Communicable Diseases
some other factors.
TOPIC OUTLINE
• Definition of terms in Communicable Disease
• Chain of infection
• Control and Management of Infectious Disease
• Immunization
• Protective Precautions / Isolation
• Diseases acquired thru GI tract
• Diseases acquired thru the skin
• Diseases acquired thru the respiratory tract
• Diseases acquired thru sexual contact
COMMUNICABLE DISEASE
• It is an illness caused by an infectious agent or
its toxic products that are transmitted directly
or indirectly to a well person through an agent,
vector or inanimate object
TWO TYPES
INFECTIOUS DISEASE
• Not easily transmitted by ordinary contact but
require a direct inoculation through a break in
the previously intact skin or mucous
membrane
CONTAGIOUS DISEASE
• Easily transmitted from one person to another
through direct or indirect means
TERMINOLOGIES
• DISINFECTION –destruction of pathogenic
microorganism outside the body by directly
applying physical or chemical means
 Concurrent – method of disinfection
done immediately after the infected
individual discharges infectious
material/secretions. This method of
disinfection is when the patient is still
the source of infection
 Terminal – applied when the patient is
no longer the source of infection.
• Disinfectant -chemical used on non living
objects
• Antiseptic – chemical used on living things.
• Bactericidal – kills microorganism
• Sterilization – complete destruction of all
microorganism
General Principles
• Pathogens move through spaces or air current
• Pathogens are transferred from one surface to
another whenever objects touch
• Hand washing removes microorganism
• Pathogens are released into the air on droplet
nuclei when person speaks, breaths, sneezes
• Pathogens are transferred by virtue of gravity
• Pathogens move slowly on dry surface but very
quickly through moisture
INFECTION
• invasion and multiplication of microorganisms
on the tissues of the host resulting to signs and
symptoms as well as immunologic response
• injures the patient either by:
o competing with the host’s metabolism
o cellular damage produced by the
microbes intracellular multiplication
Factors of severity of infection
o disease producing ability
o the number of invading microorganism
o The strength of the host’s defence and
Epidemiological triad:
o Agent
o Host
o Environment
Classification accdg to incidence:
• SPORADIC - disease that occur occasionally
and irregularly with no specific pattern
• ENDEMIC – those that are present in a
population or community at times.
• EPIDEMIC – diseases that occur in a greater
number than what is expected in a specific
area over a specific time.
• PANDEMIC – is an epidemic that affects several
countries or continents
Causes of INFECTION
• Some bacteria develop resistance to antibiotics
• Some microbes have so many strains that a
single vaccine can’t protect against all of them
ex. Influenza
• Most viruses resist antiviral drugs
• Opportunistic organisms can cause infection in
immunocompromised patients
• Most people have not received vaccinations
• Increased air travel can cause the spread of
virulent microorganism to heavily populated
area in hours
• Use of immunosupressive drugs and invasive
procedures increase the risk of infection
• Problems with the body’s lines of defense
Three Lines of Defense
• FIRST LINE OF DEFENSE
o MECHANICAL BARRIERS
o CHEMICAL BARRIERS
o BODY’S OWN POP. OF
MICROORGANISM - “microbial
antagonism principle”
• SECOND – inflammatory response
o Phagocytic cells and WBC to destroy
invading microorganism manifesting
the cardinal signs
• THIRD – immune response - Natural/Acquired:
active/passive
RISK FACTORS
• Age, sex, and genes
• Nutritional status, fitness, environmental
factors
• General condition, emotional and mental state
• Immune system
• Underlying disease ( diabetes mellitus,
leukemia, transplant)
• Treatment with certain antimicrobials (prone to
fungal infection), steroids, immunosuppresive
drugs etc.
CHAIN OF INFECTION

Mode of Transmission
Contact transmission
• Direct contact - person to person
• Indirect - thru contaminated object
o Droplet spread - contact with
respiratory secretions thru cough,
sneezing, talking. Microbes can travel
up to 3 feet.
• Airborne Transmission
• Vector Borne Transmission
• Vehicle Borne Transmission
Emerging problems in infectious diseases
• Developing resistance to antibiotics eg: anti tb
drugs, MRSA, VRE
• Increasing numbers of immunosuppressed
patients.
• Use of indwelling lines and implanted foreign
bodies has increased.
INFECTION CONTROL MEASURES
• UNIVERSAL PRECAUTION – All blood, blood
products and secretions from patients are
considered as infected.
WORK PRACTICE CONTROL
• Handwashing
o Before and after using gloves, after
hand contact with patients, patient’s
blood and other potentially infected
materials.
• Protective Equipment shall be removed
immediately upon leaving the work area. Like
apron, mask, gloves etc.
o Place in designated area.
• Used needles and sharps shall not be bent,
broken, recapped. Used needles must not be
removed from disposable syringes.
• Eating, drinking, smoking, applying cosmetics
or handling contact lenses are prohibited in
work areas.
• Foods and drinks shall not be stored in
refrigerators, freezers where blood or other
infectious materials are stored.
• All procedures involving blood or other
potentially infectious materials shall be
performed in such a manner as to minimize
splashing, or spraying.
Control Measures
• Masking – Wear mask if needed. Patient with
infectious respiratory diseases should wear
mask.
• Handwashing – Practice it with soap and water.
• Gloving – Wear gloves for all direct contact
with patients. Change gloves and wash hands
every after each patient.
• Gowning - Wear gown during procedures which
are likely to generate splashes of blood or
sprays of blood and body fluids, secretions or
excretions.
• Eye protection (goggles) – wear it to prevent
splashes.
• Environmental disinfection – Clean surfaces
with disnfectant 70% alcohol,diluted bleach)
o Ex. Normal clean – clean the room post
discharge, final clean- MRSA and
infectious pts.
ISOLATION PRECAUTIONS
• Separation of patients with communicable
diseases from others so as to reduce or
prevent transmission of infectious agents.
7 Categories Recommended in isolation
• Strict isolation – prevent spread of infection
from patient to patient/staff.- handwashing,
infectous materials must be discarded, use of
single room, use of mask, gloves and gowns
and (-) pressure if possible
• Contact isolation – prevent spread by close or
direct contact
• Respiratory isolation – prevent transmission
thru air.
• TB isolation – for (+) TB or CXR suggesting
active PTB.
• Enteric Isolation – direct contact with feces
• Drainage/secretion precaution- prevents
infection thru contact with materials or
drainage from infected person.
• Universal Precaution – for handling blood and
body fluids. (Bloods, pleural fluid, peritoneal
fluid etc.)
PREVENTION
Health Education – educate the family about
• Immunization
• MOT
• Environmental sanitation – breeding places of
mosquito, disposal of feces
• Importance of seeking medical advice for any
health problem
• Preventing contamination of food and water.
Environmental Sanitation
o Water Supply Sanitation Program –
DOH thru EHS (Environmental Health
Services)
o Policies on Food Sanitation Program
o Policies on Hospital Waste
Management
• The CHNurse is in the best position to do health
education such as
o > development of materials for
environmental sanitation
o > providing group counselling,
holding community assemblies and
conferences.
o > create programs for sanitation
o > be a role model
Immunization – introduction of specific antibody to
produce immunity to certain disease.
 o Natural – passive (from placenta), o Minimal manifestations
active (thru immunization & recovery o Lymphadenopathy
from diseases)
o Artificial – passive (antitoxins),
active (vaccine, toxoid)
Maintain vaccine potency by preventing:
o Heat and sunlight
o Freezing
• Antiseptic/ disinfectants/ detergents lessen the
potency of vaccine. Use water only when
cleaning fridge/ref.
• COLD CHAIN SYSTEM – maintenance of correct
temperature of vaccines, starting from the
manufacturer, to regional store, to district
hospital, to the health center to the DX
immunizing staff and to the client. • Tuberculin testing
• CXR
Diseases Acquired Thru Respiratory • Sputum AFB
Prevention
TUBERCULOSIS • BCG
• Chronic respiratory disease affecting the lungs • Avoid overcrowding
characterized by formation of tubercles in the • Improve nutritional status
tissues---> caseation –--> necrosis ---> TX
calcification. • DOTS
• AKA: Phthisis, Consumption, Koch’s, • 6 months of RIPE
Immigrant’s dse • Respiratory isolation,
• Etiologic agent: – Mycobacterium tuberculosis • Take medicines religiously – prevent
• Incubation period: 2 – 10 wks. resistance
• Stop smoking
• Period of communicability: all throughout the
• Plenty of rest
life if not treated
• Nutritious and balance meals, increase
• MOT: Droplet
CHON, Vit. A, C
• Sources of infection – sputum, blood, nasal
discharge, saliva
MENINGITIS
• Inflammation of the meninges usually
Classification
some combination of headache, fever, stiff
1. Inactive – asymptomatic, sputum is (-), no cavity on
neck, and delirium
chest X ray
• Meningococcemia: cerebrospinal fever
2. Active – (+) CXR, S/S are present, sputum (+) smear
o Etiologic agent: Neisseria
Classification 0-5
A. Minimal – slight lesion confined to small part of meningitidis
the lung o Incubation: 2-10 days
B. Moderately advanced – one or both lungs are o MOT: droplet
involved, volume affected should not extend to one • Acute meningococcemia - with or without
lobe, cavity not more than 4 cm. meningitis
C. Far advance – more extensive than B o Waterhouse Friederichsen
Syndrome

MANIFESTATIONS
• Primary Complex: TB in children: non
contagious, children swallow phlegm, fever,
cough, anorexia, weight loss, easy fatigability
• Adult TB
o afternoon rise in temperature
o night sweats
o weight loss
o cough dry to productive
o Hemoptysis
o sputum AFB (+)
• Milliary TB - very ill, with exogenous TB like
Pott’s disease Diagnostic exams:
• Primary Infection o Lumbar tap, CSF - high WBC and
o Asymptomatic CHON, low glucose
o No manifestations even at CXR, Manifestations:
Sputum AFB o Sudden onset of fever x 24h
• Primary Complex o Petechiae, Purpuric rashes
o Meningeal irritation
  Stiff neck 2. Diptheria Antitoxin – after – skin test if (+), fractional
 Opisthotonus dose
 Kernig’s sign 3. Supportive
 Brudzinski sign • O2, if laryngeal obstruction –
o ALOC tracheostomy
o S/S of Increase ICP • CBR for 2 weeks
Nursing Mgt: • Increase fluids, adequate nutrition-
soft food, rich in Vit C
• Administer prophylactic antibiotics:
• Ice collar
Rifampicin - drug of choice
4. Isolation till 3 NEGATIVE cultures
• Aquaeous Pen Prevention
• Mannitol  DPT
• Dexamethasone
• Priority: AIRWAY, SAFETY PERTUSIS (whooping cough)
• Maintain seizure precaution • Repeated attacks of spasmodic coughing with
• Respiratory precaution series of explosive expirations ending in long
• Handwashing drawn force inspiration
• Suction secretions • Etiologic agent: Bordetella pertusis or
Haemiphilus pertussis
DIPTHERIA • Incubation period: 7-14 days
• Acute contagious disease characterized by • Period of communicability: 7 days post
generalized toxemia coming from localized exposure to 3 wks post disease onset
inflammatory process • MOT – Droplet
• Etiologic agent: Corynebacterium Diptheria
(Klebs loffer bacillus)
• Incubation period: 2-5 days
• Period of communicability: variable, ave:2-4
weeks
• MOT – Droplet, direct or intimate contact,
fomites, discharge from nose, skin, eyes
Manifestation
 PSEUDOMEMBRANE - grayish white, smooth,
leathery and spider web like structure that
bleeds when detached
Types of Respiratory Diptheria
• NASAL
o serous to serosanginous purulent
discharge Manifestation
o Pseudomebrane on septum o rapid cough 5-10x in one
o Dryness/ excoriation on the upper lip inspiration ending a high pitched
and nares whoop.
• PHARYNGEAL
o pharyngeal pseudomembrane
• Catarrhal – slight fever in PM, colds,
watery nasal discharge, teary eyes,
o bull neck ( cervical adenitis)
nocturnal coughing, 1-2 weeks
o Difficulty swallowing
• LARYNGEAL • Paroxysmal – Spasmodic stage; 5-10
o Sorethroat, pseudomemb successive forceful coughing ending with
inspiratory whoop, involuntary micturition
o Barking, dry mettallic cough
and defecation, choking spells, cyanosis
Complications
o Due to TOXEMIA • Convalescent – 4th- 6th week; diminish in
severity, frequency
 Toxic endocarditis
Complications:
 Neuritis
• Otitis media
 Toxic nephritis • Acute bronchopneumonia
o Due to Intercurrent Infection • Atelectasis or emphysema
 Bronchopneumonia • Rectal prolapse, umbilical hernia
 Respiratory failure • Convulsions (brain damage -
DX asphyxia, hemorrhage)
• Nose and throat swabs - culture of Dx:
specimen form beneath membrane • Elevated WBC
• Virulence test • Nasopharyngeal swab
• SHICK’s TEST: test for susceptibility to diptheria Nursing Management
• MOLONEY’s TEST: test for hypersensitivity to • Prevention:
diptheria o DPT
MANAGEMENT • Parenteral fluids
1. Penicillin, Erythromycin • Erythromycin - drug of choice
 • Prone position during attack
• Abdominal binder
• Adequate ventilation, avoid dust, smoke
• Isolation
• Gentle aspiration of secretions
MEASLES
• Acute viral disease with prodromal fever,
conjunctivitis, coryza, cough and Koplik’s
spots
• AKA: Rubeola, 7-day measles
• Etiologic agent: Morbilli Paramyxoviridae
virus
• Incubation period: 10-12 days
• Period of communicability: 3 days before
and 5 days after the appearance of rashes.
Most communicable during the height of
rash.
• MOT: Airborne
• Sources of infection – secretions from eyes,
nose and throat
Pathognomonic sign:
• Koplik’s spots
Manifestations
• 1.Pre eruptive stage / Prodromal (10-11
days)
o Coryza, Cough, Conjunctivitis
o Koplik’s Spots, whitish spot at the
inner cheek
o Fever, photophobia
• 2. Eruptive stage
o Maculopapular rashes
o Rash is fully developed by 2nd day
o High grade fever –on and off
o Anorexia, throat is sore
• 3. Convalescence (7-10 days)
o Desquamation of the skin
Diagnostics
• Nose and throat swab
Treatment
• 1. Antiviral drugs- Isoprenosine
• 2. Antibiotics – if with complications
• 3. Supportive – O2, IVF
• Complications – bronchopneumonia,
otitis media, encephalitis
Nursing Management
• Preventive – measles vaccine at 9
months, MMR 15 months and then 11-
12; defer if with fever, illness
• Isolation - contact/respiratory
• TSB , Skin care – daily cleansing wash
• Oral and nasal care
• Plenty of fluids
• Avoid direct glare of the sun- due to
photophobia
GERMAN MEASLES
• Mild viral illness caused by rubella virus.
• AKA: Rubella; 3-Day Measles
• Incubation period– from exposure to rash 14
-21d
• Period of communicability – one week before
and and 4 days after onset of rashes. Worst
when rash is at it’s peak.
• MOT: Droplet, nasal ceretions, transplacental in
congenital
Manifestations
• 1. Prodromal – low grade fever, headache ,
malaise, colds, lymph node involvement on 3rd
to 5th day
• 2. Eruptive – FORSCHEIMER’S SPOTS: pinkish
rash on soft palate, rash on face, spreading to
the neck, arms and trunk
o lasts1-5 days with no pigmentation or
desquamation
o muscle pain
• Treatment
o symptomatic treatment
Complications
• 1. Encephalitis, neuritis
• 2. Rubella syndrome – microcephaly, mental
retardation, deaf mutism, congenital heart
disease
RISK for congenital malformation
• 1. 100% when maternal infection happens on
first trimester of pregnancy.
• 2. 4% - second/third trimester
Nursing Management
1. Isolation. Bed rest
2. Room darkened – photophobia
3. Encourage fluid
4. Like measles tx
PREVENTION;
• MMR, Pregnant women should
avoid exposure to rubella patients
• Administration of Immune serum
globulin one week after exposure
to rubella.
CHICKEN POX
• Acute and highly contagious viral disease
characterized by vesicular eruptions on the skin
• Infectious agent – Herpes zoster virus or
Varicella zoster
• Incubation period – 10 -21 days
• Period of communicability: 1 day before
eruption up to 5 days after the appearance of the
last crop
• MOT: airborne, direct, indirect
o Direct contact thru shedding vesicles,
o Indirect thru linens or fomites
Manifestations
• Pre eruptive: Mild fever and malaise
 • Eruptive: rash starts from trunk o Burning, itching, pain then
• Lesions - red papules then becomes milky and erythematous patches followed by crops of
pus like within 4 days, vesicles
• Pruritis o Eruptions are unilateral
Stages of skin affectations o Lesions may last 1-2 weeks
o Macule – flat o Fever, regional lymphadenopathy
o Papule – elevated above the skin diameter o Paralysis of cranial nerve, vesicles at
about 3 cm external auditory canal
o Vesicle o Paralytic ileus, bladder paralysis,
o Pustule encephalitis
o Crust – scab , drying on the skin
Complications Complications
o pneumonia, sepsis o Opthalmia herpes – blindness because
Treatment of damage of gasserian ganglion
• Zovirax 500mg tablet 1 tab BID X 7 o Geniculate herpes – deafness because
days of infection of 7th CN (AKA: Ramsay
• Acyclovir Hunt Syndrome)
• Oral antihistamine Nursing Intervention
• Calamine lotion o Compress of NSS or alluminum acetate
• Antipyretics over lesions
NURSING MANAGEMENT o Analgesics, sedatives – weeks to mos
• Strict isolation until all vesicles o Steroids
scabs disappear o Keep blister covered with sterile
• Hygiene of patient powder esp after break
• Cut finger nails short o Prevent bacterial invasion
• Baking soda - pruritus o Encourage proper disposal of
• PREVENTION: Live attenuated secretions and usage of gown and
varicella vaccine mask
• VZIG - effective if given 96h post
exposure
MUMPS
• Acute viral disease manifested by swelling of
Herpes Zoster one or both of the parotid glands, with
• Acute inflammatory disease known to be occasional involvement of other glandular
caused by herpes virus varicellae or VZ virus structures,particularly testes in male.
• Infection of the sensory nerve charac by • Etiologic agent – filterable virus of
extremely painful infection along the sensory paramyxovirus group usually found in saliva of
nerve pathway infected person.
• Occurs as reinfection of VZ virus
• MOT • AKA: Epidemic/ infectious parotitis
o Direct • Incubation period: 14 -25 days.
o Indirect – airborne • Period of communicability – 6d before and 9d
• Incubation: 1-2 weeks post onset of parotid gland swelling
o 48 hrs immediately preceding the
onset of swelling is the highest
communicability.
• MOT: direct, indirect - droplet, airborne

Diagnostic procedure
o Hx of chickenpox
o Pain and burning sensation over lesions
of vesicles along nerve pathway
o Smear of vesicle fluid- giant cells
CLINICAL MANIFESTATIONS
o Viral cultures of vesicle fluid
1. Sudden headache, earache, loss of appetite
o Electron microscopy
2. Swelling of the parotid gland
o Giemsa-stained scraping –
3. Pain is related to extent of the swelling of
multinucleate giant epithelial cells the gland which reaches its peak in 2 days and
S/S continues for 7-10 days.
 4. Fever may reach 40 C during acute stage,
5. One gland may be affected first and 2 days
later the other side is involved
COMPLICATIONS
1. Orchitis – testes are swollen and tender to
palpation.
2. Oophoritis- pain and tendeness of the
abdomen
3. Mastitis
4. Deafness may happen
5. Meningo-encephalitis -possible

DIAGNOSTIC PROCEDURES
1. Viral culture
2. WBC count

PREVENTION: MMR Vaccine

TREATMENT MODALITIES CLINICAL MANIFESTATIONS

1. Antiviral drugs ONSET
2. NSAIDS - Acetaminophen • Ladderlike fever
Nursing Interventions • Nausea, vomiting and diarrhea
o Symptomatic • RR is fast, skin is dry and hot, abdomen
o Application of warm/ cold compress is distended
o Oral care, warm salt water gargle • Head-ache, aching all over the body
o Diet – semi solid, soft food easy to • Worsening of symptoms on the 4th and
chew 5th day
• Acid foods/fluids – fruit juices may • Rose spots
increase discomfort TYPHOID STATE
• Tongue protrudes- dry and brown
Diseases Acquired thru GIT
• sordes
• Diseases caused by Bacteria
• (coma vigil)
o Typhoid Fever
• (subsultus tendinus)
o Cholera
• (Carphologia)
o Dysentery • Always slip down to the foot part of the
• Diseases caused by Virus bed,
o Poliomyelitis • Severe case - delirum sets in often
o Infectious Hepatitis A ending in death
• Diseases caused by Parasites Complications
o Amoebiasis o Hemorrhage, Peritonitis, Pneumonia,
o Ascariasis Heart failure, Sepsis
DIAGNOSTIC PROCEDURES
TYPHOID FEVER 1. WBC – elevated
• Infection of the GIT affecting the lymphoid 2. Blood Culture – (+) S. typhosa
tissues(ulceration of Peyer’s patches) of the 3. Stool Culture (+)
small intestine 4. Widal test – blood serum agglutination test
• Etiologic Agent: Salmonella typhosa and typhi,  O antigen – active typhoid
Typhoid bacillus  H antigen- previously infected
• Incubation period: 1-2 weeks or vaccinated
 Vi antigen - carrier
• Period of communicability: as long as the
TREATMENT
patient is excreting the microorganism,
1. Chloramphenicol – drug of choice
• MOT: fecal-oral route, contaminated water, 2.Paracetamol
milk or other food NURSING MANAGEMENT
• Sources of Infection 1. Restore FE balance
o A person who recovered from the 2. Bedrest
disease can be potential carrier. 3. Enteric precaution
o Ingestion of shellfish taken from waters 4. Prevent falls/ safety prec
contaminated by sewage disposal 5. Oral/personal hygiene
o Stool and vomitus of infected person 6. WOF intestinal bleeding-bloody
are sources of infection. stool,sweating, pallor 7. NPO, BT

CHOLERA
• An acute bacterial disease of the GIT
characterized by profuse diarrhea, vomiting, loss
of fluid.
 • Etiologic agent: Vibrio cholerae, V. comma
• Pathognomonic sign: rice watery stool
• Incubation period: 2-3 days
• Period of Communicability: entire illness, 7-14d
• MOT: fecal oral route
PREVENTION
1. Protection of food and water supply from
fecal contamination.
2. Water should be boiled/ chlorinated.
3. Milk should be pasteurized.
4. Sanitary disposal of human excreta
5. Environmental sanitation.

DYSENTERY
• Acute bacterial infection of the intestine
characterized by diarrhea and fever
• Etiologic Agent: Shigella group
o Shigella flesneri - commmon in the
Philippines
o Shigella boydii, S. connei,
o S. dysenteria – most infectious,
habitat exclusively in man, they
develop resistance to antibiotics
• Incubation period – 7 hrs. to 7 days
• Period of communicability – during acute
Clinical manifestations infection until the feces are (-)
o Acute, profuse, watery diarrhea.
• MOT – fecal-oral route, contaminated water/
o Initial stool is brown and contains milk/ food.
fecal material à becomes “rice
water”
o Nausea/ Vomiting
o S/s of Dehydration
o poor tissue trugor, eyes are sunken
o Pulse is low or difficult to obtain, BP
is low and later unobtainable.
o RR – rapid and deep
o Cyanosis – later
o Voice becomes hoarse– speaks in
whisper
• Oliguria or anuria Clinical manifestations
• Conscious, later drowsy • Fever esp. in children
• Deep shock • Nausea, vomiting and headache
• Death may occur as short as four hours • Anorexia, body weakness
after onset. • Cramping abdominal pain (colicky)
• Usually first or 2nd day if not treated • Diarrhea – bloody and mucoid
Principal deficits • Tenesmus
1. Severe dehydration - circulatory collapse • Weight loss
2. Metabolic acidosis – loss of large volume of DIAGNOSTICS
bicarbonate rich stool. RR rapid and deep • Fecalysis
3. Hypokalemia – massive loss of K. abdominal • Rectal Swab/culture
distention – paralytic ileus • Bloods – WBC elevated
DIAGNOSTIC EXAMS • Blood culture
Fecal microscopy TREATMENT
1. Rectal swab • Antibiotics- Ampicillin,
2. Stool exam Cotrimoxazole, Tetracycline
• IVF
• Anti diarrheal are
Treatment Contraindicated
1. IVF- rapid replacement NURSING MANAGEMENT
2. Oral rehydration 1. Maintain fluid and electrolyte balance
3. Strict I and O 2. Restrict food until nausea and vomiting
4. Antibiotics – Tetracycline, Cotrimoxazole. subsides.
3. Enteric precaution
NURSING MANAGEMENT 4. Excreta must be disposed properly.
1. Medical Asepsis 5. Prevention- food preparation, safe washing
2. Enteric precaution facilities, fly control
3. VS monitoring
4. I and O POLIOMYELITIS
5. Good personal hygiene • An acute infectious disease caused by any
6. Proper excreta disposal of the 3 types of poliomyelitis virus which
7. Concurrent disinfection. affects mainly the anterior born cells of the
8. Environmental sanitation
 spinal cord and the medulla, cerebellum
and the midbrain
• AKA: Acute anterior poliomyelitis,
heinmedin disease, infantile paralysis
• Etiologic Agent: Poliovirus (Legio
Debilitans)
3 Types of Poliovirus
• Type I - most paralytogenic, most frequent
• Type II - next most frequent
• Type III - least frequent associated with
paralytic disease
3 Strains
o Brunhilde
o Laasing
o Leon
• MOT: Fecal-Oral
• Incubation period: 7-14 days ave (3-21
days)
• Period of communicability:
o 7-16 days before and few days
after onset of s/s
• S/S
o Febrile episodes with varying
degrees of muscle weakness
o Occasionally progressive Flaccid
Paralysis
o Paralytic: asymmetrical
weakness, paresthesia, urinary
retention, constipation
o Non paralytic: slight involvement
of the CNS; stiffness and rigidity of
the spine, spasms of hamstring
muscles, with paresis
o Tripod position: extend his arms
behind him for support when
upright
o Hoyne’s sign: head falls back
when he is in supine position with
the shoulder elevated
o Meningeal irritation: (+)
Brudzinski, Kernig’s sign
Diagnostic tests:
• Throat swab, stool exam, LP
Nursing Interventions
• Supportive, Preventive – Salk and
Sabin Vaccine
• NO morphine
• Moist heat application for spasms
• AIRWAY: tracheotomy
• Footboard to prevent foot drop
• Fluids, NTN, Bedrest
• Enteric and strict precautions

HEPATITIS A
• Inflammation of the liver caused by hepatitis A
virus
• AKA: infectious hepatitis
• Incubation period: 2-6weeks
• MOT: oral-fecal/ enteric transmission
• Diagnostic test: liver function (SGOT/SGPT)

3 Types of Paralysis
• Spinal Paralytic
o Flaccid paralysis
o Autonomic involvement
o Respiratory difficulty
• Bulbar Form
o Rapid & serious
o Vagus and glossopharyngeal
nerves affected
o Cardiac and respiratory reflexes Clinical manifestations
altered Prodromal/ pre icteric
o Pulmo edema • S/S of URTI
o Hypertension, impaired temp • Weight loss
regulation • Anorexia
o Encephalitic s/s • RUQ pain
• Bulbospinal • Malaise
o Combination Icteric
• Minor Polio • Jaundice
o Inapparent / subclinical • Acholic stool
o Abortive: recover within 72 hours; • Bile-colored urine
flulike; backache; vomiting
• Major Polio Diagnostic tests: HaV Ag, Ab, SGOT, SGPT

Nursing Interventions
o Provide rest periods
 o Increase CHO, mod Fat, low CHON • Incubation period: 4-8 weeks
o Intake of vits/minerals • Communicability: as long as mature
o Proper food preparation/handling fertilized female worms live in intestine
o Handwashing to prevent transmission
• Diagnostic exams: Microscopic
identification of eggs in stool, CBC, Hx of
AMOEBIASIS passing out of worms (oral or anal), Xray,
• Involves the colon in general but may involve S/S
the liver or lungs as well o Stomachache
• Etiologic agent: Entamoeba histolytica o Vomiting
• Incubation: 3-4 weeks o Passing out of worms
• Period of communicability: duration of illness o Complications
o Energy / Protein malnutrition,
• MOT: fecal oral route
Anemia
• Indirect - Ingestion of food contaminated with
o Intestinal obstruction
E.Histolytica cysts, polluted water supply, exposure
Treatment:
to flies, unhygienic food handlers.
o Pyrantel Pamoate
• Direct contact – sexual, oral, or anal,
proctogenital o Piperazine Citrate
o Mebendazole, Tetramizole
o Dicyclomine Hcl, NSAIDS for abdominal pain
o For intestinal obstruction
 Decompression
 Fluid and electrolyte
therapy
 If persistent,
laparotomy
o FF up stool exam 1-2 weeks after treatment
Nursing Intervention
o Isolation- not needed
o Enteric precaution
o Handwashing
Clinical manifestations
o Proper nutrition
• Intermittent fever
• Nausea, vomiting, weakness o Maintenance of hydration / fluid balance / boil
• Later : anorexia, weight loss, of water
jaundice o Improve personal hygiene
o Proper food prep/handling
• Diarrhea – watery and foul smelling
o Administer meds (NSAIDS, MEBENDAZOLE
stool often containing blood
streaked mucus
• Colic and abdominal distention Diseases Acquired thru the Skin
• Intestinal perforation -bleeding • Diseases caused by Trauma and
DIAGNOSTIC EXAM Inoculation
• Stool Exam ( cyst, amoeba+++) o Tetanus
• WBC – elevated o Rabies
TREATMENT o Malaria
o Amoebacides – Metronidazole(Flagyl) o DHF
800mg TID X 7days o Leptospirosis
o Bismuth gylcoarsenilate combined with o Schistosomiasis
Chloroquine • Disease acquired thru Contact
o Antibiotic – Ampicillin, Tetracycline, o Leprosy
Chloramphenicol
o Fluid replacement – IVF, oral TETANUS
NUSING MANAGEMENT • An acute, often fatal, disease characterized
• Enteric precaution by generalized rigidity and convulsive
• Health education- boil drinking water (20- spasms of skeletal muscles caused by the
30 mins), Use mineral water. endotoxin released by C. Tetani
• Cover leftover food. • AKA: Lockjaw
• Avoid washing food from open drum/pail. • Etiologic Agent: Clostridium Tetani
• Wash hands after defecating and before o Anerobic
eating. o Spore forming, gram positive rod
• Observe good food preparations. • Sources:
• Fly control o Animal and human feces
o Soil and dust
ASCARIASIS o Plaster, unsterile sutures, rusty
• Helminthic infection of the small intestine scissors, nails and pins
caused by ASCARIS LUMBRECOIDES • MOT:
• MOT: fecal-oral
 o Direct or indirect contact to • Oxygen
wounds • NGT feeding
o Traumatic wounds and burns • Tracheostomy
o Umbilical stump of the newborn • Adequate fluid, electrolyte, caloric intake
o Dirty and rusty hair pins • During convalescence
o GIT- port of entry – rare o Determine vertebral injury
o Circumcision/ ear pearcing o Attend to residual pulmonary disability
• Incubation period: 3d-3week (ave:10d) o Physiotherapy
o TT
Nursing Interventions:
• Prevention
• DPT
o Adverse Reactions
o Local reactions (erythema, induration)
o Fever and systemic symptoms not
common
o Exagerated local reactions

Nursing interventions:
• Prevention of CV and respiratory complications
o Adequate airway
o ICU – ET- MV
S/s: • Provide cardiac monitoring
• persistent contraction of muscles in the • KVO
same anatomic area as the injury • Wound care (TIG, Debridement, TT)
• Local tetanus • Administer antibiotics as ordered
• Cephalic tetanus - rare form o Penicillin
o otitis media (ear infections) • Care during tetanic spasm/ convulsion
• Generalized tetanus o Administer Diazepam – muscle
o trismus or lockjaw rigidity/spasm
o stiffness of the neck o Administer neuromuscular blocking
o difficulty in swallowing agents (metocurin iodide) – relax
o rigidity of abdominal muscles spasms and prevent seizure
o elevated temperature • Keep on seizure precaution
o sweating • Parenteral nutrition
o elevated blood pressure episodic • Avoid complications of immobility
rapid heart rate (contractures, pressure sores)
• Neonatal tetanus - a form of generalized • WOF urinary retention, fractures
tetanus that occurs in newborn infants
Complications: RABIES
o Laryngospasm • A viral zoonotic neuroinvasive disease that
 Hypostatic pneumonia causes acute encephalitis
 Hypoxia • Etiologic agent: Rhabdovirus
 Atelectasis • AKA: Hydrophobia, Lyssa
o Trauma • Negri bodies in the infected neurons –
 Fractures pathognomonic
o Septicemia • Incubation period: 4-8 weeks; 10d-1yr
 Nosocomial infections • Period of communicability: 3-5 days before the
o Death onset of s/s until the entire course of disease
Diagnostic procedure: • MOT: contamination of a bite of infected
 entirely clinical animals
CSF – normal • Diagnostic procedures
WBC- normal or slight elevation o History of exposure
Treatment: o PE/ assessment of s/s
• Wounds should be cleaned o Microscopic examination of Negri
• Necrotic tissue and foreign material should be bodies using Seller’s May-Grunwald
removed and Mann Strains
• Tetanic spasms - supportive therapy and o Fluorescent Rabies Antibody
maintenance of an adequate airway technique / Direct Immunofluorescent
• Tetanus immune globulin (TIG) test
o help remove unbound tetanus toxin
o cannot affect toxin bound to nerve
endings
o single intramuscular dose of 3,000 to
5,000 units
o Contains tetanus antitoxin.

Clinical Manifestations
Prodromal Phase / Stage of Invasion
• Fever, anorexia, malaise,
sorethroat, copious salivation,
lacrimation, perspiration, irritability,
hyperexcitability, restlessness,
drowsiness, mental depression, marked
insomia
• Sensitive to light, sound, and
changes in temp
• Myalgia, numbness, tingling,
burning or cold sensation along nerve
pathway; dilation of pupils
Stage of Excitement
• Marked excitation, apprehension
• Delirium, nuchal stiffness, involuntary
twitching
• Painful spasms of muscles of mouth,
pharynx, and larynx on attempting to
swallow food or water or the mere sight
of them – hydrophobia
• Aerophobia
• Precipitated by mild stimuli – touch or
noise
• Death – spasm from or from cardiac /
respiratory failure
Terminal Phase or Paralytic Stage
• Quiet and unconscious
• Loss of bowel and bladder control
• Tachycardia, labored irregular
respiration, steady rising temp
• Spasm, progressively increasing
paralysis
• Death due to respiratory paralysis
TREATMENT
• No cure
• No specific – symptomatic/ supportive –
directed toward alleviation of spasm
• Employ continuing cardiac and
pulmonary monitoring
• Assess the extent and location of the
bite – biting incident/ status of the
animal
o Severe exposure
o Mild exposure
• Wound treatment (local care)
o Cleanse thoroughly with soap
and water (or ammonium
compounds, betadine, or
benzalkonium cl)
o Anti rabies serum
o Tetanus prophylaxis
o Antibiotics
o Suturing should be avoided
• Antirabies sera
o Heterologous serum obtained
by hyperimmunization of
different animal species i.e.
horses
o HRIG – Homologous reabies
immunoglobulin – human origin
• Rabies Vaccine
• Active immunization
o Administered 3 years duration
o Used for lower extremity bites
o Lyssavac (purified protein
embryo), Imovax, Anti-rabies
vaccine
• Passive immunization
o 3 months
o Rabuman, Hyper Rab, Imogam
Nursing Intervention
o Isolation of patient
o Provide comfort for the patient by:
 Place padding of
bedside or use
restraints
 Clean and dress wound
with the use of gloves
 Do not bathe the
patient, wipe saliva or
provide sputum jar
o Provide restful environment
 Quiet, dark environment
 Close windows, no faucets or running
water should be heard
 IVF should be covered
 No sight of water or electric fans
MALARIA
• Acute and chronic disease transmitted by
mosquito bite confined mainly to tropical
areas.
• Etiologic agent – Protozoa of genus
Plasmodia
• Plasmodium Falciparum (malignant tertian)
o most serious, high parasitic densities in
RBC with tendency to agglutinate and
form into microemboli. Most common
in the Philippines
• P. Vivax - non life threatening except for the
very young and old.
o Manifests chills every 48 hrs on the 3rd
day onward if not treated,
• P. malarie (Quartan) – less frequent, non life
threatening, fever and chills occur every 72 hrs
on the 4th day of onset
• P. ovale - rare
• Incubation period:
o 12days P. falciparum, 14 days P vivax
and ovale, 30 days P. malariae
• Period of communicability
o If not treated /inadequate – more than
3 yrs. P malariae, 1-2 yrs. P. vivax, 1
yr- P. falciparum
• Mode of transmission
 o Mosquito bite
VECTOR – female Anopheles mosquito
DIAGNOSTICS
• Malarial smear – film of blood is
placed on a slide, stained and
examined
• Rapid diagnostic test (RDT) –
done in field. 10 -15 mins result
blood test
• TSB, ice cap on head
• Hot drinks during chilling, lots of fluid
• Monitoring of serum bilirubin
• Keep clothes dry, watch for signs of
bleeding
• PREVENTION
o Mosquito breeding places should
be destroyed
o Insecticides, insect repellant
o Blood donor screening

DENGUE FEVER
• Is an acute febrile disease cause by infection
with one of the serotypes of dengue virus which is
transmitted by mosquito ( Aedes aegypti).

• Dengue hemorrhagic fever – fatal

characterized by bleeding and hypovolemic shock
• Etiologic agent – Arbovirus group B –
• AKA: Chikungunya, O’ nyong nyong, west nile
fever
• Mode of Transmission: Bite of infected
mosquito – AEDES AEGYPTI
• Incubation period – 3-14 days
• Period of communicability – mosquito all
throughout life
Sources of infection
Clinical Manifestions • Infected person- virus is present in the
• Rapidly rising fever with severe blood and will be the reservoir when
headache sucked by mosquitoes
• Shaking chills • Stagnant water = any
• Diaphoresis, muscular pain
• Splenomegaly, hepatomegaly
• Hypotension
o May lasts for 12 hours daily or every 2
days.
• Complicated Malaria
• GIT
o Bleeding from GUT, N/V, Diarrhea,
abdominal pain, gastric, tyhoid, choleric,
dysenteric
• CNS or Cerebral Malaria
o Changes in sensorium
o Severe headache
o N/V
• Hemolytic Diagnostic Tests
• Blackwater fever • Torniquet test
o Reddish to mahogany colored urine
• Platelet Count
due to hemoglobinuria • Hematocrit
o Anuria – death Manifestations
• Malarial lung disease • PRODROMAL symptoms
MANAGEMENT o malaise and anorexia up to 12 hrs.
• Antimalarial drugs – Chloroquine (all but o Fever and chills, head-ache, muscle
P. Malarie), quinine, Sulfadoxine (resistant pain
P falciparum) Primaquine (relapse P o N &V
vivax/ovale) • FEBRILE Phase
• RBC replacement/ erythrocyte exchange o Fever persists (39-40 C)
transfusion o Rash - more prominent on the
Nursing management: extremities and trunk
• Isolation of patient o (+) torniquet test- petechia more than
• Use mosquito nets 10.
• Eradicate mosquitos
• Care of exposed persons – case finding
o Skin appears purple with blanched
• I and O areas with varied sizes ( Herman’s
• BUN & creatinine – dialysis could be life sign)
saving o Generalized or abdominal pain
• ABG
 o Hemorrhagic manifestations –
epistaxis, gum bleeding
• CIRCULATORY Phase
o Fall of temp on 3rd to 5th day
o Restless, cool clammy skin
o Profound thrombocytopenia
o Bleeding and shock
o Pulse - rapid and weak
o Untreated shock --- coma – death
o Treated – recovery in 2 days
CLASSIFICATION
• Grade 1
• Grade 2
• Grade 3 SOURCE OF INFECTION
• Grade 4 o Rats, dogs, mice
Treatment MANIFESTATIONS
• No specific antiviral therapy for dengue o Septic Stage
• Analgesic – not aspirin for relief of pain  Early
• IV fluid  Fever (40 ‘C), tachycardia, skin
• BT as necessary flushed, warm, petechiae
• O2 therapy
 Severe
NURSING MANAGEMENT  Multiorgan
1. Kept in mosquito free environment  Conjunctival affectation,
2. Keep pt. at rest jaundice, purpura, ARF,
3. VS monitoring Hemoptysis, head-ache,
4. Ice bag on the bridge of nose and forehead. abdominal pain, jaundice
5. Observe for signs of shock – VS (BP low), cold o Toxic stage – with or w/o jaundice,
clammy skin meningeal irritation, oliguria– shock, coma ,
PREVENTION CHF
• Mosquito net o Convalescence – recovery
• Eradication of breeding places of mosquito- MANAGEMENT
o house spraying 1. IV antibiotic
o change water of vases Pen G Na
o scrubbing vases once a week Tetracycline
o cleaning the surroundings Doxycycline
2. Dialysis – peritoneal
o keep water containers covered
3. IVF
o avoid too many hanging clothes inside
4. Supportive
the house
5. Symptomatic
Nursing Interventions
o Isolation of patient – urine must
properly disposed
LEPTOSPIROSIS o Care of exposed persons – keep under
• Infectious bacterial disease carried by animals close surveillance
whose urine contaminates water or food which o Control measures
is ingested or inoculated thru the skin.  Cleaning of the environment/
• Etiologic agent: spirochete Leptospira stagnant water
interrogans  Eradicate rats
o found in river, sewerage, floods  Avoid bathing or wading in
• AKA: Weil’s disease, mud fever, Swineherd’s contaminated pool of water
disease  vaccination of animals
• Incubation Period: 6 -15 days (cattles,dogs,cats,pigs)
• Period of Communicability – found in urine
between 10-20 days SCHISTOSOMIASIS
• MOT – contact with skin of infected urine or • Parasitic disease caused by Schistosoma
feces of wild/domestic animals; ingestion, japonicum, S. mansoni, S. Hematobium
inoculation
• AKA: Bilharziasis, Snail fever
• Diagnostic tests:
• Incubation period: 2-6 weeks
o Clinical manifestations
• MOT: bathing, swimming, wading in water
o Culture
• Vector: Oncomelania quadrasi
o Cercariae: most infective stage
• Diagnostic test: ova seen in fecalysis
• Diagnostic procedures
 Fecalysis
• Identification of eggs
  Liver and rectal biosy o Proper sanitation or disposal of feces
 Immunodiagnostic tests / o Creation of a program on snail control –
circumoval precipitin test and chemical or changing snail
cercarial envelope reactions environment

LEPROSY
• Chronic systemic infection characterized by
progressive cutaneous lesions
• Etiologic agent: Mycobacterium leprae
o Acid fast bacilli that attack cutaneous
tissues, peripheral nerves producing
skin lesions, anesthesia, infection and
deformities.
• Incubation period – 5 1/2 mo - eight years.
• MOT – respiratory droplet, inoculation thru
break in skin and mucous membrane.
Diagnosis
• 1. Identification of S/s
• 2. Tissue biopsy
• 3. Tissue smear
• 4. Bloods – inc. ESR
• 5. Lepromin skin test
• 6. Mitsuda reaction
S/s
o Swimmers itch MANIFESTATIONS
 Itchiness • Corneal ulceration, photophobia –blindness
 Redness and pustule formation at site • Lesions are multiple, symmetrical and
of entry of cercariae erythematous– macules and papules
 Diarrhea • Later lesions enlarge and form plaques on
 Abdominal pain nodules on earlobes, nose eyebrows and
forehead
 hepatosplenomegaly
• Foot drop
CLINICAL MANIFESTATIONS:
• Raised large erythemathous plaques appear on
• Abdominal pain
skin with clearly defined borders. – rough
• Cough
hairless and hypopigmented – leaves an
• Diarrhea
anesthetic scar.
• Eosinophilia - extremely high eosinophil
• Loss of eyebrows/eyelashes
granulocyte count.
• Loss of function of sweat and sebaceous glands
• Fever
• Epistaxis
• Fatigue
• Hepatosplenomegaly - the enlargement of both
the liver and the spleen.
• Colonic polyposis with bloody diarrhea
(Schistosoma mansoni mostly)
• Portal hypertension with hematemesis and
splenomegaly (S. mansoni, S. japonicum);
• Cystitis and ureteritis with hematuria àbladder
cancer;
• Pulmonary hypertension (S. mansoni, S.
japonicum, more rarely S. haematobium);
• Glomerulonephritis; and central nervous
system lesions.
• Complications
o Pulmonary hypertension
o Cor pulmonale
o Myocardial damage TREATMENT
o Portal cirrhosis • multiple drug therapy
Treatment: • sulfone
• Trivalent antimony • rehab
o Tartar emetic – administered thru vein • occupational Health
o Stibophen (FUADIN) – given per IM • isolation
• PRAZIQUANTEL – per orem • moral support
• Niridazole PREVENTION
• Nursing Interventions: 1. Report cases and suspects of leprosy
o Administer prescribed drugs as ordered 2. BCG vaccine may be protective if given during
o Prevent contact with cercaria-laden the first 6 months.
waters in endemic areas like streams 3. Nursing Interventions:
 1. Isolation of patient – until causative
agent is still present
2. Care of exposed persons
1. Household contact –
Diaminodiphenylsulfone for 2
years
2. Observe carefully for
symptoms of the disease

Diseases Acquired Thru Sexual Contact

HIV /AIDS
• Chronic disease that depresses immune
function
• Characterized by opportunistic infections when
T4/CD4 count drops <200
Diagnostic Tests
• MOT – sexual contact with infected –
• ELISA
unprotected, injection of blood/products,
• Western Blot
placental transmission
• CD4 count
• Viral load testing
• Home test kits
History of HIV / AIDS Manifestations
• 1959 - African man o Minor signs – cough for one month,
• 1981- 5 homosexual men general pruritus, recurrent herpes
• 1982-Designated as disease by CDC zoster, oral candidiasis, generalized
• 1983- HIV 1 discovered lymphadenopathy
• 1987- 1.5 million HIV-infected in USA o Major signs – loss of weight 10% BW,
• 1994- WHO reports 8-10 mil. Worldwide & chronic diarrhea 1month up, prolonged
protease inhibitors introduced fever one month up.
• 1999-First clinical trials for HIV vaccine • Persistent lymphadenopathy
The immune system • Cytopenias (low)
o Macrophages • PCP
 Humoral response • Kaposis sarcoma
 Cell-mediated response • Localized candida
• Bacterial infections
• TB
• STD
 Neurologic symptoms
Criteria for Diagnosis of AIDS
• CD4 counts of 200 or less
• Evidence of HIV infection and any of
o Thrush
o Bacillary angiomatosis
o Oral hairy leukoplakia
o Peripheral neuropathy
o Vulvovaginal candidiasis
o Shingles
o Idiopathic thrombocytopenia
o Fatigue, night sweats, weight loss
o Cervical dysplasia, carcinoma in
situ
• Evidence of HIV infection and any one of the
following:
o Bronchial candidiasis
o Esophageal candidiasis
o CMV disease
o CMV retinitis
o HIV encephalopathy
o Histoplasmosis
o Kaposi’s Sarcoma
o Herpes simplex ulcers, bronchitis,
pneumonia
o Primary brain lymphoma
o Pneumocystis Carinii Pneumonia
o Recurrent pneumonia
o Mycobacterium infection
 o Progressive multifocal • A curable infection caused by the bacteria
leukoencepalopathy Neisseria gonorrhoea
o Salmonella septicemia • AKA: Clap, Drip, G. vulvovaginitis
o Toxoplasmosis • MOT: transmitted during vaginal, anal, and oral
o Wasting syndromes sex
Treatment • Incubation period: 3-10 days initial
• Started in CD4 counts of <200 manifestations
• Viral load >10,000 copies • Period of communicability: considered
• All symptomatic regardless of counts infectious from the time of exposure until
• Note: CD4 reflects immune system treatment is successful
destruction. Viral load- degree of viral activity Manifestations:
• Nucleoside Reverse Transcriptase Inhibitors • Urethritis – both male and female
• Blocks reverse transcriptase • S/S: dysuria and purulent discharge
NRT • Cervicitis
• Acts by binding directly to the reverse • Upper Genital Tract – females (PID)
transcriptase enzyme Endometritis, Salpingitis,
• Not used alone Pelvic Abscess
• Rapid development of resistance • Complications :
• Acts by binding directly to the reverse • PID
transcriptase enzyme • Infertility
• Not used alone Complications:
• Rapid development of resistance • Upper Genital Tract – male
Generic Trade Dose Notes o Epididymitis, Prostatitis, Seminal
Vesiculitis
Zidovudine AZT, ZDV, 300 mg. Taken with food • Disseminated Gonococcal Infection (DGI)
Retrovir Bid o Tenosynovitis or Polyarthritis, skin
lesions and fever
Didanosine ddI, Videx 200 mg Peripheral • Anorectal Infection
bid neuropathy • Pharyngeal Infection
• Gonococcal Conjuctivitis
Zalcitibine ddC,Hivid .75 mg No antacids
o Opthalmia Neonatorum
TID
• Meningitis, Endocarditis
Stavudine d4T, Zerit 400 mg Peripheral Diagnosis:
bid neuropathy • Culture & Sensitivity
• Blood tests for N. gonorrhoeae antibodies
Lamivudine 3TC, Epivir 150 mg Used as Treatment:
bid resistance • ANTIBIOTICS
develops • Penicillin
• Single dose Ceftriaxone IM + doxycycline PO
Lamiduvine/ Combivir 150/300 Bone marrow BID for 1 week
Zidovudine mg toxicity • Prophylaxis: Silver nitrate, Tetracycline,
Erythromycin
Protease Inhibitors Nursing Interventions:
• Introduced in 1995 o Case finding
• Acts by blocking protease enzyme o Health teaching on importance of
• Indinavir (Crixivan) monogamous sexual relationship
o Treatment should be both partners to
CDC Guidelines prevent reinfection
o Combination of 2 NRTI + PI o Instruct possible complications like
• Nursing Management infertility
o Administer Antiviral meds as ordered o Educate about s/s and importance of
o Universal precaution taking antibiotic for the entire therapy
o Reverse isolation
 gloves, needle stick injury SYPHILIS
prevention • a curable, bacterial infection, that left
o Assist in early diagnosis and untreated will progress through four stages
management of complications with increasingly serious symptoms
• 4 C’s • Etiologic agent: Treponema pallidum
o Compliance – info, + drugs • AKA: Lues, The pox, Bad blood
o Counselling – education • Type of Infection: Bacterial
o Contact tracing – tracing out and tx for • Modes of transmission :
partners o Through sexual contact/ intercourse,
o Condoms – safe sex kissing
o abrasions
o Can be passed from infected mother to
GONORRHEA
unborn child (transplacental)
Symptoms • Mutual monogamy
o Primary syphilis (10 – 90 days after • Latex condoms for vaginal and anal sex
infection) • Nursing interventions
 Chancre – a firm, painless skin o Case finding
ulceration localized at the point o Health teaching and guidance along
of initial exposure to the preventive measures
bacterium appear on the o Utilization of community health
genitals facilities
• can also appear on the o Assist in interpretation and diagnosis
lips, tongue, and other o Reinforce ff up treatment
body parts o VD control program participation
o Secondary syphilis (last 2 – 6 weeks) o Medical examination of patient’s
 syphilis rash - an infectious contacts
brown skin rash that typically
occurs on the bottom of the HEPATITIS B
feet and the palms of the hand • serious disease caused by a virus that attacks
the liver
 condylomata lata - flat broad
• Etiologic agent: hepatitis B virus (HBV)
whitish lesions
• Source of infections: Blood and body secretions
 Fever, sore throat, swollen Risk factors
glands, and hair loss can also • multiple sex partners or diagnosis of a sexually
be experienced transmitted disease
• Third stage • Sex contacts of infected persons
o Will manifest 1 – 10 years after the • Injection-drug users
infection • Household contacts of chronically infected
o characterised by gummas - soft, tumor- persons
like growths • Infants born to infected mothers
 seen in the skin and mucous • Infants/children of immigrants from areas with
membranes – occurs in bones high rates of HBV infection
o joint and bone damage • Health-care and public safety workerr
o increasing blindness • Hemodialysis patients
o Numbness in the extremities, or Complications:
• Lifelong infection
difficulty in coordinating movements.
• Liver cirrhosis
• Liver cancer
Neurosyphilis
• Liver failure
• generalized paresis of the insane • Death
which results in personality S/s:
changes, changes in emotional • Jaundice
affect, hyperactive reflexes • Pruritus
• cardiovascular syphilis • Fatigue
• aortitis, aortic aneurysm, • RUQ - Abdominal pain
Aneurysm of sinus of valsalva and • Loss of appetite
aortic regurgitation, - death • Nausea, vomiting
Consequences in Infants • Joint pain
• Congenital syphilis Prevention:
• extremely dangerous • Hepatitis B vaccine has been available since
• Deformities 1982.
• Seizures o Routine vaccination of 0-18 year olds
• Blindness o Vaccination of risk groups of all ages
• Damage to the brain, bones, teeth, and • Immune globulin if exposed
ears. MEDICAL MANAGEMENT
Test and diagnosis • Interferon alfa-2b
• Venereal Disease Research Laboratory • Lamivudine
(VDRL) test • Telbivudine
• Flourescent treponemal antibody • Entecavir
absorption (FTA – Abs) • Adefovir dipivoxil
• Micro hemagglutination test (MHA - TP) Nursing Interventions:
• CSF examination o Blood and body secretions precautions
Treatment o Prevention- Hepa B vaccine
• Syphilis is easily treatable when early o Proper rest periods
detected o Prevent stress – physio/psychological
• Penicillin & other antibiotics o Proper NTN, increase in CHO, high in
CHON, low fats, Vit. K rich foods and
minerals
Prevention o Assistance to prevent injury, promote
• Abstinence safety AAT
 o WOF s/s bleeding, edema
o Health education on safe sex

SEVERE OF ACUTE RESPIRATORY SYNDROME

• An acute and highly contagious respiratory
disease in humans
• Etiologic agent: SARS coronavirus
• November 2002 and July 2003, with 8,096
known infected cases and 774 deaths
• Incubation period: 2-3days
• MOT: Airborne
S/s
o flu like: fever, myalgia, lethargy,
gastrointestinal symptoms, cough, sore
throat
o fever above 38 °C (100.4 °F)
o Shortness of breath
o Symptoms usually appear 2–10 days
following exposure
o require mechanical ventilation
Diagnostic Test:
• Chest X-ray (CXR)- abnormal with patchy
infiltrates
• WBC and PLT CT. - LOW
• ELISA test detects antibodies to SARS
o but only 21 days after the onset of
symptoms
• Immunofluorescence assay, can detect
antibodies 10 days after the onset of the
disease
o labour and time intensive test
• Polymerase chain reaction (PCR) test that can
detect genetic material of the SARS virus in
specimens ranging from blood, sputum, tissue
samples and stools
• CXR - increased opacity in both lungs,
indicative of pneumonia
• SARS may be suspected
• fever of 38 °C (100.4 °F) or more AND
• Either a history of:
o Contact (sexual or casual) with
someone with a diagnosis of SARS
within the last 10 days OR
o Travel to any of the regions identified
by the WHO as areas with recent local
transmission of SARS (affected regions
as of 10 May 2003 were parts of China,
Hong Kong, Singapore and the province
of Ontario, Canada).
• probable case of SARS has the above findings
plus positive chest x-ray findings of atypical
pneumonia or respiratory distress syndrome
Treatment
• Supportive with antipyretics, supplemental
oxygen and ventilatory support as needed.
• Suspected cases of SARS must be isolated,
preferably in negative pressure rooms, with full
barrier nursing precautions taken for any
necessary contact with these patients
• steroids
• antiviral drug
• SARS vaccine