INFECTION

- Presence of pathogenic agent into the body

STAGES OF INFECTION
INCUBATION PRODROMAL ACUTE CONVALESCE RESOLUTION
NCE
- entry of the - with signs and - With specific - Signs and - More
microorganism symptoms but signs and symptoms energetic.
until the first nonspecific symptoms. start to Healthy again
signs and - Flu like With disappear
symptoms symptoms pathognomonic
appears. (fever, cough, sign.
- Patient is still coryza) - Ex. Tetanus –
asymptomatic sardonic smile
 Antigen
Foreign bodies
bacteria, virus, protozoan,
parasites

Antibody / Immunoglobulin
protein that destroy the
familiar antigen
Antibodies (also CALLED IMMUNOGLOBULINS or ig’s)

• are Y-shaped proteins that circulate through the blood stream and bind to specific antigens, thereby
attacking microbes.
• The antibodies are transported through the blood and the lymph to the pathogen invasion site.

classes of antibodies (listed from most common to least common):

• IgG: transplacental
• IgA = breastfeeding
• IgM
• IgE
• IgD

Antibodies work in different ways:

1. Neutralizing an Antigen
2. Activating Complement:
3. Precipitating Antigens
4. Facilitating Phagocytosis
 IMMUNITY
(response in  antibody)

NATURAL / IINNATE
ACQUIRED
(inherent in the body / specific in the body)
(produced by prior exposure in
no prior exposure or antibody production
the environment)
involved

ACTIVE
PASSIVE
antibody is produced by the individual itself
antibody are given to individual (pinasahan
(ALT = active long term)
short term)

NATURAL ARTIFICIAL
NATURAL (recover from a disease) vaccine
(transplacental = 3rd ARTIFICIAL NARS –naturally active 1. LIVE ANTENNUATED: weakened vaccine
trimester) Antibodies vaccine / recovery sakit (contraindicated = immunocompromised)
(breastfeeding = immuneglobulin
2. INACTIVATED (killed)
colostrum) Nanay to
3. TOXOID (modified toxins)
Fetus
 ACTIVE IMMUNITY
• Produce actively by immune system of host
• Body cells take part in the production of
antibodies i.e, active immunity is acquired after
infection or inoculation
• Immunity lasts long.
• Immunity not effective immediately
• It takes some time to develop the antibodies in
the system
• Immunological memory present
• Serves no purpose in immunodeficient host
• No inheritance of immunity
• After antigenic stimulus negative phase may
occur
PASSIVE IMMUNITY
• The host’s immune system does not participate
• Cells of the body do not take part in the
production of antibodies. Ready made
antibodies are injected.
• Immunity lasts for short period (10 to 14 days)
• Immunity is effective immediately
• No time is lapsed to get the antibodies
• No immunological memory
• Applicable in immunodeficient host
• May be acquired from mother
• No negative phase
 TETANUS (LOCKJAW) – acute illness caused by toxin of the tetanus bacillus
CAUSATIVE AGENT Clostridium Tetani (anaerobic0) = gangrenous wound. Anaerobic spore-forming heat-resistant and lives
in soil or intestine
INTUBATION 3 to 1 month, falling betweeb 7 to 14 days
Tetanolysis: lysis increase blood cell (weak). Dissolves RBC causing anemia
TOXIGENIC: Tetanospasmin: neurotoxin (muscle spasm)
Laryngospasm = tracheostomy
Heart spasm = cardiac monitor
Trismus – uncontrolled inability to open mouth or jaw. Painful spasms of masticatory muscles
S/Sx Opisthotonus (somatic muscles) – arching of back = POC: side lying position
Risus sardonicus (Latin: “devil smile”) – facial spasm; sardonic grin
Penicillin: s/e: potentiate the toxins
Metronidazole / Flagyl: no to alcohol Adverse effect: disulfiram-like reaction include severe nausea
MANAGEMENT and vomiting
Muscle Relaxant: Diazepam (Valium)
Avoidance of wound
PREVENTION Tetanus toxoid (ARTIFICIAL ACTIVE)
FIRST AID: = clean with soap, running water and apply thin dressing/do not cover wound
 RABIES / LYSSA/ HYDROPHOBIA/ LE RAGE
CAUSATIVE AGENT Rhabdovirus – bullet shape virus
Bite of Infected Animal tissue transplant = RA 7170 (organ donation act)
MOT scratch (rare) Airborne droplet (rare)
INCUBATION PERIOD For animals=3-8 weeks; For humans=10 days-years
Dumb stage: complete change in disposition Depressive = withdrawn
MANIFESTATIONS IN (nagbabago ng ugali) Manic = overly affectionate, hyperactive
ANIMALS
Furious Stage: animal is easily agitated, fiercely and drooling of saliva = DIE
INVASIVE/PRODROMAL EXCITEMENT/NEROLOGICAL PARALYTIC/TERMINAL
MANIFESTATIONS IN The virus easily transferred Stage when patient is confined in hospital Stage when spasm is no
HUMANS through saliva longer observed because
paralysis sets in 24-72 hrs
• Numbness on site • Aerophobia: fear of air • Loss of bowel and
• Sore throat • Hydrophobia: fear of H2O urinary control
• Restlessness • Maniacal Behavior: fierceful look, • Cessation of spasm and
S/SX • Flu like agitate, bites, jumps out of window progressive paralysis
• Photosensitivity and runs like a rabi dog.
• Mgt: HALOPERIDOL (Haldol) with
Benadryl given to calm patient.
 DIAGNOSTIC • Brain Biopsy of Animal to identify presence of negri bodies
EXAM FOR • Direct Flourescent Antibody Test (DFAT)
ANIMALS BEFORE • Observation of the animal for 10 days: if animal develops behavioral changes or die within 10 days, it
S/SX APPEAR has rabies
ACTIVE FORM PASSIVE FORM
MEDICAL
MANAGEMENT

Place patient in a din (photosensitivity) and quiet room )easily agitated

Room of patient should be away from sub-utility room
NURSING Before maniacal behavior sets in, restrain patient
MANAGEMENT Wear complete protective barriers when entering the room because patient may spit on you and
Saliva will predispose you to rabies
Keep IVF covered
• Immunization-all dogs should be given immunization in the Barangay Centers
PREVENT • Keep away from stray dogs because they are mostly infected with rabies
MEASURES • Keep animal caged or chained. Less exposure to virus, less chance of biting man
• If bitten by a dog, wash with soap and running water to wash away virus then use strong antiseptic
solution (betadine or iodine) and observe the dog
LAW Republic Act 9482 (Anti-Rabies Act of 2007), Section 5
 DENGUE HEMORRHAGIC FEVER
CAUSE OF DEATH Hemorrhage ; Hemorrhagic Fever
CAUSATIVE Arbovirus-Dengue virus=Type 1, 2, 3 and 4 FLAVIVIRUS - brought epidemic in the Philippines
AGENT (virus) O’nyong-nyong virus Chikungunya virus West Nile virus
MOT Aedes Aegypti : white stripes on the back and legs (tiger mosquito)
CHARACTER Day Biting (Peak); Low Flying; Stagnant; Urban
1 - 3: Febrile/Invasive Stage 4 - 7: Toxic/Hemorrhagic Stage 8 - 10t: Recovery/Convalescent
- starts abruptly as fever - decrease in temperature - appetite regained
- abdominal pain - severe abdominal pain - BP stable
FEVER - headache - GIT bleeding - + tourniquet sign
- vomiting - unstable BP (narrowed pulse pressure) - Herman’s sign
- conjunctival infection - Bleeding
-epistaxis
TOURNIQUET/RUMPEL’S LEAD test PLATELET COUNT VIRAL ISOLATION (PCR test)
• Test for tendency for blood • Confirmatory test • Confirmatory test
capillaries to break down or •  Platelet (+)
produce petechial. 1 in to 2.5 cm; •  Hct (plasma leakage)
DIAGNOSTIC • (+) = > 20 petechiae ; (-) = <20
• No to bleeding & dehydrated
SEROLOGICAL TEST (ELISA) +Ab DENGUE DUO = confirmatory
• Acute: (+) Ab • Rapid agglutination test
• Convalescence: (+) Ab 4x  • (+) Ab; NS1 Ag Platella
 DENGUE HEMORRHAGIC FEVER
To prevent and control bleeding which is a nursing priority:
- Epistaxis-instruct patient to avoid forceful blowing of nose or for parents to do gentle nasal care. Apply ice for
vasoconstriction. Upright position lean forward, ante flexion and apply pressure on nose bridge.
- Gum bleeding: use soft bristle toothbrush; use warm NSS as mouth gargle
Increase body resistance of patient by proper nutrition and adequate rest
Fluid replacement = crystalloid if severe = plasma expander / albumin, starch, dextran = to maintain blood volume
(monitor hct to see improvement)
MANAGEMENT Diet : No to dark colored fluids and food = to monitor for melena. Don’t give iron preparation
Medication: PARACETAMOL = no to ASPIRIN and NSAIDs 1.because it is a platelet inhibitor/de-aggregator and leads to
bleeding
• Chemically treated mosquito net
• Larva eating fish
• Environmental sanitation
• Anti mosquito soap
• Neem tree (eucalyptus)
 MALARIA aka AGUE
CAUSE OF DEATH Harsh Fever
Plasmodium Vivax
CAUSATIVE AGENT
(protozoal) Ovale Malarial
Falciforum – MOST FATAL Knowlesi
MOT Anopheles Mosquito (brown in color)
CHARACTER Night Biting; High flying; Free Flowing; Rural
COLD: chills, clatter HOT: Fever (40 C), headache, DIAPHORETIC / WET: profuse or
teeth, shaking of body vomiting, body malaise and excessive sweeting, feeling of
S/SX (RBC) & chattering of lips that abdominal pain lasts for 4-6 weakness. Every 3 or 2 days.
lasts for 10-15 minutes hours recurring
• Provide blanket to • TSB to lower body • Make patient comfortable in
keep patient warm temperature bed
• Apply hot water bag • Cold Compress • Keep patient warm
NURSING CARE over soles of feet • Increase fluid intake • Increase fluid intake to
• Expose to heat lamp • Provide adequate rest prevent dehydration
or drop light • Loose and light clothing
• Provide warm drinks
 MALARIA aka AGUE
Blood smear / Malarial Smear = blood is extracted at peak of fever because MO is in the blood
DIAGNOSTIC stream already
1st line 2nd line
1st to 3rd day: • Quirine: severe Malaria (IM/IV)
Artemether Lumefrantine • Chloroquine: phophylactic drug (1 week before
MANAGEMENT 4 day : Primaquine: follow-up drug malaria endemic place.
th

to clear infection • Cautiously used for pregnant women because of its

abortive effect and it crosses the placental barrier
causing severe anemia to the child
• Doxycycline
 FILARIASIS
CAUSE OF DEATH Elephantiasis
Wuchereria Bancrofti Brugia Timori
CAUSATIVE AGENT
(parasites) Brugia malayi Loa Loa
MOT Aedes Poecillus: distinctly spotted appearance—its legs have an abundance of contrasting white bands
CHARACTER Night Biting; High flying; Free Flowing; Rural
Asymptomatic: 8 to 16 months

LYMPHADENITIS Inflammation of lymph nodes

LYMPHANGITIS Inflammation of lymph vessels
ACUTE STAGE FUNICULITIS Spermatic cord
ORCHITIS an inflammation of one or both testicles
S/SX
EPIDIDYMITIS inflammation (swelling and irritation) of the epididymis
HYDROCELE swelling of the scrotum

CHRONIC enlargement and thickening of the skin of the upper and lower
ELEPHANTIASIS extremities, scrotum and breast (rough)
STAGE

LYMPHEDEMA temporary swelling of the upper and lower extremities (Smooth)

 FILARIASIS
Nocturnal blood examination (NBE) – taken at patient’s residence/hospital after 8PM
LAB EXAM
Immunochromatographic test (ICT) – rapid assessment method; an antigen test done at daytime
Diethylcarbamazine Citrate (DEC) or HETRAZAN – an individual treatment kills almost all microfilaria
TREATMENT
and a good proportion of adult worms.
Environmental sanitation such as proper drainage and cleanliness of surroundings
Spraying with insecticides
PREVENTION Use of mosquito nets, long sleeves, long pants and socks
Application of insect repellants
Screening of houses