COMMUNICABLE DISEASES the way the causative agent gets out of the

Communicable Diseases are Primary Cause of reservoir (body fluid or skin)

Mortality Gap between Rich and Poor Countries Reduce risk from portals of exit by:
Non-communicable diseases account for 59% of all • Covering coughs and sneezes with a tissue
deaths worldwide – estimated to rise from 28m in • Handling body fluids with gloves, then doing
1990 to 50m in 2020 hand hygiene
About 60% of deaths caused by communicable • Keeping draining wounds covered with a
diseases can be attributed to: dressing
▪ HIV/AIDS • Not working when you have exudative (wet)
▪ Malaria lesions or weeping dermatitis
▪ Tuberculosis Mode of transmission
▪ Measles any mechanism by which a pathogen is spread
▪ Diarrheal disease from a source or reservoir to a person
▪ Acute respiratory infection unwashed hands, things which are not cleaned
Philippines top 10 leading causes of morbidity between patients, droplets, or, for a few diseases,
& mortality in the year 2007: the air
Diarrhea Eliminate the mode of transmission by:
Bronchitis • Hand hygiene
Pneumonia • Wearing gloves to minimize contamination
Influenza of hands and discarding them after each
Hypertension patient
Tuberculosis • Cleaning, disinfection, or sterilization of
Malaria equipment used by more than one patient
Heart diseases
• Cleaning of the environment, especially
Cancer
high-touch surfaces
Accidents
Portal of entry
Chronic obstructive pulmonary disease and
hole in the skin that allows the infectious agent to
other respiratory diseases
get into the body (mouth, nose, eyes, rashes, cuts,
Diabetes and Kidney diseases.
needlestick injuries, surgical wounds and IV sites)
Protect portals of entry (our own and our patients)
Goal of WHO
by:
1. Prevention of disease
• Dressings on surgical wounds
2. Prevention of disability and death from infection
3.Prevention through immunization • IV site dressings and care
• Elimination of tubes as soon as possible
Chain of Infection • Masks, goggles and face shields
Pathogen or causative agent • Keeping unwashed hands and objects away
biologic agent (organism) capable of causing from the mouth
disease • Actions and devices to prevent needlesticks
Eliminate organism by: • Food and water safety
• Sterilizing surgical instruments and anything Susceptible host
that touches sterile spaces of the body a person or animal lacking effective resistance to a
• Using good food safety methods particular infectious agent
• Providing safe drinking water Minimize risk to susceptible hosts by:
• Vaccinating people so they do not become • Vaccinating people against illnesses to
reservoirs of illness which they may be exposed
• Treating people who are ill • Preventing new exposure to infection in
Reservoir people who are already ill, are receiving
Any person, animal, arthropod, plant, soil, or immunocompromising treatment, or are
substance (or combination of these) in which an infected with HIV
causative agent normally lives and multiplies, on • Maintaining good nutrition
which it depends primarily for survival, and where it • Maintaining good skin condition
reproduces in such numbers that it can be • Covering skin breaks
transmitted to a susceptible host • Encouraging rest and balance in our lives
Eliminate reservoirs by: MICROBES against HUMAN
• Treating people who are ill Definition:
• Vaccinating people Symptoms
• Handling and disposing of body fluids evidence of disease that is experienced or
responsibly perceived (subjective)
• Handling food safely subjective changes in body function noted by
• Monitoring soil and contaminated water in patient but not apparent to an observer
sensitive areas of the hospital and washing Signs
hands carefully after contact with either objective evidence of a disease the physician
can
observe and measure
Portal of exit Syndrome
a specific group of signs and symptoms that
accompany a particular disease
Incidence pre diseased state
the number of people in a population who recovery has occurred
develop a disease during a particular time Mode of Transmission
period The process of the infectious agent moving from
Prevalence the reservoir to the susceptible host
the number of people in a population who Contact Transmission
develop a disease, regardless of when it appeared - the most important and frequent mode of
refers to both old and new cases transmission
Classification of Infectious Disease Type of Contact Transmission
Based on Behavior within host Direct Contact Transmission
Infectious Disease • Person to person transmission of an agent
- Any disease caused by invasion and by
multiplication of microorganisms • physical contact between its source and
Contagious Disease • susceptible host
disease that easily spreads from one person • No intermediate object involved
to another • i.e. kissing, touching, sexual contact
• Source → Susceptible Host
Based on Occurrence of Disease Indirect Contact Transmission
Sporadic Disease • reservoir to a susceptible host by means of
disease occurs only occasionally a
i.e. botulism, tetanus
• non living object (fomites)
Endemic Disease
• Source → Non Living Object → Susceptible
constantly present in a population, country
Host
or
Susceptible Host
community
Recognition of high risk patients
i.e. Pulmonary Tuberculosis
Epidemic Disease • Immunocompromised
acquire disease in a relatively short period • DM
greater than normal number of cases in an • Surgery
area • Burns
within a short period of time • Elderly
Pandemic Disease Percentage Nosocomial Infection
epidemic disease that occurs worldwide • 17% Surgical
i.e. HIV infection • 34% UTI
Based on Severity or Duration of Disease • 13% LRI
Acute Disease • 14% Bacteremia
develops rapidly (rapid onset) but lasts only • 22% Other (incldng skin
a short time Infxn)
i.e. measles, mumps, influenza Factors for Nosocomial Infection
Chronic Disease Microorganism/Hospital Environment
Develops slowly, milder but longer lasting Most common cause
clinical manifestation • Staph aureus, Coag Neg Staph Enterococci
Based on State of Host Resistance • E. coli, Pseudomonas, Enterobacter,
Primary Infection Klebsiella
acute infection that causes the initial illness • Clostridium Difficile
Secondary Infection • Fungi ( C. Albicans)
one caused by an opportunistic pathogen after • Other ( Gram (-) bacteria)
primary infection has weakened the body’s
• 70% are drug resistant bacteria
defenses
Compromised Host
One whose resistance to infection is impaired by
Stages of Disease
broken skin, mucous membranes and a
Incubation Period
suppressed immune system
time interval between the initial infection and
the
Skin and Mucous Membrane
1st appearance of any s/sx
physical barrier
Prodromal Period
i.e. burns, surgical wounds, trauma, IV site
early, mild symptoms of disease
invasive procedures
Period of Illness
Suppressed Immune System
overt s/sx of disease
i.e. drugs, radiation, steroids, DM, AIDS
WBC may increase or decrease
IMMUNITY
can result to death if immune response or
The human body has the ability to resist almost all
medical
types of organisms or toxins that tend to damage
intervention fails
the tissues and organs. This is called immunity
Period of Decline
Functions of Immune System
s/sx subside
1. Protects the body from internal threats
vulnerable to secondary infection
2. Maintains the internal environment by removing
Period of Convalescence
dead or damaged cells.
regains strength and the body returns to its
3. Provides protection against invasion from outside Allergic and hypersensitivity reactions
the body. Combats parasitic infections
IMMUNIZATION
The immune system AND VACCINES
The major components of the immune system IMMUNIZATION
includes the bone marrow which produces the Process inducing immunity artificially by either
white blood cells (WBC), the lymphoid tissues vaccination (active) or administration of antibody
which includes the thymus, spleen, lymphnodes, (passive)
tonsils and adenoids. Active : stimulates the immune system to produce
Natural Immunity (INNATE) antibodies, cellular immune responses to protect
Non-specific immunity present at birth. This against infectious agent
includes; Passive : provides temporary protection through
a. Phagocytosis of bacteria and other administration of exogenous antibody
invaders by white blood cells and cells of the tissue IMMUNIZING AGENTS
macrophage system Vaccines : a preparation of proteins,
b. Destruction by the acid secretions of the polysaccharides or nucleic acids of pathogens that
stomach and by the digestive enzymes on are administered inducing specific responses that
organisms swallowed into the stomach. inactivate or destroy or suppress the pathogen
c. Resistance of the skin invasion by Toxoid : a modified bacterial toxin that has been
organisms made nontoxic but retains the capacity to stimulate
d. Presence in the blood of certain chemical the formation of antitoxin
compounds that attach to foreign organism or IMMUNIZING AGENTS
toxins and destroy them like lysozyme, natural killer Immune globulin : an antibody containing solution
cells and complement complex. derived from human blood obtained by cold ethanol
Acquired Immunity fractionation of large pools of plasma and used
The human body has the ability to develop primarily for immunodeficient persons or for passive
extremely powerful specific immunity against immunization
individual invading agents. It usually develops as a Antitoxin : an antibody derived from serum of
result of prior exposure to an antigen through human or animals after stimulation with specific
immunization or by contracting a disease. antigens used for passive immunity
Active Acquired Immunity - immune defense are
developed by the person’s own body. This
immunity last many years or a lifetime.
Passive Acquired Immunity - temporary immunity Expanded Program of Immunization
from another source that has developed immunity launched in July 1976 by DOH with cooperation
through previous disease or immunization. It is with WHO and UNICEF.
used in emergencies to provide immediate, short Objective was to reduce the mortality and morbidity
acting immunity when the risk is high. among infants and children caused by the six
ANTIBODIES childhood immunizable diseases.
Agglutination - clumping effect of antibodies PKI, Diptheria, Polio, Measles and tetanus
between two antigen. It helps to clear the body of • PD no. 996 (September 16, 1976)-
invading organisms by facilitating phagocytosis. compulsory immunization for children below
Opsonization – in this process, the antigen- the age of eight.
