COMMUNICABLE DISEASES

Communicable Diseases are Primary Cause of

Mortality Gap between Rich and Poor Countries
Non-communicable diseases account for 59% of all
deaths worldwide estimated to rise from !"m in
#99$ to 5$m in !$!$
%bout &$% of deaths caused by communicable
diseases can be attributed to'
()*+%)D,
Malaria
-uberculosis
Measles
Diarrheal disease
%cute respiratory infection
Philippines top 10 leading causes of o!"idit#
$ o!talit# in the #ea! %00&'
Dia!!hea
B!onchitis
Pneuonia
Influen(a
)#pe!tension
*u"e!culosis
Mala!ia
)ea!t diseases
Cance!
Accidents
Ch!onic o"st!ucti+e pulona!# disease and
othe! !espi!ato!# diseases
Dia"etes and ,idne# diseases-
Goal of .(/
#0 Pre1ention of disease
!0 Pre1ention of disability and death from infection
20Pre1ention throu3h immuni4ation
Chain of )nfection
Pathogen o! causati+e agent
biolo3ic a3ent 5or3anism6 capable of causin3
disease
7liminate or3anism by'
,terili4in3 sur3ical instruments and anythin3
that touches sterile spaces of the body
8sin3 3ood food safety methods
Pro1idin3 safe drin9in3 water
*accinatin3 people so they do not become
reser1oirs of illness
-reatin3 people who are ill
.ese!+oi!
%ny person: animal: arthropod: plant: soil: or
substance 5or combination of these6 in which an
causati1e a3ent normally li1es and multiplies: on
which it depends primarily for sur1i1al: and where it
reproduces in such numbers that it can be
transmitted to a susceptible host
7liminate reser1oirs by'
-reatin3 people who are ill
*accinatin3 people
(andlin3 and disposin3 of body fluids
responsibly
(andlin3 food safely
Monitorin3 soil and contaminated water in
sensiti1e areas of the hospital and washin3
hands carefully after contact with either
Po!tal of e/it
the way the causati1e a3ent 3ets out of the
reser1oir 5body fluid or s9in6
Reduce ris9 from portals of e;it by'
Co1erin3 cou3hs and snee4es with a tissue
(andlin3 body fluids with 3lo1es: then doin3
hand hy3iene
<eepin3 drainin3 wounds co1ered with a
dressin3
Not wor9in3 when you ha1e e;udati1e 5wet6
lesions or weepin3 dermatitis
Mode of t!ansission
any mechanism by which a patho3en is spread
from a source or reser1oir to a person
unwashed hands: thin3s which are not cleaned
between patients: droplets: or: for a few diseases:
the air
7liminate the mode of transmission by'
(and hy3iene
.earin3 3lo1es to minimi4e contamination
of hands and discardin3 them after each
patient
Cleanin3: disinfection: or sterili4ation of
e=uipment used by more than one patient
Cleanin3 of the en1ironment: especially
hi3h-touch surfaces
Po!tal of ent!#
hole in the s9in that allows the infectious a3ent to
3et into the body 5mouth: nose: eyes: rashes: cuts:
needlestic9 in>uries: sur3ical wounds and )* sites6
Protect portals of entry 5our own and our patients6
by'
Dressin3s on sur3ical wounds
)* site dressin3s and care
7limination of tubes as soon as possible
Mas9s: 3o33les and face shields
<eepin3 unwashed hands and ob>ects away
from the mouth
%ctions and de1ices to pre1ent needlestic9s
?ood and water safety
Suscepti"le host
a person or animal lac9in3 effecti1e resistance to a
particular infectious a3ent
Minimi4e ris9 to susceptible hosts by'
*accinatin3 people a3ainst illnesses to
which they may be e;posed
Pre1entin3 new e;posure to infection in
people who are already ill: are recei1in3
immunocompromisin3 treatment: or are
infected with ()*
Maintainin3 3ood nutrition
Maintainin3 3ood s9in condition
Co1erin3 s9in brea9s
7ncoura3in3 rest and balance in our li1es
MIC.OBES against )UMAN
Definition'
S#ptos
e1idence of disease that is e;perienced or
percei1ed 5sub>ecti1e6
sub>ecti1e chan3es in body function noted by
patient but not apparent to an obser1er
Signs
ob>ecti1e e1idence of a disease the physician
can
obser1e and measure
S#nd!oe
a specific 3roup of si3ns and symptoms that
accompany a particular disease
Incidence
the number of people in a population who
de1elop a disease durin3 a particular time
period
P!e+alence
the number of people in a population who
de1elop a disease: re3ardless of when it appeared
refers to both old and new cases
Classification of Infectious Disease
Based on Beha+io! 0ithin host
Infectious Disease
- %ny disease caused by in1asion and
multiplication of microor3anisms
Contagious Disease
disease that easily spreads from one person
to another

Based on Occu!!ence of Disease
Spo!adic Disease
disease occurs only occasionally
i0e0 botulism: tetanus
Endeic Disease
constantly present in a population: country
or
community
i0e0 Pulmonary -uberculosis
Epideic Disease
ac=uire disease in a relati1ely short period
3reater than normal number of cases in an
area
within a short period of time
Pandeic Disease
epidemic disease that occurs worldwide
i0e0 ()* infection
Based on Se+e!it# o! Du!ation of Disease
Acute Disease
de1elops rapidly 5rapid onset6 but lasts only
a short time
i0e0 measles: mumps: influen4a
Ch!onic Disease
De1elops slowly: milder but lon3er lastin3
clinical manifestation
Based on State of )ost .esistance
P!ia!# Infection
acute infection that causes the initial illness
Seconda!# Infection
one caused by an opportunistic patho3en after
primary infection has wea9ened the body@s
defenses

Stages of Disease
Incu"ation Pe!iod
time inter1al between the initial infection and
the
#
st
appearance of any s+s;
P!od!oal Pe!iod
early: mild symptoms of disease
Pe!iod of Illness
o1ert s+s; of disease
.AC may increase or decrease
can result to death if immune response or
medical
inter1ention fails
Pe!iod of Decline
s+s; subside
1ulnerable to secondary infection
Pe!iod of Con+alescence
re3ains stren3th and the body returns to its
pre diseased state
reco1ery has occurred
Mode of -ransmission
-he process of the infectious a3ent mo1in3 from
the reser1oir to the susceptible host
Contact -ransmission
- the most important and fre=uent mode of
transmission
*#pe of Contact *!ansission
Di!ect Contact *!ansission
Person to person transmission of an a3ent
by
physical contact between its source and
susceptible host
No intermediate ob>ect in1ol1ed
i0e0 9issin3: touchin3: se;ual contact
,ource B ,usceptible (ost
Indi!ect Contact *!ansission
reser1oir to a susceptible host by means of
a
non li1in3 ob>ect 5fomites6
,ource B Non Ci1in3 /b>ect B ,usceptible
(ost
,usceptible (ost
Reco3nition of hi3h ris9 patients
)mmunocompromised
DM
,ur3ery
Aurns
7lderly
Pe!centage Nosocoial Infection
#D% Su!gical
2E% U*I
#2% L.I
#E% Bacte!eia
!!% Othe! 1incldng s2in
Inf/n3
4acto!s fo! Nosocoial Infection
Mic!oo!ganis5)ospital En+i!onent
Most common cause
,taph aureus: Coa3 Ne3 ,taph 7nterococci
70 coli: Pseudomonas: 7nterobacter:
<lebsiella
Clostridium Difficile
?un3i 5 C0 %lbicans6
/ther 5 Gram 5-6 bacteria6
D$% are dru3 resistant bacteria
Cop!oised )ost
/ne whose resistance to infection is impaired by
bro9en s9in: mucous membranes and a
suppressed immune system

S2in and Mucous Me"!ane
physical barrier
i0e0 burns: sur3ical wounds: trauma: )* site
in1asi1e procedures
Supp!essed Iune S#ste
i0e0 dru3s: radiation: steroids: DM: %)D,
)MM8N)-F
-he human body has the ability to resist almost all
types of or3anisms or to;ins that tend to dama3e
the tissues and or3ans0 -his is called iunit#
?unctions of )mmune ,ystem
#0 Protects the body from internal threats
!0 Maintains the internal en1ironment by remo1in3
dead or dama3ed cells0
20 Pro1ides protection a3ainst in1asion from outside
the body0
-he immune system
-he ma>or components of the immune system
includes the bone marrow which produces the
white blood cells 5.AC6: the lymphoid tissues
which includes the thymus: spleen: lymphnodes:
tonsils and adenoids0
Natu!al Iunit# 1INNA*E3
Non-specific immunity present at birth0 -his
includesG
a0 Pha3ocytosis of bacteria and other
in1aders by white blood cells and cells of the tissue
macropha3e system
b0 Destruction by the acid secretions of the
stomach and by the di3esti1e en4ymes on
or3anisms swallowed into the stomach0
c0 Resistance of the s9in in1asion by
or3anisms
d0 Presence in the blood of certain chemical
compounds that attach to forei3n or3anism or
to;ins and destroy them li9e lyso4yme: natural 9iller
cells and complement comple;0
Ac6ui!ed Iunit#
-he human body has the ability to de1elop
e;tremely powerful specific immunity a3ainst
indi1idual in1adin3 a3ents0 )t usually de1elops as a
result of prior e;posure to an anti3en throu3h
immuni4ation or by contractin3 a disease0
%cti1e %c=uired )mmunity - immune defense are
de1eloped by the person@s own body0 -his immunity
last many years or a lifetime0
Passi1e %c=uired )mmunity - temporary immunity
from another source that has de1eloped immunity
throu3h pre1ious disease or immuni4ation0 )t is
used in emer3encies to pro1ide immediate: short
actin3 immunity when the ris9 is hi3h0
%N-)A/D)7,
Agglutination - clumpin3 effect of antibodies
between two anti3en0 )t helps to clear the body of
in1adin3 or3anisms by facilitatin3 pha3ocytosis0
Opsoni(ation in this process: the anti3en-
antibody molecule is coated with a stic9y substance
that facilitates pha3ocytosis0
1- Ig7 1&893
%ppears in serum and tissues
%ssumes a ma>or role in bloodborne and
tissue infections
%cti1ates the complement system
7nhances pha3ocytosis
Crosses placenta
%- IgA 11893
%ppears in body fluids 5blood:sali1a: tears:
breat mil96
Protects a3ainst respiratory: G)- and G8-
Pre1ents absorption of anti3ens from food
Passes to neonate in breast mil9 for
protection
:- IgM 11093
%ppears mostly in intra1ascular serum
?irst immuno3lobulin produced in response
to bacterial or 1iral infection
%cti1ates complement systems
;- IgD 1-%93
%ppears in small amount in serum
8- IgE 1-00;93
%ller3ic and hypersensiti1ity reactions
Combats parasitic infections
)MM8N)H%-)/N
%ND *%CC)N7,
)MM8N)H%-)/N
Process inducin3 immunity artificially by either
1accination 5acti1e6 or administration of antibody
5passi1e6
%cti1e ' stimulates the immune system to produce
antibodies: cellular immune responses to protect
a3ainst infectious a3ent
Passi1e ' pro1ides temporary protection throu3h
administration of e;o3enous antibody
)MM8N)H)NG %G7N-,
*accines ' a preparation of proteins:
polysaccharides or nucleic acids of patho3ens that
are administered inducin3 specific responses that
inacti1ate or destroy or suppress the patho3en
-o;oid ' a modified bacterial to;in that has been
made nonto;ic but retains the capacity to stimulate
the formation of antito;in
)MM8N)H)NG %G7N-,
)mmune 3lobulin ' an antibody containin3 solution
deri1ed from human blood obtained by cold ethanol
fractionation of lar3e pools of plasma and used
primarily for immunodeficient persons or for passi1e
immuni4ation
%ntito;in ' an antibody deri1ed from serum of
human or animals after stimulation with specific
anti3ens used for passi1e immunity
7;panded Pro3ram of )mmuni4ation
launched in Iuly #9D& by D/( with cooperation
with .(/ and 8N)C7?0
/b>ecti1e was to reduce the mortality and morbidity
amon3 infants and children caused by the si;
childhood immuni4able diseases0
P<): Diptheria: Polio: Measles and tetanus
PD no0 99& 5,eptember #&: #9D&6-
compulsory immuni4ation for children below
the a3e of ei3ht0
R% D"9& 5December 2$:#99E6 compulsory
hepatitis A for children below ei3ht years old
PP no0#$&& 5%u3ust !&:#99D6 national
tetanus elimination startin3 #99D
%PPR/%C( -/ %C-)*7 )MM8N)H%-)/N
C)*7 %--7N8%-7D *%CC)N7,
- induce response similar to an acti1e
infection
- /r3anisms in li1e 1accines ' multiply in
recipient until desired immune response
occurs: considered to confer lifelon3
protection
- 7;0 Measles: mumps: rubella
%PPR/%C( -/ %C-)*7 )MM8N)H%-)/N
)N%C-)*%-7D /R D7-/J)?)7D *%CC)N7
- include whole or3anisms: deto;ified
e;oto;in: purified protein anti3ens:
polysaccharide
- Cesser anti3enic mass: re=uires booster
1accinations to pro1ide protection
- 7;0 (epa A: pertussis: tetanus: diphtheria:
influen4a A: pneumococcal
7JP%ND7D PR/GR%M /? )MM8N)H%-)/N
% fully immuni4ed child under 7P) 5before #!
