COMMUNICABLE DISEASES 3.

Break in Skin Transmission

 Diseases caused by  Inoculation
pathogenic microorganisms,  Contaminated sharps or
which can be transmitted from needles
an infected person to a  Animal Bites
susceptible person by direct,
indirect means or through a 4. Airborne Transmission
break in skin integrity  Microorganisms are
suspended in air
Communicable Diseases are  There is no limitation to the
transmitted through: distance traveled by
microorganism
1. Direct Mode of Transmission  Different from Droplet
 A person to person transmission
transmission  Microorganism remains on
 Most common is through surface
Droplet transmission  Travel is limited to a maximum
 Examples: distance of three (3) feet.
o Kissing
o Sexual Contact Concept:
 Happens in humans  All these modes are classified
under Horizontal
2. Indirect Mode of Transmission Transmission
 From a source of transmission
to a new host with Horizontal Transmission
intermediary object  Manner of transfer of
 A bridge connects you to an microorganisms is in a
infected person horizontal position
 Bridges or intermediate
objects Vertical Transmission
 Examples:  Manner in which
o Vehicle-borne microorganisms are
Transmission transferred is in a vertical
 Non-living things manner – from up going down
 Articles used by  Example:
patient like o Infected mother to
catheter, newborn child
tubings, linens transmission
 Vector-borne Transmission
 Living things but Infectious Diseases
are non-human  Diseases wherein there is a
 Insects, presence of a living
arthropods, microorganism in the body,
rodents which may not be transmitted
through ordinary contact

1
  Need not be transferred from Concept:
one person to another  Consider the susceptibility of
the host
Contagious Diseases  Susceptibility
 Diseases that can easily be o Pertains to degree of
transmitted resistance
 If resistance is low,
susceptible person is prone to
Concepts: infection
 All communicable diseases
are infectious but not Types of Hosts:
contagious 1.1) Patient
 Because there is the  A person infected manifesting
presence of a living signs and symptoms
microorganism
 Because not all of the 1.2) Carrier
microorganisms can be easily  Individual who harbors
transmitted microorganisms but shows no
signs and symptoms
 All contagious diseases are
infectious 1.3) Suspect
 Individual whose medical
 All contagious diseases are history and symptoms
communicable diseases suggests that he may be
developing a specific infection
 Diphtheria is a disease, which  Signs and symptoms are
is suggestive
o Contagious
o Communicable 1.4) Contact
o Infectious  Individuals who come in close
association or in contact or
 Malaria is a disease, which is exposed to infected person
o Communicable
o Infectious Concepts:
o But not contagious  The PATIENT is the least
source of infection
 Tetanus is a disease, which is  The PATIENT has the least
o Infectious only chance to spread
microorganisms
o Because he manifests
Epidemiological Triad
Three (3) factors for a disease to signs and symptoms of
take place the disease, he is
1. HOST isolated
 A person o Precautionary
 An animal measures are now
taken

2
  The CARRIER has the  Syphilis is not fatal in the first
highest potential to spread trimester
infection  Syphilis is fatal in the third
o Because he does not trimester
manifest signs and  Anti-bacterial medications
symptoms of the give only temporary immunity
disease
o However, he has the Viruses
microorganisms  Can only multiply in living
things
2. AGENT  Reservoir is a living thing
 Microorganisms  Can pass through the body
 They have the highest filters:
population among all living o Blood Brain Barrier
things o Placental Barrier
 Not all are susceptible to  It gives rise to self-limiting
microorganisms diseases
 Not all microorganisms are  Viral infections have own time
virulent frame
 Example:
Concepts: o Colds last for 2-3 days
Virulence with watery secretions
 Strength and power of as symptoms
microorganisms to cause  After this,
infection complications
Pathogenicity of microorganisms would be the
 Capacity of microorganisms to one present with
cause infection yellowish or
mucoid
Two (2) most common discharges
microorganisms causing infections probably
 Bacteria indicative of
 Viruses sinusitis
o Influenza is present for
Bacteria one week
 Can multiply in both living and  After one week,
non-living things pneumonia sets
 Cannot pass through filters in in.
the body because they are big  Medical management for viral
 Therefore, it is okay to have infections:
bacterial infection even during o Treated
pregnancy, except for symptomatically not by
Treponema pallidum, which anti-viral agents
passes through the placental o Antibiotics may be
barrier after the 16th week of used to treat secondary
pregnancy. bacterial infections

3
 o Purpose is to increase 3. Portal of Exit
body resistance  From the reservoir,
microorganisms look for a
3. ENVIRONMENT way out
 Must be conducive and  This pertains to the
favorable to growth of individual’s body system
microorganisms  Examples:
 Example: o T. pallidum’s portal of
o Clostridium tetani will exit is the genitourinary
not cause infection in system
the presence of oxygen o Measles’ virus portal of
because it is an exit is the respiratory
anaerobic system
microorganism o Salmonella typhosa’s
portal of exit is the
Concept: gastrointestinal tract
There must be an interplay between
the three factors: 4. Mode of Transmission
 Host  When outside of the host, this
 Agent pertains to the
 Environment microorganism’s means of
for infection to set in. transportation
 Examples:
CHAIN OF INFECTIOUS PROCESS o T. pallidum’s mode of
 A cycle transmission is sexual
 It is continuous contact
o Measles’ virus mode of
Six (6) Factors transmission is
1. Causative agent airborne nuclei
 Microorganisms o Salmonella typhosa’s
mode of transmission
2. Reservoir is fecal-oral ingestion
 A place where
microorganisms can live and 5. Portal of Entry
multiply  A microorganism’s way in to
 Examples: the new host
o T. pallidum’s reservoir  Also corresponds to the
is the human genitalia individual’s body system
o Measles virus reservoir  Examples:
is the nasopharynx o T. pallidum’s portal of
o Salmonella typhosa’s entry is the
reservoir are the genitourinary system
Peyer’s patches of the o Measles’ virus portal of
small intestines entry is the respiratory
system

4
 o Salmonella typhosa’s IMMUNITY
portal of entry is the  State of having resistance
gastrointestinal tract  State of being free from
infection
6. Susceptible Host
Concept: Two (2) Types of Immunity
 Objective or goal is to limit,  Natural Immunity
prevent or control spread of  Acquired Immunity
communicable diseases by
breaking the chain of 1. Natural Immunity
diseases  Inherent in an individual’s
 Look for the weakest link in body tissues and fluids
the chain  A person is born with it
 Among the six (6) factors, the  A person dies with it
MODE OF TRANSMISSION  It is within the genes that you
is the weakest link have these antibodies
o It is not the  This is a rare type of immunity
CAUSATIVE AGENT  Example:
because of its huge o Race
population
o It is not the 2. Acquired Immunity
RESERVOIR (i.e. you  This is the more common type
cannot remove the of immunity
nasopharynx in  It is either a person is able to
humans infected by PRODUCE it or a person is
measles virus) able to GET it
o It is not the PORTAL
OF EXIT nor the Two (2) Types of Acquired
PORTAL OF ENTRY Immunity
(i.e. you cannot remove
the genitals of humans 2.1) Active Acquired Immunity
infected by T. pallidum)  An actual participation of the
o It is not the individual’s body tissues and
SUSCEPTIBLE HOST fluid in PRODUCING
for you cannot kill it. immunity
 You produce the antibodies
IMPORTANT CONCEPTS!!! yourself when
 Typhoid mode of transmission microorganisms are given to
is fecal-oral ingestion you
 First word is the PORTAL OF
EXIT Two (2) Ways of Producing
 Second word is the PORTAL Antibodies:
OF ENTRY 2.1.1) Naturally Acquired Active
 DO NOT INTERCHANGE Immunity
THIS!!!  Antibodies are produced by
nature

5
  Unintentionally  If the site has not dried off,
 Examples: there will be VACCINE
o Previous attack of a FAILURE!
disease  Therefore, squeeze off excess
o Chicken pox attack alcohol
wherein antibodies are
produced by nature 2.2) Passive Acquired Immunity
o Measles attack wherein  Immunity is developed due to
antibodies are presence of antibodies within
produced by nature the serum, which is not
 Sub-clinical immunity coming from the individual
o Developed due to itself
constant exposure to  You get it or it is given to you
certain infection
o Body produces Two (2) Types of Passive Immunity
antibodies non- 2.2.1) Naturally Acquired Passive
intentionally by nature Immunity
that provides immunity  Done by nature
 Antibodies given or obtained
2.1.2) Artificially Acquired Active by nature, in an unintentional
Immunity manner
 Body produces antibodies  Examples:
because it was intentionally o Infants below six (6)
done months seldom
 Examples: develop infection
o Vaccines o Maternal transfer of
 Attenuated antibodies
(weakened) o Placental transfer of
microorganisms antibodies
o Toxoids o Infants who are breast-
 Attenuated fed
toxins  Colostrum
(poisonous intake
substances)  Contains
produced by antibodies from
microorganisms mother given
Concepts! unintentionally
 When administering vaccines
or toxoids, alcohol is NOT 2.2.2) Artificially Acquired Passive
used to clean injection site. Immunity
 Use instead cotton balls with  Administration of substances
a clean bowl of water. containing antibodies in an
 When alcohol is used, be sure intentional manner
alcohol HAS DRIED OFF  Examples:
before administration of the o Anti-toxins
vaccine or toxoid o Anti-serum

