IMCI

FEVER A. Malarial risk
Classification VERY SEVERE FEBRILE DISEASE/ MALARIA MALARIA FEVER: MALARIA UNLIKELY Signs and symptoms Any general danger sign + stiff neck Management
‡First line AB =CHLOROQUINE ‡Paracetamol for fever ‡refer

Blood smear (+) Blood smear(-) Runny nose (+) Measles (+) Fever (+)

oRal antimalarial (5days) Paracetamol for fever Paracetamol for fever Treat other causes of fever

B. NO MALARIAL RISK
Classification VERY SEVERE FEBRILE DISEASE FEVER: NO MALARIA Signs and symptoms Danger signs + FEVER Management
‡IST LINE AB ‡Paracetamol for fever ‡refer

No signs of very severe febrile disease

Home care

C. MEASLES
Classification
SEVERE COMPLICATED MEASLES

Signs and symptoms

Management

ANY DANGER SIGN + ‡Give VIT. A and AB corneal discharge, deep or ‡Apply Tetracycline if PUS is extensive mouth ulcers draining from the eye ‡REFER PUS draining from the eye Mouth ulcers Measles now or from the last 3 months Give VIT. A Apply Tetracycline if PUS is draining from the eye Give VIT. A

MEASLES WITH EYE OR MOUTH COMPLICATIONS MEASLES

D. DHF
CLASSIFICATION
SEVERE DENGUE HEMORRHAGIC FEVER

SIGNS AND SYMPTOMS
‡Tourniquet test (+) ‡BLEEDING- melena, hematemesis, hematochezia, easy bruising ‡SHOCK-LIKE manifestations

MANAGEMENT
‡Fluids ‡ORS ‡DO NOT GIVE ASPIRIN ‡REFER URGENTLY

FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY

NO SIGNS OF SEVERE DENGUE ‡Follow up in 2 days HEMORRHAGIC FEVER ‡DO NOT GIVE ASPIRIN

ANEMIA
CLASSIFICATION
SEVERE MALNUTRITION/ SEVERE ANEMIA ANEMIA/VERY LOW WEIGHT

SIGNS AND SYMPTOMS
‡Severe palmar pallor ‡Visible severe wasting ‡Edema of both feet ‡VERY LOW WEIGHT FOR AGE ‡Some palmar pallor

MANAGEMENT
‡GIVE VIT. A ‡REFER URGENTLY

Give iron, VIT A GIVE Mebendazole/albendazole RHU: Feeding program

NO ANEMIA AND NOT VERY LOW WEIGHT

Not very low weight for age and no other signs of malnutrition

5 days follow-up

transmitted easily from one person to another by direct or indirect contact Infectious.COMMUNICABLE DISEASE .Caused by an infectious agent from an infected individual and transmitted to a susceptible host either by direct or indirect contact 2 MAJOR TYES OF COMMUNICABLE DISEASE: Contagious.not easily transmitted by ordinary contact but requires a direct inoculation .

country or community i. Sporadic Disease = disease that occurs only occasionally & irregularly with no specific pattern i. malaria .e. botulism. Pulmonary Tuberculosis.e. Endemic Disease = constantly present in a population.Classification of Infectious Diseases: ‡ Based on Occurrence of Disease: 1. tetanus 2.

SARS . typhoid 4.3. greater than normal number of cases in an area within a short period of time i.e. Epidemic Disease = patient acquire the disease in a relatively short period of time . Pandemic Disease = epidemic disease that occurs worldwide i.e. cholera. HIV infection.

measles.‡ Based on Severity or Duration of Disease 1.e. Acute Disease = develops rapidly (rapid onset) but lasts only a short time i. mumps. influenza .

e. Leprosy 3. Subacute Disease = intermediate between acute and chronic i.2.e. Latent Disease = causative agent remains inactive for a time but then becomes active to produce symptoms of the disease i. TB. amoebiasis .e. chickenpox shingles (zoster). bacterial endocarditis 4. Chronic Disease = develops more slowly (insidious onset) disease likely to be continual or recurrent for long periods i.

Focal Infection = local infection that spread but are confined to specific areas of the body . Local Infection = microbes invade a relatively small area of the body 2. measles 3. Generalized (Systemic) Infection = spread throughout the body by blood or lymph i.‡ Based on Extent of Affected Host¶s Body 1.e.

Primary Infection = acute infection that causes the initial illness 2. Subclinical (Inapparent Infection) = does not cause any noticeable illness . Secondary Infection = one caused by an opportunistic pathogen after primary infection has weakened the body¶s defenses 3.‡ Based on State of Host Resistance: 1.

is the condition of being secure against any particular disease.is the resistance that an individual has against disease . particularly the power which a living organism possesses to resist and overcome infection .IMMUNITY .

‡ ANTIBODY ‡ .a specific immune substance produced by the lymphocytes of the blood of tissue juices of man or animal in response to the introduction into the body of an antigen . IMMUNOGLOBULINS AND RELATED RESISTANCE FACTORS.‡ IMMUNE SYSTEM ‡ PROTECTION AGAINST INFECTIVE OR ALLERGIC DISEASES BY A SYSTEM OF ANTIBODIES.

Not long lasting 2.ANTIGEN TRIGGERING AGENT OF THE IMMUNE SYSTEM. single dose needed 2. ATTENUATED ( LIVE WEAKENED ORGANISM) 1. Multiple doses needed 3. Booster dose needed 2. long lasting immunity ** all vaccines lose their potency after a certain time. . INACTIVATED ( KILLED ORGANISM) ‡ 1. FOREIGN SUBSTANCE INTRODUCED INTO THE BODY causing the body to produce antibodies TYPES OF ANTIGENS: 1.

HOST . Environment 3. Agent Infectivity Pathogenicity Virulence Antigenicity 2.TRIAD OF DISEASE CAUSATION 1.

Contact. Vehicle . Reservoir/Source of infection III.CHAIN OF INFECTION I.mother to child transmission through placental transfer Horizontal. MODE OF TRANSMISSION 2 TYPES OF MOT: Vertical. Causative Agent II. Vector. Portal of exit IV. Airborne.

1. Droplet spread.person to person transfer of organism b. Contact transmission a. sneezes. .transmission thru contact with respiratory secretions when infected person coughs. Indirect contact. Direct contact. or talks up to 3 feet.occurs when susceptible person comes in contact with a contaminated object c.

2. 3. flies. Vector-borne transmission. mosquitoes transfer the microbes to another living organism. droplet nuclei. Vehicle transmission. Airborne.thru articles or substance that harbor the organism until it is ingested into the host 4. .occurs when fine microbial particles or dust particles containing microbes remain suspended in the air for a prolonged period.occurs when intermediate carriers: fleas.

Portal f Entry VI.V. Susceptible host QUARANTINE VS. ISOLATION DISINFECTION VS. STERILIZATION .

. TRANSMISSON-BASED PRECAUTION a.intended to prevent parenteral. UNIVERSAL PRECAUTION. N95 mask required.TYPES OF ISOLATION TECHNIQUES: 1. mucous membrane. 2. AIRBORNE PRECAUTION.prevent spread of infection by close or direct contact b.for diseases transmitted via airborne transmission. CONTACT PRECAUTIONS. and non-intact skin exposure of health care workers to blood-borne pathogens.

3. Medical. Surgical technique. REVERSE ISOLATION/PROTECTIVE ISOLATION .sterile technique .Protects the patient. ASEPSIS: 1.clean technique 2.

INFECTIOUS DISEASE .

Respiratory Diseases .

.

Mumps ( Epidemic Parotitis). Infectious Parotitis ‡ Acute contagious VIRAL disease. Mumps virus . paromyxovirus of the Varicella family( found in the saliva) ‡ Mumps vaccine . Adults less likely to be attacked ( If so. causes sterility) MOT: droplet. common in men. saliva . Characteristic feature is swelling of one or both of the parotid glands ‡ RNA.> 1yo ‡ MMR 15 mos ‡ Lifetime Immunity IP: 14-25 days. usually 18 days Incidence: 5-15 y/o. cold weather. fomites.

