Integumentary System CA: Pseudoparamyxovirus = Rubella or Togavirus

a. Diagnostic Examination: by clinical observation

Measles
 aka RUBEOLA, Morbilli, Little Red Disease, 7 day
measles, 9 day measles, Hard measles of First
Disease.
 Death is usually due to complications (pneumonia).
 Affects children < 2y/o, malnourished.
CA: Paramyxovirus – rubeola virus.
MOT: Droplet spread or direct contact in some
instances it is Airborne.
Incubation period: 10 days from exposure.
3 Stages of German measles
1. Pre-eruptive Stage – highly contagious stage
 High grade fever – 3-4 days
 3 C’s – cough, colds, conjunctivitis
 (+)Stimson sign / measle eye – puffiness of
the eyelid with linear congestion of the lower
conjunctiva
 Photosensitivity
 (+) enathem, fine red spot (grayish pecks) at
the center found in the inner cheek just
opposite the molars
 (Koplik’s spot) –pathognomonic
2. Eruptive Stage
 Rashes appear on the 3rd day
maculopapular, reddish, and blochy.
 Cephalo-caudal in distribution.
3. Post-eruptive Stage
 Fine, branny desquamation – peeling off.
 From red color rashes, it will fade to brown
then peel off excluding skin.
and physical examination. MOT: Droplet, direct,
3 Stages of German measles
b. Medical Management: symptomatic – viral
1. Pre-eruptive Stage
infection.
 Presence or absence of fever, if (+) 1-2 days.
1. Vit A – to prevent xeropthalmia
 Mild cough or mild colds.
2. Antibiotic
2. Eruptive Stage
Nursing Care
 (+) enanthem– seen at the soft palate,
1. Strict isolation.
maculopapular, pinkish or reddish, discrete
2. Increase or maintain body resistance.
or finer to look at
3. Keep patient warm and dry.
 (Forsheimer’s spot) - pathognomonic
4. Hygienic measures – eye care, ear care, oral care,
 Cephalocaudal
skin care.
 Lymphadenopathy
5. Immunity: Gives permanent immunity.
6. It is highly contagious during 4 days before the
3. Post-Eruptive Stage
appearance of rashes and 5 days after the
 Occurs after 24 hours where rashes start to
appearance of rashes.
disappear and enlarge lymph nodes subsides.
Preventive Measures
Laboratory Exam
1. Avoid MOT
1. Rubella Titer test – to determine the titer of
2. Immunization with Anti-measles vaccine
antibodies to german measles.
(AMV) – 9 months old, 0.5cc SQ deltoid
2. If given to women who want to bear a child 
muscle.
wait for 3 months.
 Child may experience fever, mild rash
formation 3-4 days after.
Treatment
 Allergy to eggs and neomycin →
1. Medical and Nursing treatment: Supportive
anaphylaxis.
care.
 Don’t get pregnant within 3 month.
- 2. Immunity: Gives permanent immunity.
3. Proper disposal of nasopharyngeal secretions.
4. Covering of mouth and nose when sneezing and
Preventive Measures
coughing.
1. Avoid MOT.
2. Immunization: MMR
German Measles 3. It is communicable during the entire course of
the disease = 3 days.
 aka Rubella, 3 day disease
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 4. Not fatal but could be fatal on a pregnant 3. Post-Eruptive Stage persists within 2 months even if patient had
woman- it affects fetal growth.  Rashes start to dry/crust and peel off by itself. recovered.
 Unilateral distribution of rashes.
4 Possible Major Congenital Anomaly Management  Period of communicability is the same as
chicken pox when all rashes have dried.
1. Microcephaly a. Diagnostic Examination: by clinical observation
2. Congenital Cataract and physical examination. Management
3. CHD – Tetralogy of Fallot b. Medical: treated symptomatically. a. Diagnostic Examination: Clinical observations
4. Deafness and Mutism 1. Anti-viral agent – Zovirax (Acyclovir) and physical examination
2. Anti-histamine b. Potassium Permanganate (KMNO4) with 3 Fold
If pregnant and exposed to german measles, give Effects:
gamma globulin 1 amp within 72 hours – gives c. Nursing Care 1. A- Astringent ---dries rashes
temporary immunity. 1. Skin care to prevent infection. 2. B- Bactericidal ---decrease chance of skin
2. Increase resistance and adequate rest and infection
Chicken Pox nutrition to prevent encephalitis. 3. O- xidizing ---deodorizes the rashes
3. Immunity: Gives permanent immunity. c. Analgesic for pain.