6
 o Gamma globulin  Know the MODE OF
o Immunoglobulins TRANSMISSION

IMPORTANT CONCEPTS!!! GENERAL CARE FOR PATIENTS

 If both microorganisms and WITH COMMUNICABLE DISEASES
antibodies are to be given, do
not give both injections on the Two (2) Aspects
same site  Preventive Aspect
 Artificially Acquired Passive  Control Aspect
Immunity
o Provides immediate 1. PREVENTIVE ASPECT
protection  You do not have infection yet
o Provides immunity for
only a short period as 1.1) Health Education
there are no reserves  Main goal is to effect change
of it. in knowledge, skills and
o Immunity is lost once attitude
exhausted  Change in behavior towards
 Active Immunity (i.e. – health
vaccines and toxoids) provide
longer protection 1.2) Immunization
o Because you produced Three (3) Laws in Immunization
 Presidential Decree 996 –
the antibodies yourself,
Compulsory Immunization for
they would be there
Children below Eight (8) years
anytime they are
old
needed.
 Proclamation No. 6 – United
 Pregnant mother can be given
Nations’ Universal Child
tetanus toxoid
Immunization
 Newborn receives naturally
 Proclamation No.46 of 2000 –
acquired passive immunity
National Immunization Day
o Natural because it is
from mother
Common Goal is to prevent the
o Passive because it is
seven (7) Childhood Diseases
done via placental  Tuberculosis (give Bacillus
transfer Calmette Guerin or BCG)
 Mother receives Artificially  Diphtheria
Acquired Active Immunity  Pertussis
 Tetanus
Three (3) Factors to Know before  Poliomyelitis (give Oral Polio
taking care of Patients with Vaccine or OPV)
Communicable Disease  Hepatitis B
 Know the CAUSATIVE  Measles (give anti-measles
AGENT vaccine)
 Know what BODY
SECRETION harbors the IMPORTANT CONCEPT
microorganism

7
There are only two (2) Department of Health is
PERMANENT composed of CHILDREN
CONTRAINDICATIONS to BELOW FIVE (5) YEARS
Immunization OLD
 Allergy
 Encephalopathy without CDT VACCINE
known cause or convulsions Cholera, Dysentery, Typhoid Vaccine
within seven (7) days after  Given by DOH for free
pertussis vaccine  Adult dose is 0.5 cc
administration  Adult injection site is the
deltoid muscle
There are four (4) TEMPORARY  Child dose is 0.25 cc
CONTRAINDICATIONS for  Child injection site is the
Immunization vastus lateralis
 Pregnancy  Given INTRAMUSCULARLY
o (i.e. MMR vaccine) (I.M.)
 Recent receipt of blood  Given when there are
products outbreaks of epidemic
o Wait two (2) to three (3)  Immunity lasts only for six (6)
months months.
 Very severe disease
o Hospital confinement Anti-Rabies Vaccine
o Hospital personnel will  Target group would be the
decide when animals
immunization would be  Animals are brought to the
given Barangay for free
 Immunocompromised immunization
situation  Barangay Captain is
responsible for obtaining
 Fever, diarrhea and colds are vaccines from DOH
NOT CONTRAINDICATIONS  Dogs must initially be
to Immunization. registered before this vaccine
Immunization can still be could be administered
given despite their presence
1.3) Environmental Sanitation
 In a private setting, the  Objective:
physician can POSTPONE o No proliferation of
IMMUNIZATION in the arthropods, rodents
presence of fever, diarrhea, (both of which are good
colds because patient is vectors)
returned by mother to the Presidential Decree 856
physician once these Sanitation Code
conditions are resolved.  Also includes submission of
 Current target group of sex workers in determination
Expanded Program on of sexually transmitted
Immunization of the diseases

8
 o For gonorrhea – two
times a month
o For syphilis – once a
month
o Physical Examination –
once a month
Presidential Decree 825
 Anti-Littering Law
 Proper disposal of garbage
 Anyone caught littering would
have a penalty of Php2,000 to
Php5,000 and imprisonment
for one (1) year.
1.4) Proper Supervision of Food
Handlers
 A responsibility of the
Department of Health
facilitated by its Sanitary
Inspectors
 Also a responsibility of the
Bureau of Food and Drug
 Monitors food and drug sold
to public to assure that it is
safe for consumption
2. CONTROL ASPECT
 Done when signs
symptoms are already present
 There is already the presence
of infection
 Goal is to limit the infection
2.1) Isolation
 Separation of an infected
person during period of
communicability
Two (2) ways of Isolation
2.1.1) Strict Isolation
 Intended to protect other
persons (not the patient) from
infection
 It intends to limit the
microorganisms to be within
the patient
2.1.2) Reverse Isolation
 Also called Protective
Isolation
 Intended to protect the
immunocompromised patient
from infection
 Intends to keep
microorganisms out of the
patient
Concepts:
Quarantine
 Limitation of freedom of
movement of a well person
during the longest incubation
period
 It involves the separation of
persons who are carriers
 These are persons who are
not sick
 These are persons who do
not manifest signs and
symptoms of the disease
and Center for Disease Control’s two
(2) Revised Isolation Precautions
1) Standard Precaution
 Best strategy to prevent
nosocomial infection
 Slowly taking place of
Universal Precaution
 Applies to all patients
regardless of their diagnosis
 Applies to blood and all body
fluids, excretions and
secretions except sweat.
 Applies to mucous membrane
and non-intact skin
Concept:
Universal Precaution

9
  Has double standards o Cap / Bonnet
 Used only if patient is o Goggles
diagnosed or suspected of o Mask
having blood-borne diseases
3. Avoidance of Needle Stick or
Elements included in Standard Sharps Injury
Precautions  Do not recap, bend or break
1. Practice hand washing for each needles
patient care  There must be puncture-
 For contact with body fluids of resistant sharps collector
patient
 Duration is 10 – 15 seconds IMPORTANT CONCEPT!!!
 Length of washing is not  If patient is diagnosed as
important having communicable
 What is important is the disease, practice both
friction that is applied Standard Precaution and
Transmission-based
Concepts: Precaution
For Medical Asepsis:
 Hand is lower than the elbow Transmission Based Precaution
 Hand is the dirtiest part Airborne Precaution
 Elbow is the cleaner part  Use of mask
 Special ultrafilterable mask
For Surgical Asepsis:  Particulate mask
 Hand is placed up and o For measles, chicken
remains up pox, TB
 Hand is the cleanest portion
 Elbow is less clean than the Droplet Precaution
hands  No contact to mucous
membrane, nose, mouth
2. Use of Protective Barriers or  Use mask – ordinary mask
Use of Personal Protective will do
Equipment (PPEs)  Use goggles
 If you wear them all, the o For meningitis, mumps,
correct sequence for wearing pertussis, German
them would be: measles, diphtheria
o Mask
o Goggles Contact Precaution
o Cap / Bonnet  Avoid person to person
o Gown contact
o Gloves  Use gloves
 If you are about to remove  Use gown
them, the correct sequence is:  For diarrheal diseases,
o Gloves typhoid, cholera, hepatitis,
o Do hand washing skin diseases like ringworm,
o Gown scabies and pediculosis

10
  Placarding
Control Measures other than o Placing “NO
Isolation SMOKING” sign when
1. Disinfection there is oxygen
 Killing of pathogenic inhalation in progress.
microorganisms by physical or
chemical means (i.e. boiling, COMMUNICABLE DISEASES OF
soaking) THE CENTRAL NERVOUS
SYSTEM
Types of Disinfection
Bacterial infections
Concurrent Disinfection  Tetanus
 Done when the person is still  Meningitis
a source of infection
 Example: Viral Infections
o When patient is still in  Encephalitis
the hospital  Poliomyelitis
 Boil all patient gowns  Rabies

Terminal Disinfection TETANUS

 Done when person is no  Also called LOCKJAW
longer a source of infection  With painful muscular spasms
 Example:  Ten times more painful than
o Room of patient is leg cramps
cleaned upon
discharge of patient  Clostridium tetani
using UV rays or Lysol o Causative agent of
Tetanus
2. Disinfestation o Anaerobic
 Killing of undesirable small microorganism
animal forms such as o Abundant in soil, dust,
arthropods, rodents, insects clothing
by physical or chemical o It exists in the form of a
means SPORE outside the
human body
3. Fumigation o That is why it survives
 Use of gaseous agents to kill outside the human
arthropods, rodents and body even in the
insects. presence of oxygen
o Sterilization is needed
to kill the
4. Medical Asepsis microorganism
 Hand washing
 Gloving Important Concepts:
 Gowning  When inside the human
 Masking being, the spore transforms