months of a3e6
# ACG at birth or before #! months
2 DP- and 2/P* K &wee9s old: E wee9s
apart
2 (epa A K& wee9s old: E wee9s apart
A%C)CC7-C%CM7--7-G87R)N 5ACG6
/nly intradermal 1accine
%ttenuated bo1ine strains of tubercle bacilli
5M0bo1is6
?ree4e-dried: easily destroyed by heat and
sunli3ht
Dose ' $0$5 ml )D
Normal course ' wheal disappears in 2$
minsG induration-! to 2 w9s laterG pustular
formation-E to & w9sG full scarification-& to
#! w9s later
8sually at ri3ht deltoid or buttoc9s 5upper
=uadrant6
A%C)CC7-C%CM7--7-G87R)N 5ACG6
Complications '
- deep abscess at 1accination site due to
subL or deeper in>ection
- )ndolent ulcer K#! wee9s
- Re3ional lymphadenitis
/R%C P/C)/ *%CC)N7 5/P*6
/ral preparation - li1e attenuated ,abin:
tri1alent /P*
Dose ' ! dropsG as early as & wee9s old: E
wee9s apart
Aooster dose ' # year after last dose of
primary series and between E to & years old
D)P(-(7R)%: -7-%N8,:P7R-8,,), 5D-P6
Diphtheria and tetanus to;oid: inacti1ated
pertussis adsorbed into aluminum salts
Dose ' $05 ml )M ; 2 doses as early as &
wee9s old: E wee9s apart
Aooster doses ' # year after last dose of
primary series and between E to & years old
Complications '
- Pertussis ' not used in K & y+o because of
increased ris9 of neuroparalytic reaction
M7%,C7,
- Ci1e attenuated 1accineG free4e-dried
- Dose ' $05 ml ,C at 9 months: as early as &
months
- Aooster dose ' #! to #5 months old as MMR
5Measles: Mumps: Rubella6
- -ransplacental maternal )3G interferes with
antibody formation
M7%,C7,+MMR
- ?irst dose at #! to #5 months
- ,econd dose between E-& y+o
- Mumps 1accine usually K#5 months old
3i1en as MMR
(7P%-)-), A
- )nfants born o (bs%3-positi1e mothers
should recei1e (epA 1accine 5below D
days6 plus $05 ml (epa A immuno3lobulin
5(A)G6 within #! hours of birth at ! diff0sites
- !nd dose is recommended at #-! months
and 2rd dose at & months of a3e
- )nfants born to mothers whose (bs%3 is
un9nown should recei1e (epA 1accine
within #! hours of birth
(aemophilus )nfluen4a type A 5()A6
- /ld pure capsular polysaccharide 1accine
effecti1e for K #" months
- (iA cause menin3itis and serious
respiratory infections in M#! months
-FP(/)D
- Ci1e oral -y!#%0 -hermolabile 3i1en 2
doses at ! days inter1al and !5-95%
effecti1e for 2 years
- *i %nti3en typhoid 1accine 5-yphim
*i60capsular polysaccharide of the
or3anisms0 Gi1en $05 ml ,C or )M with D5%
effecti1ity for 2 years
(7P%-)-), %
- *accine contains formaldehyde-inacti1ated
(ep % containin3 D!$ 7C),% units
- Gi1en at # to #& years of a3e at a dose of
$05 ml )M or ,C followed by a booster dose
& to #! months after
- 7ffecti1ity of 99% and side effects are mild
and uncommon
)N?C87NH%
- )mmuno3enic: safe and associated with
minimal side effects
- &months to M2& months: ! doses of 1accine
# month apart
- Protection is D$ to "$% with ran3e of 5$ to
95%
- Duration or protection is M# year
PN78M/C/CC%C
- !2-1alent pneumococcal 1accine is
composed of purified capsular
polysaccharide anti3en of !2 serotypes
- Gi1en ,C or )M
- Reacti1ation after 2-5 years is
recommended for children #$ years or
youn3er who are at hi3h ris9 of se1ere
Pneumococcal infection
- Can be 3i1en concurrently with other
1accines
PN78M/C/CC%C
-he followin3 serious patients should be immuni4ed
'
- sic9le cell disease
- ?unctional or anatomical asplenia
- Nephrotic syndrome or CR?
- )mmunosuppressi1e conditions
- ()* infections
M7N)NG/C/CC%C
- %ppro1ed for children ! years older
- $05 ml ,C
- Can be 3i1en concurrently with other
1accines
7JP%ND7D PR/GR%M /? )MM8N)H%-)/N
5.(/6
)t is safe to 1accinate a sic9 child who is sufferin3
from a minor illness 5cou3h: cold: diarrhea: fe1er or
malnutrition6 or who has already been 1accinated
a3ainst measles
)f the 1accination schedule is interrupted: it is not
necessary to restart0 )nstead: the schedule should
be resumed usin3 minimal inter1als between doses
to catch up as =uic9ly as possible0
% Nfirst e;piry and first outN 5?7?/6 1accine system
is practiced to assure that all 1accines are utili4ed
before its e;piry date0 *accine temperature is
monitored twice a day in all health facilities and
plotted to monitor brea9 in the cold chain0

Most sensiti1e to (eat /ral polio 1accine:
Measles
Ceast ,ensiti1e to (eat DP- 1accine: (epa A:
ACG: tetanus -o;oid
IN4EC*ION CON*.OL P.OCEDU.E
Medical Asepsis
- CLEAN -echni=ue
- )n1ol1es procedures and practices that
reduce the number and transfer of
patho3ens
- .ill e;clude patho3ens /NCF
Attain "#'
- ?re=uent and thorou3h hand washin3
- Personal 3roomin3
- Proper cleanin3 of supplies and e=uipment
- Disinfection
- Proper disposal of needles: contaminated
materials and infectious waste
- ,terili4ation
Su!gical Asepsis
S*E.ILE techni=ue
- Practices used to render and 9eep ob>ects
and areas sterile
- 7;clude ALL microor3anism
Attain "#'
- 8se strict aseptic precautions for in1asi1e
procedures
- ,crub hands and fin3ernails before enterin3
/0R0
- 8se sterile 3lo1es: mas9s: 3owns and shoe
co1ers
- 8se sterile solutions and dressin3s
- 8se sterile drapes and create an sterile field
- (eat sterili4ed sur3ical instruments
Uni+e!sal P!ecautions
8ni1ersal Precautions
- )nfection control 3uidelines desi3ned to
protect wor9ers from e;posure to diseases
spread by blood and certain body fluids0
- ?or pre1ention of transmission of blood-
borne patho3ens in health care settin3s to
pre1ent contact with patient blood and body
fluids
- ,tress that all patients should be assumed
to be infectious for blood-borne diseases
such as %)D, and hepatitis A0
- 8ni1ersal Precautions
?ollowed when wor9ers are e;posed to blood and
certain other body fluids: includin3'
- semen
- 1a3inal secretions
- syno1ial fluid
- cerebrospinal fluid
- pleural fluid
- peritoneal fluid
- pericardial fluid
- amniotic fluid
- 8ni1ersal Precautions
do not appl# to'
- feces
- nasal secretions
- sputum
- sweat
- tears
- urine
- 1omitus
- sali1a 5e;cept in the dental settin3: where
sali1a is li9ely to be contaminated with
blood6
Standa!d P!ecautions
,tandard Precautions
Replaced uni1ersal precautions
%pply to all patients
,tipulate that 3lo1es should be worn to touch any of
the followin3'
- blood
- all body fluids
- secretions and e;cretions: e;cept sweat:
re3ardless of whether they are 1isibly bloody
- non-intact s9in
- mucous membranes
,tandard Precautions
Glo1es
- Pre1ent contamination of the hands with
microor3anisms
- Pre1ent e;posure of the (C. to blood-
borne patho3ens
- Reduce the ris9 of transmission of
microor3anisms from the hands of (C.s to
the patient
- Do not replace the need for hand hy3iene
,tandard Precautions
(ands washed immediately after 3lo1es are
remo1ed and between patient contacts
- ?or procedures that are li9ely to 3enerate
splashes or sprays of body fluid: a mas9
with eye protection or a face shield and a
3own should be worn
- Disposable 3owns should be constructed of
an imper1ious material to pre1ent
penetration and subse=uent contamination
of the s9in or clothin3
,tandard Precautions
- Needles should not be recapped: bent: or
bro9en but should be disposed of in
puncture-resistant containers
,tandard Precautions
(and (y3iene
- ,in3le most important means to pre1ent
transmission of nosocomial patho3ens
- Remo1es the transient flora recently
ac=uired by contact with patients or
en1ironmental surfaces
- %lcohol-based hand rubs are recommended
5if hands are 1isibly soiled: washin3 with
soap and water is recommended6
- Rin3 remo1al prior to patient care
*!ansission<Based P!ecautions
-ransmission-Aased Precautions
%pply to selected patients based on a suspected or
confirmed clinical syndrome: a specific dia3nosis:
or coloni4ation or infection with epidemiolo3ically
important or3anisms
%lways implemented in con>unction with standard
precautions
2 types'
- %irborne
- Droplet
- Contact
Ai!"o!ne P!ecautions
D!oplet P!ecautions
Contact P!ecautions
%irborne Precautions
- Pre1ent transmission of diseases by droplet
nuclei 5particles smaller than 5 Om6 or dust
particles containin3 the infectious a3ent
- %irborne Precautions
- %ll persons enterin3 the room of these
patients must wear a personal respirator
that filters # Om particles with a n efficiency
of at least 95% 5N95 mas96
- Gowns and 3lo1es are used as dictated by
standard precautions
#0 Disseminated 4oster
!0 Measles
20 ,mallpo;
E0 ,%R,
50 -uberculosis 5pulmonary or laryn3eal6
&0 *aricella
D0
- Patient placed in a pri1ate room with
monitored ne3ati1e air pressure in relation
to surroundin3 areas: and the room air must
under3o at least & e;chan3es per hour
- Door to the isolation room must remain
closed
- %ir from the isolation room should be
e;hausted directly to the outside: away from
air inta9es: and not recirculated 5hi3h
efficiency filters may be used also6
- Cou3h eti=uette
- Patients should be instructed to co1er
his+her mouth and nose with tissue when
cou3hin3 or snee4in3
Droplet Precautions
Pre1ent transmission by lar3e-particle 5droplet6
aerosols
5unli9e droplet nuclei: droplets are lar3er: do not
remain suspended in the air: and do not tra1el lon3
distances6
Droplets are produced when the infected patient
tal9s: cou3hs: or snee4es and durin3 some
procedures 5e030: suctionin3: bronchoscopy6
% susceptible host may become infected if the
infectious droplets land on the mucosal surfaces of
the nose: mouth: or eye0
- Re=uire patients to be placed in a pri1ate
room: but no special air handlin3 is
necessary 5patients with same disease can
be placed in the same room if pri1ate rooms
are not a1ailable6
- Droplets do not tra1el lon3 distances
53enerally no more than 2 feet6: the door to
the room may remain open
- (C. should wear a standard sur3ical mas9
when wor9in3 within 2 feet of the patient
- Gowns and 3lo1es should be worn by
(C.s when dictated by standard
precautions
#0 Diphtheria: pharyn3eal
!0 (0 influen4ae menin3itis: epi3lottitis:
pneumonia
20 )nfluen4a
E0 Menin3ococcal infections
50 Multi-dru3 resistant pneumococcal disease
&0 Mumps
D0 Mycoplasma pneumonia
"0 Par1o1irus A#9 infections
90 Pertussis
#$0 Pla3ue: pneumonic
##0 Rubella
#!0 ,treptococcal pharyn3itis
Contact Precautions
- Pre1ent the transmission of
epidemiolo3ically important or3anisms from
an infected or coloni4ed patient throu3h
direct contact 5touchin3 the patient6 or
indirect contact 5touchin3 contaminated
ob>ects or surfaces in the patient@s
en1ironment6
- Patients are placed in a pri1ate room or
patients infected with same or3anism may
be placed in the same roo
- Aarrier precautions to pre1ent
contamination should be employed
- Glo1es and (and hy3iene
- Gowns worn if the (C. anticipates
substantial contact of his or her clothin3 with
the patient or surfaces in the patient@s
en1ironment or there is an increased ris9 of
contact with potentially infecti1e material
- Noncritical patient care e=uipment should
remain in the room and not used for other
patients: if items must be shared: they
should be cleaned and disinfected before
reuse
-
#0 %cute diarrheal illnesses li9ely to be
infectious in ori3in
!0 %cute 1iral con>uncti1itis
20 Clostridium difficile diarrhea
E0 7ctoparasistic infections 5lies and scabies6
50 (,*+*aricella+Disseminated 4oster
&0 MDR bacteria 5MR,%: *R7: *),%: *R,%6
infection or coloni4ation
D0 ,%R,
"0 ,mallpo;
90 ,treptococcal 53roup %6 ma>or s9in: burn or
wound infection
#$0 *iral hemorrha3ic fe1ers
ISOLA*ION O4 PA*IEN*S
Sou!ce Isolation
.e+e!se Isolation
- Protecti1e or neutropenic isolation
- 8sed for patients with se1ere burns:
leu9emia: transplant: immuno deficient
persons: recei1in3 radiation treatment:
leu9openic patients
- -hose that enter the room must wear mas9s
and sterile 3owns to pre1ent from
introducin3 microor3anisms to the room
%?A ),/C%-)/N
- *),)-/R, - report to nurses@ station
before enterin3 the room
- M%,<, worn in patients room
- G/.N, pre1ent clothin3 contamination
- GC/*7, for body fluids and non intact
s9in
- (%ND.%,()NG - after touchin3 patient or
potentially contaminated articles and after remo1in3
3lo1es
- articles discarded: cleaned or sent for
decontamination and reprocessin3
- room remains closed
- patients wear mas9s durin3 transport
Personal Protecti1e 7=uipment
- mas9
- 3lo1es
- 3own
- shoe co1er
- 3o33les
AC//D+*7C-/R A/RN7 D),7%,7,
Pre1ention
7radicate the source D/( CC7%N
- C chemically treated mos=uito net
- C - lar1ae eatin3 fish
- 7 en1ironmental sanitation
- % anti-mos=uito
- N neem tree 5ore3ano: eucalyptus6
Den3ue (emorrha3ic ?e1er
- caused by den3ue 1irus 5?la1i1iridae6 with E
serotypes
- transmitted to a bite of female aedes
ae3ypti mos=uito
- incubation period !-D days
- *ectors' 5day bitin36
- %edes ae3ypti 5breeds in water stored in
houses6
- %edes albopictus
- Cule; fati3ans
Clinical manifestation
?irst E days ?ebrile or )n1asi1e sta3e hi3h
3rade fe1er: headache: body malaise: con>ucti1al
in>ection: 1omittin3: epista;is or 3um bleedin3:
positi1e torni=ue test0
Eth Dth day -o;ic or (emorrha3ic ,ta3e %fter
the ly4e of the fe1er: this is were the complication of
den3ue is e;pected to come out as manifested by
abdominal pain: melena: indicatin3 bleedin3 in the
upper 3astrointestinal tract: 8nstable AP: narrow
pulse pressure and shoc90
Dth #$th day Con1alescent or reco1ery sta3e
after 2 days of afebrile sta3e and the patient was
properly hydrated and monitored AP will become
stable and laboratory 1alues of platelet count and
bleedin3 parameters will be3in to normali4e0
Classification of Den3ue ?e1er accordin3 to
se1erity
#0 Grade ) Den3ue fe1er: saddlebac9 fe1er
plus constitutional si3ns and symptoms plus
positi1e torni=ue test
!0 Grade )) ,ta3e ) plus spontaneous
bleedin3: epista;is: G): cutaneous bleedin3
20 Grade ))) Den3ue ,hoc9 ,yndrome: all of
the followin3 si3ns and symptoms plus
e1idence of circulatory failure
E0 Grade )* Grade ))) plus irre1ersible shoc9
and massi1e bleedin3
Dia3nostics
-ourni=ue test or Rumpel Ceede -est presumpti1e
test for capillary fra3ility
- 9eep cuff inflated for &-#$ mins 5child6: #$-
#5 min 5adults6
- count the petechiae formation # s= inch
5K#$-#5 petechiae+s= inch6
Caboratory Procedures
- CAC
- Aleedin3 Parameters
- ,erolo3ic test
- Den3ue blot: Den3ue )3m
- /ther '
- P- 5Prothrombin -ime6
- %P-- 5%cti1ated Partial -hromboplastin
-ime6
- Aleedin3 time
- Coa3ulation time
M3mt' symptomatic and supporti1e
Mana3ement
- ,pecific -herapy none
- ,ymptomatic+,upporti1e therapy
- )ntra1enous ?luids 5)*?6
- with hemoconcentration: 5-D ml+93+hr
- with shoc9: #$-2$ml+93 in M!$mins
- 8se of Alood+Alood Products
- Platelet concent!ate 1 unit58<&2g
- C!#op!ecipitate= 1unit582g
- 44P= 18l52g / %<;h!s
- gi+en in patient in ipending shoc2 and
un!esponsi+e to isotonic o! colloid
t!ansfusion-
- P!olonged P*
- 4>B %0cc52g
- acti+e "leeding
- chec2 se!u calciu
- P.BC 10cc52g
Nursin3 )nter1ention
- Paracetamol 5no aspirin6
- Gi1in3 of cytoprotectors
- Gastric Ca1a3e
- trendelenber3 position for shoc9
- Nasal pac9in3 with epinephrine
- No intramuscular in>ections
- mana3e an;iety of patient and family
Pre1enti1e measures
Depa!tent of )ealth p!og!a fo! the cont!ol of
Dengue )eo!!hagic 4e+e!
