Communicable Diseases
INFECTIOUS DISEASE NURSING
Host
COMMUNICABLE DISEASES – diseases that can be transmitted
through:

Direct – person-to-person; face-to-face encounter with
an infected person (e.g. skin contact, kissing); droplet
Droplet
Airborne
Respiratory Droplet
Respiratory Droplet
(droplet nuclei)
(droplet nuclei)
Bigger, heavy
Smaller,
(remains in the
carried/suspended in
surface), can be
the air, lighter
carried for some
time only
Distance
Within 3ft of the
No limitation, more
patient
extensive than droplet
*airborne transmission is not direct transmission

Indirect – from source to other person with intermediary
object
o
Vehicle-borne – fomites, inanimate objects/nonliving things (e.g. stethoscope, BP cuff, eating
utensils)
o
Vector-borne – insects, arthropods, rodents
4 types of Host
Break in Skin Integrity
o
Inoculation (BT, sharps and needles)

Airborne – stands alone, another mode of transmission
(e.g. Chicken pox, TB, Measles)
*uses N95 mask – airborne droplet can pass through
an ordinary mask.
*doors should always be closed
* ALL THESE FOUR (4) are HORIZONTAL TRANSMISSION
VERTICAL TRANSMISSION

Mother to unborn child transmission (perinatal
transmission/trans-placental transmission)
INFECTIOUS DISEASES – Presence of living organisms in the body
which may not be transmitted through ordinary contact.
CONTAGIOUS DISEASES – easily transmitted
*ALL COMMUNICABLE DISEASES are INFECTIOUS but NOT ALL are
CONTAGIOUS
*ALL CONTAGIOUS DISEASES are INFECTIOUS and at the same
time COMMUNICABLE
IDNAP – Infectious Disease Nurses Association of the Philippines
EPIDEMIOLOGIC TRIAD
Environment
Patient – infected with signs and symptoms; isolate
and observe precautionary measures; least source of
infection
Carrier – harbors/carries microorganisms but without
signs and symptoms; also a/potential source of
infection.
Contact – close contact/exposure to infected person
Suspect – medical history and symptoms suggest
infectious presence of disease.

Source of
Infection
Respiratory
Droplet

Man or animal
Consider the susceptibility (degree of resistance) of the
host





Agent

Microorganism
o
not all possesses pathogenicity (capacity of
microorganism to cause an infection) and
virulence (strength and power of microorganism
to cause infection)
*opportunistic microorganism
Virus
Bacteria
 only multiply in living things
 can pass through filters in
the body
o blood-brain barrier
o placental barrier
 Rubella/German
Measles (1st trimester)
 self-limited/self-limiting
o Colds – 2-3 days
o Influenza – 1 week
 treated according to
symptoms (no specific viral
agents)
 give us permanent immunity
 management: rest, nutrition
 multiply both in living and
non-living things
 cannot pass through filters in
the body (big in size)
 self-limited/self-limiting
o Colds – 2-3 days
o Influenza – 1 week
 Treponema pallidum (C.A.
of Syphillis) – can pass
through placental barrier
after the 16th week of
pregnancy (2nd to 3rd
trimester)
o 3rd trimester – highly fatal
 give us temporary immunity
Protozoal
Fungal




Amoebiasis
Malaria
Gardiasis
PCP

Tinea (ring worm)
o capitis (head, scalp)
o corporis (body)
o pedis (feet) –athlete’s
foot
o ugeuna (nails)
o cruris (inguinal) – jock’s
itch
o barbae (beard) –
barber’s itch
*Ricketsia – typhus fever (Phonazeki) – bites of lice on head
(causes falling of hair)
Host
Agent
University of Santo Tomas – College of Nursing / JSV
ENVIRONMENT

Conducive and favorable to the growth and
multiplication of microorganisms.
Communicable Diseases
IMMUNIZATION
IMMUNITY

State of being resistant to infection; state of being free
from infection.
Two Types:


Natural
o
Inherent in the individual’s body tissues and fluids
(born with it and die with it) – rare
o
Race (lahi)
o
Genetic abnormality
Acquired
A. Active – actual participation of the
individual’s body tissues and fluids in the
production of antibodies.
1.)
2.)
Naturally Acquired – produce antibodies by
natural means; unintentionally

previous infection

Subclinical Immunity – developed
due to constant exposure to a
certain infection.

Weakened microorganism/toxin
Stimulate antibody production
Effect: 4-7 days
Continuously produces antibody (long-lasting
immunity)
EPI: BCG, OPV, MMR, DPT, AMV
Tetanus Toxoid, Anti-rabies, HBV, Pneumovax,
Varivax, Fluvax


Passive






Antibodies
Provide high titer of Antibodies (TX)
Effect: immediate
Not long-lasting/short-lived immunity
ATS/TAT, TIg, Equinae, Rabies Ig, HRIg, ADS, PIg, VZIg
Active (toxins) and Passive (antibodies) Immunization
– do not inject on the same side/site.
CHAIN OF INFECTIOUS PROCESS
Artificially Acquired – artificial means;
intentionally done

(vaccines – attenuated/weakened
microorganisms)
B. Passive – presence of antibodies in the serum not
coming from the individual himself (get antibodies)
1.)
Active




Naturally acquired – get antibodies by natural
means/unintentionally

placental transfer of maternal
antibodies

Baby protected up to 6mos.
(antibodies from mom)

infection under 6mos. (mom’s fault)
Causative
Agent
Susceptible
Host
Reservoir
Portal of
Entry
Portal of Exit
WHO – no immunization must be
given earlier than 2mos. (mom’s
antibodies will fight infection

Exception to the rule – in a country
or state where infectious
diseases are constantly present,
they can give vaccine before two
months

Mother with HIV = baby with
antibodies = doesn’t mean baby
is infected

Mother’s antibodies stay up to
18mos.

>18mos. = body (+) HIV antibodies
= baby has HIV

Breastfeeding (IgA) – colostrum
Mode of
Transmission
Vehicle of Transmission – source of infection
*can be cut anywhere but it will be easier if the weakest link
would be cut
*portal of exit before portal of entry
In taking care of an infected person,
1. Know C.A.
2. Know vehicle of transmission
3. Know mode of transmission
General Nursing Care
University of Santo Tomas – College of Nursing / JSV
Communicable Diseases
I. Preventive – no infection yet, not allow infection to set in
A. Health Education
- Knowledge
- Attitude
- Skills


doctor – ultimately responsible for giving health
education
nurse – key person/ provider
B. Immunization
EPI – P.D. 996 - ↓8y/o
UN Goal (UCI) – Proc. No. 6 - ↓6 y/o
Yr. 2000 (NID) Proc. No. 46 - ↓5y/o
7 Childhood Diseases
1. TB
2. Diphtheria
3. Pertussis
4. Tetanus
5. Poliomyelitis
6. Hepatitis B
7. Measles
2.
Allergy

MMR – egg and neomycin
– made of chick embryo and neomycin

Hepatitis B – baker’s yeast
– Saccharomyces cerevisiae

IPV (salk vaccine) – neomycin (streptomycin)

Flu – chicken and chicken products
Encephalopathy without known cause or
convulsion within 7 days after vaccine
a. If with convulsion

No DPT = DT only

May have permanent
neurologic disorder (neurologic
encephalopathy

24o crying inconsolably
Temporary Contraindications
1. Pregnancy
a. Live vaccines – never given to pregnant
individuals – may affect growth and
development of fetus – congenital
problems
Live Vaccines
- OPV
- MMR
- BCG
- Varivax
C. Environmental Sanitation
University of Santo Tomas – College of Nursing / JSV

PD 825 – Anti-littering Law
o
Php 2000 – 5000
o
Imprisonment of 6mos.-1yr
II. Control (with infection) – limit spread
A. Isolation

Infected person during period of
communicability
o
Strict – protect others
o
Protective – protect patient;
microorganism away from patient
Quarantine

Limitation of freedom of movement of a
well person during longest incubation
period
B.
Disinfection

Killing of pathogenic microorganism by:
o
Physical – washing, boiling
o
Chemical – use of chemical agents

sterilization
Disinfestation

Killing of small undesirable animal forms
o
Arthropods and rodents
Fumigation

Gaseous agents

Kill arthropods and rodents
C.
Medical Asepsis

Hand washing
o
10 to 15 secs
o
Length is not considered anymore =
FRICTION
o
Medical Asepsis

Hands are lower than the elbow
o
Surgical asepsis

Hands are higher than elbows
Use of barrier precaution (personal protective
equipment)
o
Used when in direct contact with
patient
o
Used as necessary
o
Use only PPEs that needs to be worn
o
Wearing: Mask  goggles  bonnet
gown  gloves
o
Remove: gown  gloves 
handwashing  bonnet  goggles 
mask  handwashing

2.
3.

