BSN 2B
COLLEGE OF NURSING
COMMUNICABLE AND
NON-COMMUNICABLE
DISEASES
TRANSES
Table of Contents
Page
TITLE PAGE
TABLE OF CONTENTS
COMMUNICABLE DISEASE
Acute Respiratory Infection
Amoebiasis
Anthrax
Bacillary Dysentery
Bird Flu (Avian Influenza)
Candidiasis
Chickenpox
Cholera
Dengue
Diarrhea CHU
Diphtheria
Ebola
Filariasis
Gonorrhea
Hand, Foot, and Mouth Diseases
Hepatitis A
Hepatitis B
Hepatitis C DEL VALLE
HIV/AIDS
Influenza A (H1N1)
Leprosy
Leptospirosis
Malaria
Measles
Meningococcemia
Pertussis
Poliomyelitis
Rabies
Scabies
Scarlet Fever
Severe Acute Respiratory Syndrome (SARS)
Schistosomiasis
Soil Transmitted Helminthiasis
Syphilis
Tetanus
Tuberculosis (TB)
Typhoid Fever
NON-COMMUNICABLE DISEASE
Cardiovascular Disease
COPD
Cancer
Diabetes
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COMMUNICABLE
DISEASES
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ACUTE RESPIRATORY INFECTION
Acute Respiratory Infection or ARI is an
infection that prevents normal breathing
function that can also spread from one person
to another. This can begin as a viral infection in
the nose, trachea, or lungs which can then
spread to the entire respiratory system which
prevents the body from getting oxygen,
resulting in possible death.
An example is the Influenza virus, which is an
acute respiratory illness, caused by influenza A,
B, and C viruses, that occurs in local outbreaks
or seasonal epidemics.
ETIOLOGY
In addition to this, there are various bacteria
and viruses that can cause ARI.
Viruses can include:
• Respiratory syncytial virus
• Parainfluenza virus
• Influenza virus A and B
• Human metapneumovirus.
Also, these viral pathogens can also make you
susceptible to Bacterial infections of:
• Streptococcus pneumoniae
• Haemophilus influenzae
INCUBATION PERIOD
In relation to this, the typical flu incubation
period is between 24 hours and four days, with
the average being two days.
COMMUNICABILITY PERIOD
• In general, the communicability period
for acute respiratory infection has a
maximum period of less than 21 days.
• However, this can also vary with specific
disease agents and age groups.
• Like for Adults, they may be infectious
from approximately 5 days after the
onset of illness. Meanwhile in children,
they can remain infectious for up to 10
days after the onset of symptoms.
MODE OF TRANSMISSION
Furthermore, the mode of transmission for ARI
varies depending on the organism and could be
airborne, droplet, or through direct or indirect
contact with infected humans, objects, or
animals.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
As nurses, it is important to assess for signs and
symptoms of:
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•
•
•
•
•
•
Congestion
Runny nose
Cough
Sore throat
Body aches
Fatigue
Worsening of the condition can indicate:
• Difficulty of breathing
• Dizziness
• Low blood oxygen level
• Loss of consciousness
NURSING CONSIDERATION
Additionally, nursing considerations for ARI
includes placing the client on droplet or contact
precautions while wearing appropriate PPE; as
well as assessing the respiratory status of the
client (rate, rhythm, and depth of respiration,
chest movement, and the use of accessory
muscles) as well as observing for coughs and
sputum.
TREATMENT
In relation to this, the most common treatments
for ARI includes Analgesics: To reduce fever and
body aches; Nasal decongestant: to provide
temporary relief; and Antibiotics for bacterial
infections. However, most causes for ARI are
not treatable.
PREVENTION
Therefore, prevention is the best method to
combat acute respiratory infection, which can
be done through practicing proper hygiene.
COMPLICATION
Otherwise, failure in preventing and treating ARI
could result to the spread of infection to the
respiratory system that can result to lung failure
or worse death.
AMOEBIASIS
Amoebiasis is a disease caused by infection with
a parasitic amoeba that, when symptomatic, can
cause dysentery and invasive extraintestinal
problems. The cause of amoebiasis is mainly the
protozoan parasite Entamoeba histolytica.
Some risk factors for amoebiasis include
consuming contaminated food or water,
association with food handlers whose hands are
contaminated, contact with contaminated
medical devices such as colonic irrigation
devices, and being pregnant.
ETIOLOGY
Amoebiasis is a parasitic infection caused by the
protozoal organism E histolytica, which can give
rise both to intestinal disease (eg, colitis) and to
various extraintestinal manifestations, including
liver
abscess
(most
common)
and
pleuropulmonary,
cardiac,
and
cerebral
dissemination.
E histolytica is transmitted primarily through the
fecal-oral route. Infective cysts can be found in
fecally contaminated food and water supplies
and contaminated hands of food handlers.
Sexual transmission is possible, especially in the
setting of oral-anal practices (anilingus). Poor
nutrition, through its effect on immunity, has
been found to be a risk factor for amoebiasis.
INCUBATION PERIOD
The incubation period for E. histolytica infection
is commonly 2-4 weeks but may range from a
few days to years. The clinical spectrum of
amoebiasis ranges from asymptomatic infection
to fulminant colitis and peritonitis to
extraintestinal amoebiasis, the most common
form of which is amebic liver abscess.
COMMUNICABILITY PERIOD
Cases are infectious as long as cysts are present
in the feces. Infected patients excrete cysts
intermittently, sometimes for years if untreated.
MODE OF TRANSMISSION
• Fecal–oral route, either directly by
person-to-person contact or indirectly by
eating or drinking fecally contaminated
food or water.
• Sexual transmission by oral-rectal
contact is also recognized especially
among male homosexuals.
• Vectors such as flies, cockroaches and
rodents can also transmit the infection
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NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Most people with this infection do not have
symptoms. If symptoms occur, they are seen 7
to 28 days after being exposed to the parasite.
Mild symptoms may include:
•
•
•
•
•
•
Abdominal cramps
Diarrhea: passage of 3 to 8 semi-formed
stools per day, or passage of soft stools
with mucus and occasional blood
Fatigue
Excessive gas
Rectal pain while having a bowel
movement (tenesmus)
Unintentional weight loss
Severe symptoms may include:
•
•
•
•
Abdominal tenderness
Bloody stools, including passage of liquid
stools with streaks of blood, passage of
10 to 20 stools per day
Fever
Vomiting
NURSING CONSIDERATION
1. Observe isolation and enteric
precaution
2. Provide health education
• Boil water for drinking or use
purified water
• Avoid washing food from open
drum or pail
• Cover leftover food
• Wash hands after defecation or
before eating
• Avoid
ground
vegetables
(lettuce, carrots, and the like)
3. Proper collection of stool specimen
• Never give paraffin or any oil
preparation for at least 48 hours
prior to collection of specimen.
• Instruct patient to avoid mixing
urine with stools.
• If whole stool cannot be sent to
laboratory, select as much
portion as possible containing
blood and mucus.
• Send specimen immediately to
the laboratory; stool that is not
fresh is nearly useless for
examination.
• Label specimen properly
4. Skin care
• Cleanliness,
freedom
from
wrinkles on the sheet will be
helpful with all the usual
precautionary measures against
pressure sores
5. Mouth Care
6. Provide Optimum Comfort
• Patient should be kept warm.
Dysenteric patient should never
be allowed to feel, even for a
moment.
7. Diet
• During the acute stage, fluids
should be forced.
• In the beginning of an attack,
cereal and strained meat broths
without fat should be given.
• Chicken and fish maybe added
when
convalescence
is
established.
• Bland diet without cellulose or
bulkproducing food should be
maintained for along time.
TREATMENT
• Treatment depends on how severe the
infection is. Usually, antibiotics are
prescribed.
• If you are vomiting, you may be given
medicines through a vein (intravenously)
until you can take them by mouth.
Medicines to stop diarrhea are usually not
prescribed because they can make the
condition worse.
• After antibiotic treatment, your stool will
likely be rechecked to make sure the
infection has been cleared.
PREVENTION
• Health education
• Sanitary disposal of feces
• Protect, chlorinate, and purify drinking
water
• Observe scrupulous cleanliness in food
preparation and food handling
• Detection and treatment of carriers (such
as fly control, they can serve as vector)
COMPLICATION
Complications of amoebic colitis include the
following:
•
•
Fulminant or necrotizing colitis
Toxic megacolon
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•
•
Amoeboma
Recto vaginal fistula
Complications of amoebic liver abscess include
the following:
•
•
•
Intraperitoneal,
intrathoracic,
or
intrapericardial rupture, with or without
secondary bacterial infection
Direct extension to pleura or pericardium
Dissemination and formation of brain
abscess
Other complications due to amoebiasis include
the following:
•
•
•
•
•
•
Bowel perforation
Gastrointestinal bleeding
Stricture formation
Intussusception
Peritonitis
Empyema
ANTHRAX
Anthrax is a serious infectious disease, rare and
zoonotic disease that can be found naturally in
soil and commonly affects domestic and wild
animals around the world.
It occurs primarily in animals such as cattle,
sheep, horse, mules, and some wild animals are
highly susceptible.
ETIOLOGY
Anthrax is caused by the gram-positive Bacillus
anthracis,
which
are
toxin-producing,
encapsulated, facultative anaerobic organisms.
INCUBATION PERIOD
• Cutaneous anthrax - 1-12 days (rarely up
to 7 weeks)
• Inhalation/pulmonary anthrax - 1-7 days
• (commonly within 48 hours)
• Intestinal anthrax - 1-7 days
COMMUNICABILITY PERIOD
Anthracis spores can remain viable and infective
in soil for years and maybe decades.
MODE OF TRANSMISSION
• Humans can become infected through
direct contact with skin, ingestion or
inhalation of B. anthracis spores
originating from products of infected
animals (e.g. animal carcasses, hair, wool,
hides or bone meal).
• Inhalation of airborne oraerosolised B.
anthracis spores.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Nursing assessment for a patient with anthrax
include:
• History
• Physical assessment
There are four common routes of anthrax
infection, each with different signs and
symptoms. In most cases, symptoms develop
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within six days of exposure to the bacteria.
However, it's possible for inhalation anthrax
symptoms to take more than six weeks to
appear.
Cutaneous anthrax:
• A raised, itchy bump resembling an insect
bite that quickly develops into a painless
sore with a black center
• Swelling in the sore and nearby lymph
glands
• Flu-like symptoms including fever and
headache
Gastrointestinal anthrax:
• Nausea
• Vomiting
• Abdominal pain
• Headache
• Loss of appetite
• Fever
• Severe, bloody diarrhea in the later stages
of the disease
• Sore throat and difficulty swallowing
• Swollen neck
Inhalation anthrax:
• Flu-like symptoms for a few hours or days,
such as sore throat, mild fever, fatigue and
muscle aches
• Mild chest discomfort
• Shortness of breath
• Nausea
• Coughing up blood
• Painful swallowing
• High fever
• Trouble breathing
• Shock
• Meningitis
Oropharyngeal anthrax:
• Soft-tissue swelling in the neck
• Cervical lymph nodes enlargement
• Hoarseness
• Sore throat
• Dysphagia
NURSING CONSIDERATION
• Improve airway patency.
• Improve swallowing
• Improve tissue integrity
• Improve breathing pattern
• Eliminate diarrhea
• Diminish hyperthermia
TREATMENT
• Treat naturally occurring localized or
uncomplicated cutaneous anthrax with 7–
10 days of a single oral antibiotic. First-line
agents include ciprofloxacin (or an
equivalent
fluoroquinolone)
or
doxycycline.
• Clindamycin is an alternative, as are
penicillins if the isolate is penicillin
susceptible.
• Treat systemic anthrax with combination
broad-spectrum intravenous antibiotics
pending the results of confirmatory
testing.
PREVENTION
• Avoid direct and indirect contact with
animal carcasses and should not eat meat
from animals butchered after having been
found dead or ill.
• A three-dose series of anthrax vaccine.
• Repeated pre exposure vaccination with a
5-dose intramuscular series is required to
ensure protection.
• A 60-day treatment with antibiotics —
ciprofloxacin, doxycycline and levofloxacin
are approved for adults and children.
COMPLICATION
The most serious complications of anthrax
include:
• Your body being unable to respond to
infection normally, leading to damage of
multiple organ systems (sepsis).
Anthrax sepsis – develops after
lymphohematogenous
spread
of
anthracis from primary lesion.
•
the
B.
Inflammation of the membranes and fluid
covering the brain and spinal cord,
leading
to
massive
bleeding
(hemorrhagic meningitis) and death.
Anthrax meningitis – is the intense
inflammation of the meninges of the brain
and spinal cord.
•
•
This is marked by elevated CSF pressure
with bloody CSF followed by
rapid
loss of consciousness and death.
The case fatality rate is almost 100
percent.
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BACILLARY DYSENTERY
Bacillary Dysentery is a type of food poisoning
caused by infection with the Shigella species. It
is a major public health problem in developing
countries where sanitation is poor. One
characteristic of bacillary dysentery is blood in
stool, which is the result of invasion of
the mucosa by
the
pathogen.
Dysentery is an infectious disease associated
with severe diarrhea.
ETIOLOGY
Caused by a group of Shigella bacteria which
can be found in the human gut. You can get
dysentery if you eat food that's been prepared by
someone who has it. For example, you might get
it if the person who made your food is sick and
didn't properly wash their hands. Or you can get
dysentery if you touch something that has the
parasite or bacteria on it, such as a toilet handle
or sink knob.
Swimming in contaminated water, such as lakes
or pools, is another way you might catch
dysentery.
You can sometimes carry the bug that causes
dysentery for weeks or years without knowing it.
You can still pass the infection to other people,
even if you don't have symptoms.
Poor hygiene is the main source. Shigellosis can
also spread because of tainted food.
INCUBATION PERIOD
The incubation period is usually 1 - 3 days, but
can be up to 7 days.
COMMUNICABILITY PERIOD
Stay home from work or school until you've been
diarrhea-free for at least 48 hours to avoid passing
the infection to others. Wash your hands often
and don't prepare food for anyone else for at least
2 days after your symptoms clear up. Also
avoid sex until you feel better.
MODE OF TRANSMISSION
Transmission is fecal-oral and is remarkable for
the small number of organisms that may cause
disease. Bacillary dysentery is transmitted
directly by physical contact with the fecal
material of a patient or carrier (including during
sexual
contact), or indirectly
through
consumption of contaminated food and water.
NURSING ASSESSMENT
SYMPTOMS)
• Acute bloody diarrhea
• Abdominal cramping
(SIGNS
&
• Tenesmus
• Urgency
• Fever
• Occasional vomiting
• Dehydration
NURSING CONSIDERATION
A sample of stool for culture should be obtained
in all suspected cases of shigellosis. Specimens
should be processed immediately after
collection. Other lab tests, such as a WBC count,
may be performed in persons with severe
symptoms or to rule out other causes.
Infected persons in schools or institutions
should be isolated. They should observe
personal hygiene to avoid infecting other
persons. Treatment includes fluid replacement
and antibiotics.
TREATMENT
Antibiotic treatment is indicated in most
patients. Avoid antimotility agents because they
have the potential to worsen the symptoms and
may predispose to toxic dilation of the colon.
Clear liquids followed by a low residue; lactosefree diet is recommended until symptoms of
shigellosis resolve. Dysentery is initially
managed by maintaining fluid intake using oral
rehydration therapy.
PREVENTION
• Perform
hand
hygiene
frequently,
especially before handling food or eating,
and after using the toilet or handling fecal
matter.
• Wash hands with liquid soap and water,
and rub for at least 20 seconds. Then rinse
with water and dry with a disposable paper
towel or hand dryer. If hand washing
facilities are not available, or when hands
are not visibly soiled, hand hygiene with 70
to 80% alcohol-based hand rub is an
effective alternative.
• Refrain from work or school, and seek
medical advice when suffering from
gastrointestinal symptoms such as
diarrhea.
• Maintain good food hygiene
COMPLICATION
• Severely low potassium levels, which can
cause life-threatening heartbeat changes
• Seizures
• Hemolytic uremic syndrome (a type of
kidney damage)
• Dehydration
BIRD FLU (AVIAN INFLUENZA)
Bird flu, also called avian influenza, is a viral
infection that can infect not only birds, but also
humans and other animals. H5N1 is the most
common form of bird flu. According to the World
Health Organization, H5N1 was first discovered
in humans in 1997 and has killed nearly 60
percent of those infected. The most frequently
identified subtypes of avian influenza that have
caused human infections are H5, H7 and H9
viruses.
ETIOLOGY
Avian influenza refers to the disease caused by
infection with avian (bird) influenza (flu) Type A
viruses. H5N1 was the first avian influenza virus
to infect humans. The first infection occurred in
Hong Kong in 1997.
INCUBATION PERIOD
Avian influenza A(H5N1) virus infections in
humans, incubation period ranges up to 17
days, with an average of 2 to 5 days.
COMMUNICABILITY PERIOD
The “incubation period” of a virus is the amount
of time between the infection and the host
developing symptoms. The virus is contagious
during this time.
MODE OF TRANSMISSION
The disease is transmitted to humans through
contact with infected bird feces, nasal
secretions, or secretions from the mouth or
eyes. Birds infected with H5N1 continue to
release the virus in feces and saliva for as long
as 10 days.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• High fever (greater than or equal to
38°C)
• Cough
• Dyspnea or difficulty breathing
• Nausea, vomiting and diarrhea
• Bleeding from the nose or gums
• Encephalitis
• Chest pain
NURSING CONSIDERATION
• Place the patient in isolation, and monitor
and
give
patient
appropriate
pharmacological therapy.
• Practice standard precautions.
• Within 48 hours of admission to a
hospital, provide patients who have avian
influenza A(H5N1) required ventilatory
support.
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•
•
•
These patients should be given required
intensive
care
for
multi-organ
dysfunction and failure and in some cases
hypotension.
Provide
vigorous
treatment
with
broadspectrum
antibiotics,
antiviral
agents,
and,
in
some
cases,
corticosteroids as per doctor’s order.
Educate patients about the prevention of
the disease.
TREATMENT
• Use
antiviral
drugs,
notably
neuraminidase inhibitor
• Supportive care such as oxygen therapy,
intravenous fluids and parenteral
nutrition may be needed.
• Treatment is recommended for a
minimum of 5 days
• Use of corticosteroids but should not be
used routinely, unless indicated for other
reasons such as asthma and other
specific conditions.
PREVENTION
• Avoid sources of exposure whenever
possible
• Follow recommended biosecurity and
infection control practices
• Get a seasonal influenza vaccination
every year
• Handle raw poultry hygienically and cook
all poultry and poultry products
(including eggs) thoroughly before eating
• Travelers to countries with avian
influenza A outbreaks in poultry or people
observe the following:
• Avoid visiting poultry farms, bird markets
and other places where live poultry are
raised, kept, or sold.
• Avoid preparing or eating raw or
undercooked poultry products.
• Practice hygiene and cleanliness. Visit a
doctor if you become sick during or after
travel.
COMPLICATION
• Severe pneumonia
• Hypoxemic respiratory failure
• Multi-organ dysfunction
• Septic shock
• Secondary bacterial and fungal infections
CANDIDIASIS
Candida the scientific name for a genus of fungi.
Candida infections, also called candidiasis, are
often referred as yeast or fungal infections.
These fungi are found almost everywhere in the
environment and is opportunistic. It can affect
many parts of the body, causing localized
infections or larger illness, depending on the
person and his or her general health.
Places on and in the body that may be
affected by candidiasis includes:
1.
2.
3.
4.
5.
6.
Mouth – Thrush
Esophagus
Skin – Cutaneous Candidiasis
Nails – Nail Candidiasis
Genital Candidiasis
Invasive Candidiasis
ETIOLOGY
Candidiasis is a fungal infection caused by a
yeast (a type of fungus) called Candida. Some
species of Candida can cause infection in
people; the most common is Candida albican.
INCUBATION PERIOD
Variable. Because there is no exact known
infectious dose of Candida albicans. This is
mostly
due
to
the
fact
that
a C.
albicans infection stems from the commensal
population of C. albicans in the human
microflora. Candidiasis is caused by the
abnormal growth in C. albicans, which is usually
due to an imbalance in the environment. For
thrush in infants, it usually takes 2 to 5 days.
For others, yeast infections may occur while
taking antibiotics or shortly after stopping the
antibiotics.
COMMUNICABILITY PERIOD
The period of communicability is
while
lesions are present and contact infectivity is
unknown.
MODE OF TRANSMISSION
• Contact with secretion or excretions of
mouth, skin, vagina and feces from patient
or carrier.
• Passage from mother to neonate during
childbirth.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Thrush
• White coating or thickened white patches
visible inside the mouth and on the
tongue.
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•
•
•
•
Redness and soreness,
Loss of taste
Pain when eating
Difficulty speaking
Esophangeal Candidiasis
• white lesions on the lining of
esophagus may look like cottage
cheese and may bleed if they’re
scraped
• pain or discomfort while swallowing
• dry mouth and difficulty swallowing
• nausea and vomiting
• weight loss and chest pain
Cutaneous Candidiasis
• Feeling of warmth in the affected
area
• Itchy skin
• Lesions in moist areas such as under
skin folds
• Lesions that cluster and run
together
• Pus-filled bumps
• Red, inflamed, weepy skin
Nail Candidiasis
• Painful, redness and swelling of the
skin around the nail.
• Pus on the nails.
• The nail is lifting up and becoming
detached.
• White,
brown
or
yellow
discoloration.
Genital Candidiasis
1. Female
• Vaginal itching or soreness.
• Changes in vaginal discoloration
• Burning in vaginal discharge
• Burning or painful urination
• Painful sex
2. Male
• Burning with urination
• Foreskin sores
• Irritation and itchiness
• White, lumpy, foul-smelling
discharge.
• Redness and inflammation
• Small rash-like bumps that may
contain pus
• White, shiny skin patches
Invasive Candidiasis
Can be fatal and most often strikes the
brain, heart, bones and eyes.
• Fever and chills
• Headache
• Muscle or joint pain
• Neck stiffness
• Rash
NURSING CONSIDERATION
• Administer antibiotics as ordered by the
doctor.
• Provide nonirritating mouthwash to
loosed tenacious secretion and soft
toothbrush to avoid irritation.
• Relieve mouth discomfort with topical
anesthetic.
• Provide appropriate supportive care for
patients with systemic infections.
• Frequently check the vital signs of a
patient with systemic infection.
• If vaginal discharge is noted, document
the color and amount.
