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Autoimmunity (lymphoid interstitial pneumonitis, arthritis, hypergammaglobulinemia and production of autoimmune antibodies.) Neurologic dysfunction (AIDS dementia complex,HIV encepalopathy and peripheral neuropathies) Signs and symptoms: Mononucleosis-like syndrome. (flu like symptoms which may remain asymptomatic for years.) Persistent adenopathy Non specific symptoms: weight loss, fatigue, weakness, pallor, anorexia, diarrhea, night sweats, fever, enlarged lymph gland.) Respiratory symptoms: dyspnea, cyanosis, pain in respiration, persistent unexplained cough and colds
Fundamentals of Nursing
Adults: years, about 5 yrs before the first identifiable symptom occurs.) Children: shorter time of appearance of synptoms; like-bacterial infections- otitis media, sepsis, mycobacterium avium complex, chronic salivary gland enlargement, pneumocystis carinii.
Fundamentals of Nursing
One or more indicators coexisting with laboratory evidences: HIV infected people with CD4+ T-cell count of 200/L and associated with prolonged illness without ready explanation. Antibody test – indicates HIV infection by revealing HIV antibodies. Screening of blood products with enzyme-linked immunosorbent assay (ELISA). Test should be repeated, if positive; should be confirmed with an alternate method such as; Western blot immunoflourescent assay.
Fundamentals of Nursing
No cure has been found or developed, however, primary therapy for HIV infections include (HAART) - Highly Active Antiretroviral Therapy: 3 different types of Antiretroviral agents: 1. Protease inhibitor (PIs) i.e. amprenavir, ritonavir, indinavir and saquinavir. Nucleoside reverse transcriptase inhibitors (NRTI) i.e. zidovudine(AZT), didanosine, zalcitabine, lamivudine, abacavir/ stavudine. Non-nucleoside reverse transcriptase (NNRTI). i.e. efavirenze, nevirapine, delavirdine.
These agents are designed to inhibit HIV replication.
Fundamentals of Nursing
(Some are used prophylactically to help patients resist opportunistic infections) **Under investigation and testing= are vaccines for HIV. Anti infective and anti neoplastic agents – to combat opportunistic infection and associated cancers. Treatment protocols: combination of 2 or more medication agents & treatment in an effort to gain maximum benefits with fewest adverse reaction. Fundamentals of Nursing .Other potential therapies: Immunomodulary agents – designed to boost the weakened immune system.
body fluids and secretions. and discouraging prognosis.Special Considerations: Be sure to use precaution in all situations that risk exposure to blood. Coping with altered body image. Combination of antiretroviral therapies – aims to maximize the suppression of HIV replication. Prevention of HIV infection should include: risk reduction counseling particularly information on safe sex… Fundamentals of Nursing . the emotional burden of serious illness and the threat of death may overwhelm the patient. Recognize that the diagnosis of AIDS is profoundly distressing because of its social impact. thereby improving survival. Immuno suppression caused by HIV disease makes patients vulnerable to additional infections and complications. Poor drug compliance results to resistance and treatment failure.
Altered nutrition (less than body requirements) related to anorexia. Social isolation related to possible rejection by peers due to infectious state of illness Fundamentals of Nursing . Fear and Anxiety related to outcome of the disease.Nursing Diagnoses: Impaired gas exchange related to respiratory infection. Body image disturbance related to body weight loss. weight loss and possible GI manifestation. Infection related to immunocompetence. Impaired body image related to Kaposi’s Sarcoma. Activity intolerance related to weakness and air hunger.
5. Fundamentals of Nursing . Understanding and acceptance of the present manifestations of the disease. 3. Prevention of complications and contaminations. Proper assessment. Generous emotional support 2. (covers sexual orientations and attitudes) Medical management. 6. Emphasis in Health education. Care for physical as well as environment.Nursing Management: 1. Disease information and counseling. client to enter a disease and drug program. Balanced Nutrition. Activity and Rest balance. 7. 8. 4.
COMMON COLD Acute. causes inflammation of the upper respiratory tract. It is self-limiting. Fundamentals of Nursing . Occasionally it results from mycoplasma infection. usually afebrile viral infection. Cold stems from a viral infection of the upper respiratory passages and consequent mucous inflammation.
Causative agents / Transmissions: Rhinovirus. coxsackievirus. myxovirus. Fundamentals of Nursing . and echovirus. Airborne. droplet nuclei infection. contact with contaminated objects. hand to hand transmission. corona virus. adenovirus.
symptoms will be. lethargy Hacking non productive cough or nocturnal coughs After a day.Signs and Symptoms. sometimes chills Myalgia. Fever. Burning watery eyes Rhinitis headache. fullness with copious nasal discharge. arthralgia. Malaise. Fundamentals of Nursing . “stuffiness” that persists for a week. 4-day incubation period/ communicable:2-3 days after onset Pharyngitis Nasal congestion.
rehydration. Fundamentals of Nursing .) Decongestants / Antihistamines / lozenges.Treatment and Management: Supportive and Preventive: Analgesics or Acetamenophen –(eases myalgia and relieves headache) Fluids. Bed rest (loosens respiratory secretions. regain energy. combat fatigue and weakness. anti tussives Steam inhalations Vitamin C and Zinc.
CONJUNCTIVITIS Hyperemia of the conjunctiva. herpes simplex virus. neisseria gonorrheae. allergy or chemical reaction. neisseria meningitides. Fundamentals of Nursing . Viral – adenovirus. Chlamydial – chlamydia trachomatis. streptococcus pneumoniae. but self limiting. Highly contagious. Causative Agents: Bacterial – staphylococcus aureus. from infection.
Redness of the eye “pink eye” Swelling of orbital area Burning and Sensation of foreign body in the eye.Signs and Symptoms: Teary eyed. with discharges. Pain and Photophobia. Fundamentals of Nursing .
Lymphocytes predominant if caused by virus. Culture sensitivity tests identify the causative bacterial organism. Polymorphonuclear cells (neutrophils) if caused by bacteria Eosinophils if its allergy related. Fundamentals of Nursing .Diagnosis PE –reveals peripheral injection of the bulbar conjunctival vessels.
followed by cromolyn sulfate.Treatment Topical broad spectrum antibiotic Trifluridine drops Vidarabine ointment or oral acyclovir Corticosteroid eye drops as necessary. Antihistamines as necessary. Fundamentals of Nursing . Cold compress to relieve itching and warm compress is necessary too during swelling of eyelids.
HAEMOPHILUS INFLUENZAE (A small. gram negative. (mucosal edema and thick exudate) Most common as a secondary disease of existing immunocompromised client. clients in chronic care facilities and nursing homes. elderly. clients with debilitating conditions and children less than 5 yrs old. Fundamentals of Nursing . pleomorphic aerobic bacillus) causes disease in many organ system but frequently attacks respiratory Provokes a characteristic tissue response = acute suppurative inflammation. Incidence greatest in alcoholics.
I bacteremia found frequently in clients with meningitis. trachea and bronchial tree. Diagnosis: Blood culture Polymorphonuclear leukocytosis (15000 – 30000/ul) Leukopenia (2000-3000/ul) in young children with infection. H. Pain and difficulty in swallowing.Signs and Symptoms Onset is insidious associated with upper respiratory tract infection Fever Chills Productive cough Mucosal edema and thick exudates found in clients with infection of the larynx. Fundamentals of Nursing .
Treatment and Management 1. which necessitate intubation or tracheotomy. Check the client’s history for drug allergies.) Ceftriaxone. Antibiotic therapy Ampicillin 2 weeks course of 1500mg/day. 2. Maintain adequate respiratory function through client’s proper positioning. And for home treatment. 3. (30% of strains are resistant. suggest clients need for use of humidifier. Fundamentals of Nursing . Watch for signs of cyanosis and dyspnea. Cefotaxime Chloramphenicol –is used concurrently until sensitivities are identified. Rifampin should be given before discharge to assure treatment success. humidification and suctioning as necessary Monitor rate and type of respiration.
5.4. placing soiled tissues in a container for disposal and decontamination of all equipments in contact with the clients.Influenzae vaccine to children ages 2-6yrs old. 6. H. Maintain respiratory isolation Observe proper handwashing technique. Monitor complete blood count for signs of bone marrow depression Monitor intake (including IV infusions) and output.watch for signs of dehydration Preventive measures. Proper disposal of respiratory secretions. Fundamentals of Nursing .
highly contagious infection of respiratory tract. Popularly called “flu” Onset is sudden Fundamentals of Nursing .INFLUENZA (La Grippe) Acute.
Type C – is endemic. strikes every year with new serotypes (epidemics q 3 years. Incubation Period: 24. Type A – most prevalent. flu symptoms starts to appear.) 2. 3. 1. Type B – also strikes yearly but causes epidemics q 4-6 years.48 hours.Causative agent: Myxovirus influenzae – usually during cold months. Period of Communicability: until the 5th day of illness. causes only in sporadic cases. Peak 2-3 weeks in epidemics. Fundamentals of Nursing .
3 C – 40 C. 2. 5.legs. 3. fever persists more than 5 days indicates presence of a complication. Symptoms usually subside in about 5 days. generalized malaise.Signs and Symptoms: 1. The absence of the manifestations after 3-5 days. hoarseness of voice Conjunctivitis. laryngitis.back). Sudden onset of chills Rise in temperature 38. 6. 4. myalgia (arms. Fundamentals of Nursing . patient will still feel fatigue and weakness with anorexia. Rhinorrhea. Rhinitis. easy fatigability Nonproductive cough. Headache Malaise.
abdominal pain. sore throat. Respiratory type – high fever. or diarrhea (which may lead to dehydration. eye ache and frontal headache. as secondary condition/infection. PR-rapid and weak in toxic cases. joint pain. 3. Common complication is Meningitis or Encephalitis. Intestinal type – nausea and vomiting. tachycardia and enlarged lymph nodes. . Fundamentals of Nursing 2. fever. fever.) Neurologic type – headache. moist rales in lungs. Catarrhal symptoms cough which becomes hacking and annoying.Three distinct types: 1. constipation. lumbar back pain. increase RR and profuse sweating.
Nutritious food intake 4.) Fundamentals of Nursing . Myocarditis. Expectorants. Adequate fluid intake 3. Bed rest 2. Treatment: Uncomplicated is treated/ managed with. or Prophylactic Antibiotic (when necessary.Most Common Complication : Pneumonia Other Complications: Encephalitis. Sudden Infant Death syndrome. 1. as prescribed. Acetamenophen.
Isolation and CBR Health Education / Health Information. Watch out for signs of Complication.Special Consideration on Management: Vaccination Anti viral therapy and Chemoprophylaxis. Prevention is important! Fundamentals of Nursing .
resulting to consolidation of lung tissues. Klebsiellae(Freid Lander bacillus). and Chlamydial. Legionella. Mycobacterium TB Fundamentals of Nursing . Mycoplasma. Other opportunistic microorganisms: Pneumocystis carinii. Haemophilus influenzae.PNEUMONIA Acute infection of the lung parenchyma associated with exudates in alveoli.Pseudomonas. Staphylococcus aureus. Causative Agents: Viral Bacterial *Pneumococcus *Streptococcus. Aspergillus fumigatus.
Mycoplasmal. sudden onset. 2. lobar involves an entire lobe. Secondary Pneumonia. Location: bronchopneumonia involves distal airways and alveoli. Fungal. Mycobacterial. Rickettsial. Primary Pneumonia – results from direct cause/ aspiration of the pathogens. with predisposing and contributory factors.( old age. Types: 1. decreased level of consciousness.ngt. Fundamentals of Nursing . Bacterial.arising from lung damage from noxious chemicals and other insults (superinfection) or maybe result of hematogenous spread of the bacteria from distant focus. lobular involves part of the lobe. with predisposing and contributory factors. impaired gag reflex. Protozoal.Classifications: Microbiological etiology : Viral.) Incubation Period: 1-3 days. debilitating disease.
High fever (rapid rise) Other Signs: • Body Malaise • Difficulty in breathing/ marked tachypnea with respiratory grunting and flaring of nares • Rapid bounding pulse • Flushed cheeks. Shaking chills 5.Mode of Transmission: droplet infection –direct/indirect. Delirium in acute stage. Sputum production 3. lip blisters • Diaphoresis. Fundamentals of Nursing . Signs and Symptoms: Five Cardinal symptoms of early bacterial Pneumonia: 1. Anxiety. Coughing 2. Pleuritic chest pain 4.
1.Stage of Lung engorgement – dark red in color. polymorphonuclear and mononuclear cells found in it. Exudates in the alveoli is protein rich fibrinous edema fluid. Fundamentals of Nursing . Stage of Gray Hepatization – 4. frothy sputum. Stage of Red Hepatization – 3. blood tinge. ***Exudates consists of coagulated fibrin containing red and white corpuscles epithelial cells and some embedded bacterias. Stage of Resolution – exudates and secretions expectorated and liquefied. 2.
Widely Used Classifications of Major Pneumonias Four Categories Typical Atypical Cavitary/Anaerobic Oppurtunistic CAP (Community Acquired Pneumonia Pneumonia in Immunocompromised Host Aspiration Pneumonia Hospital Acquired (Nosocomial Pneumonia) Fundamentals of Nursing .
gangrenous lung. atelectasis. pulmonary emboli. Fundamentals of Nursing .Diagnosis: History Physical Examination and Assessment Sputum culture/tests Blood and Serologic exams Nuefeld-Quelling test –test for capsular swelling/serologic typing Complications: Pleurisy Empyema / pleural effusion Pericarditis/Endocarditis with effusion Pneumococcal Meningitis Otitis Media Hyperstatic Edema and Hyperemia Rare complications such as: arthritis. lung abscess.
analgesics to relieve pleuritic pain. Fundamentals of Nursing .Treatment: Antimicrobial therapy Supportive measures: humidified oxygen therapy for hypoxia. Patients may require positive end-expiratory pressure to facilitate adequate oxygen. mechanical ventilation for respiratory failure. High caloric diet. bed rest. adequate fluid intake.
Fundamentals of Nursing . Fever and dehydration requires IV fluids and electrolyte replacement Maintain adequate nutrition to replace high caloric utilization secondary to infection.Special Consideration/Management: Maintain patent airway and adequate oxygenation. Elevate head and shoulders if necessary to aid in respiration. High caloric. Obtain sputum specimen Administer antibiotic. soft diet. Respiratory care. Give oxygen cautiously. suction often using sterile technique. high protein. measure arterial blood gas level (administer supplemental oxygen if partial pressure of arterial 02 is less than 60mmHg. Teach patient how to cough and perform deep breathing exercises to clear secretions. Endotracheal tubing for severe pneumonia. record response to medications.
calm environment. Check for residual formula at 4-6 hour interval. Monitor fluids and I & O. and administer formula slowly. inflate the tube cuff.Supplemental oral feedings with NGT. Keep client’s head elevated for at least 30 minutes after the feeding. elevate head. Measure I & O. Absolute bed rest but with passive activities to prevent other complications arising from immobility. Keep patient warm especially in the lower extremities to maintain vasodilation. check tubes’position. Fundamentals of Nursing . Provide quiet. Parenteral nutrition. if client is in endotracheal tube. To avoid aspiration during NGT fedings.