Very severe disease/severe febrile disease
Immunocompromised situation (receiving
corticosteroids)
4. Recent receipt of blood products, wait for 2-3
months
a. AMV
b. Varivax
c. MMR
No amount of immunization will give you full protection
(vaccine failure)
PD 856
o
Gonorrhea – once a month
o
Syphillis – twice a month
*with certificates
D. Proper Supervision of Food Handlers

DOH (doctors)

FDA –monitor foods, drugs, and cosmetics if
they are safe for consumption
Permanent Contraindications to Immunization
1.


Use of Placarding Principle
o
No smoking
o
Arm precaution
Communicable Diseases
Revised Isolation Precaution
1. Standard Precaution

Primary strategy for preventing nosocomial infection

Took the place of universal precaution

Applies to the following:
o
All patients regardless of their diagnosis
o
Blood and all body fluids, excretions and
secretions except sweat

Universal precaution – visible blood
o
Non-intact skin
o
Mucous membrane

2.
Essential Elements of Standard Precaution
o
Use barrier precaution
o
Prevent inadvertent percutaneous exposure

Needle prick injury

Do not recap – one-hand technique
– scooping, fishing

Do not bend

Do not break

Do not manipulate
o
Immediate hand washing and washing of
other skin surface area
Transmission Based Precaution

Communicable Diseases

Instituted to patients infected with highly transmissible
infection

Precautions beyond those set forth in standard
precaution

Transmission based + standard precaution

Airborne Precaution
o
Use of respiratory protection (particulate
respirator)

HEPA filter – high efficiency particulate air
filter
o
Measles, TB, varicella
o
SARS, Avian flu – droplet

Droplet Precaution
o
Contact to the conjunctiva, nasal or oral
mucosa
o
PPE: regular mask and goggles
o
Ex: Meningitis, Hib infections, pneumonia







Tetanolysin – dissolves RBC
Tetanospasmin – causes muscle spasm
o
Affects the myoneural junction of the muscles
and internuncial fibers of the spinal cord and the
brain

Muscles affected:
o
Masseter muscle – closing of the mouth

Lockjaw – trimus – rigidity of the jaw
muscle
o
Facial muscle

Risus sardonicus – sardonic smile/ grin

Smiling with eyebrows raised
o
Extensor muscles of the spine

Opisthotonus position – arching of the
back
o
Abdominal muscle

Board-like abdomen


Dx Exam: Clinical observation + history of wound
Med Mgt: Objectives
o
Neutralize the toxin

ATS (Anti-tetanus serum) / TAT (Tetanus
anti-toxin)
o
ATS – from animal products –
perform skin testing

TIg (Tetanus Immuniglobulin)
o
Kill the microorganism

Antibiotic – Penicillin

Daily cleansing of wound - NSS
o
Thin dressing
o
Prevent and control spasms

Muscle relaxants
o
Diazepam – IV push, IV drip
o
Methocarbamol (Robaxin,
Robaxisal)
o
Lionesal (Baclofen)
o
Epirison (Myonal)

Osterized feeding (NGT) – patient cannot
feed through the mouth

Nursing Care:

Maintain adequate airway and ventilation
Contact Precaution
o
Activities that require physical contact
o
Contact with inanimate objects
o
PPE: gloves and gown
o
Ex: GI infections, skin infections, STI’s, Ebola
CENTRAL NERVOUS SYSTEM


1.


Bacteria
o
Tetanus
o
Meningitis
Virus
o
Encephalitis
o
Poliomyelitis
o
Rabies
TETANUS
AKA:
Lockjaw
CA:
Clostridium Tetani

Soil, clothes, dust

Intestines of herbivores – manure – soil – pasture
areas
University of Santo Tomas – College of Nursing / JSV
Anaerobic – w/o oxygen
Protected against oxygen because it is in the
form of spore

Very difficult to destroy - Sterilization

Inside the body - vegetative form – not
protected from oxygen
MOT:
Break in skin integrity (wound) – any kind of
wound
Tetanus Neonatorum – poor cord care
IP: 3 days to 4 weeks

The shorter the incubation period is, the poorer is
the prognosis
S/Sx:
o
Initially signs of wound inflammation
5 Cardinal Signs of Inflammation

Rubor - redness

Callor - warmth

Dolor - pain

Tumor - swelling

Function loss
o
Increased muscle tone near the wound
o
Tachycardia, profuse sweating
o
Low grade fever
o
Painful involuntary muscle contraction


Communicable Diseases

o
Padded tongue depressor

Maintain an IV line
o
Should be patent (for medications)

Monitor clients for signs of arrhythmia

Prevent client from having spasms
o
Exteroceptive stimuli – external
environment

Dim and quiet environment
o
Interoceptive stimuli – within patient

Stress – limit visitors

Flatus and Coughing – turn to sides
o
Proprioceptive stimuli – participation of
patient and other person

Touching – gentle handling – inform
before touching

Turning – not done frequently – at
least once/shift

Jarring the bed

Minimal handling of the patient
o
Avoid unnecessary disturbing
of the patient
o
Organized and cluster nursing
care

Protect client from injury
o
Never leave the patient
alone
o
Padded side rails
o
Call light is within the reach of
the client
Prevention:
o
Immunization

DPT
o
6 wks after birth
o
3 doses with 4 wks (1 month) interval
o
0.5 cc
o
IM/ Vastus lateralis
o
Fere – antipyretic
o
Observe – signs of convulsion for 7 days
o
Warm compress (immediately) –
vasodilation and better drug absorption
o
Cold compress 20 mins after –
vasoconstriction -  or prevent swelling
o
If there is swelling already – apply cold
compress
o
Warm compress 24 to 36 hours after
injury sets in

Tetanus Toxoid
o
2nd trimester
o
2 doses with 1 month interval
o
0.5 cc IM/ deltoid – non-dominant hand
1st dose
2nd
3rd
dose
dose
4th dose
5th dose






Anytime
1 month after 1st
dose
6 months
1 year
1 year
o
Low risk – booster dose – every 10 yrs
o
High risk – booster dose – every 5 yrs
Proper wound care
o
Thin dressing – air vent
Avoid wounds
2. MENINGITIS

Inflammation of the covering of the brain and spinal
cord
University of Santo Tomas – College of Nursing / JSV

CA: Virus, fungus, bacteria
o
Cytomegalovirus (CMV) - Virus

Opportunistic - low body resistance - AIDS
o
Cryptococcal Meningitis (C. Neoformans) - Fungus

Opportunistic – low body resistance – AIDS

SOI: Excreta of birds
o
TB Meningitis - Bacterial

Common cause of meningitis in the
Philippines

Not necessarily secondary to tuberculosis
o
Staphyloccocal
o
Streptococcal

Secondary to respiratory infection
o
Meningococcal Meningitis/ Meningococcemia/
Neisseria Meningititis

Deadliest type

Affects vascular system  DIC  prone to
intravascular bleeding  vascular collapse
 death – 10%

Waterhouse Friderichsen Syndrome – group
of symptoms - death within 6 to 24 hours
MOT: Direct (droplet)
IP: 2 to 10 days
S/sx:
o
Nasopharynx – URTI – cough, colds
o
Bloodstream

Petechiae – pinpoint red spots on the skin
o
Apply pressure and redness remain –
tumbler test (clear glass)
o
Extremities first then body

Ecchymosis – blotchy purpuric lesions
o
Area of bleeding – obstruction – may
become necrotic

Spotted fever
o
Meninges

Pathognomonic sign: nuchal rigidity – entire
neck is rigid

+ Kernig sign
o
Supine and flex knees towards the
abdomen
o
Pain/ difficulty extending the less after
knee flexion
o
Pain – hamstring – back of the thigh

+ Brudzinski sign
o
Flex neck towards the chest
o
Involuntary drawing up of extremities or
hips upon flexion of neck

 ICP – obstruction in the subarachnoid
space - CSF
o
Severe headache
o
Projectile vomiting – 2 to 3 ft away
o
Seizures/ convulsion – inflamed
meninges – altered pressure in the
cranial cavity
o
Altered vital signs -  Temp,  PR, 
RR,  Systolic and normal diastolic,
Widened pulse pressure
o
Diplopia – choking of optic disk –
double vision
o
ALOC
Dx Exam:
o
Lumbar puncture – CSF

