 days
• Blood produce – every bag change
• Do not disconnect IV unless for disposal.
• Do not leN used boOle hanging in the IV Pole
• Curros – it has 4 hexedine.
§ Schedule of changing of dressing
• Sterile gauze – every 2 days
• Sterile transparent, semi permeable dressing – 7 days
• Change of dressing as needed for diaphore.c pa.ents/bleeding.
§ Types of lumen:
• 3 lumen – 7 FR
• 5 lumen – 8.5 FR
• 4 lumen – 8.5 FR
• 3 lumen – 9 FR
§ IV therapy
• Adults – upper extremity site
• Pedia – upper/lower extremity or scalp
o Replace not more than 72 – 96 hours
o Pedia – replace only when indicated.
o Catheter associated urinary tract infec.on. (CAUTI)
§ Use small bore catheter as possible Caucasian pa4ent any size, usually
small-bore catheter are for Filipinos.
§ Insert catheter only when indicated as per ordered by the doctor.
§ Observe standard precau7on.
§ Obtain specimen asep7cally
o Surgical site infec.on (SSI)
§ Use of surgical clippers
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§ Maintain post-opera7ve normothermia.

§ Control of blood glucose level
§ Give prophylac7c an7bio7c within 1 hour.
§ Before surgery
o Ven.lator-associated pneumonia (VAP)
§ Assess extuba7ng readiness daily.
§ Perform oral care regularly.
§ Keep head elevated at 30 – 45 degrees.
§ Avoid equipment contamina7on.
§ Oral care
• Nurse can use the fingers to do oral care.
• Level of disease occurrence: SEEP
o Sporadic – refers to disease that occurs infrequently and irregular.
§ There is irregular pa:ern of that disease.
§ Example: rabies
o Endemic – refers to the constant presence and usual prevalence of a disease
infec7ous agent in a popula7on within geographic area.
§ There is disease that comes out during every other season, places, or
certain areas which are within that geographic area.
o Epidemic – refers to an increase oGen sudden in the number of cases of a disease
above what is normally expected in that popula7on in that area.
o Pandemic – refers to an epidemic that has spread over the several countries or
con7nents, usually affec7ng many people.
§ 2 or more countries
o Outbreak – sudden increase of total new cases small type version of epidemic.
• Models vital to infec.on and disease control
o The epidemiological triad
§ Disease result from the interac7on between the agent and the suscep7ble
host in an environment that supports transmission of the agent from a
source that host.
• Host à agent à environment à host
§ Iceberg principle
• Show the disease situa7on where the problem is subclinical,
unreported, or hidden from view.
• Only the “TIP OF THE ICEBERG” is known.
• Diagnosed disease à undiagnosed/misdiagnosed disease à risk
factors à free of risk factors.
§ Web of causa.on
• Shows the rela7onship between different mul7ple factors that
contribute to the cause of the disease
• This model proposes that disease is caused by interac7on between
gene7c factors and environmental factors (biological, chemical,
physical, psychological, economic or cultural.)
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• Chain of infec.on
o Condi7on that must be met for a microbe or infec7ous disease to be spread from
person to person.
o Phases:
1. Infec.ous agent
a. Link of the chain: types of causa4ve agent
i. Bacterial most common
ii. Virus most microscopic
iii. Fungi least common
iv. Parasites protozoans, helminths, flukes
2. Reservoir
a. Sources of the microorganism it can be a person.
b. Can be biological (living) or inanimate (non-living)
3. Portals of exit
a. The way the causa7ve agent leaves the reservoir.
b. Parts
i. Ear
ii. Broken skin
iii. Skin
iv. Anus
v. Seminal vesicle
vi. Urethra
vii. Vagina
viii. Mammary gland
ix. Mouth
x. Nose
xi. Eyes
4. Modes of transmission
a. Link of the chain: mode of transmission
i. The method the causa7ve agent can spread from one
person to another. Which can be from an environment.
ii. Three mode of transmission
1. Direct – person to person, person to environment
such as wound.
2. Indirect – vehicle to person (thru fomites); vector
to person (thru animals and insect)
3. Airborne – thru droplet nuclei that can remain
suspend on air for long periods of 7me. Less than
60mcg is airborne; more than 60mcg is droplet
a. Types:
i. Droplet – occur only if the source
and the host are within 1m of each
other. More than 60mcg
ii. Airborne.
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5. Portal of entry
a. The way the causa7ve agent enters the host.
b. Parts:
i. Ear
ii. Broken skin
iii. Skin
iv. Anus
v. Seminal vesicle
vi. Urethra
vii. Vagina
viii. Mammary gland
ix. Mouth
x. Nose
xi. Eyes
6. Suscep.ble hosts
a. Any person who is at risk for infec7on
b. Types of immunity
i. Ac.ve – an7gen
ii. Passive – an7bodies
1. Natural ac.ve – exposure to a certain disease
2. Natural passive – maternal an7bodies
3. Acquired Ac.e – vaccines toxoid
4. Acquired passive – immunoglobulins.
c. Types of defenses
i. Poor primary defenses
1. Impaired skin integrity
2. Poor skin moisture
ii. Poor secondary defenses
1. low levels of an7bodies
iii. poor ter.ary defenses
1. immature immune system. Young pa4ent
2. deteriora7ng immune system. Older pa4ent.
3. Immunosuppression. These are pa4ent who have
weak immune system.
Natural Ar.ficial
Exposure An.gens
Carrier AOenuated – BCG, OPV,
Ac.ve Sick of the disease AMV, rotavirus
Killed – pertussis
Weakened toxins – TT,
diphtheria
Breastmilk (IgA) Gamma globulin (6
Passive Placenta (IgG) months – 1 year)
An.toxin/an.serum
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o Breaking the chain: causa4ve agent and reservoir link

