BIO 136/186​

Microbiology and Parasitology​

Second Semester 2022 ​

Cluster 2​

Clinical Instructors​​
Dr. Cyrille Y. Panimdim​​
Ms. Jessica S. Simporios​​
Dr. Deborah G. Gemao​​
Mrs. Ana Lou B. Navaja​

M a y 1 0 , 2 0 2 2
 Topic Objectives

1. Define what specimen collection is.

2. Identify the different kinds of specimen for analysis.
3. Enumerate the fundamental requirement to protect
rights of patients in specimen collection and analysis.
4. Articulate appropriate method of handling specimen for
analysis.

M a y 1 0 , 2 0 2 2
Unit IV. Collecting Specimen
Collecting Specimen

Is one way of knowing about the patient's

health status by identifying pathogens and
analyzing urine, blood, sputum, feces, etc.

Nurses often assume the responsibility

of specimen collection, however it can
be performed by a physician at patient’s
bedside.
SPECIMEN COLLECTION
- the collection of the specimen for the purposes of diagnosis,
treatment and recovery.

SPECIMEN - a small quantity of a substance or object which shows

the kind and quality of the whole (sample).
Fundamental requirements to protect the patient’s rights:

- the act of agreeing to allow something to

happen, or to do something, with a full
understanding of all the relevant facts,
including risks, and available alternatives.

- that full knowledge and understanding is the

necessary factor in whether an individual can
give informed consent.
The fundamental requirements to protect the patient’s rights:

• The patient must understand what will

be done during a test, surgery, or any
medical procedure and must
understand the risks and implications
before he or she can legally consent
the test or procedure.
NURSING RESPONSIBILITIES

 Reinforce physician’s explanation of

the procedure.

 Confirm that the patient understands

and verify that a written consent is
NOT necessary for individual test;
informed consent may be adequate.
 Keep the patient adequately informed of
procedural details that could cause
discomfort.

 Assist the patient throughout the procedure

and determine allergies to iodine.

 Prepare the patient for diagnostic exams.

 The nurse must be prepared to answer

questions for which the patient may need
clarification.
 The patient needs to know if:

- Nothing can be taken by mouth (NPO) after midnight

- Breakfast will be held until the exam is complete.
- A special room or piece of equipment is required for
the test.
- Medication is needed before or during the test.

NOTE: All patients admitted to a health care facility have at least

one laboratory specimen collected during hospitalization.
GENERAL PREPARATION OF THE CLIENTS:

· Explain the procedure to the patient. It helps to gain

the client’s trust and cooperation.

· When preparing the client the nurse’s explanation

should be clear, straight forward and complete.

· Be sure that the client has understood clearly and

correctly the information.
GENERAL PREPARATION OF THE CLIENTS:

· In case of collection of urine, instruct the client to

wash the genitalia with soap and water and then rinse it in
water before collecting the specimen.

· Instruct the client not to contaminate the outside of

the bottle.

· Instructions to use gloves and other barriers as

necessary.
TYPES OF CONTAINERS USED FOR SPECIMEN COLLECTION

· All specimens are collected in clean and dry containers.

· Use containers with wide mouth.

· Sterile containers are used for culture.

· Wax lined disposable cups are used for sputum and

stool specimens.
·
TYPES OF CONTAINERS USED FOR SPECIMEN COLLECTION

· Large containers are used for 24 hours urine specimens.

· Sterile test tubes are used to collect fluids.

· Clean slides are used to collect smears.

· No antiseptic solution must be present in the specimen

bottle as they may hamper the growth of micro organism and
thus obscure the results.
• Laboratory Exam of
specimen provides important
information about body
functioning and contributes
to the assessment of health
status.
• Guidelines for Specimen Collection

- Consider the patient’s need and

ability to participate in specimen
collection procedures.

- Recognize that specimen collection

may provoke anxiety, embarrassment
or discomfort.

- Provide support for patients who are

fearful about the results of a
specimen exam.
- Recognize that children require clear
explanation of procedures and that they
need the support of their parents or family
member.

- Obtain specimen in accordance with the

specific prerequisite conditions as required.

- Wear gloves when collecting specimens of

blood or other body fluids.
- Most specimens are transported to the lab
in a separate outer plastic bag.

- Deliver specimens to the laboratory within

the recommended time or ensure that they
are stored properly for later transport.

- Use aseptic technique in all collections to

prevent contamination, which can cause
inaccurate test results.
- Wash hands and other skin surfaces
immediately and thoroughly.

- Collect specimens in appropriate

containers, at the correct time and in the
appropriate amount.

- Properly label all specimens with the

patient’s identification; complete lab
requisition form as necessary.
The four rules when collecting
specimens:

1. Right specimen

2. Right time

3. Right amount

4. Right container.
Data placed on the specimen
label:

1. Client’s name

2. Address

3. Type of specimen

4. Date

5. Time
 COLLECTION OF URINE SPECIMEN

Collecting Single Urine Specimen:

- Single urine specimen means the amount of urine

voided at a time.

- Usually the morning specimens are collected.

- 100-120 ml of urine will be sufficient for the usual tests.

 COLLECTION OF URINE SPECIMEN
Collecting Single Urine Specimen:

- Clean the genital

- Let client pass urine into clean urinal or a clean kidney

tray or directly in to specimen bottle

- Tell client not to spill the urine on the outside of the

container.
• Midstream urine specimen

- Urine is collected after voiding is initiated (midstream)

and before voiding is completed.

- This is the cleanest part of the voided specimen.

• Several tests can be ordered on one sample of urine: pH,

protein, glucose, ketones, blood and specific gravity.
COLLECTING 24 HOURS URINE SPECIMEN:

- 24 hours urine specimen means to collect all the urine voided in

24 hours.
- The collection of urine begins at 6AM
- All the subsequent voiding should be measured and collected in
the bottle and labelled.
- Continue to collect till morning.
- Ask the client to void at 6 -AM on the next day and add it to the
previously collected.
 24 – Hour Urine Collection

https://www.youtube.com/watch?v=T4uQJ05S
Ie0
Methods in urine collection
1. Straight catheter method

Inserting a straight catheter

into the urinary bladder and
remove urine.

2. Foley Bag catheter method

Obtaining a specimen from the

port of an indwelling catheter
using sterile technique.
3. Urine collection of an able client

4. Residual Urine

This is urine left in the bladder after voiding.

The patient voids through the catheter performed

within 10 minutes.
Residual urine is more than 50 ml of urine remaining in the
bladder.
Stool specimens are collected for a
variety of reasons.

• Determine the presence of

infection, bleeding or
hemorrhage.

• Observe the amount, color,

consistency and presence of fats.

• Identify parasites, ova and

bacteria.
Stools to be examined for
parasites must be taken to the
lab immediately while the
parasites are still alive.
Determining the presence of
occult – indication of blood in the
stool

(Guaiac Test) – test to determine

bloody stool

Bright red blood indicates the

blood is fresh and that the site is
in the lower GIT.
Black, tarry feces indicates the
presence of old blood and that the
site of bleeding is higher in the GIT

Occult indicates blood is present in

the stool but cannot be determined
unless examined
Sputum, secretions from the lungs
and contains mucus, cellular debris,
blood, pus and microorganisms.

Sputum must come from deep in the

bronchial tree and best collected
early morning because the patient
has not yet cleared of the
respiratory passages.
Many tests can be performed on sputum.
These are:

* Culture, to note or detect the

presence of microbes.

* Sensitivity, to determine the

effectiveness of antibiotics.

* Cytology, to detect cellular debris

* To determine acid-fast bacillus,

organism which is responsible for
tuberculosis.
An anaerobic bacteria culture is a
method used to grow anaerobes from a
clinical specimen.

- Obligate anaerobes are bacteria that

can live only in the absence of
oxygen.
- Obligate anaerobes are destroyed
when exposed to the atmosphere for
as briefly as 10 minutes.
Veins are a major source of blood for laboratory
testing, as well as routes for IV fluids or blood
replacement.

Blood test can yield information about

nutritional, hematological, metabolic, immune
and biochemical status.

Nurses are often responsible for collecting

blood specimens; however, many institutions
have trained technicians to draw blood.
Assess for any special conditions that must be met before
specimen collection, if patient is to be NPO

Venipuncture involves inserting a hollow-

bore needle into the lumen of a large vein
to obtain a specimen.