Color
o
Yellowish, turbid, cloudy – bacterial
etiology
o
Clear – normal or viral

Laboratory exam
o
Bacterial -  Protein,  WBC,  Sugar
Communicable Diseases
o



3.
o
Viral -  Protein,  WBC, Normal Sugar

Culture & Sensitivity – type of drug

CIE (Counter immunoelectrophoresis) – virus
or protozoa

Contraindication - Highly increased ICP –
herniation of brain
Blood Culture



o
Med Mgt:
o
Antimicrobial therapy
o
Corticosteroids – Dexamethasone
o
Osmotic Diuretics – I & O
o
Anticonvulsant Agents – Dilantin (Phenytoin)

IV - Sandwich with NSS – crystallization of drug

Oral – Gingival hyperplasia – frequent oral
care or gum massage

Nursing Care:
o
Assess neurologic function
o
Maintain adequate nutrition and elimination
o
Ensure client’s comfort

Diversionary activities

Rest

Massage
o
Effleurage – figure of 8 or circular
manner
o
Petrissage – friction; thumb, index or
middle finger
o
Tapotement – edge of hand
o
Kneading

Quiet and dim environment

Limit visitors
o
Symptomatic and supportive

Maintain fluid and electrolyte imbalance

Safety
Prevention
o
Immunization

BCG

Hib Vaccine

Meningococcemia vaccine
o
Proper disposal of nasopharngeal secretions
o
Covering of nose and mouth when coughing and
sneezing
ENCEPHALITIS

Inflammation of the encephalon/ brain

AKA Brain fever

CA: Arbovirus (Arthropod borne virus) – carried and
transferred by an arthropod

Classifications:
o
Primary Encephalitis

Affects the brain directly

St. Louise, Japanese B, Australian X,
Equine (E – W)

MOT: Mosquito bites
o
Aedes sollicitans
o
Culex Tarsalis

Ticks of horses

Migratory birds

No need to wear mask

Not common in the Philippines
o
Secondary Encephalitis

There was a previous infection

Complication
University of Santo Tomas – College of Nursing / JSV
4.
Post-vaccine encephalitis – Anti-rabies
vaccine
Wear mask – previous infection
Common in the Philippines
Toxic Encephalitis

Metal poisoning
o
Lead poisoning
o
Mercurial poisoning
S/sx:
o
o
o

Same as meningitis
ALOC
Lethargic – abnormally sleepy, difficult to
awaken
Dx Exam:
o
Lumbar puncture – clear
o
Laboratory exam -  Protein,  WBC, Normal
Sugar
o
EEG – extend of brain involvement

Med Mgt: Symptomatic

Nursing Care: Same as meningitis

Prevention:
o
Eradication of source of infection
o
Use of insecticide
o
Use of insect repellants
o
Screening doors and windows
o
4S

Search and destroy breeding places

Self-protection

Stop indiscriminate fogging – drive away
only

Seek early consultation
POLIOMYELITIS
– 10 years and below

AKA: Infantile Paralysis
Acute Flaccid Paralysis – soft,
flabby, limp
Heine – Medin’s Disease

CA: Poliovirus (Legio Debilitans)
o
Type I – Brunhilde – permanent immunity –
common in the Philippines
o
Type II – Lansing – temporary immunity
o
Type III – Leon – temporary immunity
MOT:
Early stage – direct (droplet) – 1st 4 days –
microorganism in the nasopharynx
Late stage – fecal-oral – Day 5 onwards

Enterovirus – intestines
Effects on CNS

Severe muscle pain
o
Do not turn or hold patient
o
No amount of massage or positioning can
relieve pain of patient
o
Warm compress/ narcotic drugs can relieve
pain

(x) Morphine and Nubain – may cause
respiratory depression

(/) Codeine



Stiffness of hamstring
Hoyne’s sign – head drop
o
if shoulders are lifted, head will drop
Communicable Diseases


Poker spine – Opisthotonus with head retraction
Tripod position – maintain a sitting position
o
Lean backward, not forward



Paralytic Stage (Flaccid)

Bulbar
o
Affects Cranial Nerve IX and X
o
May cause respiratory paralysis

Spinal
o
Anterior Horn Cell
o
Affects the motor function of patient
o
Extremities, intercostal muscle

BulboSpinal
o
Cranial Nerve and Anterior Horn Cell
o
CN IX and X + Motor function
Rhabdo
Virus

5.
Central nervous
system (Negri bodies
- pathologic lesions
that are formed as
microorganism
multiplies; 10% of
rabid animals (-)
negri bodies)
Dx Exam:
o
Lumbar puncture - result same as Encephalitis
o
Throat washing – 1st 4 days of the pharynx
o
Stool exam – 5th day onwards
Medical Management:
o
Supportive
o
Iron lung machine – mech vent used for polio
patients

Principle of negative pressure breathing

No problem in the lungs but with
nerves/muscles

Life-saving measure

Months and years

Weaning

7 machines in the Philippines

Nursing Care:
o
Supportive

Turn to sides

Prevention:
o
Immunization

OPV (Sabin)
o
5 weeks after birth
o
3 doses with 4 weeks interval
o
2-3 gtts/orem
o
Vomiting: Give again
o
Diarrhea: Administer but does not
count – repeat after 4 weeks – OPV 2
o
Continuous stimulation to produce
antibodies
o
Be careful with disposal of feces – virus
is excreted in the feces
o
Contraindication: If with relatives who
are immunocompromised – IPV

IPV (Salk)
o
0.5 cc/ Intramuscular
o
Not sensitive to neomycin and
streptomycin
o
Avoid mode of transmission

Proper disposal of oropharyngeal secretions

Covering of nose and mouth when
coughing and sneezing

Do not put anything in the mouth
RABIES

AKA:
Hydrophobia, Lyssa, La Rage
University of Santo Tomas – College of Nursing / JSV
Efferent
nerves
Peripheral
nerves
* Not all patients will develop paralysis
* As long as the patient does not develop paralysis/ has
not reached paralytic stage, patient has good prognosis

Low forms of animals – warm blooded - dogs, cats
CA:
Rhabdo virus - neurotropic – strong affinity to
nerves and neurons
MOT:
Contact with saliva of a rabid animal
Organ transplantation - rare
Salivary gland
(-) Negri bodies



10% of rabid animals (-) negri bodies
If bitten by a dog/animal, do not kill them immediately
Cage the animal for observation
o
Rabid if dies or have behavioral stages within 10
days

S/sx:
o
Animals - 3 to 8 weeks

Dumb Stage – complete changes in behavior
o
Withdrawn – depressed
o
Overly affectionate
o
Hyperactive – Manic

o
Furious Stage
o
Easily agitated
o
Easily bites
o
Vicious or fierce look
o
Drooling of saliva
o
Dies
Humans – 10 days to years

Invasive Stage
o
Site of the bite

Itchy

Painful

Numbness
o
Flu-like symptoms

Sore throat

Fever

Headache

Body malaise
o
Marked insomnia

Restless

Irritable

Apprehensive
Slight photosensitivity
o

Excitement Stage
o
Aerophobia
Communicable Diseases
Hydrophobia

Not a phobia – avoided
because it causes pharyngeal
spasms
o
Maniacal behavior

Benadryl – relax patient

Antipsychotic – Haloperidol
(Haldol)
o
Normalizes behavior
Paralytic Stage
o
Spasm stops
o
Paralysis sets in – rapid and progressive
o
From toes going up


o


Nursing Mgt:
o
Supportive/ Symptomatic

Keep water out of sight

Dim and quiet environment

Room should be away from sub utility room

Restrain before maniacal behavior

Provision of comfort measures

Prevention:
o
Be a responsible pet owner
o
Have the animals immunized
o
Keep animals caged or chained
o
Preventable but not curable
* Rabies is preventable but not curable – dies within
24 to 72 hours – 100% mortality


Dx Exams:
o
Done before symptoms are manifested
(animals)
o
No exams are done on humans
– results will be (-) if no s/sx
o
Brain biopsy
o
Direct Fluorescent Antibody Test
o
Observation of animal (10 days)

Site of the bite
o
Waist up – no need to observe,
vaccine is administered

Extend of the bite
o
Deep, multiple, big bite - no need to
observe, vaccine is administered
o
Reason for the bite

Provoked – no need to worry

Unprovoked – worry!
CIRCULATORY SYSTEM

Virus
o
Dengue Hemorrhagic Fever

Protozoa
o
Malaria
6.
DENGUE HEMORRHAGIC FEVER

CA: Dengue Virus (Arbovirus) – carried by one to
another by arthropod
o
Dengue Virus 1-4
o
Oinyongnyong
o
Chikungunya (less harmful than DHF)
o
West Nile Virus
o
Flavi Virus

Medical Mgt: Post-exposure prophylaxis
o
Active immunization

PVRV (Purified Vero Cell Vaccine) - ID
o
VERORAB (0.5 mL/vial)

