Communicable Diseases
What does communicable disease mean?
A disease that can be transmitted from one person to another
Definitions
Epidemic- disease that spreads rapidly
Endemic- a continued incidence of a disease in a certain environment or area
Pandemic- high incidence of a disease in a large area (can be worldwide)
Infectious Agent- causes disease
Incubation period- a period of time between the invasion of organism and onset of symptoms
Prodromal period- 1st stage of disease
Carrier- one who carries the disease
Host- provides nourishment 9ex. Tick feeds off mammals
Fomites- contaminated objects (bedrails, toys)
Mode of Transmission
Direct Contact- touch infected person
Indirect contact- touching contaminated surface
Droplet- cough, sneeze, flu
Airborne- chicken pox
Fecal-oral (contaminated food/water)
Vector- (tick) animal or insect that spreads disease
Host Resistance
Intact Skin
Phagocytes
Immune system
Transmission of Disease
Causative Agent
Immune Host
Conducive Environment
Immunity
Natural Immunity (Innate)- naturally exists without a response, protected by chemical/physical
barriers
Active Immunity- naturally or artificially acquired
Naturally acquired- obtain the disease
Artificially Acquired- immunization
Passive Immunity- injection of antibodies
Immune globulin, gamma globulin (artificially acquired passive immunity)
Naturally Acquired passive immunity
Neonates received antibodies from the mother
Contracting Disease
How do we get infection?
Must have a portal of entry- cut in the skin, mouth, eyes, ears, nose, etc.
Some organisms can pass through unbroken skin
Childhood Prevention
How do we help prevent childhood diseases?
Immunizations
Route of administration: oral, subcutaneous, and IM
Can prevent the disease
Use correct storage
Contraindications for Immunizations with live virus:
Immunocomprimised, steroid therapy
Pregnancy
Bacteremia, Acute illness with or without fever
Meningitis
History of high fevers or severe reaction after previous immunization
2 month old
15 month old
4-6 years
Allergies to Vaccines
MMR, IPV, varicella- ask if allergic to Neomycin
MMR- report allergy to eggs, gelatin
Recombinant hepatitis B- ask if allergic to baker’s yeast
Have Epi on hand in case of reaction
Vaccines
Do not give a TB test within 6 weeks of MMR or varicella vaccine, will give a false reading
Give varicella and MMR the same day. If given MMR, must give varicella within 28 days
Inform female clients to refrain from getting pregnant for 3 months after receiving Rubella
vaccine.
Nursing Responsibilities
Reduce pain at injection site- use sprays or creams to numb the area prior to the injection
Give injection properly
Vaccine Reactions
Mild fever- use Tylenol or Motrin
Irritable
Redness and tenderness at the site
Severe Reaction
High pitched cry, consistent high fever (104), seizures, increased sleep, unresponsive
Rashes
First sign of infection
Erythema- redness
Macule- reddened circular area
Papule- raised reddened circular area
Vesicle- raised reddened circular area that contains fluid
Pustule- raised reddened circular area that contains pus
Salmonella Infection
Transmission- Bacteria from mishandled raw poultry, can obtain from reptiles and pets
Causes: gastroenteritis, meningitis, osteomyelitis
Gastroenteritis is most common
Symptoms start about 12-72 hours after infected and last 3-7 days
Symptoms: NVD , cramping and fever
Will resolve within a week in a healthy child
Dx: stool specimen and history and physical
Treatment: antibiotics, hydration
Shigellosis
Bacteria ingested by fecal/oral route
Symptoms can occur as early as 2-4 days after infection, but can take up to a week. Last for
several days-weeks.
Symptoms: Fever, N/V, severe diarrhea with blood/mucous stools, stomach cramps
Dx: Stool specimen, Hx
Treated: antibiotics, fluids
Shigellosis and Salmonella
Decrease solid food intake
Clear fluids, fruit juice, jello
Avoid carbonated drinks/caffeinated drinks
Encourage pedialyte
Meningococcal Meningitis
Patho: infection of the covering of the brain and spine (meninges)
Enters the body indirectly into the blood stream- teeth, sinuses, tonsils, lungs, ears, skull
fx.