The nurse may use a needle and

syringe or a special vacuum tube
that allows the drawing of multiple
blood samples.
Possible risks of venipuncture:

 anticoagulant therapy

 low platelet count

 bleeding disorders
Possible risks of venipuncture:

 presence of shunt or fistula

 after breast or axillary

surgery
Collection Method of Venipuncture: Vacutainer system
The basilic and cephalic veins in the antecubital space are the
most common venipuncture sites.
All for Listening 
 PULMONARY
TUBERCULOSIS
ABRASADO-ALGARME-ANCIANO-ANUKUN-BACALLA
History
On March 24, 1882, Dr. Robert Koch
announced the discovery of M.
tuberculosis, the bacteria that causes
TB. Koch’s discovery was the most
important step taken toward the
control and elimination of this deadly
disease.
Pulmonary TB is caused by the Causative -
Agent
bacterium Mycobacterium
tuberculosis (M tuberculosis).
This is highly contagious which
means that the bacteria are
easily spread from an infected
person to someone else.
TB Epidemiology
Risk Factors of
Pulmonary
Tuberculosis
What Are the Risk Factors for
Getting Tuberculosis?
● Risk factors for tuberculosis include
anything that weakens a person's immune
system or puts someone in frequent,
close contact with a person who has
active TB

● you’re more likely to get TB if you travel

to or have emigrated from a country with
high rates of tuberculosis. Certain
populations are at a higher risk because
their immune systems are weaker
RISK FACTORS

Poverty , People living in poverty often lack access to

quality healthcare. It’s also possible that in the United
States, people with little means could be living close
to those who have recently emigrated from a country
where TB is common
RISK FACTORS

HIV Infection , HIV attacks the

immune system, it puts people at
greater risk of getting sick from other
bacteria and viruses. The combination
of HIV and TB can be especially
deadly because the two diseases feed
off each other. In 2017, about 300,000
people with HIV died of TB, worldwide.
RISK FACTORS
Homelessness People who are
homeless often live in crowded
conditions with little or no access to
healthcare.

Being in Jail or Prison Incarcerated

people are often in enclosed areas with
a crowd, breathing the same air.
Substance Abuse Intravenous (IV)
drug use and alcoholism weaken the
immune system.
RISK FACTORS
Taking Medication That Weakens
the Immune System Autoimmune
disorders, like rheumatoid arthritis,
psoriasis, and Crohn's disease, cause
the body’s immune system to attack
itself. Treatments for these disorders
often involve medication that
suppresses the immune system. But
that means your immune system may
not be able to fight off TB after
exposure.
RISK FACTORS
Kidney Disease and Diabetes Chronic
conditions, like kidney disease and diabetes,
weaken your immune system, making it harder for
the body to fight of TB.

Organ Transplants The drugs people

take to prevent the rejection of an organ
transplant can weaken the immune
system.
RISK FACTORS

Working in Healthcare Doctors, nurses, and

other healthcare workers get exposed to lots of
patients on a regular basis, which means
they’re also more likely to be close to someone
with tuberculosis.

Cancer Chemotherapy weakens the immune

system.
RISK FACTORS
Smoking Tobacco Smoking can increase your risk
of getting TB and dying from it. The WHO
estimates 8 percent of TB cases worldwide can be
linked to smoking

Babies, Young Children, and Elderly People The

immune system can be more vulnerable when
someone is very young or very old.
 How Effective Is the
Tuberculosis Vaccine?

A vaccine for tuberculosis called bacille

Calmette-Guérin, or BCG, has been around
since the 1920s. It was created from a weaker
strain of the Mycobacterium bovis bacteria, a
version of tuberculosis that affects cows. It’s
used in parts of the world with high rates of
the infection to prevent serious
complications, like meningitis, which is
common in young children.
How to Prevent the Spread of
Tuberculosis
The best way to prevent tuberculosis is
to keep your immune system healthy
and avoid getting exposed to someone
with active TB.

To prevent the transmission of

tuberculosis in healthcare settings, the
CDC has issued guidelines that require
most employees to be screened for
tuberculosis when they’re hired and
then again on a regular, often annual,
basis. The testing frequency will
depend on the worker’s likelihood of
being exposed to TB.
 Clinical Manifestations
Pulmonary TB is a bacterial infection of the lungs that can cause a range of
symptoms, including chest pain, breathlessness, and severe coughing.
Pulmonary TB can be life-threatening if a person does not receive treatment.
 Cause
TB is an infection caused by a type of bacteria called
Mycobacterium tuberculosis.

A person who carries the bacteria but does not develop

symptoms has “latent TB.” This is not contagious, but it
can eventually develop into active TB, particularly if a
person’s immune system becomes weakened from a
condition such as HIV.
 How can TB spread
These droplets travel through the air
and a person can breathe them in.

However, an individual generally

needs to be in prolonged close
contact with someone who has
active TB to contract the infection. A
TB infection in a part of the body
other than the lungs is not usually
contagious.
 Symptoms
The classic clinical features of pulmonary TB include
● a bad cough that lasts 3 weeks or longer
● pain in the chest
● coughing up blood or sputum (phlegm from deep inside the lungs)

Other symptoms of TB disease are

● weakness or fatigue
● weight loss
● no appetite
● chills
● fever
● sweating at night
 Treatment
TB is curable, but it can be life-threatening if a person does not receive the right
treatment. Also, latent TB can progress to active TB if a person does not receive
preventive treatment.

People with active TB usually need to

take a combination of antibiotics for
6–12 months
 Assessment
Diagnosis Procedure
For Pulmonary Tuberculosis
 Assessment / Diagnostic
Procedures

PPD tuberculin skin

test or Mantoux Test
 Assessment / Diagnostic
Procedures

Sputum by AFB
‘Acid-fast bacilli’
smear
 Assessment / Diagnostic
Procedures

Bronchoscopy
 Assessment / Diagnostic
Procedures

Chest X-ray
 Assessment / Diagnostic
Procedures

TB Blood Test
 Medical
Management
 Medical Management

The combination with three other drugs—rifampin,

pyrazinamide and ethambutol.
You will diffidently feel better only a few weeks after starting
to take the drugs but treating TB takes much longer than other
bacterial
Healthcare providers can choose the appropriate TB treatment
regimen based on drug-susceptibility results, coexisting
medical conditions
 Medical Management

The 4-month TB treatment regimen (high-dose daily

rifapentine with moxifloxacin, isoniazid, and pyrazinamide)
and 6-month RIPE (rifapentine, isoniazid, pyrazinamide, and
ethambutol) regimen have unique considerations.
Nursing Interventions /
Management
Click me Promoting airway clearance

Click me
Monitor the vital signs & breathing
sounds

Click me Promoting adequate nutrition

Click me Preventing the spread of infection

Educate the client about the necessity of

infection control measures

Educate the client about the pathology

of the disease
Administer anti-infective agents

Provide health education for the

treatment regimen
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previous slide
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previous slide
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Back to previous slide
Thank you!
DIPHTHERIA

Group 2
 A. DESCRIPTION
Description:
An acute febrile contagious disease typically marked by the
formation of a false membrane, especially in the throat and nose.

Causative Agent:
Diphtheria is caused by the bacterium Corynebacterium
diphtheria which usually multiplies on or near the surface of the
throat.
Epidemiology:
Diphtheria is usually spread from person to person in
airborne droplets after an infected person has coughed
or sneezed.
 B. RISK
FACTORS

Diphtheria rarely occurs in the United States and Western Europe,

where children have been vaccinated against the condition for
decades. However, diphtheria is still common in developing
countries where vaccination rates are low.
People are also at an increased risk of contracting diphtheria if
they:

aren’t up to date on their vaccinations

visit a country that doesn’t provide immunizations
have an immune system disorder, such as AIDS
live in unsanitary or crowded conditions.
 C. CLINICAL MANIFESTATIONS
There are two types of diphtheria: respiratory and cutaneous.
Respiratory diphtheria involves the nose, throat, and tonsils, and
cutaneous diphtheria involves the skin.

Severity of disease due to diphtheria depends on the site of

infection, the immunization status of the patient, and the
dissemination of toxin.
Tonsils and pharynx
Pseudomembrane
Edema
Larynx
Skin
D. ASSESSMENT/DIAGNOSTIC
PROCEDURES
Diphtheria is caused by the bacterium Corynebacterium
Diptheriae. The bacterium usually multiplies on or near the
surface of the throat or skin.

Diptheriae spreads via:

Airborne droplets
Contaminated personal or household items.
If left untreated, Diphtheria can lead to :
Breathing problems
Heart damage
Nerve damage

With treatment, most people can survive but recovery is slow.

Diphtheria is fatal about 5% to 10% of the time and death rates
are higher.
Prevention
Today, diphtheria is not only treatable but also preventable
with a vaccine. The diphtheria vaccine is usually combined with
vaccines for tetanus and whooping cough (pertussis). The
latest vaccine version of this is known to be the DTap vaccine
for children and the Tdap vaccine for adolescents and adults.
This vaccine is one of the childhood vaccinations that doctors
recommend during infancy. The vaccination consists of 5
shots, typically administered in the arm or thigh given to
children at the ages:

2 months
4 months
6 months
15 to 18 months
4 to 6 years
Medical Management is an
umbrella term for two
processes that occur at two
different levels:

the patient level E. MEDICAL

the organizational level. MANAGEMENT
Patient's level
-also known as medical case management, this process simply
refers to the direct management of a patient’s medical
condition

Organizational level
-medical management can refer to the management of how
medical treatment is delivered.
Examples of tasks:
examples of responsibilities you may be involved in as a part of
medical management.

