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FEVER
A. Malarial risk
Classification Signs and symptoms Management
1. Primary Infection
= acute infection that causes the initial illness
2. Secondary Infection
= one caused by an opportunistic pathogen
after primary infection has weakened the body’s
defenses
3. Subclinical (Inapparent Infection)
= does not cause any noticeable illness
IMMUNITY
• ANTIBODY
ASEPSIS:
1.Medical- clean technique
2. Surgical technique- sterile technique
INFECTIOUS
DISEASE
Respiratory Diseases
Mumps ( Epidemic Parotitis);
Infectious Parotitis
• Acute contagious VIRAL disease. Characteristic feature
is swelling of one or both of the parotid glands
• RNA, Mumps virus ; paromyxovirus of the Varicella
family( found in the saliva)
• Mumps vaccine - > 1yo
• MMR – 15 mos
• Lifetime Immunity
IP: 14-25 days, usually 18 days
Incidence: 5-15 y/o, cold weather, common in men. Adults
less likely to be attacked ( If so, causes sterility)
MOT: droplet, fomites, saliva
S/sx: Pain at the angle of the jaw (Unilateral or
bilateral) PATHOGNOMONIC SIGN
parotitis, Orchitis - sterility if bilateral,
Period of communicability: 6 days before swelling ;
until 9 days after swelling subsides ( 7th – 9th day)
** highest communicability – 48 hrs after onset
of swelling
Dx: serologic testing, ELISA
Mgmt: supportive
Supporter for orchitis
Analgesics Antipyretic, cold compress, steroids
Diet : soft. Don’t give sour foods
Promotive:
Proper disposal of nasal & throat secretions
Bed rest
Preventive: MMR vaccine ( 15 mos.)
= LIFETIME IMMUNITY
Diphtheria
• CA: Corynebacterium diphtheriae, gram (+)
( Klebs Loeffler’s Bacillus)
• IP: 2-5 days
• Period of Communicability: 2-4 wks if untreated, 1-2 days
if treated
• Active (DPT) and
Passive Immunization
(Diphtheria antitoxin)
• Source: Discharges of the nose, pharynx, eyes, or lesion of
other parts of the body infected
• More severe in unimmunized and partially immunized
Notes:
• Malaria stricken mother can still breastfeed
• Chloroquine ca be given to a pregnant woman
• If there is drug resistance, give quinine SO4
-BT in anemia
-Dialysis in renal failure
-Decreased fluids in cerebral edema
-No meds to destroy sporozoites
Day biting mosquito ( they appear 2 hours after sunrise and 2 hours before sunset.
Low flying ( Tiger mosquito – white stripes, gray wings )
- Breeds on clear stagnant water
IP: 3 – 14 days; commonly 7 – 10 days
PERIOD OF COMMUNICABILITY:
• Patients are usually infective to mosquito
from a day before the febrile period to the
end of it.
• The mosquito becomes infective from day 8 to
12 after the blood meal and remains infective
all throughout life.
PATHOPHYSIOLOGY
Dengue Fever
DHF
DHF
Vector caries virus (AEDES aegypti)
Febrile phase
2-7 days
Bite host ( IP 3-10d)
Circulatory failure
Dengue progress -hypotension death
-narrow pulse pressure
,20mm Hg (shock)
DX EXAMS:
• Platelet count - ( decreased) – confirmatory test
• Hemoconcentration – an increase of at least
20% in hematocrit or steady rise in hematocrit
• Tourniquet test (Rumpel Leads test) - screening
test, done by occluding the arm veins for about 5
minutes to detect capillary fragility.
– Keep cuff inflated for 6 – 10 minutes ( child);
10-15 minutes ( adults)
– Count the petechiae formation 1 square inch (
20 petechiae/sq.in)(+)TT
CRITERIA FOR DIAGNOSIS:
(petechiae,purpura,ecchymoses,pistaxis,gum
bleeding, hematemesis, melena)
• Laboratory: thrombocytopenia </= 100,000mm3,
hemoconcentration- an increase of at least 20%
in the hematocrit or its steady rise
CLASSIFICATIONS:
GRADE 1- fever accompanied with non-specific
constitutional symptoms and the only
hemorrhagic manifestation is positive in
tourniquet test.
