DISEASE Tuberculosis

OTHER NAME/S Kochs Disease Consumption Phthisis Weak lungs

CAUSATIVE AGENT Mycobacterium tuberculosis TB bacillus Kochs bacillus Mycobacterium bovis (rod-shaped)

MODE OF TRANSMISSION Airborne-droplet Direct invasion through mucous membranes and breaks in the skin (very rare) Incubation period : 4 6 weeks

PATHOGNOMONIC SIGN/MANIFESTATIONS 1. Usually asymptomatic 2. Low-grade afternoon fever 3. Night sweating 4. Loss of appetite 5. Weight loss 6. Easy fatigability due to increased oxygen demand 7. Temporary amenorrhea 8. Productive dry cough 9. Hemoptysis

MANAGEMENT/TREATMENT Diagnostic test: Sputum examination or the Acid-fast bacilli (AFB) / sputum microscopy 1. Confirmatory test 2. Early morning sputum about 3-5 cc 3. Maintain NPO before collecting sputum 4. Give oral care after the procedure 5. Label and immediately send to laboratory 6. If the time of the collection of the sputum is unknown, discard Chest X-ray is used to: 1. Determine the clinical activity of TB, whether it is inactive (in control) or active (ongoing) 2. To determine the size of the lesion: a. Minimal very small b. Moderately advance lesion is < 4 cm c. Far advance lesion is > 4 cm Tuberculin Test purpose is to determine the history of exposure to tuberculosis Other names: Mantoux Test used for single screening, result interpreted after 72 hours Tine test used for mass screening read after 48 hours

PREVENTION Respiratory precautions Cover the mouth and nose when sneezing to avoid mode of transmission Give BCG BCG is ideally given at birth, then at school entrance. If given at 12 months, perform tuberculin testing (PPD), give BCG if negative. Improve social Conditions

DIPHTHERIA Types: > nasal > pharyngeal most common > laryngeal most fatal due to proximity to epiglottis

Corynebacterium diphtheria Klebbs-loffler ***Diphtheria transmission is increased in hospitals, households, schools, and other crowded areas.

Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions Milk has served as a vehicle Incubation Period: 2 5 days

Pseudomembrane mycelia of the oral mucosa causing formation of white membrane on the oropharynx Bull neck Dysphagia Dyspnea

PERTUSSIS

Whooping cough Tusperina No day cough

Bordetella pertussis Hemophilus pertussis Bordet-gengou bacillus Pertussis bacillu

Droplet especially from laryngeal and bronchial secretions Incubation Period: 7 10 days but not

Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting

Interpretation: 0 - 4 mm induration not significant 5 mm or more significant in individuals who are considered at risk; positive for patients who are HIV-positive or have HIV risk factors and are of unknown HIV status, those who are close contacts with an active case, and those who have chest x-ray results consistent with tuberculosis. 10 mm or greater significant in individuals who have normal or mildly impaired immunity Diagnostic test: Nose/throat swab Moloneys test a test for hypersensitivity to diphtheria toxin Schicks test determines susceptibility to bacteria Drug-of-Choice: Erythromycin 20,000 - 100,000 units IM once only Complication: MYOCARDITIS (Encourage bed rest) Plan nursing care to improve respiration. Diagnostic: Bordet-gengou agar test Management: 1. DOC: Erythromycin or Penicillin 20,000 -

DPT immunization Pasteurization of milk Education of parents ***Infants born to immune mothers maybe protected up to 6-9 months. Recovery from clinical attack is always followed by a lasting immunity to the disease.