Important Components of Medical Practice Management

Patient Personal Data
Patient Appointment Scheduling
Insurance Claims
Reporting
Conclusion
 F. NURSING
INTERVENTIONS/MANAGEMENT
Nursing Diagnosis
Hyperthermia related to the release of an exotoxin.
Imbalanced nutrition: less than body requirements related to
painful swallowing.
Ineffective airway clearance related to pseudomembrane
blocking the airway.
Nursing Care Planning and Goals
The client will be able to maintain a normal body temperature.
The client will be able to demonstrate and maintain a normal
body weight.
The client will be able to maintain a clear airway.

Nursing Interventions
Improve thermoregulation
Improve caloric intake.
Improve airway clearance.
 https://www.dictionary.com/browse/diphtheria#:~:te
xt=noun%20Pathology.,air%20passages%2C%20espe
cially%20the%20throat
https://www.mayoclinic.org/diseases-
conditions/diphtheria/symptoms-causes/syc-
20351897
https://www.cdc.gov/diphtheria/index.html#:~:text=
Diphtheria%20spreads%20from%20person%20to,wit
h%20a%20diphtheria%20skin%20infection
https://www.lawinsider.com/dictionary/medical-
management
https://www.healthcare-administration-

SOURCES: degree.net/faq/what-are-the-important-
components-of-medical-practice-management-
software/
https://nurseslabs.com/diphtheria/#nursing_interve
ntions
GROUP 2 MEMBERS:

Bajenting, Mhilberlyann
Balaba, Jenny Lou
Baran, Kylene Shayne
Baring, John Belle Loudith
Barro, Antoinette Nicole
THANK YOU!
 GROUP 3

PERTUSSIS
Canlas, Rocky James
Batiancilla, Michelle
Baylosis, Marie Kristine
Bureros, Kim Trisha
Camblinda, Charity
Table of Contents
Topics Covered

Clinical
Decription Risk
Manifestation/
Factors
Features

Assessment/ Nursing
Medical
Diagnostic Interventions/
Management
Procedures Management
 A. DESCRIPTION
Pertussis, also known as whooping cough, is a highly
contagious respiratory disease. It is caused by the
bacterium Bordetella pertussis. Pertussis is known for
uncontrollable, violent coughing which often makes it hard
to breathe. In many people, it's marked by a severe hacking
cough followed by a high-pitched intake of breath that
sounds like "whoop."

At first, whooping cough has the same symptoms as the

average cold:
Mild coughing
Sneezing
Runny nose
Low fever (below 102 F)
You may also have diarrhea early on.

After about 7-10 days, the cough turns into “coughing spells”
that end with a whooping sound as the person tries to
breathe in air because the cough is dry and doesn't produce
mucus, these spells can last up to 1 minute. Sometimes it can
cause your face to briefly turn red or purple.

Most people with whooping cough have coughing spells, but

not everyone does. Infants may not make the whooping
sound or even cough, but they might gasp for air or try to
catch their breath during these spells. Some may vomit.
Sometimes adults with the condition just have a cough that
won’t go away.
Whooping cough is dangerous in babies, especially ones younger
than 6 months old, because it can keep them from getting the
oxygen they need. This can cause:
Brain damage or bleeding on the brain
Pneumonia
Seizures
Apnea
Convulsions
If you think your infant might have it, see their doctor right away.

Children under the age of 18 months with whooping cough should be

— Include a credit or citation
watched at all times because the coughing spells can make them
stop breathing. Young babies with bad cases may need hospital
care, too. Help protect your child by making sure they and any adult
who's around them often get vaccinated.
Whooping cough is dangerous in babies, especially ones younger
than 6 months old, because it can keep them from getting the
oxygen they need. This can cause:
Brain damage or bleeding on the brain
Pneumonia
Seizures
Apnea
Convulsions
If you think your infant might have it, see their doctor right away.

Children under the age of 18 months with whooping cough should be

— Include a credit or citation
watched at all times because the coughing spells can make them
stop breathing. Young babies with bad cases may need hospital
care, too. Help protect your child by making sure they and any adult
who's around them often get vaccinated.
In teens and adults, whooping cough can lead to pneumonia.
The severe coughing can also cause:
Abdominal hernias
Broken blood vessels
Bruised ribs
Trouble controlling when you pee
Trouble sleeping

Facts About Pertussis

Pertussis is also known as “whooping cough” because of the
“whooping” sound that — someone makes
Include a credit when gasping for
or citation
air after a fit of coughing.
Coughing fits due to pertussis infection can last for up to 10
weeks or more; some people know this disease as the “100
day cough.”
Pertussis can cause serious illness in people of all ages and
can even be life-threatening, especially in babies.
Approximately half of babies less than 1 year old who get
pertussis need treatment in the hospital.
The most effective way to prevent pertussis is through
vaccination with DTaP for babies and children and with
Tdap for preteens, teens, and adults.Vaccination of
pregnant women with Tdap is especially important to help
protect babies.
Vaccinated children and adults can become infected with
and spread pertussis; however, disease is typically much
less serious in vaccinated people.
Clinicians generally treat pertussis with antibiotics, which
are used to control symptoms and to prevent infected
people from spreading the disease.
Worldwide, there are an estimated 24.1 million cases of
pertussis and about 160,700 deaths per year, according
to a recent publicationexternal icon modeling these data.
In 2012, the most recent peak year, CDC reported 48,277
cases of pertussis in the United States, but many more go
undiagnosed and unreported. This is the largest number
of cases reported in the United States since 1955 when
public health experts reported 62,786 cases.
Since the 1980s, there has been an increase in the number
of reported cases of pertussis in the United States. In
2010, CDC saw an increase in reported cases among 7
through 10 year olds. Similar trends occurred in the
following years; however, CDC also observed an increase
in cases among teens.
Whooping cough is dangerous in babies, especially ones younger
than 6 months old, because it can keep them from getting the
oxygen they need. This can cause:
Brain damage or bleeding on the brain
Pneumonia
Seizures
Apnea
Convulsions
If you think your infant might have it, see their doctor right away.

Children under the age of 18 months with whooping cough should be

— Include a credit or citation
watched at all times because the coughing spells can make them
stop breathing. Young babies with bad cases may need hospital
care, too. Help protect your child by making sure they and any adult
who's around them often get vaccinated.
 B. RISK FACTORS

Risk factors for pertussis include the following:

Non-vaccination in children

Contact with an infected person

Epidemic exposure
— Include a credit or citation
Pregnancy
 C. CLINICAL
MANIFESTATION/FEATURES
Early Symptoms
-The disease usually starts with cold-like symptoms and maybe
a mild cough or fever. In babies, the cough can be minimal or not
even there.
-Pertussis is most dangerous for babies. About half of babies
younger than 1 year who get the disease need care in the
hospital.

Early symptoms can last for 1 to 2 weeks and usually include:

Mild coughing
Apnea
Runny nose
Low fever (below 102 F)
Later-stage Symptoms
After 1 to 2 weeks and as the disease progresses,
the traditional symptoms of pertussis may appear
and include:
Paroxysms
Vomiting
Exhaustion
Factors Known to Affect the Clinical Manifestation of Bordetella
Pertussis Infection
Patient’s age
Previous immunization or infection
Presence of passively acquired antibody
Antibiotic treatment

There are three stages to clinical course of pertussis

Catarrhal
Paroxysmal
Convalescent
 D. ASSESSMENT/DIAGNOSTIC
PROCEDURES
Assessment
https://youtu.be/s68ETEUetjs
(whooping cough sound in babies)

Infants and Children

-can cause serious and potentially
life-threatening complications
-especially those who have not
received all the recommended
vaccines
-severe for infants younger than 2
months of age
In infants younger than 12 months of age who get pertussis, about
half need treatment in a hospital. Hospitalization is most common
in infants younger than 6 months of age. Of those infants with
pertussis who need treatment in a hospital approximately:

68% will have apnea

23% get pneumonia
1.2% will have seizures
1% will die
0.4% will have encephalopathy (as a result of hypoxia from
coughing or possibly from toxin)

Other complications can include anorexia, dehydration, difficulty

sleeping, epistaxis, hernias, otitis media, and urinary incontinence.
More severe complications can include:

Refractory pulmonary hypertension

Pneumothorax
Rectal prolapse
Subdural hematomas

Take Note!
Pertussis in Babies
It is important to know that many babies with pertussis don’t
cough at all. Instead it causes them to stop breathing and turn
blue. Infant being treated for severe pertussis infection. She
received extracorporeal membrane oxygenation (ECMO), a
procedure that can take over the work of the lungs and heart.
Adolescents and Adults
-can also develop complications from pertussis
-complications are usually less severe in this older age group,
especially in those who received pertussis vaccines
-In one study, hospitalization rates were 0.8% for adolescents and
3% for adults with confirmed pertussis. Clinicians diagnosed
pneumonia in 2% of each group.

