COMMUNICABLE DISEASE
MODULE 1
DEFINITION OF COMMUNICABLE DISEASE
At the end of the course the student will be able to understand:
1. The overview and purpose of the diagnostic procedure
2. The definition of communicable diseases,
terminologies important in its process
different
3. The types of communicable diseases, pattern of diseases,
occurrence and immunity
4. Process of chain of infection, mode of transmissions
5. The different infection control measures
6. The isolation technique and the transmission based
precautions
1
COMMUNICABLE DISEASE
DEFINITION OF COMMUNICABLE
DISEASE
body by directly applying physical or
chemical means.
a. Concurrent disinfection
b. Terminal disinfection
COMMUNICABLE DISEASE NURSING
AND ITS
DIFFERENT TERMINOLOGIES
▪ Disease caused by an infectious
agent from an infected individual
and transmitted to a susceptible
host either by direct/ indirect
contact
or
through
direct
inoculation into a broken skin.
▪
HABITAT – is the place where an
organism lives or where an organism is
usually found.
HOST – is a person, animal or plant on
which a parasite depends for its survival.
ISOLATION – is the separation from
other persons of an individual suffering
from a communicable disease.
Is an illness caused by an
infectious agent or its toxic
product that are transmitted
directly or indirectly to a well
person through an agency, and a
vector or an inanimate object.
QUARANTINE – is the limitation of
freedom of movement of persons or
animals which have been exposed to
CD/s for a period of that disease.
COMMON TERMINOLOGIES
INFECTION – is the implantation and
successful replication of an organism in
the tissue of the host resulting to signs
and symptoms as well as immunologic
response.
RESERVOIR – is composed of one or
more species of animal or plant in which
an infectious agent lives and multiplies
for survival and reproduces itself in such
a manner that it can be transmitted to
man.
CARRIER – is an individual who harbors
the organisms and is capable of
transmitting it to a susceptible host
without showing manifestations of the
disease.
SURVEILLANCE
watching.
–
is
the
act
of
TYPES
OF
COMMUNICABLE
DISEASE
▪ Infectious Disease – not easily
transmitted by ordinary contact
but require a direct inoculation
through a break in the previously
intact skin or mucous membrane.
CONTACT – is any person or animal, or
freshly soiled materials.
DISINFECTION – is the destruction of
pathogenic microorganism outside the
2
COMMUNICABLE DISEASE
d. Some other factors
▪
Contagious Disease – easily
spread and is directly transmitted
from person to person
SPORADIC - intermittent occurrence of a
disease./ Occasionally and irregularly
with no specific pattern.
Why infections occur?
 Some bacteria develop resistance
to antibiotics
 Some microbes such as influenza
have so many different strains that
a single vaccine cannot protect
against all of them.
 Most viruses resist antiviral drugs
 New
infectious
agents
occasionally arise such as HIV
and Corona Viruses.
ENDEMIC – continuous or constant
occurrence of a disease in a certain area
Some microbes localize in areas of the
body that make treatment difficult
EPIDEMIC –sudden increase in the
number of cases of a disease in a short
period of time/ occur in a greater number
than what is expected in a specific area
over a specific time.
ASPECTS OF CARE OF PATIENTS
WITH COMMUNICABLE DISEASE
PATTERNS OF DISEASE/ INCIDENCE
OF THE DISEASE
A. PREVENTION
1. HEALTH EDUCATION
Educate the family and the client
with respect to:
• Availability and importance of
prophylactic immunization
• Manner in which infectious
illness is spread and methods
of avoiding the spread
• Importance of seeking medical
advice for any sign of health
problem
• Importance of environmental
cleanliness
and
personal
hygiene
• Means
of
preventing
contamination of food and
water supply
2. IMMUNIZATION – induction or
introduction of specific protective
antibodies in a susceptible person
PANDEMIC -worldwide epidemic/ affects
several countries or continents
INFECTION AND THE ASPECTS OF
CARE OF PATIENTS WITH
COMMUNICABLE DISEASE
What is infection?
❖ The production of microorganisms
injures the patient by;
1. Competing
with
the
host
metabolism,
2. Cellular damage produced by the
microbes,
3. Intracellular multiplication
Severity of Infection
⚫ Varies with the;
a. Disease producing ability
b. Number of invading organism
c. The strength of the host’s defense
3
COMMUNICABLE DISEASE
•
for the purpose of producing
cellular immunity.
• Expanded
Program
of
Immunization
(EPI)
/
Proclamation No. 6: Prevent
the seven childhood diseases,
TB, DPT, polio, measles,
hepatitis B
• U.N. goal: universal child
immunization
Proper supervision of food
handlers
B. CONTROL – LIMIT THE SPREAD
OF INFECTION BY MEANS OF:
1. Isolation – separation of infected
persons from other persons
during
the
period
of
communicability in order to
prevent the direct or indirect
transmission of the infectious
agent from infected persons to
other person who are susceptible
or who may spread the disease to
others.
Purpose of Isolation
• Is to confine the infectious
agent to a circumscribed area
and to prevent the escape of
infection from that area.
IMMUNITY
▪ Immunity is the process of
rendering an individual resistance
or
immunity to a specific
disease.
TYPES OF IMMUNITY
1.
Natural
Immunity:
innate;
inherent; inborn
A. Natural
* Natural Active: Through exposure
or having disease itself
*Natural
Passive:
Maternal
antibodies received by the baby
through placental transmission.
7 Categories Recommended In
Isolation
1. Strict Isolation – to prevent
highly contagious or virulent
infections
2. Contact Isolation – to prevent
the
spread of
infection
primarily by close or direct
contact.
3. Respiratory Isolation – to
prevent
transmission
of
infectious diseases over short
distances through the air.
4. TB isolation – for TB patients
with smear or with chest X-ray
which strongly suggest active
tuberculosis.
5. Enteric Isolation – is for
infections with direct contact
with feces
6. Drainage/Secretion
Precaution – to prevent
infections that are transmitted
2. Acquired Immunity
B. Artificial
* Artificial Active: Introduction of
antigens that will stimulate the
body to produce antibodies, e.g.
live attenuated vaccine
*Artificial Passive: Introduction of
antibodies, e.g. Immunoglobulin
3. ENVIRONMENTAL SANITATION
– P.D. 856
• Anti-littering: P.D. 825
4
COMMUNICABLE DISEASE
by direct or indirect contact
with purulent materials or
drainage from an infected
body site.
Universal Precaution –is
applied when handling blood
and body fluids
a. Applied to patients with
HIV/HBC
b. Intended
to
prevent
parenteral,
mucous
membrane, and non-intact
skin exposure of health
care workers to bloodborne pathogens.
c. The isolation is necessary
to prevent infections that
are transmitted by direct
contact with infected blood
or body fluids.
d. This applied to blood,
semen, vaginal secretions,
and other body fluids,(CSF,
synovial fluid, pleural fluid,
peritoneal fluid, pericardial
fluid, amniotic fluid), and
tissues containing visible
blood.
4. Disinfection – any physical or
chemical process to destroy
undesired animal forms present in
the
person,
clothing
or
environment.
• Concurrent – the application
of disinfection as rapidly as
possible after the discharge of
infectious material from the
body of an infected person or
as after the soiling of articles
with
such
infectious
discharges.
• Terminal – the process of
rendering
the
personal
clothing
and
immediate
physical environment of the
patient free from the possibility
of conveying the infection to
others at the time when the
patient is no longer a source of
infection.
5. Asepsis – the state or condition of
being free from infection.
A. CHAIN OF INFECTION
1. Describes the development of
an infectious process
2. An
interactive
process
involving an agent, host, and
environment is required
The six essential links (elements) in the
chain of infection:
1. AGENT
• An entity that is capable of
causing disease.
• Agents that cause disease may
be as follows:
2. Quarantine – limitation of
freedom of movement of persons
or animals who have been
exposed to a communicable
disease for a period of time equal
to the longest usual incubation
period of the diseases so as to
prevent effective contact with
those who are not exposed. May
either be complete or modified.
3. Fumigation – any process by
which the killing of animal forms is
accomplished with the use of
gaseous agents.
Biological Agents: Living organisms
that invade the host, causing disease.
a. Bacteria
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COMMUNICABLE DISEASE
•
• May be harmful or beneficial
d. Protozoa
• Larger than bacteria
• Absorb nutrients from the body
of the host
e. Rickettsia
• Small, gram-negative bacterialike microbes that can induce
life-threatening infections
• Like viruses, they require a host
cell for replication
• Usually transmitted through a
bite of arthropod carriers like
lice, fleas, ticks as well as
through waste products
f. Spirochete
• A bacterium with flexible,
slender, undulating spiral rods
that possess cell wall.
• Three forms of spirochete that
cause a disease:
 Treponema
 Leptospira
 Borilia
g. Parasites
• Live on or without other
organisms
• Live at the expenses of others
• Don’t usually kill their host but
take only the nutrients they
need.