, ee9 and destroy breedin3 places
, ay no to left and ri3ht defo33in3
S ee9 early consultation
?)C%R)%,),
- -he disease often pro3resses to become
chronic: debilitatin3 and disfi3urin3 disease
since it@s symptoms are unnoticed or
unfamiliar to health wor9ers0
- (i3h rates in re3ion 55bicol6: " 5samar and
leyte: )) 5da1ao6
- .uchereria bancrofti and Aul3aria malayi
- -ransmitted to the bite of infected female
mos=uito 5%edes: %nopheles: Mansonia6
- -he lar1ae are carried in the blood stream
and lod3ed in lymphatic 1essels and lymph
3lands where they mature in adult form
-wo biolo3ical type
Nocturnal
microfilaria circulate in peripheral blood at ni3ht
5#$pm !am6
Diurnal
microfilaria circulate in 3reater concentration at
daytime
Clinical Manifestation
%cute sta3e
- filarial fe1er and lymphatic inflammation tha
occurs fre=uently as #$ times per year and usually
abates spontaneously after D days
- Cymphadenitis 5)nflammation of the lymphnodes6
- Cymphan3itis 5)nflammation of the lymph 1essels6
Chronic ,ta3e 5#$-#5 years from the onset of the
first attac96
- (ydrocele 5,wellin3 of the scotum6
- Cymphedema 5-emporary swellin3 of the upper
and lower e;tremities6
- 7lephantiasis 5enlar3ement and thic9enin3 of the
s9in of the lower or upper e;tremities6
Caboratory Dia3nosis
- Alood smear presence of microfilaria
- )mmunochromato3raphic -est 5)C-6
- 7osinophil count
Mana3ement Guidelines
- ,pecific -herapy
- Dietylcarbama4ine 5D7C6 &m3+<A. in
di1ided doses for #! consecuti1e days
- )1ermectine 5Mectican6
- ,upporti1e -herapy
- Paracetamol
- %ntihistamine for aller3ic reaction due to
D7C
- *itamin A comple;
- 7le1ation of infected limb: elastic stoc9in3
DEC should be ta9en immediately after meals
)t may cause loss of 1ision: ni3ht blindness: or
tunnel 1ision with prolon3ed used0
I+e!ectin is best ta9en as sin3le dose with a full
3lass of water in en empty stomach0
Cannot be used in patient with asthma
Pre1enti1e Measures
(ealth teachin3s
7n1ironmental ,anitation
Ceptosiprosis 5.eil@s disease6
a 4oonotic systemic infection caused by
Ceptospires: that penetrate intact and abraded s9in
throu3h e;posure to water: wet soil contaminated
with urine of infected animals0

%nicteric -ype 5without >aundice6
manifested by fe1er: con>uncti1al in>ection
si3ns of menin3eal irritation
)cteric -ype 5.eil ,yndrome6
(epatic and renal manifestation
Iaundice: hepatome3ally
/li3uris: anuria which pri3ress to renal failure
,hoc9: coma: C(?
Con1alescent Period
Dia3nosis
Clinical history and manifestation
Culture
Alood' durin3 the #st wee9
C,?' from the 5th to the #!th day
8rine' after the #st wee9 until con1alescent period
C%%- 5Ceptospira %33lutination -est6
other laboratory
A8N:CR7%: li1er en4ymes
-reatment
,pecific
Penicillin 5$$$$ units+93+day
-etracycline !$-E$m3+93+day
Non-specific
,upporti1e and symptomatic
%dministration of fluids
Peritoneal dialysis for renal failure
7ducate public re3ardin3 the mode of transmission:
a1oid swimmin3 or waddin3 in potentially
contaminated waters and use proper protecti1e
e=uipment0
Nu!sing .esponsi"ilities
#0 Dispose and isolate urine of patient0
!0 7n1ironmental sanitation li9e cleanin3 the
esteros or dirty places with sta3nant water:
eradication of rats and a1oidance of wadin3 or
bathin3 in contaminated pools of water0
20 Gi1e supporti1e and asymptomatic therapy
E0 %dministration of fluids and electrolytes0
50 %ssist in peritoneal dialysis for renal failure
patient 5-he most important si3n of renal failure is
presence of oliguria06
MALA.IA
- Malaria
- P<in3 of the -ropical DiseaseQ
- an acute and chronic infection caused by
proto4oa plasmodia
- )nfectious but not conta3ious
- transmitted throu3h the bite of female
anopheles mos=uito
- Malaria 7;acts (ea1y -oll in %frica
- Mala!ia
- -here are 2$$-5$$m new cases annually
- /1er #m die e1ery year almost 2$$$ per
day
- 9$% of deaths are in ,ub-,aharan %frica
- Cost of malaria in %frica is R#$$bn
- *ector' 5ni3ht bitin36
- anopheles mos=uito
- or minimus fla1ire
Cife cycle'
- ,e;ual cycle+sporo3ony 5mos=uito6
- sporo4oites in>ected into humans
- %se;ual cycle+schi4o3ony 5human6
- 3ametes is the infecti1e sta3e ta9en up by
bitin3 mos=uito
Plasmodium *i1a;
- more widely distributed
- causes beni3n tertian malaria
- chills and fe1er e1ery E" hours in 2 days
Plasmodium ?alciparum
- common in the Philippines
- Causes the most serious type of malaria
because of hi3h parasitic densities in blood0
- Causes mali3nant tertian malaria
Plasmodium malaria
- much less fre=uent
- causes =uartan malaria: fe1er and chills
e1ery D! hrs in E days
- Plasmodium /1ale
- rarely seen0
Patholo3y
- the most characteristic patholo3y of malaria
is destruction of red blood cells: hypertrophy
of the spleen and li1er and pi3mentation of
or3ans0
- -he pi3mentation is due to the pha3ocytocis
of malarial pi3ments released into the blood
stream upon rupture of red cells
Clinical Manifestation
uncomplicated
- fe1er: chills: sweatin3 e1ery !E 2& hrs
Complicated
- sporulation or se3mentation and rupture of
erythrocytes occurs in the brain and 1isceral
or3ans0
- Cerebral malaria
- chan3es of sensorium: se1ere headache
and 1omitin3
- sei4ures
clinical anifestation
#0 Cold sta3e #$-#5 mins: chills: sha9es
!0 hot sta3e E-& hours: recurrin3 hi3h 3rade
fe1er: se1ere headache: 1omittin3:
abdominal pain: face is blue
20 Diaphoretic ,ta3e e;cessi1e sweatin3
Dia3nosis
- Malarial smear
- Luantitati1e Auffy Coat 5LAC6
-ra1el in endemic areas
-reatment'
Determine the species of parasite
/b>ecti1es of treatment
#0 Destroy all se;ual forms of parasite to cure
the clinical attac9
!0 Destroy the e;cerythrocytes 5776 to pre1ent
relapse
20 Destroy 3ametocytes to pre1ent mos=uito
infections
-reatment for P0 ?alciparum
#0 chloro=uine tablet 5#5$m3+base+tab6 Day
#:!:2 5E:E:!6
!0 ,ulfado;ine+Pyrimethamine
5$$m3+!5m3+tab: 2tab sin3le dose
20 Prima=uine 5#5m3+tab6 2 tabs sin3le dose
-reatment for P0 *i1a;
#0 Choloro=uine: Day #:!:2 5E:E:!6
!0 Prima=uine # tab /D for #E days
-reatment for mi;ed
- chloro=uine 5E:E:!6
- ,ulfado;ine+Pyrimethamine 2 tabs once
- Prima=uine # tab for #E days
Multi-dru3 resistant P0 ?alciparum
=uinine plus do;ycycline: or tetracycline and
prima=uine
Complications
- se1ere anemia
- cerebral malaria
- hypo3lycemia
Pre1ention and Control
- 7liminate anopheles mos=uito 1ectors
- %d1ise tra1elers
- limit dus9 to dawn outdoor e;posure
- insect repellant: nets
Nursin3 Care
#0 Consider a patient with cerebral malaria to be an
emer3ency
- %dminister )* =uinine as )* infusion
- .atch for neurolo3ic to;icity from =uinine
transfusion li9e delirium: confusion: con1ulsion and
coma
!0 .atch for >aundice this is related to the density
of the falciparum parasitemia:
20 71aluate de3ree of anemia
E0 .atch for abnormal bleedin3 that are may be
due to decrease production of clottin3 factors by
dama3e li1er0
Chemoprophyla;is
- do;ycycline #$$m3+tab: !-2 days prior to
tra1el: continue up to E wee9s upon lea1in3
the area
- Meflo=uine !5$m3+tab: # wee9 before
tra1el: continue up to four wee9s upon
lea1in3 the area
- Pre3nant: #st trimester: chloro=uine: ! tabs
wee9ly: ! wee9s before tra1el: durin3 stay
and until E wee9s after lea1in3
- !nd and 2rd trimester: Pyrimethamine-
sulfado;ine
Cate3ory of pro1inces
Catego!# A no si3nificant impro1ement in
malaria for the past #$ years0 K#$$$
- Mindoro: isabela: Ri4al: Hamboan3a: Ca3ayan:
%payao: 9alin3a
Catego!# B - M#$$$+year
- )fu3ao: abra: mt0 pro1ince: ilocos: nue1a eci>a:
bulacan: 4ambales: bataan: la3una
Catego!# C si3nificant reduction
-pampan3a: la union: batan3as: ca1ite: albay
CEN*.AL NE.?OUS S@S*EM DISEASES
)nflammation of the meni3es
Caused by bacterial patho3en: N0 meni3itidis: (0
)nfluen4a: ,trep0 Pneumoniae: Mycobacterium
-uberculosis
PA*)OLO7@
Primary spread of bacteria from the bloodstream
to the meni3es
,econdary results from direct spread of infection
from other sources or focus of infection0
-he disease usually be3ins as an infection by
normal body flora: of'
#0 -he ear 5otitis media6 - Haemophilus
influenzae
!0 -he lun3 5lobar pneumoniae6 - Streptococcus
pneumoniae
20 -he upper respiratory tract 5rhinopharyn3itis6 -
Neisseria meningitidis, Haemophilus
influenzae, Streptococcus: Group A
E -he s9in and subcutaneous tissue
5furunculosis6 S. aureus
50 -he bone 5osteomyelitis6 - S. aureus
&0 -he intestine - E. coli
Clinical anifestation
- ?e1er
- Rapid pulse: respiratory arrythmia
- ,oreness of s9in and muscles
- Con1ulsion+sei4ures
- headache
- irritability
- fe1er
- nec9 stiffness
- patholo3ic refle;es' 9erni3@s: Aabins9i:
Arud4ins9i
Dia3nosis
- Cumbar puncture
- Alood C+,
- other laboratories
umbar Puncture
- -o obtain specimen of C,?