 aka varicella 4. Avoid MOT. d. Zovirax can also be given.
5. Immunization using Varicella vaccine e. Nursing Care and Preventive Measures: same
CA: Varicella zoster virus
(Viravax) given 12 months old, 0.5cc SQ as Chicken pox.
MOT: Airborne, direct contact, droplet deltoid.
6. If <13 y/o – single dose ; if > 13y/o – 2 doses, Nervous System
Duration of sickness: 2 weeks 1 month interval.
7. Proper disposal of nasopharyngeal secretions. Tetanus
3 Stages Chicken Pox 8. Cover mouth and nose when sneezing and  aka Lock Jaw
1. Pre-Eruptive coughing.
 (+) or (-) of low grade fever, body malaise, CA: Clostridium tetani – anaerobic, non-motile, spore-
musle pain, HA lasting for 24-48 hours. Herpes Zoster forming.
 aka SHINGLES, Zona, Acute Posterior
2. Eruptive Stage Ganglionitis.  Normal habitat: intestines of plant eating animal.
 Begins as a macule, 5-10 crops → papule  Adults are usually affected.  Break in the skin
→vesicle → pastule. CA: inactive or dormant type of chicken pox  MO stays in the wound  releases toxins 
 Rashes are classified as vesiculo-pastular. travel to the blood  produces s/sx:
MOT: Airborne or droplet
 Rashes have generalized distribution all over  New born – umbilical cord (tetanus
the body (trunk and scalp 1st). Duration of Illness: 2 weeks neonatorum).
 Contagious from the time rashes appear until  Children – dental caries.
the last rash have dried or crusted. Signs and Symptoms
 Adult – any king of wound.
 Centrifugal in spread of rash.  (+) vesiculo-papular rashes- painful rather than
itchy bec it affects nerve endings and that pain
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 Toxins released by MO are:
 Tetanolysin – dissolves RBC causing anemia
 Tetanoplasmin – brings about the muscle
spasm affecting the myonueral junction and
internuncial fibers of the brain
 Immunity: No permanent immunity
s/Sx:
a. Trismus – lock jaw
b. Risus sardonicus- sarcastic smile
c. Opisthotonus- arching of the back
d. Intermittent muscle spasm ,(+) boardlike
rigidity on the abdomen
e. Extension of the extremities
(gastrocnemius)
f. Diaphoresis
g. Low grade fever
h. Type of contraction: tonic
3 Objectives in Nursing Management of tetanus:
1. To prevent pt from having spasm.
 Exteroceptive stimuli – coming from
external/outside environment.
 Interoceptive stimuli – coming from within the
pt., fatigue, stress.
 Proprioceptive stimuli – there is participation of
pt and another person.
Isolation is to prevent exposing pt to the
stimuli despite being not communicable.
2. To prevent pt from having injury.
1. Respiratory injury
a. Prevent airway obstruction - padded
tongue depressor, O2 administration –
cyanosis during spasm.
b. Prevent respiratory infection.
c. Prevent respiratory aspiration.
2. Fracture – due to restraining when having
spasm.
3. To provide comfort measures
 Provide dark, quiet room – prevent stimuli.
 Proper wound care.
Prevention
a. Avoid MOT.
b. Immunization
DPT 6 weeks after birth for 3 doses at 1 month interval
(0.5ml VL).
Health teaching: fever, swelling and tenderness,
signs of convulsions w/in 7 days.
Tetanus Toxoid given to pregnant women on the 2nd
tri-mester of pregnancy, 2 doses.
Tetanus Toxoid given for persons in high risk to
tetanus.
Rabies
 aka Hydrophobia and Lyssa
 Disease of low form of animal that is accidentally
transmitted to man through animal bites.
 An acute form of encephalitis.
CA: Neurotropic virus
Rhabdovirus – transferred from animal to man.
2 Pathways for Virus to Travel
Rhabdovirus
Peripheral Nerves Efferent nerves
↓ ↓
CNS
Salivary glands and to other organs
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 Inclusion bodies develop called Negri Bodies -
pathognomonic
 MOT: Contact with saliva of a rabid animal,
scratching, licking of wound by dogs
 Incubation Period:
a. Animals = 3-8 weeks;
b. Humans = 10 days-years
2 Stages of Manifestations in Animals
1. Dumb Stage - depressive stage, manic behaviour.
2. Furious Stage – agitated, fierceful, drooling of
saliva → will die.
3 Stages of Manifestation in Human
1. Invasive Stage