The most common complications in another study of adults with

pertussis were:

Weight loss
Urinary incontinence
Syncope
Rib fractures from severe coughing
Other complications can include anorexia, dehydration, epistaxis,
hernias, and otitis media.

More severe complications can include:

Encephalopathy as a result of hypoxia from coughing or

possibly from toxin
Pneumothorax
Rectal prolapse
Subdural hematomas
Seizures

https://youtu.be/Kw7vfuN0G3I
(the sound part of adult pertussis "whooping")
Diagnostic Procedures
Clinicians commonly use several types of laboratory tests to
diagnose Bordetella pertussis. Scientists consider culture the gold
standard because it is the only 100% specific method for
identification. Other tests that can be performed include
polymerase chain reaction (PCR) and serology.

Diagnosis
Healthcare providers diagnose pertussis (whooping cough) by
considering if you have been exposed to pertussis and by doing a:
Figure 1: Proper technique for obtaining a nasopharyngeal specimen for isolation
of Bordetella pertussis
History
Physical examination
Laboratory test
Blood test
Diagnosis Confirmation

Culture
- Useful for confirming pertussis diagnosis when you suspect an
outbreak
- Furthermore, obtaining isolates from culture allows for strain
identification and antimicrobial resistance testing. Identifying
which strains of B. pertussis are causing disease is of public
health importance.
- It is best for you to obtain a culture from nasopharyngeal (NP)
specimens collected during the first 2 weeks of cough. This is
when viable bacteria are still present in the nasopharynx. After
the first 2 weeks, sensitivity decreases and the risk of false-
negatives increases
PCR

- PCR is a rapid test and has excellent sensitivity.

- vary in SPECIFICITY
- You should test with PCR from NP specimens taken at 0 to 3
weeks following cough onset. PCR may also provide accurate
results for up to 4 weeks.
- After the fourth week of cough, the amount of bacterial DNA in
the nasopharynx rapidly diminishes, which increases the risk of
obtaining falsely-negative results. PCR assay protocols that
include multiple target sequences allow for speciation among
Bordetella species. The high sensitivity of PCR increases the risk of
false-positivity, but following some simple best practices can
reduce the risk of obtaining inaccurate results
Serology
- Generally, serologic tests are more useful for diagnosis in
later phases of the disease. For the CDC single point
serology test, the optimal timing for specimen collection is
2 to 8 weeks following cough onset, when the antibody
titers are at their highest. However, you may perform
serology on specimens collected up to 12 weeks following
cough onset.
 E. MEDICAL MANAGEMENT
The medical management of pertussis cases is primarily
supportive.
Maintaining a proper hydration and calorie balance. Small
feeds that occur frequently are preferable.
Inhaling steam can help with breathing by making
respiratory secretions less viscid.

Pertussis treatment is widely available and highly

recommended. It can help minimize the severity, length, and
risk of problems, especially in newborns. Pertussis is treated
with antibiotics, which is normally given for 3 to 5 days. The
antibiotic medicine may also be administered to people who
have been in close contact with the infected person. A number
of antibiotics can be used to treat pertussis.
These are the most common antibiotics:

Azithromycin
Clarithromycin
Erythromycin

Take Note!
Antibiotics will not be provided if you have had pertussis for
three weeks or longer because the bacteria have already
left your body.
 F. NURSING
INTERVENTIONS/MANAGEMENT
Nursing Care Planning and Goals

The major nursing care planning goals for pertussis:

·Patient will maintain clear, open airways as evidence by
normal breath sounds, normal rate and depth of respirations,
and ability to effectively cough up secretions after treatments
and deep breaths.
·Patient will demonstrate increased air exchange.
·Patient will classify methods to enhance secretion removal.
·Patient will recognize the significance of changes in sputum to
include color, character, amount, and odor.
·Patient will identify and avoid specific factors that inhibit
effective airway clearance.
Nursing Intervention

Assess vitals and monitor for fever

Fever, usually low grade, is common in pertussis. Get a
baseline to determine effectiveness of interventions.
Perform physical assessment, note any signs of poor
perfusion or oxygenation
Cyanosis and decreased capillary refill indicate inadequate
oxygenation and tissue perfusion due to inability to breathe
normally and constricted airways.
Assess respiratory status. Note rate, rhythm, effort and
presence of apneic episodes
Breathing is usually difficult due to cough. Infants may have
periods of apnea and need to be carefully monitored.
 Position patient upright
The upright position can help improve lung expansion and provide
for a more effective cough. Patients may also present in tripod
position.
Administer supplemental oxygen via mask
Give supplemental oxygen to improve perfusion and prevent
brain damage. Administer oxygen via mask or oxygen tent/hood
as appropriate for patient and per facility protocol.
Perform nasopharyngeal suction as appropriate per facility
protocol
Excess secretions produced can further restrict air flow to the
lungs. Perform suction carefully to remove secretions and clear
airway. Avoid excessive suctioning as it may further increase
inflammation.
 Initiate access and maintain IV fluids
Patients, especially infants, dehydrate quickly and require
supplemental fluids. Medications may also be given via IV route.
Monitor for and reduce risk of aspiration
Place patient on their side when vomiting
Keep patient upright while eating and drinking
Make sure patient stays upright for 30-45 min after meals
Forceful and continuous coughing may cause vomiting.
Positioning the patient upright uses the force of gravity to help
reduce the risk of aspiration.
Provide for safety. Initiate seizure precautions
Lack of oxygen and forceful continuous cough may cause
seizures. Make sure patient is in crib or rails are raised to prevent
injury. Place patient on the side and remove items from the bed
that can cause suffocation
 Provide patient and parent education about the disease
process and prevention
Length and stages of disease
Vaccination for all family members
Cover that cough

Help parents be advocates to prevent further infection or

spread of infection. Vaccines are available and
recommended to all ages, beginning as early as two months
of age, but require a full series to be protected from the
disease. Infants, who have not completed a full series of
vaccine and adults whose immunity has faded are the most
likely to develop whooping cough.
END OF SLIDES
THANK YOU FOR LISTENING!!!
ANY QUESTIONS?
GROUP 4

Microbiology and Parasitology

Cholera

Microbiology and Parasitology

 Topics for discussion

Cholera
A. Description
>Causative Agent
>Epidemiology
B. Risk Factors
C. Clinical Manifestations
D. Assessment/Diagnostic Procedures
E. Medical Management
F. Nursing Interventions/Management
 Cholera is an acute diarrheal
illness caused by infection of
the intestine with Vibrio
cholerae bacteria. People can
get sick when they swallow
food or water contaminated
with cholera bacteria. The
& Causative Agents
Defining Cholera

infection is often mild or

without symptoms, but can
sometimes be severe and life-
threatening.
 Vibrio cholerae is a Gram-
negative comma or vibrio-
shaped, highly motile by the
means of a polar flagellum
(monotrichous) and is a
facultative anaerobe bacteria
& Causative Agents

that is part of the Vibrionaceae

Defining Cholera

family. V. Cholerae also have

outer membrane which protects
and delivers active cholera toxin
to host cells.
 It is nearly always spread
through the consumption of
contaminated water or food that
has been tainted by human
feces. Bathing or washing
utensils in water that is infected
& Causative Agents

with cholera can also spread the

Defining Cholera

disease. Common sources of

infection include water from
shallow wells and surface water.
 Cholera is also known as the
"blue death" because the skin of
a person who has the disease can
turn a bluish-gray color as they
& Causative Agents
Defining Cholera

severely lose fluids.