DPT immunization Booster: 2 years and 4-5 years Patient should be segregated until after 3

exceeding 21 days

Complication: abdominal hernia

TETANUS

Lock jaw

Clostridium tetani anaerobic spore-forming heat-resistant and lives in soil or intestine Neonate: umbilical cord Children: dental caries Adult: punctured wound; after septic abortion

Indirect contact inanimate objects, soil, street dust, animal and human feces, punctured wound Incubation Period: Varies from 3 days to 1 month, falling between 7 14 days

Risus sardonicus (Latin: devil smile) facial spasm; sardonic grin Opisthotonus arching of back For newborn: 1. Difficulty of sucking 2. Excessive crying 3. Stiffness of jaw 4. Body malaise

Poliomyelitis

Infantile paralysis

Measles

Morbilli Rubeola

Legio debilitans Polio virus Enterovirus Attacks the anterior horn of the neuron, motor is affected Man is the only reservoir RNA containing paramyxovirus Period of Communicability: 4 days before and 5 days after the appearance of rash

Fecal oral route Incubation period: 7 21 days

Paralysis Muscular weakness Uncoordinated body movement Hoynes sign head lag after 4 months

100,000 units 2. Complete bed rest 3. Avoid pollutants 4. Abdominal binder to prevent abdominal hernia No specific test, only a history of punctured wound Treatment: Antitoxin antitetanus serum (ATS) tetanus immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses) Pen G Diazepam for muscle spasms Note: The nurse can give fluid provided that the patient is able to swallow. There is risk of aspiration. Check first for the gag reflex Diagnostic test: CSF analysis / lumbar tap Pandys test Management: Rehabilitation involves ROM exercises

weeks from the appearance of paroxysmal cough

DPT immunization Tetanus toxoid (artificial active) immunization among pregnant women Training and Licensing of midwives/hilots Health education of mothers Puncture wounds are best cleaned by thorough washing with soap and water.

OPV vaccination Frequent hand washing

Droplet secretions from nose and throat Incubation period: 10 days fever 14 days rashes appear (8-13 days)

1. Kopliks spots whitish/bluish pinpoint patches on the buccal cavity 2. cephalocaudal appearance of maculopapular rashes 3. Stimsons line bilateral red line on the lower conjunctiva

No specific diagnostic test Management: Supportive and symptomatic

Measles vaccine Disinfection of soiled articles Isolation of cased from diagnosis until about 5-7 days after onset of rash

Hepatitis B

Serum Hepatitis

Hepatitis B virus

Blood and body fluids Placenta Incubation period: 45 100 days

1. Right-sided Abdominal pain 2. Jaundice 3. Yellow-colored sclera 4. Anorexia 5. Nausea and vomiting 6. Joint and Muscle pain 7. Steatorrhea 8. Dark-colored urine 9. Low grade fever Vesiculo-pustular rashes Centrifugal appearance of rashes rashes which begin on the trunk and spread peripherally and more abundant on covered body parts Pruritus

Diagnostic test: Hepatitis B surface agglutination (HBSAg) test Management: > Hepatitis B Immunoglobulin Diet: high in carbohydrates

CHICKENPOX

Varicella

Human (alpha) herpes virus 3 (varicella-zoster virus), a member of the Herpesvirus group Period of Communicability: From as early as 1 to 2 days before the rashes appear until the lesions have crusted.

Droplet spread Direct contact Indirect through articles freshly soiled by discharges of infected persons Incubation Period: 2-3 weeks, commonly 13 to 17 days

GERMAN MEASLES

Rubella Three-day Measles

Rubella virus or RNAcontaining Togavirus (Pseudoparamyxovirus) German measles is teratogenic infection, can cause congenital heart disease and congenital cataract.

Droplet Incubation Period: Three (3) days

Forscheimer spots red pinpoint patches on the oral cavity Maculopapular rashes Headache Low-grade fever Sore throat Enlargement of posterior cervical and postauricular lymph nodes

Herpes

Shingles

Herpes zoster virus

Droplet

Painful vesiculo-pustular

No specific diagnostic exam Treatment is supportive. Drug-of-choice: Acyclovir / Zovirax (orally to reduce the number of lesions; topically to lessen the pruritus) NEVER give ASPIRIN. Aspirin when given to children with viral infection may lead to development of REYES SYNDROME. Nursing Diagnoses: Disturbance in body image Impairment of skin integrity Diagnostic Test: Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella. Instruct the mother to avoid pregnancy for three months after receiving MMR vaccine. MMR is given at 15 months of age and is given intramuscularly. Treatment is supportive and