 Virus is transferred through saliva by direct or
indirect contact.
 S/Sx: numbness on site, sore throat, marked
insomia, restlessness, irritable & apprehensive ,
flu-like symptoms, slight photosensitivity.
2. Excitement Stage
 Patient is confined in the hospital.
 S/Sx:
a. Aerophobia and hydrophobia
b. Drooling of saliva and spitting
c. Photosensitive
d. Maniacal behaviour
 Management: Haloperidol with Benadryl.
3. Paralytic Stage
 When spasm is no longer observed because
paralysis sets in and within 24-72 hours →
patient dies.
Diagnostic Examinations
a. Brain Biopsy of Animal
b. Direct Flourescent Antibody Test (DFAT)
c. Observation of animal for 10 days
d. Factors to consider in observing the animal:
e. Site of the bite
f. Extent of the bite
g. Reason for the bite
Medical Management
1. Vaccine – post exposure prophylaxis only.
a. Active form of Vaccine
 Purified Duck Embryo Vaccine (PDEV) –
Lyssavac
 Purified Vero Cell Vaccine (PVCV) –
Verorab with in 24 hours.
 Purified Chick Embryo Cell Vaccine –
(PCEV)
 2 Ways of Administration: IM or ID.
b. Passive form of Vaccine
 Equine Rabies Immunoglobulin (ERIg) –
from animal serum.
 Human rabies Immunoglobulin – human
serum.
Nursing Care
a. Wash wound with running water.
b. Seek consultation as soon as possible.
c. Place patient in dim and quiet room.
d. Room of patient should be away from sub-
utility room.
e. Wear complete protective barriers when
entering the room.
Preventive Measures
a. Keep away from stray dogs.
b. Keep animal caged or chained.
c. If bitten – wash with soap and running water, Meningeal irritation manifested by:
use strong antiseptic solution and observe the Nuchal rigidity/stiffneck (1st sign of meningitis)
dog. AbN reflexes – (+) kernig’s sign, (+) Brudzinki’s sign
(pathognomonic sign)
Meningitis ↓
 Inflammation of the meninges. Incresed ICP -----CsF in subarachnoid space
CA: Viruses – CytoMegaloVirus – viral meningitis. ↓
Fungus – Cryptococccal meningitis. Severe Headache,
Bacteria – common cause. Projectile vomiting,
Altered V/S: increase temp, decrease PR, decrease RR,
TB meningitis, streptococcal meningitis, hemophilus increase systolic but N diastolic,
influenza B. Convulsions
Diplopia – optic nerve/disc
Meningococcal Meningitis Tinnitus, Difficulty of hearing/deafness, loss of
Spotted fever / Meningococcemia Balance, Vertigo,
 Highly fatal and highly contagious type of Altered LOC
meningitis.
 Vascular system is affected resulting to vascular Others/sx: anorexia, body malaise and loss of appetite
collapse (DIC).
 Waterhouse Friedrichsen Syndrome – caused by Diagnostic exams:
massive invasion of blood by meningococcus
infection resulting in organ failure, coma or even 1. Lumbar Puncture (L3 & L4) – tap or aspirate
death, unless effective antibiotic or tx is quickly CSF to:
rendered. a. Color: yellowish, turbid/cloudy.
b. Increased CHON, increased WBC, decreased
Rifampicin 450 mg once/day x 3 days sugar.
Ciprobay 500 mg once/day x 3 days c. C & S – to determine CA and specific drug to
CA: Neisseria Meningitides kill the MO.
d. Counter Immuno Electrophoresis (CIE) – if
Incubation Period: 2-10 days clear CSF either viral or protozoa.
Portal of Entry: Respiratory system via the
2. Blood culture
nasopharynx .
 Done if lumbar puncture can’t be done yet
Neisseria Meningitides  Nasopharynx  Blood stream because MO travels to the blood stream.
↓
Vascular changes (petechiae, echymossis) 3. Antimicrobial drugs
↓ a. Viral – supportive
b. Fungus – antifungal
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 c. Bacteria – antibiotic Portal of entry: digestive system by mouth.  Increased CHON, increased WBC, N sugar.
b. Muscle testing – test for threshold for pain.
4. Corticosteriods – Dexamethasone or Solu-Cortef. Stages of Poliomyelitis: c. EMG
d. Stool exam – (+) all throughout the process.
5. Mannitol- osmotic diuretic, removes CSF 1. Invasive or Abortive e. Throat swab – maybe (+) in 2 weeks of the dse
a. Monitor I/O, assess effectiveness of drug.  Stage when virus invades the host. course.
b. Assess hydration.  flu-like sx, non-specific. f. Supportive and Symptomatic

