COMMUNICABLE DISEASES  Based on State of Host Resistance

Host and Microbial Interaction Primary Infection - acute infection that causes the Initial illness
Introduction Secondary Infection - one caused by an opportunistic pathogen after primary infection has weakened the body’s
Although most microorganisms live in harmony with the human body, some—called pathogens—can infect the body defenses
and cause disease. Infectious diseases range from mild illnesses, such as a cold, to fatal illnesses, such as AIDS. Subclinical (Inapparent Infection) - does not cause any noticeable illness
We occasionally come into contact with people or animals that are infected and thus expose ourselves to the pathogens Factors in Disease Development (Chain of Infection)
of their diseases. In fact, our environment is such that everyday we live with some risk of exposure to diseases.  Source of infection (the pathogen)
MICROBES against HUMAN  Reservoir
Definition:  Portal of exit
 Symptoms  Mode of transmission
evidence of disease that is experienced or  Portal of entry
perceived (subjective)  Susceptible host
subjective changes in body function noted by Chain of Infection
patient but not apparent to an observer The chain begins with the existence of a specific pathogenic microorganism
 Signs The second link is the reservoir, an environment where the pathogen can survive.
objective evidence of a disease the physician The third link is the means of escape from the reservoir.
can observe and measure The fourth link is the mode of transmission from the reservoir to the host.
 Syndrome The fifth link is the means of entry into the host
a specific group of signs and symptoms that And the last link is the host's susceptibility to the pathogenic microorganism
accompany a particular disease
Epidemiological principles Stages of Disease
◦ Epidemiology is defined as the study of the occurrence and distribution of health conditions such as  Incubation Period
disease, death, deformities or disabilities on human populations. It is also concerned with the study of time interval between the initial infection and the 1st appearance of any s/sx
probable factors that influence the development of these health conditions. (Maglaya)  Prodromal Period
 Two main areas of investigation: early, mild symptoms of disease
a. First area – distribution of health status in terms of  Period of Illness
age, gender, race, geography, time. overt s/sx of disease WBC may increase or decrease can result to death if immune response or
b. Second area – patterns of diseases distribution medical intervention fails
Epidemiologic Triangle  Period of Decline
 Host - any organism that harbors and provides nourishment for another organism. a person, animal or s/sx subside vulnerable to secondary infection
plant which a parasite depend for its survival.  Period of Convalescence
 Agent – intrinsic property of microorganism to survive and multiply in the environment to produce regains strength and the body returns to its pre diseased state recovery has occurred
diseases.
◦ Causative agent – also known as infectious agent, any microbe capable of producing EPIDEMIOLOGY AND DISEASE TRANSMISSION
a diseases. Microorganisms include bacteria, viruses, fungi, protozoa, parasites, Reservoirs of Infection
spirochete and rickettsiae. any site where the pathogen can multiply or merely survive until it is transferred to the host
 Environment  Human Reservoir principal living reservoir of human disease
◦ External condition and influences that affects the development of an organism which 1. Direct Transmission usually associated with signs and symptoms
can be biological, social and physical. The environment affects both the agents and 2. Carriers harbor the pathogen without associated sign and symptom
the host.  Type of Carrier
AGENT Incubator Carrier capable of transmitting pathogen during the incubation period
(Etiologic)- virus, bacteria Convalescent Carrier transmit disease during convalescence or recovery period
1. bio infections- fungi, protozoa, helminthes, ectoparasites Active Carrier completely recovered from disease but continue to harbor the pathogen indefinitely
2. chemical- carcinogens, poisons, allergens Passive Carrier carry the pathogen without ever having the disease
ex. MSG- poison Inanimate (Non Living) Reservoir - air, soil, food, milk, water, fomites
3. mech- car accidents, etc Fomites - articles that are easily contaminated by pathogens from the respiratory, intestinal tract and skin
4. environmental/physical- heatstroke Air - droplets of respiratory tract secretions, dust particles
5. nutritive- excess or deficiency Mode of Disease Transmission
6. Psychological Contact Transmission- spread of an agent of disease by direct, indirect or droplet transmission.
HOST Type of Contact Transmission
Intrinsic factors and environmental factors  Direct Contact Transmission- Person to person transmission of an agent physical contact between its
1. age source and susceptible host No intermediate object involved
2. sex (m or f) i.e. kissing, touching, sexual contact
F- weak emotional; morbidity (common dises.) Source → Susceptible Host
M- mortality ( killer dses.)  Indirect Contact Transmission - reservoir to a susceptible host by means of a non living object (fomites)
3. behavior Source → Non Living Object → Susceptible Host
4. educational attainment- occupation  Droplet Transmission - Microbes spread in droplet nuclei that travel only short distances (< 1 meter)
5. prior immunologic- response i.e. coughing, sneezing, laughing or talking
Extrinsic factors Susceptible Host
1. natural boundaries- physical environmental, geography  Recognition of high risk patients
2. biological envi  Immunocompromised
3. socioeconomic envi- political boundary  DM
Epidemiological principles  Surgery
 Vital Statistics – systematic study of vital events (numerical facts), statistics of diseases (Morbidity) and  Burns
death (mortality) indicate the state of health of a community and the success or failure of health work.  Elderly
 Incidence – the number of people in population who develop a disease during particular time period Preventing the Spread of Communicable Disease
 Prevalence - the number of people in population who develop a disease, regardless of when Community vs. Nosocomial
it appeared  Community Acquired Infection
 Mortality (DEATH) infection present or incubating at the time of
◦ Crude Death Rate – a measure of one mortality from all causes which may result in consultation
decrease of population  Nosocomial Infection
 Infant mortality rate – measures the risk of dying during 1st year of life. infection that develop during the course of
 Fetal death rate – measures pregnancy wastage hospital stay was not evident at time of admission
 Neonatal death rate – measures the risk of dying the 1 st month of life. Percentage Nosocomial Infection
 Maternal Mortality Rate – measures the risk of dying from causes related to pregnancy, childbirth and  17% Surgical
puerperium.  34% UTI
 Specific Death Rate - describe the risk of exposure of a certain or groups to particular diseases.  13% LRI
 SDR = Deaths in specific cause  14% Bacteremia
 Proportionate Mortality (Death ratios) – shows the relationship between deaths from all causes (or  22% Other (incldng skin Infxn)
group of causes), age (or group of age)etc., and the total no. of deaths from all causes in all ages taken Factors for Nosocomial Infection
together. Microorganism/Hospital Environment
Classification of Infectious Disease  Most common cause
 Based on Behavior within host Staph aureus, Coag Neg Staph Enterococci
Communicable Disease - any disease that spreads from one host to another, either directly or indirectly E. coli, Pseudomonas, Enterobacter, Klebsiella
Contagious Disease that easily spreads from one person to another Clostridium Difficile
Non Communicable Disease not spread from one host/person to another Fungi ( C. Albicans)
 Based on Occurrence of Disease Other ( Gram (-) bacteria)
Sporadic Disease - disease occurs only occasionally  70% are drug resistant bacteria
i.e. botulism, tetanus Compromised Host
Endemic Disease - constantly present in a population country or community  One whose resistance to infection is impaired by
i.e. Pulmonary Tuberculosis broken skin, mucous membranes and a suppressed immune system
Epidemic Disease - acquire disease in a relatively short period greater than normal number of Skin and Mucous Membrane
cases in an area within a short period of time physical barrier
Pandemic Disease - epidemic disease that occurs worldwide i.e. burns, surgical wounds, trauma, IV site
i.e. HIV infection invasive procedures
 Based on Severity or Duration of Disease Suppressed Immune System
Acute Disease - develops rapidly (rapid onset) but lasts only a short time i.e. drugs, radiation, steroids, DM, AIDS
i.e. measles, mumps, influenza
Chronic Disease - develops more slowly (insidious onset) disease likely to be continual or recurrent for Chain of Transmission
long periods  Direct Contact Transmission
i.e. TB, Leprosy Hospital staff to patient
Subacute Disease - intermediate between acute and chronic Patient to patient
i.e. bacterial endocarditis  Indirect Contact Transmission
Latent Disease - causative agent remains inactive for a time but then becomes active to produce symptoms of the Fomites
disease inanimate objects or substances capable of
i.e. chickenpox → shingles (zoster) absorbing or transmitting a pathogen
 Based on Extent of Affected Host’s Body i.e. clothing, bed linens, towels, eating utensils
Local Infection - microbes invade a relatively small area of the body  Hospital Ventilation System
Generalized (Systemic) Infection - spread throughout the body by blood or lymph Airborne transmission
i.e. measles General Control Measures
Focal Infection - local infection that spread but is confined to specific areas of the body Prevention of Airborne Contamination
  Cover mouth and nose ( coughing or sneezing) ◦ a yellow-greenish (mucopurulent) color suggests that treatment with antibiotics can
 Limit number of persons in a room reduce symptoms.
 Removal of dirt and dust ◦ a white, milky, or opaque (mucoid) appearance often means that antibiotics will be
 Open room to fresh air and sunlight ineffective in treating symptoms.
 Roll linens together ◦ (This information may correlate with the presence of bacterial or viral infections,
 Remove bacteria from the air (air filters) though current research does not support that generalization.)