antibody molecule is coated with a sticky substance • RA 7896 (December 30,1994) – compulsory
that facilitates phagocytosis. hepatitis B for children below eight years old
1. IgG (75%) • PP no.1066 (August 26,1997) – national
• Appears in serum and tissues tetanus elimination starting 1997
• Assumes a major role in bloodborne and APPROACH TO ACTIVE IMMUNIZATION
tissue infections LIVE ATTENUATED VACCINES
• Activates the complement system - induce response similar to an active
• Enhances phagocytosis infection
• Crosses placenta - Organisms in live vaccines : multiply in
2. IgA (15%) recipient until desired immune response
• Appears in body fluids (blood,saliva, tears, occurs, considered to confer lifelong
breat milk) protection
• Protects against respiratory, GIT and GUT - Ex. Measles, mumps, rubella
• Prevents absorption of antigens from food APPROACH TO ACTIVE IMMUNIZATION
• Passes to neonate in breast milk for INACTIVATED OR DETOXIFIED VACCINE
protection - include whole organisms, detoxified
3. IgM (10%) exotoxin, purified protein antigens,
• Appears mostly in intravascular serum polysaccharide
- Lesser antigenic mass, requires booster
• First immunoglobulin produced in response
vaccinations to provide protection
to bacterial or viral infection
- Ex. Hepa B, pertussis, tetanus, diphtheria,
• Activates complement systems
influenza B, pneumococcal
4. IgD (.2%)
EXPANDED PROGRAM OF IMMUNIZATION
Appears in small amount in serum
A fully immunized child under EPI (before 12
5. IgE (.004%)
months of age)
 • 1 BCG at birth or before 12 months - HiB cause meningitis and serious
• 3 DPT and 3OPV > 6weeks old, 4 weeks respiratory infections in <12 months
apart TYPHOID
• 3 Hepa B >6 weeks old, 4 weeks apart - Live oral Ty21A. Thermolabile given 3
doses at 2 days interval and 25-95%
BACILLE-CALMETTE-GUERIN (BCG) effective for 3 years
• Only intradermal vaccine - Vi Antigen typhoid vaccine (Typhim
• Attenuated bovine strains of tubercle bacilli Vi).capsular polysaccharide of the
(M.bovis) organisms. Given 0.5 ml SC or IM with 75%
• Freeze-dried, easily destroyed by heat and effectivity for 3 years
sunlight HEPATITIS A
• Dose : 0.05 ml ID - Vaccine contains formaldehyde-inactivated
Hep A containing 720 ELISA units
• Normal course : wheal disappears in 30
- Given at 1 to 16 years of age at a dose of
mins; induration-2 to 3 wks later; pustular
0.5 ml IM or SC followed by a booster dose
formation-4 to 6 wks; full scarification-6 to
6 to 12 months after
12 wks later
- Effectivity of 99% and side effects are mild
• Usually at right deltoid or buttocks (upper
and uncommon
quadrant)
INFLUENZA
BACILLE-CALMETTE-GUERIN (BCG)
- Immunogenic, safe and associated with
Complications :
minimal side effects
- deep abscess at vaccination site due to
- 6months to <36 months, 2 doses of vaccine
subQ or deeper injection
1 month apart
- Indolent ulcer >12 weeks
- Protection is 70 to 80% with range of 50 to
- Regional lymphadenitis
95%
ORAL POLIO VACCINE (OPV)
- Duration or protection is <1 year
• Oral preparation - live attenuated Sabin, PNEUMOCOCCAL
trivalent OPV - 23-valent pneumococcal vaccine is
• Dose : 2 drops; as early as 6 weeks old, 4 composed of purified capsular
weeks apart polysaccharide antigen of 23 serotypes
• Booster dose : 1 year after last dose of - Given SC or IM
primary series and between 4 to 6 years old - Reactivation after 3-5 years is
DIPHTHERIA, TETANUS,PERTUSSIS (DTP) recommended for children 10 years or
• Diphtheria and tetanus toxoid, inactivated younger who are at high risk of severe
pertussis adsorbed into aluminum salts Pneumococcal infection
• Dose : 0.5 ml IM x 3 doses as early as 6 - Can be given concurrently with other
weeks old, 4 weeks apart vaccines
• Booster doses : 1 year after last dose of PNEUMOCOCCAL
primary series and between 4 to 6 years old The following serious patients should be immunized
• Complications : :
- Pertussis : not used in > 6 y/o because of - sickle cell disease
increased risk of neuroparalytic reaction - Functional or anatomical asplenia
MEASLES - Nephrotic syndrome or CRF
- Live attenuated vaccine; freeze-dried - Immunosuppressive conditions
- Dose : 0.5 ml SC at 9 months, as early as 6 - HIV infections
months MENINGOCOCCAL
- Booster dose : 12 to 15 months old as MMR - Approved for children 2 years older
(Measles, Mumps, Rubella) - 0.5 ml SC
- Transplacental maternal IgG interferes with - Can be given concurrently with other
antibody formation vaccines
MEASLES/MMR
- First dose at 12 to 15 months EXPANDED PROGRAM OF IMMUNIZATION
- Second dose between 4-6 y/o (WHO)
- Mumps vaccine usually >15 months old It is safe to vaccinate a sick child who is suffering
given as MMR from a minor illness (cough, cold, diarrhea, fever or
HEPATITIS B malnutrition) or who has already been vaccinated
- Infants born o HbsAg-positive mothers against measles
should receive HepB vaccine (below 7 If the vaccination schedule is interrupted, it is not
days) plus 0.5 ml Hepa B immunoglobulin necessary to restart. Instead, the schedule should
(HBIG) within 12 hours of birth at 2 diff.sites be resumed using minimal intervals between doses
- 2nd dose is recommended at 1-2 months to catch up as quickly as possible.
and 3rd dose at 6 months of age A "first expiry and first out" (FEFO) vaccine system
- Infants born to mothers whose HbsAg is is practiced to assure that all vaccines are utilized
unknown should receive HepB vaccine before its expiry date. Vaccine temperature is
within 12 hours of birth monitored twice a day in all health facilities and
Haemophilus Influenza type B (HIB) plotted to monitor break in the cold chain.
- Old pure capsular polysaccharide vaccine
effective for > 18 months
Most sensitive to Heat – Oral polio vaccine, - saliva (except in the dental setting, where
Measles saliva is likely to be contaminated with
Least Sensitive to Heat – DPT vaccine, Hepa B, blood)
BCG, tetanus Toxoid Standard Precautions
INFECTION CONTROL PROCEDURE Standard Precautions
Medical Asepsis Replaced universal precautions
- CLEAN Technique Apply to all patients
- Involves procedures and practices that Stipulate that gloves should be worn to touch any of
reduce the number and transfer of the following:
pathogens - blood
- Will exclude pathogens ONLY - all body fluids
Attain by: - secretions and excretions, except sweat,
- Frequent and thorough hand washing regardless of whether they are visibly bloody
- Personal grooming - non-intact skin
- Proper cleaning of supplies and equipment - mucous membranes
- Disinfection Standard Precautions
- Proper disposal of needles, contaminated Gloves
materials and infectious waste - Prevent contamination of the hands with
- Sterilization microorganisms
Surgical Asepsis - Prevent exposure of the HCW to blood-
STERILE technique borne pathogens
- Practices used to render and keep objects - Reduce the risk of transmission of
and areas sterile microorganisms from the hands of HCWs to
- Exclude ALL microorganism the patient
Attain by: - Do not replace the need for hand hygiene
- Use strict aseptic precautions for invasive Standard Precautions
procedures Hands washed immediately after gloves are
- Scrub hands and fingernails before entering removed and between patient contacts
O.R. - For procedures that are likely to generate
- Use sterile gloves, masks, gowns and shoe splashes or sprays of body fluid, a mask
covers with eye protection or a face shield and a
- Use sterile solutions and dressings gown should be worn
- Use sterile drapes and create an sterile field - Disposable gowns should be constructed of
- Heat –sterilized surgical instruments an impervious material to prevent
Universal Precautions penetration and subsequent contamination
Universal Precautions of the skin or clothing
- Infection control guidelines designed to Standard Precautions
protect workers from exposure to diseases - Needles should not be recapped, bent, or
spread by blood and certain body fluids. broken but should be disposed of in
- For prevention of transmission of blood- puncture-resistant containers
borne pathogens in health care settings to Standard Precautions
prevent contact with patient blood and body Hand Hygiene
fluids - Single most important means to prevent
- Stress that all patients should be assumed transmission of nosocomial pathogens
to be infectious for blood-borne diseases - Removes the transient flora recently
such as AIDS and hepatitis B. acquired by contact with patients or
- Universal Precautions environmental surfaces
Followed when workers are exposed to blood and - Alcohol-based hand rubs are recommended
certain other body fluids, including: (if hands are visibly soiled, washing with
- semen soap and water is recommended)
- vaginal secretions - Ring removal prior to patient care
- synovial fluid Transmission-Based Precautions
- cerebrospinal fluid Transmission-Based Precautions
- pleural fluid Apply to selected patients based on a suspected or
- peritoneal fluid confirmed clinical syndrome, a specific diagnosis,
- pericardial fluid or colonization or infection with epidemiologically
- amniotic fluid important organisms
- Universal Precautions Always implemented in conjunction with standard
do not apply to: precautions
- feces 3 types:
- nasal secretions - Airborne
- sputum - Droplet
- sweat - Contact
- tears Airborne Precautions
- urine Droplet Precautions
- vomitus Contact Precautions
Airborne Precautions
 - Prevent transmission of diseases by droplet 3. Influenza
nuclei (particles smaller than 5 µm) or dust 4. Meningococcal infections
particles containing the infectious agent 5. Multi-drug resistant pneumococcal disease
- Airborne Precautions 6. Mumps
- All persons entering the room of these 7. Mycoplasma pneumonia
patients must wear a personal respirator 8. Parvovirus B19 infections
that filters 1 µm particles with a n efficiency 9. Pertussis
of at least 95% (N95 mask) 10. Plague, pneumonic
- Gowns and gloves are used as dictated by 11. Rubella
standard precautions 12. Streptococcal pharyngitis
1. Disseminated zoster
2. Measles Contact Precautions
3. Smallpox - Prevent the transmission of
4. SARS epidemiologically important organisms from
5. Tuberculosis (pulmonary or laryngeal) an infected or colonized patient through
6. Varicella direct contact (touching the patient) or
7. indirect contact (touching contaminated
objects or surfaces in the patient’s
environment)
- Patients are placed in a private room or
patients infected with same organism may
be placed in the same roo
- Barrier precautions to prevent
contamination should be employed
- Gloves and Hand hygiene
- Patient placed in a private room with - Gowns – worn if the HCW anticipates
monitored negative air pressure in relation substantial contact of his or her clothing with
to surrounding areas, and the room air must the patient or surfaces in the patient’s
undergo at least 6 exchanges per hour environment or there is an increased risk of
- Door to the isolation room must remain contact with potentially infective material
closed - Noncritical patient care equipment should
- Air from the isolation room should be remain in the room and not used for other
exhausted directly to the outside, away from patients, if items must be shared, they
air intakes, and not recirculated (high should be cleaned and disinfected before
efficiency filters may be used also) reuse
- Cough etiquette -
- Patients should be instructed to cover 1. Acute diarrheal illnesses likely to be
his/her mouth and nose with tissue when infectious in origin
coughing or sneezing 2. Acute viral conjunctivitis
3. Clostridium difficile diarrhea
Droplet Precautions 4. Ectoparasistic infections (lies and scabies)
Prevent transmission by large-particle (droplet) 5. HSV/Varicella/Disseminated zoster
aerosols 6. MDR bacteria (MRSA, VRE, VISA, VRSA)
(unlike droplet nuclei, droplets are larger, do not infection or colonization
remain suspended in the air, and do not travel long 7. SARS
distances) 8. Smallpox
Droplets are produced when the infected patient 9. Streptococcal (group A) major skin, burn or
talks, coughs, or sneezes and during some wound infection
procedures (e.g., suctioning, bronchoscopy) 10. Viral hemorrhagic fevers
A susceptible host may become infected if the
infectious droplets land on the mucosal surfaces of ISOLATION OF PATIENTS
the nose, mouth, or eye. Source Isolation
- Require patients to be placed in a private Reverse Isolation
room, but no special air handling is - Protective or neutropenic isolation
necessary (patients with same disease can - Used for patients with severe burns,
be placed in the same room if private rooms leukemia, transplant, immuno deficient
are not available) persons, receiving radiation treatment,
- Droplets do not travel long distances leukopenic patients
(generally no more than 3 feet), the door to - Those that enter the room must wear masks
the room may remain open and sterile gowns to prevent from
- HCW should wear a standard surgical mask introducing microorganisms to the room
when working within 3 feet of the patient
- Gowns and gloves should be worn by
HCWs when dictated by standard
precautions AFB ISOLATION
1. Diphtheria, pharyngeal
2. H. influenzae meningitis, epiglottitis, - VISITORS - report to nurses’ station
pneumonia before entering the room
 - MASKS – worn in patients room Tournique test or Rumpel Leede Test –
- GOWNS – prevent clothing contamination presumptive test for capillary fragility
- GLOVES – for body fluids and non intact - keep cuff inflated for 6-10 mins (child), 10-
skin 15 min (adults)
- HANDWASHING - after touching patient or - count the petechiae formation 1 sq inch
potentially contaminated articles and after removing (>10-15 petechiae/sq inch)
gloves
- articles discarded, cleaned or sent for Laboratory Procedures
decontamination and reprocessing - CBC
- room remains closed - Bleeding Parameters
- patients wear masks during transport - Serologic test
- Dengue blot, Dengue Igm
Personal Protective Equipment - Other :
- mask - PT (Prothrombin Time)
- gloves - APTT (Activated Partial Thromboplastin
- gown Time)
- shoe cover - Bleeding time
- goggles - Coagulation time

BLOOD/VECTOR BORNE DISEASES Mgmt: symptomatic and supportive

Prevention Management
Eradicate the source DOH CLEAN - Specific Therapy – none
- C – chemically treated mosquito net - Symptomatic/Supportive therapy
- L - larvae eating fish - Intravenous Fluids (IVF)
- E – environmental sanitation - with hemoconcentration, 5-7 ml/kg/hr
- A – anti-mosquito - with shock, 10-30ml/kg in <20mins
- N – neem tree (oregano, eucalyptus) - Use of Blood/Blood Products
Dengue Hemorrhagic Fever - Platelet concentrate 1 unit/5-7kg
- caused by dengue virus (Flaviviridae) with 4 - Cryoprecipitate, 1unit/5kg
serotypes - FFP, 15ml/kg x 2-4hrs
- transmitted to a bite of female aedes - given in patient in impending shock and
aegypti mosquito unresponsive to isotonic or colloid
- incubation period 2-7 days transfusion.
