COMMUNICABLE DISEASE NURSING

SUMMER REVIEW

COMMUNICABLE DISEASE
Disease caused by an infectious agent that are transmitted directly
or indirectly to a well person through an agency, vector or inanimate
object

CONTAGIOUS DISEASE
Disease that is easily transmitted from one person to another
INFECTIOUS DISEASE
Disease transmitted by direct inoculation through a break in the INFECTIOUS AGENT
skin Any microorganism capable of producing a disease
RESERVOIR
INFECTION Environment or object on which an organism can survive and
-Entry and multiplication of an infectious agent into the tissue of the multiply
host PORTAL OF EXIT
INFESTATION The venue or way in which the organism leaves the reservoir
- Lodgement and development of arthropods on the surface of the MODE OF TRANSMISSION
body The means by which the infectious agent passes from the portal of
exit from the reservoir to the susceptible host
ASEPSIS PORTAL OF ENTRY
- Absence of disease – producing microorganisms Permits the organism to gain entrance into the host
SEPSIS SUSCEPTIBLE HOST
- The presence of infection A person at risk for infection, whose defense mechanisms are
unable to withstand invasion of pathogens
MEDICAL ASEPSIS
-Practices designed to reduce the number and transfer of pathogens STAGES OF THE INFECTIOUS PROCESS
-Clean technique Incubation Period – acquisition of pathogen to the onset of signs
SURGICAL ASEPSIS and symptoms
-Practices that render and keep objects and areas free from Prodromal Period – patient feels “bad” but not yet experiencing
microorganisms actual symptoms of the disease
-Sterile technique Period of Illness – onset of typical or specific signs and symptoms
of a disease
CARRIER – an individual who harbors the organism and is capable Convalescent Period – signs and symptoms start to abate and
of transmitting it without showing manifestations of the disease client returns to normal health
CASE – a person who is infected and manifesting the signs and
symptoms of the disease MODE OF TRANSMISSION
CONTACT TRANSMISSION
Direct contact – involves immediate and direct transfer from
SUSPECT – a person whose medical history and signs and person-to-person (body surface-to-body surface)
symptoms suggest that such person is suffering from that particular Indirect contact – occurs when a susceptible host is exposed to a
disease contaminated object
CONTACT – any person who had been in close association with DROPLET TRANSMISSION
an infected person Occurs when the mucous membrane of the nose, mouth or
conjunctiva are exposed to secretions of an infected person within a
HOST distance of three feet
- A person, animal or plant which harbors and provides nourishment VEHICLE TRANSMISSION
for a parasite Transfer of microorganisms by way of vehicles or contaminated
RESERVOIR items that transmit pathogens
- Natural habitat for the growth, multiplication and reproduction of AIRBORNE TRANSMISSION
microorganism Occurs when fine particles are suspended in the air for a long time
or when dust particles contain pathogens
ISOLATION VECTOR-BORNE TRANSMISSION
- The separation of persons with communicable diseases from other Transmitted by biologic vectors like rats, snails and mosquitoes
persons
QUARANTINE TYPES OF IMMUNIZATION
- The limitation of the freedom of movement of persons exposed to ACTIVE – antibodies produced by the body
communicable diseases NATURAL – antibodies are formed in the presence of active
infection in the body; lifelong
STERILIZATION – the process by which all microorganisms ARTIFICIAL – antigens are administered to stimulate antibody
including their spores are destroyed production
DISINFECTION – the process by which pathogens but not their PASSIVE – antibodies are produced by another source
spores are destroyed from inanimate objects NATURAL – transferred from mother to newborn through placenta
CLEANING – the physical removal of visible dirt and debris by or colostrum
washing contaminated surfaces ARTIFICIAL – immune serum (antibody) from an animal or human
is injected to a person
CONCURRENT
- Done immediately after the discharge of infectious materials / SEVEN CATEGORIES OF ISOLATION
secretions STRICT- prevent highly contagious or virulent infections
TERMINAL Example: chickenpox, herpes zoster
- Applied when the patient is no longer the source of infection CONTACT – spread primarily by close or direct contact
Example: scabies, herpes simplex
BACTERICIDAL RESPIRATORY – prevent transmission of infectious distances
- A chemical that kills microorganisms over short distances through the air
BACTERIOSTATIC Example: measles, mumps, meningitis
- An agent that prevents bacterial multiplication but does not kill TUBERCULOSIS – indicated for patients with positive smear or
microorganisms chest x-ray which strongly suggests tuberculosis
ENTERIC – prevent transmission through direct contact with feces
Example: poliomyelitis, typhoid fever
CHAIN OF INFECTION DRAINAGE – prevent transmission by direct or indirect contact
with purulent materials or discharge

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Ex. Burns
UNIVERSAL – prevent transmission of blood and body-fluid borne
pathogens SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA
Example: AIDS, Hepatitis B