.

ELISA Mgmt: supportive Supporter for orchitis Analgesics Antipyretic.S/sx: Pain at the angle of the jaw (Unilateral or bilateral) PATHOGNOMONIC SIGN parotitis.sterility if bilateral. until 9 days after swelling subsides ( 7th 9th day) ** highest communicability 48 hrs after onset of swelling Dx: serologic testing. cold compress. steroids . Orchitis . Period of communicability: 6 days before swelling .

.

Diet : soft.) = LIFETIME IMMUNITY . Don t give sour foods Promotive:  Proper disposal of nasal & throat secretions  Bed rest Preventive: MMR vaccine ( 15 mos.

fomites . pharynx. or lesion of other parts of the body infected ‡ More severe in unimmunized and partially immunized MOT: Direct/indirect contact = Airborne/droplet.Diphtheria ‡ CA: Corynebacterium diphtheriae. gram (+) ( Klebs Loeffler s Bacillus) ‡ IP: 2-5 days ‡ Period of Communicability: 2-4 wks if untreated. eyes. 1-2 days if treated ‡ Active (DPT) and Passive Immunization (Diphtheria antitoxin) ‡ Source: Discharges of the nose.

Tonsillar low fatality rate 3.sore throat causing dysphagia . Nasal invades nose by extension from pharynx 2.more severe type .Pseudomembrane in uvula. tonsils. soft palate gray exudate - .Toxin producing organism = EXOTOXIN 1. NasoPharygeal.

Bullneck inflammation of cervical LN. Cutaneous diphtheria affect mucous membrane & any break on the skin . neck tissues are edematous .dyspnea ‡ 4.increasing hoarseness until aphonia .wheezing on expiration .

.

.

Diphtheria skin lesion BULLNECK with pharyngeal diphtheria .

S/sx: sore throat, fever, S/sx: BullBull-neck appearance ( CHARACTERISTIC SIGN) ,Pseudomembrane-( PseudomembranePATHOGNOMONIC SIGN) gray exudate, foul exudate, breath, massive swelling of tonsils and uvula, thick speech, cervical lymphadenopathy, lymphadenopathy, swelling of submandibular and anterior neck), obstruction of respiratory tract

Dx: Dx: 1.Schick test susceptibility to diphtheria toxin 2. Moloney sensitivity to diphtheria toxoid 3. Throat swab (K tellurite and Loeffler s coagulated blood serum

Treatment
‡ Neutralize the toxins antidiptheria serum ‡ Kill the microorganism penicillin, erythromycin, rifampicin, clindamycin ‡ Considered cured after 3 negative throat cultures ‡ Prevent respiratory obstruction tracheostomy, intubation ‡ CBR up to 2 weeks to prevent myocarditis ‡ Strict isolation

Nursing intervention
‡ Strict isolation of the hospitalized child ‡ Administer anti-toxin ‡ Supportive
± Maintenance of adequate nutrition
‡ Encouraged drinks rich in vitamin C

± Maintenance of adequate fluid and electrolytes ± Bed rest for at least 2 weeks
‡ Avoid exertion

‡ Ice collar must be applied to the neck ‡ Nose and throat must be taken care of ‡ Administer antibiotics as prescribed
± Penicillin effective for respiratory diphtheria

Pre exposure prophylaxis for Diphtheria.booster dose (+) culture and (-) immunization treated as a case of Diptheria . Pertussis. Tetanus ‡ DPT.0.5 ml IM 1 .after 4 weeks 1st booster 18 mos 2nd booster 4-6 yo subsequent booster every 10 yrs thereafter ‡ Household contacts (+) primary immunization and (-) culture .after 4 weeks 3 .1 ½ months old 2 .

Bordetella pertussis. crowding facilitates spread DX EXAM: ‡ Direct fluorescent Antibody ‡ Nasopharyngeal culture: Bordet-Gengou (Agar plate) . pertussis bacilli MOT: Direct spread through respiratory and salivary contacts.PERTUSSIS Other names: 100 day cough. Tuspirina CA: Haemophilus pertussis.

S/SX: Catarrhal stage.most contagious Paroxysmal stage Convalescent stagerecovery phase DOC: Penicillin .

.SARS.Severe acute respiratory syndrome Causative Agent: SARSassociated coronavirus MOT: ‡ respiratory droplets (droplet spread) produced when an infected person coughs or sneezes ‡ direct contact with respiratory secretions or body fluids of a patient with SARS.

Signs and symptoms: PRODROMAL Phase Fever > 38 C.hypoxia and crackles or rales. headache. chills. malaise RESPIRATORY phase ‡ Dry non-productive cough with or without respi distress ‡ Physical examination. dullness on percussion Treatment: Supportive treatment as needed (e. Empiric broad spectrum antibiotics also given against communityacquired pneumonia and atypical pneumonia . fluids).g. oxygen.

which caused Asian Flu in 1957 H3N2. which caused Spanish flu in 1918. which caused Hong Kong Flu in 1968 H1N2.INFLUENZA CA: ORTHOMYXOVIRUS influenza virus (A. and the 2009 flu pandemic H2N2.C) H1N1. endemic in humans and pigs MOT: ‡ person to person via small particle aerosols ‡ Fomites .B .

Signs and symptoms: Fever Chills Abdominal pain Respi tract infection ‡ Prevention Vaccination.influenza vaccine .

Influenzae and S. Pneumoniae MOT: Droplets (urti) to blood stream to CNS IP: 1-2 days ( even faster) ‡ High risk: immunocompromised .Meningococcemia ‡ CA : Neisseria meningitides ( bacteria) gram ()diplococci ‡ May also be caused by H.

purpuric or ecchymotic hemorrhage is scattered in the entire body surface appear. Bacteria is carried by circulation & when it reaches the meninges of the brain.S/sx: 1. enlarging petecchial rash. BLEEDING occurs into the medulla which extends to the cortex & petechial. Meningococcemia usually starts as nasopharyngitis. hypotension. adrenal insufficiency . followed by sudden onset of spiking fever. arthralgia. 2. Fulminant Meningococcemia (Waterhouse Friedrichsen) septic shock. tachycardia. chills.

‡ Clinical Manifestation ± sudden onset of high grade fever. rash and rapid deterioration of clinical condition within 24 hours .

.

.

Meningococcal Septicemia Waterhouse-friedrichsen Syndrome .

Treatment: ‡ antimicrobial ± Benzyl Penicillin 250-400000 u/kg/day ( drug of choice) ± Chloramphenicol 100mg/kg/day ‡ Symptomatic and supportive ± fever ± seizures ± hydration ± respiratory function ‡ Chemoprophylaxis ± Rifampicin 300-600mg q 12hrs x 4 doses ± Ofloxacin 400mg single dose ± Ceftriaxone 125-250mg IM single dose ( Ciprobay) .

Nursing Intervention 1. To prevent the occurrence of further ‡ ‡ ‡ ‡ ‡ ‡ complications -maintain strict surgical aseptic technique when doing dressings or lumbar puncture in order to prevent the spread of microorganism -administer O2 inhalation to prevent respiratory distress and to maintain a clear open airway -TSB for fever to prevent convulsions -observe signs and symptoms of increase intracranial pressure -change positions at least every 2 hours to prevent pressure sore -protect the eyes from bright lights and noise .

Prevent spread of the disease. microorganisms and contamination some precautions should be carried out . Prevent the spread of infection. Ensure the patients full comfort. prevent stress provoking factors that may retard convalescence and to prevent from injury ‡ 5. prophylaxis for close contacts ( Rifampicin ) ‡ 4. Maintain normal amount of fluid and electrolyte balance ‡ 3.‡ 2.

Maintain personal hygiene and cleanliness and avoid microorganisms to harbor in the patients body ‡ 7. Maintain proper elimination of waste product of metabolism ‡ 8.‡ 6. Nutritional intake .

CIRCULATORY CD .

