10 COMMUNICABLE DISEASES

1. Measles Definition: An Acute highly communicable infection characterized by fever, rashes and symptomsreferable to upper respiratory tract; the eruption is preceded by about 2 days or coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day affecting face, body and extremities ending in branny desquamation. Death is due to complication (e.g. secondary pneumonia, usually in children under 2 years old. Measles is severe among malnourished children with fatality of 95-100%. Etiologic Agent: Filterable virus of Measles Source of Infection: Secretion of nose and throat of infected persons. Modes of Transmission: 1. Directly by being sprayed with droplets emanating from a cough or sneeze 2. Indirectly with articles newly contaminated with respiratory secretions from a patient. 3. Probably Airborne Incidence peak age is about 1-5 years old in congested urban areas and at early school age in less crowded sections. Immunity from the disease is long lasting while passive immunity transmitted transplacentally from mothers who have had measles may last about 5-6 months. The live attenuated vaccine confers almost lifelong immunity while the inactivated antigen gives an immunity 0f 6-18 months. Incubation Period: 10-12 days; one attack usually confers a lasting immunity 8 days shortest; 20 days longest Period of Communicability: During the period of coryza or catarrhal symptoms 9 days (from 4 days before and 5 days after rash appears) Clinical Manifestations: 1. Pre-eruptive Stage patient is highly communicable fever catarrhal symptoms start in the nasal cavities; then in the conjunctivae, oropharynx, progress to the bronchi resulting successively in rhinitis, conjunctivitis and then bronchitis. Respiratory symptoms which appear first as a common cold, and sneezing nasal discharges, steadily progress into a distressing and annoying cough that persists up to convalescence. 2. Eruptive Stage/Stage of Skin Rashes exanthem sign means eruption in the skin Maculopapular Rashes appears 2-7 days after onset With high fever increases steadily Anorexia and irritability are disturbing particularly at the height of the fever Diarrhea, pruritis, lethargy and occipital lymphadenopathy 3. Stage of Convalescence Rashes fade in the same manner as they appeared, from the face downwards, leaving a dirty brown pigmentation and finely granular which maybe noted for several days. Fever gradually subsides as the eruptions disappear on the hands and feet

Treatment: No theraphy is indicated for uncomplicated measles, Gamma globulin although effective in prophylaxis is no value once symptoms are evidence. Patient should be monitored for the development of bacterial infections which should be treated with appropriate antibiotics on the basis of clinical and bacteriological findings. The patient may also take over-the-counter medications such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the fever that accompanies measles. Dont give aspirin to children because of the risk of Reyes syndrome a rare but potentially fatal disease. Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the patient not to rub the eyes. Administer antipyretic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash. Methods of Prevention and Control 1. Avoid exposing children to any person with fever or with acute catarrhal symptoms 2. Isolation of cases from diagnosis until about 5-7 days after onset of rash 3. Disinfection of all articles soiled with secretion of nose and throat 4. Encourage by health department and by private physician of administration of measles immune globulin to susceptible infants and children less than 3 years of age in families or institutions where measles occurs. 5. Live attenuated and inactivated measles virus vaccines have been tested and are available for use in children with no history of measles, at 9 months of age or soon thereafter Nursing Care 1. Protect eyes of patients from glare of strong light as they are apt to be inflamed. 2. Keep the patient in an adequately ventilated room but free from drafts and chilling to avoid complications of pneumonia. 3. Teach, guide and supervise correct technique of giving sponge bath for comfort of patient. 4. Check for corrections of medication and treatment prescribed by physician. 2. Malaria Definition: Malaria is an acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas. This disease causes more disability and heavier economic burden than any parasitic disease. Etiologic Agent: Protozoa of genus plasmodia 1. The disease is caused by four species of protozoa: a. Plasmodium falciparum (malignant tertian) This is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli. This is most common in the Philippines. b. Plasmodium vivax (Benign tertian) This is nonlife threatening except for the very young and the old.

It is manifested by chills every 48 hours on the 3rd day onward especially if untreated. c. Plasmodium malariae (Quartan) It is less frequently seen. This specie is nonlife threatening. Fever and chills usually occur every 72 hours usually on the 4th day after onset. d. Plasmodium ovale is the rare type of protozoan species. This is rarely seen in the Philippines. 2. The primary vector of malaria is the female Anopheles mosquito which has the following characteristics: a. It breeds in clear, flowing, and shaded streams usually in the mountains. b. It is bigger in size than the ordinary mosquito. c. It is brown in color. d. It is a night-biting mosquito. e. It usually does not bite a person in motion. f. It assumes a 36 position when it alights on walls, trees, curtains, and the like. Incubation period: 1. 12 days for P. Falciparum 2. 14 days for P. vivax and ovale 3. 30 days for P. malariae Period of Communicability: Untreated or insufficiently treated patient may be the source of mosquito infection for more than three years in P. malariae, one to two years in P. vivax, and not more than one year on P. falciparum. Mode of Transmission: 1. The disease is transmitted mechanically through the bite of an infected female anopheles mosquito 2. It can be transmitted parenterally through blood transfusion. 3. On rare occasions, it is transmitted from shared contaminated needles. 4. However, transplacental transmission of congenital malaria is a rare case. Clinical Manifestations: 1. Paroxysms with shaking chills 2. Rapidly rising fever with severe headache 3. Profuse sweating 4. Myalgia, with feeling of well-being in between 5. Splenomegally, hepatomegally 6. Orthostatic hypotension 7. Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two. 8. In children: a. Fever maybe continuous b. Convulsions and gastrointestinal symptoms are prominent c. Splenomegally 9. In cerebral malaria a. Changes in sensorium, severe headache, and vomiting b. Jacksonian or grand mal seizure may occur