CENTRAL NERVOUS SYSTEM DIC

ENCEPHALITIS MENINGITIS MENINGO- URTI: Micro-
Vasculitis:
COCCEMIA cough, sore thrombosis
petechial
throat,
MAIN PROBLEM rash in the Purpura
fever,
- Acute infection of trunk and
- Inflammation of - Inflammation of the bloodstream and headache, Hypotension
the brain the meninges extremities
developing vasculitis nausea and
vomiting Shock
ETIOLOGIC AGENT - Streptococcus
- Staphylococcus Death
- Arboviruses
- Pneumococcus
- Tubercle bacillus
- Neisseria meningitides ENCEPHALITIS MENINGITIS MENINGO-
INCUBATION PERIOD
COCCEMIA
5-15 days 1-10 days 3-4 days
MODE OF TRANSMISSION SIGNS AND SYMPTOMS Vasculitis
Bite of infected Stiff neck
mosquito Respiratory droplets Nuchal rigidity Waterhouse-
Photophobia Opisthotonus Friderichsen
SIGNS AND SYMPTOMS OF ENCEPHALITIS syndrome
Lethargy Brudzinski’s
Virus enters neural cells Petechiae with
Convulsions Kernig’s sign the development
of hemorrhage
Disruption in Perivascular Inflammatory INCIDENCE
cellular congestion reaction 5-10 years old < 5 years old 6 months–5
functioning years old

Lethargy Headache Fever DIAGNOSTIC EXAM

Convulsions Sore throat  Informed consent
Photophobia  Empty bowel and bladder
Seizures Vomiting  Fetal, shrimp or “C” position
Stiff neck  Spinal canal, subarachnoid space between L3-L4 or L4- L5
 After: bedrest
 Flat on bed to prevent spinal headache
ENCEPHALITIS MENINGITIS MENINGO-
COCCEMIA
SIGNS AND SYMPTOMS OF MENINGITIS
TREATMENT MODALITIES

Dexamethasone Ceftriaxone

Mannitol Penicillin
Anticonvulsants Chloramphenicol
Antipyretics

PREVENTION

1. Japanese 1. HiB vaccine Rifampicin

encephalitis
Ciprofloxacin
VAX
ENCEPHALITIS MENINGITIS MENINGO-
THREE SIGNS OF MENINGEAL IRRITATION COCCEMIA
OPISTHOTONUS
State of severe hyperextension and spasticity in which an individual’s NURSING MANAGEMENT
1. Side boards
head, neck and spinal column enter into a complete arching position 1. Comfort: quiet, 1. Respiratory
BRUDZINSKI’S SIGN 2. Close contacts
well-ventilated isolation 24-72
Place the patient in a dorsal recumbent position and then put hands room hours after onset H – ouse
behind the patient’s neck and bend it forward. of antibiotic
If the patient flexes the hips and knees in response to the 2. Skin care: I – nfected person
therapy kissing
manipulation, positive for meningitis cleansing bath,
KERNIG’S SIGN change in 2. Room protected S – ame daycare
Place the patient in a supine position, flex his leg at the hip and knee position against bright center
then straighten the knee; pain and resistance indicates meningitis lights
3. Eliminate S – hare mouth
mosquito instruments
3. Safety: side-lying
breeding sites:
position and 3. Antibiotics as
CULEX
raised side rails prophylaxis
mosquito

CD-Bucud 2
 POLIOMYELITIS RABIES TETANUS PRODROMAL/INVASION PHASE
 Fever
 Anorexia
MAIN PROBLEM  Sore throat
 Pain and tingling at the site of bite
Acute infection of Acute viral disease Acute infectious  Difficulty swallowing
the CNS – muscle of the CNS – by disease with systemic EXCITEMENT OR NEUROLOGICAL PHASE
spasm, paresis and saliva of infected neuromuscular  Hydrophobia (laryngospasm)
paralysis animals effects  Aerophobia (bronchospasm)
 Delirium
ETIOLOGIC AGENT Rhabdovirus Clostridium tetani  Maniacal behavior
Legio debilitans Bullet-shaped Anaerobic  Drooling
TERMINAL OR PARALYTIC PHASE
Affinity to CNS Gram positive  Patient becomes unconscious
Killed by sunlight, Drumstick  Loss of urine and bowel control
UV light, formalin  Progressive paralysis
appearance
 Death
Resistant to
antibiotics POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
COMPLICATION
INCUBATION PERIOD
2-8 weeks Paralysis of RESPIRATORY
DEATH
respiratory muscles FAILURE
7-21 days Distance of bite to Adult: 3 days-3
brain weeks
DIAGNOSTIC PROCEDURES
Extensiveness of the Neonate: 3-30 days
bite 1. Throat washings 1. Blood exam
1. Stool culture
2. Flourescent rabies
Resistance of the
2. CSF culture antibody (FRA)
host
MODE OF TRANSMISSION 3. Negri bodies
- Direct contact with ISOLATION PRECAUTION
infected feces
Bite of an infected Direct inoculation Enteric isolation Respiratory
- Direct contact with
respiratory secretions
animal through a broken isolation
skin
- Indirect with soiled
linens and articles
POLIOMYELITIS RABIES TETANUS
POLIOMYELITIS RABIES TETANUS
TREATMENT MODALITIES 1. Tetanus immune
1. Analgesics 1. Local globulin (TIG)
SIGNS AND SYMPTOMS R – isus sardonicus
treatment of 2. Tetanus antitoxin
1. Abortive type 1. Prodromal / 2. Morphine
O – pistothonus wound (TAT)
invasion 3. Moist heat
2. Pre-paralytic 2. Active 3. Penicillin G
phase T – rismus application
or meningetic immunization 4. Tetracycline
type 2. Excitement / C – onvulsions 4. Bed rest
Lyssavac 5. Diazepam
neurological
3. Paralytic type H – eadache 5. Rehabilitation 6. Phenobarbital
phase Imovax
7. Tracheostomy
3. Terminal / I – rritability Antirabies vax
8. NGT feeding
paralytic type 2. Passive
L – aryngeal
spasm immunization
POLIOMYELITIS RABIES TETANUS