§ Cleaning – visibly without dirt
§ Disinfect – kill all microbes except SPORES. It uses disinfectant agents.
• Disinfectant agents
o An7sep7c – usually used for the skin.
§ Example: nor-hexedine, hydrogen peroxide, and
alcohol
o Disinfectants – usually used on surfaces.
§ Example:
§ Steriliza.on – kill all microbes.
• Methods of steriliza.on
o Autoclave – use of moist heat higher than 212F. mostly
surgical instruments in the OR.
o Radia.on – alpha, beta, gamma, UV rays
o GAS – ethylene oxide
o Boiling – use of dry heat at 100C
• Bacteriosta.c
o Inhibits growth of bacteria
o Example: sulfonamides, tetracycline macrolides
• Bactericidal
o Kills and destroys bacteria.
o Example: quinolones, aminoglycosides
• Standard precau.ons
o Elements:
§ Hand hygiene
• Most effec7ve and most prac7cal method of controlling the spread
of microorganisms.
• Dura.on: 40 – 60 seconds
• Amount of soap: at least 4ml if liquid
• Focus/most important elements: fric7on
o Minimum .me: at least 20 seconds if not visibly
• Hand grabbing
o Dura7on: 30 seconds and uses an7sep7c solu7on
§ Wearing PPE
• Gloves – most used could be clean or sterile
• Gown – used to protect the uniform.
• Mask – used part of respiratory hygiene.
• Goggles – used when there is possibility of splashing on the face
• Bouffant – cap
• Shoe cover/boo7es
• Two component
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1. Donning – gown à mask à gown à mask à gloves

