COMMUNICABLE DISEASE NURSING SUMMER REVIEW COMMUNICABLE DISEASE

- An agent that prevents bacterial multiplication but does not kill microorganisms CHAIN OF INFECTION

Disease caused by an infectious agent that are transmitted directly or indirectly to a well person through an agency, vector or inanimate object CONTAGIOUS DISEASE

Disease that is easily transmitted from one person to another INFECTIOUS DISEASE Disease transmitted by direct inoculation through a break in INFECTIOUS AGENT the skin INFECTION -Entry and multiplication of an infectious agent into the tissue of the host INFESTATION - Lodgement and development of arthropods on the surface of the body ASEPSIS - Absence of disease producing microorganisms SEPSIS - The presence of infection MEDICAL ASEPSIS Practices designed to reduce the number and transfer of pathogens Clean technique SURGICAL ASEPSIS Practices that render and keep objects and areas free from microorganisms Sterile technique

Any microorganism capable of producing a disease RESERVOIR Environment or object on which an organism can survive and multiply PORTAL OF EXIT The venue or way in which the organism leaves the reservoir MODE OF TRANSMISSION The means by which the infectious agent passes from the portal of exit from the reservoir to the susceptible host PORTAL OF ENTRY Permits the organism to gain entrance into the host SUSCEPTIBLE HOST A person at risk for infection, whose defense mechanisms are unable to withstand invasion of pathogens STAGES OF THE INFECTIOUS PROCESS

Incubation Period acquisition of pathogen to the onset of signs and symptoms Prodromal Period patient feels bad but not yet experiencing actual symptoms of the disease Period of Illness onset of typical or specific signs and symptoms of a disease Convalescent Period signs and symptoms start to abate and client returns to normal health MODE OF TRANSMISSION CONTACT TRANSMISSION Direct contact involves immediate and direct transfer from person-to-person (body surface-to-body surface) Indirect contact occurs when a susceptible host is exposed to a contaminated object DROPLET TRANSMISSION Occurs when the mucous membrane of the nose, mouth or conjunctiva are exposed to secretions of an infected person within a distance of three feet VEHICLE TRANSMISSION Transfer of microorganisms by way of vehicles or contaminated items that transmit pathogens AIRBORNE TRANSMISSION Occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens VECTOR-BORNE TRANSMISSION Transmitted by biologic vectors like rats, snails and mosquitoes TYPES OF IMMUNIZATION ACTIVE antibodies produced by the body NATURAL antibodies are formed in the presence of active infection in the body; lifelong ARTIFICIAL antigens are administered to stimulate antibody production PASSIVE antibodies are produced by another source NATURAL transferred from mother to newborn through placenta or colostrum ARTIFICIAL immune serum (antibody) from an animal or human is injected to a person SEVEN CATEGORIES OF ISOLATION STRICT- prevent highly contagious or virulent infections Example: chickenpox, herpes zoster CONTACT spread primarily by close or direct contact
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CARRIER an individual who harbors the organism and is capable of transmitting it without showing manifestations of the disease CASE a person who is infected and manifesting the signs and symptoms of the disease

SUSPECT a person whose medical history and signs and symptoms suggest that such person is suffering from that particular disease CONTACT any person who had been in close association with an infected person HOST - A person, animal or plant which harbors and provides nourishment for a parasite RESERVOIR - Natural habitat for the growth, multiplication and reproduction of microorganism ISOLATION - The separation of persons with communicable diseases from other persons QUARANTINE - The limitation of the freedom of movement of persons exposed to communicable diseases

STERILIZATION the process by which all microorganisms including their spores are destroyed DISINFECTION the process by which pathogens but not their spores are destroyed from inanimate objects CLEANING the physical removal of visible dirt and debris by washing contaminated surfaces CONCURRENT - Done immediately after the discharge of infectious materials / secretions TERMINAL - Applied when the patient is no longer the source of infection BACTERICIDAL - A chemical that kills microorganisms BACTERIOSTATIC

Example: scabies, herpes simplex RESPIRATORY prevent transmission of infectious distances over short distances through the air Example: measles, mumps, meningitis TUBERCULOSIS indicated for patients with positive smear or chest x-ray which strongly suggests tuberculosis ENTERIC prevent transmission through direct contact with feces Example: poliomyelitis, typhoid fever DRAINAGE prevent transmission by direct or indirect contact with purulent materials or discharge Ex. Burns UNIVERSAL prevent transmission of blood and body-fluid borne pathogens Example: AIDS, Hepatitis B

If the patient flexes the hips and knees in response to the manipulation, positive for meningitis KERNIGS SIGN Place the patient in a supine position, flex his leg at the hip and knee then straighten the knee; pain and resistance indicates meningitis
SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA

DIC URTI: cough, sore throat, fever, headache, nausea and vomiting Vasculitis: petechial rash in the trunk and extremities Microthrombosis Purpura Hypotension Shock Death

CENTRAL NERVOUS SYSTEM

ENCEPHALITIS
MAIN PROBLEM

MENINGITIS

MENINGOCOCCEMIA
- Acute infection of the bloodstream and developing vasculitis

- Inflammation of the brain

ETIOLOGIC AGENT

- Inflammation of the meninges - Streptococcus - Staphylococcus - Pneumococcus - Tubercle bacillus

ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA Vasculitis WaterhouseFriderichsen syndrome Petechiae with the development of hemorrhage 6 months5 years old

SIGNS AND SYMPTOMS

- Arboviruses

Stiff neck Photophobia Lethargy Convulsions

Nuchal rigidity Opisthotonus Brudzinskis Kernigs sign

INCUBATION PERIOD

- Neisseria meningitides 1-10 days 3-4 days

5-15 days
MODE OF TRANSMISSION

Bite of infected mosquito

Respiratory droplets INCIDENCE

SIGNS AND SYMPTOMS OF ENCEPHALITIS

5-10 years old

< 5 years old

Virus enters neural cells

Disruption in cellular functioning Lethargy Convulsions Seizures

Perivascular congestion

Inflammatory reaction

Headache Photophobia Vomiting Stiff neck

Fever Sore throat

DIAGNOSTIC EXAM Informed consent Empty bowel and bladder Fetal, shrimp or C position Spinal canal, subarachnoid space between L3-L4 or L4- L5 After: bedrest Flat on bed to prevent spinal headache

ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA

TREATMENT MODALITIES

Dexamethasone Mannitol
SIGNS AND SYMPTOMS OF MENINGITIS

Ceftriaxone Penicillin Chloramphenicol

Anticonvulsants Antipyretics
PREVENTION

1. Japanese encephalitis VAX

1. HiB vaccine

Rifampicin Ciprofloxacin

THREE SIGNS OF MENINGEAL IRRITATION OPISTHOTONUS State of severe hyperextension and spasticity in which an individuals head, neck and spinal column enter into a complete arching position BRUDZINSKIS SIGN Place the patient in a dorsal recumbent position and then put hands behind the patients neck and bend it forward.
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ENCEPHALITIS

MENINGITIS

MENINGOCOCCEMIA
1. Side boards 2. Close contacts H ouse I nfected person kissing S ame daycare center S hare mouth instruments 3. Antibiotics as prophylaxis

NURSING MANAGEMENT 1. Comfort: quiet, well-ventilated room 2. Skin care: cleansing bath, change in position 3. Eliminate mosquito breeding sites: CULEX mosquito 1. Respiratory isolation 24-72 hours after onset of antibiotic therapy 2. Room protected against bright lights 3. Safety: side-lying position and raised side rails

Recovery within 72 hours and the disease passes by unnoticed PRE-PARALYTIC OR MENINGETIC TYPE Slight involvement of the CNS Pain and spasm of muscles Transient paresis (+) Pandys test (increased protein in the CSF) PARALYTIC TYPE CNS involvement Flaccid paralysis Asymmetric Affects lower extremities Urine retention and constipation (+) HOYNES SIGN (when in supine position, head will fall back when shoulders are elevated)

POLIOMYELITIS
MAIN PROBLEM Acute infection of the CNS muscle spasm, paresis and paralysis
ETIOLOGIC AGENT

RABIES

TETANUS

Acute viral disease of the CNS by saliva of infected animals Rhabdovirus Bullet-shaped Affinity to CNS Killed by sunlight, UV light, formalin Resistant to antibiotics

Acute infectious disease with systemic neuromuscular effects Clostridium tetani Anaerobic Gram positive Drumstick appearance

Legio debilitans

POLIOMYELITIS
INCUBATION PERIOD

RABIES
2-8 weeks
Distance of bite to brain Extensiveness of the bite Resistance of the host

TETANUS

RABIES PRODROMAL/INVASION PHASE Fever Anorexia Sore throat Pain and tingling at the site of bite Difficulty swallowing EXCITEMENT OR NEUROLOGICAL PHASE Hydrophobia (laryngospasm) Aerophobia (bronchospasm) Delirium Maniacal behavior Drooling TERMINAL OR PARALYTIC PHASE Patient becomes unconscious Loss of urine and bowel control Progressive paralysis Death

POLIOMYELITIS
7-21 days Adult: 3 days-3 weeks Neonate: 3-30 days
COMPLICATION Paralysis of respiratory muscles

RABIES

TETANUS

RESPIRATORY FAILURE

DEATH

DIAGNOSTIC PROCEDURES

MODE OF TRANSMISSION
- Direct contact with infected feces - Direct contact with respiratory secretions - Indirect with soiled linens and articles

1. Stool culture 2. CSF culture Direct inoculation through a broken skin

1. Throat washings 2. Flourescent rabies antibody (FRA) 3. Negri bodies

1. Blood exam

Bite of an infected animal

ISOLATION PRECAUTION

Enteric isolation

Respiratory isolation

POLIOMYELITIS

RABIES

TETANUS
POLIOMYELITIS

RABIES

TETANUS
1. Tetanus immune globulin (TIG) 2. Tetanus antitoxin (TAT) 3. Penicillin G 4. Tetracycline 5. Diazepam 6. Phenobarbital 7. Tracheostomy 8. NGT feeding

SIGNS AND SYMPTOMS

R isus sardonicus O pistothonus T rismus C onvulsions H eadache I rritability L aryngeal spasm

1. Abortive type 2. Pre-paralytic or meningetic type 3. Paralytic type

1. Prodromal / invasion phase 2. Excitement / neurological phase 3. Terminal / paralytic type

TREATMENT MODALITIES

1. Analgesics 2. Morphine 3. Moist heat application 4. Bed rest 5. Rehabilitation

1. Local treatment of wound 2. Active immunization Lyssavac Imovax Antirabies vax 2. Passive immunization

POLIO ABORTIVE TYPE Does not invade the CNS Headache Sore throat
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POLIOMYELITIS