-Hepatitis B immunization -Wear protected clothing -Hand washing -Observe safe-sex -Sterilize instruments used in minor surgical-dental procedures -Screening of blood products for transfusion Case over 15 years of age should be investigated to eliminate possibility of smallpox. Report to local authority Isolation Concurrent disinfection of throat and nose discharges Exclusion from school for 1 week after eruption first appears Avoid contact with Susceptible MMR vaccine (live attenuated virus) - Derived from chick embryo Contraindication: - Allergy to eggs - If necessary, given in divided or fractionated doses and epinephrine should be at the bedside.

Avoidance of mode of

Zoster

Cold sores

(dormant varicella zoster virus) Dengue virus 1, 2, 3, and 4 and Chikungunya virus Types 1 and 2 are common in the Philippines Period of communicability: Unknown. Presumed to be on the 1st week of illness up to when the virus is still present in the blood Occurrence is sporadic throughout the year Epidemic usually occur during the rainy seasons (June to November) Peak months: September and October

Direct contact from secretion

Dengue Hemorrhagic Fever

H-fever

Bite of infected mosquito (Aedes Aegypti) - characterized by black and white stripes Daytime biting Low flying Stagnant clear water Urban Incubation Period: Uncertain. Probably 6 days to 1 week Manifestations: First 4 days: Febrile/Invasive Stage - starts abruptly as fever - abdominal pain - headache - vomiting - conjunctival infection -epistaxis 4th 7th days: Toxic/Hemorrhagic Stage - decrease in temperature - severe abdominal pain - GIT bleeding - unstable BP (narrowed pulse pressure) - shock - death may occur 7th 10th days: Recovery/Convalescent Stage - appetite regained - BP stable

lesions on limited portion of the body (trunk and shoulder) Low-grade fever Classification (WHO): Grade I: a. flu-like symptoms b. Hermans sign c. (+) tourniquet sign Grade II: a. manifestations of Grade I plus spontaneous bleeding b. e.g. petechiae, ecchymosis purpura, gum bleeding, hematemesis, melena Grade III: a. manifestations of Grade II plus beginning of circulatory failure b. hypotension, tachycardia, tachypnea Grade IV: a. manifestations of Grade III plus shock (Dengue Shock Syndome)

symptomatic Acyclovir to lessen the pain

Transmission

Diagnostic Test: Torniquet test (Rumpel Leads Test / capillary fragility test) PRESUMPTIVE; positive when 20 or more oetechiae per 2.5 cm square or 1 inch square are observed Platelet count CONFIRMATORY; (Normal is 150 - 400 x 103 / mL) Treatment: Supportive and symptomatic Paracetamol for fever Analgesic for pain Rapid replacement of body fluids most important treatment ORESOL Blood tansfusion Diet: low-fat, low-fiber, nonirritating, noncarbonated. Noodle soup may be given. ADCF (Avoid Dark-Colored Foods) ALERT! No Aspirin

4 oclock habit Chemically treated mosquito net Larva eating fish Environmental sanitation Antimosquito soap Neem tree (eucalyptus) Eliminate vector Avoid too many hanging clothes inside the house Residual spraying with insecticide Daytime fumigation Use of mosquito repellants Wear long sleeves, pants, and socks For the control of Hfever, knowledge of the natural history of the disease is important. Environmental control is the most appropriate primary prevention approach and control of Hfever.