POLIO
ABORTIVE TYPE NURSING MANAGEMENT
 Does not invade the CNS 1. Enteric isolation 1. Adequate airway
 Headache 1. Isolation
 Sore throat 2. Proper disposal 2. Optimum 2. Quiet, semi-dark
 Recovery within 72 hours and the disease passes by of secretions comfort environment
unnoticed
PRE-PARALYTIC OR MENINGETIC TYPE 3. Moist hot packs 3. Restful 3. Avoid sudden
 Slight involvement of the CNS environment stimuli and light
 Pain and spasm of muscles 4. Firm /
 Transient paresis nonsagging bed 4. Emotional
 (+) Pandy’s test (increased protein in the CSF) 5. Suitable body support
PARALYTIC TYPE
alignment 5. Concurrent
 CNS involvement
 Flaccid paralysis 6. Comfort and and terminal
 Asymmetric safety disinfection
 Affects lower extremities
 Urine retention and constipation
 (+) HOYNE’S SIGN (when in supine position, head will fall
back when shoulders are elevated)

RABIES

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 POLIOMYELITIS RABIES TETANUS BIRD FLU SARS
TREATMENT MODALITIES
PREVENTION 1. Aseptic
1. If the dog is
1. Amantadine/Rimantadine 1. No definitive treatment
Salk vaccine healthy handling of for SARS
umbilical cord - Generic flu drugs
2. If the dog dies or
- Inactivated shows signs - H5N1 developed resistance 2. Antiviral drugs
polio vaccine suggestive of 2. Tetanus toxoid (normally used to treat
rabies immunization 2. Oseltamivir (TAMIFLU) AIDS)
- Intramuscular Zanamavir (RELENZA)
3. If dog is not 3. Antibiotic - RIBAVIRIN
Sabin vaccine available for prophylaxis - Primary treatment
observation - Within 2 days at onset of 3. Corticosteroids
- Oral polio - Penicillin symptoms
vaccine 4. Have domestic
dog 3 months to - Erythromycin - 150 mg BID x 2 days
- Per orem 1 year old
immunized - Tetracycline

BIRD FLU SARS

RESPIRATORY SYSTEM PREVENTION

1.Culling – killing of 1.Quarantine

BIRD FLU SARS sick or exposed
MAIN PROBLEM birds 2. Isolation
Flu infection in birds that A new type of atypical pneumonia
affects humans that infects the lungs 2. Banning of 3. WHO alert
importation of on SARS
ETIOLOGIC AGENT
birds (Executive
Avian influenza virus, H5N1 Corona virus
order # 280)
(March 12,
2003)
INCUBATION PERIOD 3. Cook chicken
3-5 days 2-8 days thoroughly
MODE OF TRANSMISSION
NURSING MANAGEMENT
Inhalation of feces and Respiratory droplets BIRD FLU
discharge of an infected bird WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD
FLU
• Isolation
BIRD FLU SARS • Face mask on the patient
• Caregiver: use a face mask and eye goggles/glasses
SIGNS AND SYMPTOMS • Distance of 1 meter from the patient
• Transport the patient to a DOH referral hospital
Body weakness or muscle
pain REFERRAL HOSPITALS
• National Referral Center – Research Institute for Tropical
Cough Medicine (RITM) (Alabang, Muntinlupa)
• Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz,
Difficulty breathing Manila)
• Visayas – Vicente Sotto Memorial Medical Hospital
Episodes of sore throat (Cebu City)
• Mindanao – Davao Medical Center (Bajada, Davao City)
Fever SARS
SUSPECT CASE
1. A person presenting after 1 November 2002 with a history of:
High fever >38’Celsius  High fever >38 0C AND
Chills  Cough or breathing difficulty AND
 One or more of the following exposures during the 10 days
prior to the onset of symptoms:
BIRD FLU SARS  Close contact, with a person who is a suspect or
COMPLICATIONS probable case of SARS
Severe viral pneumonia Severe viral  History of travel, to an area with recent local
pneumonia transmission of SARS
Acute respiratory distress  Residing in an area with recent local transmission of
syndrome SARS
Hypoxemia 2. A person with an unexplained acute respiratory illness
Fluid accumulation in resulting in death after 1 November 2002, but on whom no autopsy
alveolar sacs has been performed :
AND
Respiratory failure  One or more of the following exposures during the 10 days
Severe breathing difficulties prior to the onset of symptoms:
 Close contact, with a person who is a suspect or
probable case of SARS
Multiple organ failure  History of travel, to an area with recent local
transmission of SARS
 Residing in an area with recent local transmission of
DEATH SARS
PROBABLE CASE

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1. A suspect case with radiographic evidence of infiltrates
consistent with pneumonia or respiratory distress syndrome on Chest
DIPHTHERIA PERTUSSIS
x-ray. DIAGNOSTIC PROCEDURES

2. A suspect case of SARS that is positive for SARS coronavirus by

 SCHICK’S TESTS  CBC– increase in
one or more assays. - Susceptibility and immunity to lymphocytes
diphtheria
3. A suspect case with autopsy findings consistent with the -ID of dilute diphtheria toxin (0.1
cc)
pathology of SARS without an identifiable cause.
(+) local circumscribed area of
redness, 1-3 cm
DIPHTHERIA PERTUSSIS MALONEY’S TEST
MAIN PROBLEM -Determines hypersensitivity to
diphtheria anti-toxin
Acute bacterial disease Repeated attacks of spasmodic
characterized by the elaboration -ID of 0.1 cc fluid toxoid
coughing
of an exotoxin -(+) area of erythema in 24 hours
ETIOLOGIC AGENT