Bacteria attacks the meninges once in the blood stream
Blood brain barrier broken
Symptoms
Under 3 months old- fever, vomiting, decreased fluid intake, irritable, lethargic
Children 1 yr and older- headache, fever, nausea, vomiting, light sensitivity, neck
stiffness or neck pain, seizures
Brudzinkski’s sign- involuntary flexion of the arm, hip, knee when neck is
passively flexed
Kernig’s sign- inability to completely extend the leg out when the thigh is flexed
to the abdomen when in a seated or supine position
Dx: spinal fluid is cloudy, has increased WBC’s/protein, decreased glucose, increased CSF
pressure
Treatment: antibiotics, fluids, isolation 24 hours after antibiotics is started, seizure meds
Nursing Care: decrease stimuli, dim lit room, decrease noise, use soft voice/touch(seizures)
Report STAT- slowed pulse rate, irregular respirations, and increased blood pressure
(Increased ICP)
Fever: give antipyretics, sponge bath, hypothermia mattress
Observe for slight change in LOC and for twitching, observe for joint pain
If patient has a seizure, maintain patent airway. Remove any sharp objects. Observe
seizure.
Prevention: teach family to wash hands, may need to take prophylactic antibiotics if not fully
vaccinated for Hib
Diphtheria
Patho: bacteria causes toxins, destroys the myelin sheath which causes improper function of the
nervous system
Toxins produce a pseudomembrane (false membrane) in the throat
Incubation: 2-5 days
Symptoms: upper respiratory infection with sore throat, fever, fatigue, “bull neck” in severe
cases, fast heart rate
Spreads by direct contact or breathing in secretions from infected person
Eradicated in developed countries due to vaccines
Treatment: diphtheria antitoxins given, antibiotics, bed rest, hydration, adequate diet
Nursing care: Isolate patient, watch for difficulty breathing, eating and swallowing
Pertussis
Whooping cough- starts as a mild respiratory infection, the cough develops with an inspiratory
whoop (high pitched crowing) sound
Infected person starts to have coughing fits that can cause vomiting and appears person
cannot catch their breath.
Incubation: 2 days
Spread by airborne discharges from the mucous membranes and direct contact
Treatment: antibiotic shortness illness time period, bed rest, adequate fluid/nutrition intake, IV
therapy, IV therapy, O2, maintain patent airway
Tetanus
Neurotoxin (most deadly toxin) lives in dead tissue, soil, and intestinal tract of cows and horses
Patho: neurotoxin enters the body through a wound, cut or bloodstream
Incubation: 3-21 days
Symptoms: Irritability, headache, spasms to the muscles causing lockjaw, eventually every
muscle is affected.
Treatment: Maintain airway, antitoxin as prescribed ASAP, may need to be sedated and
ventilated.
Prevention: Cleansing and debridement of the wound, booster shot of tetanus toxoid if
previously immunized, tetanus immune globulin for those not immunized.