- -o reduce )CP
- -o )ntroduce medication
- -o in>ect anesthetic
C,? 7;amination
- ?luid is turbid+purulent K#$$$cc+mm cells
- .AC count increase
- ,u3ar content mar9edly reduced
- C(/N increased
- Presence of microor3anism
- -reatment
Aacterial menin3itis
- -A menin3itis
- )ntensi1e Phase
- Maintainance Phase
- ?un3al menin3itis
- cryptococcal menin3itis flucona4ole or
amphotericin A
!0 ,upporti1e+,ymptomatic
a0 %ntipyretic
b0 treat si3ns of increased )CP
c0 Control of sei4ures
d0 ade=uate nutrition
Nu!sing Inte!+ention
Pre1ent occurrence of further complication
- Maintain strict aseptic techni=ue when doin3
dressin3 or lumbar puncture0
- 7arly symptom should be reco3ni4e
- *ital si3ns monitorin3
- /bser1e si3ns of increase )CP
- Protect eyes from li3ht and noises
Maintain normal amount of fluid and electrolyte
balance
- Note and record the amount of 1omitus
- Chec9 si3ns of dehydration
Pre1ent ,pread of the disease
- (a1in3 proper disposal of secretions
- 7mphasi4e the importance of mas9in3
- 7;plain the importance of isolation
7nsure patient@s full reco1ery
- Maintain side rails up in episodes of
sie4ures
- Pre1ent sudden >ar of bed
- <eep patient in a dar9 room and complete
physical rest
- Di1ersional acti1ities and passi1e e;ercises
MENIN7OCOCCEMIA
- caused by Neisseria menin3itides: a 3ram
ne3ati1e diplococcus
- transmitted throu3h airborne or close
contact
- incubation is #-2 days
- natural reser1oir is human nasopharyn;
Clinical Manifestation
sudden onset of hi3h 3rade fe1er: rash and rapid
deterioration of clinical condition within !E hours
,+s;'
#0 Menin3ococcemia spi9in3 fe1er: chills:
arthral3ia: sudden appearance of
hemorrha3ic rash
!0 ?ulminant Menin3ococcemia 5.aterhouse
?riderichsen6 septic shoc9G hypotension:
tachycardia: enlar3in3 petecchial rash:
adrenal insufficiency
Caboratory
- Alood Culture
- Gram stain of peripheral smear: C,? and
s9in lesions
- CAC
-reatment'
antimicrobial
- Aen4yl Penicillin !5$-E$$$$$ u+93+day
- Chloramphenicol #$$m3+93+day
,ymptomatic and supporti1e
- fe1er
- sei4ures
- hydration
- respiratory function
Chemoprophyla;is
#0 Rifampicin 2$$-&$$m3 = #!hrs ; E doses
!0 /flo;acin E$$m3 sin3le dose
20 Ceftria;one #!5-!5$m3 )M sin3le dose
Nursin3 )nter1ention
- Pro1ide strict isolation
- .earin3 of PP7
- (ealth teachin3
- Contact tracin3
- Prophyla;is
- Menin33ococcal 1accine for hi3h ris9 patient
.ABIES
- acute 1iral encephalomyelitis
- incubation period is E days up to #9 years
- ris9 of de1elopin3 rabies: face bite &$%:
upper e;tremities #5-E$%: lower e;tremities
#$%
- #$$% fatal
Clinical Manifestation
- pain or numbness at the site of bite
- fear of water
- fear of air
E ,-%G7,
#0 prodrome - fe1er: headache: paresthesia:
!0 encephalitic e;cessi1e motor acti1ity:
hypersensiti1ity to bri3ht li3ht: loud noise:
hypersali1ation: dilated pupils
20 brainstem dysfunction dyspha3ia:
hydrophobia: apnea
E0 death
Dia3nosis
- ?%- 5fluorescent antibody test6
- Clinical history and si3ns and symptoms
Mana3ement
- No treatment for clinical rabies
- Prophyla;is

Poste/posu!e p!oph#la/is
%0 %cti1e 1accine 5PD7*:PC7C:P*R*6
)ntradermal 5$:2:D:2$:9$6
)ntramuscular 5$:2:D:#E:!"6
5$:D:!#6
A0 Passi1e *accine
a0 7R)G wt in 93 ; 0! S cc to be in>ected im
5%N,-6
b0 (R)G wt in <3 ; 0#222
Pre-e;posure Prophyla;is
)ntradermal+)ntramuscular 5$:D:!#6
)nfection control
- Patient is isolated to pre1ent e;posure of
hospital personnel: watchers and 1isitors
- PP7
- Pre1enti1e Measures
- 7ducation
- Post-e;posure and Pre-e;posure
Prophyla;is
Polio#elitis
- RN%: Polio 1irus
- ?ecal oral route+droplets
- )P D-#! days
- Disease of the lower motor neurin in1ol1in3
the anterior horn cells
- )nfantile paralysisG (elne-Medin disease
Predisposin3 ?actors
- Children below #$ years old
- Male more often affected
- Poor en1ironmental and hy3ienic conditions
Causati1e %3ent' Ce3io debilitans
- Arunhilde 5permanent6
- Cansin3 and Ceon 5temporary6
- May e;ist in contaminated water: sewa3e
and mil9
,+s;' disease manifestations'
#0 mild febrile illness fe1er: malaise: sore throat
5aborti1e sta3e6
!0 Pre-paralytic sta3e - flaccid asymetrical
ascendin3 paralysis 5Candry@s si3n6: (ayne@s si3n
5head drop6: Pofer@s si3n 5opisthotonus6
20 Paralytic sta3e
bulbar or spinal
Mode of -ransmission
- Droplet infection in early infection
- Aody secretions nasopharyn3eal
- ?ecal oral durin3 late sta3e
- ?lies may act as mechanical 1ectors
A0 ) %borti1e or inapparent
C0 )) Menin3itis 5non-paralytic6
D0 ))) Paralytic 5anterior horn of spinal cord6
70 )* Aulbar 5encephalitis6
D;' Pandy@s test - C,? 5increased C(/N6
MGM-'
%cti1e /P* 5,abin6 and )P* 5,al96
)mmunity is ac=uired for 2 strains
%0 Ce3io brunhilde 5fatal6
A0 Ce3io lansin3
C0 Ce3io leon
Respiratory distress
%0 Respirator
A0 -racheostomy life sa1in3 procedure
when respiratory failure and inability to
swallow are not corrected
C0 /;y3en therapy
D0 Rehabilitation
,N%<7A)-7
Mana3ement
- Lie the +icti flat
- ice cop!ess and const!icti+es ate!ials
a!e cont!aindicated
- *!anspo!t the patient to the nea!est
hospital
- Anti+eni adinist!ation in patientAs
0ith signs of en+enoation
- It is ne+e! too late to gi+e anti<+eni
- Anti+eni is gi+en th!u int!a+enous
infusion= 0hich is the safest and ost
effecti+e !oute- %<8 apules plus D8> to
!un i+e! 1<% hou!s e+e!# % hou!s
- Antiic!o"ial the!ap#
- sul"acta5Apicillin o! co<ao/icla+
- Su"stitute
- P!ostigine I?infusion= 80<
100ug52g5dose 6 Bh!s
- At!opine
*E*ANUS
- caused by Clostridium tetani: 3rows
anaeronically
- -etanus spores are introduced into the
wound contaminated with soil0
- )ncubation period E-!# days
Clinical manifestation
- Difficulty of openin3 the mouth 5trismus or
loc9>aw6
- Risus sardonicus
- %bdominal ri3idity
- Cocali4ed or 3enerali4ed muscle spasm
-reatment
#0 Neutrali4e the to;in
!0 <ill the microor3anism
20 Pre1ent and control the spasm
- muscle rela;ants
- ,edati1es
- -ran=uili4ers
E0 -racheostomy
-reatment'
anti-to;in
-etanus %nti--o;in 5-%-6
- %dult:children:infant E$:$$$ )8 T
)M:#+! )*
- Neonatal -etanus !$$$$
)8: #+!)M: T )*
-)G
- Neonates #$$$ )8: )*
drip or )M
- %dult: infant: children 2$$$ )8: )* drip
or )M
%ntimicrobial -herapy
Penicillin U-2 mil units = Ehours
Pedia 5$$$$$ !mil units = E hrs
Neonatal !$$$$$ units )*P = #!hrs or
="hrs
Control of spasms
- dia4epam
- chlorproma4ine
Nursin3 care
- Patient should be in a =uiet: dar9ened room:
well 1entilated0
- Minimal+3entle handlin3 of patient
- Ci=uid diet 1ia NG-
- Pre1ent )n>ury
- Pre1enti1e Measures
- -reatment of wounds
- -etanus to;oid 5$:#:&:#:#6
)EPA*O<EN*E.IC DISEASES
SC)IS*OSOMIASIS
- caused by blood flu9es: ,chistosoma
- has 2 species: ,0 haematobium: ,0
Mansoni: ,0 >aponicum
- ,0 >aponicum is endemic in the Philippines
5leyte: ,amar: ,orso3on: Mindoro:Aohol6
- )ntermediate host: /ncomelania Luadrasi
D)%GN/,),
- ,chistosoma e33s in stool
- Rectal bipsy
- <ato <at4
- 8ltrasound of (A-
Clinical Manifestation
- se1ere >aundice
- edema
- ascites
- hepatosplenome3ally
- ,+, of portal hypertention
Mana3ement
- Pra4i=uantrel &$m3+93 /nce dosin3
- ,upporti1e and sympromatic
Methods of Control
- 7ducate the public re3ardin3 the mode of
transmission and methods of protection0
- Proper disposal of feces and urine
- Pre1ent e;posure to contaminated water0 -o
minimi4e penetration after accidental water
e;posure: towel dry and apply D$% alcohol0
-he or3anism is patho3enic only in man
-FP(/)D ?7* 7R
- ,pread chiefly by carriers: in3estion of
infected foods
- 7ndemic particularly in areas of low
sanitation le1els
- /ccurs more common in may to au3ust
M/-' oral fecal route
- ,+s;' Rose spot 5abdominal rashes6: more
than Ddays ,tep ladder fe1er E$-E# de3:
headache: abdominal pain: constipation
5adults6: mild diarrhea 5children6
Dia3nosis
Alood e;amination .AC usually leu9openia with
lymphocytosis
)solation
- Alood culture #
st
wee9V
- 8rine culture !
nd
wee9
- ,tool culture 2
rd
wee9
- .idal test / or (
- #st wee9 step ladder fe1er 5AC//D6
- !nd wee9 rose spot and fastidial
- typhoid psychosis 58R)N7 W ,-//C6
Mgt' Chlo!aphenicol= Ao/icillin=
Sulfonaides= Cip!oflo/acin= Ceft!ia/one
.atch for complication
a0 Perforation symptoms of sharp
abdominal pain: abdominal ri3idity and
absent of bowel sounds0
- prepare for intestinal decompression or sur3ical
inter1ention
b0 )ntestinal hemorrha3e - withold food and
3i1e blood transfusion
Nursin3 )nter1entions
- 7n1ironmental ,anitation
- ?ood handlers sanitation permit
- ,upporti1e therapy
- %ssessment of complication 5occurin3 on
the !
nd
to 2
rd
wee9 of infection 6
- typhoid psychosis: typhoid menin3itis
- typhoid ileitis
(epatitis
- (epa % fecal oral route
- (epa A body fluids
- (epa C non % non A: A-: body fluids
- (epa D hypodermic: body fluids
- (epa 7 fecal oral route: fatal and common
amon3 pre3nant women
- (epa G A-: parenteral
(epatitis %
- )nfectious hepatitis: epidemic hepatitis
- Foun3 people especially school children are
most commonly affected0
- Predisposin3 factors'
- Poor sanitation: contaminated water supply:
unsanitary preparation of food: malnutrition:
disaster conditions
Incu"ation Pe!iod' #5-5$ days
Signs5S#ptos'
- )nfluen4a
- Malaise and easy fati3ability
- %nore;ia and abdominal discomfort
- Nausea and 1omitin3
- ?e1er: CC%D
- >aundice
D;' Anti )A? IgM C acti+e infection
Anti )A? Ig7 C old infectionD no acti+e
disease
Manageent'
- Prophyla;is
- Complete bed rest
- Cow fat diet but hi3h su3ar
- 7nsure safe water for drin9in3
- ,anitary method in preparin3 handlin3 and
ser1in3 of food0
- Proper disposal of feces and urine0
- .ashin3 hands before eatin3 and after toilet
use0
- ,eparate and proper cleanin3 of articles
used by patient
(epatitis A
- DN%: (epa A 1irus
- ,erum hepa
- .orldwide distribution
- Main cause of li1er cirrhosis and li1er
cancer
)P' !-5 months
Mode of -ransmission
- ?rom person to person throu3h
- contact with infected blood throu3h bro9en
s9in and mucous membrane
- se;ual contact
- sharin3 of personal items
- Parenteral transmission throu3h
- blood and blood products
- use of contaminated materials
- Perinatal transmission
(i3h Ris9 3roup
- Newborns and infants of infected mothers
- (ealth wor9ers e;posed to handlin3 blood
- Persons re=uirin3 fre=uent transfusions
- ,e;ually promiscuous indi1iduals
- Commercial se; wor9ers
- Dru3 addicts
Possible /utcome
- Most 3et well completely and de1elop life
lon3 immunity0
- ,ome become carriers of the 1irus and
transmit disease to others0
- %lmost 9$% of infected newborns become
carriers
(epatitis C
- Post transfusion (epatitis
- Mode of transmission percutaneous: A-
- Predisposin3 factors paramedical teams
and blood recepients
- )ncubation period !wee9s & months
(epatitis D
- Dormant type
- Can be ac=uired only if with hepatitis A
(epatitis 7
- )f hepatitis 7 recurs at a3e !$-2$: it can lead
to cancer of the li1er
- 7nteric hepatitis
- ?ecal-oral route
DJ'
- 7le1ated %,- or ,GP- 5specific6 and %C- or
,G/-
- )ncreased )3M durin3 acute phase
- 5X6 or R7%C-)*7 (As%3 S )N?7C-7D:
may be acute: chronic or carrier
- 5X6 (Ae%3 S hi3hly infectious
- %C- #
st
to increase in li1er dama3e
o (Ac%3 S found only in the li1er cells
- 5X6 %nti-(Ac S acute infection
- 5X6 %nti-(Ae S reduced infectiousness
- 5X6 %nti-(As S with antibodies 5?R/M
1accine or disease6
- Alood Chem0 %nalysis 5to monitor
pro3ression6
- Ci1er biopsy 5to detect pro3ression to C%6
M3mt'
- Pre1ention of spread )mmuni4ation and
(ealth 7ducation
- 7nteric and 8ni1ersal precautions
- %ssess C/C
- Aed rest
- %D7< deficiency inter1ention
- (i3h C(/: Moderate C(/N: Cow fat
- ?*7 pre1ention
C;'
#0 ?ulminant (epatitis s+s; of encephalopathy
!0 Chronic (epatitis - lac9 of complete resolution of
clinical s; and persistence of hepatome3aly
20 (As%3 carrier
E.UP*I?E 4E?E.