- Vectors: (day biting) - Prolonged PT
- Aedes aegypti (breeds in water stored in - FWB 20cc/kg
houses) - active bleeding
- Aedes albopictus - check serum calcium
- Culex fatigans - PRBC 10cc/kg
Clinical manifestation
First 4 days – Febrile or Invasive stage – high Nursing Intervention
grade fever, headache, body malaise, conjuctival - Paracetamol (no aspirin)
injection, vomitting, epistaxis or gum bleeding, - Giving of cytoprotectors
positive tornique test. - Gastric Lavage
4th – 7th day – Toxic or Hemorrhagic Stage – After - trendelenberg position for shock
the lyze of the fever, this is were the complication of - Nasal packing with epinephrine
dengue is expected to come out as manifested by - No intramuscular injections
abdominal pain, melena, indicating bleeding in the - manage anxiety of patient and family
upper gastrointestinal tract, Unstable BP, narrow
pulse pressure and shock. Preventive measures
7th – 10th day – Convalescent or recovery stage – Department of Health program for the control of
after 3 days of afebrile stage and the patient was Dengue Hemorrhagic Fever
properly hydrated and monitored BP will become S eek and destroy breeding places
stable and laboratory values of platelet count and S ay no to left and right defogging
bleeding parameters will begin to normalize. S eek early consultation
Classification of Dengue Fever according to FILARIASIS
severity - The disease often progresses to become
1. Grade I – Dengue fever, saddleback fever chronic, debilitating and disfiguring disease
plus constitutional signs and symptoms plus since it’s symptoms are unnoticed or
positive tornique test unfamiliar to health workers.
2. Grade II – Stage I plus spontaneous - High rates in region 5(bicol), 8 (samar and
bleeding, epistaxis, GI, cutaneous bleeding leyte, II (davao)
3. Grade III – Dengue Shock Syndrome, all of - Wuchereria bancrofti and Bulgaria malayi
the following signs and symptoms plus - Transmitted to the bite of infected female
evidence of circulatory failure mosquito (Aedes, Anopheles, Mansonia)
4. Grade IV – Grade III plus irreversible shock - The larvae are carried in the blood stream
and massive bleeding and lodged in lymphatic vessels and lymph
glands where they mature in adult form
Diagnostics
Two biological type
Nocturnal Diagnosis
microfilaria circulate in peripheral blood at night Clinical history and manifestation
(10pm – 2am) Culture
Diurnal Blood: during the 1st week
microfilaria circulate in greater concentration at CSF: from the 5th to the 12th day
daytime Urine: after the 1st week until convalescent period
LAAT (Leptospira Agglutination Test)
Clinical Manifestation other laboratory
Acute stage BUN,CREA, liver enzymes
- filarial fever and lymphatic inflammation tha
occurs frequently as 10 times per year and usually Treatment
abates spontaneously after 7 days Specific
- Lymphadenitis (Inflammation of the lymphnodes) Penicillin 50000 units/kg/day
- Lymphangitis (Inflammation of the lymph vessels) Tetracycline 20-40mg/kg/day
Chronic Stage (10-15 years from the onset of the Non-specific
first attack) Supportive and symptomatic
- Hydrocele (Swelling of the scotum) Administration of fluids
- Lymphedema (Temporary swelling of the upper Peritoneal dialysis for renal failure
and lower extremities) Educate public regarding the mode of transmission,
- Elephantiasis (enlargement and thickening of the avoid swimming or wadding in potentially
skin of the lower or upper extremities) contaminated waters and use proper protective
equipment.
Laboratory Diagnosis
- Blood smear – presence of microfilaria Nursing Responsibilities
- Immunochromatographic Test (ICT) 1. Dispose and isolate urine of patient.
- Eosinophil count 2. Environmental sanitation like cleaning the
esteros or dirty places with stagnant water,
eradication of rats and avoidance of wading or
Management Guidelines bathing in contaminated pools of water.
- Specific Therapy 3. Give supportive and asymptomatic therapy
- Dietylcarbamazine (DEC) 6mg/KBW in 4. Administration of fluids and electrolytes.
divided doses for 12 consecutive days 5. Assist in peritoneal dialysis for renal failure
- Ivermectine (Mectican) patient (The most important sign of renal failure is
- Supportive Therapy presence of oliguria.)
- Paracetamol
- Antihistamine for allergic reaction due to
DEC MALARIA
- Vitamin B complex - Malaria
- Elevation of infected limb, elastic stocking - “King of the Tropical Disease”
- an acute and chronic infection caused by
DEC should be taken immediately after meals protozoa plasmodia
It may cause loss of vision, night blindness, or - Infectious but not contagious
tunnel vision with prolonged used. - transmitted through the bite of female
Ivermectin is best taken as single dose with a full anopheles mosquito
glass of water in en empty stomach. - Malaria Exacts Heavy Toll in Africa
Cannot be used in patient with asthma - Malaria
- There are 300-500m new cases annually
Preventive Measures - Over 1m die every year – almost 3000 per
Health teachings day
Environmental Sanitation - 90% of deaths are in Sub-Saharan Africa
- Cost of malaria in Africa is $100bn
Leptosiprosis (Weil’s disease) - Vector: (night biting)
a zoonotic systemic infection caused by - anopheles mosquito
Leptospires, that penetrate intact and abraded skin - or minimus flavire
through exposure to water, wet soil contaminated Life cycle:
with urine of infected animals. - Sexual cycle/sporogony (mosquito)
- sporozoites injected into humans
Anicteric Type (without jaundice) - Asexual cycle/schizogony (human)
manifested by fever, conjunctival injection - gametes is the infective stage taken up by
signs of meningeal irritation biting mosquito
Plasmodium Vivax
Icteric Type (Weil Syndrome) - more widely distributed
Hepatic and renal manifestation - causes benign tertian malaria
Jaundice, hepatomegally - chills and fever every 48 hours in 3 days
Oliguris, anuria which prigress to renal failure Plasmodium Falciparum
Shock, coma, CHF - common in the Philippines
Convalescent Period
 - Causes the most serious type of malaria Complications
because of high parasitic densities in blood. - severe anemia
- Causes malignant tertian malaria - cerebral malaria
Plasmodium malaria - hypoglycemia
- much less frequent
- causes quartan malaria, fever and chills Prevention and Control
every 72 hrs in 4 days - Eliminate anopheles mosquito vectors
- Plasmodium Ovale - Advise travelers
- rarely seen. - limit dusk to dawn outdoor exposure
Pathology - insect repellant, nets
- the most characteristic pathology of malaria
is destruction of red blood cells, hypertrophy Nursing Care
of the spleen and liver and pigmentation of 1. Consider a patient with cerebral malaria to be an
organs. emergency
- The pigmentation is due to the phagocytocis - Administer IV quinine as IV infusion
of malarial pigments released into the blood - Watch for neurologic toxicity from quinine
stream upon rupture of red cells transfusion like delirium, confusion, convulsion and
Clinical Manifestation coma
uncomplicated 2. Watch for jaundice – this is related to the density
- fever, chills, sweating every 24 – 36 hrs of the falciparum parasitemia,
Complicated 3. Evaluate degree of anemia
- sporulation or segmentation and rupture of 4. Watch for abnormal bleeding that are may be
erythrocytes occurs in the brain and visceral due to decrease production of clotting factors by
organs. damage liver.
- Cerebral malaria Chemoprophylaxis
- changes of sensorium, severe headache - doxycycline 100mg/tab, 2-3 days prior to
and vomiting travel, continue up to 4 weeks upon leaving
- seizures the area
- Mefloquine 250mg/tab, 1 week before
clinical manifestation travel, continue up to four weeks upon
1. Cold stage – 10-15 mins, chills, shakes leaving the area
2. hot stage – 4-6 hours, recurring high grade - Pregnant, 1st trimester, chloroquine, 2 tabs
fever, severe headache, vomitting, weekly, 2 weeks before travel, during stay
abdominal pain, face is blue and until 4 weeks after leaving
3. Diaphoretic Stage – excessive sweating - 2nd and 3rd trimester, Pyrimethamine-
sulfadoxine
Diagnosis
- Malarial smear Category of provinces
- Quantitative Buffy Coat (QBC) Category A – no significant improvement in
Travel in endemic areas malaria for the past 10 years. >1000
Treatment: - Mindoro, isabela, Rizal, Zamboanga, Cagayan,
Determine the species of parasite Apayao, kalinga
Objectives of treatment Category B - <1000/year
1. Destroy all sexual forms of parasite to cure - Ifugao, abra, mt. province, ilocos, nueva ecija,
the clinical attack bulacan, zambales, bataan, laguna
2. Destroy the excerythrocytes (EE) to prevent Category C – significant reduction
relapse -pampanga, la union, batangas, cavite, albay
3. Destroy gametocytes to prevent mosquito
infections CENTRAL NERVOUS SYSTEM DISEASES
Inflammation of the meniges
Treatment for P. Falciparum Caused by bacterial pathogen, N. menigitidis, H.
1. chloroquine tablet (150mg/base/tab) Day Influenza, Strep. Pneumoniae, Mycobacterium
1,2,3 (4,4,2) Tuberculosis
2. Sulfadoxine/Pyrimethamine PATHOLOGY
500mg/25mg/tab, 3tab single dose Primary – spread of bacteria from the bloodstream
3. Primaquine (15mg/tab) 3 tabs single dose to the meniges
Treatment for P. Vivax Secondary – results from direct spread of infection
1. Choloroquine, Day 1,2,3 (4,4,2) from other sources or focus of infection.
2. Primaquine 1 tab OD for 14 days
The disease usually begins as an infection by
Treatment for mixed normal body flora, of:
- chloroquine (4,4,2) 1. The ear (otitis media) - Haemophilus
- Sulfadoxine/Pyrimethamine 3 tabs once influenzae
- Primaquine 1 tab for 14 days 2. The lung (lobar pneumoniae) - Streptococcus
pneumoniae
Multi-drug resistant P. Falciparum 3. The upper respiratory tract (rhinopharyngitis) -
quinine plus doxycycline, or tetracycline and Neisseria meningitidis, Haemophilus
primaquine influenzae, Streptococcus, Group B
4 The skin and subcutaneous tissue - Keep patient in a dark room and complete
(furunculosis) S. aureus physical rest
5. The bone (osteomyelitis) - S. aureus - Diversional activities and passive exercises
6. The intestine - E. coli
Clinical manifestation MENINGOCOCCEMIA
- Fever - caused by Neisseria meningitides, a gram
- Rapid pulse, respiratory arrythmia negative diplococcus
- Soreness of skin and muscles - transmitted through airborne or close
- Convulsion/seizures contact
- headache - incubation is 1-3 days
- irritability - natural reservoir is human nasopharynx
- fever
- neck stiffness Clinical Manifestation
- pathologic reflexes: kernig’s, Babinski, sudden onset of high grade fever, rash and rapid
Brudzinski deterioration of clinical condition within 24 hours
S/sx:
Diagnosis 1. Meningococcemia – spiking fever, chills,
- Lumbar puncture arthralgia, sudden appearance of
- Blood C/S hemorrhagic rash
- other laboratories 2. Fulminant Meningococcemia (Waterhouse
Friderichsen) – septic shock; hypotension,
umbar Puncture tachycardia, enlarging petecchial rash,
- To obtain specimen of CSF adrenal insufficiency
- To reduce ICP Laboratory
- To Introduce medication - Blood Culture
- To inject anesthetic - Gram stain of peripheral smear, CSF and
skin lesions
CSF Examination - CBC
- Fluid is turbid/purulent >1000cc/mm cells Treatment:
- WBC count increase antimicrobial
- Sugar content markedly reduced - Benzyl Penicillin 250-400000 u/kg/day
- CHON increased - Chloramphenicol 100mg/kg/day
- Presence of microorganism Symptomatic and supportive
- fever
- Treatment - seizures
Bacterial meningitis - hydration
- TB meningitis - respiratory function
- Intensive Phase
- Maintainance Phase Chemoprophylaxis
- Fungal meningitis 1. Rifampicin 300-600mg q 12hrs x 4 doses
- cryptococcal meningitis – fluconazole or 2. Ofloxacin 400mg single dose
amphotericin B 3. Ceftriaxone 125-250mg IM single dose
2. Supportive/Symptomatic
a. Antipyretic Nursing Intervention
b. treat signs of increased ICP - Provide strict isolation
c. Control of seizures - Wearing of PPE
d. adequate nutrition - Health teaching
Nursing Intervention - Contact tracing
Prevent occurrence of further complication - Prophylaxis
- Maintain strict aseptic technique when doing - Meninggococcal vaccine for high risk patient
dressing or lumbar puncture.
