5 Communicable Disease Nursing
I. EPI DISEASES
DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Tuberculosis
Other names:Koch’s Disease ConsumptionPhthisisWeak lungs
Mycobacterium tuberculosis
TB bacillusKoch’s bacillusMycobacterium bovis
(rod-shaped)
Airborne-droplet
Direct invasion through mucous membranes and breaks in the skin (very rare)
Incubation period : 4 – 6 weeks
1. Usually asymptomatic 2. Low-grade afternoon
fever3. Night sweating4. Loss of appetite5. Weight loss6. Easy fatigability – due
to increased oxygen demand
7. Temporary amenorrhea8. Productive dry cough9. Hemoptysis
Diagnostic test: Sputum examination or the Acid-fast bacilli
(AFB) / sputum microscopy1. Confirmatory test2. Early morning sputum about 3-5 cc3. Maintain NPO before collecting sputum4. Give oral care after the procedure5. Label and immediately send to laboratory6. If the time of the collection of the sputum is
unknown, discard Chest X-ray is used to:
1. Determine the clinical activity of TB, whether it is inactive (in control) or active (ongoing)
2. To determine the size of the lesion:a. Minimal – very smallb. Moderately advance – lesion is < 4 cmc. Far advance – lesion is > 4 cm
Tuberculin Test – purpose is to determine the history of exposure to tuberculosisOther names:Mantoux Test – used for single screening, result interpreted after 72 hoursTine test – used for mass screening read after 48 hoursInterpretation:0 - 4 mm induration – not significant5 mm or more – significant in individuals who are considered at risk; positive for patients who are HIV-positive or have HIV risk factors and are of unknown HIV status, those who are close contacts with an active case, and those who have chest x-ray results consistent with tuberculosis.10 mm or greater – significant in individuals who have normal or mildly impaired immunity
Respiratory precautions Cover the mouth and
nose when sneezing to avoid mode of transmission
Give BCGBCG is ideally given at birth, then at school entrance. If given at 12 months, perform tuberculin testing (PPD), give BCG if negative.
Improve social conditions
TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS; Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)
CATEGORY 1: 6 months SCCIndications:> new (+) smear> (-) smear PTB with extensive parenchymal lesions on CXR> Extrapulmonary TB> severe concominant HIV diseaseIntensive Phase: 2 monthsR&I : 1 tab each; P&E 2 tabs eachContinuation Phase: 4 monthsR&I : 1 tab each
CATEGORY 2: 8 months SCCIndications:> treatment failure> relapse> return after default
Intensive Phase:3 mosR&I 1 tab each; P&E 2 tabs eachStreptomycin – 1 vial/day IM for first 2 months = 56 vials (if given for > 2mos can cause nephrotoxicity
Continuation Phase: 5 monthsR&I : 1 tab eachE : 2 tabs
CATEGORY 3: 6 months SCCIndications:> new (-) smear PTB with minimal lesions on CXRSame meds with Category 1Intensive Phase: 2 monthsR&I 1 tab each; P&E 2 tabs eachContinuation Phase: 4 monthsR&I 1 tab each
CATEGORY 4: Chronic (*Referral needed)
SIDE EFFECTS:Rifampicin body fluid
discoloration hepatotoxic permanent
discoloration of contact lenses
Isoniazid Peripheral neuropathy(Give Vit B6/Pyridoxine)
Pyrazinamide hyperuricemia /gouty arthritis (increase fluid intake)
SIDE EFFECTS:Ethambutol Optic neuritis Blurring of vision(Not to be givento children below 6 y.o. due to inability to complain blurring of vision) Inability to recognize
green from blueStreptomycin Damage to 8th CN Ototoxic Tinnitus nephrotoxic
Most hazardous period for development of clinical disease is the first 6-12 months after infectionHighest risk of developing disease is children under 3years old
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NATIONAL TB CONTROL PROGRAM:Vision: A country where TB is no longer a public health problemMission: Ensure that TB DOTS Services are available, accessible, and affordable to the communities in collaboration with LGUs and othersGoal: To reduce prevalence and mortality from TB by half by the year 2015 (Millennium Development Goal)Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered 2. Detect at least 70% new sputum smear (+) TB casesObjectives: 1. Improve access to and quality of services 2. Enhance stakeholder’s health-seeking behavior 3. Increase and sustain support for TB control activities 4. Strengthen management of TB control activities at all levelsKEY POLICIES:*Case finding:- DSSM shall be the primary diagnostic tool in NTP case finding- No TB Dx shall be made based on CXR results alone- All TB symptomatic shall be asked to undergo DSSM before treatment- Only contraindication for sputum collection is hemoptysis- PTB symptomatic shall be asked to undergo other tests (CXR and culture), only after three sputum specimens yield negative results in DSSM- Only trained med techs / microscopists shall perform DSSM- Passive case finding shall be implemented in all health stations
*Treatment: Domiciliary treatment – preferred mode of care DSSM – basis for treatment of all TB cases*Hospitalization is recommended: massive hemoptysis, pleural effusion, military TB, TB meningitis, TB pneumonia, & surgery is needed or with complications*All patients undergoing treatment shall be supervised*National & LGUs shall ensure provision of drugs to all smear (+) TB cases*Quality of fixed-dose combination (FDC) must be ensured*Treatment shall be based on recommended category of treatment regimen
DOTS Strategy – internationally-recommended TB control strategyFive Elements of DOTS: (RUSAS)Recording & reporting system enabling outcome assessment of all patientsUninterrupted supply of quality-assured drugsStandardized SCC for all TB casesAccess to quality-assured sputum microscopySustained political commitment
sMANAGEMENT OF CHILDREN WITH TUBERCULOSIS
Prevention: BCG immunization to all infants (EPI)
Casefinding: - cases of TB in children are reported and identified in 2 instances: (a) patient was screened and was found symptomatic of TB after consultaion (b) patient was reported to have been exposed to an adult TB patient - ALL TB symptomatic children 0-9 y.o, EXCEPT sputum positive child shall be subjected to Tuberculin testing (Note: Only a trained PHN or main health center midwife shall do tuberculin testing and reading which shall be conducted once a week either on a Monday or Tuesday. Ten children shall be gathered for testing to avoid wastage.