PULMONARY TUBERCULOSIS (Koch’s Disease 1882) -is a bacterial infection caused by Mycobacterium tuberculosis. joints.can be eliminated by heat. Characterized by pulmonary infiltrates. sunshine. drying and UV light.multiplies slowly and characterized as AF aerobic organism . formation of granulomas in the tissues of tubercles that undergo caseation and necrosis or fibrosis and cavitation.reservoir is clients’ sputum Most common and most contagious type of active tuberculosis. Bacterium resembles fungus . the TB bacilli can infect almost any part of the body. Fundamentals of Nursing . Transported by the blood or lymphatic system. kidneys and bone – extra-pulmonary TB. most commonly affecting lymph glands. .
w/c develops 3-6wks later) ____________l_____________ Some clients go into active disease Others maybe able to contain the l infection.) Fundamentals of Nursing .Pathophysiology Susceptible pax inhales the airborne droplets l Bacilli traverse URT and bronchi to reach alveoli l Alveolar macrophages takes up the bacilli. bacilli remain dormant & viable l latent TB infection (usually + TB skin test but have no symptoms & are not contagious. (cell-mediated immunity to myobacteria.holding some in the lungs and transporting others throughout the body. (*) l some may eliminate all bacteria/in many. l Immune response limits further multiplication and spread of the bacilli.
l process continues causing extensive damage to the lung tissue and its blood vessels. Fundamentals of Nursing .*Etiology Small areas in the lung infected with the bacilli l gradually merge to form a bigger lesion l filled with infected material that has a cheese-like consistency l This material can become liquid. l then is coughed out leaving a cavity in the lung. l ___________________________ Generates more infectious material and inflammation. The damage to the blood vessels can result in Some patients coughing up blood (hemoptysis ) l healing may occur in parts of the lung l resulting in scar tissue.
D. Vitamin deficiencies (A. Poverty and Overcrowded homes 2. walling it up in a tiny nodule (tubercle) bacillus may lay dormant within the tubercle for years.C) 4. Fundamentals of Nursing .4-8 wks) Factors that contribute to the development of the disease: 1.Leading cause of morbidity and mortality with 8 – 10 million new cases/yr. 5% exposed and infected develop the disease within the year The immune system usually controls the tubercle bacillus by killing it. Decrease in clients resistance due to existing infections (that threatens their immune system). later reactivated and spreads. Incubation period: 2-10 weeks (ave. 5. Malnutrition 3. Children below 5yrs old who are prone to infections due to factors found above.
Inhalation – microbes found in the sputum.expelled by carriers and active clients through coughing. Person to person. Ingestion – bacteria can be ingested in form of droplet secretions. spread thro coughing. Two most common Mode of Entry: 1. common route is respiratory tract. 2. Bacilli maybe swallowed. In pulmonary. sneezing. Patients with cavity lesion are particularly infectious because their sputum usually contains 1M – 10M bacilli/ml. talking via droplets suspended in the air. suspended in the air for a prolong time and is inhaled by a susceptible host.Mode of Transmission: Airborne. sneezing or just plain talking. Fundamentals of Nursing . reach intestinal mucosa producing early lesions in the mesenteric nodes. transmitted thro’ droplet nuclei.
Risk of Death : 1. greatest risk during the first two years after infection. 2. personally or amongst friends and extended family. Others – smoking. poverty. alcohol/substance abuse. strength of person’s immune system. travel. 4. behaviors (communal drug taking) Risk of infection : (depends on) number of mycobacterium inhaled.1. malnutrition. need to develop adequate laboratory capacity to diagnose these new cases. Other social habits. 3. Vitamin D deficiency. Risk of developing MDR-TB : 4% of new cases is MDR-TB. 5. Fundamentals of Nursing . duration of exposure. improper use of anti TB agents. virility of bacilli. Risk of developing active TB : 10% risk of developing active TB in their lifetime. Urban areas where people live. Inadequate Tx. Malnutrition. migration from places/country or history of travel to an area with high incidence of TB. Risk of exposure : history of TB. HIV infection. Severe pulmonary disease.7 M deaths every yrworldwide. work in cramped condition.
General symptoms: .Fatigue .Fever .Night sweats . often attributed to other conditions and remains undetected for sometime.Loss of appetite Other prominent S&S: Pulmonary symptoms Extra –pulmonary symptoms Dry productive cough localized pain/swelling (depenChest pain -ding on site of disease) Shortness of breathe signs arising specific to area Haemoptysis affected.Weight loss . Fundamentals of Nursing .Signs and Symptoms: Early symptoms – vague.
Ziehl-Neelsen stain technique Other: auramine-rhodamine stain : flourescence microscopy Mantoux test (PPD skin test) –tuberculin skin test Fundamentals of Nursing . Mycobacteria may also be isolated and identified by means of: 1. lesions and cavities.Laboratory / Diagnosis These processes. 2. initial infiltration. so called because of their staining characteristics when sputum is prepared for microscopic examination. to confirm active disease. can all be seen on x-ray. Sputum test : AFB (acid fast bacillus) = stained bright red stands against blue background. Sputum culture. the patient’s sputum must be examined for the presence of acid-fast bacilli (AFB). However.
Treatment : 1. streptomycine. wheezes and whispered pectoriloquy.) 2.Diagnostic Help Auscultation – detects crepitant rales. cycloserine & quinolone drugs. para aminosalisylic acid. Chest X-rays – shows nodular lesions. Fundamentals of Nursing . Chest percussion – detects dullness over the affected area indicating consolidation or pleural fluid. rifampicin10mg/. scar tissue. calcium deposits. pyrazinamide25mg/. Will not distinguish active from inactive stage of tuberculosis. (after 2-6 wks. Antitubercular therapy: isoniazid 5mg/kg daily. patchy infiltrates(mainly upper lobes). bronchial breathe sounds. For client who are Drug resistant are being given second linedrugs : capreomycin. streptomycin15mg. client is no longer infectious. To be taken for six months. ethanbutol15mg/. cavity formation.
4. Record weight weekly. Fundamentals of Nursing . Be alert for adverse reaction of medications and watch for signs of complication. 6. Well balanced diet. 2. Management/ Special considerations: 1. sterilizing activity. Teach client to cough and sneeze through a tissue or a handkerchief. Instruct client to wear mask when outside his room. Be firm on clients drug/medication compliance. Sufficient rest. well ventilated room. Isolate the infectious client in a quiet. Anti-TB drugs have 3 main actions: bactericidal activity. and ability to prevent resistance. DOTS (direct observed therapy system) is being employed to patients in treatment of anti TB drugs. Visitor and hospital personnel should likewise wear mask when inside client’s room. 5.To prevent non compliance. and proper disposal of secretion infected things 3. inadequate or incomplete teatment of patients.
radiation. aging. immunosuppressive drugs. these fungi is part of a normal flora of GIT and mouth. Caused by Candida Albicans . Infects nails (onychomycosis). lowered resistance/immunocompromised from disease (cancer).rise in glucose level as in diabetes mellitus. esophagus and GITract. elevated estrogen levels during pregnancy.FUNGAL INFECTION: CANDIDIASIS Most commonly called: Moniliasis. human immune deficiency virus (HIV)infection. IV or urinary catheters. vagina (moniliasis). hyperalimentation or surgery. Causes infection only when body permits their proliferation. vagina and skin. drug abuse. . mucous membrane especially oropharynx (thrush). skin (diaper rash). Fundamentals of Nursing .
papules appear in the edges of the rash. mouth or pharynx that reveal bloody engorgement when scraped. Fundamentals of Nursing . groin. appearing below the breasts. axilla. sometimes purulent discharge and the separation of the pruritic nail from the nailbed. erythematous.Most common predisposing factor: -use of broad spectrum antibiotics! The incidence increases especially because of wider use of IV therapy and greater number of HIVpatients. retrosternal pain. between the fingers. NAIL : red swollen. regurgitation and occassional scales in mouth and throat. papular rash sometimes covered w/exudates. darkened nailbed. Signs and Symptoms: Corresponds to the following sites of infection: SKIN : scaly. OROPHARYNGEAL : (thrush) cream colored or bluish-white patches of exudates on the tongue. in diaper rash. and umbilicus. ESOPHAGEAL MUCOSA : dysphagia.
focal neurologic deficits.nuchal rigidity. Brain : headache. Eye : endophthalmitis. flank pain. Specific symptoms according to site: Pulmonary system : hemoptysis.VAGINAL MUCOSA : white or yellow discharge cheese like. fever. dysuria. Systemic infections produces : chills. embolic phenomena. chest pain. seizures. orbital or periorbital pain. Renal system : fever. fever. scotoma exudates. hematuria. hypotension. white-grayish raised patches on vaginal walls with local inflammation with dyspareunia. pruritus with local excoriation. Fundamentals of Nursing . occasional rash. cough. blurred vision. high spiking fever. pyuria. Endocardium: systolic and diastolic murmurs.
Cornstarch or dry padding in intigenous areas for obese patient to prevent irritation. 7. Non-irritating mouth wash. Fundamentals of Nursing . ketoconazole. 2. Nystatin – effective antifungal superficial medication.control of DM. miconazole are effective antifungals in mucous membrane and vaginal candidiasis. Soft tooth brush to prevent mucal irritation. 5. fluconazole. discontinuation of antibiotic or catheter or cleaning and change of NGTubing. Swab Nystatin on oral mucosa for infant with thrush. Topical anesthesia (lidocaine) 1 hour before meals. 3. 1. Instruct patient to swish Nystatin solution around mouth before swallowing. Systemic tx is IV of Fluconazole or IV of Amphotericin B with or without Fluorocytocin. Soft diet. 4. 6. Chlotrimazole.Treatment and Management: Aim to improve the underlying condition that predisposes the patient to candidiasis: .
a penetrating head wound. sinusitis. empyema. mastoiditis encephalitis. Fundamentals of Nursing . endocarditis. myelitis. or brain abscess Usually caused by: Neisseria Meningitides. viral. lumbar puncture. usually as a result of bacterial.MENINGITIS Inflammation of the meninges of the brain and spinal cord. Can follow a skull fracture. or ventricular shunting procedure. Causative Agents: Meningococcus Other bacterias and viruses arising from diseases like : pneumonia. streptococcus pneumoniae. and eschirichia coli. osteomyelitis. haemophilus influenzae. otitis media.
deep stupor. diplopia. photophobia. a spasm in which the back and extremities arch backward.Signs and Symptoms Cardinal Signs: Infection – fever. malaise Increased Intracranial Pressure – headache. chills. the body rests on heels and head. vomiting. coma. and (rarely) papilledema. Fundamentals of Nursing . and other visual problem. Meningeal Irritation : Nuchal rigidity. delirium. irritability. Other manifestations: sinus arrythmia. (+) brudzinski’s and kernig’s sign Opisthotonous.
Meningitis Fundamentals of Nursing .
KERNIG’S & BRUDZINSKI SIGN Fundamentals of Nursing .
Chest X ray. nose and throat as well. Blood test reveals leukocytosis and serum electrolyte abnormalities. given 15-20 minutes before first dose of antibiotic and every 6hrs x 4 days.Diagnosis 1. Dexamethasone. or Cephalospherins (ceftriaxone sodium. 3. cefotaxime sodium) Vancomycin hydrochloride alone or in combination with Rifampin for resistant strain.improves the outcome of Tx in adult and does not increase the risk of gastrointestinal bleeding Fundamentals of Nursing .as adjunct therapy. Lumbar puncture (tap) Blood and urine culture. piperacillin). 2. ECG ALERT: Meningitis if left untreated has a 70 . CAT scan 4.100% mortality Treatment: Antibiotic IV: Penicillin (ampicillin.
specific gravity and osmolality. Management: Supportive treatment Fluid Volume expanders for Dehydration and Shock IV fluid replacement (care is given to prevent overload) Supportive care – client’s prognosis depends on this.Dilantin (Phenytoin) – controls seizure that occurs early part of the disease. Position client carefully to prevent joint stiffness and neck pain. Fundamentals of Nursing . Turn often and Assist in ROM. serum electrolytes. Monitor body weight. as increasing ICP compromises the brain stem. Assess neurologic status/functions & vital signs continuously Pulse oximetry and arterial blood gases – basis to identify the need for respiratory support. urine volume.
Institute droplet precautions until 24 hrs after initiation of antibiotic therapy (oral and nasal discharge is considered infectious). Watch of adverse reaction of medications Keep and ensure client’s comfort.Protect client from injury secondary to seizures or altered level of consciousness. Prevent complications specially associated with immobility. Fundamentals of Nursing . Provide generous emotional support and Health education Follow strict Aseptic technique.
endocarditis. Meningioma. purulent conjunctivitis.caused by gram negative bacteria Neisseria meningitides which also causes primary pneumonia. sinusitis and genital infection. Meningitis 2. Fundamentals of Nursing . Infection occurs sporadically or in epidemics. Virulent infections maybe fatal within a matter of hours.MENINGOCOCCEMIA Occurs as simple bacteremia. Incubation period : 2 – 10 days Two major meningococcal infections: 1. .
It often accompanies meningitis. Petechial nodular maculopapular rash. Signs and Symptoms: 1. tachypnea. Alert: unless treated promptly. (back and legs). cough 3. chills. Extreme prostration 7. Shock. mild hypotension. headache 2. arthralgia 4.Meningococcemia occurs as simple bacteremia. myalgia. Sudden spiking fever. enlargement of skin lesions 6. Disseminated intravascular coagulation (DIC). Fundamentals of Nursing . fulminant meningococcemia results to death within 24 hours. 5. Sore throat. fulminant meningococcemia and (rarely) chronic meningococcemia. Tachycardia.
. Proper ventilation (room and good patent airway and oxygen). give Chloramphenicol*iv Therapy includes: IV Heparin for DIC Mannitol for cerebral edema Dopamine for shock Digoxin or diuretic if heart failure develops Strict Isolation and Observance of Standard precaution. CVP line to monitor cardiovascular status. Ampicillin. Health education Fundamentals of Nursing . for clients allergic to penicillin.Treatment and Special Considerations: Large dose of Aqueos Penicillin G. Bed rest Chemophrophylaxis with Rifampin. Minocycline – temporarily eradicates infection in carriers. Cephalosphorin. Supportive therapy: Fluid and Electrolyte balance.
usually caused by mosquito-borne or arthropod-borne virus (Arbovirus). herpes simplex virus (HSV). Clinical manifestation: 1. 2. Diffuse nerve cell destruction Fundamentals of Nursing . and fungal infection.ENCEPHALITIS A severe inflammation of the brain. Intense lymphocytic infiltration of the brain tissues and leptomeninges causing cerebral edema. Degeneration of brains’ ganglion cells 3. It can also be transferred through ingestion of infected goat’s milk.
HIV. 3. LaCrosse encephalitis . Fungus – related to compromised immune system Fundamentals of Nursing .most common pediatric encephalitis 2. Varicella. Eastern equine encephalitis – non specific.Rubella or post vaccination.Causative agents: Herpes simplex virus (HSV). Arbovirus – (primary vector is mosquito) – occurs during summer and fall and common in north america. 4. 4 types: 1. Western equine encephalitis – pediatric encephalitis but less prevalent. Mumps virus. Adenovirus also demyelinating disease such as Measles.most common cause of acute encephalitis in US. St. Louis encephalitis – affects adults over 50 years old.
ENCEPHALITIS Fundamentals of Nursing .
paralysis. In arbovirus: necrotizing disease – flu-like prodrome. mental status changes. Symptoms include also confusion and behavioural (changes) abnormalities. headache. ICP. focal seizures(focal symptoms present within 7days of infection and progress for 14-21 days). and organic psychoses). frontal lobe and limbic system. hemiparesis. vascular changes (arteritis or cerebral infarction) Fundamentals of Nursing . coma. In Fungal: common symptoms with lethargy. seizures In herpes virus: spreads thro trigeminal nerve. Inflammation and necrosis of the temporal lobe. seizures. dysphasia. ataxia.Signs and Symptoms/ Clinical Manifestations: All viral forms have similar clinical features although there are certain differences: Acute illnesses starts with: Sudden onset of fever. altered level of consciousness. vomiting and progresses to signs of meningeal irritation (stiff neck & back) and neuronal damage (drowsiness.
