Communicable Diseases
• Communicable disease are most often the leading cause
of illness in our country today
• Knowing what type of communicable disease could
prevent a health care provider from acquiring or
harboring the disease
COMMON TERMS
• Epidemiology – science that study the patterns of
health and disease, its occurrence & distribution for the
prevention and control of disease.
• Sporadic – occasional or intermittent occurrence of
disease with no specific pattern
• Endemic - constant or continuous occurrence of disease
• Epidemic – sudden increase in # of cases in short
period of time, an outbreak
• Pandemic – worldwide epidemic
• Attack rate
• is the number of cases developing in a group
people who were exposed to the infectious
agent
• Morbidity rate
• calculated as the number of cases of illness
given time period divided by the population at
risk.
• Mortality rate
• the percentage of population that dies from
disease
• incidence
• described as the number new cases in a
specific time period in a given population risk
• way of measuring the risk of an individual
contracting the disease
• Prevalence
• reflects the number of total existing cases (both
old and new)
• useful to assess the overall impact of the
diseases on society
• Outbreak
• generally implies a cluster of cases occurring
during a brief time interval and affecting a
specific population
The Infectious Process
• For an infection to occur a process involving six links or
steps must be present
• A. if any of the links are missing, the infection will not
occur
• B. Infection control measures can interrupt the process
by eliminating one or more of the steps.
INFECTIOUS DISEASE PROCESS or CHAIN OF INFECTION
• Infectious Agent
• Reservior
• Portal of Exit
• Route of Transmission of MO
• Portal of Entry
• Susceptible Host
Six links form the chain of infection
1. Infectious agent (Microorganism): Bacteria, virus, fungi, etc.
• A. Capability of producing an infection depends on:
• i. Virulence and number of organisms present
• ii. Susceptibility of the host.
• iii. Existence of portal of entry
• iv. Affinity of host to harbor MO
2. Reservoir: Provide survival for organism
• People, equipment, water, etc.
• A. Appropriate environment for growth and multiplication
of microorganism must be present.
• B. Reservoir include respiratory, gastrointestinal,
reproductive and urinary tracts, and the blood
3. Portal of exit
• Allows the microorganism to move from reservoir to host
( includes excretions, secretions, skin, droplets)
4. Route of transmission of MO (five routes)
• Types of transmission of pathogens:
– Horizontal transmission
• from one person to another through
contact, ingestion of food or water, or
via a living agent such as insect.
– Vertical transmission
• from a pregnant woman to fetus, or
from a mother to her infant during
childbirth
• Three Primary routes (Contact, droplet and airborne)
• Two lesser routes ( Vehicle and vector)
Primary Routes
• A. Contact- most frequent source of nosocomial infection
• 1. Direct contact- transmission body to body and physical
transmisssion (sexual intercourse, kissing or touching)
• 2. Indirect contact- contact with contaminated
intermediate object ( needle, dressing or dirty hands)
• B. Droplet- transmission of large particle droplets ( larger
the 5 microns) Diphtheria, pertusis, pnuemonia, etc.
• C. Airborne- transmission of small particle droplets or
residue of 5 microns ( measles, varicella, TB)
Two lesser routes
• Common Vehicle: transmission by contaminated items
such as food, water or devices.
• Vector borne: Mosquitoes, fleas, rats, etc.
5. Portal of entry
• Mucous membrane, gastrointestinal (GI) tract,
Genitourinary (GU) tract, Respiratory tract, Nonintact
skin
6. Susceptibility of the host
• A host who is immunosuppressed, fatigue,
malnourished, weakened by other diseases, elderly,
stressed, or hospitalized with wounds, IV’s and catheters
are at high risk.
TRIAD OF DISEASE CAUSATION –
Epidemiologic Triad
1. Host (suscepibility)
- intrinsic or extrinsic characteristics
2. Agent
3. Environment
- Medium for culture of MO and MOT
Characteristics of an Agent
• Infectious dose – number of causative agent
• Pathogenecity – ability to cause the disease
• Virulence / Potency – extent/severity of toxin quality
• Antigenecity – ability to stimulate an anti-body response
Viruses
• can only multiply in living things as its reservoir
• can pass through the filters of the body, Blood
Brain Barrier & Placenta Barrier
• self limiting
• lasts for a specific length of time with or without
treatment,
 • patients are treated according to the symptoms
• it’s the body’s own resistance that will fight the
infection
• Bacteria
• can multiply in both living and non-living things
• can not pass through the filters of the body
except for Treponema Palladium causing
Syphilis which passes the placental barrier after
the 16th week (4th month of pregnancy)
• INFECTIOUS DISEASES – disease caused by living MO
which may not be transmitted through ordinary contact.
• CONTAGIOUS DISEASES – are diseases that can be
easily transmitted.
• All communicable diseases are infectious but not all are
easily transmitted
• All infectious diseases are communicable but not all are
contagious
• All contagious diseases are both communicable and
infectious
Stages of Communicable Disease
• Communicabilty period- entry of MO
• Incubation period – time interval from the 1st exposure
from disease to appearance of the 1st s/sx.
• Prodromal – time interval from the 1st s/sx to
appearance of the characteristics sx of the disease.
• Stages of Illness – period when the characteristic sx of
the disease are manifested by patient and others.
• Convalescence – period of recovery, s/sx are gradually
disappearing
3 Nursing Concerns in Dealing with a Patient with
Communicable Disease
• Know the causative agent
• Know what body secretions harbour the MO
• Know the mode of transmission
General nursing Care for Patients with Communicable
Diseases
• Preventive Aspect
– Health education
– Immunization
– Environmental control
– Proper Supervision of Food Handlers
– Control Aspect
– Isolation
– Quarantine
– Disenfection
– Medical asepsis
I. Preventive aspect
A. Health Education