Plasmodium vivax ( Benign tertian) Non-life threatening except for the very young & old . Plasmodium ovale rare . manifest chills q48H on the 3rd day onward if untreated 3. Plasmodium falciparum ( malignant tertian) Most fatal . non life threatening . fever & chills usually occur q72H usually on the 4th day after the onset 4. common in the Philippines 2.MALARIA (Ague) King of Tropical Disease Causative agent : Protozoa of genus Plasmodia 4 species of Protozoa: 1. Plasmodium malariae (Quartan) Less frequently seen .

Vector Female Anopheles mosquito .

trees. curtains and the like . free flowing shaded streams usually in the mountains = bigger in size than the ordinary mosquito = brown in color. usually does not bite a person in motion = assumes a 36 degree position when it alights on walls.Vector: (night biting) ‡ Female anopheles mosquito or minimus flavirustris = infectious but not contagious = thrives in clear.

hypertrophy of the spleen and liver and pigmentation of organs. ± The pigmentation is due to the phagocytocis of malarial pigments released into the blood stream upon rupture of red cells .Pathology ± the most characteristic pathology of malaria is destruction of red blood cells.

abdominal pain and vomiting » TSB . shakes » Keep the patient warm » Hot water bath » Expose to heat » Warm drinks ± Last about 10-15min 2. . cold compress » Light clothing.‡ Clinical manifestations : 1. . Hot stage (3-4Hrs) ± Recurring high grade fever . Cold stage ± Chilling sensation of the body ( 10-15 mins) ± Chattering of lips. headache .

Rapid diagnostic test ( RDT) blood test for malaria conducted outside the lab & in the field.Peripheral blood extraction (extract blood at the height of fever or 2 hrs before chilling ( AGUE) 2. This is done to detect malarial parasite antigen in the blood. Wet stage ± Profuse sweating » Keep patient comfortable » Keep them warm and dry » Increase fluid intake Diagnostics: 1.III.result is within 1015 mins. . Malarial smear .

pyrimethamine/sulfadoxine (fansidar) C. Erythrocyte exchange transfusion for rapid production of high levels of parasites in the blood. Anti. .Medical Mgmt: A. IVF s B. Premaquine For chloroquine resistant plasmodium quinine Prophylaxis chloroquine or mefloquine.Malarial Drugs Chloroquine ( less toxic).

travellers are advised to take chloroquine from 1-2 weeks at weekly interval. Protection is good for 1 year ‡ Patient must be closely monitored ‡ Soaking of mosquito nets in an insecticide solution ‡ Bio pond for fish ‡ On stream clearing cut vegetation overhanging stream banks to expose the breeding stream to sunlight ‡ Vectors peak biting is at night (9pm-3am) .Nursing Considerations ‡ If entering an endemic area.

‡ Planting of neem tree ( repellant effect) ‡ Zooprophylaxis ( deviate mosquito bite from man to animals ‡ Wear long sleeves/ pants/Socks ‡ Apply insect repellant on skin ‡ Screening of houses Notes: ‡ Malaria stricken mother can still breastfeed ‡ Chloroquine ca be given to a pregnant woman ‡ If there is drug resistance. give quinine SO4 .

‡ Mosquito breeding places must be destroyed. ‡ Homes should be sprayed with effective insecticides which have residual actions on the walls. ‡ A thorough screening of all infected persons from mosquitoes is important.-BT in anemia -Dialysis in renal failure -Decreased fluids in cerebral edema -No meds to destroy sporozoites Prevention and Control: ‡ Malaria cases should be reported. .

‡ Mosquito nets should be used especially when in infected areas. ‡ People living in malaria-infested areas should not donate blood for at least 3 years. ‡ Blood donors should be properly screened. ‡ Insect repellents must be applied to the exposed portion of the body. .

DENGUE FEVER Other names: ( H-Fever. Phil Hemorrhagic fever) . Dandy Fever. Breakbone Fever.

gray wings ) .CA: Arbovirus/flavivirus/chikungunya virus. dengue virus type 1-4 VECTOR: Aedes aegypti Day biting mosquito ( they appear 2 hours after sunrise and 2 hours before sunset. Low flying ( Tiger mosquito ² white stripes.Breeds on clear stagnant water .

.IP: 3 14 days. ‡ The mosquito becomes infective from day 8 to 12 after the blood meal and remains infective all throughout life. commonly 7 10 days PERIOD OF COMMUNICABILITY: ‡ Patients are usually infective to mosquito from a day before the febrile period to the end of it.

myalgia . PLT Ct . (+) TT Dengue Fever Vector caries virus (AEDES aegypti) Bite host ( IP 3-10d) s/sx : Fever .20mm Hg (shock) death . sorethroat.anorexia Vomiting. rashes IMPROVE 3rd day WBC. headache.PATHOPHYSIOLOGY DHF Febrile phase 2-7 days First 2 days Vascular injury Plasma leakage (+) petechiae . Hct >20% (+) Pleural effussion Dengue progress Circulatory failure -hypotension -narrow pulse pressure .

( decreased) ± confirmatory test ‡ Hemoconcentration ± an increase of at least 20% in hematocrit or steady rise in hematocrit ‡ Tourniquet test (Rumpel Leads test) . done by occluding the arm veins for about 5 minutes to detect capillary fragility. ± Keep cuff inflated for 6 ± 10 minutes ( child).screening test. 10-15 minutes ( adults) ± Count the petechiae formation 1 square inch ( 20 petechiae/sq.DX EXAMS: ‡ Platelet count .in)(+)TT .

CRITERIA FOR DIAGNOSIS: ± Fever .g um bleeding. hematemesis.acute.ecchymoses. hemoconcentration.an increase of at least 20% in the hematocrit or its steady rise .purpura. lasting for 2-7 days ‡ Positive torniquet test ‡ Spontaneous bleeding (petechiae.pistaxis.000mm3. melena) ‡ Laboratory: thrombocytopenia </= 100. high continous.

CLASSIFICATIONS: GRADE 1.profound shock. hypotension. cold clammy skin and restlessness. GRADE 4.presence of circulatory failure as manifested by weak pulse. GIT are present. narrow pulse pressure. and pulse. undetectable blood pressure.fever accompanied with non-specific constitutional symptoms and the only hemorrhagic manifestation is positive in tourniquet test. GRADE 3. GRADE 2. .All signs of Grade I plus spontaneous bleeding from the nose. gums.

Sedatives maybe needed to allay anxiety and apprehension. . ocular pain. Oxygen therapy is indicated to all patients in shock.Treatment Modalities 1. 2. Blood transfusion is indicated in patient with severe bleeding. Initial phase may require intravenous infusion to prevent dehydration and replacement of plasma. 3. 5. Analgesic drugs other than aspirin may be required for relief of headache. and myalgia. 4.

apply ice bag to the bridge of nose and to the forehead. and fall of blood pressure. maintain patient s position in elevated trunk. Observe signs of shock. d. e.Nursing Management a. Vital signs must be promptly monitored. Keep patient at rest during bleeding episodes. For nose bleeding. cold clammy skin. Patient should be kept in mosquito-free environment to avoid further transmission of infection. . prostration. such as slow pulse. c. b.

oregano . eucalyptus .hemically treated Mosquito Net L arvae eating fish Gold fish E nvironmental Sanitation 4 0 clock habit A antimosquito soap lanzones peeling N atural mosquito repellant Neem tree .Dengue hemorrhagic Fever ‡ PREVENTION : DOH 1995 Program ‡ ‡ ‡ ‡ ‡ C.

FILARIASIS .