- Early symptom should be recognize RABIES
- Vital signs monitoring - acute viral encephalomyelitis
- Observe signs of increase ICP - incubation period is 4 days up to 19 years
- Protect eyes from light and noises - risk of developing rabies, face bite 60%,
Maintain normal amount of fluid and electrolyte upper extremities 15-40%, lower extremities
balance 10%
- Note and record the amount of vomitus - 100% fatal
- Check signs of dehydration
Prevent Spread of the disease
- Having proper disposal of secretions Clinical Manifestation
- Emphasize the importance of masking - pain or numbness at the site of bite
- Explain the importance of isolation - fear of water
Ensure patient’s full recovery - fear of air
- Maintain side rails up in episodes of
siezures 4 STAGES
- Prevent sudden jar of bed 1. prodrome - fever, headache, paresthesia,
 2. encephalitic – excessive motor activity,
hypersensitivity to bright light, loud noise, B. I – Abortive or inapparent
hypersalivation, dilated pupils C. II – Meningitis (non-paralytic)
3. brainstem dysfunction – dysphagia, D. III – Paralytic (anterior horn of spinal cord)
hydrophobia, apnea E. IV – Bulbar (encephalitis)
4. death
Dx: Pandy’s test - CSF (increased CHON)
Diagnosis MGMT:
- FAT (fluorescent antibody test) Active – OPV (Sabin) and IPV (Salk)
- Clinical history and signs and symptoms Immunity is acquired for 3 strains
A. Legio brunhilde (fatal)
Management B. Legio lansing
- No treatment for clinical rabies C. Legio leon
- Prophylaxis
Respiratory distress
Postexposure prophylaxis A. Respirator
B. Tracheostomy – life saving procedure
A. Active vaccine (PDEV,PCEC,PVRV) when respiratory failure and inability to
Intradermal (0,3,7,30,90) swallow are not corrected
Intramuscular (0,3,7,14,28) C. Oxygen therapy
(0,7,21) D. Rehabilitation
B. Passive Vaccine
a. ERIG wt in kg x .2 = cc to be injected im SNAKEBITE
(ANST) Management
b. HRIG wt in Kg x .1333 - Lie the victim flat
- ice compress and constrictives materials
Pre-exposure Prophylaxis are contraindicated
Intradermal/Intramuscular (0,7,21) - Transport the patient to the nearest
hospital
Infection control - Antivenim administration in patient’s
- Patient is isolated to prevent exposure of with signs of envenomation
hospital personnel, watchers and visitors - It is never too late to give anti-venim
- PPE - Antivenim is given thru intravenous
- Preventive Measures infusion, which is the safest and most
- Education effective route. 2-5 ampules plus D5W to
- Post-exposure and Pre-exposure run iver 1-2 hours every 2 hours
Prophylaxis - Antimicrobial therapy
- sulbactam/Ampicillin or co-amoxiclav
- Substitute
Poliomyelitis - Prostigmine IVinfusion, 50-
- RNA, Polio virus 100ug/kg/dose q 8hrs
- Fecal oral route/droplets - Atropine
- IP 7-12 days
- Disease of the lower motor neurin involving TETANUS
the anterior horn cells
- Infantile paralysis; Helne-Medin disease - caused by Clostridium tetani, grows
Predisposing Factors anaeronically
- Children below 10 years old - Tetanus spores are introduced into the
- Male more often affected wound contaminated with soil.
- Poor environmental and hygienic conditions - Incubation period 4-21 days
Causative Agent: Legio debilitans
- Brunhilde (permanent) Clinical manifestation
- Lansing and Leon (temporary) - Difficulty of opening the mouth (trismus or
- May exist in contaminated water, sewage lockjaw)
and milk - Risus sardonicus
S/sx: disease manifestations: - Abdominal rigidity
1. mild febrile illness – fever, malaise, sore throat - Localized or generalized muscle spasm
(abortive stage)
2. Pre-paralytic stage - flaccid asymetrical Treatment
ascending paralysis (Landry’s sign), Hayne’s sign 1. Neutralize the toxin
(head drop), Pofer’s sign (opisthotonus) 2. Kill the microorganism
3. Paralytic stage 3. Prevent and control the spasm
bulbar or spinal - muscle relaxants
Mode of Transmission - Sedatives
- Droplet infection – in early infection - Tranquilizers
- Body secretions – nasopharyngeal 4. Tracheostomy
- Fecal oral – during late stage
- Flies may act as mechanical vectors Treatment:
anti-toxin - Spread chiefly by carriers, ingestion of
Tetanus Anti-Toxin (TAT) infected foods
- Adult,children,infant 40,000 IU ½ - Endemic particularly in areas of low
IM,1/2 IV sanitation levels
- Neonatal Tetanus 20000 - Occurs more common in may to august
IU, 1/2IM, ½ IV
TIG MOT: oral fecal route
- Neonates 1000 IU, IV - S/sx: Rose spot (abdominal rashes), more
drip or IM than 7days Step ladder fever 40-41 deg,
- Adult, infant, children 3000 IU, IV drip headache, abdominal pain, constipation
or IM (adults), mild diarrhea (children)
Antimicrobial Therapy
Penicillin !-3 mil units q 4hours Diagnosis
Pedia 500000 – 2mil units q 4 hrs Blood examination WBC usually leukopenia with
Neonatal 200000 units IVP q 12hrs or lymphocytosis
q8hrs Isolation
Control of spasms - Blood culture 1st week\
- diazepam - Urine culture 2nd week
- chlorpromazine - Stool culture 3rd week
Nursing care - Widal test O or H
- Patient should be in a quiet, darkened room, - 1st week step ladder fever (BLOOD)
well ventilated. - 2nd week rose spot and fastidial
- Minimal/gentle handling of patient - typhoid psychosis (URINE & STOOL)
- Liquid diet via NGT
- Prevent Injury Mgmt: Chloramphenicol, Amoxicillin,
- Preventive Measures Sulfonamides, Ciprofloxacin, Ceftriaxone
- Treatment of wounds
- Tetanus toxoid (0,1,6,1,1) Watch for complication
a. Perforation – symptoms of sharp
abdominal pain, abdominal rigidity and
HEPATO-ENTERIC DISEASES absent of bowel sounds.
SCHISTOSOMIASIS - prepare for intestinal decompression or surgical
- caused by blood flukes, Schistosoma intervention
- has 3 species, S. haematobium, S. b. Intestinal hemorrhage - withold food and
Mansoni, S. japonicum give blood transfusion
- S. japonicum is endemic in the Philippines Nursing Interventions
(leyte, Samar, Sorsogon, Mindoro,Bohol) - Environmental Sanitation
- Intermediate host, Oncomelania Quadrasi - Food handlers sanitation permit
- Supportive therapy
DIAGNOSIS - Assessment of complication (occuring on
- Schistosoma eggs in stool the 2nd to 3rd week of infection )
- Rectal bipsy - typhoid psychosis, typhoid meningitis
- Kato Katz - typhoid ileitis
- Ultrasound of HBT
Hepatitis
Clinical Manifestation - Hepa A – fecal oral route
- severe jaundice - Hepa B – body fluids
- edema - Hepa C – non A non B, BT, body fluids
- ascites - Hepa D – hypodermic, body fluids
- hepatosplenomegally - Hepa E – fecal oral route, fatal and common
- S/S of portal hypertention among pregnant women
- Hepa G – BT, parenteral
Management
- Praziquantrel 60mg/kg Once dosing
- Supportive and sympromatic Hepatitis A
- Infectious hepatitis, epidemic hepatitis
Methods of Control - Young people especially school children are
- Educate the public regarding the mode of most commonly affected.
transmission and methods of protection. - Predisposing factors:
- Proper disposal of feces and urine - Poor sanitation, contaminated water supply,
- Prevent exposure to contaminated water. unsanitary preparation of food, malnutrition,
To minimize penetration after accidental disaster conditions
water exposure, towel dry and apply 70%
alcohol. Incubation Period: 15-50 days
The organism is pathogenic only in man Signs/Symptoms:
TYPHOID FEV ER - Influenza
- Malaise and easy fatigability
- Anorexia and abdominal discomfort
 - Nausea and vomiting - Enteric hepatitis
- Fever, CLAD - Fecal-oral route
- jaundice
DX:
Dx: Anti HAV IgM – active infection - Elevated AST or SGPT (specific) and ALT
Anti HAV IgG – old infection; no active or SGOT
disease - Increased IgM during acute phase
Management: - (+) or REACTIVE HBsAg = INFECTED,
- Prophylaxis may be acute, chronic or carrier
- Complete bed rest - (+) HBeAg = highly infectious
- Low fat diet but high sugar - ALT – 1st to increase in liver damage
- Ensure safe water for drinking o HBcAg = found only in the liver cells
- Sanitary method in preparing handling and - (+) Anti-HBc = acute infection
serving of food. - (+) Anti-HBe = reduced infectiousness
- Proper disposal of feces and urine. - (+) Anti-HBs = with antibodies (FROM
- Washing hands before eating and after toilet vaccine or disease)
use. - Blood Chem. Analysis (to monitor
- Separate and proper cleaning of articles progression)
used by patient - Liver biopsy (to detect progression to CA)

Hepatitis B Mgmt:
- DNA, Hepa B virus - Prevention of spread – Immunization and
- Serum hepa Health Education
- Worldwide distribution - Enteric and Universal precautions
- Main cause of liver cirrhosis and liver - Assess LOC
cancer - Bed rest
- ADEK deficiency intervention
IP: 2-5 months - High CHO, Moderate CHON, Low fat
Mode of Transmission - FVE prevention
- From person to person through
- contact with infected blood through broken Cx:
skin and mucous membrane 1. Fulminant Hepatitis – s/sx of encephalopathy
- sexual contact 2. Chronic Hepatitis - lack of complete resolution of
- sharing of personal items clinical sx and persistence of hepatomegaly
- Parenteral transmission through 3. HBsAg carrier
- blood and blood products ERUPTIVE FEVER
- use of contaminated materials MEASLES
- Perinatal transmission - Extremely contagious
High Risk group - Breastfed babies of mothers have 3 months
- Newborns and infants of infected mothers immunity for measles
- Health workers exposed to handling blood - The most common complication is otitis
- Persons requiring frequent transfusions media
- Sexually promiscuous individuals - The most serious complications are
- Commercial sex workers bronchopneumonia and encephalitis
- Drug addicts
Measles, Rubeola, 7 Day Fever, Hard Red
Possible Outcome Measles
- Most get well completely and develop life - RNA, Paramyxoviridae
long immunity. - Active MMR and Measles vaccine
- Some become carriers of the virus and - Passive Measles immune globulin
transmit disease to others. - Lifetime Immunity
- Almost 90% of infected newborns become - IP: 7-14 days
carriers
MOT: droplets, airborne
Hepatitis C - *Contagious 4 days before rash and 4 days
- Post transfusion Hepatitis after rash
- Mode of transmission – percutaneous, BT
- Predisposing factors – paramedical teams Clinical Manifestation
and blood recepients Pre eruptive stage
- Incubation period – 2weeks – 6 months - Patient is highly communicable
- 4 characteristic features
Hepatitis D A. Coryza
- Dormant type B. Conjunctivitis
- Can be acquired only if with hepatitis B C. Photophobia
D. Cough
Hepatitis E - Koplik’s spots
- If hepatitis E recurs at age 20-30, it can lead - Stmsons line
to cancer of the liver
Eruptive stage Spiking fever w/c subsides 2-3 days, Face and
- Maculopapular rashes appears first on the trunk rashes appear after fever subsides, Mild
hairline, forehead, post auricular area the pharyngitis and lymph node enlargement
spread to the extremities (cephalocaudal)
- Rashes are too hot to touch and dry Chicken Pox, Varicella
- High grade fever and increases steadily at - Herpes zoster virus (shingles),
the height of the rashes varicella zoster virus(chocken pox)
Stage of convalescence - Active : Varicella vaccine
- Rashes fade in the same manner leaving a - Passive: VZIG, ZIG – given 72-96 hrs
dirty brownish pigmentation (desquamation) w/n exposure
- Black measles – severe form of measles - Lifetime Immunity
with hemorrhagic rashes, epistaxis and - IP: 14-21 days
melena
Rashes: maculopapaular, cephalocaudal (hairline MOT: Respiratory route
and behind the ears to trunk and limbs), confluent, * Contagious 1 day before rash and 6 days after
desquamation, pruritus first crop of vesicles
Complication - S/sx:
- Bronchopneumonia fever, malaise, headache
- Secondary infections - Rashes: Maculopapulovesicular (covered
- Encephalitis areas), Centrifugal, starts on face and trunk
- Increase predisposition to TB and spreads to entire body
- Leaves a pitted scar (pockmark)
MANAGEMENT - CX furunculosis, erysipelas,
1. Supportive meningoencephalitis
2. Hydration - Dormant: remain at the dorsal root ganglion
3. Proper nutrition and may recur as shingles (VZV)
4. Vitamin A
5. Antibiotics Mgmt:
6. Vaccine a. oral acyclovir
Nursing Care b. Tepid water and wet compresses for pruritus
- Respiratory precautions c. Aluminum acetate soak for VZV
- Restrict to quite environment d. Potassium Permanganate (ABO)
- Dim light if photophobia is present a. Astringent effect
- Administer antipyretic b. Bactericidal effect
- Use cool mist vaporizer for cough c. Oxidizing effect (deodorize the rash)

German Measles (rubella) Small Pox, Variola

- Acute infection caused by rubella virus - DNA, Pox virus
characterized by fever, exanthem and - Last case 1977
retroauricular adenopathy. - spreads from man-to-man only
- Has a teratogenic potential on the fetuse of - Active: Vaccinia pox virus
women in the 1st trimester - IP: 1-3 weeks
S/sx:
s/sx: - Rashes:
- forschheimer’s (petecchial lesion on buccal - Maculopapulovesiculopustular
cavity or soft palate), - Centripetal
- cervical lymphadenopathy, low grade fever - contagious until all crusts disappeared
- “ Oval, rose red papules about the size of
pinhead
Dx:
Dx: clinical - Paul’s test - instilling of vesicular fluid w/
CX: rare; pneumonia, meningoencephalitis small pox into the cornea; if keratitis
CX to pregnant women: develops, small pox
- 1st tri-congenital anomalies - Cx: same with chicken pox
- 2nd tri-abortion
- 3rd tri-pre mature delivery KAWASAKI DISEASE
Rashes: Maculopapular, Diffuse/not confluent, No - Mucocutaneous lymph node syndrome
desquamation, spreads from the face downwards - Children younger than 5 years old are
primarily affected.