Goal: The person will have a change of KSA which eventually TB – BCG, DPT – DPT vaccine, Poliomyelitis – OPV,
lead to a change in behaviour towards health or do some Hepatitis B , Measles
modification of behaviour.
4 Temporary Contraindications for Immunization
-doctor is the primary giver of health education (main
responsibility) • pregnancy
-nurse is the key provider of information • immunocompromised
B. Immunity/ Immunization • very severe disease
• Immunity - state of being resistant to infection or a state • recently received blood products
of being free from infection
2 Permanent Contraindications for Immunization
• Immunization – the process of rendering immunity to an
individual • Allergy
2 types of Immunity
• encephalopathy without known cause or convulsions
within 7 days after pertussis vaccine
1. Active immunization occurs when a person’s own immune
system is activated and generates a primary immune response. C. Environmental Sanitation
a. Natural Acquired Active Immunity – the body 1. PD 856 – integrated all those working in night clubs
will contracts the disease and recovers and beer gardens to submit themselves for STD exams at least
once a month and for gonorrhea at least twice a month.
b. Artificial Acquired Active Immunity- chemically
killed bacteria, weakened forms 2. PD 825 – anti-littering law or proper disposal of
garbage
- vaccine, toxoid
Fine: P2,000-5,000 or 6 months-1year imprisonment
2. Passive immunization - receives antibodies that were created in
D. Proper Supervision of Food Handlers
another person or animal.
1. DOH responsibility
a. Naturally Acquired Passive Immunity – maternal transfer of
antibodies (IgG/IgA)
2. BFAD – monitor food and drugs for safe consumption
b. Artificially Acquire Passive Immunity – intentionally given for
• II. Control Aspect – there is already infection but control
immediate protection from infection (ex: human immunoglobulin,
human serum, anti-toxin, anti-tetanus) or limit the spread of infection
3 Laws of Immunization: • A. Isolation - separation of the infected person
based on the longest period of communicability of the
1. Expanded Program on Immunization (EPI) – PD #996
disease.
2. UN Goal: Universal Child Immunization (UCI) –
Proclamation #6
• Strict isolation – protecting other person by containing
the MO within the patient
3. Health for Filipino CY 2000: National Immunization
Day (NID) – Proclamation #46
Goal: To prevent the 7 Childhood Diseases for children
under 5 years old
 • Reverse Isolation – protecting the patient
wherein MO will be away from the patient
2 Revised Isolation Precaution to be practiced
1. Standard Precaution
2. Transmission Based Precaution
1. Standard Precaution – the primary strategy for preventing
nosocomial infection
• applies to all pts regardless of their dx
• applies to all body fluids, secretions and excretions
except sweat
• applies to non intact skin and mucous membrane
Elements of Standard Precaution
CDC
Centers for Disease Control and Prevention
• Handwashing
• Wear gloves if there is a possibility of direct contact with
blood or bodily secretions
• Gloves must be worn when in contact with items or
surfaces soiled with blood or body fluids
• Removal of false fingernails
• Protect clothing with gowns or plastic aprons if there is
possibility of being splashed or direct contact with
contaminated material
• Wear mask and/or goggles or face shields to avoid being
splashed, suctioning, irrigations, during OR and
deliveries
• Do not break needles into receptacles; rather discard
them intact and uncapped into containers
• 2. Transmission Based Precaution – is instituted to
patients with highly transmissible infections. Precautions
are beyond the set for the standard precautions.
3 Ways to Practice Transmission Based Precaution:
• Airborne Precaution – use of respiratory protection such
as use of special types of mask = ultra filter mask or
particulate mask
• Droplet Precaution – use ordinary mask and goggles
• Contact Precaution – use of gloves and gowns
• B. Quarantine – limitation of freedom of movement of a
well person during the longest incubation period;
- quarantine of person with no disease but were
exposed.
• C. Disinfection – killing/destruction of pathogen by
mechanical or chemical
2 Ways of Attaining Disinfection:
• Concurrent – done when a person is still the
source of infection
• Terminal – done when the patient is no longer the source
of infection
• Sterilization - killing of all MO including spores
• Disinfestation - destruction of MO, insects, rodents or
animals that are living in the human habitat that can
transmit disease to man.
• Fumigation – killing of arthropods and rodents using
gaseous agents
D. Medical Asepsis
• Hand washing – the no. 1 principle
• Use of protective barrier (PPE)
• Placarding – no smoking sign
Integumentary System
Measles
-aka RUBEOLA, Morbilli, Little Red Disease, 7 day measles, 9
day measles, Hard measles of First Disease
– death is usually due to complications (pneumonia)
– affects children < 2y/o, malnourished
CA: Paramyxovirus – rubeola virus
MOT: Droplet spread or direct contact in some instances it is
Airborne
Incubation period- 10 days from exposure
1. Pre-eruptive Stage – highly contagious stage
- high grade fever – 3-4 days
- 3 C’s – cough, colds, conjunctivitis
- (+)Stimson sign / measle eye – puffiness of
the eyelid with linear congestion of the lower conjunctiva
- Photosensitivity
- (+) enathem, fine red spot (grayish pecks) at the center
found in the inner cheek just opposite the molars
- (Koplik’s spot) –pathognomonic
2. Eruptive Stage
– Rashes appear on the 3rd day - maculopapular,
reddish, and blochy
– cephalo-caudal in distribution
3. Post-eruptive Stage
– fine, branny desquamation – peeling off
from red color rashes, it will fade to brown then peel off excluding
skin
 Preventive Measures • Rubella Titer test – to determine the titer of
antibodies to german measles
• Avoid MOT
• If given to women who wants to bear a child à
• Immunization with Anti-measles vaccine (AMV) – 9 wait for 3 months
months old, 0.5cc SQ deltoid muscle
Treatment
– child may experience fever, mild rash formation
3-4 days after • Medical and Nursing treatment : Supportive care

