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M U M P S

Infectious
Parotitis
Epidemic

Carlo Vincent J.
Definition

- Is an acute, contagious
infection that causes
inflammation of the parotid
gland.
Etiologic
Agent
Paramyxo Virus.

Incubation
Period
14-21 days.

POC
7 days before and 9 days after the
onset of parotid glands swelling
Mode of
Transmission
1. Droplet contact
2. Indirect contact with objects
contaminated with
nasopharyngeal secretions.
3. Saliva is the source of
infection.
Manifestations
Remember: HEALS
1. Headache
2. Earache
3. Anorexia
4. Loss of Appetite
5. Swelling of the
parotid gland
Diagnostic Test

1. Compliment Fixation Test


2. Hemo-agglutination Test
3. Neutralization Test
4. *Serum Amylase
determination
*Confirmatory Test
Local Measures

1. Isolate the patient


2. Paracetamol for fever
3. Advise soft diet
4. Advise not to apply indigo
dye
5. Watch for warning signs
Complications

Watch for warning signs:


POEM
a. Pancreatitis
b. Orchitis/Oophoritis
c. Encephalitis
d. Myocarditis
Emergency
Measures
Assess ABC
Start IV line
<12 years old: D5 0.3
NaCl
>12 years old: D5 NM
O2 2-4 L/m via nasal
cannula
Diazepam maximum 10mg
Refer to the hospital with
referral letter
Prevention

1. Measles, Mumps, Rubella


vaccine
1st dose: 12-15 months
2nd dose: 11-12 years old
2. Isolate the client and
observe droplet precaution
until 9 days after the onset
of parotid swelling.
MENINGITIS

Cerebrospinal Fever

Carlo Vincent J. Jordan


Definition

- Inflammation of the meninges


of the brain and spinal cord as
a result of viral and bacterial
infection.

- Dura matter
- Arachnoid
- Pia matter
Etiologic Agent

• Pneumococcus
• Staphylococcus
• Streptococcus
• Tubercle bacillus
• *Neisseria Meningitides
• or Meningococcus- is the
organism causing most
epidemics of meningitis.
Incubation Period
1 to 10 days
Period of Communicability
As long as causative agents are
present in the discharges of the
patient
Mode of
• Transmission
Respiratory Droplets
Diagnostic Test
Bacterial Meningits
• CBC: Increase
polymorphonuclear
leukocytes
• CSF Analysis
• Increase CSF pressure
• Increase Protein
• Increase Leokocytes
• Decrease Glucose
Diagnostic Test
Viral Meningits
• CBC: Decrease
polymorphonuclear
leukocytes
• CSF Analysis
• Normal or slightly increase
CSF pressure
• Normal or slightly Protein
• Few Leukocytes
• Normal Glucose
Manifestations
Classical Symptoms in Adult:
• Fever, Headache, Nuchal
rigidity
• Altered Level of
Consciousness
• Petechial or Purpuric rashes
Manifestations
Classical Symptoms in Children:
• Neck Tenderness,
• Nuchal rigidity,
• Bulging fontanels
• High Pitched cry
• Signs of Increased ICP
• Signs of Meningeal Irritation:
KNOB
Kernig’s sign
Nuchal rigidity
Opisthotonus
Complications
Waterhouse Friedrichen Syndrome
Medical Treatment
Mannitol
- is given to decrease cerebral
edema
Digitalis
- is given to control arrythmias
Antibiotics:
- Ceftriaxone is given to combat
causative agent
Anti Convulsant
- is given to control seizure
Nursing
Management
2. Isolate the patient
3. Follow strict aseptic technique
4. Assess Level of consciousness
5. Check for signs of Increased ICP
6. Provide quite and noise free
environment
7. Maintain Fluid balance
Prevention
2. Vaccination of HiB for children
3. Vaccination of Neisseria
Menigitides Serogroups for older
clients
4. Chemoprophylaxis: Rifampicin
ENCEPHALITI
S