Diagnosis and Laboratory Based on clinical findings and clients history Identification of causative agent in the CSF or Blood CSF elevated. normal glucose level(Arbovirus). Polymorphonuclear leukocytic pleocytosis. glucose level.normal to low(HSV). Fundamentals of Nursing . Serologic studies shows rising titers of complementfixing antibodies. WBC and Protein level elevated. EEG reveals abnormalityCAT scan and MRI is ordered to rule out cerebral hematoma – reveals reveal lesions in basal ganglia and thalamus.
dose must be high enough to penetrate the BBB without causing renal toxicity.drug of choice for HSV enceph. increase in liver enzymes.E. (to inhibit viral DNA replication) to prevent relapse.of Flucy. slow adm over 1 hr to prevent crystallizationof the meds in urine. dizziness. rashes. Seizures are controlled by antiseizure medications Increased ICP is controlled by repeated lumbar punctures or shunting Antifungal agents are given for a specific period of time to cure infection of client with competent immune system.] Fundamentals of Nursing . Fluconazole (Diflocan) or Flucytosine may be administered in conjunction with ampho. Foscarnet sodium is given No specific meds for arbovirus enceph. Medical mgmt is aimed in controlling seizures and increase in ICP.bone marrow suppression. reversible alopecia. therefore leukocyte and platelet monitored twice a wk.[S.E. abd pain. S.Treatment and Management Acyclovir (Zorivax). tx should continue for up to 3weeks. Amphotericin B is used for tx. If client is resistant . headache. of Fluco – nausea.
Other drug therapy : Phenytoin given thro IV Glucocorticoids –cerebral edema/swelling. Furosemide or Mannitol Sedatives for restlessness Aspirin/acetamenophen-headache & fever Supportive care Adequate fluids and electrolyte: avoid fluid overload, Measure and record I & O. Antibiotic for associated infection Adequate nutrition, small but frequent feedings.NGT or parenteral feeding Assess neurologic functions often (assessment should focus on early changes in intracranial dynamics. Cranial nervecompression is due to swelling. Monitor signs of herniation pattern: flaccidity, decerebration, decortication, noxious to stimuli Watch for cranial nerve involvement (ptosis, strabismus, diplopia), abnormal sleep pattern, behavioral changes. Fundamentals of Nursing
GUILLIAN BARRE SYNDROME
Autoimmune attack of the peripheral nerve myelin. = acute, rapid segmental demyelination of peripheral nerves and some cranial nerves producing ascending weakness with Dyskinesia (inability to execute voluntary movements) and Paresthesias (numbness) Myelin is complex substance that covers nerves, provides insulation and speeds the conduction of impulses from cell body to dendrites. (The cell that produces myelin is Schwann cell.) Predisposing factors: Respiratory or gatrointestinal infections Post vaccination Pregnancy Surgery
Fundamentals of Nursing
Cell mediated immune attack on peripheral nerve myelin protein
By infectious microorganism that mimics peripheral nerve Myelin protein
Immune system unable to distinguished between the two protein and attacks.
Destroys peripheral nerve myelin
_________________________________________ l l
Inflammation and Destruction Axon unable to support nerve conduction.
Posterior(sensory) and Anterior(motor) nerve roots
Signs of sensory and motor losses occurs simultaneously Symptoms of muscle weakness and diminished reflexes
Fundamentals of Nursing
Muscle weaknesses (symmetric weakness, ascending). 24-72hrs Diminished reflexes Cranial nerve demyelination: Optic nerve= blindness; Bulbar muscle weakness related to demyelination of glossopharyngeal and vagus nerves= inability to swallow or clear seretions. Vagus nerve demyelination= autonomic dysfunction- tachy/bradycardia, hypertension, orthostatic hypotension. Progressive sensory symptoms – an atypical axonal destruction and the Miller-Fisher variant includes paralysis and ocular muscles, ataxia, areflexia. Rapid progression and neuromuscular respiratory failure
GB is a life threatening disease, / is a medical emergency therefore requires an intensive care unit management. is an infectious polyneuritis. Fundamentals of Nursing
Initial phase. Treatment and Management: Respiratory therapy or mechanical ventilation Adequate Oxygenation Anticoagulant Thigh-high elastic compression stockings – preventions of thrombosis and pulmonary emboli. but may take up until 2years to recover. Plateau phase – several days to 2 wks. Fundamentals of Nursing .Clinical course: 1. 3.first symptom to 1-3 wks later. Recovery phase – coincide with remyelination and axonal process regrowth. Continuous ECG monitoring Short acting alpha adrenergic blocking agent for cardiovascular symptoms To treat and manage hypotension. increase in the administration of IVFluids. 2. 4-6 wks.
Imbalanced nutrition. Nursing Management: Primarily Supportive: endotracheal intubation (clear secretions) Incentive spirometry – monitors vital capacity and negative inspiratory force – key to early intervention for neuromuscular respiratory failure. Fear and Anxiety related to loss of control and paralysis. Impaired verbal communication related to cranial nerve dysfunction. Impaired physical mobility related to paralysis. less than body requirements related to inability to swallow.Nursing Diagnoses Ineffective breathing pattern and Impaired gas exchange related to rapidly progressive weakness and impending respiratory failure. Fundamentals of Nursing .
partial pressure of arterial oxygen (Pao2) below 70mmHg results to respiratory failure. turn or reposition patient regularly and encourage coughing and deep breathing.Mechanical ventilation – needed if vital capacity falls (spontaneous breathing impossible andtissue oxygenation inadequate) Trial dose of Prednisone Watch for ascending sensory loss (precedes motor loss) Obtain arterial blood gases measurement (because neuromuscular disease results hypoventilation with hypoxemia and hypercapnia. Skin care to prevent skin break and contractures. Auscultate for breathe sounds. Passive ROM Fundamentals of Nursing .
highly contagious toxin mediated infection Causative agent : corynebacterium diphtheriae.DIPHTHERIA Acute. droplet infection. Mode of transmission : airborne. a gram positive rod that usually infects the respiratory tract primarily the tonsils. Humans are the only known reservoir of the bacteria. or direct intimate contact. More prevalent in cold months. Referred to as : Klebs Loffler bacterium. nasopharynx and larynx. Incubation Period : 1-7 days Fundamentals of Nursing .. Characterized by local inflammation and fibrin formation (pseudomembrane) or sometimes called membranous pharyngitis.
Diphtheria Fundamentals of Nursing .
soft extends to palate and uvula. streptococci.Communicability period : toxins released and accumulates at the membrane and is released to the system. tonsils. Tonsils/Pharynx.formation of thin fibrin of fibrinous membrane that rapidly increases to thick patchy. Signs and symptoms : 1. as in laryngeal diptheria. Breathe-characteristic odor. swelling of Neck glands. FETID-due to necritic cells/tisues If membrane causes airway obstruction. grayish-green membrane over the mucous membrane of the pharynx. finds Ca. 3. pneumococcous found in membrane that tends to affect the heart and peripheral nerves. 2. larynx. Rasping / barking cough 4. Stridor 6. Husky / hoarseness of voice 5.bull-neck appearance due to edema rather than gland enlargement. Fundamentals of Nursing . By culture.
Cyanosis. Fundamentals of Nursing .7. and suffocation follows due to much obstruction of brochial tree. tachycardia. Death follows because of Asphyxiation. Coma. rapid weak pulse rate. Keep patient quiet and in cool protected room 2. 9. Treatment and Management 1.muco-sanguinous discharge 13. CBR 2.marked excoriation of upper lips and nasi.Attempts to remove membrane can cause bleeding. skin lesion resemble impetigo 12.In cutaneous diptheria. tachypnea. 11. Retraction of sternum 8. Keep visitors to the minimal and wear of gown. mask and gloves is advised for prevention of contamination and cross infection. 10. Strict Isolation 1.
Proper disposal of Nasopharyngeal secretions 4. Ice collar to reduce pain. Warm irrigation of NaHCO3. until after 3 consecutive negative culture of at least 24 hours apart. Suction 6. Nasal gavage is done for feeding. 6. Croup tents 7. Monitor respirations. Infection Control 4. If airway obstruction is present. Anoint petroleum jelly on skin and lips. Gentle swabbing of liquid albolene after cleaning to prevent from dying. Supportive meds. Tracheostomy 5. The presence of discharges that client is unable to expel. in aid for dificulty in breathing due to mucus discharges. Care of the nose and throat Maintain infection precaution. 5. 3.3. 7. as prescribed Fundamentals of Nursing . For steam inhalation.
Medications. In antitoxin administration. watch for thrombophlebitis. Immunization should be given during convalescence. Thro’IM or IV. Pts who receive erythromycin. 8. Immunization Diptheria antitoxin 8. antitoxin is given before laboratory confirmation of diagnosis if sensitivity test is negative. Fundamentals of Nursing . Because mortality increases directly with the delay. Be alert for anaphylaxis Keep ephinephrine 1:1000 and resuscitation equipment handy.Treatment must not wait for confirmation by culture. But this doesn’t confer immunity.
watch for airway obstruction and resistance. ECG should be performed twice weekly 4-6 wks. Be aware of peripheral neuritis. may not develo 2-3 months after onset of illness. heart murmurs. Fruit juices to maintain alkalinity. Obtain cultures as needed. Erythrocin 9. Monitor for signs of shock. Preventions. Monitor respirations. Be alert for the development of myocarditis. 10.Antibiotics: Penicillin. vetricular fibrillation 10. hypodermoclysis or intravenously Fundamentals of Nursing . To terminate carrier state 9. Nutrition To eliminate microbes from upper respiratory tract and other sites. Soft diet. small but frequent feeding. Nourishment maybe given by rectum.
Special consideration : Serial ECGs should be performed twice weekly for 4-6 weeks to watch for myocarditis. Neurologic involvement (motor fibers.Diptheriae or other superinfecting microbes. 1. vomiting. Paralysis 2. heart murmurs. irregular weak pulse. Thrombocytopenia 5. 4. Ventricular fibrillation is a common cause of a sudden death in diptheria patients. Throat culture or culture of other lesions. Myocarditis – with the ff symptoms. decrease blood pressure. Fundamentals of Nursing . Renal involvement Diagnosis : 1. restlessness. Be alert for the signs of developing myocarditis.Complications : maybe due to C. Respiratory involvement : Bronchpneumonia 3. abdominal pain. sensory neurons) 6.
But vaccine was only developed in early 50’s called Salk vaccine. This is an acute communicable disease caused by a virus ranging from inapparent infection to fatal paralytic illness. Mostly in infants and children but now known to have occur in 15 years old and above. Discovered in 1840.POLIOMYELITIS Commonly referred to as infantile paralysis. Fundamentals of Nursing .
Fundamentals of Nursing .An RNA virus and are resistant to ether or chloroform. Calcifi virus. (Ave of 9-12 days) Mode of transmission : droplet infection / fecal-oral route Portal of entry : oral / upper respiratory tract. season(summer). but can be inactivated by formaldehyde. age. Classified to 3 genera./ multiplies in GIT but particularly neurotropic. Entero virus is the polio virus because the behavior of virus is affected by climate(temperature). Rhino virus. Entero virus. Incubation period : 5 – 35 days.Causative agent: Piconavirus (Piconaviridae family). and socio-economic status.
skin. and the heart. l infects motor neurons (anterior horn cells and brain stem) l causing inflammation of perivascular cells and diffuse infiltration of mononuclear cells of the meninges. l infiltrates mucosa and lymphoid tissues from pharynx to gut. l (multiplies in the oropharynx and lower intestinal tract). Fundamentals of Nursing . l Development of flaccid paralysis which may be: Bulbar or Spinal in distribution. l spreads to regional lymph nodes and the blood (hematologic spread.*Virus enters the body through alimentary tract. then becomes neurotropic). testicles.
5-10% of cases. Meningeal irritation(asceptic meningitis) persists to about 2wks :Stiffness of neck. (duration of illness is less than 5 days). Patient normally recovers after 72 hrs. with history of: Anorexia. 3.few hours to days only.more toxic than abortive. Abortive recovers with significant sequelae. higher temperature. abdominal pain Presence of: Fever. Phases/Stages in the progress of the disease and its corres. Fundamentals of Nursing . Inapparent infection – 90-95% of cases.ponding Signs and Symptoms. muscle pain. Symptoms in abortive disease is present. vomiting. sorethroat. frequently asymptoma-tic 2. Spinal poliomyelitis follows. and. Abortive Phase.Bulbar poliomyelitis is associated with the highest rate of complication and mortality. increased headache. 1. headache. Non paralytic phase. Manifest in 4 different forms differentiated in. pharyngitis and listlessness.
. arms. Lethargy. Non Paralytic: Nuchal rigidity. Non paralytic symptoms – meningeal symptoms with chills and rigors.-minor illness (viremia.4. Major polio involves CNS : paralytic and non paralytic. back. and abdomen and sometimes hamstring and other muscles. pains in the neck. Paralytic: 5-7 days of the onset of the fever.- Fundamentals of Nursing .1-3 days / 2-5 days asymptomatic. Frank paralysis phase(Paralytic disease). Systemic manifestations – mortality associated with respiratory failure due to respiratory arrest (paralysis).compromised motor neurons localized or widespread. legs.contains 1% of all viruses Biphasic course. irritability.
hypersensitivity to touch.Paralytic. Contipation and abdominal distention Extent of paralysis depends on the level of spinal lesions. or lombar Resistance to neck flexion = patient will “tripod” (extends his arm behind him for support when he sits up) Patient displays Hoyne’s sign. Recovery maybe complete.head will fall back when he is in supine position and shoulders are elevated. Urine retention. Loss of superficial and deep reflexes. Fundamentals of Nursing . partial or absent. when in supine position he won’t be able to raise his legs a full 900 Also positive for Kernig’s and Brudzinski’s signs. thoracic. cervical. Paresthesia. 5-7 days of the onset of the fever. Asymmetrical weakness of various muscles.
POLIOMYELITIS Fundamentals of Nursing .
4.given on 2 mos. rhythm = respiratory arrest 1. But is associated with Vaccine Associated Paralytic Poliomyelitis (VAPP). The present IPV was enhanced to suit the need. VAPP occurs frequently after the 1st dose. but may occur anytime after. . Vaccines : a. 6 mos with booster dose @4 yrs. providing appropriate herd immunity increasing vaccine uptake because it is taken orally and cost effective. dysphagia. As an alternative to prevent rising cases of these development). This is the 1st polio vaccine available. depth. b.oral attenuated polio vaccine (1960) it induces mucosal immunity. but this does not induce mucosal immunity. regurgitation of food through nasal passages Dyspnea. an All Inactivated Poliovirus Vaccine (IPV) was instituted and is administered parenterally. Oral Polio vaccine (OPV). inability to swallow or expel saliva Difficulty in chewing. Treatment and Management : Fundamentals of Nursing . 8-10 cases/year of polio is associated with vaccine virus. abnormal respiratory rate.Other signs and symptoms : Facial weakness Diplopia.
Physical therapy for long term rehabilitation . back pains. More fluid intake. Bed rest. muscle spasms and other pains.c.Active/Passive motion exercises during convalescent 6. Isolation 7. New Monovalent Oral Poliovirus type 1 Vaccine (mOPV1) Introduced in India in 2005.prescribe meds for headache. Analgesia for myalgias and aches • Morphine is contraindicated because of danger of respiratory suppression • Moist heat application to reduce muscle spasm and pain Laxatives for fecal impaction frequent in paralytic cases. 4. Tracheostomy care – often needed in patients requiring long term ventilatory support. 5. 3. Vaccine targets to eliminate some polio virus reservoir and eradicate wild poliovirus. Prevention of complications Fundamentals of Nursing . Supportive./ Diet rich in fiber. Mechanical ventilation is needed in patients with bulbar paralysis.Frequent mobilization to avoid development of decubitus ulceration . 2.
stool and throat for viral culture Acute and Convalescent serum for antibody concentration against 3 polioviruses. Aspiration Pneumonia 3. Paralytic ileus and 7. Paralysis 9. Laboratory: Specimen from CSF. Viral Myocarditis 5. Shock 10. Respiratory failure 2. Pulmonary Edema 4. and other CNS involvement conditions. 4 fold increase in immunoglobulin G antibody titers or a positive anti Immunoglobulin M (IgM) titers during the acute stage. GI hemorrhage 6. Gastric dilatation 8. Fundamentals of Nursing .Complications : 1.
