Inflammatory inflammation -response of the tissue to an injury -a defensive reaction intended to neutralize, control or eliminate the offending agent

t and to prepare the site for repair. 5 Cardinal Sign 1. heat -calor 2. redness rubor 3. swelling -tumor (on microscopic examination shows the presence of many giant cells.) 4. pain -dolor 5. loss of function Cause 1. Physical stressors - ex. Trauma 2. Chemical stressors ingestion e.g Na, Mg, K etc. 3. Biologic stressors - virus, bacteria, fungi Major Components 1. Blood vessels 2. Blood cells 3. Inflammatory exudates 4. Defensive cells ex.microphages (a small cell (phagocyte - A body cell which can eat or destroy foreign matter or bacteria.), active in combating and digesting germs which may be in the tissues) , macrophages (A large white blood cell, active in destroying and devouring bacteria or foreign matter that has entered the body.) 5. Antibodies - A substance produced in the blood of an individual which is capable of producing a specific immunity to a specific germ or virus. 6. Surrounding tissue 1. Vascular response formation of inflammatory exudates (eg. In blood vessel system) 2. Cellular response immigration , phagocytosis (is the process in which phagocytes destroy circulating bacteria, viruses or foreign bodies.) 3. Chemical response - histamine (A breakdown product of protein metabolism. It has many actions within the body, including the stimulation of secretion of gastric juice, the stimulation of secretions of glands and the dilatation of small blood vessels.) , serotonin (A chemical found in the blood which causes blood vessels to constrict and contract. It is present in large amounts in people who have a spreading tumor in the intestines) ,prostaglandin (-Fatty acids, found naturally in all people, that affect many body activities. They tend to lower blood pressure, regulate body temperature, stimulate contractions of the uterus and other involuntary muscles, and regulate acid secretion of the stomach. 4. Fibrin barrier response fibrin is the substance responsible for blood-clotting mechanism. 5. Humoral response A body fluid, such as the humor within the eyeball. 6. Hormonal response - A chemical produced by a gland, secreted into the bloodstream, and affecting the function of distant cells or organs. Hormone - A chemical produced by a gland, secreted into the bloodstream, and affecting the function of distant cells or organs. Vasodilation Enlargement or dilation of blood vessels. - there is heat and redness Hyperemia An increased amount of blood in an organ or other part of the body, as seen in an area of inflammation - there is blood estasis Factors for formation of exudates (exudate - Inflammatory fluid (pus, serum, etc.) which bathes the tissues in the vicinity of an infection.) 1. Hyperemia that occurs after injury. 2. Capillary permeability allowing solutions and fine particles to pass through, as a permeable membrane. 3. Increase filtration pressure. - passing it through a membrane (filter) Function of exudate 1. To dilate the toxin release by bacteria 2. To bring to the site certain nutrients necessary for tissue repair 3. To carry the protective cell that will phagocytize bacteria. CVA (cerebrovascular accident; a stroke) embolus, thrombus -Circulation will slow Immigration- squeezing out of blood vessels Chemotaxis- site of inflammation by chemical signal - Positive chemotaxis occurs when one substance is attracted toward another; negative chemotaxis is said to take place when one substance is repelled by another. Phagocytosis engulping and ingestion of foreign substance - A process in which phagocytes destroy circulating bacteria, viruses or

foreign bodies. Fibrin barrier fibrinogen is important in blood that is involved in clotting mechanism as converted to fibrin (The substance which enmeshes blood corpuscles in the blood-clotting mechanism. Fibrin is a body protein which hardens) Humoral response it neutralizes bacteria toxin where defence mechanism defend antitoxin and antibodies. Hormonal Response Cortisone (A hormone secreted by the cortex of the adrenal gland.) anti inflammatory suppressing the formation of eusinophils and lymphocytes causing shrinking.Of lymphoid tissu Aldosterone ( A hormone produced by the adrenal gland. It regulates potassium and sodium metabolism) an inflammatory corticoids that stimulate the bodys defensive act to promote and support inflammatory reaction. Characteristics Duration Important anatomical changes Acute Response -last from few days to few weeks -vascular congestion, exudation of inflammatory lymph and defensive cells -poly morphonuclear leukocytes with neutrophils arriving first -pain -heat -swelling Chronic Response - persist over many week or may last for several months -proliferative cell, multiplication.

Dominant cell at the site of injury Symptoms

-mononuclear cells especially lymphocyte and plasma cell. -symptoms may not be severe because orolifiration of fibroplastic bearing deformity and adhesion develop or permanent tissue damage.

Epidemiology study of the factors, events and circumstances that influence the transmission of infectious disease in the human population. - The study of the occurrence and prevalence of disease, often applied to the study of the manner of spread of contagious diseases. Classification: a. Incidence b. Portal of entry c. Source d. Symptoms e. Disease course f. Site of infection g. Virulence factors - Able to cause disease; a powerful germ A. Incident use to describe the number of new cases of infection that occur in a define population over an establish period. a. Prevalence indicates the number of an active cases at any given time. b. Endemic disease is considered in a particular geographic region when incidence and prevalence are stable. -A disease, usually contagious, which occurs in one locality, such as one town or city c. Epidemic describe as abrupt and unexpected increase in the incidence of disease over endemic state. - A disease which simultaneously affects large numbers of people in a community. d. Pandemic refers to the spread of disease beyond continental boundaries. - - One that spreads throughout the world. Ex. The Asian flu became a pandemic disease several years ago. B. Portal of entry refers to the process by which pathogen enter body to gain access to susceptible tissue and will cause disease. C. Direct contact directly from infected tissue. D. Penetration any disruption in the integrity of the body surface barrier. E. Ingestion to eat, through oral cavity into the gastrointestinal tract.

F. Inhalation through respiratory tract. -In healthy person It is equipped with multidefence system to prevent potential pathogens from entering.