Corynebacterium diphtheriae or Bordetella pertussis

Klebs-Loeffler bacillus
DIPHTHERIA PERTUSSIS
INCUBATION PERIOD COMPLICATIONS Convulsions (brain
2-5 days 7-14 days Toxins in the bloodstream
damage from
MODE OF TRANSMISSION asphyxia)
1. Respiratory droplets Myocarditis Peripheral Broncho-
(epigastric
or chest
paralysis
(tingling,
pneumonia
(fever,
Otitis media
2. Direct contact with respiratory secretions
pain) numbness, cough) (invading
3. Indirect contact with articles paresis)
organisms)
DIPHTHERIA PERTUSSIS Heart Respirat
Decreased Bronchopneumonia
SIGNS AND SYMPTOMS failure in ory
respiratory arrest
(most dangerous
Types: rate complication)
Stages:
1.Nasal 1. Catarrhal DEATH

2.Tonsilopharyngeal
2. Paroxysmal DIPHTHERIA PERTUSSIS
3.Laryngeal
3. Convalescent TREATMENT MODALITIES
4.Wound or
1. Diphtheria anti-toxin 1. Erythromycin – drug of
cutaneous choice
- Requires skin testing
- Early administration 2. Ampicillin – if resistant
aimed at neutralizing the to erythromycin
NASAL DIPHTHERIA toxin present in the 3. Betamethasone
• Bloody discharge from the nose circulation before it is (corticosteroid) –
• Excoriated nares and upper lip absorbed by the tissues decrease severity and
TONSILOPHARYNGEAL DIPHTHERIA 2. Antibiotic therapy length of paroxysms
• Low grade fever
• Sore throat - Penicillin G 4. Albuterol
• Bull-neck appearance (bronchodilator)
- Erythromycin
• Pseudomembrane- Group of pale yellow membrane over
tonsils and at the back of the throat as an inflammatory
response to a powerful necrotizing toxins
LARYNGEAL DIPHTHERIA DIPHTHERIA PERTUSSIS
• Hoarseness
NURSING MANAGEMENT
• Croupy cough 1. Isolation: 4-6 weeks from
• Aphonia 1. Isolation: 14 days (until onset of illness
• Membrane lining thickens  airway obstruction 2-3 cultures, 24 hours
• Suffocation, cyanosis or death apart) 2. Supportive measures
WOUND OR CUTANEOUS DIPHTHERIA (bedrest, avoid
• Yellow spots or sores in the skin
2. Bedrest for 2 weeks excitement, dust, smoke
3. Care for nose and and warm baths)
PERTUSSIS throat (gentle swabbing) 3. Safety (during
CATARRHAL STAGE
• Lasts for 1 to 2 weeks 4. Ice collar (decrease pain paroxysms, patient
• Most communicable stage of sore throat) should not be left alone)
• Begins with respiratory infection, sneezing, cough and 5. Diet (soft food, small 4. Suctioning (kept at
fever frequent feedings) bedside for emergency
• Cough becomes more frequent at night use)
PAROXYSMAL STAGE
• Lasts for 4 to 6 weeks
• Aura: sneezing, tickling, itching of throat
• Cough, explosive outburst ending in “whoop”
MUMPS
MAIN PROBLEM
• Mucus is thick, ends in vomiting
An acute contagious disease, with swelling of one or both of the
• Becomes cyanotic
parotid glands
• With profuse sweating, involuntary urination and
ETIOLOGIC AGENT
exhaustion
Filterable virus of paramyxovirus group
CONVALESCENT STAGE
INCUBATION PERIOD
• End of 4th-6th week
12-26 days
• Decrease in paroxysms MODE OF TRANSMISSION
Respiratory droplets
PERIOD OF COMMUNICABILITY
6 days before and 9 days after onset of parotid swelling

CD-Bucud 5
SIGNS AND SYMPTOMS
AMOEBIASIS SHIGELLOSIS
PRODROMAL PHASE DIAGNOSTIC TESTS
F-ever (low grade)
H-eadache 1. Stool exam
M-alaise 2. Blood exam

PAROTITIS 3. Sigmoidoscopy
F-ace pain
E-arache TREATMENT MODALITIES
S-welling of the parotid glands
1. Metronidazole – drug 1. Cotrimoxazole – drug
COMPLICATIONS of choice of choice
• Orchitis – the most notorious complication of mumps
• Oophoritis – manifested by pain and tenderness of the 2. Tetracycline
abdomen
• CNS involvement – manifested by headache, stiff neck, 3. Chloramphenicol
delirium, double vision
• Deafness as a result of mumps
NURSING MANAGEMENT AMOEBIASIS SHIGELLOSIS
1. Prevent complications
 Scrotum supported by suspensory NURSING MANAGEMENT
 Use of sedatives to relieve pain 1.Enteric isolation
 Treatment: oral dose of 300-400 mg cortisone followed by 100
mg every 6 hours 2. Boil water for
 Nick in the membrane drinking
2. Diet
- Soft or liquid diet 3. Handwashing
- Sour foods or fruit juices are disliked
3. Respiratory isolation 4. Sexual activity
4. Comfort: ice collar or cold applications over the parotid glands may
relieve pain 5. Avoid eating
5. Fever: aspirin, tepid sponge bath uncooked leafy
6. Concurrent disinfection: all materials contaminated by these
secretions should be cleansed by boiling vegetables
7. Terminal disinfection: room should be aired for six to eight hours