Diagnostic Procedure: 1. Malarial smear In this procedure, a film of blood is placed on a slide, stained, and examined microscopically. 2. Rapid diagnostic test (RDT) This is a blood test for malaria that can be conducted outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the blood. Nursing Management: 1. The patient must be closely monitored. a. Intake and output should be closely monitored to prevent pulmonary edema. b. Daily monitoring of patients serum bilirubin, BUN creatinine, and parasitic count 2. If the patient exhibits respiratory and renal symptoms, determine the arterial blood gas and plasma electrolyte 3. During the febrile stage, tepid sponges, alcohol rubs, and ice cap on the head will help bring the temperature down. 4. Application of external heat and offering hot drinks during chilling stage is helpful. 5. Provide comfort and psychological support. 6. Encourage the patient to take plenty of fluids. 7. As the temperature falls and sweating begins, warm sponge bath maybe given. 8. The bed and clothing should be kept dry. 9. Watch for neurologic toxicity (from quinine infusion) like muscular twitching, delirium, confusion, convulsion, and coma. 10. Evaluate the degree of anemia. 11. Watch for any signs especially abnormal bleeding. 12. Consider severe malaria as medical emergency that requires close monitoring of vital signs. Prevention and Control: 1. Malaria cases should be reported. 2. A thorough screening of all infected persons from mosquitoes is important. 3. Mosquito breeding places must be destroyed. 4. Homes should be sprayed with effective insecticides which have residual actions on the walls. 5. Mosquito nets should be used especially when in infected areas. 6. Insect repellents must be applied to the exposed portion of the body. 7. People living in malaria-infested areas should not donate blood for at least three years. 8. Blood donors should be properly screened. 3. Amoebiasis/Amebiasis Introduction: Amoebiasis protozoal infection of human beings initially involves the colon, but may spread to soft tissues, most commonly to the liver or lungs, by contiguity or hematogenous or lymphatic dissemination. Amoebiasis is the third leading parasitic cause of death worldwide, surpassed only by malaria and schistosomiasis. On a global basis, amoebiasis affects approximately 50 million persons each year, resulting in nearly 100,000 deaths. Etiologic Agent: Enatamoeba Histolytica Prevalent in unsanitary areas

Common in warm climate Acquired by swallowing Cysts survives a few days outside of the body Cyst passes to the large intestine and hatch into trophozoites. It passes into the mesenteric veins, to the portal vein, to the liver, thereby forming amoebic liver abscess. Entamoeba Histolytica has two developmental stages: 1. Trophozoites/vegetative form Trophozoites are facultative parasites that may invade the tissues or may be found in the parasitized tissues and liquid colonic contents. 2. Cyst Cyst is passed out with formed or semi-formed stools and are resistant to environmental conditions. This is considered as the infective stage in the cycle of E. histolytica Source: Human Excreta Incubation Period: The incubation period in severe infection is three days. In subacute and chronic form it lasts for several months. In average cases the incubation period varies from three to four weeks Period of Communicability: The microorganism is communicable for the entire duration of the illness. Modes of Transmission: 1. The disease can be passed from one person to another through fecal-oral transmission. 2. The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and proctogenital sexual activity. 3. Through indirect contact, the disease can infect humans by ingestion of food especially uncooked leafy vegetables or foods contaminated with fecal materials containing E. histolytica cysts. Food or drinks maybe contaminated by cyst through pollution of water supplies, exposure to flies, use of night soil for fertilizing vegetables, and through unhygienic practices of food handlers. Clinical Manifestations: 1. Acute amoebic dysentery Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus. Diarrhea, watery and foul smelling stool often containing blood-streaked mucus Colic and gaseous distension of the lower abdomen Nausea, flatulence, abdomnal distension and tenderness in the right iliac region over the colon 2. Chronic amoebic dysentery Attack dysentery that lasts for several days, usually succeeded by constipation Tenesmus accompanied by the desire to defacate Anorexia, weight loss, and weakness Liver may be enlarged The stool at first is semifluid but soon becomes watery, bloody, and mucoid Vague abdominal distress, flatulence, constipation or irregularity of bowel Mild toxemia, constant fatigue and lassitude Abdomen loses its elasticity when picked up between fingers On sigmoidoscopy, scattered ulceration with yellowish and erythematous border The gangrenous type (fatal cases) is characterized by the appearance of large sloughs of intestinal tissues in the stool accompanied by hemorrhage. 3. Extraintestinal forms 1. Hepatic

Pain at the upper right quadrant with tenderness of the liver Abscess may break through the lungs, patient coughs anchovy-sauce sputum Jaundice Intermittent fever Loss of weight or anorexia Treatment: 1. Metronidazole (Flagyl) 800mg TID X 5 days 2. Tetracyline 250 mg every 6 hours 3. Ampicillin, quinolones sulfadiazine 4. Streptomycin SO4, Chloramphenicol 5. Lost fluid and electrolytes should be replaced Several antibiotics are available to treat amoebiasis. Treatment must be prescribed by a physician. You will be treated with only one antibiotic if your E. histolytica infection has not made you sick. You probably will be treated with two antibiotics (first one and then the other) if your infection has made you sick. Nursing Management: 1. Observe isolation and enteric precaution 2. Provide health education and instruct patient to Boil water for drinking or use purified water Avoid washing food from open drum or pail Cover leftover food Wash hands after defacation and before eating Avoid ground vegetables (lettuce, carrots, and the like) Methods of Prevention: 1. Health education 2. Sanitary disposal of feces 3. Protect, chlorinate, and purify drinking water 4. Observe scrupulous cleanliness in food preparation and food handling 5. Detection and treatment of carriers 6. Fly control (they can serve as vector) 4.Chlamydial Infection