11
 into a VEGETATIVE FORM,
which can be destroyed by
the presence of oxygen
 Why is Clostridium tetani
abundant in soil?
o Normal habitat of C.
tetani is in the
intestines
herbivorous animals
(i.e. cows, carabaos,
goats, sheep, horses)
o Manure of these
animals is used as
fertilizer
 Mode of Transmission of C.
tetani
o Break in skin integrity
 Person is at risk for infection
when there is any kind of
would (i.e. splinter or
salubsob, tooth decay, otitis
media)
Important Concepts!
 You need not be wounded by
a RUSTY OBJECT to acquire
tetanus
 In the newborn, tetanus
neonatorum is caused by poor
cord care.
 When C. tetani enters the
body, it seldom migrates to
the bloodstream where
oxygen is present
 C. tetani remains in the
wound but the effects are
systemic
IMPORTANT CONCEPT!
 Toxin is released to the blood
and is responsible for the
manifesting signs and
symptoms of the disease
Two (2) Types of Toxins in Tetanus
1. Tetanolysin
 Dissolves red blood cells
 Results to anemia
 Thus, patient is pale-looking
of
2. Tetanospasmin
 Causes muscle spasm
 Acts on MYONEURAL
JUNCTION of the muscles
and on the INTERNUNCIAL
FIBERS of the spinal cord and
the brain.
 Results into multiple muscle
spasms
 Inhibits the spastic muscle
from sending transmissions to
the brain, which would inhibit
progression of spasms. Due
to this, adjacent muscles will
also undergo spasm similar to
a chain reaction or a domino
reaction.
In the wound, there would be an
inflammatory response:
 Rubor - rednes
 Calor - heat
 Tumor - swelling
 Dolor - pain
 Functiolaesa – loss of function
Signs and Symptoms of Tetanus
 The patient manifests:
o Restlessness
o Fever
o Profuse Sweating
IMPORTANT CONCEPTS!!!
 Masseter muscle is involved
o It functions for
mastication, for
12
 opening and closing of o Resulting into
the mouth constipation
o Tetanus affects strong
muscles  Abdominal muscles are
o Therefore, it affects the affected
closing of the mouth o Results into abdominal
muscle rigidity
o This is called o Abdomen is hard as a
LOCKJAW or board
PRISMUS o This sign serves as a
basis for recovery
 Facial muscle is affected o If abdominal rigidity
o Gives rise to “risus decreases, it means
sardonicus” that the patient is on
o Known as the his way to recovery
“Sardonic Smile”
o Also known as “Ngiting  Extremity muscles are
Aso” affected
o Patient is smiling but o Results into stiffness of
his eyebrows are extremities
raised. o There is difficulty in
flexing
 Spinal muscle is affected o Robot gait is evident
o Resulting into the
Ophistotonus position Concept!
o This is the arching of  Thus, almost all of the
the back muscles are rigid and stiff in
o In the vernacular, it is Tetanus!
called “LIAD”
Diagnostics for Tetanus:
 Respiratory muscles are
affected 1. Clinical Observation
o Results to difficulty of  Assess patient physically
breathing, dyspnea and  Assess for the presence of
chest heaviness lockjaw
 If this is positive, a logical
 Genitourinary tract muscles question would be – “Do you
are affected have a wound”
o Results into urinary
retention 2. Obtain history of wound
o Intervention would  Wound Culture
involve catheterization  If there is a fresh wound,
microorganism is still present
 Gastrointestinal muscles are there
affected
Concept:

13
  The shorter the incubation increase in the dose of
period, the poorer the the drug
prognosis
 Shortest incubation period is 2 IMPORTANT CONCEPT!!!
– 3 days.  When administering tetanus
 An incubation period of one horse serum, always have
month has a better prognosis ready the following:
than an incubation period of 2 o EPINEPHRINE
– 3 days. o CORTICOSTEROID
 These would be necessary to
Three (3) Objectives of Medical counteract any delayed
Management reaction, which may cause
hypersensitivity reactions
Neutralize the toxin leading to anaphylaxis and
 This is the top priority eventually the death of the
 The toxin is responsible for patient.
the signs and symptoms of
the disease and the systemic 2. Kill the Microorganism
infection  Give Penicillin
 Give anti-tetanus serum or o This is the drug of
tetanus anti-toxin choice to kill the
o It comes from a horse bacteria
serum  In the fresh wound, do daily
o Do skin testing first cleansing with the use of
o If (+) for skin testing, hydrogen peroxide
DO NOT GIVE the  Then apply antiseptic solution
drug. like Betadine or Povidone
 Resort to human  Then cover wound with THIN
serum – tetanus DRESSING to allow air to
immunoglobulin circulate through the wound.
 It may also be good to expose
Concept: the wound but avoid contact
 In the Philippine setting, the with flies.
horse serum is still given
despite a positive skin test. 3. Prevent and Control Spasm
 This is done by giving  Give muscle relaxant
fractional doses. o Given during the acute
 Example: phase of tetanus
o Initial administration of o Done via the I.V. route
0.01 of drug and 0.99  Give Diazepam / Valium
PNSS o Use I.V. push or I.V.
o After 30 minutes, 0.05 drip
of the drug and 0.95 of
PNSS Concepts:
o After another 30
minutes, another

14
  I.V. drip regulation is titrated 3. Proprioceptive
based on the frequency of the  There is participation of
spasm. patient and other persons
o The more frequent the  Examples are touching,
spasm, the faster the turning, jarring the bed of the
rate of the titration patient

 When the patient is on his Nursing Care in Tetanus

way to recovery, muscle  Done to prevent patient from
relaxants per orem may be having spasms
used:  Place the patient in a dim and
o Methocarbamol or quiet environment
Robaxin  Practice minimal handling of
o Lionesal or Baclofen the patient
o Eperison or Myonal o Avoid unnecessary
disturbance of the
Proceed with other supportive patient
management  Practice Cluster Care
 For urinary retention, do o Do all nursing care
catheterization activities in one setting
 For constipation, administer o Do other nursing care
laxatives as ordered activities with vital
signs taking
Nursing Management in tetanus  Gentle handling of the patient
 Muscle spasms are the first  Touching is not
concern contraindicated
 Turning is not contraindicated
Concept: o However, do these as
 Stimuli trigger spasms. gently as possible
o Inform the patient
Types of Stimuli: before proceeding with
any procedure
1. Exteroceptive
 Comes from outside
environment of the patient
 Examples are bright light and  Concept:
noise o Tetanus patients are
 Place the patient in dim and isolated so as not to be
quiet environment exposed to stimuli

2. Interoceptive Prevent injury:

 Comes from inside or within Respiratory injury
the patient  Airway obstruction
 Examples are stress, pain,  Tongue could be drawn back
coughing, passage of flatus and cause blockage or
obstruction

15
  Use padded tongue depressor  When given:
for retaining patency of the o 1st Dose: 6 weeks
airway after birth; 0.5 ml
Respiratory Infection o 2nd Dose: 10 weeks
 Turning to side is usually not after birth; 0.5 ml
done o 3rd Dose: 14 weeks
o This results to pooling after birth; 0.5 ml
of respiratory  Number of Doses:
secretions in the lungs o Three (3)
o This leads to  Interval between Doses:
pulmonary infection o Four (4) weeks
 Profuse sweating and draft  Administration Site:
exposure also leads to o Vastus lateralis muscle
pulmonary infection  Route:
 Therefore, always keep o Intramuscular
patient dry; especially at the
back. IMPORTANT CONCEPTS!!!
 Expect fever to set in after
Physical Injury administration of DPT vaccine
 For falls: o Give paracetamol
o Never leave the patient
o Apply warm compress
alone
for better drug
o If you do leave the
absorption
patient, keep the o Immediately follow up
padded side rails up
with cold compress to
o Keep call light within
avoid soreness
the reach of the patient  If tenderness or swelling on
 Fractures due to spasm: site of injection is present:
o Caused by restraining o Do cold compress
by relatives within twenty-four (24)
hours
Provide Patient with Comfort o Then do warm
Measures
compress
 Oral care
 Observe for signs of
o To prevent mouth sores
convulsions within seven (7)
o Cotton swab used on days after DPT immunization
inner and outer chick o This indicates that child
o Do not use toothbrush has reaction with the
pertussis component of
IMPORTANT CONCEPT!!! the drug
 Attack of tetanus does not o Therefore, succeeding
give permanent immunity doses of DPT will NOT
BE GIVEN
Vaccine Given: o Give ONLY the DT
Diphtheria Pertussis Tetanus
components
Vaccine or DPT vaccine

16
 o If DPT is given again,  5th Dose given:
this predisposes the o 10-05-2007 (After one
child to neurologic (1) year from the LAST
disorders dose)
 Observe if child cries
uncontrollably IMPORTANT CONCEPTS!!!
 This is an  Succeeding doses of Tetanus
indication of Toxoid are given based on
development of DATE OF LAST DOSE
neurologic  If a person is high-risk, give
disorders. booster dose every five (5)
years
DPT Immunization for Pregnant  If a person is low risk, give
Individuals booster dose every ten (10)
 Dose: 0.5 ml years
 Route: Intramuscular  Effect of Tetanus Toxoid
 Number of Doses given: administration on the Mother
o Two (2) doses with  Slight soreness or heaviness
three (3) booster doses on site of injection
or;
o Two (2) doses with Wound Care
booster dose given  Wash wound with soap and
every pregnancy running water
 When given:  Place antiseptic solution on
o 1st Dose: Anytime wound
during second trimester  Use thin dressing
of pregnancy  Band Aid Plastic Strips are
o 2nd Dose: With one allowable as they have air
(1) month interval ventilation holes
o Booster Dose: Given  Do not use plaster
with successive  Use only those types of
pregnancy/ies plasters with air ventilation
holes to introduce oxygen to
For High-Risk Individual the wound
 1st Dose given:
o 03-05-2005 Key Concept!!!
 Avoid Wounds
 2nd Dose given:
o 04-05-2005
rd MENINGITIS
 3 Dose given:
 Inflammation of the meninges
o 10-05-2005 (six
(covering of the brain and
months after the LAST spinal cord)
dose)
th
 4 Dose given: Concepts!
o 10-05-2006 (After one  Meninges are composed of:
(1) year from the LAST o Dura mater
dose)