• Assess the patient with candidiasis for
underlying systemic causes such as
diabetes mellitus, infection or immune
dysfunction.
• Demonstrate comprehensive hygiene
practices and have the patient perform a
return demonstration.
TREATMENT
Treatment for Candida typically involves the use
of antifungal medications, although oral
thrush in babies often goes away on its own.
The type of antifungal therapy depends on the
site and severity of the infection, and whether
any past treatment was effective. Antifungal
medications may be topical, oral or intravenous.
Topical antifungal medications
Topical antifungal medications can be used for
cutaneous candidiasis, thrush, or genital
candidiasis.
• Butoconazole (Femstat) vaginal cream
• Clotrimazole (Lotrimin, Mycelex) topical
cream, vaginal cream, or vaginal
suppositories
• Clotrimazole lozenges
• Ketoconazole (Nizoral) topical cream
• Miconazole (Micatin, Monistat) topical
cream or vaginal cream
• Nystatin “swish and swallow” oral
suspension
• Tioconazole (Vagistat) vaginal cream
Oral antifungal medications
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Oral antifungal drugs may be used for
cutaneous candidiasis, thrush, or genital
candidiasis, especially for infections that are
more severe or that fail to resolve with topical
treatment, or for systemic Candida infections.
• Fluconazole (Diflucan)
• Ketoconazole (Nizoral)
• Voriconazole (Vfend)
Intravenous antifungal medications
Systemic candidiasis is often treated with
intravenous antifungal medications including:
• Amphotericin B
• Anidulafungin (Eraxis)
• Caspofungin (Cancidas)
• Fluconazole (Diflucan)
• Micafungin (Mycamine)
• Voriconazole (Vfend)
PREVENTION
• Perform hand hygiene frequently,
especially before handling food or eating,
and after using the toilet or handling fecal
matter.
• Wash hands with liquid soap and water,
and rub for at least 20 seconds. Then
rinse with water and dry with a
disposable paper towel or hand dryer. If
hand washing facilities are not available,
or when hands are not visibly soiled,
hand hygiene with 70 to 80% alcoholbased hand rub is an effective
alternative.
• Refrain from work or school, and seek
medical advice when suffering from
gastrointestinal symptoms such as
diarrhea.
• Maintain good food hygiene
COMPLICATION
• Abscess formation in the spleen
• Arthritis
• Encephalitis (brain inflammation)
• Esophagitis (inflammation or infection of
the esophagus)
• Endophthalmitis
(inflammation
or
infection inside the eye)
• Malnutrition
• Inflammation and infections of the heart,
such as endocarditis, and pericarditis
• Meningitis (infection or inflammation of
the sac around the brain and spinal cord)
• Peritonitis (infection of the lining that
surrounds the abdomen)
• Recurrent
• Secondary infection of skin lesions
CHICKENPOX
Chickenpox is an infection caused by the
varicella-zoster virus. It produces a rash of
small, fluid-filled blisters that is itchy. People
that have never experienced chickenpox or who
have not been vaccinated against it are
extremely infectious.
ETIOLOGY
• The VARICELLA-ZOSTER VIRUS (VZV)
is responsible for chickenpox.
• VZV is a DNA virus that belongs to the
herpesvirus family. VZV, like other
herpesviruses, survives the main (first)
outbreak as a latent infection in the body;
it is found in sensory nerve ganglia.
• Herpes zoster (shingles) may occur when
a latent infection
reactivates.
• The virus has a short survival time in the
environment.
INCUBATION PERIOD
Varicella takes 14 to 16 days to develop after
being exposed to a varicella or herpes zoster
rash, with a duration of 10 to 21 days. In adults,
a moderate prodrome of fever and malaise
could occur one to two days before the rash
appears. The rash is often the first symptom of
illness in infants.
COMMUNICABILITY PERIOD
An individual that has chickenpox is infectious
from its first two days until the rash appears
before all the lesions have crusted over
(scabbed). People who have been vaccinated
can still get chickenpox, however their lesions
do not crust. These individuals are considered
infectious until no new lesions occur in the next
24 hours.
Chickenpox takes about 2 weeks (from 10 to 21
days) to grow after being exposed to someone
who has chickenpox or shingles. If an individual
who has been vaccinated contracts the disease,
they can still pass it on to others.
13 | P a g e
MODE OF TRANSMISSION
Direct Touching and/or Droplets
Chickenpox is transmitted by directly touching
an infected person's blisters, saliva, or mucus.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
HISTORY TAKING. The history should elicit if
a recent outbreak of chickenpox in the
community has occurred and if any exposure to
varicella at school, daycare, or among family
members has occurred.
IMMUNIZATIONS. It should also be noted
whether the child has previously received
varicella vaccine or if the child is
immunocompromised (including recent systemic
steroid use) to help guide management.
IMMUNOCOMPROMISED
CHILD.
Immunocompromised children often have
severe and complicated varicella, and their
mortality rate is higher than that in
immunocompetent children.
ISOLATION
PRECAUTION
COMMUNICABILITY PERIOD
FOR
SIGNS AND SYMPTOMS:
•
Flu-like symptoms such as fever,
fatigue, loss of appetite, body aches, and
headache.
• Red spots appear on the face and chest,
eventually spreading over the entire
body.
• Blisters weep, become sores, form
crusts, and heal.
NURSING CONSIDERATION
AIRBORNE PRECAUTION
To protect against airborne transmission of
infectious agents
MANAGE PRURITUS
Manage pruritus in patients with varicella with
cool compresses and regular bathing.
DIETARY MEASURES
Advise parents to provide a full and unrestricted
diet to the child.
TREATMENT
There is no definite treatment for chickenpox,
but there are pharmacy remedies that can
alleviate symptoms such as cooling lotions or
gels, and antihistamine.
Some treatments that can be done at home
would be; staying hydrates, keeping cool,
avoiding scratching, and painkillers or
paracetamol in cases of fever.
Stronger medications include antiviral medicine
and immunoglobulin treatment.
PREVENTION
The best way to prevent chickenpox is getting
vaccinated. In any case that you do get infected
(after the vaccine), it won’t be as bad and
infectious than normal.
To prevent spreading the disease, it is better to
avoid as much human interaction as possible
until the blisters crust over. Better to keep
things around you, or the infected person, clean
and sanitized.
COMPLICATION
Complications are possible but it is uncommon
to happen with healthy people.
Those who are prone to complications are:
infants, adolescents, adults, pregnant
women, and people with weakened
immune systems (people who have
HIV/AIDS, transplants, and/or people on
chemotherapy,
immunosuppressive
medications, or long-term use of steroids.
Serious complications are:
•
•
•
•
•
•
Bacterial infections of the skin and soft
tissues in children, including Group A
streptococcal infections.
Infection of the lungs (pneumonia)
Infection or inflammation of the brain
(encephalitis, cerebellar ataxia)
Bleeding
problems
(hemorrhagic
complications)
Bloodstream infections (sepsis)
Dehydration
14 | P a g e
CHOLERA
An infectious disease characterized by intense
vomiting and profuse watery diarrhea that
rapidly leads to dehydration which is caused by
infection of the intestine with the bacteria Vibrio
•
cholerae.
•
•
•
ETIOLOGY
• The bacteria Vibrio cholerae is
responsible for the presence of the
disease
• comma-shaped
• gram-negative aerobic or facultatively
anaerobic bacillus
• varies in size from 1-3 µm in length by
0.5-0.8 µm in diameter
INCUBATION PERIOD
• Ranges from a few hours to 5 days
• Average is 1-3 days
• Shorter incubation period:
▪ High gastric pH (from use of
antacids)
▪ Consumption of high dosage of
cholera
COMMUNICABILITY PERIOD
Bacteria are present in feces of infected
individuals for up to 14 days after infection with
V. cholerae. Patients are infectious from the
onset of symptoms until seven days after
resolution of diarrhoea. Asymptomatic patients
typically shed the organism for one day.
Intermittent shedding may occur occasionally
but chronic carriage is rare. The carrier state
may develop and persist for a few months. Very
rarely, chronic biliary carriage can develop in
adults with intermittent shedding can persist for
years.
•
•
•
•
During acute stage
A few days after recovery
By end of week, 70% of patients noninfectious
By end of third week, 98% non-infectious
MODE OF TRANSMISSION
Generally, it is a food- and water-borne, usually
transmitted through fecal-oral route.
15 | P a g e
Person-to-person contact is rare because
large doses of the organism are needed
to cause illness.
Direct contact from humans only
reservoirs
Ingestion of contaminated food or water
▪ Inadequate sewage treatment
▪ Lack of water treatment
▪ Improperly cooked shellfish
Transmission by casual contact unlikely
Person-to-person contact is rare because large
doses of the organism are needed to cause
illness.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Assess for dehydration. Assess the status of
dehydration (skin color, temperature, skin
turgor, mucous membranes, eyes, crown, body
temperature, pulse, respiration, behavior,
weight loss).
Observe for diarrhea. Observe for a sudden
attack of diarrhea, fever, anorexia, vomiting,
nausea, abdominal cramps, increased bowel
sounds, and bowel movements more than 3
times a day, with liquid stool consistency, with
or without mucus or blood.
Assess the level of knowledge of the
family. Assess for the knowledge of diarrhea at
home, dietary knowledge, and knowledge about
the prevention of recurrent diarrhea.
Stool examination. Although observed as a
gram-negative organism, the characteristic
motility of Vibrio species cannot be identified on
a Gram stain, but it is easily seen on direct darkfield examination of the stool.
Stool culture. V cholerae is not fastidious in
nutritional requirements for growth; however, it
does need an adequate buffering system if
fermentable carbohydrate is present because
viability is severely compromised if the pH is less
than 6, often resulting in auto sterilization of the
culture.
Serotyping and biotyping. Specific antisera
can be used in immobilization tests; a positive
immobilization test result (ie, cessation of
motility of the organism) is produced only if the
antiserum is specific for the Vibrio type present;
the second antiserum serves as a negative
control.
Hematologic tests. Hematocrit, serumspecific gravity, and serum protein are elevated
in dehydrated patients because of resulting
hemoconcentration; when patients are first
observed, they generally have a leukocytosis
without a left shift.
Metabolic panel. Serum sodium is usually
130-135 mmol/L, reflecting the substantial loss
of sodium in the stool; serum potassium usually
is normal in the acute phase of the illness,
reflecting the exchange of intracellular
potassium for extracellular hydrogen ion in an
effort to correct the acidosis; hyperglycemia
may be present, secondary to systemic release
of epinephrine, glucagon, and cortisol due to
hypovolemia; patients have elevated blood urea
nitrogen and creatinine levels consistent with
prerenal azotemia.
Isolation Precaution
Strict isolation of cases is not necessary,
provided good hygiene is observed. Cases who
are food handlers are required not to attend
work until 2 stool specimens 24hours apart are
negative for V. cholerae.
NURSING CONSIDERATION
• Assess patient for hydration status, and
assure appropriate replacement; observe
for additional symptoms.
• For isolation, standard precautions are
recommended except for infants and
young children or incontinent persons in
which case contact precautions are
recommended.
• In emergencies, the cholera cot has been
used which consists of a bucket placed
under a bed with a hole in the middle of
the mattress which is protected by plastic
with a sleeve draining from the hole into
the bucket.
• Hand washing is important for staff,
patients and visitors
TREATMENT
The course of treatment is decided by the
degree of dehydration. Three options prove
most effective:
•
•
•
Oral Rehydration
Intravenous Rehydration
Antimicrobial Therapy
16 | P a g e
PREVENTION
V. Cholerae is spread through contaminated
food and water, therefore, prevention depends
upon the interruption of fecal-oral transmission
Anti-biotic
prophylaxis,
vaccines
and
surveillance of new cases are the answer to
preventing the spread of disease.
COMPLICATION
Complications result from massive volume and
electrolyte loss as the Cholera stool contains
high concentrations of sodium, potassium,
chloride, and bicarbonate.
Therefore, in addition to volume depletion,
which can cause renal failure, additional
complications can occur:
▪
▪
▪
▪
▪
Hypokalemia: causes arrhythmias, ileus,
leg cramps
Metabolic Acidosis: due to phosphate
moving out of cells
Hypoglycemia: mental status changes
and seizures
Hypotension: due to water loss
Hypofusion of critical organs
DENGUE
Dengue is a viral infection characterized as a
severe, flu-like illness caused by four different
serotypes of a flavivirus named DENV1-DENV4.
ETIOLOGY
Dengue fever is a viral infection spread by
mosquitos. Female mosquitoes from the genus
Aedes, specifically Aedes aegypti and, to a
lesser degree, Aedes albopictus transmit the
infection. Dengue is a single-stranded positivesense virus belonging to the Flavivirus genus in
the Flaviviridae family. DENV or dengue virus
has four serotypes (DENV-1, DENV-2, DENV-3,
DENV-4), which means that a person can get
infected four times. DENV can cause an acute
flu-like illness, although most DENV infections
are mild. Extreme dengue fever is a potentially
fatal condition that may occur in some cases
INCUBATION PERIOD
Dengue fever has a 3-14-day incubation period
(average 4-7 days) after being inoculated into a
human host, during which time the virus
replicates in target dendritic cells.
COMMUNICABILITY PERIOD
The infected mosquito is infectious around 3-5
days.
MODE OF TRANSMISSION
1. Mosquito bite. It is the most common
mode of transmission.
2. From mother to child. pregnant
woman already infected with dengue can
pass the virus to her fetus during
pregnancy or around the time of birth.
3. Through infected blood, laboratory,
or healthcare setting exposures.
Rarely, dengue can be spread through
blood transfusion, organ transplant, or
through a needle stick injury
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Assessment
•
•
Evaluation of the patient’s heart rate,
temperature, and blood pressure.
Evaluation of capillary refill, skin color
and pulse pressure. Assessment of
17 | P a g e
•
•
evidence of bleeding in the skin and
other sites.
Assessment of increased capillary
permeability.
Measurement and assessment of the
urine output.
Signs and symptoms to assess
NURSING CONSIDERATION
Do
Don’ts
Do tell outpatients
Don’t use
when to return
corticosteroids
Do closely monitor
Don’t give platelet
fluid intake and
transfusion for a low
output as well as
platelet count
vital signs
Do recognize and
Don’t assume that IV
treat early shock
fluids are always
necessary
Do give PRBCs or
whole for clinically
significant bleeding
TREATMENT
• Rest as much as possible
• Take acetaminophen for fever
• Oral rehydration
• Blood transfusion (only if necessary)
PREVENTION
A. Vaccine
B. Prevent mosquito bites
• Stay in air-conditioned or well-screened
housing
• Wear protective clothing
• Use mosquito repellent.
• Reduce mosquito habitat
COMPLICATION
Dengue shock syndrome. Common symptoms
in impending shock include abdominal pain,
vomiting, and restlessness.
DIARRHEA
Diarrhea is characterized by loose, watery stools
or a frequent need to have a bowel movement.
•
•
•
Acute Diarrhea
Chronic Diarrhea
Traveler’s Diarrhea
ETIOLOGY
Virus
•
Rotavirus and Noravirus
Bacteria
•
•
•
•
Vibrio cholorae
Campylobacter jejuni
Enterotoxigenic
Escherichia coli
Parasite
•
Giardia
INCUBATION PERIOD
• 24 hours – 60 hours
• 5-7 days
• 12 hours – 48 hours
COMMUNICABILITY PERIOD
COPD is a progressive disease. It is not
contagious.
MODE OF TRANSMISSION
• Patient to patient
• Health care worker-patient
• Patient-health care worker
• Common vehicle
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
The first question nurses should ask is if the
patient is presenting with a new onset of
diarrhea.
•
•
•
•
•
Abdominal pain
Cramping
Frequency of stools
Hyperactive bowel sounds
Loose or liquid stools
NURSING CONSIDERATION
• Identifying whether a patient has
diarrhea
• Remove embarrassment
• Responsive care and thoughtful planning
• Diet, hydration and elimination issues,
coping with the stresses of life, reduction
in mobility and support networks,
changes in health and mental state
18 | P a g e
TREATMENT
Oral Medications
•
Loperamide and Bismuth
Probiotics
•
Groupings of good bacteria, probiotics
are sometimes used to re-establish a
healthy biome to combat diarrhea
PREVENTION
• Good hygiene. Washing hands.
• Vaccinations. Rotavirus vaccine.
• Storing food properly. Storing foods at
the right temperature.
• Watch out. Avoiding traveler’s diarrhea.
• Taking part in community activities.
Saturn is composed of hydrogen and
helium.
• Safe disposal. Hygienic disposal of the
feces of all young children is an important
aspect of diarrhea prevention.
COMPLICATION
• Reduced Effectiveness of Some
Medicines.
• Haemolytic Uraemic Syndrome
• Dehydration
• Hypokalemia
• Lactose Intolerance
DIPHTHERIA
Diphtheria is an acute, toxin-mediated disease
caused by the bacterium Corynebacterium
diphtheriae. Diphtheria primarily infects the
throat and upper airways, particularly the
mucous membranes of the throat and nose, and
produces a toxin (poison) affecting other
organs.
ETIOLOGY
Diphtheria is an acute, bacterial disease caused
by toxin-producing strains of Corynebacterium
diphtheriae - an aerobic gram-positive bacillus.
The bacteria produce a toxin because they
themselves are infected by a certain type of
virus called a phage.
The toxin that is released:
• Inhibits the production of proteins by
cells
• Destroys the tissue at the site of the
infection
• Leads to membrane formation
• Gets taken up into the bloodstream and
distributed around the body’s tissues
• Causes inflammation of the heart and
nerve damage
• Can cause low platelet counts, or
thrombocytopenia, and produce protein
in the urine in a condition called
proteinuria
Non-toxin-producing strains of C. diphtheriae
can also cause disease. It is generally less
severe, potentially causing a mild sore throat
and, rarely, a membranous pharyngitis. Invasive
disease, including bacteremia and endocarditis,
has been reported for non-toxin-producing
strains of C. diphtheriae.
INCUBATION PERIOD
The incubation period of diphtheria is usually
2–5 days (range: 1–10 days).
COMMUNICABILITY PERIOD
Transmission may occur for as long as virulent
bacilli are present in discharges and lesions. The
time is variable but is usually 2 weeks or less,
and seldom more than 4 weeks without
antibiotics. Appropriate and effective antibiotic
therapy promptly terminates shedding. The rare
chronic carrier may shed organisms for 6
months or more. Even if an infected person
doesn’t show any signs or symptoms of
diphtheria, they’re still able to transmit the
19 | P a g e
bacterial infection for up to six weeks after the
initial infection.
MODE OF TRANSMISSION
• Transmission is most often person-toperson spread from the respiratory tract,
usually through respiratory droplets, like
from coughing or sneezing.
• It is contagious by direct physical contact
with: droplets breathed out into the air,
secretions from the nose and throat, such
as mucus and saliva, infected skin
lesions, objects such as bedding or
clothes an infected person has used, in
rare cases the infection can spread from
an infected patient to any mucous
membrane in a new person, but the toxic
infection most often attacks the lining of
the nose and throat.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Symptoms usually start 2 to 5 days after
becoming infected. The most visible and
common symptom of diphtheria is a thick, gray
coating on the throat and tonsils.
Specific signs and symptoms of diphtheria
depend on the particular strain of bacteria
involved, and the site of the body affected.
Pharyngeal and Tonsillar Diphtheria
• Malaise
• Sore throat
• Anorexia
• Low-grade fever (less than 101°F).
Within 2 to 3 days, a bluish-white membrane
forms and extends, varying in size from covering
a small patch on the tonsils to covering most of
the soft palate. Often by the time a physician is
contacted the membrane is greyish-green or, if
bleeding has occurred, black. Extensive
membrane formation may result in respiratory
obstruction.
Laryngeal Diphtheria
• Fever
• Hoarseness
• Barking cough
The membrane can lead to airway obstruction,
coma, and death.
Anterior Nasal Diphtheria
• Common
cold
and
is
usually
characterized by a mucopurulent nasal
discharge that may become blood-
tinged. A white membrane usually forms
on the nasal septum.
Cutaneous Diphtheria
• Scaling rash
• Ulcers with clearly demarcated edges and
an overlying membrane.
NURSING CONSIDERATION
• Improve thermoregulation. Maintain
room temperature; advise the client to
wear thin clothes that absorb sweat
easily; encourage increasing oral fluid
intake, and administering antipyretics as
ordered.
• Improve caloric intake. Monitor calorie
intake and quality of food consumption;
provide foods that stimulate the appetite,
and measure the bodyweight daily.
• Improve airway clearance.
• Monitor patient for respiratory distress,
sepsis, and myocardial or neural
involvement.
• Assess patient for increased ventilatory
effort, use of accessory muscles, nasal
flaring, stridor, cyanosis, and agitation or
decreased level of consciousness.
• Closely monitor the patient who receive
antitoxin
for
local
or
systemic
anaphylaxis.
• Educate the patient and the family about
the importance of immunization for
prevention from Diphtheria.
• Keep patient on strict bed rest, strict
isolation.
• Room should be bright, sunny and with
adequate means of ventilation
• Provide cleansing throat gargle as
ordered.
• Give liquid or soft diet, gavage or
parenteral fluid.
• Observe for respiratory obstruction
(tracheotomy).
• Use suctioning as needed.
• O2 therapy as ordered.
• Administer Antitoxin against toxin (as
ordered)
• Administer toxoid to immunized contact
(as ordered)
• Administer Broad spectrum antibiotic
against diphtheria bacilli (as ordered)
• Provide Health teaching on proper
hygiene and universal precaution
20 | P a g e
•
Provide oral care as the mouth, teeth and
lips demand careful attention
TREATMENT
• Treatment usually lasts 2 to 3 weeks.
• Medical
Management
aimed
at
countering the bacterial effects has two
components: (a) Antitoxin also known as
anti-diphtheritic serum aims to neutralize
the toxin released by the bacteria; (b)
Antibiotics, erythromycin or penicillin,
aims to eradicate the bacteria and stop it
from spreading. The antibiotic needs to
be administered for one week to
completely eliminate the bacteria.
PREVENTION
• The diphtheria vaccine is usually
combined with vaccines for tetanus and
whooping cough (pertussis). The threein-one vaccine is known as the
diphtheria, tetanus and pertussis
vaccine. The latest version of this vaccine
is known as the DTaP vaccine for children
and the Tdap vaccine for adolescents and
adults.
• The diphtheria, tetanus and pertussis
vaccine are one of the childhood
immunizations that doctors in the United
States recommend during infancy.