RABIES

TETANUS

BIRD FLU
COMPLICATIONS

SARS Severe viral pneumonia Hypoxemia Respiratory failure

NURSING MANAGEMENT

1. Enteric isolation 2. Proper disposal of secretions 3. Moist hot packs 4. Firm / nonsagging bed 5. Suitable body alignment 6. Comfort and safety POLIOMYELITIS
PREVENTION

1. Isolation 2. Optimum comfort 3. Restful environment 4. Emotional support 5. Concurrent and terminal disinfection

1. Adequate airway 2. Quiet, semi-dark environment 3. Avoid sudden stimuli and light

Severe viral pneumonia Acute respiratory distress syndrome Fluid accumulation in alveolar sacs Severe breathing difficulties Multiple organ failure DEATH

RABIES
1. If the dog is healthy 2. If the dog dies or shows signs suggestive of rabies 3. If dog is not available for observation 4. Have domestic dog 3 months to 1 year old immunized

TETANUS 1. Aseptic handling of umbilical cord 2. Tetanus toxoid immunization 3. Antibiotic prophylaxis - Penicillin - Erythromycin - Tetracycline

BIRD FLU
TREATMENT MODALITIES

SARS

Salk vaccine - Inactivated polio vaccine - Intramuscular Sabin vaccine - Oral polio vaccine - Per orem

1. Amantadine/Rimantadine 1. No definitive treatment for SARS - Generic flu drugs - H5N1 developed resistance 2. Antiviral drugs (normally used to treat 2. Oseltamivir (TAMIFLU) AIDS) Zanamavir (RELENZA) - RIBAVIRIN - Primary treatment - Within 2 days at onset of 3. Corticosteroids symptoms - 150 mg BID x 2 days

BIRD FLU
RESPIRATORY SYSTEM
PREVENTION

SARS

BIRD FLU
MAIN PROBLEM

SARS
A new type of atypical pneumonia that infects the lungs

1.Culling killing of sick or exposed birds 2. Banning of importation of birds (Executive order # 280) 3. Cook chicken thoroughly
NURSING MANAGEMENT

1.Quarantine 2. Isolation 3. WHO alert on SARS (March 12, 2003)

Flu infection in birds that affects humans

ETIOLOGIC AGENT

Avian influenza virus, H5N1

INCUBATION PERIOD

Corona virus

3-5 days
MODE OF TRANSMISSION

2-8 days

Inhalation of feces and discharge of an infected bird

Respiratory droplets

BIRD FLU
SIGNS AND SYMPTOMS

SARS

Body weakness or muscle pain Cough Difficulty breathing Episodes of sore throat Fever
High fever >38Celsius Chills

BIRD FLU WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD FLU Isolation Face mask on the patient Caregiver: use a face mask and eye goggles/glasses Distance of 1 meter from the patient Transport the patient to a DOH referral hospital REFERRAL HOSPITALS National Referral Center Research Institute for Tropical Medicine (RITM) (Alabang, Muntinlupa) Luzon San Lazaro Hospital (Quiricada St., Sta. Cruz, Manila) Visayas Vicente Sotto Memorial Medical Hospital (Cebu City) Mindanao Davao Medical Center (Bajada, Davao City) SARS SUSPECT CASE 1. A person presenting after 1 November 2002 with a history of: High fever >38 0C AND Cough or breathing difficulty AND One or more of the following exposures during the 10 days prior to the onset of symptoms: Close contact, with a person who is a suspect or probable case of SARS
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History of travel, to an area with recent local transmission of SARS Residing in an area with recent local transmission of SARS 2. A person with an unexplained acute respiratory illness resulting in death after 1 November 2002, but on whom no autopsy has been performed : AND One or more of the following exposures during the 10 days prior to the onset of symptoms: Close contact, with a person who is a suspect or probable case of SARS History of travel, to an area with recent local transmission of SARS Residing in an area with recent local transmission of SARS PROBABLE CASE 1. A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome on Chest x-ray. 2. A suspect case of SARS that is positive for SARS coronavirus by one or more assays. 3. A suspect case with autopsy findings consistent with the pathology of SARS without an identifiable cause.

Begins with respiratory infection, sneezing, cough and fever Cough becomes more frequent at night PAROXYSMAL STAGE Lasts for 4 to 6 weeks Aura: sneezing, tickling, itching of throat Cough, explosive outburst ending in whoop Mucus is thick, ends in vomiting Becomes cyanotic With profuse sweating, involuntary urination and exhaustion CONVALESCENT STAGE End of 4th-6th week Decrease in paroxysms

DIPHTHERIA
DIAGNOSTIC PROCEDURES SCHICKS TESTS - Susceptibility and immunity to diphtheria -ID of dilute diphtheria toxin (0.1 cc) (+) local circumscribed area of redness, 1-3 cm MALONEYS TEST -Determines hypersensitivity to diphtheria anti-toxin -ID of 0.1 cc fluid toxoid -(+) area of erythema in 24 hours