Roseola Infantum, - Associated with large coronary blood vessel
Exanthem Subitum, Sixth disease vasculitits
- Human herpes virus 6 - A febrile, exanthematous, multisystem
- 3mos-4 yo, peak 6-24 mos illness characterized by
- MOT: probably respiratory secretions o Acute febrile phase manifested by
high spiking fever, rash, adenopathy,
S/sx: peripheral edema, conjunctivitis and
exanthem
 o sub acute phase, thrombocytosis,
desquamation and resolution of Corynebacterium diphtheriae, gram (+), slender,
fever. curved clubbed organism “Klebs-Loeffler
o Convalescent stage Bacillus”
IP: 2-6 days
Manifestations Mode of transmission is direct or indirect contact
- bilateral, non purulent conjuctivitis 1. Nasal – invades nose by extension from pharynx
- congested oropharynx, strawberry tongue, 2. Pharygeal
erythematous lymphs - sorethroat causing dysphagia
- erythematous palms/soles, edematous - Pseudomembrane in uvula, tonsils, soft palate
hands/feet - Bullneck – inflammation of cervical LN
- periungal desquamation, truncal rash 3. Laryngeal
- CLADP ( 1node >1.5cm) - increasing hoarseness until aphonia
- wheezing on expiration
Diagnosis - dyspnea
- CBC: leukocytosis
- Platelet count >400000 Diagnosis
- 2D echo (if coronary artery involvement is - Nose and throat swab using loeffler’s
highly suggestive medium
- ESR and CRP elevated - Schick test – determine susceptibility or
immunity in diptheria
Management - Maloney test – determines hypersensitivity
- IV Gamma globulin – 2g/kg as single dose to diptheria toxoid
for 10-12 hours. Effective to prevent
coronary vascular damage if given within 10 Complications
days of onset. Toxic myocarditis – due to action of toxin in the
- Salicylates: 80-100mg/kg/24 hours in 4 heart muscles (1st 10-14 days)
divided doses Neuritis caused by absorption of toxin in the nerve
- Symptomatic and supportive therapy - Palate paralysis (2nd week)
- Ocular palsy (5th week)
Respiratory System - Diapgram paralysis (6-10wk causing GBS)
Mumps - Motor and skeletal muscle paralysis
- RNA, Mumps virus Treatment
- Mumps vaccine - > 1yo A. Neutralize the toxins – antidiptheria serum
- MMR – 15 mos B. Kill the microorganism – penicillin
- Lifetime Immunity C. Prevent respiratory obstruction –
- IP: 12-16 days tracheostomy, intubation
- MOT: Droplet, saliva, fomites
Treatment
S/sx: Unilateral or bilateral Serum therapy (Diptheria antitoxin)
- parotitis, Orchitis - sterility if bilateral, - early administration aimed at neutralizing the
- Oophoritis, Stimulating food cause severe toxin present in the general circulation
pain, aseptic meningitis Antibiotics
- Dx: serologic testing, ELISA - Penicillin G 100000mg/kg.day
- Erythromycin 40mg/kg
Mgmt: supportive Nursing Intervention
- Rest.
Nursing care - Patient should be confined to bed for at
- Respiratory precautions least 2 weeks
- Bed rest until the parotid gland swelling - Prevent straining on defecation
subsides - vomiting is very exhausting, do not do
- Avoid foods that require Chewing procedures that may cause nausea
- Apply hot or cold compress - Care for the nose and throat
- To relieve orchitis, apply warmth and local - Ice collar to reduce the pain of sorethroat
support with tight fitting underpants - Soft and liquid diet

Diptheria Whooping Cough, 100 day fever

- Acute contagious disease Bordetella pertussis, B. parapertussis, B.
- Characterized by generalized systemic bronchiseptica, gram (-)
toxemia from a localized inflammatory focus IP: 3-21 days
- Infants immune for 6 months of life MOT: airborne/droplet
- Produces exotoxin Signs and symptoms
- Capable of damaging muscles especially - Invasion or catarrhal stage (7-14days) starts
cardiac, nerve, kidney and liver with ordinary cough
- Increase incidence prevalence during cooler - Spasmodic or paroxysmal
months - 5-10 spasms of explosive cough (no time to
- Mainly a disease of childhood with peak at catch breath. A peculiar inspiratory crowing
2-5 years, uncommon in >6months sound followed by prolonged expiration and
 a sudden noisy inspiration with a long high - Monitor signs of splenic rupture, which
pitched “whoop” include abdominal pain, left upper quadrant
- During attack the child becomes cyanotic pain or left shoulder pain
and the eyes appear to bulge or popping out
of the eyeball and tongue protrudes PULMONARY TUBERCULOSIS
- The world’s deadliest disease and remains
Diagnosis as a major public health problem.
- WBC count 20000-50000 - Badly nourished, neglected and fatigued
- Culture with Bordet Gengou Agar individuals are more prone
- Susceptibility is highest in children under 3
Treatment years
- Erythromycin shorten the period of - AKA: Koch’s disease: Galloping
communicability consumption
- Ampicillin if with allergy to erythromycin
- Heperimmune pertusis gamma globulin in S/sx:
<2 years old (1.25ml IM) - Wt loss
- Control of cough with sedatives - night sweats
- low fever,
- non productive to productive cough
- anorexia,
Dx: WHO - >21 days cough + close contact w/ - Pleural effusion and hypoxemia
pertussis px + (+) culture OR rise in Ab to FHA - cervical lymphadenopathy
or pertussis toxin
* throat culture w/ Bordet gengou agar PPD – ID
Management - macrophages in skin take up Ag and deliver
- CBR to conserve energy it to T cells
- Prevent aspiration - T cells move to skin site, release
- High calorie, bland diet lymphokines
- Omit milk and milk product because it - activate macrophages and in 48-72 hrs, skin
increases the mucous becomes indurated
- Refeeding of infants 20 min after vomitting - > 10 mm is (+)
- Milk should be given at room temperature Dx:
- Chest xray - cavitary lesion
complications - Sputum exam
- Bronchopneumonia - sputum culture
- Abdominal hernia
- Severe malnutrition The National Tuberculosis Control Program
- TB, asthma - Vision: A country where TB is no longer a
- encephalitis public health problem.
- Mission: Ensure that TB DOTS services are
Pre exposure prophylaxis for Diphtheria, available to the communities.
Pertussis, Tetanus - Goal: To reduce the prevalence and
DPT- 0.5 ml IM mortality from TB by half by the year 2015
- 1 - 1 ½ months old
2 - after 4 weeks Targets:
3 - after 4 weeks 1. To cure at least 85% of the sputum smear
- 1st booster – 18 mos positive TB patient discovered.
- 2nd booster – 4-6 yo 2. Detect at least 70% of the estimated new
- subsequent booster – every 10 yrs sputum smear positive TB cases.