Brain Fever

Carlo Vincent J. Jordan


Definition

- Inflammation of the cerebral


tissue accompanied by meningeal
irritation as a complication of
infectious nervous system disease.
Classifications
Primary Encephalitis
- The microorganism directly
targets and attacks the brain and
the spinal cord.
c. Eastern Equine Encephalitis
- Considered as a serious epidemic
disease of the horses.
- It affects children under 5 years
of age.
Classifications
b. Western Equine Encephalitis
- Milder form and usually affects
adults.
c. St. Louise Encephalitis
- Microorganism gain entrance
through the olfactory tract.
d. Japanese Encephalitis
- Severe viral disease carried by
the vector mosquito, Culex
Triteaniorhynchus.
- Affects children under 5 to 10
Classifications
Secondary Encephalitis
- Result as a complication of viral
diseases.
c. Post Infection Encephalitis
- Results as a complication or
sequalae of viral diseases like
measles, chicken pox, and mumps.
b. Post Vaccinal Encephalitis
- Most common after receiving anti
rabies vaccine.
Classifications
Toxic Encephalitis
- Caused by ingesting chemical or
heavy metals such as lead and
mercury.
Causative Agent
West Nile Virus
Vector
Mosquito
Host
Birds
Incubation Period
5-15 days
POC
As long as microbes are present in the
discharges
Mode of
Transmissions
1. Vector Borne Transmission
2. Direct Complication
3. Accidental inhalation or ingestion
of chemicals
Manifestations
Prodromal Period
2. Fever, Headache, Dizziness,
Vomiting.
3. Chills, Sore throat, Conjunctivitis,
Myalgia,
Abdominal pain.

Encephalitic Signs
7. Nuchal rigidity, Ataxia, Tremors,
Mental confusion, Speech
difficulties, Stupor or hyper
Diagnostic Test
1. CSF Analysis
- Leuckocytosis
- Increase mononuclear pleocytosis
- Increase Proteins
- Normal or slightly decrease
glucose.

2. ELISA IgM

3. Polymerase Chain Reaction Test


- Analysis of the virus DNA and
Specific Treatment
1. Acyclovir: Drug of Choice
Intravenous 10-21 days
Pregnant: 3rd Trimester
2. Anti Convulsant
To control seizures
3. Mannitol
To decrease cerebral edema
4. Corticosteroid
To decrease inflammation
Nursing
Management
2. Isolate the patient
3. Follow strict aseptic technique
4. Assess Level of consciousness
5. Check for signs of Increased ICP
6. Provide quite and noise free
environment
7. Maintain Fluid balance
Prevention
1. Immunization with MMR

2. CLEAN Program by the DOH


C- chemically treated mosquito
net
L- larvae eating fishes
E- environmental sanitation
A- anti mosquito lotion
N- neem tress such as
PNEUMONIA

Carlo Vincent J. Jordan


Definition

- Inflammation of the lung


parenchyma with the production of
alveolar exudates resulting to
consolidation of the air sacs.
Causative Agents

1. Streptococcus Pnuemoniae
2. Staphylococcus Aureus
3. Klebsiella Pnuemoniae
(Friedlander's Bacilli)
4. Mycoplasma
Incubation Period
1-3 days
Mode of
Transmission
Respiratory
Droplets
Indirect contact with
objects
contaminated by
Diagnostic Test
Chest Xray: confirmatory
Sputum C/S
Manifestations
Adult:
1. Cough
2. Tachypnea RR>20 breaths per
minute
3. Tachycardia CR> 100 beats per
minute
4. Fever 37.8C
5. And at least one abnormal
findings
a. Diminished breath sounds
b. Ronchi
Local Measures
1. Isolate the patient
2. Give oral antibiotic
DOC: Amoxycillin 1 gm po every 8
hours for 7 days.
3. Give Salbutamol 2mg tablet 3-4 x
a day.
4. Give Paracetamol 500mg every 4
hours
5. Increase Oral fluid intake
6. Balanced nutrition and exercises
7. Observe for warning signs
Local Measures
Warning Signs:
1. Worsening of vital signs
a. RR> 30 breaths per minute
b. CR> 125 beats per minute
c. T> <35C or 40C>
2. Respiratory Failure
RR< 12 breaths per minute or
cyanosis
3. Evidence of Sepsis
Bleeding and Jaundice
Manifestations
Pedia
1. Cough
2. Fever
3. Rapid Breathing
2-12 months RR>50
12 months-5 years old RR>40
5 years old- 13 years old RR>30
4. Any of the following abnormal lung
sound
a. Diminished breath sound
b. Ronchi ( Snoring sound)
c. Crackles ( short, sharp, rough
Local Measures
1. Give Paracetamol every 4 hours
2. Adequate fluid intake
3. Give oral antibiotics
Cotrimoxazole 5mg/kg bid for 5
days
Amoxicillin 40-50 mkd tid for 5
days
4. Oral salbutamol
5. Observe for warning signs
Local Measures
5. Observe for warning signs
a. Chest indrawing
b. Rapid RR>60
c. Irritability/Restlessness
d. Poor feeding/Unable to drink
e. Persistent vomiting
f. Decrease level of consciousness
Local Measures
5. Observe for warning signs
a. Chest indrawing
b. Rapid RR>60
c. Irritability/Restlessness
d. Poor feeding/Unable to drink
e. Persistent vomiting
f. Decrease level of consciousness
REFER to the HOSPITAL
Manifestations
Cough and Sputum Production
1. Staphylococcus Aureus
- Yellow blood streaked sputum
2. Streptococcal
- Rusty Sputum
3. Klebsiella
- Red gelatinous sputum
4. Mycoplasma
- mucoid sputum: pus + blood
DIPTHERIA