– allergy to eggs and neomycin → anaphylaxis • Immunity: Gives permanent immunity

– don’t get pregnant within 3 month Preventive Measures

• proper disposal of nasopharyngeal secretions • Avoid MOT

• covering of mouth and nose when sneezing and • Immunization: MMR

coughing
• It is communicable during the entire course of the
German Measles disease = 3 days
• aka Rubella, 3 day disease
• Not fatal but could be fatal on a pregnant woman- it
affects fetal growth
• CA: Pseudoparamyxovirus = Rubella or Togavirus
4 Possible Major Congenital Anomaly
• MOT: Droplet, direct,

3 Stages of German Measles: • Microcephaly

• Diagnostic Examination: by clinical observation and 1. Pre-eruptive Stage • Congenital Cataract

physical examination
– presence or absence of fever, if (+) 1-2 days • CHD – Tetralogy of Fallot
• Medical Management: symptomatic – viral infection
– mild cough or mild colds • Deafness and Mutism
– Vit A – to prevent xeropthalmia
Eruptive Stage • If pregnant and exposed to german measles, give
– antibiotic gamma globulin 1 amp within 72 hours – gives
• (+) enanthem– seen at the soft palate, maculopapular, temporary immunity
Nursing Care pinkish or reddish, discrete or finer to look at
Chicken Pox
• strict isolation
• (Forsheimer’s spot) - pathognomonic
• increase or maintain body resistance • aka varicella
• Cephalocaudal
• keep patient warm and dry • CA: Varicella zoster virus
• Lymphadenopathy
• hygienic measures – eye care, ear care, oral care, skin • MOT: Airborne, direct contact, droplet
care • 3. Post-Eruptive Stage – occurs after 24 hours where
rashes starts to disappear and enlarge lymph nodes • Duration of sickness: 2 weeks
• Immunity : Gives permanent immunity subsides
3 Stages Chicken Pox
• It is highly contagious during 4 days before the • Laboratory Exam
appearance of rashes and 5 days after the appearance 1. Pre-Eruptive - (+) or (-) of low grade fever, body malaise, musle
of rashes pain, HA lasting for 24-48 hours
2. Eruptive Stage  Immunization using Varicella vaccine (Viravax) given 12 • B- Bactericidal ---decrease chance of skin infection
months old, 0.5cc SQ deltoid
 begins as a macule, 5-10 crops → papule • Oxidizing ---deodorizes the rashes
→vesicle → pastule  If <13 y/o – single dose ; if > 13y/o – 2 doses, 1 month
interval • analgesic for pain
 rashes are classified as vesiculo-pastular
 Proper disposal of nasopharyngeal secretions
• Zovirax can also be given
 rashes have generalized distribution all over the
body (trunk and scalp 1st)  Cover mouth and nose when sneezing and coughing
• Nursing Care and Preventive Measures: same as
Herpes Zoster Chicken pox
 contagious from the time rashes appear until
the last rash have dried or crusted Nervous System
• aka SHINGLES, Zona, Acute Posterior Ganglionitis
 centrifugal in spread of rash Tetanus
• adults are usually affected
3. Post-Eruptive Stage – rashes starts to dry/crust and peel off by • aka Lock Jaw
itself • CA: inactive or dormant type of chicken pox

• MOT: Airborne or droplet

• CA: Clostridium tetani – anaerobic, non-motile, spore-
forming
• Duration of Illness – 2 weeks
• Normal habitat: intestines of plant eating animal
Signs and Symtoms
• Break in the skin
• (+) vesiculo-papular rashes- painful rather than itchy bec
it affects nerve endings and that pain persists within 2
• MO stays in the wound à releases toxins à travel to the
blood à produces s/sx
months even if patient had recovered.

Management • unilateral distribution of rashes • New born – umbilical cord (tetanus

neonatorum)
 Diagnostic Examination: by clinical observation and • period of communicability is the same as chicken pox
physical examination when all rashes have dried • Children – dental caries

 Medical: • Adult – any king of wound

 treated symptomatically • Toxins released by MO are:

 Anti-viral agent – Zovirax (Acyclovir) • Tetanolysin – dissolves RBC causing anemia

 Anti-histamine • Tetanoplasmin – brings about the muscle spasm

affecting the myonueral junction and internuncial fibers of
 Nursing Care the brain