Simple, one-celled microbes
with double-celled membranes
that protect them from harm
• Produce rapidly and are
considered the most common
cause of fatal infectious disease
• Classified according to:
 Shape
(cocci,
bacilli,
spirillae)
 Need of oxygen (aerobic,
anaerobic)
 Response of staining (grampositive or negative; acid fast
or non-acid fast)
 Motility (motile, non-motile)
 Tendency
to
capsulate
(encapsulated, capsulated)
 Capacity to form spores
(spore-forming, non-sporeforming)
b. Viruses
• Smallest known microbes
• Cannot replicate independently
in the host’s cells; rather, they
invade and stimulate the host’s
cells to participate in the
formation of additional viruses
c. Fungi
• Found almost everywhere on
earth
• Live in organic matter, soil,
water, animals and plants
• Can also live inside and outside
the body
6
COMMUNICABLE DISEASE
THE CHAIN OF INFECTION
BIOLOGICAL
AGENT
Intact immune
system
Disinfection
Exercise
Cleaning
Immunization
Sterilization
Proper nutrition
SUSCEPTIBLE HOST
RESERVOIR OR
SOURCE
Skin integrity
Proper hygiene
Sterile technique
Change of
dressing
Proper disposal of
needle or sharps
Cleaning of
equipment
Sterilization
PORTAL OF
ENTRY TO HOST
PORTAL OF EXIT
FROM RESERVOIR
Wearing of gloves
masks gowns
goggles (APPEs)
Clean dressing
over wounds
Medical or
surgical asepsis
Covering mouth
and nose when
coughing or
sneezing
Proper disposal of
contaminated
object
Hard hygiene
MODE OF
TRANSMISSION
FIGURE 1.1 THE CHAIN OF INFECTION
7
COMMUNICABLE DISEASE
Chemical agents. Substances that can interact
with the body, causing disease, such as food
additives, medications, pesticides, and industrial
chemicals
Contact Transmission
This involves the transfer of an agent
from an infected person through a
fomite, or close contact with
contaminated secretions. Sexually
transmitted diseases are spread by
direct contact. Common viral infections
(cold, measles, and flu) are spread by
close contact with contaminated
secretions.
▪ Direct Contact – person to person
▪ Indirect Contact – inanimate
objects or personal things
▪ Droplet Contact – contact with
discharges
from
coughing,
sneezing or talking with infected
person
Physical agents. Factors in the environment that
are capable of causing disease, such as heat,
light, noise, and radiation
2. RESERVOIR
• A place or environment where the agent
can survive and multiply
• The most common reservoirs are:
 Humans
 Animals
 Physical environment
 Fomites
3. PORTAL OF EXIT
• Route, path or way by which an
infectious agent leaves the reservoir to
be transferred to a susceptible host.
• The agent leaves the reservoir through
body secretions including:
 Sputum (from the respiratory tract)
 Semen, vaginal secretions, or urine
(from the genitourinary tract)
 Saliva and feces (from the
gastrointestinal tract)
 Blood
 Draining wounds
 Tears
▪
4. MODES OF TRANSMISSION
• The process of the infectious agent
moving from the reservoir or source
through the portal of exit to the portal of
entry of the susceptible “new” host.
Most infectious agents have a usual
primary mode of transmission, but
some microorganisms may be
transmitted by more than one
mode/depending on the agent. Almost
anything in the environment can
become a potential mode of
transmission.
HORIZONTAL TRANSMISSION
Figure 1.2
Horizontal Transmission (Direct Contact)
8
COMMUNICABLE DISEASE
DIRECT CONTACT
Airborne Transmission
▪ Occurs when a susceptible host contacts
droplet nuclei or dust particles that are
suspended in the air. Contaminated
droplets containing the measles virus are in
the spray from sneezing. The droplet can
find a portal of entry through the mucous
membranes or conjunctiva. Droplets that do
not remain airborne or settle out are
excluded from this category.
Figure
1.4
(Mosquitoes)
Vectorborne
Transmissions
Vertical Transmission
▪
Refers
to
the
mother-to-child
transmission through the placental barrier
or breastfeeding
Figure 1.3 Airborne Transmission
Vehicle Transmission
▪ Occurs when an agent is transferred to a
susceptible host by contaminated
inanimate objects such as water, food,
milk, drugs, and blood. Cholera is
transmitted through drinking water and
salmonellosis is transmitted through
contaminated meat.
Figure 1.5
Verticaltransmissions through breastfeeding
and placental barrier
5. Portal of Entry
• The route by which an infectious agent
enters the host
Vectorborne Transmission
▪ Occurs when an agent is transferred to a
susceptible host by animate means such
as mosquitoes, fleas, ticks, lice, and other
animals. Lyme disease, malaria, and
West Nile virus are examples of diseases
spread by vectors.
6. Host
• A host is an organism that can be affected
by an agent.
• A human being is usually considered a
host.
• Susceptible host is a person who has no
resistance to an agent and thus is
9
COMMUNICABLE DISEASE
•
vulnerable to disease. For example, an
individual who has not received the
measles vaccine is more likely to contract
the infection because of the lack of
immunity o the infectious agent.
Compromised host is a person whose
normal body defense is impaired and is
therefore susceptible to infection. For
example, a person with a common cold or
superficial burns is at greater risk for
infection because of the impaired state of
the body system mechanisms.
FIGURE 1.6 BREAKING THE CHAIN OF INFECTION
10
COMMUNICABLE DISEASE
1. Infection
Defense
Control:
First
Line
of
Hand hygiene is the first line of
defense against infection and is the
single most important practice in
preventing the spread of infection.
•
Between Agent and Reservoir
The first link in the chain of
infection is between the agent
and the reservoir.
•
Between Reservoir and Portal
of Exit
Promoting
proper
hygiene,
changing dressings and linens,
and
ensuring
that
clean
equipment is used in client care
ways to break the chain of
infection between the reservoir
and the portal of exit
The goal is to eliminate the
reservoir for the microorganism
before a pathogen can escape to
a susceptible host.
•
Between Portal of Exit and
Mode of Transmission
The goal in breaking the chain of
infection between the portal of
exit
and
the
mode
of
transmission is to prevent the
exit of the infectious agents.
Clean dressings must be
maintained on all wounds.
Clients should be encouraged to
cover their mouths and noses
when sneezing or coughing, and
the nurse must do so as well.
Gloves must be worn when
caring for a client who may have
infectious secretions, and care
must be taken to properly
11
dispose of any contaminated
article.
•
Between
Mode
of
Transmission and Portal of
Entry
Asepsis must be ensured and
barrier protection worn when the
care of clients involves contact
with the body secretions. Gloves,
masks, gowns, and goggles are
barrier protection that can be
used. Proper hand hygiene and
proper disposal of contaminated
equipment and linens are ways
to prevent transmission of
microorganisms to other clients
and health care workers.
•
Between Portal of Entry and
Host
Maintaining skin integrity and
using sterile technique or client
contacts
are
methods
of
breaking the chain of infection
between portal of entry and host.
Avoiding needle sticks by
properly disposing of sharps also
reduces the
potential
for
infection by denying a portal of
entry. The goal at this point in the
chain is to prevent the
transmission of infection to a
client or health care worker who
is not infected.
•
Between Host and Agent
Breaking the chain of infection
between host and agent means
eliminating infection before it
begins. There are many ways to
reduce the risk of acquiring
infection:
COMMUNICABLE DISEASE
Proper nutrition, exercise, and
immunizations
allow
an
individual to maintain an intact
immune system, thus preventing
infection.
kind
and
contamination.
•
2. Infection Control: Cleansing
Cleansing is a potential hazard to
the nurse from the splashing of
contaminated material onto the
body. Nurses should wear gloves,
masks,
and
goggles
during
cleansing.
•
Disinfection is the elimination of
pathogens, except spores, from
inanimate objects. Disinfectants
are chemical solutions used to
clean
inanimate
objects.
Common
disinfectants
are
alcohol, sodium hypochlorite,
quaternary ammonium, phenolic
solutions, and glutaraldehyde.
•
A germicide is a chemical that
can be applied to both animate
(living) and inanimate objects to
eliminate pathogens. Antiseptic
preparations such as alcohol and
silver
sulfadiazine
are
germicides.
•
Sterilization is destroying all
microorganisms
including
spores. Equipment that enters
normally sterile tissue or blood
vessels must be sterilized.
Methods
of
achieving
sterilization are moist heat
(steam), dry heat, and ethylene
oxide gas. The method of
sterilization depends on the
object to be sterilized and the
12
•
amount
of
Autoclaving
sterilization,
which uses moist heat or steam,
is the most common sterilization
technique used in the hospital
setting. Boiling water is not an
effective sterilization measure,
because some viruses and
spores can survive boiling water.
Objects that have been boiled in
water for 15 to 20 minutes at
121ºC (249.8ºF) are considered
clean but not sterile (Department
of Labor, 1991)
Promoting
proper
hygiene,
changing dressings and linens,
and
ensuring
that
clean
equipment is used in client care
are ways to break the chain of
infection between the reservoir
and the portal of exit. The goal is
to eliminate the reservoir for the
microorganism
before
a
pathogen can escape to a
susceptible host.
B. TYPES
AND
INFECTIONS
STAGES
OF
1. Types of Infections
• Localized
infections are
limited to a defined area or
single organ with symptoms
that resemble inflammation
(redness, tenderness, and
swelling), such as a cold
sore.
• Systemic infections affect the
entire body and involve
multiple organs, such as
AIDS.
COMMUNICABLE DISEASE
2. Stages of Infection
•
Incubation
Stage.
The
incubation period is the time
between entry of infectious
agent in the host and the
onset of symptoms. During
this time, the infectious agent
invades the tissue and
multiplies to produce an
infection. The client is
typically infectious to others
during the latter part of this
stage. For example, the
incubation period for varicella
(chicken pox) is 2 to 3 weeks.
The infected person is
contagious from 5 days
before any skin eruptions to
no more than 6 days after the
skin eruptions appear.