Vaccination consists of a series of five
shots, typically administered in the arm
or thigh, given to children at these ages:
2 months, 4 months, 6 months, 15 to 18
months, 4 to 6 years
COMPLICATION
• Breathing problems. the toxin damages
tissue in the immediate area of infection
— usually, the nose and throat. At that
site, the infection produces a tough,
gray-colored membrane composed of
dead
cells,
bacteria
and
other
substances. This membrane can obstruct
breathing.
• Myocarditis, or Heart damage. The
diphtheria toxin may spread through your
bloodstream and damage other tissues in
your body, such as your heart muscle,
causing
such
complications
as
inflammation of the heart muscle
(myocarditis).
• Neuritis, or Nerve damage. The toxin can
also cause nerve damage. Typical targets
are nerves to the throat, where poor
nerve conduction may cause difficulty
swallowing. Nerves to the arms and legs
also may become inflamed, causing
muscle weakness. If it damages the
nerves that help control muscles used in
breathing, these muscles may become
paralyzed. At that point, patient might
need mechanical assistance to breathe.
21 | P a g e
EBOLA
Ebola Virus Disease (EVD) is a rare and deadly
disease in people and nonhuman primates. It is
a notoriously deadly virus that cause severe
symptoms, the prominent being high fever and
massive internal bleeding. People can get EVD
through direct contact with an infected animal
(bat or nonhuman primate) or a sick or dead
person infected with Ebola virus.
The Ebola virus causes an acute, serious illness
which is often fatal if untreated. EVD first
appeared in 1976 in 2 simultaneous outbreaks,
one in what is now Nzara, South Sudan, and the
other in Yambuku, DRC. The latter occurred in
a village near the Ebola River, from which the
disease takes its name.
ETIOLOGY
Ebola Virus disease is caused by ebolavirus
which is a member of the Filoviridae family
(genus Ebolavirus; order: Mononegavirales).
These viruses are elongated, filamentous
structures of variable length. There have been
six identified species of ebolavirus:
1. Ebola virus (species Zaire ebolavirus)
2. Sudan virus (species Sudan ebolavirus)
3. Taï Forest virus (species Taï Forest
ebolavirus, formerly Côte d’Ivoire
ebolavirus)
4. Bundibugyo virus (species Bundibugyo
ebolavirus)
5. Reston virus (species Reston ebolavirus)
6. Bombali
virus
(species
Bombali
ebolavirus)
COMMUNICABILITY PERIOD
• As long as the body fluids including
(seminal fluid and breast-milk) contain
the virus.
• It includes post-mortem period.
MODE OF TRANSMISSION
Human-to-human transmission via direct
contact
• Blood or body fluids of a person who is
sick or has died from Ebola
• Objects that have been contaminated
with body fluids
• People remain infectious as long as their
blood contains the virus
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Fever
• Fatigue
• Muscle pain
• Vomiting
• Headache
• Sore throat
• Diarrhea
• Rash
• Symptoms of impaired kidney and liver
function
• Both internal and external bleeding (for
example, oozing from the gums, or blood
in the stools).
• Laboratory findings include low white
blood cell and platelet counts and
elevated liver enzymes.
History Taking
•
Only four (Ebola, Sudan, Taï Forest, and
Bundibugyo viruses) are known to cause disease
in people.
Physical Exam
•
INCUBATION PERIOD
The time interval from infection with the virus to
onset of symptoms, is from 2 to 21 days. A
person infected with Ebola cannot spread the
disease until they develop symptoms.
22 | P a g e
History of primary exposure involved in
travel or work human-to-human or
primates-human exposures
Physical Findings
NURSING CONSIDERATION
• Stay well-informed about EVD
• Educate patient and public with proper
information
• Essential to wear Personal Protective
Equipment (PPE)
• Limit the use of needles
• Limit contact with the infected patient as
much as possible
TREATMENT
• Rehydration with Oral or Intravenous
Fluids
• Inmazed and Ebanga for Zaire ebolavirus
• Ervebo Vaccine for Zaire ebolavirus
• Zabdeno-and-Mvabea Vaccine
PREVENTION
• Reducing the risk of wildlife-to-human
transmission
• Outbreak Containment Measures
• Reduce the possibility of sexual
transmission
• Reducing the risk of human-to-human
transmission
• Reduce risks or transmission from
pregnancy related fluids and tissue
COMPLICATION
It can cause death and can lead to sever
damage in organs.
• Multiple Organ Failure
• Coma
• Delirium
• Jaundice
• Severe bleeding
• Seizures
People may survive and experience
• Hair Loss
• Weakness
• Eye Inflammation
• Testicular Inflammation
• Sensory Changes
• Hepatitis
23 | P a g e
FILARIASIS
• Disease group
caused by
filariae that
affects
humans and
animals
(nematode
parasites of the
family Filariidae).
• It is an infectious disease that affects
tropical areas.
• It is commonly known as “elephantiasis”.
Classifications:
Lymphatic Filariasis
•
•
Affects the lymphatic system
Inflammation and lymphedema leading
to lymphatic damage, chronic swelling,
and elephantiasis of the legs, arms,
scrotum, vulva, and breasts
Subcutaneous Filariasis
•
•
Affects the subcutaneous area of the skin
Serous Cavity Filariasis
Affects the serous cavity of the abdomen.
ETIOLOGY
Caused by infection with parasites classified as
nematodes (roundworms) of the family
Filariodidea.
There are 3 types of these thread-like filarial
worms:
1. Wuchereria bancrofti
2. Brugia malayi
3. Brugia timori
Wuchereria bancrofti
responsible for 90% of the
cases
endemic in 78 countries and
affects 128 million people
worldwide
widespread throughout humid and tropical
zones of Asia, Africa, the Americas and the
Pacific islands
Brugia malayi
Causes
most
of
the
remainder of the cases
Potentially endemic in 16
countries, where it is most
common in Southern China
24 | P a g e
and India, but it also occurs in Indonesia,
Thailand, Vietnam, Malaysia, the Philippines,
and South Korea.
Brugia timori
Sheathed and measure on
average 310 µm in stained
blood smears and 340 µm
in 2% formalin.
INCUBATION PERIOD
Both microfilaria and adult worms have been
observed in patients as early as 6 months and
as late as 12 months after infection.
COMMUNICABILITY PERIOD
The mosquito remains infectious for only 10-14
days after consuming an infected blood meal.
MODE OF TRANSMISSION
The
disease
is
transmitted through the
bite of an infectious
mosquito.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Asymptomatic
• No external signs of infection while
contributing to transmission of the
parasite
Chronic
• Lymphoedema (tissue swelling)
• Elephantiasis
• Scrotal swelling
Acute
• Local inflammation involving skin, lymph
nodes and lymphatic vessels often
accompanied by chronic lymphoedema or
elephantiasis
NURSING CONSIDERATION
• Monitor the client’s vital signs
• Assess skin color and integrity
• Assess for any discomfort and pain
• Elevate affected body area to reduce
swelling
• Provide support to perform basic
activities
• Encourage a range of motion and simple
exercises
• Recognize the client’s self-esteem needs
•
Provide health teaching and information
TREATMENT
• Ivermectine – drug of choice for W.
bancrofti
• Doxycycline – used to reduce tissue
swelling
• Suramin – effective against adult
roundworms
• Diethylcarbamazine
(DEC)
–
treatment for W. bancrofti (no longer
recommended)
• Albendazole and Flubendazole –
eliminate roundworms easily
• Mass treatment of the people living in
established endemic areas.
PREVENTION
At night:
•
•
Sleep in an air-conditioned room or,
Sleep under a mosquito net
Between dusk and dawn:
•
•
Wear long sleeves and trousers and
Use mosquito repellent on exposed skin
 Eliminate breeding grounds for
mosquitoes.
 Client education
COMPLICATION
• Chronic lymphedema- debilitating
condition in which excess fluid called
lymph collects in tissues and causes
swelling
• Hydrocele- type of swelling in the
scrotum that occurs when fluid collects in
the thin sheath surrounding a testicle.
• Skin pigmentation- Skin changes such
as
skin
fold
thickening
and
hyperkeratosis.
• Chyluria- rare condition in which
lymphatic fluid leaks into the kidneys and
turns the urine milky white.
25 | P a g e
GONORRHEA
Gonorrhea is a sexually transmitted disease
(STD) caused by infection with the Neisseria
gonorrhoeae bacterium.
blood on toilet
tissue
ETIOLOGY
Infected parts: mucous membranes of the
reproductive tract, the cervix, uterus, and
fallopian tubes in women, and the urethra in
women and men.
The gonorrhea bacteria are most often passed
from one person to another during sexual
contact, including oral, anal or vaginal
intercourse.
INCUBATION PERIOD
Usually 2 to 5 days. But sometimes symptoms
may not develop for up to 30 days.
COMMUNICABILITY PERIOD
Gonorrhea is communicable from the time the
infection is acquired until adequate treatment is
received.
MODE OF TRANSMISSION
• Sexual contact with: penis, vagina,
mouth, anus
•
Throat: sore throat Joints: septic arthritis
and swollen lymph cause joints to be warm,
nodes in the neck red,
swollen
and
extremely painful
NURSING CONSIDERATION
• Teach the importance of completing
antibiotic therapy. Tell patient to avoid
sexual activity until all tests are negative
•
If cultures are still positive after
treatment, submit specimens for drugresistant testing
•
Report all cases of gonorrhea to your
local health department
•
Encourage patient to disclose health
condition to his/her partner and to
encourage them to undergo testing and
treatment
Can also be spread perinatally from
mother to baby during childbirth.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
MEN
WOMEN
- pus-like, yellow, -increased
vaginal
white
or
green discharge
discharge
-painful
urination,
-painful urination, burning urination
burning urination
-vaginal
bleeding
-pain or swelling in between periods, such as
testicles
after vaginal intercourse
-abdominal or pelvic pain
Rectum: itching,
pus-like discharge,
spots of bright red
26 | P a g e
Eyes:
eye
pain,
sensitivity to light, and
pus-like discharge from
one or both eyes
TREATMENT
• Antibiotic injection of ceftriaxone one
time to the buttocks and a single dose of
azithromycin by mouth
•
Combine oral azithromycin with either
oral
gemifloxacin
(Factive)
or
injectable gentamicin if patient is
allergic to ceftriaxone
•
If
antibiotic-resistant
strains
of
gonorrhea emerge, a 7-day course of an
oral antibiotic or dual therapy with two
different antibiotics is required
PREVENTION
• Abstinence
• Awareness about your own and your
partner’s sexual health
• Use condom during copulation
• Monogamy- only have one sexual partner
at a time
COMPLICATION
When
gonorrhea
spreads
to
the
bloodstream; arthritis, heart valve damage, or
inflammation of the lining of the brain or spinal
cord may occur
In women
•
Untreated bacteria - may ascend up the
reproductive tract and involve the uterus,
fallopian tubes, and ovaries
•
Pelvic Inflammatory Disease (PID) - can
cause severe and chronic pain and
damage to the reproductive organs
•
Blocking or scarring of the fallopian
tubes,
which
can prevent future
pregnancy or cause ectopic pregnancy
•
Gonorrhea may also pass to a newborn
infant during delivery
In men
•
Scarring of the urethra
•
Painful abscess in the interior of the penis
which can cause reduced fertility
or sterility
27 | P a g e
HAND, FOOT AND MOUTH DISEASES
Is a common infection in children that causes
sores called ulcers inside or around their mouth
and a rash or blisters on their hands, feet, legs,
or buttocks. It can be painful, but it isn't serious.
ETIOLOGY
Common causes of hand, foot, and mouth
disease are:
• Coxsackievirus A16 is typically the
most common cause of hand, foot, and
mouth disease in the United States.
Other coxsackieviruses can also cause
the illness.
• Coxsackievirus A6 can also cause
HFMD and the symptoms may be more
severe.
• Enterovirus 71 (EV-A71) has been
associated with cases and outbreaks in
East and Southeast Asia. Although rare,
EV-A71 has been associated with more
severe diseases such as encephalitis
(swelling of the brain).
INCUBATION PERIOD
The usual period from initial infection to the
onset of signs and symptoms (incubation
period) is three to seven days. A fever is often
the first sign of hand-foot-and-mouth disease,
followed by a sore throat and sometimes a poor
appetite and feeling unwell.
• One or two days after the fever begins,
painful sores may develop in the front of
the mouth or throat. A rash on the hands
and feet and possibly on the buttocks can
follow within one or two days.
COMMUNICABILITY PERIOD
People with hand, foot, and mouth disease are
usually most contagious during the first
week that they are sick. People can sometimes
spread the virus to others for days or weeks
after symptoms go away or if they have no
symptoms at all.
MODE OF TRANSMISSION
You can get hand, foot, and mouth disease by:
• Contact
with
respiratory
droplets
containing virus particles
• Touching an infected person
• Touching an infected person’s feces
• Touching objects and surfaces that have
the virus on them
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Nursing assessment of a patient with HFMD may
include:
28 | P a g e
History. The incubation period of hand-footand-mouth disease (HFMD) lasts approximately
1 week; patients then report a sore mouth or
throat; malaise may develop; rarely, vomiting
occurs in HFMD cases caused by EV-71.
Physical exam. Initially, macular lesions
appear on the buccal mucosa, tongue, and/or
hard palate; these mucosal lesions rapidly
progress to vesicles that erode and become
surrounded by an erythematous halo
Early symptoms may include:
• Fever
• Sore throat
• Painful blisters inside a child’s mouth,
usually toward the back, or on their tongue
• Feeling unwell (malaise)
• Loss of appetite
• Fatigue
• Crankiness
A day or two later, a child might have:
• A rash that turns into blisters
• Flat spots or sores on their knees, elbows,
or buttocks
NURSING CONSIDERATION
In planning for medications to ease patient’s
discomfort, the nurse should consider the
patient’s age. For children younger than 12
years, do not give over-the-counter (OTC) cold
remedies without asking your child’s doctor. Do
not give aspirin or products that contain aspirin.
Aspirin given to any viral infection under 12
years old may lead to life threatening
complications affecting the liver and the brain
called Reye’s syndrome. It can cause seizures,
coma, and death. If the child is under one-year
old, continue to give either breastmilk, formula,
or both. The nurse should also plan and consider
the following nursing interventions such as
improving the integrity of the skin and mucous
membranes, improve nutritional intake. prevent
infection and relieve pain
TREATMENT
Medical Management
There is no specific medical treatment for hand,
foot, and mouth disease.
You can take steps to relieve symptoms and
prevent dehydration while you the child is sick.
• Relieve fever and pain. Take overthe-counter medications to relieve fever
and pain caused by mouth sores and
never give aspirin to children.
•
Prevent dehydration. Drink enough
liquids; mouth sores can make it painful
to swallow, so the patient might not want
to drink much; make sure they drink
enough to stay hydrated.
Pharmacologic Management
The goals of pharmacotherapy are to reduce
morbidity and to prevent complications.
• Antipyretics/analgesics. These
agents are used to control fever and pain.
• Topical anesthetics. These agents can
be applied to ulcerations to control pain.
• Antihistamines. These agents act by
competitive inhibition of histamine at the
H1 receptor.
PREVENTION
• Wash your hands. Help children keep
their hands clean.
• Teach kids to cover their mouth and nose
when they sneeze or cough.
• Clean and disinfect surfaces and shared
items.
• Avoid close contact with sick people.
• Don’t send your child to school or day
care until their symptoms are gone.
COMPLICATION
Dehydration
Some people, especially young children, may
get dehydrated if they are not able to swallow
enough liquids because of painful mouth sores.
Parents can prevent dehydration by making sure
their child drinks enough liquids.
Fingernail and toenail loss
Very rarely, people may lose a fingernail or
toenail after having hand, foot, and mouth
disease. Most reports of fingernail and toenail
loss have been in children. In these reported
cases, the person usually lost the nail within a
few weeks after being sick. The nail usually
grew back on its own. However, there is no
evidence that hand, foot, and mouth disease
was the cause of the nail loss.
Viral (aseptic) meningitis
Although very rare, a small number of people
with hand, foot, and mouth disease get viral
meningitis. It causes fever, headache, stiff neck,
or back pain and may require the infected
person to be hospitalized for a few days.
29 | P a g e
Encephalitis or paralysis
Very rarely, a small number of people with hand,
foot, and mouth disease get encephalitis
(swelling of the brain) or paralysis (can’t move
parts of the body). It is extremely rare.
HEPATITIS A
Hepatitis A is a liver disease caused by the
hepatitis A virus (HAV). The virus is primarily
spread when an uninfected and unvaccinated
person ingests food or water that is
contaminated with the feces of an infected
person. The disease is closely associated with
unsafe water or food, inadequate sanitation,
poor personal hygiene and oral-anal sex.
ETIOLOGY
The virus is primarily spread when an uninfected
and unvaccinated person ingests food or water
that is contaminated with the feces of an
infected person. Hepatitis A is caused by a virus
that infects liver cells and causes inflammation.
The inflammation can affect how your liver
works and cause other signs and symptoms of
hepatitis A.
INCUBATION PERIOD
After the virus enters the body, there is an
incubation period lasting 2 to 7 weeks until
illness begins.
COMMUNICABILITY PERIOD
Infected persons are most likely to transmit HAV
1 to 2 weeks before the onset of illness, when
HAV concentration in stool is highest.
MODE OF TRANSMISSION
Fecal-Oral Route
• Close person-to-person contact with an
infected person
• Sexual contact with an infected person
• Ingestion of contaminated food or water
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Symptoms of hepatitis A range from mild to
severe and can include:
• Jaundice
• Fever
• Nausea
• Vomiting
• Dark Urine
• Fatigue
• Loss of Appetite
30 | P a g e
• Joint pain
• Abdominal pain
• Clay-colored stool
• Diarrhea
NURSING CONSIDERATION
• Monitor dietary intake and caloric count.
Suggest several small feedings and offer
“largest” meal at breakfast. - Large meals
are difficult to manage when patient is
anorexic. Anorexia may also worsen
during the day, making intake of food
difficult later in the day.
• Encourage mouth care before meals. Enhances appetite by eliminating
unpleasant taste.
• Recommend eating in upright position. Reduces sensation of abdominal fullness
and may enhance intake.
• Encourage intake of fruit juices,
carbonated beverages, and hard candy
throughout the day. - These supply extra
calories and may be more easily digested
or tolerated than other foods.
• Consult with dietitian, nutritional support
team to provide diet according to
patient’s needs, with fat and protein
intake as tolerated. - Useful in
formulating dietary program to meet
individual needs
• Monitor serum glucose as indicated. Hyperglycemia or hypoglycemia may
develop, necessitating dietary changes
and insulin administration. Fingerstick
monitoring may be done by patient on a
regular schedule to determine therapy
needs.
• Administer medications as indicated: Antiemetics, antacids, vitamins and
steroid therapy
• Provide supplemental feedings and TPN
if needed. - May be necessary to meet
caloric requirements if marked deficits
are present and symptoms are
prolonged.
TREATMENT
There is no specific treatment for hepatitis
A.
• Recovery from symptoms following
infection may be slow and may take
several weeks or months. Most important
is the avoidance of unnecessary
medications.
Acetaminophen
/
Paracetamol and medication against
vomiting should not be given.
• Therapy is aimed at maintaining comfort
and adequate nutritional balance,
including replacement of fluids that are
lost from vomiting and diarrhea.
PREVENTION
Improved sanitation, food safety and
immunization are the most effective ways
to combat hepatitis A.
The spread of hepatitis A can be reduced by:
• Adequate supplies of safe drinking water
• Proper disposal of sewage within
communities
• Personal hygiene practices such as
regular hand-washing before meals and
after going to the bathroom
COMPLICATION
• Cholestatic hepatitis. Occurring in
about 5% of patients, this means the bile
in your liver is obstructed on its way to
the gallbladder. It can cause changes in
your blood and result in jaundice fever
and weight loss
• Relapsing hepatitis. More common in
the elderly, the symptoms of liver
inflamation such as jaundice, reoccur
periodlically but are not chronic.
• Autoimmune hepatitis. this triggers
your own body to attack the liver. If left
untreated, it could result in chronic liver
disease, cirrhosis and ultimately liver
failure.
31 | P a g e
HEPATITIS B
Hepatitis B is a serious liver infection caused by
the hepatitis B virus (HBV). For some people,
hepatitis B infection becomes chronic, meaning
it lasts more than six months. Having chronic
hepatitis B increases your risk of developing liver
failure, liver cancer or cirrhosis — a condition
that permanently scars of the liver.
Most adults with hepatitis B recover fully, even
if their signs and symptoms are severe. Infants
and children are more likely to develop a chronic
an infected woman to her newborn during
pregnancy or childbirth.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• History taking should be taken that
includes ethnicity, place of birth, risk
factors for acquiring the hepatitis B virus
(HBV), any previous HBV medication and
any factors that could influence disease
progression.
• Physical examination for signs and
symptoms of liver disease and all patients
should have a baseline liver ultrasound.
• Laboratory investigations must be
taken to check for other forms of liver
disease or bloodborne viruses.
SIGNS AND SYMPTOMS
(long-lasting) hepatitis B infection.
ETIOLOGY
• Hepatitis B is caused by Hepatitis B virus
(HBV).
• The HBV is a small DNA virus that belongs
to the “Hepadnaviridae” family. Related
viruses in this family are also found in
woodchucks, ground squirrels, tree
squirrels, Peking ducks, and herons.
INCUBATION PERIOD
The incubation period of the hepatitis B virus is
75 days on average, but can vary from 30
to 180 days. The virus may be detected within
30 to 60 days after infection and can persist and
develop into chronic hepatitis B.
Most people do not experience any symptoms
when newly infected. However, some people
have acute illness with symptoms that last
several weeks, including yellowing of the skin
and eyes (jaundice), dark urine, white or gray
stools, extreme fatigue, nausea, vomiting,
abdominal pain, headache, low-grade fever,
irritable and fretful from pruritus (itching).
A small subset of persons with acute hepatitis
can develop acute liver failure, which can lead
to death.
COMMUNICABILITY PERIOD
Later part of incubation period and during
the acute stage. Transmission by infected
people can occur many weeks before the onset
of symptoms, throughout the acute clinical
course of the disease and during the chronic
state. All people who are HBsAg positive are
potentially infectious, and those with detectable
HBV DNA are highly infectious (especially if
HBsAg positive).
NURSING CONSIDERATION
• Additional doses may be required for
individuals with a suppressed immune
system.
