COMMUNICABLE

DISEASE NURSING

Mrs. Ma. Lucy D. de Leon,PhD.,RN

Definition Of Common Terminologies:
Communicable Diseases – are diseases that are transmitted from
one person to another directly or indirectly.

Infectious Diseases – requires direct inoculation of microorganism

of microorganism to produce a disease

Contagious Diseases – are diseases that are easily transmitted

from one person to another by direct or indirect means

Epidemiology – that branch of medical science which deals

on the causes, occurrence, and distribution of disease, dis-
ability , and death among groups of people.
a. epidemic
b. endemic
c. pandemic
d. sporadic
 Triad of Epidemiology

Factors Affecting The Acquisition Of Organism

Host
• Patient
• Carrier
• Contact
• Suspect

Agents
1. Virus

a.  Smallest microorganism

b. Attack only living organisms
c.  Usually has longer incubation period
d. Person acquire longer or lifetime immunity
e. Self-limiting
2. Bacteria
a. Attack both living and non-living organism
b. Usually has shorter incubation period
c.  Short or no immunity acquired
d. Bacterial infection can be treated easily due to the advent of
antibiotics

3. Rickettsia
a. Unable to grow on artificial media
b. All rickettsial diseases are transmitted by arthropods (ticks,
flea, mites, lice )
c. Require living cell for growth and multiplication
 4. Spirochete
a. Spiral-shape bacteria
b. Move in an spiral, helical, or inch-worm manner (leptospira)

5. Chlamydia - usually are transmitted through sexual contact

6. Fungi – some are harmful, some are beneficial .

7. Protozoa
•Single-celled organism
•Composed of two stages;
a) Throphozoite is the motile, feeding, and dividing stage of life
cycle
b) Cyst- the dormant, survival stage

8. Parasites – usually lives in the expense of others.

For the organism to cause a disease, it should posses the following;
1. Pathogenicity
2. Virulence
3. Invasiveness
4. Infective dose
5. Elaboration of toxin
Environment:

Should be favorable for the growth and multiplication of

microorganisms

CHAIN OF INFECTION

Infection – is the implantation and successful replication of

the organisms in the tissue of the host.
Chain of Infection Diagram
1. Agent
2. Reservoir
a. Human
·  Frank cases – the very ill
·  Sub-clinical/ambulatory
·  Carrier
b. Animals
c. Non-living
3. Portals of Exit (GIT, GUT. Respiratory. Integumentary)
4. Mode of transmission
a.  Contact transmission
b. Airborne
c. Vehicle borne
d. Vector borne

5. Portals of entry

6. Susceptible host
 Factors in consider in the host’s resistance;

1. Skin and mucous membrane

2. Humoral immune response
3. Cell-mediated immune response

Immunity – free from any particular disease

1. Natural or inherent

a. Natural active – participation of the body in the acquisation

of immunity

b. Natural passive – acquired through placental transfer

2. Artificially acquired
a. Active – gained through administration of toxoid

b. Passive – gained through administration of anti-toxin,

anti-serum. This elicit immediate action

Vaccines:

1. Attenuated (live organism)

·  Single dose
·  Lasting immunity

2. Inactivated (killed organism)

·  Requires multiple doses
·  Booster dose needed to confirm immunity
Aspects Of Care of a CD Patient

1. Preventive aspect
·    Health education
·    Immunization
 Levels of prevention
a. Primary – considered as the true prevention
- precedes a disease or dysfunction
- applied to clients who are physically and
emotionally healthy
b. Secondary – focuses on individuals who are
experiencing health problems
- protecting those who are risk for
developing complications
- geared toward early diagnosis
and treatment
c. Tertiary – nursing management is directed toward pre-
vention of complication, deterioration and disability
 2. Control system
·    Isolation
·    Quarantine
·    Disinfection
♠ Concurrent
♠ Terminal
·    Disinfestation
·    Fumigation
·    Use of PPE
·    Universal/Standard precaution
3. Curative
·     Medical management
·     Nursing management

4. Rehabilitative
·    Activity
·    Nutrition
DISEASES AFFECTING THE
CENTRAL
NERVOUS SYSTEM
 Tetanus
(Lockjaw)

- An infectious disease affecting the CNS usually manifested by

generalized spasmodic contractions of the skeletal musculator
 
- Incubation period; 3 days – 3 weeks in adult, 3 – 30 days in neonate
  
- Etiologic agent is Clostridium tetany with the following characteristics;
 
 
Anaerobic, gram (+) spore former, drumstick in appearance
Comes in two forms, spore forming & vegetative
Releases two types of toxin; Tetanolysin – responsible for RBC
destruction, and tetanospasmin – responsible for muscular spasm.
Next to Botulinus, these toxin is known to be the most lethal toxin to
man.
Habitat is the intestinal wall of grass-eating animals
Avenues for entrance of the organism;

● Rugged traumatic wounds and burns

● Umbilical stump
● unrecognized wounds
● Dental extraction, circumcision, ear piercing

Pathogenesis:
 
-  Clostridium tetani enters the body, produce local infection and
tissue necrosis
-  While reproducing, release toxin, absorbed by the bloodstream
and the lymphatics, spread to the CNS to the anterior horn cells
of the spinal cord, thus, stimulate contraction of the muscles
supplied by the neurons to which toxin difuses.
 Clinical Manifestations:
  A. Neonate
ü   Feeding and sucking difficulty
ü   Excessive crying
ü   Spasm and cyanosis (spasm provoked by stimuli)
ü   Exhaustion
ü   D E A T H
B. Older children and adults:

1. Increase muscle tone near the wound if tetanus remain localized

2. If it become systemic,
a)  Low grade fever and painful involuntary muscle contraction
b)  Trismus
c)  Risus sardonicus
d) Abdominal rigidity
e)  Opisthotonos
f)   Intermittent clonic and tonic convulsions resulting to sudden
death due to asphyxation
g)  Laryngospasm
 3. In mild cases, after a period of weeks, spasm diminishes in
frequency and severity, with trismus being the last symptom to
disappear.
4. In fatal cases, death usually occurs during the first 10 days
of the disease

Complications:
1. Respiratory
a) Hypostatic pneumonia
b) Hypoxia due to laryngospasm
c) Atelectasis
d) Pneumothorax

2. Due to trauma
a) Laceration of the tongue and bucal mucosa
b) Intramuscular hemtoma
c ) Fracture of the ribs and the spine due to prolong
opisthotonos
3. Septicemia

Baby infected with Tetanus

 Treatment:
1. Specific
a) ATS, TAT, and TIG should be given within 72 hours after injury
b) Tetanus toxoid given in regular schedule
c) Antibiotics to control infection
d) Adequate fluid, electrolyte and caloric intake
e) Good nursing care
 
ü      Avoidance of external stimulation
ü      Prevention from further injury
ü      Maintain adequate airway
ü      Maintain an IV line for medication and emergency care
if necessary
ü      Carry out efficient wound care
ü      Avoid contractures and pressure sores
ü      Watch for urinary retention
ü      Close monitoring of vital signs and muscle tone
ü      Provision of optimum comfort measures
 
Prevention and Control:

1. Active immunization with Tetanus toxoid in adult

2. DPT for babies and children
3. Early consultation and adequate wound care after an
injury
 Meningitis
(Cerebrospinal fever)
 
Ø      The inflammation of the meninges of the brain and the spinal
cord.

Ø      Caused by several organisms which include; pneumococcus,

staphylococcus, streptococcus, and tubercle bacillus. Neisseria
meningitides (meningococcus) is the organism causing most
epidemics of meningitis.

Ø      Incubation period : 1 – 10 days.

Ø      Mode of transmission :

ü     Respiratory droplet
ü     Direct invasion through oitis media
ü     Skull fracture, penetrating head injury
ü      Complication of an existing viral disease
  
Ø      Diagnostic Tests:
a.) CSF analysis ( lumbar puncture)

 Purposes of Lumbar puncture:

1. Diagnostic
ü     To obtain specimen (CSF)
ü     To take x-ray of the spinal canal
2. Therapeutic
ü     To reduce intra-cranial pressure
ü     To introduce medication
ü     To inject anesthetic agent

b) Gram staining
c) Smear and blood culture
c) Urine culture
Types of Meningitis:
1. Aseptic meningitis

Ø      Begin with benign syndrome characterized by headache,

fever, vomiting and meningeal symptoms
ü      Stiff neck or nuchal rigidity
ü      Opisthotonos
ü      (+) Brudzinski
ü      (+) Kernig

 Ø      Sinus arrythmia, irritability, photophobia, diplopia and

other visual problems

Ø      Abnormal movements of the extremities, spasm,

decortication, descerebrate.
 
Ø      Delirium, deep stupor, coma
Ø      Signs of intracranial pressure:
ü      Bulging fontanel in infants
ü      Nausea and vomiting (projectile)
ü      Severe frontal headache
ü      Blurring of vision
ü      Alteration in sensorium

Complications:

Ø            Subdural effusion

Ø            Hydrocephalus
Ø            Deaf-mutism
Ø            Blindness
Ø            Otitis media and mastoiditis
Ø            Pneumonia and bronchitis
Modalities of treatment:
Ø   If left untreated, mortality rate 70 – 100%
Ø   Antibiotics (Ceftriaxone) to control infection
Ø   Digitalis (Digoxin) to control arrythmias
Ø   Manitol (diuretics) to control edema
Ø   Anticonvulsants to reduce restlessness and convulsions
Ø   Acetaminophen and paracetamol to relieve headache and
fever

Nursing Management:
Ø    Assess neurologic condition of patient
Ø    Observe level of consciousness
Ø    Check for signs of ICP
ü     Plucking at bedcovers
ü     Projectile vomiting
ü     Seizures
ü     Change in motor functions and vital signs
 Ø    Maintain adequate fluid intake to avoid dehydration but
avoid fluid overload to prevent cerebral edema
Ø    Correct positioning to prevent deformities, pressure sores and
respiratory complications
Ø    Maintain adequate nutrition and elimination
Ø    Isolation
Ø    Provide reassurance to patient and the family

2. Acute meningococcemia (Spotted fever)

Ø      Most common among children ages 6 months to 5 years

Ø      Following an incubation period of 3 – 5 days, meningococci
invade the bloodstream, the joints, the skin, the adrenals,
and the lungs without involving the meninges.
Ø      Manifestations start with nasopharyngitis followed by sudden
onset of spiking fever with chills, nausea, vomiting, malaise,
and headache
 Ø      Petechiae, purpura, ecchymotic hemorrhages scaterred all over the
body and mucous membrane
Ø      Adrenal lesions start to bleed into the medulla which extends into
the cortex
Ø      Dermal manifestations and adrenal hemorrhages is known as
Waterhause-Friderichen syndrome
 
Types of meningococcemia:

 a)  Fulminant – the rapid development of petechiae, purpuric,

ecchymotic spots associated with shock. The condition
runs short and usually fatal.

b)  Non-fulminant – transition of lesions is delayed and chance for

survival is 85%.
Opisthotonus

Decortication
Meningococcemia
Nursing Management:
 
Ø      Isolation
Ø      Strict aseptic technique
Ø      Emotional support

Prevention:

Ø      Immunization. (Polysaccharide vaccines)

ü     Monovalent A
ü     MonovalentC
ü     Bivalent AC
Ø      Prompt medical treatment and diagnosis
Ø      Rifampicin as prophylaxis
 Encephalitis
(Brain fever)

Ø An acute inflammatory condition of the brain usually occurring

as a complication or sequel to some viral diseases

Ø  Caused by a variety of pathologic agents, like bacteria, viruses,

fungi, rikettsia, toxins, chemical, substances, or trauma.