Is a common sexual transmitted disease that occurs in women and men, particularly in adolescents and young adults. Women are asymptomatic or present with cervicitis. Men are commonly asymptomatic but may present with urethritis. Untreated chlamydial infections can lead to epididymitis, salphingitis, pelvic inflammatory disease and eventually sterility. Mode of Transmission 1. The disease is transmitted through vaginal or rectal intercourse. 2. The disease is also transmitted through oral-genital contact with an infected person. 3. Conjunctivitis, otitis media, and pneumonia may develop to children born to mothers with chlamydial infection passed through birth canal. Clinical Manifestations 1. May be asymptomatic or have vaginal discharge may be clear mucoid to creamy discharge. 2. May have dysuria and mild pelvic disorder.

3. Cervix may be covered by thick mucopurulent discharge and be tender, erythematous, edematous, and friable. Diagnostic Evaluation 1. DNA detection test on cervical smear or urine sample (by DNA amplification method). 2. Chlamydia culture from cervical exudate. 3. Screening urinalysis in males for leukocytes; if positive result, confirmed by DNA detection test. 4. ELISA 5. Direct fluorescent anti-body test. 6. The Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active adolescents women as well as young women, ages 20 to 24, and older women at high risk (multiple sex partners or new partner). Complications 1. Pelvic Inflammatory Disease. 2. Ectopic pregnancy or infertility secondary to untreated or recurrent pelvic inflammatory diseases. 3. Transmission to neonate born through infected birth canal. Treatment 1. Doxycycline oral for several days. 2. Azithromycin in single dose. Nursing Interventions 1. Advice abstinence from sexual intercourse until treatment has been completed. No follow-up culture is necessary to ensure cure; however, re-screening is recommended 3 to 4 months after treatment to detect reinfection, particularly in adolescents and young women. 2. Ensure that the partner is treated at the same time; recent partners should receive treatment despite lack of symptoms and negative Chlamydia result. 3. Report case to local public health department (Chlamydia is a reportable infectious disease). 4. Ensure that the patient begins treatment and will have access to prescription follow up. 5. Explain mode of transmission, complications, and the risk for other STDs. 6. Teach about all STDs and their symptoms. 7. Explain the treatment regimen to patient and advise her of adverse effects. 8. Encourage abstinence, monogamy, or safer sex methods, such as female or male condom. 9. Stress the importance of follow-up examination and testing to eradication of infection. Recurrence rates are highest in young patients. 5.Scabies

A communicable disease of the skin caused by Sarcopte Scabiei and characterized by the eruptive lesions produced from the burrowing of the parasite into the skin. Etiologic Agent 1. The mite is yellowish-white and can barely be seen by unaided eye. 2. The female parasite burrows beneath the epidermis to lay her eggs and sets up an intense irritation. 3. The males are smaller and reside at the surface of the skin. 4. Scabies occurs worldwide, and is predisposed by overcrowding and poor hygiene. Incubation It occurs within 24 hours from the original contact, the length of time required from itch mite to (burrow) or infected skin lay ova. Period of Communicability The disease is communicable for the entire period that the host is infected.

Signs and Symptoms 1. Itching 2. When secondarily infected the skin may feel hot and burning but this is a minor discomfort. 3. When large areas are involved and secondary infection is severe there will be fever, headache and malaise. Secondary dermatitis is common. Mode of Transmission 1. The disease is transmitted by direct transmission of infected individuals. 2. The disease is also be transmitted through sleeping in an infected bed or wearing infected clothing. 3. Anyone may become infected or re-infected. 4. Infestation with mites may also result from contact with dogs, cats, and small animals. Diagnosis 1. Appearance of lesion, and intense itching and finding of the causative mite. 2. Scraping from its burrow with a hypodermic needle or curette, and then examined under low power of the microscope or by hard lens. Treatment 1. The whole family should be examined before undertaking treatment, as long as a member of family remains infected, other members will get the disease 2. Treatment for scabies consists of application of pediculicide, like permethrin cream of lindane lotion in thin layer over the entire skin surface and is left for ten to twelve (10-12) hours. 3. Crotamiton cream applied for five consecutive nights. 4. Neosporin ointment rubbed into the affected skin four to five times a day. 5. Eurax and kwell lotion also prove effective to some patients. 6. All clothes used before and during the treatment period should be disinfected by dry cleaning or boiling. Nursing Interventions 1. Instruct patient to apply the cream at bedtime, from neck down to toes, covering the entire body. 2. Advise patient to report any skin irritation. 3. Suggest the family members and other close contact of the patient be checked for possible symptoms and be treated if necessary. 4. If patient is hospitalized, practice good handwashing technique, or use gloves while performing nursing procedure. 5. Terminal disinfection should be carried out after discharge of patient. Prevention and Control 1. Good personal hygiene daily bath; washing the hands before and after eating, and after using the toilet; cutting off fingernails. 2. Regular changing of clean clothing beddings and towels. 3. Eating the right kind of food like rich in Vitamin A and Vitamin C such as green leafy vegetable and plenty of fruits and fluids. 4. Keeping the house clean. 5. Improving the sanitation of the surroundings. 6. Anthrax

Is a serious infection caused by the gram-positive, spore-forming bacteria, Bacillus anthracis. In industrialized nations, infection in human was all but nonexistent until the threat of bioterrorism became apparent in late 2001. Infection occurs through contact with infected animals, products from infected animals, and intentionally tainted materials.