17
 o Arachnoid mater o Disseminated
o Pia mater Intravascular
 Cerebrospinal Fluid or CSF is Coagulation occurs
found in the and leads to vascular
SUBARACHNOID SPACE collapse
o Vascular collapse leads
Causative Agents in Meningitis to death in ten percent
 Viral (10%) of patients
o CMV – o This ten percent (10%)
Cytomegalovirus has the FULMINANT
 Opportunistic TYPE or the
infection for Waterhouse-
AIDS Freiderichen Syndrome
 Fungal (characterized by
o Cryptococcal vascular collapse)
Meningitis o Causative agent is
 Source is Neisseria meningitides
excreta of fowls
and feathered Important Concept!
animals  In children below four (4)
 Another form of years old, Neisseria
opportunistic meningitidis is a normal flora
infection for in the nasopharynx.
AIDS  If resistance goes down,
 Bacterial these children become prone
o Tubercle Bacilli to infection
 TB meningitis
 Staphylococcal meningitis Mode of Transmission
o Secondary to skin  Droplet transmission
infection  In cryptococcal meningitis:
 Haemophilus influenzae bacilli o Inhalation of spores
o Common cause of
meningitis in the United Portal of Entry
States  Respiratory system via the
 Meningococcemia nasopharynx
o Meningococcemial
meningitis Pathophysiology of Meningitis
o Spotted Fever Disease  From the nasopharynx, the
o Most fatal microorganism goes to the
o The only type of bloodstream
 Once in the bloodstream, the
meningitis where the
microorganism causes
VASCULAR SYSTEM
petechiae formation (pin point
is affected
red spots on the skin)
o Bleeding is triggered

18
 From the bloodstream,
microorganism goes to the Pathophysiology of
meninges and irritates them Meningococcemia
o There is inflammation  Portal of entry of Neisseria
of the meninges and meningitidis is also the
accumulation of nasopharynx
substances in the  The bacteria then goes to the
meninges bloodstream
 This results into increased  Presence of bacteria in the
Intracranial Pressure (ICP) bloodstream causes
o Increased ICP leads to: ecchymosis
 Severe o These ecchymoses are
headache blotchy (pantal-pantal)
 Projectile purpuric lesions
Vomiting o They are purplish in
 Two (2) to three color
(3) feet away o Usually found on the
from patient wrist and the ankles
o Management involves  From the bloodstream, they
turning patient to side go to the meninges and
 Position kidney irritate them.
basin about two  Same sequence of events
(2) to three (3) follow as mentioned above
feet away
 Altered Vital Signs Signs and Symptoms of
o Increased Temperature Meningitis
o Decreased Pulse Rate  Once the microorganism is at
o Decreased Respiratory the nasopharynx:
Rate o Fever
o Increase in Systolic o Headache
Blood Pressure and o Sore throat
Normal Diastolic o Cough
Pressure o Colds
 This results in  Other signs and symptoms
the widening of present as discussed in the
the Pulse pathophysiology
Pressure
 Convulsions (seizures) Pathognomonic Sign of Meningitis
 Diplopia  Nuchal Rigidity
o Due to choking of optic  Stiffening of the neck
discs o No flexing of the neck
o Double vision but not o No hyperextending of
crossed eyed the neck
o Determined by finger o No turning from side to
counting side
 Altered level of consciousness  Abnormal Reflexes

19
 o Positive for Kernig’s  Viral infection is present if:
Sign o CSF is clear
 Place patient in  No infection is present if:
supine position o CSF is clear
 Flex both knees
toward the Send CSF for Laboratory
abdomen Examination
 Then ask the  Laboratory findings would
patient to extend show:
the legs o Increased protein
 If pain is levels
present, the o Increased White Blood
patient is said to Cell levels
be positive (+) o Decreased Sugar
for Kernig’s Sign content
or difficulty of
extending the Concepts
leg  If caused by bacteria, do
 Positive for Brudzinski’s Sign Culture and Sensitivity test
o Place the patient in o This is done to know
supine position what bacteria caused
o Flex the neck the infection
o If there is no reaction, o This is also done to
the patient is said to be determine what drug
negative (-) for will be used to kill the
Brudzinski’s Sign. offending
o If there is microorganism
INVOLUNTARY
DRAWING UP of the  If CSF is clear, it is subjected
LEGS / HIP upon to Counter Immuno-
flexion of the neck, the Electrophoresis (CIE)
patient is said to be  This is done to determine if
positive (+) for causative agent or a protozoa
Brudzinski’s Sign
 IMPORTANT CONCEPT!!!
Diagnostic Tests for Meningitis In patients with HIGHLY
INCREASED INTRACRANIAL
1. Lumbar Puncture PRESSURE due to CNS
 Cerebrospinal Fluid (CSF) is infection, lumbar puncture or
the specimen used aspiration of the CSF is
o Assess for the color of CONTRAINDICATED
the CSF o This will bring about
 Bacterial infection is present HERNIATION OF THE
if: BRAIN and would
o CSF is yellowish, eventually lead to
turbid, cloudy death

20
  Therefore, it is important that the urine output must
the nurse performs Physical increase by thirty (30)
Assessment before doing a to fifty (50) ml.
lumbar tap. o If no changes in urine
output occurs, then
2. Blood Culture Mannitol is not effective
 Done because microorganism o Refer this to the
can travel to the bloodstream physician
 If there are convulsions due to
Medical Management of CNS infection
Meningitis o Give anti-convulsants
 If bacterial  Dilantin
o Give anti-bacterial  Phenytoin
agent in the form of  Routes of Administration of
antibiotics Dilantin
 If viral o Per Intravenous
o Symptomatic  Nursing Care for
 If fungal I.V.
o Give Amphotericin B administration of
 If with inflammation Dilantin
o Give corticosteroids in  Sandwich
the form of Dilantin
DEXAMETHASONE with NSS
o Never give  NSS –
PREDNISONE Dilantin –
 Prednisone NSS
does not cross  Rationale:
the Blood-Brain  Dilantin
barrier would
 Prednisone crystallize
causes sodium o Per Orem
retention  Nursing Care for
 Retains CSF P.O.
 If with excess CSF administration of
o Give osmotic diuretic in Dilantin
the form of MANNITOL  Do
o Check blood pressure frequent
before administration oral care
as it causes  Do gum
hypotension massage
o Monitor the intake and o Rationale:
output to evaluate the  Dilantin causes
effectiveness of gingival
Mannitol hyperplasia or
o Expect that after two overgrowth of
(2) to three (3) hours, the gums

21
 4. Potential for fluid and
Important Concept! electrolyte imbalance due to
 Dilantin is never given projectile vomiting
Intramuscularly  Monitor intake and output
o This is irritating to the  Provide fluids per orem
tissues
o This has an erratic Important Concept
effect  An attack of meningitis does
not provide permanent
Nursing Care immunity
 Symptomatic
 Supportive Preventive Measures

Nursing Diagnoses 1.Proper disposal of

nasopharyngeal secretions
1. Alteration in body temperature  Burning
related to infection  Burying
 Priority is to lower body  Proper procedure for disposal
temperature of nasopharyngeal secretions
o Do TSB o Use tissue paper
o Provide cold compress o Put it in a plastic bag
o Provide loose clothing after use
o Knot the plastic bag
2. Pain: Alteration in comfort o Dispose plastic bag in
related to increased Intracranial a trashcan
Pressure
 Priority is to relieve headache Important Concepts!
within thirty (30) minutes  The best and most economic
o Provide diversion way preventing spread of
o Provide proper infection is through
positioning swallowing of nasopharyngeal
 Low-Fowler’s secretions
position (30° o This brings the
incline) secretions to the
o Provide comfort stomach and to the
measures intestines and would
o Massage the forehead then be eliminated in
o Do petrissage with the stool
circular action  Children have less chance of
spreading infection because
3. Potential for injury related to they swallow nasopharyngeal
altered level of consciousness secretions.
 Never leave the patient alone  This is contraindicated,
 Place call switch and light however, for tuberculosis
within reach of patient patients

22
  Thus, for TB patients, they
have to spit
nasopharygeal secretions
 Swallowing is allowable for
other respiratory infections
2. Cover nose and mouth when
sneezing and coughing
Important Concepts!
 When you transfer patient…
o Make the patient wear
a mask so as not to
infect people in the
hallway, elevator, etc.
 Wear mask when you enter
the patient’s room
3. Vaccine
 Hib vaccine for Haemophilus
influenza
BRAIN FEVER
 Arbovirus
 Arthropod-borne Virus
Primary cause
 St. Louise
 Japan B
 Australian X: Equine (E-W)
Mode of Transmission
 Mosquito bites
o Aedes Sollicitans
o Culex tarsalis
 Ticks of horse
 Migratory birds
Secondary cause
 Post racene encephalitis
Toxic
 Metal poisoning
o Lead poisoning
o Mercury poisoning
ENCEPHALITIS
out
Signs and Symptoms
 With altered level of
consciousness
 With lethargy
o Difficult to awaken
o Patient is abnormally
sleepy
 With behavioral changes
 Brain is immediately affected
relative to meningitis
Diagnostic Tests
1. Lumbar Puncture
 Specimen is cerebrospinal
fluid (CSF)
 Laboratory Results would
indicate:
o Increased Proteins
o Increased White Blood
Cells
o Normal Sugar Content
2. Electroencephalogram (EEG)
 To assess extent of brain
damage
 Patient recovers but because
he is epileptic, he develops
irreversible brain damage
Medical Management
 Symptomatic due to viral
cause
Concepts!
 No permanent immunity is
obtained from attack of
encephalitis, only temporary
immunity, due to causation by
various viruses
 Source of infection is
mosquito
Preventive Management:
23
  CLEAN PROGRAM
o C – Chemically Treated
Mosquito Net
o L – Lavivorous fishes
o E – Environmental
Sanitation
o A – Anti-mosquito Soap
(Basic Soap)
o N – Neem Trees or
Eucalyptus Tree (draws
away mosquitoes)
Concepts!
 To kill mosquitoes in canal,
pour oil or gas in canal
o This depletes oxygen
present in the canal
o There is no need to
light it up
Important Concepts!
 When Brunhilde infects you,
Leon or Lansing will no longer
affect you!
 In the Philippines, the most
prominent type is Brunhilde!
Mode of Transmission
 Droplet
o In early stage of
infection, virus if found
at nasopharyngeal
secretions
 Fecal-Oral Route
o In late stage of
transmission, virus is
found at the mouth