Ø  Incubation period is 5 – 15 days

Ø  Classifications:

1. Primary – caused by direct inhalation of noxious substances;

- direct invasion of the CNS by arthropods.
a. Eastern Equine Encephalitis
ü      Principally affecting children below 5 years old
ü      Harbored by Aedes sulicitans mosquito
 b. Western Equine Encephalitis – milder type and usually
affecting adults.

c. St. Louise Encephalitis

ü      Usually harbored by mosquito Culex tarsalis
ü      Organism is believed to gain entrance through the
olfactory tract

d. Japanese Encephalitis

ü  Disease is spread by mosquito Culex triteaniorhynchus that live in

rice-growing and hog-raising areas
ü  Once mosquito is infected, it is capable of transmitting the
disease for life
ü  Usually affecting children 5 – 10 years old, more in male than
in female with a ratio of 3 : 1
ü  Peak season for JE is March – April; September – October
where rice field is flooded
 2. Secondary Encephalitis
a) Post infection – usually post viral infection
b) Post vaccinal – most common is anti-rabies vaccine

Clinical Manifestations:

1) Fever, headache, dizziness, vomiting, and apathy

2)  Chills, sore throat, conjunctivitis, artharlgia, myalgia, and
abdominal pain
3)  Ocular palsy, ptois, and flccid paralysis
4)  Disturbances in swallowing, mastication, phonation, respiration and
movements of the muscles of the eyes or face
5)  Uncontrollable contraction or twitching of the muscles of the
different parts of the body
6)  Encephalitic signs manifested by nuchal rigidity, ataxia, tremors,
mental confusion, speech difficulties, stupor, hyperexcitability,
convulsions, coma, and DEATH
 Diagnostic Tests
1) EEG
2)  CSF analysis
3)  Serologic test – 90% confirmatory
4)  ELISA
Sequelae:
1) Motor disturbance
ü      Persistent convulsion
ü      Parkinsonian syndrome or Paralysis agitans
ü      Epilepsy-like manifestation
2) Mental Disturbances
ü      Mental dullness
ü      Mental deterioration
ü      Lethargy
ü      Mental depression
ü      Sleep disturbance
3) Endocrine disturbances
ü      Patient may grow fat or thin
ü      In adult, sexual interest or activity is lost
Nursing Management:

ü      Symptomatic and supportive

ü      Control of convulsions
ü      Sanitary disposal of nose and throat secretions
ü      Unless patient is comatose, patient is encouraged oral fluid
intake
ü      Provide safety
ü      Intake and output should be closely monitored
ü      Observe for neurologic signs involving speech, swallowing
difficulty of speech
ü      Frequency and duration of convulsions should be observed

Prevention and Control:

1. Elimination of breeding places

2. Destruction of larvae
3. Screening of houses
4. Use of repellents
5. Health education, information dissemination
 
 Rabies
(Hydrophobia; Lyssa)

 
Ø A specific, viral infection communicated to man by an infected
animal

Ø Caused by a bullet shape organism that has an affinity to the CNS

Ø The organism is resistant to phenol, merthiolate, and common

antibacterial agents

Ø Recommended first aid is to wash the wound with soap and water
for about 3 minutes and apply tincture of iodine
Ø  Incubation period is 1 week – 7 months in dogs; and 10

days to 15 years in human

Ø  Incubation period depends upon 5 factors;

ü     Distance of the bite to the brain
ü     Extensiveness of the bite
ü     Specie of the biting animal
ü     Richness to nerve and blood supply
ü     Resistance of the host

Ø  Patient is communicable 3 – 5 days before onset of

symptoms until the entire course of illness
Pathogenesis:
 Clinical Manifestation:
1. Prodromal/invaion phase

ü      Fever, anorexia, malaise, sore throat, lacrimation, irritability,

hyperexcitability, apprehensiveness, restlessness, mental
depression
ü      Numbness, pain, and tingling sensation at the site of the bite
felt along the peripheral nerves

2. Excitement/Neurological phase

ü      Marked excitation, apprehension, and terror may occur

ü      Delirium, associated with nuchal rigidity, generalized
muscular twitching and convulsions
ü      Maniacal behavior, skin cold and clammy
ü      Painful spasm of the muscles of the mouth, pharynx, larynx
on attempt to swallow water or even at the mere sight of them
ü      Aerophobia
ü      Frothy saliva drools from the patient’s mouth
ü      DEATH may occur during the episodes of spasm
3. Terminal /Paralytic phase
ü      Patient becomes quiet and unconscious
ü      Loss of bowel and urinary control
ü      Spasm ceases with progressive paralysis
ü      Tachycardia, labored, and irregular respiration
ü      DEATH occurs due to respiratory and circulatory collapse

Diagnostic Tests:
1. Virus isolation from the patient’s saliva and throat
2. Fluorescent rabies-antibody (FRA) – provides the most definitive
diagnosis
3. Presence of negri bodies in the dog’s brain

Treatment Modalities:
1. Thoroughly wash wound with soap and water
2. Immunization/vaccination
3 ATS/TAT infiltrated around the wound or IM ANST
4. Anti-rabies vaccine, both passive and active
Schedule of Vaccination (Adopted from SLH)
A. Passive
1. ERIG - P
2. ERIG – B
3. HRIG

B. Active

1) Standard Regimen
 
PVRV (Verorab) PCEC (Rabiphur)

D0 ..1cc x 2 sites . 2cc x sites ID Deltoid

D3 . 1 cc x 2 sites .2cc x 2 sites ID Deltoid
D7 .1 cc x 2 sites .2 cc x 2 sites ID Deltoid
D28. 1 cc x 1 site .2 cc x 1 site ID Deltoid
D90. 1 cc x 1 site . 2 cc x 1 site ID Deltoid
 2) Special Regimen: (2 – 1 – 1)
 
D0 1 vial x 2 sites IM Deltoid
D7 1 vial x 1 site IM Deltoid
D141 vial x 1 site IM Deltoid

* If the vaccine is given IM, it should be given ANST

Prevention:
1. Vaccination of all dogs
2. Enforcement of the regulation regarding stray dogs
3. Public education in avoiding or reporting all animals that appear
weak.
 POLIOMYELITIS
(Heine-medin Dse; Infantile paralysis)

 
·  Caused by a filterable virus., Picorna virus, or Legio Debilitan
·  Incubation period is 7 – 21 days
·  Pd of communicabiolty – 3 days to 3 months

·  Mode of transmission:
ü     Direct contamination with oropharyngeal secretions and feces
ü     Through carriers
ü     Indirectly, through contaminated articles, water and food

·  Predisposing Factors:
ü     Age : 80% less than 10 years old
ü     Sex : More in male than in female
ü     Environment and hygienic condition
ü     Excessive work, strain, overexertion
 
Types:

A. Abortive ( accounts 4 – 8 % )
ü     Does not invade the CNS
ü     Headache and sore throat
ü     Moderate grade fever
ü     Occasional vomiting
ü     Low lumbar pain
ü     Patient usually recover within 72 hours
B. Pre-paralytic

ü     Above signs

ü     Higher temperature, more severe headache,
vomiting, anorexia, lethargy
ü     Pain at the neck and back, and the muscles of the
hamstring
ü     Changes in deep and superficial reflexes
ü     Inability to place the head in between the knees
ü     Positive Pandy’s test
ü     Transient paresis
ü     Positive for signs of meningeal irritaion
C. Paralytic
ü     Above signs and symptoms
ü     Positive (+) Hoyne’s ign
ü     Paralysis occurs
ü     Less tendon reflexes
ü     Positve Kernig and Brudzinski’s signs
ü     Weakness of the muscles
ü     Hypersensitivity to touch
ü Urine retention, constipation, and abdominal
tympanism
C.1. Spinal Paralytic
o       Paralysis occurs in muscles innervated by the motor neurons
of the spinal cord
o       Flaccid paralysis of one or both extremities
o       Autonomic involvement characterized by excessive sweating
o       Respiratory difficulty
C.2. Bulbar
o       More serious type
o       Muscles supplied by the cranial nerves weakens specially
the 9th (glossopharyngeal) and the 10th (vagus)
o       Paralysis of the facial, pharyngeal, and the ocular muscles
o       Respiratory failure and cardiac irregularities
o       Hypothalamic dysfunction (altered temperature regulation

C.3. Bulbospinal
o       Involvement of the neurons both the brainstem and the
spinal cord
 Pathogenesis:
1. Intestinal phase
·  Organism enters the mouth, multiply in the oropharynx,
proceed to the intestines where they lodge and multiply
2. Viremic phase
·   Organisms are spread to the regional lymph nodes and the
bloodstream
3. Neural phase
·  Organisms migrate to the CNS

Complications:
1. Respiratory failure
2. Circulatory collapse
3. Electrolyte imbalance
4. Urinary paralysis
5. Abdominal distension

Diagnostic Procedures
·        Throat swab
·        Stool culture
·        CSF analysis
Nursing Management:
·        Enteric isolation
·        Observe and assess for neurologic changes
·        Watch for fecal impaction
·        Carry out strict medical asepsis
·        Proper disposal of excreta and vomitus
·        Provide emotional support both to patient and family
·        Maintain good personal hygiene particularly skin care

Prevention and Control:

·        Immunization
·        Enteric isolation
·        Implementation of Standard precaution
·        Avoid overcrowding
 
DISEASES AFFECTING
THE
RESPIRATORY SYSTEM
 DIPHTHERIA
(Membranous Croup)

Ø      A acute respiratory and cutaneous disease caused by a bacteria,

Corynebacterium diphtheriae (Klebs Loeffler bacilli); a gram (+),
non-spore forming, and toxin-produsing organism
Ø      Incubation period is 2 – 5 days
Ø      Period of communicability : 2 – 4 weeks in untreated patients;
1-2 weeks in treated patients
Ø      Sources of infection:
ü    Discharges from the nose, pharynx, eyes, or lesions in some
parts of the body.
Types:
1. Nasal
·        Irritating discharge with excoriated nares and upper lip
·        Discharge is usually bloody
·        Pseudomembrane is rarely visible
·        Cervical and sub-maxillary gland are enlarge
·        Moderate grade fever
2. Tosilopharyngeal

·     Start with sore throat, fever, and membrane formation

·     Cervical lymph nodes are prominent leading to “Bull’s
neck” appearance
·     Pulse become rapid and feeble associated with low BP
·     Toxemia usually become severe and DEATH usually
occurs from toxic myocarditis or bronchopneumonia
3. Laryngeal
·     The onset is gradual, with increasing hoarseness an croupy
cough
·     Inspiration become croupy, expiration become wheezy
·     Voice becomes lost, muscle between the ribs are sucked in each
breath
·     Laryngeal lining thickens, reducing the lumen, thereby
obstructing the air passages
·      Every breath is a struggle, fever increases as symptoms
progresses
·      Unless treatment is done DEATH usually results from
suffocation
·      Tracheotomy is us indicated to free airway to the lungs
·      Laryngeal involvement is considered as most fatal of all the
types

4. Wound or cutaneous diphtheria

·        Affecting mucous membrane or any break on the skin
·        Symptoms are usually mild
Complications:
1. Myocarditis
2. Polyneuritis – paralysis of the soft palate,, ciliary
muscles of the eyes, pharynx, larynx,
and the extremities
3.Airway obstruction
4. Nose bleeding

Diagnostic Exams:
1. Nose and throat swab
2. Schick’s test
3. Molony test
Treament:
1. AntiiDiphtheria Serum (ANST)

Fractional dose are given in positive cases:

·        0.05 ml (1:20 dilution) – s/c
·        0.05 ml (1:10 dilution) – s/c
·        0.10 ml undiluted – s/c
·        0.20 ml undiluted – s/c
·        0.50 ml undiluted – IM
·        0.10 ml undiluted – IV
·        remaining solution given an hour after

2. Erythromycin, 40mg/kg BW Q6 x 7 – 10 days

3. Supportive therapy
·        Maintenance of adequate nutrition
·        Maintenance of fluid and electrolyte balance
·        Bed rest
·        Oxygen therapy
·        For laryngeal type, tracheotomy is usually done

Nursing Management:
·        Absolute bed rest
·        I & O measurement
·        Keep patient warm
·        Care of tracheotomy

Prevention:
·        Mandatory DPT immunization of babies
·        Children under 5 years old should receive diphtheria-tetanus
vaccine
·        Concurrent and terminal disinfection
·        Isolation for at least 14 days from onset until 3 N & T swab
are negative
Bull Neck Tonsilar Diphtheria
Who should & should not receive DPT

1. Febrile patients can be given after their fever subsides

2. Children with minor respiratory illness, with or without fever can

be given

3. Immunosuppressed patients receiving therapies for cancer can be

given vaccine one month after the last dose

4. HIV (+) children can receive DPT

5. Children who develop encephalitis within 7 days after

administration of DPT should not receive another dose.