Who would be at high risk and need to be given a tetanus shot? Burn victims, accident victims,
children
Typhoid Fever
Patho: contaminated food or water with feces of infected person, the bacteria invades the
macrophages and becomes resistant to the immune response. Spreads through the lymph
system and the organs
Incubation: lasts up to 60 days
Symptoms: High fever (104.0), non-bloody diarrhea, profuse sweating, gastroenteritis
Diagnosis: blood test, bone marrow, or stool cultures
Treated: antibiotics
Most cases are nonfatal
Nursing Care: sponge bath for fever, hand washing a must, do not allow infected person to
handle food others will eat, hydration
Measles (Rubeola)
Caused by a virus, spread airborne through the respiratory system by cough, nose, or mouth of
infected person
Incubation: 7-14 days
Symptoms: fever, cough, conjunctivitis, Koplik’s spots which appear before the rash,
photophobia
Dx: Koplik’s spots, blood work
Koplik’s spots are found on the mucosa, they are red with blue/white center
1-2 days after spots in mouth rash appears first on the face (macule-papules) red/blotchy
appearance
Complications
Diarrhea
Pneumonia
Encephalitis
Death (higher- underdeveloped countries)
Nursing Considerations
Bed rest, isolation, antipyretics, calamine lotion, dispose of contaminated tissues
properly, teach that the skin will shed (desquamation) after the rash starts fading
Prevention: immunization at age 12-15 months
Rubella (German measles)
Rubella- viral disease, very contagious
Spreads by droplet
Incubation: 12-23 days
Symptoms: mild upper respiratory infection, lymph nodes enlarged, fine red maculopapular
rash, arthralgia
Treatment: no special treatment, will last about 2-3 days
Chicken Pox (Varicella)
Patho: highly contagious viral infection, caused by herpes virus (varicella)
Starts as macules---papules---vesicles
Vesicles have clear liquid inside, break and become crusted
Transmission- contact and droplet
Dx: physical exam and culture of vesicles
Incubation: 2-3 weeks, followed by fever, headache, malaise
Lasts for a few days t weeks
Symptoms: pruritic vesicular eruptions on the skin, usually on the back and chest, arms, neck,
face.
Treatment: bed rest, antipyretics, calamine lotion, antihistamines
Mumps
Viral diseases- swelling of the salivary (parotid) glands
Incidence- higher in the winter and early spring
Virus lives in the saliva 6 days prior t glands swelling and 9 days after swelling
Transmission: direct contact, droplet
Diagnosis- symptoms, antibody tests
Symptoms- enlarge neck from salivary glands swelling, painful, headache, low grade fever
Treatment: isolation, antipyretics, analgesics, hydration, may need IV therapy if client can’t
swallow
Complications:
Sterility in men- orchitis (inflammation of the testicles)
Meningitis
Hearing loss
Inflammation of the ovaries, does not affect sterility
Rabies (hydrophobia)
Virus found in wild animals that effects the central nervous system
Transmission: spread by saliva, usually from a bite, can obtain by infected blood or tissue
Animals: skunks, bats, dogs, raccoons, squirrels, fox
After a bite, the virus travels through the nerve pathway and then to organs
Incubation: 10 days up to 1 year
Symptoms: fever, malaise, headache, paresthesia, myalgia
If not treated early will lead to encephalitis, paralysis, coma, death
Most cases are not fatal
No treatment if virus reaches the nervous system
Cleanse wounds, take immune globulin (given the day of exposure, day 3,7,14,28, 90)
Prevention: get animals vaccinated for rabies and don’t touch wild animals
Infectious Mononucleosis (Kissing Disease)
Patho: infection of the Epstein-Barr Virus
Incubation: up to 8 weeks and spread through saliva
Dx: blood work shows large irregular nuclei and symptoms
Symptoms:
Fever
Fatigue
Weight Loss
Pharyngeal Inflammation
Petechiae
Lymphadenopathy, spleenomegaly
Treatment: rest and relief of symptoms
Contact sports and strenuous activity should be avoided for one month
Fifth Disease (erythema infectiosum)
Caused by erythrovirus
Bright red cheeks, rash to arms and legs
Rash lasts for a few days to a couple weeks
Treatment: none
Rocky Mountain spotted fever (bacteria)
Patho: caused by (Rickettsia rickettsii)
Ticks obtain the disease while feeding on a host and pass it while feeding on a host. Male ticks
transfer the disease to female ticks
Rash occurs 2-5 days after the onset of fever
Sixth day after symptoms a petechial rash will occur on the palms and soles of the feet.