thereafter Mgmt:
short course – 6-9 months
Infectious Mononucleosis long course – 9-12 months
- Epstein Barr virus Follow-up
- Inc. period: 4-6 weeks • 2 wks after medications – non
- Communication period: Unknown, virus is communicable
shed before the onset of the dse until 6 o 3 successive (-) sputum - non
months or longer after recovery communicable
- Source: oral secretions o rifampicin - prophylactic
- Transmission: Direct intimate contact,
infected blood MDT side effects
• r-orange urine
Assessment • i-neuritis and hepatitis
- Fever, sorethroat, malaise, headache, • p-hyperuricemia
fatigue, nausea, abdominal pain • e-impairment of vision
- CLADP, hepatosplenomegally • s-8th cranial nerve damage
Nursing care Methods of Control
- Supportive • Prompt treatment and diagnosis
 • BCG vaccination GIT
• Educate the public in mode of transmission Amoebiasis
and importance of early diagnosid - Entamoeba Hystolitica, protozoa
• Improve social condition - IP: few days to months to years,
- usually 2- 4 weeks
Pneumonia - MOT: Ingestion of cysts from fecally
1. Community acquired contaminated sources (Oral fecal route)
Typical– Strep. Pneumoniae, H. Influenzae type B oral and anal sexual practices
Atypical Pneumonia – S. Aureus, M. Pneumoniae, - Extraintestinal amoebiasis- genitalia,
L. Pneumophila, P. Cariini spleen, liver, anal, lungs and meninges
2. Nosocomial – Pseudomonas, S. Aureus s/sx:
MOT: aspiration, inhalation, hematogenous, direct - Blood streaked, watery mucoid diarrhea,
inoculation, contiguous spread foul smelling,
CHILDHOOD PNEUMONIA - abdominal cramps
1. No pneumonia - Pain on defecation (tenesmus)
- infant, 60/min and no chest indrawing - Hyperactive bowel sounds
2. Pneumonia
- young infant >60/min, fast breathing without Diagnostic test
chest indrawing - Stool culture of 3 stool specimens
3. Severe pneumonia - Sigmoidoscopy
- fast breathing, severe chest indrawing, with one - Recto-sigmoidoscopy and coloscopy for
of danger signs intestinal amoebiasis
4. Very severe pneumonia
- below 2 mos old, fast breathing, chest indrawing, Medical treatment
with danger signs - Metronidazole – trichomonocide and
4 Danger Signs amoebicide for intestinal and extra intestinal
1. Vomits sites (monitor liver function test)
2. Convulsion - Diloxanide furoate – luminal amoebicide
3. Drowsiness/lethargy - Paromomycin – eradicate cyst of histolytica
4. Difficulty of swallowing or feeding - Tinidazole – hepatic amebic abscess
S/sx:
1. Typical – sudden onset Fever of > 38 x 7-10 Bacillary Dysentery
days, productive cough, pleuritic chest Shigellosis
pain, dullness, inc fremitus, rales - Shiga bacillus: dysenteriae (fatal), flexneri
2. Atypical – gradual onset, dry cough, (Philippines), boydii, sonnei; gram (-)
headache, myalgia, sore throat - Shiga toxin destroys intestinal mucosa
Watch out for complications; In 24 hours death will - Humans are the only hosts
occur from respiratory failure - Not part of normal intestinal flora
- IP: 1-7 days
Nursing Diagnosis - MOT : oral fecal route
• Ineffective airway clearance S/sx: fever, severe abdominal pain, diarrhea is
• Ineffective breathing pattern watery to bloody with pus, tenesmus
• Impaired gas exchange Dx: stool culture
• Risk for activity intolerance Mgmt: Oresol, Ampicillin, Trimethoprim-
Mgmt: Sulfamethoxazole, Chloramphenicol, Tetracycline,
Ciprofloxacin
• Antibiotics, hydration, nutrition, nebulization
• CARI-health teaching
Cholera
• Nursing Interventions - Vibrio coma (inaba, ogawa, hikojima), vibrio
• Respiratory support cholerae, vibrio el tor; gram (-)
- oxygen supplementation - Choleragen toxin induces active secretion of
- mechanical ventilation NaCl
• Positioning - Active Immunization
• Rest - IP: few hours to 5 days
• Suctioning of secretions - MOT: oral fecal route
• Antipyretic and TSB S/sx: Rice watery stool with flecks of mucus,
• Nutrition s/sx of severe dehydration ie Washerwoman’s
skin, poor skin turgor
Scarlet fever Dx: stool culture
- Group A beta hemolytic streptococcus mgmt: IV fluids, Tetracycline, Doxycycline,
- Respiratory Erythromycin, Quinolones, Furazolidone and
- Incubation 2-5 days Sulfonamides (children)
- Fever, red sandpaper rash, white strawberry
tongue, flushed cheeks, red strawberry Via the skin
tongue Hookworm (Roundworm)
- Diagnostics is throat culture - Necator Americanus, Ancylostoma
- Penicillin for 10 days Duodenale
 - Leads to iron deficiency and hypochromic C. Pierazine citrate: paralyze muscles of
microcytic anemia parasite, this dislodges the parasites
- Gain entry via the skin promoting their elimination
- Dx: microscopic exam (stool exam)
- Mgmt: Pyrantel Pamoate and Mebendazole Nursing Intervention
- don’t give drug without (+) stool exam - Environmental sanitation
- members of the family must be examined - Health teachings
and treated also - Assessment of hydration status
- Use of ORS
Paragonimiasis - Proper waste disposal
- Chronic parasitic infection - Enteric precautions
- Closely resembles PTB
- Endemic areas: mindoro, camarines sur, Complications
norte, samar, sorsogon, leyte, albay, basilan - Migration of the worm to different parts of
- Paragonimiasis the body Ears, mouth,nose
- AKA: Lung fluke disease - Loefflers Pneumonia
- causative agent: paragonimus westermani; - Energy protein malnutrition
Trematode - Intestinal obstruction
- Eating raw or partially cooked fish or fresh
water crabs Tapeworm (Flatworms)
- Taenia Saginata (cattle), Taenia Solium
Signs and symptoms (pigs)
- Cough of long duration - MOT: fecal oral route
- Hemoptysis (ingestion of food contaminated by the
- Chest/back pain agent)
- PTB not responding to anti-koch’s meds - s/sx: neurocysticercosis – seizures,
hydrocephalus
Diagnosis - Dx: Stool Exam
- sputum examination – eggs in brown spots - Mgmt: Praziquantel, Niclosamide
Treatment
1. Praziquantrel (biltrizide) Pinworm
2. Bithionol - Enterobius Vermicularis
- MOT: fecal oral route
- S/sx: Itchiness at the anal area d/t eggs of
Ascariasis the agent
- Common worldwide with greatest frequency - Dx: tape test at night time
in tropical countries. (agents release their eggs during night time)
- Has an infection rate of 70-90% in rural - flashlight
areas - Mgmt: Pyrantel Pamoate, Mebendazole
- MOT: ingestion of embryonated egss (fecal-
oral) Nursing Intervention
- Worms reach maturity 2 months after - Promote hygiene
ingestion of eggs. - Environmental Sanitation
- Adult worms live less than 10 months(18 - Proper waste and sewage disposal
months max.) - Antihelmintic medications repeated after 2
- Female can produce up to 200000 eggs per weeks (entire family)
day
- Eggs may be viable in soils for months or PARALYTIC SHELLFISH POISONING
years - A syndrome of characteristic symptoms
- Worms can reach 10-30cm in length predominantly neurologic which occurs
within minutes or several hours after
Initial symptom: ingestion of poisonous shellfish
- loss of appetite - Single celled dinoflagellates (red planktons)
- Worms in the stool become poisonous after heavy rain fall
- Fever preceded by prolonged summer
- Wheezing - Common in seas around manila bay, samar,
- Vomiting bataan and zambales
- Abdominal distention MOT = Ingestion of contaminated bi-valve
- Diarhea shellfish
- dehydration IP = within 30 minutes
CLINICAL MANIFESTATIONS:
Medical Management - NUMBNESS OF THE FACE ESPECIALLY
A. Mebendazole (antihelmintic) effect occurs AROUND THE MOUTH
by blocking the glucose uptake of the - VOMITING, DIZZINESS, HEADACHE
organisms, reducing the energy until death - TINGLING SENSATION, WEAKNESS
B. Pyrantel pamoate: neuromuscular blocking - RAPID PULSE, DIFFICULTY OF SPEECH
effect which paralyze the helminth, allowing (ATAXIA), DYSPHAGIA, RESPI
it to be expelled in the feces PARALYSIS, DEATH.
 Dx: biopsies/scrapings of lesions
MANAGEMENT AND CONTROL MEASURES: Mgmt: Permethrin (Nix) cream, crotamiton cream,
- NO DEFINITE MEDICATIONS Sulfur soap, antihistamines and calamine for
- INDUCE VOMITING (EARLY pruritus, wash linens with hot water, single dose of
INTERVENTION) Ivermectin, treat close contacts
- DRINKING PURE COCONUT MILK Dx: biopsies/scrapings of lesions
(WEAKENS TOXIC EFFECT) DON’T GIVE NURSING CARE
DURING LATE STAGE IT MAY WORSEN A. Administer antihistamines or topical steroids
THE CONDITION. to relieve itching.
- NaHCO3 SOLUTION (25 GRAMS IN ½ B. Apply topical antiscabies creams or lotion
GLASS OF WATER) like lindasne(kwell), Crotamiton (Eurax),
- RESPIRATORY SUPPORT permithrin
- AVOID USING VINEGAR IN COOKING C. d. Lindane (kwell) not used in <2 years old,
SHELLFISH AFFECTED BY RED TIDE causes neurotoxicity and seizures
(15X virulence) D. e. Apply thinly from the neck down and
- TOXIN OF RED TIDE IS NOT TOTALLY leave for 12-14hrs then rinse
DESTROYED IN COOKING. E. f. Apply to dry skin, moist skin increases
- AVOID TAHONG, TALABA, HALAAN, absorption
KABIYA, ABANIKO. WHEN RED TIDE IS F. g. All family members and close contacts
ON THE RISE. G. h. Beddings and clothings should be
washed in very hot water and dried on hot
BOTULISM dryer
- A True poison known to be one of the
deadliest substance and usually released
into the food shortly after it has been Leprosy
canned - Chronic infectious and communicable
- Botulism disease
- Clostridium Botulinum, gram (+), spore - No new case arises without previous
forming contact
- Ingestion of contaminated foods (canned - Majority are contracted in childhood,
foods), wound contamination, infant manifestation arises by 15 yrs old and will
botulism (most common; ingestion of honey) definitely diagnose at 20
- Neurotoxins block AcH - it is no hereditary
- IP: 12-36H (canned food) - Does not cross placenta
- IP: 4-14 days (wound)
- Active and passive immunization Cardinal Sign
S/sx: Diplopia, dysphagia, symmetric descending A. Presence of Hansen’s bacilli in stained
flaccid paralysis, ptosis, depressed gag reflex, smear or dried biopsy material.
nausea, vomiting, dry mouth, respiratory paralysis B. Presence of localized areas of anesthesia
Dx: gastric siphoning, wound culture, serum
bioassay (food borne) * Lepromatous or malignant
Mgmt: respiratory support, antitoxin - many microorganisms
- open or infectious cases
CONTACT - negative lepromin test
Pediculosis * Tuberculoid or benign
Blood sucking lice/Pediculus humanus - few organism
p. capitis-scalp - noninfectious
p. palpebrarum-eyelids and eyelashes - positive reaction to lepromin test
p. pubis-pubic hair
p. corporis-body s/sx:
MOT: skin contact, sharing of grooming implements • Early/Indeterminate – hypopigmented /
s/sx: nits in hair/clothing, irritating maculopapular or hyperpigmented anesthetic
urticarial rash macules/plaques
Mgmt: disinfect implements, Lindane (Kwell) topical • Tuberculoid – solitary hypopigmened
Permethrin (Nix) topical hypesthetic macule, neuritic pain,
contractures of hand and foot, ulcers, eye
Scabies involvement ie keratitis
- Sarcoptes scabiei • Lepromatous – multiple lesions, Loss of
- Pruritus (excreta of mites) lateral portion of eyebrows (madarosis),
- Mites come-out from burrows to mate at corugated skin (leonine facies), septal
night collapse (saddlenose)
- MOT: skin contact Diagnosis
- Skin smear test
s/sx: itching worse at night and after hot shower; - Skin lesion biopsy
rash; burrows (dark wavy lines that end in a bleb w/ - Lepromin test -
female mite) in between fingers, volar wrists, elbow,
penis; papules and vesicles in navel, axillae, belt Mgmt:
line, buttocks, upper thighs and scrotum MDT-RA 4073 (home meds)
Paucibacillary - 6-9 months 4. Hypersensitivity
1. Dapsone Most protein antibiotics can induce the
2. Rifampicin body’s immune system to produce allergic
Multibacillary- 12-24 months responses. Drugs are considered foreign
1. Dapsone – mainstay; hemolysis, substances and when taken by the individual, it
agranulocytosis encounters the body’s immune cells.
2. Clofazimine – reddish skin pimentation, Common Adverse Reactions to Anti-infective
intestinal toxicity Therapy
3. Rifampicin – bactericidal; renal and liver 5. Superinfections
toxicity Opportunistic infections that develop during
the course of antibiotic therapy are called
SUPERINFECTIONS.
Nursing Intervention Teaching about anti-infective therapy
- Health teachings - Take the drug exactly as prescribed.
- Counseling involving the family members Complete the entire prescribe regiment,
and even the community comply with instruction RTC
- Prevention of transmission ( use of mask ) - Report unusual reactions such as rash,
fever or chills
Anthrax - Check the drug expiration date before using
- Bacillus anthracis, gram (+) it. Discard unused drug
- Releases exotoxin - Don’t share the drug with family or friends
- Cattle, sheep, goat and pig - Don’t stop taking the drug, even if
- IP: 1-3 days symptoms are relieved.
- Dx: gram stain, culture, Ab testing - Don’t take drug left over from a previous
- Mgmt: parenteral Penicillin G, cutaneous illness or someone else drugs
lesions should be cleaned - Don’t take over the counter drugs or herbal
products without consulting a doctor
MOT - Take drug with full glass of water
- Inhalation (Woolsorter’s disease) - Follow the manufacturer’s directions for
URTI (fever x 3-5 days) lower infection reconstituting, dilution and storing drugs .
(alveoli) metabolic acidosis hypoxia Check expiration dates.
- Skin (most common) - Refrigerate oral suspension (stable 14
itchiness papule-vesicle depressed days), shake well before administering to
black eschars (painless) septicemia ensure dosage
Spectrum of Activity of Anti-infectives - Give I.M dose into large muscle mass.