- Criteria to be TB symptomatic (any three of the following:) * cough/wheezing of 2 weeks or more * unexplained fever of 2 weeks or more * loss of appetite/loss of weight/failure to gain weight/weight faltering * failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection * failure to regain previous state of health 2 weeks after a viral infection or exanthem (e.g. measles)
-Conditions confirming TB diagnosis (any 3 of the following:) * (+) history of exposure to an adult/adolescent TB case * (+) signs and symptoms suggestive of TB * (+) tuberculin test * abnormal CXR suggestive of TB * Lab findings suggestive or indicative of TB
- for children with exposure to TB* a child w/ exposure to a TB registered adult patient shall undergo physical exam and tuberculin testing* a child with productive cough shall be referred for sputum exam, for (+) sputum smear child, start treatment immediately* TB asymptomatic but (+) tuberculin test and TB symptomatic but (-) tuberculin test shall be referred for CXR examination
- for TB symptomatic children*a TB symptomatic child with either known or unknown exposure to a TB case shall be referred for tuberculin testing* (+) contact but (-) tuberculin test and unknown contact but (+) tuberculin test shall be referred for CXR examination*(-) CXR, repeat tuberculin test after 3 months* INH chemoprophylaxis for three months shall be given to children less than 5y.o. with (-) CXR; after which tuberculin test shall be repeated
Treatment (Child with TB):Short course regimenPULMONARY TBIntensive: 3 anti-TB drugs (R.I.P.) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 4 months
EXTRA-PULMONARY TBIntensive: 4 anti-TB drugs (RIP&E/S) for 2 monthsContinuation: 2 anti-TB drugs (R&I) for 10 months
PERIOD OF COMMUNICABILITY OF TUBERCULOSIS:
as long as bacillus is contained in the sputum
Primary complex in children is NOT contagious
Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment
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2. Diphtheria
Types:> nasal> pharyngeal – most common> laryngeal – most fatal due to proximity to epiglottis
Corynebacterium diphtheria
Klebbs-loffler
***Diphtheria transmission is increased in hospitals, households, schools, and other crowded areas.
Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions
Milk has served as a vehicle
Incubation Period:2 – 5 days
Pseudomembrane – mycelia of the oral mucosa causing formation of white membrane on the oropharynx
Bull neckDysphagiaDyspnea
Diagnostic test: Nose/throat swab Moloney’s test – a test for hypersensitivity to
diphtheria toxin Schick’s test – determines susceptibility to
bacteriaDrug-of-Choice:Erythromycin 20,000 - 100,000 units IM once only
Complication: MYOCARDITIS (Encourage bed rest)
Plan nursing care to improve respiration.
DPT immunizationPasteurization of milkEducation of parents
***Infants born to immune mothers maybe protected up to 6-9 months. Recovery from clinical attack is always followed by a lasting immunity to the disease.
3. Pertussis
Whooping coughTusperinaNo day cough
Bordetella pertussisHemophilus pertussisBordet-gengou bacillusPertussis bacillus
Droplet especially from laryngeal and bronchial secretions
Incubation Period: 7 – 10 days but not exceeding 21 days
Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting
Complication: abdominal hernia
Diagnostic:
Bordet-gengou agar test
Management:1. DOC: Erythromycin or Penicillin 20,000 -
100,000 units2. Complete bed rest3. Avoid pollutants4. Abdominal binder to prevent abdominal hernia
DPT immunizationBooster: 2 years and 4-5 yearsPatient should be segregated until after 3 weeks from the appearance of paroxysmal cough
4. Tetanus
Other names:Lock jaw
Clostridium tetani – anaerobic spore-forming heat-resistant and lives in soil or intestine
Neonate: umbilical cordChildren: dental cariesAdult: punctured wound; after septic abortion
Indirect contact – inanimate objects, soil, street dust, animal and human feces, punctured wound
Incubation Period:Varies from 3 days to 1 month, falling between 7 – 14 days
Risus sardonicus (Latin: “devil smile”) – facial spasm; sardonic grin
Opisthotonus – arching of back
For newborn:1. Difficulty of sucking2. Excessive crying3. Stiffness of jaw4. Body malaise
No specific test, only a history of punctured wound
Treatment:Antitoxin antitetanus serum (ATS)tetanus immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses)Pen GDiazepam – for muscle spasms
Note: The nurse can give fluid provided that the patient is able to swallow. There is risk of aspiration. Check first for the gag reflex
DPT immunizationTetanus toxoid (artificial
active) immunization among pregnant women
Training and Licensing of midwives/”hilots”
Health education of mothers
Puncture wounds are best cleaned by thorough washing with soap and water.
Incidence: highest under 7 years of ageMortality: highest among infants (<6 months)One attack confers definite and prolonged immunity. Second attack occasionally occurs
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5. Poliomyelitis
Other name:Infantile paralysis
Legio debilitansPolio virusEnterovirus
Attacks the anterior horn of the neuron, motor is affectedMan is the only reservoir
Fecal – oral route
Incubation period: 7 – 21 days
ParalysisMuscular weaknessUncoordinated body movementHoyne’s sign – head lag after 4 months
(!Safety)
Diagnostic test:
CSF analysis / lumbar tap Pandy’s test
Management:Rehabilitation involves ROM exercises
OPV vaccinationFrequent hand washing
6. Measles Other names:MorbilliRubeola
RNA containing paramyxovirus
Period of Communicability:4 days before and 5 days after the appearance of rash
Droplet secretions from nose and throat
Incubation period: 10 days – fever14 days – rashes appear(8-13 days)
1. Koplik’s spots – whitish/bluish pinpoint patches on the buccal cavity2. cephalocaudal appearance of maculopapular rashes3. Stimson’s line – bilateral red line on the lower conjunctiva
No specific diagnostic test
Management:Supportive and symptomatic
Measles vaccineDisinfection of soiled articlesIsolation of cased from diagnosis until about 5-7 days after onset of rash
7. Hepatitis B
Other names:Serum Hepatitis
Hepatitis B virus Blood and body fluidsPlacenta
Incubation period: 45 – 100 days
1. Right-sided Abdominal pain
2. Jaundice3. Yellow-colored sclera4. Anorexia5. Nausea and vomiting6. Joint and Muscle pain7. Steatorrhea8. Dark-colored urine9. Low grade fever
Diagnostic test:
Hepatitis B surface agglutination (HBSAg) test
Management:> Hepatitis B Immunoglobulin
Diet: high in carbohydrates
-Hepatitis B immunization-Wear protected clothing-Hand washing-Observe safe-sex-Sterilize instruments used in minor surgical-dental procedures-Screening of blood products for transfusion
Hepatitis A – infectious hepatitis; oral-fecalHepatitis B – serum hepatitis; blood and body fluidsHepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluidsHepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis BHepatitis E – oral-fecal
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II. DISEASES TRANSMITTED THROUGH FOOD AND WATER
DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Cholera
Other names:El tor
Vibrio choleraVibrio comaOgawa and Inaba bacteria
Fecal-oral route
5 Fs
Incubation Period:Few hours to 5 days; usually 3 days
Rice watery stool
Period of Communicability:7-14 days after onset, occasionally 2-3 months
Diagnostic Test:Stool cultureTreatment:Oral rehydration solution (ORESOL)IVFDrug-of-Choice: tetracycline (use straw; can cause staining of teeth). Oral tetracycline should be administered with meals or after milk.