GASTROINTESTINAL TRACT
CHOLERA TYPHOID FEVER
AMOEBIASIS SHIGELLOSIS MAIN PROBLEM

Acute bacterial disease of the An infection affecting the

MAIN PROBLEM
GIT characterized by profuse Peyer’s patches of the small
Protozoal infection of the large Acute infection of the lining secretory diarrhea intestines
of the small intestine
intestine ETIOLOGIC AGENT

ETIOLOGIC AGENT Vibrio cholerae Salmonella typhi

Entamoeba histolytica Shigella group INCUBATION PERIOD

- Prevalent in areas with ill 1. Shigella flesneri – most

sanitation
-Acquired by swallowing
- Trophozoites: vegetative form
1 to 3 days 1 to 3 weeks
common in the Philippines
MODE OF TRANSMISSION
2. Shigella connei
3. Shigella boydii 1. Fecal-oral transmission

- Cyst: infective stage 4. Shigella dysenterae – most 2. 5 F’s

infectious type
CHOLERA TYPHOID FEVER
AMOEBIASIS SHIGELLOSIS SIGNS AND SYMPTOMS
Fever (ladder-like)
SIGNS AND SYMPTOMS Rice-water stool
1. Acute amoebic dysentery Rose spots
Fever Abdominal cramps
- Diarrhea alternated with Diarrhea
constipation Abdominal pain Vomiting TYPHOID STATE
- Tenesmus
- Bloody mucoid stools Diarrhea and Intravascular Sordes
2. Chronic amoebic tenesmus Dehydration
Subsultus Tendinum
dysentery
Bloody mucoid Shock Coma vigil
- Enlarged liver
- Large sloughs of intestinal stool Carphologia
tissues accompanied by
hemorrhage

CD-Bucud 6
 CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
TREATMENT MODALITIES • Rashes
1.Chloramphenicol – SIGNS AND SYMPTOMS

1.Lactated Ringer’s -Unilateral, band-like

drug of choice • Rashes : Centrifugal distribution
solution distribution -Dermatomal
2. Ampicillin/
2. Oral rehydration Amoxicillin – for •Rash stages: macule - Erythematous base
therapy typhoid carriers papule vesicle - Vesicular, pustular or
3. Antibiotic therapy pustule crust crusting
3. Cotrimoxazole – for •Regional
- Tetracycline – drug severe cases with lymphadenopathy
• Pruritus
of choice relapses •Pruritus
- Cotrimoxazole •Pain – stabbing or
burning
- Chloramphenicol
CHOLERA TYPHOID FEVER CHICKENPOX HERPES ZOSTER
NURSING MANAGEMENT
COMPLICATIONS
RAMSAY-HUNT
1. Maintain and restore the fluid SYNDROME - Involvement of
SCARRING – most common
and electrolyte balance the facial nerve in herpes zoster
complication; associated with
with facial paralysis, hearing
staphylococcal or streptococcal
2. Enteric isolation loss, loss of taste in half of the
infections from scratching
tongue
3. Sanitary disposal of excreta NECROTIZING FASCIITIS –
GASSERIAN
most severe complication GANGLIONITIS –
4. Adequate provision of safe Involvement of the optic nerve
REYE SYNDROME –
drinking water abnormal accumulation of fat in resulting to corneal anesthesia
the liver plus increase of
ENCEPHALITIS – acute
5. Good personal hygiene pressure in the brain resulting to
inflammatory condition of the
coma, therefore leading to
brain
DEATH

CHICKENPOX HERPES ZOSTER

INTEGUMENTARY SYSTEM TREATMENT MODALITIES

1. Antihistamines – 4. Corticosteroids – anti-

inflammatory and decreased
CHICKENPOX HERPES ZOSTER symptomatic relief of itching
pain
Ex. Diphenhydramine
MAIN PROBLEM (Benadryl) Ex. Prednisone
A highly contagious disease An acute viral infection of 2. Analgesics and antipyretics
characterized by vesicular the sensory nerve
eruptions on the skin and Ex. Acetaminophen
mucous membranes
3. Antiviral agents – for patient to
ETIOLOGIC AGENT
Varicella zoster virus experience less pain and faster
resolution of lesions when used within
INCUBATION PERIOD
48 hours of rash onset
10-21 days 13-17 days
Ex. Acyclovir (Zovirax)
MODE OF TRANSMISSION
1. Droplet method CHICKENPOX HERPES ZOSTER
2. Direct contact
NURSING MANAGEMENT
3. Indirect contact
Strict isolation
CHICKENPOX HERPES ZOSTER Prevent secondary infection (cut
fingernails short, wear mittens)
PERIOD OF COMMUNICABILITY
Eliminate itching: calamine
One day before eruption lotions, warm baths, baking soda
One day before eruption
of 1st lesion and five days paste
of 1st rash and five to six
after appearance of last
days after the last crust Encourage not going to school:
crop
usually 7 days
SIGNS AND SYMPTOMS
Disinfection of clothes and linen
PRODROMAL with nasopharyngeal discharges
PERIOD by sunlight or boiling
- Fever (low-grade)
- Headache
- Malaise

CD-Bucud 7
 MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES
MAIN PROBLEM TREATMENT MODALITIES

A contagious exanthematous A benign communicable 1.Vitamin A – helps 1.Aspirin – help reduce

disease with chief symptoms to exanthematous disease caused prevent eye damage inflammation and
the upper respiratory tract by rubella virus and blindness fever
ETIOLOGIC AGENT
2. Antipyretics – for
Filterable virus of Rubella virus fever
paramyxoviridae
3. Penicillin – given
INCUBATION PERIOD
only when secondary
10-12 days 14-21 days
infection sets in
MODE OF TRANSMISSION
1. Droplet method
2. Direct contact with respiratory discharges
3. Indirect with soiled linens and articles