MEASLES
- 7;tremely conta3ious
- Areastfed babies of mothers ha1e 2 months
immunity for measles
- -he most common complication is otitis
media
- -he most serious complications are
bronchopneumonia and encephalitis
Measles= .u"eola= & Da# 4e+e!= )a!d .ed
Measles
- RN%: Paramy;o1iridae
- %cti1e MMR and Measles 1accine
- Passi1e Measles immune 3lobulin
- Cifetime )mmunity
- )P' D-#E days
M/-' droplets: airborne
- YConta3ious E days before rash and E days
after rash
Clinical Manifestation
Pre erupti1e sta3e
- Patient is hi3hly communicable
- E characteristic features
%0 Cory4a
A0 Con>uncti1itis
C0 Photophobia
D0 Cou3h
- <opli9@s spots
- ,tmsons line
7rupti1e sta3e
- Maculopapular rashes appears first on the
hairline: forehead: post auricular area the
spread to the e;tremities 5cephalocaudal6
- Rashes are too hot to touch and dry
- (i3h 3rade fe1er and increases steadily at
the hei3ht of the rashes
,ta3e of con1alescence
- Rashes fade in the same manner lea1in3 a
dirty brownish pi3mentation 5des=uamation6
- Alac9 measles se1ere form of measles
with hemorrha3ic rashes: epista;is and
melena
Rashes' maculopapaular: cephalocaudal 5hairline
and behind the ears to trun9 and limbs6: confluent:
des=uamation: pruritus
Complication
- Aronchopneumonia
- ,econdary infections
- 7ncephalitis
- )ncrease predisposition to -A
M%N%G7M7N-
#0 ,upporti1e
!0 (ydration
20 Proper nutrition
E0 *itamin %
50 %ntibiotics
&0 *accine
Nursin3 Care
- Respiratory precautions
- Restrict to =uite en1ironment
- Dim li3ht if photophobia is present
- %dminister antipyretic
- 8se cool mist 1apori4er for cou3h
German Measles 5rubella6
- %cute infection caused by rubella 1irus
characteri4ed by fe1er: e;anthem and
retroauricular adenopathy0
- (as a terato3enic potential on the fetuse of
women in the #
st
trimester
s+s;'
- forschheimer@s 5petecchial lesion on buccal
ca1ity or soft palate6:
- cer1ical lymphadenopathy: low 3rade fe1er
- P /1al: rose red papules about the si4e of
pinhead
D;' clinical
CJ' rareG pneumonia: menin3oencephalitis
CJ to pre3nant women'
- #st tri-con3enital anomalies
- !nd tri-abortion
- 2rd tri-pre mature deli1ery
Rashes' Maculopapular: Diffuse+not confluent: No
des=uamation: spreads from the face downwards
.oseola Infantu=
E/anthe Su"itu= Si/th disease
- (uman herpes 1irus &
- 2mos-E yo: pea9 &-!E mos
- M/-' probably respiratory secretions
S5s/'
,pi9in3 fe1er w+c subsides !-2 days: ?ace and
trun9 rashes appear after fe1er subsides: Mild
pharyn3itis and lymph node enlar3ement
Chic2en Po/= ?a!icella
- (erpes 4oster 1irus 5shin3les6:
1aricella 4oster 1irus5choc9en po;6
- %cti1e ' *aricella 1accine
- Passi1e' *H)G: H)G 3i1en D!-9& hrs
w+n e;posure
- Cifetime )mmunity
- )P' #E-!# days
M/-' Respiratory route
Y Conta3ious # day before rash and & days after
first crop of 1esicles
- ,+s;'
fe1er: malaise: headache
- Rashes' Maculopapulo1esicular 5co1ered
areas6: Centrifu3al: starts on face and trun9
and spreads to entire body
- Cea1es a pitted scar 5poc9mar96
- CJ furunculosis: erysipelas:
menin3oencephalitis
- Dormant' remain at the dorsal root 3an3lion
and may recur as shin3les 5*H*6
M3mt'
a0 oral acyclo1ir
b0 -epid water and wet compresses for pruritus
c0 %luminum acetate soa9 for *H*
d0 Potassium Perman3anate 5%A/6
a0 %strin3ent effect
b0 Aactericidal effect
c0 /;idi4in3 effect 5deodori4e the rash6
Sall Po/= ?a!iola
- DN%: Po; 1irus
- Cast case #9DD
- spreads from man-to-man only
- %cti1e' *accinia po; 1irus
- )P' #-2 wee9s
,+s;'
- Rashes'
- Maculopapulo1esiculopustular
- Centripetal
- conta3ious until all crusts disappeared
D;'
- Paul@s test - instillin3 of 1esicular fluid w+
small po; into the corneaG if 9eratitis
de1elops: small po;
- C;' same with chic9en po;
<%.%,%<) D),7%,7
- Mucocutaneous lymph node syndrome
- Children youn3er than 5 years old are
primarily affected0
- %ssociated with lar3e coronary blood 1essel
1asculitits
- % febrile: e;anthematous: multisystem
illness characteri4ed by
o %cute febrile phase manifested by
hi3h spi9in3 fe1er: rash: adenopathy:
peripheral edema: con>uncti1itis and
e;anthem
o sub acute phase: thrombocytosis:
des=uamation and resolution of
fe1er0
o Con1alescent sta3e
Manifestations
- bilateral: non purulent con>ucti1itis
- con3ested oropharyn;: strawberry ton3ue:
erythematous lymphs
- erythematous palms+soles: edematous
hands+feet
- periun3al des=uamation: truncal rash
- CC%DP 5 #node K#05cm6
Dia3nosis
- CAC' leu9ocytosis
- Platelet count KE$$$$$
- !D echo 5if coronary artery in1ol1ement is
hi3hly su33esti1e
- 7,R and CRP ele1ated
Mana3ement
- )* Gamma 3lobulin !3+93 as sin3le dose
for #$-#! hours0 7ffecti1e to pre1ent
coronary 1ascular dama3e if 3i1en within #$
days of onset0
- ,alicylates' "$-#$$m3+93+!E hours in E
di1ided doses
- ,ymptomatic and supporti1e therapy
.espi!ato!# S#ste
Mups
- RN%: Mumps 1irus
- Mumps 1accine - K #yo
- MMR #5 mos
- Cifetime )mmunity
- )P' #!-#& days
- M/-' Droplet: sali1a: fomites
,+s;' 8nilateral or bilateral
- parotitis: /rchitis - sterility if bilateral:
- /ophoritis: ,timulatin3 food cause se1ere
pain: aseptic menin3itis
- D;' serolo3ic testin3: 7C),%
M3mt' supporti1e
Nursin3 care
- Respiratory precautions
- Aed rest until the parotid 3land swellin3
subsides
- %1oid foods that re=uire Chewin3
- %pply hot or cold compress
- -o relie1e orchitis: apply warmth and local
support with ti3ht fittin3 underpants
Dipthe!ia
- %cute conta3ious disease
- Characteri4ed by 3enerali4ed systemic
to;emia from a locali4ed inflammatory focus
- )nfants immune for & months of life
- Produces e;oto;in
- Capable of dama3in3 muscles especially
cardiac: ner1e: 9idney and li1er
- )ncrease incidence pre1alence durin3 cooler
months
- Mainly a disease of childhood with pea9 at
!-5 years: uncommon in K&months
Co!#ne"acte!iu diphthe!iae= g!a 1E3= slende!=
cu!+ed clu""ed o!ganis F,le"s<Loeffle!
BacillusG
)P' !-& days
Mode of transmission is direct or indirect contact
#0 Nasal in1ades nose by e;tension from pharyn;
!0 Phary3eal
- sorethroat causin3 dyspha3ia
- Pseudomembrane in u1ula: tonsils: soft palate
- Aullnec9 inflammation of cer1ical CN
20 Caryn3eal
- increasin3 hoarseness until aphonia
- whee4in3 on e;piration
- dyspnea

Dia3nosis
- Nose and throat swab usin3 loeffler@s
medium
- ,chic9 test determine susceptibility or
immunity in diptheria
- Maloney test determines hypersensiti1ity
to diptheria to;oid
Complications
-o;ic myocarditis due to action of to;in in the
heart muscles 5#
st
#$-#E days6
Neuritis caused by absorption of to;in in the ner1e
- Palate paralysis 5!
nd
wee96
- /cular palsy 55
th
wee96
- Diap3ram paralysis 5&-#$w9 causin3 GA,6
- Motor and s9eletal muscle paralysis
-reatment
%0 Neutrali4e the to;ins antidiptheria serum
A0 <ill the microor3anism penicillin
C0 Pre1ent respiratory obstruction
tracheostomy: intubation
-reatment
,erum therapy 5Diptheria antito;in6
- early administration aimed at neutrali4in3 the
to;in present in the 3eneral circulation
%ntibiotics
- Penicillin G #$$$$$m3+930day
- 7rythromycin E$m3+93
Nursin3 )nter1ention
- Rest0
- Patient should be confined to bed for at
least ! wee9s
- Pre1ent strainin3 on defecation
- 1omitin3 is 1ery e;haustin3: do not do
procedures that may cause nausea
- Care for the nose and throat
- )ce collar to reduce the pain of sorethroat
- ,oft and li=uid diet
>hooping Cough= 100 da# fe+e!
Aordetella pertussis: A0 parapertussis: A0
bronchiseptica: 3ram 5-6
)P' 2-!# days
M/-' airborne+droplet
,i3ns and symptoms
- )n1asion or catarrhal sta3e 5D-#Edays6 starts
with ordinary cou3h
- ,pasmodic or paro;ysmal
- 5-#$ spasms of e;plosi1e cou3h 5no time to
catch breath0 % peculiar inspiratory crowin3
sound followed by prolon3ed e;piration and
a sudden noisy inspiration with a lon3 hi3h
pitched PwhoopQ
- Durin3 attac9 the child becomes cyanotic
and the eyes appear to bul3e or poppin3 out
of the eyeball and ton3ue protrudes
Dia3nosis
- .AC count !$$$$-5$$$$
- Culture with Aordet Gen3ou %3ar
-reatment
- 7rythromycin shorten the period of
communicability
- %mpicillin if with aller3y to erythromycin
- (eperimmune pertusis 3amma 3lobulin in
M! years old 5#0!5ml )M6
- Control of cou3h with sedati1es
D/' >)O < H%1 da#s cough E close contact 05
pe!tussis p/ E 1E3 cultu!e O. !ise in A" to 4)A
o! pe!tussis to/in
I th!oat cultu!e 05 Bo!det gengou aga!
Mana3ement
- CAR to conser1e ener3y
- Pre1ent aspiration
- (i3h calorie: bland diet
- /mit mil9 and mil9 product because it
increases the mucous
- Refeedin3 of infants !$ min after 1omittin3
- Mil9 should be 3i1en at room temperature
complications
- Aronchopneumonia
- %bdominal hernia
- ,e1ere malnutrition
- -A: asthma
- encephalitis
P!e e/posu!e p!oph#la/is fo! Diphthe!ia=
Pe!tussis= *etanus
DP-- $05 ml )M
- # - # T months old
! - after E wee9s
2 - after E wee9s
- #
st
booster #" mos
- !
nd
booster E-& yo
- subse=uent booster e1ery #$ yrs
thereafter
Infectious Mononucleosis
- 7pstein Aarr 1irus
- )nc0 period' E-& wee9s
- Communication period' 8n9nown: 1irus is
shed before the onset of the dse until &
months or lon3er after reco1ery
- ,ource' oral secretions
- -ransmission' Direct intimate contact:
infected blood
%ssessment
- ?e1er: sorethroat: malaise: headache:
fati3ue: nausea: abdominal pain
- CC%DP: hepatosplenome3ally
Nursin3 care
- ,upporti1e
- Monitor si3ns of splenic rupture: which
include abdominal pain: left upper =uadrant
pain or left shoulder pain
PULMONA.@ *UBE.CULOSIS
- -he world@s deadliest disease and remains
as a ma>or public health problem0
- Aadly nourished: ne3lected and fati3ued
indi1iduals are more prone
- ,usceptibility is hi3hest in children under 2
years
- %<%' <och@s disease' Gallopin3
consumption
S5s/'
- .t loss
- ni3ht sweats
- low fe1er:
- non producti1e to producti1e cou3h
- anore;ia:
- Pleural effusion and hypo;emia
- cer1ical lymphadenopathy
PPD C ID
- macropha3es in s9in ta9e up %3 and deli1er
it to - cells
- - cells mo1e to s9in site: release
lympho9ines
- acti1ate macropha3es and in E"-D! hrs: s9in
becomes indurated
- K #$ mm is 5X6
D/'
- Chest ;ray - ca1itary lesion
- ,putum e;am
- sputum culture
*he National *u"e!culosis Cont!ol P!og!a
- *ision' % country where -A is no lon3er a
public health problem0
- Mission' 7nsure that -A D/-, ser1ices are
a1ailable to the communities0
- Goal' -o reduce the pre1alence and
mortality from -A by half by the year !$#5
-ar3ets'
#0 -o cure at least "5% of the sputum smear
positi1e -A patient disco1ered0
!0 Detect at least D$% of the estimated new
sputum smear positi1e -A cases0
M3mt'
short course &-9 months
lon3 course 9-#! months
?ollow-up
! w9s after medications non
communicable
o 2 successi1e 5-6 sputum - non
communicable
o rifampicin - prophylactic
MD* side effects
r-oran3e urine
i-neuritis and hepatitis
p-hyperuricemia
e-impairment of 1ision
s-"th cranial ner1e dama3e
Methods of Control
Prompt treatment and dia3nosis
ACG 1accination
7ducate the public in mode of transmission
and importance of early dia3nosid
)mpro1e social condition
Pneuonia
#0 Community ac=uired
-ypical ,trep0 Pneumoniae: (0 )nfluen4ae type A
%typical Pneumonia ,0 %ureus: M0 Pneumoniae:
C0 Pneumophila: P0 Cariini
!0 Nosocomial Pseudomonas: ,0 %ureus
M/-' aspiration: inhalation: hemato3enous: direct
inoculation: conti3uous spread
C()CD(//D PN78M/N)%
#0 No pneuonia
- infant: &$+min and no chest indrawin3
%- Pneuonia
< youn3 infant K&$+min: fast breathin3 without
chest indrawin3
20 ,e1ere pneumonia
- fast breathin3: se1ere chest indrawin3: with one
of dan3er si3ns
E0 *ery se1ere pneumonia
- below ! mos old: fast breathin3: chest indrawin3:
with dan3er si3ns
E Dan3er ,i3ns
#0 *omits
!0 Con1ulsion
20 Drowsiness+lethar3y
E0 Difficulty of swallowin3 or feedin3
,+s;'
#0 -ypical sudden onset ?e1er of K 2" ; D-#$
days: producti1e cou3h: pleuritic chest
pain: dullness: inc fremitus: rales
!0 %typical 3radual onset: dry cou3h:
headache: myal3ia: sore throat
.atch out for complicationsG )n !E hours death will
occur from respiratory failure

Nursin3 Dia3nosis
)neffecti1e airway clearance
)neffecti1e breathin3 pattern
)mpaired 3as e;chan3e
Ris9 for acti1ity intolerance
M3mt'
%ntibiotics: hydration: nutrition: nebuli4ation
C%R)-health teachin3
Nursin3 )nter1entions
Respiratory support
- o;y3en supplementation
- mechanical 1entilation
Positionin3
Rest
,uctionin3 of secretions
%ntipyretic and -,A
Nutrition
Sca!let fe+e!
