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POLIOMYELITIS

> Also called:


- Infantile Paralysis
-Heine-Medin Disease
>Affects children below ten (10) years of
age
Less risk for people above ten (10) years
Old
Causative Agent
Virus
Legio debilitans
Type 1 Brunhilde
Type 2 Lansing
Type 3 Leon
If Brunhilde
Gives permanent immunity
If Lansing or Leon
Gives temporary immunity
Important Concepts!
When Brunhilde infects you, Leon or Lansing will no longer affect
you!
In the Philippines, the most prominent type is Brunhilde!
Mode of Transmission
>Droplet
In early stage of infection, virus if found at
nasopharyngeal secretions
>Fecal-Oral Route
In late stage of transmission, virus is found
at the mouth

Portal of Entry
Gastrointestinal Tract
Pathophysiology
>Legio debilitans goes to the nasopharynx or the mouth
>If in the nasopharynx, it goes to the tonsils and causes:
-Sore throat
-Fever and chills
-Headache with body malaise
>If at the mouth, it goes to the Peyers patches and causes:
-Abdominal pain
-Anorexia
-Nausea and Vomiting
-Diarrhea or Constipation
STAGES of POLIOMYELITIS
1
ST
Stage: Invasive Stage or Abortive Stage
All the abovementioned signs and symptoms will appear
Patient recovers
Disease process is aborted
But there will be instances when disease process will not be aborted
Tonsils Peyers Patches

Cervical Mesenteric
Lymph Lymph
Nodes Nodes

B L O O D S T R E A M

Central Nervous System


2
nd
Stage: Pre-paralytic Stage of Poliomyelitis
Central Nervous System is already involved but there will be no
paralysis
Signs and Symptoms:
Once in the CNS, microorganism will cause:
Sever muscle pain
Do not keep on turning or holding patient
Do not do massage
No positioning will relieve patient
Instead, what would relieve the patient would be:
Application of warm packs
Analgesics
Never administer Morphine
Once in the CNS, the microorganism will also cause:
Stiffness of the hamstring
Patient will be positive for HOYNES Sign and exhibit a
HEAD DROP
To check for Hoynes Sign
Lift shoulders of patient when lying supine or extend
head of patient beyond the edge of the bed
If head of patient drops, he is said to be positive (+) for
Hoynes Sign
Once in the microorganism is in the CNS, the patient would elicit a POKER SPINE
Ophistotonus with head retraction
Sitting position cannot be assumed
Therefore, patient will assume a TRIPOD POSITION
Central Nervous System