Handling of Food and Eating Utensils  Foamy white - may come from obstruction or even Edema
 Organisms Community Settings
Staphylococcus (skin /dust)  Onsite - During Consultation
Clostridium Botulinum ( dust/dirt)  Early Morning - 2 nd Day
Clostridium Perfringens ( dust/dirt/hand)  Onsite [On Target- 3rd Day
Salmonella, Shigella, Camphylobacter, Proteus Eruptive Diseases
( feces/hands/flies/pets) Measles, Rubeola, 7 Day Fever, Hard Red Measles
Pseudomonas Sp (dirt/hand/contaminated equipment)  RNA, Paramyxoviridae
 Active MMR and Measles vaccine
 Passive Measles immune globulin
 Use high quality foods  Lifetime Immunity
 Proper refrigeration and storage of food IP: 7-14 days
 Proper washing, preparing, and cooking of food MOT: droplets, airborne
 Proper disposal of uneaten food *Contagious 1-2 days before rash and 4 days after rash
 Proper hand washing S/sx:
 Proper disposal of oral and nasal secretion prodrome (2-4 days) - malaise, cough, conjunctivitis, , fever, kopliks spots (1-2 mm blue white spots on red background
 Cover hair and wear clean clothes and apron along 2nd molars), stimsons, photophobia
 Provide periodic health exam for kitchen workers Dx: clinical
 Keep cutting boards clean Cx: pneumonia, meningitis, SSPE
 Prohibit anyone with respiratory or GIT disease from handling food
 Rinse and wash utensils with a temperature above 80°C Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs), confluent, desquamation,
Handling of Fomites pruritus
 Use disposable equipments MANAGEMENT
 Sterilize or disinfect equipment 1. Supportive
 Use individual equipment for each patient 2. Hydration
 Use single use thermometers 3. Proper nutrition
 Empty bedpans and urinals properly and wash with hot water, store in dry ,clean area or storage 4. Vitamin A
 Place used linens and personal care equipments, and soiled laundry in a bag 5. Antibiotics
Diagnostic Assessment 6. Vaccine
 Complete Blood Count with platelet count Nursing Care
 Gram Stain/Culture & Sensitivity  Respiratory precautions
 ELISA  Restrict to quite environment
 Western Blot  Dim light if photophobia is present
 Sputum Exam/AFB  Administer antipyretic
 Test for Emerging Infections  Use cool mist vaporizer for cough
Complete Blood Count German Measles, Rubella, Rotheln Disease, 3 Day Measles
with platelet count  RNA, rubella virus
 A CBC includes  Active - rubella vaccine and MMR
1. Enumeration of the cellular elements of the blood,  Lifetime Immunity
2. Evaluation of RBC indices, and IP: 10-21 days
3. Determination of cell morphology by means of stained smears. MOT: droplets, transplacental
4. Counting is performed by automated electronic devices capable of rapid analysis of * Contagious 5 days before and 5 days after rash
blood samples with a measurement error of less than 2 percent And probably during catarrhal stage
THE PROCEDURE s/sx: forschheimer’s (petecchial lesion on buccal cavity or soft palate), cervical lymphadenopathy, low grade fever
 A venipuncture is performed and the sample collected in a lavender-topped tube. A capillary sample Dx: clinical
may be obtained in infants and children, as well as in adults for whom venipuncture may not be CX: rare; pneumonia, meningoencephalitis
feasible. CX to pregnant women:
 A phlebotomist collects the specimen, in this case blood is drawn in a test tube containing an  1st tri-congenital anomalies
anticoagulant (EDTA, sometimes citrate) to stop it from clotting, and transported to a laboratory.  2nd tri-abortion
 In the past, counting the cells in a patient's blood was performed manually, by viewing a slide prepared  3rd tri-pre mature delivery
with a sample of the patient's blood under a microscope (a blood film, or peripheral smear). Nowadays, Roseola Infantum,
this process is generally automated by use of an automated analyzer, with only approximately 30% Exanthem Subitum, Sixth disease
samples now being examined manually.  Human herpes virus 6
Gram Stain/Culture & Sensitivity  3mos-4 yo, peak 6-24 mos
 Gram staining (or Gram's method) is an empirical method of differentiating bacterial species into two MOT: probably respiratory secretions
large groups (Gram-positive and Gram-negative) based on the chemical and physical properties of their S/sx: Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear after fever subsides, Mild pharyngitis and
cell walls. The Gram stain is almost always the first step in the identification of a bacterial organism. lymph node enlargement
While Gram staining is a valuable diagnostic tool in both clinical and research settings Mgmt: symptomatic
 Gram stains are performed on body fluid or biopsy when infection is suspected. It yields results much Chicken Pox, Varicella
more quickly than culture, and is especially important when infection would make an important  Herpes zoster virus (shingles),
difference in the patient's treatment and prognosis; examples are cerebrospinal fluid for meningitis and varicella zoster virus(chocken pox)
synovial fluid for septic arthritis.  Active : Varicella vaccine
Enzyme-linked immunosorbent assay (ELISA),  Passive: VZIG, ZIG – given 72-96 hrs
 Enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is a w/n exposure
biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen  Lifetime Immunity
in a sample. IP: 14-21 days
 The test is repeated if the results are positive or borderline. Repeat testing after a positive value MOT: Respiratory route
requires confirmation by the Western immunoblot (WIB) assay, which has the ability to identify * Contagious 1 day before rash and 6 days after first crop of vesicles
antibodies to at least nine different epitopes of HIV-1. S/sx:
 Most common tests to screen for HIV-1 virus antibodies fever, malaise, headache
Western Blot Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and spreads to entire body
 The western blot (alternatively, protein immunoblot) is an analytical technique used to detect specific  Leaves a pitted scar (pockmark)
proteins in a given sample of tissue homogenate or extract. It uses gel electrophoresis to separate  Dormant: remain at the dorsal root ganglion and may recur as shingles (VZV)
native or denatured proteins by the length of the polypeptide (denaturing conditions) or by the 3-D Mgmt: oral acyclovir
structure of the protein (native/ non-denaturing conditions). The proteins are then transferred to a Tepid water and wet compresses for pruritus
membrane (typically nitrocellulose or PVDF), where they are probed (detected) using antibodies Aluminum acetate soak for VZV
specific to the target protein. Small Pox, Variola
 It has the ability to identify antibodies to at least nine different epitopes of HIV-1.
Medical diagnostic applications  DNA, Pox virus
 The confirmatory HIV test employs a Western blot to detect anti-HIV antibody in a human serum  Last case 1977
sample. Proteins from known HIV-infected cells are separated and blotted on a membrane as above.  spreads from man-to-man only
Then, the serum to be tested is applied in the primary antibody incubation step; free antibody is washed  Active: Vaccinia pox virus
away, and a secondary anti-human antibody linked to an enzyme signal is added. The stained bands IP: 1-3 weeks
then indicate the proteins to which the patient's serum contains antibody. S/sx:
 A Western blot is also used as the definitive test for Bovine spongiform encephalopathy (BSE, Rashes:
commonly referred to as 'mad cow disease'). Maculopapulovesiculopustular
 Some forms of Lyme disease testing employ Western blotting.  Centripetal
 Western blot can also be used as a confirmatory test for Hepatitis B infection.  contagious until all crusts disappeared
Sputum Exam Dx:
 A sputum sample is the name given to the mucus that is coughed up from the lower airways. It is  Paul’s test - instilling of vesicular fluid w/ small pox into the cornea; if keratitis develops, small pox
usually used for microbiological investigations of respiratory infections. Cx: same with chicken pox
 The best sputum samples contain very little saliva, as this contaminates the sample with oral bacteria.
This event is assessed by the clinical microbiologist by examining a Gram stain of the sputum. More
than 25 squamous epithelial cells at low enlargement indicates salivary contamination. Respiratory System
 When a sputum specimen is plated out, it is best to get the portion of the sample that most looks like Mumps
pus onto the swab. If there is any blood in the sputum, this should also be on the swab.
 Microbiological sputum samples are usually used to look for infections by Moraxella catarrhalis,  RNA, Mumps virus
Mycobacterium tuberculosis , Streptococcus pneumoniae and Haemophilus influenzae. Other  Mumps vaccine - > 1yo
pathogens can also be found.  MMR – 15 mos
 Purulent Sputum is that containing, or consisting of, pus.  Lifetime Immunity
Sputum can be: IP: 12-16 days
 Bloody (often found in tuberculosis) (Hemoptysis) MOT: Droplet, saliva, fomites
 Rusty colored - usually caused by pneumococcal bacteria (in pneumonia) S/sx: Unilateral or bilateral parotitis, Orchitis - sterility if bilateral, Oophoritis, Stimulating food cause severe pain, aseptic
 Purulent - containing pus. The color can provide hints as to effective treatment in Chronic Bronchitis meningitis
Patients: Dx: serologic testing, ELISA
Mgmt: supportive Adult - trismus (lockjaw), dysphagia, Risus sardonicus (sneering grin), generalized muscle rigidity, opisthotonus,
Nursing care spasms, respiratory paralysis to death
 Respiratory precautions Dx: history, leukocytosis, serum antitoxin levels
 Bed rest until the parotid gland swelling subsides Management:
 Avoid foods that require swelling Anticonvulsant, muscle relaxants, antibiotics, wound cleansing and debridement
 Apply hot or cold compress Active-DPT and tetanus toxoid
 To relieve orchitis, apply warmth and local support with tight fitting underpants Passive-TIG and TAT, placental immunity
NEUROLOGICAL DISEASES
 Meningitis/Meningococcemia
 Tetanus Criteria Stage I Stage II Stage III
 Botulism
 Poliomyelitis Incubation Period > 11 days 8-10 days <7days
 Rabies
 Leprosy
Trismus mild moderate Severe

Meningitis Muscle rigidity mild Pronounced Severe, boardlike

 Inflammation of the meniges
 Caused by bacterial pathogen, N. menigitidis, H. Influenza, Strep. Pneumoniae,
Mycobacterium Tuberculosis
PATHOLOGY Spasm absent Mild, short Frequent, prolonged
 Primary – spread of bacteria from the bloodstream to the meniges
 Secondary – results from direct spread of infection from other sources or focus of infection.
Clinical manifestation Dyspnea, cyanosis absent absent Present
 headache
 irritability
 fever Pre exposure prophylaxis
 neck stiffness  DPT- 0.5 ml IM
 pathologic reflexes: kernig’s, Babinski, Brudzinski 1 - 1 ½ months old
Diagnosis 2 - after 4 weeks
 Lumbar puncture 3 - after 4 weeks
 Blood C/S 1st booster – 18 mos
 other laboratories 2 booster – 4-6 yo
nd

Treatment subsequent booster – every 10 yrs thereafter

Bacterial meningitis  TT – 0.5 ml IM
TT1 6 months within preg
Age group Common etiology Drug of choice TT2 one month after TT1
TT3 to TT5 every succeeding preg or every year
3 types of patients w/ skin wounds
post exposure prophylaxis
0-2 months e.coli, grp B strep Ampicillin + Genta
1. (+) immunization as a child w/ boosters but last shot > 10 yrs – give TT + TIG/TAT
2. (-) immunization - TT + TIG/TAT
3. (+) tetanus – TIG/TAT + TT + Abx + wound cleansing + supportive therapy
3 mos – 5 y/o H. Influ, S. Pneu, N. Ampicillin or chloraphenicol Treatment:
Meningitidis Anti-toxin
 Tetanus Anti-Toxin (TAT)
> 5 yrs S. pneumonia Penicillin or chloramphenicol Adult,children,infant 40,000 IU ½ IM,1/2 IV
N. Meningitidis Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
 TIG
Neonates 1000 IU, IV drip or IM
 TB meningitis Adult, infant, children 3000 IU, IV drip or IM
 Intensive Phase Antimicrobial Therapy
 Maintainance Phase Penicillin 1-3 mil units q 4hours
 Fungal meningitis Pedia 500,000 – 2mil units q 4 hrs
 cryptococcal meningitis – fluconazole or amphotericin B Neonatal 200,000 units IVP q 12hrs or q8hrs
2. Supportive/Symptomatic Control of spasms
 a. Antipyretic  diazepam
 b. treat signs of increased ICP  chlorpromazine
 c. Control of seizures Rabies
 d. adequate nutrition  acute viral encephalomyelitis
MENINGOCOCCEMIA  incubation period is 4 days up to 19 years
 caused by Neisseria meningitides, a gram negative diplococcus  risk of developing rabies, face bite 60%, upper extremities 15-40%, lower extremities 10%
 transmitted through airborne or close contact  100% fatal
 incubation is 1-3 days Clinical Manifestation
 natural reservoir is human nasopharynx
Clinical Manifestation Category I Observe the dog for 14 days
 sudden onset of high grade fever, rash and rapid deterioration of clinical condition Licking of intact skin
within 24 hours
S/sx: Category II
1. Meningococcemia – spiking fever, chills, arthralgia, sudden appearance of hemorrhagic rash Abrasion, laceration, punctured wound on the 1. Active vaccine
2. Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension, tachycardia, lower extremities
enlarging petecchial rash, adrenal insufficiency 2. 2. Observe
Laboratory dog for 14 days
 Blood Culture
 Gram stain of peripheral smear, CSF and skin lesions
 CBC Category III
Treatment: Abrasion, laceration on upper extremities, head 1. Active
 antimicrobial and neck
 Benzyl Penicillin 250-400000 u/kg/day Dog is killed, lost, died 2. Passive
 Chloramphenicol 100mg/kg/day
 Symptomatic and supportive
 fever
 seizures
 pain or numbness at the site of bite
 hydration
 fear of water
 respiratory function
 fear of air
 Chemoprophylaxis
4 STAGES
 Rifampicin 300-600mg q 12hrs x 4 doses
1. prodrome - fever, headache, paresthesia,
 Ofloxacin 400mg single dose
2. encephalitic – excessive motor activity, hypersensitivity to bright light, loud noise,
 Ceftriaxone 125-250mg IM single dose
hypersalivation, dilated pupils
Nursing Intervention
3. brainstem dysfunction – dysphagia, hydrophobia, apnea
 Provide strict isolation
4. death
 Wearing of PPE
 Health teaching
Rabies Virus
 Contact tracing
The rabies virus is usually transmitted to humans by a bite from an infected dog, but the bite of any animal (wild or
 Prophylaxis
domestic) is suspect in an area where rabies is present. Symptoms of the disease appear after an incubation period of
 Meninggococcal vaccine for high risk patient
ten days to one year and include fever, breathing difficulties, and muscle spasms in the throat that make drinking
Tetanus
painful. Death almost invariably occurs within three days to three weeks of the onset of symptoms. For this reason, the
 Clostridium tetani (gram (+), spore forming)
emphasis of treatment is on prevention. In the United States, veterinarians recommend regular vaccination of domestic
 Wound setting
dogs.