PERTUSSIS
CBC

increase in lymphocytes

DIPHTHERIA
MAIN PROBLEM

PERTUSSIS
Repeated attacks of spasmodic coughing

Acute bacterial disease characterized by the elaboration of an exotoxin

ETIOLOGIC AGENT

DIPHTHERIA
COMPLICATIONS
Toxins in the bloodstream

PERTUSSIS Convulsions (brain

damage from asphyxia)

Corynebacterium diphtheriae or Klebs-Loeffler bacillus

INCUBATION PERIOD

Bordetella pertussis

2-5 days
MODE OF TRANSMISSION

7-14 days 1. Respiratory droplets

Myocarditis (epigastric or chest pain)

Peripheral paralysis (tingling, numbness, paresis)

Bronchopneumonia (fever, cough)

Otitis media
(invading organisms)

2. Direct contact with respiratory secretions 3. Indirect contact with articles

Heart failure

DIPHTHERIA
SIGNS AND SYMPTOMS

PERTUSSIS

Decreased in respiratory rate DEATH

Respirat ory arrest

Bronchopneumonia
(most dangerous complication)

Types: 1.Nasal 2.Tonsilopharyngeal 3.Laryngeal 4.Wound or cutaneous

Stages: 1. Catarrhal 2. Paroxysmal 3. Convalescent

DIPHTHERIA
TREATMENT MODALITIES

PERTUSSIS
1. Erythromycin drug of choice 2. Ampicillin if resistant to erythromycin 3. Betamethasone (corticosteroid) decrease severity and length of paroxysms 4. Albuterol (bronchodilator)

1. Diphtheria anti-toxin - Requires skin testing - Early administration aimed at neutralizing the toxin present in the circulation before it is absorbed by the tissues 2. Antibiotic therapy - Penicillin G - Erythromycin

NASAL DIPHTHERIA Bloody discharge from the nose Excoriated nares and upper lip TONSILOPHARYNGEAL DIPHTHERIA Low grade fever Sore throat Bull-neck appearance Pseudomembrane- Group of pale yellow membrane over tonsils and at the back of the throat as an inflammatory response to a powerful necrotizing toxins LARYNGEAL DIPHTHERIA Hoarseness Croupy cough Aphonia Membrane lining thickens airway obstruction Suffocation, cyanosis or death WOUND OR CUTANEOUS DIPHTHERIA Yellow spots or sores in the skin PERTUSSIS CATARRHAL STAGE Lasts for 1 to 2 weeks Most communicable stage

DIPHTHERIA
NURSING MANAGEMENT

PERTUSSIS
1. Isolation: 4-6 weeks from onset of illness 2. Supportive measures (bedrest, avoid excitement, dust, smoke and warm baths) 3. Safety (during paroxysms, patient should not be left alone) 4. Suctioning (kept at bedside for emergency use)
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1. Isolation: 14 days (until 2-3 cultures, 24 hours apart) 2. Bedrest for 2 weeks 3. Care for nose and throat (gentle swabbing) 4. Ice collar (decrease pain of sore throat) 5. Diet (soft food, small frequent feedings)

MUMPS
MAIN PROBLEM An acute contagious disease, with swelling of one or both of the parotid glands ETIOLOGIC AGENT Filterable virus of paramyxovirus group INCUBATION PERIOD 12-26 days MODE OF TRANSMISSION Respiratory droplets PERIOD OF COMMUNICABILITY 6 days before and 9 days after onset of parotid swelling SIGNS AND SYMPTOMS PRODROMAL PHASE F-ever (low grade) H-eadache M-alaise PAROTITIS F-ace pain E-arache S-welling of the parotid glands COMPLICATIONS Orchitis the most notorious complication of mumps Oophoritis manifested by pain and tenderness of the abdomen CNS involvement manifested by headache, stiff neck, delirium, double vision Deafness as a result of mumps NURSING MANAGEMENT 1. Prevent complications Scrotum supported by suspensory Use of sedatives to relieve pain Treatment: oral dose of 300-400 mg cortisone followed by 100 mg every 6 hours Nick in the membrane 2. Diet - Soft or liquid diet - Sour foods or fruit juices are disliked 3. Respiratory isolation 4. Comfort: ice collar or cold applications over the parotid glands may relieve pain 5. Fever: aspirin, tepid sponge bath 6. Concurrent disinfection: all materials contaminated by these secretions should be cleansed by boiling 7. Terminal disinfection: room should be aired for six to eight hours

AMOEBIASIS
SIGNS AND SYMPTOMS

SHIGELLOSIS

1. Acute amoebic dysentery - Diarrhea alternated with constipation - Tenesmus - Bloody mucoid stools 2. Chronic amoebic dysentery - Enlarged liver - Large sloughs of intestinal tissues accompanied by hemorrhage

Fever Abdominal pain Diarrhea and tenesmus Bloody mucoid stool

SHIGELLOSIS

AMOEBIASIS
DIAGNOSTIC TESTS 1. Stool exam 2. Blood exam 3. Sigmoidoscopy TREATMENT MODALITIES

1. Metronidazole drug of choice 2. Tetracycline

1. Cotrimoxazole drug of choice

3. Chloramphenicol

AMOEBIASIS
NURSING MANAGEMENT

SHIGELLOSIS

1.Enteric isolation 2. Boil water for drinking 3. Handwashing 4. Sexual activity 5. Avoid eating uncooked leafy vegetables