Anthrax is potential biologic weapon because spores can be distributed easily through the mail or other means. People exposed to airborne particles may develop cutaneous, inhalation, or G.I. anthrax, based on the route of exposure. Complications include meningitis, circulatory collapse, and death. Modes of Transmission 1. Direct transmission through contact with infected animals or contaminated animal products. 2. Indirect transmission through animal bites and ingestion of contaminated meat. 3. Airborne transmission through inhalation of contaminated or polluted air. Assessment 1. Cutaneous anthrax: After incubation period of 1 to 12 days, a papule develops and progresses to vesicle and, ultimately, to necrotic ulcer; fever, malaise, headache, and lymphadenopathy may also occur. 2. Inhalation anthrax: After an incubation period of several days to 60 days, a brief prodrome of fever, cough, fatigue, and mild chest discomfort occurs and may rapidly progress to severe respiratory distress, diaphoresis, stridor, cyanosis, and signs of meningitis (nuchal rigidity, headache, photophobia, altered mental status); may proceed to shock and death within 24 to 36 hours. 3. GI anthrax: Approximately 1 to 7 days after ingestion of tainted material or undercooked contaminated meat, nausea, anorexia, fever, severe abdominal pain, hematemesis, and bloody diarrhea may occur; the oropharyngeal form may also occur, characterized by lesions at base of tongue, dysphagia, fever, and cervical lymphadenopahy. Diagnostic Evaluation 1. Nasal swab testing may be conducted on several people to detect contamination by anthrax in the environment, but this does not confirm infection by anthrax in an individual. 2. Testing to confirm disease in an individual includes blood, tissue, and spinal fluid cultures (before antibiotics); polymerase chain reaction testing; and x-ray to identify mediastinal widening in inhalation anthrax. Pharmacologic Interventions 1. Antibiotic prophylaxis after exposure to spores is warranted, and 60 days therapy is advised. Drug recommendations include: Ciprofloxacin 500 mg bid for adults: 10 to 15 mg/kg bid for children. Doxycycline 100 mg bid for those weighing 99 pounds (45kg) and over; 2.2 mg/kg bid for children at least age 8 but weighing 99 pounds or less. Amoxicillin 500 mg bid for adults; 80 mg/kg divided into three doses for children (if penicillin sensitivity of organism is confirmed). 2. Treatment of cutaneous anthrax involves 60 days treatment using antibiotics, however, signs of systemic involvement, including lesions of the head and neck and extensive edema, require I.V. treatment with multiple drugs as for inhalation anthrax. 3. I.V. corticosteroids may be given to adjunct therapy in severe cases. 4. Symptomatic treatment includes analgesics, antiemetics, and emergency drugs for circulatory collapse. 5. An anthrax vaccine has been available for veterinarians (not routinely used due to low incidence of animal disease). Complications 1. Antrax meningitis is the intense inflammation of the meninges of the brain and spinal cord. This is marked by elevated CSF pressure pressure with bloody CSF followed by rapid loss of consciousness and death. The case fatality rate is almost 100 percent.

2. Anthrax sepsis - develops after the lymphohematogenous spread of B. anthracis from primary lesion. Nursing Interventions 1. Monitor vital signs and hemodynamic parameters closely for circulatory collapse. 2. Monitor temperature for response to antibiotic therapy. 3. Auscultate chest for crackles, indicating need for better secretion mobilization. 4. Monitor oxygen saturation and arterial blood gases periodically to determine oxygenation status and acid-base balance. 5. Monitor level of consciousness and for meningeal signs such as nuchial rigidity. 6. Provide supplemental oxygen or mechanical ventilation, as needed. 7. Position for maximum chest expansion and reposition frequently to mobilize secretions. 8. Suction frequently and provide chest physiotherapy to clear airways, prevent atelectasis, and maximize oxygen therapy. 9. Administer I.V. fluids to encourage oral fluid intake to replace the fluid lost through hyperthermia and tachypnea. 10. For G.I. anthrax, maintain G.I decompression, monitor emesis and liquid stool output, and medicate for abdominal pain, as needed. 11. Advice the patient and family that anthrax is not transmitted person to person; one must come in contact with the spores to contact infection. 7. Herpes Zoster (Shingles)

Herpes Zoster also known as Shingles is an acute viral infection of the sensory nerve caused by a variety of chickenpox virus. It is an inflammatory skin condition in which the varicella zoster virus produces a painful vesicular eruption along the nerve tracks leading from one or more dorsal root ganglia. After a primary chickenpox infection, the virus persists in a dormant state in the dorsal ganglia. The virus may then become active again in later years, either spontaneously or in association with immunosuppression, to cause the eruptions. Herpes zoster may progress too chronic pain syndrome (postherpetic neuralgia), characterized by constant aching and burning pain or intermittent lancinating pain or hyperesthesia of affected skin after healing. Herpes zoster is communicable a day before the appearance of the first rash until five to six days after the last crust. Assessment 1. Eruption may be accompanied or preceded by fever, malaise, headache, and pain. Pain may be burning, lancilating, stabbing or aching. 2. Inflammation usually unilateral, involving the cranial, cervical, thoracic, lumbar, or sacral nerves in a bandlike configuration. 3. After 3 to 4 days, patches of grouped vesicles appear on erythematous, edematous skin. 4. Early vesicles contain serum, these later rupture and form crusts. Scarring usually does not occur unless the vesicles are deep and involve in the dermis. 5. Patient may have a painful eye if ophthalmic branch of the facial nerve is involved. 6. Lesions usually resolve in 2 to 3 weeks. Diagnostic Evaluation 1. Culture of varicella zoster virus from lesions or detection by fluorescent antibody techniques, including monoclonal antibodies.