 IP: 3-21 days
 Tetanus neonatorum - umbilical cord
Diagnosis
 FAT (fluorescent antibody test)
Pathophysiology
 Clinical history and signs and symptoms
Clostridium tetani in puncture wound
Management
Tetanospasmin
 No treatment for clinical rabies
attack PNS and CNS
 Prophylaxis
GABA and Glycine inhibited
Postexposure prophylaxis
Tetanic spasm
Active vaccine (PDEV,PCEC,PVRV)
Clinical Manifestation:
– IM. ID
Neonatal tetanus - Poor sucking, irritability, excessive crying, grimaces, intense rigidity, and
Passive Vaccine
opisthotonus
a. ERIG wt in kg x .2 = cc to be injected im (ANST)
b. HRIG wt in Kg x .1333 s/sx:
Pre-exposure Prophylaxis 1. Early/Indeterminate – hypopigmented / hyperpigmented anesthetic macules/plaques
a. Intradermal/Intramuscular (0,7,21) 2. Tuberculoid – solitary hypopigmened hypesthetic macule, neuritic pain, contractures of hand and foot,
Infection control ulcers, eye involvement ie keratitis
 Patient is isolated to prevent exposure of hospital personnel, watchers and visitors 3. Lepromatous – multiple lesions, Loss of lateral portion of eyebrows (madarosis), corugated skin
 PPE (leonine facies), septal collapse (saddlenose)
Preventive Measures 4. Borderline – between lepromatous and tuberculoid
 Education Dx: slit skin smear, skin biopsy, serodiagnostic test (Ab)
 Post-exposure and Pre-exposure Prophylaxis
Poliomyelitis Management:
 RNA, Polio virus  MDT-RA 4073 (home meds)
 Fecal oral route/droplets  Paucibacillary - 6-9 months
 IP 7-12 days 1. Dapsone
S/sx: disease manifestations: 2. Rifampicin
1. mild febrile illness – fever, malaise, sore throat  Multibacillary- 12-24 months
2. aseptic meningitis – fever, meningismus 1. Dapsone – mainstay; hemolysis, agranulocytosis
3. paralytic polio - flaccid asymetrical ascending paralysis (Landry’s sign), Hayne’s sign (head drop), Poker’s sign 2. Clofazimine – reddish skin pimentation, intestinal toxicity
(opisthotonus) 3. Rifampicin – bactericidal; renal and liver toxicity
Poliomyelitis Viruses Nursing Intervention
A microscopic image shows poliomyelitis viruses, which enter the body through the nose and mouth and destroy nerve  Health teachings
cells by multiplying rapidly inside of them. The infection can cause permanent paralysis. Since an effective vaccine was  Counseling involving the family members and even the community
developed in the 1950s, poliomyelitis has been nearly eliminated in developed countries.  Prevention of transmission ( use of mask )

Jonas Edward Salk Respiratory Diseases

• INFLUENZA
The first effective vaccine used as a preventative against poliomyelitis was developed in 1952 by Jonas Salk. Salk’s • PULMONARY TUBERCULOSIS
earlier work on an anti-influenza vaccine during the 1940s led to his discovery. By the mid-1950s, the vaccine had been • DIPHTHERIA
widely distributed in the United States, greatly reducing the domestic incidence of polio. • PERTUSIS
INFLUENZA (LA GRIPPE)
• An acute viral infectious disease affecting the respiratory disease.
Albert Sabin Causative Agent:
• RNA containing Paramyxovirus type A, B and C.
In the 1950s American virologist Albert Sabin developed an oral poliomyelitis vaccine containing attenuated, live Incubation Period:
viruses. The vaccine replaced the inactivated, injectable vaccine developed by Jonas Salk as the standard form of • 24 to 72 hours.
immunization against poliomyelitis in the United States. Period of Communicability:
Franklin Delano Roosevelt • Until the 5th days of illness
• Up to 7 days in children
As the only United States president elected to four terms, Franklin Delano Roosevelt guided the nation for 12 years, • About 3 to 7 days from onset of symptoms
through the Great Depression and World War II. Roosevelt initiated a series of programs, termed the New Deal, to help Modes of Transmission:
bring the U.S. back to prosperity. Although he was crippled by polio at age 39, he continued his political career, which • Airborne spread among crowded populations
spanned 35 years. Roosevelt died on April 12, 1945, less than three months after he began his fourth term. • Direct contact through droplet spread
Polio Patient in Iron Lung • Influenza virus persist for hours in dried mucus

Poliomyelitis is an infectious viral disease that sometimes results in paralysis of the muscles involved in breathing. In Initial Symptoms:
the early half of the 20th century, paralytic patients were treated using an iron lung, or respirator, a large cylinder that • Chilly sensation
encased the patient in an airtight seal. Motors in the iron lung forced air in and out of the patient’s lungs, providing • Fever
lifesaving support until recovery and rehabilitation restored the ability to breathe unaided. • Headache
• Muscular ache
I – Abortive or inapparent • Cough
II – Meningitis (non-paralytic) Clinical Manifestations:
III – Paralytic (anterior horn of spinal cord) • Onset is sudden chilly sensation, hyperpyrexia, malaise, sore throat, coryza, rhinorrhea, myalgia and
IV – Bulbar (encephalitis) headache.
Dx: Pandy’s test - CSF (increased CHON) • Severe aches and pain usually at the back associated with severe sweating.
MGMT:  
 Active – OPV (Sabin) and IPV (Salk) Diagnostic Exam:
 Immunity is acquired for 3 strains • Viral Culture
Legio brunhilde (fatal) • Immunoflourescence
Legio lansing Assessment
Legio leon • Assess vital sign.
SNAKEBITE • Measure intake and output
• Assess turgor and mucous membrane for signs of dehydration.
Neurotoxic Slow swelling then necrosis Ptosis, respiratory Cobra • Assess nutritional status
paralysis, cardiac • Auscultate lungs for presence of breath sounds.
problems • Assess skin integrity.
• Assess pain characteristic.
• Assess patient’s level of mobility.
• Physical examination.
Nursing Diagnosis
• Hyperthermia
Myotoxic None Myalgia on moving Sea snake • Pain
paresis • Impaired physical mobility
• Activity intolerance
• Nutrition: less than body requirement
• Ineffective airway clearance
Vasculotoxic Rapid swelling Bleeding abnormalities Vipers
• Fluid volume deficit
• Risk for ineffective breathing pattern
• Anxiety
Management • Alteration in body comfort
 Lie the victim flat • Knowledge deficit
 ice compress and constrictives materials are contraindicated • Body image disturbances
 Transport the patient to the nearest hospital • Impaired individual coping
 Antivenim administration in patient’s with signs of envenomation • Altered health maintenance
 It is never too late to give anti-venim • Fear
 Antivenim is given thru intravenous infusion, which is the safest and most effective Medical Treatment
route. 2-5 ampules plus D5W to run iver 1-2 hours every 2 hours • Amantadine
 Antimicrobial therapy • Rimantadine
 sulbactam/Ampicillin or co-amoxiclav • Oseltamivir Phosphate
 Substitute • Zanamivir
 Prostigmine IVinfusion, 50-100ug/kg/dose q 8hrs Nursing Intervention
 Atropine 1. Monitor and record vital sign.
Botulism 2. Control environmental temperature
 Clostridium Botulinum, gram (+), spore forming 3. Maintain a well ventilated room
 Ingestion of contaminated foods (canned foods), wound contamination, infant botulism (most common; 4. Encourage patient to drink prescribed fluid amounts.
ingestion of honey) 5. Eliminate additional stressors or sources of discomfort whenever possible.
 Neurotoxins block AcH 6. Provide rest periods to facilitate comfort, sleep and relaxation.
 IP: 12-36H (canned food) 7. Refrain from performing non – essential procedures to promote rest
 IP: 4-14 days (wound) 8. Encourage physical activity consistent with patients energy resources.
 Active and passive immunization 9. Position patient with proper body alignment for optimal breathing.
S/sx: Diplopia, dysphagia, symmetric descending flaccid paralysis, ptosis, depressed gag reflex, nausea, vomiting, dry 10. Acknowledge awareness of patient’s anxiety.
mouth, respiratory paralysis 11. Assist in developing anxiety reducing skills such as relaxation and deep breathing.
Dx: gastric siphoning, wound culture, serum bioassay (food borne) 12. Reduce sensory stimuli by maintaining a quiet environment.
Mgmt: respiratory support, antitoxin 13. Assists patient with meals as needed.
Leprosy/Hansen’s disease 14. Maintain a calm and tolerant manner while interacting with patient.
 Mycobacterium Leprae, acid fast bacilli 15. Establish a working relationship through continuity of care.
 MOT: may be due to prolonged Complications:
skin-skin contact or droplets • Primary influenza
 IP - years to decades • Myocarditis
 Tuberculoid – highly resistant, • Myositis
less severe • Secondary bacterial pneumonia
 Lepromatous –low resistance, most severe • Reye syndrome
 Active immunization (BCG) • Myogobinuria
 • Encephalitis
PULMONARY TUBERCULOSIS (KOCH’S DISEASE; PHTHISIS; CONSUMPTION DISEASE)
• A chronic, sub acute or acute respiratory disease commonly affecting the lungs characterized by the - > 10 mm is (+)
information of tubercles in the tissues which tend to undergo caseation, necrosis and calcification.
Causative Agent: Dx:
• Mycobacterium Tubercle or Koch’s Bacillus Chest xray - cavitary lesion
Incubation Period: Sputum exam
• 2-10 weeks. sputum culture
Period of Communicability: MDT side effects
• The patient is capable of discharging the organism all throughout life if he remains untreated; highly • r-orange urine
communicable during its active phase. • i-neuritis and hepatitis
Predisposing Factors: • p-hyperuricemia
• Infants and elderly • e-impairment of vision
• Immunocompromised patient (HIV, Steroid Therapy, Chemotherapy, Organ transplant or rejection) • s-8th cranial nerve damage
• Over crowding * 2 wks after medications – non communicable
• Unsanitary living conditions 3 successive (-) sputum - non communicable
• Poor nutrition rifampicin - prophylactic
Modes of Transmission: Diphtheria
• The disease is transmitted by deliberate inoculation of microorganism or by droplet • An acute bacterial disease that can infect the body in 2 areas, throat and skin.
• Inhalation of organism directly into the lungs from contaminated air.  Causative Agent:
• Direct or indirect contact with infected persons, usually by discharges from the respiratory tract by • Corynebacterium Diptheriae (Klebs Leoffler Bacillus)
means of coughing, sneezing or kissing. • A toxin producing organism; manufactures an exotoxin which is responsible for major pathologic
• By contact with contaminated eating or drinking utensils. changes.
• Source of infection from hemoptysis, nasal discharges and saliva. • Gram (+), non-sporulating and generally aerobic.
• The bacilli invade the superficial tissue with very limited extension beyond the mucous membrane, but
Pathognomonic Sign: soluble toxin is capable of producing severe fatal sequela.
• Hemoptysis • Easily destroyed by light, heat and aging.
Clinical Manifestations: • Capable of damaging muscles especially the cardiac, nerve, kidneys, liver and other tissues.
• Low grade afternoon fever Incubation Period:
• Night sweating • 2-5 days for symptoms to develop.
• Body malaise Period of Communicability:
• Weight loss • Variable, more than 2-4 weeks in untreated patients or 1-2 days in treated patients.