GASTROINTESTINAL TRACT

AMOEBIASIS
MAIN PROBLEM Protozoal infection of the large intestine ETIOLOGIC AGENT

SHIGELLOSIS
Acute infection of the lining of the small intestine

CHOLERA
MAIN PROBLEM

TYPHOID FEVER
An infection affecting the Peyers patches of the small intestines

Entamoeba histolytica
- Prevalent in areas with ill sanitation -Acquired by swallowing - Trophozoites: vegetative form

Shigella group 1. Shigella flesneri most common in the Philippines 2. Shigella connei 3. Shigella boydii 4. Shigella dysenterae most infectious type

Acute bacterial disease of the GIT characterized by profuse secretory diarrhea

ETIOLOGIC AGENT

Vibrio cholerae
INCUBATION PERIOD

Salmonella typhi

- Cyst: infective stage

1 to 3 days
MODE OF TRANSMISSION

1 to 3 weeks

1. Fecal-oral transmission 2. 5 Fs

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CHOLERA
SIGNS AND SYMPTOMS

TYPHOID FEVER
Fever (ladder-like) Rose spots Diarrhea TYPHOID STATE Sordes Subsultus Tendinum Coma vigil Carphologia

CHICKENPOX
PERIOD OF COMMUNICABILITY

HERPES ZOSTER

Rice-water stool Abdominal cramps Vomiting Intravascular Dehydration Shock

One day before eruption of 1st lesion and five days after appearance of last crop
SIGNS AND SYMPTOMS

One day before eruption of 1st rash and five to six days after the last crust

PRODROMAL PERIOD - Fever (low-grade) - Headache - Malaise

CHOLERA
TREATMENT MODALITIES

TYPHOID FEVER
1.Chloramphenicol drug of choice 2. Ampicillin/ Amoxicillin for typhoid carriers 3. Cotrimoxazole for severe cases with relapses

CHICKENPOX
SIGNS AND SYMPTOMS

HERPES ZOSTER
Rashes

1.Lactated Ringers solution 2. Oral rehydration therapy 3. Antibiotic therapy - Tetracycline drug of choice - Cotrimoxazole - Chloramphenicol

Rashes

: Centrifugal distribution Rash stages: macule papule vesicle pustule crust Pruritus

-Unilateral, band-like distribution -Dermatomal - Erythematous base - Vesicular, pustular or crusting Regional lymphadenopathy Pruritus Pain stabbing or burning

CHOLERA
NURSING MANAGEMENT

TYPHOID FEVER

CHICKENPOX
COMPLICATIONS SCARRING most common complication; associated with staphylococcal or streptococcal infections from scratching NECROTIZING FASCIITIS most severe complication REYE SYNDROME abnormal accumulation of fat in the liver plus increase of pressure in the brain resulting to coma, therefore leading to DEATH

HERPES ZOSTER
RAMSAY-HUNT SYNDROME - Involvement of the facial nerve in herpes zoster with facial paralysis, hearing loss, loss of taste in half of the tongue GASSERIAN GANGLIONITIS Involvement of the optic nerve resulting to corneal anesthesia ENCEPHALITIS acute inflammatory condition of the brain

1. Maintain and restore the fluid and electrolyte balance 2. Enteric isolation 3. Sanitary disposal of excreta 4. Adequate provision of safe drinking water 5. Good personal hygiene

INTEGUMENTARY SYSTEM

CHICKENPOX
MAIN PROBLEM

HERPES ZOSTER
An acute viral infection of the sensory nerve

A highly contagious disease characterized by vesicular eruptions on the skin and mucous membranes
ETIOLOGIC AGENT INCUBATION PERIOD

Varicella zoster virus 13-17 days 1. Droplet method 2. Direct contact 3. Indirect contact

10-21 days
MODE OF TRANSMISSION

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CHICKENPOX
TREATMENT MODALITIES

HERPES ZOSTER
4. Corticosteroids antiinflammatory and decreased pain Ex. Prednisone

- Soft palate to mucus membrane

MEASLES
SIGNS AND SYMPTOMS 2. ERUPTIVE STAGE Rashes - Elevated papules - Begin on the face and behind the ears - Spread to trunk and extremities Color: Dark red purplish hue yellow brown 3. Stage of Convalescence - Desquamation - Rashes fade from the face downwards

GERMAN MEASLES
ERUPTIVE STAGE 1. Rash - pinkish, maculopapular - Begins on the face - Spread to trunk or limbs - No pigmentation or desquamation 2. Posterior auricular and suboccipital lymphadenopathy

1. Antihistamines symptomatic relief of itching Ex. Diphenhydramine (Benadryl)

2. Analgesics and antipyretics Ex. Acetaminophen 3. Antiviral agents for patient to experience less pain and faster resolution of lesions when used within 48 hours of rash onset Ex. Acyclovir (Zovirax)

CHICKENPOX
NURSING MANAGEMENT

HERPES ZOSTER

MEASLES
COMPLICATIONS

GERMAN MEASLES
1. Encephalitis
2. Congenital rubella syndrome - Spontaneous abortion - Intrauterine growth retardation (IUGR) - Thrombocytopenia purpura blueberry muffin skin - Cleft lip, cleft palate, club foot - Heart defects (PDA, VSD) - Eye defects (Cataract, glaucoma) - Ear defects (Deafness) - Neurologic ( microcephaly, mental retardation, behavioral disturbances