6. Child with a history of CNS disorder or history of convulsions

does not justify withholding DPT
 INFLUENZA
(La Grippe)

Ø      A highly contagious, self-limiting viral disease usually

affecting the respiratory system that occur sporadically or
endemically.
Ø      Caused by myxoviruses types A, B, & C

Ø      Incubation period 24 – 72 hours

Ø      Period of communicability: until the 5th day of illness in adult,

and the 7th day in children
Types:
1. Respiratory
ü      Fever that usually last for several days leaving the patient
exhausted
ü      Chilly sensation
ü      Coryza
ü      Muscular and joint pain
ü      Intraocular and periorbital pain
ü      Frontal headache
ü      Cough
ü      Recovery is gradual

2. Intestinal
ü      Vomiting
ü      Fever
ü      Obstinate constipation or diarrhea
  
3. Nervous form
ü      Headache and fever
ü      Terrific muscular and joint pain
ü      Profound prostration

Complications
1. Related viral infection
a)      Hemorrhagic pneumonia
b)      Encephalitis
c)      Myocarditis
d)      Sudden death in infants
2. Super imposed bacterial infection
a)      Otitis media
b)      Sinusitis
c)      Pneumonia
Nursing Management;
ü      Stay at home
ü      Plenty of fluid intake
ü      Antipyretics
ü      Hydrotherapy
ü      Isolation
ü      Limit strenuous activities activities
ü      Watch out for complications

Preventive Measures
ü      Immunization
ü      Avoidance of crowded places
u Personal hygiene
 
 PERTUSSIS
(Whooping Cough)

Ø  An infectious disease characterized by repeated spasmodic

coughing, typically ending in a long-drawn inspiration,
the crowing sound, the whoop.

Ø   Cause by Bordetella pertussis, a gram negative organism easily

destroyed by light, heat and drying

Ø   Considered most communicable during the first week of the

disease up 3 weeks following paroxysms

Ø   Transmitted by direct contact, by droplet, and other articles

contaminated by respiratory secretions.

Ø   One attack usually confirms lifetime immunity

 Signs and Symptoms:

1. Catarrhal stage
ü      Coryza, lacrimation and dry cough
ü      Cough becomes irritating, hacking and nocturnal
ü      It is during this stage that the disease is very communicable

2. Paroxysmal stage
ü      Occurs on the 7th – 14th day
ü      Excessive explosive outburst of coughing about 5 – 10 rapid
coughs in one expiration
ü      Paroxysmal coughing may induce nosebleed, increased
venous pressure, periorbital edema, and conjunctival
hemorrhage.
ü      Violent coughing usually is accompanied by profuse
sweating.
Involuntary urination, lethargy, and exhaustion
 ü      Cough is provoked by crying, eating, drinking , or physical
exertion
ü      Convulsion may occur due to cerebral hemorrhage
ü      This stage lasts for 4 - 6 weeks

3. Convalescent stage
ü      Gradual decrease in patoxysms both in frequency and
severity

COMPLICATIONS
1.Interstitial pneumonia
2. Atelectasis
3.Umbilical hernia
4. Otitis media
5 Bronchopneumonia
6. Severe malnutrition and starvation
 DIAGNOSTIC EXAM
1.      Nasopharyngeal swab
2.      Sputum culture
3.      CBC ( leukocytosis)

Modalities of Treatment:
1. Supportive therapy
ü      Fluid and electrolyte replacement
ü      Adequate nutrition
ü      Oxygen therapy
2. Antibiotics
3. Hyperimmune convalscent serum
Nursing Management:
1. Isolation and medical asepsis
2. Provide quiet environment
4. Sunshine and fresh air
5. Warm baths preferred
6.  Monitor intake and output

Prevention:
1. Any case of pertussis should be reported
2. Public education regarding massive immunization of DPT
 
 PNEUMONIA
Ø      An acute infectious disease characterized by general toxemia and the
consolidation of one or more lobes of either one or both lungs
Ø      Caused by several organisms, and or other noxious substances
ü   Bacteria
ü   Viruses
ü   Mycoplasma
ü  Various chemicals

Classification According to How and Where the disease is acquired

1. Community-Acquired Pneumonia (CAP)

ü   If hospitalized patient develops pneumonia in less than 36 hours
during his stay in the hospital
ü  Pneumococcus is the most common cause of CAP
 2. Hospital acquired (Nosocomial)
ü  Develops while the client is in the hospital
3. Aspiration pneumonia
u  Occurs when a foreign material is inhaled (aspirated)
into the lung
4. Pneumonia caused by an opportunistic organism
      ü   Strikes people with compromised immune system

Anatomical aClassification of Pneumonia

1. Bronchopneumonia (Catarrhal pneumonia)

ü      Most common type
ü      Infection start from the bronchus, the bronchioles, and
spread to the alveoli
ü      Alveoli collapse due to plugging of the bronchioles that
supplies them
ü      Commonly caused by Klebsiela group, Hemophilus influenza,
and pneumococcus
ü      Onset is slow with low grade fever
2. Lobar pneumonia (Croupus pneumonia)

ü      Consolidation of the entire lobe

ü      Manifested by chills, chest pain on breathing, coughing with
blood-streaked sputum (Rusty/prune juice sputum)
ü      In unfavorable cases, the heart weakens, lung become
edematous, severe general exhaustion, DEATH occurs due
to heart failure

3. Primary Atypical pneumonia (Virus pneumonia)

ü      Solidification of the lung comes in patches
ü      Greenish to whitish secretions are raised on coughing
 General Classification:

 1. Primary – results due to direct inhalation or aspiration of

microorganism or noxious substances
2. Secondary – pneumonia that develop as a complication to a disease

Pathology: 
1. Stage of lung engorgement
ü      Dark red in color
ü      Exuding a bubbly, blood-tinged froth
2. Red hepatization
ü      Looks like a piece of red granite
3. Gray hepatization
ü      More softer and tears more easily
ü      When pressed, exudes a purulent fluid
4. Stage of resolution
ü      Inflammatory exudates are either expectorated or absorbed
the blood stream
 Diagnostic Exam:
1. Physical findings
2. Chest x-ray
3. Sputum analysis, culture, smear
4. Blood/serologic exam

Clinical Manifestation (Adult)

·   Sudden onset of chills with rising fever
·   Stabbing chest pain aggravated by respiration and coughing
·   Paroxysmal or chocking cough
·   Sputum is rusty or prune juice
·   Pain on abdomen mistaken as appendicitis
·   Herpes may appear on the lips
·   Body malaise
·   Respiratory grunting with marked tachypnea and flaring of the nares
·   Pulse is rapid and bounding
·   Diaphoresis
Signs And Symptoms in Children:
·   Fever, chills, cough
·   Unusually rapid breathing
·   Rib muscle retraction
·   Vomiting, chest pain, decreased activity
·   Loss of appetite in older children and feeding difficulty in infants

Modalities of Treatment:

1. Antimicrobial therapy

a)   Streptococcus – Microlides
b)  
        Klebsiela - minoglycosides and cephalosporin
c)  Streptococcu - Nafcillin/oxacillin
d)   Pneumocystis - Co-trimozasole
e)  Pen G still the drug of choice
 2. Bronchodilators
3. Expectorants
4. Pain relievers for pleuritic pain

Nursing Management:
·   Maintain patent airway and adequate oxygenation
·   Teach patient how to cough and do deep breathing exercises
·   Maintain adequate nutrition
·   Proper disposal of sputum
·   Control temperature by cooling measures
·   Monitor vital signs closely, watch for danger signs like;
ü     Marked dyspnea
ü     Irregular, thready pulse
ü     Delirium with extreme restlessness
ü     Cold, moist skin
ü     Cyanosis and exhaustion
Prevention:
·   Hib – anti-haemophilus influenza B
·   Pneumonia vaccine (PCV)
·   Prevent common colds, influenza, and other upper respiratory
infection
 TUBERCULOSIS
(Consumption Dse.; Koch’s Dse.; Phthisis)

Ø     A chronic, acute or sub-acute disease commonly known as TB,

characterized by formation of tubercle in the tissue which tend
to undergo caseasion, necrosis and calcification
Ø      Caused by Mycobacterium tuberculosis; M. Africanum from
human; M bovi, from cattle
Ø      Incubation period; 2 – 10 weeks
Ø      Pd. Of communicability; Variable
Ø      Transmitted by deliberate inoculation of the organism or by
droplet
Classification of TB
1. Pulmonary Tuberculosis
2. Extra pulmonary tuberculosis
a)      TB meningitis
b)      Pott’s disease
c)      Miliary tuberculosis
Quantitative Classification of TB
1. Minimal – with slight lesion without demonstrable excavation
2. Moderately advance
·        One or both lungs maybe involved
·        Diameter of the cavity should not exceed 4 cm
3. Far advance – lesions are more extensive than moderate

Clinical Classification
1. Inactive
·        Symptoms of TB are absent
·        Sputum negative for TB bacilli
·        No evidence of cavity on chest x-ray
2. Active
·        Positive Tuberculin test
·        Chest x-ray reveal progressive activity
·        Symptoms are present
·        Sputum and gastric content positive for tubercle bacilli
3. Activity not determined
Clinical Manifestations
·        Afternoon rise of temperature
·        Night sweating
·        Body malaise and weight loss
·        Cough, dry to productive
·        Dyspnea, hoarseness of voice
·        Hemoptysis
·        Occasional chest pains
·        Sputum positive for AFB

Diagnostic Exam
1. Ask for medical history
2. Physical exam
3. Chest x-ray
4. Microbiologic test
5. Tuberculin test
Treatment Modalities
1. SCC –Short Course Chemotherapy (6 months)
R – Rifampicin
I – Isoniazid
P – Pyrazinamide
E - Ethabutol