• Dyspnea  Modes of Transmission:
• Dry to productive cough • Contact with patient or carrier, or with articles soiled with discharges of infected person.
• Hemoptysis Pathognomonic Sign:
 Complications: • Pseudomembrane- inflammatory reaction is initiated by the body and exudates consisting of
• Pleural effusion leukocytes, RBC and necrotic tissues begin to form. The exudate forming the membrane is grayish in
• Pleurisy appearance as it begins to form.
• Emphysema Types:
Methods of Prevention and Control: • Nasal- with serosanguinous secretions from the nose with foul smell.
• BCG vaccination of newborn, infants and grade I or school entrance. • Tonsilar- low fatality rate.
• Educate the public in the mode of spread and methods of control and the importance of early • Nasopharyngeal- more severe type. Highest fatality rate.
diagnosis. • Cutaneous Diphtheria- affecting mucous membrane and any break on the skin.
• Improve social conditions, which increase the risk of becoming infected such as overcrowding. Clinical Manifestations:
• Make available medical, laboratory and X ray facilities for examination of patients, contacts and • The onset of the disease is insidious with feeling of fatigue, malaise, slight sore throat and elevation of
suspects, and facilities for early treatment of cases and persons at high risk of infection and beds for temperature usually not exceeding 38 C.
those needing hospitalization. • Pseudomembrane.
• Provide public health nursing and outreach services for home supervision of patients to supervise • Body malaise, weakness and apathy with rapid pulse rate.
therapy directly and to arrange for examination and preventive treatment of contacts. • Bull neck appearance- entire neck becomes swollen with edema extending to the chest.
• DIRECT OBSERVED TREATMENT SHORT COURSE (DOTS): Other common symptoms of Respiratory Diphtheria includes:
  The DOTS is the name for a comprehensive strategy which primary health services around the world ▫ Dispend
are using to detect and cure TB patients. As part of the DOTS strategy, health workers counsel and observe their ▫ Hoarseness of voice
patients swallow each dose of powerful combination of medicines and health services, monitor the patients progress ▫ Increased HR
until each is cured. Political and financial commitment and a dependable drug supply are essential parts of the DOTS ▫ Strider
strategy. ▫ Nasal secretions
Elements of DOTS: ▫ Swelling of the palate
• Political will in terms of funds and manpower. Complications:
• Sputum microscopy service. • Myocarditis caused by action of Diphtheria toxin on the heart muscle.
• Regular drug supply. • Polyneuritis; that includes paralysis of the soft palate, ciliary’s muscle of the eyes, pharynx, larynx or
• Recording books to monitor patient’s progress until cured. extremities.
• Drug intake supervised by health worker or family member. • Airway obstruction may lead to death through asphyxia.
Management of Pulmonary Patients Who Interrupted Treatment: Methods of Prevention and Control:
  • Active immunization of all infants (6 weeks) and children with 3 doses of Diphtheria, Pertusis and
• Sometimes a patient may stop taking his/her drugs. This can happens when a patient does not Tetanus (DPT) administered at 4-6 weeks interval and then booster doses following year after the last
understand that he needs to take ALL his drugs for the full duration of treatment. When such a patient dose of primary series and another dose on the 4th or 5th year of age.
returns to the treatment, he should be put back to treatment. The regimen would depend on the length • Pasteurization of milk.
of interruption and whether he is smear positive or smear negative when he returns for treatment. • Education of the parents.
  • Reporting of the cases to the Health Officer for proper medical care.
• Make sure that the health workers know how to treat pulmonary patients who interrupted treatment. Public Health Nursing Responsibilities:
CATEGORY AND TREATMENT REGIMEN: • Carry on continuous preventive education in the community to maintain a high level of immunity with
Category 1: emphasis on the infant and pre school age groups.
• This treatment regimen is to be prescribed to: • Observe correct technique for taking nose and throat cultures for diphtheria.
• New pulmonary TB patients whose sputum is (+). • Teach procedures of disposal by burning of nose and throat discharges and uneaten food as
• Seriously ill patients with severe forms of: concurrent disinfection. Family should be helped or assisted to go to the hospital for proper medical
▫ Smear negative PTB with extensive parenchymal involvement. and nursing care, upon appearance of suspicious symptoms.
▫ Extra pulmonary TB (TB Meningitis, TB Pericarditis, Pleurisy, Pott’s disease, Intestinal • Encourage early prophylactic immunization of infants and children.
TB). Who Should or Should Not Receive the Vaccine:
Intensive Phase: • Children with moderate or severe fever can be vaccinated as soon as they have recovered.
• The following drugs are given daily for 2 months: • Children with minor illness, such as upper respiratory infection with or without fever can be vaccinated.
• Isoniazid + Rifampicin+ Pyrazinamide+ Ethambutol. • Persons on immunosuppressive therapies given for cancer or other treatments may not develop the
• At the end of 2 months the maintenance phase of treatment will start only if the sputum result is same response as a normal person. Therefore, if immunosuppressive therapies are to be discontinued
negative by direct smear. shortly, it is reasonable to defer immunization until the patient has been off the therapy for one month. If
• If the sputum smear is (+) at the end of the 2nd month of directly observed chemotherapy, drug the therapy is to be discontinued, then proceed with the immunization.
resistance should be suspected. • Those who are infected with HIV may receive a diphtheria toxoid containing like DPT or DT.
Maintenance Phase: • Person, who has experienced an immediate life threatening, allergic reaction, requiring medical
• INH + Rifampicin given daily for the next 4 months. attention after a dose of diphtheria toxoid containing vaccine, should not receive additional doses of the
• For patient with neurological complications, RIF and INH should be given daily during maintenance vaccines.
phase for 7 months. • Persons who develop encephalitis within 7 days of DPT immunization should not receive additional
Category 2: immunizations containing the Pertusis vaccine. The immunization series should be completed using the
• This treatment regimen is to be prescribed to previously treated patients who are: DT vaccine. It may be the child’s neurologic status become clear.
• Relapses • A family history of convulsions or other CNS disorder does not justify withholding diphtheria
• Failures immunization. Decision not to immunize should be made by the doctor who is familiar with the Patient’s
Intensive Phase: history and circumstances.
• INH + RIF + PZA + ETH + Streptomycin for the 1 st 2 months; followed by • Corynebacterium diphtheriae, gram (+)
• Streptomycin + RIF + PZA + ETH for 1 month. • Exotoxin damages
• After 3 months of treatment with (-) sputum result patient will proceed to maintenance phase. heart and neural cells
• (+) sputum the phase will continue for 1 more month. • IP: 2-5 days
 Maintenance Phase: • More severe in unimmunized and partially immunized
• INH + RIF + ETH will be given daily for 5 months. MOT: Airborne/droplet, fomites
Category 3: • Active (DPT) and
• This treatment regimen is to be prescribed to: Passive Immunization
• New PTB patient whose sputum is negative for 3 months and CXR results is minimal PTB. (Diphtheria antitoxin)
• Extra-pulmonary • Carrier state – Penicillin/Erythromyin
• Intensive Phase: • S/sx: sore throat, fever, “Bull-neck”(lymphadenitis) ,Pseudomembrane- gray exudate, foul breath,
• INH + RIF + PZA daily for 2 months. massive swelling of tonsils and uvula, obstruction of respiratory tract
• Maintenance Phase: • Dx: Schick test - susceptibility to diphtheria toxin
• INH + RIF daily for 2 months. • Moloney - sensitivity to diphtheria toxoid
PPD – ID • Throat swab (K tellurite and Loeffler’s coagulated blood serum)
macrophages in skin take up Ag and deliver it to T cells • Mgmt: strict isolation, Diphtheria antitoxin (Skin test), Penicillin,erythromycin, rifampicin, clindamycin
T cells move to skin site, release lymphokines PERTUSSIS (WHOOPING COUGH)
activate macrophages and in 48-72 hrs, skin becomes indurated
 • An infectious disease characterized by repeated attacks of spasmodic coughing which consist of a  Plasmodium Falciparum (malignant tertian): considered as the most serious malarial infection because
series of explosive expirations, typically ending in a long drawn forced inspiration which produces a of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into
crowing sound, the “whoop” and usually followed by vomiting. microemboli.
Causative Agent:  Plasmodium Vivax (benign tertian): non-life threatening except for the very young and the old.
• Bordetella Pertusis- an infection that is more serious when it occurs in infants. The organism is non  Plasmodium Malariae (quartan): less frequently seen, non-life threatening.
motile, gram negative bacillus easily destroyed by light, heat and drying.  Plasmodium Ovale: rare type.
Incubation Period:  The primary vector of malaria is the Female Anopheles mosquito which has the following
• 7-14 days. characteristics:
Period of Communicability:  Breeds in clear, flowing and shaded streams usually in the mountains.
• Starts from 7 days after exposure to 3 weeks after typical paroxysms.  Bigger in size than the ordinary mosquitoes.
   Brown in color.
Modes of Transmission:  Night biting mosquitoes.
• Pertusis is primarily spread by direct contact and droplet.  Don’t bite a person in motion.
• It may also spread indirectly through soiled linens and other articles contaminated by respiratory  Incubation Period:
secretions.  12 days for P. Falciparum.
Pathognomonic Sign:  14 days for P. Vivax and Ovale.
• Whooping Cough- spasmodic coughing which consist of a series of explosive expirations, typically  30 days for P. Malariae.
ending in a long drawn forced inspiration which produces a crowing sound and usually followed by Period of Communicability:
vomiting.  Untreated or insufficiently treated patient may be source of mosquito infection for more than 3 years in
Initial Symptoms: P. Malariae; 1-2 years in P. Vivax and not more than 1 year on P. Falciparum.
• Common cold Modes of Transmission:
• Runny nosed  Through bite of an infected female Anopheles Mosquito.
• Sneezing  Through blood transfusion.
• Mild cough  Shared contaminated needles.
• Low grade fever Clinical Manifestation:
Clinical Manifestations:  Paroxysms of shaking chills.
CATARRHAL STAGE:  Rapidly rising fever with severe headache.
• There is coryza, sneezing, lacrimation and dry bronchial cough.  Diaphoresis.
• Cough becomes irritating, hacking and nocturnal becoming more severe.  Myalgia.
• Last for 1 to 2 weeks.  Spleenomegaly; Hepatomegaly.
• Stage is most contagious.  Orthostatic hypotension.
PAROXYSMAL STAGE:  Black Water fever: reddish or mahogany colored urine due to hemoglobinuria is passed by the patient.
• Occurs on the 7th to the 14th day. And commonly associated with P. Falciparum.
• Cough becomes spasmodic and recurrent with excessive explosive outburst in series of rapid 5-10 Prevention and Control:
coughs in expiration.  INSECTICIDE-TREATMENTOF MOSQUITO NET:
• Whooping cough. This involves the soaking of the mosquito net in an insecticide solution and allowed to
• Paroxysmal coughing may induce nose bleeding, increased venous pressure, periorbital edema, and dry. Such treated net is used as a protective measure against the vector mosquito during sleeping time at night.
conjunctival hemorrhage. Insecticide- treated curtains maybe used in areas where they are more culturally acceptable than mosquito nets, as in
• During paroxysm, the face becomes cyanotic, vein on the face and neck becomes distended, the eyes Bukidnon.
appear to bulge, or pop out of the eyeballs and the tongue protrudes.  HOUSE SPRAYING:
• Coughing is usually provoked by crying, eating, drinking or physical exertion. This is the application of insecticide on the indoor surfaces of the house.
 ON STREAM SEEDING:
This involves the construction of bio-ponds for fish propagation which shall be the
CONVALESCENT STAGE: responsibility of the LGU’s and their corresponding communities. The numbers of bio-ponds to be constructed, as
• Marked by gradual decrease in paroxysms of coughing, both in frequency and severity, vomiting source of larvivorous fish, for each malaria-endemic municipality, will depend on the number of streams to be seeded
ceases. with the propagated larvivorous fish. To be effective, about 2-4 fish per sq. m is needed for an immediate impact and
• After about 6 weeks from the onset, the attack subsides about 200-400 fish per hectare is needed for a delayed effect.