Vectors: American dog tick, Rocky Mountain wood tick
Early Symptoms:
Fever
N/v
Severe headache and muscle pain
Late Symptoms
Abdominal pain
Joint pain
Maculopapular rash
Petechial rash
Treatment
Doxycycline- antibiotic immediately or can be deadly
Hydration, rest
Malaria
Patho: vector-borne disease with protozoan parasites
Infected mosquito transmits by feeding on host
Theses parasites replicate in the red blood cells
Mostly common in South and Central America, Africa, and Asia
Symptoms:
Anemia, tachycardia, SOB
Fever
Chills
Nausea
No vaccine
Antimalarials- Aralen is drug of choice
Prevention: wear insect repellant, use of netting, get rid of swamp areas
Drug resistant protozoa is a concern
Pinworms (Enterobiasis)
Look like white thread and lives in the intestines, comes out of anus at night to lay eggs.
Spread within large groups. Children ingest the eggs into their mouth.
Notice child scratching rectum, irritable, weight loss, restless at night, vaginitis in girls
Dx: Scotch Tape test
Treatment: Anthelmintics
Vermox- single dose, chewable tablet (pregnant women shouldn’t take)
Povan- single dose, teach parents that it turns stools red and will stain clothing
Nursing considerations:
Teach children to wash their hands
Keep nails trimmed
Soothing ointment applied to rectum
Roundworms (Ascariasis) (Trichinella)
Live well in warm climates
Caused by unsanitary disposal of human waste and poor hygiene
Patho: eggs turn into larvae in the intestines, enter into the liver, circulate to the lungs/heart
No symptoms until larvae gets into the glottis
Eggs live a long time in the soil
Children play outside and touch this contaminated soil
Chronic cough and fever
Diagnosis by stool specimen
Treatment is the same as for Pinworms
Syphilis
Patho: caused by a spirochete, transmitted by sexual contact
Can be transmitted by saliva or bodily fluids
Incubation: 20-30 days
Spreads through the blood and lymphatic system
Clinical Stages:
Primary
Painless ulcer (chancre) at the inoculation site
Regional lymph nodes swollen
Highly infectious
Chancre appears abut 3-4 weeks after contact
Secondary
From 2 weeks- 6 months skin rash will appear after chancre has resolved
Flu-like symptoms
Alopecia
General lymphadenopathy
Will disappear in 2-6 weeks
Latent
Can last up to 50 years
No symptoms
Unable to transmit disease
Tertiary
2 different forms
Benign Late syphilis- localized infiltrating tumors in skin, bones, and liver
Diffuse inflammatory response- involvement of the nervous system
Both can be treated
Diffuse response- cardiovascular and nervous system damage is irreversible
Diagnostic Test
VDRL and RPR- positive in 4-6 weeks
FTA-ABS- confirm VDRL, RPR
Treatment
PCN-G intramuscular
If allergic to PCN, oral doxycycline given
Teach client prevention measures
Tests for other STD’s needed
Congenital Syphilis
Transferred to the fetus via placenta
Gonorrhea
Known as “clap”
Most common communicable disease
Patho: Neisseria gonorrhoeae- gram negative bacteria
Incubation: 2-8 days
Transmission: sexual contact and delivery of neonates
Cervix and male urethra are targeted, disease will spread to other organs
Males- inflammation of prostate, epididymis, and periurethral glands
Women- PID, endometritis, salpingites (fallopian tubes), and pelvic peritionitis
Symptoms:
Males
No symptoms
Dysuria
Serous to purulent urethral damage
Regional lymphadenopathy
Females
No symptoms
Dysuria
Urinary frequency
Abnormal vaginal discharge
Diagnostic Tests
Men- smear of urethral discharge
Women- culture of cervical discharge
Treatment starts before culture results obtained
Teach:
Abstain from sexual contact
Both client and partners are to be treated
Use condoms for future sexual contact
Follow up 4-7 days for recheck at the MD’s office
Treatment: Penicillin
Genital Herpes
45 million people in the US have contracted genital herpes
Cause: herpes simplex virus type 2
Herpes simples virus type 1---cold sores
High in teens and young adults
Symptoms go unnoticed or has no symptoms
Patho: the virus spreads through sexual contact
Incubation: 3-7 days
Week after exposure: painful red papules appear in the genital area
Papules form blisters (clear fluid filled)
Blisters break, shed virus-become ulcers
Ulcers last up t 6 weeks or longer
Autoinoculation- if you touch the ulcers they can spread to anywhere on the body
First episode infection- first outbreak
Subsequent outbreaks- recurrent infections
Latency- period between outbreaks, lays dormant in the nerve fibers
Prodromal symptoms of outbreaks (warning signs)
Burning
Itching
Tingling
Throbbing at common lesion area
Pain radiation to the legs, thighs, groin or buttocks
Can infect others during the prodromal symptoms
Can transmit at birth
Higher risk for cervical cancer in women
Rare- herpes encephalitis, life threatening
No cure
Dx: symptoms, H/P
Prevent spread of disease- abstinence or condoms
Relieve symptoms
Treatment
Antivirals- acyclovir (Zovirax), famciclovir (Famvir)
Acyclovir can be given IV, PO, or topical cream
Valtrex given PO
Creams accelerates healing time
PO meds minimizes the number of outbreaks
Nosocomial Infections
What is a Nosocomial infection?