 skin care to prevent infection • Immunity: No permanent immunity

Management
 increase resistance and adequate rest and s/Sx:
• Diagnostic Examination: Clinical observations and
nutrition to prevent encephalitis physical examination
– Trismus – lock jaw
 Immunity: Gives permanent immunity
• Potassium Permanganate (KMNO4) with 3 Fold EffectS:
– Risus sardonicus- sarcastic smile
 Avoid MOT
• A- Astringent ---dries rashes
– Opisthotonus- arching of the back
 – Intermittent muscle spasm ,(+) boardlike rigidity
on the abdomen
– Extension of the extremities (gastrocnemius)
– Diaphoresis
– Low grade fever
– Type of contraction: tonic
3 Objectives in Nursing Management of tetanus:
1. To prevent pt from having spasm –
 Exteroceptive stimuli – coming from external/outside
environment
 Interoceptive stimuli – coming from within the pt., fatigue,
stress
 Proprioceptive stimuli – there is participation of pt and
another person
 Isolation is to prevent exposing pt to the stimuli despite
being not communicable.
 2. To prevent pt from having injury
 a.Respiratory injury
 1. Prevent airway obstruction - padded tongue
depressor, O2 administration – cyanosis
during spasm
 2. Prevent respiratory infection
 3. Prevent respiratory aspiration
 •
 b. Fracture – due to restraining when having
spasm
 3. To provide comfort measures
 - provide dark, quiet room – prevent stimuli
 - Proper wound care
 Avioid MOT
 Immunization
 DPT 6 weeks after birth for 3 doses at 1 month interval • Inclusion bodies develop called Negri Bodies -
(0.5ml VL) pathognomonic
 Health teaching: fever, swelling and • MOT: Contact with saliva of a rabid animal, scratching,
tenderness, signs of convulsions w/in 7 days licking of wound by dogs
 Tetanus Toxoid given to pregnant women on the 2nd tri- • Incubation Period: animals = 3-8 weeks; humans = 10
mester of pregnancy, 2 doses days-years
 Tetanus Toxoid given for persons in high risk to tetanus 2 Stages of Manifestations in Animals
1. Dumb Stage - depressive stage, manic behaviour
2. Furious Stage – agitated, fierceful, drooling of saliva → will die.
3 Stages of Manifestation in Human
1. Invasive Stage – virus is transferred through saliva by direct or
indirect contact
• S/Sx:
Rabies
• numbness on site, sore throat, marked insomia,
• aka Hydrophobia and Lyssa restlessness, irritable & apprehensive
• disease of low form of animal that is accidentally • flu-like symptoms, slight photosensitivity
transmitted to man through animal bites
2. Excitement Stage – patient is confined in the hospital
• An acute form of encephalitis
• S/Sx:
• CA: Neurotropic virus
• aerophobia and hydrophobia
Rhabdovirus – transferred from animal to man
• drooling of saliva and spitting
2 Pathways for Virus to Travel:
• photosensitive
Rhabdovirus
• maniacal behaviour
↓
Management: Haloperidol with Benadryl
Peripheral Nerves
• 3. Paralytic Stage – when spasm is no longer observed
↓
because paralysis sets in and within 24-72 hours →
CNS
patient dies.
↓
Diagnostic Examinations:
Efferent nerves
• Brain Biopsy of Animal
↓
• Direct Flourescent Antibody Test (DFAT)
Salivary glands and to other organs
• Observation of animal for 10 days
 • Factors to consider in observing the animal:
• Site of the bite
• Extent of the bite
• Reason for the bite
Medical Management
1. Vaccine – post exposure prophylaxis only
• Active form of Vaccine
a. Purified Duck Embryo Vaccine (PDEV) – Lyssavac
b. Purified Vero Cell Vaccine (PVCV) – Verorab
with in 24 hours
c. Purified Chick Embryo Cell Vaccine – (PCEV)
• 2 Ways of Administration: IM or ID
• Passive form of Vaccine
a. Equine Rabies Immunoglobulin (ERIg) – from animal
serum
b. Human rabies Immunoglobulin – human serum
Nursing Care
• Wash wound with running water
• Seek consultattion asap.
• Place patient in dim and quiet room
• Room of patient should be away from sub-utility room
• Wear complete protective barriers when entering the
room
Preventive Measures:
• Keep away from stray dogs
• Keep animal caged or chained
• If bitten – wash with soap and running water, use strong
antiseptic solution and observe the dog
Meningitis
• inflammation of the meninges • AbN reflexes – (+) kernig’s sign, (+)
brudzinki’s sign (pathognomonic sign)
• CA:
• ↓
Viruses – CytoMegaloVirus – viral meningitis
• Incresed ICP -----CsF in subarachnoid space
Fungus – Cryptococccal meningitis
• ↓
Bacteria – common cause
• severe HA
TB meningitis, streptococcal meningitis, hemophilus
influenza B • projectile vomiting
Meningococcal Meningits
Spotted fever / Meningococcemia • altered VS:increase temp, decrease PR, decrease RR,
increase systolic but N diastolic
• highly fatal and highly contagious type of meningitis
• convulsions
• vascular system is affected resulting to vascular collapse
(DIC) • diplopia – optic nerve/disc
• Waterhouse Friedrichsen Syndrome – caused by • tinnitus, difficulty of hearing/deafness, loss of balance,
vertigo
massive invasion of blood by meningococcus infection
resulting in organ failure, coma or even death, unless
effective antibiotic or tx is quickly rendered • altered LOC
• Rifampicin 450 mg once/day x 3 days • Others/sx: anorexia, gen body malaise and loss of
apetite
• Ciprobay 500 mg once/day x 3 days
Diagnostic exams:
• CA: Neisseria Meningitides • Lumbar Puncture (L3 & L4) – tap or aspirate CSF to
• Incubation Period: 2-10 days a. Color: yellowish, turbid/cloudy
• Portal of Entry: Respiratory system via the nasopharynx b. increased CHON, increased WBC, decreased sugar
• Neisseria Meningitides à Nasopharynx à Blood stream c. C & S – to determine CA and specific drug to kill the
MO
•
↓ d. Counter Immuno Electrophoresis (CIE) – if clear CSF
either viral or protozoa
• Vascular changes (petechiae,
echymossis)
• Blood culture – done if lumbar puncture cant be done
yet bec MO travels to the blood stream
• ↓
• Antimicrobial drugs
• Meningeal irritation manifested by: a. Viral – supportive
• nuchal rigidity/stiffneck (1 sign of
st
b. Fungus – antifungal
meningitis)
c. Bacteria – antibiotic
 • Corticosteriods – Dexamethasone or Solu-Cortef Stages of Poliomyelitis:

• Mannitol - osmotic diuretic, removes CSF • Invasive or Abortive –stage when virus invades the host

- monitor I/O, assess effectiveness of - flu-like sx, non-specific

drug
• Non-paralytic – slight CNS involvement
- assess hydration
- hump temp curve
• Anticonvulsant drug – Phenytoin (Dilantin) - (+) Poker spine - stiffness of the back (opisthotonus)
with head retraction
• Symptomatic and supportive
- spasm of the hamstrings
• if phenytoin is given IV, it should be sandwich with NSS
(NSS-Dilanti-NSS) à can cause crystallization when - hypersensitivity of the skin (hyperparesthesia)
mixed with CSF Diagnostic Exams:
- (+) babinski reflex,
• if per orem, do oral care and gum massage à gingival • Lumbar Puncture Test – Pandy’s Test – increased
hyperplasia Paralytic Stage – severe CNS involvement CHON, increased WBC, N sugar