Proper handwashingProper food and water sanitationImmunization of Chole-vac
2. Amoebic Dysentery
Entamoeba histolytica
Protozoan (slipper-shaped body)
Fecal-oral route Abdominal cramping Bloody mucoid stool Tenesmus - feeling of
incomplete defecation (Wikipedia)
Treatment:
Metronidazole (Flagyl)* Avoid alcohol because of its Antabuse effect can cause vomiting
Proper handwashingProper food and water sanitation
3. Shigellosis
Other names:Bacillary dysentery
Shigella bacillus
Sh-dysenterae – most infectious Sh-flesneri – common in the PhilippinesSh-conneiSh-boydii
Fecal-oral route
5 Fs: Finger, Foods, Feces, Flies, Fomites
Incubation Period:1 day, usually less than 4 days
Abdominal cramping Bloody mucoid stool Tenesmus - feeling of
incomplete defecation (Wikipedia)
Drug-of-Choice: Co-trimoxazole
Diet: Low fiber, plenty of fluids, easily digestible foods
Proper handwashingProper food and water sanitationFly control
4. Typhoid fever Salmonella typhosa (plural, typhi)
Fecal-oral route
5 Fs
Incubation Period:Usual range 1 to 3 weeks, average 2 weeks
Rose Spots in the abdomen – due to bleeding caused by perforation of the Peyer’s patches
Ladderlike fever
Diagnostic Test:Typhi dot – confirmatory test; specimen is fecesWidal’s test – agglutination of the patient’s serum
Drug-of-Choice: Chloramphenicol
Proper handwashingProper food and water sanitation
5. Hepatitis A
Other names:Infectious Hepatitis /
Hepatitis A Virus Fecal-oral route
5 Fs
Incubation Period:
Fever Anorexia (early sign) Headache Jaundice (late sign) Clay-colored stool
Prophylaxis: “IM” injection of gamma globulinHepatitis A vaccineHepatitis immunoglobulinAvoid alcoholComplete bed rest – to reduce the breakdown of fats
Proper handwashingProper food and water sanitationProper disposal of urine and feces
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Epidemic Hepatitis /Catarrhal Jaundice
15-50 days, depending on dose, average 20-30 days
Lymphadenopathy for metabolic needs of liverLow-fat diet; increase carbohydrates (high in sugar)
In convalescent period, patient may have difficulty with maintaining a sense of well-being.
Separate and proper cleaning of articles used by patient
6. Paralytic Shellfish Poisoning (PSP I Red tide poisoning)
Dinoflagellates
Phytoplankton
Ingestion of raw of inadequately cooked seafood usually bivalve mollusks during red tide season
Incubation Period:30 minutes to several hours after ingestion
Numbness of face especially around the mouth
Vomiting and dizziness Headache Tingling
sensation/paresthesia and eventful paralysis of hands
Floating sensation and weakness
Rapid pulse Dysphonia Dysphagia Total muscle paralysis
leading to respiratory arrest and death
Treatment:1. No definite treatment2. Induce vomiting3. Drink pure coconut milk – weakens the
toxic effect4. Sodium bicarbonate solution (25 grams in ½
glass of water)Advised only in the early stage of illness because paralysis can lead to aspiration
NOTE: Persons who survived the first 12 hours after ingestion have a greater chance of survival.
1. Avoid eating shellfish such as tahong, talaba, halaan, kabiya, abaniko during red tide season
2. Don’t mix vinegar to shellfish it will increase toxic effect 15 times greater
ROBERT C. REÑA, BSN
Death from diarrhea is usually due to dehydration.
Food recall is the basis for the diagnosis of food poisoning.
III. SEXUALLY TRANSMITTED DISEASES
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DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Syphilis
Other names:SyBad BloodThe poxLues venerealMorbus gallicus
Treponema pallidum(a spirochete)
Incubation Period:10 to 90 days (3 months); average of 21 days
Direct contactTransplacental (after 16th week AOG)Through blood transfusionIndirect contact with contaminated articles
Primary stage (4-6 weeks): painless chancre at site of entry of germ with serous exudates
Tertiary stage (one to 35 years) : Gumma, syphilitic endocarditis and meningitis
Diagnostic test:Dark field illumination testFluorescent treponemal antibody absorption test – most reliable and sensitive diagnostic test for Syphilis; serologic test for syphilis which involves antibody detection by microscopic flocculation of the antigen suspensionVDRL slide test, CSF analysis, Kalm test, Wasseman test
Treatment:Drug of Choice: Penicillin (Tetracycline if resistant to Penicillin)
AbstinenceBe faithfulCondom
2. Gonorrhea
Other names:GC, Clap, Drip,Stain, Gleet,Flores Blancas
Neiserria gonorrheae Direct contact – genitals, anus, mouth
Incubation Period:2 – 10 days
Thick purulent yellowish dischargeBurning sensation upon urination / dysuria
Diagnostic test:Culture of urethral and cervical smearGram staining
Treatment:Drug of Choice: Penicillin
Abstinence, Be faithfulCondom
Prevention of gonococcal ophthalmia is done through the prophylactic use of ophthalmic preparations with erythromycin or tetracycline
3. Trichomoniasis
Other names:VaginitisTrich
Trichomonas vaginalis Direct contact
Incubation Period:4 – 20 days; average of 7 days
Females:white or greenish-yellow odorous dischargevaginal itching and sorenesspainful urinationMales:Slight itching of penisPainful urinationClear discharge from penis
Diagnostic Test:Culture
Treatment:Drug of Choice: Metronidazole (Flagyl)
AbstinenceBe faithfulCondom
Personal Hygiene
4. Chlamydia Chlamydia trachomatis(a rickettsia)
Direct contact
Incubation Period:
Females:AsymptomaticDyspareunia
Diagnostic Test:Culture
AbstinenceBe faithfulCondom
Primary and secondary sores will go even without treatment but the germs continue to spread throughout the body. Latent syphilis may continue 5 to 20+ years with NO symptoms, but the person is NO longer infectious to other people. A pregnant mother can transmit the disease to her unborn child (congenital syphilis).