Safety
•
Always verify the incubation
period of a suspected
infection. Remember that a
client may be able to transmit
the infection to another
person before the onset of
symptoms.
Prodromal
Stage.
The
prodromal stage is the time
from the onset of non-specific
symptoms
until
specific
symptoms begin to manifest.
The
infectious
agent
continues to invade and
multiply in the host. A client
may also be infectious to
other persons during this time
period. In the client with
13
chickenpox, a slight elevation
in temperature will occur
during this stage, followed
within 24 hours by eruptions
on the skin.
•
Illness Stage. The illness
stage is the time when the
client has specific signs and
symptoms of an infectious
process. The client with
chickenpox will experience a
further rise in temperature
and continued outbreak of
skin eruptions for at least 2 to
3 more days.
•
Convalescent Stage. From
the
beginning
of
the
disappearance
of
acute
symptoms until the client
returns to the previous state
of health. The client with
chickenpox will see the skin
eruptions
and
irritations
begin to resolve during this
stage.
C. NOSOCOMIAL INFECTION
A nosocomial infection is
an infection acquired in a
hospital or other health care
facility that was not present or
incubating at the time of the
client’s admission. They also
include those infections that
become symptomatic after
the client is discharged and
infections passed among
medical
personnel.
Nosocomial infections are
COMMUNICABLE DISEASE
also called hospital-acquired
infections. These types of
infections typically fall into
four categories: urinary tract,
surgical wounds, pneumonia,
and septicemia.
Most nosocomial infections
are transmitted by health care
personnel who fail to practice
proper hand hygiene or who
fail to change gloves between
client contacts.
The hospital environment
provides exposure to a
variety of organisms to which
the client has not typically
been exposed in the past.
Therefore, the client has no
resistance
to
these
organisms, illness impairs the
body defenses.
STANDARD PRECAUTIONS FOR INFECTION
CONTROL (Use for all clients)
Wear Gloves
Figure 1.8
Handwashing
Wear gloves (clean, nonsterile adequate) whenever
contact is expected
with blood, body
fluids, secretions,
excretions, mucous
membranes
and
non-intact skin and
contaminated items.
Wash hands before
contact with each
client, during care as
needed (even if
wearing gloves) to
prevent
cross
contamination
of
body sites, and after
touching blood, body
fluids,
secretions,
excretions,
and
contaminated items
(with or without
gloves).
Figure 1.7
Use a plan (non-antimicrobial) soap during routine
handwashing: Use a antimicrobial agent or a
waterless antiseptic agent as per agency policy.
Always
change
gloves
between
clients and between
tasks
and
procedures on the
same client after
contact with material that may contain a high
concentration of microorganisms.
Remove gloves promptly after use, before touching
non-contaminated items and environment surfaces,
and before going to another client, wash hands.
14
COMMUNICABLE DISEASE
Face Protection (mask, goggles, face shield)
Figure 1.9
Wear a face shield, or wear goggles and a
mask thatcovers both the nose and the
mouth during proceduresand client care
activities that are likely to generate
splashes or sprays of blood, body fluids,
secretions or excretions to provide
protection of the mucousmembranes of
the eyes, nose and mouth.
Wear Gown and other protective
apparel
Figure 1.10
Wear
a
gown
to
prevent
contamination of clothing and skin
from blood and body fluids
exposures. Gowns especially treated
to make them permeable to liquids
and leg/shoe covers provide greater
skin
Patient-Care Equipment
Figure 1.11
Handle used patient – care equipment soiled with
blood, body fluids, secretions or excretions in a
manner that prevents skin and mucous membrane
exposures, contamination of clothing and transfer
of microorganism, to other patients and
environments. Ensure that reusable equipment is
not used for the care of another patient until it has
been appropriately cleaned and reprocessed and
single use items are properly discarded.
15
protection when splashes or large
quantities of ineffective material are
present or anticipated. Remove
soiled gown as soon as possible;
wash hands to avoid transfer of
microorganisms.
COMMUNICABLE DISEASE
Environmental Control
Figure 1.12
Follow hospital procedures for routine
care, cleaning, and disinfection of
environment surfaces, beds, and
bedrails, bedside equipment and
other frequently touched surfaces.
Linen
Figure 1.13
Handle, transport, and process used linen
soiled with blood, body fluids, secretions or
excretions in a manner that prevents exposures
and contamination of clothing and avoids
transfer of microorganisms to other patients
and environments designed for holding the 16
needle sheath.
Never recap used needles using both hands
and any other technique that involves
directing the point of a needle toward any part
of the body; rather, use either a one-handed
“scoop” technique or a mechanical device
assist in maintaining appropriate hygiene or
environment control. Consult Infection
Control if a private room is not available.
Figure 1.14
Occupational
Pathogens
Health
and
Bloodborne
Prevent injuries when using needles, scalpels
and other sharp instruments or devices, when
handling sharp instruments after procedures;
when cleaning used instruments and when
disposing of used needles. Handle, transport,
and process used linen soiled with blood,
body fluids, secretions or excretions in a
manner that prevents exposures and
contamination of clothing and avoids transfer
of microorganisms to other patients and
environments designed for holding the needle
sheath.
COMMUNICABLE DISEASE
Figure 1.15
Figure 1.16
Use Resuscitation devices as in alternative to
mouth-to-mouth resuscitation.
Patient Placement
17
Use a private room for a patient who
contaminates the environment or who does not
(or cannot be expected to)
COMMUNICABLE DISEASE
Table 1.1 TRANSMISSION BASED PRECAUTIONS (use when indicated)
Airborne Precautions
Use when small (<5 um) pathogen-infected
droplet nuclei may remain suspended in air
over time and travel distances greater than 3
feet.
Examples, varicella, measles, tuberculosis
Droplets Precautions
Observe standard precautions.
Place client in private room or with another client having the same infection but
not other infections (cohorting).
If possible, use room equipped with negative pressure ventilation, outside
venting, and 6-12 air exchanges per hour.
Keep the door to the room closed.
Wear a special approved particulate filter mask (N95) whenever entering room
of all clients with tuberculosis or when staff or visitors not exposed to rubella or
varicella must enter room.
Limits visitors and caretakers to those already immune if chicken pox (varicella)
or measles are involved.
Keep client in room. Place surgical mask on client if transport is necessary.
Follow additional agency guidelines.
Observe standard precautions.
Use with large (>5 um) pathogen-infected
droplets that travel 3 feet or less via coughing,
sneezing, etc. or during procedures
(sunctioning)
Place client in private room or with another client having the same infection,
but no other infections (cohorting).
Examples: hemophilis influenza, Neisseria
meningitides, others
Special ventilation is not necessary and the door may remain open.
When private room or cohorting is unavailable, keep a distance of 3 feet or
more between the infected client and other clients or visitors.
Wear a mask when working within 3 feet of the client or entering the room
according to agency policy.
Limit the transport of the client from the room and then mask the client, if
possible.
Contact Precautions:
Use with known or suspected microorganisms
transmitted by direct hand-to-skin client
contact or indirect contact with surfaces or
care items in the environment.
Examples: Clostridium difficile, diphtheria
(cutaneous), herpes simplex (mucocutaneous
or neonatal), impetigo, pediculosis, scabies,
zoster (disseminated, immunocompromised
host), (Ebola, Lassa, Marburg), others
Additional recommendations for specific pathogens may also apply.
Observe standard precautions.
Place client in private room or use cohorting, consult agency infectious disease
department as needed.
Wear gloves when entering the room, change gloves after contact with infected
material, remove gloves before leaving room and wash hands immediately with
antimicrobial agent or waterless antiseptic agent, then ensure that hands do
not touch potentially contaminated room surfaces or items.
Wear a clean, non-sterile gown when entering room is clothing may have
substantial contact with client, environmental surfaces or items, or if client is
incontinent, or has diarrhea, ileostomy, colostomy or wound drainage not
contained by a dressing. Remove gown before leaving the room, then ensure
that clothing does not contact potentially contaminated environmental
surfaces.
Limit to essential purposes client transport from room. If transport is needed,
maintain precautions to minimize the risk of pathogen transmission to other
clients and environmental surfaces or equipment.
When possible, dedicate the use of non-critical client-care equipment to a
single client or cohort colonized with the same pathogen; if use of common
equipment or items is unavoidable, adequately clean and disinfect them before
use on another client.
Additional recommendations for specific pathogens may also apply.
18
COMMUNICABLE DISEASE
PRACTICE TO PASS:
Answer the puzzle below:
19
COMMUNICABLE DISEASE
MODULE 2
DISEASES AFFECTING GASTROINTESTINAL SYSTEM
LEARNING OBJECTIVES
At the end of the course the student will be able to understand:
1. The different communicable diseases occur, other names, and etiologic
agents
2. The incubation period, period of communicability and transmission of
different communicable diseases
3. The different diagnostic procedures, signs and symptoms and treatment
4. The process, prevention and control and management of every
communicable diseases.
20
COMMUNICABLE DISEASE
DISEASES AFFECTING
GASTROINTESTINAL SYSTEM
(Bacterial in Origin)
TYPHOID FEVER
A. AKA: Enteric Fever
B. Causative agent – Salmonelia
typhosa
C. Incubation period
between 7-14 days
–
usually
Figure 2.1 Diagnostic Features of
Typhoid Fever
D. Period of communicability – for
as long as the bacteria are in the
stools
G. Signs and symptoms
1. Prodromal stage – for 3-4 days
1.1. Dull headache; malaise
1.2. Chills; fever; body aches
1.3. Vomiting or diarrhea.
2. Fastigeal/pyrexial stage –
during the second week
2.1. Exanthema rose spots –
4 to 5 peculiar rosecolored macules or
meculopapules seen on
the 7th to the 12th day on
the abdomen and chest (in
adult) or on the face (in
infants)
2.2. Ladder-like fever
2.3. Enlarged spleen
2.4. Typhoid psychosis
2.4.1. Coma-vigil look –
pupils
dilate
and
patient appears to
have blank stares or
staring
without
seeing.