6. Anticonvulsant drug – Phenytoin (Dilantin). 2. Non-paralytic Preventive Measurement:

7. Symptomatic and supportive.
8. If phenytoin is given IV, it should be sandwich with
NSS (NSS-Dilanti-NSS)  can
crystallization when mixed with CSF.
9. If per orem, do oral care and gum massage 
gingival hyperplasia.
10. Preventive Measures: Proper disposal of nasal
secretions, covering of mouth and nose, avoid
MOT.
11. Immunity: No permanent immunity.
Poliomyelitis
 aka Infantile Paralysis or Heine-Medin’s dse.
 High risk – below 10y/o.
CA: Legio Debilitans virus
a. Type 1 – Brunhilde – common in the Phil.
b. Type 2 – Lansing
c. Type 3 – Leon
a. Early Stage: Nasopharyngeal secretions.
MOT: droplet
Port of Entry: respiratory system by nasopharynx.
b. Late Stage: found in stool.
MOT: fecal-oral route
 Slight CNS involvement.
 Hump temp curve. 1. Immunization: OPV – Sabin Vaccine, given 6
cause  (+) Poker spine - stiffness of the back weeks after birth.
(opisthotonus) with head retraction.
 Spasm of the hamstrings. Instructions to mothers:
 hypersensitivity of the skin a. Don’t feed child 30 mins before administration.
(hyperparesthesia). b. If vomiting occurs, repeat dose.
 (+) babinski reflex. c. Be careful in handling the stool of the child who
had received OPV.
3. Paralytic Stage d. For immunocompromised – give Inactivated
 Severe CNS involvement. Polio Vaccine (IPV-Salk Vaccine) – 0.5 cc
 Flaccid (soft, flabby and limp) paralysis IM, VL in 3 doses at one month interval.
(pathognomonic sign) 2. Avoid MOT.
Circulatory System
4 Types
Dengue
1. Bulbar – CN9 (glossopharyngeal) and 10th (vagus)
affectation swallowing, vocal cord and respiratory
CA:
paralysis.
2. Spinal – c0mmon type, AHC affectation paralysis  Arbovirus- Dengue virus
of U/L extremities – uni or bilateral intercostal  West Nile virus
muscle paralysis.  Flavivirus
3. Bulbo-spinal – CN and AHC are both affected.
4. Landry’s – ascending paralysis (quadriplegia). MOT: Biological transmitter  Aedes Aegypti
mechanical transmitter – Celux fatigan
Diagnostic Exams:  Day biting and low flying mosquito.
 Breed in clear stagnant water.
a. Lumbar Puncture Test
Pandy’s Test  Urban area.