Hospital acquired
2 million patients are affected each year
Most common site: UTI’s
Invasive procedures
More than 2 million clients a year obtain a Nosocomial infection
About 4-6% nationally affected ****
Centers for Disease Control and prevention monitors nosocomial infection rates
Risk factors:
Chronic diseases- AIDS, Renal, DM
Morbid obesity
Major surgery
Invasive procedures
Burns length of hospital stay
Very young, very old
Invasive procedures
Prosthetic devices
History of frequent antibiotic use
Infections in other sites
Burns
Length of hospital
Sites for Nosocomial Infections
Urinary due to catheterization or urological procedures
UTI’s number one nosocomial infection
Surgical wounds- staph aureus
Respiratory tract
Bloodstream
Prevention
Hand washing is the #1 way to prevent transmission of nosocomial infection
Wash hands before and after putting gloves on
Autoclaving- ensures destruction of all pathogens
Hospitals/Facilities- policies and procedures for infection control issues
Pathogens
Escherichia Coli- in the gut/intestines
Staphylococcus Aureus- in nose, on skin
Group A streptococci- starts in the throat or skin then further disease to lung, blood
Enterococcus- lives in feces- UTI’s, Bacteremia, wound infections
Staphylococcal infection
Toxins can live in food and on dry surfaces
Food poison- improper storage of food
Wound infections- contact precautions
Toxic shock syndrome- blood stream
MRSA- resistive staph, contact precautions
Infections
When barriers are broken, the host becomes susceptible to infection of staph
Treatment:
Bed rest
Analgesics
Antibiotics
Surgical Incision and Drainage
MRSA
Methicillin Resistant Staphylococcus aureus
Staph that is resistant to the treatment of Methicillin (broad spectrum antibiotics)
Exist in the hospital and community
Carriers have colonized bacteria in their nose
Cause:
Staph lives in the nose and on skin (colonized in healthy people)
Colonized people can show no symptoms but can spread the disease
Bacteria enters the body through cut, wound
Occurs in older patients and immunocompromised
We are responsible for the resistant staph antibiotic resistance
Using too many antibiotics
Livestock are being fed antibiotics
Germ mutation, drug companies can’t keep up
Risk factors:
Children- immune system not fully developed
Participating in contact sports
Sharing towels, equipment
Weakened immune system
Living in crowded areas/unsanitary
Healthcare workers
Recent hospitalization- surgical wounds, long inpatient stay, older adults, weak immune
system
Long term care facilities
Recent antibiotic use
Invasive devices- feeding tubes, catheters, etc.
Healthcare workers transmit with their hands
Lives on hands for more than 3 hours
New resistant strains:
VRSA- vancomycin resistant S. aureus
VISA- intermediate- vancomycin- intermediate s. aureus
Symptoms
Skin infections- small, red bumps that look like a pimple
Pimples can turn into deep, painful infection (surgical drainage)
Can penetrate into the body causing life threatening infections (bone, bloodstream,
heart valves, etc.)