Diagnostic Exam  ON STREAM CLEARING:
• Agar Plate This is the cutting of the vegetation overhanging along the stream banks to expose the
• Blood Test breeding stream to sunlight, rendering it unsuitable for mosquito vector habitation.
• Chest X - ray  RECOMMENDED ANTI-MALARIA DRUGS:
• Bordet – Gengou Test  Drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations:
Assessment  Chloroquine
• Increase WBC  Sulfadoxine
• Roentgenograms show increased hilar shadow  Quinine
• Abnormal ecg tracing  Quinidine
• (+) Agar Plate, Borde – Gengou gram, throat swab SUSTAINABLE PREVENTIVE AND VECTOR CONTROL MEASURES:
• Fever  Sustainable Preventive and vector control measures refer to the adoption of measures for the
• (+) whooping cough prevention and control against the malaria parasite and the mosquito vector. Such measures being
• Auscultation - abnormal breath sound affordable, applicable and appropriate under out local conditions so that these measures can be
Nursing Diagnosis sustained through out the duration of malaria control operations.
• Pain OTHER PREVENTIVE MEASURES:
• Ineffective breathing pattern  Wearing of clothing that covers arms and legs in the evening.
• Impaired Gas exchange  Avoiding outdoor night activities, particularly during the vector’s peak biting hours from 9pm to 3 am.
• Hyperthermia  Using mosquito repellents such as mosquito lotion, coils, soap or other personal protection measures
• Fluid Volume Deficit advocated by the DOH.
• Altered Nutrition : Less than body requirement  Planting of Neem tree or other herbal plants which are mosquito repellents as advocated by the DOH.
• Potential Infection  Zooprophylaxis- the typing of domestic animals like carabao, cow etc. near human dwellings to deviate
• Knowledge Deficit mosquito bites from human to these animals.
• Activity Intolerance  PREVENTION OF THE EPIDEMIC:
• Ineffective social isolation  The ff should be done in the event that an imminent epidemic occurs:
• Ineffective airway clearance  Mass blood smears collection.
• Sleep pattern disturbances  Immediate confirmation and follow up of cases.
• Self care deficit  Insecticide-treatment of mosquito nets.
• Fatigue  Focal spraying.
Medical Treatment  Stream clearing.
• Erythromycin  Intensive IEC campaign.
• Azithromycin  All cases should be given drug treatment and followed up until clinically and or microscopically found
• Clarithtromycin negative.
• Ampicillin  Continuous surveillance measures should be implemented for 3 years.
   The LGU’s in collaboration with NGO’s and with the technical assistance from the Provincial Malaria
Nursing Interventions: Coordinator should contribute in terms of IEC campaign and logistics support.
• Isolation of the patient DENGUE FEVER/ DENGUE HEMORRHAGIC FEVER
• Bed rest  (BREAKBONE FEVER; DANDY FEVER/ HEMORRHAGIC FEVER; THROMBOCYTOPENIC
• Avoid excitement dust, smoke, and sudden changes in temperature. PURPURA)
• Do not bring outdoors, especially by the sea shore.  An acute febrile disease caused by infection with one of the serotypes of dengue virus which is
• Increase fluid intake transmitted by mosquito.
• Administer the prescribed medication.  Is a severe, sometimes fatal manifestation of dengue virus infection characterized by a bleeding
• Elevate the head and shoulder of the patient by means of pillow often to relieved labored breathing and diathesis and hypovolemic shock?
lessen cough. Causative Agent:
• Do back rubbing  Flavirus 1, 2, 3, 4; Arbovirus; Westnile; Chinkungunya; Onyonyong virus.
• Do bronchial tapping Incubation Period:
• Observed for ineffective breathing pattern  7-10 days
• Oral hygiene. Period of Communicability:
Complications:  Patients are usually infective to mosquito from the day before the febrile period to the end of it.
• Bronchopneumonia  Mosquito become infective from day 8-12 after the blood meal and remains infective all throughout life.
• Umbilical hernia  Modes of Transmission:
• Otitis media  By the bite of an infected Female Aedes Aegypti: a day biting mosquito, breeds on stagnant water, low
• Convulsion flying, fine white dots at the base of the wings with white bands on the legs.
• Atelectasis  Pathognomonic sign:
• Severe malnutrition  Herman sign: maculopapular rash starts at distal portion of the extremities with blanched areas.
Clinical Manifestation:
SPECIFIC DISEASES  GRADE I:
Vector Borne Diseases Fever Accompanied with non specific symptoms (myalgia, anorexia and vomiting) and
 Malaria (+) Tourniquet Test (Rumpel leads test): more than 20 petechia/ square inch.
 Dengue Hemorrhagic Fever  
 Filariasis  GRADE II:
Malaria (AGUE) All signs of grade 1 plus spontaneous bleeding from the nose, gums etc.
 An acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is con fined  GRADE III:
mainly to tropical and sub-tropical areas. Circulatory Failure.
Causative Agent:  
  GRADE IV: AMOEBIASIS (AMOEBIC DYSENTERY)
Profound shock.  A protozoal infection of man initially involving the colon but may spread to soft tissues by contiguity or
Prevention and Control: hematogenous or lymphatic dissemination most commonly to the liver or lungs.
 THE INFECTED INDIVDUAL, CONTACTS AND ENVIRONMENT: Agent:
 Recognition of the disease.  Entamoeba Hystolitica: prevalent in ill-sanitated areas, common in warm climates, acquired through
 Isolation of patient. swallowing.
 Epidemiological investigation. DEVELOPMENTAL STAGES:
 Case finding and reporting.  Trophozites/ Vegetative form: a facultative parasite that may invade tissue or they are found in the
 Health education. parasitized tissues and liquid contents.
CONTROL MEASURES:  Cyst: are passed out with formed or semi-formed stools and are resistant to environmental conditions.
 Avoid too many hangings clothes inside the house. Considered as the infective stage in the life cycle of E. Hystolitica.
 Residual spraying with insecticides.  Incubation Period:
 Eliminate vectors by:  3 days in severe infection; 3-4 weeks
 Changing water and scrubbing sides of lower vases once a week.  Period of Communicability:
 Destroy breeding places of mosquito by cleaning surrounding, proper disposal of  For duration of the illness.
rubber tires, empty bottles and cans.  Modes of Transmission:
 Keep water containers covered.  Fecal –oral route transmission.
FILARIASIS  Direct contact- sexual contact by orogenital, oroanal, proctoanal sexual activity.
(ELEPHANTIASIS; BARBADOS LEG; ELEPHANT LEG; MORBUS HERCULUS)  Indirect contact man gets infected by ingestion of food especially uncooked leafy vegetables or
 An extremely debilitating and stigmatizing disease caused by parasitic worm affecting men, women and contaminated with fecal material containing the organism. Food or drink maybe contaminated by cyst
children. The adult worm can only live in the lymphatic system. through pollution of water supplies, exposure of food to flies, use of night soil for fertilizing vegetables
 Rarely fatal, it causes extensive disability, gross disfigurement and untold suffering for millions of men, and through unhygienic practices of food handlers.
women and children. Clinical Manifestation:
Causative Agent:  Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus.
 Wuchereria Bancrofti: A 4-5 cm long thread like worms that affected the body’s lymph nodes and  Diarrhea is watery and foul smelling stools often containing blood-streaked mucus.
vessels.  Colic and gaseous distention of the lower abdomen.
Incubation Period:  Nausea, flatulence and abdominal distention and tenderness in the right iliac region over the colon.
 The incubation period which starts from the entry of the infective larvae to the development of the Prevention and Control:
clinical manifestation is variable; nevertheless, it ranges from 8-16 months.  Health Education:
Modes of Transmission:  Boil water for drinking/ purified.
 The disease is transferred from person to person by mosquito bites: Anopheles and Aedes Aegypti.  Avoid washing food from open drum or pail.
Clinical Manifestation:  Cover left over foods.
ASYMPTOMATIC STAGE:  Wash hands after defecation and before eating.
 No clinical signs and symptoms of the disease.  Avoid ground vegetables (lettuce, carrots etc)
 Presence of microfilariae in the peripheral blood.  Sanitary disposal of feces.
 Microfilariae rate increases with age and then levels off  Protect, chlorinate and purify drinking water.
 Some remain asymptomatic for years.  Use scrupulous cleanliness in food preparation and handling.
ACUTE STAGE:  Detection and treatment of carriers.
 Lymphadenitis (inflammation of the lymph nodes).  Fly control.
 Lymphangitis (inflammation of the lymph vessels). Bacillary Dysentery
 In some cases, the male genitalia are affected leading to funiculitis, Epidydimitis, or orchitis (redness, Shigellosis
painful and tender scrotum).  Shiga bacillus: dysenteriae (fatal), flexneri (Philippines), boydii, sonnei; gram (-)
CHRONIC STAGE:  Shiga toxin destroys intestinal mucosa
 Hydrocoele (swelling of the scrotum).  Humans are the only hosts
 Lymphedema (temporary swelling of the upper and lower extremities).  Not part of normal intestinal flora
 Elephantiasis (enlargement and thickening of the skin of the lower and upper extremities, breast and IP: 1-7 days
genitals). MOT : oral fecal route
Prevention and Control: S/sx: fever, abdominal pain, diarrhea is watery to bloody with pus, tenesmus
MEASURES AIMED TO CONTROL THE VECTOR: Dx: stool culture
 Environmental sanitation such as proper drainage and cleanliness of surrounding. Mgmt: Oresol, Ampicillin, Trimethoprim-Sulfamethoxazole, Chloramphenicol, Tetracycline, Ciprofloxacin
 Spraying with insecticides. HEPATITIS A ( INFECTIOUS HEPATITIS; CATARRHAL JAUNDICE)
   An inflammation of the liver that is not really very severe and runs an acute course, generally starting
MEASURES AIMED TO PROTECT THE INDIVIDUAL AND FAMILIES IN ENDEMIC AREAS: within 2-6 weeks after contact with the virus and lasting no longer than 2 months.
 Use mosquito nets.  It is known as infectious hepatitis because it spreads relatively easily from those infected to close
 Use of long sleeves, long pants and socks. contact.
 Application of insect repellants.  Causative Agent:
 Screening of the house.  Hepatitis A virus
 Health education. Predisposing Factors:
TREATMENT:  Poor sanitation
 Diethylcatbamazine Citrate (DEC) or Hetrazan: An individual treatment kills almost all microfilaria and a  Contaminated water supply
good proportion of adult worms. Drug is given to patients with clinical manifestation and microfilariae.  Unsanitary method of preparing and serving of food
MASS TREATMENT:  Malnutrition
 Distribution to all population.  Disaster
 Endemic and infected or not infected with Filariasis in establish endemic areas. Incubation Period:
 The dosage is 6 mg/kg body weight taken as a single dose per year.  3 to 5 weeks or 15 to 60 days.
  Period of Communicability:
Food & water borne Diseases  The infected person is capable of transmitting the organism a week before and a week after the
 Cholera appearance of the symptoms.
 Amebiasis Modes of Transmission:
 Shigella  By ingestion of contaminated drinking water or ice, uncooked fruits and vegetable, grow in or washed
 Hepatitis A with contaminated water.
 Typhoid Fever  Fecal-oral pathways.
Cholera (EL TOR)  By infected food handlers.
 An acute bacterial enteric disease of the GIT characterized by profuse diarrhea, vomiting, massive loss Prevention and Control:
of fluids and electrolytes that could result to hypovolemic shock, acidosis and death.  Ensure safer water for drinking.