• Correct cold chain vaccine storage should
be ensured.
• The injection site batch number and expiry
date should be recorded in the patient
record.
• Patient teaching
• Hepatitis B vaccine does not protect
against hepatitis caused by other agents or
viruses.
• Universal precautions should always be
maintained.
MODE OF TRANSMISSION
The hepatitis B virus (HBV) is transmitted
through blood and infected bodily fluids. It can
be passed to others through direct contact with
blood, unprotected sex, use of illegal drugs,
unsterilized or contaminated needles, and from
TREATMENT
• Antiviral medications. Several antiviral
medications
—
including
entecavir
(Baraclude), tenofovir (Viread), lamivudine
(Epivir),
adefovir
(Hepsera)
and
telbivudine (Tyzeka) — can help fight the
32 | P a g e
virus and slow its ability to damage your
liver. These drugs are taken by mouth.
• Interferon injections. Interferon alfa-2b
(Intron A) is a man-made version of a
substance produced by the body to fight
infection. It's used mainly for young people
with hepatitis B who wish to avoid longterm treatment or women who might want
to get pregnant within a few years, after
completing a finite course of therapy.
Interferon should not be used during
pregnancy. Side effects may include
nausea, vomiting, difficulty breathing and
depression.
• Liver transplant. If your liver has been
severely damaged, a liver transplant may
be an option. During a liver transplant, the
surgeon removes your damaged liver and
replaces it with a healthy liver.
PREVENTION
• The hepatitis B vaccine is the mainstay of
hepatitis B prevention that is typically
given as three or four injections over six
months.
• The hepatitis B vaccine is a safe and
effective vaccine that is recommended for
all infants at birth and for children up to 18
years. The hepatitis B vaccine is also
recommended for adults living with
diabetes and those at high risk for infection
due to their jobs, lifestyle, living situations,
or country of birth. Since everyone is at
some risk, all adults should seriously
consider getting the hepatitis B vaccine for
a lifetime protection against a preventable
chronic liver disease.
COMPLICATION
Having a chronic HBV infection can lead to
serious complications, such as:
• Scarring of the liver (cirrhosis)
• Liver cancer
• Liver failure and other conditions
33 | P a g e
HEPATITIS C
A viral infection that causes the liver to be
inflamed.
•
•
•
•
Viral infection
Spreads through contaminated blood
Takes decades to diagnose
Inflammation causing serious damage
ETIOLOGY
Hepatitis C infection is caused by the hepatitis C
virus (HCV). The infection spreads when blood
contaminated with the virus enters the
bloodstream of an uninfected person. Globally,
HCV exists in several distinct forms, known as
genotypes. Seven distinct HCV genotypes and
more than 67 subtypes have been identified.
INCUBATION PERIOD
The incubation period for hepatitis C ranges
from 2 weeks to 6 months. Following initial
infection, approximately 80% of people do not
exhibit any symptoms.
COMMUNICABILITY PERIOD
The contagious period is indefinite in chronically
infected persons. All persons who test positive
should be considered to be potentially
contagious.
MODE OF TRANSMISSION
• Sharing drug injection equipment
• Birth
• Sharing personal items
• Organ transplants
• Body modifications
• Blood transfusions
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Bleeding easily
• Bruising easily
• Fatigue
• Poor appetite
• Yellow discoloration of the skin and eyes
(jaundice)
• Dark-colored urine
• Itchy skin
• Fluid buildup in your abdomen (ascites)
• Swelling in your legs
• Weight loss
• Confusion, drowsiness and slurred
speech (hepatic encephalopathy)
• Spiderlike blood vessels on your skin
(spider angiomas)
34 | P a g e
NURSING CONSIDERATION
• Transmission
• Standard Infection Control Precautions
• Preventing Needle Sticks
• Education
TREATMENT
• Antiviral medications
• Liver Transplant
• Liver transplantation
• Vaccinations
PREVENTION
• Help prevent others from coming in
contact with your blood
• Avoid medications that may cause liver
damage.
• Stop drinking alcohol
• Have regular screening tests for the Hep
C virus
COMPLICATION
• Cirrhosis
• Liver failure
• Liver cancer
HIV/AIDS
HIV (human immunodeficiency virus) is a
sexually transmitted infection (STI). It is a virus
that attacks the body’s immune system. By
damaging the immune system, HIV interferes
with the body's ability to fight infection and
disease.
5. Full-blown AIDS
1. Primary or acute HIV infection is the first
stage of HIV disease when the virus first
establishes itself in the body. This typically
last for 1 to 2 weeks. This is the period of
time between first infection and when the
body begins to produce antibodies.
This disease is chronic and progressive, and
without medication, it may take years before
HIV weakens the immune system and becomes
AIDS.
People infected by HIV develop a flu-like
illness within two to four weeks after the virus
enters the body.
There's no cure for HIV/AIDS, but medications
can dramatically slow the progression of the
disease. These drugs have reduced AIDS deaths
in many developed nations.
ETIOLOGY
2. Seroconversion Period is when the body
begins to produce antibodies against the
virus. This is the body’s natural response to
detecting an infection.
Not everyone develops symptoms at this
stage. Others experience mild flu-like
symptoms that go largely unnoticed. This
means that people may contract HIV without
knowing it, which makes testing very
important.
Healthcare providers can order tests to check
for HIV. Some tests can detect the virus after
10 days, while others may not detect the
infection until 90 days after exposure. People
often need to take more than one test for
accurate results.
• HIV infection in humans came from a type of
chimpanzee (primary hosts) in Central Africa.
• Studies show that HIV may have jumped
from chimpanzees to humans as far back as
the late 1800s.
• The chimpanzee version of the virus (called
simian immunodeficiency virus, or SIV) was
introduced into the human population when
hunters became exposed to infected blood.
• This all happened because it was confirmed
that our closest living biological relatives are
chimpanzees and bonobos, with whom we
share many traits.
INCUBATION PERIOD
The interval from HIV infection to the diagnosis
of AIDS ranges from about 9 months to 20 years
or longer, with a median of 12 years.
There are
infection:
1.
2.
3.
4.
five
stages
of
Primary or acute infection
Seroconversion Period
The asymptomatic period
The symptomatic period
35 | P a g e
HIV/AIDS
3. Asymptomatic Period. People infected
with HIV continue to look and feel completely
well, except for having a flu-like and
unnoticed signs, for long periods, sometimes
for many years. During this time, the virus is
replicating and slowly destroying the immune
system.
This asymptomatic stage is sometimes
referred to as clinical latency. This means
that, although a person looks and feels
healthy, they can infect other people through
any body fluid contact such as unprotected
anal, vaginal, or oral sex or through needle
sharing.
4. Symptomatic Period. This stage occurs
when clinical manifestations appear as mild
infections and chronic signs.
5. Full-blown AIDS. When AIDS occurs, the
immune system has been severely damaged.
You’ll be more likely to develop opportunistic
infections or opportunistic cancers – diseases
that wouldn’t usually cause illness in a person
with a healthy immune system.
COMMUNICABILITY PERIOD
While the period of communicability is not
known precisely, it begins early after onset of
HIV infection and presumably extends
throughout life. Transmissibility may increase at
the onset of infection (with or without
symptoms), during periods of high viral load,
worsening clinical status and in the presence of
other STIs.
MODE OF TRANSMISSION
To become infected with HIV, infected blood,
semen or vaginal secretions must enter your
body. This can happen in several ways:
1. By having sex. You may become infected if
you have vaginal, anal or oral sex with an
infected partner whose blood, semen or
vaginal secretions enter your body. The virus
can enter your body through mouth sores or
small tears that sometimes develop in the
rectum or vagina during sexual activity.
2. By sharing needles. Sharing contaminated
IV drug paraphernalia (needles and syringes)
puts you at high risk of HIV and other
infectious diseases, such as hepatitis.
3. From blood transfusion. In some cases,
the virus may be transmitted through blood
transfusions. American hospitals and blood
banks now screen the blood supply for HIV
antibodies, so this risk is very small.
4. During
pregnancy/delivery
or
breastfeeding. Infected mothers can pass
the virus on to their babies. Mothers who are
HIV-positive and get treatment for the
infection during pregnancy can significantly
lower the risk to their babies.
NURSING ASSESSMENT (SIGNS
SYMPTOMS)
1. Primary or Acute HIV Infection
• Fever
• Headache
• Muscle and joint pains
• Rash
• Throat and mouth sores
• Swollen lymph glands
• Diarrhea
• Weight loss
• Cough
• Night sweats
36 | P a g e
&
These symptoms can be so mild that you might
not even notice them. However, the amount of
virus in your bloodstream (viral load) is quite
high at this time. As a result, the infection
spreads more easily during primary infection
than during the next stage. The virus is highly
infectious but unfortunately not detectable by
any tests.
2. Seroconversion Period – not everyone
develops symptoms aside from the flu-like
symptoms that are unnoticed.
3. Asymptomatic Period – from the word
itself, asymptomatic, the infected person
continues to look fine.
4. Symptomatic Period
• Fever
• Fatigue
• Swollen lymph nodes
• Diarrhea
• Weight loss
• Oral yeast infection (thrush)
• Shingles (herpes zoster)
• Pneumonia
Because these symptoms occur with many other
illnesses, patients don’t recognize them as
unique to HIV infection and often do not get
screened, tested, diagnosed, or treated. Clinical
symptoms appear as the body’s immune system
can no longer respond effectively to other
pathogens because the HIV has taken over the
CD4 lymphocytes.
5. Full-blown AIDS
• Sweats
• Chills
• Recurring fever
• Chronic diarrhea
• Swollen lymph nodes
• Persistent white spots/unusual lesions on
the tongue or mouth
• Persistent, unexplained fatigue
• Weight loss
• Skin rashes/bumps
NURSING MANAGEMENT
The nursing care of patients with HIV/AIDS is
challenging because of the potential for any
organ system to be the target of infections or
cancer.
Nursing Assessment
Nursing assessment includes identification of
potential risk factors, including a history of risky
sexual practices or IV/injection drug use.
1. Nutritional status. Nutritional status is
assessed by obtaining a diet history and
identifying factors that may affect the oral
intake.
2. Skin integrity. The skin and mucous
membranes are inspected daily for evidence
of breakdown, ulceration, or infection.
3. Respiratory status. Respiratory status is
assessed by monitoring the patient for cough,
sputum production, shortness of breath,
orthopnea, tachypnea, and chest pain.
4. Neurologic status. Neurologic status is
determined by assessing the level of
consciousness; orientation to person, pace,
and time; and memory lapses.
5. Fluid and electrolyte balance. F&E status
is assessed by examining the skin and
mucous membranes for turgor and dryness.
6. Knowledge level. The patient’s level of
knowledge about the disease and the modes
of disease transmission is evaluated.
Nursing Interventions
The plan of care for a patient with AIDS is
individualized to meet the needs of the patient.
1. Promote skin integrity. Patients are
encouraged to avoid scratching; to use
nonabrasive, nondrying soaps and apply
nonperfumed moisturizers; to perform
regular oral care; and to clean the perianal
area after each bowel movement with
nonabrasive soap and water.
2. Promote usual bowel patterns. The nurse
should monitor for frequency and consistency
of stools and the patient’s reports of
abdominal pain or cramping.
3. Prevent infection. The patient and the
caregivers should monitor for signs of
infection and laboratory test results that
indicate infection.
4. Improve activity intolerance. Assist the
patient in planning daily routines that
maintain a balance between activity and rest.
5. Maintain thought processes. Family and
support network members are instructed to
speak to the patient in simple, clear language
and give the patient sufficient time to
respond to questions.
6. Improve airway clearance. Coughing,
deep
breathing,
postural
drainage,
percussion and vibration is provided for as
often as every 2 hours to prevent stasis of
secretions and to promote airway clearance.
37 | P a g e
7. Relieve pain and discomfort. Use of soft
cushions and foam pads may increase
comfort as well as administration of NSAIDS
and opioids.
8. Improve nutritional status. The patient is
encouraged to eat foods that are easy to
swallow and to avoid rough, spicy, and sticky
food items.
TREATMENT and PREVENTION
There's no vaccine to prevent HIV infection and
no cure for AIDS. But you can protect yourself
and others from infection.
To help prevent the spread of HIV:
1. Use treatment as prevention (TasP). If
you're living with HIV, taking HIV medication
can keep your partner from becoming
infected with the virus. If you make sure your
viral load stays undetectable — a blood test
doesn't show any virus — you won't transmit
the virus to anyone else. Using TasP means
taking your medication exactly as prescribed
and getting regular checkups.
2. Use post-exposure prophylaxis (PEP) if
you've been exposed to HIV. If you think
you've been exposed through sex, needles or
in the workplace, contact your doctor or go
to the emergency department. Taking PEP as
soon as possible within the first 72 hours can
greatly reduce your risk of becoming infected
with HIV. You will need to take medication for
28 days.
3. Use a new condom every time you have
sex. Use a new condom every time you have
anal or vaginal sex. Women can use a female
condom. If using a lubricant, make sure it's
water-based. Oil-based lubricants can
weaken condoms and cause them to break.
During oral sex use a nonlubricated, cut-open
condom or a dental dam — a piece of
medical-grade latex.
4. Consider
preexposure
prophylaxis
(PrEP). The combination drugs emtricitabine
plus tenofovir (Truvada) and emtricitabine
plus tenofovir alafenamide (Descovy) can
reduce the risk of sexually transmitted HIV
infection in people at very high risk. PrEP can
reduce your risk of getting HIV from sex by
more than 90% and from injection drug use
by more than 70%, according to the Centers
for Disease Control and Prevention. Descovy
hasn't been studied in people who have
receptive vaginal sex.
5. Your doctor will prescribe these drugs
for HIV prevention only if you don't
already have HIV infection. You will need
an HIV test before you start taking PrEP and
then every three months as long as you're
taking it. Your doctor will also test your
kidney function before prescribing Truvada
and continue to test it every six months.
6. You need to take the drugs every day.
They don't prevent other STIs, so you'll still
need to practice safe sex. If you have
hepatitis B, you should be evaluated by an
infectious disease or liver specialist before
beginning therapy.
7. Tell your sexual partners if you have
HIV. It's important to tell all your current and
past sexual partners that you're HIV-positive.
They'll need to be tested.
8. Use a clean needle. If you use a needle to
inject drugs, make sure it's sterile and don't
share it. Take advantage of needle-exchange
programs in your community. Consider
seeking help for your drug use.
9. If you're pregnant, get medical care
right away. If you're HIV-positive, you may
pass the infection to your baby. But if you
receive treatment during pregnancy, you can
significantly cut your baby's risk.
10. Consider male circumcision. There's
evidence that male circumcision can help
reduce the risk of getting HIV infection.
COMPLICATION
HIV infection weakens your immune system,
making you much more likely to develop many
infections and certain types of cancers.
Infections common to HIV/AIDS:
1. Pneumocystis pneumonia (PCP). This
fungal infection can cause severe illness.
Although it’s declined significantly with
current treatments for HIV/AIDS, in the U.S.
PCP is still the most common cause of
pneumonia in people infected with HIV.
2. Candidiasis (thrush). Candidiasis is a
common HIV-related infection. It causes
inflammation and a thick, white coating on
your mouth, tongue, esophagus or vagina.
3. Tuberculosis (TB). In resource-limited
nations, TB is the most common opportunistic
infection associated with HIV. It’s a leading
cause of death among people with AIDS.
4. Cytomegalovirus. This common herpes
virus is transmitted in body fluids such as
38 | P a g e
saliva, blood, urine, semen and breast milk. A
healthy immune system inactivates the virus,
and it remains dormant in your body. If your
immune system weakens, the virus
resurfaces — causing damage to your eyes,
digestive tract, lungs or other organs.
5. Cryptococcal meningitis. Meningitis is an
inflammation of the membranes and fluid
surrounding your brain and spinal cord
(meninges). Cryptococcal meningitis is a
common central nervous system infection
associated with HIV, caused by a fungus
found in soil.
6. Toxoplasmosis. This potentially deadly
infection is caused by Toxoplasma gondii, a
parasite spread primarily by cats. Infected
cats pass the parasites in their stools, which
may then spread to other animals and
humans. Toxoplasmosis can cause heart
disease, and seizures occur when it spreads
to the brain.
Cancers common to HIV/AIDS
1. Lymphoma. This cancer starts in the white
blood cells. The most common early sign is
painless swelling of the lymph nodes in your
neck, armpit or groin.
2. Kaposi’s sarcoma. A tumor of the blood
vessel walls, Kaposi’s sarcoma usually
appears as pink, red or purple lesions on the
skin and mouth. In people with darker skin,
the lesions may look dark brown or black.
Kaposi’s sarcoma can also affect the internal
organs, including the digestive tract and
lungs.
INFLUENZA A (H1N1)
The Influenza A (H1N1), commonly known as
swine flu, is primarily caused by the H1N1 strain
of the flu (influenza) virus.
H1N1 is a type of influenza A virus, and H1N1 is
one of several flu virus strains that can cause
the seasonal flu.
ETIOLOGY
• In 2009, scientists recognized a particular
strain of flu virus known as H1N1.
• This virus is a combination of viruses from
pigs, birds and humans that causes
disease in humans.
• During the 2009-10 flu season, H1N1
caused the respiratory infection in humans
that was commonly referred to as swine flu
• Influenza is caused by infection of the
respiratory tract with influenza viruses,
RNA viruses of the Orthomyxovirus genus.
• Influenza viruses are classified into 4
types: A, B, C, and D.
• Only virus types A and B commonly cause
illness in humans.
INCUBATION PERIOD
Ranges from 1 to 4 days, with the average
around 2 days in most individuals, but some
individuals, it may be as long as 7 days.
COMMUNICABILITY PERIOD
From 1 day before to 7 days after the onset of
symptoms.
Period of Communicability Influenza virus
shedding (the time during which a person might
be infectious to another person) begins the day
before illness onset and can persist for 5 to 7
days, although some persons may shed virus for
longer periods, particularly young children and
severely immunocompromised persons.
MODE OF TRANSMISSION
• Direct or indirect contact with infected live
or dead poultry.
• Human to Human transmission:
• Coughing and sneezing of (infected)
person with influenza.
• Virus deposit on any surface
• Healthy
individual
touches
the
contaminated surface
• Then touches his/her Eyes, Nose, or
Mouth.
• Healthy individual becomes infected.
39 | P a g e
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
The signs and symptoms of flu caused by the
H1N1 virus are similar to those of infections
caused by other flu strains and can include:
• Fever, but not always
• Chills
• Cough
• Sore throat
• Runny or stuffy nose
• Watery, red eyes
• Body aches
• Headache
• Fatigue
• Diarrhea
• Nausea and vomiting
• Flu symptoms develop about one to three
days after you're exposed to the virus.
NURSING CONSIDERATION
• Standard Precautions - For all patient
care, use non-sterile gloves for any contact
with potentially infectious material,
followed by hand hygiene immediately
after glove removal; use gowns along with
eye protection for any activity that might
generate splashes of respiratory secretions
or other infectious material.
• Respiratory
Protection
–
Recommendation: CDC continues to
recommend the use of respiratory
protection that is at least as protective as
a fit-tested disposable N95 respirator for
healthcare personnel who are in close
contact with patients with suspected or
confirmed 2009 H1N1 influenza.
TREATMENT
ANTIVIRAL DRUGS
•
•
•
All anti-viral drugs inhibit viral replication
but they act in different ways to achieve
this.
Drugs that are effective against influenza
A viruses: amantadine and rimantadine.
Drugs that are effective against influenza
A viruses and influenza B viruses:
zanamivir and oseltamivir.
SUPPORTIVE MEASURES
• Increase liquid intake like water, juice, and
soups
• Rest for the 7 to 10 days during which
symptoms may persist
• Anti-pyretic
• If patients begin taking antiviral drugs
within 48 hours after their symptoms
begin, the drugs may reduce the length of
the illness by about 1 to 2 days.
PREVENTION
• H1N1 Vaccination (flu vaccine)
These measures also help prevent the flu and
limit its spread:
• Wash your hands thoroughly and
frequently. Use soap and water, or if
they're unavailable, use an alcohol-based
hand sanitizer.
• Cover your coughs and sneezes.
Cough or sneeze into a tissue or your
elbow. Then wash your hands.
• Avoid touching your face. Avoid
touching your eyes, nose and mouth.
• Clean surfaces. Regularly clean oftentouched surfaces to prevent spread of
infection from a surface with the virus on
it to your body.
• Avoid contact. Stay away from crowds if
possible. Avoid anyone who is sick. If
you're at high risk of complications from
the flu — for example, you're younger than
5 or you're 65 or older, you're pregnant, or
you have a chronic medical condition such
as asthma — consider avoiding swine
barns at seasonal fairs and elsewhere.
COMPLICATION
• Worsening of chronic conditions, such as
heart disease and asthma
• Pneumonia
• Neurological signs and symptoms, ranging
from confusion to seizures
• Respiratory failure
40 | P a g e
LEPROSY
Leprosy, also known as Hansen’s disease, is a
chronic infectious disease. The disease mainly
affects the skin, the peripheral nerves, mucosal
surfaces of the upper respiratory tract and the
eyes. Leprosy is known to occur at all ages
ranging from early infancy to very old age.
Leprosy is curable and treatment in the early
stages can prevent disability.
ETIOLOGY
Leprosy is an infection caused by slow-growing
bacteria called Mycobacterium leprae. It can
affect the nerves, skin, eyes, and lining of the
nose. With early diagnosis and treatment, the
disease can be cured.
INCUBATION PERIOD
It usually takes about 3 to 5 years for symptoms
to appear after coming into contact with the
bacteria that causes leprosy. Some people do
not develop symptoms until 20 years later.
Leprosy's long incubation period makes it very
difficult for doctors to determine when and
where a person with leprosy got infected.
COMMUNICABILITY PERIOD
Infectiousness is lost in most cases following the
first dose of multi-drug therapy.
MODE OF TRANSMISSION
It may happen when a person with Hansen’s
disease coughs or sneezes, and a healthy
person breathes in the droplets containing the
bacteria. Prolonged, close contact with someone
with untreated leprosy over many months is
needed to catch the disease.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Mucous membranes
•
•
Stuffy nose
Nosebleeds
Nerves
•
•
Numbness of affected areas of the skin
Muscle weakness or paralysis
41 | P a g e
•
•
Enlarged nerves
Eye problems that may lead to blindness
Skin
•
•
•
•
•
•
Discolored patches of skin, usually flat,
that may be numb and look faded
Growths on the skin
Thick, stiff or dry skin
Painless ulcers on the soles of feet
Painless swelling or lumps on the face or
earlobes
Loss of eyebrows or eyelashes
Precaution
Prevention of contact with droplets from nasal
and other secretions from patients with
untreated M. leprae infection is currently the
most effective way to avoid the disease.