- Anti-infectives that interfere with the ability Rotate injection site to minimize tissue injury
of the cell to reproduce/replicate without
killing them are called BACTERIOSTATIC Penicillin – interfere with bacterial cell wall
drugs. Tetracycline is an example. synthesis; broad spectrum
- Antibiotics that can aggressively cause a. Amoxicillin, ampicilin, methicillin, Penicillin
bacterial death are called BACTERICIDAL. Cephalosporin
These properties (-cidal and –static) can a. 1st generation – cefazolin, cephalexin,
also depend on the antibiotic concentration cephalothin
in the blood. b. 2nd generation – Cefaclor, Cefamandole
c. 3rd generation – Ceftriaxone, cefotaxime
Common Adverse Reactions to Anti-infective Inhibits cell wall synthesis
Therapy - Erythromycin
The most common adverse effects are due to the - Tetracycline
direct action of the drugs in the following organ - Aminoglycosides
system- Neuro, nephro and GI system - Chloramphenicol
1. Nephrotoxicity Side Effects
Antibiotics that are metabolized and excreted in the Tetracycline – hepatotoxic, phototoxicity,
kidney most frequently cause kidney damage.. hyperurecemia, enamel hypoplasia
Common Adverse Reactions to Anti-infective Aminoglycosides – ototoxicity, leukopenia,
Therapy thrombocytopenia, neurotoxicity
2. Gastro-intestinal toxicity Chloramphenicol – bone marrow depression,
Direct toxic effect to the cells of the GI tract can hypersensitivity
cause nausea, vomiting, stomach pain and
diarrhea. Some drugs are toxic to liver cells and Infective endocarditis
can cause hepatitis or liver failure. Infection of the heart valves and the endothelial
Common Adverse Reactions to Anti-infective surface of the heart
Therapy Can be acute or chronic
3. CNS toxicity Etiologic factors
When drugs can pass through the brain 1. Bacteria- Organism depends on several
barrier and accumulate in the nervous tissues, they factors
can interfere with neuronal function. 2. Fungi
Common Adverse Reactions to Anti-infective
Therapy Risk factors
1. Prosthetic valves - The heart itself must receive enough
2. Congenital malformation oxygenated blood.
3. Cardiomyopathy - Blood is supplied to the heart through the
4. IV drug users coronary arteries, two main branches which
5. Valvular dysfunctions originate just above the aortic valve.

Dukes criteria Signs and Symptoms

I. Criteria for IE - Fever (38.9-40C)
- Two major criteria or - Chills
- One major and three minor - Sore throat
- Five major criteria - Diffuse redness of throat
Major criteria - CLADP
- Positive blood culture typical for IE - Abdominal pain (children)
- Positive echocardiogram study - Tiny translucent vegetations or growths,
Minor criteria which resemble pinhead size beads at the
- Predisposing heart condition valves.
- Febrile syndrome - Cause valvular regurgitation (mitral valve)
- Vascular phenomena: conjuctival - MV (Left sided heart failure)
hemorrhage, janeway lesions - Risk for embolic phenomena on the lungs ,
- Immunologic phenomena kidney, spleen, heart, brain
- Osler nodes and roth spots
- Echocardiogram suggestive of IE but not Urinary Tract Infection (UTI)
classified as major Bacterial invasion of the kidneys or bladder
(CYSTITIS) usually caused by Escherichia coli
Acute 1. Bacterial infections of urinary tract are a
- nafcillin or oxacillin very common reason to seek health services
- gentamycin 2. Common in young females and uncommon
Subacute in males under age 50
- penicillin 3. Common causative organisms
- gentamycin a. Escherichia coli (gram-negative enteral
Assessment findings bacteria) causes most community acquired
1. Intermittent fever infections
2. anorexia, weight loss b. Staphylococcus saprophyticus, gram-
3. cough, back pain and joint pain positive organism causes 10 – 15%
4. splinter hemorrhages under nails c. Catheter-associated UTI’s caused by gram-
5. Osler’s nodes- painful nodules on fingerpads negative bacteria: Proteus, Klebsiella, Seratia,
6. Roth’s spots- pale hemorrhages in the retina Pseudomonas
7. Heart murmurs Normal mechanisms that maintain sterility of urine
8. Heart failure a. Adequate urine volume
b. Free-flow from kidneys through urinary
Prevention meatus
Antibiotic prophylaxis if patient is undergoing c. Complete bladder emptying
procedures like dental extractions, d. Normal acidity of urine
bronchoscopy, surgery, etc. e. Peristaltic activity of ureters and competent
LABORATORY EXAM ureterovesical junction
Blood Cultures to determine the exact organism f. Increased intravesicular pressure
Nursing management preventing reflux
1. regular monitoring of temperature, heart g. In males, antibacterial effect of zinc in
sounds prostatic fluid
2. manage infection Pathophysiology
3. long-term antibiotic therapy 1. Pathogens which have colonized urethra,
Medical management vagina, or perineal area enter urinary tract by
1. Pharmacotherapy ascending mucous membranes of perineal area
IV antibiotic for 2-6 weeks into lower urinary tract
Antifungal agents are given – amphotericin B 2. Bacteria can ascend from bladder to infect
2. Surgery the kidneys
Valvular replacement 3. Classifications of infections
Prevention a. Lower urinary tract infections: urethritis,
- AnTibiotic prophylaxis is recommended for prostatitis, cystitis
high risk patients before or after procedure b. Upper urinary tract infection: pyelonephritis
(inflammation of kidney and renal pelvis)
Rheumatic Endocarditis Urethrovesical reflux – backward flow of urine from
- Occurs most often in children the urethra to the badder
- Grp A beta hemolytic streptococcal Ureterovesical reflux – backward flow of urine from
pharyngitis the bladder to the ureters
- It is a preventable disease Risk Factors
- Penicillin therapy can prevent RHD 1. Aging
- Throat culture a. Increased incidence of diabetes mellitus
b. Increased risk of urinary stasis 7. Vesicourethral reflux
c. Impaired immune response
2. Females: short urethra, having sexual Manifestations
intercourse, use of contraceptives that alter normal 1. Rapid onset with chills and fever
bacteria flora of vagina and perineal tissues; with 2. Malaise
age increased incidence of cystocele, rectocele 3. Vomiting
(incomplete emptying) 4. Flank pain
3. Males: prostatic hypertrophy, bacterial 5. Costovertebral tenderness
prostatitis, anal intercourse 6. Urinary frequency, dysuria
4. Urinary tract obstruction: tumor or calculi, Assessment findings: Upper UTI
strictures o Fever and CHIILS
5. Impaired bladder innervation o Flank pain
6. Bowel incontinence o Costovertebral angle tenderness
7. Diabetes mellitus
8. Instrumentation of urinary tract Laboratory Examination
Urinalysis: assess pyuria, bacteria, blood cells
Cystitis in urine; Bacterial count >100,000 /ml indicative
o Most common UTI of infection
o Remains superficial, involving b. Rapid tests for bacteria in urine
bladder mucosa, which becomes 1. Nitrite dipstick (turning pink = presence
hyperemic and may hemorrhage of bacteria)
o General manifestations of cystitis 2. Leukocyte esterase test (identifies WBC
o Dysuria in urine)
o Frequency and urgency c. Gram stain of urine: identify by shape
o Nocturia and characteristic (gram positive or negative);
o flank or low back pain obtain by clean catch urine or catheterization
o Suprapubic pain and tenderness Urinary Tract Infection (UTI)
Nursing interventions
Assessment and laboratories o Administer antibiotics as ordered
o Urinalysis – bactereriuria >10’5 colonies of o Provide warm baths and allow client to
bacteria/ml void in water to alleviate painful voiding.
o E.coli – 55% o Force fluids. Nurses may give 3 liters of
o Pseudomonas and enterrococcus – catheter fluid per day
associated UTI o Encourage measures to acidify urine
o Urine culture- gold standard (cranberry juice, acid-ash diet).
Criteria o Provide client teaching and discharge
o All men planning concerning
o All children a. Avoidance of tub baths
o Women with commpromised IS b. Avoidance of bubble baths that
o DM pt might irritate urethra
o Recent documentation c. Importance for girls to wipe
o Prolonged or persistent uti perineum from front to back
o >3 UTI/year d. Increase in foods/fluids that
o Pregnant women acidify urine.
o Women sexually active or have new
partners Pharmacology
1. Sulfa drugs
5. Readily responds to treatment Highly concentrated in the urine
6. Untreated, may involve kidneys Effective against E. coli!
7. Severe or prolonged may cause sloughing Can cause CRYSTALLURIA
of bladder mucosa with ulcer formation 2. Quinolones
8. Chronic cystitis may lead to bladder stone Not given to less than 18 because they can
formation cause cartilage degradation
3. Pyridium= urinary antiseptic
Pyelonephritis Can cause urine discoloration
1. Inflammation of renal pelvis and Acute Glomerulonephritis
parenchyma (functional kidney tissue) o Inflammation of the glomerular capillaries
2. Acute pyelonephritis o Disease of children older than 2 years old
a. Results from an infection that ascends to o Preceded by a throat infection due to Grp A
kidney from lower urinary tract betahemolytic streptococal infection
Risk factors
1. Pregnancy Clinical Manifestation
2. Urinary tract obstruction and congenital o Hematuria –microscopic, gross
malformation o Coca cola colored urine due to RBC and
3. Urinary tract trauma, scarring protein cast
4. Renal calculi o Abrupt onset, 10 days after streptococcal
5. Polycystic or hypertensive renal disease infection
6. Chronic diseases, i.e. diabetes mellitus
 o May be mild or severe presenting with ARF Complications
with oliguria o Infection
o Proteinuria due to increased permeability of o Thromboembolism (renal vein)
the glomerular membrane o Pulmonary emboli
o Edema and hypertension in 75% o Accelerated atherosclerosis
o Headache, malaise and flank pain o ARF (hypovolemia)
Diagnostic findings
o Serial Anti-streptolysin O Medical Management
o Serum IgA and complement level o to preserve the renal function
o Electron microscopy and o Diuretics with ACE inhibitors to reduce the
immunofluorescent identify the nature of the degree of proteinuria
lesion o Low sodium diet, liberal potassium diet
o Kidney biopsy – definitive diagnosis o Protein intake .8g/kg/day (eggs, meats,
Complications dairy products)
o Hypertensive Encephalopathy Nursing Intervention
o Pulmonary edema o Provide bed rest
o RPGN, rapid and progressive decline in o conserve energy
renal function. Will go to ESRD in weeks to o quiet play
months o Provide high protein and low sodium diet
o Crescent shaped cells accumulate in o Maintain skin integrity
Bowman’s space, disrupting the filtering o Avoid IM-edematous
surface. o Turn frequently
o Obtain morning urine for protein studies
Medical Management o Provide scrotal support
Goals o Monitor I and O, VS, Weigh daily
1. Treating symptoms o Administer Steroids
2. Preserve kidney function o Protect for infection
3. Treatment of complications
Antibiotics - penicillin Acne Vulgaris
o Corticosteroid and Immunosuppressants o Common, self limiting, multifactorial skin
o Protein and sodium restriction disease
o Loop diuretics o Over production of sebum,
Nursing Management propionibacterium acnes, hormonal,
Hospital setting o Closed comedones – whiteheads
1. Monitor intake and output o Open comedones – blackheads
2. High carbohydrate to provide energy and o Requires active treatment
reduce catabolism of protein o Intervention: don’t squeeze, prick or pick,
3. Bp monitoring Isotretinoin Accutane (avoid sunlight and vit
Home Care A, may increase triglycerides), antibiotics
Health education regarding o No evidence that chocolate, nuts, fatty
1. Notify physician of renal failure symptoms. foods or cosmetics affects acne
2. Fluid and diet restrictions to avoid o Exacerbation coincides with menstrual
worsening of edema and HPN activity.