• Preventive Measures: Proper disposal of nasal
secretions, covering of mouth and nose, avoid MOT
• Immunity: No permanent immunity
Poliomyelitis
• aka Infantile Paralysis or Heine-Medin’s dse
• high risk – below 10y/o
• CA: Legio Debilitans virus
Type 1 – Brunhilde – common in the Phil.
Type 2 – Lansing
Type 3 – Leon
• Early Stage: Nasopharyngeal secretions
MOT: droplet
- flaccid (soft, flabby and limp) paralysis – • Muscle testing – test for threshold for pain
pathognomonic sign
• EMG
4 Types
• Stool exam – (+) all throughout the process
• Bulbar – CN9 (glossopharyngeal) and 10th (vagus)
affectation • Throat swab – maybe (+) in 2 weeks of the dse course
- swallowing, vocal cord and respiratory • Supportive and Symptomatic
paralysis
• Preventive Measurement:
• Spinal – c0mmon type, AHC affectation
1. Immunization: OPV – Sabin Vaccine, given 6 weeks after birth
- paralysis of U/L extremities – uni or bilateral
Instructions to mothers:
- intercostal muscle paralysis
a. Don’t feed child 30 mins before administration
• Bulbo-spinal – CN and AHC are both affected
b. If vomiting occurs, repeat dose
• Landry’s – ascending paralysis (quadriplegia)
c. Be careful in handling the stool of the child who had
received OPV

Port of Entry: respiratory system by d. for immunocompromised – give Inactivated Polio

nasopharynx Vaccine (IPV-Salk Vaccine) – 0.5 cc IM, VL in 3
doses at one month interval

2. Avoid MOT
• Late Stage: found in stool

MOT: fecal-oral route

Portal of entry: digestive system by mouth

Circulatory System a. fever – 3-5 days • Release the cuff, check and count the petechial
formation per one square inch (>20 petechial formation =
Dengue b. HA; periorbital, abdominal, joint and bone pains (+) tourniquet test

• CA: Arbovirus-Dengue virus c. N/V • Platelet Count - ↓ in DHF – definitive test

West Nile virus d. pathological vascular changes: petechiae and • Hematocrit (Hct) determination - ↑ in DHF due to
Herman sign (generalized flusing/redness of the skin hemoconcentration
Flavivirus
e. diagnosed as Dengue Fever or Dandy Fever or • Symptomatic treatment
• MOT: biological transmitter – Aedes Aegypti Breakbone Fever
• Antipyretic – but never give Acetyl Salicylic or Aspirin
mechanical transmitter – Celux fatigan • Grade 2 (ASA)

• day biting and low flying mosquito a. persistence of s/sx of Grade 1 + Bleeding • Reye’s Syndrome – a neurologic d/o associated with
viral infection (<12y/o)
• breed in clear stagnant water
b. bleeding from: 1. nose – epistaxis • Vit K (Aquamephyton, Phytomenadion, Synkavit and
• urban area Konakion)
• white stripes on legs, gray wings 2. gum - gum bleeding
• Vit C
3. stomach -
• Blood Transfusion
Mosquito (Aedes Aegypti) 4. hematemesis, melena,
hematochezia • 1. To prevent and control bleeding
↓
• Grade 3 a. Epistaxis
Bloodstream
a. persistence of s/sx of Grade 2 + Circulatory Failure b. Gum Bleeding
↓
b. cold clammy skin c. Hematemesis
Creates multiple lesions in the bloodstream
c. check for capillary refill d. Melena
----------------------------------------------------
d. hypotension, very rapid weak pulse and rapid • Supportive & Symptomatic
↓ respiration
• Increase body resistance – proper nutrition and
↓
• Grade 4 adequate rest
↑ capillary fragility ↑ capillary permeability
a. persistence of s/sx of Grade 3 + Hypovolemic Shock • Preventive Measures:
( easily bleeds ) (allows shifting of fluid fr 1 → Death
CLEAN Program of DOH
comp to another)
• Torniquet Test or Rumpel Leede Test - presumptive
C- hemically treated mosquito net
↓
↓ • Test for capillary fragility
L- arva eating fish
Thrombocytopenia edema, ascites, and • 3 Criteria before performing Torniquet test
E- nvironmental Sanitation
hemoconcentration
1. 6 months or older
A- nti mosquito soap/off lotion
2. fever > 3 days
N- atural mosquito repelant trees
• Grade 1
3. (-) signs of DHF- fever of 3 days
 • Immunity: No permanent immunity ---------------------------------- Tuberculosis

↓ • aka Kokh’s Infection, Phthisis, PTB, Galloping

↓ Consumption
Malaria
RBC is penetrated • CA: Acid Fast Bacilli - M. Tuberculosis, M. Bovis, M.
• aka AGUE Liver Avium/Avis
• king of tropical diseases manifested by indefinite period (MO reproduce) (MO stay for 3-5years) • MOT:
of fever and chills
↓ 1. Airborne and droplet
• CA: Protozoa – Plasmodium,
RBC 2. Ingestion of infected milk of cows
1. Plasmodium Vivax
Nursing Care: 3. Blood – TB meningitis, TB of bones, TB of the spine
2. Plasmodium Falciparum – most fatal
• Cold Stage – shaking of body & chattering of lips (10- • Incubation Period: 1-2 months (4-8 weeks)
3. Plasmodium Malariae 15mins)