CA: Helminths ‡ Wuchereria bancrofti ( african eye worm) Only live in lymphatic system ‡ Brugia malayi ‡ Brugia timori MOT: Bites of Aedes poecilius (night biting) DX TEST: Nocturnal blood smear Demonstration of microfiliaria in fresh blood obtained between 10:00 to 2:00 am Patient s history must be taken and pattern of inflammation and signs of lymphatic obstruction must be observed .

done in the morning ‡ DOC: Diethylcarbamazepine citrate (Beltrazan.‡ Immunochromatographic test. Hetrazan) » Eliminate the larvae » Impairing the adult worm s ability to reproduce » Kill the adult worm .

grow as adult Adult worm lives for 7 yrs in lymph vessels Mate release into blood stream.microfilaria Note: a person needs Many mosquito bite Over several months.Filariasis ( elephantiasis ) Mosquito bites Aedes poiculus . travel to LN . reach Sexual maturity & cycle is completed Microscopic worms pass from mosquito Through the human skin.years to get Filariasis . culex faligans and anopheles flavirostris Bites a person with lymphatic filariasis & infect the mosquito Person infected ± bitten by mosquito Transmitted to another person Larvae migrate to LN.

. breast.‡ Organs affected : kidney & lymph system ± Fluid collects and causes swelling in the arms. legs and for men genitalia ± Swelling decrease function of lymph system ‡ Susceptible to bacterial infection ± Skin harden and thicken ELEPHANTIASIS ± Conjuctival filariasis worm migrate eye cause blindness if untreated known as Onchoceriasis.

S/SX: ACUTE: ‡ Chills. headache and fever between 3 months and 1 year after the insect bite CHRONIC: Hydrocele Lymphedema Elephantiasis ‡ Lymphadenitis ‡ Lympangitis .

.

.

Mgmt: Environmental sanitation Personal Hygiene Provide mosquito nets Long sleeves. long pants & socks Mosquito repellant Take yearly dose of medicine that kills worms circulating in the blood Screening of houses .

NERVOUS SYSTEM CD .

RABIES .

scratch DIAGNOSTIC TEST: Brain tissue (dog). salivation.numbness at the bite site. Fluorescent antibody staining CLINICAL MANIFESTATIONS: ± PRODROMAL. tingling sensation.CA: Rhabdovirus (Lyssa virus) MOT: bite of an infected animal. sore throat . low grade fever.

For this reason. the emphasis of treatment is on prevention. veterinarians recommend regular vaccination of domestic dogs. In the United States. but the bite of any animal (wild or domestic) is suspect in an area where rabies is present. Symptoms of the disease appear after an incubation period of ten days to one year and include fever. . and muscle spasms in the throat that make drinking painful.Rabies Virus The rabies virus is usually transmitted to humans by a bite from an infected dog. breathing difficulties. Death almost invariably occurs within three days to three weeks of the onset of symptoms.

death . apnea 4. hydrophobia. hypersalivation. encephalitic excessive motor activity.‡ Clinical Manifestation ± pain or numbness at the site of bite ± fear of water ± fear of air 4 STAGES 1. headache.fever. loud noise. dilated pupils 3. 2. paresthesia. brainstem dysfunction dysphagia. prodrome . hypersensitivity to bright light.

.

kidney. lungs. skeletal muscles.Pathophysiology Bite/wound Local wound replication CNS ANS Salivary glands. adrenal medulla. skin. heart encephalitis .

head and neck Dog is killed. lost. laceration on upper extremities.Postexposure prophylaxis Category I Licking of intact skin Observe the dog for 14 days Category II Abrasion. died Active Passive . laceration. punctured wound on the lower extremities Active vaccine Observe dog for 14 days Category III Abrasion.

.

Ptosis. cardiac problems Cobra Myotoxic None Myalgia on moving paresis Bleeding abnormalities Sea snake Vasculotoxic Rapid swelling Vipers .SNAKEBITE Neurotoxic Slow swelling then necrosis Ptosis. respiratory paralysis.

.

.

Management ‡ Lie the victim flat ‡ ice compress and constrictive materials are contraindicated ‡ Transport the patient to the nearest hospital ‡ Antivenim administration in patient s with signs of envenomation ‡ It is never too late to give anti-venim .

2-5 ampules plus D5W to run over 1-2 hours every 2 hours ‡ Antimicrobial therapy ‡ sulbactam/Ampicillin or co-amoxiclav ‡ Substitute ‡ Prostigmine IVinfusion. 50-100ug/kg/dose q 8hrs ‡ Atropine .‡ Antivenim is given thru intravenous infusion. which is the safest and most effective route.

anaerobic ( survives w/o air) non-motile.Tetanus/Lockjaw/Trismus CA: ‡ Clostridium tetani (gram (+).umbilical cord . vegetative( ability to grow) ‡ Produces potent exotoxin ‡ Tetanus spores are introduced into the wound contaminated with soil ‡ IP: 4-21 days ‡ Tetanus neonatorum . spore forming.

Pathophysiology Clostridium tetani in puncture wound Release of Neurotoxin (Tetanospasmin) Hemolysin ( tetanolysin attack PNS and CNS GABA and Glycine inhibited Tetanic spasm .

Clinical manifestations ‡ Difficulty of opening the mouth (trismus or lockjaw) ‡ Risus sardonicus ( sneering grin) ngiting aso ‡ Dysphagia ‡ Generalized muscle rigidity ‡ Opisthotonus ( severe arching of the back) ‡ Localized or generalized muscle spasm ‡ Respiratory paralysis to death .

irritability. excessive crying. and opisthotonus .S/Sx: Neonatal tetanus . grimaces.Poor sucking. intense rigidity.

.

.

.

.

prolonged Dyspnea. short Frequent.Criteria Stage I Stage II 8-10 days Stage III <7days Incubation Period > 11 days Trismus mild moderate Severe Muscle rigidity mild Pronounced Severe. boardlike Spasm absent Mild. cyanosis absent absent Present .

Dx: history. muscle relaxants. leukocytosis. antibiotics. wound cleansing and debridement Active-DPT and tetanus toxoid Passive-TIG and TAT. serum antitoxin levels Mgmt: Anticonvulsant. placental immunity .

Non-specific .muscle relaxant to decrease muscle rigidity.TAT or TIG espicially if no previous immunization . Specific : -within 72 hours after punctured wound received ATS.oxygen inhalation .Pen G to control infection .Tetanus Treatment: 1. 2.

children. IV drip or IM 3000 IU.anti-toxin ‡ Tetanus Anti-Toxin (TAT) Adult. children Treatment: 40.infant Neonatal Tetanus ‡ TIG Neonates Adult.000 IU ½ IM. ½ IV 1000 IU. 1/2IM. IV drip or IM . infant.1/2 IV 20000 IU.

1 ½ months old 2 .after 4 weeks 3 .5 ml IM 1 .Pre exposure prophylaxis ‡ DPT.5 ml IM TT1 6 months within preg TT2 one month after TT1 TT3 to TT5 every succeeding preg or every year .0.after 4 weeks 1st booster 18 mos 2nd booster 4-6 yo subsequent booster every 10 yrs thereafter ‡ TT 0.

Antimicrobial Therapy Penicillin !-3 mil units q 4hours Pedia 500000 2mil units q 4 hrs Neonatal 200000 units IVP q 12hrs or q8hrs .

(-) immunization . (+) tetanus TIG/TAT + TT + Abx + wound cleansing + supportive therapy . (+) immunization as a child w/ boosters but last shot > 10 yrs give TT + TIG/TAT 2.TT + TIG/TAT 3.3 types of patients w/ skin wounds post exposure prophylaxis 1.

Control of spasms ‡ diazepam ‡ chlorpromazine .

acute orchitis.LEPROSY CA: Mycobacterium leprae/ Hansen s bacillus MOT: Prolonged skin to skin contact Dx Exam: Slit skin smear/ Lepromin test Symptoms: ‡ MILD. paralysis ‡ LATE. lagopthalmus . loss of sensation ‡ SEVERE.skin patches.madarosis.