POLIOMYELITIS Portal of Entry

 Also called:  Gastrointestinal Tract
o Infantile Paralysis
Pathophysiology
o Heine-Medin Disease
 Legio debilitans goes to the
 Affects children below ten (10)
nasopharynx or the mouth
years of age
 If in the nasopharynx, it goes
 Less risk for people above ten
to the tonsils and causes:
(10) years Old
o Sore throat
o Fever and chills
Causative Agent
 Virus o Headache with body
o Legio debilitans malaise
 Type 1 –  If at the mouth, it goes to the
Brunhilde Peyer’s patches and causes:
 Type 2 – o Abdominal pain
Lansing o Anorexia
 Type 3 – Leon o Nausea and Vomiting
 If Brunhilde o Diarrhea or
o Gives permanent Constipation
immunity
 If Lansing or Leon STAGES of POLIOMYELITIS
o Gives temporary
immunity 1ST Stage: Invasive Stage or
Abortive Stage
 All the abovementioned signs
and symptoms will appear

24
  Patient recovers respiratory
 Disease process is aborted depression
 But there will be instances
when disease process will not  Once in the CNS, the
be aborted microorganism will also
cause:
Tonsils Peyer’s Patches o Stiffness of the
▼ ▼ hamstring
Cervical Mesenteric o Patient will be positive
Lymph Lymph for HOYNE’S Sign and
Nodes Nodes exhibit a HEAD DROP
▼▼▼ ▼▼▼ o To check for Hoyne’s
BLOODSTREAM Sign
▼▼▼  Lift shoulders of
Central Nervous System patient when
lying supine or
2nd Stage: Pre-paralytic Stage of extend head of
Poliomyelitis patient beyond
 Central Nervous System is the edge of the
already involved but there will bed
be no paralysis  If head of patient
drops, he is said
Signs and Symptoms: to be positive (+)
 Once in the CNS, for Hoyne’s Sign
microorganism will cause:
o Sever muscle pain  Once in the microorganism is
 Do not keep on in the CNS, the patient would
turning or elicit a POKER SPINE
holding patient o Ophistotonus with head
 Do not do retraction
massage o Sitting position cannot
 No positioning be assumed
will relieve o Therefore, patient will
patient assume a TRIPOD
o Instead, what would POSITION
relieve the patient
would be: Central Nervous System
 Application of ▼▼▼
warm packs Paralysis
 Analgesics
o Never administer Concept!
Morphine  From the CNS, the patient will
 It is a narcotic experience paralysis.
analgesic that  This leads to the third (3rd)
would cause stage of the disease

25
3rd Stage: Paralytic Stage  Patient has cranial nerve
 Presence of paralysis affectations and anterior horn
 Characteristics of Paralysis: cell affectations
o Flaccid
 Soft Important Concepts!!!
 Flabby Not all patients will develop paralysis
 Limp  If patient is non-paralytic,
o He has GOOD
Important Concept! PROGNOSIS
 Flaccid Paralysis is
PATHOGNOMONIC SIGN of Diagnostic Tests
Poliomyelitis
1. Lumbar Puncture
Three (3) Types of Paralysis  Laboratory results would
reveal:
1. Bulbar Type o Increased White Blood
 Cranial nerves are affected Cell levels
 9Th cranial nerve o Increased Protein
(Glossopharyngeal Nerve) levels
and 10th cranial nerve (Vagus o Normal Sugar levels
Nerve) affectations give rise
to: 2. Muscle Testing
o Respiratory problems  To determine what specific
o Vocal cord swelling / muscle is affected
paralysis
o Excessive salivation 3. Electromyelogram
o Aspiration  To determine extent of muscle
o Regurgitation involvement

2. Spinal Type 4. Stool Examination

 Most common type of  Perfomed at the late stage
paralysis  About ten (10) days after
 Affects ANTERIOR HORN being affected
CELLS 5. Nasopharyngeal Examination
 Affects MOTOR FUNCTION  Performed at the early stage
o Paralysis of extremities
o Paralysis of intercostal Medical Management
muscles leads to  Symptomatic
DIFFICULTY OF  Causative agent is viral
BREATHING
If there is respiratory paralysis
3. Bulbo-Spinal Type  Place patient in a
 Combination of Bulbar and MECHANICAL VENTILATOR
Spinal types  Use the IRON LUNG
MACHING

26
 o This works on the  1st Dose – at six
principle of Negative (6) weeks old
Pressure Breathing  2nd Dose – at ten
o No tracheostomy tube (10) weeks old
needed (tracheostomy  3rd Dose – at
tube or endotracheal fourteen (14)
tube work on the weeks old
principle of Positive o Important Concepts!!!
Pressure Breathing)  Do not feed
o Capsular in shape child for thirty
o With glass windows (30) minutes
o With metal plate after
o Works on electricity administration of
o During brownout or OPV
o Rationale:
power shortages,
operate the machine  For better
manually absorption
o It has a steering wheel, o If child vomits,
which can be REPEAT!!!
manipulated manually o If child has diarrhea
o Patient stays in the Iron  Give OPV
Lung Machine for  But do not
months record it
 Not all of the
Nursing Care for Poliomyelitis vaccine may be
 Symptomatic and Supportive absorbed
 Psychological Aspect of Care properly
o Use empathy  When OPV 3 is
given four
weeks after,
Preventive Measures
record it as OPV
1. Immunization
2
 Vaccine given:
o Oral Polio Vaccine
 Integrated Management of
(OPV) or Sabin
Childhood Illnesses (IMCI)
o Dose:
o Tell mother also that
 Two (2) to three
she should be very
(3) drops
careful in handling
o Route:
stool of child because
 Oral this vaccine eliminates
o Number of Doses: virus to the stool
 Three (3) o If significant others at
o Interval: home are
 Four (4) weeks immunocompromised
o When given: o Do not administer OPV
o Due to feces of child

27
 o Rather give, IPV or o Fox
Inactivated Polio o Wolves
Vaccine / SALK o Boar
o Dose: o Monkeys
 0.5 cc o Bats
o Route: o Cats
 Intramuscular o Dogs
o Number of Doses:
 Three (3) Causative Agent:
o Interval:  Rhabdovirus
 Four (4) weeks o A neurotropic virus
o When given: o Has special affinity to
 1st Dose – at six neurons and the
(6) weeks old Central Nervous
 2nd Dose – at ten System
(10) weeks old
 3rd Dose – at R H A B D O V I R U S
fourteen (14) ▼▼▼ ▼▼▼
weeks old Peripheral Efferent
o Rationale: Nerves Nerves
 Because stool of ▼▼▼ ▼▼▼
child may CNS Salivary
contain the virus Pathologic Gland
if OPV is given Lesions of Rabid
(negri bodies) Animal

2. Avoid mode of transmission

 Proper disposal of Important Concept!
nasopharyngeal secretions  Pathologic lesions that are
 Cover mouth when coughing formed as microorganism
 Do not put anything through multiplies
the mouth  If there is no multiplication of
the microorganisms at the
RABIES Central Nervous System,
 Also called: there will be NO negri bodies.
o Hydrophobia Mode of Transmission
o Lyssa  Contact with saliva of a rabid
o La Rage animal
 A disease of a low form of
animal Important Concept!
o Not a human infection  Therefore, you need not be
o Only accidentally bitten
transmitted to man  Even a scratch could cause
 Occurs in canine animals or rabies as animals lick their
animals with fangs: paws
 Infection may occur through:

28
 o Corneal transplantation years (this is the
o Kissing animal longest
o Dog licking wounds incubation
period recorded
Manifestation: in the
 In Animals Philippines)
o Incubation Period
 Three (3) to Stage 1 – Invasive Stage
eight (8) weeks  Numbness on the site of the
bite
Stages of Manifestations in  Itchiness on the site of the
Animals bite
 Flu-like symptoms
Stage 1 – Dumb Stage o Fever
 Animal will have complete o Headache
change in disposition o Sore throat
 May show any of the following  Marked Insomnia
behaviors:  Restless
o Withdrawn  Irritable
o Stays in one corner  Apprehensive
o Depressed  Slight photosensitivity
o May be overly  Vague symptoms
affectionate
 Can lick wounds Important Concept!
o May be walking to and  When a family member at
home is bitten by a rabid
from
animal, vaccinate all people at
o Hyperactive
home because patient has
o Manic
virus at saliva
 It is better if the animal is
withdrawn as it is easy to note Stage 2 – Excitement Stage
 Acrophobia
Stage 2 – Furious Stage o Fear of Air
 Easily agitated
 Hydrophobia
 Easily bites
o Fear of Water
 With vicious look
Important Concept!
 With drooling of the saliva
 Air and Water both cause
 Expect the animal to die
PHARYNGOLARYNGEAL
 Dying and biting happens on
SPASM
this stage
 This is characterized by:
 Animal can die without biting
o A drowning sensation
Manifestation: o Strangulation to death
 In Humans syndrome
o Incubation Period o Like breathing in thick
 Ten (10) days to smoke
twenty one (21)  Other signs and symptoms