Secondary syphilis (6-8 weeks: generalized rashes, generalized tender discrete lymphadenopathy, mucus patches, flu-like symptoms, condylomata, patchy alopecia
Latent stage (one to two to 50 years): non-infectious
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2 to 3 weeks for males; usually no symptoms for females
Fishy vaginal discharge
Males:Burning sensation during urinationBurning and itching of urethral opening (urethritis)
Treatment:Drug of Choice: Tetracycline
5. Candidiasis
Other names:MoniliasisCandidosis
Candida albicans Direct contact White, cheese-like vaginal dischargesCurd like secretions
Diagnostic Test:CultureGram staining
Treatment:Nystatin for oral thrushCotrimazole, fluconazole for mucous membrane and vaginal infectionFluconazole or amphotericin for systemic infection
AbstinenceBe faithfulCondom
6. Acquired immune deficiency syndrome (AIDS)
Retrovirus (Human T-cell lymphotrophic virus 3 or HTLV 3)
Attacks the T4 cells: T-helper cells; T-lymphocytes, and CD4 lymphocytes
The major route of HIV transmission to adolescent is SEXUAL TRANSMISSION.
French kissing brings low risk of HIV transmission.
Direct contactBlood and body fluidsTransplacental
Incubation period:3-6 months to 8-10 years
Variable. Although the time from infection to the development of detectable antibodies is generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed range of less than 1 year to 15 years or longer.
1. Window Phasea. initial infectionb. lasts 4 weeks to 6 monthsc. not observed by present laboratory test (test should be repeated after 6 months)
2. Acute Primary HIV Infectiona. short, symptomatic periodb. flu-like symptomsc. ideal time to undergo screening test (ELISA)
3. Asymptomatic HIV Infectiona. with antibodies against HIV but not protectiveb. lasts for 1-20 years
Diagnostic tests:Enzyme-Linked Immuno-Sorbent Assay (ELISA)
- presumptive testWestern Blot – confirmatory
Treatment:1. Treatment of opportunistic infection2. Nutritional rehabilitation3. AZT (Zidovudine) – retards the replication
of retrovirus; must be taken exactly as ordered
4. PK 1614 – mutagen
Major signs of Pediatric AIDS: Chronic diarrhea > 1 month Prolonged fever > 1 month Weight loss or abnormally slow growth
Breastmilk is important in preventing intercurrent infection in HIV infected infants and children.
The care of HIV patients is similar to the routine
AbstinenceBe faithfulCondom
Sterilize needles, syringes, and instruments used for cutting operations
Proper screening of blood donors
Rigid examination of blood and other blood products
Avoid oral, anal contact and swallowing of semen
Avoid promiscuous sexual contact
Avoid sharing of toothbrushes.
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(PHN Book) depending upon factors
4. ARC (AIDS Related Complex)a. a group of symptoms indicating the disease is likely to progress to AIDSb. fever of unknown originc. night sweatsd. chronic intermittent diarrheae. lymphadenopathyf. 10% body weight loss
5. AIDSa. manifestation of severe immunosuppressionb. CD4 Count: <200/dLc. presence of variety of infections at one time:
oral candidiasisleukoplakiaAIDS dementia complexAcute encephalopathyDiarrhea, hepatitisAnorectal diseaseCytomegalovirusPneumonocystis carinii pneumonia (fungal)TBKaposi’s sarcoma (skin cancer; bilateral purplish patches)Herpes simplexPseudomonas infectionBlindnessDeafness
care given to cases of other diseases.
Not everybody is in danger of becoming infected with HIV through sex.
Never give live attenuated (weakened) vaccines e.g. oral polio vaccine.
HIV positive pregnant women and their partner must be informed of the potential risk to the fetus.
HIV/AIDS Prevention and Control Program:
Goal: Contain the transmission of HIV /AIDS and other reproductive tract infections and mitigate their impact
LECTURE DISCUSSION – best method to use in teaching about safe sex
Priority intervention when caring for AIDS patient:Use disposable gloves when in contact with non-intact skin.
IV. ERUPTIVE DISEASES
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DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Chickenpox
Other names:Varicella
Human (alpha) herpes virus 3 (varicella-zoster virus), a member of the Herpesvirus group
Period of Communicability:From as early as 1 to 2 days before the rashes appear until the lesions have crusted.
Droplet spread
Direct contact
Indirect through articles freshly soiled by discharges of infected persons
Incubation Period:2-3 weeks, commonly 13 to 17 days
Vesiculo-pustular rashes
Centrifugal appearance of rashes – rashes which begin on the trunk and spread peripherally and more abundant on covered body parts
Pruritus
No specific diagnostic examTreatment is supportive.
Drug-of-choice:Acyclovir / Zovirax ® (orally to reduce the number of lesions; topically to lessen the pruritus)
NEVER give ASPIRIN. Aspirin when given to children with viral infection may lead to development of REYE’S SYNDROME.
Nursing Diagnoses:Disturbance in body imageImpairment of skin integrity
Case over 15 years of age should be investigated to eliminate possibility of smallpox. Report to local authorityIsolationConcurrent disinfection of throat and nose dischargesExclusion from school for 1 week after eruption first appearsAvoid contact with susceptibles
2. German Measles
Other Names:RubellaThree-day Measles
Rubella virus or RNA-containing Togavirus (Pseudoparamyxovirus)
German measles is teratogenic infection, can cause congenital heart disease and congenital cataract.
Droplet
Incubation Period:Three (3) days
Forscheimer spots – red pinpoint patches on the oral cavity
Maculopapular rashesHeadacheLow-grade feverSore throatEnlargement of posterior cervical and postauricular lymph nodes
Diagnostic Test:Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella.
Instruct the mother to avoid pregnancy for three months after receiving MMR vaccine.
MMR is given at 15 months of age and is given intramuscularly.