Fundamentals of Nursing . physicians and if necessary a psychiatrist to help manage emotional stability. family. To control poliomyelitis. To alleviate discomfort. Reposition patient often and keep dry Apply high top sneakers or use a top board to prevent foot drop. well balanced diet Provide good skin care to prevent pressure ulcers. and light splints. as ordered. Help setup an interdisciplinary rehab program. Watch for signs of fecal impaction-(due to dehydration and intestinal inactivity) give sufficient fluids to ensure adequate. sterile solution for nebulize medication. which can cause HPN or shock because of its effect on the brain stem.which includes physical. occupational therapists.Special considerations : Observe for signs of paralysis and other neurologic damage Practice strict aseptic technique specially during suctioning. use foam rubber pads and sandbags as needed. community. Provide emotional support to patients. wash hands properly and often Check BP frequently specially on bulbar poliomyelitis.
MUMPS (Acute Parotitis) Causative Agent :myxovirus Acute viral contagious disease characterized by inflammation of parotid glands and tendency to involve the testes. Fundamentals of Nursing . immediately when swelling starts and 6 days after swelling ends Recovery : about 10-12 days. droplet nuclei Period of Communicability : 2 days before symptoms appear. person-person contact. Inflammation confined largely to interstitial tissue/parenchyma – slightly affected Incubation Period: 14-21 days (2-3 weeks) Mode of transmission : direct. It takes about 1 week (7days) for the swelling to subside.
lassitude. Moderate fever.congestion.Prodromal Signs : 1. malaise. Swelling of parotids. Stiffness and pain at angle of jaw 4.tender and diffuse –lasts for 7-10 days 5. redness (Stensen’s duct) Fundamentals of Nursing . sore throat 2.sometimes absent –Severe if c secondary illness –Mouth. Pain at the region of both parotids & ear for a few days 3. headache. Anorexia and Dysphagia 6.
usually occurs 10 days after the parotitis. shaking chills and headache : Nausea and Vomiting : Abdominal pain (mistaken for appendicitis.Clinical Manifestations and Complications Meningo encephalitis.frequent complication of the disease or post infectious encephalitis with demyelination.tender… Atrophy later Fundamentals of Nursing . Orchitis (epididymo-orchitis) : High-fever.) : General prostration : Swollen testes.
Acute pancreatitis : Abdominal pain with nausea and vomiting. Fundamentals of Nursing .pelvic pain Nephritis Thyroiditis Myocarditis.pericardial pain. chills Deafness and Optic Neuritis Oophoritis. bradycardia. fatigue and depression of S-T segment in the ECG.
Analgestics for pain and steroid for orchitis . Comfort: Rest in bed (duration of swelling) .Nursing Care/ Management 1.Isolation (until all swelling and until 5 days after) .Mouth wash w/ Na Perborate (cinnamon or nut meg) Fundamentals of Nursing .Care of nose and throat .Hot & cold compress .
Protection for the exposed clients: Stage after puberty. Usually given to children 12-15 months of age. Diet: -Soft bland: CHO. those that are taking immunosuppressive drugs or the presence of immune deficiencies. Control Measures: Immunization and Disinfections of contaminated articles (Infection control) Vaccines given alone or part of MMR. should be no later than 11-12 years of age. This is not recommended either to children less than 1 years old. no milk low fats 3.2.live attenuated mumps virus vaccine or attenuated lyophilized vaccine –(protective in 98% of susceptible vaccines. Fundamentals of Nursing .) Contraindications: patients allergic to eggs. 4. 2nd dose given 4-6 yrs of age.
Incubation Period/ Prodromal stage.coryza. fever. (4-5 days). characterized by fever and catarrhal symptons involving URT and with typical eruptions in skin and mucous membrane Stages: 1. malaise Fundamentals of Nursing .MEASLES (Rubeola/ Morbelli) Causative Agent : paramyxovirus Incubation Period:21 days (ave 14 days) *acute onset. cough.
arms.hemorrhagic rashes. Invasive / Pre-eruptive stage. Fundamentals of Nursing . legs. Covalescent stage. This is the stage wherein complication starts (if there is negligence in management of the disease) severe form of measles called “black measles”. fever of 40O40. buccal mucous appearance of koplick’s spots (after18O. Eruptive stage. spots fades/ disappear). 3. Fever subsides.photophobia. Excessive lacrimation and edema of eyelids. (3-6 days). along hairline.5O. Then desquamation starts extend to 1 week. along neck. Rash. and then rises again 6 days after koplik’s spots. epistaxis. 4. may occur. Fever falls when rash appears. trunk) it takes 3 days for the rash to cover the entire body. rashes fades the same way as it appears. melena and marked toxicity are some of the manifestations. forehead.2. Enanthem (mucous membrane) then exanthem (7-10 days) Reddish inflammation maculopopular eruptions from post auricular to face and extremities to trunk (behind ears.
MEASLES Fundamentals of Nursing .
wherein this should be treated with appropriate antibiotics basing on the clinical and laboratory findings. pus exudates/ mucous dripping out of ear/ears.Complications : 1. Pulmonary Tubercolosis 9. 4. often complicated by bacterial infection)= dry cough. foul smell coming from the ears. Membraneous laryngitis (rare) 6. Bronchopneumonia (usually after rash) *failure of the temperature to decrease during this stage. Diarrhea/ Abdominal pain 5. 7.acute usually occurs in the 2nd week of illness but may occur in the prodromal stage or after rash appears.patient should be monitored for this. Fundamentals of Nursing . Bacterial super infection. 2.occulomotor. 3. earache. 8. increase respiratory/ dilation of alaenasi. cyanosis. Encephalitis. indicates Pneumonia (viral involvement of the lungs/ interstitial. Catarrhal inflammation of conjunctiva. Otitis Media. (Paralysis of three cranial nerves). corneal ulceration. increase pulse rate.
only if infection sets in according to clinical evaluation and confirmed by laboratory tests. 4grams. cool mint vaporizer. Vaccines and immunoglobins for prophylaxis.Treatment and Management : 1. though this is of no value once the illness is in progress Fundamentals of Nursing . Provide client comfort. Increased fluid intake 8. eyes. TSB. Rest. 7.applied at the eyelids. Antibiotic. mouth and nose Neosilvol 5% solution. Keep client warm and dry 3. ears.) Vaseline. Medications: Promotive.(instill1-2 gtts directly into each of the eye daily 5 gtts in each nostrils od. Bed rest till fever subsides 6. Preventive / Symptomatic and Supportive= Antipyretic.Activity balance 2. antitussives. Care of the skin. Isolation until 5th day of/with rash 5. to moisturize area around 4.
04-ml/kg body wt. is given within 5 days after exposure.05ml/kg body wt (max 0.9. Care for the exposed person : Measles Hyperimmune Globulin.1-ml/kg body wt.Previously healthy unvaccinated children. 8 weeks thereafter.25-ml/kg body wt.15) Prophylaxis: Active Immunity: *Natural acquired.Unvaccinated children with malignancy/ or immuno deficiency disorder or those that are receiving immunosuppressive drugs= 0. Old baby (not to give a patient with leukemia / lymphoma or pregnant) Fundamentals of Nursing . In place of MHG. child should be vaccinated with live attenuated measles virus vaccine. client should receive 0. after infection confers a limited time of immunity *Artificially acquired. live attenuated virus vaccine. 0. standard immune serum globulin should be given IM immediately after exposure.0. IM.5ml subcutaneous (arm) single dose to 9-12 mos. . beyond 5 days after exposure. .
by watching out for signs of secondary infections.infants acquire a temporary transplacental immunity *Artificially acquired. Special Consideration : Prevent client from developing complications.25ml/kg gamma globulin or killed virus vaccine given within 5 days after exposure. appropriate nursing management. and giving prescribed medications and good.0. Report case of measles to public health office for continuing community care. 250-750 mg IM given to young children exposed to the disease and in poor health.Passive immunity : *Natural acquired. Fundamentals of Nursing .
and may also be found in blood. (human amnion cells infected by the virus presents a round clumping of nuclear chromatin and eosinophilic intranuclear inclusions) Mode of transmission: direct contact (droplet as well as respiratory secretions. stools and urine. characterized by fever. an average of 14 days (2 weeks) Period of Communicability: rash stage Fundamentals of Nursing . Incidence: symptoms are often missed or are misdiagnosed as an allergy.GERMAN MEASLES (Rubella) -acute onset but mild disease. or mild measles Incubation Period: 10-21 days. enanthem and retoauricular and sub occupital adenopathy and which is found to have a teratogenic effect on a pregnant woman’s fetus Causative agents: sheroidal RNA containing virus.
-Pinkish. stifness of the neck and anorexia 4. sore throat. then on the neck. followed by the arms (exposed part of the body). within 24 hrs. Small red lesions at the palate called(forecheimers spot) this is not a pathognomonic sign 5. spreads very rapid that it may progressively fade away within 48-72 hours (with some cases. only) 6. Minimal rashes that can be diagnose as an allergy. headache. Malaise.Signs and Symptoms: 1. mild conjunctivitis. Lymphadenopathy (swelling of posterior auricular & sub occupital nodes) appears before the rashes are apparent and lasts about 3-5 days. Mild catarrhal symptoms 3. eventually the trunk and legs. Fundamentals of Nursing . Low grade fever 2. maculopapular rash which begins on the first day with or without fever. Starts on the face.
GERMAN MEASLES Fundamentals of Nursing .
Fundamentals of Nursing . changes in Ab titers 3. ELISA (enzymes link immunosorbent assay). Splenomegaly 8. Hemaglutination Inhibitation (HI) antibody test. Polyarthralgia and Poly arthritis 9. C-fixationtest.7. identification. Pain and swelling of the wrist. fingers. No Pathognomonic sign 2. SRH (single radial hemolysis) 4. Testicular pain in young adult Diagnosis: 1. Virus isolation. which are most marked during period of rashes and persists to about 14 days after all other symptoms disappear. RIA (radioimmunoassay). and knees.the most useful for diagnosing german measles.
eyes. Good Ventilation and Environment 4.Treatment : Purely symptomatic and suuportive Management : 1. care of skin. Proper Nutrition and Good Diet Fundamentals of Nursing . Isolation 3. neurological abnormalities and CHD) 5. Prevention of complication (for the fetus is Congenital Rubellaretardation. eyes and ear defects. ears and mouth & nose 2.Relief of discomfort.
drying up and leaving a superficial crust.CHICKEN POX (Varicella) -Acute. 2-3 weeks vary Period of communicability: 1 day before rash and until vesicles is fully crusted. in vesicular fluids (moist lesions) on the skin. Virus present in mouth. Fundamentals of Nursing . highly contagious disease. Causative Agent: herpes virus varicella zoster (v-z) Mode of transmission: direct contact (droplet. and respiratory secretions and vesicular content) Incubation period: 14 days. infectious 24O hours prior to appearance of eruptions and till fully crusted. A DNA carrying virus characterized by mild constitutional symptoms and generalized eruptions of papules and vesicles. which appears in crops.
all forms are present. anorexia. Prodromal stage. formation of scabs/ crust. malaise. 2. cellulites. vesicles continue to appear 3-4 days after prodromal signs. coryza – within 24 hrs of rash. 7 – 9 days after.initially with slight fever (chicken pox doesn’t manifest increase in temperature.Signs and Symptoms: 1. presence of Pocks (main lesion) then. Complications: • Infection (skin abscess) • Myocarditis • Encephalitis • Pneumonia • Other minor complications: furuncles.). Rash maculopapulo-vesicular eruptions : highly pruritic. erysipelas. Fundamentals of Nursing . most pocks have dried up.
CHICKEN POX Fundamentals of Nursing .
Supportive and preventive measure Care of the Skin : > provide mittens to prevent infection due to scratches. Geimsa strain – distinguishes V-Z from vaccinia variola viruses. > Local / systemic antipruritic agents. Serum contains antibody 7 after onset.Diagnosis: Virus can be isolated in 3-4 days after rash. Strict Isolation 2. > Equal parts of boric acid. zinc oxide and talcum powder Fundamentals of Nursing . Fluorescent antibody to membrane antigen (FAMA) – for identification of antibody Complement Fixation test Treatment and Management: 1.
speed skin healing and control systemic spread of infection. Warm bath.Comfort: > Calamine lotion. Cool bicarbonate of soda baths. *** Salicylates are contraindicated! 3. Health Education Fundamentals of Nursing . > Antihistamine – dipenhydramine > Olive oil. > Acyclovir – may slow vesicle formation. Prevention of Infection: > Antibiotics: penicillin ointments.
and segmental inflammation of the dorsal root ganglia caused by infection of herpes virus varicella which also causes chicken pox. paresthesia and hyperesthesia develop Fundamentals of Nursing . Skin lesions runs in a typical course 2. begins with fever and malaise 3. 2-4 days severe deep pain. Also called Shiingles Causes: .Reactivation of varicella virus that has lain dormant in the cerebral ganglia (extramedullary ganglia of the cranuial nerves) Signs and Symptoms : 1.HERPES ZOSTER -an acute unilateral. pruritus 4.
HERPES ZOSTER Fundamentals of Nursing .
under fluorescent light differentiaties zoster from simplex Fundamentals of Nursing . csf shows increased protein levels. nodular that turns to vesicles filled with clear fluids or pus 6. trigeminal.5. 2 wks after the first symptom. pleurisy 3. Positive diagnosis isn’t possible until the characteristic skin lesions develop 2. fluid and infected tissues. small. fluid.shows eosinophilic intranuclear inclusion and varicella virus Lumbar puncture shows increased CSF pressure. When it involves cranial nerve.. nodlar skin lesions erupt on the painful areas. Diagnostic test. possibly pleocytosis Staining antibodies from v. red. spread unilaterally around the thorax or vertically over the arms or legs. V. geniculate ganglia. vesicles dry up and form scabs 7. Pain mimics that of appendicitis. 10 days after. occulomotor nerve Diagnosis : 1.
this prevents dessiminated life threatening disease in some patients.this shortens the duration of the pain and symptoms in normal adult. or sedatives. tricyclic antidepressants with phenothiazines Acyclovir therapy maybe administered through IV. Fundamentals of Nursing .No Specific Treatment Primary goal is supportive tx relieve itching and neuralgic pain with calamine lotion and antipruritic Collodion or tincture of benzoin applied to unbroken lesions Analgesics Systematic antibiotic Instillation of antiviral agent Systematic cortecosteroid to reduce inflammation and to deal with post herpetic neuralgia Tranquilizers..
Special Considerations : Keep patient comfortable. maintain cleanliness and good hygiene to prevent infection During acute phase encourage rest and promote proper healing of lesions Apply calamine lotion Fundamentals of Nursing .
children under 5 years old are most affected Portal of Entry: oral ingestions.DIARRHEAL DISEASES In developing countries. In Industrial countries like United States. (high acidity of the stomach.) Fundamentals of Nursing . and antibody-producing cells of small bowel serves to decrease potential of pathogens. infectious diarrhea kills about 4 million people/year.
Parasitic. ** Bacterial . Goal of rehydration: To correct dehydration…immediately! Assessment includes: Thirst Oral mucous membrane dryness Sunken eyes Weakened pulse Loss of skin turgor Fundamentals of Nursing .most important element is : Assessment is to determine hydration status. ** Rotavirus – most significant viral cause of diarrhea in young children.Shigella Nursing Process: .Escherichia Coli . Bacterial.Specific causes: Viral.Salmonella .
whether client has been in contact with anyone who has recently had diarrheal disease. weigh regularly Assess physical signs of dehydration. Deficient knowledge about infection and risk of transmis-sion to others related to specific personal status. Fundamentals of Nursing . . Nursing Intervention / Management: Correcting dehydration associated with diarrhea. Fluid infusion and oral rehydration Measure I & O.whether client was recently treated of antibiotics . Nursing Diagnosis: Deficient fluid volume related to fluid loss due to diarrhea.Health history – check for recent travel .recent food intake.