29
 o Photosensitivity
o Maniacal behavior Brain Biopsy of the Animal
o Resembles attitude of  Identifies presence of negri
a rabid animal bodies
o Easily agitated  10% of animals have rabies
o Runs after people but are negative for negri
o Violent bodies
o Because virus may
o Club walls
travel through efferent
o Jumps out of window
nerves and may not
have reached the CNS
Important Concepts!
before death
 Before, THORAZINE and
 Therefore, do the next test…
BENADRYL were given for
maniacal behavior but had
Direct Fluorescent Antibody Test
proven to be ineffective
(DFA Test)
 Now, HALOPERIDOL and
 Confirmatory test for rabies
BENADRYL are administered
and are very effective against
Observation of the Animal
maniacal behavior
 Done for ten (10) days
 Important Concept!
Stage 3 – Paralytic Sage
o Submit yourself for
 Patient’s spasms will stop
treatment if, within ten
 He can be fed, etc.,
(10) days:
 Paralysis sets in from toes
 Animal dies
going upwards
 Animal shows
 If respiratory system is
behavioral
affected, the patient will die
changes
 Manifestation of signs and
 Consider the following:
symptoms sets within 24
o Site of Bite
hours and death follows
 If above waist
Important Concept!!!  Submit
 Rabies is a preventable but yourself
not a curable disease for
 Maximum time before death treatment
occurs is seventy-two (72) as soon
hours. as
possible
Diagnostic Tests Done Before  This is
Patient Manifests Signs and due to the
Symptoms proximity
of the bite
Important Concept! to the
 There is no diagnostic brain
examination done to humans, o Velocity of Virus
ONLY TO ANIMALS

30
  Three o Stock dose is 0.5 cc /
millimeters per vial
hour (3mm/hr)
o Extent of Bite  Purified Duck Embryo Virus
 Submit yourself o PDEV
for treatment at o Lyssavac
once if: o Stock dose is 1.0 cc /
 You have vial
multiple
bites  Purified Chick Embryo Cell
 You have o PCEC
a deep o Also one of the more
bite common types
o Reason for the Bite o Rabipur
 If bite is o Stock dose is 1.0 cc /
provoked vial
 Example:
 You Important Concepts!!!
stepped  If given intramuscularly (I.M.)
on the o Do skin testing first
dog’s tail  If given intradermally (I.D.)
 Do not o No skin testing is done
worry  Site
 If unprovoked o Deltoid
 Example: o Vastus lateralis
 There is
Important Concepts!!!
no reason If active form of vaccine
 Then, If via I.M.
WORRY,  Schedule is:
because Dose Day Example Dosage Remarks
IT IS A 1st 00 03/05/ 2 vials 1 cc on
RABID 2005 each site;
DOG!!! One on
the left
and one
on the
Medical Management right
Post-Exposure Prophylaxis 2nd 07 3/12/ 1 vial One site
Vaccines 2005 only
3rd 21 3/26/ 1 vial One site
2005 only
Active Form of Vaccine
Important Concepts!!!
 Made up of microorganisms
 Counting is ALWAYS BASED
 Purified Vero Cell Vaccine
on the FIRST DOSE!!!
o PVCV
 You can afford not to continue
o One of the more
vaccine if dog does not die
common types after ten (10) days
o Verorab

31
  However, continuance is 4th 28 04/01/ 0.1 cc if Given on
encouraged because doing so to 2005 Verorab one site
30 to or only
would give three (3) years of 04/03/ 0.2 cc if
immunity 2005 Lyssavac
 If you abort vaccination, you Or
will not get three (3) years of Rabipur
immunity 5th 90 06/03/ 0.1 cc if Given on
2005 Verorab one site
 When you get bitten again, or only
you start all over again 0.2 cc if
 In case the dog: Lyssavac
o Died Or
o Disappeared Rabipur
o Was killed within (3) Important Concepts!!!
 Verorab
days
o Once reconstituted is
 Avail of complete doses plus a
BOOSTER DOSE only potent for eight (8)
o Booster Dose hours
 Antibodies are produced in
 Given at DAY 91
about seven (7) days
 In the tabulated
 Therefore, also give passive
example
form of vaccine.
 Schedule
would be
at
Passive Forms
6/05/2005
Temporary antibodies
 Dosage is
one vial Animal Serum
If via I.D.  Equine Rabies
 Schedule is: Immunoglobulin (ERIG)
Dose Day Example Dosage Remarks
1st 00 03/05/ 0.1 cc if Given on o Anti-rabies serum
2005 Verorab each site: o HyperRab
or Right and o FaviRab
0.2 cc if Left
Lyssavac
Or Important Concepts!
Rabipur  Do skin test first
2nd 03 3/08/ 0.1 cc if Given on o If negative for skin test,
2005 Verorab each site: give drug
or Right and
0.2 cc if Left
 Dosage is based
Lyssavac on body weight
Or and is provided
Rabipur in direct
3rd 07 3/12/ 0.1 cc if Given on proportion
2005 Verorab each site:
 0.2 cc / kg body
or Right and
0.2 cc if Left weight is the
Lyssavac standard
Or  Example:
Rabipur

32
  A 50 kg side of the
person buttocks
would o Other half is...
receive  Infiltrated
10 ml of around site of
ERIG bite using four
 Cost is distinct points or
approxim  Given inside the
ately wound of the
Php1,800 patient
/ 5.0 cc o This is prophylactic and
o If positive for skin test, is not considered as a
give HRIG or Human treatment
Rabies Immunolobulin
 Imogam Nursing Care
 Rabuman  Place patient in a dim and
 0.133 cc / kg quiet environment
body weight is  Keep patient away from sub-
the standard utility room
dose  Restrain the patient before he
 Example: exhibits maniacal behavior
 A 50 kg  Wear all Personal Protective
person Equipment when you enter
would the room because patient
receive continues to spit
6.65 cc of
HRIG Preventive Measures
 Cost is  Be a responsible pet owner
approximately o Have pets immunized
Php4,500 / 2.0  Wash wound with soap, water
cc and antiseptic
o This is given as a  Then observe the dog
single dose within
seven (7) days from Important Concept!!!
the date of the bite  Virus rabies is destroyed by
o After seven days, 60°C heat for thirty-five (35)
patient already has seconds
antibodies  Therefore, you will not acquire
o Computed Dosage is rabies from eating dog meat
divided in two
 Half is given
Intramuscular COMMUNICABLE DISEASES OF
 On the THE CIRCULATORY SYSTEM
ventrogluteal
muscle or at the
DENGUE HEMORRHAGIC FEVER

33

Important Concept!
 Dengue Fever is different from
Dengue Hemorrhagic Fever!
 Dengue fever is an affectation
of the circulatory system
without bleeding
o It is a mild form of
hemorrhagic fever
 Life span of these types of
mosquitoes is four (4) months
Mechanical Transmitter
 After this mosquito bites an
infected person, the very next
person it bites is the only
person who gets the virus.
 One is to one
 Immediate transfer of virus

Causative Agent:
 Arbovirus Aedes aegypti
 Carried from one person to  More common in the
another by an Arthropod Philippines
 Day-biting
 Low-flying
Types of Dengue Viruses  Low-extremity biting
 Type 1 – Onyong-nyong virus  Breeds on clear, stagnant
 Type 2 – Chikungunya water usually in urban area
 Type 3 – West Nile o Old tires
 Type 4 – Flavivirus o Flower vases
o Brought epidemics in o Plant cans
several areas in the  In the Philippines, any area is
Philippines a dengue risk area
 Other information:
o When it lands on a
Mode of Transmission surface, body of
 Mosquito Bite mosquito is on a
 Biological Transmitters PARALLEL POSITION
o Aedes aegypti and two (2) legs are
o Aedes albopectus raised
 Mechanical Transmitter o It has white stripes on
o Culex fatigans legs
o It has a gray-
millennium color
Biological Transmitter
 After this mosquito has bitten Four Classifications of Dengue
an infected person, after eight Hemorrhagic Fever
(8) to ten (10) days, it can
transfer virus to other people DHF Grade 1
 Virus becomes a part of the  Increased grade fever (lasts 3
system of the mosquito as – 5 days)
long as it is alive o Even if antipyretics are
given, fever will persist

34
 o Fever will come down  If patient recovers, he only
but the patient is still has Dengue Fever (and not
febrile Dengue Hemorrhagic Fever)
o Important Concept!  Dengue Fever is also called:
 Therefore, give o Dandy Fever
antipyretic round o Breakbone Fever
the clock
 Pain is present DHF Grade 2
o Headache  If there is persistence of signs
o Periorbital pain and symptoms of DHF Grade
o Pain behind the eyes 1
o Joint and bone pain  If there is bleeding from:
o Abdominal Pain o Nose – epistaxis
 Nausea and o Gums – gum bleeding
Vomiting o Vomiting of blood –
 Presence of Pathological Hematamesis (coffee
Vascular Changes ground appearance
o Petechiae from the stomach)
o Herman’s Sign  Upper Gastro-Intestinal Tract
 Generalized Bleeding
redness o Melena
 Flushing of the skin  Passing of black
tarry stool
 Acted upon by
INFECTED MOSQUITO digestive
▼▼▼ enzymes
BLOODSTREAM (multiplies)  Lower Gastro-Intestinal Tract
▼▼▼ Bleeding
Multiple lesions in the o Hematochezia
bloodstream  Passing of fresh
▼▼▼▼ ▼▼▼▼ blood in the
Increased Increased stool
Capillary Capillary  Then, these signs and
Fragility Permeability symptoms indicate the START
(causes easy (allows shifting OF HEMORRHAGIC FEVER
bleeding; of fluid from
difficult to stop one DHF Grade 3
due to compartment  Persistence of signs and
thrombocytopenia; to symptoms of DHF Grade 2
poor clotting another leads  With signs of circulatory
to ascites; collapse or failure
hemo-  With cold clammy skin
concentration  Nursing Alert!
o Check for capillary refill
Important Concept! o How?