Source refers to the location, caused, object, substance from which infections agent was acquired.

- Acquired host of microbial flora as would be in the cause in another Opportunistic infection Exogeneous external environment Nosocomial infection developed whole in the hospital Symptomatology- refers to collection of signs and symptoms expressed during disease course/ clinical picture/dse.presentation Resolution total elimination without residual signs and symptoms Site of infection abscess, there isPhagocytosis. 1. Acute stage period during which the host experience the maximum impact of the infectious process for responding to rapid proliferation and dessimination of the pathogen. 2. Convalesent period characterized by contentment of infection progression elimination as pathogen repair of the damage tissue and resolution of symptoms Resolution total elimination of pathogen in the body without the residual signs and symptoms Site of infection determined by the time of pathogen the portal of entry and competence of host immunologic defense system Abcess-specialize or bucket infection, composed of microorganism and the most pathogucitic WBC. Virulence Factors substance product generated by 4 gen.inhibitory 1. Toxin substance that alter &destroy the normal function of the host - It is he poison manufactured by germs or other forms of animal or vegetable life. When it gains access to the body of humans, it acts as a poison and stimulates the formation of antibodies (antitoxins). 2. Adhesion factor A band or fiber. Abdominal adhesions are caused by abnormal bands which bind the organs to one another. 3. Evasive splitting or lifting out. no. of factors produce by microorganism enhanced by the various component of the host immune system. 4. Invasive Referring to a localized infection or tumor which moves or grows and invades other parts of the body. - product produce by infectious that facilitate or anatomic barriers of the host tissue. Chain of infection 1. Causative agent Bacteria fungi (A form of plant life sometimes causing infections in humans such as athlete's foot and trichomoniasisvaginalis) spirochete protozoa (One-celled organisms; the lowest form of animal life. Some protozoa act as parasites and can cause serious disease in humans.) Viruses parasites (ex. of invading parasite; malaria, amebic ( one cell organism) dysentery, hookworm disease (A parasitic disease caused by a hookworm, a nematode parasite. The hookworm penetrates the skin of the feet, enters the circulation and eventually fastens itself to the lining of the intestine. It sucks blood and ultimately causes severe anemia. This disease is sometimes seen among barefoot children and adults.) Rickets- A disease of infancy caused by lack of vitamin D, evidenced in marked cases by bone deformities such as bow legs, funnel chest, beading of the ribs, etc. 2. Reservoir of transmission Human Animal Non living 3. Portal of exit Respiratory GUT GIT 4. Mode of transmission By contact Indirect contact Droplet Airborne Vectorborne (vector- An insect or other form of animal life which acts as a 'go between' in the transmission of germs to humans.) 5. Mode of entry to human Respiratory GIT 6. Susceptible host

Systemic effects an infectious organism can escape the confines of the immediate tissue via the circulatory system or lymphatic system, where it may spread to other parts of the body. If an org. is not contained by the action of acute inflam. It may gain access to the lymphatic system via nearby vessels. An infection of the lymph vessels is known as lymphagitis and infection of the lymph node as known as lymphadenitis a pathogen can gain access to the blood stream through lymphatic drainage into the circulatory system. Systemic effects Symptoms: -fever - high BP - Lower sweating - loss of appetite - Somnolence Leukocyte inflammation after affect the no. of leukocytes present in the body. - White blood cells having characteristic cell nuclei. The varying appearance of the nucleus of the leukocyte, as seen under the microscope, determines whether it is a neutrophil, an eosinophil, a basophil, a monocyte, a lymphocyte, etc. Pathophysiology ----------Injury Vascular Changes -vasodilation -increase capillary permeability -increase blood flow -local tissue congestion Disruption of Tissue Integrity Ischemic Damage Inflammatory Response -----Immune Reaction Cellular Changes -phagocytosis -leukocytes(granulocytes and monocytes) - release of chemical mediators(most cell and macrophages) Body Response Local effects - Erythema - Warmth - Edema - Pain - Impaired functioning Systematic effets - Fever - Leucocytosis - Malaise - Anorexia - Sepsis

Systemic response to inflammation-the inflammatory response is often confined to the site, causing only the local signs
and symptoms.

Fever -is the most common sign of a systemic response to injury, and it is most likely

caused by endogenous pyrogens( internal

substance that cause fever) released from neutrophils and macrophages ( specialized forms of leukocytes these substance reset the hypothalamic thermostat) , which controls body temp. and produce fever. During this process, general, non specific symptoms develop, including malaise, loss of appetite, aching and weakness 4 stage 1.Invasion - Process by which bacteria enter into the body 2. incubation period of entrance of bacteria into the body up to the time the signs and symptoms appear. 3.convalescence period from the s & s of the disease up to the time there are signs of recovery. 4. recovery period from first signs of recovery up to the time the person is fully recovered. Types of infection 1.communicator infectious disease that can be transmitted from an infected person, animals or object from an unaffected person 2.nosocomial - infection acquired with in the health care facilities -Referring to a hospital, such as nosocomial infection, which has been acquired while the patient is in a hospital. 3. opportunities that occur in immunocompromise host Ex. Elderly Bacterial infection

1. Furuncle or boil or abscess acute inflammmation. Causative agent: staphylococusaureus from a multiple/ recurrent lesion. 2. Stye furuncle that form in the eyelid margin. -An infection of a sebaceous gland of an eyelid. Hordeolum (Sty. An abscess or boil on the eyelid) Clinical features initial occurrence begin around hair follicle Site * axilla Buttocks Neck Back of neck Symptoms 1. Tenderness 2. Pain in surrounding cellulitis 3. Center becomes buggy 4. There is an irritation, pressure friction 5. Perspiration Tx and Mgt. - Protect the area from irritation 1. Apply hot/warm compression for vascularization. 2. Clean the surrounding skin with bacterial soap 3. Apply antibacterial ointment to the surrounding skin MGT. If the boil is already big ( I and D is advice) Health education in the community Instruct how to keep the lesion sterile Advice to wash hands

Carbuncle it is an abcess of skin and subscutaneous tissue an extension of furuncle invading multiple follicle
- A large boil, usually of the skin and tissues beneath the skin, which discharges pus from several points. Causes: Seen most frequently in the thick fibrous and elastic skin in the back of neck and buttocks. Occur in debilitated person e.g. diabetic patient.