2. SR – Standard Regimen (56 vials Streptomycin SO4)

3. FDC – Fixed Dose Combination

Myrin P Forte x 2 months
Myrin – remaining 4 months

4. DOTS
Elements of DOTS
1. Sustained political commitment –
·  increase financial and human resources
2. Access to quality-assured TB sputum microscopy
·        Case detection of persons presenting symptoms of TB
·        Screening of individuals
·        Health education about quality-assured sputum microscopy
3. Standard short-course chemotherapy to all cases of TB
·        Direct observe of treatment
4. Uninterrupted supply of quality-assured drugs
·        Sustained supply of anti-TB drugs
·        Establish a reliable system of regular distribution of anti-TB
drugs
·        Anti-TB drugs should be available FREE to all TB patients
·        Reduce non-adherence to treatment and prevent the
development of MDR
5. Recording and reporting system
·        Monitors treatment and progress outcome of individual
patient
·        Evaluate overall program performance
Nursing Management:

a)      Maintain respiratory isolation

b)     Administer medicines as ordered
c)      Encourage questions, conversation to air their feelings
d)     Teach or educate patient all about PTB
e)      Advise patient to have plenty of rest and eat balanced meals
f)       Be alert on signs of drug reaction
g)      Emphasize the importance of regular follow-up

Prevention:
a) Massive BCG immunization
b) Avoid overcrowding
c) Good personal hygiene and environmental sanitation
d)  Improved nutritional status
 SARS
Ø      First reported in China in Nov. 2002
Ø      Caused by Corona virus
Ø      Transmitted by respiratory droplets or direct contact with
fomites
Ø      Contamination of materials or objects by respiratory secretions
or body fluids
Ø      Virus is stable in urine for 1 – 2 days and in stool for 4 days in
urine at room temperature
Ø      Survives on paper, walls for 36 hours and in plastic surfaces for
72 hours, and glass surfaces for 96 hrs.
Ø      Virus loses infectivity after exposure to common disinfectants
Ø      Heat of 55 ° C rapidly kills the virus
Signs and Symptoms:

1. Sudden onset of high grade fever

2. Headache and overall feeling of discomfort and body aches
3. Mild respiratory symptoms at the start and suddenly patient
develops cough and have difficulty of breathing

Preventive Measures:

1. Consult physician promptly for any signs of respiratory

problem
2. Build up a good immunity/resistance
3. Maintain good personal hygiene
4. Proper use of PPE
5. Proper handwashing
 DISEASES AFFECTING
THE
GASTROINTESTINAL TRACT
(GIT)
  
AMOEBIASIS
(Amoebic dysentery)

Ø       A protozoal infection of man initially involving the colon

but may spread to soft tissues most commonly to the liver or to
the lungs
Ø   Is considered the third leading cause of death from parasitic
disease worldwide
Ø       Caused by Entamoeba histolitica
Ø       Prevalent in ill-sanitated areas
Ø       Common in warm climate
Ø       Cyst survives a few days outside the body
Ø    Cyst pass to the large intestine and hatch into trophozoites.
Pass into the mesenteric veins, to the portal vein, to the liver,
thereby forming Amebic liver abscess.
Ø       Human excreta is the source of infecvtion
Ø       Incubation period ranges from 3 – 4 weeks
Ø       Period of communicability :For the duration of illness
Ø   Can be transmitted by 

·  Fecal - oral:
· Direct contact – sexual contact by orogenital, oroanal,
proctogenital sexual activity.
·  Indirect contact –by ingestion of food specially uncooked leafy
vegetables or contaminated with fecal material
containing E. hystolitica cysts

Ø    Source of infection is human excreta

Entamoeba hystolitica has two developmental stages:

1. Trophozoites / vegetative form

·   A facultative parasite that may invade tissue or they are found
in the parasitized tissues and liquid colonic contents.
2. Cyst

· Are passed out with formed or semi-formed stools and are resistant
to environmental conditions
·  Can remain viable and infective in moist an cool environment for
at least 12 days, and in water for 30 days.
    
·  They are resistant to all levels of chlorine normally used for
water purification
·  They are rapidly killed by temprature below 5 and above 40
degrees centigrade
·  Considered as the infective stage in the life cycle of E. hystolitica
·  Cyst pass to the large imtestines and htch into trophozoites. Pass
into the mesenteric veins, to the portal veins, to the liver, thereby
forming amoebic abscess.
Clinical Manifestations:
A. Acute amoebic dysentery 
·   Slight attack of diarrhea, altered with periods of constipation and
often accompanied by tenesmus 
·   Diarrhea, watery and foul-smelling stools often containing
blood-streaked mucus 
·   Colic and gaseous distension of the lower abdomen 
·   Nausea, flatulence and abdominal distension, and tenderness in the
right iliac region over the colon.
 
B .Chronic amoebic dysentery 
·   Tenesmus accompanied by the desire to defecate 
·   Anorexia, weight loss and weakness 
·   Liver may be enlarged 
·   The stools at first are semi-fluid but soon become watery,
bloody, and mucoid 
·   Vague abdominal distress, flatulence, constipation or irregularity
of the bowel. 
 · Abdomen lost its elasticity when picked – up between fingers. 
· On sigmoidoscopy, scattered ulceration with yellowish and
erythematous border. 
· The gangrenous type (fatal cases) is characterized by the
appearance in the stools of large sloughs of intestinal tissues
accompanied by hemorrhage.

3. Extraintestinal forms:
Hepatic
·   Pain at the upper right quadrant with tenderness of the liver
·   Jaundice
·   Intermittent fever
·   Abscess may break through the lungs, patient coughs anchovy-sauce
sputum
Diagnostic Exam:
1. Stool exam (cyst, pus white and yellow with plenty of amoeba)
2. Blood exam (leukocytosis)
3. Proctoscopy / Sigmoidoscopy

Treatment modalities:

1. Metronidazole (Flagyl) 800 mg TID X 5 days

2. Tetracycline 250 mg every 6 hours
3. Ampicillin, quinolones, sulfadiazine
4. Streptomycin SO4, Chloramphenicol
5. Fluid and electrolytes lost should be replaced
Nursing management:
1. Isolation, enteric precaution
2. Health education
·         Boil water for drinking / purified water
·         Avoid washing food from open drum or pail
·         Cover leftover food
·         Wash hands after defecation or before eating
·         Avoid ground vegetables (lettuce, carrots, etc.)

Methods of prevention:

1. Health education
2. Sanitary disposal of feces
3. Protect, chlorinate and purify drinking water
4. Use scrupulous cleanliness in food preparation and handling
5. Detection and treatment of carriers
6. Fly control (they can serve as vector)
 BACILLARY DYSENTERY
(Shigellosis; Bloody flux)

Ø An acute bacterial infection of the intestine characterized by

diarrhea, and fever associated with the passing out of
bloody-mucoid stools with tenesmus. 
Ø  The causative agent is a bacteria of the Shigella group.of four
serologic groups:

1. Shigella boydii
2. Shigella connei
3. Shigella flesneri (group B) common in the Philipines
4. Shigella dysenterae

·   considered as the most infectious

·   Habitat is the GIT of man
·   Develops resistance on antibiotics
 Ø  Incubation period is 7 hours to 7 days
Ø  Period of communicability is during the acute stage until the
feces is negative of the organism
Ø  After the incubation period, the organism invade the intestinal
mucosa and cause inflammation 
Ø  Formation of dirty, green fibrinous sloughing areas or ulcers. 
Ø  Within a few days, the stool may contain pus, mucus and
blood

Clinical manifestations
·    Fever, specially in children
·    Tenesmus, nausea, vomiting and headache
·    Colicky or cramping abdominal pain associated with anorexia
and body weakness
·    Diarrhea with bloody-mucoid stools that at first is watery
·    Dehydration and loss of weight is rapid
Complications
·     Rectal prolapse particularly in undernourished children
·     Respiratory complications, such as cough and pneumonia
·     Non-suppurative arthritis and peripheral neuropathy

Diagnostic Procedure
  ·   Fecalysis or microscopic examination of the stools
·   Isolation of the causative organism from rectal swab or culture
·   Peripheral blood examination
·   Blood culture
Nursing Management
 
·         Maintain fluid and electrolyte balance to prevent profound
dehydration
·         Restrict food until nausea and vomiting subsides
·         Isolation; can be carried out through medical aseptic technique
·         Maintain personal hygiene
·         Proper disposal of excreta
·         Concurrent and terminal disinfection.

Methods of Prevention and Control

·         Sanitary disposal of human feces
·         Sanitary supervision of processing, preparation and serving of food
particularly those eaten raw
·         Adequate provision of safe washing facilities
·         Fly control and protection against fly contamination
·         Isolation of patient during acute stage toxin in the area.
 CHOLERA
(El Tor)
 
 
Ø   An acute bacterial enteric disease of the GIT characterized by
profuse diarrhea, vomiting, massive loss of fluid and electrolytes
that could result to hypovolemic shock, acidosis, and death. 

Ø   Caused Cholera vibrio, a coma-shaped, gram negative organism

  ü  The organism survives well at ordinary temperature and can
grow well in temperature ranging from 22 – 40 degrees centigrade.
 ü  Can survive longer in refrigerated foods
ü  An enterotoxin, choleragen, is elaborated by the organism as they
grow in the intestinal tract.

 Ø   Pathognomonic sign: Rice water stool

 Ø    Incubation Period:few hours – 5 days
 Ø  Pd. Of Communicability: while stool positive stage, and a few days
after recovery
Mode of Transmission
 
1. Fecal – oral route via contamination of water, milk, and other foods
2. Ingestion of food or water contaminated with stools or vomitus
3. Flies, soiled hands, and utensils also serve to transmit the infection
 
Pathogenesis And Pathology:
 
·  The fluid loss is attributed to the enterotoxin elaborated by the
organism as they are in the intestines
 
·  The toxin acts upon the intact epithelium on the vasculator of the
bowel, thus, results to outpouring of intestinal fluids.

·  Fluid loss of 5% - 10% of the body weight result in

dehydration and metabolic acidosis.

·  If treatment is delayed or inadequate, acute renal failure

and hypokalemia become secondary problem.
Clinical Manifestations: 

1. Initially, the stools are brown and contain fecal materials but
soon become pale gray, “rice-water” in appearance with an
inoffensive, slightly fishy odor.

2. Vomiting often occurs after the diarrhea has been established.

3. Dehydration and electrolyte loss.

4.. Tissue turgur is poor, eyes are sunken into the orbit.

5. The skin is cold, the fingers and toes are wrinkled, assuming
the characteristic “washer-woman’s-hand”

6. Radial pulses become imperceptible and the blood pressure

unobtainable.

7. Cyanosis is present
 
8. The voice become hoarse and then, is lost, so that the patient
speaks in whisper (aphonia)

9. Breathing is rapid and deep.

10. Patient develops oliguria and may even develops anuria

11 . Temperature could be normal at the onset of the disease but

become sub-normal in later stage especially if the patient is in
shock

12. When the patient is in deep shock, the passage of diarrhea stops
13. Death may occur as short as four (4) hours after onset, but usually
occurs on the first or the second day if not properly treated
Principal Deficits: 

1. Extracellular Volume – lost of intestinal fluid that can lead to;

 ·   Severe dehydration, restlessness and excessive thirst.
·   Circulatory collapse or shock
 
2. Metabolic Acidosis – due to loss of large volume of bicarbonate-rich
stools that results in rapid respiration with intervals of apnea
(Kussmaul respiration).
 
3. Hypokalemia – due to massive loss of potassium in stools.
Patient may manifest abdominal distention that could be attributed
to paralytic ileus.

Diagnostic Exams:

1. Rectal swab
2. Darkfield or phase microscopy
3. Stool exam
Modalities of Treatment:
 
1. Intravenous treatment – this is achieved by rapid intravenous
infusion of alkaline saline solution containing sodium, potassium,
chloride and bicarbonate ions in proportions comparable to those
in water-stools.
 