- Group % beta hemolytic streptococcus
- Respiratory
- )ncubation !-5 days
- ?e1er: red sandpaper rash: white strawberry
ton3ue: flushed chee9s: red strawberry
ton3ue
- Dia3nostics is throat culture
- Penicillin for #$ days
7I*
Aoe"iasis
- 7ntamoeba (ystolitica: proto4oa
- )P' few days to months to years:
- usually !- E wee9s
- M/-' )n3estion of cysts from fecally
contaminated sources 5/ral fecal route6
oral and anal se;ual practices
- 7;traintestinal amoebiasis- 3enitalia:
spleen: li1er: anal: lun3s and menin3es
s5s/'
- Alood strea9ed: watery mucoid diarrhea:
foul smellin3:
- abdominal cramps
- Pain on defecation 5tenesmus6
- (yperacti1e bowel sounds
Diagnostic test
- ,tool culture of 2 stool specimens
- ,i3moidoscopy
- Recto-si3moidoscopy and coloscopy for
intestinal amoebiasis
Medical treatment
- Metronida4ole trichomonocide and
amoebicide for intestinal and e;tra intestinal
sites 5monitor li1er function test6
- Dilo;anide furoate luminal amoebicide
- Paromomycin eradicate cyst of histolytica
- -inida4ole hepatic amebic abscess
Bacilla!# D#sente!#
Shigellosis
- ,hi3a bacillus' dysenteriae 5fatal6: fle;neri
5Philippines6: boydii: sonneiG 3ram 5-6
- ,hi3a to;in destroys intestinal mucosa
- (umans are the only hosts
- Not part of normal intestinal flora
- )P' #-D days
- M/- ' oral fecal route
S5s/' fe+e!= se+e!e a"doinal pain= dia!!hea is
0ate!# to "lood# 0ith pus= tenesus
D;' stool culture
M3mt' /resol: %mpicillin: -rimethoprim-
,ulfametho;a4ole: Chloramphenicol: -etracycline:
Ciproflo;acin
Chole!a
- *ibrio coma 5inaba: o3awa: hi9o>ima6: 1ibrio
cholerae: 1ibrio el torG 3ram 5-6
- Cholera3en to;in induces acti1e secretion of
NaCl
- %cti1e )mmuni4ation
- )P' few hours to 5 days
- M/-' oral fecal route
S5s/' .ice 0ate!# stool 0ith flec2s of ucus=
s5s/ of se+e!e deh#d!ation ie >ashe!0oanAs
s2in= poo! s2in tu!go!
D;' stool culture
gt' I? fluids= *et!ac#cline= Do/#c#cline=
E!#th!o#cin= Juinolones= 4u!a(olidone and
Sulfonaides 1child!en3
*ia the s9in
)oo20o! 1.ound0o!3
- Necator %mericanus: %ncylostoma
Duodenale
- Ceads to iron deficiency and hypochromic
microcytic anemia
- Gain entry 1ia the s9in
- D;' microscopic e;am 5stool e;am6
- M3mt' Pyrantel Pamoate and Mebenda4ole
- don@t 3i1e dru3 without 5X6 stool e;am
- members of the family must be e;amined
and treated also
Pa!agoniiasis
- Chronic parasitic infection
- Closely resembles P-A
- 7ndemic areas' mindoro: camarines sur:
norte: samar: sorso3on: leyte: albay: basilan
- Para3onimiasis
- %<%' Cun3 flu9e disease
- causati1e a3ent' para3onimus westermaniG
-rematode
- 7atin3 raw or partially coo9ed fish or fresh
water crabs
Signs and s#ptos
- Cou3h of lon3 duration
- (emoptysis
- Chest+bac9 pain
- P-A not respondin3 to anti-9och@s meds
Dia3nosis
- sputum e;amination e33s in brown spots
-reatment
#0 Pra4i=uantrel 5biltri4ide6
!0 Aithionol
Asca!iasis
- Common worldwide with 3reatest fre=uency
in tropical countries0
- (as an infection rate of D$-9$% in rural
areas
- M/-' in3estion of embryonated e3ss 5fecal-
oral6
- .orms reach maturity ! months after
in3estion of e33s0
- %dult worms li1e less than #$ months5#"
months ma;06
- ?emale can produce up to !$$$$$ e33s per
day
- 733s may be 1iable in soils for months or
years
- .orms can reach #$-2$cm in len3th
Initial s#pto'
- loss of appetite
- .orms in the stool
- ?e1er
- .hee4in3
- *omitin3
- %bdominal distention
- Diarhea
- dehydration
Medical Mana3ement
%0 Mebenda4ole 5antihelmintic6 effect occurs
by bloc9in3 the 3lucose upta9e of the
or3anisms: reducin3 the ener3y until death
A0 Pyrantel pamoate' neuromuscular bloc9in3
effect which paraly4e the helminth: allowin3
it to be e;pelled in the feces
C0 Piera4ine citrate' paraly4e muscles of
parasite: this dislod3es the parasites
promotin3 their elimination
Nursin3 )nter1ention
- 7n1ironmental sanitation
- (ealth teachin3s
- %ssessment of hydration status
- 8se of /R,
- Proper waste disposal
- 7nteric precautions
Complications
- Mi3ration of the worm to different parts of
the body 7ars: mouth:nose
- Coefflers Pneumonia
- 7ner3y protein malnutrition
- )ntestinal obstruction
*ape0o! 14lat0o!s3
- -aenia ,a3inata 5cattle6: -aenia ,olium
5pi3s6
- M/-' fecal oral route
5in3estion of food contaminated by the
a3ent6
- s+s;' neurocysticercosis sei4ures:
hydrocephalus
- D;' ,tool 7;am
- M3mt' Pra4i=uantel: Niclosamide
Pin0o!
- 7nterobius *ermicularis
- M/-' fecal oral route
- ,+s;' )tchiness at the anal area d+t e33s of
the a3ent
- D;' tape test at ni3ht time
5a3ents release their e33s durin3 ni3ht time6
- flashli3ht
- M3mt' Pyrantel Pamoate: Mebenda4ole
Nursin3 )nter1ention
- Promote hy3iene
- 7n1ironmental ,anitation
- Proper waste and sewa3e disposal
- %ntihelmintic medications repeated after !
wee9s 5entire family6
PA.AL@*IC S)ELL4IS) POISONIN7
- % syndrome of characteristic symptoms
predominantly neurolo3ic which occurs
within minutes or se1eral hours after
in3estion of poisonous shellfish
- ,in3le celled dinofla3ellates 5red plan9tons6
become poisonous after hea1y rain fall
preceded by prolon3ed summer
- Common in seas around manila bay: samar:
bataan and 4ambales
MO* K Ingestion of containated "i<+al+e
shellfish
IP K 0ithin :0 inutes
CC)N)C%C M%N)?7,-%-)/N,'
- NUMBNESS O4 *)E 4ACE ESPECIALL@
A.OUND *)E MOU*)
- ?OMI*IN7= DILLINESS= )EADAC)E
- *IN7LIN7 SENSA*ION= >EA,NESS
- .APID PULSE= DI44ICUL*@ O4 SPEEC)
1A*AMIA3= D@SP)A7IA= .ESPI
PA.AL@SIS= DEA*)-
M%N%G7M7N- %ND C/N-R/C M7%,8R7,'
- NO DE4INI*E MEDICA*IONS
- INDUCE ?OMI*IN7 1EA.L@
IN*E.?EN*ION3
- D.IN,IN7 PU.E COCONU* MIL,
1>EA,ENS *OMIC E44EC*3 DONA* 7I?E
DU.IN7 LA*E S*A7E I* MA@ >O.SEN
*)E CONDI*ION-
- Na)CO: SOLU*ION 1%8 7.AMS IN N
7LASS O4 >A*E.3
- .ESPI.A*O.@ SUPPO.*
- A?OID USIN7 ?INE7A. IN COO,IN7
S)ELL4IS) A44EC*ED B@ .ED *IDE
118M +i!ulence3
- *OMIN O4 .ED *IDE IS NO* *O*ALL@
DES*.O@ED IN COO,IN7-
- A?OID *A)ON7= *ALABA= )ALAAN=
,ABI@A= ABANI,O- >)EN .ED *IDE IS
ON *)E .ISE-
BO*ULISM
- % -rue poison 9nown to be one of the
deadliest substance and usually released
into the food shortly after it has been
canned
- Botulis
- Clostridium Aotulinum: 3ram 5X6: spore
formin3
- )n3estion of contaminated foods 5canned
foods6: wound contamination: infant
botulism 5most commonG in3estion of honey6
- Neuroto;ins bloc9 %c(
- )P' #!-2&( 5canned food6
- )P' E-#E days 5wound6
- %cti1e and passi1e immuni4ation
,+s;' Diplopia: dyspha3ia: symmetric descendin3
flaccid paralysis: ptosis: depressed 3a3 refle;:
nausea: 1omitin3: dry mouth: respiratory paralysis
D;' 3astric siphonin3: wound culture: serum
bioassay 5food borne6
M3mt' respiratory support: antito;in
CON*AC*
Pediculosis
Alood suc9in3 lice+Pediculus humanus
p0 capitis-scalp
p0 palpebrarum-eyelids and eyelashes
p0 pubis-pubic hair
p0 corporis-body
M/-' s9in contact: sharin3 of 3roomin3 implements
s+s;' nits in hair+clothin3: irritatin3 maculopapular or
urticarial rash
M3mt' disinfect implements: Cindane 5<well6 topical
Permethrin 5Ni;6 topical
Sca"ies
- ,arcoptes scabiei
- Pruritus 5e;creta of mites6
- Mites come-out from burrows to mate at
ni3ht
- M/-' s9in contact
s+s;' itchin3 worse at ni3ht and after hot showerG
rashG burrows 5dar9 wa1y lines that end in a bleb w+
female mite6 in between fin3ers: 1olar wrists: elbow:
penisG papules and 1esicles in na1el: a;illae: belt
line: buttoc9s: upper thi3hs and scrotum
D;' biopsies+scrapin3s of lesions
M3mt' Permethrin 5Ni;6 cream: crotamiton cream:
,ulfur soap: antihistamines and calamine for
pruritus: wash linens with hot water: sin3le dose of
)1ermectin: treat close contacts
D;' biopsies+scrapin3s of lesions
N8R,)NG C%R7
%0 %dminister antihistamines or topical steroids
to relie1e itchin30
A0 %pply topical antiscabies creams or lotion
li9e lindasne59well6: Crotamiton 57ura;6:
permithrin
C0 d0 Cindane 59well6 not used in M! years old:
causes neuroto;icity and sei4ures
D0 e0 %pply thinly from the nec9 down and
lea1e for #!-#Ehrs then rinse
70 f0 %pply to dry s9in: moist s9in increases
absorption
?0 30 %ll family members and close contacts
G0 h0 Aeddin3s and clothin3s should be
washed in 1ery hot water and dried on hot
dryer
Lep!os#
- Chronic infectious and communicable
disease
- No new case arises without pre1ious
contact
- Ma>ority are contracted in childhood:
manifestation arises by #5 yrs old and will
definitely dia3nose at !$
- it is no hereditary
- Does not cross placenta
Cardinal ,i3n
%0 Presence of (ansen@s bacilli in stained
smear or dried biopsy material0
A0 Presence of locali4ed areas of anesthesia
Y Lep!oatous o! alignant
- many microor3anisms
- open or infectious cases
- ne3ati1e lepromin test
I *u"e!culoid o! "enign
- few or3anism
- noninfectious
- positi1e reaction to lepromin test
s+s;'
7arly+)ndeterminate hypopi3mented +
hyperpi3mented anesthetic
macules+pla=ues
-uberculoid solitary hypopi3mened
hypesthetic macule: neuritic pain:
contractures of hand and foot: ulcers: eye
in1ol1ement ie 9eratitis
Cepromatous multiple lesions: Coss of
lateral portion of eyebrows 5madarosis6:
coru3ated s9in 5leonine facies6: septal
collapse 5saddlenose6
Dia3nosis
- ,9in smear test
- ,9in lesion biopsy
- Cepromin test -
M3mt'
MD--R% E$D2 5home meds6
Paucibacillary - &-9 months
#0 Dapsone
!0 Rifampicin
Multibacillary- #!-!E months
#0 Dapsone mainstayG hemolysis:
a3ranulocytosis
!0 Clofa4imine reddish s9in pimentation:
intestinal to;icity
20 Rifampicin bactericidalG renal and li1er
to;icity
Nursin3 )nter1ention
- (ealth teachin3s
- Counselin3 in1ol1in3 the family members
and e1en the community
- Pre1ention of transmission 5 use of mas9 6
Anth!a/
- Aacillus anthracis: 3ram 5X6
- Releases e;oto;in
- Cattle: sheep: 3oat and pi3
- )P' #-2 days
- D;' 3ram stain: culture: %b testin3
- M3mt' parenteral Penicillin G: cutaneous
lesions should be cleaned
M/-
- )nhalation 5.oolsorter@s disease6
8R-) 5fe1er ; 2-5 days6 lower infection
5al1eoli6 metabolic acidosis hypo;ia
- ,9in 5most common6
itchiness papule-1esicle depressed
blac9 eschars 5painless6 septicemia
Spect!u of Acti+it# of Anti<infecti+es
- %nti-infecti1es that interfere with the ability
of the cell to reproduce+replicate without
9illin3 them are called A%C-7R)/,-%-)C
dru3s0 -etracycline is an e;ample0
- %ntibiotics that can a33ressi1ely cause
bacterial death are called A%C-7R)C)D%C0
-hese properties 5-cidal and static6 can
also depend on the antibiotic concentration
in the blood0
Common %d1erse Reactions to %nti-infecti1e
-herapy
-he most common ad1erse effects are due to the
direct action of the dru3s in the followin3 or3an
system- Neuro: nephro and G) system
#0 Nephroto;icity
%ntibiotics that are metaboli4ed and e;creted in the
9idney most fre=uently cause 9idney dama3e00
Common %d1erse Reactions to %nti-infecti1e
-herapy
!0 Gastro-intestinal to;icity
Direct to;ic effect to the cells of the G) tract can
cause nausea: 1omitin3: stomach pain and
diarrhea0 ,ome dru3s are to;ic to li1er cells and
can cause hepatitis or li1er failure0
Common %d1erse Reactions to %nti-infecti1e
-herapy
20 CN, to;icity
.hen dru3s can pass throu3h the brain
barrier and accumulate in the ner1ous tissues: they
can interfere with neuronal function0
Common %d1erse Reactions to %nti-infecti1e
-herapy
E0 (ypersensiti1ity
Most protein antibiotics can induce the
body@s immune system to produce aller3ic
responses0 Dru3s are considered forei3n
substances and when ta9en by the indi1idual: it
encounters the body@s immune cells0
Common %d1erse Reactions to %nti-infecti1e
-herapy
50 ,uperinfections
/pportunistic infections that de1elop durin3
the course of antibiotic therapy are called
,8P7R)N?7C-)/N,0
-eachin3 about anti-infecti1e therapy
- -a9e the dru3 e;actly as prescribed0
Complete the entire prescribe re3iment:
comply with instruction R-C
- Report unusual reactions such as rash:
fe1er or chills
- Chec9 the dru3 e;piration date before usin3
it0 Discard unused dru3
- Don@t share the dru3 with family or friends
- Don@t stop ta9in3 the dru3: e1en if
symptoms are relie1ed0
- Don@t ta9e dru3 left o1er from a pre1ious
illness or someone else dru3s
- Don@t ta9e o1er the counter dru3s or herbal
products without consultin3 a doctor
- -a9e dru3 with full 3lass of water
- ?ollow the manufacturer@s directions for
reconstitutin3: dilution and storin3 dru3s 0
Chec9 e;piration dates0
- Refri3erate oral suspension 5stable #E
days6: sha9e well before administerin3 to
ensure dosa3e
- Gi1e )0M dose into lar3e muscle mass0
Rotate in>ection site to minimi4e tissue in>ury
Penicillin interfere with bacterial cell wall
synthesisG broad spectrum
a0 %mo;icillin: ampicilin: methicillin: Penicillin
Cephalosporin
a0 #st 3eneration cefa4olin: cephale;in:
cephalothin
b0 !