GowMaGogGlow
2. Doffing – gloves à googles à gown à mask
GlovGogGowMa
§ Safe injec.on prac.ces
• Never do the following:
o Recap needle
o Bend break needle
o Reuse share contaminated needle.
• Throw used needles in a puncture resistant container.
• Color coding
o Black – noninfec7ous dry
o Green – noninfec7ous wet
o Orange – radioac7ve/hazardous
o Red – puncture resistance/sharps
§ Safe handling contaminated instruments
§ Respiratory hygiene
• Coughing/sneezing e7que:e
o Cover your mouth and nose with a 7ssue when cough or
sneeze.
o Put your used 7ssue in a waste basket.
o If you don’t have a 7ssue, cough or sneeze into your upper
sleeve, not your hands.
• Environmental Sanita.on
o Regula.ng sanita.on in the Philippines
§ PD 856 – sanita7on code of the Philippines
§ PD 825 – an7-li:ering law
§ RA 9003 – solid waste management acts
§ RA 8749 – clean air act
§ RA 9275 – clear water act
§ EO 26 – na7onal smoking ban
§ RA 10611 – food safety act
o safe source
§ level I: tuburon, balon, bokal
• rural areas houses are thinly sca:ered.
• 15-25 HH
• Not greater than 250 meters from the farthest house
• 40 to 140 liters
§ Level II puso de bomba
• Rural area where houses are clustered densely.
• Average of 100 household
• Not more than 25 meters from the farthest household
• 40 to 80 liters of water per capital per day with one faucet per
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§ Level III linya ng gripo

• Densely populated urban areas
• More than 100 household
o Disposal
§ Open burning of solid wastes
§ Open dumping
§ burying on flood prone areas
§ Squakng in landfills
§ Opera7on of landfills on any aquifer, groundwater reservoir or watershed
§ Construc7on of any establishment within 200 meters from a dump or
landfill
o Food safety
§ Right source
• Buy fresh, check expiry dates, avoid deformed canned foods.
• When in doubt with water source boil for at least 2 minutes
§ Right prepara7on
§ Right cooking
• 70 degrees cen7grade
§ Right storage
• Food should not be leG at room temperature for more than 2 hours.
• Stored cooked foods in 7ghtly sealed container.
• Hot condi7on – at least 60 degrees cen7grade
• Cold condi7on – below or equal to 10 degrees cen7grade
• 10 – 60C organism easily mul7ply
o RA 10152
§ Mandatory Basic immuniza7on law
Vaccine Disease Components
Bacillus calmeg Tuberculosis Live a:enuated
guerin bacterial. Freeze dried
with special diluent
Hepa..s B vaccine Hepa77s B Plasma deriva7ve or
(monovalent) RNA recombinant
cloudy, liquid
Pentavalent (DPT- Diphtheria D – weakened toxins
HEPB-HAEMOPHILUS Pertussis P – killed bacteria
INFLUENZA) Tetanus T – weakness toxins,
Hepa77s B liquid clear
Pneumonia
Meningi7s
Oral polio Poliomyeli7s Live a:enuated virus
Measles Mump Measles mumps Live a:enuated virus
Rubella (MMR) rubella dried freeze with
special diluent
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Vaccine disease components

Inac7vated polio Poliomyeli7s Liquid clear for serum
vaccine immunity (blood)
Pneumococcal Pneumonia Liquid clear
conjugate vaccine meningi7s
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immunizable disease
o tuberculosis
§ other names:
• Koch’s disease
• Consump7on disease
• Phthisis
• Great white plague
§ Causa.ve agent: myobacterium sp.
• Tubercle – most common in asia
• Africanum – most common in Africa
• Bovis – derviced from caSles
• Caneki – derived from farm animals.
• Avium – opportunis4c type
• Kansasii – opportunis4c type
§ Mode of transmission: airborne making tb highly contagious, sneezing is
the most highly transmiSable method for TB.
§ Incuba7on period: 4 – 6 weeks
§ Manifesta.ons:
• Classic/most salient foe 2 weeks – cough for 2 weeks (starts dry
then becomes bloody)
o 2 coughs
• Other signs and symptoms
o Low grade aGernoon fever
o Anorexia
o Weight loss
o Night sweats
• Late signs
o Hemoptysis
o Low back pain
§ Screening/diagnos.c test
• Mantoux test
o Also known as Mendel Mantoux test, tuberculin test or
purified protein deriva7ves test (PPD)
o Purpose: to screen exposure to mycobacterium
o Disclaimer: will not indicate ac7ve TB infec7on
o Method: intradermal injec7on of 0.1ml of PPD usually in the
inner aspect of the lower arm
• Direct sputum smear microscopy (DSSM) confirmatory
o TB diagnosis
o Purpose: to confirm ac7ve infec7on by demonstra7ng of
mycobacterium by fluorescence acid fast microscopy
o Method: three expectorated sputum specimens for at least
5mL is checked for acid fast bacilli (Staining red)
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o Results: aGer three sputum samples are tested