Symptoms -fever - pain -leucocytosis (An increase in the number of white blood cells circulating in the blood. This occurs during most infections and toxic conditions.) -bacteremia bacteria in blood Note: It is difficult to remove especially in pt. who is diabetic TX. 1. Antibiotic until infected person is controlled 2. Determine if the pt. has history of DM. 3. Prepare the surgical Mgt. as I and D (incision and drainage) done locally with anesthesia as pain reliever. -Use supportive mgt. IV (infusion)

Impetigo impetigocontagiosa
- superficial, infection of the skin caused by streptococcusaureus, characterized by formation of bullet ( fluid blister/ large fluid filled blister) from the original vesicle. a lesion appears on a skin and ruptures and loosely adherent like yellow honey crust. - A pustular inflammatory disease of the skin, highly contagious, seen often in infants and young children.

Common Area affected: -skin neck -hand -extremities -face Note:contagious disease seen in all ages but particularly common in children (undernourished) Source of infections: -childrens pet - contaminated towels -secondarypediculosiscapile( A skin condition caused by lice) MGT. Systemic antibiotic (Penicillin) Complication: Glomerulonephritis - An inflammation of the kidneys, often secondary to a severe infection elsewhere in the body. Fungal infection TineaPedis athletes foot or ringworm artificial fungal infection which may manifest itself as an acute inflammation involving sole of feet and interdigital. Fungi - plant like organism responsible for a variety of common skin infection. Clinical manifestation - Intense itching and burning sensation - Lymphagitis(Inflammation of a lymph vessel, a common mode of spread from a localized infection.) and cellulitis (Inflammation of connective tissue, usually the tissues just beneath the - skin surface.) if bacterial superinfection is present. Diagnostic Evaluation - Diabetic examination of skin - Isolation of the organism for culture - Soak it in a K manganite or saline solution to remove scale, debris and residual medication. Test - Apply cream or lotion o Timactin - An antifungal medication, applied locally in the form of a cream, powder or aerosol. o Micronasol - Topical therapy Preventive Measures and Health Education instruct the patient to keep the feet dry. 1. Dry carefully between the toes. 2. Alternate shoes to permit adequate drying of toes between wearing 3. Wear stocking which is synthetic material for it does not absorb perspiration. 4. Wear appropriate shoes to permit irrigation 5. Use small piece of cotton between toes.

PNEUMONIA - Inflammation of the lungs. It may be caused by the pneumonia germ, a virus, or other germs such as influenza,
staphylococcus, streptococcus, etc. Most cases can now be cured. Types: 1. Bronchopneumonia most common type - Infection usually starts from the bronchiole and bronchus and spread to the alveoli, - lobules pain, with consolidation, something are not inflamed but are collapse due tomucopurulent clogging. 2. Lobular Pneumonia consolidation (consolidated lung is one in which the air cells are filledwith fluid, mucus or pus) of the entire lobe - it manifest chills, chest pain on breathing and cough with blood-streak sputum - as disease progresses the prune juice color of the sputum may be replaced by a thinner of yellowish color. 3. Primary Atypical Pneumonia produced as direct result of inhalation or aspiration of pathogen. 4. Secondary Pneumonia develops as complication of a disease. Stages of Pneumonia 1. Stage of Engorgement lung is heavy, dark red in color & exuding a bubbly blood 2. Stage of red Hepatization lung is still heavy which sink in waterit looks like a piece of red granite. 3. Stage of GrayHepatization the red color changes to gray.it looks like an ordinary granite -is softer and tears more easily -when pressed the exudate is purulent fluid. 4. Stage of Resolution the inflammation exudate (Inflammatory fluid (pus, serum, etc.) which bathes the tissues in the vicinity of an infection) is either absorbed by the blood stream. Clinical Manifestation: - Sudden chills - Rising fever

Stabbing chest pain is aggravated by respiration and coughing Paroxysmal cough rusty The sputum is rusty Body malaise Labored breathing Diaphoresis All of a sudden convulsion Vomiting (in children)

Diagnostic Procedure 1. Chest X-ray 2. Sputum analysis 3. Blood exam

Treatment:
1.Anti-microbial therapy varies in different agent a.Staphylococcus - A type of germ (bacteria). It appears round under a microscope. Probably the most prevalent type of germ in existence. It may cause simple pimples, boils, etc., or more important infections in organs of the body. Macrolides 7- 10 days after the start of culture.

b. Klebsiela - medicines: Aminoglycosides and Cephalosporin. c. Streptococcus - napcillin or Doxycycline (An antibiotic particularly effective against infections of the intestinal tract associated with diarrhea.) - for 14 days d. pneumocystitiscarini-Cotrimoxazole - antibiotic Note: Pen G Na - common antibiotic

2.Supportive measures 1.administer O2/ elevate head 2.encourage to give high caloric food ( such as vegetable) -Vit C rich food 3.encourage breathing 4.encourage bed rest 3.Administerbroncho dilators - salbutamol - D5W1/2 + 2 amps of Aminophyline Nursing Management 1.To maintain a patent airway and to have adequate oxygenation. 2. Teach the patient deep breathing and coughing exercise. 3. Obtain a sputum specimen as needed - Sputum AFB for 3 days in a.m. 4. Maintain adequate nutrition - a. high caloric b. provide a calm environment. 5. Control the spread of infection - proper disposal of waste product. 6. Monitor V/S and watch for danger signs of: a. marked dyspnea b. treddy and small irregular pulse c. LOC delirium d. cold and moist skin e. cyanosis and exhaustion Prevention: 1.Proper hygiene 2. Proper isolation 3. Prevent common colds 4. Immunization

INFLUENZA acute viral infectious disease affecting the respiratory system.