4. Plasmodium Ovale • Hot Stage – fever, chills, vomiting, abdominal pain (4-6 • S/Sx:
hours)
- Only female mosquitoes suck blood 1. low grade fever with night sweats
Nursing Care:
- P. Vivax and P. Falciparum – common causes of 2. anorexia and weight loss
• Wet Stage – profuse sweating, feeling of weakness
malaria in the Phils. 3. fatigability
Nursing Care: Make patient comfortable
• MOT: mosquito bite, blood transfusion 4. chest pain and dyspnea
Keep patient warm
5. dry cough à productive (yellowish/greenish) à
• Night biting from dusk til dawn
blood streak sputum/hemoptysis – pathognomonic sign
Increase fluid intake
6. back and epigastric pain
• Cerebral Hypoxia – caused by P. falciparum causes
• Breeds in a clear slow flowing water anemia 7. anemia and amennorhea in female
• Rural areas – mountains and forest • Diagnostic Examinations: • Tuberculin skin testing – screening, ID
• Lands on surface – 45 degrees angle/slanting 1. Malarial Smear/ Blood Smear – blood is extracted at - a presumptive test
peak of fever
- Mantoux test – most reliable skin test for TB.
2. Quantitative Buffy Count (QBC) – no need for the
height of fever to set in - 0.1 cc Purified Protein Derivative, volar aspect
• Medical Management: - bleb or wheal formation
1. Chloroquine (Aralen) – mainstay =<or = to 4mm à negative
2. Other Drugs: Primaquine, Atabrine, fansidar and = 5-9 mm à doubtful (repeat the test)
Quinine (reserve drug for severe cases)
If infected by mosquito = > or = 10mm à positive
• Used cautiously for pregnant women
↓ • Sputum Examination – confirmatory, done in 3 series
• Immunity: No permanent immunity
Blood stream
 • 3. Chest X-ray - not definite test, tells only the extent of c. Pyrazinamide (P)– causes hyperurecemia Diphtheria
involvement of the lungs
d. Ethambutol (E)– causes irreversible optic neuritis that • acute contagious dse char by generalized toxaemia
• According to extent of disease based on cavitations brings about blindness coming from a localized inflammatory process known as
within the lungs PSEUDOMEMBRANE.
• 2. Standard Regimen(SR) – Streptomycin, Isoniazid &
a. Minimal Ethambutol (SIE) • CA: Corynebacterium diphtheria or Klebs-Loeffler
bacillus
b. Moderately advanced a. Streptomycin (S)
• MOT: Droplet (direct contact) – affects all ages
c. Advanced – (+) of cavitations within the lungs Side Effects: 1. Nephrotoxicity
• Nasal
• According to clinical manifestations 2. Ototoxicity – CN8
(tinnitus/vertigo) - dryness, excoriation of upper lip and nares
a. Active PTB
• 3. Directly Observed Treatment Short Course (DOTS) - (+) of pseudomembrane in the nasal
b. Inactive PTB WHO- “tutuk gamutan” turbinate– pathognomonic sign
• According to American Pulmonary Society 5 Elements: - grayish-white membrane with
leathery consistency
a. TB 0 – (-) exposure (-) infection (-) tuberculin testing 1. Political will to support the program
b. TB I- (+) exposure (-) infection (-) tuberculin testing • Pharyngeal – (+) bullneck appearance (enlargement of
2. Microscopic availability the cervical lymphnode)
c. TB II – (+) exposure (+) infection (+) tuberculin testing 3. Steady supply of medicine
(-) s/sx • Laryngeal – (+) respiratory distress
4. Personnel – RN and midwife - (+) hoarseness/aponia
d. TB III – (+) exposure (+) infection (+) tuberculin testing
(+) s/sx 5. Documentation and recording - (+) laryngeal stridor – brassy metallic cough
• Short Course Chemo therapy – Rifampicin, Isoniazid, D – iet - small frequent nutritious foods
Pyrazinamide Ethambutol (RIPE) • Nose and Troat Culture
D – rugs - adequate drugs and emphasize
a. Isoniazid (INH) – mainstay drug importance of compliance • Shick’s Test – to determine resistance or susceptibility to
diphtheria
- 6mons for carrier & inactive adult patient R – est - conserve energy
• Moloney’s Test – to determine hypersensitivity to
- 9mons for children • Contraindicated Nursing Care: Do not do chest diphtheria
physiotherapy
- 12mons for immunocompromised patients *Removal of the pseudomembrane is not encouraged à facilitate
• Avoid MOT bleeding and fast regrowth
Side Effects: 1. Peripheral neuropathies/neuritis
• Immunization with BCG immediately after birth 0.5cc ID • Neutralize toxin
a. Foods rich in Vit B6 ® deltoid area
(pyroxidine) ADS – IM,IV ANST; if (+) give in fractional
Instruction to mothers: don’t massage the dose – desensitization
2. Hepatotoxicity – (+) jaundice area, (+) fever, (+) abscess formation on
the site of injection →scar IV fluid to dilute toxin
a. Monitor liver enzymes
• Proper disposal of nasopharyngeal secretions • Antibiotic – Penicillin
b. Avoid alcohol
• Covering of mouth when sneezing • Supportive – O2 inhalation, tracheostomy
b. Rifampicin (R) – causes orange color of tears, urine
and stool • Immunization : Gives temporary immunity • Strict Isolation – highly contagious
 • CBR – to limit the circulation of toxin • 2. nocturnal coughing 3. Fluid and Electrolyte Replacement