Treatment of patients with appropriate
antibiotics stops the person from spreading the
disease.
NURSING CONSIDERATION
1. Encourage the affected people to
maintain regular medical care with MTD.
2. Keep continuing to follow up with the
affected leprosy patient.
3. Monitor any signs of adverse effects and
take proper action.
4. Closely monitor the family and
community people for the development
of leprosy signs and symptoms.
5. Provide information to community people
that leprosy is an infectious disease but
curable with treatment.
TREATMENT
Hansen’s disease is treated with a combination
of antibiotics. Typically, 2 or 3 antibiotics are
used at the same time. These are dapsone with
rifampicin, and clofazimine is added for some
types of the disease. This is called multidrug
therapy. This strategy helps prevent the
development of antibiotic resistance by the
bacteria, which may otherwise occur due to
length of the treatment.
PREVENTION
The vaccine offers a variable amount of
protection against leprosy in addition to
tuberculosis. This vaccine appears to be about
25% effective with two doses working better
than one.
COMPLICATION
1. Paralysis and crippling of hands and feet
2. Shortening of toes and fingers due to
reabsorption
3. Chronic non-healing ulcers on the
bottoms of the feet
4. Blindness
5. Loss of eyebrows
6. Nose disfigurement
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LEPTOSPIROSIS
A zoonotic disease that is transmitted by
rodents, skunks, opossums, raccoons, foxes,
and other vermin and is caused by a specific
form of bacteria called a spirochete.
Leptospirosis is found all over the world, but it
is most widespread in the tropics.
ETIOLOGY
An infection with the
spirochete
bacterium
Leptospira
causes
leptospirosis.
It
is
transmitted most often
through direct contact
with the urine of infected animals or through
contact with urine-contaminated soil or water.
INCUBATION PERIOD
Usually 5-14 days, with a range of 2-30 days.
COMMUNICABILITY PERIOD
Direct transmission from one person to another
is uncommon.
MODE OF TRANSMISSION
Humans can become infected through:
• Contact with urine (or other body fluids,
except saliva) from infected animals.
• Contact with water, soil, or food
contaminated with the urine of infected
animals.
• Documented through sexual intercourse
and breastfeeding.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Symptoms can include fever, headache,
myalgia (typically of the calves and lower
back), conjunctival suffusion, nausea,
vomiting, diarrhea, abdominal pain,
cough, and sometimes a skin rash.
• Severe symptoms can include jaundice,
renal failure, hemorrhage (especially
pulmonary), aseptic meningitis, cardiac
arrhythmias, pulmonary insufficiency,
and hemodynamic collapse. Combined
renal and liver failure associated with
leptospirosis is referred to as Weil’s
disease.
NURSING CONSIDERATION
• A blood sample should be obtained in a
suspected case of leptospirosis, following
signs and symptoms to establish a
reliable diagnosis.
43 | P a g e
•
Isolate the patient and concurrent
disinfection of soiled articles.
• Stringent community-wide rat eradication
program. Remove rubbish from work and
domestic environment to reduce rodent
population.
• Health Teaching
Control rats in the household by using rat
traps or rat poison, maintaining
cleanliness in the house.
TREATMENT
Patient with Mild Symptoms
• Doxycycline is the drug of choice (100 mg
orally, BID), if not contraindicated.
• Azithromycin (500 mg orally, once daily),
• Ampicillin (500-750 mg orally, every 6
hours),
• Amoxicillin (500 mg orally, every 6
hours).
Patient with Severe Symptoms
• IV penicillin is the drug of choice (1.5
MU IV, every 6 hours),
• Ceftriaxone (1 g IV, every 24 hours) can
be equally effective.
PREVENTION
• The first line of leptospirosis prevention is
to avoid exposure.
• Avoid wading, swimming, bathing,
swallowing, or submersing head in
potentially contaminated freshwater
(rivers, streams) especially after periods
of heavy rainfall or flooding.
• Avoid contact with floodwater, and do not
eat food contaminated with floodwater.
• Keep rodent populations (rats and mice)
or other animal pests under control. Do
not eat food that may have been exposed
to rodents and possibly contaminated
with their urine.
COMPLICATION
Without treatment, Leptospirosis can lead to:
• Kidney damage,
• Meningitis
(inflammation
of
the
membrane around the brain and spinal
cord),
• Liver failure,
• Respiratory distress
• Death.
MALARIA
Malaria is a life-threatening disease. It’s typically
transmitted through the bite of an infected
Anopheles mosquito. Infected mosquitoes carry
the Plasmodium parasite. Malaria is a disease
caused by a parasite. The parasite is spread to
humans through the bites of infected
mosquitoes. People who have malaria usually
feel very sick with a high fever and shaking
chills.
ETIOLOGY
The plasmodium parasite is spread by female
Anopheles mosquitoes, which are known as
"night-biting" mosquitoes because they most
commonly bite between dusk and dawn. If a
mosquito bites a person already infected with
malaria, it can also become infected and spread
the parasite on to other people. However,
malaria can't be spread directly from person to
person.
Once you're bitten, the parasite enters the
bloodstream and travels to the liver. The
infection develops in the liver before re-entering
the bloodstream and invading the red blood
cells. The parasites grow and multiply in the red
blood cells. At regular intervals, the infected
blood cells burst, releasing more parasites into
the blood. Infected blood cells usually burst
every 48-72 hours. Each time they burst, you'll
have a bout of fever, chills and sweating.
Malaria can also be spread through blood
transfusions and the sharing of needles, but this
is very rare.
INCUBATION PERIOD
44 | P a g e
COMMUNICABILITY PERIOD
Mosquitoes may acquire the parasites from
infected humans as long as the gametocytes are
present in the blood; this varies with parasite
species and with response to therapy. Untreated
or insufficiently treated patients may be a
source of mosquito infection for several years in
P. malariae, up to 5 years in P. vivax, and
generally not more than 1 year in P. falciparum
malaria. Transfusion transmission may occur as
long as asexual forms remain in the circulating
blood (with P. malariae up to 40 years or
longer). Stored blood can remain infective for at
least one month.
MODE OF TRANSMISSION
Usually, people get malaria by being bitten by
an infective female Anopheles mosquito. Only
Anopheles mosquitoes can transmit malaria and
they must have been infected through a
previous blood meal taken from an infected
person. An infected mother can also pass the
disease to her baby at birth. This is known as
congenital malaria.
Malaria is transmitted by blood, so it can also be
transmitted through:
•
•
•
an organ-transplant
a transfusion
use of shared needles or syringes
NURSING ASSESSMENT (SIGNS
SYMPTOMS)
• Fever
• Chills and cough
• General feeling of discomfort
• Headache
• Nausea and vomiting
• Diarrhea
• Abdominal pain
• Muscle or joint pain
• Fatigue
• Rapid breathing
• Rapid heart rate
&
These symptoms are often mild and can
sometimes be difficult to identify as malaria.
With some types of malaria, the symptoms
occur in 48-hour cycles. During these cycles,
you feel cold at first with shivering. You then
develop a high temperature, accompanied by
severe sweating and fatigue. These symptoms
usually last between 6 and 12 hours.
The most serious type of malaria is caused by
the Plasmodium falciparum parasite. Without
prompt treatment, this type could lead to you
quickly developing severe and life-threatening
complications, such as breathing problems and
organ failure.
NURSING CONSIDERATION
• Ensure meticulous nursing care. This can
be life-saving, especially for the
unconscious patient. Maintain a clear
airway.
• Keep a careful record of fluid intake and
output. If this is not possible, weigh the
patient daily in order to calculate the
approximate fluid balance.
• Note any appearance of black urine
(haemoglobinuria).
• Check the speed of infusion of fluids
frequently. Too fast or too slow an infusion
can be dangerous.
• Monitor
the
temperature,
pulse,
respiration, blood pressure and level of
consciousness. These observations should
be made at least every 4 hours until the
patient is out of danger.
• Report changes in the level of
consciousness, occurrence of convulsions
or changes in behaviour of the patient
immediately. All such changes suggest
developments that require additional
treatment.
• If the rectal temperature rises above 39
ºC, remove the patient’s clothes and start
tepid sponging and fanning. Give
paracetamol (the rectal route is usually
best).
TREATMENT
Early diagnosis and treatment of malaria
reduces disease and prevents deaths. It also
contributes to reducing malaria transmission.
The best available treatment, particularly for P.
falciparum malaria, is artemisinin-based
combination therapy (ACT).
45 | P a g e
In some instances, the medication prescribed
may not clear the infection because of parasite
resistance to drugs. If this occurs, your doctor
may need to use more than one medication or
change medications altogether to treat your
condition.
Additionally, certain types of malaria parasites,
such as P. vivax and P. ovale, have liver stages
where the parasite can live in your body for an
extended period of time and reactivate at a later
date causing a relapse of the infection. If you’re
found to have one of these types of malaria
parasites, you’ll be given a second medication to
prevent a relapse in the future.
PREVENTION
There’s no vaccine available to prevent malaria.
Talk to your doctor if you’re traveling to an area
where malaria is common or if you live in such
an area. You may be prescribed medications to
prevent the disease. These medications are the
same as those used to treat the disease and
should be taken before, during, and after your
trip.
But if you’re living in an area with malaria cases,
Vector control is the main way to prevent and
reduce malaria transmission. If coverage of
vector control interventions within a specific
area is high enough, then a measure of
protection will be conferred across the
community.
COMPLICATION
ANEMIA- The destruction of red blood cells by
the malaria parasite can cause severe anemia.
This is a condition where the red blood cells are
unable to carry enough oxygen, which leaves
you feeling drowsy, weak and faint.
CEREBRAL MALARIA- In some rare cases of
malaria, the infected red blood cells can block
the small blood vessels leading to the brain,
stopping blood flow and leading to a shortage of
oxygen. This is known as cerebral malaria.
OTHER COMPLICATIONS
Other complications of a severe case of malaria
can include:
• breathing problems (such as fluid in your
lungs)
• liver failure and juandice
• shock (sudden drop in blood flow)
• spontaneous bleeding
• abnormally low blood sugar
• kidney failure
• swelling and rupturing of the spleen
• dehydration
MEASLES
Measles is caused by a virus in the
paramyxovirus family and it is normally pass
through the air. It is also known as Rubeola,
morbilli, red measles or English measles.
ETIOLOGY
The virus infects the respiratory tract, then
spreads throughout the body and causes viral
exanthem (rashes).
INCUBATION PERIOD
First sign of measles is usually a high fever,
which begins about 10 to 12 days after exposure
to the virus, and lasts 4 to 7 days.
COMMUNICABILITY PERIOD
Fifth day of incubation period through the first
few days of rash.
MODE OF TRANSMISSION
Normally passed through direct contact and
through the air. On surfaces, the virus remains
active for 2 hours. 90% of susceptibility for
those who are exposed.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
1. Mild to moderate Fever (39.5° - 40°C)
2. Dry cough
3. Runny nose
4. Sore throat
5. Sneezing
6. Watery eyes (conjunctivitis)
7. Body aches
8. Koplik’s spot
9. Red
to
brown
erythematous
maculopapular rash (cephalocaudally)
Symptoms appears 7-14 days after exposure
and can take up to 23 days
DROPLET PRECAUTION
NURSING CONSIDERATION
• Isolation – decrease transmission within
the community
• Skin care – keeping the patient’s nails
short, encourage long pant and long
sleeves to prevent scratching, keeping skin
moist with recommended lotions and
avoiding sunlight and heat.
• Hydration – encourage oral hydration
• Eye care – use warm saline when removing
eye secretions and encourage patient not
to rub eyes; protecting the eyes from the
glare of strong light
46 | P a g e
• Temperature
control
–
administer
antipyretics to the patient and keep sure
that you remind parents not to administer
aspirin due to the risk of Reye’s syndrome
TREATMENT
There is no current treatment for the virus.
There is preventive vaccine, but once a patient
is diagnosed, there is no treatment.
But we can offer:
SUPPORTIVE CARE
• Hydration
• Vitamin A supplementation
• Hospitalization
• Antibiotic therapy
• Post exposure prophylaxis
PHARMACOLOGIC THERAPY
• Vitamin A
• Antivirals (ribavirin but not approved by
FDA)
• Vaccines
• Immunoglobulin
PREVENTION
In children:
MMR (Measles, Mumps and Rubella) vaccine
• One shot at 12 -15 months of age
• A booster shot at 4-6 years, before starting
school. If travelling abroad with 6 to 11
months old, talk with the child’s doctor. If
the child or teenager didn’t get the two
doses at recommended times, he or she
may need two doses of the vaccine four
weeks apart.
In adults:
• Attending college, traveling internationally
or working in a hospital environment and
don’t have proof of immunity.
• Was born in 1957 or later and you don’t
have proof of immunity.
• Proof of Immunity includes written
documentation of your vaccinations or lab
confirmation of immunity or previous
illness
COMPLICATION
• Pneumonia
• Airway obstruction
• Acute encephalitis
• Otitis media (ear infection)
• Vision loss
• Severe diarrhea and dehydration
In pregnancy,
• Loss of pregnancy
• Early delivery
• Low birth weight
At risk for complication
• People with weakened immune system
• Very young children
• Adults over the age of 20 years
• Pregnant women
47 | P a g e
MENINGOCOCCEMIA
Meningococcemia is defined as dissemination of
meningococci (Neisseria meningitidis) into the
bloodstream causing bleeding into the skin and
organs and can lead to a significant rash.
2 Subdivisions:
Fulminant Meningococcemia
• Waterhouse-Friderichsen Syndrome
• The most severe form of the disorder
• In less than a few hours the affected
individual may experience very high fever,
chills, weakness, vomiting and severe
headache.
Chronic Meningococcemia
• Rarer form of the disease
• Characterized by fever that comes and
goes over a period of weeks or months
• Symptoms may come and go
ETIOLOGY
Meningococcemia is caused by infection with the
meningococci
bacteria
(Neisseria
memingitidis) which are gram-negative
diplococci bacteria.
•
Infection with the bacteria is usually
caused by a carrier (Human).
• The natural place for the bacteria to be
located is in either the nose or throat of
the carrier
• By breathing in respiratory droplets or
by direct contact with oral secretions
INCUBATION PERIOD
The incubation period of meningococcal disease
is 3 to 4 days, with a range of 2 to 10 days.
COMMUNICABILITY PERIOD
• Meningococcal disease is communicable
until the organisms are no longer
present in discharges from the nose
and mouth.
• With
effective
antibiotic
therapy,
meningococci usually disappear from the
nasopharynx within 24 hours.
MODE OF TRANSMISSION
• Primary mode is by respiratory droplet
spread or by direct contact
• Person to person, transmitted by droplet
aerosol
or
secretions
from
the
nasopharynx of colonized persons.
• Transmission usually requires either
frequent or prolonged close contract
48 | P a g e
NURSING ASSESSMENT
SYMPTOMS)
(SIGNS
&
Common early symptoms include:
• Fever
• Headache
• Rash consisting of small spots
• Nausea
• Vomiting
• Irritability
• Anxiety
As the disease progresses, you may develop
more serious symptoms, including:
• blood clots
• patches of bleeding under your skin
• lethargy
• shock
Pneumonia may also develop along with the
other symptoms if the affected individual has a
suppressed immune system.
NURSING CONSIDERATION
• Increase cerebral perfusion
• Improve body temperature.
• Decrease pain
• Maintain normal LOC
• Decrease anxiety
• Educate the caregivers and family
TREATMENT
Penicillin or Ampicillin. For persons who are
unable to take penicillin, other antibiotics are
used such as: cefuroxime, cefotaxime or
ceftriaxone.
During times of epidemics, prophylaxis with
other
antibiotics
(i.e.,
Rifampin,
minocycline, and sulfadiazine) is used to
protect persons exposed to or in close contact
with infected patients.
PREVENTION
• Practicing healthy hygiene
• Covering mouth and nose when sneezing
and coughing
• Hand washing
• Vaccines
• Keeping a routine of Healthful habits
• Covering mouth and nose when sneezing
and coughing
COMPLICATION
Even with antibiotic treatment, 10 to 15 in 100
people infected with meningococcal disease will
die. Up to 1 in 5 survivors will have long-term
disabilities, such as
•
•
•
Loss of limb(s)
Deafness
Nervous system problems or Brain
damage
49 | P a g e
PERTUSSIS
Uncontrollable, violent coughing which often
makes it hard to breathe. Also known as
whooping cough. After cough fits, someone with
pertussis often needs to take deep breaths,
which result in a “whooping” sound.
ETIOLOGY
Pertussis, a respiratory illness, is a very
contagious disease caused by a type of bacteria
called Bordetella pertussis. These bacteria
attach to the cilia (tiny, hair-like extensions) that
line part of the upper respiratory system. The
bacteria release toxins (poisons), which damage
the cilia and cause airways to swell.
MODE OF TRANSMISSION
People with pertussis usually spread the disease
to another person by coughing or sneezing or
when spending a lot of time near one another
where you share breathing space.
NURSING ASSESSMENT
SYMPTOMS)
EARLY SYMPTOMS
•
INCUBATION PERIOD
Incubation period 5-10 days
•
(SIGNS
&
The disease usually starts with cold-like
symptoms and maybe a mild cough or
fever.
In babies, the cough can be minimal or
not even there. Babies may have a
symptom known as “apnea.” Apnea is a
pause in the child’s breathing pattern.
Pertussis is most dangerous for babies.
About half of babies younger than 1 year
who get the disease need care in the
hospital.
LATER-STAGE SYMPTOMS
COMMUNICABILITY PERIOD
Infected people are most contagious up to
about 2 weeks after the cough begins.
After 1 to 2 weeks and as the disease
progresses, the traditional symptoms of
pertussis may appear and include:
•
•
•
Paroxysms (fits) of many, rapid coughs
followed by a high-pitched “whoop”
sound
Vomiting (throwing up) during or after
coughing fits
Exhaustion (very tired) after coughing
fits.
NURSING CONSIDERATION
Nursing Interventions
•
•
•
•
•
•
50 | P a g e
Educate about coughing and breathing.
Promote effective coughing.
Educate about proper positioning.
Encourage increase in oral fluid intake.
Administer medications as prescribed.
Provide chest physiotherapy.
TREATMENT
Prior to diagnosis,
•
Antibiotics are prescribed as treatment of
pertussis. The most popular are
azithromycin, clarithromycin and
erythromycin.
Have had pertussis for three weeks or more,
•
•
Antibiotics will not be prescribed because
the bacteria causing pertussis is already
gone from the body. Treatments may
differ to address any damage from onset
of the condition.
Includes Supportive care
PREVENTION
Prevention methods of Pertussis includes;
•
•
•
•
Childhood Immunization
Good Health Habits
Proper Hand Washing
If someone in the family has pertussis,
doctors will most likely suggest that
everyone in the household is treated with
antibiotics.
COMPLICATION
BABIES AND CHILDREN
•
•
•
•
•
1 out of 4 (23%) get pneumonia (lung
infection)
1 out of 100 (1.1%) will have convulsions
(violent, uncontrolled shaking)
3 out of 5 (61%) will have apnea (slowed
or stopped breathing)
1 out of 300 (0.3%) will have
encephalopathy (disease of the brain)
1 out of 100 (1%) will die
TEENS AND ADULTS
•
•
•
•
Weight loss in 1 out of 3 (33%) adults
Loss of bladder control in 1 out of 3
(28%) adults
Passing out in 3 out of 50 (6%) adults
Rib fractures from severe coughing in 1
out of 25 (4%) adults
51 | P a g e
POLIOMYELITIS
Poliomyelitis s a communicable enteroviral
disease caused by the human poliovirus. The
virus can colonize in the intestinal tract in which
then attacks the spinal cord or in severe cases
the CNS which results temporary or permanent
muscle
weakness(paralysis),
and
other
symptoms.
FOCI OF INFECTION:
• Pharynx: the virus is found in the
oropharyngeal secretions
• Small intestine: the virus finds exit in
stools
INCUBATION PERIOD
Commonly 7 to 10 days with a range from 4 to
35 days (WHO, 2020)
It largely affects children under 5 years of age.
And it is commonly called polio or infantile
paralysis.
COMMUNICABILITY PERIOD
• Estimated to about 2 weeks
• 7 to 10 days before and after the onset
of symptoms.
• virus is excreted commonly for 2-3
weeks, sometimes as long as 3-4 months
in feces.
• In polio cases, infectivity in the
pharyngeal foci is around one week, and
in the intestinal foci 6-8 weeks.
Three Serotypes:
•
•
•
PV3 – less virulent than type 1, causing
paralysis in about 1 in 1,000 cases,
declared eradicated in October 2019
PV2 – declared eradicated in September
2015, with the last virus strain detected
in India in 1999
PV1 – the only poliovirus that remains,
causes paralysis in about 1 in 200 case
MODE OF TRANSMISSION
Since foci of infection are the throat and small
intestines, poliomyelitis spread by two routes:
•
•
Oral-oral infection (RARE): direct droplet
infection such as coughing and sneezing.
Faeco-oral
infection:
through
contaminated foods and hand to mouth
infection.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Polio infections that do causes symptoms are
categorized as:
ETIOLOGY
AGENT:
• Small RNA viruses of the Enterovirus C.
genus of the Picornaviridae family cause
poliomyelitis. The single-stranded RNA
core is surrounded by a protein capsid
without a lipid envelope, which makes
poliovirus resistant to lipid solvents and
makes it stable at a low pH.
RESISTANCE:
• Lives up to 4 hours in water and 6 hours
in feces and cold environment
• Readily destroyed by heat (e.g.,
pasteurization of milk and chlorination of
water)
•
Flu-like symptoms such as low-grade fever, sore
throat, nausea and vomiting, loss of appetite,
malaise, with abdominal cramps. These
symptoms develop 3 to 5 days after exposure to
the virus.
•
52 | P a g e
Non-paralytic poliomyelitis (serious)
Typically, develop a stiff neck and/or back and
headache (aseptic meningitis) several days after
the flu-like symptoms of abortive poliomyelitis.
Person with this type of polio can have signs
such as Tripod sign, Kiss the knee test, Head
drop sign, Neck rigidity. The symptoms last 2 to
10 days. Does not develop paralysis.