TX: Multi-drug therapy MONOTHERAPY: Dapsone PAUCIBACILLARY: Rifampicin + Dapsone MULTIBACILLARY: Rifampicin + Dapsone + Lamprin S/E: Dapsone.increase lesions Lamprin. dryness and flakiness Rifampicin.skin discoloration.orange-colored secretions .

years to decades ‡ Active immunization (BCG) . acid fast bacilli ‡ MOT: may be due to prolonged skin-skin contact or droplets ‡ IP .Leprosy/Hansen s disease ‡ Chronic communicable disease of the skin & the peripheral nerves ‡ Causative Agent: Mycobacterium Leprae.

contractures of hand and foot. Early/Indeterminate hypopigmented / hyperpigmented anesthetic macules/plaques 2. Tuberculoid solitary hypopigmened hypoesthetic macule. eye involvement ie keratitis .TYPES: PAUCIBACILLARY 1. neuritic pain. ulcers.

loss of digits.MULTIBACILLARY 1. enlargement of male breasts ( gynecomastia) 2. Borderline between lepromatous and tuberculoid . corugated skin (leonine facies). Loss of lateral portion of eyebrows (madarosis). septal collapse (saddlenose) clawing of fingers & toes. Lepromatous inability to close eyelids unblinking eyes ( lagophthalmos) multiple lesions.

.

.

‡ Domiciliary home treatment ( RA 4073) ‡ Multi Drug Therapy ( MDT) use of 2 or more drugs for the tx of leprosy. ‡ Paucibacillary.Dapsone. Proven effective cure for leprosy & renders patients non-infectious a week after starting treatment.Clofazimine ‡ Diaminodiphenylsulfone DDS( Dapsone) ‡ Rifampicin ‡ Clofazimine (lamprene) ‡ Treatment is from 9 mos to 18 mos(2 years ) Mgt: .Rifampicin and Dapsone ‡ Multibacillary-Rifam.

INTEGUMENTARY CD SCABIES CA: Sarcoptes scabiei/itch mite/dog mite MOT: discharge of infected individual. indirect contact (beddings) Diagnostic exam: Scraping from its burrow with hypodermic needle or currete Pathognomonic sign: weeping itch linear lesions with serosanguineous exudates TX: Benzyl benzoate emulsion Kwell ointment .

oval-white nits on hair shafts TX: PEDICULOSIDE ‡ Kwell shampoo ‡ Vinegar solution (1:2 sol) . itching.PEDICULOSIS DX TEST: CA: Pediculosis humanis Nits in hair Pediculosis capitis.head lice follicles Pthirus pubis.pubic lice Pediculosis corporis.body lice S/sx: head scratching. excoriation. rashes.

the lice must feed within 24 hours otherwise it will die.PEDICULOSIS a. . After the nits hatch. c. It injects toxin into the skin that produces mild irritation & a purpuric spot. b. d. They mature in about 2 3 weeks. Feed on human blood & lay their eggs in body hair & clothing fibers.

a. spot swells & secondary crust & excoriation is formed on the surrounding skin as a result of scratching. initial lesions are minute red louse spots b. Infects more malathion powder is a children than adults. then rinse. ova. b.Clinical Manifestations Head louse Treatment a. reliable & convenient b. crusts. nits. massage with gamma c. excoriation & crusting benzene hexachloride & foul smelling mass shampoo in the scalp for consisting of matted hair. laundry (dry clean) or boil the clothing & beddings b. pus. & pediculi results (plica polonica) Body a.Itching is the first & method predominant symptom. 4 minutes. good body hygiene must be observed always. dusting the scalp with 1% in male. . irritation. more common in female than a.

contact with the patient e. Maculae caeruleae ± Geigy) into the affected area.Clinical Manifestations Crab lice Treatment a. remove remaining nits mechanically. unusual. persistent itching in the pubic region (Lindane) cream or lotion b. . pea-size to a person who had sexual small coin. the inner thighs or the d. simultaneously treat the abdomen. apply Kwell or Gamene a. grayish pigmented spots c. Rub crotaminon (Eurax. b. repeat the application of ± found in the surface of crotaminon after 1 week.

Herpes virus ‡ IP 10-21 days ‡ MOT: droplet spread > nose & throat secretions > Vesicles ( contagious in early stage of eruption > Airborne . Varicella ‡ Acute & highly contagious disease of viral etiology ‡ Childhood disease & adolescents (adults more severe) Not common in infancy ‡ Locally called Bulutong ‡ Human beings are the only source of infection ‡ CA = Varicella Zoster virus.Chicken Pox.

‡ Prodromal period: headache . vomiting. fever ‡ Papulovesicular rashes appear on trunk spreading to face and extremties ( centrifugal) ‡ Macules papules vesicles with clear fluid inside crusting and scar formation ‡ The disease is communicable until the last crust disappear ( D1 before D6 after appearance of rashes) .

dry Rashes: Maculopapulovesicular (covered areas).Period of Communicability ± 5 days before rashes & 5 days after rashes ± crusting . Centrifugal rash distribution. starts on face and trunk and spreads to entire body ‡ Leaves a pitted scar (pockmark) .

CX = secondary bacterial infection. meningoencephalitis ( rare) ‡ Dormant: remain at the dorsal root ganglion and may recur as shingles (VZV) . pneumonia. furunculosis.

.

.

give oral antihistamine or local antihistamine ‡ Avoid rupture of lesions ‡ Cut nails short ‡ Pay attention to nasopharyngeal secretions/ discharges ‡ Disinfection of linen ( sunlight or boiling) ‡ Prophylactic antibiotics .Curative & Nursing Considerations: ‡ If it feels itchy.

Tepid water and wet compresses for pruritus Soothing Baths. cool baths .

oral acyclovir b. Astringent effect b. Bactericidal effect c.Treatment: a. Tepid water and wet compresses for pruritus c. Oxidizing effect (deodorize the rash) . Potassium Permanganate (ABO) a.

‡ Exclusion from school for 1 week after eruption appears ‡ An attack gives lifetime immunity. Second attack is rare ‡ Immunoglobulins can be given ( 12 mos) ‡ Drug of choice: Acyclovir ( Zovirax ) topical cream applied to crusts .

‡ Preventive measures ± Active immunization with LIVE ATTENUATED VARICELLA VACCINE ‡ ‡ ‡ ‡ Start at 1 yr old ( 1 dose ) booster 4-12y If >13 yrs = 2 doses Given SC ± Avoid exposure as much as possible to infected person .

discharge with secretions from vesicles S/SX: Painful vesiculo-papular lesion confined to a dermatome Primary goal of supportive tx: 1.HERPES ZOSTER/SHINGLES CA: Herpes zoster virus MOT: Droplet. Relieve itching and neuralgic pain 2. Potassium manganate .

Paramyxoviridae ‡ Measles virus is rapidly inactivated by heat.‡ RNA. airborne). Hard Red Measles. & extreme degrees of acidity & alkalinity ‡ Active immunity (MMR and Measles vaccine) ‡ Passive immunity (Measles immune globulin) ‡ Lifetime Immunity IP: 8-12 days MOT: Direct ( droplets. Rubeola. 7 Day Fever. Morbili. UV light. . Indirect ( fomites) *Contagious 1-2 days before rash and 4 days after the appearance of rash Measles.

leukopenia. leukocytosis) . nose & throat Diagnostics: ± Nose & throat swab ± Urinalysis ± Blood exams ( CBC.‡ Sources of Infection: ± Patient s blood ± Secretions from the eyes.

confluent. cephalocaudal (hairline and behind the ears to trunk and limbs).Rashes: maculopapaular. desquamation. pruritus) .

fever subsides Cx: pneumonia. conjunctivitis. . cough. desquamation begins. Pre-eruptive stage: (2-4 days) . Eruptive stage: Rash is usually seen late on the 4th day Maculo-papular rash 3. meningitis.Clinical manifestations: 1. . kopliks spots ( PATHOGNOMONIC SIGN) (1-2 mm blue white spots on red background along 2nd molars). Stage of convalescence: Rashes fade away.malaise. fever. stimsons ( puffiness of eyelid) photophobia 2.

.

MEASLES ± Fever persist means (+) complication ‡ Bronchopneumonia. exacerbation malnutrition ‡ Encephalitis . reactivation of previous TB ‡ Bronchitis. laryngitis.most common ‡ Otitis media.