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  White stripes on legs, gray wings. a. Persistence of s/sx of Grade 2 + Circulatory  To prevent and control bleeding:
Failure a. Epistaxis
Mosquito (Aedes Aegypti) b. Cold clammy skin b. Gum Bleeding
↓ c. Check for capillary refill c. Hematemesis
Bloodstream d. Hypotension, very rapid weak pulse and rapid d. Melena
↓ respiration.
Creates multiple lesions in the bloodstream Supportive & Symptomatic
---------------------------------------------------- 4. Grade 4  Increase body resistance – proper nutrition
↓ ↓  Persistence of s/sx of Grade 3 + Hypovolemic and adequate rest.
↑ capillary fragility ↑ capillary permeability Shock → Death
(easily bleeds ) (allows shifting of fluid Preventive Measures:
from 1 comp to Diagnostic Exams: CLEAN Program of DOH
another) a. Torniquet Test or Rumpel Leede Test – C- hemically treated mosquito net
↓ ↓ presumptive. L- arva eating fish
Thrombocytopenia edema, ascites,  Test for capillary fragility. E- nvironmental Sanitation
and A- nti mosquito soap/off lotion
hemoconcentration 3 Criteria before performing Torniquet test N- atural mosquito repelant trees
1. 6 months or older.
1. Grade 1 2. Fever > 3 days. Immunity: No permanent immunity.
a. Fever – 3-5 days 3. (-) signs of DHF- fever of 3 days.
b. HA; periorbital, abdominal, joint and bone Malaria
pains.  Release the cuff, check and count the  aka AGUE
c. N/V petechial formation per one square inch (>20  king of tropical diseases manifested by
d. Pathological vascular changes: petechiae and petechial formation = (+) tourniquet test. indefinite period of fever and chills.
Herman sign (generalized flusing/redness of
the skin. b. Platelet Count - ↓ in DHF – definitive test CA: Protozoa – Plasmodium:
e. Diagnosed as Dengue Fever or Dandy Fever c. Hematocrit (Hct) determination - ↑ in DHF 1. Plasmodium Vivax
or Breakbone Fever. due to hemoconcentration . 2. Plasmodium Falciparum – most fatal.
3. Plasmodium Malariae
2. Grade 2 Symptomatic treatment 4. Plasmodium Ovale - Only female mosquitoes
a. Persistence of s/sx of Grade 1 + Bleeding 1. Antipyretic – but never give Acetyl Salicylic or suck blood.
b. Bleeding from: Aspirin (ASA).  P. Vivax and P. Falciparum – common causes of
 Nose – epistaxis 2. Reye’s Syndrome – a neurologic d/o associated malaria in the Phils.
 Gum - gum bleeding with viral infection (<12y/o). MOT: mosquito bite, blood transfusion
 Stomach - hematemesis, melena, 3. Vit K (Aquamephyton, Phytomenadion,  Night biting from dusk till dawn.
hematochezia Synkavit and Konakion).  Breeds in a clear slow flowing water.
4. Vit. C.  Rural areas – mountains and forest.
3. Grade 3 5. Blood Transfusion.  Lands on surface – 45 degrees angle/slanting.
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 b. Sputum Examination – confirmatory, done in 3
If infected by mosquito Tuberculosis series.
↓  aka Kokh’s Infection, Phthisis, PTB, c. Chest X-ray - not definite test, tells only the extent
Blood stream Galloping Consumption. of involvement of the lungs.
----------------------------------
↓ ↓ CA: Acid Fast Bacilli - M. Tuberculosis, M. Bovis, M. 1. According to extent of disease based on
RBC is penetrated Liver Avium/Avis. cavitations within the lungs.
(MO reproduces) (MO stays for 3-5years) a. Minimal
↓ MOT: b. Moderately advanced.
RBC 1. Airborne and droplet c. Advanced – (+) of cavitations within the
2. Ingestion of infected milk of cows lungs.
 Cold Stage – shaking of body & chattering of 3. Blood – TB meningitis, TB of bones, TB of 2. According to clinical manifestations.
lips (10-15 mins). the spine. 1. Active PTB
 Hot Stage – fever, chills, vomiting, 2. Inactive PTB
abdominal pain (4-6 hours). Incubation Period: 1-2 months (4-8 weeks) 3. According to American Pulmonary Society.
 Wet Stage – profuse sweating, feeling of a. TB 0 – (-) exposure (-) infection (-) tuberculin
weakness. S/Sx: testing.
1. Low grade fever with night sweats. b. TB I- (+) exposure (-) infection (-) tuberculin
2. Anorexia and weight loss testing.
Nursing Care: 3. Fatigability c. TB II – (+) exposure (+) infection (+) tuberculin
a. Make patient comfortable. 4. Chest pain and dyspnea. testing (-) s/sx.
b. Keep patient warm. 5. Dry cough  productive (yellowish/greenish) d. TB III – (+) exposure (+) infection (+) tuberculin
c. Increase fluid intake.  blood streak sputum / hemoptysis testing (+) s/sx.
 Cerebral Hypoxia – caused by P. falciparum (pathognomonic sign).
causes anemia. 6. Back and epigastric pain. 1. Short Course Chemo therapy – Rifampicin,
7. anemia and amennorhea in female. Isoniazid, Pyrazinamide, Ethambutol (RIPE)
Diagnostic Examinations:
1. Malarial Smear/ Blood Smear – blood is extracted Diagnostic Examinations: a. Rifampicin (R) – causes orange color of tears,
at peak of fever. a. Tuberculin skin testing – screening, ID. urine and stool.
2. Quantitative Buffy Count (QBC) – no need for  A presumptive test. b. Isoniazid (INH) – mainstay drug.
the height of fever to set in.  Mantoux test – most reliable skin test for TB.  6mons for carrier & inactive adult patient.
 0.1 cc Purified Protein Derivative, volar  9mons for children.