2.4.2. Difficulty putting out
the tongue.
E. Mode of transmission – by food
and water contaminated by stools
and urine of patients or carriers.
The vehicles are the 5 Fs:
1. Feces
2. Food
3. Flies
4. Fomites
5. Fingers
F. Diagnostic/laboratory exams
1. Blood culture – during the
prodromal stage
Widal Test to determine the
antigen
left
by
the
microorganism
• Antigen O – presently
infected
• Antigen H – has been
exposed before or has
received toxin
• Typhidot
2. Urine culture
3. Stool culture
21
COMMUNICABLE DISEASE
2.4.3. Carphologia –
involuntary and
aimless picking of
linen
2.4.4. Subsultus tendinum
– involuntary
twitching of the
tendon of the wrists.
2.4.5. Constant tendency
to slip down toward
the foot of the bed.
1.2. Vivotif
1.2.1. Capsule form
1.2.2. Given 1 hour
before
meal
every other day
for 3 doses
1.2.3. 3 years
immunity
2. Control
2.1. Proper handwashing;
clean environment
2.2. Boil drinking water
2.3. Avoid street foods and
improperly washed or
improperly
cooked
food
3. Deferenscence stage – 3rd
week
Intestinal hemorrhage –
microorganism produces
ulcers in the intestine
Intestinal perforation –
spillage of fecal material in
the peritoneum, causing
peritonitis
Cough and hypostatic
congestion of the lungs;
pneumonia
Leukopenia
3. Treatment
3.1. Medical care – the
drug of choice is
Chloromycetin
3.2. Nursing care
3.2.1. Regulation of
the diet
3.2.2. Regulation of
dehydration
3.2.3. hygiene
and
control
TETANUS
• Important information
▪ Infectious but not contagious
▪ Brought about by direct
inoculation
of
material
containing the causative agent
▪ Always a serious disease
4. Lysis/convalescence stage –
although signs and symptoms
subsides, patient should still
be observed for relapses
which could be fatal.
H. Management
1. Prevention
1.1. Immunization – CDT
(Cholera, Dysentery,
Typhoid)
1.1.1. Given IM at
the deltoid
1.1.2. Children
–
0.25 ml, Adults –
0.5 ml
1.1.3. 6
months
immunity
•
•
22
AKA: lockjaw
Causative agent: clostridium
tetani
▪ A common inhabitant of the
soil specially if fertilized with
manure
▪ Long, slender, gram-positive
bacillus
COMMUNICABLE DISEASE
▪
▪
▪
▪
•
Forms spores which are
extremely resistant to heat and
ordinary antiseptics
Extremely anaerobic (does not
grow in the presence of free
oxygen)
Multiplies only at the site of the
wound
Produces its deadly effect by
releasing a true soluble toxin
(tetanospasmin)
which
reaches the brain and spinal
cord and responsible for
muscle spasm
•
Predisposing factors
▪ Newborns whose method of
delivery and umbilical cord
care are not aseptic
▪ Following surgeries, infected
wounds
▪ Women are poorer risks than
men, so are the very young
and the very old.
•
Incubation Period
▪ Commonly 5-10 days but may
vary from 2 days to several
weeks or longer, depending on
the extent, location and
characteristics of the wound.
▪ A short incubation period gives
a bad prognosis
▪ The longer the incubation the
greater the probability of
recovery
•
Mode of Transmission
▪ Normally
mode
of
transmission
is
through
punctured wound that is
contaminated by dust, soil, or
animal excreta containing C.
tentani
• Rugged traumatic wounds
and burns
•
•
•
23
Umbilical
stump
in
newborn especially for
babies delivered at home
with faulty cord dressing;
babies
delivered
to
mothers without tetanus
toxoid immunization
Unrecognized
wounds
(cleaning of the ears with
sharp materials)
Dental
extraction,
circumcision, ear piercing
Signs and Symptoms
▪ Stiffness in the neck, jaw
muscles (trismus), abdomen
or limbs which either rapidly or
gradually increases until the
jaws are locked (trismus) and
cannot be opened. Masseter
muscle is dominant.
▪ The lips protrude and the
corners of the mouth are
drawn out of shape, giving rise
to rise to the sardonic grin
(risus sardonicus). Heightened
by simultaneous elevation of
the eyebrows and wrinkling of
the forehead, the eyes remain
partially closed
▪ The head retract, other
muscles of the body become
spastic, the back become
bowed and the stiffened
patient rests on his head and
heels (opisthotonos)
▪ Slightest stimulation of the
patient
causes
frightful
convulsions
and
causes
unbearable pain. Voluntary
movements are not possible.
Convulsion last from a few to
COMMUNICABLE DISEASE
an almost continuous seizure
during the 24-hour period
Types of Stimuli
1. Exteroceptives – outside the
patient, bright lights, loud noise
2. Interoceptives – from the patient
himself’ flatus
3. Proprioceptives – touching the
patient, jamming the bed, turning
the patient
• Low grade fever, profuse
sweating
• Difficulty in breathing and
swallowing
• Difficulty in breathing and
swallowing
• Cyanosis
• Urinary
retention
and
Constipation
should be wrapped in paper and
burned ASAP)
c. Terminal disinfection (walls and
furniture washed with soap and
water , room thoroughly aired
mattress and pillows autoclave
or aired/sunned for 6-8 hours
Treatment
MEDICAL CARE
1. ATS, (ANST),
2. TAT 0.01 ml Neutralizes the toxin
3. and 0.09 ml NSS
4. Epinephrine or steroid to counteract
anaphylaxis
5. Antibiotics – Penicillin , destroy the
microorganism
6. Prevent and control spasm
a. muscle relaxants –
methocarbamol (Robaxin,
Robaxisal) Baclofen
b. Sedatives –Valium (diazepam)
c. Tranguilizers – Thorazine
7. Tracheostomy, if needed
MANAGEMENT
1. Prevention
a. Active
Immunization
with
tetanus toxoid – DPT 6 weeks
after birth, 0.5ml for 3 doses –(46 weeks interval)
b. Tetanus toxoid for non-pregnant
women
▪ 1st dose given anytime –
0.5ml
▪ 2nd dose after one month
▪ 3rd dose after 6 months
▪ 4th dose after 1 year
▪ 5th dose after another year
c. Antitoxin – is used for the
treatment of clinical tetanus and
for passive immunization or
prophylaxis in recently wounded
individuals never previously
immunized with tetanus toxoid.
NURSING CARE
1. Patient should be in a quiet,
darkened, well ventilated and nonstimulating environment
2. Minimal gentle handling of patientproper scheduling of nursing care
activities so as not to disturb patient
very often, daily cleansing bath with
warm water, change position, oral
hygiene
3. Liquid diet of 3000-4000 calories via
tube feedings if indicated
4. Prevent injury
a. do not leave the patient alone
b. siderails of the bed always raised
c. padded tongue blades or metal
spoon to guard against respiratory
obstruction
5. Proper wound care – wash with
flowing water, then rinse with
antiseptic solution and cover with thin
dressing.
2. Control
a. Medical aseptic technique
b. Concurrent
(All
materials
contaminated with secretions
24
COMMUNICABLE DISEASE
Figure 3.1 Manifestations of Tetanus
Hookworm Disease
Etiologic Agent
•
⚫ Ancylostomiasis, Miner’s Disease,
Egyptian Chlorosis
⚫ An intestinal parasite of humans that
usually causes diarrhea or cramps.
Occurs mostly in tropical and
subtropical countries
Cyclostome duodenale – prevalent in
Europe and Asia
• Necator americanus – Central and
South America and West Africa
o Both are pathogenic to man
o Source of infection is the soil
contaminated with feces
o Female hookworm – 10,000 to 20,000
eggs
25
COMMUNICABLE DISEASE
•
•
o Eggs in moist and oxygen-rich soil will
develop into embryos within 24-72 hrs.
o Larvae take about 6 weeks to develop
into a mature larvae that can cause
human infection.
o It remains alive in the soil for several
weeks under favorable condition.