MMR vaccine (live attenuated virus)- Derived from chick
embryoContraindication:- Allergy to eggs- If necessary, given in
divided or fractionated doses and epinephrine should be at the bedside.
3. Herpes Zoster
Other names:ShinglesCold sores
Herpes zoster virus(dormant varicella zoster virus)
DropletDirect contact from secretion
Painful vesiculo-pustular lesions on limited portion of the body (trunk and shoulder)
Low-grade fever
Treatment is supportive and symptomatic
Acyclovir to lessen the pain
Avoidance of mode of transmission
4. Dengue Hemorrhagic Fever
Other names:
Dengue virus 1, 2, 3, and 4 and Chikungunya virus
Types 1 and 2 are common in the
Bite of infected mosquito (Aedes Aegypti) - characterized by black and white stripes
Classification (WHO):
Grade I:a. flu-like symptomsb. Herman’s sign
Diagnostic Test:
Torniquet test (Rumpel Leads Test / capillary fragility test) – PRESUMPTIVE; positive when 20 or more oetechiae per 2.5 cm square or 1 inch
4 o’clock habit
Chemically treated mosquito netLarva eating fish
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H-fever Philippines
Period of communicability: Unknown. Presumed to be on the 1st week of illness up to when the virus is still present in the blood
Occurrence is sporadic throughout the year
Epidemic usually occur during the rainy seasons (June to November)
Peak months: September and October
Daytime bitingLow flyingStagnant clear waterUrban
Incubation Period:Uncertain. Probably 6 days to 1 week
Manifestations:
First 4 days: Febrile/Invasive Stage- starts abruptly as fever- abdominal pain- headache- vomiting- conjunctival infection-epistaxis
4th – 7th days: Toxic/Hemorrhagic Stage- decrease in temperature- severe abdominal pain- GIT bleeding- unstable BP (narrowed pulse pressure)- shock- death may occur
7th – 10th days:Recovery/Convalescent Stage- appetite regained- BP stable
c. (+) tourniquet sign
Grade II:a. manifestations of Grade I plus spontaneous bleedingb. e.g. petechiae, ecchymosis purpura, gum bleeding, hematemesis, melena
Grade III:a. manifestations of Grade II plus beginning of circulatory failureb. hypotension, tachycardia, tachypnea
Grade IV:a. manifestations of Grade III plus shock (Dengue Shock Syndome)
square are observed
Platelet count – CONFIRMATORY; (Normal is 150 - 400 x 103 / mL)
Treatment:Supportive and symptomaticParacetamol for feverAnalgesic for pain
Rapid replacement of body fluids – most important treatment
ORESOL
Blood tansfusion
Diet: low-fat, low-fiber, non-irritating, non-carbonated. Noodle soup may be given. ADCF (Avoid Dark-Colored Foods)
ALERT! No Aspirin
Environmental sanitationAntimosquito soapNeem tree (eucalyptus)
Eliminate vector
Avoid too many hanging clothes inside the house
Residual spraying with insecticide
Daytime fumigation
Use of mosquito repellants
Wear long sleeves, pants, and socks
For the control of H-fever, knowledge of the natural history of the disease is important.
Environmental control is the most appropriate primary prevention approach and control of H-fever.
V. VECTOR-BORNE DISEASES
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DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Malaria Plasmodium Parasites:VivaxFalciparum (most fatal; most common in the Philippines)OvaleMalariae
-attacks the red blood cells
Bite of infected anopheles mosquito
Night time bitingHigh-flyingRural areasClear running water
Cold Stage: severe, recurrent chills (30 minutes to 2 hours)
Hot Stage: fever (4-6 hours)
Wet Stage: Profuse sweating
Episodes of chills, fevers, and profuse sweating are associated with rupture of the red blood cells. - intermittent chills and sweating- anemia / pallor- tea-colored urine- malaise- hepatomegaly- splenomegaly- abdominal pain and enlargement- easy fatigability
NURSING CARE:1. TSB (Hot Stage)2. Keep patent warm (Cold Stage)3. Change wet clothing (Wet Stage)4. Encourage fluid intake5. Avoid drafts
Early Diagnosis and Prompt TreatmentEarly diagnosis – identification of a patient with malaria as soon as he is seen through clinical and/or microscopic methodClinical method – based on signs and symptoms of the patient and the history of his having visited a malaria-endemic areaMicroscopic method – based on the examination of the blood smear of patient through microscope (done by the medical technologist)
QBC/quantitative Buffy Coat – fastestMalarial Smear – best time to get the specimen is at height of fever because the microorganisms are very active and easily identified
ChemoprophylaxisOnly chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering the endemic area). In pregnant women, it is given throughout the duration of pregnancy.