o 2 or 3 posi7ve samples confirms smear posi7ve status
o Only 1 posi7ve sample is douboul and will need to repeat
three sputum sampling again.
o Process: for sputum collec4on
§ Day 1 – case finding (spot specimen) it can be
any4me and should early morning.
§ Day 2 – early morning specimen
• Ask the pa7ent to inhale-exhale-inhale then
cough to put the sputum out.
§ Day 2 – RHU
• This is where the sputum are directly brough
aGer sputum are collected
• Case finding
o Ac.ve – RN à community à s/sx à sputum
o Passive – Client/pa7ent à health à facility à s/sx à
sputum
o Systema.c screening for ac.ve TB – refers to the systema7c
iden7fica7on of presump7ve TB in a predetermined target
group, using examina7ons or other procedures that can be
applied rapidly.
§ Ac.ve case finding – systema7c screening
implemented outside health facili7es.
§ Intensified case finding – systema7c screening in
health facili7es among all consults.
§ Enhance case finding – systema7c screening in the
community using symptoms screening using
§ symptoms screening, such as house-to-house visits
by community workers.
• Chest x-ray
o Purpose: secondary test only since there is no specific x-ray
appearance for TB pa7ent’s lungs
o Disclaimer: done only if pa7ent has hemoptysis which is a
contraindica7on to DSSM
o Method: non-invasive use of low levels of radia7on to
visualize parenchymal lesions
§ Preven.on
• Primary level
o Vaccina7on with BCG vaccine
o Given at birth.
o Airborne precau7ons
§ Place pa7ent in a nega7ve pressure room
§ Perform 6 to 12 air charges per day
§ Keep door closed at all 7mes.
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§ Keep distance from pa7ent.

§ Wear PPE
§ Limits pa7ent’s movement
• Secondary level
o Case finding and repor7ng
o Screening of health care provider
§ Treatment regiment
• Mul. drug therapy/ DOTS
o Short course chemotherapy given to pa7ent by treatments
partners.
o Two methods of administra7on:
§ Fixed dose combina.on (FDC) – 2 or more an7-TB
medica7ons are combined in one tablet.
§ Single Drug formula.on (SDF) – each drug is
prepared individually.
o Drug involved:
§ isoniazid
§ Rifampicin
§ Pyrazinamide (PZA)
§ Ethambutol
§ streptomycin
Category Classifica.on Intensive Maintenance
phase phase
1 New Ripe 2 RI 4
Relapse Ripes 2 RIE 5
2 TAF
TALF Ripe 1
PTOU

§ na.onal tuberculosis control program

• vision: TB-free Philippines
• mission:
o to reduce TB burden(TB incidence and TB mortality)
o To achieve catastrophic cost of TB affected household
o To responsively deliver TB service
• RA 10767 – comprehensive TB elimina7on plan act of 2016
§ types of pa.ents
• new: never had treatment, <1 month in treatment.
• Relapse: previously treated, cured, completed tx but presently
posi7ve
• TAF (treatment a1er failure): treatment aGer failure, previously Tx
bust s7ll posi7ve, do not show improvement.
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• TALF (treatment Lost to follow up): treatment aGer lost to follow