PCEV (Purified Chick Embryo Vaccine) - IM
o
RABIPUR (1 mL/vial)

IM with sensitivity test – Deltoid
Day 0
Day 7
Day 21

ID
0.1 mL on each site
Day 3
0.1 mL on each site
Day 7
0.1 mL on each site
Day 21
0.1 mL on each site

o
2 vials
1 vial
1 vial
Day 0
Avoid drinking alcohol – interferes with
antibody production
Passive Immunization

ERIg – Equine Rabies Immunoglobulin
o
ARS (Anti rabies serum) 0.2 cc/ kg
BW
o
Equirab

HRIg – Human Rabies Immunoglobulin
o
Imogam
0.133 cc/ kg BW
o
Rabuman 0.133 cc/ kg BW
University of Santo Tomas – College of Nursing / JSV
Site: Vastus lateralis
Given within 7 days – body has not yet
produced antibodies

MOT: Mosquito bites
o
Aedes Aegypti; Aedes Albopictus

Biological Transmitter

8-11 days after the mosquito bit a
person, it will be able to pass the virus

Transfers virus to its offspring
o
Culex Fatigans

Mechanical transmitter

After it acquires the virus, only the very
first person it will bite will get the
disease
o
Aedes Aegypti (day and night biting)

Breed on a clear, stagnant water

(X) on dirty water – no O2 – larva
will not survive

Low-flying – bites on lower extremities
(usual)

With white stripes on the legs, gray
wings, lands parallel on the skin
S/Sx:
o
Dengue Grade 1 or Dengue without warning sign

High grade fever for 3-5 days

Pain

Headache

Retroorbital

Joint and bone

Abdominal
* misdiagnosed for influenza

Nausea/vomiting

Petechiae/Herman’s sign (generalized
flushing/redness of the skin)
Communicable Diseases
* Dengue fever only
* Aka Dandy fever, Break bone fever
o
Grade 2 or Dengue with warning signs

With spontaneous bleeding
o
Epistaxis, gum bleeding
o
Hematemesis, melena (GIT)

Coffee ground (blood was acted
upon by the digestive enzymes)
o
Hematochezia (LGI)
o
Grade 3 or Severe DHF

With signs of circulatory failure
o
Cold, clammy skin
o
Cold extremities
o
Prolonged capillary refill
o
Severe Shock Syndrome
7.
MALARIA

AKA:

CA: Plasmodium
o
Vivax –most common

Falciparum – most common/most
fatal
o
Ovale
o
Malariae

MOT: Mosquito bite (Female) – Anopheles Mosquito
(Biological Mosquito)
o
Night Biting Mosquito
o
Breeding sites: clear, slow-flowing water
o
Most common in:

Palawan

Saranggani

Davao

Cagayan Valley


Dx Exam:
o
Rumpel Leede Test

Test for Capillary Fragility

Presumptive Test
o
Tourniquet test

BP = (S + D)/ 2 = ? mmHg

Amount of inflation

Obscure for Petechial Formation

Count how many in a square inch

(+) result = ≥ 20 patches in a square inch


Criteria for Tourniquet Test
1. Age = 6 mo. or older
2. Fever more than 3 days
3. No other signs of DHF
o


S/Sx: 3 Stages
o
Cold Stage (15mins.)

Chilling sensation (shaking of the body)

Keep patient warm (provide with blanket,
warm drinks, expose to droplight, hot
water bag as ordered on soles of feet
o
Hot Stage (2-6 hours)

High grade fever

Vomiting

Abdominal pain
Nursing Obj: Lower down temperature
 TSB
 Cold compress over forehead
 Light, loose clothing
 Provide fluids
o
X ↑OFI – aggravate
Blood Tests

Plt count ↓

Hct determination ↑
Medical Mgt:
o
Symptomatic
o
Prevention of bleeding
o
Nursing Care
o
Prevention and control of bleeding

Control of nose bleeding
o
Avoid forceful blowing
o
Avoid nose picking

Prevention of gum bleeding
o
Last resort: soft-bristled toothbrush

Prevent GI Bleeding
o
Avoid irritating foods (spicy, hot, etc.)
o
If with bleeding already –

Ice compress on epigastric area

NPO

Comfort measures

If not relieved, refer to MD

Avoid dark-colored foods
o
Avoid red meat (for occult blood test)
o
No salmon
o
Increase Oral Fluid intake
o
↑ body resistance
o
Supportive Care
Prevention
o
Eradicate mosquitos (4S)
University of Santo Tomas – College of Nursing / JSV
Wet Stage

Profuse sweating

Feeling of weakness
Nursing Obj: make patient comfortable
 Keep warm and dry
 Provide fluids to prevent dehydration


Anemic (RBC’s are destroyed as the microorganism
reproduces)
Microorganism in the bloodstream = fever; several
RBC’s destroyed
o
Falciparum

Severe Anemia

Cerebral Hypoxia
1. Restlessness
2. Confusion
3. Delirium
4. Convulsions
5. Loss of Consciousness
6. Coma
o
Black Water Fever

Black urine/dark red urine
Dx Exam:
o
Malarial Smear

Timing is IMPORTANT!
Communicable Diseases

o
Collect blood when patient is at the
peak of fever (microorganism in the
bloodstream)
Quantitative Buffy Coat (QBC)

Rapid Malarial Test

No fever needed

Medical Mgt:
o
Chloroquine (mainstay), Primaquine, Arabnine
o
Fansidar, Quinine, Antemethen (1st choice)

Quinine – 1st developed; parenteral; not
regularly used (for severe cases only)(
o
Used cautiously in pregnant women –
abortifacient
o
If not treated = neonatal malaria = severely
anemic = death
o
Doesn’t give permanent immunity

Prevention: Eradicate Mosquito (4S)

Types:
o
Paucibacillary
o
Multibacillary

S/Sx
o
Early Manifestations
1. Color changes on skin that does not
disappear even with treatment
2. Skin lesions that does not heal even with
treatment
3. Pain and redness of the eyes
4. Muscle weakness and paralysis of the
extremities
5. Nasal obstruction and nose bleeding
6. Area affected – loss of sensation

Loss of growth

Anhydrosis
Late manifestations
1. Lagopthalmus – inability to close eyelids
2. Madarosis – loss of eyebrow, eyelashes
3. Sinking of the bridge of the nose (Saddle-nose
deformity)

Absorption of small bones

“Natural Amputation”
4. Contractures (clawing of fingers and toes)
5. Chronic skin ulcers

Integumentary: may be infected
already but remains unnoticed due to
patient’s loss of sensation
6. Gynecomastia (males)
o
INTEGUMENTARY SYSTEM


Bacteria
o
Leprosy
Virus
o
Measles
o
German measles
o
Chicken pox
o
Herpes Zoster
Macule – flat rashes
Papule – elevated rashes
Vesicle – elevated rashes filled with fluid
Pustule – elevated rashes filled with pus
1. LEPROSY

AKA:
Hansen’s Disease; Hansenosis
o
Lepers – Hansenites

CA: Mycobacterium Leprae (closely associated with M.
tuberculosis)

MOT: prolonged intimate skin-to-skin contact
 Research: droplet (highly concentrated in
respiratory secretions

Cardinal Signs
o
Peripheral Nerve Enlargement
o
Lossof sensation
o
(+) skin smear test for M. leprae
Types
Previously called
Paucibacillary
Tuberculoid
Leprosy
- non-infectious
- benign
Severity
Mild
Unique S/Sx
Milder with skin
lesions, peripheral
enlargment
Defined by WHO
as
1-5 patches
associated with
leprosy
Is the person
infectious?
No
Multibacillary
Lepromatous
Leprosy
- Infectious
-Malignant
Severe
Fatal without
treatment
Leonine Face
(Lagopthalmus,
Madarosis, Saddlenose Deformity)
>5 patches
associated with
leprosy
Possibly – high
concentration on
respiratory
secretions
University of Santo Tomas – College of Nursing / JSV

Dx Test:
o
Skin Smear Test
o
Skin Lesion Biopsy
o
Lepromin Test
o
Wassermann Reaction Test

Medical Mgt:
Multiple Drug Therapy
o
Combination of Drugs to:
1. Prevent drug resistance (esp. Dapsone –
mainstay drug)
2. Hasten recovery
3.
o
Lessen period of communicability (1-2
weeks)
Reportable Side Effects:
(discontinue treatment)

Rifampicin – hepatotoxicity s/sx
Paucibacillary
Multibacillary
 Rifampicin – once/month
 Dapsone – OD
 Duration: 6-9 mos.
 Rifampicin – once/month
 Dapsone – OD
 Lamphen – OD (SE:
hyperpigmentation of
skin)
 Duration: 12-18 mos.