Diagnostics
• Microscopic exam of feces for the
eggs
• Blood exam reveals eosinophilia
• Treatment Modalities:
o Pyrantel embonate (Quantrel)
o Tetrachloroethylene
o Carbon tetrachloride
Incubation Period
o Hookworm ova appear in the stool
about 4-6 weeks after the larvae
penetrate the skin
o 40-100 days or 2-8 weeks
• Period of Communicability
o Person remains spreaders of infection
as long as they remain infected
Nursing Management
•
•
Mode of Transmission
•
•
Directly through the skin of the foot
(ground itch)
• Ingestion of contaminated drinking
water and food
• Incidence:
o Most important helminth infection of
man
• All persons are susceptible
• 15-25 years of age (common)
• Tropical and subtropical countries
(common)
•
•
•
•
•
•
•
Clinical Manifestations
•
•
•
•
•
•
•
•
Perverted appetite
Pedal edema and edema in other
portions of the body maybe present
•
Small lesion of the intestinal mucosa
Iron deficiency anemia
Abdominal pain, diarrhea, allergic
reactions like urticaria
Mentally
and
physically
underdeveloped (children)
Protruding abdomens and lethargic
(child)
Malnourished and undernourished
(child)
Lazy, have no energy, lack ambition
(child)
Pupils are dilated
Isolation not necessary
Diet high in calories, vitamins, and
minerals
Personal
hygiene
should
be
maintained
Prevention:
Health education
Prevent pollution of streams and lakes
with human excreta
In endemic areas, avoid walking
barefoot
Good hygiene is important
Animals should not be allowed to
defecate on the streets or beaches
where most people likely linger
Purified or boiled water must be used
for drinking
Vegetables should not be eaten raw
Hydatid Disease
•
26
Cystic echinocccosis (CE), also
known as hydatid disease, is caused
by infection with the larval stage of
Echinococcus granulosus, a ~2-7
millimeter long tapeworm found in
dogs (definitive host) and sheep,
cattle, goats, and pigs (intermediate
hosts). Although most infections in
humans are asymptomatic, CE
COMMUNICABLE DISEASE
causes harmful, slowly enlarging cysts
in the liver, lungs, and other organs
that often grow unnoticed and
neglected for years.
Prevention
•
Mode of Transmission
•
•
•
•
Humans can be exposed to these
eggs by "hand-to-mouth" transfer or
contamination.
o By ingesting food, water or soil
contaminated with stool from
infected dogs.
o By petting or handling dogs infected
with the Echinococcus granulosus
tapeworm. These dogs may shed the
tapeworm eggs in their stool, and
their fur may be contaminated.
•
•
•
Prevent dogs from feeding on the
carcasses of infected sheep.
Control stray dog populations.
Restrict home slaughter of sheep
and other livestock.
Do not consume any food or water
that may have been contaminated by
fecal matter from dogs.
Wash your hands with soap and
warm water after handling dogs, and
before handling food.
Teach children the importance of
washing hands to prevent infection.
Leptospirosis is a bacterial disease that
affects both humans and animals.
Humans become infected through direct
contact with the urine of infected animals
or
with
a
urine-contaminated
environment. The bacteria enter the body
through cuts or abrasions on the skin, or
through the mucous membranes of the
mouth, nose and eyes. Person-to-person
transmission is rare.
Risk factors for human infection
include uncontrolled dogs living
closely with people, uncontrolled
slaughter of livestock, and unsanitary
living conditions.
Clinical Manifestations
• Pain or discomfort in the upper
abdominal region or chest, nausea,
vomiting, or coughing may occur as a
result of the growing cysts. Rupture of
cyst fluid can lead to allergic reactions
or even death.
In the early stages of the disease,
symptoms include high fever, severe
headache, muscle pain, chills, redness of
the eyes, abdominal pain, jaundice,
hemorrhages’ in the skin and mucous
membranes, vomiting, diarrhea, and
rash.
Diagnostics
•
•
•
o
o
X-rays or MRI scans
Blood tests
Treatment:
Surgical removal of the cyst
modified
surgical
procedure
(aspiration)
o Medication
Synonyms
o Weil’s Disease, Canicola Fever,
Hemorrhagic
Jaundice,
Mud
Fever, Swine Herd Disease
27
COMMUNICABLE DISEASE
During pregnancy, leptospirosis can
affect the fetus. Anyone who has the
infection during pregnancy will need to
spend time in the hospital for monitoring.
Symptoms
The signs and symptoms of leptospirosis
usually appear suddenly, about 5 to 14
days after infection. However, the
incubation period can range from 2 to 30
days, according to the CDC.
Mild leptospirosis
Signs and symptoms of mild leptospirosis
include:
o
o
o
o
o
For mild cases, the doctor may prescribe
antibiotics, such as doxycycline or
penicillin.
o
o
o
o
Patients with severe leptospirosis will
need to spend time in the hospital. They
will receive antibiotics intravenously.
Depending on which organs leptospirosis
affects, the individual may need a
ventilator to help them breathe.
a fever and chills
coughing
diarrhea, vomiting, or both
headache
muscle pain, particularly lower back
and calves
a rash
red and irritated eyes
jaundice
Most people recover within a week
without treatment, but around 10
percent go on to develop severe
leptospirosis.
Severe leptospirosis
If it affects the kidneys, dialysis may be
necessary.
Signs and symptoms of severe
leptospirosis will appear a few days after
mild leptospirosis symptoms have
disappeared.
Intravenous fluids can provide hydration
and essential nutrients.
Symptoms depend on which vital organs
are involved. It can lead to kidney or liver
failure,
respiratory
distress,
and
meningitis. These can be fatal.
Hospital stays may range from a few
weeks to several months. This mostly
depends on how the patient responds to
antibiotic treatment, and how severely
the infection damages their organs.
The heart, liver, and kidneys
28
COMMUNICABLE DISEASE
If leptospirosis affects the heart, liver,
and kidneys, the person will experience:
The lungs
If it affects the lungs, the person cannot
breathe.
o
o
o
o
o
o
o
o
o
o
o
fatigue
irregular, often fast, heartbeat
muscle pains
nausea
nosebleeds
pain in the chest
panting
poor appetite
swelling of the hands, feet, or ankles
unexplained weight loss
jaundice, seen in a yellowing of the
whites of the eyes, tongue, and skin
o Without treatment, this can lead to
life-threatening kidney failure.
Signs and symptoms include:
o
o
o
o
high fever
panting
coughing up blood
In severe cases, there may be so
much blood that the person
suffocates.
Diagnosis
Early-stage, mild leptospirosis is hard to
diagnose, because the symptoms can
resemble those of flu and other common
infections.
The brain
If it affects the brain or spinal cord,
meningitis, encephalitis, or both may
develop.
If a physician suspects severe
leptospirosis, the patient may undergo
specific diagnostic tests. Various tests
are available. In some cases, tests may
need repeating to confirm the result.
Meningitis is an infection of the
membrane covering the brain and spinal
cord, while encephalitis refers to infection
of brain tissue. Both conditions have
similar signs and symptoms.
The doctor will ask about any recent
travel, especially to areas where
leptospirosis is common.
These may include:
They may ask if the person:
confusion or disorientation
drowsiness
fits or seizures
high fever
nausea
photophobia, or sensitivity to light
problems with physical movements
stiff neck
inability to speak
vomiting
aggressive or unusual behavior
Untreated meningitis or encephalitis can
result in serious brain damage, and it
may be life-threatening.
has been swimming in a lake, pond,
canal, or river
has had contact with any activities that
occurred in a slaughterhouse, on a farm,
or relating to animal care
may have had contact with animal urine
or blood
A number of blood and urine tests can
confirm or rule out leptospirosis.
29
COMMUNICABLE DISEASE
In the United States, leptospirosis is a
notifiable disease. The doctor must
inform the relevant health authorities if a
person’s diagnosis confirms an infection.
Types
There are
leptospirosis.
2. Victims who survive the
first
12
hours
after
ingestion have a greater
chance of survival
B. AKA: Red Tide
two
main
types
of
Mild leptospirosis: This accounts for 90
percent of cases. Symptoms include
muscle pain, chills, and possibly a
headache.
Severe leptospirosis: Between 5 and
15 percent of cases can progress to
severe leptospirosis. Organ failure,
internal haemorrhaging, and death can
result if the bacterium infects the liver,
kidneys, and other major organs.
The Centers for Disease Control and
Prevention (CDC) puts the fatality rate
between 5 and 15 percent among those
with severe illness.
With effective and timely treatment,
leptospirosis is less likely to become
severe.
Figure 2.3
Poisoning
Paralytic Shellfish
C. Causative agent – single celled
dinoflagellates,
specifically
Pyromidium bahamenvar
compressum
1. There are 2000 varieties,
30 of which become
poisonous after heavy
rainfall
preceded
by
prolonged summer
2. Commonly
called
planktons
3. Toxins are not totally
destroyed by cooking
Those more likely to develop severe
leptospirosis tend to be those who are
already sick, for example, with
pneumonia, those under the age of 5
years, and those in older age.
PARALYTIC SHELLFISH POISONING
A. Important Information
1. A
syndrome
of
characteristics symptoms
predominantly neurologic
which occur within minutes
or several hours after
ingestion of poisonous
shellfish
D. Incubation period – 30 minutes
to several hours after ingestion of
30
COMMUNICABLE DISEASE
poisonous
shellfish
talaba, halaan, etc.)
(tahong,
3. More common and more
severe in children than in
adults
E. Mode
of
transmission
–
Ingestion of raw or inadequately
cooked seafood: specially bivalve
shellfish or mollusk during red tide
season
B. AKA
1. Bacillary – Shigellosis, Bloody
Flux
2. Cholera – El Tor
3. Amoebic – Amoebiasis
F. Signs and Symptoms
1. Numbness of the face
specially around the mouth
2. Dizziness,
floating
sensation, weakness
3. Headache; rapid pulse;
vomiting
4. Difficulty of speech (ataxia)
and difficulty of swallowing
(dysphagia)
5. Tingling
sensation,
paresthesia and eventual
paralysis of the hands and
feet
C. Causative agent – gramnegative,
nonsporulating,
nonmotile bacteria
1. Bacillary
–
shigella
Dysenteriae; Flexnar; Boyclii;
Sonne
2. Cholera – Vibrio comma;
Ogawa; Inaba; El Tor
3. Amebic
–
Entamoeba
histolytica
D. Incubation period – 4-7 days
E. Period of communicability –
during acute infection and until the
infectious agent is no longer
present in the stools, usually
within 4 weeks after illness
G. Management
1. Induce vomiting
2. To weaken the effect of
toxic effect of Red tide, give
coconut milk and sodium
bicarbonate solution during
the early stage. If given the
last stage the condition will
get worst.