Medical Management: aspect.  12mons for immunocompromised patients.
1. Chloroquine (Aralen) – mainstay  bleb or wheal formation.  Side Effects:
2. Other Drugs: Primaquine, Atabrine, fansidar and a. =<or = to 4mm  negative. 1. Peripheral neuropathies/neuritis
Quinine (reserve drug for severe cases). b. = 5-9 mm  doubtful (repeat the  Foods rich in Vit B6 (pyroxidine).
 Used cautiously for pregnant women. test).
 Immunity: No permanent immunity. c. = > or = 10mm  positive. 2. Hepatotoxicity – (+) jaundice
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  Monitor liver enzymes.  Instruction to mothers: don’t massage the area,  ADS – IM, IV ANST; if (+) give in fractional
 Avoid alcohol. (+) fever, (+) abscess formation on the site of dose – desensitization.
injection →scar.  IV fluid to dilute toxin.
c. Pyrazinamide (P) – causes hyperurecemia.
d. Ethambutol (E) – causes irreversible optic neuritis Diphtheria Nursing Care:
that brings about blindness.  Acute contagious dse char by generalized a. Antibiotic – Penicillin
toxaemia coming from a localized b. Supportive – O2 inhalation, tracheostomy.
2. Standard Regimen (SR) – Streptomycin, Isoniazid inflammatory process known as c. Strict Isolation – highly contagious.
& Ethambutol (SIE). PSEUDOMEMBRANE. d. CBR – to limit the circulation of toxin.
 Myocarditis, bronchopneumonia &
a. Streptomycin (S) CA: Corynebacterium diphtheria or Klebs-Loeffler peripheral neuritis – fatal
 Side Effects: bacillus. complications.
1. Nephrotoxicity e. Diet: Liquid to soft diet. (-) spices , small
2. Ototoxicity – CN8 (tinnitus/vertigo). MOT: Droplet (direct contact) – affects all ages. frequent feeding, observe strict aspiration
precaution, increase fluid intake.
3. Directly Observed Treatment Short Course S/Sx f. Provide diversional activities for children.
(DOTS) WHO - “tutuk gamutan”. 1. Nasal - dryness, excoriation of upper lip and g. Avoid MOT.
 5 Elements: nares (+) of pseudomembrane in the nasal h. Immunization: DPT 0.5cc IM VL, 6, 10,
1. Political will to support the program. turbinate – pathognomonic s/sx. 14 wks of age simultaneous with OPV.
2. Microscopic availability. 2. Grayish-white membrane with leathery  Do not massage area to prevent lump
3. Steady supply of medicine. consistency. formation (press).
4. Personnel – RN and midwife. 3. Pharyngeal – (+) bullneck appearance  (+) lump  hot moist compress.
5. Documentation and recording. (enlargement of the cervical lymphnode).  (+) fever – give paracetamol; cooling
4. Laryngeal – (+) respiratory distress - (+) measures.
Nursing Care: hoarseness/aponia.  Adverse side effect: CONVULSION
1. D – iet - Small frequent nutritious foods. 5. (+) laryngeal stridor – brassy metallic cough.  Nsg. Management: Take temp accurately
2. D – rugs - Adequate drugs and emphasizes to differentiate it from febrile convulsion.
importance of compliance. Diagnostic Examinations:
3. R – est - Conserve energy. a. Nose and Throat Culture Pertusiss
4. Contraindicated Nursing Care: Do not do chest b. Shick’s Test – to determine resistance or
physiotherapy. susceptibility to diphtheria.  aka as Whooping cough and Chin cough.
5. Avoid MOT. c. Moloney’s Test – to determine  Affects below 6 y/o.
6. Proper disposal of nasopharyngeal secretions. hypersensitivity to diphtheria.
7. Covering of mouth when sneezing.  *Removal of the pseudomembrane is not CA: Coccobacillus -
8. Immunization : Gives temporary immunity. encouraged  facilitate bleeding and fast a. Bordetella pertussis
 Immunization with BCG immediately after birth regrowth. b. Hemophilus pertussis
0.5cc ID ® deltoid area. d. Neutralize toxin.
Incubation Period: 7-10 days
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MOT: Droplet
S/Sx
1. Catarrhal stage – highly contagious, child stays at
home.
s/sx:
a. (+) of colds
b. Nocturnal coughing
c. Fever
d. Tiredness and listlessness
2. Spasmodic or Paroxysmal stage
s/sx:
a. 5-10 successive forceful coughing which
ends in a prolonged inspiratory phase or
whoop.
b. (+) production of mucus (tenacious) plug
on airway passage.
c. Other manifestations:
a. Congested face, tongue.
b. Teary eyes with protrusion of eyeball.
c. Distended face and neck veins.
d. Involuntary mict. and defecation.
e. Abdominal/inguinal hernia.
f. Deafness due to hemorrhage of
vestibular apparatus of ear.
2. Convalescent stage – s/sx starts to disappear.
 Patient no longer communicable and on
road to recovery.
Diagnostic Examinations:
a. Nasal Swab
b. Bordet-Gengou Test
c. Agar Plate – use nasopharyngeal secretions
d. Cough Plate
a. Rose spots in the the abdomen –pathognomonic
Medical sign.
1. Immunization: Pertussis Immune b. Ladder like fever.
Globulin. a. splenomegaly
2. Antibiotics: Erythromycin b. Typhoid psychosis – due to release of toxins.
3. Fluid and Electrolyte Replacement  Coma vigil look.
4. Mild form of sedation: Codeine  Difficulty in protruding the tongue.
 Carphologia – involuntary picking up of
Nursing Care: linen.
1. CBR  Sabsultus tendinum – involuntary
2. Maintain F&E balances. twitching of tendon.
3. Provide adequate nutrition. 3. Defervescence Stage – (+) ulcer formation