•
RESERVOIR OF INFECTION:
• Man is the only reservoir of the infection
poliomyelitis
Abortive poliomyelitis (mild)
Paralytic poliomyelitis (severe)
About 1% of polio cases can develop into
paralytic polio. Paralytic polio leads to paralysis
in the spinal cord (spinal polio), brainstem
(bulbar polio), or both (bulbospinal polio).
Initial symptoms are similar to non-paralytic
polio. But after a week, more severe symptoms
include:
•
•
•
•
•
loss of reflexes
severe spasms and muscle pain
loose and floppy limbs, sometimes on
just one side of the body
sudden
paralysis,
temporary,
or
permanent
deformed limbs, especially the hips,
ankles, and feet
NURSING CONSIDERATION
• Bed rest and care
• Opioids and Morphine are not prescribed
• Catheterization of distended bladder
• Long term ventilation may be necessary
• Enteric precautions in hospital settings
TREATMENT
There is no specific treatment available for polio.
The aim is to prevent or reduce the symptoms.
This includes:
•
•
•
•
•
•
•
•
Hospitalization (may require for those
individuals who develop paralytic
poliomyelitis)
Pain killer to reduce muscle pain and
headache (Acetaminophen or Ibuprofen)
Physical therapy, braces or corrective
shoes, or orthopedic surgery to help
recover muscle strength and function
Fluid therapy
Adequate diet
Antispasmodic medications to relax
muscles
Antibiotics for urinary tract infections
Rehabilitation
PREVENTION
The best preventive measure for poliomyelitis is
ensuring good hygiene and encouraging good
sanitation practices. But polio prevention begins
with polio vaccination. Polio vaccine specifically
the OPV and IPV vaccine has been developed
against all 3 subtypes of the poliovirus and is
very effective in producing protective antibodies
that induces immunity against poliovirus and
provides protection from paralytic polio.
COMPLICATION
• Myocarditis
• Hypertension
53 | P a g e
•
•
•
•
•
•
•
•
Pulmonary edema
Pneumonia
Urinary Tract Infections
Compression Neuropathy
Scoliosis
Osteoporosis
Bone Fractures
Skeletal Deformities – Equinus foot
RABIES
Rabies is a preventable viral disease most often
transmitted through the bite of a rabid animal.
The rabies virus infects the central nervous
system of mammals, ultimately causing disease
in the brain and death.
ETIOLOGY
Family:
Rhabdoviridae
Genus:
Lyssavirus
INCUBATION PERIOD
Ranges from 6 days to 2 years depending on
the bitten site. Prodome (an early symptom
indicating the onset of a disease or illness)
begins when the virus enters the peripheral
nerves and spinal cord between 2 days to 10
days. Study shows that the viral infection can
travel 1-2 cm/day.
COMMUNICABILITY PERIOD
Rabid animals are infectious when the virus
reaches the salivary glands up until death.
Different species may shed virus in saliva for
different lengths of time prior to onset of clinical
signs.
Animal hosts: may shed virus in saliva for up
to 10 days
Other mammals: may shed virus in saliva for
up to 14 days
Wildlife rabies reservoir species: may shed
virus for much longer periods of time
MODE OF TRANSMISSION
Rabies can be transmitted to humans through
the saliva of infected animals through bites,
scratches or other contact with mucosal
membranes or open skin.
NURSING ASSESSMENT
SYMPTOMS)
FLU-LIKE SYMPTOMS
• weakness or discomfort
• fever
• Headache
(SIGNS
Hydrophobia – attempting to drink may
induce hydrophobic spasms
54 | P a g e
&
Aerophobia – having air blown in the face
produces severe laryngeal or diaphragmatic
spasms; sensation of asphyxia
PSYCHOLOGIC SYMPTOMS
• Delirium
• Abnormal behavior
• Hallucinations
• Insomnia
• Anxiety
• Confusion
• Agitation
DIAGNOSTIC TESTS
• Direct fluorescent antibody test
• Histologic examination
• Immunohistochemistry
• Amplification methods
• Electron microscopy
NURSING CONSIDERATION
Improve breathing pattern
Place patient with proper body alignment for
maximum breathing pattern; maintain a clear
airway by encouraging patient to mobilize own
secretions with successful coughing.
Maintain normal body temperature
Adjust and monitor environmental factors like
room temperature and bed linens as indicated;
eliminate excess clothing and covers; and give
antipyretic medications as prescribed.
Improve nutritional intake
Consider six small nutrient-dense meals instead
of three larger meals daily to lessen the feeling
of fullness; for patients with impaired
swallowing, coordinate with a speech therapist
for evaluation and instruction; determine time of
day when the patient’s appetite is at peak and
offer highest calorie meal at that time.
Reduce anxiety
Use presence, touch (with permission),
verbalization, and demeanor to remind patients
that they are not alone and to encourage
expression or clarification of needs, concerns,
unknowns, and questions; interact with patient
in a peaceful manner.
Prevent injury
Avoid use of restraints; obtain a physician’s
order if restraints are needed; if patient has a
new onset of confusion (delirium), render reality
orientation when interacting with him or her;
ask family or significant others to be with the
patient to prevent him or her from accidentally
falling.
Prevent Infection
Maintain or teach asepsis for dressing changes
and wound care; wash hands and teach patient
and to wash hands before contact with patients
and between procedures with the patient.
TREATMENT
MEDICAL TREATMENT
• Inpatient care-may be needed if
wounds are extensive or are on the face
and hands, if surgical repair or
replacement of blood loss is required, or
if infection occurs.
• Preexposure
prophylaxis-Preexposure, active prophylaxis or
immunization is recommended for
veterinarians,
veterinary
students,
persons who regularly explore or hike in
caves, laboratory workers who are
exposed to rabies virus or who handle
specimens considered high risk for
rabies, and persons who visit countries
where rabies is a significant problem.
• Postexposure prophylaxis-Before the
onset of rabies symptoms, optimal results
require immediate, vigorous wound
cleansing; passive immunization with
immunoglobulin;
and
active
immunization with rabies vaccine.
• Washing and Wound debridementleaning of the wound for longer than 10
minutes; generally, leave wounds to heal
by secondary intention.
• Intensive
cardiopulmonary
supportive care
PHARMACOLOGIC TREATMENT
• Rabies
immunoglobulinrecommended as part of the rabies
postexposure regimen for persons not
previously immunized against rabies.
• Rabies vaccines- promote immunity by
inducing an active immune response
✓ cell-cultured vaccines-developed
from mammalian cell lines rather
than the more common method
which uses the cells in embryonic
55 | P a g e
chicken eggs to develop the
antigens.
✓ nerve tissue vaccines – contains a
phenol
or
ß-propiolactoneinactivated homogenate of rabies
virus-infected goat or sheep brain
tissue.
PREVENTION
FOR THE PEOPLE
• Do not disturb the wildlife.
• Be educated about the disease
• Wash the wound area with soap and
water
• Refer to a health care provider when
bitten, scratch or even unsure
FOR THE DOMESTICATED ANIMALS
• Vaccinate domesticated pets to protect
them and your family
COMPLICATION
• Adult Respiratory Distress Syndrome
• Disturbances in Thermoregulation
• Myocarditis
• Diabetes Insipidus
• Acute Renal Failure
• Gastrointestinal Hemorrhage
• Paralysis
• Autonomic Dysfunction
• Convulsions
SCABIES
Human
scabies
is
caused by an infestation
of the skin by the human
itch mite (Sarcoptes
scabiei var. hominis).
The microscopic scabies
mite burrows into the
upper layer of the skin
where it lives and lays its eggs. The most
common symptoms of scabies are intense
itching and a pimple-like skin rash
Scabies infestations often happen in crowded
places where close body and skin contact is
frequent (such as nursing homes, prisons,
childcare centers).
ETIOLOGY
Female itch mite/ Sarcoptes scabiei var. hominis
INCUBATION PERIOD
If a person has never had scabies before,
symptoms may take 4-8 weeks to develop.
COMMUNICABILITY PERIOD
Since the scabies mite is an ectoparasite, an
exposed individual is potentially immediately
infectious to others, even in the absence of
symptoms. Cases are communicable from the
time of infestation until mites and eggs are
destroyed by treatment.
MODE OF TRANSMISSION
Scabies usually is spread by direct,
prolonged, skin-to-skin contact with a
person who has scabies. Contact generally must
be prolonged; a quick handshake or hug usually
will not spread scabies. Scabies is spread easily
to sexual partners and household members.
Scabies in adults frequently is sexually acquired.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
After the mite burrows into the skin, it takes
time to develop signs and symptoms. If you've
had scabies before, the itching usually begins
within one to four days. When a person has not
had scabies, the body needs time to react to the
mite.
Itching, mainly at night: Itching is the most
common symptom. The itch can be so intense
that it keeps a person awake at night.
Rash: Many people get scabies rash. This rash
causes little bumps that often form a line. The
56 | P a g e
spots can look like hives, tiny bites, knots under
the skin, or pimples.
Sores: Scratching the itchy rash can cause
sores. An infection can develop in the sores
Thick crusts on the skin: Crusts form when a
person develops a severe type of scabies called
crusted scabies. With so many mites burrowing
in the skin, the rash and itch become severe.
Assessment of a patient with scabies
include:
Patient history can reliably suggest the
presence of scabies; lesion distribution, and
intractable pruritus that is worse at night, as
well as scabies symptoms in close contacts
(including multiple family members), should
immediately rank scabies at the top of the
clinical differential diagnosis.
Physical exam- Clinical findings include
primary and secondary lesions; primary lesions
are the first manifestation of the infestation and
typically include small papules, vesicles, and
burrows; secondary lesions result from rubbing
and scratching, and they may be the only clinical
manifestation of the disease.
NURSING CONSIDERATION
Prevent infection. Wash hands and teach
patient and so to wash hands before contact
with patients and between procedures with the
patient
Restore skin integrity. Monitor status of skin
around the wound monitor patient’s skincare
practices, noting the type of soap or other
cleaning agents used.
Relieve pain. Acknowledge reports of pain
immediately; provide rest periods to promote
relief, sleep, and relaxation
Teach the patient about the prescribed
treatments and medications and how to prevent
re-infestation
Tell the patient to apply the prescribed scabicide
cream or lotion to clean skin from her neck to
her toes, including all skin folds, and to wash it
off after 8 to 14 hours or as directed
TREATMENT
Treatment for scabies usually involves getting
rid of the infestation with prescription
ointments, creams, and lotions that can be
applied directly to the skin.
•
•
•
•
•
5 percent permethrin cream
25 percent benzyl benzoate lotion
10 percent sulfur ointment
10 percent crotamiton cream
1 percent lindane lotion
PREVENTION
The best way to prevent getting scabies is to
avoid direct skin-to-skin contact with a person
known to have scabies. It’s also best to avoid
unwashed clothing or bedding that’s been used
by a person infested with scabies.
Scabies mites can live for three to four days
after falling off your body, so you’ll want to take
certain precautions to prevent another
infestation. Make sure to wash all of the
following in hot water that reaches 122°F
(50°C): clothing; bedding; towels; pillows.
COMPLICATION
The intense itching of scabies leads to
scratching that can lead to skin sores. The sores
sometimes become infected with bacteria on the
skin, such as Staphylococcus aureus or betahemolytic streptococci.
57 | P a g e
SCARLET FEVER
Scarlet fever, also known as scarlatina, is an
infection that can develop in people who have
strep throat. It’s characterized by a bright red
rash on the body, usually accompanied by a high
fever and sore throat. The same bacteria that
cause strep throat also cause scarlet fever.
ETIOLOGY
Scarlet fever is an illness caused by pyrogenic
exotoxin-producing S. pyogenes. S. pyogenes
are gram-positive cocci that grow in chains.
They exhibit β-hemolysis (complete hemolysis)
when grown on blood agar plates. They belong
to group A in the Lancefield classification system
for β-hemolytic Streptococcus, and thus are
called group A streptococci.
INCUBATION PERIOD
The incubation period for scarlet fever has a
fairly wide range from about 12 hours to seven
days. Individuals are contagious during this first
subclinical or incubation period and during the
acute illness. The primary strep infection is the
contagious aspect.
COMMUNICABILITY PERIOD
If untreated, uncomplicated cases 10-21 days.
MODE OF TRANSMISSION
Usually by direct or intimate contact via airborne
droplets, i.e.: sneezing and coughing.
Occasionally transmitted via contaminated food.
Treated cases usually do not transmit after 48
hours. Untreated cases can transmit as long as
21 days.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Red rash with a sandpaper feel when
touched
• Red, sore throat
• Fever above 101 F
• Headache, body aches
• Nausea and vomiting
• A "strawberry-like" appearance of the
tongue
• Enlarged lymph nodes
• Some individuals may have whitish
coating on the tongue and/or back of the
throat
NURSING CONSIDERATION
• Hand hygiene is especially important
after coughing and sneezing and before
preparing foods or eating. Good
58 | P a g e
•
•
respiratory etiquette involves covering
your cough or sneeze.
Treating an infected person with an
antibiotic for at least 12 hours reduces
their ability to transmit the bacteria.
Always wear PPE when in contact with
the person with scarlet fever.
TREATMENT
Penicillin or amoxicillin is the antibiotic of choice
to treat scarlet fever.
For patients with a penicillin allergy,
recommended regimens
include
narrow
spectrum cephalosporins (e.g., cephalexin,
cefadroxil), clindamycin, azithromycin, and
clarithromycin.
PREVENTION
• Wash your hands. Show your child how
to wash his or her hands thoroughly with
warm soapy water.
• Don't share dining utensils or food. As a
rule, your child shouldn't share drinking
glasses or eating utensils with friends or
classmates. This rule applies to sharing
food, too.
• Cover your mouth and nose. Tell your
child to cover his or her mouth and nose
when coughing and sneezing to prevent
the potential spread of germs.
COMPLICATION
If scarlet fever goes untreated, the bacteria may
spread to the:
•
•
•
•
•
•
Tonsils
Lungs
Skin
Kidneys
Blood
Middle ear
Rarely, scarlet fever can lead to rheumatic fever,
a serious condition that can affect the:
•
•
•
•
Heart
Joints
Nervous system
Skin
SEVERE
ACUTE
RESPIRATORY
SYNDROME (SARS)
Severe acute respiratory syndrome (SARS) is a
viral respiratory disease.
ETIOLOGY
SARS is caused by a SARS-associated
coronavirus.
INCUBATION PERIOD
The incubation period of SARS is usually 2-7
days but may be as long as 10 days.
COMMUNICABILITY PERIOD
After onset of symptoms and maximum period
of communicability is less than 21 days.
MODE OF TRANSMISSION
SARS is an airborne virus and can spread
through small droplets of saliva in a similar way
to the cold and influenza. (AIRBORNE
TRANSMISSION).
SARS can also be spread indirectly via surfaces
that have been touched by someone who is
infected with the virus. (VECTOR-BORNE
TRANSMISSION).
NURSING ASSESSMENT (SIGNS
SYMPTOMS)
• Fever over 100.4°F
• Dry cough
• Sore throat
• Problems breathing
• Including shortness of breath
• Headache
• Body aches
• Loss of appetite
• Malaise
• Night sweats and chills
• Confusion
• Rash
• Diarrhea
NURSING CONSIDERATION
SARS cases should be isolated
accommodated.
&
59 | P a g e
be
disposed
PPE should be worn by all staff and visitors
accessing the isolation unit.
TREATMENT
There is no confirmed treatment that works for
every person who has SARS. Antiviral
medications and steroids are sometimes given
to reduce lung swelling, but aren’t effective for
everyone.
Supplemental oxygen or a ventilator may be
prescribed if necessary. In severe cases, blood
plasma from someone who has already
recovered from SARS may also be administered.
However, there is not yet enough evidence to
prove that these treatments are effective.
PREVENTION
• Wash your hands frequently.
• Wear disposable gloves if touching any
infected bodily fluids.
• Wear a surgical mask when in the same
room with a person with SARS.
• Disinfect surfaces that may have been
contaminated with the virus.
Wash all personal items, including
bedding and utensils, used by a person
with SARS.
COMPLICATION
Most of the fatalities associated with SARS result
from respiratory failure. SARS can also lead to
heart and liver failure. The group most at risk of
developing complications is people over 60 who
have been diagnosed with another chronic
condition.
and
negative pressure rooms with the door
closed
• single rooms with their own bathroom
facilities
• cohort placement in an area with an
independent air supply, exhaust system
and bathroom facilities
Use precautions for airborne, droplet and
contact transmission.
should
Particular attention should be paid to
interventions such as the use of nebulisers,
chest
physiotherapy,
bronchoscopy
or
gastroscopy.
•
•
Equipment used
appropriately.
Hand washing is crucial
of
SCHISTOSOMIASIS
Schistosomiasis is also known as Bilhariasis or
snail fever. It is a chronic inflammatory disorder
which causes tissue damage and systemic
pathology that often persist into adulthood,
even after infection abates. It affects mostly
farmers and their families, resulting to
manpower loss and lessened agricultural
productivity, making it not only a public health
problem but also a socio-economic one.
penetrate the soft part of the snail
(Oncomelania quadrasi), multiplies, and within
two months becomes cercaria. Cercariae
ETIOLOGY
Schistosomiasis is caused by some species of
blood trematodes (flatworms) in the
genus Schistosoma. Among the many species
of Schistosoma, the major human diseasecausing ones are S. mansoni, S. haematobium,
and S. japonicum. Schistosoma japonicum is
endemic in the Philippines.
Intestinal symptoms are caused by Schistosoma
mansoni,
Schistosoma
Schistosoma
Schistosoma
intercalatum,
mekongi
and
japonicum;
haematobium causes bladder
involvement (urinary schistosomiasis)
INCUBATION PERIOD
Incubation Period: 2 months
Cercariae (the infective stage of the parasite)
reach the portal venous system several days
post-infection. 4-6 weeks usually pass before
egg production begins. Toxemic schistosomiasis
may develop 6-8 weeks post infection. Urinary
schistosomiasis may develop 10-12 weeks post
infection.
COMMUNICABILITY PERIOD
This disease in not directly transmitted from
person-to-person. However, an infective
person will release eggs in urine and feces and
an infective snail will release cercariae as long
as they live (several weeks to 3 months)
MODE OF TRANSMISSION
Male and female parasites (S. japonicum) live in
the vessels of the intestine and liver. The eggs
of the parasite are laid and pass out with the
feces. Upon contact with freshwater, eggs hatch
into larva known as miracidium. Miracidia then
60 | P a g e
emerges from the snail into the water and
enters the skin when humans come in contact
with infected water. It eventually goes to the
intrahepatic portal circulation where they
mature, copulate, and start laying eggs in about
one month’s time.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
SIGNS AND SYMPTOMS
Invasion Phase: transient itching papulae called
cercarial dermatitis
Migration and Maturation Phase: fever, muscle
ache, night sweats, coughing, diarrhea, joint
pain, hepato‐ and splenomegaly, urticarial
exanthema, and eosinophilia in the blood smear
Intestinal Schistosomiasis: diarrhea, stomach
ache, blood and mucous in feces, dysentery
Urinary Schistosomiasis: hematuria and dysuria
NURSING ASSESSMENT
Subjective Data:
• Onset and characteristics of disease
• Recent travel to another geographical
area
• A history of living in an endemic area
• Information about means of water supply
and agricultural production.
• Altered bowel elimination pattern
• Stool (Frequency, Consistency, and
Color)
• Urine (Dysuria. Frequency, and Color)
• Other Symptoms
Objective Data:
• Maculopapular rash,
• Cercarial dermatitis
• Conjuctiva (pale or pink)
• Hepatospleenomegally
• Abdominal distention
• Ascites
• Tenderness
• Generalized Lymphadenopathy
• Emaciation of upper trunk and upper
limbs
• Edema of lower limbs
NURSING CONSIDERATION
• Asses vital sign
• Collect stool or/and urine specimen
properly including type, time of sample,
volume or amount, sample number
• Inform patient regarding his/ her disease
and treatment
• Administer medication as prescribed
• Monitor food and fluid intake
• Keep the skin clean and dry
• Monitor the patient’s response to therapy
• Monitor for complications
• Monitor fecal and urine output
• Give information for the patient about
medications, their dosage and side
effects
• Provide health information on prevention
of schistosome infections
TREATMENT
Pranziquantel (Biltricide) - against all species
Oxamniquine for S. mansoni and Metrifornate
for S. haematobium
PREVENTION
• Educate the public in endemic areas
regarding mode of transmission and
methods of protection
• Dispose of feces and urine
• Improve irrigation and agriculture
practices
• Treat
snail-breeding
sites
with
molluscicides
• Prevent exposure to contaminated water
• Provide water for drinking bathing and
washing clothes from sources free of
cercariae or treated to kill them
• Treat patients in endemic areas
• Travellers visiting endemic areas should
be advised of the risks and informed
about preventive measures
61 | P a g e
COMPLICATION
Intestinal schistosomiasis can lead to portal
hypertension, portal fibrosis, esophageal
varicose veins.
Urinary chronic infection can lead to
hydroureter, hydronephrosis, bladder polyps,
bladder cancer.
SOIL TRANSMITTED HELMINTHIASIS
Soil-transmitted helminths refer to the intestinal
worms infecting humans that are transmitted
through contaminated soil.
These helminthes infect a fairly large number of
the world’s population
• Approx. 807 million -1,121 billion with
Ascaris
• Approx. 604-795 million with whipworm
• Approx. 576-740 million with hookworm
Infections of these helminthes usually occur in
areas with warm and moist climate where
sanitation and hygiene are poor.
ETIOLOGY
These intestinal worms come in different
species:
1. Ascaris (Ascaris
lumbricoides)
most
common
cause of helminth
infection; largest
among
the
intestinal
nematodes affecting humans
COMMUNICABILITY PERIOD
• Direct person-to-person transmission is
impossible
• Eggs passed in the feces need about 3
weeks to mature before becoming
infective.
• There is no specific time frame for its
communicability, but infection rate will be
much evident after the maturation of the
eggs.
MODE OF TRANSMISSION
1. STH are primarily transmitted by eggs
present in feces.
2. Eggs contaminate the soil through:
• Clinging on to vegetables and are
ingested when these are not cooked,
peeled or washed properly
• Contaminated water sources
• Ingestion via soiled hands (particular in
children)
• Production of larvae that penetrates the
skin
2. Whipworms
(Trichuris
trichiura) - derives
its name from its
characteristic
whiplike shape
3. Hookworms
(Ancylostoma
duodenale
and
Necator
americanus) - an
S-shaped
worm
because of its
flexure at the frontal end
INCUBATION PERIOD
Many potential infections are eliminated by host
defenses; others become established and may
persist for prolonged periods, even years.