Causative Agent RNA containing myxovirus type A. Incubation period: 24 to 48 days Period of communicability:- 7 days in children th -until the 5 day of illness to others. Mode of transmission - Airborne

-Direct contact/ droplet spread. Note: Influenza virus persist for 2 hours in dry mucous place.

Clinical manifestation:
-sudden chill sensation -hyperpyrexia (40C) -malaise -sore throat -headache -severe headache of back -severe sweating -G.I. disturbance e.g. vomiting

Complications: 1. Directly related to primary viral infection e.g. hemorrhagic pneumonia. 2. Encephalitis 3. Myocarditis may lead to cardiac failure or sudden infant death syndrome. 4. Bacterial infection e.g. Otitis media, sinusitis and pneumonia.

Diagnostic Procedure: 1. Physical exam 2. Blood examination 3. Throat culture 4. Viral serology - a. Compliment fixation test b. Hemo agglutination test c. neutralization test.

Management: 1. Provide bedrest 2. Increase fluid intake 3. TSB 4. Antipyretic (Paracetamol) 5. Isolate patient 6. Watch out for complication Preventive Measures 1. Immunization 2. Proper ventilation (avoid crowded places)

STD Sexually Transmitted Disease - transmitted by sexual activity such as syphilis and gonorrhoea. Gonorrhea an infection involving the mucosal surface of the genitourinary tract. -A venereal infection of the lining of the penis (urethra). It is accompanied by swelling, pain on voiding, and discharge of pus.

Epidemiology 1. Change in sexual behaviour 2. Sexual contact at earlier age Complications: On Women: (most percentage) 1. Sterility 2. Pelvic infection On Men( most percentage ) 1. Post gonococcal urethritis On Women ( small percentage ) 1. Vaginal discharge 2. Abnormal uterine bleeding 3. Urinary frequency and pain 4. Pelvic infection 5. Fever 6. Nausea and vomiting 7. Abdominal pain and tenderness.

On Men ( small percentage ) 1. Urethritis - with purulent discharge -Inflammation of the urethra, the outlet from the bladder to the outside.

2. Painful urination 3. Spread of infection to posterior urethra, seminal vesicle and epididymis (That portion of the seminal tube immediately attached to the testicle. It collects sperm, from the testicle, which will be transported by the seminal duct.) 4. Prostatitis- Inflammation of the prostate gland. This condition may give pain in the bladder region, frequency of urination, blood in the urine, etc.

5. Pelvic pain 6. Epididymitis - Inflammation of the epididymis, a structure immediately adjacent to the testicle, often caused by gonorrhea 7. Pain of tenderness and swelling. Note: Anal --anal burning, itching, bleeding, mucupurulent discharge, painful defecation. Pharyngeal -sore throat , asymptomatic. Diagnostic Evaluation - Pap smear and culture specimen, anal culture for women. -smear of urethral exudate in microscopic exam for men. Treatment/Management: 1. Drug Regimen - such as injection of -Aqueous procaine, penicillin -Tetracycline Hydrochloride 4 x a day for 5 days. -Ampicillin and Amoxicillin 2. Treatment of sexual contact - for culture as exam, secure serologic test (One performed on the serum of the blood.) Complication 1. Endocarditis 2.Bacteremia 3.Arthritis Note: Principle of Control a reportable cases, each patient should be interview. 3. Contact known Gonorrhea should be investigated 4. Patient should be reinstructed to avoid reinfection. Gonorrhea- a venereal infection of the lining of the penis (urethra). It is accompanied by swelling, pain on voiding, and discharge of pus. Syphilis - A communicable venereal disease, characterized by a primary sore (chancre) and subsequent involvement of all the organs of the body. It can be cured through intensive treatment. -a sexually transmitted disease that begin in mucous membrane and become systemic. Incubation period: 10 - 90 days or 3 weeks (ave.) Sources: 1. Discharge from obvious lesion of skin or mucous membrane 2. The semen of infected person also tears and urine. 3. Discharges from nose, eyes and genital tract. Period of communicability: - indefinite Mode of transmission: direct contact with an infected person. -indirect contact with particles or discharge of bloods containing the organism. -congeniality to the placenta. Clinical manifestation: Primary 1. Starts from chancres that erupt in genitalia, anus or nipple 2. This chancres disappear for 3-6 days even without treatment. 3. Chancres usually associated with lymph adenopathy (Swelling or diseaseof lymph gland) Secondary 1. Macular, popular, postulates or nodular. 2. Macules often erupt b/w walls of fats - found in trunk and arms, palm, face and scalp. 3. The mild constitutional symptoms, headache, anorexia, malaise, weight loss, nausea and vomiting, sore throat, slight fever and alopecia (A skin disease characterized by loss of hair, partial or total.), also nails become brittle.