MEASLES GERMAN MEASLES MEASLES GERMAN MEASLES

PERIOD OF COMMUNICABILITY NURSING MANAGEMENT

4 days before and 5 days after
the appearance of rashes
SIGNS AND SYMPTOMS
PRE-ERUPTIVE STAGE
Cough
Coryza
Conjunctivitis
Fever (high-grade)
Photophobia
One week before and four days 1. Darkened room to relieve photophobia
after the appearance of rashes 2. Diet: should be liquid but nourishing
3. Warm saline solution for eyes to relieve
eye irritation
PRE-ERUPTIVE STAGE
Fever 4. For fever: tepid sponge bath and anti-
pyretics
Headache
5. Skin care: during eruptive stage, soap is
Malaise omitted; bicarbonate of soda in water or
lotion to relieve itchiness
Coryza
6. Prevent spread of infection: respiratory
Conjunctivitis isolation

KOPLIK’S SPOT (Rubeola)

- Bluish white spots surrounded by a red halo SCABIES
- Appear on the buccal mucosa opposite the premolar teeth MAIN PROBLEM
FORCHEIMER’S SPOTS (Rubella) Infestation of the skin produced by the burrowing action of a parasite
- small, red lesions mite resulting in skin irritation and formation of vesicles and pustules
- Soft palate to mucus ETIOLOGIC AGENT
membrane Sarcoptes scabiei
MEASLES GERMAN MEASLES INCUBATION PERIOD
Within 24 hours
MODE OF TRANSMISSION
SIGNS AND SYMPTOMS ERUPTIVE STAGE Direct contact
2. ERUPTIVE STAGE 1. Rash Indirect contact
Rashes - pinkish, maculopapular
- Elevated papules Sarcoptes scabiei
- Begins on the face 1. Yellowish white in color
- Begin on the face and behind
the ears - Spread to trunk or limbs 2. Barely seen by the unaided eye
- Spread to trunk and 3. Female parasite burrows beneath the epidermis to lay eggs
extremities - No pigmentation or
desquamation 4. Males are smaller and reside on the surface of the skin
Color: Dark red – purplish hue SIGNS AND SYMPTOMS
– yellow brown 2. Posterior auricular and • Thin, pencil-mark lines on the skin
3. Stage of Convalescence suboccipital • Itching, especially at night
- Desquamation lymphadenopathy
• Rashes and abrasions on the skin
- Rashes fade from the face PRIMARY LESIONS
downwards NODULAR LESIONS
SECONDARY LESIONS
TREATMENT MODALITIES
• SCABICIDE : Eurax ointment (Crotamiton)
MEASLES GERMAN MEASLES • PEDICULICIDE : Kwell lotion (Gamma Benzene
Hexachloride) – contraindicated in young children and
COMPLICATIONS 1. Encephalitis pregnant women
• Topical steroids
2. Congenital rubella syndrome
Pneumonia • Hydrogen peroxide : cleanliness of wound
- Spontaneous abortion
• Lindane Lotion
- Intrauterine growth retardation NURSING MANAGEMENT
Otitis media (IUGR)
• Apply cream at bedtime, from neck to toes
- Thrombocytopenia purpura
“blueberry muffin skin” • Instruct patient to avoid bathing for 8 to 12 hours
Severe diarrhea (leading - Cleft lip, cleft palate, club foot • Dry-clean or boil bedclothes
to dehydration) • Report any skin irritation
- Heart defects (PDA, VSD)
• Family members and close contact treatment
Encephalitis - Eye defects (Cataract,
glaucoma)
• Good handwashing
• Terminal disinfection
- Ear defects (Deafness)
- Neurologic (microcephaly,
mental retardation, behavioral
SEXUALLY TRANSMITTED DISEASES
disturbances

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 AIDS SYPHILIS AIDS SYPHILIS

SIGNS AND SYMPTOMS 2. SECONDARY SYPHILIS

MAIN PROBLEM
- Skin rash
Final and most serious stage Infectious disease caused
of HIV disease, which causes - Mucous patches
severe damage to the immune
by a spirochete
system - Hair loss

ETIOLOGIC AGENT - CONDYLOMATA LATA:

Retrovirus – Human T-cell
lymphotropic virus III
(HTLV-3)
coalescing papules which
form a gray-white plaque
Treponema pallidum
frequently in skin folds

INCUBATION PERIOD

3 to 6 months to 8 to 10 years 10-90 days

AIDS SYPHILIS AIDS SYPHILIS

MODE OF TRANSMISSION SIGNS AND SYMPTOMS 3. TERTIARY SYPHILIS
• Sexual contact – oral, anal or - 1 to 10 years after infection
vaginal sex
- Appear on the skin, bones,
•Blood transfusion mucus membrane, URT, liver
and stomach
•Mother-to-child - GUMMA: chronic, superficial
nodule or deep
•Indirect contact through soiled granulomatous lesion that is
articles solitary, painless, indurated