MEASLES ‡ Diagnostic procedure ‡ Physical examination ‡ Nose and throat swab ‡ Urinalysis ‡ CBC ( leukopenia & leukocytosis) ‡ Complement fixation or hemogglutinin test Eruptive fever .

5. 2. Anti viral drugs ( Isoprenosine) ‡ 1. Vaccine.measles vaccine @ 9 mos and MMR @ 15 mos 7. 4. Observe respiratory Isolation .MANAGEMENT Supportive Hydration Proper nutrition Vitamin A Antibiotics if w/ secondary bacterial infection 6. 3.

should have a daily cleansing bed bath.Nursing Care ‡ Isolation of the patient if necessary ‡ TSB for fever ‡ Skin care is of utmost importance. ‡ Oral & nasal hygiene is a very important aspect of nursing care of patients with measles ‡ Restrict to quiet environment ‡ Dim light if photophobia is present. care of the eyes is necessary ‡ Administer antipyretic ‡ Use cool mist vaporizer for cough . The pt.

rubella virus ( Togaviridae) ‡ Immunity: Active natural ( permanent or lifetime) ‡ Active immunity . Rotheln Disease. 3 Day Measles ‡ = contagious viral disease characterized by fever. Rubella.gammaglobulin ‡ Period of communicability contagious 7 days before & 7 days after appearance of rash & probably during the catarrhal stage . arthralgia. URTI.rubella vaccine and MMR ‡ Passive immunity . DIFFUSED fine red maculopapular rash) ‡ CA .RNA.German Measles.

German Measles. Rotheln Disease. Rubella. 3 Day Measles IP: 14-21 days MOT: Direct contact: droplets spread through the nasopharynx Indirect contact: transplacental ** Highly communicable infant may shed virus for months after birth** .

Rashes: Maculopapular. Diffuse/not confluent. No desquamation. spreads from the face downwards .

Clinical Manifestations: > FORSCHEIMER·S SPOTS (petecchial lesion on buccal cavity or soft palate) > oval, rose red papule about the size of pin head > cervical lymphadenopathy, > low grade fever Dx: clinical CX: rare; pneumonia, meningoencephalitis CX to pregnant women: ‡ 1st tri-congenital anomalies ( microcephaly, heart defects, cataracts, deafness ‡ 2nd tri-abortion or bleeding ‡ 3rd tri-pre mature delivery

Nursing Considerations:
‡ MMR immunization ‡ Use of immunoglobulins ( IG s)- ppost exposure prophylaxis 72 hrs after exxposure ‡ Prevention of congenital measles ‡ Avoid exposure

Roseola Infantum, Exanthem Subitum, Sixth disease
‡ Human herpes virus 6 ‡ 3mos-4 yo, peak 6-24 mos MOT: probably respiratory secretions S/sx: Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear after fever subsides, Mild pharyngitis and lymph node enlargement Mgmt: symptomatic

Dick s test.susceptibility Penicillin Schultz-charltonhypersensitivity S/SX: Prodromal phase Eruptive phase: ‡ Fever ‡Circumoral pallor ‡Rashes ‡ Flushed face ‡ Slapped cheek appearance ‡Strawberry tongue .SCARLET FEVER/SCARLATINA CA: Group A beta hemolytic streptococcus MOT: droplet DOC: DX TEST: ‡Erythromycin.

IMPETIGO CA: Group A beta hemolytic streptococcus MOT: Direct or indirect contact S/SX: Vesiculo-papular lesions with thick honeycombed crust n the face. around the mouth . neck and hands DOC: antibiotics .

‡ IMPETIGO A disease causing skin lesions Most common in children May but rarely affects adults May follow an URTI Also occurs as a result of breaks in skin .

‡ ‡ ‡ ‡ ‡ ‡ AREAS AFFECTED Face Lips Arms Legs Other Areas .

SYMPTOMS ‡ Skin Rash ‡ Begins as tiny fluid filled vesicles ‡ Fluid is yellow or honey coloured ‡ Vesicles will burst causing brown/yellow ‡ crusting ‡ Rash is itchy .

.

Diagnosis & Treatment ‡ Diagnosis is usually made on appearance ‡ of skin lesion ‡ Culture of infecting bacteria will confirm ‡ Staphylococcal or Streptococcal infection ‡ Aim of treatment is to cure infection ‡ Cure rate 100% ‡ Recurrence common in children .

with other ‡ people .‡ Treatment ‡ Application of topical antibiotics ‡ Wash several time a day with antibacterial ‡ soap to remove crusts ‡ Prevent spread of infection ‡ Wash clothing/bed sheets etc. ‡ Use clean towel and flannel each time ‡ Do not share towels/razors etc.

GASTROINTESTINAL CD .

vibrio cholerae. vibrio el tor. ogawa. shellfish) . gram () ‡ Curved rod or coma shaped organism. hikojima).Cholera / El Tor ‡ Causative agent: Vibrio coma (inaba. water. motile ‡ Habitat: small intestine ‡ Can survive longer in refrigerated foods IP: few hours to 5 days MOT: oral fecal route ( by contaminated food.

.

Cholera Sigmoidoscopic view of colonic mucosa .

Fatal case of infection .

Rice Watery Stool in Cholera .

Cholera Cot and Bucket .

Nursing Mx: ‡ Replacement of lost F & E ± Administer D5LR ( more in Na) DLR ( more in K) ± Enteric Isolation ± All patients should be isolated until rectal swab shows (-) result ± All water & milk should be boiled for 15 minutes ± Food must be protected from flies ± Prepare food properly ± Proper disposal of excreta ± Good environmental sanitation .

bilharziosis or snail fever CA: Species of Schistosoma that can infect humans: Schistosoma mansoni can cause intestinal schistosomiasis Schistosoma haematobium-causes urinary schistosomiasis Schistosoma japonicum and Schistosoma mekongi cause Asian intestinal schistosomiasis VECTOR: Oncmelania quadrasi .SCHISTOSOMIASIS also known as bilharzia.

MOT: Waterborne transmission occurs via penetration of larval cercariae in contaminated bodies of fresh water. Diarrhea 3. S/SX: SWIMMER S ITCH 1. Abdominal pain 4. Itchy red pustule @ point of entry of cercariae 2. hepatosplenomegaly .

effective for the treatment of urinary schistosomiasis .used exclusively to treat intestinal schistosomiasis in Africa and South America ‡ Metrifonate .TREATMENT ‡ Praziquantel . with virtually no side effects ‡ Oxamniquine .effective in the treatment of all forms of schistosomiasis.

Food & Fluids . Flies. Feces. Fomites.Typhoid Fever ‡ Salmonella typhosa. gram (-) ‡ Carried only by humans Bacterial infection transmitted by contaminated water. shellfish ( oyster ) & other foods Infection of the GIT affecting the lymphoid tissue ( payer s patches) of the small intestine Most severe form of salmonellosis caused by salmonella typhi MOT: oral fecal route 5 F s : Fingers. milk.

spleen.Pathophysiology Oral ingestion Bloodstream Reticuloendothelial system (lymph node. liver) Bloodstream Gallbladder Peyer s patches of SI necrosis and ulceration .

Typhoid Fever Ulceration of the Peyer's Patches .

abdomen. headache. Spleenomegaly .Typhoid Fever Clinical Manifestations: Incubation Period: 1-2 weeks 1. Remittent fever ( ladder like) 3. Prodromal 1st week: Step ladder fever 40-41 deg. back 2. GI manifestations 3 cardinal signs of pyrexial stage: 1. abdominal pain.ROSE SPOTS ( irregular rashes found on the chest.

Typhoid Fever Rose Spots .

.

typhoid psychosis w/ hallucination. Chloramphenicol ‡ 2. Severe abdominal pain c Sordes typhoid state . Fastidial = 2nd week ( Typhoid) ‡ a. Ampicillin ‡ 3.‡ 2. Cotrimoxazole b. delirium ± Drug of choice: Antibiotics ‡ 1. High fever. confusion.