Subtype: 1. Late benign - symptoms appear on skin, bones and mucous membrane. 2. Gamma - typical lesions, superficial lesion nodule or deep granulomatous lesion -painless -gammas are found in the long bones of leg. 3. Late syphilis - involves the liver. -can cause epigastric pain, enlarge spleen and anemia. -there is a destruction of bone and other organ that can lead to death. Cardiovascular Syphilis - develop in 10 yrs. After the initial infection. Congenital syphilis - thefetus may be overwhelemed by the infection, can also cause still birth. Clinical manifestation: Early congenital: -lesions on the skin and mucous membrane -mucous patches in lips, mouth and throat and in nasal passage. -liver and spleen enlargement causing the infants abdomen to enlarge (liver cells are immature) 1. Severe damage to several. 2. Hearts disease and brain damage. 3. Severe illness or death of the newborn. Diagnostic procedure 1. Serologic test: Non Treponema/Reagin test - screening test to detect antibody 2. Treponematest - measure specific antibody to treponemapallidum, recommended for patient with reactive. treponemapallidum -The germ, a spirochete, which causes syphilis. a. FTB FlourescentTreponemal) antibody absorption test b. Microhemagglutination test (MHA) Medication: Pen. G Benzathine (I.M.) - form of penicillin that is very potent. -5 cc diluted to 20 cc distilled h2O deep IM each buttocks. -for infected patient may add oral tetracycline or erythromycin. Nursing Management 1. Stress the implementation of treatment of disease. 2. Observe universal precaution. 3. Keep lesion dry. 4. Check LOC. Prevention and Control 1. Report cases to DOH 2. Control prostitution. 3. Require sex worker to have regular check up 4. Proper sex education be given in early life at home, in schools and in the community. 5. Look for case of syphilis infection. XXXXXend3A Chlamydial infection is a sexually transmitted disease caused by chlamydia trachomatis. Chlamydia Pneumonia can spread through coughing and sneezing. Chlamydia Psittaci - which birds can pass to human. It may lead to: (Complications) 1. Epididymitis -Inflammation of the epididymis(That portion of the seminal tube immediately attached to the testicle. It collects sperm, from the testicle, which will be transported by the seminal duct.) , a structure immediately adjacent to the testicle, often caused by gonorrhea. 2. Salphingitis - Inflammation of the fallopian (uterine) tubes which extend out from both sides of the uterus. 3. Pelvic Inflammatory Disease ( PID) - a not uncommon condition associated with disease of the ovaries and fallopian tubes. 4. Sterility - Incapable of bearing children. Unable to reproduce. In Women: 1. Spontaneous abortion 2. Premature Delivery Mode of Transmission 1. Through vaginal or rectal intercourse. 2. Through oral-genital contact with an infected person. 3. Conjunctivitia Otitis Media and Pneumonia may develop in children born to mother with chlamydial infection passed through the birth canal. Signs and Symptoms 1. Cervicitis Inflammation of the cervix of the uterus.Thers is cervical erosion, mucopurulent discharges, pelvic pain

2. Endomitritis or Salphingitis - pain and tenderness of abdomen, cervix, uterus and lymph node. -chills, fever, breakthrough bleeding and bleeding after intercourse. 3. Women with urethral syndrome dyspnea, pyuria(Pus in the urine, denoting an inflammation within the urinary tract) and urinary frequency. 4. Men who have urethritis dysuria(Impaired ability to pass urine; also, painful voiding.) , erythema (A patch of redness of the skin.) , tenderness of urethral meatus and urethra discharges. 5. Men with Epididymis pain, scrotal swelling and urethral discharge. Other Symptoms: diarrhea, tenesmus (Pain and spasm when attempting to pass urine or evacuate the bowels. Various inflammatory conditions can produce tenesmus.) , pruritus, bloody or mucopurulent discharge, ulceration of rectosigmoid colon (The last few feet (in the adult) of the large intestine.) Diagnosis: 1. Swab from the site of infection 2. Cultured of aspirated material. 3. Direct Flourescent antibody test Treatment: 1. Doxycycline - oral meds for 7 days - An antibiotic particularly effective against infections of the intestinal tract associated with diarrhea. 2. Azithromycin - as single dose. Nursing Management: 1. Practice universal precaution 2. Both partner should submit for test. 3. Check newborn for signs of chlamydial infection. Ameba - A one-celled organism. (Certain amebae cause dysentery.) Amebiasis - Infection with the Endamoeba histolytica. Endamoeba - A parasite, a type of ameba, which can cause dysentery and other infections in man Amoebiasis(Amoebic Dysentery) -protozoalinfection of human being initially involve the colon but may spread to soft tissue e.g. most commonly the liver and lungs by lymphatic dessimination or hematogenous. Patient w/ liver abscess&ameabiasis Etiologic Agent: EntamoebaHistolytica. Note: - prevalent in unsanitary areas -common in warm climates -acquired by swallowing -cyst survives a few days outside of the body. -cyst passes to the large intestine and hatches into Trophozoite. It passes into the mesenteric veins, portal vein and finally into the liver where it causes amoebic liver abscess. Development Stage of E. Hystolytica 1. Trophozoites/Vegetative form - parasite may invade the tissue or found in parasitized tissue or liquid caloric content. 2. Cyst passed out with formed or semiformed stools and is resistant to environmental conditions. -considered as the infected stage in the life cycle of E. hystolytica. Source: Human excreta. Incubation Period: -severe infection is 3 days. -sub-acute and chronic from last for several months, average vasries from 3-4 weeks. Mode of Transmission: 1. Fecal-oral transmission 2. Direct contact/sexual contact 3. Indirect contact - ingestion of food Clinical Manifestation: 1. Acute Amoebic Dysentery -slight diarrhea with period of constipation and often accompanied by tenesmus.(Pain and spasm when attempting to pass urine or evacuate the bowels. Various inflammatory conditions can produce tenesmus) -diarrhea, watery and foul smelling stools and often contain blood streaked mucous. -colic and gaseous distention of the lower abdomen. -nausea, flatulence (Excessive gas in the stomach or bowels.), abdominal distention. -tenderness in the right iliac region over the colon. Note: Iliac -Referring to the ilium, the winglike portion of the hip bones. The flank.

2. Chronic Amoebic Dysentery- an inflammation of the large bowel associated with pain, cramps and diarrhea. (There are many different types of dysentery, each caused by a specific germ.) -attack of dysentery that lasts for several days, usually succeded by constipation. -anorexia, weight loss and weakness -stools at first are semifluidbut soon become watery, bloody and mucoid. -vague abdominal distress, flatulence, constipation or irregularity of bowel movement. -mild toxaemia, constant fatigue -abdomen losses elasticity. (ex. When picked up by the fingers. -on sigmoidoscopy there is scattered ulceration with yellowish and erythematous borders. -in fatal it is gangrenous characterized by appearance of large slough(a Dead tissue which separates from a wound, abscess, burned area, etc) of intestinal tissue in the stools accompanied by haemorrhage. Clinical Feature 1. Onset is gradual 2. Diarrhea increase and stools becomes bloody and mucoid. 3. If untreated: Fluid stool severe bloody mucoid stool Haemorrhage intestinal perforation Peritonitis death. Diagnostic Exam 1. Stool Exam for presence of cyst, white & yellow pus with plenty of amoeba. 2. Blood Exam - for leucocytosis 3. Proctoscopy (there is a hollow, metal tube inserted into the anus and rectum for the purpose of examination.) andsigmoidoscopy ( there is a long, hollow, lighted tube used to look into the rectum and sigmoid colon. It is inserted through the rectum and is about 10 inches long. Treatment: 1. Metronidazole (eg. Flagyl) 800 mg TID for 5 days. 2. Tetracycline 250 mg every 6 hours. 3. Ampicillin, quinolone, sulfadiazine 4. Streptomycin sulphate, Chloramphenicol 5. Replacement of lost fluids and electrolytes. Nursing Management: 1. Observe isolation 2. Provide health education and instruct pt. to: a. Boil water for drinking or use purified water b. Cover leftover food c. Wash hands after defecation and before eating. 3 Proper collection of stool specimen. Prevention: 1. Health education 2. Sanitary disposal of feces 3. Protect, chlorinate and purify drinking water 4. Observe cleanliness in food preparation and food handling 5. Detection and treatment of carrier 6. Fly control.

Bacillary Dysentery is

an acute bacterial infection of the intestine characterized by diarrhea and fever and is associated with the passing out of loodymucoid stools accompanied by tenesmus (Pain and spasm when attempting to pass urine or evacuate the bowels. Various inflammatory conditions can produce tenesmus.) . - A diarrheal disease caused by a specific rod-shaped bacillus. It is contracted by eating infected food or drinking infected water. Food handlers also may be responsible for transmission of the disease. Etiologic agent: Shigella (the bacillus of Salmonelleae group) 4 1. Shigellaflexnen 2. Shigellabaydil 3. Shigellaconnei 4. Shigelladysenteriae Incubation period: 7 hrs to 5 days, average is 3 to 5 days Period of Communicability: the p. is capable of transmitting the microorganism during the acute infection until the feces are negative of the organism. Some patient remain a carrier for a year or two. Mode of Transmission:

1. Ingestion of contaminated food or water or milk. 2. Transmitted by flies. 3. Fecal-oral transmission is possible. Clinical Manifestation: 1. Fever, especially in children. 2. Tenesmus, headache, nausea and vomiting 3. Colicky or cramping abdominal pain associated with anorexia and body weakness. 4. Diarrheawth bloody mucoid stools that are watery at first. 5. Rapid dehydration and loss of weight. Complications 1. Rectal prolapse, particularly in undernourished children. 2. Respiratory complications such as cough and pneumonia. 3. Non-supporative arthritis and peripheral neuropathy. Diagnostic Procedures: 1. Fecalysis 2. Rectal swab and culture 3. Peripheral blood examination 4. Blood culture Nursing Management 1. Maintain fluid & electrolyte balance to prevent profound dehydration. 2. Keep the patient warm and comfortable. 3. Restrict food unitl nausea and vomiting subsides. 4. Isolation can be carried out through medical aseptic technique. 5. Personal hygiene nust be maintained. 6. Excreta must be properly disposed. 7. Concurrent and terminal disinfection should be employed.

Parasites
Trichinosis infectation by the parasite or roundworm.
Causative agent: richinillaSpirallis. -acquired by consuming an infected meat e.g pork -is a tiny embryo looks like. Clinical anifestation: 1. Malaise 2. Gastrointestinal problem - Diarrhea - Fever - Nausea and vomiting - Muscular invasion -edema of the eyelid -generalized pain -cardiac irregularities -DOB Diagnosis: - Biopsy of the specimen muscle -serologic test One performed on the serum of the blood. Serum - That part of whole blood which remains after blood has clotted. It is yellowish in color. -aesinophil count Management: - Thiabendazole - Cortecostenoids - Bed rest - ECG ( to determine if there is myocarditis) Health Education: - Isolation -Proper disposal of waste and garbage.

Hookworm

- A parasitic disease caused by the hookworm, a nematode parasite. The hookworm penetrates the skin of the feet, enters the circulation and eventually fastens itself to the lining of the intestine. It sucks blood and ultimately causes severe anemia. -this disease is sometimes seen among barefoot children and adults. -is an infestation of small intesting -1.2 cm or inch long -is an intestinal parasite that usually causes diarrhea or cramps

-infection occurs mostly in tropical or subtropical countries. Etiologic Agent: 1. Ancylostomadyodenale an agent that is most prevantl in Europe and West Asia. 2. NecarotAmericanus is distributed in Central and South America and West Africa. Charqcteristics: - Both species are pathologic to man and have similar life cycle. - Slight difference in structure of the mouth, but but have hooks and can pierce and they attach themselves in intestinal mucosa. - The source is SOIL that is contaminated by feces that contains hookworm OVA. - Female hookworm may produce as many as 10,000-20,000 eggs per day. - Eggs are deposited in moist and oxygen rich soil and it will be develop in embryos within 24-72hrs.. - The young larvae take about 6 wks. To develop into mature larvae that cause human infection the larvae remain alive in the soil for several weeks. - They remain in infective stage for several days or weks and enter the body by penetrating the skin. Mode of Transmission: - skin of the foot -possible through ingestin of contaminated water of food. Treatment/edication: -pyrantelembonate( Quantrel ) -tetrachloroethylene -carbon Tetrachloride Nursing Management: -isolation is not necessary. -high calorie, vitamin and mineral diet -maitain personal hygiene