AIDS SYPHILIS
AIDS SYPHILIS
SIGNS AND SYMPTOMS
OPPORTUNISTIC INFECTIONS DIAGNOSTIC PROCEDURES
1. Pneumocystis carinni
pneumonia
1.ELISA 1.Dark Field
Illumination test
2. Oral candidiasis 2. Western blot
3. Toxoplasmosis
3. RIPA 2. Flourescent
4. Acute/chronic diarrhea
Treponemal
5. Pulmonary tuberculosis
4. PCR Antibody
MALIGNANCIES
Absorption Test
1. Kaposi’s sarcoma
2. Non-Hodgkin’s lymphoma 3. VDRL
AIDS SYPHILIS
1. PRIMARY SYPHILIS
AIDS SYPHILIS
SIGNS AND SYMPTOMS
- CHANCRE: small, painless, TREATMENT MODALITIES
pimple-like ulceration on the 1. Penicillin G Benzathine
penis, labia majora, minora 1. Antivirals - Disease < 1 year: 2.4 M units
and lips once in two injection sites
- Shorten the clinical
- May erupt in the genitalia, - Disease > 1 year: 2.4 M units
anus, nipple, tonsils or eyelids course, prevent
in 2 injection sites x 3 doses
- Lymphadenopathy
complications, prevent
development of 2. Doxycycline – if allergic to
penicillin
latency, decrease
3. Tetracycline
transmission
- if allergic to penicillin
- Example: Zidovudine - Contraindicated for
(Retrovir) pregnant women

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 CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

MAIN PROBLEM MAIN PROBLEM

A viral disease
Sexually transmitted disease caused by a bacteria
Mild superficial fungal characterized by the
Purulent inflammation of mucous appearance of sores and
membrane surfaces infection
blisters on the skin
ETIOLOGIC AGENT

Chlamydia trachomatis Neisseria gonorrhea ETIOLOGIC AGENT

INCUBATION PERIOD Herpes simplex virus
Candida albicans types 1 and 2
2-3 weeks (males)
2-10 days
Asymptomatic (females) INCUBATION PERIOD
MODE OF TRANSMISSION
2-3 weeks 2-12 days
Sexual contact: Oral, vaginal or anal sex

CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX

SIGNS AND SYMPTOMS Women MODE OF TRANSMISSION
Women Bleeding after intercourse 1. Rise in glucose as in TYPE 1
Abdominal or pelvic pain Burning sensation during diabetes mellitus - Respiratory droplets
Bleeding after intercourse and urination
in-between menses Yellow or bloody vaginal
2. Lowered body - Direct exposure to
discharge resistance as in cancer infected saliva
Unusual vaginal discharge
3. Increase in estrogen - Kissing and sharing
Men level in pregnant women utensils
Burning with urination
4. Broad-spectrum TYPE 2
Swollen, painful testicles antibiotics are used
White, yellow or - Sexual or genital
Discharge from the penis green pus from the
penis
contact

SIGNS AND SYMPTOMS (Candidiasis)

CHLAMYDIA GONORRHEA ONYCHOMYCOSIS
• Red, swollen darkened nailbeds
COMPLICATIONS
Women • Purulent discharge
• Separation of pruritic nails from nailbeds
Pelvic inflammatory
disease
DIAPER RASH
• Scaly, erythematous, papular rash
Ectopic pregnancy • Covered with exudates
Sterility • Appears below the breasts, between fingers, axilla, groin
and umbilicus
Men THRUSH
• Cream-colored or bluish-white patches on the tongue,
Epididymitis mouth or pharynx
Sterility • Bloody engorgement when scraped
Newborn
MONILIASIS
Conjunctivitis Newborn • White or yellow discharge
Otitis media Gonococcal ophthalmia
• Pruritus
• Local excoriation
Pneumonia
• White or gray raised patches on vaginal walls with local
inflammation
CHLAMYDIA GONORRHEA CANDIDIASIS HERPES SIMPLEX
TREATMENT MODALITIES
1. Cefixime TREATMENT MODALITIES

1. Azithromycin 1. Antifungals 1. Antivirals

(Zithromax) - Drug of choice
because of oral - Fluconazole (Diflucan) - Acyclovir (Zovirax)
- Drug of choice because
efficacy, single dose - Ketoconazole (Nizoral)
of single-dose treatment
effectiveness and lower 2. Ciprofloxacin - Imidazole (Nystatin)
cost - Used for oral thrush
3. Ceftriaxone
2. Doxycycline - 48 hours until
- Secondary drug of 4. Erythromycin symptoms disappear
choice - Cotrimoxazole

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VECTOR-BORNE DISEASES DENGUE MALARIA

DENGUE MALARIA DIAGNOSTIC PROCEDURES 1. CLINICAL DIAGNOSIS

1. TORNIQUET TEST - Based on triad symptoms, 50%

MAIN PROBLEM
An acute febrile disease
The most common arboviral
illness transmitted globally
ETIOLOGIC AGENT
Dengue virus types 1, 2, 3 and 4
Chikungunya virus
O’nyong’nyong virus
An acute and chronic parasitic
disease
The most deadly vector-borne
disease in the world
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
- Screening test for dengue
- A test for the tendency for blood
capillaries to break down or produce
petechial hemorrhage
- Performed by examining the skin of
the forearms after the arm veins
have been occluded for 5 minutes
- To detect unusual capillary fragility
2. PLATELET COUNT
- Confirmatory test for dengue
- Decreased count is confirmatory
accuracy
2. BLOOD SMEAR
- Definitive diagnosis of infection is
based on demonstration of malaria
parasites in blood film
3. RAPID DIAGNOSTIC TEST
- Uses immunochromatographic
methods to detect Plasmodium-
specific antigens
- Takes about 7 to 15 minutes
- Sensitivity and specificity > 90%