F. Mode of transmission – by direct
or indirect fecal-oral transmission
from a patient or carrier
DYSENTERY/ CHOLERA
G. Diagnostic/laboratory exams
1. Stool exam – fresh stool
within 30 minutes to one
hour should be examined
for the presence of
trophozoites
2. Rectal swab
A. Important Information
1. Protozoa in origin
2. Name used in connection with
various-intestinal disturbances
with such common symptoms
as severe abdominal pain
(griping),
tenesmus
and
frequent mucoid or bloody
stools.
H. Signs and symptoms
1. Bacillary
1.1 Ushered by chills followed
by fever
31
COMMUNICABLE DISEASE
1.2 Nausea,
vomiting,
tenesmus
(constant
bearing down sensation in
the rectum as though the
bowels must move; yet
when thay do, no relief is
left)
1.3 Severe diarrhea at first
mucoid and later bloody,
alternating
with
constipation
1.4 Bowek movements may be
30-40 times or more in 24
hours
1.5 Extreme thirst and rapid
dehydration
2. Cholera
2.1. Starts with acute colicky
pains in the abdomen,
accompanied
by
mild
diarrhea in which stools are
at first yellowish becoming
grayish-white
(“ricewatery”). Use of water bed
is necessary because
bowel movements are very
frequent
2.2.
Marked
mental
depression,
headache,
vomiting, fever may or may
not be present
2.3 Extreme thirst, thickly
furred tongue, severe or
violent cramps in the legs
and feet
2.4. Face appears shriveled,
eyes sunken and the skin
an ash-gray color
2.5. Washerwoman’s hands –
because
of
rapid
dehydration
Figure 2.4 Cholera Control
3. Amoebic
3.1 Primary or intestinal
3.1.1. Vomiting, tenesmus,
severe
abdominal
cramps
3.1.2. Diarrhea alternating
with
constipation;
stools
are
mucopurulent, foulsmelling and with
bloody streaks
3.2 Secondary – incident to the
migration of amoeba to
other organs, usually the
liver (hepatitis) and the
brain
32
COMMUNICABLE DISEASE
I. Medical Management – basically
IV therapy
1. Bacillary and Cholera –
antibiotics
2. Amoebic – antiprotozoan
agent, e.g. Araien
2.2. Causative agent – DNAcontaining virus
2.3. Mode of transmission –
blood and other body
fluids;
percutaneous/inoculation
2.3.1 Use of contaminated
needles
2.3.2 Blood transfusion
2.3.3
Oral-oral
transmission
2.3.4 Sexual transmission
2.3.5
Vertical
/
transplacental
transmission
2.4 Predisposing factors
2.4.1 Health workers
2.4.2 Blood recipients
2.4.3 Drug addicts
2.4.4
Promiscuous
individual/multiple sex
partners
2.5 Incubation period – 6
weeks to 6 months
HEPATITIS
A. Causative agents
1. Microorganisms – bacteria,
viruses, protozoa, spirochetes
2. Too much alcohol
3. Drug intoxication
4. Chemical intoxication
B. Types
1. Hepatitis A
1.1 Synonyms:
Infectious
hepatitis;
Catarrhal
hepatitis;
Epidemic
Hepatitis
1.2 Causative agent – RNAcontaining virus
1.3 Mode of transmission –
food
and
water
contaminated with feces
and saliva of patient with
Hepatitis A
1.3.1 Fecal-oral
1.3.2 Oral-oral
1.4 Predisposing factor
1.4.1 Food handlers
1.4.2 Unsanitary
living
conditions
1.4.3 Oral-anal sex
3. Hepatitis C
3.1 AKA: Past-transfusion
hepatitis
3.2 Causative agent –
Hepatitis C virus
3.3 Mode of transmission –
percutaneous,
particularly
blood
transfusion
3.4 Predisposing factors
3.4.1 Paramedical team
3.4.2 Blood recipients
3.5 Incubation Period – 2
weeks to 6 months
1.5 Incubation period 2 – 7
weeks
2. Hepatitis B – most fatal
2.1.
AKA:
Serum
hepatitis;
Homologous
hepatitis; Viral hepatitis
4. Hepatitis D
4.1. Dormant
type
of
hepatitis
4.2. Can be acquired only
if with Hepatitis B
33
COMMUNICABLE DISEASE
4.3. Same
mode
of
transmission,
predisposing factors
and incubation period
as Hepatitis B
Post-icteric stage
▪ Signs and symptoms subside
▪ Takes 3-4 months for the liver to
regenerate
5. Hepatitis E
 Important information – if
hepatitis recons at age 2030, it can lead to cancer of
the liver
 AKA: Enteric hepatitis
 Causative
agent
–
Hepatitis E virus
 Mode of transmission –
fecal-oral
 Predisposing factors and
incubation – same as
Hepatitis
Manifestation/Signs
Symptoms
C. Diagnostic/laboratory exams
1. Liver Functions Test. Liver
Enzyme Test – to determine
the extent of liver damage
1.1 Alanine
Amino
Transferase (ALT) – 1st to
increase when there is
liver damage
1.2 Aspartate
Amino
Tranferase
(AST)
–
SGOT
1.3 Alkaline
Phosphatase
(ALP)
and
2. Serum Antigen Antibody Test
– for hepatitis
2.1
HasAg-surface
AntiHAV
2.1.1 IgG
2.1.2 IgM
2.2
HbsAg-surface
AntiHBs
2.3
HbeAg-Protein
Independent AntiHBe
2.4
HbcAg-Care
Independent AntiHBc
2.5
HcsAg-Surface
Independent AntiHCs
Pre-icteric stage
▪ Fever, body malaise (due to
irritability of the liver to convert
glucose to glycogen)
▪ Weight loss
▪ Anorexia and vomiting (due to
inability of the liver to deaminase
protein)
▪ Right upper quadrant pain (due to
infiltration and liver inflammation)
▪ Anemia (due to decreased life
span of RBCs – normal life span
of RBCs is 120 days)
3. Ultrasound
4. Liver biopsy
5. Urinalysis
Icteric stage
▪ Jaundice – due to excessive
bilirubin in the blood
▪ Pruritus (itchiness) – due to bile
salts in the sweat
▪ Tea-colored urine – due to excess
bilirubin in the kidneys
▪ Acholic (gray-colored) stools
▪ Hepatomegaly
D. Management
1. Prevention
▪ Immunization for Hepatitis
A and B
▪ Monogamy
34
COMMUNICABLE DISEASE
2. Control
▪ avoid mode of transmission
▪ handwashing
▪ standard precaution
PINWORM-INFESTATION
3. Nursing care
3.1 Complete bed rest – to
facilitate liver regeneration
3.2 Diet – to promote tissue
repair
3.2.1 decrease fat,
carbohydrates
increases
(CHO), protein
(CHON) – if with
simple hepatitis
3.2.2 decrease fat,
increase CHO,
decrease
CHON – if with
severe hepatitis
Figure 2.6 Viral Hepatitis Overview
35
▪
Important Information
An intestinal roundworm which
infects only man.
If found in one family member,
there are most probably
infected also
▪
AKA
:
Nocturnal
Ani;
Enterobiasis,
Oxyurasis,
seatworm or threadworm
▪
Causative agent – Enterobius
vermicularis, (a nematode)
1. Lives and breads in the
small intestine.
2. When eggs are swallowed,
they hatch in the stomach
and small intestine.
3. Gravid worms migrate
during the night down the
rectum and even the
perianal area to lay their
eggs,
causing
severe
itching.
4. May enter the vagina and
into the peritoneal cavity.
5. Eggs are infective within a
few hours after leaving the
GIT.
6. Eggs are easily blown
around by mild breezes
and are very infectious.
7. Eggs are not destroyed by
ordinary laundering.
▪
Incubation period – the life cycle
of the worm requires 2-6 weeks to
be completed.
▪
Period of communicability – as
long as gravid females are
discharging eggs on the perineal
skin.
COMMUNICABLE DISEASE
▪
Mode of transmission – direct
transfer of infective eggs by hand
from anus to mouth of the same or
another person, or indirectly
through contaminated clothing,
linen, food, etc. Dustborne
infection is also possible.
ASCARIASIS
▪
Important information
 A chronic condition often
producing no symptoms.
 More prevalent in tropical
countries like the Philippines
▪
Causative agent – Ascaris
lumbricoides
 A large roundworm
 Eggs hatch in the intestinal
canal and release larva →
intestinal wall → lymphatic and
circulatory systems → lungs →
bronchioles → bronchi →
pharynx → back to the small
intestines where they mature.
 Female produces around
20,000 eggs/day.
Figure 2.8 Pinworm Cycle
▪
Diagnostic exam – Test tape
➢ Best done upon waking up in
the morning before bathing or
bowel movement.
➢ Scotch tape placed against the
anus and then examined
microscopically for eggs.
▪
Management
▪ Handwashing
▪ Wear well-fitting underwear
▪ all
members
of
the
household should be treated
with Piperazine hexahydrate
(500 mg/tsp) for 1 week
➢ ½ tsp OO for children
➢ tsps BID for adults
▪
36
Figure 2.9 Ascariasis
Incubation period – reach
maturity about 2 months after
ingestion
COMMUNICABLE DISEASE
▪
Period of communicability – as
long as mature gravid worms are
in the intestines.