Pharmacologic Interventions 1. Antivirals, such as acyclovir or valacyclovir, interfere with viral replication; may be used orally in all cases but especially for the treatment of immunosuppressed or debilitated patients (I.V route). Antivirals are most effective if started within 48 hours of onset of symptoms. 2. Corticosteroids early in illness for severe herpes zoster if symptoms measures fail; given for antiinflammatory effect and relief of pain. 3. Aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, or opiiods to manage pain during the acute stage; good pain control may reduce the incidence of postherpetic neuralgia. Nursing Interventions 1. Asses the patients level of discomfort and medicate as prescribed. 2. Teach the patient to apply wet dressings and calamine lotion for soothing and cooling effect on inflamed tissue. 3. Encourage diversional activities. 4. Teach relaxation techniques, such as deep breathing, progressive muscle relaxation, and imagery, to help control pain. 5. Apply anti-bacterial ointments (after acute stages) as prescribed to soften and separate adherent crusts and prevent secondary infection. 6. Teach the patient to use proper hand-washing techniques to avoid spreading herpes zoster virus. 7. Advise the patient not to open the blister to avoid a secondary infection and scarring. 8. Reassure the patient that shingles is a viral infection of the nerves. 8.Bird Flu Virus Definition: Bird flu or Avian Influenza (A1) is a contagious disease of bird raging from mild to serve form of illness. Some forms of bird flu infections can cause illness to humans. Bird flu is caused by an influenza A virus. The outbreaks affecting some Asian countries have been caused by influenza A/H5N1 virus. It can also cause severe infection in humans. Etiologic Agent: The causative agent is the avian influenza (A1) virus. A1 viruses all belong to the influenza virus, a genus of the Orthomyxoviridae family and are negative-stranded, and segmented. Modes of Transmission: 1. Avian influenza spreads in the air and in manure. Wild fowl often acts as resistant carrier spreading it to more susceptible domestic stocks. 2. It can also be transmitted through contaminated feeds, water, equipment, and clothing; however, there is no evidence that the virus can survive in well cooked meat. 3. Cats are also thought to be possible infection vectors for H5N1 strains of avian flu. 4. While avian influenza spreads rapidly among birds, it does not infect humans easily, and there is no confirmed evidence of human-to-human transmission. Of the 15 subtypes known, only subtypes H5 and H7 are known to be capable of crossing the species barrier. Incubation Period: The incubation period is three to five days. Signs and Symptoms: 1. Symptoms in animals vary, but virulent strains can cause death within a few days. 2. The symptoms of avian influenza in humans following exposure to bird flue infected chicken patient develops:

fever, body weakness or muscle pain, sore throat, cough, sore eyes, may have difficulty of breathing in severe cases Prevention and Treatment: Avian influenza in humans can be detected reliably with standard influenza tests. Antiviral drugs are clinically effective in both preventing and treating the disease. Vaccines, however, taken at least four months to produce and must be prepared for each subtype. 1. Wash hands thoroughly with soap and water before and after handling live and dressed chicken. 2. Cook chicken thoroughly. 3. Do not sell live chickens and other birds in the market while there is a threat of bird flu. 4. Do not let chickens roam freely. Keep them in cages or pens. 5. Do not place chicken, ducks and pigs together in one area, cage or pen. 6. Do not catch, get near or keep in captivity wild birds. 7. Report to the nearest agricultural/veterinary office any unusual death or illness of chickens and other birds. 8. Report to the nearest local health centers any case of respiratory illness with history of exposure to sick or dead chickens and other birds. 9. Individuals at risk are those directly exposed to sick chicken and other birds. The government thereby advises prospective travelers to countries affected with bird flu not to go to bird parks, poultry farms and markets where live chicken and other birds are sold. 9.Chicken Pox (Varicella) Definition: is highly contagious disease caused by herpes virus varicella, characterized by vesicular eruptions on the skin and mucous membranes usually with mild constitutional manifestations. Etiologic Agent: Varicella zoster virus Source of Infection: Secretion of respiratory tract of infective persons. Modes of Transmission: 1. Direct Contact with patient who sheds the virus from vesicles 2. Indirect Contact through articles fresh soiled by discharges of infected persons 3. Airborne or spread by droplet infection Incidence: Most frequent in childhood but it may occur at any age, including the neonatal period with peak age between 5 and 9 years old. Incubation Period: From10-21 days with a mean of 14 days or 2 weeks Period of Communicability: The patient is contagious about a day before the eruption of rashes and continuous to be so up to the 5th or 6th day after the last scab formation or until all vesicles have become encrusted. Clinical Manifestations: 1. Prodromal symptoms are mild and consist of fever and malaise 2. Rash Start from trunk and then spread to other parts of the body In bigger children, the lesions may be more widespread and severe Rapid progressions so that transitions is completed in 6-8 hours All stages are present simultaneously before all are covered scabs Diagnostic Test: Determination of V-Z virus though Complement Fixation Test