Strict isolation Prevent secondary infection (cut

fingernails short, wear mittens)

Eliminate itching: calamine

lotions, warm baths, baking soda paste

Pneumonia Otitis media Severe diarrhea (leading

to dehydration)

Encourage not going to school:

usually 7 days

Encephalitis

Disinfection of clothes and linen

with nasopharyngeal discharges by sunlight or boiling

MEASLES
MAIN PROBLEM

GERMAN MEASLES
A benign communicable exanthematous disease caused by rubella virus Rubella virus

MEASLES
TREATMENT MODALITIES

GERMAN MEASLES
1.Aspirin help reduce inflammation and fever

A contagious exanthematous disease with chief symptoms to the upper respiratory tract
ETIOLOGIC AGENT

Filterable virus of paramyxoviridae

INCUBATION PERIOD

10-12 days
MODE OF TRANSMISSION

14-21 days 1. Droplet method 2. Direct contact with respiratory discharges 3. Indirect with soiled linens and articles

1.Vitamin A helps prevent eye damage and blindness 2. Antipyretics for fever 3. Penicillin given only when secondary infection sets in

MEASLES
PERIOD OF COMMUNICABILITY

GERMAN MEASLES
One week before and four days after the appearance of rashes PRE-ERUPTIVE STAGE

MEASLES
NURSING MANAGEMENT

GERMAN MEASLES

4 days before and 5 days after the appearance of rashes

SIGNS AND SYMPTOMS

1. Darkened room to relieve photophobia 2. Diet: should be liquid but nourishing 3. Warm saline solution for eyes to relieve eye irritation 4. For fever: tepid sponge bath and antipyretics 5. Skin care: during eruptive stage, soap is omitted; bicarbonate of soda in water or lotion to relieve itchiness 6. Prevent spread of infection: respiratory isolation

PRE-ERUPTIVE STAGE

Cough Coryza Conjunctivitis Fever (high-grade) Photophobia

Fever Headache Malaise Coryza Conjunctivitis

KOPLIKS SPOT (Rubeola) - Bluish white spots surrounded by a red halo - Appear on the buccal mucosa opposite the premolar teeth FORCHEIMERS SPOTS (Rubella) - small, red lesions

SCABIES
MAIN PROBLEM Infestation of the skin produced by the burrowing action of a parasite mite resulting in skin irritation and formation of vesicles and pustules ETIOLOGIC AGENT Sarcoptes scabiei
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INCUBATION PERIOD Within 24 hours MODE OF TRANSMISSION Direct contact Indirect contact Sarcoptes scabiei 1. Yellowish white in color 2. Barely seen by the unaided eye 3. Female parasite burrows beneath the epidermis to lay eggs 4. Males are smaller and reside on the surface of the skin SIGNS AND SYMPTOMS Thin, pencil-mark lines on the skin Itching, especially at night Rashes and abrasions on the skin PRIMARY LESIONS NODULAR LESIONS SECONDARY LESIONS TREATMENT MODALITIES SCABICIDE : Eurax ointment (Crotamiton) PEDICULICIDE : Kwell lotion (Gamma Benzene Hexachloride) contraindicated in young children and pregnant women Topical steroids Hydrogen peroxide : cleanliness of wound Lindane Lotion NURSING MANAGEMENT Apply cream at bedtime, from neck to toes Instruct patient to avoid bathing for 8 to 12 hours Dry-clean or boil bedclothes Report any skin irritation Family members and close contact treatment Good handwashing Terminal disinfection

AIDS
SIGNS AND SYMPTOMS
OPPORTUNISTIC INFECTIONS

SYPHILIS

1. Pneumocystis carinni pneumonia 2. Oral candidiasis 3. Toxoplasmosis 4. Acute/chronic diarrhea 5. Pulmonary tuberculosis MALIGNANCIES 1. Kaposis sarcoma 2. Non-Hodgkins lymphoma

AIDS
SIGNS AND SYMPTOMS

SYPHILIS
1. PRIMARY SYPHILIS - CHANCRE: small, painless, pimple-like ulceration on the penis, labia majora, minora and lips - May erupt in the genitalia, anus, nipple, tonsils or eyelids - Lymphadenopathy

SEXUALLY TRANSMITTED DISEASES

AIDS
MAIN PROBLEM Final and most serious stage of HIV disease, which causes severe damage to the immune system ETIOLOGIC AGENT Retrovirus Human T-cell lymphotropic virus III (HTLV-3) INCUBATION PERIOD 3 to 6 months to 8 to 10 years

SYPHILIS

AIDS
SIGNS AND SYMPTOMS

SYPHILIS
2. SECONDARY SYPHILIS - Skin rash - Mucous patches - Hair loss - CONDYLOMATA LATA: coalescing papules which form a gray-white plaque frequently in skin folds

Infectious disease caused by a spirochete

Treponema pallidum

10-90 days

AIDS
MODE OF TRANSMISSION

SYPHILIS

AIDS
SIGNS AND SYMPTOMS

SYPHILIS
3. TERTIARY SYPHILIS - 1 to 10 years after infection - Appear on the skin, bones, mucus membrane, URT, liver and stomach - GUMMA: chronic, superficial nodule or deep granulomatous lesion that is solitary, painless, indurated