Dapsone – generalized itchiness; dryness
and flaking of skin
o
Microorganism dies → toxin → Leprae Reaction
→ do not discontinue treatment; go to health
center
o
Leprae Reaction – manage symptomatically

MILD
Communicable Diseases
R – reddening in and around the
nodule

E – edema

S – sudden ↑ in the number of lesions

T – tenderness and pain on nerves
SEVERE

I – Iritis

S – sudden acute paralysis

A – acute uveitis




Dx Exam: Clinical observation

Med Mgt: Symptomatic
o
Antibiotics – to prevent secondary bacterial
infection
o
Cause of death – pneumonia

Nrsg Care: Supportive
o
Avoid Draft
o
Adequate rest
o
Adequate nutrition
o
Communicable

4 days before and 5 days after
appearance of rashes

Hightly communicable: BEFORE rashes
appear

More respiratory secretions before =
more/highly communicable before
appearance of rashes
o
Gives permanent immunity
Prevention:
o
Immunization

AMV – 9 mos.
o
0.5 mL/ SC
o
Deltoid
o
May have fever
o
May experience mild rash reaction –
NORMAL

MMR – 12 to 15 months
o
Same dosage, route, site and
instructions
o
Female of child bearing age – no
pregnancy within 3 months

Congenital defect
o
Endemic – may be given as early as 6
months then revaccination at 15
months
o
Proper disposal
Nursing Mgt:
o
Psychological Aspect of Care

↓ self-esteem

Social stigma
o
Skin Care

Skin injury because of loss of sensation

Chronic skin ulcer
o
Provide/encourage physical exercise
o
Provide drug information
* does not give permanent immunity


Prevention
o
Immunization (BCG)
o
Avoid MOT (contact with patient with Leprosy)
o
PPE: Contact precaution; Droplet Precaution
2. MEASLES (Rubeola)

AKA:
Rubeola, Morbilli, Hard Measles, Little Red
Disease, 7 day measles, 9 day measles, 1st Disease

1st
Measles
2nd
Scarlet Fever/Scarletina
3rd
German measles
4th
Duke’s Disease
5th
Erythema Infectiosum / Slapped cheek
disease
6th
Roseola Infantum, Exanthem Crotiam,
Exanthem Subitum, Tigdas Hangin

CA: Paramyxovirus (Rubeola virus)

MOT: Airborne (Respiratory Droplet)

S/sx:
o
Pre-eruptive Stage

High grade fever (3 to 4 days)

3 C’s
o
Cough
o
Colds/ coryza
o
Conjunctivitis

Eyes are res, excessive lacrimal
discharges

Photosensitivity

Koplick Spots
o
Fine red spots with bluish or grayish white
spot at the center
o
Within the inner cheek
o
Eruptive Stage

Maculo-papular rashes
o
Reddish, blotchy
o
Cephalocaudal – 1st appears behind the
ears, face, neck, extremities
o
Appears 3rd day of illness (2 to 3 days
entire body)
o
Post-eruptive Stage

Fine branny

Desquamation

If the spots start to peel off – on the road to
recovery
University of Santo Tomas – College of Nursing / JSV
3. GERMAN MEASLES (Rubella)

AKA:
3 day disease, Rubella, Roteln

CA:
Pseudoparamyxovirus (Togavirus/Rubella virus)

MOT:
Direct (droplet)

S/sx:
o
Pre-eruptive Stage

Presence or absence of fever (1 to 2 days)

Mild cough or mild colds

Hallmark sign : Forschheimer’s Spots
o
Fine red spots/ Petechial spots
o
Soft palate
o
Eruptive Stage

Maculo-papular rashes
o
Pinkish, discreet – smaller/finer rashes
o
Cephalocaudal – starts at the face
o
24 hrs entire body

Enlargement of lymph nodes – differentiating
factor between measles and German
measles
o
Suboccipital
o
Posterior auricular
o
Posterior cervical
o
Post-eruptive Stage

Rashes disappears (3rd day of illness)

Enlarged lymph node gradually subsides
Communicable Diseases




Dx Exam:
Same as measles
Med Mgt:
Same as measles
Nrsg Care:
Same as measles
Prevention:
Same as measles
o
Communicable during the entire course of the
disease – includes incubation period
o
Permanent immunity
o
Fatal – Pregnancy during the 1st to 2nd trimester
(acquired or exposure)

Even exposure could cause defect

If exposed, needs gammaglobulin within 72
hours

Congenital defects
o
Microcephaly
o
Congenital Heart Defect
o
Congenital Cataract  Blindness
o
Deafness and Mutism
4. CHICKEN POX

AKA
Varicella

CA:
Varicella-zoster virus
o
Nasopharyngeal secretions
o
Secretions of rashes

Can cause disease if the virus entered
the nasopharynx

MOT:
Airborne

S/sx:
o
Pre-eruptive Stage – 24 to 48 hours

Presence of absence of low grade fever

Headache, body malaise, muscle pain
o
o
Eruptive Stage

Vesiculo-papular/ pustular rashes
o
Macule  Papule  Vesicle 
Vesiculopapular
o
Common: Vesiculo-pustular
o
Itchy – Pock Marks

Take a bath everyday
o
Generalized distribution
o
Covered part of the body first –
trunk and scalp
o
Abundantly found on the
covered parts
o
Unifocular appearance – one at
a time and never fuses together
o
Different sizes
Post-eruptive Stage

Rashes start to dry

Crusts (dry), falls off (peels off)
o
DO NOT peel it off by yourself
o
Let it fall of by itself

Leave pock marks

On the road to recovery

Dx Exam: Clinical Observation

Med Mgt: Symptomatic
o
Acyclovir (Zovirax)
o
Antipruritic Agents

Temporary relief of itchiness
o
Permanent relief: take a bath daily

Tepid water

Nrsg Care: Supportive
o
Increase body resistance
University of Santo Tomas – College of Nursing / JSV
No diet restriction
Permanent immunity
Communicable: Until all the rashes dry
Not Communicable: all rashes are dry; not
necessarily fall or peel off

Prevention:
o
Immunization:

Varivax
o
12 to 18 months
o
0.5 mL/ SC
o
Deltoid
o
 13 y/o – single dose
o
 13 y/o – 2 doses with 1 month interval
o
May have rash or fever
o
Same as measles
o
Proper disposal of nasopharyngeal secretions
o
Covering of mouth and nose when coughing and
sneezing
5. HERPES ZOSTER

Dormant type/ Inactive type

Cannot have herpes zoster without chicken pox first

Adults

AKA
Shingles, Zona, Acute Posterior Ganglionitis –
ganglion of the posterior nerve roots

CA:
Varicella-zoster virus

MOT:
Direct (droplet)

S/sx:
Same as chicken pox
o
Vesiculo-pustular rashes

Painful – up to 2 months

Unilateral distribution – follows the nerve
pathway
o
Vertical

Appears in cluster

Dx Exam:
Clinical observation

Med Mgt:
Symptomatic

Nrsg Care:
Supportive
o
NO permanent immunity

Prevention:
o
Chicken pox and herpes zoster can appear
simultaneously
o
o
o
o
RESPIRATORY SYSTEM


Bacteria
o
o
o
o
Virus
o
o
Diptheria
Pertussis
Pneumonia
Tuberculosis
Colds
Influenza
1. DIPTHERIA

Contagious disease

All ages

Generalized toxemia – causes systemic infection and
signs and symptoms

CA:
Corynebacterium Diphteriae (Klebs-Loeffler
Bacillus)

MOT:
Direct (droplet)

S/sx:
o
Irritating nasal discharge – sero-sanguinous; foul
mousy odor
o
Sore throat
o
Dysphagia
o
Neck edema – bullneck appearance
o
Hoarseness of voice, aphonia

Temporary, larynx is affected
Communicable Diseases
o
o

Barking cough – dry metallic cough, dry husky
cough
Pseudomembrane – grayish white membrane
(pathognomonic sign)

Nasal septum

Larynx

Soft palate

Uvula

Pillars of the tonsils
Dx Exam:
o
Nose and throat swab – Definitive Test
o
Schick Test – Immunity/ susceptibility
o
Moloney Test – Hypersensitivity to diphtheria
antitoxin

Med Mgt:
o
Antidiphteria serum (ADS) – neutralize toxin
o
Antibiotic – Penicillin – kill the microorganism

Nrsg Care:
o
Provide complete bed rest – prevent Myocarditis

Some toxin goes to the heart muscles

Waits until the resistance of the heart is
decreased and invades

Signs of Myocarditis
o
Marked facial pallor
o
Very irregular PR
o
 BP
o
Chest pain/ epigastric pain
o Maintain patent airway