Causative Agent:  Sanitary method in preparing, handling and serving foods
 Vibrio Cholerae/ Vibrio Coma:  Screening of food handlers.
 The organism are slightly curved rods, gram (-) and motile with single polar flagellum.  Educate public on the modes of transmission of the disease.
 The organism survives well at ordinary temperature and can grow well in temperature ranging from 22-  Proper disposal of feces and urine
40 C.  Wash hands very well before eating and after using the toilet.
 Can survive well in ordinary temperature; can survive longer in refrigerated foods.  Separate and proper cleaning of articles used by patient.
 An enterotoxin (Choleragen) is elaborated by the organism as they grow in the intestinal tract.  Travelers should avoid water and ice if unsure of their purity.
Incubation Period: Typhoid Fever
 A few hours to 5 days.  Salmonella typhosa, gram (-)
   Carried only by humans
Period of Communicability:  Enteric Fever
 During stool (+) stage, usually a few days after recovery however occasionally the carrier persists for  Active Immunization
several months.  Carrier state – harbor in gallbladders
Modes of Transmission:  IP: 1-3 weeks
 Fecal-oral route via contaminated water, milk and other foods.  MOT: oral fecal route
 Ingestion of food or water contaminated with stool or vomitus of patient.  S/sx: Rose spot (abdominal rashes), more than 7days Step ladder fever 40-41 deg, headache,
 Flies, soiled hands and utensils also serve to transmit the infection. abdominal pain, constipation (adults), mild diarrhea (children)
Pathognomonic Sign: Pathophysiology
 Rice watery stool- pale gray fecal material with slightly fishy odor. Oral ingestion
Clinical Manifestation: Bloodstream
 There is an acute, profuse rice watery stool without intestinal cramping. RES (lymph node, spleen, liver)
 Vomiting often occurs after the diarrhea has been established. Bloodstream
 Washer woman hands- wrinkled fingers and toes. Gallbladder
 Aphonia- hoarseness of voice Peyer’s patches of SI necrosis and ulceration
 Signs of severe dehydration (Oliguria to anuria, Increase RR, Poor skin turgor, sunken eyeballs).  1st week step ladder fever (BLOOD)
Prevention and Control:  2nd week rose spot and fastidial
 Report case at once to Health Officer.  typhoid psychosis (URINE & STOOL)
 Bring patient to hospital for proper isolation and prompt and competent medical care.  3rd week (complications) intestinal bleeding, perforation, peritonitis, encephalitis,
 Other general preventive measures are the same as those of Typhoid and Dysentery.  4th week (lysis) decreasing S/SX
 All contacts of the cases should submit for stool examination and be treated accordingly if found or  5th week (convalescent)
discovered (+). Dx: Blood culture (typhi dot) 1st week
 Protection of food and water supply from fecal contamination.  Stool and urine culture 2nd week
 Water should be boiled or chlorinated.  Widal test (Ab to O and H Ag) - nonspecific
 Milk should be pasteurized. Mgmt: Chloramphenicol, Amoxicillin,
 Sanitary disposal of human excreta.  Sulfonamides, Ciprofloxacin,
 Sanitary supervision.  Ceftriaxone
 Nursing Interventions  2nd and 3rd trimester, Pyrimethamine-sulfadoxine
 Environmental Sanitation Category of provinces
 Food handlers sanitation permit  Category A – no significant improvement in malaria for the past 10 years. >1000
 Supportive therapy - Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao, kalinga
 Assessment of complication (occuring on the 2nd to 3rd week of infection )  Category B - <1000/year
- typhoid psychosis, typhoid meningitis - Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan, zambales, bataan, laguna
- typhoid ileitis  Category C – significant reduction
Leptosiprosis (Weil’s disease) -pampanga, la union, batangas, cavite, albay
 a zoonotic systemic infection caused by Leptospires, that penetrate intact and abraded skin through EMERGING DISEASES
exposure to water, wet soil contaminated with urine of infected animals. Severe Acute Respiratory Syndrome
Anicteric Type (without jaundice)  Coronavirus
 manifested by fever, conjunctival injection  Severe acute respiratory syndrome
 signs of meningeal irritation IP: 2-7 days
Icteric Type (Weil Syndrome) Mortality rate – 5% only
 Hepatic and renal manifestation Risk Factors:
 Jaundice, hepatomegally  history of recent travel to China, Hong Kong, singapore Taiwan, vietnam, canada. or close contact w/ ill
 Oliguris, anuria which prigress to renal failure persons with a hx of recent travel to such areas, OR
 Shock, coma, CHF  Is employed in an occupation at particular risk for SARS exposure, healthcare worker with direct patient
 Convalescent Period contact or a worker in a laboratory that contains live SARS, OR
Diagnosis  Is part of a cluster of cases of atypical pneumonia without an alternative diagnosis
 Clinical history and manifestation Clinical Manifestations
 Culture  History of travel to SARS affected country or close contact with persons suspected of having SARS and
◦ Blood: during the 1st week within 14 days manifest the ff
◦ CSF: from the 5th to the 12th day  High grade fever (>38.0 c)
◦ Urine: after the 1st week until convalescent period  Headache, body malaise, muscle pain
 LAAT (Leptospira Agglutination Test)  Cough, sneezing, nasal congestion
 other laboratory  Difficulty of breathing after 2-7 days
 BUN,CREA, liver enzymes  SARS suspect
Treatment  Probable SARS
 Specific Diagnosis:
◦ Penicillin 50000 units/kg/day Chest X-ray, CBC, Isolation of virus
◦ Tetracycline 20-40mg/kg/day Mgt:
 Non-specific Supportive
 Supportive and symptomatic Treat as Atypical Pneumonia
 Administration of fluids Quarantine
 Peritoneal dialysis for renal failure UNDERSTANDING CANCER
MALARIA Oncology Nursing
 an acute and chronic infection caused by protozoa plasmodia CANCER is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal
 transmitted through the bite of female anopheles mosquito tissue, eventually harming and destroying the host
 4 Species A large group of diseases characterized
Vector: (night biting) by:
 anopheles mosquito – Uncontrolled growth and spread of abnormal cells
or minimus flavire – Proliferation (rapid reproduction by cell division)
Life cycle: – Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected)
 Sexual cycle/sporogony (mosquito) Oncology defined
 sporozoites injected into humans  Branch of medicine that deals with the study, detection, treatment and management of cancer and
 Asexual cycle/schizogony (human) neoplasia
 gametes is the infective stage taken up by biting mosquito Terms to Define
 Plasmodium Vivax  Hyperplasia – increase in the number of cells
 more widely distributed  Metaplasia – conversion of one cell to another cell
 causes benign tertian malaria  Dysplasia – bizarre cell growth resulting in difference in size, shape and arrangement
 chills and fever every 48 hours in 3 days  Anaplasia – cells that lack normal cellular characteristic
 Plasmodium Falciparum  Neoplasia – uncontrolled cell growth
 common in the Philippines “Root words”
 Causes the most serious type of malaria because of high parasitic densities in blood.  Neo- new
 Causes malignant tertian malaria  Plasia- growth
 Plasmodium malaria  Plasm- substance
 much less frequent  Trophy- size
 causes quartan malaria, fever and chills every 72 hrs in 4 days  +Oma- tumor
 Plasmodium Ovale  Statis- location
 rarely seen.  A- none
 Pathology  Ana- lack
 the most characteristic pathology of malaria is destruction of red blood cells,  Hyper- excessive
hypertrophy of the spleen and liver and pigmentation of organs.  Meta- change
 The pigmentation is due to the phagocytocis of malarial pigments released into the  Dys- bad, deranged
blood stream upon rupture of red cells Characteristics of Neoplasia
Clinical Manifestation  Uncontrolled growth of Abnormal cells
 uncomplicated  1. Benign
 fever, chills, sweating every 24 – 36 hrs  2. Malignant
 Complicated  3. Borderline
 sporulation or segmentation and rupture of erythrocytes occurs in the brain and visceral organs. BENIGN
 Cerebral malaria  Well-differentiated
◦ changes of sensorium, severe headache and vomiting  Slow growth
 Encapsulated
◦ seizures
 Non-invasive
Diagnosis
 Does NOT metastasize
 Demonstration of asexual forms of plasmodia in thin and thick smear
MALIGNANT
 Travel in endemic areas
 Undifferentiated
Treatment:
 Erratic and Uncontrolled Growth
 Determine the species of parasite
 Expansive and Invasive
 Objectives of treatment
 Secretes abnormal proteins
 Destroy all sexual forms of parasite to cure the clinical attack
 METASTASIZES
 Destroy the excerythrocytes (EE) to prevent relapse
Nomenclature of Neoplasia
 Destroy gametocytes to prevent mosquito infections
Tumor is named according to:
 Treatment for P. Falciparum
1. Parenchyma, Organ or Cell
 chloroquine tablet (150mg/base/tab) Day 1,2,3 (4,4,2)
 Hepatoma- liver
 Sulfadoxine/Pyrimethamine 500mg/25mg/tab, 3tab single dose
 Osteoma- bone
 Primaquine (15mg/tab) 3 tabs single dose
 Myoma- muscle
 Treatment for P. Vivax
2. Pattern and Structure, either GROSS or MICROSCOPIC
 Choloroquine, Day 1,2,3 (4,4,2)
 Fluid-filledà CYST
 Primaquine 1 tab OD for 14 days
 Glandularà ADENO
 Treatment for mixed
 Finger-likeà PAPILLO
 chloroquine (4,4,2)
 Stalkà POLYP
 Sulfadoxine/Pyrimethamine 3 tabs once
3. Embryonic origin
 Primaquine 1 tab for 14 days
 Ectoderm ( usually gives rise to epithelium)
 Multi-drug resistant P. Falciparum
 Endoderm (usually gives rise to glands)
 quinine plus doxycycline, or tetracycline and primaquine
 Mesoderm (usually gives rise to Connective tissues)
Complications
BENIGN TUMORS
◦ severe anemia
 Suffix- “OMA” is used
◦ cerebral malaria  Adipose tissue- LipOMA
- hypoglycemia  Bone- osteOMA
Prevention and Control  Muscle- myOMA
 Eliminate anopheles mosquito vectors  Blood vessels- angiOMA
 Advise travelers  Fibrous tissue- fibrOMA
 limit dusk to dawn outdoor exposure “PASAWAY”
 insect repellant, nets 1. “OMA” but Malignant
Chemoprophylaxis  HepatOMA, lymphOMA, gliOMA, melanOMA
 doxycycline 100mg/tab, 2-3 days prior to travel, continue up to 4 weeks upon leaving the area 2. THREE germ layers
 Mefloquine 250mg/tab, 1 week before travel, continue up to four weeks upon leaving the area  “TERATOMA”
 Pregnant, 1st trimester, chloroquine, 2 tabs weekly, 2 weeks before travel, during stay and until 4 3. Non-neoplastic but “OMA”
weeks after leaving  Choristoma
  Hamatoma – Intravenous
Etiology of cancer • Use of vascular access devices because of threat
1. PHYSICAL AGENTS of extravasation (leakage into tissues) & long term
 Radiation therapy
 Exposure to irritants  Types of vascular access devices:
 Exposure to sunlight – PICC lines: (peripherally inserted central catheters)
 Altitude, humidity – Tunneled catheters: (Hickman, Groshong)
2. CHEMICAL AGENTS – Surgically implanted ports: (accessed with 90o angle needle- Huber needles)
 Smoking Nursing care of clients receiving chemotherapy
 Dietary ingredients • Assess and manage:
 Drugs – Toxic effects of drugs (report to physician)
3. Genetics and Family History – Side effects of drugs: manage nausea and vomiting, inflammation and ulceration of mucous membranes, hair loss,
 Colon Cancer anorexia, nausea and vomiting with specific nursing and medical interventions
 Premenopausal breast cancer Monitor lab results (drugs withheld if blood counts seriously low); blood and blood product administration
4. Dietary Habits • Assess for dehydration, oncologic emergencies
 Low-Fiber • Teach regarding fatigue, immunosuppression precautions
 High-fat • Provide emotional and spiritual support to clients and families
 Processed foods Breast Cancer
 alcohol  The most common cancer in FEMALES
5. Viruses and Bacteria  Numerous etiologies implicated
 DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RISK FACTORS
 RNA Viruses- HIV, HTCLV 1. Genetics- BRCA1 And BRCA 2
 Bacterium- H. pylori 2. Increasing age ( > 50yo)
6. Hormonal agents 3. Family History of breast cancer
 DES 4. Early menarche and late menopause
 OCP especially estrogen 5. Nulliparity
7. Immune Disease 6. Late age at pregnancy
 AIDS 7. Obesity
8. Hormonal replacement
Patterns of cell Proliferation 9. Alcohol
•Metaplasia 10. Exposure to radiation
• conversion of one type of cell in a tissue to another type not normal for that tissue
•Anaplasia PROTECTIVE FACTORS
• change in the DNA cell structure and orientation to one another, characterized by loss of differentiation and a return to 1. Exercise
a more primitive form. 2. Breast feeding
Neoplasia 3. Pregnancy before 30 yo
• uncontrolled cell growth, either benign or malignant BREAST EXAMINATION
Metastasis 1, While in the shower or bath, when the skin is slippery with soap and water, examine your breasts. Use the pads of
• Metastasis: 3 stages your second, third, and fourth fingers to press firmly every part of the breast. Use your right hand to examine your left
– Invasion – neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph. breast, and use your left hand to examine your right breast. Using the pads of the fingers on your left hand, examine the
– Spread – tumor cells spread through lymph or circulation or by direct expansion entire breast using small circular motions in a spiral or in an up-and-down motion so that the entire breast area is
– Establishment and growth – tumor cells are established and grow in secondary site: lymph nodes or in organs from examined. Repeat the procedure using your right hand to examine your left breast. Repeat pattern of palpation under
venous circulation the arm. Check for any lump, hard knot, or thickening of the tissue.