Sexual

contact oral, anal or vaginal sex Blood transfusion Mother-to-child Indirect contact through soiled articles

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AIDS
DIAGNOSTIC PROCEDURES

SYPHILIS 1.Dark Field Illumination test 2. Flourescent Treponemal Antibody Absorption Test 3. VDRL

CHLAMYDIA
COMPLICATIONS

GONORRHEA

Women Pelvic inflammatory disease Ectopic pregnancy Sterility Men

1.ELISA 2. Western blot 3. RIPA 4. PCR

Epididymitis
Newborn Conjunctivitis Otitis media Pneumonia

Sterility
Newborn Gonococcal ophthalmia

AIDS
TREATMENT MODALITIES

SYPHILIS
1. Penicillin G Benzathine - Disease < 1 year: 2.4 M units once in two injection sites - Disease > 1 year: 2.4 M units in 2 injection sites x 3 doses 2. Doxycycline if allergic to penicillin 3. Tetracycline - if allergic to penicillin - Contraindicated for pregnant women

CHLAMYDIA
TREATMENT MODALITIES

GONORRHEA
1. Cefixime - Drug of choice because of oral efficacy, single dose 2. Ciprofloxacin 3. Ceftriaxone 4. Erythromycin

1. Antivirals - Shorten the clinical course, prevent complications, prevent development of latency, decrease transmission - Example: Zidovudine (Retrovir)

1. Azithromycin (Zithromax) - Drug of choice because of single-dose treatment effectiveness and lower cost 2. Doxycycline - Secondary drug of choice

CANDIDIASIS CHLAMYDIA
MAIN PROBLEM

HERPES SIMPLEX
A viral disease characterized by the appearance of sores and blisters on the skin

GONORRHEA

MAIN PROBLEM

Sexually transmitted disease caused by a bacteria

Purulent inflammation of mucous membrane surfaces
ETIOLOGIC AGENT

Mild superficial fungal infection

ETIOLOGIC AGENT

Chlamydia trachomatis
INCUBATION PERIOD

Neisseria gonorrhea

Candida albicans
INCUBATION PERIOD

Herpes simplex virus types 1 and 2 2-12 days

2-3 weeks (males)

2-10 days
Asymptomatic (females)

2-3 weeks

MODE OF TRANSMISSION

Sexual contact: Oral, vaginal or anal sex

CANDIDIASIS
MODE OF TRANSMISSION

HERPES SIMPLEX
TYPE 1 - Respiratory droplets - Direct exposure to infected saliva - Kissing and sharing utensils TYPE 2 - Sexual or genital contact

CHLAMYDIA
SIGNS AND SYMPTOMS

GONORRHEA
Women Bleeding after intercourse Burning sensation during urination Yellow or bloody vaginal discharge

1. Rise in glucose as in diabetes mellitus 2. Lowered body resistance as in cancer 3. Increase in estrogen level in pregnant women 4. Broad-spectrum antibiotics are used
White, yellow or green pus from the penis

Women Abdominal or pelvic pain Bleeding after intercourse and in-between menses Unusual vaginal discharge

Men Burning with urination Swollen, painful testicles Discharge from the penis

SIGNS AND SYMPTOMS (Candidiasis) ONYCHOMYCOSIS Red, swollen darkened nailbeds Purulent discharge Separation of pruritic nails from nailbeds DIAPER RASH Scaly, erythematous, papular rash Covered with exudates
CD-Bucud 10

Appears below the breasts, between fingers, axilla, groin and umbilicus

THRUSH Cream-colored or bluish-white patches on the tongue, mouth or pharynx Bloody engorgement when scraped MONILIASIS White or yellow discharge Pruritus Local excoriation White or gray raised patches on vaginal walls with local inflammation

CANDIDIASIS
TREATMENT MODALITIES

HERPES SIMPLEX
1. Antivirals - Acyclovir (Zovirax)

1. Antifungals - Fluconazole (Diflucan) - Ketoconazole (Nizoral) - Imidazole (Nystatin) - Used for oral thrush - 48 hours until symptoms disappear - Cotrimoxazole

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VECTOR-BORNE DISEASES

DENGUE MALARIA
DIAGNOSTIC PROCEDURES
1. TORNIQUET TEST Screening test for dengue A test for the tendency for blood capillaries to break down or produce petechial hemorrhage Performed by examining the skin of the forearms after the arm veins have been occluded for 5 minutes To detect unusual capillary fragility -

MALARIA
1. CLINICAL DIAGNOSIS Based on triad symptoms, 50% accuracy

DENGUE
MAIN PROBLEM An acute febrile disease The most common arboviral illness transmitted globally ETIOLOGIC AGENT Dengue virus types 1, 2, 3 and 4 Chikungunya virus Onyongnyong virus West Nile virus

An acute and chronic parasitic disease The most deadly vector-borne disease in the world Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae

2. BLOOD SMEAR Definitive diagnosis of infection is based on demonstration of malaria parasites in blood film

3. RAPID DIAGNOSTIC TEST Uses immunochromatographic methods to detect Plasmodiumspecific antigens Takes about 7 to 15 minutes Sensitivity and specificity > 90%

2. PLATELET COUNT Confirmatory test for dengue Decreased count is confirmatory

DENGUE
TREATMENT MODALITIES
1. Analgesics and antipyretics

MALARIA
1. Chloroquine 2. Primaquine 3. Pyrimethamine 4. Sulfadoxine 5. Quinine 6. Quinidine