Treatment:Blood Schizonticides - drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations
1. QUININE – oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism – quinine toxicity
2. CHLOROQUINE3. PRIMAQUINE – sometimes can also be
given as chemoprophylaxis4. FANSIDAR – combination of
pyrimethamine and sulfadoxine
*CLEAN Technique *Insecticide – treatment of mosquito net*House Spraying (night time fumigation)*On Stream Seeding – construction of bio-ponds for fish propagation (2-4 fishes/m2 for immediate impact; 200-400/ha. for a delayed effect)*On Stream Clearing – cutting of vegetation overhanging along stream banks
*Avoid outdoor night activities (9pm – 3am)*Wearing of clothing that covers arms and legs in the evening*Use mosquito repellents*Zooprophylaxis – typing of domestic animals like the carabao, cow, etc near human dwellings to deviate mosquito bites from man to these animals
Intensive IEC campaign
2. Filariasis Wuchereria bancrofti Brugia malayi
Bite of Aedes poecillus (primarily)
Asymptomatic Stage:Presence of microfilariae
DiagnosisPhysical examination, history taking, observation
CLEAN Technique
17 Communicable Disease Nursing
Other names:Elephantiasis
Endemic in 45 out of 78 provinces
Highest prevalence rates: Regions 5, 8, 11 and CARAGA
Brugia timori
– nematode parasites
Aedes flavivostris (secondary)
Incubation period:8 – 16 months
in the blood but no clinical signs and symptoms of disease
Acute Stage:LymphadenitisLymphangitisAffectation of male genitalia
Chronic Stage: (10-15 years from onset of first attack)HydroceleLymphedemaElephantiasis
of major and minor signs and symptoms
Laboratory examinationsNocturnal Blood Examination (NBE) – blood are taken from the patient at his residence or in hospital after 8:00 pmImmunochromatographic Test (ICT) – rapid assessment method; an antigen test that can be done at daytime
Treatment:Drug-of-Choice: Diethylcarbamazine Citrate (DEC) or Hetrazan
Use of mosquito repellentsAnytime fumigationWear a long sleeves, pants and socks
3. Shistosomiasis
Other Names:Snail FeverBilharziasis
Endemic in 10 regions and 24 provinces
High prevalence: Regions 5, 8, 11
Schistosoma mansoniS. haematobiumS. japonicum (endemic in the Philippines)
Contact with the infected freshwater with cercaria and penetrates the skin
Vector: Oncomelania Quadrasi
DiarrheaBloody stools (on and off dysentery)Enlargement of abdomenSplenomegalyHepatomegalyAnemia / pallorweakness
Diagnostic Test:COPT or cercum ova precipitin test (stool exam)
Treatment:Drug-of-Choice: PRAZIQUANTEL (Biltracide)
Oxamniquine for S. mansoniMetrifonate for S. haematobium
*Death is often due to hepatic complication
Dispose the feces properly not reaching body of waterUse molluscidesPrevent exposure to contaminated water (e.g. use rubber boots)Apply 70% alcohol immediately to skin to kill surface cercariaeAllow water to stand 48-72 hours before use
ROBERT C. REÑA, BSNREFERENCES:
THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION
DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov
VI. DISEASES TRANSMITTED BY ANIMALS
18 Communicable Disease Nursing
DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Leptospirosis
Other Names:- Weil’s Disease- Mud Fever- Trench Fever- Flood Fever- Spirochetal Jaundice- Japanese Seven Days fever
Leptospira interrogans – bacterial spirochete
RAT is the main host. Although pig, cattle, rabbits, hare, skunk, and other wild animals can also serve as reservoir
Occupational disease affecting veterinarians, miners, farmers, sewer workers, abattoir workers, etc
Through contact of the skin, especially open wounds with water, moist soil or vegetation infected with urine of the infected host
Incubation Period:7-19 days, average of 10 days
Leptospiremic Phase- leptospires are present in blood and CSF- onset of symptoms is abrupt- fever- headache- myalgia- nausea- vomiting- cough- chest pain
Immune Phase- correlates with the appearance of circulating IgM
DiagnosisClinical manifestationsCulture of organismExamination of blood and CSF during the first week of illness and urine after the 10th dayLeptospira agglutination test
Treatment:Penicillins and other related B-lactam antibioticsTetracycline (Doxycycline)Erythromycin
Most common complication: kidney failure
Protective clothing, boots and gloves
Eradication of ratsSegregation of
domestic animalsAwareness and early
diagnosisImproved education of
peopleAvoid wading or
swimming in water contaminated with urine of infected animals.
Concurrent disinfection of articles soiled with urine.
2. Rabies
Other Names:LyssaHydrophobiaLe Rage
Rhabdovirus of the genus lyssavirus
Degeneration and necrosis of brain – formation of negri bodies
Two kinds of Rabies:a. Urban or canine – transmitted by dogs
b. Sylvatic – disease of wild animals and bats which sometimes spread to dogs, cats, and livestock
Bite or scratch (very rare) of rabid animal
Non-bite means: leaking, scratch, organ transplant (cornea), inhalation/airborne (bats)Source of infection: saliva of infected animal or human
Incubation period:2 – 8 weeks, can be years depending on severity of wounds, site of wound as distance from brain, amount of virus introduced, and protection provided by
Sense of apprehensionHeadacheFeverSensory change near site of animal biteSpasms of muscles of deglutition on attempts to swallowFear of water/hydrophobiaParalysisDeliriumConvulsions
“FATAL once signs and symptoms appear”
Diagnosis: history of bite of animalculture of brain of rabid animaldemonstration of negri bodies
Management:*Wash wound with soap immediately. Antiseptics e.g. povidone iodine or alcohol may be applied*Antibiotics and anti-tetanus immunization*Post exposure treatment: local wound treatment, active immunization (vaccination) and passive immunization (administration of rabies immunoglobulin)*Consult a veterinarian or trained personnel to observe the pet for 14 days
*Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is often due to respiratory paralysis.
Have pet immunized at 3 months of age and every year thereafter
Never allow pets to roam the streets
Take care of your pet
National Rabies Prevention and Control ProgramGoal: Human rabies is eliminated in the Philippines and the country is declared rabies-free
19 Communicable Disease Nursing
clothing3. Bubonic Plague
Bacteria (Yersinia pestis)
Vector: rat flea
Direct contact with the infected tissues of rodents
Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental Sanitation
VII. DISEASES OF THE SKIN
DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
20 Communicable Disease Nursing
1. Leprosy
Other names:HansenosisHansen’s disease
-an ancient disease and is a leading cause of permanent physical disability among the communicable diseases
Mycobacterium leprae Airborne-droplet
Prolonged skin-to-skin contact
Early signs:Change in skin color – either reddish or whiteLoss of sensation on the skin lesionLoss of sweating and hair growthThickened and painful nervesMuscle weakness or paralysis or extremitiesPin and redness of the eyesNasal obstruction or bleedingUlcers that do not heal
Late Signs:MadarosisLoss of eyebrowsInability to close eyelids (lagophthalmos)Clawing of fingers and toesContracturesChronic ulcersSinking of the nosebridgeEnlargement of the breast (gynecomastia)
Diagnostic Test:Slit Skin Smear - determines the presence of M. leprae; optional and done only if clinical diagnosis is doubtful to prevent misclassification and wrong treatmentLepromin Test – determines susceptibility to leprosy
Treatment:Ambulatory chemotherapy through use of MDTDomiciliary treatment as embodied in RA 4073 which advocates home treatment
PAUCIBACILLARY (tuberculoid and indeterminate); noninfectious typeDuration of treatment: 6 to 9 monthsProcedure: Supervised: Rifampicin and Dapsone once a month on the health center supervised by the rural health midwifeSelf-administered: Dapsone (side effect: itchiness of the skin) everyday at the client’s house
MULTIBACILLARY (lepromatous and borderline); infectious typeDuration of treatment: 24-30 monthsProcedure: Supervised: Rifampicin, Dapsone, and Lamprene (Clofazimine; side effect: dryness or flaking of the skin) once a month on the health center supervised by the rural health midwifeSelf-administered: Dapsone and Lamprene everyday at the client’s house
Avoid prolonged skin-to-skin contact
BCG vaccination – practical and effective preventive measure against leprosy
Good personal hygiene
Adequate nutrition
Health education
Major activity of leprosy control program: casefinding and treatment with effective drugs
Prevent deformities by self-care, exercise, and physical therapy.