up, lost to follow up for 2 months.
• PTOU: previously treatment outcome unknown, undocumented.
§ NTCP
• Rapid diagnos7c test, such has Xpert MTB/RIF, shall be the primary
diagnos7c test for PTB and EPTB in adults and children.
• Smear microscopy whether (brighXield or fluorescence
microscopy) or loop mediated isothermal applica7ons shall be
alterna7ve diagnos7c if Xpert is not accessible.
o Leprosy
§ Other name
• Hansenosis
• Hansen’s disease
• Leon7asis
• Leper’s disease
§ Causa.ve agent:
• Macrobacterium laprae otherwise known as Hansen ‘bacillus.
§ Mode of transmission:
• Direct contact
o Prolong skin to skin contact it is the family members. Also
constant exposure
o Droplet
o Inhala7on of droplet
• You cannot get leprosy from a casual contact with a person who has
hansen’s disease like
o Shaking
o Talking
§ Incuba.on: 5 months to 5 years (average 8 to 16 months)
§ Clinical manifesta.on:
• Skin – discolored patches skin, usually flat, that may be numb and
look faded lighter than the skin around; growths on the skin; skin,
s4ff, or dry skin; painless ulcers on the soles of feet; painless swelling
or lumps on the face or earlobes; loss of eyebrow or eyelashes.
o Lesions vary depending individual immune response.
o Well-demarcated with central hypopigmenta4on
(erythematous and raised)
o Nodules
o Punched out – keloid-like.
o Target like – yung may mat ana parang pigsa
o How the manifesta.on occurs:
§ Redness à itchiness à whi7sh à silver light à loss
of sensory
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• Nerves – numbness; muscle weakness or paralysis; enlarged

nerves; eye problems that leads to blindness.
• Mucous membranes – a stuffy nose or nosebleeds
§ Diagnos.c test
• Slit skin smear (SSS)
• Blind fold test
o Get the informed consent of the pa7ent
o Measure the length and width using the tape measures. à
Blind fold pa7ent à go to the part that there is no wound
à using a ballpen or sharp try to pinch it with the 7p of the
ballpen and ask if the pa7ent can feel anything this is to
measure if the nerves is s4ll alive.
§ Classifica.on based on the skin smear
• Paucibacillary – less than 5 skin lesions; (-) SSS; 6-9 months; RD
o Rifampicin – day 1
o Dapsone – day 2 to 28
• Mul.bacillary – more than 5 skin lesions; (+) SSS; 12-24 months;
RCD
o Rifampacin, Clofazimine, Dapsone – day 1
o Clofazimine, Dapsone – day 2 to 28
• Single lesion – single dose of ROM (-) SSS
§ Treatment regiment
• Drug involved:
o Rifampicin
§ Is given once a month. No toxic effect. The urine may
be colored slightly reddish for a few hours aGer its
intake.
o Ofloxacin
o Minocycline
o Clofazimine
§ Administered daily. Well tolerated and non-toxic
o Dapsone
§ It is a very safe dosage.
§ Preven.on
• Primary
o Vaccine such as BCG
o PPE is gloves and mask
o Hand hygiene
o Keep distance from the pa7ent
§ Leprosy day is every Sunday of January
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o Measles and Rubella