4. Proper positioning when feeding. intestinal perforation  bleeding spillage in
5. Provide abdominal binder to prevent hernia. peritoneal cavity.
Preventive Measures: same as Diptheria.  S/Sx of Peritonitis:
1. Sudden and severe abdominal pain.
Immunity: No permanent immunity. 2. Persistence of fever.
3. board-like rigid abdominal.
Typhoid Fever 4. Convalescent /Lysis Stage – s/sx starts to subside.
 Still have to observe for relapse.
CA: Salmonella typhosa →Payer’s patches
Diagnostic Examinations:
MOT: Fecal-oral
Sources of infection: feces, fingers, food, flies and 1. Blood Culture
fomites. a. Widal Test
 Antigen O (AG O) or Somatic Antigen =
3 Stages of Typhoid Fever presently infected.
 Antigen H (Ag H) or Flagellar Antigen =
1. Prodromal Stage – (+) MO in the blood stream. previously exposed to TF or has had an
 Fever, dull HA, N/V, abd pain, diarrhea or immunization.
constipation. b. Thypi dot – uses blood specimen where it
2. Fastigial/Pyrexial - MO invades the payer’s identifies antibodies.
patches.
Features: 2. Stool and Urine Exams
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Medical: orange skin, orange eyes  pathognomonic Jaundice, Hepa
 Antibiotic – Chloramphenicol. sign. Epidemic
Hepa
Nursing Care: Diagnostic Examination: Source of Feces Blood, semen, Blood
1. Fluid and Electrolyte Management. 1. Blood culture: Leptospira Infection cervical
2. Provide adequate nutrition – (+) vomiting - small agglutination test (LAT) secretions
frequent meals ; (+)diarrhea - (x) fatty food.  Leptospira antigen-antibody test Causative HAV or RNA HBV of DNA HCV
3. Provide comfort measures. (LAAT). agent containing containing
 Microscopic agglutination test (MAT). virus
virus
MOT Fecal - oral Person-person, Percutaneous
Leptospirosis Medical Management: parenteral/
 aka Mud fever, Swamp fever, Canicola 1. Antibiotics – Tetracyline  drug of choice. percutaneous,
fever, Pre-tibial fever, Weil dse,  Not given to a. child <8y/o staining of teeth. placental
Swineherd dse and Ictero-Hemorrhagica  Pregnant women – teratogenic effect bone Incubation 2-7 wks 6wks-6mons 5wks-7-8
dse. defect. Period wks/12wks
 Never give tetracycline with calcium rich food, Risk Crowding, Multiple sex Blood
Source of infection: Excreta of rats particularly urine. antacid and iron prep & milk. homosexual partners, recipients
2. Give Penicillin to patient allergic to tetracycline. members of
s, food
CA:  Give 1hr before meals or 2hrs after meals or medical team,
1. Leptospira (spirochete) – bacteria empty stomach. handlers,
blood, drug
2. Leptospira canicola poor addicts
3. Leptospira hemorrhagica Nursing Care: Symptomatic sanitation,
4. Leptospira enterogans – common in Phils. 1. Provide eye care. unsafe
2. Warm compress for muscle pain. water
MOT: Skin penetration 3. I/O, consistency, frequency & amount. supply,
children
Incubation Period: 2 days to 4 weeks Preventive Measures:
1. Environmental sanitation by eradication Carrier No No Yes
People at risk: sewage workers, farmers, miners, of rats. state
people living in Manila areas. 2. Avoid walking through floods. Prognosis 0.5% 1-10% 1-2%
mortality mortality mortality
Incidence: rainy seasons Hepatitis Prevention Proper Screen blood Screen blood
 Inflammation of the liver. handwashing donors donors
S/sx: Hepa A Hepa B Hepa C , sanitation,
1. Fever, HA, vomiting. Synonym Infectious Serum Hepa, Post – screen food
2. Myalgia and myositescalf muscles. Hepa, Homologous transfusion handlers,
3. Jaundice with hemorrhages on skin & mucous Catarrhal Hepa, Viral Hepa enteric
membrane icter-hemorrhagic  yellow and red precautions
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  Hep. B Protein Independent Antigen
1. Pre-Icteric Stage (HBeAa)= (+)chronic hep B. a. Male - Urethritis
S/Sx: 3. Routine Test b. Female – Cervicitis
 Fever, RUQ, pain, fatigability, weight loss, body a. Bilirubin Testing
malaise, N/V, anorexia, signs of anemia. b. Prothrombin Time Testing (PTT) For Male:
c. Ultrasound or CT Scan of Liver 1. Dysuria
d. Urinalysis 2. Redness & edema of urinary meatus  acidic
urine passes through burning sensation  (+)
2. Icteric Stage pain.
S/Sx: Medical Management: 3. Purulent urethral discharges abundant in the
 (+) jaundice – inability of liver to eliminate (N) 1. Hepatic Protectors or Liver Aides contain vitamins, morning – morning drop.
amount of bilirubin , (+) pruritus, urine is tea minerals and phospholipids: 4. Abscess forms on the prostate gland  prostitis 
colored or brown, passing out of alcoholic or a. Essentiale for adults. epidydimitis  formation of scar on epidydimis 
clay colored or no color stool, persistence of sx b. Jetepar or Silymarine for pedia. obstruction flow of the sperm cellsterility.
of pre-ecteric stage but to a lesser degree. 2. New trends in treating Hepatitis
a. Antiviral : Lamivudine For Female:
3. Post – Icteric Stage b. Immuno-modulating drug: Interferon 1. Dysuria and urinary frequency.
S/Sx: 2. Itchy, red and edematous meatus, if cervix is
 Jaundice and other s/sx starts to disappear. Nursing Care: affected.
 Energy starts to increase and patient is on the 1. Provide rest to promote liver regeneration. 3. Burning pain and purulent discharges, if urethra