Determination of V-Z virus through Electron Microscopic examination of vesicular fluid Complications: Secondary infection of the lesions furuncles, cellulites, skin abscess, erysipelas Meningoencephalitis Pneumonia Sepsis Treatment Modalities: Zoverax 500mg/tablet, 1 tab 2x a day for seven days must be administered Oral acyclovir 800 mg 3x a day for five days must also be given Oral antihistamine can be taken to symptomatic pruritus Calamine lotion will ease itchiness Salicylates must not be given Antipyretics for fever. Nursing Management: 1. Prevention of secondary infection of the skin lesions through hygienic care of the patient 2. Attention should be given to nasopharyngeal discharges and disinfection of cloths and linen by sunlight or boiling 3. Cut fingernails short and wash hands more often in order to minimize bacterial infections; may be introduced by scratching 4. Calamine lotion over rashes 5. Antipyretics for fever 6. Isolation of patient; cannot be confined in general hospital; isolated until all lesions have become encrusted. Preventive Measures: 1. Active immunization with live attenuated varicella vaccine is necessary. 2. Avoid exposure as much as possible to infected persons. 10.Cholera (El Tor) Definition: Cholera is an acute bacterial entric diseases of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis and death. Sometimes known as Asiatic orepidemic cholera Cholera was originally endemic to the Indian subcontinent, with the Ganges River likely serving as a contamination reservoir. The disease spread by trade routes (land and sea) to Russia, then to Western Europe, and from Europe to North America during the Irish immigration period. Cholera is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies, but still heavily affects populations in developing countries. Source of Infection: Vomitus and feces of infected persons and feces of convalescent or healthy carriers. Contacts may be temporary carriers. Etiologic Agent: Vibrio Cholerae/Vibrio coma 1. The organisms are slightly curved rods (coma shape), gram negative (-) and motile with a single polar flagellum. 2. The organisms survive well at ordinary temperature and can grow well in temperature ranging from 22-40 degrees centigrade.

3. They can survive well in ordinary temperature and can survive longer in refrigerated foods. 4. An enterotoxin, choleragen, is elaborated by the organism as they grow in the intestinal tract. Incubation Period: The incubation period ranges from a few hours to five days; usually one to three days. Period of Communicability: The organisms are communicable during stool positive stage, usually a few days after recovery, however occasionally the carrier may have the organism for several months. Mode of Transmission: 1. Fecal transmission passes via oral route form contaminated water, milk, and other foods. 2. The organisms are transmitted through ingestion of food or water contaminated with stool or vomitus of patient. 3. Flies, soiled hands and utensils also serve to transmit the infection. Clinical Manifestations: 1. There is an acute, profuse, watery diarrhea with no tenesmus or intestinal cramping. 2. Initially, the stool is brown and contains fecal materials, but soon becomes pale gray, rice-water in appearance with an inoffensive, slightly fishy odor. 3. Vomiting often occurs after diarrhea has been established. 4. Diarrhea causes fluid loss amounting to 1 to 30 liters per day owing to subsequent dehydration and electrolyte loss. 5. Tissue turgur is poor and eyes are sunken into the orbit. 6. The skin is cold, the fingers and toes are wrinkled, assuming the characteristic washer-momans hand. 7. Radial pulse become imperceptible and the blood pressure unobtainable. 8. Cyanosis is present. 9. The voice becomes hoarse and then, is lost, so that the patient speaks in whisper (aphonia). 10. Breathing is rapid and deep. 11. Despite marked diminished peripheral circulation, consciousness is present. 12. Patients develops oliguria and may even develop anuria. 13. Temperature could be normal at the onset of the disease but becomes subnormal in later stage especially if the patient is in shock. 14. When the patient is in deep shock, the passage of diarrhea stops. 15. Death may occur as short as four hours after onset, but usually occurs on the first or second day if not properly treated. Susceptibility, Resistance Occurrence: Susceptibility and resistance general although variable. Frank clinical attacks confer a temporary immunity which may afford some protection, for several years. Immunity artificially induced by vaccine is of variable and uncertain duration. Appears occasionally in epidemic form in the Philippines and in other parts of the world. Diagnostic Exams: Rectal Swab Darkfield or phase microcopy Stool Exam Modalities of Treatment: Treatment of cholera consist in correcting the basic abnormalities without delay restoring the circulating blood volume and blood electrolytes to normal levels. 1. Intravenous treatment is achieved by rapid intravenous infusion of alkaline saline solution containing sodium, potassium, chloride and bicarbonate ions in proportions comparable to that in water-stool.

2. Oral therapy rehydration can be completed by oral route (Oresol, Hydrites) unless contraindicated or, if the patient is not vomiting. 3. Maintenance of the volume of fluids and electrolytes to ensure rehydration. This is done by careful intake and output measurement. 4. Antibiotics 1. Tetracycline 500mg every 6 hours might be administered to adults, and 125 mg/kg body weight for children every 6 hours to 72 hours. 2. Furazolidone 100 mg for adults and 125mg/kg for children, might be given every 6 hours for 72 hours. 3. Chlorampenicol may also be given 500 mg for adults and 18 mg/kg for children every 6 hours for 72 hours. 4. Cotrimoxazole can also be administered 8mg/kg for 72 hours. Nursing Management: 1. Medical septic protective care must be provided. 2. Enteric isolation must be observed. 3. Vital signs must be recorded accurately. 4. Intake and output must be be accurately measured. 5. A thorough and careful personal hygiene must be provided. 6. Excreta must be properly disposed of. 7. Concurrent disinfection must be applied. 8. Food must be properly prepared. 9. Environmental sanitation must be observed. Prevention: 1. Food and water supply must be protected from fecal contamination. 2. Water should be boiled or chlorinated. 3. Milk should be pasteurized. 4. Sanitary disposal of human excreta is a must. 5. Sanitary supervision is important.