2. Oral therapy – rehydration can be completed by oral route
(ORESOL, HYDRITES) unless contraindicated or, if the patient is
not vomiting.
 
3. Antibiotics
 
a. Tetracycline 500 mg every 6 hours for adults, and 125 mg/kg
body weight for children every 6 hours for 72 hours.
 
b.   Chloramphenicol – 500 mg for adults and 18 mg/kg for
children every 6 hrs. for 72 hours.
 
c.    Co-trimoxazole – 8mg/kg for 72 hours.
 
Nursing Management:

1. Medical aseptic protective care.

2. Enteric isolation
3. Accurate recording of vital signs, I & O
4. Provide a thorough and careful personal hygiene
5. Proper disposal of excreta
6. Concurrent disinfection

Prevention:
·         Protection of food and water supply from fecal contamination.
·         Water should be boiled or chlorinated
·         Proper preparation and storage of food
·         Milk should be pasteurized
·         Sanitary disposal of human excreta
·         Environmental sanitation
 HEPATITIS A
(Infectious hepatitis; Catarrhal jaundice)

Ø An inflammation of the liver that runs an acute course,

generally starting within two to six weeks after contact with the
virus, and lasting to no longer than two months
Ø  It is known as infectious hepatitis because it spreads relatively easily
from those infected to close contact. 
Ø  The incubation period for hepatitis A ranges from 15 – 60 days,
or 3 – 5 weeks
Ø  The infected patient is capable of transmitting the organism a week
before and a week after the appearance of symptoms
Ø Transmitted by
·  Ingestion of contaminated drinking water or ice, uncooked
fruits and vegetables
·   Fecal-oral pathway
 ·   By infected food handlers
 ·   Oral-anal sexual contact
 Clinical Manifestations
·   Flu-like illness with chills and high fever
·   Diarrhea, fatigue, and abdominal pain
·   Loss of appetite
·   Nausea, diarrhea, and fever
·   Jaundice, dark-colored (tea-colored) urine, and pale stools
·   The infection in young children is often mild a asymptomatic
 
Complications
  ·   Progressive encephalopathy characterized by drowsiness,
cerebral edema
·   GIT bleeding progressing to stupur and later coma. Bleeding not
responsive to parenteral vitamin K administration
·   Clonus and hyperflexia, later replaced by loss of deep tendon
reflexes
·   Edema and ascitis
·   Aplastic anemia
·   In late course of the disease, loss of corneal and papillary
reflexes, elevated arterial blood, respiratory failure, to
cerebrovascular collapse
Diagnostic procedure:
 ·  HAV and HBV – complement fixation rate
·  Liver function test – to determine the presence and extent of liver
damage and to check the progress of the liver.
·  Bile examination in stool and urine
·  SGOT – (8 – 29 U/L) serum glutamic oxaloacetic transaminase;
·  SGPT – (4 – 24 U/L) serum glutamic pyruvic transaminase;
 

Treatment modalities
 
·   No specific treatment, although bed rest is essential
·   High carbohydrate, low fat, low protein diet
·   Vitamin supplement specially the B complex group
·   Intravenous therapy is occasionally necessary
·  Isoprinosine (methisoprenol), may enhance the cell-mediated
immunity of the T- lymphocytes
·  Administer alkalies, belladonna, and anti-emetics to control
dyspepsia and malaise
Nursing management
 
·   Isolation of the patient (enteric isolation)
·   Promote rest during acute or symptomatic phase
·   Improve nutritional status
·   Utilize appropriate measures to minimize spread of the disease
·   Check stools for presence of blood
·   Provide optimum skin and oral care
·   Increase in ability to carry out activities
·  Encourage gradual resumption of activities and mild
exercise during recovery

Prevention and Control

 
·  A thorough handwashing every after use of toilet
·  Travelers should avoid water and ice if unsure of their purity
·  Screen food handlers carefully
·  Practice safe preparation and serving of food
·  Educate the public on the mode of transmission of the disease
 
 
  
TYPHOID   FEVER
 
 
Ø  A bacterial infection of the GIT affecting the lymphoid tissues
(Peyer’s Patches) of the small intestines
Ø  Caused by an organism Salmonella typhosa/typhi, a gran negative,
non-spore forming, pathogenic to man only
Ø  Incubation Period is 5 – 40 days
Ø  Period of Communicability: Variable
 
Sources of Infection

ü Carriers – could be one who recovered from the disease or one who
have cared for a patient with Typhoid and was infected.
ü  Ingestion of shellfish (oysters) taken from waters contaminated by
sewage disposal
ü  Stool and vomitus of infected individual
 Mode of Transmission
·     Fecal-oral transmission
·     Organism can be transmitted through the five (5) F’s
·     Ingestion of contaminated food, water and milk
 Pathogenesis
I. Typhoid Ileitis

Salmonella thyphi
 
Bowel (Peyer’s patches)

Lymph nodes are swollen

 
Pus formation; necrosis

Tissue slough off leaving ulcerated surface

 
 
 Hemorrhage and perforation (melena)

Peritonitis & Toxemia

 
Heart, spleen, liver, mesynteric lymph nodes are red and swollen
 

Clinical Manifestations
 
I. Onset
·  Headache, chilly sensation, aching all over the body,
·  Nausea, vomiting and diarrhea
·  By the 4th and 5th day all symptoms are worst
·  Fever is higher in the morning than it was in the afternoon.
Temperature graph appears “ladder – like or stairway”
·  Breathing is accelerated, the tongue is furred, the skin is dry
and hot, abdomen is distended and tender
·  Rose spots appear on the abdominal wall on the 7th to the 9th day
· On the second week symptoms become more aggravated.
Temperature remains in uniform level. Rose spots become more
prominent.
II. Typhoid State
·   Intense symptoms decline in severity
·   The tongue protrudes, become dry and brown
·   Teeth and lips accumulate a dirty-brown collection of dried
mucus and bacteria known as sordes.
·   Coma vigil
·   Subsultus tendinum
·   Carphologia
·   There is constant tendency for the patient to slip down to the foot
part of the bed 
·    In severe cases rambling delirium sets in often ending in coma
& death
 
Complications
·   Bronchitis and pneumonia
·   Meteorism or excessive distention of the bow-
els (Tympanites)
·   Thrombosis and embolism
·   Early heart failure
·   “Typhoid spine” or neuritis
·   Septicemia
·   Reiter”s syndrome – joint pain, eye irritation,
painful urination that
can led to chronic arthritis
Diagnostic Procedure
·         SEIA – Salmonella Enzyme Immuno-Assay
·         Typhidot
·         ELISA
·         Widal test
·         Rectal swab
 
Modalities of Treatment
·         Chloramphenicol – drug of choice
·         Ampicillin
·         Co-trimoxazole
·         Ciprofloxacin or Ciftriaxone
 
Nursing Management
·         Maintain or restore fluid and electrolyte balance
·         Monitor patient’s vital signs
·         Prevent from further injury (fall) in patient with typhoid
psychosis
·         Maintain good personal hygiene and mouth care
·         Cooling measures during febrile state
·         Watch for signs of intestinal bleeding

Prevention and Control

·         Sanitary/proper disposal of excreta

·         Proper supervision of food handlers
·         Enteric isolation
·         Adequate protection or provision of safe drinking water
supply
·         Reporting of cases to health authorities
 SCHISTOSOMIASIS
(Bilharziasis; Snail fever)

Ø  A slowly progressive disease caused by blood flukes of class

trematoda common among farmers in some parts of the
Philippines
Ø  The cause of the disease is a parasitic worm, Schistosoma japonicum.

There are three major types of the organism:

1. Schistosoms japonica
·        Infects the intestinal tract (Katayama Disease)
·        Found to be the only type that is endemic in the Philippines
·        This is also known as “Oriental schistosomiasis”.
 
2. Schistosoma mansoni
·        Also affects the intestinal tract
·        Common in some parts of Africa
 
3. Schistosoma haematobium
·        Affects the urinary tract
·        Can be found in some parts of the Middle East, like Iraq, Iran

Ø      Incubation period : at least two months

Ø      Sources of infection: Feces of infected person, and manure of infected
dogs, pig, carabaos
 
Mode of Transmission
·  Through ingestion of contaminated water
·  Through the skin pores
·  The disease is transmitted through an intermediary host, a
tiny snail called Oncomelania Quadrasi.
 
Clinical manifestations
 
The signs and symptoms of the disease depends on the site of infection,
however, the following can be observed;

·  A pruritic rash develops at the site of penetration “swimmer’s itch”

·   Low grade fever, myalgia, and cough
·   Abdominal discomfort due to hepatomgally. spleenomegally, and
lymphadenopathy
·   Bloody-mucoid stools, “dysentery-like” that comes on and off for
weeks
·   Patient becomes icteric and jaundice
·   Later, his belly becomes big because of an inflamed liver, resulting
from eggs that accumulate in that organ.
 ·  After some years of suffering from this chronic disease, the patient
becomes weak, marked muscle wasting and pale
 ·  When the parasite reaches the brain, the victim experiences severe
headache, dizziness, and convulsion
 
Diagnostic procedures
·  Fecalysis or direct stool exam
·  Kato Katz technique
·  Liver and rectal biopsy
·  Enzyme Link Immunosorbent Assay (ELISA)
·  Cercum Ova Precipetin Test (COPT) – confirmatory diagnostic
test
 
Modalities of Treatment

·  Praziquantel tablet for 6 months; 1 tab 2X a day for 3 months, then

1 tab a day for another 3 months
 
·  Fuadin injection given either IM or IV. The patient should consume
360mg for the entire treatment
 
·  If the patient continue to live in the endemic area, he frequently
gets reinfected and has to be retreated.
 
Prevention and Control
To prevent schistosomiasis, one must have a thorough knowledge
of how the disease is spread. The basic principle of its prevention and
control is to interrupt the life cycle of the worm and protect people from
infection. This can be achieved through the following measures;
ERUPTIVE FEVER DIS-
EASES
 MEASLES
(Rubeola; Morbilli)

 
Ø  An acute, contagious exanthematous disease usually affect children
which are referable to Upper Respiratory Tract Infection (URTI)
Ø  Caused by a filtrable virus that belongs to genus Morbilivirus of the
family paramyxoviridae.
Ø   Incubation period: 10 – 12 days; single attack conveys lifetime immunity

Ø  Period of communicability
  ·        Measles usually lasts about 9 – 10 days, measured from the
beginning of the prodromal symptoms to the fading of the rash.
 ·       The disease is communicable 4 days before and 5 days after the
appearance of rashes 
·        The disease is most communicable during the height of rash 
Ø  Sources of infection: Patient’s blood, nasopharyngeal secretions and secre
tions from the eyes
Transmitted
·  Direct contact by droplets spread through coughing or sneezing
·  Indirectly, through articles or fomites freshly contaminated with
respiratory secretions of infected patients 

Pathognomonic sign: Koplik spot

Clinical manifestations come in three stages:

I. Pre-eruptive stage
·   Fever
·   Catarrhal symptoms (Rhinitis, coryza, conjunctivitis, photophobia)
·   Respiratory symptoms – starts from common colds to persistent
coughing (metallic/brassy cough)
·   Enanthem sign (Koplik spot, Stimson’s line)
II. Eruptive stage
·        The rash is usually seen late in the 4th day
·        Maculo-papular rash
·        High grade fever that comes on and off
·        Abdominal tympanism, pruritus, lethargy
·        The throat is red and often extremely sore.
·        As fever subsides, coughing may diminish, but more often it
hangs on for a week or two, become looser and less metallic.

III. Stage of convalescence

·      Rashes fades away the manner as they erupt
·      Fever subsides as eruption disappears
·      When the rash fades, desquamation begins.
Diagnostic procedures

·        Nose and throat swab

·        Urinalysis
·        Blood exams (CBC, leukopenia, leukocytosis)
·        Complement fixation or hemogglutinin test

Modalities of treatment

·        Anti-viral drugs (Isoprenosine)

·        Antibiotics if with complication
·        Supportive therapy (oxygen inhalation, IV fluids)

Complications

·        Bronchopneumonia
·        Otitis media
·        Pneumonia/Bronchitis
·        Encephalitis; encephalo-myelitis
·        Blindness (seldom)
Unfavorable Signals
·    Violent onset with high grade fever
·     Fading eruption with rising fever
·     Hemorrhagic or black measles
·     Persistence of fever 10 days or more
·     Slight eruptions accompanied by severe symptoms, especially
those of encephalitis
 
Nursing Management
·     Isolation (quiet, well ventilated, subdued light in patient’ room)
·     Control high temperature with warm or tepid sponges
·     Skin care.
·     Oral and nasal hygiene
·     Care of the eyes.
·     Care of the ears.
·     Daily elimination is important.
·     During the febrile stage, limit the diet to fruit juices, milk, and
water..
·     Patient’s position should be changed every 3 to 4 hours
Preventive measures

Immunization with:

·  Anti-measles at the age of 9 months, as single dose

 
·   Mumps, measles, rubella (MMR) to be give at age 15 months old, and
the 2nd dose at 11 to 12 years
 
·   Measles vaccine should not be given to pregnant women, or to
persons with active tuberculosis, leukemia, lyphoma, or depressed
immune system
 GERMAN MEASLES
(Rubella; 3-day Measles)

Ø   A mild viral illness caused by rubella virus. associated with a rash,
and aches in joints, that usually has a teratogenic effect on the fetus.

Ø    Infectious agent: Rubella virus

 
Incubation period: 14 – 21 days
 
Period of communicability: Approximately one week before and four
Days after the onset of rashes,
 
Mode of Transmission:
·  Direct contact with nasopharyngeal secretions
·  Doplets
·  Transplacental in congenital rubella
·  Infants with congenital rubella shed large quantities of virus in their
pharyngeal secretions and urine which serve as source of infection
to other contacts.
Clinical Manifestations:
 
I. Prodromal period
·  Low grade fever, headache, malaise
·  Mild coryza and conjunctivitis
· Post-auricular, sub-occipital, and posterior cervical lympha-
denopathy which occur on the 3rd to the 5th day after onset
 
II. Eruptive period
· A pinkish rash on the soft palate (Forchheimer’s spot),
an exanthematous rash that appear first on the face, spreading to
the neck, the arms, trunk and legs.
·  Eruption appears after the onset of adenopathy
·  Children usually present less or no constitutional symptoms.
·  The rash may last for 1 – 5 days and leaves no pigmentation
no desquamation
·  Testicular pain in young adults.
·  Transient polyarthralgia and polyarthritis may occur in adults
and occasionally in children.
Modalities of Treatment:
 ·  Essentially symptomatic
 
Complications:
·   Encephalitis
·   Neuritis
·   Arthritis
·   Arthralgias
·   Rubella syndrome, manifested by;
= microcephally = mental retardation
= cataract = deaf-mutism
= heart disease
 
Risk of congenital malformation;
 · 100% - when maternal infection occurs on the first trimester of
pregnancy or first month of gestation
 ·  4% - in the second and third trimester
·  90% - of congenital rubella cases will excrete the virus at birth and
are therefore infectious.
 ·  10% remain contagious until one year of age.
Clinical Manifestations (Congenital Rubella)
 
I. Classic congenital rubella syndrome
·        intrauterine growth retardation; infant has low birth weight
·        all manifestations of congenital rubella syndrome
·        thrombocytopenic purpura known as “blueberry muffin” skin
·        lethargy and hypothermia
 
II. Intrauterine infection 
·        may result spontaneous abortion
·        birth of a live child who may have one or multiple birth anomalies
such as;
a.      Cleft palate, hare lip, talipes, and eruption of teeth
b.      Cardiac defects (patent ductus arteriosus, atrial septal defect)
c.      Eye defects (glaucaoma, retinopathy, micropthalmia, unequal
eyeballs)
d.      Ear defects (deafness usually bilateral, abnormally shaped ears)
e.      Neurologic ( microcephally, mental retardation, psychomotor
retardation, behavioral disturbances, vasomotor instability)
Nursing Management:
·    Isolation
·    Bedrest until fever subsides
·    Darken room to avoid photophobia
·    Mild liquid diet but nourishing
·    Irrigate eyes with warm normal saline to relieve irritation
·    Good ventilation
·    Prevent spread of infection
·    Prevent occurrence of complications

Prevention
·    Administration of live attenuated vaccine (MMR)
·    Pregnant women should avoid exposure to patients infected with
Rubella
·   Administration of Immune Serum Globulin one week after
exposure to Rubella.
 EXANTHEM SUBITUM
 
(Roseola infantum; Rose Rash of Infants)

Ø A benign disease that occur almost exclusively in infants and young
adults

Ø Etiologic agent is unknown, though believed to be a virus

Ø Incubation period is 8 – 10 days

Ø Course of the disease:

ü  Child suddenly develops high grade fever, sometimes associated
with convulsions
ü  After 2 – 5 days, fever suddenly drops to normal and child
appears well
ü  Morbilliform eruption spread all over the body that usually start
on the trunk
 ü  Rashes may disappear after a few hrs to 2
days without any mark left
ü  Regions above the nose and cheeks are free
of rash
ü  Pharynx slightly inflamed, tonsils are red-
dened or covered with follicular exudates 

Treatment:

ü      Symptomatic
ü      No isolation needed
 CHICKENPOX
(Varicella)

Chickenpox – An acute, highly contagious disease of viral etiology that

is characterized by vesicular eruptions on the skin and mucous
membrane with mild constitutional symptoms.

HERPES ZOSTER
(shingles)

Herpes zoster, commonly known as shingles, is caused by the same

virus responsible for chickenpox.  After the initial exposure, herpes
zoster virus lies dormant in certain nerve fibers.   It may become active
as a result of many factors such as:  aging, stress, suppression of the im-
mune system, and certain medications.
Clinical Feature Chickenpox Herpes Zoster

Synonym Varicella Shingles

Causative Agent Varicella virus VZ virus

Pd. Of Commu- A day before the erup- Same as chickenpox

nicability tion of the 1st rash up to
5 days after the last crop

Evolution of Macule  
rashes Papule Same
Vesicle
Pustule

Distribution of - Appear first on the - Clustered

rashes unexposed - Unilateral
part of the body - Does not cross the
-    Generalized sagital portion of the
body
Manifestation Itchy - Deep seated burning
pain that is usually worst
at night
- Lymphadenopathy
- Corneal anesthesia
(Gasserian genglionitis)
- Paralysis of the fa-
cial nerve and the exter-
nal auditory canal (Ram-
say Hunt Syndrome)

Drug/s of Acyclover (Zoverax) Acyclover

choice Antipyretic for fever Analgesics to control pain
Calamine lotion Anti-inflammatory

Nursing Man- - Management is - Management is geared

agement geared toward the re- toward the relief of pain
lief of itchiness - Prevent secondary infec-
- Prevent secondary tion
infection
VECTOR – BORNE DIS-
EASES
 DENGUE FEVER
(Breakbone Fever)
 
Ø   An acute febrile disease caused by Dengue virus which are
transmitted by a mosquito Aedes egypti with the following
characteristics:
ü     Day-biting (2 hours after sunrise and 2 hrs before sunset)
ü     Breeds on stagnant water
ü     Limited movement and usually low-flying
ü     Fine dots at the base of the wings with white bands

Ø   Incubation period: 3 – 14 days

Ø   Patient is infective to mosquito from a day before the febrile period to
the end
Ø   Mosquito become infective from day 8 – 12 after blood meal and
remains infective through out life

Ø   Pathognomonic sign: Herman’s sign (Extravasation of blood in petechia

Clinical Manifestations:

I. Dengue fever
·  Fever and chills associated by severe frontal headache, ocular pain,
myalgia with severe backache, and arthralgia
·  Nausea and vomiting
·  Fever is non-remitting and persist for 3 – 7 days
·  Rash is more prominent on the extremities and the trunk. It may
involve the face in some isolated case
·  Petechiae usually appear near the end of the febrile period and
most common on the lower extremities.
 
II. Dengue Hemorrhagic Fever (DHF)

This severe form of dengue virus infection is manifested by fever,

hemorrhagic diathesis, hepatomegally and hypovolemic shock.
Phases of the Illness:

1. Initial febrile phase lasting from 2 – 3 days

·  fever (39 –40 ºC) accompanied by headache
·  palms and sole are usually flushed
·  positive tourniquet test
·  anorexia, vomiting, myalgias
· Appearance of Herman’s sign known as pathognomonic to the
disease.that usually start from the distalportion of the body
·  Generalized or abdominal pain
·  Hemorrhagic manifestations, like positive tourniquet test,
purpura, epistaxis and gum bleeding maybe present
2. Circulatory phase
•Fall of temperature accompanied by profound circulatory changes
usually on the 3rd – 5th day 
•Patient become restless, with cool clammy skin 
•Profound thrombocytopenia accompanies the onset of shock 
•Bleeding diathesis may become more severe with GIT hemorrhage 
•Shock may occur due to loss of plasma from the intravascular spa-
ces and hemoconcentration with markedly elevated hematocrit is
present 
•Pulse is rapid and weak; pulse pressure become narrow and blood
pressure may drop to an unobtainable level 
•Untreated shock may result to comma, metabolic acidosis and death
may occur within 2 – days. 
• With effective therapy, recovery may follow in 2 – 3 days.
Classification According to Severity (Halstead & Nimmanitya)

Grade I
Fever accompanied by non-specific constitutional symptoms and the
Only hemorrhagic manifestation is positive (+) tourniquet test.

Grade II
All signs of grade I plus spontaneous bleeding from the nose, gums,
GIT

Grade III
Presence of circulatory failure as manifested by weak pulse, narrow
pulse pressure, hypotension, cold clammy skin and restlessness

Grade IV
Profound shock, undetectable blood pressure and pulse
  
Complications:
  
1. Dengue Fever
1. Epistaxis; menorrhagia
2. Gastrointestinal bleeding
3. Concomitant gastrointestinal disorder (peptic ulcer)

2. D H F
1. Metabolic acidosis
2. Hyperkalemia
3. Tissue anoxia
4. Hemorrhage into the CNS or adrenal glands
5. Uterine bleeding may occur
6. Myocarditis
3. Severe manifestations
1. Dengue encephalopathy – manifested by increasing restlessness,
apprehension or anxiety, disturbed
sensorium, convulsions, spacity,
and hyporeflexia

Diagnostic Tests:
2. Tourniquet test – screening test, done by occluding the arm veins
for about 5 minutes to detect capillary fragility
2. Platelet count (decreased) – confirmatory test
3. Hemoconcentration – an increase in at least 20% in hematocrit or
steady rise in hemartocrit
4. Occult blood
5. Hemoglobin determination
Treatment Modalities:

There is no effective anti-viral therapy for dengue fever. Treatment is

entirely symptomatic;
1. Analgesic drugs other than aspirin maybe required for relief of
headache, ocular pain, and myalgia.