▪
Signs and symptoms – seen
only when with heavy infestation
- Abdominal pain; marked
disturbances of digestion
- Insomnia; restlessness
Sequela – destruction of the
bowel when there is a bolus of
worms
▪
▪
2. Small filterable virus introduced
through the oropharynx and which
leaves the body via discharges
from
the
throat and the
gastrointestinal tract (virus found
in +stools 2 weeks before
appearance of symptoms
3. May exist in contaminated water
supplies and sewage or infected
milk
4. Can survive in body secretions at
ordinary temperature outside the
body for long periods.
5. Multiplies in the tonsils an Peyer’s
Management – anthelminthics
e.g., Antiox
POLIOMYELITIS
▪ Disease of the lower motor neuron
involving the anterior horn cells,
characterized by changes in the
CNS
▪ An acute paralytic condition which
is very contagious and infectious.
▪ Characterize by changes in the
central nervous system
▪ Disease of the lower motor neuron
involving the anterior horn cells
▪ No patient dies except if
respiration
is
affected
by
involvement of the spinal cord. No
matter how severely paralyzed, if
respiration is not involved the
prognosis is good.
patches before it enters the blood
stream
Figure 2.10 Poliomyelitis
Predisposing Factors
1. children below 10 years old
2. male more often affected
3. poor environmental and hygienic
conditions – flies may act as
mechanical vectors
Synonym: Infantile paralysis, Heine
medin disease
Causative Agents: Legio debilitants
Characteristics:
1. Three stains: Brunhilde (provides
permanent immunity) Lansing and
Leon (give temporary immunity)
Incubation Period: usually 12 days,
may vary from 7-21 days
37
COMMUNICABLE DISEASE
Signs and Symptoms
1. Abortive stage – headache sore throat,
slight or moderate, occasional vomiting
2. Preparalytic stage – signs of infection
a. tightness/spasm of the back muscle
and hamstrings
b. stiff neck
c. paresthesias
d. Hoynes signs – in supine lift patient
shoulder, if head drops abnornal
e. Pofer sign – opisthotonos with head
refraction
Mode of Transmission
1. droplet infection – in early
infection
2. body secretions –
nasopharyngeal
3. fecal-oral –during late stage
Diagnostic /Laboratory Exams
1. Lumbar tap –(+) Pandy test
(increased protein in CSF)
2. Muscle wasting
3. Stool exam – 10 days after being infested
(late stage)
3. Paralytic Stage –classified according to
the site involved and the resulting clinical
picture
a. actual paralysis is commonly the first
presenting sign
b. persistent headache
c. biphasic pattern
1. first phase is similar to signs of
the abortive type, then a few days
of remission of symptoms
wherein patient appears to have
recovered
2. Second phase starts when
patient develops weakness or
paralysis, which appears more
often on the 2nd day and then
reaches its maximum by the 6th
day.
a. Constipation; vomiting
b. Irritability, lethargy
c. Pinched, poison affording
maximum comfort to
painful
muscle
is
diagnostic
d. Profuse sweating usually
over areas in which the
muscles are involved
e. Changing deep tendon
reflexes, hyperactive at
the start and then
diminution or loss.
Pathophysiology
Legio debilitants
Children below 10 years of age
Droplets
Nasopharyngeal secretions
Abortive Stage
Multiplies in tonsils and Payer’s patches
Sore throat
Fever, headache, body malaise
Anorexia, abdominal pain, nausea and vomiting
Low lumbar pains
Diarrhea/constipation
Lymphatic system
Prepalytic Stage
Blood stream
Muscle tightness/spasm
Stiffneck
Paresthesia
Hoyne sign
Pover sign
CNS
Paralytic stage
(Flabby, flaccid and soft muscle)
1. bulbar
2. spinal
3. bulbospinal
Figure 2.11 Pathophysiology of Poliomyelitis
38
COMMUNICABLE DISEASE
Management
 Prevention
▪ Passive Immunization – gamma
globulin IM may protect a person who
has had intimate contact with a fresh
case of active poliomyelitis for 2-3
weeks
▪ Active immunization – oral polio
vaccine (Sabin), 2-3 drops p. o. 4-6
weeks after birth for 3 doses (infant
should not be fed for at least 30
minutes after to promote absorption
of the vaccine)
 Control
▪ Aseptic techniques and avoiding
infected discharges
 Treatment: generally symptomatic and
supportive
▪ Medical care
➢ Iron lung machine – if with
respiratory paralysis
➢ Tracheostomy if necessary
➢ Physiotherapy
 Nursing Care
▪ Comfort and hygiene measures
➢ Do not touch or massage painful
areas
➢ Apply warm packs to relieve
muscle shortening, pain and
tenderness
▪ Diet – bland, high protein
▪ Tracheostomy care
Types of paralysis
a. bulbar – cranial nerve are affected
b. spinal – anterior horn cells are
affected, causing paralysis of the
affected extremities
c. bulbospinal – combination of both
Figure 2.12 Muscles Commonly
weakened by Polio
39
COMMUNICABLE DISEASE
PRACTICE TO PASS:
Answer the puzzle below, refer to the next page for the questions/items:
40
COMMUNICABLE DISEASE
PRACTICE TO PASS:
Questions/Items for puzzle on page 57
41
COMMUNICABLE DISEASE
PRACTICE QUESTIONS:
Situation: Malaria is said to be endemic
in Tropical countries
1. A client is concerned about
contracting malaria while visiting
relatives in Palawan. The nurse
explains that the best way to prevent
malaria is to avoid;
A. Mosquito bites
B. Untreated water
C. Undercooked food
D. Over-populated areas
B. inhaling cocaine
C. sharing food utensils with an HIV
positive person without proper
cleansing of the utensils
D. having sexual intercourse with a
HIV positive person without using
a condom
5. A client with HIV is taking Zidovodine
(AZT). AZT is the drug that acts to;
A. destroys the virus
B. enhance the body’s antibody
production
C. slow replication of the virus
D. neutralizes the toxins produces by
the virus
2. When teaching a client about drug
therapy
against
plasmodium
falcifarum, the nurse should indicate
the fact that;
A. The infection are controlled
B. Immunity
will
prevent
immunization
C. The infection can generally be
eliminated
D. Transmission by the anophelies
mosquito can occur
6. The nurse is instructing a group about
food preparation. They are told to
avoid using products in damaged
cans because they might contain the
anaerobic spore-forming rod;
A. Escheria coli
B. Clostridium tetani
C. Salmonella typhosa
D. Clostridium botulism
7. When caring for a client with
Hepatitis A the nurse should take
special precautions to;
A. prevent droplet spread of
infection
B. use caution when bringing food to
the client
C. use gloves when removing the
client’s bedpan
D. wear mask and gown before
entering the client’s room
3. When caring for a client who is HIV
positive, the primary responsibility of
the nurse is to explain how the client
can prevent;
A. AIDS
B. Social isolation
C. Other infections
D. Kaposi’s sarcoma
4. A home health care nurse begins
caring for a 25 year old female client
who has just been diagnosed with the
human
immunodeficiency
virus
infection. The client asks the nurse,
“How could this have happened”?
The nurse responds to the question
based on the most frequent mode of
HIV transmission which is;
A. hugging with HIV positive sexual
partner without using barrier
protection
8. The nurse is planning a community
education program on how to
prevent the transmission of viral
hepatitis. Which of the following
types of hepatitis is considered to be
primarily a sexually transmitted
disease?
A. Hepatitis A
42
COMMUNICABLE DISEASE
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
A.
B.
C.
D.
9. When caring for a client with
scabies, the nurse should be aware
that scabies is;
A. highly contagious
B. a chronic problem
C. caused by a fungus
D. associated with other allergies
impotence
scrotal swelling and dysuria
urinary retention
Dribbling of urine
14. The nurse understand that organism
that causes a trichonomal infection is
a;
A. yeast
B. fungus
C. protozoa
D. spirochete
10. The term Condylomata acuminate
refers to;
A. scabies
B. herpes zoster
C. venereal warts
D. cancer of the epididymis
15. The oral drug that is likely to be
prescribed for treatment of
trichonomas vaginalis is
A. penicillin
B. Gentian violet
C. Nystatin (mycostatin)
D. Metronidazole (flagyl)
11. Client’s who develop general paresis
as a complication of syphilis are
usually treated with;
A. Penicillin
B. Major tranquilizers
C. Behavioural modification
D. Electroconvulsive therapy
16. When teaching parents at the school
about communicable diseases, the
nurse reminds them that these
diseases are serious and that
encephalitis can be a complication
of;
A. pertussis
B. chicken pox
C. poliomyelitis
D. scarlet fever
12. When educating a female client
about gonorrhea, the nurse should
emphasize that for women
gonorrhea;
A. is often marked by dysuria and
vaginal discharge
B. does not lead to serious
complications
C. can be treated but not cured
D. may not cause symptoms until
serious complications occur
17. A mother ask the nurse how to tell
the difference between measles and
a German measles . The nurse tells
the mother that with measles the
child has;
A. a high fever and koplik’s spots
B. a rash on the trunk with pruritus
C. nausea, vomiting and abdominal
cramps
D. symptoms similar to a cold,
followed by a rash
13. A female client with gonorrhea
informs the nurse that she has had
sexual intercourse with her boyfriend
and asks the nurse, “Would he have
other symptoms?” The nurse
responds that in men the symptoms
of gonorrhea includes;
43
COMMUNICABLE DISEASE
D. “Respiratory precautions are
indicated for 18 days after the
onset of parotid swelling”
18. Chicken pox can sometimes be fatal
to children who are receiving;
A. insulin
B. steroids
C. antibiotics
D. anti-convulsants
Situation: Isadora, age 9 was bitten by
a dog on his way home from school.