GRADE 2- All signs of Grade I plus spontaneous
bleeding from the nose, gums, GIT are present.
GRADE 3- presence of circulatory failure as
manifested by weak pulse, narrow pulse
pressure, hypotension, cold clammy skin and
restlessness.
GRADE 4- profound shock, undetectable blood
pressure, and pulse.
Treatment Modalities
1. Analgesic drugs other than aspirin may be required for
relief of headache, ocular pain, and myalgia.
2. Initial phase may require intravenous infusion to
prevent dehydration and replacement of plasma.
3. Blood transfusion is indicated in patient with severe
bleeding.
4. Oxygen therapy is indicated to all patients in shock.
5. Sedatives maybe needed to allay anxiety and
apprehension.
Nursing Management
a. Patient should be kept in mosquito-free
environment to avoid further transmission of
infection.
b. Keep patient at rest during bleeding episodes.
c. Vital signs must be promptly monitored.
d. For nose bleeding, maintain patient’s position in
elevated trunk, apply ice bag to the bridge of
nose and to the forehead.
e. Observe signs of shock, such as slow pulse, cold
clammy skin, prostration, and fall of blood
pressure.
Dengue hemorrhagic Fever
• PREVENTION : DOH 1995 Program
• C- hemically treated Mosquito Net
• L – arvae eating fish – Gold fish
• E – nvironmental Sanitation – 4 0’ clock habit
• A – antimosquito soap – lanzones peeling
• N – atural mosquito repellant – Neem tree ,
eucalyptus , oregano
FILARIASIS
CA: Helminths
• Wuchereria bancrofti ( african eye worm)
Only live in lymphatic system
• Brugia malayi
• Brugia timori
MOT: Bites of Aedes poecilius (night biting)
DX TEST: Nocturnal blood smear
Demonstration of microfiliaria in fresh blood obtained
between 10:00 to 2:00 am
Patient ‘s history must be taken and pattern of
inflammation and signs of lymphatic obstruction must
be observed
• Immunochromatographic test- done in the
morning
• DOC: Diethylcarbamazepine citrate (Beltrazan,
Hetrazan)
» Eliminate the larvae
» Impairing the adult worm’s ability to
reproduce
» Kill the adult worm
Filariasis ( elephantiasis )
Mosquito bites
Aedes poiculus , culex
faligans and Person infected – bitten by mosquito
anopheles flavirostris Transmitted to another person
4 STAGES
1. prodrome - fever, headache, paresthesia,
2. encephalitic – excessive motor activity,
hypersensitivity to bright light, loud noise,
hypersalivation, dilated pupils
3. brainstem dysfunction – dysphagia,
hydrophobia, apnea
4. death
Pathophysiology
Bite/wound
CNS encephalitis
ANS
Category III
Abrasion, laceration on upper Active
extremities, head and neck Passive
Dog is killed, lost, died
SNAKEBITE
Tetanic spasm
Clinical manifestations
Mgmt:
Anticonvulsant, muscle relaxants, antibiotics,
wound cleansing and debridement
Active-DPT and tetanus toxoid
Passive-TIG and TAT, placental immunity
Tetanus
Treatment:
1. Specific :
-within 72 hours after punctured wound
received ATS,TAT or TIG espicially if no previous
immunization
- Pen G to control infection
- muscle relaxant to decrease muscle rigidity.