ACUTE BIOLOGIC CRISIS ASSESSMENT SHOCK - A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia - Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction - Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis - Thirst and dry mouth, due to fluid depletion - Cold and mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin -chest pain that occurs suddenly and continues despite rest and medication is the primary presenting symptoms. -pain may radiate to the jaw, neck, shoulders and arm, -pain may be accompanied by cool skin, pallor, clammy diaphoresis, tachycardia, and tachypnea. -symptoms of inadequate tissue perfusion -diminished cardiac output with accompanying dizziness, confusion, fatigue, exercise, or heat intolerance, cool NURSING DIAGNOSIS - Hypothermia due to decreased perfusion and evaporation of sweat IMMEDIATE MANAGEMENT - Aggressive intravenous fluids are recommended in shock -Increased OFI -Monitor VS -Monitor urine output

MYOCARDIAL INFARCTION

-Acute pain -ineffective cardiac tissue perfusion r/t reduced coronary blood flow from coronary thrombus and atherosclerotic plaque -Risk for imbalanced fluid volume resulting in impaired gas exchange

-relieve chest pain by administering medications and administering oxygen as indicated. -assess respiratory function to detect early signs of complications. -Promote adequate tissue perfusion -Reduce anxiety -monitor and manage further complications

HEART FAILURE

-activity intolerance r/t imbalance between oxygen supply and demand secondary to decreased cardiac output -fatigue secondary to heart failure -Excess fluid volume r/t

-Monitor patients response to activity. Instruct the patient to avoid prolonged bed rest -Encourage patient to perform an activity more slowly than usual -Monitor Vital signs

extremities, and oliguria -congestion of tissue -increased pulmonary venous pressure manifested by cough and shortness of breath -Dysrhythmias may indicate heart failure or may be noted as a result of the treatment for heart failure -Increased systemic venous pressure, as evidenced by generalized peripheral edema and weight gain, RESPIRATORY FAILURE & Acute respiratory distress syndrome (ARDS) -difficulty of breathing -shortness of breath -cyanosis -intercostals retractions and crackles -;labored breathing and tachypnea -arterial hypoxemia not responsive to oxygen supplementation

excess fluid and sodium intake or retention secondary to heart failure and its medical therapy -Anxiety r/t breathlessness and restlessness secondary to inadequate oxygenation

-Anxiety r/t oxygen deprivation -Impaired gas exchange r/t loss of functioning lung tissue and inadequate ventilation -risk for infection r/t microbial invasion -fatigue r/t oxygen deprivation -fear r/t air hunger and mechanical ventilation

DIABETES MELLITUS & Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

-polyuria, polydipsia, polyphagia -fatigue, weakness, sudden vision changes. Tingling or numbness in hands or feet, dry skin, sores that heal slowly, and recurrent infections -onset of type 1 diabetes may be associated with nausea, vomiting, or stomach pains. -Signs and symptoms of DKA include abdominal

-Risk for fluid volume deficit r/t polyuria and dehydration -imbalanced nutrition r/t imbalance of insulin, food and physical activity. -Deficient knowledge about diabetes self-care skills and information -anxiety r/t loss of control, misinformation r/t diabetes complications

-reduce anxiety -Manage fluid volume by administering diuretics and monitoring fluid status closely. -Control anxiety by promoting physical comfort and psychological support of the family. -Minimizing powerlessness and managing potential complications by assessing the electrolytes levels. -assure that the patient receive adequate air. -after airway management, attention must turn to correcting the underlying hypoxemia. -encourage bed rest in semi-fowler position. -Monitor VS -administered prescribed bronchodilators -prepare the client and family in mechanical ventilation -primary treatment of type 1 diabetes is insulin. - Primary treatment of type 2 diabetes is weight loss. -Exercise is important in enhancing the effectiveness of insulin -Assess for sign of DKA, including ketonuria, kussmaul respirations, orthostatic hypotension & lethargy. -Plan the diet with

THYROID CRISIS

pain, nausea, vomiting, hyperventilation, and a fruity breath odor. Untreated DKA may result in altered level of consciousness, coma and death. -Hyperpyrexia. May be extreme (>41oC) and is generally considered essential to diagnosis. Skin usually moist and warm - confusion, fits, coma, muscle weakness. Very common. Features of UMN lesions have been described as has rhabdomyolysis and sudden onset of thyrotoxic periodic paralysis - arrhythmias, cardiac failure. Decreasing pulse rate and BP with the development of shock are associated with poor prognosis - vomiting, diarrhea. Occasionally jaundice: associated with poor prognosis - hypercalaemia relatively common (15%) but rarely a problem in itself - rarely apathetic hyperthyroidism (usually elderly patients) may present in crisis with features of profound exhaustion, tachycardia, hyporeflexia, severe myopathy, marked weight loss and hypotension

-Ineffective breathing pattern r/t

glucose control as the primary goal. -Measure I and O. -Administer IVF and electrolytes as ordered. -Monitor VS to detect dehydration. -oxygen is administered to improve tissue oxygenation and meet high metabolic demands and respiratory status is monitored. -IVF containing dextrose is administered. -medications such as hydrocortisone I and iodine are administered to treat shock and decreased output of t4.