Epidemiology of

Microbiology and Parasitology

Cholera
In 1800s, cholera killed thousands in Europe
and America. London doctor John Snow
studied cholera for decades, and he is most
famous for curing cholera outbreak in London
in 1854. Snow began analyzing cholera
victims and noticed that their earliest
symptoms were always gastrointestinal. He
reasoned that if cholera was carried by foul
air, it should cause lung symptoms, but
because the symptoms were gastrointestinal,
it might be conveyed by water or food.
Epidemiology of

Microbiology and Parasitology

Cholera

Snow linked cholera to contaminated water

and he traced cholera's source to drinking
water and identified its prevention and
control. John Snow is a legend in
epidemiology for his work on the 1854 Soho
cholera outbreak.
Epidemiology of

Microbiology and Parasitology

Cholera
\There is a strong correlation between a lack
of access to clean water and sanitation
facilities and the transmission of cholera.
Typical high-risk regions include peri-urban
slums and camps for people who have been
internally displaced or are refugees. These
are places that do not meet the basic
requirements for access to clean water and
sanitation.
Epidemiology of

Microbiology and Parasitology

Cholera
Cholera occurs globally where clean water
and sanitation are inadequate. Cholera is
endemic in 50 countries, especially in Africa
and Asia. In Africa, Asia, the Middle East,
South and Central America, and the
Caribbean, V. cholerae has caused
widespread epidemics. The 2010 Haiti strain
was later linked to outbreaks in Dominican
Republic, Cuba, and Mexico.
 Poor Sanitary Conditions
Large-scale cholera epidemics are
frequently caused by contaminated public
Cholera is spread wells. People who live in congested areas
without sufficient sanitation are
mostly through particularly vulnerable.

contaminated Type O Blood

water supplies. The Persons with type O blood are twice as
Microbiology and Parasitology

bacterium can also likely to get cholera as people with other

blood types, because the cholera toxin
be found or hyperactivates a key signaling molecule in
intestinal cells.
acquired through:
Household Exposure
You're at increased risk of cholera if you live
with someone who has the disease.
 Reduced or Nonexistent Stomach Acid
Cholera germs cannot thrive in an acidic
environment, therefore stomach acid is
typically used to fight illness. People who
Cholera is spread
have little stomach acid, such as
youngsters, the elderly, and those who
mostly through
take antacids, H-2 blockers, or proton contaminated
pump inhibitors, do not have this
protection, and are therefore more water supplies. The
Microbiology and Parasitology

susceptible to cholera.
bacterium can also
Raw or Undercooked Shellfish be found or
Although large-scale cholera outbreaks are acquired through:
no longer common in developed countries,
eating shellfish from waters known to
carry the bacteria considerably increases
your risk.
Clinical

Microbiology and Parasitology

Manifestations
Vibrio cholerae infection causes a wide range of
symptoms, from asymptomatic intestinal
colonization to severe diarrhea. Other common
symptoms include abdominal discomfort,
borborygmi, and vomiting, especially in the early
stages of the disease. The majority of problems in
patients with severe illness are attributable to the
significant volume and electrolyte loss caused by
diarrhea. Fever is unusual.
Clinical

Microbiology and Parasitology

Manifestations
Mild cases of V. cholerae infection may be
clinically indistinguishable from other causes of
diarrhea, but severe cholera is a clinically distinct
entity. Early cholera stools contain feces and bile.
Cholera gravis is characterized by copious "rice-
water" feces, a watery stool with mucous flecks.
Fishy smell. Usually, diarrhea is painless and
tenesmus-free. In severe situations, individuals
can poop 1 liter each hour. In severe cholera,
toddlers excrete 10 to 20 cc/kg/hour. Other
diarrheal illnesses don't generate this much fluid
loss.
Clinical Manifestations

Microbiology and Parasitology

Incubation period – Cholera usually takes one to two days to develop.
Cholera incubation times vary depending on host susceptibility and inoculum
size, and can last anywhere from a few hours to three to five days.

Other gastrointestinal symptoms — Vomiting, frequently with watery emesis,

is common, and may begin either before or after the onset of diarrhea.

Manifestations of hypovolemia and electrolyte loss — Because of the rapid

fluid and electrolyte loss characteristic of diarrhea associated with severe
cholera, hypovolemia and electrolyte abnormalities are the most important
sequelae. Severe hypovolemia may occur within hours of the onset of
symptoms.
Assessment/Diagnostic

Microbiology and Parasitology

Procedures

A cholera diagnosis includes the following:

Observation of symptoms, which often include

watery diarrhea, nausea, vomiting, and stomach
pains. Diarrhea and vomiting causes the patient to
become listless and dehydrated over time.
Assessment/Diagnostic

Microbiology and Parasitology

Procedures
A cholera diagnosis includes the following:

Stool culture — A definite diagnosis of cholera is

based on the isolation of the organism from clinical
samples, which also allows the antibiotic
susceptibility profile to be determined. Selective
media such as thiosulfate citrate bile sucrose (TCBS)
agar or taurocholate tellurite gelatin agar can be
used to isolate V. cholerae from feces (TTGA). V.
cholerae may be recognized biochemically once
cultivated, and serogroup and serotype can be
assigned using particular antibodies.
Assessment/Diagnostic

Microbiology and Parasitology

Procedures

A cholera diagnosis includes the following:

Antigen detection- For the diagnosis of cholera,

various fast antigen detection-based techniques are
commercially available . Immunochromatographic
lateral flow devices (dipsticks) such as Crystal VC
detect the presence of the O1 or O139 antigen in
watery diarrheal feces, while Cholkit detects just the
O1 antigen.
Assessment/Diagnostic

Microbiology and Parasitology

Procedures

A cholera diagnosis includes the following:

Molecular tests- Molecular testing for V. cholerae

(eg, PCR), including tests that employ dried fecal
spots, is also possible; however, molecular testing
has so far been restricted to epidemiologic research
and surveillance.
Assessment/Diagnostic

Microbiology and Parasitology

Procedures

A cholera diagnosis includes the following:

Darkfield microscopy- (at 400x magnification) of

rice-water stools may also be utilized to detect the
presence of extremely motile Vibrios, whose
shooting star-like motion can be prevented by the
later addition of particular antibodies . Darkfield
microscopy is very specific for V. cholerae but lacks
sensitivity to be utilized for diagnosis.
 Microbiology and Parasitology
Medical
Management
1. Oral or intravenous hydration is the
primary treatment for cholera.
2. In conjunction with hydration, treatment
with antibiotics is recommended for
severely ill patients. It is also
recommended for patients who have
severe or some dehydration and
continue to pass a large volume of stool
during rehydration treatment.
 Microbiology and Parasitology
Medical
Management
3. Maintenance Phase. The goal of the
maintenance phase is to maintain normal
hydration status by replacing ongoing losses;
the oral route is preferred, and the use of
oral rehydration solution (ORS) at a rate of
500-1000 mL/hr is recommended.
 Microbiology and Parasitology
Medical
Management
4. Antibiotic susceptibility should be
monitored during an epidemic or outbreak
by testing sample isolates from various
geographic areas on a regular basis.

5. Education of healthcare workers,

assurance of adequate supplies, and
monitoring of practices are all important for
appropriate dispensation of antibiotics.
 Microbiology and Parasitology
Medical
Management
6. When available, supplementation (20 mg
zinc per day in children 6 months or older)
should be started immediately. A study in
Bangladesh showed that zinc
supplementation significantly reduced the
duration and severity of diarrhea in children
suffering from cholera.
Nursing

Parasitology
Microbiology and
Interventions/
Management
For Infants:
Emphasize to the mother to continue
breastfeeding the baby.
If the baby is exclusively breastfeeding, give ORS
or 100 to 200ml clean water in addition to breast
milk
If the baby is not exclusively breastfeeding, teach
the mother to give food-based fluids like rice
water and soups or ORS
Nursing

Parasitology
Microbiology and
Interventions/
Management
For Infants:
Encourage the mother to give frequent small sips
of clean water or ORS from a cup; the child
vomits, tell to wait for at least 10 minutes and
continue slowly
Nursing

Parasitology
Microbiology and
Interventions/
Management
For Children and Adult:
Rehydration is the main goal to compensate for
the fluid loss from diarrhea and vomiting.
Clients are encouraged to take more fluids as
much as possible or are given with ORS to replace
electrolyte losses.
If moderate to severe dehydration ensues,
intravenous infusion with normal saline or
Lactate ringer’s solution is the main priority.
Nursing

Parasitology
Microbiology and
Interventions/
Management
For Children and Adult:
The administration of antibiotics is done to
reduce the volume and duration of diarrhea.
Meanwhile, Zinc supplement is given to children
to reduce the duration of diarrhea and to
minimize its successive episodes.
Group 4 Members
Carunungan, Rodney
Cerro, Kyle Monique
Denoyo, Daimarie
Gonzales, Katrina
 Resources
Microbiology and Parasitology

Microbiology and Parasitology

https://www.cdc.gov/cholera/treatment/rehydration-therapy.html

https://rnspeak.com/cholera-management/

https://nurseslabs.com/cholera/
Salmonellosis
n5
 CONTENTS OF REPORT

01 02
RISK FACTORS;
INTRODUCTION SIGNS AND
SYMPTOMS

03 04
DIAGNOSiS AND
NURSING
MEDICAL
MANAGEMENT
MANAGEMENT
 reporters

Eron m. Christine m. Shiela n.