2. Anthrax
Other names:Malignant pustuleMalignant edemaWoolsorter
Bacillus anthracis
Incubation period: few hours to 7 days
Contact witha. tissues of animals (cattle, sheep, goats, horses, pigs, etc.) dying of the disease
1. Cutaneous form – most common- itchiness on exposed part - papule on inoculation site- papule to vesicle to eschar- painless lesion
Treatment: Penicillin Proper handwahing
Immunize with cell-free vaccine prepared from culture filtrate containing the protection antigen
MDT Facts:It reduces communicability period of leprosy in 4-6 weeks time.It prevents development of resistance to drugs.It shortens the duration of treatment.
21 Communicable Disease Nursing
diseaseRagpicker diseaseCharbon
most cases occur within 48 hours of exposure
b. biting flies that had partially fed on such animalsc. contaminated hair, wool, hides or products made from them e.g. drums and brushesd. soil associated with infected animals or contaminated bone meal used in gardening
2. Pulmonary form – contracted from inhalation of B. anthracis spores- at onset, resembles common URTI- after 3-5 days, symptoms become acute, with fever, shock, and death
3. Gastrointestinal anthrax – contracted from ingestion of meat from infected animal- violent gastroenteritis- vomiting- bloody stools
Control dust and proper ventilation
3. Scabies Sarcoptes scabiei- An itch mite
parasite
Direct contact with infected individuals
Incubation Period:24 hours
Itching
When secondarily infected:Skin feels hot and burning
When large and severe: fever, headache, and malaise
Diagnosis:Appearance of the lesionIntense itchingFinding of causative mite
Treatment: (limited entirely to the skin)Examine the whole family before undertaking treatmentBenzyl benzoate emulsion (Burroughs, Welcome) – cleaner to use and has more rapid effectKwell ointment
Personal hygieneAvoid playing with dogsLaundry all clothes and ironMaintain the house cleanEnvironmental sanitationEat the right kind of foodRegular changing of clean clothing, beddings and towels
4. Pediculosis
Other name:Phthipiasis
PediculosisCapitis (head lice)Corporis (body lice)Pubis (crab lice)
Direct contact
Common in school age
Itchiness of the scalp Kwell shampoo
One tbsp water + one tbsp vinegar
Proper hygiene
VIII. INTESTINAL PARASITISM
DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Ascariasis Ascaris lumbricoides Fecal-oral route Pot-belliedVoracious eater
Diagnostic Test: Fecalysis Proper handwahing
22 Communicable Disease Nursing
Other names:RoundwormGiant worms
(nematode) 5 Fs: Finger, Foods, Feces, Flies, Fomites
Thin extremities Treatment:Antihelminthic: Mebendazole / Pyrantel Pamoate
2. Taeniasis
Other name:Tape worm
Taenia solium – porkTaenia saginata – beefDyphyllobotruim latum – fish
Eating inadequately cooked pork or beef
5 Fs: Finger, Foods, Feces, Flies, Fomites
Muscle sorenessScleral hemorrhage
Diagnostic Test: Fecalysis
Treatment:Antihelminthic: Mebendazole / Pyrantel Pamoate
Proper handwahing
Cook pork and beef adequately
3. Capillariasis
Other name:Whip worm
Trichuris trichuria
Capillararia Philippinensis
Eating inadequately cooked seafood
5 Fs: Finger, Foods, Feces, Flies, Fomites
Abdominal painDiarrheaborborygmi
Diagnostic Test: Fecalysis
Treatment:Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Cook seafoods adequately
4. Enterobiasis
Other name:Pinworm
Enterobium vermicularis Inhalation of ovaToilet seatInfected bedsheets
5 Fs: Finger, Foods, Feces, Flies, Fomites
Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test
Treatment:Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Proper disinfection of beddings
5. Ancyloclos-tomiasis
Other name:Hookworm
Ancyclostoma duodenal
Necatur americanus
Walking barefooted
5 Fs: Finger, Foods, Feces, Flies, Fomites
Dermatitis
Anemia
Black fishy stool
Diagnostic Test: Fecalysis
Treatment:Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Avoid walking barefooted
ROBERT C. REÑA, BSN
IX. OTHER COMMUNICABLE DISEASES
DISEASE CAUSATIVE AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Pneumonia
Types:a. Community Acquired Pneumonia (CAP)
Bacteria:Pneumococcus, streptococcus pneumoniae, staphylococcus aureus, Klebsiella pneumonia
Droplet
Incubation Period:2 – 3 days
Rusty sputumFever and chillsChest painChest indrawingRhinitis/common coldProductive cough
Diagnosis:Based on signs and symptomsDull percussion on affected lungSputum examination – confirmatory Chest x-ray
Avoid mode of transmission
Build resistance
Turn to sides
23 Communicable Disease Nursing
b. Hospital / Nosocomialc. Atypical
(Friedlander’s bacilli)
Virus:Haemophilus influenzae
Fungi: Pneumonocystis carinii pneumonia
Fast respirationVomiting at timesConvulsions may occurFlushed faceDilated pupilsHighly colored urine with reduced chlorides and increased urates
Management:BedrestAdequate salt, fluid, calorie, and vitamin intakeTepid sponge bath for feverFrequent turning from side to sideAntibiotics based on CARI of the DOH
Oxygen inhalationSuctioningExpectorants / mucolyticsBronchodilatorsOral/IV fluidsCPT
Proper care of influenza cases
2. Mumps
Other name:Epidemic Parotitis
Mumps virus, a member of family Paramyxoviridae
Direct contact
Source of infection:Secretions of mouth and nose
Incubation Period:12 to 26 days, usually 18 days
Painful swelling in front of the ear, angle of the jaws and down the neckFeverMalaiseLoss of appetiteSwelling of one or both testicles (orchitis) in some boys
Supportive and symptomatic
Sedatives – to relieve pain from orchitisCortisone – for inflammation
Diet: Soft or liquid as tolerated
Support the scrotum to avoid orchitis, edema, and atrophy
Dark glasses for photophobia
MMR vaccine
Isolate mumps cases
3. Influenza
Other name:La Grippe
Influenza virus A – most commonB – less severeC – rare
Period of Communicability:Probably limited to 3 days from clinical onset