4th week (lysis) decreasing S/SX 5th week (convalescence) . perforation.1st week step ladder fever (BLOOD) 2nd week rose spot and fastidial ‡ typhoid psychosis (URINE & STOOL) 3rd week (complications) intestinal bleeding. encephalitis. peritonitis.

Sulfonamides. Amoxicillin.Dx: Blood culture (typhi dot) 1st week Stool and urine culture 2nd week Widal test Mgmt: Chloramphenicol. Ceftriaxone ** Observe standard precaution until 3 negative stool culture** . Ciprofloxacin.

typhoid meningitis .Nursing Interventions ‡ Environmental Sanitation ‡ Food handlers sanitation permit ‡ Supportive therapy ‡ Assessment of complications (occuring on the 2nd to 3rd week of infection ) .typhoid psychosis.typhoid ileitis .

Intestinal Parasitism .

or poorly cooked food containing parasites. ‡ MOT : they are often spread by poor hygiene related to feces ± contact with animals. .INTESTINAL PARASITISM ‡ are parasites that populate the gastrointestinal tract.

Helminths ‡ Tapeworms. pinworms.‡ Two main types of intestinal parasites: ± A. Protozoa. and roundworms are among the most common helminths ± B. .

children are more likely to get infected ± Exposure to child and institutional care centers .Cause of intestinal Parasitism ‡ high risk for getting intestinal parasites: ± Living in or visiting an area known to have parasites ± Poor sanitation (for both food and water) ± Poor hygiene ± Age -.

INTESTINAL PARASITISM ‡ Some asymptomatic ‡ S/SX: ± ± ± ± ± ± ± ± ± ± Diarrhea Nausea or vomiting Gas or bloating Dysentery (loose stools containing blood and mucus) Rash or itching around the rectum or vulva Stomach pain or tenderness Feeling tired Weight loss Passing a worm in your stool Anemia .

Then the tape is examine under a microscope for eggs .‡ Fecal testing (stool exam) can identify both helminths and protozoa. ‡ The "Scotch tape" test identifies pinworm by touching tape to the anus..

ingestion of food and drinks contaminated by embryonated eggs Affects 4-12 years old Dx: stool for ova Mgmt: Mebendazole.Ascariasis (Roundworm) CA: Ascaris Lumbricoides IP: weeks to months MOT: transmitted through contaminated fingers into the mouth./ Albendazole/ Pyrantel Pamoate .

MOT: ingestion of food contaminated by ascaris eggs larvae in large intestine penetrate wall lung where larvae grow and coughed up intestine larvae mature and passed out in feces .

.

Ascariasis ( roundworm infection) ‡ Nursing Intervention: ± Isolation is not needed ± Preventive measures in each home and in the community should be enforced ± Wash hands before handling food ± Wash all fruits and vegetable thoroughly ± Availability of toilet facilities must be ensured ± Importance of personal hygiene should be explained ± Proper waste disposal. .

Ascariasis ( roundworm infection) ‡ Prevention: ± Improved sanitation and hygienic practices ± Improved nutrition ± Deworming may be advised .

Complications ‡ Migration of the worm to different parts of the body Ex. Ears. mouth.nose ‡ Loefflers Pneumonia .

STANDARS PRECAUTIONS RECOMMENDED . Taenia Solium (pigs) MOT: fecal oral route (ingestion of uncooked.years Dx: Stool Exam Mgmt: Praziquantel.Tapeworm (Flatworms) ‡ CA: Taenia Saginata (cattle). infected meat ) IP: 2-3 mos . Niclosamide ISOLATION OF HOSPITALIZED PATIENTS.

.

.

Pinworm ‡ Enterobius Vermicularis MOT: fecal oral route S/sx: Itchiness at the anal area d/t eggs of the agent Dx: tape test at night time (agents release their eggs during night time) Mgmt: Pyrantel Pamoate. Mebendazole .

Enterobius vermicularis (PIN WORM) The pinworm lives in the lower part of the small intestine and the upper part of the colon Human the only natural host IP : 1-2 months or longer MOT : indirectly by contaminated fomites -shared toys. toilet seat and bath Isolation is not needed .

.

Nursing Intervention ‡ ‡ ‡ ‡ Promote hygiene Environmental Sanitation Proper waste and sewage disposal Antihelmintic medications repeated after 2 weeks (entire family) .

diarrhea. abd l cramps. Ancylostoma Duodenale ‡ IP . anemia.Hookworm (Roundworm) ‡ CA: Necator Americanus.few weeks to months to years S/sx: Ground itch or dew itch at site of entry of filariform larvae involving the feet/legs. abd l distention. perforation to peritonitis to septicemia ** Isolation is not necessary ** .

Proper disposal of excreta 2.Dx: microscopic exam (stool exam) Mgmt: Pyrantel Pamoate and Mebendazole ‡ don t give drug without (+) stool exam ‡ members of the family must be examined and treated also Nsg. Avoid walking or playing barefooted 3. Intervention: 1. Periodic deworming of school age group .

protozoa ± ± ± ± ± Prevalent in unsanitary areas Common in warm climate Acquired by swallowing Cyst survives a few days after outside of the body Cyst passes to the large intestine & hatch into TROPHOZOITES. to the liver thereby forming AMOEBIC LIVER ABSCESS. most commonly to the liver or lungs.Amoebiasis ( Amoebic Dysentery) ‡ Protozoal infection of human beings initially involving the colon. . but may spread to soft tissues. It passes into the mesenteric veins. to the portal vein. ‡ CA: Entamoeba Hystolitica.

2. Cyst is passed out with formed or semi-formed stools and are resistant to environmental conditions.‡ Entomoeba histolytica has two developmental stages: ‡ 1. Cyst a. Trophozoites/vegetative form ± Trophozoites are facultative parasites that may invade the tissues or may be found in the parasites tissues and liquid colonic contents. .

When it reaches the alkaline medium of the intestine. the metacyst begins to move within the cyst wall.b. This is considered as the infective stage in the life cycle of E. histolytica Pathology When the cyst is swallowed. which rapidly weakens and tears. This is the first opportunity of the organism to colonize. it passes through the stomach unharmed and shows no activity while in an acidic environment. and its success depends on one or more metacystic trophozoites making contact with the mucosa. . The quadrinucleate amoeba emerges and divides into amebulas that are swept down into the cecum.

The cysts are resistant to levels of chlorine normally used for water purification.Mature cyst in the large intestines leaves the host in great numbers (the host remains asymptomatic). and in water for 30 days. They are rapidly killed by desiccation. and temperatures below 5 and above 40 degrees. The cyst can remain viable and infective in moist and cool environment for at least 12 days. .

genitalia. lungs and meninges .MOT: Ingestion of cysts from fecally contaminated sources (Oral fecal route) oral and anal sexual practices ‡ Extraintestinal amoebiasis. anal. spleen. liver.

lifecycle .

sulfadiazine ‡ Metronidazole (Flagyl) 800 mg TID x 5 days ‡ Strptomycin SO4. Chloramphenicol ‡ F&E balance . Quinolones.trophozoites ‡ Pd of Communicability: the microorganism is communicable for the entire duration of the illness Mgmt: ‡ Tetracycline 250 mg every 6 hours ‡ Ampicillin. abdominal cramps Dx: microscopic stool exam . watery mucoid diarrhea.s/sx: Blood streaked.

Nsg. Mx ‡ Observe isolation & enteric precaution ‡ Provide health education & instruct patient to: ± Boil water for drinking or use purified water ± Avoid washing food from open drum or pail ± Cover leftover food ± Wash hands after defecation or before eating ± Avoid ground vegetables ( lettuce. etc) . carrots.

Prevention: Health education Sanitary disposal of feces Protect. chlorinate & purify drinking water Observe scrupulous cleanliness in food preparation & food handling ‡ Detection & tx of carriers ‡ Fly control ( they can serve as vectors) ‡ ‡ ‡ ‡ .