Introduction Risk Factors, Clinical Diagnostic Procedures,
Manifestations Medical Management
 Reporters

Carmell l. Jamaica j.
Diagnostic Procedures, Nursing Interventions
Medical Management
01 introduction
Causative Agent | Epidemiology
 jargon

Virulence Serotype/
sp./spp. subsp.
factor serovar
the molecules groups within a
Abbreviation for Abbreviation for
that assist the single species of
species and subspecies
bacterium microorganisms,
several species
colonize the host such as bacteria
at the cellular or viruses, which
level share distinctive
surface
structures.
 jargon

Nonspecific Specific host Focal

Antigen
host defense defense infections
Any substance that General Recognizes and
causes the body to mechanisms coordinates a localized or
make an immune (cellular functions attacks against general infection
response against that and biochemical specific caused by the
substance. Antigens pathways) engaged pathogens dissemination of
include toxins, after any kind of microorganisms
chemicals, bacteria, injury and protect or toxic products
viruses, or other against all from a focus of
substances that come pathogens in infection.
from outside the body. general.
 Causative agent
● Salmonella/Salmonellae
● Ubiquitous human and animal pathogens
○ Causes substantial loss in livestock
● May either be in the form of self-limiting food poisoning (gastroenteritis)
● May manifest in serious systemic infection (enteric fever)
 S. enterica S. bongori
Typically affect warm-blooded Typically affect cold-blooded
organisms organisms
 S. Typhi & s. Non-typhoidal
paratyphi salmonella
cause enteric fever, a syndrome cause gastroenteritis
associated with fever and
abdominal pain
Causative agent
 Causative agent
Salmonella infection is caused by a group of salmonella bacteria called
Salmonella. The bacteria are passed from feces of people or animals to other
people or animals. Contaminated foods are often animal in origin. They
include beef, poultry, seafood, milk, or eggs. However, all foods, including
some unwashed fruits and vegetables can become contaminated.

Scientific Name:
S. enterica , Typhi S. enterica subsp. enterica

serotype
Species

Shortened Scientific Name:

Salmonella Typhi
 salmonella
Salmonella species are Gram-negative, flagellated facultatively anaerobic bacilli characterized by
O, H, and Vi antigens. There are over 1800 known serovars which current classification considers to
be separate species.
 salmonella
Salmonella species are Gram-negative, flagellated facultatively anaerobic bacilli characterized by
O, H, and Vi antigens. There are over 1800 known serovars which current classification considers to
be separate species.
 salmonella
Pathogenic salmonellae ingested in food survive passage through the gastric acid barrier and
invade the mucosa of the small and large intestine and produce toxins. Invasion of epithelial cells
stimulates the release of proinflammatory cytokines which induce an inflammatory reaction. The
acute inflammatory response causes diarrhea and may lead to ulceration and destruction of the
mucosa. The bacteria can disseminate from the intestines to cause systemic disease.

Host Defense Mechanism:

Specific:
● Gastric acidity
● Intestinal mucus and motility (peristalsis)
● Lactoferrin
● lysozyme

Non-Specific:
● Mucosal and systemic antibodies
● Genetic resistance
 salmonellosis
Non-typhoidal salmonellosis is a worldwide disease of humans and animals. Animals are the main
reservoir, and the disease is usually food borne, although it can be spread from person to person.

The salmonellae that cause Typhoid fever and other enteric fevers spread mainly from person-to-
person via the fecal-oral route and have no significant animal reservoirs. Asymptomatic human
carriers (“typhoid Marys”) may spread the disease.

● CDC estimates Salmonella bacteria cause about 1.35 million infections, 26,500
hospitalizations, and 420 deaths in the United States every year. Food is the source for most
of these illnesses.
02
Risk factors
&
Clinical
manifestations
 Risk factors
There are many things that increase your risk
of contracting or spreading salmonella. Here
are habits and practices to avoid:

● Failure to wash your hands after using

the restroom, diapering, or caring for a
sick person
● Failure to wash your hands before and
after preparing food and after handling
raw meat or eggs
● Handling or cutting raw meat or eggs
and then using the knife, cutting board,
bowl, or other utensils for other food
items such as vegetables or fruit
● Consuming undercooked or raw meat,
eggs, or unpasteurized milk products
● Not washing fresh fruit and vegetables
before eating them
 Risk factors
Amphibians, reptiles, and live poultry carry the biggest risks as pets.
These include turtles, lizards, frogs, and chickens that can carry
salmonella bacteria. Salmonella can also be found in animal pens,
tanks, cages and litter boxes.

The animals listed above should not be kept in a home with:

● Children under age 5
● People over age 65
● People who have immune system problems

These pets should also not be kept in facilities that serve these age
groups, such as:
● Daycare
● Hospitals
● Senior centers
● Skilled nursing facilities

People in these risk groups should not touch these animals. All
children and adults should avoid eating or drinking around pets in
this group.
 Risk factors
These behaviors increase your risk of getting salmonella
from a pet:

● Allowing animals in areas where food and drinks are

prepared, eaten, or stored
● Failure to wash your hands after handling or touching
an animal, especially before preparing or eating food
● Discarding cleaning water from the pet's habitat in a
sink that is used for food preparation
● Allowing people who are at increased risk for
salmonella to clean a pet's habitat, especially without
wearing disposable gloves
● Using uncured pet manure to fertilize gardens or
flower beds
 Clinical manifestations
The typical symptoms includes:
● Diarrhea
● Blood in the stool
● Fever
● Chills
● Stomach (abdominal) cramps

Less frequent, but fairly common symptoms includes:

● Nausea
● Vomiting
● Headache

The symptoms usually last about four to seven days and don't typically require a trip to the
healthcare provider, unless it affects an infant or if complications develop.
3
DIAGNOSiS AND
MEDICAL
MANAGEMENT
 Assessment/Diagnostic Procedures
Salmonella infection is usually diagnosed based on signs and symptoms. In order to know if the
patient was infected by salmonella it requires testing a specimen sample such as stool, body
tissue, or fluids. This laboratory test can help guide treatment decisions.

Stool Test CIDT qPCR

 Salmonella control
● Shift to more hygienic practices in the workplace
● Irradiation
● Government surveillance programs
● Antibiotic medication
● Replenishing lost fluids in the body
 Medical management
● A doctor will not always prescribe antibiotics for Salmonella. Scientists have
determined that overuse can lead to antibiotic resistance, and this increases the risk
of the infection reappearing.
● Non-typhoidal salmonellosis typically resolves in a few days without treatment, but if
the infection threatens to spread, then medications, hospitalization, and even surgery
may be required.
● Treatment for a salmonella infection usually starts with home remedies and over the
counter medications. You may need prescriptions or medical care as well depending on
a number of factors. This includes the severity of the condition, how long you’ve had it,
and if you’re experiencing dehydration.
 Medical management

● Treatments may include:

Rest and Rehydration Over the counter therapies drugs Vaccines

 Medical management

Eating mild food Heating pads

4 DIAGNOSiS AND
MEDICAL
NURSING
MANAGEMENT
INTERVENTIONS/
RESPONSIBILITIES
● Relieve diarrhea. Teach the client about the importance of hand washing after each bowel
movement and before preparing food for others; encourage increase fluid intake of 1.5 to 2.5
liters/24 hour plus 200 ml for each loose stool in adults unless contraindicated; encourage
the client to eat foods rich in potassium; and administer antidiarrheal medications as
prescribed.

● Educate patient and folks. Assess client’s knowledge of salmonellosis, its mode of
transmission, and its treatment; educate the client and the family about the causes of and
treatments for salmonellosis; educate the client about the importance of hand washing
after toileting and perianal hygiene and before preparing food for others; and educate the
client about food preparation and storage methods to reduce contamination by
microorganisms.
● Prevent fluid volume deficit. Assess the client’s skin turgor and mucous membranes for
signs of dehydration; monitor BP for orthostatic changes (changes seen when changing
from a supine to a standing position); instruct the client to monitor weight daily and
consistently with the same scale, preferably at the same time of the day, and wearing the
same amount of clothing; and administer antiemetic medications as ordered.

● Improve nutritional intake. Measure client weight; monitor and record the number of
vomiting, amount and frequency; monitor the client’s food intake; provide a diverse diet
according to his needs; and provide parenteral fluids, as ordered.
FAQs
Frequently Asked Questions
1
Do all salmonellae
cause salmonellosis?
No
2
Does salmonellosis affect
everyone the same way?
No
3
How do i prevent
salmonellosis?
● wash food and kitchenware
thoroughly
● Cook food to the appropriate
temperature
○ 145°F for roasts
○ 160°F for ground meats
○ 165°F for all poultry
4
When should i go to the
doctor?
● If illness persists after a couple of days
● Fever over 101.5°F that lasts over a day
● infants/elderly/individuals with pre-
existing conditions
5
Should i immediately take
antibiotics when i have
salmonellosis?
No
6
How is salmonellosis
transmitted?
● Unhygienic food-related (and/or
water) practices
● Direct animal contact
● Person-to-person
7
How serious is
salmonellosis?
● Worldwide Endemic
● 2nd most common leading cause of
infectious intestinal disease
● 60-80% cases are sporadic
8
Why is it called salmonella?