ADRENAL CRISIS

-Abdominal pain -Confusion or coma -Darkening of the skin -Dehydration -Dizziness or lightheadedness -Fatigue -Flank pain -Headache -High fever -Joint pain -Loss of appetite -Loss of consciousness -Low blood pressure -Nausea -Profound weakness -Rapid heart rate -Rapid respiratory rate -Shaking chills -Skin rash or lesions -Slow, sluggish movement -Unintentional weight loss -Unusual and excessive sweating on face or palms -Vomiting -Stage I (prodromal stage) : mood fluctuation, sleep=wake reversal, forgetfulness, commonly overlooked because of early symptoms such as disorientation and slurred speech. -Stage II (impending stage): disorientation, confusion, may be incontinent, tremor progressing to asterixis lethargy, aberrant behaviors, apraxia. -Stage III (stuporous stage): hyperventilation,

-Risk for infection -Fatigue -Activity intolerance

-close monitor of ECG changes and careful administration of alphaadrenergic blocking agents -teach the patient how to give himself injection of hydrocortisone

LIVER CIRRHOSIS & HEPATIC COMA

-Altered though process -Potential impaired skin integrity -Impaired skin integrity

-IVF administration of glucose to minimize protein breakdown -Correction of any fluid and electrolyte imbalance -promote rest, comfort and quiet environment -Administered antiinfective as indicated.

patients is stuporous but noisy abusive when aroused. -Stage IV (comatose stage): hyperactive reflexes, a positive babinskis reflex, fetor hepaticus and coma. RENAL FAILURE & End Stage Of Renal Disease (ESRD) ACUTE RENAL FAILURE: -inititaion period : initial insult and oliguria -oliguric period : uremic symptoms may appear and hyperkalemia may develop -Diuresis period: gradual increase in UO signaling beginning of glomerular filtrations recovery. Laboratory results stabilize. -Recovery period: improving renal function (may take 3 to 12 months) ESRD -cardiovascular hypotension, pitting edema 9feet, hands, sacrum) periorbital edema, pericardial friction rub, pericardial effusion, hyperkalemia, hyperlipidemia -integumentay: graybronze skin color, dry flaky skijn, severe pruritus, ecchymosis, purpura, thin brittle nails, -Pulmonary: crackles, thick tenacious sputum; depressed cough refle, pleuritic pain, SOB, tachypnea, kussmaul respirations -Fluid volume excess r/t decreased UO -Activity intolerance r/t fatigue, toxins and fluid build-up -risk for impaired skin integrity r/t edema or tissue perfusion -risk for infection r/t IV lines or catheters -Imbalanced nutrition: Less than body requirements r/t anorexia, nausea & vomiting, dietary restrictions and altered oral mucous membranes. -Deficient knowledge regarding condition and treatment regimen -Assess fluid status and help patient limit fluid intake -Blood flow is restore to the kidneys with the use of IVF, albumin or blood products transfusion -Reduce metabolic rate with bed rest -Practice universal precautions and provide skin care -implement a dietary program to ensure nutritional intake -auscultate lungs for moist and crackles -*assess for generalized edema -continually assess patient for potential complications

RH INCOMPATIBILITY

Gastrointestinal: ammonia odor to breath, metallic rtaste, mouth ulcerations, anorexia, nausea and vomiting, hiccups, constipation or diaarhea, bleeding from GI tract, -Neurologic: weakness and fatigue, confusion, inability to concentrate, disorientation, tremors, seizures, restlessness of legs, burning of soles of feet -reproductive: amenorrhea, infertility, decreased libido -Hematologic: anemia, thrombocytopenia -Yellowing of the skin and whites of the eyes (jaundice) -Low muscle tone (hypotonia) and lethargy.

-Risk for impaired skin integrity r/t inflammation of dermal- epidermal junctions secondary to jaundice and renal failure.

-Assess the skin and sclera of the patient. -Encourage early feeding and frequent breastfeeding. -Assist with phototherapy treatment.

Pregnancy Induced Hypotension (PIH)

-Rapid weight gain, 4 - 5 lbs in a single week -A rise in your blood pressure -Protein in your urine -Severe headaches -Blurry vision -Seeing spots in your eyes -Severe pain over your stomach, under your ribs -Decrease in the amount of urine Breathlessness, abdominal pain, and

-Ineffective health maintenance r/t inadequate health teachings -

-Recommend strategies that are dietary, while others involve exercise and rest. -administered medications as ordered. -Advised the patient to consult her physician regularly to monitor the fetus inside the womb. -advised to increased fluid intake and avoid salty foods.

HYDRAMNIOS

-Acute pain r/t abdominal cramps

-advised the patient to consult his physician

PSEUDOCYESIS

marked swelling or bloating, which can be signs of more severe hydramnios. Nausea, Vomiting, Amenorrhea, Enlargement of the abdomen

secondary to increased amniotic fluid

regularly -

-Hopelessness r/t prolonged caretaking responsibilities of having a child.

-to explain to the client that she is not really pregnant by the use of ultrasound or other imaging techniques.

Olivarez College Tagaytay Bachelor of Science in Nursing

10 COMMUNICABLE DISEASES And ACUTE BIOLOGIC CRISIS

In Partial Fulfillment of Requirements in NCM 104

Presented To: Dra. Anelyn Orbe Clinical Instructor

Presented By: Nikka F. Gatpandan BSN IV