3. Importance of follow up evaluations of BP, o Heat, increase sweat increase acne
Urinalysis protein, BUN, CREA
Nephrotic syndrome Nursing care
a. Group of clinical findings, not specific o Use of topical or oral antibiotics
disorder o Instruct in the use of isotretinoin
b. Characterized by (ACCUTANE) to decrease sebum
1. Massive proteinuria production
2. Hypoalbuminemia o Adverse effect, cheilitis, skin dryness,
3. Hyperlipidemia elevated triglycerides and eye discomfort
4. Edema (often facial and periorbital) o Stop Vit A supplement during treatment
Pathophysiology o Instruct not to squeeze, prick or pick at
Characterized by loss of plasma protein (albumin) lesions
in the urine. o Use products labeled noncomedogenic and
The liver cannot keep up with the daily loss of cosmetics that are water based
albumin in the urine
Clinical manifestation Decubitus Ulcer
Edema – soft and pitting o Skin impairment secondary to immobility
- periorbital, in dependent areas, ascites o Common to immobilized and with
- Headache decreased sensory perception patient
- Irritability Risk Factors
- fatigue o Malnutrition
Diagnosis o Incontinence
Proteinuria > 3-3.5g/day o Immobility
Protein electrophoresis and immunophoresis o Skin shearing
Needle biopsy of the kidney o Decreased sensory perception
Nursing care o First documented infection of humans with
o Institute measures to prevent decubitus avian flu occurred in Hong Kong in 1997
ulcer o Affected 18 humans, 6 died
o Assess the nutritional status Bird Flu
o Provide adequate nutritional intake to Human cases of influenza A (H5N1) infection
promote skin integrity have been reported in Cambodia, China,
o Monitor for alteration in skin integrity Indonesia, Thailand, and Vietnam.
o Relieve or remove pressure on skin Clinical manifestations
o Turn every 2 hours Patients develop fever, sore throat, cough, in fatal
o Ambulate the patient cases, severe respiratory distress may result
o Provide active and passive exercise q 8hrs secondary to pneumonia
o Keep skin clean and dry and bed wrinkle A constantly mutating virus
free All type A influenza virus, including those that
o Apply medications or dressing on the wound regularly cause seasonal epidemics of influenza in
humans are genetically labile and well adapted to
Emerging Diseases elude host defenses
Severe Acute Respiratory Syndrome So far bird flu is mainly transmitted between birds,
o Coronavirus but experts fear the H5N1 virus could be
o Severe acute respiratory syndrome devastating to humans if it genetically mutates and
o IP: 2-7 days develops the capacity to be transmitted from
o Mortality rate – 5% only human to human.
Risk Factors: Deadly Avian Flu
o history of recent travel to China, Hong The WHO has warned that if this happens it could
Kong, singapore Taiwan, vietnam, canada. trigger a new human flu pandemic, potentially killing
or close contact w/ ill persons with a hx of up to 50 million people worldwide
recent travel to such areas, OR A total of 55 people have died from the H5N1 virus
o Is employed in an occupation at particular since the beginning of the epidemic in 2003
risk for SARS exposure, healthcare worker Trivalent Inactivated Vaccine (TIV)
with direct patient contact or a worker in a o Most widely used influenza vaccine
laboratory that contains live SARS, OR o Administered IM
o Is part of a cluster of cases of atypical o Indicated for all persons older than 6
pneumonia without an alternative diagnosis months of age
o Studies in children have shown efficacy
Clinical Manifestations from 30-90%
o History of travel to SARS affected country or
close contact with persons suspected of STD
having SARS and within 14 days manifest Gonorrhea, Morning drop, Clap, Jack
the ff o Neisseria gonorrheae, gram (+)
o High grade fever (>38.0 c) o IP: 3-7 days
o Headache, body malaise, muscle pain S/sx:
o Cough, sneezing, nasal congestion - Females: usually asymptomatic or minimal
o Difficulty of breathing after 2-7 days urethral discharge w/ lower abdominal pain
SARS suspect sterility or ectopic pregnancy
Probable SARS - Male: Mucopurulent discharge, Painful
Diagnosis: urination
Chest X-ray, CBC, Isolation of virus decreased sperm count
Mgt:
Supportive DX:
Treat as Atypical Pneumonia - gram stain and culture of cervical secretions
Quarantine on Thayer Martin VCN medium
Mgmt: single dose only
AVIAN INFLUENZA - Ceftriaxone (Rocephin) 125 mg IM
Serious consequences for ASIA - Ofloxacin (Floxin) 400 mg orally
Avian Influenza….. - treat concurrently with Doxycycline or
o Is an infectious disease of birds caused by Azithromycin for 50% infected w/ Clamydia
Type A strains of the influenza virus CX:
o First identified in Italy more than 100 years PID, ectopic pregnancy and infertility,
ago peritonitis, perihepatitis, Ophthalmia neonatorum,
o Occurs worldwide sepsis and arthritis
o Infection causes a wide spectrum of
symptoms in birds, ranging from mild illness Syphilis
to a highly contagious and rapidly fatal Treponema pallidum, spirochete
disease resulting in severe epidemics “ Beautiful” fast moving but delicate spiral
o “ highly pathogenic avian influenza” thread
Pathogenesis IP: 10-90 days
o Avian influenza do not normally infect Primary (3-6 wks after contact) – nontender
species other than birds and pigs lymphadenopathy and chancre; most infectious;
resolves 4-6 wks
Chancre – painless ulcer with heaped up firm • Cauliflower or hyperkeratotic papular
edges appears at the site where the treponema lesions
enters. Related to pattern of sexual behavior Treatment
(genitalia, rectal, oral, lips) - liquid nitrogen
BUBO – swelling of the regional lymphnode - podophylin resin
Secondary – systemic; generalized macular
papular rash including palms and soles and Mgmt:
painless wartlike lesions in vulva or scrotum Laser treatment is more effective
(condylomata lata) and lymphadenopathy CX:
Tertiary – (6-40 years) - neurosyphilis/permanent • Neoplasia
damage (insanity); gumma (necrotic granulomatous • Neonatal laryngeal papillomatosis (vaginal
lesions), aortic aneurysm birth)
DX:
Dark-field examination of lesion- 1st and 2nd Candidiasis, Moniliasis
stage • Candida Albicans, Yeast or fungus
Non specific VDRL and RPR • S/sx: Cheesy white discharge,
FTA-ABS • \Extreme itchiness
Mgmt DX:
- Primary and secondary - Pen G KOH (wet smear indicate positive result)
- Tertiary - IV Pen G Mgmt:
Imidazole, Monistat, Diflucan
Chlamydia CX:
- Chlamydia trachomatis, gram (-) Oral thrush to baby (vaginal birth)
- IP: 2-10 days Trichomoniasis
- S/sx: • Trichomona vaginalis, parasite
- Maybe asymptomatic
• S/sx: Females: itching, burning on urination,
- Gray white discharge, Burning and itchiness
Yellow gray frothy malodorous vaginal
at the urethral opening
discharge, Foul smelling
DX:
• Males: usually asymptomatic
- Gram stain
- Antigen detection test on cervical smear • Dx: microscopic exam of vaginal discharge
- Urinalysis • Mgmt: Metronidazole (Flagyl); include
Mgmt: partners
- Doxycycline or Azithromycin • CX: PROM
- Erythromycin and Ofloxacin
CX: HIV and AIDS
- PID • Retrovirus (HIV1 & HIV2)
- Ectopic pregnancy • Attacks and kills CD4+ lymphocytes (T-
- Fetus transmittal (vaginal birth) helper)
• Capable of replicating in the lymphocytes
Herpes Genitalis undetected by the immune system
HSV 2 • Immunity declines and opportunistic
S/sx: Painful sexual intercourse, Painful vesicles microbes set in
(cervix, vagina, perineum, glans penis) • No known cure
- Dx: • HIV/AIDS Reverses Development and
- Viral culture Poses Serious Threat to Future Generations
- Pap smear (shows cellular changes) • Since 1980s, 60m have been infected and
- Tzanck smear (scraping of ulcer for 25m have died
staining) • About 40m live with HIV/AIDS – 38m in
Mgmt: developing countries and 28m in Africa
Anti viral - acyclovir (zovirax) alone
• CX: • The spread is accelerating in India, Russia,
• Meningitis the Caribbean and China
• Neonatal infection (vaginal birth) • AIDS is stretching health care systems
beyond their limits
Genital Warts, • There are 12m AIDS orphans – they are
Condyloma Acuminatum estimated to rise to 40m by 2010
• HPV type 6 & 11, papilloma virus • In Sub-Saharan Africa, 58% of HIV/AIDS
• S/sx: Single or multiple soft, fleshy painless infected adults are women. More than two-
growth of the vulva, vagina, cervix, urethra, thirds of newly infected teenagers are
or anal area, Vaginal bleeding, discharge, female.
odor and dyspareunia • Life expectancy has declined by more than
DX: 10 years in South Africa and Botswana –
• Pap smear-shows cellular changes Swaziland faces the risk of extinction
(koilocytosis) • Most HIV/AIDS Infected Live in Africa and
• Acetic acid swabbing (will whiten lesion) South Asia
Health
Health care workers often have rates of infection as o AIDS dementia
high or higher than adults in general • Kaposis
Illness and death of skilled personnel further
weakens the sector Treatment
Education Anti-retroviral Therapy (ART) – ziduvirine (AZT)
Education faces decimation of skilled teachers a. Prolong life
Children of families struck by AIDS often have to b. Reduce risk of opportunistic infection
leave school to help generate income or undertake c. Prolong incubation period
basic household tasks PREVENTION
MOT: • A – ABSTINENCE
• Sexual intercourse (oral, vaginal and anal) • B – BE FAITHFUL
• Exposure to contaminated blood, semen, • C – CONDOMS
breast milk and other body fluids • D – DON’T USE DRUGS
• Blood Transfusion
• IV drug use Integrated Management of Childhood Diseases
• Transplacental IMCI process can be used by doctors, nurses and
• Needlestick injuries other health care personnel in a primary health care
HIGH RISK GROUP facility like health centers, clinics or OPD.
• Homosexual or bisexual Components of IMCI
• Intravenous drug users A. Upgrading the case management and
• BT recipients before 1985 counseling skills of health care providers.
• Sexual contact with HIV+ B. Strengthening the health care system for
• Babies of mothers who are HIV+ effective management of childhood illness
s/sx: C. Improving family and community practices
1. Acute viral illness (1 mo after initial related to child health and nutrition.
exposure) – fever, malaise,
lymphadenopathy Focused on the common childhood diseases.
2. Clinical latency – 8 yrs w/ no sx; towards A. Pneumonia
end, bacterial and skin infections and B. Measles
constitutonal sx – AIDS related complex; C. Malaria
CD4 counts 400-200 D. Diarrhea
3. AIDS – 2 yrs; CD4 T lymphocyte < 200 w/ E. Malnutrition
(+) ELISA or Western Blot and opportunistic F. Ear infection
infections G. Dengue
HIV CLASSIFICATION
CATEGORY 1 – CD4+ 500 OR MORE IMCI case management process
CATEGORY 2 – CD4+ 200-499 Assess a child by checking first for danger signs,
CATEGORY 3 – CD4+ LESS THAN 200 examining the child, checking nutritional and
HIV TEST immunization status.
• Elisa Classify the child illness using the color coded
triage system
• Western Blot
- (pink) urgent
• Rapid hiv test
- (yellow) OPD treatment
- (green) Home management
How to Diagnose
• Identify the specific treatments for the child.
HIV+
If the child needs urgent referral, give
2 consecutive positive ELISA and
essential treatment before the patient is
1 positive Western Blot Test
transferred.
AIDS+
HIV+ • Provide practical treatment instructions
CD4+ count below 500/ml • Assess feeding problems
Exhibits one or more of the ff: (next slide) • Follow up care
Full blown AIDS Danger signs
CD4 is less than 200/ml • Not able to drink
Exhibits one or more of the ff: • Vomiting
o Extreme fatigue • Convulsions
o Intermittent fever • Abnormally sleepy
o Night sweats
o Chills Parameters for assessing dehydration
o Lymphadenopathy • Eyes – sunken, absent of tears, lack of
o Enlarged spleen laster
o Anorexia • Fontanelles
o Weight loss • Skin turgor
o Severe diarrhea • Mouth
o Apathy and depression • Abnormally sleepy
o PTB • Level of thirst
o Kaposis sarcoma END
o Pneumocystis carinii