Myocarditis, bronchopneumonia & peripheral 4. Mild form of sedation: Codeine

neuritis – fatal complications • 3. fever
• Nursing Care:
• Diet: Liquid to soft diet. (-) spices , small frequent • 4. tiredness and listlessness
feeding, observe strict aspiration precaution, increase 1. CBR
fluid intake • 2. Spasmodic or Paroxysmal stage
2. Maintain F&E balances
• Provide diversional activities for children • s/sx: 3. Provide adequate nutrition
• Avoid MOT
• a. 5-10 successive forceful coughing which 4. Proper positioning when feeding
ends in a prolonged inspiratory phase or whoop
• Immunization: DPT 0.5cc IM VL
5. Provide abdominal binder to prevent hernia
• b. (+) production of mucus (tenacious) plug on
6,10,14 wks of age simultaneous with airway passage
OPV • Preventive Measures: same as Diptheria
• c. other manifestations • Immunity: No permanent immunity
- do not massage area to prevent lump formation (press)
- congested face, tongue
- (+) lump à hot moist compress
- teary eyes with protrusion of eyeball Typhoid Fever
- (+) fever – give paracetamol; cooling measures
- distended face and neck veins CA: Salmonella typhosa →Payer’s patches
• Adverse side effect: CONVULSION
- involuntary mict. and defecation MOT: Fecal-oral
• Nsg Mx: take temp accurately to differentiate it from
febrile convulsion - abdominal/inguinal hernia Sources of infection: feces, fingers, food, flies and
fomites
- deafness due to hemorrhage of vestibular apparatus of ear
1. Prodromal Stage – (+) MO in the blood stream
Pertusiss
- fever, dull HA, N/V, abd pain, diarrhea or
• aka as Whooping cough and Chin cough
• 3. Convalescent stage – s/sx starts to disappear constipation
• affects below 6 y/o
• - patient no longer communicable and on road 2. Fastigial/Pyrexial - MO invades the payer’s patches
• CA: Coccobacillus - to recovery
Features:
a. Bordetella pertussis • Nasal Swab
1. rose spots in the the abdomen –pathognomonic sign
b. Hemophilus pertussis • Bordet-Gengou Test 2. ladder like fever
• Incubation Period: 7-10 days • Agar Plate – use nasopharyngeal secretions 3. splenomegaly
• MOT: Droplet • Cough Plate 4. Typhoid psychosis – due to release of toxins
• 1. Catarrhal stage – highly contagious, child stays at • Medical a. coma vigil look
home
1. Immunization: Pertussis Immune Globulin b. difficulty in protruding the tongue
• s/sx: 1. (+) of colds
2. Antibiotics: Erythromycin c. carphologia – involuntary picking up of linen
 d. sabsultus tendinum – involuntary twitching of • CA: • 2. Give Penicillin to patient allergic to tetracycline
tendon
1. Leptospira (spirochete) – bacteria • - give 1hr before meals or 2hrs after meals or empty
3. Defervescence Stage – (+) ulcer formation àintestinal stomach
perforation à bleeding àspillage in peritoneal cavity 2. Leptospira canicola
• Nursing Care: Symptomatic
S/Sx of Peritonitis: 3. Leptospira hemorrhagica
1. Provide eye care
1. sudden and severe abd pain 4. Leptospira enterogans – common in Phils.
2. Warm compress for muscle pain
2. persistence of fever • MOT: Skin penetration
3. I/O,consistency, frequency & amt
3. board-like rigid abd • Incubation Period: 2 dyas to 4 weeks
• Preventive Measures:
4. Convalescent /Lysis Stage – s/sx starts to subside • People at risk: sewage workers, farmers, miners, people
living in Manila areas 1. Environmental sanitation by eradication of rats
still have to observe for relapse
• Incidence: rainy seasons • 2. Avoid walking through floods
1. Blood Culture
• striated muscles Hepatitis
a. Widal Test
• inflammation of the liver
Antigen O (AG O) or Somatic Antigen = presently infected • liver
Hepa A Hepa B Hepa C
Antigen H (Ag H) or Flagellar Antigen = previously exposed to TF • kidneys
1. Infectiuos Serum Hepa, Post-
or has had an immunization Synonym Hepa, Homologous Hepa, transfusion
• fever, HA, vomiting
Catarrhal Viral Hepa Hepa
b. Thypi dot – uses blood specimen where it Jaundice,
identifies antibodies • myalgia and myositesàcalf muscles Epidemic
Hepa
• 2. Stool and Urine Exams • jaundice with hemorrhages on skin & mucous membrane 2. Source Feces Blood,semen,cervic Blood
icter-hemorrhagic à yellow and red orange skin, orange of Infection al secretions
• Medical: eyes à pathognomonic sign 3. HAV or RNA HBV of DNA HCV
Causative cointaining containing virus
• Antibiotic – Chloramphenicol • Diagnostic Examination: agent virus
4. MOT Fecal-oral Person-person, percutaneou
• Nursing Care: • 1. Blood culture Leptospira agglutination test (LAT) parenteral/ s
percutaneous,
1. Fluid and Electrolyte Management • Leptospira antigen-antibody test (LAAT) placental
5.Incubatio 2-7 wks 6wks-6mons 5wks-7-8
2. Provide adequate nutrition – (+) vomiting-small,freq • Microscopic agglutination test (MAT) n Period wks/12wks
meals; (+)diarrhea-(x) fatty food 6. Risk Crowding, Multiple sex Blood
• Medical Management: homosexual partners, members recipients
3. Provide comfort measures s, food of medical team,
handlers, blood, drug addicts
Leptospirosis
• 1. Antibiotics – Tetracyline à drug of choice
poor
sanitation,
• aka Mud fever, Swamp fever, Canicola fever, Pre-tibial
• - not given to a. child <8y/o àstaining of teeth unsafe water
fever, Weil dse, Swineherd dse and Ictero-Hemorrhagica supply,
dse • b. pregnant women – teratogenic effect àbone children
defect
7. Carrier No No Yes
• Source of infection: Excreta of rats particularly urine
• - never give tetracycline with calcium rich food, antacid state
and iron prep & milk
8. 0.5% 1-10% mortality 1-2%
- Anti- HAV • CA: Neisseria Gonorrhea

Prognosis mortality mortality b. Hepatitis B • MOT: Sexual Contact, transferred to baby during birth
9. Proper Screen blood Screen
Prevention handwashin donors blood - Hep B Surface Antigen (HBsAG): (+) acute hepatitis B • Incubation Period: 3-21 days
g, sanitation, donors
screen food - Hep B Protein Independent Antigen (HBeAa)= (+)chronic hep B • Manifestation: Male- Urethritis
handlers,
enteric 3. Routine Test Female – Cervicitis
precautions
a. Bilirubin Testing • For Male:

1. Pre-Icteric Stage – S/Sx: b. Prothrombin Time Testing (PTT)

– dysuria
fever c. Ultrasound or CT Scan of Liver
– redness & edema of urinary meatus à acidic
RUQ pain d. Urinalysis urine passes through àburning sensation à (+)
pain
fatigability, weight loss, body malaise • Medical
– purulent urethral discharges abundant in the
N/V, anorexia 1. Hepatic Protectors or Liver Aides contain vitamins, morning – morning drop
minerals and phospholipids
signs of anemia – abscess forms on the prostate gland à prostitis
a. essentiale for adults à epidydimitis à formation of scar on
2. Icteric Stage – (+) jaundice – inability of liver to eliminate (N) epidydimis à obstruction flow of the sperm
amt of bilirubin b. Jetepar or Silymarine for pedia cellàsterility