● Daniel E. Salmon
 resources
● https://www.biologyonline.com/dictionary/o-antigen
● https://www.mayoclinic.org/diseases-conditions/salmonella/symptoms-causes/syc-20355329
● https://www.verywellhealth.com/salmonella-causes-risk-factors-2633811
● https://www.verywellhealth.com/salmonella-symptoms-2634330
● https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/salmonella-
bongori#:~:text=Salmonella%20spp.,variety%20of%20warm%2Dblooded%20animals.
● https://byjus.com/biology/flagella/#:~:text=Flagella%20Function&text=They%20help%20an%20or
ganism%20in,used%20as%20a%20secretory%20organelle.
● http://www.antimicrobe.org/h04c.files/history/Nomenclature%20of%20Salmonella.asp
● https://www.cdc.gov/salmonella/general/diagnosis-
treatment.html#:~:text=Diagnostic%20and%20Public%20Health%20Testing,-
Related%20Pages&text=Infection%20is%20diagnosed%20when%20a,genetic%20material%20o
f%20the%20bacteria.
● https://www.singlecare.com/conditions/salmonella-treatment-and-medications
● https://www.verywellhealth.com/salmonella-treatment-4164292
● https://www.google.com/search?q=is+salmonellosis+an+endemic&oq=is+salmonellosis+an+endem
ic&aqs=chrome..69i57j33i10i160l3.5937j0j7&sourceid=chrome&ie=UTF-8
● https://www.cdc.gov/salmonella/index.html#:~:text=CDC%20estimates%20Salmonella%20bacteri
a%20cause,%2C%20fever%2C%20and%20stomach%20cramps.
● https://www.news-medical.net/health/Salmonella-History.aspx
GROUP 6
Rabadon, Scot Graham
Ricacho, Micha Marie
Sagayno, Ivy
Sakkam, Ram Vincent
Sanchez, Rhobinkier
TETANUS
TETANUS
 What is Tetanus?
Tetanus is an acute, often fatal, disease contracted through exposure to
the spores produced by the bacterium Clostridium tetani.

It is commonly acquired when the bacteria comes in contact with deep cuts,
wounds, or burns on the body.

This disease affects the Nervous System with the exotoxin

produced by the spores of the bacteria.
Clostridium Tetani
Anaerobic gram-positive, spore-
forming bacteria
Spores resistant to heat and
antiseptics
Spores found in soil and intestines
and feces of some animals
Two exotoxins produced with growth
of bacteria: tetanolysin and
tetanospasmin.
 Tetanus Pathogenesis
Enters body through wound
Spores germinate in anaerobic
conditions
Tetanus toxin binds in central
nervous system
Interferes with neurotransmitter
release to block inhibitor impulses
Leads to unopposed muscle
contraction and spasm
 EPIDEMIOLOGY

Occurrence

Tetanus occurs worldwide but is most

frequently encountered in densely
populated regions in hot, damp climates
with soil rich in organic matter.
 Epidemiology
RESERVIOR
Soil and intestine of animals and
humans

TRANSMISSION
Contaminated wounds
 Epidemiology
TempORAL pATTERN
Temperature climate: Peaks in
summer
Tropical climate: Year-round, but may
rise during wet seasons

communicability
Not contagious
 Risk Factors
The greatest risk factor for tetanus infection is not being
vaccinated or not keeping up with the 10-year booster shots.

Other risk factors for the development of a tetanus infection

include:

contaminated wounds, punctured wounds, crushing, burns and

working or living in poor hygiene conditions.
Punctured wounds
wounds caused by an object puncturing the skin like a
nail or needle, splinters, body piercings, tattoos, injection drugs
 compound fracture
a break or crack in your bone that is visible through your skin.
gunshot wounds crush injuries

burns surgical wounds

animal bite infected foot ulcer

infected umbilical stumps in newborns

 complications:
Complications of tetanus infection may include:
- Breathing problems
- Blockage of a lung artery (pulmonary embolism)
- Pneumonia
- Broken bones
- Death

prevention:
You can prevent tetanus by being vaccinated.

other recommendation:
Ask your doctor to review your vaccination status regularly.
Check whether you are current on your vaccination schedule
if you are planning international travel.
 Clinical Manifestations

Tetanus is a serious disease of the nervous system caused by a toxin-producing

bacterium. The disease causes muscle contractions, particularly of your jaw and neck
muscles. Tetanus is commonly known as lockjaw.

Severe complications of tetanus can be life-threatening. There's no cure for tetanus.

Treatment focuses on managing symptoms and complications until the effects of the
tetanus toxin resolve.

Because of the widespread use of vaccines, cases of tetanus are rare in the United
States and other parts of the developed world. The disease remains a threat to
people who aren't up to date on their vaccinations. It's more common in developing
countries.

 Symptoms
The average time from infection to
appearance of signs and symptoms
(incubation period) is 10 days. The
incubation period can range from 3 to 21
days.

generalized tetanus
The most common type of tetanus is called
generalized tetanus. Signs and symptoms
begin gradually and then progressively
worsen over two weeks. They usually start at
the jaw and progress downward on the body.
Signs and symptoms of generalized tetanus
include:
Painful muscle spasms and stiff, immovable muscles (muscle rigidity) in your jaw
Tension of muscles around your lips, sometimes producing a persistent grin
Painful spasms and rigidity in your neck muscles
Difficulty swallowing
Rigid abdominal muscles
Progression of tetanus results in repeated painful, seizure-like spasms that last for
several minutes (generalized spasms). Usually, the neck and back arch, the legs
become rigid, the arms are drawn up to the body, and the fists are clenched.
Muscle rigidity in the neck and abdomen may cause breathing difficulties.

These severe spasms may be triggered by minor events that stimulate the senses
— a loud sound, a physical touch, a draft or light.
As the disease progresses, other signs and symptoms may include:

High blood pressure

Low blood pressure
Rapid heart rate
Fever
Extreme sweating
Localized tetanus

This uncommon form of tetanus results in muscles spasms near the site of a
wound. While it's usually a less severe form of disease, it can progress to
generalized tetanus.
 Localized
tetanus
Localized tetanus is an uncommon
form of the disease in which patients
have persistent contraction of muscles
in the same anatomic area as the
injury. These contractions may persist
for many weeks before gradually
subsiding. Localized tetanus may
precede the onset of generalized
tetanus but is generally milder.
Cephalic tetanus
Cephalic tetanus is a rare
form of the disease,
occasionally occurring with
otitis media in which C.
tetani is present in the flora
of the middle ear or
following injuries to the
head. There is involvement
of the cranial nerves,
especially in the facial area.
 Neonatal tetanus
Neonatal tetanus is a form of generalized tetanus that occurs in
newborn infants. Neonatal tetanus occurs in infants born without
protective passive immunity because the mother is not immune.
It usually occurs through infection of the unhealed umbilical
stump, particularly when the stump is cut with an unsterile
instrument. In neonatal tetanus, symptoms usually appear from
4 to 14 days after birth, averaging about 7 days.
Diagnostic procedures

Doctors diagnose tetanus based on a physical exam, medical

and vaccination history, and the signs and symptoms of muscle
spasms, muscle rigidity and pain
 Medical Management
Any cut or wound must be thoroughly cleaned to prevent infection. A tetanus-prone
wound should be treated by a medical professional immediately.

A wound likely to develop tetanus is defined as:

a wound or burn that requires surgical intervention that is delayed for over 6 hours
a wound or burn that has a considerable amount of removed tissue
any puncture-type injury that has been in contact with manure or soil
serious fractures where the bone is exposed to infection, such as compound fractures
wounds or burns in patients with systemic sepsis
Tetanus Immunoglobulin (TIG)
- Any patient with a wound listed should receive tetanus immunoglobulin (TIG) as soon
as possible, even if they have been vaccinated.

- contains antibodies that kill Clostridium tetani.

Penicillin or Metronidazole
- These antibiotics prevent the bacterium from multiplying and producing the
neurotoxin that causes muscle spasms and stiffness.
In treating muscle spasms and stiffness, patients may be prescribed:

Anticonvulsants, such as diazepam (Valium), relax the muscles to prevent

spasms, reduce anxiety, and work as a sedative.

Muscle relaxants, such as baclofen, suppress nerve signals from the brain
to the spinal cord, resulting in less muscle tension.

Neuromuscular blocking agents, block the signals from nerves to muscle

fibers and are useful in controlling muscle spasms. They include
pancuronium and vecuronium.

Surgery
If the tetanus prone wound is very large, they may surgically remove as
much of the damaged and infected muscle as possible (debridement).

Debridement is the act of removing dead or contaminated tissue, or

foreign material. In the case of a tetanus-prone wound, the foreign material
may be dirt or manure.

Nutrition
A patient with tetanus requires a high daily calorie intake because of increased
muscle activity.
Prevention
Most cases of tetanus occur in people who have never had the vaccine or
who did not have a booster shot within the previous decade.