Independent:
o
Proper positioning
o
Increase oral fluid intake
o
Chest physiotherapy
o
Encourage deep breathing and
coughing exercises
o
Turn to sides at least every 2 hours

Dependent:
o
Inhalation therapy
o
O2
o
Nebulization
o
Steam inhalation
o
Suctioning
o
Postural drainage
o
Provide adequate nutrition – soft
o
Provide comfort measures
o
TEMPORARY IMMUNITY

Prevention:
o
Immunization
o
Proper disposal of nasopharyngeal secretions
o
Covering of the nose and mouth when sneezing
and coughing
o
Never kiss the patient
2. PERTUSSIS –  6 y/o

AKA:
Whooping Cough, Chin Cough

CA:
Bordetella Pertussis, Hemophilus
Pertussis

MOT:
Direct (droplet)

IP:
7-10 days

S/sx:
o
Catarrhal stage - highly communicable for 1
week

colds, fever, nocturnal coughing

tiredness and listlessness
University of Santo Tomas – College of Nursing / JSV
o
Paroxysmal/ Spasmodic

5 – 10 successive forceful coughing,
which ends in a prolonged inspiratory
phase or a whoop

Congested face

Congested tongue (purple) – pressure of
teeth when coughing

Teary red eyes w/ eyeball protrusion

Distended face and neck vein

Involuntary micturition and defecation

Abdominal hernia

Chokes on mucous/ vomiting
o
Convalescent – No longer communicable

Signs and symptoms subsides

On the road to recovery

Dx Exam:
o
Nasal swab – Catarrhal stage – plenty of nasal
discharges
o
Nasopharyngeal culture – Definitive test

Bordet-gengou

Agar plate

Cough plate

Med Mgt:
o
Antibiotic

Erythromycin – drug of choice

Penicillin
o
Pertussis Immune globulin
o
Fluid and electrolyte replacement
o
Codeine with mild sedation

Nrsg Care:
o
Provide adequate rest – conserve energy and
decrease O2 consumption
o
Maintain fluid and electrolyte balance
o
Maintain adequate nutrition with aspiration
precaution

Feed upright

NPO when child starts coughing

Bottle feeding – should have a small hole
o
Apply abdominal binders – prevent abdominal
hernia
o
NOT permanent immunity but second attack is
rare

Prevention:
o
Same as measles
3. PNEUMONIA

Inflammation of the lung parenchyma

CA:
Virus, Protozoa, Bacteria (common)
o
PCP – Pneunocystis Carinii Pneumoniae
(protozoa)
o
CAP – Streptococcus (bacteria)
o
HCAP – Staphylococcus, Gram (-) Bacteria
o
ICU - Pseudomonas, Klebsiella
o
Inhalation of noxious substances

Aspiration pneumonia

Lipid pneumonia – use of oil for cleaning
the nose or as lubricant

MOT:
Direct (droplet)

S/sx:
o
Cardinal Signs:

Fever
Communicable Diseases




o
IMCI




Shaking chills (rigor)
Productive cough
Sputum production
o
Rusty – Strepto
o
Creamy Yellow – Staph
o
Greenish – Pseudomonas
o
Currant Jelly – Klebsiella
o
Clear – No infection
Pleuritic/ chest pain – friction between
the pleural layers of the lungs
o
Splint the chest wall
o
Apply chest binder
o
Turn to sides (affected side)
Fast breathing
Chest indrawing
o
Subcostal retraction – use of
accessory muscles
Stridor – harsh breath sound during
INSPIRATION
Wheezing – high pitched sound during
EXPIRATION

Dx Exam:
o
Chest X-ray – Confirmatory test

Lung consolidation

Patchy infiltrates
o
Sputum exam

Specific cause

Med Mgt:
o
Antibiotic
o
Inhalation therapy – nebulization

Nrsg Care:
o
Maintain patent airway
o
Provide adequate rest
o
Provide adequate nutrition
o
Provide comfort measures

Prevention:
o
Immunization
o
Proper disposal of nasopharyngeal secretions
o
Covering of the nose and the mouth when
sneezing and coughing




Dx Exam:
University of Santo Tomas – College of Nursing / JSV
Tuberculin Test/ PPD Test (Purified Protein
Derivative)
o
Screening Test
o
(+) result – exposure to TB
o
Consistently (+) – developed sensitivity to
microorganism
o
Uses purified protein derivative
o
Administered intradermally
o
Interpreted 48 to 72 hours
o
(+) result of tuberculin testing > 10 mm
induration
o
Immunocompromised > 5 mm
induration
o
o
Sputum Exam (AFB Stain)
Chest X-ray – extent of the disease
1 wk to 2 mos.
60 bpm
2 mos. to 12 mos.
50 bpm
12 mos. to 5 y/o
40 bpm
o
o
o
Minimal PTB
Moderate Advanced PTB
Far Advanced PTB

Med Mgt:
o
Antitubercular agents – SCC – Short course
chemotherapy
o
Rifampicin
o
Hepatotoxic
o
Avoid alcoholic beverages
o
Monitor liver enzymes
o
Remove contact lenses and replace with
glasses
o
Turn to color orange
o
Isoniazid
o
Hepatotoxic
o
Avoid alcoholic beverages
o
Monitor liver enzymes
o
Peripheral neuritis
o
Vitamin B6 Pyridoxine
o
Pyrazinamide
o
Hyperuricemia – Gout/ Kidney Stone
o
Alkaline urine

Increase OFI

Increase milk intake

Increase vegetable intake
o
Ethambutol
o
Optic neuritis
o
Irreversible
o
Color blindness
o
Difficulty differentiating red and
green
o
Streptomycin
o
Nephrotoxicity
o
Monitor I and O
o
Monitor creatinine level
o
Ototoxicity
o
Monitor for signs of vertigo and
tinnitus

Nursing Care:
o
Provide adequate rest
o
Provide adequate nutrition – increase immunity
o
Encourage drug compliance
4. TUBERCULOSIS

AKA:
Koch’s Infection, Phthisis, Galloping
Consumption, PTB
CA:
Mycobacterium Tuberculosis Hominis (human)
o
Bovis – Bovine – Cattles
o
Avis – Avium – Birds
MOT:
Airborne
S/sx:
o
Low grade fever, night sweats
o
Anorexia, weight loss, fatigability
o
Body malaise, chest/ back pain
o
Productive cough, hemoptysis, dyspnea
o
Erosion of lung capillaries – NO CPT
o
Communicable Diseases
o

DOTS – program to encourage drug
compliance
Prevention
o
Same as pneumonia
o
BCG – at birth
o
0.05/ ID
o
Deltoid
o
Abscess formation  heal  scar (within 2
to 3 months)
o
Indolent Abscess – Koch’s
Phenomenon

Wrong technique by the nurse
o
Child had exposure to a patient with
active TB – usually asymptomatic
o
Bring back child to health center – I &
D
o
Give prophylaxis – INH

Effect:
o
Children - 6 mos to 8 mos

Immunocompromised – 12 mos
o
No booster
GASTROINTESTINAL TRACT




Bacteria
o
Typhoid
o
Leptospirosis
o
Bacillary
o
Cholera
Protozoa – Amebiasis
Virus – Hepatitis
Helminths – Parasitism
1. TYPHOID FEVER

CA:
Salmonella typhosa

MOT:
Fecal-oral
o
5 Fs

Food

Fingers

Flies

Feces

Fomites

Target organ: Peyer's patches




S/sx:
o
Fever, dull headache, abdominal pain
o
Vomiting, diarrhea/ constipation
o
Clinical features:

Ladderlike fever

Rose spots – Abdomen

Spleenomegaly
Dx Exam:
o
Blood culture
o
Widal Test – Antigen left by the microorganism

AgO – Somatic – Presently infected

AgH – Flagellar – Exposed/ Had an
immunization
o
Thyphidot – Antibody

IgM – presently infected

IgG – some form of immunity/ recovering
Med Mgt:
o
Antibiotic

Chloramphenicol – drug of choice
o
Fluid and electrolyte replacement
Nrsg Care:
University of Santo Tomas – College of Nursing / JSV
Maintain fluid and electrolyte balance

Monitor I and O

Assess for signs of DHN - # 1 sign within 24 hrs
– weight loss

Fluids per orem

Regulate IVF
o
Provide adequate nutrition

Small but frequent feeding

Pedia – NPO 4 to 8 hrs – rest the GI tract

Clear liquid diet  soft diet  DFA
o
Provide comfort measures
Prevention: TEMPORARY IMMUNITY
o
Immunization – CDT – Cholera, Dysentery, Typhoid
o
Avoid the 5 Fs