Clean Water.Prevent spread of infection: . CBR. proper management of Diet and Nutrition Maintain Fluid and Electrolyte balance.Screening Practice standard precaution with enteric precaution Isolation Medications: Antibiotic and other supportive medications. . Monitoring and managing potential complications. Fundamentals of Nursing .Proper Sanitation & Sewerage.
Causes local and nosocomial infection. Fundamentals of Nursing .ESCHIRICHIA COLI /GASTROENTERITIS Aerobic. inflammation and diarrhea Transmissions : -directly from infected person.Coli infections. –these toxins interact with intestinal juices and promote excessive loss of chloride and water. or indirectly by ingestion of contaminated food or contact with contaminated utensils. gram negative bacilli. The invasive form directly invades the intestinal mucosa without producing enterotoxins= local irritations. a major cause for diarrheal illness. enterotoxin-producing E. Non-invasive.
Abrupt onset of loose watery diarrhea 2.Signs and Symptoms : depends on the causative toxins. Vomiting. listlessness.Culturing is of little value since E. mucoid or blood tinged 5. irritability 6. pain 3. Anorexia 7.Coli resides in GI tract. severe dehydration.which rules out shigellosis. Changes in consistency=yellow to green stools. Therefore clinical observation is most appropriate. In severe illness. Abdominal cramping. Identification procedures : bioessay.fever. and salmonellosis Fundamentals of Nursing . 1. Chills & fever 4. acidosis and shock Diagnosis : .
Report cases to public health.Treatment and Management : 1. boil water and wash raw foods before intake Fundamentals of Nursing . Monitor volume of stool and note of the presence of blood or mucous 6. Bismuth subsalicylate 5. 7. proper hand-washing technique. Keep an accurate intake and output records. irrigating tubes etc. Prevent the spread of infection: screen all personnel and staff of diarrhea. Correction of fluid and electrolyte imbalance 3. Isolation 2. IV of antibiotics to the appropriate case 4. discard used bottles.
motile and ferments lactose. gram negative bacilli. Food to humans through a vehicle with 5 F’s.SALMONELLOSIS / (SALMONELLA THYPOSA) A common infection usually caused by non-spore forming. Causative agent : Salmonella typhosa Incubation period : 7-14 days with (innoculum size 3-60 days) Mode of transmission: direct / indirect. Most severe form of salmonellosis. sucrose and glucose. Reservoir : only humans. Fundamentals of Nursing .
3. Progress of the Disease ST enters the body through alimentary tract l GI tract (localized in the reticulo-endothelial system) l invades the bloodstream via lymphatics (there is hyperplasia and hypertrophy of the lymph nodes) l Setting up intracellular sites – infection sets in including gallbladder and affects the billiary tract Fundamentals of Nursing . 2. Certain drug substances of animal origin Salmonella produce disease only if host’s resistance is impaired and an increase in the virulence of the organism. Ingestion of infected food or water. Carriers – patients who have recovered from fever but whose stools or urine may carry the bacilli for years.Sources of infection: 1.
Signs and Symptoms: First week > gradual increase in temperature. ulcerated and necrosed tissue. anorexia > headache. Fundamentals of Nursing . malaise. l Hemorrhage Symptoms are due to the effect of endotoxins and other bacterial products.l Intestinal seeding of millions of bacilli. slow pulse ( which is disproportion to presence of high temperature) with distinct dicrotic wave. starts with low grade fever > myalgia. penetrates and involve lymphoid tissues (peyers patches in the ileum) l Enlarged.
> relapse or complications occur. delirium > abdominal pain and distention (tympanites) and tenderness at the right quadrant (hepatomegaly) and left (spleenomegaly) > diarrhea and constipation. Third week > persist fever.Second week >remittent fever up to 40 C usually in the evening. moist crackles > maculopapular rash especially in the abdomen and chest. diaphoresis. gallbladder is a site of persistent intestinal infection (asymptomatic) Fundamentals of Nursing . Subsides on the 3rd week. weakness. increasing fatigue and weakness. Carrier state – bacteria present in at least a year in the fecal matter. > cough. > chills. lasts for 4-6 weeks.
Intestinal hemorrhage due to perforation 2. Abcesses. thrombophlebitis. Pneumonia. Fundamentals of Nursing . osteomyelitis. Meningitis.Complications: 1. cerebral thrombosis 6. Treatment: Specific: Ampicillin IV or PO 100mg/kg body wt/day Amoxicillin PO 4g/day Trimethoprim(320-640mg) combined with Sulfametazole (1600-3200mg/day) – given in 2 divided doses – is given to clients resisting to chloramphenicol. Myocarditis 3. acute circulatory failure. bone marrow suppression 4. Localized infection 5.
Chloramphenicol – IV or PO 50mg/kg/day given in 4 divide doses or 100mg/kg/day given in 4 divided doses. Non-specific: Acetaminophen Steroid (prednisone) 1-2 mg/kg/day in 3-4 divide doses orally for 3days in severe delirious client For blood loss – give plasma expanders. Widal’s tests – agglutination or clamping of organism on clients serum. Total dose should not exceed 2grams *Recommended duration of therapy : 2 weeks. (+) in the 10thday or end of 2ndwk. Diagnostic tests: Stool exams – McConkey’s agar (differntial agar positive for organism after the 1st week and throughout the course. Serologic test – positive for organism after 1 week. Fundamentals of Nursing .
care for the exposed persons. low fats and low residue diet with Vit B.shows rising titer in the 2nd-3rd wk of the disease recommended time of test on the 8th-10thday and repeat by the 4thwk Bone marrow puncture or culture – to determine presence of microorganism. avoidance of further contact. Fundamentals of Nursing . Management: Isolation of client – enteric precaution. Supportive care with CBR Antibiotics and prescribed medications given cautiously. cho. high protein. immunization for prevention Diet : avoid gas forming foods Fluid and Electrolyte (oral rehydration or IVF ) Most important: determine hydration state of the client I&O should be measured High caloric. Environmental sanitation Vaccine. Watch altered state and other signs of complications.
Causative agent: Vibrio Cholerae – gram negative motile. unsanitary environment. causing severe gastrointestinal symptoms resulting to generalized physiological imbalance. host and victims.dirty surroundings. Infectd stools. water and preparation of food Fundamentals of Nursing .CHOLERA is an enterotoxin-mediated GI infection. aerobic bacillus. ** transferred through contaminated food and water by infected feces/stools. Mode of transmission: humans as carriers.
Fundamentals of Nursing . Tachypnea Thready or absent peripheral pulses. (rice watery stools) Effortless vomiting. metabolic acidosis. especially the extremities. hypoactive bowel sound. and death if treatment is delayed. falling blood pressure. pinched facial expression Muscle cramps.) Specific Symptoms: Rice watery stools Vomiting Generalized weakness. Poor skin turgor. Tachycardia. painless. Oliguria. Intense thirst – due to massive diarrhea and vomiting Fluid and Electrolyte imbalance Fluid loss is as much as 1L/hour. profuse watery diarrhea Stools – white fleck mucous. Cyanosis. =(hypovolemic shock. Inaudible. Fever and body malaise. Sunken eyes.Signs and Symptoms Acute.
especially if symptoms persists despite replacement of Fluids and Electrolytes IV infusion of large amount of isotonic saline solution (50-100ml/min.) alternating with isotonic sodium bicarbonate or sodium lactate. Antibiotic therapy. Cholera may lead to metabolic acidosis. Incubation period: several hours to 5 days. Treatment and Management: If treatment is delayed or inadequate. however. Oral glucose electrolyte solution. uremia and possibly coma and death. most of the clients are free from infection after about 2 weeks. but is given to prevent complication. (is not proven to have shorten the course of infection. Potassium replacement added to IV solution.) Doxycycline (tetracycline) given through IV. Fundamentals of Nursing . Improved Sanitation and Administration of Cholera vaccine. Community health education.3% of clients who recover continue to carry V.cholerae in their gallbladder.
Wear gloves and gown in handling feces contaminated articles. Monitor intake and output. including volume of stools and fluid replacements. Fundamentals of Nursing . Proper boiling of water and cooking of food as preventions Avoid areas where there is an endemic case of Cholera. Proper hand washing and avoidance of contact with infected materials. Supportive care and close observation.A cholera patient requires enteric precautions. Protect clients family by giving prophylactic oral medications of tetracycline.
pleural cavity pericardium. Fundamentals of Nursing . Acute or Chronic protozoa infection caused by: Entamoeba Histolytica Most common in the tropics. Extraintestinal amebiasis can induce Hepatic abscess. infections of the lungs. mild to severe fulminant dysentery. produces varying degrees of illness.AMOEBIASIS Also known as amebic dysentery. peritoneum but rarely the brain.
but with some common complications Causes: Entamoeba Histolytica exists in 2 forms : A Cyst (survives outside the body).Incidence higher in gay men and lesbian women and institutionalized people in whom fecaloral contamination is common. Prognosis: Good. it is encysted and then excreted with the feces/stool. then invades and ulcerate the mucosa of large intestine l Or simply feeds on the bacterias l As these are carried slowly towards the rectum. Fundamentals of Nursing . A Trophozoite (cannot survive outside the body) Mode of transmission: fecal oral route / contaminated food and water Ingested cysts pass through to the intestine l Digestive secretions break down the cyst and liberates the motile trophozoites within l Trophozoites multiply.
Partial or complete bowel obstruction due to complication of granuloma. recurs several times a year. tenderness over the cecum and ascending colon (indicates hepatomegaly) Foul smelling mucoid and blood tinged stools daily Weight loss Chronic amebic dysentery: intermittent diarrhea. mucoid diarrhea with tenesmus Diffuse abdominal tenderness due to extensive rectosigmoid ulcers. Fundamentals of Nursing .Signs and Symptoms: Sudden rise in temperature(40 C) and chills Abdominal pain and cramping Profuse bloody. 1-4 weeks.
Diagnosis: Isolating E.Histolytica from feces or aspirated fluids from abscesses, ulcers or tissues confirms Amebic Dysentery. Sigmoidoscopy – detects recto-sigmoid ulceration, biopsy maybe helpful. X-rays, Stool exams, Cecum palpation. Indirect Hemagglutination test –(+) with current & previous infection Complement fixation– usually (+) only during active phase of disease. Barium studies – rule out non-amebic causes of diarrhea such as polyps and cancer. Complications: Amebic granuloma commonly mistaken as cancer. Acute appendicitis due to toparasitic and bacterial invasion of the appendix. Perforation of the intestinal wall, causing spread to the liver and diaphragm. Perforation of the lungs, pleural cavity and sometimes the brain. Treatment : Drugs – Metronidazole - Iodoquinol, Diloxamide, Paronomycin *** advise clients with Amebic Dysentery to avoid drinking alcohol when taking metronidazole, the combination causes nausea, vomiting and headache.
Fundamentals of Nursing
A common systemic disease, marked by hepatocellular destruction, necrosis and autolysis leading to anorexia, jaundice, hepatomegaly. Some patients hepatic cells regenerate. Prognosis is poor if edema and end stage liver disease develops
Fundamentals of Nursing
Types of hepatitis :
1. Type A (infectious or short incubation hepa.) rising among homosexuals and people with immunosuppression related to human immunodeficiency virus (HIV) infection. Usually self-limiting. Highly contagious, usually transmitted by fecal-oral route. Usually results from ingestion of contaminated food, milk, or water. Often ingestion seafood from polluted water. At risk: IV drug abusers and recipients of multiple blood product transfusions. Type B (serum or long incubation hepa.) is now considered sexually transmitted disease. Transmitted by contact with human secretions and stool passed or recipients of plasma derived products or hemodialysis patients. Also during sexual contact or perinatal transmission.
Fundamentals of Nursing
VIRAL HEPATITIS A
Fundamentals of Nursing
Fundamentals of Nursing
Type C accounts for 20% of all viral hepatitis. Usually obtained from tattooing. Transmitted through transfused blood from asymptomatic donors. Associated with high rate of chronic liver disease(chronic hepatitis, cirrhosis, increased risk of hepatocellular carcinoma) Type D (delta hepa.) responsible for 50% of all fulminant hepatitis, high mortality – causes unremitting liver failure with encephalopathy, progresses to coma and death. People who are frequently exposed to blood and blood products. Transmitted parenterally, less frequent in sexually frequent H-B illness. Type E (non-A or non-B hepatitis)- water borne. Fecal oral route. Detection is difficult.
Fundamentals of Nursing
Signs and Symptoms : 1. Prodromal stage (pre icteric) : weight loss, malaise, depression, headache, weakness, arthalgia, myalgia, photophobia, nausea and vomiting. Vital signs; 37.9OC-38.9O 1-5 days before jaundice stage. Dark colored urine and clay-colored stools Clinical stage (icteric) : jaundice stage, pruritus, abdominal pain, tenderness, anorexia, jaundice of sclerae, mucous membranes and skin, lasts for 1-2 wks. Indicates liver damage is unable to remove bilirubin from blood, rashes, erythematous patches, urticaria occasionally, splenomegaly and cervical adenopathy Recovery stage (post icteric) : patients symptoms decrease. Lasts for 2-12 weeks although sometimes it lasts longer.
Fundamentals of Nursing
Diagnosis : - Serumaspartate aminotransferase and serum alanine aminotransferaselevels are increased in acute viral hepa. - Serum alkaline phosphatase are slightly increased - Serum bilirubin levels elevated - Prothrombin time- prolonged (more than 3 seconds longer indicates liver damage) - WBC – reveals transient neutropenia and lymphocytosis - Liver biopsy done only if diagnosis is questionable. Treatment and Management : 1. No specific drug therapy except on type c which is successfully responding to interferon alfa-2b. 2. Rest is strongly recommended 3. Small frequent feedings in high protein, largest meal should be in the morning.
Fundamentals of Nursing
patent airway. 6. 7.4. importance of activity pacing Health education and restrictions emphasized to prevent recurrence Administer supplemental vitamins and feedings Monitor patient’s weight daily. Strict isolation. 5. confusion and mental changes Antiematic Parental nutrition Anti pruritic – resin cholestyramine Enteric precaution Thorough and proper hand washing. Protein reduce if there is sign of lethargy. Provide rest periods. control hypoglycemia Fundamentals of Nursing . maintain F7E balance. record intake and output Watch for signs of fluid shift such as fluid gain and orthostasis Watch signs of hepatic coma. prevent infections and control bleeding. maintain electrolyte balance Watch out for signs of complications In fulminant hepatitis.
most clients recover but some develops fulminating hepatitis or cirrhosis. Causes : Alcohol overuse Direct hepatotoxicity liver cell damage due to toxins. Hypersensitivity to phenothiazine derivatives such as chlorpromazine. antidiabetic drugs and cytotoxic drugs. methyldopa. antibiotics. mercaptopurine. pravastatin. and halothane. classified as toxic or drug induced inflammation of the liver. dipyridamole. Cholestatic reactions – lack of bile excretion. also dose dependent. Fundamentals of Nursing . thyroid meds.Non viral hepatitis. isoniazid. usually caused by acetamenophen overdose Idiosyncratic hepatotoxicity – sensitivity to medications such as. lovastatin. direct damage from oral contraceptives or anabolic steroids.