Vaccination
The tetanus vaccine is routinely given to children as part of the diphtheria
and tetanus toxoids and acellular pertussis (DTaP) shot.
The DTaP vaccine consists of five shots, usually given in the arm or thigh
of children when they are aged:

2 months
4 months
6 months
15 to 18 months
4 to 6 years

Booster
Tdap vaccine is normally given between the ages of 11 and 18 years, and then
another booster every 10 years. If an individual is traveling to an area where
tetanus is common, they should check with a doctor regarding vaccinations.
Nursing Intervention/Management
example
Ineffective airway clearance related to the accumulation of sputum in the trachea and respiratory
muscle spasm

Characterized by:
Ronchi, cyanosis, dyspnea, cough accompanied by sputum ineffective or lenders, the results of
laboratory tests showed: abnormal blood gas analysis (respiratory acidosis)

Objectives:

Effective airway

Criteria:
Clients are not crowded, no lender or sleam
Breathing 16-18 times / minute
No nostril breathing
No additional respiratory muscle
The results of laboratory blood gas analysis of blood is within normal limits (pH = 7.35 to 7.45; PCO2 =
35-45 mmHg, PO2 = 80-100 mmHg)

Nursing Intervention/Management
example
Nursing Interventions and Rationale

1. Clear the airway by adjusting the position of head extension.

Rational: the anatomy of the head position of the extension is a way to align the respiratory cavity so
that the process of respiration is still running smoothly by removing the blockage of the airway.

2. Physical examination by auscultation of breath sounds heard (there Ronchi) every 2-4 hours.
Rational: Ronchi show an upper respiratory problems due to fluid or a secrete that covered most of
the respiratory tract that needs to be removed to optimize the airway.

3. Clean the mouth and respiratory tract of mucus with a secret and do section.
Rational: section is an act of assistance to issue a secret, thus simplifying the process of respiration.

4. Oxygenation according to physician instructions.

Rational: the provision of adequate oxygen can supply and provide backup oxygen, thus preventing
hypoxia.
Nursing Intervention/Management
example
Nursing Interventions and Rationale

5. Observation of vital signs every 2 hours.

Rational: dyspnea, cyanosis is a sign of breathing disorder which is accompanied by decreased
cardiac work arising tacikardi reffil time and capillary length / time.

6. Observation of the onset of respiratory failure / apnea.

Rational: the inability of the body in the respiratory process required critical interventions by using a
breathing (mechanical ventilation)

7. Collaboration in a secret-thinning medication (mukolotik).

Rational: mukolitik drugs can thin the thick secretions so easy to remove and prevent viscosity.
Thank You!
 Microbiology and Parasitology

GONORRHEA

Group 7_N5
 Here are your presentors

John Marco Y. Merry Loraine Abigail Joy M. Marlyn B. Jan Michael D.

Sarol M. Serrano Socajel Villarin Sestoso
Microbiology and Parasitology

Pre-conditioning
activity
Before we begin the discussion,
let's first play a game!
 Unlock the code !

A B C D E F G H I J K L M
N O P Q R S T U V W X Y Z
1. GONORRHEA

 Unlock the code !

A B C D E F G H I J K L M
N O P Q R S T U V W X Y Z
2. STD

 Unlock the code !

A B C D E F G H I J K L M
N O P Q R S T U V W X Y Z
3. BACTERIA

 Unlock the code !

A B C D E F G H I J K L M
N O P Q R S T U V W X Y Z
4. ABSTINENCE

 Unlock the code !

A B C D E F G H I J K L M
N O P Q R S T U V W X Y Z
5. NEISSERIA GONORRHOEAE

Thanks for participating !

 Microbiology and Parasitology

GONORRHEA

Group 7_N5
A. Description
by John Marco Y. Sarol
What is Gonorrhea?

Gonorrhea is a sexually transmitted

disease (STD). You get it from having sex

someone who is infected with it. You
with
may have heard people call it “the clap.”
Both men and women can get it, though
men get it more often than women. It can
cause infection in the genitals, rectum,
and throat. It is very common, especially
among young people ages 15-24 years.

 Description

What is the causative agent

responsible?

Neisseria gonorrhoeae is a bacterium which

causes gonorrhoea and is most prevalent in the
developing world. These bacteria frequently
colonize in the genital mucosa, but also have
the ability to colonize other mucosal areas of
the body, including the anal, ocular, and
nasopharyngeal mucosa.
Epidemiology
Reported cases of
gonorrhea were up to
10% and 7%,
respectively, compared
to 2019 which has an
estimated global annual
incidence of 86.9
million adults.
B. Risk Factors
by Merry Loraine M. Serrano
 Sexual contact with a person who has
gonorrhea
Sex with a new partner without barrier
Common risk protection

factors for Unprotected sex with someone from

an area with high gonorrhea burden

gonorrhea: Sexually active people under 25 years

of age
History of STBBI
Being birthed by a person with gonorrhea
Unprotected anal intercourse in gay, bisexual
and other men who have sex with men

Unprotected sex with multiple partners

Spread via blood from sharing needles

C. Clinical Manifestations
by Abigail Joy M. Socajel
 Clinical Greater frequency or urgency of
Manifestations
urination, and pain during urination

Anal itching, pus-like discharge

from the rectum

What are the Spots of bright red blood on toilet

tissue and having to strain during

signs and bowel movements

symptoms of Yellow, white, or green discharge

from male penis
having
gonorrhea? Pain or swelling in male testicles
D. Assessment/Diagnostic Procedures
by Abigail Joy M. Socajel
 Assessment and
Diagnostic
Procedure Swab of
Urine Test affected area

This can help A swab of your throat,

identify bacteria in urethra, vagina or
rectum can collect
your urethra
bacteria that can be
identified in a lab.

How is
A healthcare provider will use a urine sample to diagnose
gonorrhea gonorrhea. However, if a person had oral or anal sex, the
being healthcare provider may use swabs to collect samples
from the throat or rectum. In some cases, a healthcare
assessed and provider may also use a swab to collect a sample from a
man’s urethra (urine canal) or a woman’s cervix (opening
diagnosed?
to the womb).
E. Medical Management
by Marlyn B. Villarin
 Uncomplicated Gonococcal infection of cervix,
urethra and rectum
• Single dose of Tab. Cefixime 400mg, Inj.
Ceftriaxone 125 mg IM, tab. Ciprofloxacin 500mg, tab.
Medical Ofloxacin 400mg, or tab. Levofloxacin 250mg

Management Uncomplicated Gonococcal infection of pharynx

•Single dose of Inj. Ceftriaxone 125 mg IM, or tab.
Ciprofloxacin 500mg

Disseminated gonococcal infection (DGI)

•Inj. Ceftriaxone 1 g IM or IV daily
 Gonococcal conjuctivitis:
Inj. Ceftriaxone 1 g IM single dose

Gonococcal meningitis:
Medical •Inj. Ceftriaxone 1-2 g IV every 12 hrs X 10-14 days.

Management Gonococcal endocarditis:

•Inj. Ceftriaxone 1-2 g IV every 12 hrs for at least 4 weeks

Ophthalmia neonatorum:
•Inj. Ceftriaxone 25-50 mg/kg IV/IM single dose( not more than
125 mg)
 Management of Sex partners:
All sex partners of patient who have N. gonorroeae
infection should be evaluate and treated for both N.
gonorroeae and C. trachomatis if their last sexual contact
Medical with patient was within 60 days before onset of symptoms
or diagnosis.
Management
Follow up:
Treated patients with CDC regimen need not follow up to
confirm their cure but the patient with persistent
symptoms may be tested for antimicrobial susceptibility
and other cause and tested accordingly.
F. Nursing Interventions/
Management
by Jan Michael D. Sestoso
 Nursing Interventions/
Management for Gonorrhea:
1. Use standard precautions when obtaining specimens for
laboratory examination and when caring for the patient
2. Isolate the patient with an eye infection

3. If the patient has gonococcal arthritis, apply moist heat to

ease the pain in the affected joints.
4. Before treatment, determine if the patient has any drug
sensitivities.

5. Monitor the patient for complications.

 Nursing Interventions/
Management for Gonorrhea:

6. Tell the patient that until cultures prove negative, he’s still
infectious and should avoid unprotected sexual contact.
7. Urge the patient to inform his sexual partners of his
infection so that they can seek treatment.
8. Advise the partner of an infected person to receive
treatment even if she doesn’t have positive cultures

9. Counsel the patient and his sexual partners to be tested

for human immunodeficiency virus and hepatitis B infection.
 Nursing Interventions/
Management for Gonorrhea:

10. Instruct the patient to be careful when coming in

contact with his bodily discharges so that he doesn’t
contaminate his eyes.

11. Tell the patient to take anti-infective drugs for the length
of time prescribed.

12. To prevent reinfection, tell the patient to avoid sexual

contact with anyone suspected of being infected, to use
condoms during intercourse, to wash genitalia with soap and
water before and after intercourse.

The best cure and treatment

is prevention!
-Education

-Detection

-Effective Diagnosis

-Treatment of infected persons

-Evaluation, treatment, counseling of sex partners
-END OF PRESENTATION-

for listening !