copyright © 2008 delmar. all rights reserved

Copyright © 2008 Delmar. All rights reserved.

Part IV

Provision of Public Health

Nursing to Vulnerable Populations


Chapter 20

Populations with

Infectious and Communicable Disease


3

Contributing Factors

• Institute of Medicine (IOM) 1992 report Emerging Infections: Microbial Threats to Health in the United States – Emerging infectious diseases– Increasingly present infectious diseases– Identified six important factors in disease

emergence and reemergence


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Six Factors

1. Changes in human demographics and behavior

2. Advances in technology and industry3. Economic development; changes in land

use4. Commerce5. Microbial adaptation6. Deterioration in the public health system


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Models of Transmission

• Epidemiological triangle and the chain of transmission– Agent-host-environment

• Agent and reservoir– Biological agents

• Fungi, parasites• Bacteria, viruses


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• Agent and reservoir– Reservoir

• Human, animal, environment


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• Infectivity

• Pathogenicity

• Virulence

• Antigenicity


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• Modes of exit– Respiratory– Gastrointestinal– Urinary and reproductive system

• Mode of entry to a new host is often the same as the mode of exit from the reservoir


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• Modes of transmission (Table 20-1)– Direct person to person– Common vehicle– Vectors


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Types of Host Immunity

• Natural

• Acquired

• Passive

• Active

• Herd


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Levels of Prevention

• Leavell and Clark (1958) Preventive Medicine for the Doctor in His Community

–Three levels of prevention 1. Primary

• Education, immunizations• Chemoprophylaxis, universal precautions• Protective clothing, barrier protection


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Levels of Prevention

• Three levels of prevention 2. Secondary

• Screening• Disease management• Treatment• Directly observed treatment (DOT)

3. Tertiary • Management of complications• Prevention


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Common Infectious and Communicable Diseases

• Foodborne and waterborne disease– Food intoxication

• Shellfish, mushrooms, bacterial growth, mercury

– Food infections• Trichinosis, Salmonellosis• Escherichia coli, Toxoplasmosis• Hepatitis A, Parasites


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Prevention

• Five keys to safer food:1. Keep clean

2. Separate raw and cooked

3. Cook thoroughly

4. Keep food at safe temperatures

5. Use safe water and raw materials


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Vectors

• Disease carriers– Animals, insects, birds

• Malaria

• Anthrax

• Brucellosis

• Mad Cow

• Avian Flu


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Lyme Disease

• Most common vector-borne disease– White-tailed deer– Bull’s-eye skin lesion

• Red spot at the site of bite, followed by spreading rings of inflammation as infection progresses

• Develops 3-30 days after tick bite


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Lyme Disease

• Symptoms– Fatigue– Headache– Fever – Stiff neck, joint pain– Muscle aches – Enlarged tender lymph nodes


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Lyme Disease

• Treatment: 10-14 days of penicillin or tetracycline– Left untreated can progress to Stage II

• Neurological and cardiac symptoms

– Stage III• Months to years of ongoing attacks

– Arthritis and arthralgia


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RockyMountain Spotted Fever

• Vector– Dog and wood ticks

• Atlantic and western south central region


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RockyMountain Spotted Fever

• Occurs 4-6 hours after bite

• Incubation period 3-14 days– Maculopapular rash on extremities, palms of

hands, soles of feet– Antibiotic therapy required


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Malaria

• Vector– Infected mosquito

• Tropical and subtropical area

• Travelers should use mosquito repellent – Use mosquito nets while sleeping– Prophylaxis can begin 4-6 weeks prior to

travel


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Parasitic Diseases

• Tropical climates, underdeveloped countries– Lack of sanitation– Insufficient primary care– Inadequate access to medications


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Parasitic Diseases

• Four groups of organisms:1. Roundworms

2. Tapeworms

3. Flukes

4. Single celled organisms


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Nosocomial Infections

• Acquired in a hospital setting

• May affect anyone who has contact with a hospital– Other patients– Staff– Environment


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Respiratory Infections

• Tuberculosis – Airborne pathogen

• Droplet nuclei


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• Symptoms– Fever, cough, chest pains, fatigue– Hemoptysis, weight loss– Incubation period 4-12 weeks


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• Active cases begin 6-12 months after infection– Extrapulmonary– Multi-drug resistant

• Isoniaid and Rifampin


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• Influenza– Influenzia A, B, or C virus– Occur annually – Last 5-6 weeks


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• Small children and elderly most vulnerable– Flu vaccine 70-90 percent effective

• Pneumonia– Aspiration of virulent and nonvirulent

organisms– Inhalation of toxic fumes– Aspiration of stomach acids


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• Symptoms– Upper respiratory tract infection– Chills, fever, cough– Chest pain and dyspnea

• Treatment– Antibiotics


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Hepatitis

• Hepatitis A– Fecal-oral routes– Vaccine available and provides protection

• Hepatitis B– Blood borne pathogen

• Fatigue and right upper quadrant discomfort• Treat with Interferon and Lamivudine


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Hepatitis

• Hepatitis C– Blood-borne infection – Causes up to 10,000 deaths a year – Interferon, Ribavirin


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HIV

• Destruction of immune system

• Antibody test can confirm diagnosis

• Early detection better prognosis– Elisa – Western Blot

• Treatment– Protease inhibitors, anti-retroviral drugs


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HIV

• Role of public health nurse– Promote prevention of spread of HIV through

education

• Venereal Warts– HPV

• Gardasil


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STDs

• Syphilis

• Gonorrhea– Bacterial disease, purulent discharge with

painful urination– Treatment

• Antibiotics


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Bioterrorism

• Three categories of biological agents:1. Category A highest risk

• Easy spread • Can be transmitted person to person• High death rates• Public panic• Require special action


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Category A

• Anthrax

• Plague

• Smallpox

• Botulinum toxin

• Tularemia

• Hemorrhagic fever


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Category B

2. Category B second highest: – Moderately easy to spread– Moderate illness rates– Low death rates– Require specific enhancements of CDC’s

lab capacity


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Category B

• Q Fever• Brucellosis• Glanders• Melioidosis• Psittacosis

• Ricin toxin• Typhus Fever• Staphylococcal

Enterotoxin B• Viral encephalitis• Food and waterborne

diseases


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Category C

3. Category C third highest priority:– Emerging pathogens– Easily available– Easily produced and spread– Potential for high morbidity and mortality


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Category C

• Napin virus

• Hantaviruses

• Tick-borne encephalitis viruses

• Yellow fever virus

• Multi-drug resistant Mycobacterium tuberculosis


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Managing Bioterrorism

• Plans in place for local response

• State and Federal agencies can assist

• U.S. Department of Homeland Security


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Strategies for Nurses

• Often first to detect presence of illness

• Often manages the communicable disease program for county– Surveillance systems– Nurse conducts case and contact follow up– Communication skills

• Risk communication


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Planning for Pandemic Disease Events

• WHO Global Influenza Preparedness Plan– Inter-pandemic

• Phase I and II

– Pandemic alert • Phase III, IV, V

– Pandemic period• Phase VI

copyright © 2008 delmar. all rights reserved

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