When his father knew about this, he
wanted the dog killed once.
19. The nurse obtains a sputum
specimen from a client with
suspected tuberculosis for laboratory
study. Which of the following
laboratory techniques is most
commonly used to identify tubercle
bacilli sputum?
A. acid fast staining
B. sensitivity testing
C. agglutination testing
D. dark field illumination
22. When Isadora was brought to the
health center you interviewed
Isadora and his father. You told
Isadora’s father not to kill the dog….
A. observe the dog for 24 hours
B. must be confined in a cage
C. should be experimented for negri
bodies
D. has to be observed for 10 days
20. The nurse should include which of
the following instruction when
developing a teaching plan for clients
who are receiving INH and
Rifampicin for treatment of
tuberculosis
A. take the medication with antacid
B. double the dose if a drug dose is
forgotten
C. increase intake of dairy products
D. limit alcohol intake
23. Sight and sound of water as well as
drip of the faucet disturb a patient
with rabies, which one should you do
first?
A. place patient near window
B. cover the IV bottle with brown
paper
C. sponge only with warm face cloth
D. keep patient clean and quiet
24. Immunization with tetanus toxoid is
an example of;
A. naturally acquired immunity
B. naturally acquired passive
immunity
C. artificially induced active
immunity
D. artificially acquire passive
immunity
25. An example of active naturally
acquired immunity is;
A. Gamma globulins injection
B. Measles vaccination
C. Chicken pox
D. Placental transfer of maternal
antibodies
21. A nurse provides instructions to a
mother of a child with mumps
regarding respiratory precautions.
The mother asked the nurse about
the length of time required for the
respiratory precautions. The nurse
most appropriately responds that;
A. “respiratory precautions are
necessary for the entire time of
illness”
B. “respiratory precautions are
necessary until swelling is gone”
C. “Respiratory precautions are
indicated during the period of
communicability”
44
COMMUNICABLE DISEASE
D. 2-3 weeks after 1st eruption 1st
appeared
26. Measles (Rubeola) is a viral
disease, which is large contributor to
pneumonia deaths in young children.
Which of these are characteristics
signs of measles?
A. Vomiting, headache, fine
petecheal rashes and epistaxis
B. Sudden onset of slight fever, skin
eruptions which are abundant of
the face and extremities
C. Rash which spreads from face to
trunk and limbs, conjunctivitis,
high fever and tiny white spots in
the mucosa inside the check.
D. Sudden onset of slight fever and
skin eruptions which are more
abundant on covered than on
exposed parts of the body
29. Characteristics eruption in chicken
pox
A. macular
B. popular
C. pustular
D. vesicular
30. Which of the following
communicable diseases cannot be
transferred through droplet infection?
A. Malaria
B. Mumps
C. Tuberculosis
D. Measles
27. What statement made by a pregnant
mother whose niece has German
measles best indicates an
understanding of the implications of
viral infections like rubeola and
more importantly rubella?
A. “I’ll remember to give my niece
aspirin for the fever”
B. “I’ll ring my niece to wish her well
and explain why I cannot go and
visit”
C. “if I catch the infection, I need not
worry for the virus won’t harm my
unborn child”
D. “If I catch the infection, I will need
to be vaccinated against measles
immediately”.
31. Which of the following are
respiratory diseases?
A. pertussis, pneumonia, malaria
B. diphtheria, leprosy, shingles
C. PTB, coryza, pertussis
D. Elephantiasis, parotitis, impetigo
contagiosa
32. Etiologic agent of diphtheria
A. staphylococcus aureus
B. klebs loefflers bacillus
C. bordet-Gengao bacillus
D. alpha-hemolytic streptococcus
33. Characteristic sign of diphtheria;
A. bullneck appearance
B. Aerosangenous discharge
C. Pseudomembrane
D. Inflamed tonsils
28. School children with chicken pox
should be kept out of control for at least;
A. 1 week before appearance of
rashes
B. 1 week after eruption appears or
until vesicles becomes dry
C. 1 week before recovery
Situation: Roger 8 years old was
referred to the hospital because of low
grade fever, general malaise and loss of
appetite. On PE there is a whitest-gray
45
COMMUNICABLE DISEASE
membrane patch on his tonsils, soft
palate and ovula. Diagnosis: Diphtheria
D. Treponema Pertenue
38. The primary lesion of Syphilis is:
A. Chancre
B. Gummas
C. Condylamata Lata
D. Maculopapular rashes
34. Diphtheria is characterized by;
A. acute nasopharyngitis
B. persistent cough for 2 weeks
C. acute pharyngitis and laryngitis
with pseudomembrane
D. catarrhal symptoms with
paroxysmal cough
39. Prevention and control of syphilis
will be one of the agenda in your
conference with the midwives. Which of
these is not relevant?
A. Immunization of contacts
B. Need to immediate report cases
found and their contacts to health
authority
C. Need for early diagnosis and
treatment
D. Symptoms of syphilis and its
mode of transmission
35. Bacterial conjunctivitis is common
usually during summer months.
Conjunctivitis is transmitted through;
except;
A. contact with discharges from the
conjunctivitis of infected persons
B. mechanical transmission by
vectors such as flies
C. contact with discharges from the
upper respiratory tract of infected
persons through contaminate
finger articles
D. all these mode of transmission
Situation: One of the responsibilities of
a nurse is to protect self and patient
from acquiring infections.
40. A nurse is assigned in the
emergency room, admitted a patient
with hemoptysis and fever, cough for
a month but with stable vital signs.
Which kind of precautions should
you employ?
A. Contact precautions
B. Enteric precautions
C. Droplet precautions
D. Airborne Precautions
Situation: Leprosy is chronic skin and
peripheral nerves disease caused by
Mycobacterium leprae.
36. A nurse role in the prevention of
spread of leprosy is through;
A. health education
B. proper nutrition
C. Personal hygiene
D. BCG vaccination
41. The receiving nurse in the Medical
surgical ward will expect which
isolation technique upon the arrival
of the patient?
A. respiratory isolation
B. strict isolation
C. TB isolation
D. Enteric Isolation
Situation: Mrs. Escudero lives in an
urbanized community. She is positive to
syphilis so she goes to the health center
for proper management.
29. The causative agent of Syphilis is:
A. Treponema Pallidum
B. HIV
C. Neisseria group
Situation: Knowledge of the basic
concepts and principles related to care
46
COMMUNICABLE DISEASE
of patients with communicable disease
is vital in the performance of the nurse
role as health educator.
B. personal hygiene
C. complete immunization
D. physical stamma
42. Air, water and food can serve as:
A. Vehicle of transmission of
infectious agents
B. Reservoirs of microorganism
C. Entry routes for infectious agents
D. Vehicles for exit of infectious
sperm
46. When “breaking the chain of
infection” which of the following is
TRUE?
A. a virulent agent can resist
disinfectant
B. an appropriate portal of entry will
not cause infection
C. mode of entry of harmful
organisms is direct entry
D. every link in the chain of infection
can be interrupted
43. As you made your home visits, you
see mothers preparing food at home.
Conscious of the principles
underlying hand washing, you
remind them to wash their hands
before handling foods for the simple
reasons that:
A. Hands can be sterile by
thoroughly scrubbing with soap
and water.
B. Soap used in hand washing acts
as a disinfectant.
C. transient bacteria can be reduced
by mechanical cleansing
D. through hand washing, heat
coagulates protein
Situation: Pneumonia remains to be
one of the leading causes of deaths.
Hence, this was discussed in the one
conferences at the Rural Health Unit.
47. This disease is characterized by:
A. sudden onset with chills, fever,
pleural pain and cough
productive of “rusty” sputum
B. fever, headache, malaise,
anorexia, and non productive
cough
C. fever, fatigue, cough chest pain
and loss of weight
D. fever, cough, hoarseness and
hemoptysis
44. The incidence of ascariasis can be
reduced by preventing other children
from acquiring the disease. This can be
done through:
A. Teaching the children to cut
fingernails and was hands before
putting anything into the mouth
B. Avoiding overcrowded places
C. Teaching children to use slippers
while playing on the soil.
D. Avoiding direct contact with
children suffering from parasitism
48. Pneumonia is transmitted through
which of these modes:
A. through articles freshly soiled
with respiratory discharges
B. by direct oral contact
C. by droplet spread
D. any of these mode of
transmission
45. The first line of defense of the body
against disease is:
A. an intact skin
Situation: Rainy season is evident
again and dengue hemorrhagic fever is
47
COMMUNICABLE DISEASE
one of the locally endemic diseases in
the community.
49. Capillary fragility test was done to a
patient suspected of DHF. It can be
achieved by doing:
A. schick's test
B. rumple needle test
C. tine test
D. dick's test
50. Hematology report on platelet count
revealed 250, 000 mm3. From the
nurses knowledge of the lab she
would:
A. call the physician's attention to
this value and anticipate
transfusion of the whole blood
B. have vitamin K available for IV
infusion
C. call the physician's attention and
call laboratory to order the
platelet transfusion
D. realize that this is a normal value
References:
David L. Heymann, Control of
Communicable Disease Manual 19th
Edition
Dionesia Mondejar – Navales, Handbook
of
Common
Communicable
and
Infectious Diseases. Copyright 20008
48