DENGUE
INCUBATION PERIOD 3-14 days

MALARIA
P. Falciparum 12 days P. Vivax 14 days P. Ovale 14 days

- acetaminophen
2. Volume expanders - Used in the treatment of intravascular volume deficits - Example: Lactated Ringers

MODE OF TRANSMISSION

P. Malariae 30 days

Bite of an infected mosquito Blood transfusion, contaminated syringe or needle Trans-placentally

3. Blood transfusion for severe bleeding 4. Oxygen therapy 5. Sedatives

SCHISTOSOMIASIS DENGUE
VECTOR

LEPTOSPIROSIS

MALARIA
MAIN PROBLEM A slowly progressive disease caused by a blood fluke ETIOLOGIC AGENT
1. SCHISTOSOMA JAPONICUM

A zoonotic infectious disease

Aedes aegypti (Aedes albopictus) White stripes on the back and legs (Tiger mosquito) Day biting (2 hours after sunrise and 2 hours before sunset) Breeds on clear stagnant water Urban-based

Anopheles flavirostris

Brown in color Night biting (9 PM-3 AM) Breeds on clear, flowing and shaded streams Rural-based

Leptospira interrogans

Intestinal tract, endemic in the Philippines

2. SCHISTOSOMA MANSONI Africa

3. SCHISTOSOMA HAEMATOBIUM - Middle East countries like Iran and Iraq

SCHISTOSOMIASIS
INCUBATION PERIOD

LEPTOSPIROSIS

DENGUE
SIGNS AND SYMPTOMS

MALARIA
At least 2 months 7 to 19 days

FEVER HEADACHE MALAISE RASH EPISODES OF BLEEDING

FEVER CHILLS PROFUSE SWEATING

MODE OF TRANSMISSION Ingestion Skin penetration Contact with the skin

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SCHISTOSOMIASIS
VECTOR

LEPTOSPIROSIS

SCHISTOSOMIASIS
TREATMENT MODALITIES 1. Praziquantel (Biltricide) - Taken for 6 months - 1 tablet BID for 3 months - 1 tablet OD for 3 months

LEPTOSPIROSIS

Oncomelania quadrasi 1. Thrives in fresh water stream 2. Clings to grasses and leaves 3. Greenish brown in color 4. Size is as big as the smallest grain of palay

1st line drugs 1. Penicillin G drug of choice 2. Doxycycline 2nd line drugs 3. Ampicillin 4. Amoxicillin

SCHISTOSOMIASIS
SIGNS AND SYMPTOMS ACUTE STAGE 1. Cercarial dermatitis (swimmers itch) 2. Katayama syndrome C - ough H eadache and fever A norexia and lethargy R ash M - yalgia

LEPTOSPIROSIS
Septic or Leptospiremic Stage F ever (remittent H eadache M yalgia N ausea V omiting C ough C hest pain

FILARIASIS
MAIN PROBLEM A parasitic disease caused by an African eye worm ETIOLOGIC AGENT Wuchereria bancrofti Brugia malayi Brugia timori INCUBATION PERIOD 8 to 16 months MODE OF TRANSMISSION Person-to-person by mosquito bites ACUTE STAGE Lymphadenitis (inflammation of lymph nodes) Lymphangitis (inflammation of lymph vessels) Male genitalia affected leading to funiculitis, epididymitis and orchitis (redness, painful and tender scrotum) CHRONIC STAGE Develop 10-15 years from onset of first attack Hydrocele (swelling of the scrotum) Lymphedema (temporary swelling of the upper and lower extremities) Elephantiasis (enlargement and thickening of the skin of the upper and lower extremities, scrotum and breast LABORATORY EXAMINATIONS Nocturnal blood examination (NBE) taken at patients residence/hospital after 8PM Immunochromatographic test (ICT) rapid assessment method; an antigen test done at daytime TREATMENT Diethylcarbamazine Citrate (DEC) or HETRAZAN an individual treatment kills almost all microfilaria and a good proportion of adult worms. PREVENTION AND CONTROL Measures aimed to control vectors Environmental sanitation such as proper drainage and cleanliness of surroundings Spraying with insecticides PREVENTION AND CONTROL Measures aimed to protect individuals and families: Use of mosquito nets Use of long sleeves, long pants and socks Application of insect repellants Screening of houses

SCHISTOSOMIASIS
SIGNS AND SYMPTOMS CHRONIC STAGE
1. Hepatic: pain, abdominal distension, hematemesis, melena 2. Intestinal: fatigue, abdominal pain, dysentery 3. Urinary: dysuria, urinary frequency, hematuria 4. Cardiopulmonary: palpitations, dyspnea on exertion 5. CNS: seizures, headache, back pain and paresthesia

LEPTOSPIROSIS
Immune or Toxic Stage - Lasts for 4 to 30 days - Iritis, headache, meningeal manifestations - Oliguria, anuria with renal failure - Shock, coma and congestive heart failure

SCHISTOSOMIASIS
DIAGNOSTIC PROCEDURES 1. Fecalysis 2. Kato-Katz Technique 3. Cercum ova precipitin test (COPT) - Confirmatory test for schistosomiasis

LEPTOSPIROSIS

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