MALARIA

Plasmodium Parasites: Vivax Falciparum (most fatal; most common in the Philippines) Ovale Malariae -attacks the red blood cells

Bite of infected anopheles mosquito Night time biting High-flying Rural areas Clear running water

Cold Stage: severe, recurrent chills (30 minutes to 2 hours) Hot Stage: fever (4-6 hours) Wet Stage: Profuse sweating Episodes of chills, fevers, and profuse sweating are associated with rupture of the red blood cells. - intermittent chills and sweating - anemia / pallor - tea-colored urine - malaise - hepatomegaly - splenomegaly - abdominal pain and enlargement - easy fatigability NURSING CARE: 1. TSB (Hot Stage) 2. Keep patent warm (Cold Stage) 3. Change wet clothing (Wet Stage) 4. Encourage fluid intake 5. Avoid drafts

Early Diagnosis and Prompt Treatment Early diagnosis identification of a patient with malaria as soon as he is seen through clinical and/or microscopic method Clinical method based on signs and symptoms of the patient and the history of his having visited a malaria-endemic area Microscopic method based on the examination of the blood smear of patient through microscope (done by the medical technologist) QBC/quantitative Buffy Coat fastest Malarial Smear best time to get the specimen is at height of fever because the microorganisms are very active and easily identified Chemoprophylaxis Only chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering the endemic area). In pregnant women, it is given throughout the duration of pregnancy. Treatment: Blood Schizonticides - drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations

CLEAN Technique *Insecticide treatment of mosquito net *House Spraying (night time fumigation) *On Stream Seeding construction of bioponds for fish propagation (2-4 fishes/m2 for immediate impact; 200-400/ha. for a delayed effect) *On Stream Clearing cutting of vegetation overhanging along stream banks *Avoid outdoor night activities (9pm 3am) *Wearing of clothing that covers arms and legs in the evening *Use mosquito repellents *Zooprophylaxis typing of domestic animals like the carabao, cow, etc near human dwellings to deviate mosquito bites from man to these animals Intensive IEC campaign

FILARIASIS

Elephantiasis Endemic in 45 out of 78 provinces Highest prevalence rates: Regions 5, 8, 11 and CARAGA

Wuchereria bancrofti Brugia malayi Brugia timori nematode parasites

Bite of Aedes poecillus (primarily) Aedes flavivostris (secondary) Incubation period: 8 16 months

Asymptomatic Stage: Presence of microfilariae in the blood but no clinical signs and symptoms of disease Acute Stage: Lymphadenitis Lymphangitis Affectation of male genitalia Chronic Stage: (10-15 years from onset of first attack) Hydrocele Lymphedema Elephantiasis

SHISTOSOMI ASIS

Snail Fever Bilharziasis Endemic in 10 regions and 24 provinces High prevalence:

Schistosoma mansoni S. haematobium S. japonicum (endemic in the Philippines)

Contact with the infected freshwater with cercaria and penetrates the skin Vector: Oncomelania Quadrasi

Diarrhea Bloody stools (on and off dysentery) Enlargement of abdomen Splenomegaly Hepatomegaly Anemia / pallor weakness

1. QUININE oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism quinine toxicity 2. CHLOROQUINE 3. PRIMAQUINE sometimes can also be given as chemoprophylaxis 4. FANSIDAR combination of pyrimethamine and sulfadoxine Diagnosis Physical examination, history taking, observation of major and minor signs and symptoms Laboratory examinations Nocturnal Blood Examination (NBE) blood are taken from the patient at his residence or in hospital after 8:00 pm Immunochromatographic Test (ICT) rapid assessment method; an antigen test that can be done at daytime Treatment: Drug-of-Choice: Diethylcarbamazine Citrate (DEC) or Hetrazan Diagnostic Test: COPT or cercum ova precipitin test (stool exam) Treatment: Drug-of-Choice: PRAZIQUANTEL (Biltracide) Oxamniquine for S. mansoni Metrifonate for S. haematobium

CLEAN Technique Use of mosquito repellents Anytime fumigation Wear a long sleeves, pants and socks

Dispose the feces properly not reaching body of water Use molluscides Prevent exposure to contaminated water (e.g. use rubber boots)

Regions 5, 8, 11

*Death is often due to hepatic complication

Apply 70% alcohol immediately to skin to kill surface cercariae Allow water to stand 4872 hours before use