Enterobiasis (pinworm) - A parasite which sometimes invades the intestinal tract and rectum,
causing inflammation of the bowel wall and rectal itching. -Pinworm infestation, usually involving the intestinal tract. -common in children. Causative Agent: EnterobiasVernicularis Clinical Problem: the cecum. skin or peri-anal area. -the eggs reach maturity in 2-6 wks. Clinical Manifestation: -asymptomatic but with night itching -restlessness -nervousness -vaginitis. Diagnosis: -anal inspection taken in the morning before the patient take a bath. -ingested egg hatch in small intestine and the embryo adulthood is in -gravid female migrates down the large intestine and deposit egg in the

Immunologic response- pertains to immunity.

(immune system) The body mechanism that protects against harmful invaders, including the production of antibodies. (The bone marrow, the thymus gland, and lymph tissue are prominent in activating the immune system.) immune from latin immunis means free from burden -protected against a disease. -Protect against a disease Immunity relative resistance of the host to reinfection of microbes. -immune responses include the ff: a. antibody production b. activation of cellular component c. activate certain white blood cells and tissue macrophages to phagocytized foreign materials. . - resulting of having recovered from a disease or from having been given an immunizing vaccine or toxoid. Function: 1. Defense resistance to infection. 2. Hemostasis work out of cell component. -he act of clamping and tying off bleeding blood vessels. 3. Surveillance identification and destruction of mutant cells. Damaged mmune System: -produced antibodies against the following disease: 1. Autoimmune disease. 2. Hypersensitivity by allergic reaction.

3. Damage various organs through accumulation of immune response component. 4. Results in some immune deficiency response eg. AIDS. Antigen the substance capable of stimulating the formation of an antibody. Immunogen any sustances that includes a detectable immune reponse like humoral and cellular or both when introduce into the host. Types of Immunity: 1. Non-speciic acts as an internal barriers against infection. Eg. Skin 2. Specific in active immunity. Natural Passive immunity recreiving immune response component that have been manufactured in the body of other people or animals. -Ex.maternal immunoglobulin via placenta it protect the infants from various infectious disease for a few months. Acquired immunity - temporary immunity which follows the infection of humn globulin called gamma globulin. - a protein substance that circulate in the blood and it neutralizes. Immuno Assay quantitative estimate of the protein contain in the blood serum. Immune-deficiency deficiency of immune response either it is meditated by humoral antibody. - it provide and produce immune lymph cells that is susceptible to infectious disease. Immunization process of increasing the state of body immunity. (Immune system )-The body mechanism that protects against harmful invaders, including the production of antibodies. (The bone marrow, the thymus gland, and lymph tissue are prominent in activating the immune system.) characteristics of Specific mmunity: Provides effective protection against a wide range of organism. Allows the body to recognized foreign sustances. Protects the body from reinfection. Provide specific immunity.

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Organs of the mmune System 1. Thymus allowing t-lymphocyt to develop before migrating to the the lymph nodes and spleen. Note: Thymus gland - A gland composed of a special type of lymphoid tissue, located beneath the breastbone. It shrinks and becomes inactive early in childhood. 2. Lymph Nodes removing worked out erythrocytes from the blood. -storing blood and platelets -filtering and purifying blood. Note: Lymph - The fluid which is derived from connective tissue and tissue between organs. Lymph travels through lymph channels and lymph nodes (glands). 3. Spleen removing worked out erythrocytes froom blood. - storing blood and platelets. -filtering and purifying blood. (Anatomy)- An abdominal organ located in the left upper portion of the abdomen. It is a lymph organ which, during the life of the embryo, manufactures blood cells. After birth, one of its functions is related to disposal of old, worn-out red blood cells. Other functions are not yet completely determined. 4. Tonsils - Lymph glands located in the mouth near the back of the tongue. They frequently become enlarged and infected. -defend the body against microorganism. Humoral Immunity results from the development of antibodies. Cellular Immunity results from the development of lymphocytes sensitized to specific antigen. 1. Lymphocytes derives from bone marrow. - A type of white blood cell having a single, rounded nucleus (cell center. 2 Major Types 1.B-Lymphocytes Bursa dependent lymphocytes 2. T-Lymphocytes thymus dependent lymphocytes. Classification: 1.Pre-dominating Humoral 2.Predominantly cellular 3Combination of two. 2. Antibodies - Immunoglobulin - is a specific gamma-globulin. Types: 1. Precipitation - antibodies react with soluble antigen resulting insoluble complex which precipitate.

2. Agglutination antibodies disarm antigen by causing them to clamp together. 3. Neutralization antibodies combine with the toxin release by some infectious agent. 4. Lysis antibodies attack cell membrane and cause cell rupture. Difference b/w Humoral and Cellular Immunity Humoral 1. Cell B-Lymphocytes 2. Product Antibodies

3. 4. 5. 6.

Memory Reaction Protection Against

Present Immediate Protects bacteria Respiratory and G.I, pathogens Anaphylactic shock - Atopic dse. (relating to an allergy. - Transfusion reaction - Immune complex dse.

7. Example

Cellular T-Lymhocytes Sensitized T-cell Lymphokines (a Powerful antitumor cells produced by incubating lymphocytes) Present Delay Protects fungi Virus, chronic infectious agent, tumor cell. Tuberculosis - Contact dermatitis - Graft infection - Destruction of cancer cell.