Incubation period varies depending on infecting
worm
• Ascaris - ranges from 18 days to several
weeks
• Whipworms - ranges from 60 to 90 days
• Hookworms - 5 weeks to 9 months for A.
duodenale; 7 weeks for N. americanus
62 | P a g e
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Ascaris
• Light infection usually have no symptoms
Hookworms
• General Symptoms Include:
a. Chronic blood loss
b. Depletion of body iron stores leading
to iron deficiency anemia
• Children:
a. Retarded physical growth and
development.
Whipworms
• Majority of infections are mild and
asymptomatic
• Mild infections causes:
a. Epigastric pain
b. Nausea
c. Vomiting
d. Distention
e. Flatulence
f. Weight loss
• Moderate infections causes:
a. Growth Deficit
b. Anemia
NURSING CONSIDERATION
• Providing the patient with rest periods
helps in promoting relief
• Continuous monitoring of affected tissues
for signs of infection such as color
changes, redness, swelling, warmth, and
pain.
• Educating the patient about the disease,
its signs and symptoms, prevention and
treatment can help avoid recurrence of
disease
TREATMENT
Treatment for STH is often associated with
multiple-drug therapy.
A 2003 study suggested that the medications
ivermectin taken with albendazole had higher
efficacy against T trichiura than monotherapy.
Other drugs that are effective in treating STH
include:
• Piperazine
• Mebendazole
• Levamisole
• Pyrantel
PREVENTION
Preventions include:
• Proper (and sanitary) disposal of human
wastes
• Provision of safe drinking water
• Food hygiene habits
• Personal hygienic behavior
• Wearing preventive footwear
COMPLICATION
Severe infections may cause the following:
• Diarrhea with blood and mucus rectal
prolapse
• Colonic obstruction
• Hypoproteinaemia
• Chronic iron deficiency
• Iron Deficiency Anemia
• Abdominal Pain
• Malaise (a general feeling of discomfort)
• Weakness
• Impaired
cognitive
and
physical
development
63 | P a g e
SYPHILIS
Syphilis is a sexually transmitted disease (STD)
caused by an infection with bacteria known
as Treponema pallidum. Like other STDs,
syphilis can be spread by any type of sexual
contact. Syphilis can also be spread from an
infected
mother
to
the
fetus
during pregnancy or to the baby at the time of
birth.
Syphilis has been described for centuries. It can
cause long-term damage to different organs if
not properly treated.
ETIOLOGY
The bacteria that cause syphilis, Treponema
pallidum, are referred to as spirochetes due to
their spiral shape. The organisms penetrate into
the lining of the mouth or genital area.
INCUBATION PERIOD
The average time between acquisition of syphilis
and the start of the first symptom is 21 days,
but can range from 10 to 90 days.
COMMUNICABILITY PERIOD
A case is considered sexually infectious until the
end of the early latent period, which is
approximately 2 years after infection. Infectious
moist mucocutaneous lesions are present in the
primary and secondary stages of syphilis, and
may recur intermittently in the early latent
period. These lesions may not be apparent to
the infected individual.
MODE OF TRANSMISSION
Syphilis is transmitted from person to person by
direct contact with a syphilitic sore, known as a
chancre. Chancres can occur on or around the
external genitals, in the vagina, around the
anus, or in the rectum, or in or around the
mouth. Transmission of syphilis can occur
during vaginal, anal, or oral sex. In addition,
pregnant women with syphilis can transmit the
infection to their unborn child.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
Primary
• Painless sores appear at the site of
infection (mouth, anus, rectum, vagina,
or penis). These are called chancres.
• The sores heal on their own after 3 to 6
weeks, but you can still spread syphilis.
• It’s easily treated and cured with
medicine
64 | P a g e
Secondary
• Sores that resemble oral, anal,
and genital warts
• A non-itchy, rough, red or red-brown
rash that starts on the trunk and spreads
to the entire body, including the palms
and soles muscle aches
• Fever
• Sore throat
• Swollen lymph nodes
• Patchy hair loss
• Headaches
• Unexplained weight loss
• Fatigue
Latent
Latent syphilis is the third stage of infection
marked by the relative absence of symptoms
but positive blood tests. It is further divided into
two stages:
1. Early latent syphilis is the period of less
than a year from the last blood test. Secondary
symptoms can sometimes relapse during the
early latent phase.
2. Late latent syphilis is the period greater
than a year from the last blood test. It can last
for years and even decades with no signs of
disease.
During this phase, the syphilis bacteria are still
alive in your body, but you have no signs or
symptoms of the infection. You’re not
contagious during this stage, but syphilis may
still affect your heart, brain, nerves, bones, and
other parts of your body. This phase can last for
years.
Not everyone who has syphilis will enter this
phase of the infection. Some people will go into
the tertiary stage.
Tertiary (LATE)
This stage begins when symptoms from the
secondary stage disappear. Syphilis isn’t
contagious at this point, but the infection has
started to affect your organs. This can lead to
death.
Tertiary syphilis is the most serious stage of
infection and is characterized by three major
complications:
1. Gummatous Syphilis
• Causes the formation of soft,
tumor-like lesions called gummas.
These noncancerous lesions can
cause large ulcerative sores on the
skin and mouth, and erode tissues
of heart, liver, muscles, bones,
and other vital organs.
2. Cardiovascular Syphilis
• Causes severe inflammation of the
aorta and the development of
an aortic aneurysm (the swelling
and weakening of the aortic wall).
3. Neurosyphilis
• Affects the central nervous system
and usually develops within four
to 25 years of an infection. While
some
people
will
remain
symptom-free,
others
may
experience severe neurological
symptoms
including meningitis
(inflammation of the membrane
surrounding the brain and spinal
cord) or tabes dorsalis (a condition
characterized by nerve pain, loss
of motor skills, visual impairment,
deafness, and incontinence).
NURSING CONSIDERATION
• Establish a sexual history, including the
number of sexual partners and whether
the patient was protected by a condom.
• Question the patient about the
intravenous IV drug use and previous
STIS.
• Establish a history of fever, headaches,
nausea, anorexia, weight loss, sore
throat, mild fever, hair loss, or rashes,
symptoms of the primary and secondary
stages.
• Determine if the patient has experienced
paresis, seizures, arm and leg weakness,
alternations in judgement or personality
changes, of all which are symptoms of
late – stage syphilis.
• The patient with syphilis is usually
embarrassed with infection and may be
reluctant to seek out and continue
treatment. Be non-judgemental.
• Assure the patient that his/her privacy
and confidentiality will be maintained
during examination, diagnosis, and
treatment, although all sexual partner s
need to be notified so that they can be
examined and treated as needed.
• Medical treatment for syphilis infection at
any stage consist of antibiotic therapy to
destroy the infecting bacteria. After
65 | P a g e
treatment, patients are instructed to
refrain from sexual contact for at least 2
weeks or until lesions heal and to return
for serology testing in 1 month and then
every 3 months for 1 year.
• Carefully question patient about penicillin
sensitivity before treatment.
• Instruct the patient to rest, drink fluids,
and take antipyretics.
• Tell the patient that the disease must be
reported to the local health authority and
that confidentiality will be maintained.
• Provide care for the patient’s lesions.
Keep them clean and dry. Properly
dispose of contaminated materials from
draining lesions.
• Focus on prevention. Educate patients
about the course of the disease and the
need to return for follow – up treatment
or blood tests.
• Teach patients on how to reduce risks
factors to prevent future infections by
limiting the number of sexual partners
and practicing safer sex.
• Patient need ongoing emotional support
to make lifestyle changes.
• Explain the need for regular laboratory
testing (VDRL) every months for 2 years
to detect a relapse. Urge patients in the
latent or late stages to have blood tests
every 6 months for 2 years.
TREATMENT
The treatment strategy will depend on the
symptoms and how long a person has harbored
the bacteria. However, during the primary,
secondary, or tertiary stage, people with syphilis
will typically receive an intramuscular injection
of
penicillin
G
benzathine.
Tertiary syphilis will require multiple injections
at weekly intervals. Neurosyphilis requires
intravenous (IV) penicillin every 4 hours for 2
weeks to remove the bacteria from the central
nervous system. Curing the infection will
prevent further damage to the body, and safe
sexual practices can resume. However,
treatment cannot undo any damage trusted
Source that has already occurred.
PREVENTION
• Abstaining from sex
• Maintaining long term mutual monogamy
with a partner who does not have syphilis
• Using a condom, although these only
protect against genital sores and not
those that develop elsewhere on the
body
• Using a dental dam, or plastic square,
during oral sex
• Avoiding sharing sex toys
• Refraining from alcohol and drugs that
could potentially lead to unsafe sexual
practices
COMPLICATION
Neurological Problems
•
•
•
•
•
•
•
•
•
Headache
Stroke
Meningitis
Hearing loss
Visual problems, including blindness
Dementia
Loss of pain and temperature sensations
Sexual dysfunction in men (impotence)
Bladder incontinence
Cardiovascular Problems
• Bulging (aneurysm)
• Inflammation of the aorta
• Damage of heart valves
HIV Infection
Pregnancy and Childbirth Complications
•
•
•
•
•
•
•
•
•
Deformities
Developmental delays
Seizures
Rashes
Fever
Swollen liver or spleen
Anemia
Jaundice
Infectious sores
66 | P a g e
TETANUS
• Tetanus is also known as “lockjaw.”
• A vaccine preventable disease that is not
spread from person to person.
• May cause severe muscle spasms,
serious breathing difficulties, and can
ultimately be fatal.
• It is a soil-borne disease. Has 4
classifications
namely:
generalized,
neonatal, localized, and cerebral tetanus.
Generalized:
Most common and amount to 80% of the cases.
Patients present with a descending pattern of
muscle spasms, first presenting with lockjaw,
and risus sardonicus. This can progress to a stiff
neck, difficulty swallowing, and rigid pectoral
and calf muscles.
Neonatal:
Generalized form of tetanus that occurs in
newborns of unimmunized mothers or from
infection through a contaminated instrument
when cutting the umbilical cord. Exhibit
irritability, poor feeding, facial grimacing,
rigidity, and severe spastic contractions
triggered by touch.
Localized:
Localized tetanus is the persistent contraction of
muscles at the site of injury that can persist for
weeks. This type is uncommonly fatal; however,
it can progress to the generalized form of
tetanus, which is more life-threatening.
Cerebral:
Cephalic or cerebral tetanus is limited to the
muscles and nerves of the head. Cephalic
tetanus occurs most commonly after head
trauma such as a skull fracture, head laceration,
eye injury, dental procedures, otitis media, or
from another injury site. It presents with neck
stiffness, dysphagia, trismus, retracted eyelids,
deviated gaze, and risus sardonicus.
ETIOLOGY
Infection caused by bacteria called Clostridium
tetani. If Clostridium tetani spores are deposited
in a wound, the neurotoxin interferes with
67 | P a g e
nerves that control muscle movement. Exist in
soil, manure, and other environmental agents.
INCUBATION PERIOD
The incubation period is usually between 3 and
21 days (average 10 days). However, it may
range from one day to several months,
depending on the kind of wound. Most cases
occur within 14 days.
Inoculation of spores in body locations distant
from the central nervous system (ex. hands and
feet) results in a longer incubation period than
inoculation close to the CNS (ex. head or neck).
COMMUNICABILITY PERIOD
Clostridium tetani spores are able to survive for
a long time outside of the body. The spores can
remain infectious for more than 40 years in soil
and can be inoculated through skin cuts and
puncture wounds.
MODE OF TRANSMISSION
Tetanus does not spread from person to
person– it is spread by the direct transfer of C.
tetani spores from soil and excreta of animals
and humans to wounds and cuts.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Jaw cramping
• Sudden, involuntary muscle tightening
(muscle spasms) — often in the stomach
• Painful muscle stiffness all over the body
• Trouble swallowing
• Jerking or staring (seizures)
• Headache
• Fever and sweating
• Changes in blood pressure and heart
rate
NURSING CONSIDERATION
• Initiate support therapy.
• Assess the type of wound and provide
appropriate wound care.
• Debride the wound to eradicate spores
and alter conditions for germination.
• Evaluate the immunization status of the
patient.
• Assess need for administering TIG for
prophylaxis.
TREATMENT
• Immediate treatment with medicine
called human tetanus immune globulin
(TIG)
• Aggressive wound care
• Drugs to control muscle spasms
•
•
Antibiotics
Tetanus vaccination
PREVENTION
Tetanus
can
be
prevented
through
immunization with tetanus-toxoid-containing
vaccines (TTCV), which are included in routine
immunization
programs
globally
and
administered during antenatal care contacts.
It's essential to clean the wound to prevent the
growth of tetanus spores. This involves
removing dirt, foreign objects and dead tissue
from the wound.
COMPLICATION
• Uncontrolled/involuntary tightening of
the vocal cords (laryngospasm)
• Infections gotten by a patient during a
hospital
visit
(hospital-acquired
infections)
• Blockage of the main artery of the lung
or one of its branches by a blood clot that
has travelled from elsewhere in the body
through the bloodstream (pulmonary
embolism)
• Pneumonia, a lung infection, that
develops by breathing in foreign
materials (aspiration pneumonia)
• Breathing difficulty, possibly leading to
death (1 to 2 in 10 cases are fatal)
68 | P a g e
TUBERCULOSIS (TB)
A contagious infection that usually affects the
lungs. It can also spread to other parts of the
body, like the brain, and the spine
(Extrapulmonary Tuberculosis). Tuberculosis is
categorized into three: Active TB Disease,
Latent TB Infection, and Miliary TB.
Active TB Disease this condition makes the
infected person sick, and is more contagious.
Latent TB Infection is a condition in which the
infected person does not develop symptoms and
is mostly not contagious.
Military TB although rare, it is a potentially
fatal form of TB. It is when the bacteria that
causes TB find their way into the bloodstream.
ETIOLOGY
Mycobacterium
tuberculosis is the
causative agent for
Tuberculosis. It is a
species of pathogenic
bacteria in the family
Mycobacteriaceae. It has an unusual, waxy
coating on its cell surface primarily due to the
presence of mycolic acid.
INCUBATION PERIOD
May vary from about two to 12 weeks. A person
may remain contagious for a long time, as long
as viable TB bacteria are present in the sputum,
and can remain contagious until they have been
on appropriate therapy.
COMMUNICABILITY PERIOD
An infected person is able to spread TB from an
assigned date of 3 months prior to symptom
onset or a positive lab report.
MODE OF TRANSMISSION
• Tuberculosis is transmitted through air.
Most commonly by sneezing and
coughing.
• Being near to someone with tuberculosis
for an extended period of time may
increase the risk for infection.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
People who have any of the following should be
evaluated for TB Disease:
• Cough that lasts for more than 3 weeks
• Loss of appetite and unintentional weight
loss
• Fever
69 | P a g e
• Chills
• Night sweats
These symptoms can also occur with other
diseases, so it is important to see a healthcare
provider and have it properly diagnosed.
You may also experience other symptoms
related to the function of a specific organ or
system that is affected.
NURSING CONSIDERATION
Isolation Precautions
• A person who has or is suspected of
having infectious TB disease should be
placed in an area away from other
patients.
Airborne Precautions
• It should be initiated for any patient who
has signs or symptoms of TB disease, or
who has documented infectious TB and
remains infectious in spite of treatment.
Droplet Precautions
TREATMENT
Treatment Period is about 6 to 12 months. It is
divided into two phases:
Intensive Phase:
• Isoniazid, 300mg, daily for 8 weeks.
• Rifampin, 600mg, daily for 8 weeks.
• Pyrazinamide*, 1000mg to 2000mg, daily
for 8 weeks.
• Ethambutol*, 800mg to 1600mg, daily
for 8 weeks.
* depending on the patient’s weight.
Continuation Phase:
• Isoniazid, 300mg, daily for 18 weeks.
• Rifampin, 600mg, daily for 18 weeks.
There are other treatment modifications that is
made under specific circumstances.
PREVENTION
Risk for infection can be reduced by:
• Having good ventilation
• Natural light
• Good hygiene
• Completion of treatment
• Vaccination
COMPLICATION
• Respiratory Failure
• Pneumothorax
• Pneumonia
• Spinal Pain
• Joint Damage
• Meningitis
• Liver or Kidney Problems
• Heart Disorders
TYPHOID FEVER
Also known as enteric fever it is a potentially
fatal multisystemic illness
It is an infection of the intestinal tract and
occasionally in the bloodstream.
The typhoid fever is a serious disease spread
through contaminated food and water causing
high fever, abdominal pain and diarrhea. It is
caused by bacteria called Salmonella typhi.
ETIOLOGY
Typhoid fever is caused by the Gram-negative
bacillus known as Salmonella enterica
subspecies enterica serotype Typhi. Commonly
known as salmonella typhi or s. typhi.
INCUBATION PERIOD
The typical incubation period for typhoid fever is
10-14 days.
COMMUNICABILITY PERIOD
As long as S. Typhi is being excreted in stools or
urine, the communicability period of typhoid is
usually from one week after symptom onset, ,
through recovery, and for a variable period
thereafter
MODE OF TRANSMISSION
Fecal-oral transmission route
•
This means that Salmonella typhi is
passed in the feces and sometimes in the
urine of infected people.
Typhoid carriers
•
Even after antibiotic treatment, a small
number of people who recover from
typhoid fever continue to harbor the
bacteria. These people, known as chronic
carriers, no longer have signs or
symptoms of the disease themselves.
NURSING ASSESSMENT (SIGNS
SYMPTOMS)
Signs and symptoms usually include:
•
•
•
•
&
High fever
Headache
Stomach pain
Constipation or diarrhea
Signs and symptoms are likely to develop
gradually — often appearing one to three weeks
after exposure to the disease.
70 | P a g e
Early illness
Signs and symptoms include:
•
•
•
•
•
•
•
•
•
•
•
Fever that starts low and increases daily,
possibly reaching as high as 104.9 F
(40.5 C)
Headache
Weakness and fatigue
Muscle aches
Sweating
Dry cough
Loss of appetite and weight loss
Stomach pain
Diarrhea or constipation
Rash
Extremely swollen stomach
Later illness
Without treatment, you may:
•
•
•
•
Become delirious
Lie motionless and exhausted with your
eyes half-closed in what's known as the
typhoid state
Life-threatening complications often
develop at this time.
In some people, signs and symptoms
may return up to two weeks after the
fever has subsided.
NURSING CONSIDERATION
Health Teaching
Teach members of the family how to report all
symptoms to the attending physician especially
when the patient is being cared for at home
Teach, guide and supervise members of the
family on nursing techniques which will
contribute to the patient’s recovery
Interpret to family nature of disease and the
need for practicing preventive and control
measures.
Management
Demonstrate to the family how to give bedside
care such as a tepid sponge, feeding changing
of bed linen, use of bedpan and mouth care
Any bleeding from the rectum, blood in stools
sudden acute abdominal pain restlessness,
falling of temperature should be reported at
once to the physician or the patient should be
brought at once to the hospital.
Take vital signs and teach patient family
members on how to take and record the same.
threatening complication requires immediate
medical care.
TREATMENT
Antibiotic therapy is the only effective treatment
for typhoid fever.
Other possible complications include:
Commonly prescribed antibiotics
Commonly prescribed antibiotics include:
•
•
•
Ciprofloxacin (Cipro).
Azithromycin (Zithromax).
Ceftriaxone.
These drugs can cause side effects, and longterm use can lead to the development of
antibiotic-resistant bacteria.
•
•
•
•
•
•
•
Other treatments
•
•
•
Other treatments include:
Drinking fluids.
Surgery.
PREVENTION
A vaccine is recommended if you live in or are
traveling to areas where the risk of getting
typhoid fever is high.
Because the vaccine won't provide complete
protection, follow these guidelines when
traveling to high-risk areas:
•
•
•
•
•
•
Wash your hands.
Avoid drinking untreated water
Avoid raw fruits and vegetables.
Choose hot foods.
Know where the doctors are.
Prevent infecting others
If you're recovering from typhoid fever, these
measures can help keep others safe:
•
•
•
Take your antibiotics.
Wash your hands often.
Avoid handling food.
COMPLICATION
Intestinal bleeding or holes
Intestinal bleeding or holes in the intestine are
the most serious complications of typhoid fever.
They usually develop in the third week of illness.
In this condition, the small intestine or large
bowel develops a hole. Contents from the
intestine leak into the stomach and can cause
severe stomach pain, nausea, vomiting and
bloodstream infection (sepsis). This life-
71 | P a g e
•
Inflammation of the heart muscle
(myocarditis)
Inflammation of the lining of the heart
and valves (endocarditis)
Infection of major blood vessels (mycotic
aneurysm)
Pneumonia
Inflammation
of
the
pancreas
(pancreatitis)
Kidney or bladder infections
Infection and inflammation of the
membranes and fluid surrounding your
brain and spinal cord (meningitis)
Psychiatric problems, such as delirium,
hallucinations and paranoid psychosis
With quick treatment, nearly all people in
industrialized nations recover from typhoid
fever. Without treatment, some people may not
survive complications of the disease.
NONCOMMUNICABLE
DISEASES
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CARDIOVASCULAR DISEASE (MORE
FOCUSED ON CORONARY ARTERY
DISEASE OR CAD)
Cardiovascular disease (CVD) is a general
term for conditions affecting the heart or blood
vessels. It's usually associated with a build-up of
fatty
deposits
inside
the
arteries
(atherosclerosis) and an increased risk of
blood clots. It can also be associated with
damage to arteries in organs such as the brain,
heart, kidneys and eyes.
ETIOLOGY
Coronary artery disease is thought to begin
with damage or injury to the inner layer of a
coronary artery, sometimes as early as
childhood. The damage may be caused by
•
•
•
•
•
•
•
various factors, including:
• Smoking
• High blood pressure
• High cholesterol
• Diabetes or insulin resistance
• Not being active (sedentary lifestyle)
Once the inner wall of an artery is damaged,
fatty deposits (plaque) made of cholesterol and
other cellular waste products tend to collect at
the site of injury. This process is called
atherosclerosis. If the plaque surface breaks
or ruptures, blood cells called platelets clump
together at the site to try to repair the artery.
This clump can block the artery, leading to a
heart attack.