(+) pruritus 2. New trends in treating Hepatitis

urine is tea colored or brown a. Antiviral : Lamivudine

passing out of alcoholic or clay colored or no b. Immuno-modulating drug: Interferon

color stool
• Nursing Care:
persistence of sx of pre-ecteric stage but to a
lesser degree 1. Provide rest to promote liver regeneration

3. Post-Icteric Stage – jaundice and other s/sx starts to disappear 2. Low fat diet, High CHON intake to spare protein
metabolism
- energy starts to increase and patient is on the road to
recovery In US, “butterball” diet
• For Female:

- it takes 3-4 months for the liver to recover (avoid • Immunization: Hep B vaccine is given at 6 wks after
– dysuria and urinary frequency
alcohol for 1year and ASA & acetaminophen) birth, 3 doses at one month interval, Dose: 0.5cc IM, VL

1. Liver Enzyme Test – determine extent of liver damage
ALT, AST, GGT, ALP, LDH
2. Serum Antigen- Antibody (Ag-Ab) Test
• Avoid MOT – itchy, red and edematous meatus, if cervix is
affected
• Immunity: Don’t give a permanent immunity
– burning pain and purulent discharges, if urethra
• is affected

a. Hepatitis A Gonorrhea – abscess forms on the bartholin’s and skene’s

gland à endocervitis & endometritis
- Hepatitis A Surface Antigen = (+) 2 wks after exposure to HepA – aka Jack, Gleet, Clap, Strain, GC and Morning Drop
 – (+) narrowing of fallopian tube à sterility • Medical :

• If pregnant, it will cause: ectopic pregnancy or opthalmia Antibiotic: Benzathine Penicillin G

neonatorum (Penadur)

• Nursing Care & Preventive Management: same as

gonorrhea

HIV infection means one is infected with AIDS Virus

• AIDS = infected by virus + incompetent immuno-

response
2. Secondary Stage: highly infectious & contagious
• CA: Human Immuno-Deficiency Virus (HIV) retrovirus
a. fever & malaise

b.skin rashes & dermatitis: dry, hard, wart like

• C&S by mucosal scrapping
• Pap Smear or Vaginal Smear
• Medical Management:
a. Ceftriaxone (Rocephin)
• MOT: BT, sexual contact,
lesions à Condyloma lata
exposure to infected blood, products or
tissuesvertical (mother-child) or
c. Oral mucous patches
Perinatal (pregnancy,delivery&breastfeeding)
d. alopecia – patchy, polka dot or moth eaten
appearance of hair and thinning of pubic hair sharing needles
Antibiotic
• Incubation Period: 6 mons – 7 years

b. Doxycycline (Tetracycline)
MOà detected by macrophageàalert T Cells
• Psychological aspect of care – low self-esteem

• Health education: - safe sex, monogamous relationship, ↓

masturbation
HIV ← Antibodies ← stimulate B cells
use of condom, behaviour modification
• fever with night sweats without a cause
Syphilis 3. Tertiary Stage –
• enlargement of the lymph nodes without a cause
• aka Pox, Lues, SY, and Bad Blood Disease a. Gumma – infiltrating lesion found on deeper tissues &
body organs such as skin, bone and liver • fatigability
• CA: Treponema Pallidum – a spirochete that passes to
the placental barrier during the 16th week of pregnancy b. aortitis & aneurysm • weight loss
(2nd & 3rd trimester)
c. paresthesia, abnormal reflexes, dementia and • altered sleeping patterns
• MOT: Sexual contact, vertical transmission psychosis
• temporary memory loss
• Incubation period: 10-90 days • C&S by mucosal scrapping
• altered gait
• 1. Primary Stage • Dark Field Microscope

• a. Chancre, a painless popular lesion on face, • Serologic Test

lips, tongue, under the breast, fingers and genitals Adults: 2 Major sxs and 1 Minor sx
• Flourescent Treponema Antibody Absorption Test –
Children: 2 Major sxs and 2 Minor sxs
• b. Regional lymphadenopathy confirmatory test
3 Major Sx: 1. fever – 1 month & above 4. Dideoxyinosine (DDI) - Didanosine

2. diarrhea – 1 month & above 4. Dideoxycytidine (DDC) – Zalcitabine, Hivid

3. 10% weight loss/ stunted growth for pedia

6 Minor Sx: 1. persistent cough – 1 month & above b. Non-Nucleoside reverse Transcriptase (NNRTI)

2. persistent generalized lymphadenopathy a. Delavirdine

3. generalized pruritic dermatitis b. Nevirapine

4. oropharyngeal candidiasis 2. Protase Inhibitor (PI) prevets virus to multiply during the last
phase of call division
5. recurrent herpes zoster
a. Indinavir
6. progressive dessiminated herpes zoster
b. Retonavir
Opportunistic Infection:
c. Saquinavir
• TB is the most common of the Avium Type (from birds)
d. Nalfinavir
• PCP
3. Fusion Inhibitor- Fuseon (Enfuritide)
• CMV
• Promote knowledge and understanding
• CNS à lungs à eyes
• Promote quality of life
• Cancer : Kaposi Sarcoma à malignancy of blood vessel
(skin) – appearing as pink/purple painless sots on the
• Provide self care and comfort
skin called Leopard Look
• Preventive Measures:
• Enzyme Link Immunoassorbent Assay (ELISA) Test –
screening test
• 1. Practice ABCD of HIV: A – bstinence

• Western Blot – confirmatory B – e faithful

• CD4 and T cell count C – ondom

- if more than or equal to 200 à HIV infected D – on’t use drugs

- if less than 200 à AIDS • 2. Education

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

1. Azidothymidine (AZT) – Zidovudin, retrovir

2. Lamivudine -3#TC, Epion

3. Stavudine – Cd4T, Zerit