§ Other names:
• Measles long
o Rubeola
o 7 days measles
o English measles
o Hard measles
o Brown/black measles
o Tigdas
• Rubella short
o German measles
o 3 days measles
o Tigdas hangin
§ Causa.ve agent:
• Measles: Rubeola
• German Measles: rubella
§ Mode of transmission
• Measles: airborne
• rubella: Droplet
§ Incuba.on period:
• Measles: 10 -20 days
• Rubella: 12 to 23 days
§ Manifesta.ons
• Measles – cough coryza and conjunc7vi7s
o Rashes (measles = 7 days nonpruri4c, cephalocaudal,
maculopapular with fine flaking)
o Kolpik spots there are chance it will bruise.
• Rubella – mild, maculopapular rash along with lymphadenopathy
and a slight fever
o Rashes (German measles = 3 days, non-pruri7c,
cephalocaudal, maculopapular, li:le to no desquama7on
o Forscheimer spots
• Soothing of throat for mouth ulcers the interven.on is (1) water
or breasoeed (breast milk), (2) buko juice since it has sugar effect
which gives energy. (3) calamnsi juice, (4) ginger – salabat, (5)
tamarind juice.
§ Diagnos.cs
• Clinical syndrome without confirmatory laboratory test
• Measles: real 7me polymerase chain reac7on (RT-PCR) – detec7on
of an7body in serum.
• CBC
§ Measles and rubella: pregnancy
• Measles: pregnant women who have not had the MMR vaccine
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• Rubella: infec7on with rubella virus causes the most severe damage
when the mother is infected early in pregnancy.
§ Preven.on
• Primary level
o MMR vaccine
§ Congenital rubella syndrome
• The most common birth defects from CRS can include.
o Deafness
o Cataracts
o Heart defects
o Intellectual disabili7es
o Liver or spleen damage
o Low birth weight
o Skin rash at birth
• Least common complica7ons
o Glaucoma
o Brain damage
o Thyroid
o And other hormonal problems
§ Nursing management
• Measles:
o Using airborne and contact precau7ons if the child is
hospitalized.
o Restrict child to quiet ac7vi7es and bed rest.
o Use a cool mist vaporizer for cough and coryza.
o Dim lights if photophobia is present.
o Administer an7pyre7c for fever.
o Administer vitamin A supplementa7ons as prescribed.
• Gen.an violet – are given for deep and extensive mouth ulcers;
an7-fungal especially in pH; should not be swallowed it causes
permanent staining.
§ Treatment regimen.
• Vitamin A supplementa7on
o The recommended age specified daily doses are
§ 50,000 – infants younger than 6 months
§ 100,000 – 6-11 months
§ 200,000 – 12 months above
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o Chicken pox
§ Other name
• Varicella
• Child pox
• Itching pox
§ Causa.ve agent: Varicella zoster virus
§ Mode of transmission: airborne
§ Incuba.on: 10 to 12 days aGer exposure symptoms start to appear
§ Manifesta.on
• Rashes
o Centripetal distribu7on
o Begins as a macula then progresses rapidly.
• Different types of rashes in chicken pox:
o Macule – circumcised change in the color of the skin that is
neither not depressed. Flat and can be appreciated visually.
o Papule – circumscribed, solid eleva7on of skin with no
visible fluid. Varies in size from that of pinhead 1cm. brown,
purple, pink or red can be clustered into popular rash.
o Vesicle – small blister filled with fluid.
o Pustules – small bumps on the skin that contain fluid or pus
o Crust – dried sebum, pus or bloody usually mixed with
epithelial and
§ Period of communicability
• A person with chickenpox is considered contagious beginning 1 to
2 days before rash onset un7l all the chicken pox lesion have
crusted (scabbed).
§ Diagnos.cs
• Physical examina7on/presen7ng signs and symptoms.
• PCR if vague clinical presenta7on
• Different diangos7cs of chicken pox and measles rubella
o Chicken pox
§ Centripetal rashes
§ Highly pruri7c rashes
§ Prominent crus7ng of lesions
§ Very itchy
§ Usual onsent during childhood
o Measles and rubella
§ Cephalocaudal rashes
§ Non pruri7c or mild
§ Fine flaking/less crus7ng of lesions
o Shingles
§ Usual onset during childhood
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§ Characterized by painful vesicular lesions located