Infectious agents – systemic virus such as cytomegalovirus. varicella zoster. spirochetes such as syphilis and leptospirosis. adenovirus. coxsackievirus. Metabolic and autoimmune disorders – acute exacerbations of other liver disease. mononucleosis or Epstein-Barr virus. Fundamentals of Nursing . and human immune deficiency virus. herpes simplex. measles virus.
fasting blood glucose. total protein. abnormally low • Serum bilirubin levels. Urinalysis . CBC. elevated. AST. hemoglobin level. ALT. hematocrit. albuminglobulin levels. • Anemia commonly results from decreased red blood cell life • Enzymes will show elevation 4-10 times normal due to liver cell necrosis • Protein and serum A/G levels.Diagnostic Evaluation : • Hermatologic and Liver function test.Proteinuria and hematuria maybe present Fundamentals of Nursing . LDH. prothrombin time. bilirubin levels. alkaline phosphatase.elevated bilirubin levels .
vomiting. and diarrhea. Nursing Diagnosis : Altered nutrition (less than body requirements) related to anorexia Fluid volume deficit related to nausea.Chest X-Ray and ECG : this determines the condition of the respiratory and cardiac tissues. Liver Biopsy : shows local or diffuse. widespread necrosis Serum studies for hepatitis B surface antigen (HBsAg): confirms the diagnosis if antigen is present. Impaired physical mobility related to bed rest Impaired skin integrity related to pruritus Social isolation related to bed rest and separation from peers Depression due to anxiety related to knowledge deficit Planning and Goals Client recovers from hepatitis w/out life threatening sequel Regain adequate nutritional and fluid through intake Learn how to prevent infection Fundamentals of Nursing .
Maintain infectious disease precaution to prevent spread of hepatitis. Monitor vital signs and weight. Promote gradual intake of high biologic value protein with vitamins and minerals. HBV protein contains all essential amino acids. Although anorexia may be pronounced.Nursing care 1. Nursing Rationale 1. Maximum precautions help prevent infecting others with the client’s equipment and utensil 3. 4. Fundamentals of Nursing . provide skin care 2. Assist client to comfortable positions in bed. encourage fluid intake. 4. Bed rest is necessary until the diagnosis is clearly established (client have limited mobility for 5-10 days or until liver enlargement decreases) Because of weight loss. measure I & O. client’s appetite will slowly improve as he recovers. his skin and bony prominences may be vulnerable to injury 2. Client’s temperature may fluctuate and weight continue during the acute stage of the disease 3. provide padding to lessen pressure over bony prominences.
7. 7. Contact community health care providers. as needed. the client may develop toxicity. Discharge when condition improves sufficient for him to continue recovery at home. Knowledge deficit can be associated with clients deteriorating condition. Assist client with ROM exercises. Teach client about the disease methods of transmission and preventive measures. 10. Prepare for home care. Fundamentals of Nursing . Bed rest and fatigue may prevent client from maintaining satisfactory muscle mass or function. Refrain from administering medications not ordered by the physician. Hepatitis-B has a 6month recovery period. 6. 10. A dysfunctioning liver cant metabolize medications. 6.5. 8. 5. 9. Provide activities to induce positive mood and self concept. Follow up care at home is vital to the health and safety of the client and those in contact with him. 8. 9. Fatigue and depression may hinder the client in investing full interest or participation.
Vector Borne Diseases And Other Zoonotic common Infectious disease Fundamentals of Nursing .
Fundamentals of Nursing . Literally means “bad air” It is transmitted by the bite of female Anopheles mosquitoes. which proliferates in humid swampy areas.VECTOR-BORNE DISEASES viral * bacterial * parasitic MALARIA An acute infectious disease caused by a protozoa of genus Plasmodium.
and Plasmodium Ovale Etiology: Infected mosquito bites injects a Plasmodium sporozoites in a host l Sporozoites goes with the blood circulation l Invades parenchymal cells of the liver l Forms cyst-like structures containing thousands of Merozoites Fundamentals of Nursing .Types: Plasmodium Falciparum Plasmodium Vivax Plasmodium Malariae.
ovale. (which if not destroyed will destroy more erythrocytes) Infected person becomes the reservoir l non infected mosquito gets infected blood from reservoir.malariae persists in the liver for years – chronic carriers Fundamentals of Nursing .vivax. cell debris and more merozoites. Hepatic parasites P. l Same cycle begins. P. releasing malaria pigments. P.Merozoites are released in the circulation. each merozoite invades an erythrocyte and feeds on hemoglobin l Eythrocyte rupture.
Fundamentals of Nursing . headache.ovale) Hepatospleenomegaly Hemolytic anemia Persistent high fever. Hot stage 3-4 hours : high fever (107.C) Wet stage 2-4 hours : profuse sweating Paroxysms every 48-72 hrs (P.Malariae) Every 42-50 hrs (P.F / 41.Falciparum which the most life threatening form of Malaria.Signs and Symptoms: Specific: Chills.vivax or P. fever. RBC sludging w/c leads to capillary obstruction at various sites – found in P. orthostatic hypotension. myalgia (with periods of well being) In acute attacks: 3 stages when erythrocytes rupture: Cold stage 1-2 hours : chills to extreme shaking.
MALARIA Fundamentals of Nursing .
Urine – presence of protein and leukocyte. seizures. delirium.000/ul) .Signs and symptoms of obstruction of the capillaries in specific sites Cerebral – hemiplegia. uremia Diagnosis: Blood test –indirect fluorecent serum antibody (but can be unreliable in acute phase because antibodies cant be detected 2wks after onset) . abdominal pain. Renal – oliguria. coma.000-50.000/ul) . Fundamentals of Nursing .prolonged partial thromboplastin time (60-100 secs) .prolonged prothrombin time (18-20 sec. melena.) .reduced number of platelets (20. hemoptysis Splanchnic – vomiting. Pulmonary –coughing. anuria.normal – decreased leukocyte count (as low as 3.decreased hemoglobin level .decreased plasma fibrinogen. diarrhea.
Treatment: Chloroquine therapy – oral for comatose. – with severe adverse reaction for drug combination Fundamentals of Nursing . Primaquine phosphate is given daily for 14 days. pt is given thru IM Oral Quinine ( for chloroquine resistant malaria) for 10 days Pyrimethamine and Sulfonamide (Sulfadiazine) or Tetracycline. In hepatic stage. Chloroquine and Sulfadoxine-Pyrimethamine (Fansidar) for those staying longer than 3 weeks in the area. (induces hemolytic anemia) Preventions/ Prophylaxis: Oral Chloroquine should be taken weekly 2wks before the trip and 6 wks after – for those staying less than 3 wks in a malaria infested areas.
noting any recent travel. Community care with health education. Proper and frequent hand washing. Protect patient from secondary bacterial infection. Practice standard precaution and Aseptic techniques. blood transfusion. Double bag these items Supportive care Preventive care Watch for signs of Complications. Fundamentals of Nursing . Discard used needles. Proper assessment of patient upon admission. type of malaria. Enforce bed rest. Record symptom pattern. or drug addiction. Fluid and Electrolyte watch and balance. syringe and contaminated objects. foreign residence. strict record of I & O Monitor IV fluids closely and avoid fluid overload.Special Considerations/ Management: Obtain a detailed patient history. fever. and any systemic sign.
zoonotic in origin).Leptospirosis A group of bacterial diseases caused by antigenetically distinct members of the bacteria which is aerobic. Weil’s or Swineherd’s in humans. gram-negative spirochete tightly coiled around axial filament bent at one or both ends producing hook-like appearance. Also known as Red Water disease in cattle (primarily an animal pathogen. motile. Mutated as human pathogen Thrives in kidney / urine. Fundamentals of Nursing .
vomiting. Meningitis. nose. Signs and Symptoms: Exposure and manifestation of first clinical symptoms: 2days to 4weeks. Kidney or Liver failure. hemorrhagic rash. muscle aches. sometimes asymptomatic. Symptoms usually lasts 4-7 days. weakness. 2.Causative agent: leptospira interrogans Organism is released through urination. Second phase is more severe with the ff symptoms: 1. which complicates recovery – this phase is called Weil’s disease Fundamentals of Nursing . abdominal pain. mouth as well as abraded/break in the skin. Vasculitis 3. Can survive several weeks outside the body/host in a moist. First phase / Initial signs are: Abrupt onset of: fever. Disease is Biphasic. jaundice. Portal of entry: Mucous membranes of the eye. transmission from humans to animals and vice versa. diarrhea. alkaline soil or stagnant slow moving slightly alkaline water. conjunctivitis. headache.
For severe cases. Cerebrospinal fluid. urine. Blood. Penicillin IV is recommended. Streptomycin during acute phase. Fundamentals of Nursing .Diagnosis: Wharthin-Starry or Geimsa stains can reveal leptospire. Fluid therapy to prevent dehydration In severe cases: Dialysis and life support measures Phrophylactic therapy: Doxycycline 200mg once a week. Penicillin. and tissues can be cultured. Treatment and Management: Antibiotics – Doxycycline. beginning in the week prior to anticipated exposure. Flourescent antibody and microscopic andm macroscopic agglutination tests are serologic methods of detection.
Monitor BUN. Laboratory tests should be done. Fundamentals of Nursing . Maintain Fluids and Electrolyte balance. Community involvement for prevention and awareness. Creatine. Patients who have been infected of leptospira should not donate blood for at least 12 months after recovery. Liver function test and Bleeding time.Special Consideration: Although human to human infection has not been documented. Monitor I & O accurately. wear gloves in handling fluids. Proper hand washing.
more prevalent by dawn. Dengue) Condition arising from infection due to virus transmitted by specific mosquitoes carrying disease that can sometimes cause internal bleeding which can be life threatening due to shock. around 4am or early morning till sunrise) Fundamentals of Nursing . Mode of Transmission: through a bite of the virus carrying mosquito (daytime mosquito. Causative Agent: Aedes mosquitoes (Aedes Aegypti) Four serotypes of Viruss that rely on mosquitoes and other organisms to complete their life cycle.Hemorrhagic Fever (H-Fever .
Dengue Hemorrhagic Fever Fundamentals of Nursing .
Fundamentals of Nursing .
cough. Severe Signs and symptoms: Sudden onset of headache Fever (with the characteristic of 3 days elevated.Incubation period: 2 – 5 days (sometimes 24 hours) after the bite of an infected mosquito. and plateau after the 3rd day. bone and joints / weakness Malaise Fundamentals of Nursing . Forms of H-Fever: 1. patient complaint od sorethroat. groin pain photophobia Retro orbital pain Backache. Mild 2.) Flu-like symptoms.
Hyperpigmented rashes Flushing of the face Conjunctivitis Anorexia Abdominal pain, Nausea or vomiting Lymphadenopathy Hepatomegaly may occur. Diagnostic tests: (Tourniquet test is done initially) Complete blood count Platelet count Clotting time
Fundamentals of Nursing
Bite of a virus carrying aedes mosquito l Mosquito injects fluid into victim’s skin And virus enters the blood stream. l Infects cells and generate cellular response (as in any viral infection, virus enters the cells and initiates cell activity to survive) l Initiates immune reponse (stimulates release of cytokines) l In the process the cytokines (release to destroy the virus),it also destroys the cell membrane and cell wall. l (viral antigens found in monocytes) Fluid shift
Fundamentals of Nursing
l when treated early with doctor prescribed Medications and managed to prevent the Appearance of other symptoms. l IVFs and Electrolyte replacements and preventions. l Patient recovers
l when illness becomes severe l > damage cells due to both cytokines & and virus l > fluid shifts from ICF to ECF l Manifests evanescent rashes, (indicating there is bleeding) and rashes in several areas of the body. l may have bloody vomitus, urine and stool. l this precedes circulatory collapse that will result to SHOCK = Death.
Fundamentals of Nursing
Management: IVF (intravenous fluids) specially to patients with dehydration and hemoconcentration. Electrolyte replacements Blood plasma / platelet transfusion Oxygen inhalation Sedatives and other medications deem necessary according to the evaluation of the attending physician.
Health Teachings on: Awareness Instructions and education, Behavior modification Avoidance.. Precaution and Prevention Good nursing care
Fundamentals of Nursing
Diseases / Conditions that affects Brain and Spinal Cord Fundamentals of Nursing .
especially those that with low acid content. sore throat.Dry mouth.Botulinum spores and should not be fed to infants. home canned fruits and vegetables. vomiting and diarrhea. .e. weakness.BOTULISM (Food Poisoning) -results from exotoxin produced by gram positive anaerobic bacillus Clostridium Botulinum occurs as food poisoning. Fundamentals of Nursing . i. sausages.disease presents 12 to 36 hours after ingestion of infected food. Causes: . Honey or corn syrup may contain C. smoked or preserved fish or meat.ingesting inadequately cooked contaminated food. Signs & Symptoms: .
Diagnosis: -Identification of toxins in the patients serum. Cerebro Vascular accident. staphylococcal food poisoning. They should be used only for the secondary infections. Guuillain Barre syndrome. fish poisoning.e. -Electromyogram . Fundamentals of Nursing . carbon monoxide poisoning. stool and gastric content. tick paralysis.IV or IM adminsitration of botulinum antitoxins. Myasthenia gravis.must rule out other disease often confused with botulism i. trichinosis and diphtheria. chemical intoxications. Antibiotics and aminoglycosides should be avoided because the risk of neuromuscular blockade. Treatment: .
begin gastric lavage and give enema to purge any unabsorbed toxin from the bowel. and slurred speech. . .Obtain accurate history of allergies. blurred visions. induced vomiting. . Signs for : weakness.Management: . .Administer botulinum antitoxin. Check for the presence of symptoms with the other members of the family.if ingestion occurred within several hours only.Serum sample should be collected to identify the toxins before the antitoxins are administered.Observe carefully for abnormal neurologic signs. perform skin test. . especially with horses.observe careful history of the patient’s food intake for the past several days.Bring the patient to intensive care unit. . Fundamentals of Nursing . as required to neutralize any circulating toxins.
Because botulism is fatal. or one with peculiar odor. assisted respiration required. 7. encourage patients to observe proper techniques in processing. 3.1. Keep Epinephrine 1:1000 (subcutaneous) and emergency airway equipment available. ability to move legs and arm). bilateral motor status (reflexes. 6. 2. watch for anaphylaxis or other hypersensitivity. Fundamentals of Nursing . 5. and serum sickness. keep patient and family informed of the progress of the disease. Isolation required. Immediately notify community/ public health authorities of all cases of botulism. preserving and storing foods. After administration of antitoxins. encourage deep breathing exercises. To help prevent botulism . Turn patient often. 4. Warn them not to taste food from bulging can. 8. Closely observe and accurately record neurologic function. Give IV fluids as needed. Sterilize by boiling any utensils that comes in contact with suspect food.
Usually infection is systemic. It is an acute exotoxin mediated infection caused by Clostridium Tetani. less often localized. prognosis is poor. Tetanus is fatal in 60% of unimmunized persons. Fundamentals of Nursing . Release potent exotoxin that affects nerves and destroys blood components.TETANUS Infectious disease characterized by generalized spasmodic contractions of skeletal muscles. Causitive Agent: Clostridium Tetani – an anaerobic. usually within 10 days of onset. Incubation Period: 3-36 days (an average of 10 days) depending on the area of infection and history of vaccines/immunization of the patient. spore forming gram positive rod shaped (drumstick appearance) bacteria. If symptoms develop in 3 days after exposure.
Mode of Transmission Wounds (deep punctured) contact of an article or contaminated soil. GIT = causes local infection and tissue necrosis. When it reaches the CNS it will affect both Spinal Cord and the Brain creating now combination of dangerous symptoms arising from the effect of toxins. clostridium tetani. Along the way it will destroy red and white blood cells (tetanolysin) causing a deadly effect on the patient. The toxin will affect nerves as well causing localized spasm and pain. dust or animal excreta harboring the anaerobic bacteria. circumcision or ear piercing or tattooing. Exotoxins released by Clostridium Tetani on the site of the wound normally travels through neural path and through blood stream. Fundamentals of Nursing . In rare cases. Burns Accessed through contaminated instruments/umbilical stump.