Feces – proper disposal

Fingers – hand washing

Food – preparation, handling, storage

Flies – environmental sanitation

Fomites – Avoid putting anything to our
mouths – ballpen
o

2. LEPTOSPIROSIS

AKA:
Mud Fever, Canicola Fever, Swamp Fever,
Pre-tibial Fever, Ictero-hemorrhagica
Disease, Weil’s Disease, Swineherd’s Disease

CA:
Leptospira (Spirochete)

Source: Rats

MOT: Skin penetration

IP:
2 days to 4 weeks

Affects striated muscles, Liver, Kidneys
o
Cause of death: Kidney failure

S/sx:
o
o
o
o
o




Fever, headache, vomiting
Muscle tenderness, pain (calf)

Patient does not stand up or walk
Jaundice with hemorrhage
Orange eyes/ skin
Oliguria/ Anuria – Kidney failure
Dx Exam:
o
Microscopic Agglutination Test (MAT)
Med Mgt:
o
Antibiotic – Doxycycline

Prophylaxis - 200 mg twice a day for 3 days
Nrsg Care:
o
Supportive
o
UO – consistency, frequency and amount

Refer if with changes
Prevention: TEMPORARY IMMUNITY
o
Eradicate the source of infection (rats)
o
Use of protective barrier when walking in flood
3. DYSENTERY
* see table
4. HEPATITIS

Inflammation of the liver

Causes:
o
Alcoholism
o
Drug intoxication
o
Chemical intoxication – Arsenic
o
Microorganism

Viral Hepatitis
o
Hepatitis A

Infectious hepatitis
Communicable Diseases







o
o
o

Catarrhal jaundice hepatitis
Epidemic hepatitis
CA: Hepatitis A Virus (RNA)
Feces and blood
MOT: fecal-oral
At risk: Children and food handlers
IP: 2 to 6 weeks
Liver
Hepatitis G

CA:
Hepatitis G virus

MOT: Same as hepatitis C

IP:
Unknown
University of Santo Tomas – College of Nursing / JSV
Urine
Intestines
Stools
Acholic
o
Post-icteric

Jaundice disappears

Signs and symptoms subsides

Energy level increases

Avoid alcoholic beverages and OTC drugs
for at least 1 year
o
Liver recovers

Dx Exam:
o
Liver Enzyme Test

ALT
Alanine Aminotransferase
o
1st to shoot up if liver problem is
present even if asymptomatic

AST
Aspartate Aminotransferase
o
Increases upon onset of jaundice
o
Not reliable

ALP
Alkaline Phosphatase
o
Obstructive jaundice

GGR
Gamma Glutanyl Transferase
o
Toxic Hepatitis due to toxic substances
(e.g. alcohol, drugs, substances)

LDH
Lactic Dehydrogenase
o
Increase = Liver Damage
o
Serum Antigen Antibody Test

Med Mgt: Symptomatic
o
Hepatic Protection (Liver aid) - ↓ effort of
metabolism, allow liver to relax
Pre-incteric

Fever, RUQ pain

Fatigability, weight loss, body malaise
o
inability to convert glucose to
glycogen – source of energy

Anorexia, nausea and vomiting –
deamination of CHON

Anemia -  lifespan RBC (60 to 120 days)
o
Bilirubin – end product of RBC
destruction - accumulates – jaundice
Icteric

Jaundice, pruritus - accumulation of bile
salts on the skin
Kidneys - 2x
Un/conj
Hepatitis D

Dormant type of Hepatitis B

CA:
Hepatitis D / Delta virus

Delta virus cannot multiply by itself – needs
the help of the B virus

MOT: Same as hepatitis B

IP: 3 to 13 wks
o
o
Bloodstream
Hepatitis C

Post Transfusion Hepatitis

CA:
Hepatitis C virus

MOT: Parenteral

IP:
5 to 12 wks

At risk: Paramedical team, drug addicts, BT
recipients
Hepatitis E

CA:
Hepatitis E virus

Source:
Feces

MOT: Same as hepatitis A

IP:
3 to 6 wks

Tea-colored urine
Acholic stool – clay-colored
Some pre-icteric symptoms may persist but
a lesser degree
Bilirubin
(unconjugated)
Hepatitis B – Serum Hepatitis

Homologous Hepatitis

Viral Hepatitis – most fatal

Blood, sputum and other body fluids

MOT:

Parenteral – BT, sharps and needles
o
At risk: Blood recipients, drug
addicts

Oral – oral
o
Kissing
o
6 to 8 gallons

Sexual contact
o
Seminal and cervical fluids

Vertical
o
Mother and child
o
Childbirth

IP: 6 wks to 6 months
o
S/sx:
o


Communicable Diseases
o
o
o



Essentiale, Sillymarin, Jettipar (pedia)
Antiviral – Lamivudine OD for 1 year
Immune Stimulant – Chronic Hepatitis B, C, D

IM

Interferon

2-3x/wk. for 6mos.
Rest and Nutrition
Nrsg Care:
o
Rest – liver recovery
o
Nutrition

 Fats – no enough bile released by the liver
for emulsification of fats; increases tendency
for bleeding

 CHO every now and then – spare CHON
metabolism – ammonia – encephalopathy

Butterball diet – hard candy (source of
energy)
o
Infected
Moderate CHON
o
Recovery Period
High CHON
o
Complications
Low CHON
Prevention:
o
Immunization

Hepatitis B vaccine
o
0.1 mL
o
3 doses
o
IM – Vastus Lateralis
o
2 kg: 0-6-14
o
<2 kg (4 doses): 0-6-10-14
o
No special instructions
o
Side effects:

soreness at injection site

slight increase in ALT
o
Avoid mode of transmission
Parasitism through Ingestion
Enterobiasis

AKA
Pinworm infection, Seatworm, Oxyuriasis

CA:
Enterobius Vermicularis

MOT:
Ingestion

S/sx:
o
Nocturnal ani – night itchiness

Female worm goes out of the intestinal

Well-fitted underwear

Dx Exam:
o
Not diagnosed with stool exam
o
Cellophane tape test

Morning
Ascariasis

AKA
Giant intestinal roundworms

CA:
Ascaris Lumbricoides

MOT:
Ingestion

S/sx:
Intestinal obstruction
o
Passing out or vomiting of worms
Trichuriasis

AKA

CA

MOT:
Whipworm
Trichuris Trichiuria
Ingestion
Trichinosis

Roundworm

Trichiniasis

Trichinellosis

CA:
Trichinella Spiralis – Helminth

MOT:
Ingestion

Source: Insufficiently cooked or raw meat
University of Santo Tomas – College of Nursing / JSV
Taeniasus

AKA
Tapeworm

Taenia Saginata
o
Ingestion of insufficiently cooked or raw beef

Taenia Solium
o
Pork

Diphyllobothrium Latum
o
Fish

Hymenolepsis Nana
o
Dwarf tapeworm
o
Person to person
o
Hand to mouth transmission

Get it as a whole – regenerate
Paragonimiasis

Flatworm, Oriental lung fluke

CA: Paragonimus westermani

Source: ingestion of insufficiently cooked crab or
crayfish

S/sx: productive cough and hemoptysis
o
Misdiagnosed as TB
Parasitism through skin of the feet
Ancylostomiasis

Hookworm

Only blood-sucking worm

Loss of 50 mL of blood/ day

Ancylostoma Duodenale

Necatur Americanus
Stongyloidiasis

Threadworm

Strongyloide Stercoralis
S/sx:



Voracious appetite
Weakness, pot belly, anemia
Stunted growth
Dx:
Stool exam
Med Mgt:

Antihelminthic – Albendazole
Nursing Care: Supportive
Prevention:

Personal hygiene

Cutting long nails

Wearing slippers

Taking a bath

Proper preparation of food
GENITO-URINARY SYSTEM


Bacterial
o
Gonorrhea
o
Syphillis
Virus
o
HIV
1. GONORRHEA

AKA
Clap, Strain, Jack, G.C., Gleet, Morning drop,
“Tulo”
o
Pus draining from the genitalia in the morning
Communicable Diseases






GA:
Neisseria Gonorrhea
MOT:
Sexual Contact
IP:
3 to 21 days
S/sx:
o
Male – obvious signs because same opening for
reproduction and urination

Urethritis, dysuria

Redness and edema of urinary meatus

Purulent urethral discharge

Frequent gonorrhea - scar in the
epididymis – obstruct flow of sperm cell sterility
o
Female – shows symptoms if they have PID;
urethra is not usually affected