Warning Signs of Cancer 2, Look at your breasts in a mirror. Stand with your arms at your side.
CAUTION US! 3, Raise your arms overhead and check for any changes in the shape of your breasts, dimpling of the skin, or any
– Change in bowel or bladder habits changes in the nipple.
– A sore that does not heal 4, Next, place your hands on your hips and press down firmly, tightening the pectoral muscles. Observe for asymmetry
– Unusual bleeding or discharge or changes, keeping in mind that your breasts probably do not match exactly.
– Thickenings or lumps 5, While lying down, feel your breasts as described in step
– Indigestion or difficulty in swallowing 1. When examining your right breast, place a folded towel under your right shoulder and put your right
– Obvious change in a wart or mole hand behind your head. Repeat the procedure while examining your left breast. Mark your calendar that you have
– Nagging or persistent cough or hoarseness completed your breast-self-examination; note any changes or unique characteristics you want to check with your health
– Unexplained anemia care provider.
– Sudden unexplained weight loss (From Lewis, S., Heitkemper, M., & Dirksen, S. [2004]. Medical-surgical nursing: Assessment and management of
Laboratory & Diagnostic Tests clinical problems [6th ed.]. St. Louis: Mosby.)
• Cancer detection examination
• Laboratory tests
– Complete blood cell count (CBC)  Stages I and 2 are 70-90% curable
– Tumor markers – identify substance (specific proteins) in the blood that are made by the tumor  Invasive or infiltrating, capable of metastasis
• PSA (Prostatic-specific antigen): prostate cancer a. Ductal – 70%
• CEA (Carcinoembryonic antigen): colon cancer b. Lobular – 10 % higher incidence of contralateral breast cancer
• Alkaline Phosphatase: bone metastasis ASSESSMENT FINDINGS
– Biopsy 1. MASS- the most common location is the upper outer quadrant
TREATMENT MODALITIES 2. Mass is NON-tender. Fixed, hard with irregular borders
• Aimed towards: 3. Skin dimpling
– CURE - free of disease after treatment → normal life 4. Nipple retraction
– Control - Goal for chronic cancers 5. Peau d’ orange
– Palliative Care: Quality of life maintained at highest level for the longest possible time LABORATORY FINDINGS
• Surgery – surgical removal of tumors; most commonly used treatment 1. Biopsy procedures
• Preventive or prophylactic 2. Mammography
• Diagnostic surgery 3. Tumor marker CA 2729
• Curative surgery Breast cancer Staging
• Reconstructive surgery TNM staging
• Palliative surgery I - < 2cm
• Chemotherapy – use of antineoplastic drugs to II - 2 to 5 cm, (+) LN
promote tumor cell death, by interfering with III - > 5 cm, (+) LN
cellular functions and reproduction IV- metastasis
Care of Clients Receiving Chemotherapy Metastatic sites
• Classes of Chemotherapy Drugs:  Bone
• Alkylating agents:  Liver
– Action: create defects in tumor DNA  Lung
– Ex: Nitrogen Mustard, Cisplatin  Brain
– Toxic Effects: reversible renal tubular necrosis Treatment
Classes of Chemotherapy Drugs  Surgical management is the primary treatment for breast cancer
• Antimetabolites:  Breast conservation (lumpectomy, segmental resection)
– Action: phase specific - removal of the cancer with margin of healthy tissue
– Ex: Methotrexate; 5 fluorouracil - If followed by radiation therapy has equivalent 5 year survival to mastectomy
– Toxic Effects: nausea, vomiting, stomatitis, diarrhea, alopecia, leukopenia SURGICAL MANAGEMENT
Antitumor Antibiotics: 1. Radical mastectomy
– Action: non- phase specific; interfere with DNA 2. Modified radical mastectomy
– Ex: Actinomycin D, Bleomycin, adriamycin (doxorubicin) 3. Lumpectomy
– Toxic Effect: damage to cardiac muscle 4. Quadrantectomy
Miotic inhibitors: 1. Simple – removal of all breast, nipple and skin
– Action: Prevent cell division during M phase of cell division 2. Modified radical – axillary lymphnodes are removed
– Ex: Vincristine, Vinblastine 3. Radical mastectomy – pectoral muscles are removed
– Toxic Effects: affects neurotransmission, alopecia, bone marrow depression Medical therapy
Hormones:  External beam radiation therapy 3 weeks after surgery. Most commonly used
– Action: stage specific G1  Chemotherapy
– Ex: Corticosteroids  Tamoxifen therapy
• Hormone Antagonist: NURSING INTERVENTION : PRE-OP
– Action: block hormones on hormone- binding tumors ie: breast, prostate, endometrium; cause tumor regression 1. Explain breast cancer and treatment options
– Ex: Tamoxifen (breast); Flutamide (prostate) 2. Reduce fear and anxiety and improve coping abilities
– Toxic Effects: altered secondary sex characteristics 3. Promote decision making abilities
Effects of Chemotherapy 4. Provide routine pre-op care:
• Tissues: (fast growing) frequently affected Consent, NPO, Meds, Teaching about breathing exercise
• Examples: mucous membranes, hair cells, bone marrow, specific organs with specific agents, reproductive organs (all Post-OP
are fetal toxic; impair ability to reproduce) 1. Position patient:
Chemotherapy Administration  Supine
• Routes of administration:  Affected extremity elevated to reduce edema
– Oral 2. Relieve pain and discomfort
– Body cavity (intraperitoneal or intrapleural)  Moderate elevation of extremity
  IM/IV injection of pain meds 2. Pneumonectomy – position on the back or operative side only
 Warm shower on 2nd day post-op  Instruct the client on deep breathing, coughing and ambulation
3. Maintain skin integrity  Pain management to promote deep breathing
 Immediate post-op: snug dressing with drainage  Refer client to smoking cessation
 Maintain patency of drain (JP) Cervical Cancer
 Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon  13,000 new cancers and 4000 deaths
4.Promote activity  Very treatable and curable
 Support operative site when moving  80-90% are squamous carcinoma
 Hand, shoulder exercise done on 2ndday
 Post-op mastectomy exercise 20 mins TID
 NO BP or IV procedure on operative site Risk factors
 Heavy lifting is avoided  Sexual intercourse before age 17, multiple partners
 Elevate the arm at the level of the heart  Sexual partner who has multiple partners
 On a pillow for 45 minutes TID to relieve transient edema  Cigarette smoking
 Human papilloma virus
 Lower socioeconomic status
MANAGE COMPLICATIONS Metastatic sites
 Lymphedema  Abdomen and pelvis
 10-20% of patients  Lung
 Elevate arms, elbow above shoulder and hand above elbow  Liver
 Hand exercise while elevated  Bone
 Refer to surgeon and physical therapist Screening
 Hematoma  Pap’s smear beginning at age 18 or sexually active
 Notify the surgeon Assessment
 Apply bandage wrap (Ace wrap) and ICE pack  Assymptomatic in the early stage
TEACH FOLLOW-UP care  Watery vaginal discharge
 Regular check-up  Late manifestation, postcoital, heavy or intermenstrual bleeding.