along a nerve pathaway
§Preven7on
• Varicella vaccine
o First dose given at 12 to 15 months
o Second dose given at 4 to 6 years old
o Route: SQ
o Dose: 0.5ml
o Site: upper arm
o Side effect: low grade fever
§ Nursing management
• An.-viral acyclovir (Zovirax) 500mg/tab BID 7 days
• Oral an7histamine for pruri7s, community sekng: bathing using
young guava leaves
• Calamine lo.on and a cool bath with added baking soda
• Fever: cooling measures
• Itching: use oat soap/trim nails
§ Pregnancy
• It causes congenital varicella syndrome is a n extremely rare
disorder in which affected infants have dis7nc7ve abnormali7es at
birth due to mother’s infec7on with chicken pox
o Diphtheria
§ Other names
• Pseudo membrane
• Bull neck disease
• Klebs-Löffler disease
§ Causa7ve agent: Corynebacterium diphtheriae or Klebs Loffler bacillus
§ Mode of transmission: oGen person to person spread from respiratory
tract
• 2 to 5 days possible longer
§ Manifesta7ons
• Pseudomembrane (smooth adherent white or gray memberane on
the hand palate)
• Signs and symptoms
o Fa7gue
o Malaise
o Sore throat
o Mild fever
o Difficulty swallowing
§ Diagnos7c
• Inspec7on of the buccal mucosa and neck palpa7on
• Culture using throat swab specimen.
• Diagnosis of diphtheria
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§ Preven.on
• Primary level
o Pentavalent vaccine
o Contact precau7ons
§ Keep distance.
§ Wear PPE gloves and mask
§ Hand hygiene
§ Clean and disinfect
§ Decrease number of ar7cles inside the room
§ Nursing management
• Ensure isola7on for the hospitalized child
• Administer diphtheria an7toxin as prescribed (aber a skin or
conjunc4val test to rule out sensi4vity to horse serum.)
• Provide bed rest for 2 weeks
§ An7bio7c
• Procaine penicillin for 14 days
• Erythromycin 40mg/kg/day for 14 days
• An7toxin (an4-diphtheria serum)
o Can be given with penicillin
o Skin tes4ng before administra4on
o Given in frac4onal doses
o Pertussis whooping cough
§ Causa.ve agent:
• Bordetella pertussis
• Bordet-gengou bacillus
• Pertussis bacillus
§ Mode of transmission: droplet or direct contact with infected person;
indirect contact with freshly contaminated ar7cles
§ Incuba.on period:
• 6-20 days less than 21 days
• 7-10 days in average days
§ Manifesta.on
• Pathognomonic – whooping cough or known as nocturnal
coughing.
• Signs and symptoms:
o coryza
o tongue protrusion
o low grade fever
§ diagnos.c test: nasopharyngeal swab or aspirate; PCR within first three
weeks
§ preven.on:
• pentavalent vaccine (DPT)
• contact precau7on:
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o keep distance.
o wear PPE such as gloves and mask
o hand hygiene
o isolate the child during catarrhal stage; if the child is
hospitalized
o administer an7microbial therapy
o reduce environment factors that cause coughing spasm
such as dust, smoke, and sudden changes in temperature
o ensure adequate hydra7on and nutri7on
o provide suc7on and humified oxygen if needed
o monitor cardiopulmonary sta7s (via monitor as prescribed)
and pulse oximetry
§ treatment regimen
• An7bio7cs: erythromycin
o Tetanus
§ Other name
• Lock jaw
§ Causa.ve agent: Clostridium tetani
§ Mode of transmission: direct or indirect contact
• Such as the following
1. Soil
2. Manure
3. Unsterilized medical equipment
4. Penetra7ng eye injuries
5. Deep punctured wound
§ Incuba.on period: varies from 3 days to 20 days (average of 10 days),
falling between 7-14 days
§ Types
• Generalized – most common
• Localized – uncommon/milder
• Cephalic – rarest/paralysis of the Facial nerve
• Neonatal – unvaccinated mother
§ Manifesta7ons
• Tetanic triad
o Trismus
o Risus sardonicus “sardinian” grin
o Opisthotonos – severe simultaneous spasm of all muscle
§ Diagnos7cs
• Clinical syndrome without confirmatory laboratory test
• Spatula test
o (+) involuntary ac7on of the jaw
o (-) gag reflex
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§ Preven.on
• Primary level
o Pentavalent vaccine
• Contact precau7ons
o Wear PPE gloves and masks
o Hand hygiene
o Clean, disinfect, sterile fomites
o Avoid contact with infected soil
o Trim fingernails
§ Nursing management
• Immediate treatment with human tetanus immune globulin 9TIG)
• An7bio7c therapy
• Maintain patent airway
• Keep accurate cardiac monitor
• Maintain IV line for medica7on, put splint
• Carry out efficient wound care
• Avoid s7mula7on; dim light, turn off tv
• Turn to prevent contractures and pressure sores
• Watch urinary reten7on; an7cipate doctors order fir
catheteriza7on
• Prescribed nutri7ous diet: high caloric diet to increase muscle
ac7vity