Urethral discharge

Frequent gonorrhea - Narrowing of the
fallopian tube – ectopic pregnancy/
sterility
o
Gonococcal septicemia

Tender papillary skin lesion (pustular,
hemorrhagic or necrotic)

Migratory polyarthralgia, polyarthritis,
tenosynovitis
Dx Exam:
o
Culture and sensitivity

Urethral discharge
o
Swab/scrape directly on the
anterior urethra
o
Cervical smear/ Pap smear
Med Mgt:
o
Antibiotic

Penicillin – Benzathine Penicillin G
o
IM use only
o
Large muscle – preferably on the
buttocks
o
Big gauge needle – Gauge 19
o
Only penicillin that is NOT given per
IV – death – readily coagulates –
embolus
o
Given to patients with gonorrhea
and RHD

Cephalosporin – Ceftriaxone, Cefuroxime
o



If Gonorrhea does not heal – (+) Chlamydial
Infection – clear discharge

Tetracycline – Doxycycline
Nursing Care:
o
Psychological aspect of care
o
Health education – prevent recurrence and
spread of infection
Prevention:
o
Safe sex practices

No sex

Long term mutually monogamous
relationship

Mutual masturbation without direct
contact
o
Holding part but no sexual contact
o
Education and Counseling
o
Behavior modification

Stick to one partner
o
Use of condom – PREVENTIVE measure only, NOT
part of safe sex practice
Chlamydial infection
University of Santo Tomas – College of Nursing / JSV
o
Opthalmia Neonatorum (effect to child)

Crede’s Prophylaxis
2. SYPHILIS

AKA
Pox, Lues, Bad Blood Disease

CA:
Treponema Pallidum – crosses placental
barrier – 2nd to 3rd trimester

MOT:
Sexual contact, blood transfusion (rare)

IP:
10 – 90 days






S/sx:
o
Primary

Chancre
o
Painless moist ulcer that heals
spontaneously w/ or w/o treatment
o
Genitals or extragenitally (face, fingers,
tongue, anal, lips)

Regional lymphadenopathy
o
Secondary/ Infectious

Highly communicable

Flu-like symptoms

Fever, headache, body malaise, sore throat

Skin rashes, condyloma lata/ condylomata
lata
o
Lesions fused together found under the
breast or genitalia

Oral mucous patches

Patchy alopecia

Thinning of pubic hair

Generalized lymphadenopathy
o
Latent Phase

Asymptomatic (1 to 2 yrs)

May still spread infection
o
Tertiaty/ Late Stage

Gumma – infiltrating tumor (skin, bone, liver)

Not communicable

CV changes – aortitis, aneurysms

CNS degeneration – paresthesia, abnormal
reflexes, shooting pains, dementia, psychosis
Dx Exam:
o
Darkfield microscope
o
Serologic test

FTA-ABS (Flourescent Treponema Antibody
Absorption Test) – DEFINITIVE

VDRL (Venereal Disease Research Laboratory)

RPR (Rapid Plasma Reagin)
Med Mgt: Antibiotic
Nrsg Care: Same as gonorrhea
Prevention: Same as gonorrhea
Pregnancy – fetal death or congenital anomaly
3. HIV IINFECTION / AIDS

HIV is the early stage of AIDS

CA:
Human Immunodeficiency Virus (Retrovirus)

Fragile – easily destroyed by:
o
Alcohol 70%
o
Chlorine
o
56 C
o
Na Hypochloride – 1: 10 parts of water

Survive outside of the body
o
With body fluids – 4 hours
o
With blood – 12 hours

Dead patient – cremated or sealed metal coffin
o
Buried within 24 hrs – not embalmed

MOT:
Single exposure
Communicable Diseases

Blood transfusion
90%
Sexual contact
0.1 to 1%
Exposure to infected blood
products or tissue
Perinatal transmission
(Pregnancy)
Sharing needles or syringes
T cells
o
Synthesis of
secretions of
leukotrienes
o
Backbone of
immune system
Killer T cells
o
Cytotoxic
o
Traces down and kills
infected human cells
Helper T cells
o
Stimulates B cells
Suppresor T cells
o
Time-keeper
o
Infection is under
control
o
Tells immune system
to relax

0.1 to 0.5%
30% (without treatment)
5% (with treatment)
0.1 to 5%







Humoral Immunity

B cells
o
Produces
antibodies
o
Stimulated by
Helper T cells

Med Mgt: Does not kill virus, only prevents viral
multiplication
o
ARV Drugs

Cocktail Drugs – 21 tablets/ day
o
Neucloside reverse transcriptase inhibitor (NRTI)

Blocks or terminates viral multiplication

AZT (Azidothymidine), zidovudine, retrovir

Agranulocytosis

CBC every 2 weeks
o
Non-nucleoside reverse transcriptase inhibitor
(NNRTI)

Blocks DNA activity of virus

Nevirapine (Viramune)
o
Protease Inhibitor (PI)

Prevents and inhibits viral maturation

Saquinavir (Invirase), Indinavir (Crixivan),
Ritonavir (Novir)
o
Fusion inhibitor

Prevents fusion of the virus to human cell

Nrsg Care:
o
Promote knowledge and understanding
o
Promote quality of life – unpredictable
o
Provide self-care and comfort

Prevention:
o
Same with other STIs
MO  detected macrophage  alert T cells 
stimulate B cells  antibodies  MO
HIV  reverse transcriptase  becomes T cells (allow
virus to multiply)  damaged T cell  Virus will leave
the T cell  virus will retrovert
Macrophages does not easily detect virus – symptoms
not seen easily
S/sx:
o
AIDS Related Complex Symptoms

Fever w/ night sweats w/o a cause

Enlarged lymph nodes w/o a cause

Fatigability, weight loss, body malaise

Altered sleeping patterns

Temporary memory loss

Altered gait
o
AIDS Defining Disease

Major signs
o
Persistent fever 1 month and above
o
Chronic diarrhea 1 month and above
o
10 % weight loss (stunted growth)

Minor signs
o
Persistent cough 1 month and above
o
Persistent generalized
lymphadenopathy
o
Generalized pruritic dermatitis
o
Oropharyngeal candidiasis
o
Recurrent herpes zoster
o
Progressive disseminated herpes
simplex

Adults – 2 major, 1 minor
University of Santo Tomas – College of Nursing / JSV
Opportunistic Infections

MAC

CMV

PCP

CA – Kaposi’s Sarcoma
o
Malignancy of blood vessel wall
o
Manifested in the skin

Leopard Look - pink or purple
painless pus on the skin
Dx Exam:
o
ELISA Test – Enzyme Linked Immuno Sorbent Assay –
Screening
o
Western Blot

Prerequisite: 2 positive ELISA test

Definitive
o
HIV Viral Load

Monitors replicating activity of the virus

Low value – T cell count is maintained

Monitored in an HIV woman who wants to
be pregnant
o
CD4 cell count

1200 cells

Monitors stage of infection

> or = 200 – HIV infection

< 200 – AIDS – may develop opportunistic
infections
o
Newborn/ Pedia

Blood Culture for HIV

Immune-complex-dissociated p24 assay
o
Check for antigen
o

Cell Mediated Immunity
Children – 2 major, 2 minor
Community Health Nursing
DYSENTERY
Synonym
Bacillary
Shigellosis Bloody Flux
Violent
Cholera Eltor
Amebic
Amebiasis
Vibrio Cholerae
 Comma
o Ogawa
o Inaba
o El Tor
Entamoeba Histolytica
Causative Agent
Shigella
 Shiga
o Flexneri
o Boydii
o Bonnet
Mode of
Transmission
Fecal-oral
Mucoid stool
Blood streak if severe
Rice watery stool one after the
other
 Vibriolytic substances 
peristalsis  s/sx
 Rapid DHN
 Washerwoman’s hand
o Dry, wrinkled
 Waten bed
o Hole and pail for the
stool
Mucopurulent blood streaked stool with foul smell
 Dissolved intestinal tissue
 Stool has pus
Stool Examination
Rectal Swab
Stool Examination
Rectal Swab
Stool Examination
Rectal Swab
 Fresh – w/in 30 mins
 Trophozoides  cyst
Antibiotic (Ciprofloxacin)
Oral rehydration Therapy
Antibiotic (Tetracycline)
IV Therapy
Antibiotic (Metronidazole)
*Chloroquine – antiprotozoal
Oral rehydration Therapy
Signs and
Symptoms
Diagnostic Exams
Medical
Management
Nursing Care
Prevention
2 stages:
 Inactive – cyst - harmless
 Active – trophozoides – becomes active when
passes the intestines
Same as typhoid
Same as typhoid
University Of Santo Tomas – College Of Nursing
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