Direct contactDroplet infection or by articles freshly soiled with nasopharyngeal discharges Airborne
Incubation Period:Short, usually 24 – 72 hours
Sudden onsetFever with chillsHeadacheMyalgia / arthralgia
Supportive and symptomatic
Keep patient warm and free from draftsTSB for feverBoil soiled clothing for 30 minutes before laundering
Avoid use of common towels, glasses, and eating utensilsCover mouth and nose during cough and sneezeImmunization: Flujob/Flushot – effective for 6 months to 1 year
4. Streptococcal sore throat
Other name:Pharyngitis
Group A beta hemolytic streptococcus
Other diseases:Scarlet fever
Droplet
Complication:Rheumatic Heart Disease
Sudden onsetHigh grade fever with chillsEnlarged and tender cervical lymph nodes
Diagnosis:Throat swab and culture
Treatment: erythromycin
Avoid mode of transmission
24 Communicable Disease Nursing
Tonsillitis St. Anthony firePuerperal sepsisImoetigoAcute glomerulonephritisRheumatic Heart Disease
Inflamed tonsils with mucopurulent exudatesHeadachedysphagia
Care:Bed restOral hygiene with oral antiseptic or with saline gargle (1 glass of warm water + 1 tsp rock salt)Ice collar
5. Meningitis
Other name:Cerebrospinal fever
MeningococcusNeisseria meningitides
Direct (Droplet)
Incubation Period:2 - 10 days
A. Sudden Onset- high fever accompanied by chills- sore throat, headache, prostration (collapse)
B. entrance into the bloodstream leading to septicemia (meningococcemia)a. rash, petchiae, purpura
C. Symptoms of menigeal irritation- nuchal rigidity (stiff neck) – earliest sign- Kernig’s sign – when knees are flexed, it cannot be extended- Brudzinski signs – pain on neck flexion with automatoc flexion of the knees- convulsion- poker soine (poker face / flat affect)- Increased ICP (Cushing’s triad: hypertension, bradycardia, bradypnea) and widening pulse pressure
Diagnostic Test:
Lumbar puncture or Lumbar tap - reveals CSF WBC and protein, low glucose; contraindicated for increased ICP for danger of cranial herniation
Hemoculture – to rule out meningococcemia
Treatment:Osmotic diuretic (Mannitol) – to reduce ICP and relieve cerebral edema; Alert: fastdrip to prevent crystallizationAnti-inflammatory (Dexamethasone) – to relieve cerebral edemaAntimicrobial (Penicillin)Anticonvulsany (Diazepam / Valium)
Complications:HydrocephalusDeafness (Refer the child for audiology testing) and mutism Blindness
Respiratory Isolation
IX. KILLER DISEASES OF THE NEW MILLENNIUM
25 Communicable Disease Nursing
DISEASECAUSATIVE
AGENTMODE OF
TRANSMISSIONPATHOGNOMONIC
SIGNMANAGEMENT/TREATMENT PREVENTION
1. Meningococcemia Neisseria meningitides Direct contact with respiratory droplet from nose and throat of infected individuals
Incubation Period:2 – 10 days
High grade fever in the first 24 hoursHemorrhagic rash – petechiaenuchal rigidityKernig’s signBrudzinski signShockDeath
Respiratory isolation within 24 hours
Drug-of-Choice: Penicillin
Universal precaution
Chemoprophylaxis with Rifampicin to protect exposed individual from developing the infection
Proper hand washing
2. Severe Acute Respiratory Syndrome / SARS
Earliest case: Guangdong Province, China in November 2002
Global outbreak: March 12, 2003
First case in the Philippines:April 11, 2003
Coronavirus Close contact with respiratory droplet secretion from patient
Incubation Period:2 – 10 days
Prodromal Phase:Fever (>38 0C)ChillsMalaiseMyalgiaHeadacheInfectivity is none to low
Respiratory Phase:Within 2-7 days, dry nonproductive cough progressing to respiratory distress
No specific treatment
PREVENTIVE MEASURES and CONTROL1. Establishment of triage2. Identification of patient3. Isolation of suspected probable case4. Tracing and monitoring of close contact5. Barrier nursing technique for suspected
and probable case
Utilize personal protective equipment (N95 mask)
Handwashing
Universal PrecautionThe patient wears maskIsolation
3. Bird Flu
Other Name:Avian Flu
Influenza Virus H5N1 Contact with infected birds
Incubation Period:3 days, ranges from 2 – 4 days
FeverBody weakness and body malaiseCoughSore throatDyspneaSore eyes
Control in birds:1. Rapid destruction (culling or stamping out of all infected or exposed birds) proper disposal of carcasses and quarantining and rigorous disinfection of farms2. Restriction of movement of live poultry
In humans:1. Influenza vaccination2. Avoid contact with poultry animals or migratory birds
Isolation techniqueVaccinationProper cooking of poultry
4. Influenza A Influenza Virus A Exposure to droplets - similar to the symptoms Diagnostic: - Cover your nose and
26 Communicable Disease Nursing
(H1N1)
Other Name:Swine Flu
May 21, 2009 – first confirmed case in the Philippines
June 11, 2009 - The WHO raises its Pandemic Alert Level to Phase 6, citing significant transmission of the virus.
H1N1
This new virus was first detected in people in April 2009 in the United States.
Influenza A (H1N1) is fatal to humans
from the cough and sneeze of the infected person
Influenza A (H1N1) is not transmitted by eating thoroughly cooked pork.
The virus is killed by cooking temperatures of 160 F/70 C.
Incubation Period:7 to 10 days
of regular flu such as
Fever Headache Fatigue Lack of appetite Runny nose Sore throat Cough
- Vomiting or nausea- Diarrhea
Nasopharyngeal (throat) swabImmunofluorescent antibody testing – to distinguish influenza A and B
Treatment:Antiviral medications may reduce the severity and duration of symptoms in some cases:Oseltamivir (Tamiflu) or zanamivir
mouth when coughing and sneezing- Always wash hands with soap and water- Use alcohol- based hand sanitizers- Avoid close contact with sick people- Increase your body's resistance- Have at least 8 hours of sleep- Be physically active- Manage your stress- Drink plenty of fluids- Eat nutritious food
ROBERT C. REÑA, BSN
REFERENCES: THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN
CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov