CHN 4

I. Health Education  Patterns of Disease Occurrence and

 Information  provision of knowledge Distribution
 Communication  exchange of information 1.Epidemic  intermittent occurrence of a few
 Education  change in knowledge, attitude and isolated & unrelated cases in a given locality
skills 2.Endemic  continuous occurrence through out
a period of time, of the usual number of cases in
II. DEMOGRAPHY science which deals with the study a given locality
of the human population’s size, composition and 3.Sporadic large number of cases in a relatively
distribution in space short period of time
4.Pandemic  Simultaneous occurrence of
 CensusOfficial and periodic enumeration of the epidemic of the same disease in several
population countries

 Sample Survey Demographic information is  Outline of Plan for Epidemiological

collected from a sample of a given population Investigation
1.Establish fact of presence of epidemic
 Registration SystemsCollected by the civil 2.Establish time and space relationship of a
registrar’s office which deal with the recording of vital disease
events in the community 3.Relation of cases to characteristic of the group
Vital events refer to births, of community
deaths, marriages, divorces and the like 4.Correlation of all data obtained

A. Population Distribution  National Epidemic Sentinel Surveillance

1.Urban- rural Distribution Illustrates the System (NESS) Hospital based information
proportion of the people living in urban compared system that monitors the occurrence of infectious
to the rural areas diseases with outbreak potential.
2.Crowding Index Describes the ease by which a
communicable disease will be transmitted from  Objectives:
one host to another susceptible host 1.Provide early warning on an occurrence of
3.Population density Determine how congested outbreak
a place is and has implications in terms of the 2.Provide program managers, policy makers,
adequacy of basic health services present in the and public administrators information to initiate
community control measures

B. Epidemiology occurrence and distribution of III. Vital Statistics Systematic study of vital events
health conditions such as disease, death, such as birth, illnesses, marriages and death
deformities or disabilities and determinants of
health states in a specific population  Uses
1.Indices of health and illness status of a community
 Uses of Epidemiology 2.Bases for carrying out CHN services and
1.Diagnose health of the community programs
2.Estimate risk of disease, accidents, defects and
chances of avoiding them  Sources of Data
3.Complete clinical picture of chronic disease 1.Population Census
4.Study the history of the health of populations 2.Registration of vital data
3.Health survey
 Epidemiologic Triangle 4.Studies and researches

Host A. RATES and RATIOS

1. Rate relationship between a vital event and
those persons exposed in a given area in a
specified time
2. Ratio relationship between 2 numerical
Agent Environment quantities without consideration to place or time
3. Crude or General Rates total living
population (total pop’n was exposed to risk of
occurrence or event)

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CHN 4

4. Specific Rates measures relationship of IV. Infection  implantation & successful replication of
event for a specific population class or group an organism in the host resulting to signs & symptoms
5. Herd Immunity  basis for determining the as well as immunologic response
community’s reaction against disease invasion; A. Chain of Infection
represents the immunity and susceptibility levels 1.Causative agent  microbe capable of producing
of individuals comprising the population a disease
# of total contacts developing a.Bacteria
a disease with maximum incubation period/ total b.Spirochete
# of susceptible individuals c.Ricketssia
6. CBR natural growth/ increase of the pop’n d.Chlamydia
 live births/ pop as of July 1 x 1,000 e.Fungi
7. CDR mortality form all causes resulting to a f. Protozoa
decrease in pop’n g.parasite
 deaths/ pop as of July 1 x 1, 000 2.Reservoir of Infection  env’t & objects on w/c
8. IMR risk of dying during 1st year of life; good an organism survives and multiplies
index of the general health condition of a a. Human reservoir
community 1)frank cases or very ill
 deaths <1 yo/ livebirths x 1, 000 2)sub-clinical or ambulatory
9. MMRrisk of dying RT pregnancy 3)carriers
 deaths from maternal cause/ live births x 1, a) incubatory carrier  person incubating
000 illness
10. FDR pregnancy wastage b) convalescent person who is at the
 fetal deaths/ livebirths x 1, 000 recovery stage of illness but continues to
11. NDR risk of dying in the 1st month of life shed pathogenic microorganism
 deaths <28 days/ livebirths x 1, 000 c) intermittent carrier  occasionally sheds
12. IR frequency of occurrence of a phenomenon pathogenic microorganism
 new cases/ pop at risk x 100, 000 d) chronic or sustained carrier  always has
13. PR  proportion of the population exhibiting a the infectious organism in his or her sys.
particular disease b.animals
 old and new cases/ pop examined x 100 c.nonliving things
14. CFR killing power of a disease 3.Portal of Exit  path or way in w/c organism
 deaths from a specific dse/ registered cases leaves the reservoir
from same specific dse x 100 a.resp. sys.
15. Attack Rate accurate measure of the risk of b.GUT
exposure c.GIT
 acquiring a dse/ exposed to same disease x d.Skin & mucous membrane
100 e.placenta
4.Mode of Transmission
B. Data Presentation a.contact transmission
1.Graphs used: 1)direct contact  person to person transfer of
a.bar graph  for comparison organism
b.line graph  to see the trend 2)indirect contact  susceptible person comes
2.Pie graph: in contact w/ contaminated object
 not used for FHSIS report 3)droplet spread  transmission contact w/
 only used for presentation resp. secretions when infected person
sneezes, coughs or talks
C. Functions of the Nurse in Vital Statistics
1.Collects data b.air-borne transmission  microbial or dust
2.Tabulates data particles containing microbes remain
3.Analyzes and interprets data suspended in the air for a prolonged period
4.Evaluates data c.
5.Recommends redirection and/or strengthening infectious dse. Through articles or subs. That
specific areas of health programs as needed harbor the organism until it’s ingested
d.
sfleas, flies & mosquitoes transfer the
microbes to another living organism
5.Portal of Entry  venue where the organism
gains entrance into the susceptible host.

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6.Susceptible Host  human body has many d.Policies on Hospital Waste Mg’t
defenses against the entry & multiplication of 1)All newly constructed/ renovated gov’t &
organism. private hosp. shall prepare & implement a
HWM program as requirement for registration/
V. Stages of Infection renewal of licenses
1.Incubation  time interval bet. The initial infection 2)Use of appropriate technology & indigenous
& first appearance of any signs or symptoms materials for HWM shall be adopted
2.Prodromal characterized by early, mild symptoms 3)Training of hosp. personnel involved in waste
of the dse., as general aches & malaise mg’t shall be an essential part of hosp. training
3.illness  person exhibit overt signs & symptoms of program
dse., such as fever chills, muscle pain , sensitivity to 4)Local ordinances regarding collection &
light disposal techniques, esp. incinerators shall be
4.Convalescence  person regains strength & body institutionalized
returns to its pre-disease state
VI. General Care of Patients with Communicable 4.Infection Control
Diseases a.Isolation & quarantine
A. General Universal Precaution (all patients shall 1)Strict Isolation  prevent highly contagious
be assumed infected w/ HIV and other blood or virulent infections
borne pathogens) a) Wash hands after every contact w/ pt.
1.masking patients w/ resp. prob. b) articles contaminated w/ infectious materials
2.handwashing  before and after contact on each should be appropriately discarded
patient c) Use of mask, gown, & gloves
3.gloving  for direct contact w/ patients d) Negative pressure to surrounding area is
4.gowning  prevents splashes or sprays of blood desirable
& body fluids 2)Contact isolation  prevent spread of
5.eye protection  to avoid aerosol infection primarily by close or direct contact
6.environmental disinfection diluted household, 3)Respiratory isolation  prevent
70% alcohol transmission of infectious dse. Over short
distances through the air
B. Preventive Aspect 4)TB isolation  for TB patients w/ positive
1.Health Education smear or w/ chest x-ray w/c strongly suggests
a. Availability & importance of prophylactic active TB
immunization 5)Enteric Isolation  is for infections w/ direct
b.importance of env’tal cleanliness & personal contact w/ feces
hygiene 6)Drainage/ secretion precaution  prevent
c.manner in w/c infection is spread infections that are transmitted by direct or
d.preventing food contamination & water supply indirect contact w/ purulent materials or
2.Immunization  introduction of specific protective drainage from infected body site
antibodies in a susceptible person or animal 7)Universal precaution  applied when
handling & body fluid
Immunity
b.Disinfection  destruction of pathogenic
microorganism outside the body by physical of
Natural Artificial chemical means
1)concurrent  done immediately after the
infected individual discharges infectious
passive active Passive Active secretions (patient is still the source of
infection)
transplacental breastfeeding vaccine 2)terminal applied when patient is no longer
the source of infection
c.disinfection or killing of undesirable small
Life long immunity
animals by physical or chemical means
d.fumigation  application of gaseous agent to
3.Environmental Sanitation kill or drive organisms & insects
a.Water supply sanitation Program
b.Policies on proper excreta & sewage
disposal
c.Policies on food sanitation program

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VII. Communicable Diseases 3.Improve social conditions, such as

 Bacterial Infection overcrowding.
A.Tuberculosis  reportable communicable dse. w/c 4.Make available medical, laboratory and x-ray
is characterized by pulmonary manifestations facilities for examination of patients, contacts
 Cause and suspects
1. mycobacterium 5.Provide public health nursing and outreach
tuberculosis (gram + , acid-fast bacillus) services for home supervision of patients
2. mycobacterium
africanum  Pathophysiology
3. mycobacterium bovis  Causative organism
from cattle (alveoli)

 2 Kinds of TB:
inflammation
1. Pulmonary TB  involves the lungs only
2. Extrapulmonary (EP) TB  involves the
bones, skin, etc.
Infection spreads Release of
antibodies
 Risk Factors
1. Highest in children under 3 years old (Primary lymphatic ducts
Fibrosis, calcification or
Complex)
inflammation of the
 Primary Complex  also called Koch’s Inflamed lymph area
infection nodes
2. Lower in later childhood
Exudates forms
3. Highest again among adolescents, young adults
& the elderly
Caseous necrosis
 Incubation Period  2 – 10 weeks
Caseous liquefication
 Mode of Transmission
1. Airborne droplets
cavitation
2. Direct invasion through mucous membranes,
which is extremely rare
hemoptysis
 Diagnostics  Signs & Symptoms
1. tuberculin test / 1.Cough for 2 weeks or more, usually with
Mantoux test  purified protein derivative test expectoration
2. chest x-ray  2.Night sweating
presence of calcified lesions or tubercle 3.Loss of appetite
 done if sputum is negative 4.Weight loss  due to hypoxia
 5.Fever, on & off especially in the afternoon
When a person has TB, his/her X-ray results will 6.Chest and/or back pain
show spots on his/her lungs. These spots will 7.Hemoptysis or blood streak sputum
remain in the lungs as scars even when the
person is already cured of TB.  Period of TB Communicability As long as
 tubercle bacilli are being discharged in the sputum
The X-ray result will also show if the bacteria is
active or inactive. IP MP
Regimen 1  (+) sputum RIPE/ RHZE RI
3. sputum exam  acid- exam  1st (8wks) (16 wks)
fast bacilli in sputum time to
 if (+), 100% contagious undergo
sputum exam
 (-) sputum &
 Preventive Measures x-ray
1.BCG vaccination of newborn, infants and grade FA/MA
I/school entrants.  EP TB
2.Educate the public about the mode of spread, Regimen 2  Relapse RIPES RIE
 Failure (8 wks) (20 wks)
methods of control and importance of early  Can’t be
diagnosis. classified as another
regimen 1 or

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2 RIPE (4 wks) infectious  Dapsone (50mg)

Regimen 3  (-) sputum RIP RI D2 – 28
exam (8 wks) (16 wks) Multibacillary  Rifampicin  Rifampicin
 PTB minimal 450mg 1st day of (600mg)
a.> 6 lesions
(x-ray) month  Dapsone (100mg)
b.infectious  Dapsone (50mg)  Lamprene (300mg)
4. Regimen 4
 D2 - 28
 Chronic (still smear + after supervised re-  Lamprene (150mg)
treatment)  D2 - 28
 Refer to specialized facility or DOTS Plus Center  Prevention of Leprosy
 Refer to Provincial/ City NTP coordinator (HABAG)
Anti-TB DRUGS 1. Health education
(old) (new) Side effects 2. Avoidance of
Rifampicin R R Hepatotoxic & prolonged skin-to-skin contact
orange urine
Isoniazid INH H Peripheral neuritis 3. BCG vaccination
( Vit. B6 / 4. Adequate nutrition
pyridoxine) 5.Good personal hygiene
Pyrazinamide PZA Z  uric acid
Ethambutol E E Visual  Treatment Completion
disturbances
Streptomycin S S ototoxicity 1.A patient on PB regimen should take6 blister
packs within 9 months.
B. Leprosy  Hansen’s Dse. / Hansenosis 2.A patient on MB regimen should take 12
 Causative  blister packs within 18 months.
mycobacterium leprae 3.At the end of this duration, the patient should be
considered as Treatment Completed (TC).
 Incubation Period  5 ½
C. Diptheria
mos. To 8 yrs
 Cause 
 Mode of Transmission
Corynebacterium diphteriae (Klebs-Loeffler
1.skin to skin contact
bacillus)
2.droplet (rare)
 Incubation Period
 2-7 days
 Diagnostics
1.Signs and Symptoms  Mode of
2.Tissue biopsy Transmission
3.tissue smear 1.Direct or intimate contact
2.indirect contact w/ food, & articles
 Types
1.Single lesion Paucibacillary  1 lesion & no  Diagnostics
nerve affectation 1.C &S
2.Paucibacillary  <6 lesions w/ or w.out nerve 2.gramstain  fluorescent antibody stain
affectation
 non-infectious  Pathophysiology
3.Multibacillary  >6 lesions Bacterial invasion
 infectious
Low grade fever Pseudomembrane forms(gray smooth
 Signs and Symptoms & spider web like)
Early Late
a. change in skin color a. Lion’s face
b. ulceration  wound that b. Lagophthalmos  loss of
doesn’t heal eyelid reflex
c. numbness of affected area c. Madarosis  loss of Nasal Faucial & Laryngeal
d. nasal obstruction/ bleeding eyebrows pharyngeal obstruction
d. Gynecomastia
Enlargement of male breast
e. Sinking of the nose bridge Serosanguinous Bull neck (cervical
f. Chronic ulcer discharge adenitis)
 Treatment
Multi-drug Therapy Muco-purulent
Children Adult discharge stridor Metallic cough
Paucibacillary  Rifampicin  Rifampicin
(450mg)  1st day (600mg)
a.<6lesions  Collaborative Mg’t
of month  Dapsone (100mg)
b.non-
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CHN 4

1.Prevention  DPT 0.5ml IM 3 doses (ages 6,  Mode of Transmission

10, 14 wks) & 2 boosters ( 15-16 mos. & 4 -6 1.feco-oral transmission
yrs.) 2.ingestion of contaminated water and food
2.Isolation  until 2 negative cultures (taken 24 3.flies, soiled hands & utensils
hours apart after cessation of antibiotic therapy)
3.diphtheria antitoxin to avoid risk of  Diagnostics
sensitization from repeated doses of horse 1.rectal swab
serum 2.stool exam
4.antibiotics  to eradicate microorganism &
prevent carrier state  Period of Communicability  as long as + stool
a.penicillin for cholera
b.erythromycin
5.supportive
a.bed rest 2 -3 weeks  Collaborative Mg’t
b.nutrition & hydration 1.IV therapy
c.gas exchange 2.ORS
3.antibiotics
D. Anthrax  Woolsorter Disease/ Ragpicker Dse. a.tetracycline
b.chloramphenicol
 Cause  Bacillus anthracis (an aerobic c.cotrimoxazole
encapsulated spore forming gram +)
F. Pertussis
 Incubation Period  9 hours to 2 weeks  Cause  Bordetella pertusis
 Mode of Transmission
1.ingestion  Incubation Period  7 – 10 days
2.inhalation
3.direct contact  Mode of Transmission
1.man  only communicable host
 Pathophysiology 2.respiratory & salivary contact from 7 days after
Bacterial infestation exposure to 4 weeks after onset but most
infectious during catarrhal stage
fever skin inhalation GI  Diagnostics  Bordet Gengaou Agar Plate

 Stages
pruritus Papule Bronchial tree Intestinal 1.Catarrhal Stage  1 -2 weeks; coryza, fever
inflammation inflammation
2.Paroxysmal stage  2 -6 weeks of severe
vesicle violent coughing
Abd. pain 3.convalescent stage  return to normal
respiration
Bronchial tree Impaired gas
irritation exchange
 Signs and Symptoms  5 - 10 rapid coughs w/c
ends in high pitch (whoop)
cough Chest pain
 Collaborative Mg’t
 Collaborative Mg’t 1.prevention DPT 0.5ml IM 3 doses (ages 6,
1.standard precaution 10, 14 wks) & 2 boosters ( 15-16 mos. & 4 -6
2.immunization yrs.)
3.Penicillin, Doxycycline and Ciprofloxacin 2.isolation w/ droplet precaution
4.Erythromycin, Tetracycline or Chloramphenicol 3.drug of choice  erythromycin
5.Length of treatment: 60 days 4.supportive care:
a.bed rest
b.humidified oxygen as ordered
E. Cholera  El Tor c.gentle & brief suctioning
d.avoid excitement, dust, smoke & sudden
 Cause  Vibrio cholerae/ Vibrio coma temp. change
 Pathognomonic Sign  rice watery stool e.don’t bring by seashore
 Incubation Period  hours to 5 days f. abdominal support
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 Cause of Infant’s Death  mother’s failure to

G. Pneumonia acute inflammatory process caused recognize s/sx of pneumonia
by a virus, bacteria, or fungi w/c involves small airway  ALL  Ask, Look, & Listen
& alveoli  Age  to know what treatment to be given
<2mos AGE 2mos – 5y/o
 Cause Very Severe  Stridor
1. Streptococcus pneumonia  Inability to feed/
drink
2. Staphyloccocus aureus
 Sleeping
3. Haemophilus influenzae abnormalities
4. Klebisiella pneumoniae  Convulsion
 Chest indrawing Severe  Chest indrawing
 Incubation period  1 -3 days (subcostal)
 Fast breathing >
60cpm
 Risk Factors
1.Chronic URTI Pneumonia  Fast breathing
2.surery  RR:
 2mos. To 1yr 
3.immobility > 50
4.smoking  1y/o – 5 y/o  >
5. immunity 40
6.aspiration of foreign bodies NO Pneumonia
(common
cough/cold)
 Pathophysiology
Bacteria found in lungs  Mg’t for Pneumonia
1.Cotrimoxazole  drug of choice
Alveoli inflammation & infection fever Age Syrup Table
(pediatric)
1. <2mos. 2.5ml 1
2. 2mos. – 1y/o 5.0ml 2 5ml
3. 1y/o – 5y/o 7.5ml 3 100ml
Produce exudates WBC (neutrophils) For 5 days (CARI) IMCI
migrates to alveoli & fill
air spaces
2.Procaine-penicillin  also for pneumonia &
given IM, OD for 5 days
thickened & edematous
a.<2mos  200,000 units
alveolar walls b.2mos – 1y/o  400,000 units
c.1y/o – 5 y/o  800,000 units

Crackles & Poor gas Blood vessel ruptures H. Bacillary Dysentery/ Shigellosis/ Body Flux
wheezing exchange  Cause
Rusty sputum
1.Shigella flesneri  common in the Phil
2.Shigella boydii
3.Shigells conei
4.Shigella dysenteriae  most infectious & their
dyspnea  RR  HR
habitat is exclusively the GIT of man

Chest pain  Incubation Period  7 hours – 7 days ( 3 -5

days)
 Mode of transmission
1. Droplet  Mode of Transmission
2. Indirect through contaminated objects 1.ingestion of contaminated food/ drink
2.flies or through other objects
 Diagnostics 3.feco-oral transmission
1.sputum culture  Diagnostics
2.chest x-ray 1.fecalysis
3.CBC 2.stool culture
4.ABG 3.peripheral blood exam
4.blood culture

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 Pathophysiology
Bacterial infestation Slough
formation (bile
colored)
Invasion on intestinal mucosa

Slough
GI inflammation separates

ulceration
Cramping abd. pain Intestinal Green
fibrous sloughing
hemorrhage
anorexia
Ulceration
 Collaborative Mg’t
n/v 1.prevention
 Collaborative Mg’t Bloody mucoid stool a.proper waste disposal
1.Diet  low residue b.proper food handling
2.NPO until n/v subsides c.enteric isolation
3.IV therapy d.safe drinking water
4.antibiotics  ampicillin, tetracycline, 2.watch for signs of bleeding
cotrimoxazole 3.TSB
5.NO Anti-diarrheal drugs  bec. They delay fecal 4.meds
excretion e.chloramphenicol  drug of choice
6.dispose excrete properly f. ampicillin
g.cotrimoxazole
I. Typhoid Fever  bacterial infection transmitted by h.ciprofloxacin/ ceftriaxone
contaminated water, milk, shellfish, or other food. It
is an infection affecting the GIT affecting the J. Meningitis acute or viral bacterial inflammatory
lymphoid tissues (peyer’s patches) of the small condition of meningeal tissue covering the brain
intestines  Bacterial meningitis  less common but more
severe than viral
 Cause  salmonella typhi/ typhosa
 Risk Factors
 Incubation Period 5 – 40 days 1.organism  site of entry is from other infections
in the body
 Period of Communicability as long as the 2.meningococcal meningitis  type of w/c is
person secretes microorganism contagious (MOT – direct contact w/ droplets
from airway of infected person)
 Mode of Transmission
1.person recovered from dse.  Pathophysiology
2.ingestion of shellfish from contaminated water
Site of entry of organism
3.stool/vomitus of infected individuals

 Diagnostics Infection of meninges

1.Typhidot  confirmatory
2.ELISA inflammation
3.Widal
 Pathophysiology
Bacterial invasion Cerebral edema  membrane permeability

 ICP  CHON concentration

Blood stream fever
 CHON in CSF
Lymph nodes chills
swells  Signs & Symptoms
1.nuchal rigidity
Peyer’s patch 2.fever
inflames 3.headache (severe & persistent
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4.irritability animals, mainly rat (also cattlke, swine, dogs,

5.resp. distress rodents)
6.gen. seizures
7.Kernig’s sign  resistance or pain at the knee  Signs and Symptoms
when client attempts to extend legs after thigh 1.Anicteric Phase
flexion a.abrupt fever
8.Brudzinki’s sign  reflex flexion of hips when b.headache
neck is flex c.myalgia
9.petechiae  meningococcal meningitis d.n./v
10. photophobia 2.Icteric Phase
11. opisthotonos  dorsal arched position a.jaundice
b.hemorrhage
 Diagnostics c.renal failure
1.lumbar puncture   CSF pressure d.myocarditis
2.examination of CSF for bacteria
 Collaborative Mg’t
 Collaborative Mg’t 1.high dose of penicillin or tetracycline or
1.treatment erythromycin
a.Antibiotic therapy 2.supportive & symptomatic
b.Digoxin 3.isolation  contact precaution w/ urine
c.Mannitol  osmotic diuretic 4.Properly disposed urine
d.Anticonvulsants
e.Acetaminophenc  antipyretics (NO  Viral Infections
morphine)
f. Corticosteroids  reduce inflammation A. Dengue Fever
 Cause
2.Diet  DAT 1.Chikungunya virus
3.HOB slightly elevated ICP 2.dengue virus 1, 2 , 3 & 4
4.if opisthotonos  side lying for comfort & safety
5.strict resp. isolationuntil causative agent has  Incubation Period  3 – 10 days
been identified  Mode of Transmission  bite of Aedes egypti
6.identify other people exposed to the dse.   Diagnostics
give prophylactic treatment 1.Tourniquet test (capillary fragility test or
7.seizure precautions Rumpel Leads Test) --> more than 20 petichiae
a.adequate ventilation per square inch
b.oxygen ready 2.Dengue Blot
c.dim & quiet env’t
8.place near nurse’s station  for max.  Classification
observation 1.Grade 1
a.fever
b.+ tourniquet test
 Complications c.abd. pain
1. ICP  permanent brain damage 2.Grade 2  grade 1 plus
2.visual & hearing deficits a.spontaneous bleeding
3.subdural effusion  will be absorbed when b.rashes
treatment is started & protein leaks stops c.epistaxis
3.Grade 3  grade 2 plus
K. Leptospirosis  Weil’s Dse., Mud fever, Trench a.circulatory failure
fever, spiroketal jaundice, Japanese 7 days fever b.weak thready pulse
c.narrow pulse pressure
 Cause Leptospira interrogans (present in blood d.hypotension
7 – 10 days, CSF – 5 days, & urine after 1st week) e.restlessness
4.Grade 4  grade 3 plus
 Incubation Period  7 – 19 days (ave. 10 days) a.profound shock
b.No pulse or BP
 Mode of Transmission direct or indirect contact
w/ urine (or carcasses) of infected wild or domestic  Collaborative Mg’t
1.Prevention
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CHN 4

a.Treat mosquito nets w/ insecticides 3.Most communicable at the height of rash

b.House spraying
c.Cover water containers  Collaborative Mg’t
d.Avoid too many hanging clothes inside the 1.prevention
house a.AMV  9 month old as single dose
2.bed rest b.MMR vaccine  15 months old & next dose at
3.nose bleeding  flex neck and apply ice bag 11 – 12 yrs.
4.paracetamol  NO aspirin c.Measles vaccine should not be given to
5.TSB pregnant women or persons w/ active TB,
6.BT as needed leukemia, lymphoma or depressed immune
sys.
2.isolation  well ventilated w/ subdued light
3.TSB for fever
4.moisten skin  warm water daily
5.stress on oral & nasal hygiene
B. Measles/ Rubeola/ Morbilli  acute, contagious 6.meds
& exanthematous dse. That usually affects a.antiviral  Isoprinosine
children w/c are susceptible to URTI b.antibiotics  if w/ complication

 Cause  filterable virus (rapidly inactivated by C. SARS

heat, ultraviolet light, extreme degrees of acidity &
alkalinity)  Cause  corona virus
 Incubation Period  10 – 12 days  Clinical criteria
 Mode of Transmission 1.asymptomatic or mild resp. illness w/ temp. >
1.direct contact w/ droplets spread through 38OC
coughing or sneezing 2.one or more clinical findings of resp. illness (ex.
2.articles or fomites Cough, shortness of breath, difficulty in
breathing or hypoxia)
 Diagnostics
1.nose & throat swabs  Mode of Transmission
2.Urinalysis 1.direct mucous membrane  eyes, nose, mouth
3.blood exams (CBC, leucopenia, leukocytosis) 2.droplets
4.hemogglutinin test 3.secretions  saliva, tears, urine & stool