nd
3eneration Cefaclor: Cefamandole
c0 2
rd
3eneration Ceftria;one: cefota;ime
)nhibits cell wall synthesis
- 7rythromycin
- -etracycline
- %mino3lycosides
- Chloramphenicol
,ide 7ffects
-etracycline hepatoto;ic: phototo;icity:
hyperurecemia: enamel hypoplasia
%mino3lycosides ototo;icity: leu9openia:
thrombocytopenia: neuroto;icity
Chloramphenicol bone marrow depression:
hypersensiti1ity
Infective endocarditis
Infection of the hea!t +al+es and the endothelial
su!face of the hea!t
Can "e acute o! ch!onic
Etiologic facto!s
1- Bacte!ia< O!ganis depends on se+e!al
facto!s
%- 4ungi
.is2 facto!s
1- P!osthetic +al+es
%- Congenital alfo!ation
:- Ca!dio#opath#
;- I? d!ug use!s
8- ?al+ula! d#sfunctions
Du2es c!ite!ia
)0 Criteria for )7
- -wo ma>or criteria or
- /ne ma>or and three minor
- ?i1e ma>or criteria
Ma>or criteria
- Positi1e blood culture typical for )7
- Positi1e echocardio3ram study
Minor criteria
- Predisposin3 heart condition
- ?ebrile syndrome
- *ascular phenomena' con>ucti1al
hemorrha3e: >aneway lesions
- )mmunolo3ic phenomena
- /sler nodes and roth spots
- 7chocardio3ram su33esti1e of )7 but not
classified as ma>or
%cute
- nafcillin or o;acillin
- 3entamycin
,ubacute
- penicillin
- 3entamycin
Assessent findings
1- Inte!ittent fe+e!
%- ano!e/ia= 0eight loss
:- cough= "ac2 pain and Ooint pain
;- splinte! heo!!hages unde! nails
8- Osle!As nodes< painful nodules on finge!pads
P- .othAs spots< pale heo!!hages in the !etina
&- )ea!t u!u!s
B- )ea!t failu!e
P!e+ention
Anti"iotic p!oph#la/is if patient is unde!going
p!ocedu!es li2e dental e/t!actions=
"!onchoscop#= su!ge!#= etc-
LABO.A*O.@ EMAM
Blood Cultu!es to dete!ine the e/act o!ganis
Nu!sing anageent
1- !egula! onito!ing of tepe!atu!e= hea!t
sounds
%- anage infection
:- long<te! anti"iotic the!ap#
Medical anageent
1- Pha!acothe!ap#
I? anti"iotic fo! %<P 0ee2s
Antifungal agents a!e gi+en C aphote!icin B
%- Su!ge!#
?al+ula! !eplaceent
Pre1ention
- %n-ibiotic prophyla;is is recommended for
hi3h ris9 patients before or after procedure
.heuatic Endoca!ditis
- /ccurs most often in children
- Grp % beta hemolytic streptococcal
pharyn3itis
- )t is a pre1entable disease
- Penicillin therapy can pre1ent R(D
- -hroat culture
- -he heart itself must recei1e enou3h
o;y3enated blood0
- Alood is supplied to the heart throu3h the
coronary arteries: two main branches which
ori3inate >ust abo1e the aortic 1al1e0
,i3ns and ,ymptoms
- ?e1er 52"09-E$C6
- Chills
- ,ore throat
- Diffuse redness of throat
- CC%DP
- %bdominal pain 5children6
- -iny translucent 1e3etations or 3rowths:
which resemble pinhead si4e beads at the
1al1es0
- Cause 1al1ular re3ur3itation 5mitral 1al1e6
- M* 5Ceft sided heart failure6
- Ris9 for embolic phenomena on the lun3s :
9idney: spleen: heart: brain
U!ina!# *!act Infection 1U*I3
Bacte!ial in+asion of the 2idne#s o! "ladde!
1C@S*I*IS3 usuall# caused "# Escherichia coli
#0 Aacterial infections of urinary tract are a
1ery common reason to see9 health ser1ices
!0 Common in youn3 females and uncommon
in males under a3e 5$
20 Common causati1e or3anisms
a0 Escherichia coli 53ram-ne3ati1e enteral
bacteria6 causes most community ac=uired
infections
b0 Staphylococcus saprophyticus: 3ram-
positi1e or3anism causes #$ #5%
c0 Catheter-associated 8-)@s caused by 3ram-
ne3ati1e bacteria' Proteus: <lebsiella: ,eratia:
Pseudomonas
Normal mechanisms that maintain sterility of urine
a0 %de=uate urine 1olume
b0 ?ree-flow from 9idneys throu3h urinary
meatus
c0 Complete bladder emptyin3
d0 Normal acidity of urine
e0 Peristaltic acti1ity of ureters and competent
uretero1esical >unction
f0 )ncreased intra1esicular pressure
pre1entin3 reflu;
30 )n males: antibacterial effect of 4inc in
prostatic fluid
Pathophysiolo3y
#0 Patho3ens which ha1e coloni4ed urethra:
1a3ina: or perineal area enter urinary tract by
ascendin3 mucous membranes of perineal area
into lower urinary tract
!0 Aacteria can ascend from bladder to infect
the 9idneys
20 Classifications of infections
a0 Cower urinary tract infections' urethritis:
prostatitis: cystitis
b0 8pper urinary tract infection' pyelonephritis
5inflammation of 9idney and renal pel1is6
8rethro1esical reflu; bac9ward flow of urine from
the urethra to the badder
8retero1esical reflu; bac9ward flow of urine from
the bladder to the ureters
Ris9 ?actors
#0 %3in3
a0 )ncreased incidence of diabetes mellitus
b0 )ncreased ris9 of urinary stasis
c0 )mpaired immune response
!0 ?emales' short urethra: ha1in3 se;ual
intercourse: use of contracepti1es that alter normal
bacteria flora of 1a3ina and perineal tissuesG with
a3e increased incidence of cystocele: rectocele
5incomplete emptyin36
20 Males' prostatic hypertrophy: bacterial
prostatitis: anal intercourse
E0 8rinary tract obstruction' tumor or calculi:
strictures
50 )mpaired bladder inner1ation
&0 Aowel incontinence
D0 Diabetes mellitus
"0 )nstrumentation of urinary tract
Cystitis
o Most common 8-)
o Remains superficial: in1ol1in3
bladder mucosa: which becomes
hyperemic and may hemorrha3e
o General manifestations of cystitis
o Dysuria
o ?re=uency and ur3ency
o Nocturia
o flan9 or low bac9 pain
o ,uprapubic pain and tenderness
%ssessment and laboratories
o 8rinalysis bactereriuria K#$@5 colonies of
bacteria+ml
o 70coli 55%
o Pseudomonas and enterrococcus catheter
associated 8-)
o 8rine culture- 3old standard
Criteria
o %ll men
o %ll children
o .omen with commpromised ),
o DM pt
o Recent documentation
o Prolon3ed or persistent uti
o K2 8-)+year
o Pre3nant women
o .omen se;ually acti1e or ha1e new
partners
50 Readily responds to treatment
&0 8ntreated: may in1ol1e 9idneys
D0 ,e1ere or prolon3ed may cause slou3hin3
of bladder mucosa with ulcer formation
"0 Chronic cystitis may lead to bladder stone
formation
P#eloneph!itis
#0 )nflammation of renal pel1is and
parenchyma 5functional 9idney tissue6
!0 %cute pyelonephritis
a0 Results from an infection that ascends to
9idney from lower urinary tract
Ris9 factors
#0 Pre3nancy
!0 8rinary tract obstruction and con3enital
malformation
20 8rinary tract trauma: scarrin3
E0 Renal calculi
50 Polycystic or hypertensi1e renal disease
&0 Chronic diseases: i0e0 diabetes mellitus
D0 *esicourethral reflu;
Manifestations
#0 Rapid onset with chills and fe1er
!0 Malaise
20 *omitin3
E0 ?lan9 pain
50 Costo1ertebral tenderness
&0 8rinary fre=uency: dysuria
Assessent findings' Uppe! U*I
o 4e+e! and C)IILS
o 4lan2 pain
o Costo+e!te"!al angle tende!ness
La"o!ato!# E/aination
U!inal#sis' assess p#u!ia= "acte!ia= "lood cells
in u!ineD Bacte!ial count H100=000 5l indicati+e
of infection
"- .apid tests fo! "acte!ia in u!ine
1- Nit!ite dipstic2 1tu!ning pin2 K p!esence
of "acte!ia3
%- Leu2oc#te este!ase test 1identifies >BC
in u!ine3
c- 7!a stain of u!ine' identif# "# shape
and cha!acte!istic 1g!a positi+e o! negati+e3D
o"tain "# clean catch u!ine o! cathete!i(ation
U!ina!# *!act Infection 1U*I3
Nu!sing inte!+entions
o Adiniste! anti"iotics as o!de!ed
o P!o+ide 0a! "aths and allo0 client to
+oid in 0ate! to alle+iate painful +oiding-
o 4o!ce fluids- Nu!ses a# gi+e : lite!s of
fluid pe! da#
o Encou!age easu!es to acidify urine
1c!an"e!!# Ouice= acid<ash diet3-
o P!o+ide client teaching and discha!ge
planning conce!ning
a- A+oidance of tu" "aths
"- A+oidance of "u""le "aths that
ight i!!itate u!eth!a
c- Ipo!tance fo! gi!ls to 0ipe
pe!ineu f!o f!ont to "ac2
d- Inc!ease in foods5fluids that
acidif# u!ine-
Pha!acolog#
1- Sulfa d!ugs
)ighl# concent!ated in the u!ine
Effecti+e against E- coliQ
Can cause C.@S*ALLU.IA
%- Juinolones
Not gi+en to less than 1B "ecause the# can
cause ca!tilage deg!adation
:- P#!idiuK u!ina!# antiseptic
Can cause u!ine discolo!ation
Acute 7loe!uloneph!itis
o )nflammation of the 3lomerular capillaries
o Disease of children older than ! years old
o Preceded by a throat infection due to Grp %
betahemolytic streptococal infection
Clinical Manifestation
o (ematuria microscopic: 3ross
o Coca cola colored urine due to RAC and
protein cast
o %brupt onset: #$ days after streptococcal
infection
o May be mild or se1ere presentin3 with %R?
with oli3uria
o Proteinuria due to increased permeability of
the 3lomerular membrane
o 7dema and hypertension in D5%
o (eadache: malaise and flan9 pain
Dia3nostic findin3s
o ,erial %nti-streptolysin /
o ,erum )3% and complement le1el
o 7lectron microscopy and
immunofluorescent identify the nature of the
lesion
o <idney biopsy definiti1e dia3nosis
Complications
o (ypertensi1e 7ncephalopathy
o Pulmonary edema
o RPGN: rapid and pro3ressi1e decline in
renal function0 .ill 3o to 7,RD in wee9s to
months
o Crescent shaped cells accumulate in
Aowman@s space: disruptin3 the filterin3
surface0
Medical Mana3ement
Goals
#0 -reatin3 symptoms
!0 Preser1e 9idney function
20 -reatment of complications
%ntibiotics - penicillin
o Corticosteroid and )mmunosuppressants
o Protein and sodium restriction
o Coop diuretics
Nursin3 Mana3ement
(ospital settin3
#0 Monitor inta9e and output
!0 (i3h carbohydrate to pro1ide ener3y and
reduce catabolism of protein
20 Ap monitorin3
(ome Care
(ealth education re3ardin3
#0 Notify physician of renal failure symptoms0
!0 ?luid and diet restrictions to a1oid
worsenin3 of edema and (PN
20 )mportance of follow up e1aluations of AP:
8rinalysis protein: A8N: CR7%
Neph!otic s#nd!oe
a0 Group of clinical findin3s: not specific
disorder
b0 Characteri4ed by
#0 Massi1e proteinuria
!0 (ypoalbuminemia
20 (yperlipidemia
E0 7dema 5often facial and periorbital6
Pathophysiolo3y
Characteri4ed by loss of plasma protein 5albumin6
in the urine0
-he li1er cannot 9eep up with the daily loss of
albumin in the urine
Clinical manifestation
7dema soft and pittin3
- periorbital: in dependent areas: ascites
- (eadache
- )rritability
- fati3ue
Dia3nosis
Proteinuria K 2-2053+day
Protein electrophoresis and immunophoresis
Needle biopsy of the 9idney
Complications
o )nfection
o -hromboembolism 5renal 1ein6
o Pulmonary emboli
o %ccelerated atherosclerosis
o %R? 5hypo1olemia6
Medical Mana3ement
o to preser1e the renal function
o Diuretics with %C7 inhibitors to reduce the
de3ree of proteinuria
o Cow sodium diet: liberal potassium diet
o Protein inta9e 0"3+93+day 5e33s: meats:
dairy products6
Nursin3 )nter1ention
o Pro1ide bed rest
o conser1e ener3y
o =uiet play
o Pro1ide hi3h protein and low sodium diet
o Maintain s9in inte3rity
o %1oid )M-edematous
o -urn fre=uently
o /btain mornin3 urine for protein studies
o Pro1ide scrotal support
o Monitor ) and /: *,: .ei3h daily
o %dminister ,teroids
o Protect for infection
Acne ?ulga!is
o Common: self limitin3: multifactorial s9in
disease
o /1er production of sebum:
propionibacterium acnes: hormonal:
o Closed comedones whiteheads
o /pen comedones blac9heads
o Re=uires acti1e treatment
o )nter1ention' don@t s=uee4e: pric9 or pic9:
)sotretinoin %ccutane 5a1oid sunli3ht and 1it
%: may increase tri3lycerides6: antibiotics
o No e1idence that chocolate: nuts: fatty
foods or cosmetics affects acne
o 7;acerbation coincides with menstrual
acti1ity0
o (eat: increase sweat increase acne
Nursin3 care
o 8se of topical or oral antibiotics
o )nstruct in the use of isotretinoin
5%CC8-%N76 to decrease sebum
production
o %d1erse effect: cheilitis: s9in dryness:
ele1ated tri3lycerides and eye discomfort
o ,top *it % supplement durin3 treatment
o )nstruct not to s=uee4e: pric9 or pic9 at
lesions
o 8se products labeled noncomedo3enic and
cosmetics that are water based
Decu"itus Ulce!
o ,9in impairment secondary to immobility
o Common to immobili4ed and with
decreased sensory perception patient
Ris9 ?actors
o Malnutrition
o )ncontinence
o )mmobility
o ,9in shearin3
o Decreased sensory perception
Nursin3 care
o )nstitute measures to pre1ent decubitus
ulcer
o %ssess the nutritional status
o Pro1ide ade=uate nutritional inta9e to
promote s9in inte3rity
o Monitor for alteration in s9in inte3rity
o Relie1e or remo1e pressure on s9in
o -urn e1ery ! hours
o %mbulate the patient
o Pro1ide acti1e and passi1e e;ercise = "hrs
o <eep s9in clean and dry and bed wrin9le
free
o %pply medications or dressin3 on the wound
Ee!ging Diseases
,e1ere %cute Respiratory ,yndrome
o Corona1irus
o ,e1ere acute respiratory syndrome
o )P' !-D days
o Mortality rate 5% only
Ris9 ?actors'
o history of recent tra1el to China: (on3
<on3: sin3apore -aiwan: 1ietnam: canada0
or close contact w+ ill persons with a h; of
recent tra1el to such areas: /R
o )s employed in an occupation at particular
ris9 for ,%R, e;posure: healthcare wor9er
with direct patient contact or a wor9er in a
laboratory that contains li1e ,%R,: /R
o )s part of a cluster of cases of atypical
pneumonia without an alternati1e dia3nosis
Clinical Manifestations
o (istory of tra1el to ,%R, affected country or
close contact with persons suspected of
ha1in3 ,%R, and within #E days manifest
the ff
o (i3h 3rade fe1er 5K2"0$ c6
o (eadache: body malaise: muscle pain
o Cou3h: snee4in3: nasal con3estion
o Difficulty of breathin3 after !-D days
,%R, suspect
Probable ,%R,
Dia3nosis'
Chest J-ray: CAC: )solation of 1irus
M3t'
,upporti1e
-reat as %typical Pneumonia
Luarantine
A?IAN IN4LUENLA
Se!ious conse6uences fo! ASIA
A+ian Influen(aR--
o )s an infectious disease of birds caused by
-ype % strains of the influen4a 1irus
o ?irst identified in )taly more than #$$ years
a3o
o /ccurs worldwide
o )nfection causes a wide spectrum of
symptoms in birds: ran3in3 from mild illness
to a hi3hly conta3ious and rapidly fatal
disease resultin3 in se1ere epidemics
o P hi3hly patho3enic a1ian influen4aQ
Pathogenesis
o %1ian influen4a do not normally infect
species other than birds and pi3s
o ?irst documented infection of humans with
a1ian flu occurred in (on3 <on3 in #99D
o %ffected #" humans: & died
Aird ?lu
)uan cases of influen(a A 1)8N13 infection
ha+e "een !epo!ted in Ca"odia= China=
Indonesia= *hailand= and ?ietna-
Clinical anifestations
Patients de1elop fe1er: sore throat: cou3h: in fatal
cases: se1ere respiratory distress may result
secondary to pneumonia
A constantl# utating +i!us
%ll type % influen4a 1irus: includin3 those that
re3ularly cause seasonal epidemics of influen4a in
humans are 3enetically labile and well adapted to
elude host defenses
,o far bird flu is mainly transmitted between birds:
but e;perts fear the (5N# 1irus could be
de1astatin3 to humans if it 3enetically mutates and
de1elops the capacity to be transmitted from
human to human0
Deadl# A+ian 4lu
-he .(/ has warned that if this happens it could
tri33er a new human flu pandemic: potentially 9illin3
up to 5$ million people worldwide
% total of 55 people ha1e died from the (5N# 1irus
since the be3innin3 of the epidemic in !$$2
-ri1alent )nacti1ated *accine 5-)*6
o Most widely used influen4a 1accine
o %dministered )M
o )ndicated for all persons older than &
months of a3e
o ,tudies in children ha1e shown efficacy
from 2$-9$%
S*D
7ono!!hea= Mo!ning d!op= Clap= Sac2
o Neisseria 3onorrheae: 3ram 5X6
o )P' 2-D days
,+s;'
- ?emales' usually asymptomatic or minimal
urethral dischar3e w+ lower abdominal pain
sterility or ectopic pre3nancy
- Male' Mucopurulent dischar3e: Painful
urination
decreased sperm count
DJ'
- 3ram stain and culture of cer1ical secretions
on -hayer Martin *CN medium
M3mt' sin3le dose only
- Ceftria;one 5Rocephin6 #!5 m3 )M
- /flo;acin 5?lo;in6 E$$ m3 orally
- treat concurrently with Do;ycycline or
%4ithromycin for 5$% infected w+ Clamydia
CJ'
P)D: ectopic pre3nancy and infertility:
peritonitis: perihepatitis: /phthalmia neonatorum:
sepsis and arthritis
S#philis
*!eponea pallidu= spi!ochete
F BeautifulG fast o+ing "ut delicate spi!al
th!ead
IP' 10<T0 da#s
Primary 52-& w9s after contact6 nontender
lymphadenopathy and chancreG most infectiousG
resol1es E-& w9s
Chancre painless ulcer with heaped up firm
ed3es appears at the site where the treponema
enters0 Related to pattern of se;ual beha1ior
53enitalia: rectal: oral: lips6
A8A/ swellin3 of the re3ional lymphnode
Secondary systemicG 3enerali4ed macular
papular rash includin3 palms and soles and
painless wartli9e lesions in 1ul1a or scrotum
5condylomata lata6 and lymphadenopathy
Tertiary 5&-E$ years6 - neurosyphilis+permanent
dama3e 5insanity6G 3umma 5necrotic 3ranulomatous
lesions6: aortic aneurysm
DJ'
Dar9-field e;amination of lesion- #
st
and !
nd

sta3e
Non specific *DRC and RPR
?-%-%A,
M3mt
- Primary and secondary - Pen G
- -ertiary - )* Pen G
Chla#dia
- Chlamydia trachomatis: 3ram 5-6
- )P' !-#$ days
- ,+s;'
- Maybe asymptomatic
- Gray white dischar3e: Aurnin3 and itchiness
at the urethral openin3
DJ'
- Gram stain
- %nti3en detection test on cer1ical smear
- 8rinalysis
M3mt'
- Do;ycycline or %4ithromycin
- 7rythromycin and /flo;acin
CJ'
- P)D
- 7ctopic pre3nancy
- ?etus transmittal 51a3inal birth6
)e!pes 7enitalis
(,* !
,+s;' Painful se;ual intercourse: Painful 1esicles
5cer1i;: 1a3ina: perineum: 3lans penis6
- D;'
- *iral culture
- Pap smear 5shows cellular chan3es6
- -4anc9 smear 5scrapin3 of ulcer for
stainin36
M3mt'
%nti 1iral - acyclo1ir 54o1ira;6
CJ'
Menin3itis
Neonatal infection 51a3inal birth6
7enital >a!ts=
Cond#loa Acuinatu
(P* type & W ##: papilloma 1irus
,+s;' ,in3le or multiple soft: fleshy painless
3rowth of the 1ul1a: 1a3ina: cer1i;: urethra:
or anal area: *a3inal bleedin3: dischar3e:
odor and dyspareunia
DJ'
Pap smear-shows cellular chan3es
59oilocytosis6
%cetic acid swabbin3 5will whiten lesion6
Cauliflower or hyper9eratotic papular
lesions
-reatment
- li=uid nitro3en
- podophylin resin

M3mt'
Caser treatment is more effecti1e
CJ'
Neoplasia
Neonatal laryn3eal papillomatosis 51a3inal
birth6
Candidiasis= Moniliasis
Candida %lbicans: Feast or fun3us
,+s;' Cheesy white dischar3e:
V7;treme itchiness
DJ'
</( 5wet smear indicate positi1e result6
M3mt'
)mida4ole: Monistat: Diflucan
CJ'
/ral thrush to baby 51a3inal birth6
*!ichooniasis
-richomona 1a3inalis: parasite
,+s;' ?emales' itchin3: burnin3 on urination:
Fellow 3ray frothy malodorous 1a3inal
dischar3e: ?oul smellin3
Males' usually asymptomatic
D;' microscopic e;am of 1a3inal dischar3e
M3mt' Metronida4ole 5?la3yl6G include
partners
CJ' PR/M
)I? and AIDS
Retro1irus 5()*# W ()*!6
%ttac9s and 9ills CDEX lymphocytes 5--
helper6
Capable of replicatin3 in the lymphocytes
undetected by the immune system
)mmunity declines and opportunistic
microbes set in
No 9nown cure
()*+%)D, Re1erses De1elopment and
Poses ,erious -hreat to ?uture Generations
,ince #9"$s: &$m ha1e been infected and
!5m ha1e died
%bout E$m li1e with ()*+%)D, 2"m in
de1elopin3 countries and !"m in %frica
alone
-he spread is acceleratin3 in )ndia: Russia:
the Caribbean and China
%)D, is stretchin3 health care systems
beyond their limits
-here are #!m %)D, orphans they are
estimated to rise to E$m by !$#$
)n ,ub-,aharan %frica: 5"% of ()*+%)D,
infected adults are women0 More than two-
thirds of newly infected teena3ers are
female0
Cife e;pectancy has declined by more than
#$ years in ,outh %frica and Aotswana
,wa4iland faces the ris9 of e;tinction
Most ()*+%)D, )nfected Ci1e in %frica and
,outh %sia
)ealth
(ealth care wor9ers often ha1e rates of infection as
hi3h or hi3her than adults in 3eneral
)llness and death of s9illed personnel further
wea9ens the sector
Education
7ducation faces decimation of s9illed teachers
Children of families struc9 by %)D, often ha1e to
lea1e school to help 3enerate income or underta9e
basic household tas9s
M/-'
,e;ual intercourse 5oral: 1a3inal and anal6
7;posure to contaminated blood: semen:
breast mil9 and other body fluids
Alood -ransfusion
)* dru3 use
-ransplacental
Needlestic9 in>uries
()G( R),< GR/8P
(omose;ual or bise;ual
)ntra1enous dru3 users
A- recipients before #9"5
,e;ual contact with ()*X
Aabies of mothers who are ()*X
s+s;'
#0 %cute 1iral illness 5# mo after initial
e;posure6 fe1er: malaise:
lymphadenopathy
!0 Clinical latency " yrs w+ no s;G towards
end: bacterial and s9in infections and
constitutonal s; %)D, related comple;G
CDE counts E$$-!$$
20 %)D, ! yrsG CDE - lymphocyte M !$$ w+
5X6 7C),% or .estern Alot and opportunistic
infections
()* CC%,,)?)C%-)/N
CA*E7O.@ 1 C CD;E 800 O. MO.E
CA*E7O.@ % C CD;E %00<;TT
CA*E7O.@ : C CD;E LESS *)AN %00
()* -7,-
Elisa
>este!n Blot
.apid hi+ test
(ow to Dia3nose
)I?E
% consecuti+e positi+e ELISA and
1 positi+e >este!n Blot *est
AIDSE
)I?E
CD;E count "elo0 8005l
E/hi"its one o! o!e of the ff' 1ne/t slide3
4ull "lo0n AIDS
CD; is less than %005l
7;hibits one or more of the ff'
o 7;treme fati3ue
o )ntermittent fe1er
o Ni3ht sweats
o Chills
o Cymphadenopathy
o 7nlar3ed spleen
o %nore;ia
o .ei3ht loss
o ,e1ere diarrhea
o %pathy and depression
o P-A
o <aposis sarcoma
o Pneumocystis carinii
o %)D, dementia
<aposis
-reatment
%nti-retro1iral -herapy 5%R-6 4idu1irine 5%H-6
a0 Prolon3 life
b0 Reduce ris9 of opportunistic infection
c0 Prolon3 incubation period
PR7*7N-)/N
% %A,-)N7NC7
A A7 ?%)-(?8C
C C/ND/M,
D D/N@- 8,7 DR8G,
Integ!ated Manageent of Childhood Diseases
)MC) process can be used by doctors: nurses and
other health care personnel in a primary health care
facility li9e health centers: clinics or /PD0
Components of )MC)
%0 8p3radin3 the case mana3ement and
counselin3 s9ills of health care pro1iders0
A0 ,tren3thenin3 the health care system for
effecti1e mana3ement of childhood illness
C0 )mpro1in3 family and community practices
related to child health and nutrition0
?ocused on the common childhood diseases0
%0 Pneumonia
A0 Measles
C0 Malaria
D0 Diarrhea
70 Malnutrition
?0 7ar infection
G0 Den3ue
)MC) case mana3ement process
%ssess a child by chec9in3 first for dan3er si3ns:
e;aminin3 the child: chec9in3 nutritional and
immuni4ation status0
Classify the child illness usin3 the color coded
tria3e system
- 5pin96 ur3ent
- 5yellow6 /PD treatment
- 53reen6 (ome mana3ement
)dentify the specific treatments for the child0
)f the child needs ur3ent referral: 3i1e
essential treatment before the patient is
transferred0
Pro1ide practical treatment instructions
%ssess feedin3 problems
?ollow up care
Dan3er si3ns
Not able to drin9
*omitin3
Con1ulsions
%bnormally sleepy
Parameters for assessin3 dehydration
7yes sun9en: absent of tears: lac9 of
laster
?ontanelles
,9in tur3or
Mouth
%bnormally sleepy
Ce1el of thirst
END