Drip CA: Neisseria gonorrhoeae MOT: sexual intercourse with infected partner DX TEST: culture and sensitivity of urethral discharge S/SX: Male. burning sensation upon urination Female.GENITO-URINARY CD GONORRHEA Other names: GC.yellowish. thick purulent urethral discharge.80% asymptomatic . Clap.

PID TREATMENT: DOC: Penicillin.COMPLICATION: sterility. Doxycycline Disseminated gonococcal infection . Amoxycillin. Disseminated gonococcal infection (DGI).

CHLAMYDIA CA: Chlamydia trachomatis MOT: sexual contact.slight vaginal discharge. painful intercourse TREATMENT: Azithromycin.discharge from penis. infants during vaginal delivery of an infected mother DX TEST: Culture and sensitivity test of the discharge S/SX: MALES. doxycycline . itching and burning of vagina. burning sensation during urination FEMALES. burning and itching of urethral opening.

Trichomonas vaginalis MOT: Direct sexual contact DX TEST: examination of vaginal secretion by wet slide treated with Potassium hydroxide S/SX: initially asymptomatic-malodorous discharge TREATMENT: DOC.TRICHOMONIASIS CA: Protozoa.Metronidazole .

to swish nystatin solution around his mouth for several minutes before swallowing . cheese-like vaginal discharge. prolonged use of broad spectrum antibiotics DX TEST: clinical picture S/SX: creamy. itchiness.CANDIDIASIS/MONILIASIS CA: Candida albicans MOT: sexual contact. redness at the vulva DOC: Nystatin Health teachings: Swab nystatin on the oral mucosa of an infant with thrush Instruct pt.

Gonorrhea
(Clap/Flores Blancas/Gleet) - sexually transmitted bacterial disease involving the mucosal lining of the genitourinary tract, the rectum, and pharynx. Causative Agent: Neisseria gonorrhoeae Incubation Period: 3-21 days average: 3-5 days

Mode of Transmission
1. Bacteria is transmitted by contact with exudates from the mucous membrane of infected persons. 2. Through direct contact with contaminated vaginal secretions of the mother as the baby comes out of the birth canal. 3. May also be transmitted through fomites.

Clinical Manifestations
1. In females a. Burning sensation and frequent urination. b. Yellowish purulent vaginal discharge c. Redness and swelling of the genitals d. Burning sensation and itching of vaginal area e. Urinary frequency and pain on urination

f. Urethritis or cervicitis occurs initially a few days after exposure g. Pregnant women with gonorrhea may infect the eye of her baby during the passage through the birth canal.

2. In males a. Dysuria with purulent discharge from the urethra 2 7 days after exposure. b. Rectal infection is common in homosexuals. c. Inflammation of the urethra can cause stricture that can prevent passage of urine. d. Prostatitis e. Pelvic pain and fever

In female culture of specimen taken from the cervix and anal canal (use of ThayerMartin medium) 2.Diagnostic Exam 1. In male gram stain .

Treatment Modalities ‡ Ceftriaxone for uncomplicated gonorrhea in adults ‡ Ceftriaxone & Erythromycin for pregnant women ‡ Aqueous procaine Penicillin ‡ Direct fluorescent antibody test .

3. Infants born to mothers positive of gonorrhea should be instilled with ophthalmic prophylaxis into both eyes at the time of birth. 2.Nursing Management 1. The patient should be isolated until he/she recovers from the disease. . All information concerning the patient is considered confidential.

HERPES SIMPLEX TYPE 2 CA: Herpes simplex virus type 2 MOT: ‡ SEXUAL contact oral/genital sex ‡ During delivery through an infected maternal genital tract DX TEST: Viral culture S/SX: ‡ Rashes in genital areas ‡ Recurrent clusters of blisters ‡ DOC: Acyclovir/Zovirax .

. intimate physical disease Dx test: Heterophil antibody agglutination TREATMENT: S/SX: symptomatic and supportive ‡ severe sore throat ‡ Fever ‡ swollen lymph nodes (glands) in the neck area.INFECTIOUS MONONUCLEOSIS/KISSING S DISEASE CA: Epstein Barr virus MOT: saliva.

bad blood.SYPHILIS Other names: the pox. Morbu Gallicus CA: Treponema pallidum MOT: ‡ Close sexual contact ‡ An infected mother can pass on the infection to the child during birth ‡ Blood infection from infected person PRIMARY SYPHILIS .

Secondary stage: ‡ Condylomata lata. Latency (Resting stage) ‡ Early. Late syphilis: ‡ meningeal syphilis ‡ Stroke syndrome DX TEST: ‡Reaginic tests.most syphilis infections are spread to other people ‡ Late.S/SX 1. dull pink or gray papules at mucocutaneous junctions and in moist areas of the skin ‡ Alopecia araeta-baldness 3. flattened.the most sensitive and specific test for early primary syphilis TREATMENT: ‡Sustained-release penicillin ‡Treatment of sex partners . Primary stage: painless chancre at 2-6 mm 2.hypertrophic.screening ‡Treponemal testsconfirmatory ‡Darkfield microscopy.not infectious 4.

Condylomata lata Alopecia araeta .

Primary (Genital Chancre) Primary (Anal Chancre) Primary (Mouth Chancre) .

.belongs to lentevirus.retrovirus .Acquired Immune Deficiency Syndrome (AIDS) Human Immunodeficiency Virus (HIV) causes AIDS. also called slow virus . .

macrophages. Langerhans & neurons CD4 ---------T4 cells T4 cell dies Signs & symptoms will manifest .Pathophysiology of AIDS: HIV Antibodies Lymphocytes.

Signs and Symptoms: ‡ AIDS-related Complex (ARC)  Memory loss  Altered gait  Depression  Sleep disorders  Chronic diarrhea .

Minor Sign Persistent cough for one month Generalized pruritic dermatitis Recurrent herpes zoster Oropharyngeal candidiasis Chronic disseminated herpes simplex Generalized lymphadenopathy s: ‡ Loss of weight 10% of body weight ‡ Chronic diarrhea for more than one month ‡ Prolonged fever for one month Major Signs .

cervical dysplasia & cancer.Common Opportunistic Infections ‡ ‡ ‡ ‡ ‡ ‡ Pneumocystis carinii peumonia Oral candidiasis Toxoplasmosis of the CNS Chronic diarrhea/wasting syndrome Pulmonary/extra-pulmonary tuberculosis Cancers (Kaposi s sarcoma. Non-Hodgkin s lymphoma) .

child delivery. or breastfeeding) .Mode of Transmission ‡ Sexual intercourse ‡ Blood transfusion and sharing of infected syringes and needles among intravenous drug users ‡ Vertical or perinatal transmission (from a pregnant woman to the fetus during pregnancy.

Diagnostic Examinations ‡ EIA or ELISA Enzyme link immunosorbent assay ‡ Particle Agglutination (PA) test ‡ Western Blot analysis confirmatory diagnostic test ‡ Immunofluorescent test ‡ Radio immuno-precipitation assay (RIPA) .

inhibits the reproduction of the virus. .referred to as anteroviral drugs .Treatment Modalities AIDS Drugs medicines used to treat but not to cure HIV infection. . .

Nursing Management 1.avoid fear tactics .know the patient .be consistent and concise . Health Education .use positive statement .give practical advice .avoid judgmental and moralistic messages .

b. Thorough medical hand washing after every contact with patient and after removing the gown and gloves. Use of Universal barrier or Personal Protective Equipment (PPE). and before leaving the room of an AIDS suspect or known AIDS patient. . Practice universal/standard precaution a.2.

Prevention a. . Wear gloves when handling blood specimens and other body secretions c.3. Label blood and other specimens with special warning AIDS Precaution . Avoid accidental pricks from sharp instruments contaminated with potentially infectious materials from AIDS patient. b.

. 7. Personal articles should not be shared with other members of the family. like chlorox . 5. 6. but should be disposed into a puncture-resistant container.4. Blood spills should be cleaned immediately using common household disinfectants. Patients with active AIDS should be isolated. Needles should not be bent after use.

Sign up to vote on this title
UsefulNot useful