Fundamentals of Nursing . 3.irritability and restlessness with progressively increasing stiffness of the voluntary muscles within 24-48 hours. 2. Trismus – painful spasm of the mastoid muscles that is caused by the affected trigeminal nerve. Lockjaw – when there is spasm of the mastoid muscles that causes difficulty and pain in opening and closing of the mouth that it tends to lock in a certain movement. Risus Sardonicus – facial nerve is affected. Muscle hypertonicity. Opisthotonous – hyperextension and arching of the back. dysphagia. 4. Rigidity and convulsions.muscular spasm and cramp like pain . profuse sweating.anxiety and apprehension (sensorium). . .Signs and Symptoms / Clinical Manifestations 1.difficulty of breathing. Specific signs – onset is insidious. 5.headache. Hyperactive deep tendon reflex. due to the spasm and rigidity of the back muscles. .urinary incontinence . (patient appears to have a permanent smile). .
TETANUS Fundamentals of Nursing .
Complications 1. Atelectasis – collapse of the lungs. due to pneumonia. Despite pronounced neuromuscular symptoms. 4. 8. Fundamentals of Nursing . 5. Cardiac Arrythmias Septicemia – uncontrolled bacteremia (microorganisms in the blood and in the circulation) that causes septic shock. Pulmonary emboli Acute gastric ulcers Intramuscular hematomas Laceration of tongue or buccal cavity. Hypostatic pneumonia – respiratory (secretion) obstruction due to patients poor position. 3. cerebral and sensory functions remain normal. 9. 7. /Flexion Contractures. Fractures of the spine or some other bones that is subjected to violent muscular spasm direct trauma due to spasm and convulsion. 2. 6.
only 1/3rd of patients have positive wound culture.500-5. Treatment 1. CSF – normal.Diagnosis is based on clinical manifestation and clinical features and a history of trauma and no previous tetanus immunization. IM or Tetanus antitoxin (TAT) or tetanus horse serum antitoxin – to confer a temporary protection – 50. Tetanus Immune Globulin (TIG) – 3. Tetanus antibody tests are often negative.000 units only). rabies.000-100. Blood exam – normal to slightly elevated WBC Diagnosis should rule out meningitis. CSF pressure may rise above normal.000-6.000 units. *skin testing is imperative! *a patient who has not received any tetanus immunization within 5 years should be given a booster injection of tetanus toxoid.000 units ½ IV and the rest can be given through IM (newborn=1. phenothiazine or strychnine toxicity and other conditions that mimic tetanus. Fundamentals of Nursing .
PenG 100. In neonates. Patient needs a high dose of antibiotics: Penicillin G 200. give tetracyclines with caution and not more than 2 grams (40 mg/kg/day in 4 divided doses for 10-14 days. if muscle relaxant is ineffective then patient should be given neuromuscular blocker. IV for 10-14 days Tetracyclines – NOT recommended. Fundamentals of Nursing . 2.000 units/kg/24 hours in 6 divided doses for ten days.If tetanus develops despite immediate post injury treatment. patient will need airway maintenance and muscle relaxant to decrease muscle rigidity and spasm.000 units/kg/day in 3 doses. 3. But if patient is sensitive to penicillin.
Adequate nutrition and proper diet. 5.2 mg/kg/dose every 3-4 hours IV (higher dose can be used but not more than 8 mg/kg/day (infants) and 10 mg/kg/day for adults. 3. 2.0 gr every 6 hours.1-2. Chlorpromazine (thorazine) 2mg/kg/day in divided doses. 4. Nursing Management 1. Wound care.4. 3-5 doses in mild cases. axionil. Prevention of respiratory and cardiovascular complications. Chloral hydrate (valium. Supportive treatment and intervention. Other drugs: for control of spasm: a) b) c) d) e) Diazepam 0. Health education. useful for newborn Mephenesin – muscle relaxant 1-3 ml of 2% solution IV or 175 mg/kg PO. Fundamentals of Nursing . trazepam) Paraldehyde and Avertin maybe used Phenobarbital = 0.
Fundamentals of Nursing . Characterized by extreme excitation and delirium. uncontrolled manic behavior. with violent and painful spasms of the muscles and tissues. Rhabdoviridae (filterable virus with strong affinity to CNS cells. causing a central nervous system infection caused by a ribonucleic acid virus.RABIES Acute viral disease of warm blooded animal. it can be destroyed with high temperature heat as well as UV light.
Mode of Transmission: virus transmitted to humans through a bite of an infected animal that is introduced through skin or mucous membrane. Furious form – common in humans with classic symptoms of paresthesia at the site of the bite . Dumb rabies . / present in the saliva of a rabid animals for several days before onset of clinical signs of illness Rabies is always almost fatal.seizures and coma with death in 1-3 weeks. 1. Fundamentals of Nursing .paralytic form Both progress to paralysis of pharyngeal and respiratory muscles. hypersalivation and hydrophobia including spasms and contractions of neck muscles 2. 2 Forms of Rabies: vary in nature of presentation.
RABIES Fundamentals of Nursing .
Fundamentals of Nursing .
and 10 days for insectivorous bats Rhabdo l Remains in site (innoculates) l Replication occurs in muscles (striated cells) l Spreads up through the nerves to CNS and replicates in the brain (deposited negri bodies) l Causes neuronal necrosis affecting the spinal cord including the (sympathetic ganglia and dorsal root) and mononuclear infiltration causing demyelination and degeneration of the axis cylinder l Causing the damage and cranial nerve nuclei destruction l Moves through the nerves into the tissues including the salivary glands (unless inactivated by natural or induced immune mechanism) l Enters periheral nervous system. Fundamentals of Nursing .3 days for dog. 1 day for cat.
hypersalivation.slight elevation in temperature 37. anxiety. restlessness. headache. tissue distruction.5-39. pruritus and tingling in the bite site > prodromal signs. Evidence of secondary complications such as bacterial super infection. papillary dilation. hyperactivity and bizarre behaviour with interspersed calm periods. anorexia. hyperthermia. radiating. Neurologic examination presents altered mental status. Localized – extent of the wound. nausea and sore throat.5C. hyperventilation Signs and Symptoms: Progressive stage of Invasive phase : > local.Physical Symptoms. > marked nervousness. agitation. sensitivity to noise. excessive salivation and perspiration Fundamentals of Nursing . burning pain > sensation of cold. Autonomic instability –HPN. > photophobia.
involuntary twitching and uncontrolled salivation > becomes violent and delirious > tachycardia or bradycardia and a cyclic respiration with urinary retention. constriction.2 – 10 days after prodromal symptoms…. absence of corneal reflexes. restlessness & hypersensitivity > cranial nerve dysfunction – occular palsies. > painful spasm. strabismus. Temperature is elevated to 39. then client’ condition deteriorates rapidly and enters the terminal stage… Fundamentals of Nursing . noise. > hypersensitivities to light.C and up to 3days. light and air. touch and hearing > fear of water. during which client suffers from tonic and clonic contraction of muscles. Stage of Excitation : characterized by marked excitation. > hydrophobia / difficulty of swallowing > cyanosis.
Treatment: Wound treatment > Thoroughly wash the bite wounds and scratches with soap and water. > steady rise in temperature > spasm ceases.Terminal stage or Paralytic phase : > client becomes quiet and unconscious > loss of bowel and urine control. > Apply 1% solution of Benzalconium chloride (Zephiran) or Povidone Iodine. > labored and irregular respiration. Suturing of wound if necessary Fundamentals of Nursing . Quantenary ammonium compound may be used to cleansed the wound. progressive increase in paralytic condition > respiratory distress due to paralysis of respiratory muscles. but all forms of soap should be thoroughly washed out before applying.
(HRIg is produced from individuals who have been vaccinated and Equine Rabies Immunoglobulins (ERIg) is produced from immunized horses) > Active : 3 different Inactivated Rabies Vaccines 1.intradermal preparation only as a pre exposure prophylaxis.given to person not previously vaccinated against rabies in a dose of 20 iu/kg body wt.. Fundamentals of Nursing . Imovax). Immunization (after exposure) with : > Passive : Human Rabies immune globulin (HRIg).apply as much as possible at the injury site and the remainder given deep IM / gluteal. Regular dose given IM only. Human diploid cell vaccine (HDCV.Take measures to control infection and prevention of complications. Administer Tetanus-Diphtheria prophylaxis and antibacterial medications.
deltoid or upper thigh for Infants. HRIg (HumanRabies Immunoglobulin)– 20 iu/kg with full dose injected to the site and remainder administered /IM Vaccine administered: HDCV. 14 & 28. 5 doses schedule is the same for all 3 vaccines product as follows: Day 0. RVA 1 ml @deltoid. Rabies Vaccine Absorbed (RVA) – IM only 3. 7. & day 28 post exposure. Post exposure prophylaxis for patient NOT previously vaccinated: Local wound cleansing with soap and water. Purified Chick Embryo Cell Vaccine (PCECV. Dose of all vaccines for post exposure prophylaxis = 1 ml IM. day 14. 3. day 7. day 3.2. Days 0. Fundamentals of Nursing . Rabavert) – IM only.
used for microscopic exam of the characteristics of Negri bodies in the brain tissue samples and saliva of the infected animal.increase ICP.Complications : Myocarditis Neurological : . Seller’s May-Grunwald and Mann strains. cerebral edema. WBC count – increase polymorphonuclear cells and large mononuclear cells. Fundamentals of Nursing . Hypotension. cardiac arrythmia (atrial premature contraction.) Autonomic dysfunction: . and seizures. Arterial and Veinal thrombosis Secondary bacterial infection of lungs and Urinary tract and GIT > pneumothorax > paralytic ileus > urinary bladder paralysis Diagnosis: Flourescent rabies antibody (FRA) most definitive diagnosis. hypothermia.HPN. sinus bradycardia) causing cardiac arrest. hypothalamic involvement ( inappropriate secretions of ADH.
Monitor Cardiac and Pulmonary functions. Control spread of rabies infection. Proper diet and nutrition. with maintenance of balanced fluid and electrolyte. Studying and eradicating cause. cool environment Prevention of complication.Special Consideration / Nursing management Provide comfort to the patient Isolation of the patient : dark. Fundamentals of Nursing . Community care includes animal management as well as community education and protection. quiet.
New Diseases /Conditions with Global Threat Fundamentals of Nursing .
Viral peak load : 7-10 days (incubation period) w/c accounts for high risk of nosocomial outbreaks. Can be detected extra-pulmonary sites. Zoonotic in origin (emerged from animal reservoir and adapted to efficient human-to-human transmission. hemophagocytosis.SEVERE ACUTE RESPIRATORY SYNDROME (Sars-CoV) - Was first recognized during a global outbreak of severe and highly contagious infectious “atypical pneumonia” in 2003. occasional lesions. Fundamentals of Nursing .) Is characterized by diffuse alveolar damage (DAD). - Causative/ Etiologic agent: SARS-corona virus.
Severe cytokine dysregulation has been demonstrated.) Specific Signs of extra-pulmonary organs affected: hematological system.Confronting this outbreak required understanding the etiology. with or without non-productive cough. Fundamentals of Nursing . Droplet (Respiratory) Signs and Symptoms: High fever Flu-like illness Shortness of breathe. modes of transmission and pathogenesis. (which progressed to acute respiratory failure in absence of medical attention. gastrointestinal and liver. specific diagnostic tests and effective infection control! Mode of Transmission: Airborne.
different forms of experimental pharmacotherapies are in place and most of them are seen to have improved outcomes of the disease.Treatment: There is no optimal treatment for SARS. interferons. Ventilatory care for patient in acute stage. Quarantine suspected patient and all those who were in close contact. Lopinvair. family and community. Manage client as pneumonia case and other care necessary. Immunotherapy.. Ritonavir plus ribavirin Interferon alphacon-1 Other Protease inhibitors. Prevention of complication. and others. Fundamentals of Nursing . hyperimmune globulin Monoclonal antibodies and RNA interference Management and Care: Early detection and identification of the disease. pentaglobin. Antiviral. Health teaching to patient.
Fundamentals of Nursing .Meticulous attention has to be made to infection control measures to reduce nosocomial spread of SARS among hospital patients and healthcare workers.
AVIAN INFLUENZA A (“Bird Flu”) Caused by H5N1 Influenza virus. that have dried up. Mode of Transmission: Airborne (through pulverized particles) virus present in particles blown by wind. Fundamentals of Nursing . Droppings and respiratory secretions of infected bird. that exists primarily in birds. pulverized then is carried by the wind and is inhaled by host (humans and other birds). (H5N1 virus is a potent inducers/stimulant for cytokine responses) Originated in Asia-Pacific region and is carried throughout the world by infected migratory birds.
Dizziness Fever. Autonomic dysfunction: vital signs becomes erratic Some symptoms related to involvement of CNS. cough and dyspnea Myalgia Abdominal pain/and vagueness / Diarrhea Respiratory distressed syndrome – high fatality rate. Organ failure or dysfunction Management: No known specific cure but patient is treated as symptom is presented** Symptomatic and Supportive care Preventive care: effective Infection control Strict Isolation Fundamentals of Nursing .Signs and Symptoms: Body malaise / general weakness Headache.
lympophenia and thrombocytopenia. Antiviral medications: Oseltamivir for three days (dosage depend on Physician”s assessment. Prednisone 2.) Empiric broad spectrum antibiotic for community acquired pneumonia. Laboratory finds: CBC – mild to moderate leukopenia.High level of chemokines (confirms cytokine dysregulation) Fundamentals of Nursing . Respiratory specimens of patients – (+)for H5 virus. 3. Pennicillin. Ceftriaxone. Serum test . or Doxycycline Systemic steroids for complicated condition of ARDS.Treatment: 1.
Sexually Transmitted Disease Fundamentals of Nursing .
. Causative agent: Chlamydia Trachomatis Mode of Transmission: Vaginal / Rectal intercourse – oral.: Fundamentals of Nursing .CHLAMYDIAL INFECTION Most common sexually transmitted disease. genital contact with infected persons. both Male and Female are asymptomatic if symptoms appear. Signs and Symptoms: Appears very late in the course of the disease and vary with the specific type of Chlamydial infection and determined by the organism’s route of transmission to susceptible tissue.
Fundamentals of Nursing . Prostatitis – lower back pain. vaginal discharge. pain and tenderness of the abdomen. tenesmus. dysuria. urinary frequency. dyspareunia. urinary frequency. urinary frequency. Endometritis or Salphingitis – experienced signs of PID. pelvic pain. mucopurulent discharge. fever.Female: Cervicitis – cervical erosions. pruritus. erythema. painful ejaculation. Urethral syndrome – dysuria. tenderness of urethral meatus. nocturia. cervix. bloody or mucopurulent discharge and diffuse or discrete ulceration of the rectosigmoid colon. pyuria. Male: Urethritis – dysuria. Epididymitis – scrotal swelling and urethral discharge. bleeding after intercourse. uterus & lymphnodes: chills. Proctitis – diarrhea. pruritus.
Culture of aspirated materials establishes epididymitis. Fundamentals of Nursing .If left untreated. salphingitis. Antigen detection method :Enzyme link immunosorbent assay(ELISA) Direct fluorescent antibody test. Sterility Diagnosis: Swabbing the site of infection (urethra. cervix or rectum) – establishes urethritis. Salphingitis 3. PID 4. Nucleic acid probe using polymerase chain reactions are diagnostic method of choice. or proctitis. endometritis. Acute Epididymitis 2. this leads to: Complications: 1. Tissue cell cultures – more specific and sensitive. cervicitis.
Community care and health education. Practice universal precaution.treatment of choice.Treatment: Drug therapy – Oral Doxycycline 200mg for 7 days Azithromycin (Zithromax) single dose . Special Consideration: 1. 2. Patient should fully understand the importance of medication and dosage requirement. 3. Record and report 4. Fundamentals of Nursing . 5. Patient and partner should be treated for the disease and submit for HIV testing.