2. Non-specific
- oxygen inhalation
anti-toxin Treatment:
• Tetanus Anti-Toxin (TAT)
Adult,children,infant 40,000 IU ½ IM,1/2 IV
Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
• TIG
Neonates 1000 IU, IV drip or IM
Adult, infant, children 3000 IU, IV drip or IM
Pre exposure prophylaxis
• DPT- 0.5 ml IM
1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
1st booster – 18 mos
2nd booster – 4-6 yo
subsequent booster – every 10 yrs thereafter
• TT – 0.5 ml IM
TT1 6 months within preg
TT2 one month after TT1
TT3 to TT5 every succeeding preg or every year
Antimicrobial Therapy
Penicillin !-3 mil units q 4hours
Pedia 500000 – 2mil units q 4 hrs
Neonatal 200000 units IVP q 12hrs or
q8hrs
3 types of patients w/ skin wounds
post exposure prophylaxis
Eruptive fever
• MANAGEMENT
1. Supportive
2. Hydration
3. Proper nutrition
4. Vitamin A
5. Antibiotics – if w/
secondary bacterial
infection
6. Vaccine- measles
vaccine @ 9 mos and
MMR @ 15 mos
7. Anti viral drugs
( Isoprenosine)
Observe respiratory
Isolation
Nursing Care
• Isolation of the patient if necessary
• TSB for fever
• Skin care is of utmost importance. The pt.
should have a daily cleansing bed bath.
• Oral & nasal hygiene is a very important aspect
of nursing care of patients with measles
• Restrict to quiet environment
• Dim light if photophobia is present; care of the
eyes is necessary
• Administer antipyretic
• Use cool mist vaporizer for cough
German Measles, Rubella, Rotheln
Disease, 3 Day Measles
• = contagious viral disease characterized by fever,
URTI, arthralgia, DIFFUSED fine red maculopapular
rash)
• CA - RNA, rubella virus ( Togaviridae)
• Immunity: Active natural ( permanent or lifetime)
• Active immunity - rubella vaccine and MMR
• Passive immunity - gammaglobulin
• Period of communicability – contagious 7 days
before & 7 days after appearance of rash & probably
during the catarrhal stage
German Measles, Rubella, Rotheln Disease,
3 Day Measles
** Highly
communicable infant may shed virus
for months after birth**
Rashes: Maculopapular,
Diffuse/not confluent,
No desquamation,
spreads from the face
downwards
Clinical Manifestations:
> FORSCHEIMER’S SPOTS (petecchial lesion on
buccal cavity or soft palate)
> oval, rose red papule about the size of pin head
> cervical lymphadenopathy,
> low grade fever
Dx: clinical
CX: rare; pneumonia, meningoencephalitis
CX to pregnant women:
• 1st tri-congenital anomalies ( microcephaly, heart
defects, cataracts, deafness
• 2nd tri-abortion or bleeding
• 3rd tri-pre mature delivery
Nursing Considerations:
• MMR immunization
• Use of immunoglobulins ( IG’s)- ppost
exposure prophylaxis – 72 hrs after exxposure
• Prevention of congenital measles
• Avoid exposure
Roseola Infantum,
Exanthem Subitum, Sixth disease
• Human herpes virus 6
• 3mos-4 yo, peak 6-24 mos
MOT: probably respiratory secretions
Bloodstream
Bloodstream
Gallbladder
Parasitism
INTESTINAL PARASITISM
• are parasites that populate the gastro-
intestinal tract.
• MOT : they are often spread by poor hygiene
related to feces
– contact with animals, or poorly cooked food
containing parasites.
• Two main types of intestinal parasites:
– A. Helminths
• Tapeworms, pinworms, and roundworms are among
the most common helminths
– B. Protozoa.
Cause of intestinal Parasitism
• high risk for getting intestinal parasites:
– Living in or visiting an area known to have
parasites
– Poor sanitation (for both food and water)
– Poor hygiene
– Age -- children are more likely to get infected
– Exposure to child and institutional care centers
INTESTINAL PARASITISM
• Some asymptomatic
• S/SX:
– Diarrhea
– Nausea or vomiting
– Gas or bloating
– Dysentery (loose stools containing blood and mucus)
– Rash or itching around the rectum or vulva
– Stomach pain or tenderness
– Feeling tired
– Weight loss
– Passing a worm in your stool
– Anemia
• Fecal testing (stool exam) can identify both
helminths and protozoa..
• 1. Trophozoites/vegetative form
– Trophozoites are facultative parasites that may
invade the tissues or may be found in the parasites
tissues and liquid colonic contents.