Paralysis
Concept!
From the CNS, the patient will experience paralysis.
This leads to the third (3
rd
) stage of the disease
3
rd
Stage: Paralytic Stage
Presence of paralysis
Characteristics of Paralysis:
Flaccid
Soft
Flabby
Limp
Important Concept!
Flaccid Paralysis is PATHOGNOMONIC SIGN of Poliomyelitis
Three (3) Types of Paralysis
1. Bulbar Type
Cranial nerves are affected
9
Th
cranial nerve (Glossopharyngeal Nerve) and 10
th
cranial
nerve (Vagus Nerve) affectations give rise to:
Respiratory problems
Vocal cord swelling / paralysis
Excessive salivation
Aspiration
Regurgitation
2. Spinal Type
Most common type of paralysis
Affects ANTERIOR HORN CELLS
Affects MOTOR FUNCTION
Paralysis of extremities
Paralysis of intercostal muscles leads to DIFFICULTY OF BREATHING
Exams and Tests
The health care provider may find signs of meningeal irritation
(similar to meningitis), such as stiff neck or back stiffness with
difficulty bending the neck. The person also might have difficulty
lifting the head or lifting the legs when lying flat on the back, and
their reflexes might be abnormal.
Tests include:
Routine CSF examination
Test for levels of antibodies to the polio virus
Viral cultures of throat washings, stools, or cerebrospinal fluid
(CSF)
Medical Mgmt:
Treatment
The goal of treatment is to control symptoms while the infection runs its
course.
People with severe cases may need lifesaving measures, especially breathing
help.
Symptoms are treated based on how severe they are. Treatments include:
- Antibiotics for urinary tract infections
- Medications (such as bethanechol) for urinary retention
- Moist heat (heating pads, warm towels) to reduce muscle pain and spasms
- Pain killers to reduce headache, muscle pain, and spasms (narcotics are not
usually given because they increase the risk of breathing difficulty)
- Physical therapy, braces or corrective shoes, or orthopedic surgery to help
recover muscle strength and function
3. Bulbo-Spinal Type
Combination of Bulbar and Spinal types
Patient has cranial nerve affectations and
anterior horn cell affectations
Important Concepts!!!
Not all patients will develop paralysis
If patient is non-paralytic,
He has GOOD PROGNOSIS
Diagnostic Tests
1. Lumbar Puncture
Laboratory results would reveal:
Increased White Blood Cell levels
Increased Protein levels
Normal Sugar levels
2. Muscle Testing
To determine what specific muscle is affected
3. Electromyelogram
To determine extent of muscle involvement
4. Stool Examination
Perfomed at the late stage
About ten (10) days after being affected
5. Nasopharyngeal Examination
Performed at the early stage
Medical Management
Symptomatic
Causative agent is viral
If there is respiratory paralysis
Place patient in a MECHANICAL VENTILATOR
Use the IRON LUNG MACHING
This works on the principle of Negative Pressure Breathing
No tracheostomy tube needed (tracheostomy tube or endotracheal tube
work on the principle of Positive Pressure Breathing)
Capsular in shape
With glass windows
With metal plate
Works on electricity
During brownout or power shortages, operate the machine manually
It has a steering wheel, which can be manipulated manually
Patient stays in the Iron Lung Machine for months
Surgical management
a. Muscle and tendon transplantation
Operation of Tendons
tenotomy- division of tendon
myotomy- division of muscle
fasciotomy- operation on deep fascia the most
useful procedure in the surgical treatment of
poliomyelitis are operations that restore stability
to failed joints.
b. Arthrodesis- fusion of bones
across a joint space by surgical
means, which eliminates
movement, usually performed to
eliminate pain over a joint.
c. Osteotomy- cutting of bone into
2 parts followed by realignment of
ends to allow healing
d. Operation to equalized the leg
length discrepancy After poliomyelitis,
growth affected leg is slowed down as
much 6 to 7 cm by disuse, atrophy and
diminished blood flow to the limb. The
degree of shortening depends of the
severity of the paralysis and the age at
which paralysis begins.
Orthotic devices:
1. Hooks corset
Prevent deformity
2. Long leg brace
To provide needed support
3. Oppenens Splints
Prevent weakening of muscles
4. Mobile arm support
To increase hand function
Nursing Care for Poliomyelitis
Symptomatic and Supportive
Psychological Aspect of Care
Use empathy
Preventive Measures
1. Immunization
Vaccine given:
Oral Polio Vaccine (OPV) or Sabin
Dose:
Two (2) to three (3) drops
Route:
Oral
Number of Doses:
Three (3)
Interval:
Four (4) weeks
When given:
1
st
Dose at six (6) weeks old
2
nd
Dose at ten (10) weeks old
3
rd
Dose at fourteen (14) weeks old
Important Concepts!!!
Do not feed child for thirty (30) minutes after administration of
OPV
Rationale:
For better absorption
If child vomits, REPEAT!!!
If child has diarrhea
Give OPV
But do not record it
Not all of the vaccine may be absorbed properly
When OPV 3 is given four weeks after, record it as OPV 2
Integrated Management of Childhood Illnesses
(IMCI)
Tell mother also that she should be very careful
in handling stool of child because this vaccine
eliminates virus to the stool
If significant others at home are
immunocompromised
Do not administer OPV
Due to feces of child
Rather give, IPV or Inactivated Polio Vaccine /
SALK
Dose:
0.5 cc
Route:
Intramuscular
Number of Doses:
Three (3)
Interval:
Four (4) weeks
When given:
1
st
Dose at six (6) weeks old
2
nd
Dose at ten (10) weeks old
3
rd
Dose at fourteen (14) weeks old
Rationale:
Because stool of child may contain the virus if OPV is given
. Avoid mode of transmission
Proper disposal of nasopharyngeal
secretions
Cover mouth when coughing
Do not put anything through the
mouth

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