Diagnostic test: culture of wounds or nares
Treatment- Vancomycin IV
Adverse reactions- kidney and hearing damage, red man syndrome, petechial
hemorrhages
Red Man syndrome- red face, flushed, rash to face neck, upper torso (infuse slowly)
Prevention
Wash hands
Use alcohol based sanitizer
Use sterile technique and aseptic technique
Don’t share personal items
Take all antibiotics as prescribed
Shower after contact sports or working out at a gym
Tuberculosis
Organism- Mycobacterium bacteria
Diagnostic test- sputum culture, TB test, or CXR
Symptoms: prolonged productive cough, hemoptysis (blood stained sputum), fever, chills, night
sweats
Transmission: cough/speak/sneeze (airborne)
Site of infection: Lung most common, can spread to other organs
Diagnostics: Mantoux test, CXR, sputum culture (5mm of induration Mantoux test +)
Treatment: rifampicin, isoniazid, 6-12 months for treatment
Prevention: immunization for children, isolation of client, teach client to cover nose/mouth
when sneezing and coughing
Streptococcal Infection
Strep Throat
Streptococcal bacterial infection to the pharynx, sometimes to the pharynx, sometimes the
larynx and tonsils
Transmission: close contact
Incubation: 2-5 days
Signs and Symptoms
Severe sore throat
Fever
Yellow/white patches in the back of the throat
Difficulty swallowing
Dx: Rapid strep test or culture
Treatment
Ibuprofen or Tylenol for fever
No aspirin for kids
Oral or IM penicillin
Complications
Scarlet fever
Fever- rash 12-48 hours after fever
Strawberry red tongue
Sore throat
Dx: blood work, throat culture may + for strep
Treatment: same as strep
Acute rheumatic fever- heart disease
Glomerulonephritis- kidney failure, antibodies against Strep lodge in the kidney
Hepatitis A
Patho: liver inflammation from the Hepatitis A virus
Most common of the three: A, B, C
1 in 3 people in the US have been exposed, have the antibody, did not get sick
Virus found in infected person’s stool
Transmission: improper hand washing and handling of food
Symptoms: N/V/D, low grade fever, jaundice, urine dark brown color
Dx: antibody test, liver function test
Treatment: no treatment, will resolve. If exposed may take immune globulin
Hepatitis B
Patho: inflammation of the liver by the Hepatitis B virus
350,000 in the US are chronic carriers
250,000 die each year
Blood borne virus, exchange of body fluids
Dx: liver function test, blood test
Treatment: hydration, anti-viral, Interferon
Infection Control
Prevention of the spread of organisms
Aseptic technique during procedures
Standard precautions
Hand washing
Urinary bags below the bladder at all times
Encourage to turn, deep breathe, and cough
Tier 1 Universal Precautions
Tier 2 Transmission based precautions
Airborne precautions
Measles
Varicella
Tuberculosis
Droplet precautions
Meningitis
Pneumonia
Epiglottitis
Sepsis
Diphtheria
Pertussis
Mumps
Rubella
Contact precautions
MRSA
E Coli
Shigellosis
Hep A
RSV
Herpes
Isolation Principles
Touches floor- clean it or get a new one
Items brought into isolation must stay in the room
Don’t touch your face or eyes when in a room
Hand washing
Keep water pitcher and cups in the room
Immunizations (per Peds book)
2 months- Dtap , Hib, IPV, Pneumococcal, Hep B
15 months- Hep B, DTap, Hib, IPV, MMR, Varicella, PCV, Influenza, Hep A
4-6 years- Dtap, IPV, MMR, MpSV4 , PPV, Influenza, Hep A
Dtap- Diphtheria, Pertussis, Tetanus
Hib- Influenza group b
IPV- polio
MMR- Measles, mumps, rubella
Varicella- chicken pox
PCV- pneumonia carinii
MPSV4- meningitis