 Signs and Symptoms  Signs and Symptoms

1.Pre-eruptive stage 1.fever
a.fever 2.head ache/ body aches
b.catarrhal symptoms  rhinitis, conjunctivitis, 3.mild resp. symptoms
photophobia, coryza
c.resp. symptoms  common colds to  Treatment
persistent coughing 1.Early detection and treatment improves chances
d.enanthema /kolpik’s spot/ Stimson’s line  of recovery
inflammatoryu lesions of the buccal mucous 2.No specific treatment has been developed yet.
glands w/ superficial necrosis 3.No vaccines available.
2.eruptive stage 4.Steroid and anti-virals are being used at present.
a.presence of maculo-papular rash on 4th day\ 5.Anti-bacterials are given to cover secondary
b.on and off fever bacterial infections.
c.throat is red & extremely sore
3.convalescence stage  prevention
a.rash fades away 1.consult doctor if there are symptoms
b.fever subsides as eruption appears 2.build up good immunity
c.when rashes fade, desquamation begins a.diet
b.exercise
 Period of Communicability c.healthy lifestyle
1.9 – 10 days from beginning of prodromal d.personal hygiene
symptoms to the fading of rash 3.wear mask
2.4 days before or 5 days after the appearance of 4.proper hand washing
rash
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CHN 4

D. Rabies/ Hydrophobia/ Lyssa

 Cause Rhabdovirus (sensitive to light, ether,  Cause  Herpesvirus varicellae
formalin, & nitric acid)  Incubation Period  10 – 21 days
 Mode of Transmission
 Incubation Period 1.direct contact  from patients w3ho shed
1.1wk to 7 months in dogs virus from vesicles
2.10 days – 15 yrs in human 2.indirect contact  fomites and linens
3.incubation period depends on: 3.airborne 
a.distance of bite to the brain 4.droplet
b.extensiveness of bite
c.specie of animal
d.richness of nerve supply in the area of bite  Signs and Symptoms
e.resistance of host 1.pre-eruptive manifestations  mild fever &
malaise
 Mode of Transmission  direct contact 2.Eruptive stage
 Diagnostics a.Rash  starts from trunk, then body parts
1.viral isolation form saliva & throat b.Initial lesions  red papules and become
2.fluorescent anti-body (FRA)  definitive milky w/in 4 days
3.negri bodies in dog’s brain c.Vesicular lesions  pruritic
d.Stages of lesions
 Signs and Symptoms 1)macule  non-elevated
1.Prodromal/ Invasion phase 2)papule  elevated skin surface
a.sensitivity to light, sound & temp. 3)vesicle  dries w/in 3 – 5 days
b.pain at site of bite
c.numbness on peripheral nerves
d.fever  Period of Communicability  day before
eruption of 1st lesion up to 5 days after appearance
2.Excitement/ Neurological Phase of last crop
a.Delirium
b.Tonic-clonic muscular contractions  Collaborative Mg’t
c.Aerophobia 1.resp. isolation  until all vesicles have crusted
d.Drooling of saliva 2.disinfect lionens under sunlight or boiling
3.cut fingernails short/ wear mittens
3.Terminal/ Paralytic phase 4.meds
a. quiet & unconscious a.zoverax/ acyclovir (500mg/tab)  5x a day for
b. loss of bowel and urinary control 7 days
c. death b.anthistamine  for pruritus
c.calamine lotion
 Period of Communicability  3 – 5dfays until d.anti-pyretics  NO salicylates
onset of symptoms until the entire course of illness

 Collaborative Mg’t
1. prevention
a. dog vaccination
b. public education
2. bitten person
a. wash wounds from bite &
scratches of dog  soap & running water
b. give TT as needed
c. give tetanus antiserum
d. give anti-rabies vaccine
3. rabid person
a.isolate
b.dim & quiet env’t
c.pt. should not be bathed
d.IVF  should be wrapped (hyrophbic client)

E. Varicella
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