road to recovery. 2. Low fat diet, High CHON intake to spare protein is affected.
 It takes 3-4 months for the liver to recover metabolism. 4. Abscess forms on the bartholin’s and skene’s
(avoid alcohol for 1year and ASA &  Immunization: Hep B vaccine is given at gland  endocervitis & endometritis.
acetaminophen). 6 wks after birth, 3 doses at one month interval, 5. (+) narrowing of fallopian tube  sterility.
Dose: 0.5cc IM, VL.
Diagnostic Examination:  Immunity: Don’t give a permanent immunity.  If pregnant, it will cause: ectopic pregnancy or
1. Liver Enzyme Test – determine extent of liver opthalmia neonatorum.
damage. Gonorrhea
 ALT, AST, GGT, ALP, LDH.  aka Jack, Gleet, Clap, Strain, GC and Morning Diagnostic Examination:
2. Serum Antigen- Antibody (Ag-Ab) Test Drop. 1. C&S by mucosal scrapping
a. Hepatitis A 2. Pap Smear or Vaginal Smear
 Hepatitis A Surface Antigen = (+) 2 wks CA: Neisseria Gonorrhea
after exposure to Hep. A. Medical Management:
 Anti- HAV. MOT: Sexual Contact, transferred to baby during birth. 1. Antibiotic
b. Hepatitis B a. Ceftriaxone (Rocephin)
 Hep. B Surface Antigen (HBsAG): (+) acute Incubation Period: 3-21 days b. Doxycycline (Tetracycline)
hepatitis B. 2. Psychological aspect of care – low self-esteem.
Manifestation:
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 3. Health education: safe sex, monogamous Diagnostic Examination:  Temporary memory loss.
relationship, masturbation, use of condom, 1. C&S by mucosal scrapping  Altered gait.
behaviour modification. 2. Dark Field Microscope
3. Serologic Test
4. Flourescent Treponema Antibody  Adults: 2 Major sxs and 1 Minor sx.
Absorption Test – confirmatory test.  Children: 2 Major sxs and 2 Minor sxs.
Syphilis
 aka Pox, Lues, SY, and Bad Blood Disease. Medical Management: 3 Major Sx:
 Antibiotic: Benzathine Penicillin G 1. Fever – 1 month & above.
CA: Treponema Pallidum – a spirochete that passes to (Penadur). 2. Diarrhea – 1 month & above.
the placental barrier during the 16th week of pregnancy 3. 10% weight loss/ stunted growth for pedia.
(2nd & 3rd trimester). Nursing Care & Preventive Management:
same as GONORRHEA. 6 Minor Sx:
MOT: Sexual contact, vertical transmission. 1. Persistent cough – 1 month & above.
HIV infection means one is infected with AIDS 2. Persistent generalized
Incubation period: 10-90 days Virus lymphadenopathy.
AIDS = infected by virus + incompetent immuno- 3. Generalized pruritic dermatitis.
1. Primary Stage response. 4. oropharyngeal candidiasis.
a. Chancre, a painless popular lesion on face, lips, 5. Recurrent herpes zoster.
tongue, under the breast, fingers and genitals. CA: Human Immuno-Deficiency Virus (HIV) 6. Progressive dessiminated herpes zoster.
b. Regional lymphadenopathy. retrovirus.
Opportunistic Infection:
2. Secondary Stage: highly infectious & contagious. MOT: BT, sexual contact, exposure to infected blood, a. TB is the most common of the Avium Type (from
a. Fever & malaise products or tissues vertical (mother-child) or Perinatal birds)
b. Skin rashes & dermatitis: dry, hard, wart like (pregnancy, delivery & breastfeeding), sharing needles. b. PCP
lesions  Condyloma lata. c. CMV
a. Oral mucous patches. Incubation Period: 6 mons – 7 years d. CNS  lungs  eyes
b. Alopecia – patchy, polka dot or moth eaten e. Cancer : Kaposi Sarcoma  malignancy of
appearance of hair and thinning of pubic hair. MO detected by macrophagealert T Cells blood vessel (skin) – appearing as pink/purple
↓ painless sots on the skin called Leopard Look
3. Tertiary Stage – HIV ← Antibodies ← stimulate B cells f. Enzyme Link Immunoassorbent Assay
a. Gumma – infiltrating lesion found on deeper  Fever with night sweats without a cause. (ELISA) Test – screening test
tissues & body organs such as skin, bone and  Enlargement of the lymph nodes without a g. Western Blot – confirmatory
liver. cause. h. CD4 and T cell count
b. Aortitis & aneurysm.  Fatigability.  If more than or equal to 200  HIV infected.
c. Paresthesia, abnormal reflexes, dementia and  weight loss.  If less than 200  AIDS.
psychosis.  Altered sleeping patterns.

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1. Nucleus Analogs prevent the virus to multiply 2. Education
during the initial phase of cell division. 3. Counselling
4. Behavior Modification
a. Nucleoside Reverse Transcriptase Inhibitor
(NRTI)

a. Azidothymidine (AZT) – Zidovudin, retrovir

b. Lamivudine -3#TC, Epion
c. Stavudine – Cd4T, Zerit
d. Dideoxyinosine (DDI) - Didanosine
e. Dideoxycytidine (DDC) – Zalcitabine, Hivid

b. Non-Nucleoside reverse Transcriptase (NNRTI)

a. Delavirdine
b. Nevirapine

2. Protase Inhibitor (PI) prevents virus to multiply

during the last phase of call division.
a. Indinavir
b. Retonavir
c. Saquinavir
d. Nalfinavir

4. Fusion Inhibitor- Fuseon (Enfuritide)

Nursing Care:
1. Promote knowledge and understanding.
2. Promote quality of life.
3. Provide self care and comfort.

Preventive Measures:

1. Practice ABCD of HIV:

A – bstinence
B – e faithful
C – ondom
D – on’t use drugs
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