2. Cyst
a. Cyst is passed out with formed or semi-formed
stools and are resistant to environmental conditions.
b. This is considered as the infective stage in the life
cycle of E. histolytica
Pathology
When the cyst is swallowed, it passes through the
stomach unharmed and shows no activity while in an
acidic environment. When it reaches the alkaline
medium of the intestine, the metacyst begins to move
within the cyst wall, which rapidly weakens and tears.
The quadrinucleate amoeba emerges and divides into
amebulas that are swept down into the cecum. This is
the first opportunity of the organism to colonize, and its
success depends on one or more metacystic
trophozoites making contact with the mucosa.
Mature cyst in the large intestines leaves the
host in great numbers (the host remains
asymptomatic). The cyst can remain viable
and infective in moist and cool environment
for at least 12 days, and in water for 30 days.
The cysts are resistant to levels of chlorine
normally used for water purification. They are
rapidly killed by desiccation, and
temperatures below 5 and above 40 degrees.
MOT: Ingestion of cysts from fecally
contaminated sources (Oral fecal route)
oral and anal sexual practices
• Extraintestinal amoebiasis- genitalia, spleen,
liver, anal, lungs and meninges
lifecycle
s/sx: Blood streaked, watery mucoid diarrhea,
abdominal cramps
Dx: microscopic stool exam - trophozoites
• Pd of Communicability: the microorganism is
communicable for the entire duration of the illness
Mgmt:
• Tetracycline 250 mg every 6 hours
• Ampicillin, Quinolones, sulfadiazine
• Metronidazole (Flagyl) 800 mg TID x 5 days
• Strptomycin SO4, Chloramphenicol
• F&E balance
Nsg. Mx
• Observe isolation & enteric precaution
• Provide health education & 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 defecation or before eating
– Avoid ground vegetables ( lettuce, carrots, etc)
Prevention:
• Health education
• Sanitary disposal of feces
• Protect, chlorinate & purify drinking water
• Observe scrupulous cleanliness in food
preparation & food handling
• Detection & tx of carriers
• Fly control ( they can serve as vectors)
GENITO-URINARY CD
GONORRHEA
Other names: GC, Clap. Drip
CA: Neisseria gonorrhoeae
MOT: sexual intercourse with infected partner
DX TEST: culture and sensitivity of urethral
discharge
S/SX:
Male- yellowish, thick purulent urethral
discharge; burning sensation upon urination
Female- 80% asymptomatic
COMPLICATION:
sterility, Disseminated
gonococcal infection
(DGI), PID
TREATMENT:
DOC: Penicillin,
Amoxycillin,
Doxycycline Disseminated gonococcal
infection
CHLAMYDIA
CA: Chlamydia trachomatis
MOT: sexual contact; infants during vaginal delivery
of an infected mother
DX TEST: Culture and sensitivity test of the
discharge
S/SX: MALES- discharge from penis; burning and
itching of urethral opening; burning sensation
during urination
FEMALES- slight vaginal discharge; itching and
burning of vagina; painful intercourse
TREATMENT: Azithromycin, doxycycline
TRICHOMONIASIS
CA: Protozoa- Trichomonas vaginalis
MOT: Direct sexual contact
DX TEST: examination of vaginal secretion by
wet slide treated with Potassium hydroxide
S/SX: initially asymptomatic-malodorous
discharge
TREATMENT:
DOC- Metronidazole
CANDIDIASIS/MONILIASIS
CA: Candida albicans
MOT: sexual contact; prolonged use of broad
spectrum antibiotics
DX TEST: clinical picture
S/SX: creamy, cheese-like vaginal discharge,
itchiness, redness at the vulva
DOC: Nystatin
Health teachings: Swab nystatin on the oral mucosa
of an infant with thrush
Instruct pt. to swish nystatin solution around his
mouth for several minutes before swallowing
Gonorrhea
(Clap/Flores Blancas/Gleet)
- sexually transmitted bacterial disease
involving the mucosal lining of the genito-
urinary tract, the rectum, and pharynx.
HIV
Antibodies
Lymphocytes, macrophages,
Langerhans & neurons