 Monthly BSE on the other breast Diagnostics
 Annual mammography  Colposcopy – application of acetic acid followed by magnified examination of the pelvis
Lung Cancer  Biopsy
 The number 1 cancer killer in men and women  Endocervical curettage
 6th to 7th decade of life  Cone biopsy
 70% involvement of lymphnodes Management
 85% caused by inhalation of carcinogenic chemicals  Total abdominal hysterectomy and lymphadenectomy
Pathophysiology  Depends on the stage and desire for child bearing
 Arise from a single transformed epithelial cell in the tracheobronchial airways.  Radiation therapy
a. Adenocarcinoma - most prevalent carcinoma of the lung for men and women, peripherally located and  Chemotherapy for advanced disease
often metastasized Leukemia
b. Squamous cell Ca – centrally located and arises in the segmental and subsegmental bronchi  Malignancy that involves the blood forming tissues on the bone marrow, spleen, lymphnodes
c. Large cell Ca – fast growing tumor that arise peripherally  ALL – abnormal proliferation of immature lymphoblast
d. Bronchioalveolar – slower growing and arises at the alveoli  AML
Classification and staging - proliferation of immature myeloblast
 Non small cell Ca – 70-75% - Predisposing factors, down syndrome, chemotherapy (alkylating agents)
a. Adenocarcinoma - Peak age 2-5 years old
- most common (40%)
- slowest growing, metastasize early Assessment
b. Squamous cell – 30%  Symptomatic anemia
c. Large cell – rarest - pallor, fatigue
- has the worst prognosis  Thrombocytopenia
 Small cell (25%) - petechiae, bleeding
a. Oat cell (90%)  Neutropenia
- very aggressive and metastasize at diagnosis. - fever, infection
 5 year survival rate is 48% if detected early and localize (rare)  Enlarged LN
 Overall 5 year survival rate is 15%  Hepatosplenomegally
Risk factors  Bone pain
 Tobacco smoking  Neurological symptoms
- single most important preventable cause of death - invrease ICP
- 10x more common than in non-smoker Tumor evaluation
- passive smoke exposure increases the risk to 35%  Bone marrow aspiration and biopsy
 Environmental and occupational exposure 1. greater than 25% blast indicate leukemia
- arsenic, asbestos, mustard gas, oil, radiation 2. Chest xray to check for mediastinal mass
 .genetics Management of ALL
 Diet  Sanctuary chemotherapy
Clinical manifestation - CNS prophylaxis
 Develops insidiously and is assymptomatic until late in the course - Inthratecal methotrexate
 s/sx depends on the location and size of the tumor, degree of obstruction and metastasis  Systemic chemotherapy (2 phases)
 Cough or chronic cough - 3 drug: Vincristine, Prednisone, L-asparginase
- dry, persistent without sputum production - 4 drug: + daunorubicin
 Wheezing
 Hemoptysis or blood tinged sputum
 Chest and shoulder pain SEXUALLY TRANSMITTED DISEASES
Common sites of metastasis Gonorrhea
 LN Neisseria gonorrheae, gram (+)
 Bone IP: 3-7 days
 Brain S/sx:
 Contralateral lung Females: usually asymptomatic or minimal urethral discharge w/ lower abdominal pain
 Adrenal glands Male: Mucopurulent discharge, Painful urination
 liver DX:
 Screening test: No screening program currently exist. gram stain and culture of cervical secretions on Thayer Martin VCN medium
Assessment: Mgmt: single dose only
a. Clients are very rarely symptomatic at the time of diagnosis.  Ceftriaxone (Rocephin) 125 mg IM
b. Persistent cough and dyspnea  Ofloxacin (Floxin) 400 mg orally
c. Recurrent bronchitis and pneumonia  treat concurrently with Doxycycline or Azithromycin for 50% infected w/ Clamydia
d. Blood streaked sputum CX:
e. Chest pain PID, ectopic pregnancy and infertility, peritonitis, perihepatitis, Ophthalmia neonatorum, sepsis and
arthritis
Diagnostics Syphilis
 Chest xray (solitary peripheral nodule, coin lesion)  Treponema pallidum, spirochete
 Ct scan of the chest IP: 10-90 days
 Fiberoptic bronchoscopy S/sx:
 Fine needle biopsy under ct scan  Primary (3-6 wks after contact) – nontender lymphadenopathy and chancre; most infectious; resolves
Surgical Management 4-6 wks
 Dependent on whether the tumor is resectable  Secondary – systemic; generalized macular papular rash including palms and soles and painless
 May be cure for non small cell if no metastasis occurred and lung function is sufficient on removal of all wartlike lesions in vulva or scrotum (condylomata lata) and lymphadenopathy
or part of the lungs (50%)  Tertiary – (6-40 yyears) - neurosyphilis/permanent damage (insanity); gumma (necrotic granulomatous
 Lobectomy – removal of lobe (common) lesions), aortic aneurysm
 Pneumonectomy – removal of the lung Primary – painless chancre
 Segmentectomy – partial removal of the lung lobe Secondary – generalized rash
Adjuvant therapy Tertiary - gumma
 Chemotherapy is the primary treatment for small cell
 Radiation is standard post op for advanced non-small cell DX:
 Radiation therapy – for localized intrathoracic lung ca and palliation for hemprtysis, obstruction Dark-field examination of lesion- 1 st and 2nd stage
dysphagia and pain Non specific VDRL and RPR
 Chemotherapy FTA-ABS
 Immunotherapy Mgmt
Nursing Intervention  Primary and secondary - Pen G
 Assess for signs of superior vena cava syndrome  Tertiary - IV Pen G
 Postlobectomy, manage chest tube Chlamydia
 Assess respiration and for presence of pneumothorax or atelectasis  Chlamydia trachomatis, gram (-)
 Position properly post-op IP: 2-10 days
1. Lobectomy – avoid prolonged lying on the operative site S/sx:
  Maybe asymptomatic  Blood recipients, hemodialysis, IV drug users, sexually active homosexual, tattooing and health care
 Gray white discharge, Burning and itchiness at the urethral opening workers (high risk)
DX:  Active Immunity (hevac-B)
 Gram stain  Passive Immunity (HBIg)
 Antigen detection test on cervical smear  Carrier state
 Urinalysis IP: 2-5 months
Mgmt: MOT: Blood and other body fluids route, percutaneous, perinatal
 Doxycycline or Azithromycin Manifestations
 Erythromycin and Ofloxacin Stage I pre-icteric for 1-21 days
CX: Anorexia, nausea and vomiting, LBM, weight loss RUQ pain, fatty food intolerance, fever, chills and
 PID headache
 Ectopic pregnancy Stage II icteric for 2-6 weeks
 Fetus transmittal (vaginal birth) Jaundice, pruritus, weight gain, ascites, dark-tea colored urine (urobilirubin), S/sx of ADEK deficiency
Herpes Genitalis Stage III pre coma
 HSV 2 NH3 level increases with decreasing LOC, Flapping tremors or asterixis
S/sx: Painful sexual intercourse, Painful vesicles (cervix, vagina, perineum, glans penis) Stage IV recovery (lifetime carrier) or death
Dx: DX:
 Viral culture  Elevated AST or SGPT (specific) and ALT or SGOT
 Pap smear (shows cellular changes)  Increased IgM during acute phase
 Tzanck smear (scraping of ulcer for staining)  (+) or REACTIVE HBsAg = INFECTED, may be acute, chronic or carrier
Mgmt:  (+) HBeAg = highly infectious
Anti viral - acyclovir (zovirax)  HBcAg = found only in the liver cells
CX:  (+) Anti-HBc = acute infection
 Meningitis  (+) Anti-HBe = reduced infectiousness
 Neonatal infection (vaginal birth)  (+) Anti-HBs = with antibodies (FROM vaccine or disease)
 Liver biopsy (to detect progression to CA)
Genital Warts, Mgmt:
Condyloma Acuminatum  Prevention of spread – Immunization and Health Education
 HPV type 6 & 11, papilloma virus  Enteric and Universal precautions
S/sx: Single or multiple soft, fleshy painless growth of the vulva, vagina, cervix, urethra, or anal area, Vaginal bleeding,  Assess LOC
discharge, odor and dyspareunia  Bed rest
DX:  ADEK deficiency intervention
 Pap smear-shows cellular changes (koilocytosis)  High CHO, Moderate CHON, Low fat
 Acetic acid swabbing (will whiten lesion)  FVE prevention
Mgmt: Cx:
Laser treatment is more effective 1. Fulminant Hepatitis – s/sx of encephalopathy
CX: 2. Chronic Hepatitis - lack of complete resolution of clinical sx and persistence of hepatomegaly
 Neoplasia 3. HBsAg carrier
 Neonatal laryngeal papillomatosis (vaginal birth) Infectious Mononucleosis
 “Kissing Disease”
Trichomoniasis  Epstein Barr Virus
 Trichomona vaginalis, parasite  Self limiting
S/sx: Females: itching, burning on urination, Yellow gray frothy malodorous vaginal discharge, Foul smelling IP: 10-50 days
Males: usually asymptomatic MOT: salivary secretions
Dx: microscopic exam of vaginal discharge S/sx:3 hallmarks: low grade fever,
Mgmt: Metronidazole (Flagyl); include partners sore throat, cervical lymphadenopathy;
CX: PROM Morbiliform/papular rash, spleno- and hepatomegaly
HIV and AIDS PATHOPHYSIOLOGY
 Retrovirus (HIV1 & HIV2) Spread via oropharyngeal route (intimate Kissing)
 Attacks and kills CD4+ lymphocytes (T-helper) B cells of lymphoid tissue
 Capable of replicating in the lymphocytes undetected by the immune system B cells die
 Immunity declines and opportunistic microbes set in virus is released in the blood fever, other sx
 No known cure Ab in blood fight the virus
MOT: disappear in the blood
 Sexual intercourse (oral, vaginal and anal) lodges in to the salivary glands
 Exposure to contaminated blood, semen, breast milk and other body fluids Dx:
 Blood Transfusion WBC count abnormally high
 IV drug use (+) heterophil antibodies
 Transplacental Monospot test
 Needlestick injuries Indirect immunoflourescent (+) EBV (specific)
HIGH RISK GROUP Mgmt:
 Homosexual or bisexual  Symptomatic
 Intravenous drug users  Steroids – prevent airway obstruction d/t tonsillar hypertrophy
 BT recipients before 1985 Cx: splenic rupture
 Sexual contact with HIV+
 Babies of mothers who are HIV+ PARASITIC DISEASES
s/sx: Leptosiprosis (Weil’s disease)
1. Acute viral illness (1 mo after initial exposure) – fever, malaise, lymphadenopathy • a zoonotic systemic infection caused by Leptospires, that penetrate intact and abraded skin through
2. Clinical latency – 8 yrs w/ no sx; towards end, bacterial and skin infections and constitutonal sx – AIDS exposure to water, wet soil contaminated with urine of infected animals.
related complex; CD4 counts 400-200 Anicteric Type (without jaundice)
3. AIDS – 2 yrs; CD4 T lymphocyte < 200 w/ (+) ELISA or Western Blot and opportunistic infections • manifested by fever, conjunctival injection
DX: • signs of meningeal irritation
HIV+ Icteric Type (Weil Syndrome)
 2 consecutive positive ELISA and • Hepatic and renal manifestation
 1 positive Western Blot Test • Jaundice, hepatomegally
AIDS+ • Oliguris, anuria which prigress to renal failure
 HIV+ • Shock, coma, CHF
 CD4+ count below 200/ml • Convalescent Period
 Exhibits one or more of the ff: Diagnosis
Exhibits one or more of the ff: • Clinical history and manifestation
 Extreme fatigue • Culture
 Intermittent fever – Blood: during the 1st week
 Night sweats – CSF: from the 5th to the 12th day
 Chills – Urine: after the 1st week until convalescent period
 Lymphadenopathy • LAAT (Leptospira Agglutination Test)
 Enlarged spleen • other laboratory
 Anorexia • BUN,CREA, liver enzymes
 Weight loss Treatment
 Severe diarrhea • Specific
 Apathy and depression – Penicillin 50000 units/kg/day
 PTB – Tetracycline 20-40mg/kg/day
 Kaposis sarcoma • Non-specific
 Pneumocystis carinii • Supportive and symptomatic
 AIDS dementia • Administration of fluids
Mgmt: • Peritoneal dialysis for renal failure
 Nucleoside Reverse Transcriptase Inhibitors NRTI’s Ascariasis (Roundworm)
Zidovudine (AZT) – limit viral growth • Ascaris Lumbricoides
 Non-nucleoside Reverse Transcriptase Inhibitors NNRTI’s Ritonavir (Norvir) IP: weeks to months
 Prevention of spread (safe sex) S/sx: Coughing, wheezing and hemoptysis
 Universal precautions Dx: fecal exam
 Symptomatic intervention and treatment of opportunistic infections Mgmt: Mebendazole, Pyrantel Pamoate
 Vaccines (influenza and hepa B) Diphenhydramine
Hepatitis MOT: ingestion of food contaminated by ascaris eggs larvae in large intestine penetrate wall lung where
 Hepa A – fecal oral route larvae grow and coughed up intestine
 Hepa B – body fluids larvae mature and passed out in feces
 Hepa C – non A non B, BT, body fluids Nursing Intervention
 Hepa D – hypodermic, body fluids • Environmental sanitation
 Hepa E – fecal oral route, fatal and common among pregnant women • Health teachings
 Hepa G – BT, parenteral • Assessment of hydration status
Hepatitis B • Use of ORS
 DNA, Hepa B virus • Proper waste disposal
 • Enteric precautions
Complications
• Migration of the worm to different parts of the body Ears, mouth,nose
• Loefflers Pneumonia
Tapeworm (Flatworms)
• Taenia Saginata (cattle), Taenia Solium (pigs)
MOT: fecal oral route
(ingestion of food contaminated by the agent)
s/sx: neurocysticercosis – seizures, hydrocephalus
Dx: Stool Exam
Mgmt: Praziquantel, Niclosamide
Pinworm
• Enterobius Vermicularis
MOT: fecal oral route
S/sx: Itchiness at the anal area d/t eggs of the agent
Dx: tape test at night time
(agents release their eggs during night time)
flashlight
Mgmt: Pyrantel Pamoate, Mebendazole
Nursing Intervention
• Promote hygiene
• Environmental Sanitation
• Proper waste and sewage disposal
• Antihelmintic medications repeated after 2 weeks (entire family)