Herpes Type 2 – HSV (herpes simplex virus) primary affects the genital area and is transmitted by sexual contact. Herpes Type 1 – HVH (herpes virus hominis) typically affects oral mucous membranes. stool. Purulent eye exudates are potential sources of infection. recurrent viral infection.HERPES SIMPLEX / GENITALIS This is a widespread. Cross infection may result from orogenital sex. Causes and MOT: 1. Urine. Saliva. Affect skin and mucous membranes and commonly produces cold sores and fever blisters. Fundamentals of Nursing . respiratory secretions. Skin lesions. 2. and is transmitted by oral.
ruptures and becomes painful ulcers with yellowish crust. anorexia and high temperature of 40. Primary lesion erupt as vesicles on an erythematous base. pharyngitis. halitosis. cheeks With: submaxillary lymphadenopathy.6 C. edema and excessive lacrimation 85% are subclinical localized lesions and systematic reaction Generalized infection. Onset of infection begins with: fever. Completed in 3 weeks 3. increase salivation . 1. virus reactivation causes cold sores. gingival. and edema 2. tongue. 4 – 10 days. erythema. Fundamentals of Nursing . herpetic keratoconjunctivitis. Brief prodromal itching and tingling. healing begins 7 – 10 days after onset. blepharitis. Clinical features: Herpetic Stomatitis – vesicles in oral mucosa.IP: 2 – 12 days / Signs and Symptoms : aslo effect the eye.
chills. Typically very painful 5. personality changes and seizures. usually affects adolescents and young adults. blepharitis. Smell and taste hallucination 7. and red streak up the arm. excessive lacrimation. chemosis. DX: Isolation of virus in specialized culture tubes – to identify and confirm the type of virus Fundamentals of Nursing . 6. vesicles on eyelids. photophobia.aphasia 8. erupts and ulcerates. Vesicles with red halo. Localized infection. Both types can cause acute sporadic encephalitis = causes altered level of consciousness. edema. Other effect. fever. red and painful. Neurologic abnormalities. Herpetic Whitlow – an HVH finger infections: finger tingles then it becomes swollen. 4. satellite vesicles. malaise.Herpetic Keratoconjunctivitis – and other local eye symptoms.
2. (topical steroid contraindicated in active infection). Fundamentals of Nursing . idoxoridine are given for eye infections. ointment and intravenous. 9. 8. 5. 6. Avoid unprotected intercourse during active stage of disease. Topical lidocaine – for vulvovaginal pain. 3. Eyedrops such as trifluridine. Acyclovir – oral. Supportive therapy. 4. 10. No sharing of towel or utensils with others. Increased fluid intake. To reduce duration of episodes. analgesic – antipyretics. Warm compress. vidarabine.Treatment and Management: 1. hot sitz bath several times a day for relief 7. Anesthetic mouthwash – viscous lidocaine ( may reduce pain of gingivo stomatitis). Standard precaution. or avoidance of sexual intercourse.
self limiting but may cause painful local/ systematic disease. Incubation Period: . dysuria and leukorrhea Fundamentals of Nursing . with redness. when the lesions rupture.3 – 7 days Sign and Symptoms: 1. malaise. tender inguinal lymphnodes 5.Herpes Genitalis (Genital Herpes) is an acute inflammatory disease of the genitalia. Fluid filled vesicles. shallow. kissing. perianal skin. In male. vulva or vagina in female. . it develops into extensive. usually cervix (primary site of infection). . Labia. anus 4. 2. Fever. Painless.through sexual intercourse. and hand to body contact. painful ulcers. penils shaft 3. initially. orogenital sexual activity.is usually caused by infection with herpes simplex virus type2 and type1 MOT: . marked edema. Extra genital lesions – mouth. at the glans penis. foreskin.
Herpetic encephalitis – fatal Diagnosis/ Diagnostic test : 1. Laboratory data's. 2. 2. Papanicolaou test is recommended to females Fundamentals of Nursing . IV administration – to those with severe infection and those who are immunocompromised and have potential life threatening infection. Smears of genital lesions show atypical cells and cytologic preparations (Tzanck test) – reveals giant cells 4. 3. 4. Hygiene. increased antibody titers 3. health and cleanliness. Herpetic Keratitis. PE and Pt’s history 2. Record and Report.Complications: 1. Tissue culture or antigen test that identify specific antigens Treatment and Management: Medical management: Acyclovir – oral to first – time infection or recurrent outbreaks. Practice standard precaution 5.may lead to blindness.
Incubation period: 3 – 6 days after contact. meninges or the endocardium.GONORRHEA . . Causative Agent: Neisseria Gonorrheae MOT and POE: Sexual intercourse/ activity.This is a common sexually transmitted disease.When untreated – spreads through the blood and joints. It is infection of genitourinary tract (especially urethra and cervix) and occasionally rectum. Fundamentals of Nursing . pharynx and eyes. through genital/ oral or rectal.
Vagina: most common site in children over 1 = engorgement. redness and swelling at the site of infection. 2. (severe before puberty and after menopause. urinary frequency/incontinence. Clinical features: vary according to site involved. In Male: lead to Epididymitis and Sterility.In Female: leads to PID and sterility. Urethritis. purulent discharge. Urethra: dysuria. dysuria.) 3. Fundamentals of Nursing . redness and edematous meatus. itching. 1. 1. redness and swelling and profuse purulent discharges. burning and pain due to exudates from adjacent infected area. Vulva: occasional itching. purulent urethral discharge.( Usually Asymptomatic) But may develop inflammation in the cervix with greenish yellow mucupurulent discharge to some.
5. Liver: right upper quadrant pain in patients with perihepatitis. muscle rigidity. with abundant mucupurulent discharge 2. Pelvis: severe pain of pelvis and lower abdominal. rectal burning and itching. bilaterla conjunctival infection. tachycardia for patients with salpingitis or PID. with lesions (maybe purulent. tenderness and abdominal distention. Fundamentals of Nursing . Other symptoms: tonsillitis. bloody. Gonococcal opthalmia neonatorium = lid edema. fever.4. patient presents. hemorrhagic or necrotic) on hands and feet. Gonococcal septicemia: more common in females than in male: tender papillary skin. pharyngitis. mucopurulent discharges.3 days after birth. As infection spreads. nausea and vomiting.
Diagnosis: Tissue culture on site of infection. Or Single dose Ciprofloxacin 500mg PO.G. DNA probe analysis – (can also detect chlamydia) Complement – fixation Immunoflourescent assay Treatment and Management: For uncomplicated gonorrhea caused by non – penicillinase N. Or Single dose Cefixime 400mg PO. Fundamentals of Nursing . or Single dose Ofloxacin 400mg. using Thayer – Martin or Transgrow medium – establishes the diagnosis by isolating the microorganism. is: Single dose 125mg of Ceftriaxone IM.
For recommended initial regimen for disseminated gonococcal infection. PO. (All regimens should be continued 24. adults and adolescents: Ceftriaxone 1g IM or IV q24hrs. PO 2x daily x 7days.For presumptive treatment with concurrent chlamydia trachomatis infection: Doxycycline 100mg./ for patients allergice to beta-lactam antiboitics: Spectinomycin2g IM q12hrs. Or Single dose Azithromycin(Zithromax) 1g. then may switch to one of the ff.48hrs after improvement begins. For pregnant patients and those allergic to penicilline: Single dose of Ceftriaxone and Erythromycin x 7 days.) Cefixime 400mg PO 2xdaily or Azithromycin 1g single dose Fundamentals of Nursing . to complete 1 whole week of antimicrobial therapy.
3. Fundamentals of Nursing . use of condom to decrease incidence of transmission and to avoid sharing washcloth or douche equipment. Routinely instill 2 gtts. Practice standard precaution 2.Special considerations: 1. establish drug sensitivity. 5. Before treatment. 4. Urge patient to inform sexual partner/s of the infection and encourage to seek medical treatment. ** Safe sex should be advised to clients. 1% silver nitrate or erythromycin ointment or tetracycline ointment in the eyes of the neonates immediately after birth. Record and report.
poor hygiene and pregnancy. Consists of papillomas with fibrous tissue overgrowth from the dermis and thickened epithelial lining. MOT – sexual contact wart grows rapidly in heavy perspiration. or accompany other genital infections.GENITAL WARTS Also called venereal warts and condylomata acuminata. IP – 1 – 6 months (usually 2 months) Fundamentals of Nursing . Causes: infection with one of the more than 60 strains of HPV (human papilloma virus) – uncommon before puberty or before menopause.
4. within urethral meatus. For multiple swellings give them a cauliflower. Genitalwarts may develop years after the first contact. vagina or cervical wall. on the vulva. on supra preputial sac. Develops in moist area: in men. Painless wart.Signs and Symptoms: 1. becomes malodorous. and peri anal area.vascularization of epidermal cells which differentiates wart from condylomata lata of syphillis. Dark field examination scrapings from wart cells. 2. 6. If infected. which started as a tiny pink or red swelling (about 10 cm). In women. penile shaft. 3. 5.like appearance. Papilloma spreads to perineum. Few complains of itch or pain Diagnosis/ Diagnostic tests: 1. Fundamentals of Nursing .
Cryosurgery or electrocautery 5. Carbon dioxide laser treatment for warts larger than 2. Interferon (intralesional) 6. Podophyllum resin maybe applied topically. weekly (contraindicated for pregnancy) 3. Treatment & Management:. 3. Topical drug therapy. 2.2.for classification and assess cancer risk. Histologic exams of biopsies of wart. trichloroacetic acid 85% applied to the external areas.to remove exophatic wart and to ameliorate S&S 1. 4. Podofilox (patient applied) Fundamentals of Nursing . Applying 5% acetic acid (white vinegar) turns the wart to white.5cm.
9. because cancer of the penis may develop. Fundamentals of Nursing . 11. and male be examined by urologist. 10.7. recommend annual paps smear test. Imiquimod (patient applied) Combined laser and interferon therapy. 8. Use standard precaution Recommend abstinence of sexual intercourse till healing Encourage sexual partner to be checked for HPV and HIV and other STDs Relapse is common.
bladder. frequent douches w/c disturbs lactobacilli. than normal (normal 5. prostrate gland. Trichomonas Vaginale: grows best when vaginal mucosa is alkaline. Fundamentals of Nursing . urethra & endocervix. Female: infects vagina.5. bartholins or skins Male: lower urethra. exudative cervical or vaginal lesions. seminal. bacterial overgrowth.5.TRICHOMONIASIS / TRICHOMONAS VAGINALIS Protozoa infection of genitourinary tract (A & C) *Risk minimized when sexual partners are treated. pregnancy.8) Cause: oral contraceptives.
Signs & Symptoms: Male: asymptomatic/ mild to moderate urethritis dysuria. swelling. Diagnosis: Direct micrscopic examination of vaginal or seminal fluid. Female: gray to greenish yellow & possibly profuse & frothy malodorous vaginal severe itch. dysparunia. (redness. mennorhagia. Physical examination Fundamentals of Nursing . Occasional post coital spotting. urinary frequency. dysmenorrhea. tenderness). dysuria.
. Abstain from sexual intercourse until client is cured and both partners are treated Warn client to abstain from alcohol while being treated with metronidazole. dark. PREVENTION TIP: Tell client she can reduce genitourinary bacterial growth by wearing loose fitting. . Fundamentals of Nursing .Treatment and Management: . moist environment. . Instruct client to refrain from douching before being examined for trichomoniasis.not safe during pregnancy.Single dose of oral Metronidazole given to both partners. cotton underwear which allows ventilation. Bacteria flourishes in warm.Alternative treatment is 500mg of oral metronidazole 2x daily for 7 days.Hot sitz bath to relieve symptoms.
Prenatal transmission from an infected mother to her fetus. infectious. sexually transmitted disease.SYPHILIS Chronic. quickly becomes systematic. Begins in the mucous membrane. This disease is characterized by progressive stages Serologic test developed by August Von Wasserrmann in 1906 Paul Ehrlich discovered the drug salvarsan (606) Causitive agent: Treponema Pallidum MOT: primarily through sexual contact. Fundamentals of Nursing . spreading to nearby lymphnodes and the bloodstream.
no itch – found on the genitalia. Fundamentals of Nursing . In women. eyelids. labia minora. often it is overlooked since it appears in the cervix or vagina. glans. anus. a small fluidfilled lesions called Chancre – usually painless and start as papules and then erode. Primary. fingers. Stages of disease progression with specific Signs and Symptoms: 1. lips. 2. 94% genital. Associated with lymphadenopathy.6 weeks before there are evidences of the disease (90 days maximum) ** Treponema Pallidum loses viability upon exposure to air and sunlight. 48 – 720 congenital or acquired. Develops within the few days or up to 8weeks after onset of initial chancre. raised edges and clear bases. tongue.Incubation period: 3. 6% extra genital.appearance of a pimple like on infected spot. tonsils. nipples. prepuse. they have indurated. Secondary – development of symetrical mucocutaneous lesions and general lymphadenopathy. Disappears after 3-6 weeks even when untreated.
anorexia. but it produces a reactive serologic test. 2/3s of patients are asymptomatic in late latent stage until death. vulva).Rash can be maculopapular. malaise. 3. May disappear spontaneously. weight loss. soles. palms. and in warm moist areas (perineum. Tertiary or Latent – no clinical symptoms. or grayish-white lesions called Condylomata lata – often erupt between rolls of fat on the trunk. nails are brittle and pitted. Lesions enlarged and eroded producing highly contagious pink. slight fever. Infectious mucocutaneous lesions may reappear. scrotum. Alopecia may occur. pustular or nodular – lesions are uniform in size. Fundamentals of Nursing . well defined edges. scalp. surface covered with necrotic membrane. face. Gumma – usually mistaken as sebaceous cyst. Symptoms: headache. arms. sorethroat. nausea & vomiting.
mucous membranes. asymmetric. painless and indurated. liver or stomach. Gumma. a chronic superficial nodule. may appear in skin. This typical lesion is same with latent stage. upper respiratory tract. Lesions of benign syphilis develops in 1-10 yrs after infection.4 Late Syphilis – noninfectious but final and destructive. particularly in long bones of the leg. deep granulomatous lesion that is solitary. cardiovascular syphilis (develops in about 10years).4 million units). neurosyphilis (develops in about 5-35 yrs after infection. Syphilis of more than 1year duration should be treated with the same but given per week for three weeks. Single injection of Penicillin G benzathine IM (2. bones. Communicable Disease Nursing . Late benign syphilis. Treatment and Management: • Administration of Penicillin IM – drug of choice for early syphilis. or in the organ. this can be found in the bones.
12. Urge patient to seek VDRL testing. decreased CO. Promote comfort and healing. Blood test at 6 months interval x 2yrs. Dispose contaminated materials properly. hypoxia.Antibiotics with Arsenicals (2 injections/wk x 10wks)IM with Bismuth (1 injection/wk x 10 wks) Oral Tetracyclines or Doxycycline for 15 days for those that are allergic to Penicillin.24 months to detect possible relapse. Check for signs of complications arising from and indicative of the subtypes of syphilis. Check history of drug sensitivity.6. coherence. Stress importance of completing the course of therapy even after symptoms subsides. ataxia. Note: tetracycline is contraindicated in pregnant women. pulmonary congestion. Control of the disease. 3. Communicable Disease Nursing . Check for leel of consciousness. mood. decreased sensorium. Keep lesions dry and clean. Practice universal precaution.
Darkfield exam. CSF exams – identify neurosyphilis when total protein level is above 40mg/100ml. Refer patient and partner for treatment and for HIV testing. and when VDRL slide test is reactive and CSF cell count exceeds 5 mononuclear cells/ul Communicable Disease Nursing . – special condenser identifies T. secretions) 3.Pallidum from a moist lesion in primary. secondary and prenatal syphilis.detects nonspecific antibodies (4-5 wks after infection) TPI & FTAA (identifies antigen in tissues. Laboratory / Diagnosis: 1. CSF. Serologic reaction: Wassermann test (10days – 3weeks) Kahn precipitation reacton Nelson test – treponema fixation test which rules out false (+) reaction. Health teachings for client. 2.Report all cases of syphilis to local health authorities. family and community. VDRL slide test and rapid plasma reantgen (RPR).
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