2. Initial phase may require intravenous infusion to prevent from

dehydration and replacement of plasma.

3. Blood transfusion is indicated in patient with severe bleeding

4. Oxygen therapy is indicated to all patients in shock

5. Sedatives maybe needed to allay anxiety and apprehension

Nursing Management:
1. Patient should be kept in mosquito-free environment to
avoid further transmission of infection

2. Keep patient at rest during bleeding episodes

3. Prompt monitoring of vital signs

4. For nose bleeding, maintain patient’s position in elevated

trunk, apply ice bag to bridge of nose and to the fore-
head.

5. Observe signs of shock, such as slow pulse, cold clammy

skin, and fall of BP

6. Restore blood volume, put patient in Trendelenberg position

to provide greater blood volume to the head part
Prevention and Control:
 
1. Early detection and treatment of cases
2. Insecticide treatment of mosquito nets
3. House spraying
4. Implementation of 4 o’clock habit
5. Avoid too many hanging clothes inside the house

Four “S” in Dengue (Adopted From DOH)

1. Search and destroy

2. Self protection measures
3. Seek early consultation
4. Say NO to indiscriminate fogging
 MALARIA
(Ague)
Ø      An acute and chronic parasitic disease transmitted by the bite of
infected female Anopheles mosquitoes .
Ø      Etiologic agent is a protozoa of genus plasmodia
 
1.Plasmodium falciparum (malignant tertian)
·  considered as the most serious malarial infection
 
2.Plasmodium vivax (Benign tertian)

·  manifested by chills every 48 hours on the 3rd day onward

especially if untreated

3.Plasmodium malariae (Quartan)

·  fever and chills usually occur on the 4th day after onset
·  non-life threatening

4.Plasmodium ovale – the rare type

Anopheles mosquito has the following characteristics
·  breeds in clear, flowing, and shaded streams usually in the mountains
·  they are brownish in color and bigger in size than the ordinary
mosquitoes
·  they are the night-biting mosquitoes
·  usually don’t bite a person in motion
·  assumes a 36º position when they alight on walls, trees, curtains, etc.
 
Incubation period
·  12 days for P. Falciparum
·  14 days for P. vivax and ovale
·   30 days for malariae

Period of Communicability
·   Untreated or insufficiently treated patient may be source of mosquito
nfection for more than 3 years in P. malariae; 1 – 2 years in P. vivax,
and not more than one year on P. falciparum.
Mode of Transmission

·  Mechanical, through bite of an infected female anopheles mosquito

·  Parenteral, through blood transfusion
·  In rare occasion, from shared contaminated needles
·  Transplacental, congenital malaria; a rare case
 
Clinical Manifestations

·  Paroxysms of shaking chills

·  Rapidly rising fever with severe headache
·  Profuse sweating
·  Myalgia, with feeling of well-being in between
·  Splenomegally, hepatomegally
·  Orthostatic hypotension
·  Paroxysms may last for 12 hours, then, maybe repeated daily or after
a day or two
·  In children;
= fever maybe continuous
= convulsions and gastrointestinal symptoms are prominent
= splenomegally

·  In cerebral malaria

= changes in sersorium, severe headache, and vomiting
=Jacksonian or grand mal seizure may occur
 
Diagnostic Procedure

 · Malarial smear – a film of blood is placed on a slide, stained and

examined microscopically

·  Rapid diagnostic test (RDT) – are blood tests for malaria that can
be conducted outside the laboratory and in the field, giving a
result within 10 – 15 minutes. This is done to detect malarial
parasite antigen in the blood.
 
Means of propagation:
1. Sexual – takes place in the stomach of mosquito
2. Asexual – takes place in the RBC of man
 
Management
 
1. Medical
·  Anti-malarial drugs
= Chloroquine (all species except for P. malariae)
= Quinine/Quinidine
= Sulfadoxine for resistant P. falciparum
= Primaquine – for relapse of P. vivax and ovale

Antimalarial drugs currently used for treatment

P. Falciparum Regimen
D1 _ Chloroquin 4 tabs
Sulfadoxin 3 tabs
D2 – Chloroquin 4 tabs
D3 - Chloroquin 2 tabs
D4 – Primaquin 3 tabs
P. Vivax Regimen
D1 – Chloroquin 4 tabs
D2 – Chloroquin 4 tabs
D3 – Chloroquin 2 tabs

D4 – Primaquin 1 tab OD x 2 days

Relapsing
D1 – Coartem 20/120 (Artemether Lumefantrine)
– 4 tabs

D2 – Coartem 4 tabs after 8 hours

D3 – Coartem 4 tabs BID

 2. Nursing Management

· Close monitoring of patient

· Strict monitoring of intake and output to prevent pulmonary edema
ü daily monitoring of patient’s serum bilirubin, BUN creatinine,
and parasitic count
ü   if with respiratory and renal symptoms, determine arterial
blood gas and plasma electrolyte
· When the patient is chilling, keep him warm
· During the febrile stage, tepid sponges, alcohol rubs, ice cap on the
head will help bring down the temperature
· Encourage patient to take plenty of fluids
· Bed and clothing should be kept dry
· Provide psychological and spiritual support
 
Prevention
1. Reporting of malaria cases
2. Destruction of breeding places
3. Spraying homes with effective insecticides with residual
actions on the wall
4. Use of mosquito nets
5. Proper screening of blood donors
6. People living in malaria-infected areas should not donate
blood for at least 3 years
 FILARIASIS
(Elephantiasis)
 Ø  An extremely debilitating and stigmatizing disease caused by parasitic
 worms, Wuchereria bancrofti, a 4-5 cm long thread-like worms that
 affect the body’s lymph nodes and lymph vessels 
Ø The disease is transferred from person to person by mosquito bites,
Culex tarsalis which is active during the night time to dawn

 The microscopic worms pass from the mosquito through the skin and travel
to the lymph vessels where they grow into adults, and live in 7 years in the
lymph vessels 
· The disease damage the kidneys and the lymph system; fluid collects
and causes swelling in the arms, breasts, legs, and for men, the genital area.
· A person with this disease tend to have more bacterial infections in the
skin, thus, causes hardening and thickening of the skin, which
is called elephantiasis. 
·  In conjunctival filariasis, the worms’ larvae migrate to the eye and
sometimes can be seen beneath the conjunctivae, that can lead to
blindness known as onchoceriasis
Symptoms: 
· Infections usually begin with chills, headache, and fever between
three months and one year after the insect bite. 
· There may also be swelling, redness, and pain in the arms, legs, or
scrotum.  
· Areas of abscesses may appear as a result of dying worms or a
secondary bacterial infection.
 
Complications
1. Recurring infections, fevers, severe inflammation of the lymph system
2. Lung condition called Tropical Pulmonary Eosinophilia (TPE).
3. The legs become grossly swollen .that can lead to severe disfigurement,
decreased mobility, and long-term disability.
4.Testicular hydrocele is a disfiguring enlargement of the scrotum.
Diagnostic Procedures:
· Circulating Filarial Antigen (CFA) test – performed on a finger-prick
blood droplet taken any time of the day and gives result in a few minutes
 
 
 
Modalities of Treatment.
 
1. Ivermectin,
2. Albendazole, or
3..Diethylcarbamazine (DEC) – used to treat by;
·   Eliminating the larvae
·   Impairing the adult worms ability to reproduce
·   By actually killing the adult worms
LEPTOSPIROSIS
 Mode of Transmission
 
·  Ingestion or contact with the skin and mucous membrane with the infected
urine or carcasses of wild and domestic animals 
· Through the mucous membrane of the eyes, nose, and mouth, and
through a break on the skin 
· Leptospira enters the blood stream to cause damage on the kidneys,
the liver, meninges and conjunctivae.
 
 
Clinical Manifestations
 
1. The symptoms range from severe to asymptomatic fatal outcome
2. Clinical course is generally biphasic and the majority of the cases are
unicteric. In icteric cases, typical color of the eyes is- orange
3 Three stages can be recognized:

·  Septic stage –. There is an abrupt onset of remittent fever, chills,

headache, anorexia, abdominal pain, and severe prostration and
respiratory distress.

·   Immune or toxic stage –

ü Iritis, headache, meningeal manifestations like disorientation,
convulsions wit CSF findings of aseptic meningitis
ü Oliguria and anuria with progressive renal failure 
ü Shock, coma, and congestive heart failure. Death may occur between
the 9th to the 16th day
 
·        Convalescence - relapse may occur during he 4th to 5th week
Management
 
1. Medical
a. Penicillin G Na
b Tetracycline
a. Peritoneal dialysis
b. Administration of fluid and electrolyte and blood as indicated

2. Nursing
a. Isolate the patient, urine must be properly disposed
b. For home care, cleaning near dirty places, pools, and stagnant water
c. Eradicate rats and rodents

Prevention and control

 
a. Sanitation in homes, workplaces, and farms
b. Proper drainage system and control of rodents (40 – 60% infected)
c. Vaccination of animals (cattle, dog, cats and pigs)
d. Treatment of infected human and pets
e. Effective information- dissemination campaign
HELMINTHS
 ASCARIASIS
(Roundworm Infection)

Ø      An infection caused by a parasitic roundworm, Ascaris lumbricoides

 
Ø      Causative agent: Ascaris lumbricoides
 
Ø      Mode Of Transmission:
 
 ü     Ingestion of food and drinks contaminated with embryonated
 eggs
 1. Adult worms  live in the lumen of the small intestine. A female may
produce up to 240,000 eggs per day, which are passed with the feces 
2. Fertile eggs become infective after 18 days to several weeks 
  3. After infective eggs are swallowed the larvae hatch , invade the
intestinal mucosa, and are carried via the portal, then systemic
circulation to the lungs
4. The larvae mature further in the lungs (10-14 days), penetrate the
alveolar walls, ascend the bronchial tree to the throat, and are swallowed
5. Upon reaching the small intestine, they develop into adult worms 
6. Between 2 and 3 months are required from ingestion of the
infective eggs to oviposition by the adult female. Adult worms can live
‘ 1 to 2 years

Complications:
 
1. Biliary tract obstruction, patient develops cholestatic jaundice
2. Hepatic abscess and cholangitis
3 Intestinal obstruction, perforation, peritonitis
4. Malnutrition – due to damage to the intestinal mucosa impairing the
absorption of nutrients
Diagnostic tests:

1. Stool for ova – demonstration of a fertilized or unfertilized eggs in the

stool “Kato Technics”

2. Abdominal X-ray – dense shadow of adult ascaris which looks like

strands of spaghetti, “dot” sign

3. Routine blood counts - significant eosinophelia

 
Treatment:

1. Albendazole or mebendazole 15 cc as single dose

2. Piperazine Citrate – 75 mg/kg, daily x 2 doses orally

3. Pyrantel Pamoate – 1 mg/kg as a single dose, orally

Nursing Interventions
 
1. No isolation needed
 
2. Health teachings to all members of the family,

3. Inspection for the availability of toilet facilities

4. Importance of personal hygiene should be explained

 
Prevention:

1. Improved sanitation and hygienic practices

2. Improved nutrition
3. Deworming may be advised
 HOOKWORM
(Ancylostomiasis, Miner’s Disease, Egyptian chlorosis)
Definition: An intestinal parasite of humans that usually causes diarrhea or cramps
Hookworm infection occur mostly in tropical and sub-tropical countries
 
Etiologic agent;
 
1. Ancylostom duodenale – most prevalent in Europe and Asia..
2. Necatar americanus - distributed in Central and South America, and
West Africa.
·   Both species are pathogenic to man and have similar life cycle.
·   The source of infection is the soil contaminated with feces that contain
hookworm ova.
·   The female hookworm may produce as many as 10,000 to 20,000 eggs
per day.
·   Eggs deposited in moist soil, rich in oxygen, will develop into embryos
within 24 to 72 hour
·   The larvae takes about 6 weeks to develop into a mature larvae that can
cause human infection.
·   The larvae remain alive in the soil for several weeks under favorable
condition.
Incubation period 
·   Hookworm ova appear in the stools about 4 – 6 weeks after the larvae
penetrate the skin 
·   Incubation period is 40 – 100 days or 2 – 8 weeks
 
Period of Communicability 
·    Persons remain spreaders of infection as long as they remain infected
 
Mode of Transmission 
·    This is usually accomplished directly through the skin of the foot
(ground itch) 
·    Ingestion of contaminated drinking water or food

Pathology
 
·   The larvae penetrate the blood and lymph vessels, damaging them in the process
after which they enter the inferior vena cava to the right atrium, to the lungs where
they pierce the capillary walls and pass into the alveoli.
 