NURSING ASSESSMENT
• Character – Substernal chest pain,
pressure, heaviness, or discomfort. Other
sensations include a squeezing, aching,
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burning, choking, strangling, or cramping
pain.
Severity – Pain maybe mild or severe
and typically present with a gradual
buildup of discomfort and subsequent
gradual fading away.
Location – Behind middle or upper third
of sternum; the patient will generally will
make a fist over the site of pain (positive
Levine sign; indicates diffuse deep
visceral pain), rather than point to it with
fingers.
Radiation – Usually radiates to neck,
jaw, shoulders, arms, hands, and
posterior intrascapular area. Pain occurs
more commonly on the left side than the
right; may produce numbness or
weakness in arms, wrist, or hands.
Duration – Usually last 2 to 10 minutes
after stopping activity; nitroglycerin
relieves pain within 1 minute.
Precipitating factors – Physical
activity, exposure to hot or cold weather,
eating a heavy meal, and sexual
intercourse increase the workload of the
heart and, therefore, increase oxygen
demand.
Associated
manifestation
–
Diaphoresis,
nausea,
indigestion,
dyspnea, tachycardia, and increase in
blood pressure.
Signs of unstable angina:
A change in frequency, duration, and
intensity of stable angina symptoms.
Angina pain last longer than 10
minutes, is unrelieved by rest or
sublingual nitroglycerin, and mimics
signs and symptoms of impending
myocardial infarction.
NURSING CONSIDERATION
• Monitor blood pressure, apical heart rate,
and respirations every 5 minutes during
an anginal attack.
• Maintain continuous ECG monitoring or
obtain a 12-lead ECG, as directed,
monitor for arrhythmias and ST
elevation.
• Place patient in comfortable position and
administer oxygen, if prescribed, to
enhance myocardial oxygen supply.
Identify specific activities patient may
engage in that are below the level at
which anginal pain occurs.
• Reinforce the importance of notifying
nursing staff whenever angina pain is
experienced.
• Encourage supine position for dizziness
caused by antianginals.
• Be alert to adverse reaction related to
abrupt
discontinuation
of
betaadrenergic blocker and calcium channel
blocker therapy. These drugs must be
tapered to prevent a “rebound
phenomenon”; tachycardia, increase in
chest pain, and hypertension.
• Explain to the patient the importance of
anxiety reduction to assist to control
angina.
• Teach the patient relaxation techniques.
• Review specific factors that affect CAD
development and progression; highlight
those risk factors that can be modified
and controlled to reduce the risk.
TREATMENT
Cholesterol-modifying medications
Calcium channel blockers
These medications reduce (or modify) the
primary material that deposits on the coronary
arteries. As a result, cholesterol levels —
especially low-density lipoprotein (LDL, or the
"bad") cholesterol — decrease. Your doctor can
choose from a range of medications, including
statins, niacin, fibrates and bile acid
sequestrants.
Sometimes more aggressive treatment
needed. Here are some options:
•
Aspirin
Your doctor may recommend taking a daily
aspirin or other blood thinner. This can reduce
the tendency of your blood to clot, which may
help prevent obstruction of your coronary
arteries. If you've had a heart attack, aspirin can
help prevent future attacks. But aspirin can be
dangerous if you have a bleeding disorder or
you're already taking another blood thinner, so
ask your doctor before taking it.
Beta blockers
These drugs slow your heart rate and decrease
your blood pressure, which decreases your
heart's demand for oxygen. If you've had a
heart attack, beta blockers reduce the risk of
future attacks.
74 | P a g e
These drugs may be used with beta blockers if
beta blockers alone aren't effective or instead of
beta blockers if you're not able to take them.
These drugs can help improve symptoms of
chest pain.
Ranolazine
This medication may help people with chest pain
(angina). It may be prescribed with a beta
blocker or instead of a beta blocker if you can't
take it.
Nitroglycerin
Nitroglycerin tablets, sprays and patches can
control chest pain by temporarily dilating your
coronary arteries and reducing your heart's
demand for blood.
Angiotensin
Converting enzyme (ACE) inhibitors and
angiotensin II receptor blockers (ARBs). These
similar drugs decrease blood pressure and may
help prevent progression of coronary artery
disease.
Angioplasty
and
(percutaneous
revascularization)
stent
is
placement
coronary
Your doctor inserts a long, thin tube (catheter)
into the narrowed part of your artery. A wire
with a deflated balloon is passed through the
catheter to the narrowed area. The balloon is
then inflated, compressing the deposits against
your artery walls. A stent is often left in the
artery to help keep the artery open. Most stents
slowly release medication to help keep the
arteries open.
Coronary artery bypass surgery
A surgeon creates a graft to bypass blocked
coronary arteries using a vessel from another
part of your body. This allows blood to flow
around the blocked or narrowed coronary
artery. Because this requires open-heart
surgery, it's most often reserved for people who
have multiple narrowed coronary arteries.
PREVENTION
Dietary measures – These are based on
DASH
(Dietary
Approaches
to
Stop
Hypertension)
1. Limiting use of salt to less than 2.4g of
sodium per day (ex. No added salt in cooking or
at table), avoid canned food, salted meat, etc.
2. Reducing excessive dietary fat (especially
saturated fat and trans-fatty acids) to no more
than 30 % of calories. Saturated fat should not
exceed 10% of total calories
3. Ensuring intake of fiber of at least 30-40
gm/day
4. Ensuring intake of potassium between 7080mmol/L daily. This can be achieved by a good
selection of fruits and vegetables especially
bananas, tomatoes, oranges, as well as coconut
water.
5. Avoiding red meat
6. Physical exercise- This should be undertaken
for 30-60 mins at least five times each week, but
preferably daily. Walking is the easiest form of
exercise for most people.
7. BMI <25 or at least a significant reduction, if
overweight or obese. There is a possibility of 520 mmHg decrease in systolic pressure for every
10kg (22lb) weight loss.
8. Reduction of alcohol intake- Alcohol use
should not exceed 2 drinks/day for men and 1
drink/day for women. (1 drink= one ounce of
spirits or 1 bottle of beer or 1 glass of wine)
9. Cessation of Tobacco use
COMPLICATION
Heart failure
One of the most common complications of heart
disease, heart failure occurs when your heart
can't pump enough blood to meet your body's
needs. Heart failure can result from many forms
of heart disease, including heart defects,
cardiovascular disease, valvular heart disease,
heart infections or cardiomyopathy.
Heart attack
A blood clot blocking the blood flow through a
blood vessel that feeds the heart causes a heart
75 | P a g e
attack, possibly damaging or destroying a part
of the heart muscle. Atherosclerosis can cause a
heart attack.
Stroke
The risk factors that lead to cardiovascular
disease can also lead to an ischemic stroke,
which happens when the arteries to your brain
are narrowed or blocked so that too little blood
reaches your brain. A stroke is a medical
emergency — brain tissue begins to die within
just a few minutes of a stroke.
Aneurysm
A serious complication that can occur anywhere
in your body, an aneurysm is a bulge in the wall
of your artery. If an aneurysm bursts, you may
face life-threatening internal bleeding.
Peripheral artery disease
When you develop peripheral artery disease,
your extremities — usually your legs — don't
receive enough blood flow. This causes
symptoms, most notably leg pain when walking
(claudication). Atherosclerosis also can lead to
peripheral artery disease.
Sudden cardiac arrest
Sudden cardiac arrest is the sudden,
unexpected loss of heart function, breathing and
consciousness, often caused by an arrhythmia.
Sudden cardiac arrest is a medical emergency.
If not treated immediately, it results in sudden
cardiac death.
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE (COPD)
Chronic inflammatory lung disease that causes
obstructed airflow from the lungs. People
with COPD are at increased risk of developing
heart disease, lung cancer and a variety of other
conditions.
COPD is a progressive disease that gets worse
over time, COPD is treatable. With proper
management, most people with COPD can
achieve good symptom control and quality of
life, as well as reduced risk of other associated
conditions.
Emphysema and chronic bronchitis are the
two most common conditions that contribute
to COPD. These two conditions usually occur
together and can vary in severity among
individuals with COPD.
•
Chronic bronchitis is inflammation of
the lining of the bronchial tubes, which
carry air to and from the air sacs (alveoli)
of the lungs. It's characterized by daily
cough and mucus (sputum) production.
•
Emphysema is a condition in which the
alveoli at the end of the smallest air
passages (bronchioles) of the lungs are
destroyed as a result of damaging
exposure to cigarette smoke and other
irritating gases and particulate matter.
ETIOLOGY
• The main cause of COPD is smoking, but
nonsmokers can get COPD too.
• A long-term exposure to irritants that
damage your lungs and airways: Pipe,
Cigar, other types of Tobacco Smoke and
Inhaled Irritants
INCUBATION PERIOD
It takes several years for COPD to develop. Most
people are at least 40 years old when symptoms
of COPD first appear.
COMMUNICABILITY PERIOD
COPD is a progressive disease. It is not
contagious.
MODE OF TRANSMISSION
All forms of COPD, including emphysema and
chronic bronchitis, stem from airborne irritants
that are inhaled.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Shortness of breath
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•
•
•
•
•
•
•
•
Wheezing
Chest tightness
A chronic cough that may produce mucus
Frequent respiratory infections
Lack of energy
Unintended weight loss
Swelling in ankles, feet or legs
People with COPD are also likely to
experience
episodes
called
exacerbations, during which their
symptoms become worse than the usual
day-to-day variation and persist for at
least several days.
NURSING CONSIDERATION
• Assess patient’s exposure to risk factors.
• Assess the patient’s past and present
medical history.
• Assess the signs and symptoms of COPD
and their severity.
• Assess the patient’s knowledge of the
disease.
• Assess the patient’s vital signs.
• Assess breath sounds and pattern.
TREATMENT
• Quit Smoking
• Medications: Bronchodilators, Inhaled
steroids, Oral Steroid, Combination
Inhalers, Phosphodiesterase-4 inhibitors,
Theophylline, Antibiotics
• Lung Therapies: Oxygen Therapy, and
Pulmonary Rehabilitation Program
• In-home Noninvasive Ventilation
Therapy
• Managing Exacerbations
• Surgery: Lung Volume Reduction
Surgery,
Lung
Transplant
and,
Bullectomy
PREVENTION
• Never smoke/Stop smoking
• Use respiratory protective equipment
• Get an annual flu vaccination
• Get a regular vaccination against
pneumococcal pneumonia
• Talk to your doctor
COMPLICATION
• Respiratory Infection: Catch colds, flu
and pneumonia.
• Heart Problems
• Lungs cancer
• High blood pressure in lung arteries
• Depression
CANCER
Cancer is a complex group of diseases with
many possible causes. Diseases in which
abnormal cells divide out of control and invades
other tissues. Cancer cells can spread to other
parts of the body through the blood and lymph
systems. There are more than 100 different
types of cancer.
ETIOLOGY
Cancer is caused by changes (mutations) to the
DNA within cells.
Mutation makes the cell to stop its normal
function and may allow a cell to become
cancerous. Mutation causes the healthy cells to:
• Allow rapid growth
• Fail to stop uncontrolled cell growth
• Make mistakes when repairing DNA
errors
TYPES OF CANCERS
Carcinomas
Begins in the skin or the tissue that covers the
surface of internal organs and glands. They are
the most common type of cancer.
•
Examples: prostate cancer, breast
cancer, lung cancer, and colorectal
cancer.
Sarcomas
Begins in the tissues that support and connect
the body. A sarcoma can develop in fat,
muscles, nerves, tendons, joints, blood vessels,
lymph vessels, cartilage, or bone.
Leukemias
Leukemia is a cancer of the blood. Leukemia
begins when healthy blood cells change and
grow uncontrollably.
4 main types of leukemia:
1.
2.
3.
4.
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
Acute myeloid leukemia
Chronic myeloid leukemia
Lymphomas
Lymphoma is a cancer that begins in the
lymphatic system. The lymphatic system is a
network of vessels and glands that help fight
infection.
2 main types of lymphomas:
77 | P a g e
1. Hodgkin lymphoma
2. Non-Hodgkin lymphoma
STAGES OF CANCER
Stage 0
This stage describes cancer in situ, which means
“in place”. This stage is often highly curable,
usually by removing the entire tumor with
surgery.
Stage I
This stage is usually a small cancer or tumor that
has not grown deeply into nearby tissues. It also
has not spread to the lymph nodes or other
parts of the body. It is often called early-stage
cancer.
Stage II and Stage III
In general, these 2 stages indicate larger
cancers or tumors that have grown more deeply
into nearby tissue. They may have also spread
to lymph nodes but not to other parts of the
body.
Stage IV
This stage means that the cancer has spread to
other organs or parts of the body. It may also
be called advanced or metastatic cancer
ETIOLOGIC FACTORS/ CAUSES:
• Tobacco use Alcohol use
• Overweight and obesity
• Dietary factors, including insufficient fruit
and vegetable intake
• Physical inactivity
• Genetic or inherited cancers
• Hormonal changes
• Chronic infections from Helicobacter
pylori, Hepatitis B Virus (HBV), Hepatitis
C Virus (HCV) and some types of Human
Papilloma Virus (HPV)
• Environmental and occupational risks
including ionizing and non-ionizing
radiation
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
• Fatigue
• Lump or area of thickening that can be
felt under the skin
• Weight changes, including unintended
loss or gain
• Skin changes, such as yellowing,
darkening or redness of the skin, sores
•
•
•
•
•
•
•
•
that won't heal, or changes to existing
moles
Changes in bowel or bladder habits
Persistent cough or trouble breathing
Difficulty swallowing
Hoarseness
Persistent indigestion or discomfort after
eating
Persistent, unexplained muscle or joint
pain
Persistent, unexplained fevers or night
sweats
Unexplained bleeding or bruising
NURSING CONSIDERATION
• Maintaining Tissue Integrity
• Promoting Nutrition
• Relieving Pain
• Decreasing Fatigue
• Improving Body Image and Self-esteem
• Monitoring and Managing Potential
Complications
• Promoting Home and Community-Based
Care
TREATMENT
• Surgery
• Chemotherapy
• Radiation Therapy
• Hormone Therapy
• Immunotheraphy
• Precision Medicine
• Stem Cell Therapy
• Targeted Therapy
• Bone marrow transplant
PREVENTION
• Practice abstinence
• Stop smoking
• Avoid excessive sun exposure
• Eat a healthy diet
• Exercise most days of the week
• Maintain a healthy weight
• Drink alcohol in moderation, if you
choose to drink
• Schedule cancer screening exams
COMPLICATION
• Pain
• Fatigue
• Difficulty breathing
• Nausea
• Diarrhea or constipation.
• Weight loss
• Chemical changes in your body
78 | P a g e
•
•
•
•
Brain and nervous system problems
Unusual immune system reactions to
cancer
Cancer that spreads
Cancer that returns
DIABETES
Diabetes is a chronic disease that occurs either
when the pancreas does not produce enough
insulin or when the body cannot effectively use
the insulin it produces. (WHO, 2021). Unlike
most diseases, it is non-contagious but pose
serious danger when not properly diagnosed
and untreated.
Main Types
1. Diabetes Insipidus
1.1
Central
1.2
Nephrogenic
1.3
Dipsogenic
1.4
Gestational
2. Diabetes Mellitus
2.1 Type 1
2.2 Type 2
2.3 Gestational
ETIOLOGY
1. Diabetes Insipidus - Caused by ADH
(vasopressin) deficiency that leads to
excessive urination of dilute urine.
1.1
Central - Caused by damage
in the pituitary gland or
hypothalamus.
1.2
Nephrogenic - Caused by
genetic defects that damages
the kidney that leads to
unresponsive mechanism to
ADH.
1.3
Dipsogenic - Caused by
dysfunction of the thirst
mechanism
in
the
hypothalamus.
1.4
Gestational - Caused by ADH
being destroyed by the
enzyme in the placenta
during pregnancy.
2. Diabetes Mellitus - Caused by inability to
produce insulin or properly use it, leading to
hyperglycemia.
2.1
Type 1
2.1.1 Type 1A - Caused by
autoimmune
destruction
of
beta cells.
2.1.2 Type 1B - Caused by
beta cell destruction
without evidence
of autoimmunity.
2.2
Type 2 - The type both caused
by beta cell dysfunction
(inability to sense the need for
insulin) and insulin resistance.
79 | P a g e
2.3
Gestational - Caused by
glucose intolerance during
pregnancy, usually 24th to
28th week.
NURSING ASSESSMENT (SIGNS &
SYMPTOMS)
1. Polydipsia
- characterized by excessive
thirst caused by the excretion of excess
glucose that the kidney is not able to
absorb- such excretion drags along fluids
from the tissues that makes you
dehydrated.
2. Cardiovascular symptoms
- characterized by pain or
pressure in the chest.
3. Fatigue
- characterized by sudden low
energy and physical activity due to
blood sugar fluctuations, medications,
and even psychological effects like stress
on weight gain.
4. Weight loss/weight gain
- A person with diabetes can
undergo weight loss or gain depending
on body regulations for the disease.
Weight loss occurs when the body is
unable to acquire glucose from the blood
to be used by cells for energy- turning on
to fats as an alternative source. This puts
the body into ketosis. On the other
hand, weight gain occurs when insulin
therapy is done to a patient.
5. Paresthesia
- characterized by painful
tingling and numbness that occurs
when impairment to the peripheral
system is happening due to diabetes.
6. Polyuria
- characterized by increased
frequency of urination that may lead
to risk for dehydration to the patient.
7. Dizziness
- is a secondary symptom caused
by polyuria, when dehydration induces
light-headedness.
8. Prolonged wound healing
- is the most commonly seen
symptom of diabetic patients that occurs
when high blood glucose stiffens the
arteries and narrows the blood
vessels, impairing body function to heal
wounds in specific areas like limbs.
9. Hyperglycemia
- characterized as high blood
sugar caused by food and low physical
activity as well as non-compliance to
glucose-lowering medication.
10. Sweating
- In most cases, sweating occurs
to potential diabetics due to blood
sugar drop.
11. Polyphagia
- characterized by increased
hunger that is triggered by loss of
glucose in the urine, thus craving for
more intake of glucose is seen.
12. Visual changes
- characterized by blurry vision
that is caused by impairments to the
small vessels in the eye, which may
aggravate to complications such as
cataract, or even blindness.
NURSING CONSIDERATION
1. Monitor fasting plasma glucose level
(FPG) and glucose tolerance (OGTT) for
patients at risk for diabetes.
2. Monitor mental health and cognitive
impairment in older patients diagnosed
with diabetes.
3. Parent-child understanding of the
disease and its complications should be
supervised to allow proper transition of
care, and allow autonomy as the child
matures.
4. Pregnant mothers should be checked for
early identification of GDM.
TREATMENT
1. Dietary Management
- Therapy of food intake fall on
both lean and obese diabetic patients to
manage weight loss/gain, achievement
of appropriate fat component levels, and
prevention of complications.
- Type 1 diabetes is managed by
adjusting insulin amount
and
ensuring consistency of the amount
and kind of food to be given. Home
glucose monitoring is also advised.
- Type 2 diabetes is managed by
significance of weight loss program,
and optimal lipid levels.
- GDM is commonly managed
through fruits and vegetables and
moderation on lean protein and
healthy fats.
2. Oral Anti-Diabetic Agents
- Oral medications such as
Sulfonylureas,
Repaglinide,
and
Nateglinides which fall into the beta cell
stimulator agents; Biguanides, αglucosidase
inhibitors,
and
80 | P a g e
Thiazolidinediones are some of the
approved anti-diabetic agents by the US
FDA.
- Insulin therapy is also used to
manage people with Type 1 diabetes
since they are deficient from it.
3. Exercise
- Helps in weight loss and
improvement of body function.
4. Insulin
- Insulin therapy is needed to
regulate the need by intake of
manufactured
insulin
that
is
differentiated by three types: short
acting (lasts 5 to 8 hrs), intermediate
acting (lasts for 12 to 16 hrs), and long
acting (lasts for 24 hrs).
- Insulin regimen can fall into
MDI (Multiple Daily Injection) which
uses long-acting and intermediate acting
insulin to maintain basal insulin levels;
and CSII (Continuous subcutaneous
infusion of insulin) that is administrated
through a pump method and delivery of
amounts of insulin is regulated by the
pump.
5. Pancreas or Islet Cell Transportation
- A surgical procedure not
guaranteed to give a lifesaving
result, but may open a potential for
improvement in the quality of life.
Complications of this procedure are due
to effects of immunosuppressive drug
that may impair cells.
PREVENTION
1. Healthy and Age-appropriate Diet
2. Exercise
3. Monitoring weight
4. Adequate hydration
5. Enough rest and sleep
6. Avoid smoking
COMPLICATION
1. Retinopathy
- Development of cataract and
loss of visual acuity.
2. Urinary Retention and Infection
- Frequent urination allows
bacteria to easily accumulate in
areas where urine is not excreted fully.
This may lead to injury to the kidney or
bladder, and may further lead to septic
shock.
3. Hearing Impairment
- Damage to blood vessels of
the inner ear due to prolonged high
blood glucose level.
4. Hypoglycemia
- Acute complication that results
due intake of insulin.
5. Skin and Foot Lesions
- Can cause loss of sensation
and high risk for infection. This is
aggravated by the impaired wound
healing of the disease.
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BSN 2B:
Ana Domini Tulang
Andrea Balcos
Ann Mariz Dominguez
April Masongsong
Aubrey Mia Chu
Beatrix Madeline Tanquion
Carlyle Fleur Quijada
Christian Kent Baclayo
Cleinstein Clark Baptista
Denise Gullem
Dixie Louise Sanchez
Eula Marie Victoria Orate
Evans Jake Dacut
Glee Marie Ocaya
Jastine Nicole Sabornido
Jella Erica Thea Gulfan
Jiesther May Sabuga
Joannah Mharie Parajes
Joshua Del Valle
Joyce Dalagan
Junelito Oga, Jr.
Karla Trizzia Duldulao
Karyl Clarisse Bautista
Kin Narita Sepala
Kint Manlangit
Kristiane Danielle Alenton
Lailane Mae Lagmay
Leah Andrada
Lea Marie Khristine Santos
Mark Albert Pepito
Mary Claire Rosales
Maria Isabel Casiño
Povey Rouse Franz Estrada
Rheanelyn Arquilos
Richie Marie Baja
Rogelen May Gauran
Sheila Mae Grace Garduque
Sheila Mae Solis
Teffany Mae Salapang
Xyra Keith Verganio
Fitzgeraldine Madula
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