West Nile virus Plasmodium malariae DENGUE MALARIA

DENGUE MALARIA TREATMENT MODALITIES 1. Chloroquine

1. Analgesics and antipyretics
2. Primaquine
INCUBATION PERIOD P. Falciparum – 12 days - acetaminophen
3. Pyrimethamine
3-14 days P. Vivax – 14 days 2. Volume expanders
- Used in the treatment of 4. Sulfadoxine
P. Ovale – 14 days intravascular volume deficits
5. Quinine
P. Malariae – 30 days - Example: Lactated Ringers
MODE OF TRANSMISSION 6. Quinidine
3. Blood transfusion – for severe
bleeding
Bite of an infected mosquito
4. Oxygen therapy
Blood transfusion, contaminated
syringe or needle 5. Sedatives

Trans-placentally
SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
MAIN PROBLEM
VECTOR A slowly progressive disease A zoonotic infectious disease
caused by a blood fluke
Aedes aegypti Anopheles flavirostris
ETIOLOGIC AGENT
(Aedes albopictus)
1. SCHISTOSOMA JAPONICUM Leptospira interrogans
White stripes on the back and Brown in color - Intestinal tract, endemic in the
legs (Tiger mosquito) Philippines

Day biting (2 hours after sunrise 2. SCHISTOSOMA MANSONI

Night biting (9 PM-3 AM)
and 2 hours before sunset) - Africa

Breeds on clear stagnant water Breeds on clear, flowing and

3. SCHISTOSOMA HAEMATOBIUM
shaded streams
- Middle East countries like Iran and Iraq

Urban-based Rural-based
SCHISTOSOMIASIS LEPTOSPIROSIS
DENGUE MALARIA
INCUBATION PERIOD
SIGNS AND SYMPTOMS At least 2 months 7 to 19 days

FEVER FEVER
MODE OF TRANSMISSION
HEADACHE CHILLS
Ingestion
MALAISE PROFUSE SWEATING Skin penetration
RASH Contact with the skin

EPISODES OF
BLEEDING

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SCHISTOSOMIASIS LEPTOSPIROSIS SCHISTOSOMIASIS LEPTOSPIROSIS

VECTOR TREATMENT MODALITIES

1st line drugs
Oncomelania quadrasi 1. Praziquantel (Biltricide)
1. Penicillin G – drug of choice
1. Thrives in fresh water - Taken for 6 months
stream 2. Doxycycline
- 1 tablet BID for 3 months
2. Clings to grasses and leaves 2nd line drugs
- 1 tablet OD for 3 months
3. Greenish brown in color 3. Ampicillin
4. Size is as big as the smallest 4. Amoxicillin
grain of palay

SCHISTOSOMIASIS LEPTOSPIROSIS FILARIASIS

MAIN PROBLEM
A parasitic disease caused by an African eye worm
ETIOLOGIC AGENT
SIGNS AND SYMPTOMS Septic or Leptospiremic Stage Wuchereria bancrofti
ACUTE STAGE F – ever (remittent Brugia malayi
Brugia timori
1. Cercarial dermatitis H – eadache INCUBATION PERIOD
(swimmer’s itch) 8 to 16 months
M – yalgia MODE OF TRANSMISSION
2. Katayama syndrome
N – ausea Person-to-person by mosquito bites
C - ough ACUTE STAGE
V – omiting • Lymphadenitis (inflammation of lymph nodes)
H – eadache and fever • Lymphangitis (inflammation of lymph vessels)
C – ough
A – norexia and lethargy • Male genitalia affected leading to funiculitis, epididymitis
C – hest pain and orchitis (redness, painful and tender scrotum)
R – ash CHRONIC STAGE
M - yalgia • Develop 10-15 years from onset of first attack
• Hydrocele (swelling of the scrotum)
• Lymphedema (temporary swelling of the upper and lower
SCHISTOSOMIASIS LEPTOSPIROSIS extremities)
• Elephantiasis (enlargement and thickening of the skin of
the upper and lower extremities, scrotum and breast
SIGNS AND SYMPTOMS Immune or Toxic Stage
LABORATORY EXAMINATIONS
CHRONIC STAGE - Lasts for 4 to 30 days • Nocturnal blood examination (NBE) – taken at patient’s
1. Hepatic: pain, abdominal residence/hospital after 8PM
- Iritis, headache, meningeal
distension, hematemesis, melena • Immunochromatographic test (ICT) – rapid assessment
manifestations
method; an antigen test done at daytime
2. Intestinal: fatigue, abdominal pain, TREATMENT
- Oliguria, anuria with renal
dysentery
failure • Diethylcarbamazine Citrate (DEC) or HETRAZAN – an
3. Urinary: dysuria, urinary individual treatment kills almost all microfilaria and a good
frequency, hematuria - Shock, coma and congestive proportion of adult worms.
heart failure PREVENTION AND CONTROL
4. Cardiopulmonary: palpitations,
dyspnea on exertion • Measures aimed to control vectors
• Environmental sanitation such as proper drainage and
5. CNS: seizures, headache, back cleanliness of surroundings
pain and paresthesia
• Spraying with insecticides
PREVENTION AND CONTROL
SCHISTOSOMIASIS LEPTOSPIROSIS • Measures aimed to protect individuals and families:
• Use of mosquito nets
• Use of long sleeves, long pants and socks
DIAGNOSTIC PROCEDURES • Application of insect repellants
• Screening of houses
1. Fecalysis

2. Kato-Katz Technique

3. Cercum ova precipitin test

(COPT)
- Confirmatory test for
schistosomiasis

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