·   Some maybe coughed out and expectorated, while some are swallowed
and reach the small intestine where maturation occurs and egg production
takes place.
Symptoms
·   They feed on the host’s blood and may consume 50 ml of blood daily.
The gradual loss of blood results in iron deficiency anemia
·   Other symptoms include abdominal pain, diarrhea, and allergic reactions
like urticaria
·   Children infected with worms are often underdeveloped mentally and
physically, have protruding abdomen, and are lethargic
·   They tend to be malnourished and undersized
·   They are lazy, have no energy, and lack ambition
·   Many of them have perverted appetite
·   Pedal edema and other portion of the body maybe present
 
Diagnosis
 
·   Microscopic examination of feces for the eggs
·   Blood exam reveals eosinophilia

Modalities of Treatment
·   Pyrantel embonate (Quantrel)
·   Tetrachloroethylene
·   Carbon tetrachloride
Nursing Management
·   Isolation is not necessary
·   Diet – should be high in calories, vitamins and minerals.
·   Personal hygiene should be maintained
 
Prevention
·   Health education on the proper disposal of excreta
·   Regulations to prevent the pollution of streams and lakes with human excreta
should be adopted
·   All persons in areas where hookworm is endemic should avoid going barefoo
·   Good hygiene is extremely important
·   Animals should not be allowed to defecate on the streets or places
where people most likely linger
LIFE CYCLE OF HOOKWORM
 LEPROSY
(Hansen’s Disease; Hansenosis)

Definition - a chronic systemic infection characterized by progressive

cutaneous lesions
 
Etiologic agent
 
Mycobacterium leprae – an acid-fast bacilli that attack cutaneous tissues
and peripheral nerves, producing skin lesions, anesthesia, infection, and deformitie

ü   Contrary to popular belief, leprosy is not highly contagious but actually

has low infectivity.
 
Incubation period : ranges from five and a half months to eight years
 
Mode of Transmission 
·  Through respiratory droplet
·  Inoculation through the skin break and mucous membrane
 
Leprosy occur in Three Distinct Forms:

1. Lepromatous leprosy  
·   The most serious type and considered to be the most infectious 
·   Causes damage to the respiratory tract, eyes, and testes as well as the
nerves and the skin 
·   Lepromin test is negative but the skin lesion contain large amount of
Hansen’s bacillus 
·   There is a gradual thickening of the skin with the development of
granulomatous condition. 
·  The lesions frequently appear as macules, becoming nodular in
character (leproma). 
·  There is slow involvement of the peripheral nerves, with some degree
of anesthesia and loss of sensation and gradual destruction of the nerves. 
·  There is atrophy of the skin and muscles and eventual absorption of small
bones, primarily the bones of the hands and feet. 
·  There is ulceration of the mucous membrane of the nose
· Because of absorption of small bones and ulcerations, natural amputation
may occur.
2. Tuberculoid leprosy 
·  Affects peripheral nerves and sometimes the surrounding skin, specially on
the face, eyes, and testes as well as the nerves and the skin. 
·   Lepromin test is positive, but the organism is rarely isolated from the lesions. 
·  Macules are elevated with clearing at the center and are more clearly defined
than in the lepromatous form 
·  Anesthesia is present, and involvement of the peripheral nerves occur more
rapidly than in the lepromatous form 
3. Borderline (dimorphous) leprosy – has characteristics of both lepromatous
and tuberculoid. Skin lesions in this type are diffused and poorly defined
 
Clinical Manifestations: 
1. Clawhand, footdrop, and ocular manifestations, such as corneal
insensitivity and ulceration, conjunctivitis, photophobia and blindness 
2. Lepromatous leprosy can invade tissues in every organ of the body
3. In lepromatous disease, early lesions are multiple, symmetrical and
erythematous, sometimes appearing as macules or papules with smooth
surfaces. 
4. Later, these lesions enlarged and form plagues on nodules on the earlobes,
nose, eyebrows, and forehead, giving the patient a leonine appearance. 
5. Loss of eyebrows and eyelashes 
6. Loss of function of sweat and sebaceous glands
7. Epistaxis, ulceration of the uvula and tonsils, septal perforation and nasal
collapse
SEXUALLY TRANSMIT-
TED DISEASES
Definition :

Infections that are transmitted

from one person to another
through sexual contact.
 COMMON SEXUALLY
TRANSMITTED DISEASES
  
HIV/AIDS
* Caused by a retrovirus, Immunodefficiency virus
that posses an enzyme “reverse transcriptease”
that tend to “mimic” the entire characteristics of
the human cell.
    
* Most people acquire HIV by;
a) Having sex with an infected person
b) Sharing of needles, or needle pricks from
needles used byan infected person
c) Baby born to infected mother, or sucking milk
from infected woman
d) Blood transfusion
e) Oral sex, deep kissing especially if the person
has mouth sores or gum bleeding
 * Confirmatory diagnostic exam is Western Blot
* HIV (+) person may remain asymptomatic for
years but the virus continue to multiply and damage
our immune system
* If the CD4 (Helper T-cells) count is less than 200,
the client is categorized as AIDS
* Opportunistic diseases like;
a) Pneumocystis Carinii Pneumonia (PCP)
b) Kaposi’s sarcoma (KS) – a skin cancer
c)  Cytomegalovirus (CVM) – infection of the eyes
d) Candidiasis – a fungal infection affecting the
mouth, the throat, and the vagina
* Aids-related diseases such as; weight loss, due to
severe diarrhea that leads to “slim” disease
 Treatment Modalities:
·       “AIDS Drugs” are medicines that are used to
treat but not to cure HIV infection
·       These drugs work by inhibiting the reproduction
of the virus
1. Reverse transcriptase inhibitor – inhibit enzyme
Reverse Transcriptase which is needed to
“copy” information for the virus to replicate.

a) Zedovudine (ZDV) Retivir

b) Zalcitabine Havid
c) Stavudine Zerit
d) Lamivudine Epivir
2. Protease inhibitors - inhibit the production of enzyme
protease which are needed for
the assembly of viral particles
 
a) Saquinqvir 600 mg q8h
b) Ritonavir 300 mg BID
c)  Indinavir 800 mg q8h
d) Nelfinavir 750 mg TID

 Signs/Symptoms
1.        Persistent cough for one month
2.        Generalized pruritic dermatitis
3.        Recurrent herpes zoster
4.        Generalized lymphadenopathy
5.        Prolong fever
6.        Loss of weight
Four “C’s” in the management of HIV/AIDS
 
1.        Compliance
2.        Counseling
3.        Contact tracing
4.        Condom
  SYPHILIS
* A sexually transmitted disease caused by a bacterium
Treponema pallidum, the great imitator

* Transmitted through vaginal, anal, and oral sex.

Direct contact with syphilis sores also serve as the
mode of transmission
* These sores occur mainly on the external genitals,
vagina, and anus, on the lips and mouth

* The organism can pass through the placenta to infect

the fetus during the 2nd and 3rd trimester.
 Signs & Symptoms:
A) Primary stage
 ·  Usually marked by the appearance of sore/s called
“chancre” that usually start at the point where
syphilis entered the body.
·  Incubation period is 10 – 90 days
·  The chancre is usually firm, round, small, and painless
·  This chancre lasts for 3 – 6 weeks and it heals without
treatment
·  In women, these chancres are often overlooked
because they appear on the internal surfaces, the
cervix, the vaginal wall
B) Secondary syphilis
· Generalized lymphadenopathy signifies the onset of
secondary phase, characterized by:
 ·         
Ø    Macular, popular, pustular, or nodular
Ø    Macules appear in between fatty folds, arms, palm,
sole, face and acalp
Ø    Moist areas of the body like, perineum, vulva, rolls
of fat on scrotum, the lesions enlarge and erode.
Producing highly contaminated pink or grayish-white
lesion (Condylomata lata)
Ø    Alopecia may occur
Ø    Nails become brittle and pitted

C. Latent
Ø   No clinical symptoms occur but serologic test
proved reactive
 D. Congenital syphilis
 
Ø     Fetus become infected and is expelled from the
uterus either as miscarriage, or stillbirth
Ø     Stillborn may have macerated appearance with
collapse of the skull and protuberant abdomen
Ø     The skin is red, with a number of bullae filled with
hemorrhagic fluid

  Diagnostic Tests:
a)    Dark field illumination test – most effective if moist
lesions are present
b)    Fluorescent treponemal antibody absorption test-
exudates from lesions
c)    VDRL – slide and rapid plasma test
d)    CSF analysis
Drug of Choice:
a) Pen G Benzathine 2.4 million units/week x 3 weeks
b) Tetracycline or Dopxycycline (contraindicated for
pregnant women)
Nursing Management:
a)    Instruct patient to abstain from sexual contact
while on treatment
b)    Stress the importance of completing the treatment
c)    Practice Universal/Standard precaution
d) Report all cases to health
Prevention:
a)    Control of prostitution
b)    Requiring health workers for regular check up
c)    Proper sex education
d) Case finding
Congenital Syphilis
Adult Syphilis
 GONORRHEA
(Clap. Gleet, Flores blancas)

*  A sexually transmitted disease involving the mucosa

lining of the genit-urnary tract, the rectum and the
pharynx
* Caused by Neisseria gonorrheae or gonococcus
* Incubation period: 3 – 21 days
* Pd. Of communicability : Variable

Mode of Transmission:
1.  Contact with exudates of infected persons
2.  Direct contact with vaginal secretions during delivery
3.  Sexual contact
4.  Through fomites
 Signs/Symptoms:
A) Female:
1.    Burning and frequent urination
2.    Yellowish purulent vaginal discharge
3.    Burning and itching of the vaginal area
4.    Urethritis andcervicitis, endometriutitis, salphingitis
5.    Pregnant women may infect the eye of her baby
during delivery
B) Males
1.    Dysuria with purulent discharge (gleet) From
urethra 2 – 7 days after exposure
2.    Rectal infection
3.    Prostatitis
4.    Pelvic pain and fever
 Complications:
1.    Sterility
2.    Arthritis
3.    Endocarditis
4.    Conjunctivitis
5.    Meningitis
Treatment:
1. For uncomplicated gonorrhea – Ceftriaxone 125-250
mg IM single dose; Doxycycline 100mg BID x 7 days
2. Pregnant women – Ceftriaxone 125-250 mg IM as
single dose plus erythromycin 500mg orally x 7 days
3. Acqueous procaine penicillin 4 million units IM ANST
GENITAL HERPES
CANDIDIASIS
THE END