Carlo Vincent J. Jordan


Definition

- An acute, febrile infection of the


tonsils, throat, nose, and larynx
Causative Agent
Corynebacterium Diptheriae
Klebs loeffler bacillus
Incubation Period
2-5 days
Period of
2-4 weeks
Communicability
Mode of transmission
Respiratory droplets
Contaminated objects
Causative Agent
Corynebacterium Diptheriae
Klebs loeffler bacillus
Three strains of Corynebacterium
a. Gravis- (severe)- Produces the
most severe and fatal cases of
diphtheria.
b. Intermedius- ( intermediate)- more
on bleeding manifestations.
c. Mitis- (mild)- Produces lesions
extending to the larynx and lungs.
Manifestations
1. Nasal Diphtheria
- microorganism is localized in the
nares
- excoriation of the upper lip
- PS: Foul smelling serosanginous
secretions from the nose
2. Pharyngeal Diphtheria
- Fever, malaise
- Bull neck appearance
of the neck
- PS: Pseudomembrane
Manifestations

3. Laryngotracheal Diphtheria
- most common in infants
- most deadly
- signs of respiratory distress
- PS: laryngeal stridor: Hoarseness
of voice
4. Fever 38C
5. Cervical Adenitis
6. Body weakness
7. DOB
Diagnostic Test

1. Nose and Throat culture


2. Loeffler Slant
3. Moloney’s Test
- Determine hypersensitivity to
diphtheria toxoid
3. Schick’s Test
- Test for susceptibility to
diphtheria toxin
- Skin testing
Treatment

1. Diphtheria Antitoxin
- To combat the toxins secreted
by the microorganism
2. Antibiotic:
- DOC: Penicillin: to combat
causative agent
3. Standby Resuscitative
Equipment at the bed side.
Complications
1. Myocarditis caused by action
of toxin to heart muscle
2. Polyneuritis that includes;
- Paralysis of the soft palate
- Paralysis of the ciliary muscle
of the eye
3. Airway obstruction
4. Cervical Adenitis
5. Otitis media
6. Bronchopneumonia
Nursing
1. IsolateInterventions
and Bed rest for 2 weeks:
to conserve energy and decrease
workload of the heart.
2. Soft diet: frequent small feedings
3. Increase intake of fruit juices rich
in Vitamin C to alkalinize the blood
and increase the resistance of the
patient
4. Ice collar must be applied to the
neck
5. Proper disposal of nasopharyngeal
Pertussis

Whooping
Cough
Carlo Vincent J. Jordan
Definition

- An acute, contagious disease


characterized by paroxysmal
cough followed by an explosive
expiration ending in vomiting.
Causative Agent

Bordetella Pertussis.
a. Non motile, gram (-) bacillus.
b. Easily destroyed by light, heat,
and drying
Incubation Period
7-12 days
Period of
7 Communicability
days after exposure up
to 3 weeks after paroxysms
Mode of Transmissions
Droplets
Indirect contact with contaminated
objects
Sources of Infection
Secretions from the nose and
Manifestations
1. Catarrhal Stage
- Most communicable stage
- Mucoid rhinoria, Sneezing,
Lacrimation, dry bronchial cough .
- Cough becomes irritating,
hacking, and nocturnal and
becoming more severe.
- Last for 1 to 2 weeks.
2. Paroxysmal Stage
- 7th to 14th day
- Cough becomes spasmodic and
Manifestations
2. Paroxysmal Stage
- Cough ends in a loud, crowing
inspiratory whoop and vomiting.
- Coughing may induce nose
bleeding, increased venous
pressure, periorbital edema,
conjunctival hemorrhage,
hemorrhage of the anterior portion
of the eye.
- Lasts 4 to 6 weeks
Manifestations

3. Convalescent Stage
- Marked by gradual decrease in
paroxysms of coughing, vomiting
ceases.
- Attacks subsides.
Diagnostic Test

1. Nasopharyngeal Swabbing
2. CBC
3. Bordet Gengou Test
4. *Sputum Culture and Sensitivity
*Confirmatory diagnostic test
Treatment

1. Fluid and Electrolytes replacement


2. Oxygen Therapy
3. Hyper immune convalescent
serum or gamma globulin
4. Antibiotics: Erythromycin and
Ampicillin
5. Antitussive : Sinecod Forte
Nursing
Intervention
1. Isolate the patient
2. Suctions secretions during the
attack to prevent airway
obstruction
3. NPO during the attack to prevent
aspiration
4. Small frequent feedings
5. Immunization with DPT vaccine