Immunoglobulin (Ig) - is an antibodies produced in the lymphatic cells to combat infections or other invading substances. Also known as immune serum globulins. 5 Classes: 1. Immunoglobulin M (Gamma M) - is the largest molecule that tends to stay in blood stream -it primarily engage and defends in intramuscular compartment. 2. IgG (Gamma G) most abundant, smallest that readily diffuses. 3. IgA (gamma A) circulates in the blood but its role is to produce external secretions (eg. Saliva & tears) where it provides a primary defense mechanism. 4. IgD (gamma D) - function has not been determine. 5. IgE (gamma E) responsible for most of the immediate type pf allergic reaction. Ex. Immunodeficiency - such as Acquired Immuno deficiency Syndrome (AIDS) -characterized by a collapse of body natural immunity against disease. 1. HTLV Human T Lymphotropic virus Type 3 2. LAV Lymph adenopathy associated virus. 3. ARV age related virus. Mode: 1. Male homosexual 2. Intravenous drug users 3. People w/ haemophilia (An inherited disease in which the blood clots improperly. Hemophiliacs are almost invariably males; they are called 'bleeders.) ELISA it can detect the presence of antibodies of the AIDS virus. Characteristics: 1. Swollen lymph nodes 2. Rapid unexplained weight loss 3. Fever w/ night sweat. 4. Chronic diarrhea 5. Unexplained and prolonged fatigue 6. Cough and SOB 7. Fungal infection mostly in mouth and sore 8. Rashes w/ reddish bluish brown patch. AIDS - an abbreviation for 'acquired immune deficiency syndrome,' a fatal condition caused by the HTLV-III/LAV virus. The disease is found predominantly among male homosexuals who practice anal intercourse and among drug addicts who share intravenous needles. The virus destroys T-cell lymphocytes that are essential in protecting the body against infections. Minor signs: 1. Persistent cough for 1 month. 2. Generalized pruritic dermatitis 3. Recurrent herpes zoster (Shingles; an eruption, caused by a virus, following the course of a nerve.) ( -A disease of the nerve endings in the skin characterized by the formation of blisters, crusts and severe pain along the course of the involved nerve. It is a virus infection and may last several weeks.) 4. Oropharyngeal candidiasis 5. Chronic dessiminated 6. Generalized lymph adenopathy (Swelling or disease of a lymph gland)

Major Signs: 1. Loss of weight usually 10% 2. Chronic diarrhea for 1 month 3. Prolonged fever for 1 month Common Opportunistic Infection 1. Pneumocysticcarini - A viral pneumonia often seen in patients with AIDS. 2. Oral Candidiasis 3. Toxoplasmosis of the CNS 4. Chronic Diarrhea 5. Pulmonary or Extra pulmonary TB 6. Cancer a. Kaposis Sarcoma it affects small blood vessels and internal organs. b. Cervical dysplasia (Impaired growth processes.) c. Non-HodginsLycoma cancerous tumor of the lymph nodes and the late manifestation of HIV infection. Mode of Transmission: 1. Sexual intercourse 2. Blood transfusion 3. Perinatal or Vertical transmission ( pregnant mother to the delivery of fetus) Diagnostic Exam: 1. ELISA - Enzyme linked immune sorbent assay 2. Particle agglutination 3. Western blot analysis 4. Immune-flourescent test 5. RIPA Radio immune precipitation assay. Treatment 1. Reverse Transcriptase nhibitor inhibits the enzyme Generic Retivir Zerit Havid

Brand Name Epivir Viramune Videx

2. Protease Inhibitor works by inhibiting the enzyme protease (An enzyme (chemical) which digests proteins) Norvir, Envivar Lymphocytes Antibodies neutralization Lysis- receding of the symptoms of a disease, Decline of a fever, cutting of adhesions during an operation and Decomposition or dissolution. Immune globulin- A drug given into the muscles or intravenously to bolster the body's immune system. Used in cases of agammaglobinemia and in some cases of purpura to initiate greater production of antibodies.

Anemia - Insufficiency of red blood cells, either of quality or quantity. Pernicious anemia- A serious specific type of anemia associated with lack of hydrochloric acid in the stomach juices and
nervous disorders. The administration of vitamin B12, folic acid, liver and stomach extracts have been found effective in control of this condition.

Aplastic anemia -Anemia due to bone marrow defects and degenerative changes.
Leukemia- A group of malignant, fatally terminating diseases of the white blood cells and blood-forming organs. There are many
forms of this disease, the specific type being diagnosed microscopically. Chronic lymphocytic leukemia - A form of leukemia in which the increase in white blood cells occurs among the lymphocytes. Hypersensitivity - often called an allergic response ( Allergy ) 4 main types of hypersensitivity 5. factors autoimmune altered antigen cross reaction antibodies viral infections hormonal function genetic factors corpusenthinotosis disorder of connective tissue autoimmune disorder

1.multiple sclerosis 2Myastenia Disorder of cornea Dry eye Keratocones Disorder of conjunctiva Conjunctivitis Pinguecula Pterygion Disorder of Iris Iritis.uveitis/chronovetiritis Malignant melanoma Disorder retina Retinal detachment Retinitis pigmentosa Macula Optic nerve disorder

Extraocular muscle Disorder: vergencies Strabismus Amblyopia Optic nerve disorder Basic examination eyes Visual acuity Dsorder of eye Dry eye Keratoconus Conjunctivitis Pingecula Pterygium Glaucoma Cataracts Corneal disorders: corneal dystrophies Keratoconous Retinal disorders: retinal detachment Serous detachment Tumor Vanthelasmachororetinitis Maliganant melanoma Suconjuntival haemorrhage Iris irits Iridocystitis Choriodirttis Crystalline lens : myopia Hyperopia

Presbyopia Cataracts

Carbuncle Asthma