35
  Apply pressure  Three (3) criteria that must be
on nailbeds present before you perform
 Normal capillary the tourniquet test:
refill time is o Person must be at
about one (1) to least six (6) months old
two (2) seconds o Fever should be more
 If capillary refill than three (3) days
time is about o No other signs of DHF
three (3) are present
seconds or  Patient only
more, blood flow feels fever
is sluggish due  If there are other
to circulatory manifestations (i.e.
failure stomachache), do not do
 Check Vital Signs tourniquet test
o Indicators of  How is it done?
Circulatory Failure: o Get the blood pressure
 Hypotension or of the patient
decreased blood o Add systolic and
pressure diastolic pressures
 Rapid but weak o Divide the sum by two
pulse o Apply that pressure on
 Rapid
the cuff. . .
respiration
 For five (5)
minutes if the
DHF Grade 4
patient is
 With signs and symptoms of
pediatric
DHF Grade 3
 For ten (10)
 With shock
minutes if the
 Hypovolemic shock due to
patient is an
excessive blood loss due to
adult
uncontrolled bleeding
o Deflate the Blood
Pressure Cuff
Diagnostic Tests for Dengue
o Check for the presence
Hemorrhagic Fever
of petechial formation
1. Tourniquet or Rumpel Leede’s o If greater than or equal
Test to petechial formations
 Test for capillary fragility per square inch, then
 Concept! patient is positive (+) to
o This is only a Tourniquet Test
presumptive test for o Therefore, patient is
DHF (not a probably suffering from
confirmatory test) Dengue Hemorrhagic
o Not all patients are Fever
subjected to this test  To confirm the diagnosis, do
the next test. . .

36

2. Blood Examination
 Platelet Count
o Normal value is
150,000 to 400,000
platelets per cubic
millimeter
o Values lower than the
normal indicate that
patient is positive (+)
for Dengue
Hemorrhagic Fever
 Hematocrit Determination
o Measures degree of
hemoconcentration
o Normal value is 37% to
54%
o Values higher than the
normal indicate that
patient is positive (+)
for Dengue
Hemorrhagic Fever
Medical Management
 Symptomatic
 No specific treatment
Important Concepts!
 If patient is febrile
o Administer antipyretic
o But never use aspirin
 Potentiates
clumping of
platelets
 Results to
bleeding
o ASA is not given to
children below twelve
(12) years old and
when cause of disease
is unknown.
 Side effect is
Reye’s
Syndrome
 A neurologic
disorder
37
associated
with viral
infection
 If there is bleeding
o Give coagulants
 Vitamin K
 Aquamephyton
 Konakion
 Vitamin C
To increase capillary
resistance
 Provide blood transfusion
Nursing Management
 Prioritize bleeding prevention
and control
 For gum bleeding
o Use cotton swab
o This is softer than any
toothbrush
 Provide ice chips
 Advise patient to gargle
o It will not cause injury
o Use mouthwash
 Use soft-bristled toothbrush
o Consider this as the
last measure to be
taken compared with
the three others above
 Keep patient on NPO if
patient vomits blood
 Apply ice pack over epigastric
region of patient
 Doctor may order NGT
insertion
 For gastric lavage, use ice
cold NSS or coagulant
 Provide adequate nutrition
 Avoid dark colored foods
Important Concept!
 Attack of Dengue
Hemorrhagic Fever does not
give permanent immunity
 o It breeds in CLEAR,
Prevention: SLOW FLOWING
 Practice CLEAN PROGRAM WATER
of the DOH o It is common in
 Rural Areas
 Mountainous
MALARIA Areas
 Also called Ague  Forested Areas
 King of tropical diseases  Palawan
 Manifested by indefinite  Dumaguete
periods of chills and fever  Surigao
o It lands on the surface
on a forty-five (45)
Important Concepts! degree angle or in a
 Microorganism is a slanting position
PROTOZOA
 Plasmodium has four species
o Plasmodium malariae
o Plasmodium ovale
o Plasmodium vivax
 One of the most Pathophysiology of Malaria
common in the
Philippines P LAS M O D I U M
o Plasmodium falciparum ▼▼▼
 Another of the BLOODSTREAM
most common in ▼▼▼▼ ▼▼▼▼
the Philippines Inside RBC (for Those that don’t
o The most fatal due to reproduction) penetrate RBC
its tendency to multiply go to the LIVER.
rapidly They do nothing
 Plasmodium is acquired and may remain
through a mosquito bite – dormant for
Anopheles mosquito 3 – 5 years.
 Blood is needed by the female They wait for the
Anopheles mosquito for the liver to release
fertilization of its eggs the RBC for
them to
penetrate other
Important Concepts! RBC
 Anopheles mosquito is ▼▼▼
o A NIGHT biting Inside RBC
mosquito
 It bites from Important Concepts!!!
sunset to  Once inside the Red Blood
sunrise or from Cells (RBC), the
dusk to dawn

38
 microorganism multiplies and o Headache
destroys the RBC. o Abdominal Pain
 This leads to ANEMIA! o Vomiting
 Rupturing of membranes of  Nursing Responsibilities
Plasmodium coincides with o Lower the body
the presence of CHILLS in the temperature
patient o Provide tepid sponge
 Presence of more or new bath
microorganisms in the o Provide cold compress
bloodstream causes FEVER!
o Increase fluid intake
o Provide light, loose
Important Concepts!
 If you have malaria and your clothing
last attack is more than five o Provide antipyretic as
(5) years ago, then you can ordered
be a blood donor
 If your last attack is less than Stage 3 – Wet Stage
five (5) years ago, you  Patient exhibits:
CANNOT BE A BLOOD o Profuse sweating
DONOR o Feeling of weakness
 Malaria can also be obtained
by BLOOD TRANSFUSION  Nursing Responsibilities
o Make patient
Manifestations of Malaria comfortable
o Keep patient dry and
Stage 1 – Cold Stage warm
 Lasts for ten (10) to fifteen o Provide fluids to
(15) minutes prevent dehydration
 Chilling sensation is present o Make patient rest
 Shaking, chattering of the lips comfortably in bed
is present
 Nursing Responsibilities Important Concepts!!!
o Provide warmth  In other types of sicknesses
o Blankets or disorders, chills occur
o Warm drinks before fever
o Not warm compress  This is due to body’s response
o Hot water bag on soles to heat loss
of the feet  In ordinary infections, higher
o Expose to heat lamp or temperatures are seen during
droplight CHILLS because patient is
trying to retain heat
Stage 2 – Hot Stage  In malaria, increased
 Last for four (4) to six (6) temperature occurs on
hours FEVER or HOT STAGE
 The patient has:  There is no fever during the
o Fever cold stage

39
  Chills occur due to the release  During the Hot Stage, the
of Plasmodium microorganism is in the
bloodstream
Key Concept!  During the Cold Stage, the
 If causative agent is P. microorganism is inside the
falciparum, its rapid red blood cells
multiplication and RBC
destruction would lead to… Quantitative Buffy Coat (QBC)
o Anemia  This is seldom done
o Liver then  This test is expensive
compensates and  Specimen used is blood
results to  A rapid test for malaria
HEPATOMEGALY  You do not have to wait for
o Splenomegaly fever to set in to undergo this
o Mild jaundice test
sometimes occurs  You can extract blood earlier
o Cerebral Hypoxia
 Restlessness Medical Management of Malaria
 Confusion  Anti-malarial Agents
 Delirium  Drug of Choice
 Convulsions o Chloroquine
 Loss of  Other Drugs used:
consciousness o Primaquine
 Coma o Atabrine
o Black Water Fever o Pancidar
 Passing out o Quinine
black urine or  A reserve drug
dark red urine for severe type
due to rapid of malaria
RBC destruction
 This may lead to Important Concepts!
death  Anti-malarial agents are
cautiously used in pregnant
Diagnostic Tests for Malaria women
 They are considered as
Blood Smear or Malarial Smear ABOTIFACIENT AGENTS
 Best time to collect o They can cause
o At the HOT STAGE ABORTION
o At the peak of fever  However, this is NOT
(this is when the CONTRAINDICATED
microorganism is in the because if mother (infected
blood stream) with malaria) is not treated,
the child may be born with
Concepts! NEONATAL MALARIA
 Child with Neonatal Malaria
exhibits the following:

40
 o Decreased levels of  Three (3) C’s
RBC o Coryza
o Immature liver o Cough
o Severe anemia o Conjunctivitis
 Child may die  Kuplick Spots
o Fine red spots with
Key Concepts! bluish white spot at the
 Malaria may be acquired center
through: o Found at the inner
o Blood Transfusion cheeks
o Vertical Transfusion o This is the
 RBC passes PATHOGNOMONIC
through the SIGN of Measles
placenta (not the
microorganism) Eruptive Stage
 Rashes are now present
Important Concept!  Maculopapular Rashes
 An attack of Malaria does not o Flat to elevated
provide permanent immunity o Reddish in color
 A repeat bite from a malaria o With blotchy
mosquito is not needed appearance
because the microorganism o In the vernacular,
may be dormant in the liver pantal-pantal
Prevention o Face of the patient
 Practice the CLEAN
looks bloated
PROGRAM of the DOH
o Cephalocaudal
distribution
COMMUNICABLE DISEASES OF
 Appears first on
THE INTEGUMENTARY SYSTEM
the hairline
 Head to toe
Viral Communicable Diseases
distribution
 Measles
o Appears on the 3RD
 German Measles
 Chicken Pox DAY of illness
 Herpes Zoster o Within two (2) to three
(3) days, the entire
MEASLES body will be covered
with rashes
Causative Agent
 Morbilli 3. Post-eruptive Stage
o Paramyxovirus  Time when rashes start to
 Rubeola Virus disappear
 Fine, branny desquamation
Manifestations of Measles appears
 Then the desquamation peels
1. Pre-eruptive Stage off

41
  Peeling off proceeds in a  Keep patient’s back dry and
cephalocaudal manner warm
 It is only the rashes that will o Rationale
be peeling off, NOT THE  Exposure to
SKIN of the patient draft gives rise
 Concept! to cough and
o Use of Colantro cold
o Has a burning effect  It gives rise to a
o Causes skin to likewise good medium
peel off for growth of
o Use of colantro is now microorganisms
discouraged  Leads to
pulmonary
Diagnostic Tests for Measles complications
like pneumonia,
Concept! which could lead
 There is no specific diagnostic to death
test for measles  Provide hygienic measures
o Eye care
1.Clinical Observation  Measles
patients have
Medical Management for Measles much “MUTA”
 Symptomatic Management  To prevent eye
 Recovery dependent on complications
Nursing Care o Ear care
 To prevent otitis
Nursing Care media
 Maintain and increase body o Mouth care
resistance of the patient o Nasal care
 Provide the following: o Skin care
 Adequate rest  Taking a bath or
 Adequate nutrition taking a sponge
o No diet restrictions bath is not
o Provided that patient is contraindicated
not a hypersentitive  However, do not
individual (i.e. prone to expose the
allergies) patient to draft
o Seafood or poultry
products are Other Nursing Care
contraindicated if the  Symptomatic nursing care
patient is allergic to  Patient is photophobic
these foods o Provide dim and quiet
o Increase oral fluid environment
intake
o Especially those rich in Important Concept!
Vitamin C

42
  Attack of measles gives o Age of fifteen (15)
permanent immunity to the months
disease  Dosage:
o 0.5 cc
Key Concept!  Route:
 When is the patient o Subcutaneous
communicable?  Site:
 Patient is communicable o Deltoid muscle
before rashes appear or  Ask mother if the child has
during the pre-eruptive stage. allergies to egg and neomycin
o MMR is made up of
Preventive Measures duck embryo and
1. Immunization neomycin
 Anti-measles vaccine (AMV) o If patient is allergic to
 When given:
egg
o Age of nine (9) months
 Give vaccine
 Dosage:  But observe for
o 0.5 cc signs and
 Route: symptoms of
o Subcutaneous allergies
 Site: o If patient is allergic to
o Deltoid muscle neomycin
 Important Instructions to be  Do NOT give
given to the mother of the MMR vaccine
patient!  It may cause
o Child may experience anaphylaxis
fever
o Give paracetamol to Important Concept!
lower the body  DOH Program on Measles
temperature o Ligtas Tigdas
o After three (3) to four Immunization Program
(4) days, child will have in 2004
a rash formation. This
is a NORMAL Mode of Transmission
REACTION to the  Airborne
vaccine
o In fact, it is a good Prevention
reaction, indicating that  Proper disposal of
the patient’s body has nasopharyngeal secretions
produced anti-bodies to  Cover the mouth when
measles coughing or sneezing
Key Concepts!!!
Important Concepts!  Measles is not fatal by itself
 In the private setting, MMR  Common complications
vaccine is given… o Bronchopneumonia
 When: o Encephalitis

43
 o Rashes are smaller
GERMAN MEASLES compared with those of
 Also called: measles
o Rubella o Also has
o Three (3) day disease cephalocaudal
o Poteln distribution
o Appears first at the
Causative Agent head
 Pseudoparamyxovirus  Important Concept!
o Rubella Virus o Once the rashes
 Togavirus appear, within twenty-
four (24) hours, the
Mode of Transmission entire body is filled with
 Droplet (not airborne) rashes
o However, head-to-toe
Manifestations of German Measles distribution is not as
distinct as in measles
1. Pre-eruptive Stage  Key Concepts!
 Fever may be present or o Patient is positive for
absent enlargement of lymph
 If patient has fever, it lasts nodes
only for one (1) to two (2)  Suboccipital
days lymph nodes
 Patient has mild cough and  Posterior
mild cold auricular lymph
 NO CONJUNCTIVITIS nodes
o Therefore, he only has  Posterior
two (2) C’s. cervical lymph
 Important Concept! nodes
o Enanthem of German o This is a differentiating
Measles are called factor between German
FORSCHEIMER Measles (positive for
SPOTS enlargement of lymph
 Fine red spots nodes) and Measles
 Also called (negative for
petechial spots enlargement of lymph
 Appears on the nodes).
soft palate
3rd Stage – Post-Eruptive Stage
nd
2 Stage – Eruptive Stage  Rashes now start to
 With maculopapular rashes disappear
o Not reddish but pinkish  But they disappear at the third
o Not blotchy but discreet (3rd) day of illness
o Appearance is fine  Important Concept!
o Slightly unnoticeable o In measles, rashes just
start to manifest

44
 themselves by the third  After three (3) days, the virus
(3rd) day of the illness has already passes through
o Enlarged lymph nodes the placenta
will gradually subside o Therefore, once
pregnant, women
Diagnostic Tests, Medical should be already
Management, Nursing given gamma globulin
Management and Preventive  German Measles is more fatal
Measures for German Measles are to pregnant women relative to
THE SAME AS THAT FOR Measles
MEASLES  All people have been exposed
to measles, therefore, anti-
Important Concepts! bodies to measles have
 An attack of German Measles already been developed.
gives permanent immunity  Not all have been exposed to
 When is German Measles German Measles, therefore,
communicable? not all have developed anti-
o During the entire bodies to German Measles
course of the disease.  MMR vaccine
o Until enlarged lymph o Measles, Mumps,
nodes return to normal Rubella vaccine
 German Measles is NOT o If you are an
FATAL adolescent, you can
 It can become fatal if patient receive this but do not
is on her first trimester of be pregnant within the
pregnancy due to chances of next three (3) months
giving birth to a child with because you may give
congenital anomalies: birth to a child with
o Microcephaly congenital anomalies
o Congenital Defect
(Tetralogy of Fallot, CHICKEN POX
etc.)  Also called Varicella
o Cataract leading to
blindness Causative Agent
o Deafness and mutism  Varicella Zoster Virus
 Mere exposure of pregnant o Can be found both on:
woman to German Measles  Nasopharyngeal
MUST BE AVOIDED Secretions
o If exposed during the  Secretions of
first trimester of rashes
pregnancy, pregnant o But only causes
mother must infection if. . .
immediately receive  It enters the
immunoglobulin or nasopharynx
gamma globulin within
seventy-two (72) hours.

45
 o Does NOT cause
infection by skin to skin Additional Concepts!!!
contact  These rashes are itchy
 Therefore, it is a MUST that
Mode of Transmission the patient takes a bath DAILY
 Airborne  If the patient does not take a
bath. . .
Three (3) Stages of Manifestation o Patient will perspire
o Patient will accumulate
Stage 1 – Pre-Eruptive Stage dirt
 Presence or absence of low- o Dirt + Wetness + Itchy
grade fever rashes will lead to
 Headache greater itching and
 Body malaise would eventually result
 Muscle pain into SCRATCHING
 Lasts for twenty-four (24) to  Scratching may be avoided
forty-eight (48) hours while the patient is awake
 However, scratching during
Stage 2 – Eruptive Stage sleep is common among
 Presence of rashes Chicken Pox patients
o Vesiculopustular
rashes Key Concept!
 Development of  Do not scratch rashes
Vesiculopustular Rashes:  Scratching results to infection
o Initially, these rashes or pox marks!!!
are macules – FLAT
RASHES SCRATCHING WHILE ASLEEP
o They will become ▼▼▼
elevated or become RUPTURES THE VESICLES
PAPULES ▼▼▼ ▼▼▼
o Then, another set of Leads to skin Permanent
macules appear Infection Scar
o The original rashes ▼▼▼ (Pox mark)
(now papules) will Becomes a
become vesicles Boil,
o Pus then develops or a Furuncle
 Important Concept! (big Boil),
o It is only during the or a Carbuncle
eruptive fever stage (several boils
that you can see all the attached to one
following: another)
 Macules ▼▼▼
 Papules Results to cellulitis
 Vesicle or gangrene
 Vesiculopustular
Rashes Important Concepts:

46
  The distribution of the rashes
are: 3rd Stage – Post-Eruptive Stage
o Generalized  Rashes now start to crust
o Found all over the body  They start to dry
 Found first on the trunk  They start to peel off
 Found on the covered parts of  If rashes start to dry, let them
the body peel off by themselves
 Then found on the scalp  If allowed to dry and peel off,
 Abundantly found on the there will be no infection
covered parts of the body and  However, it leaves a pox mark
then on the exposed parts of
the body Diagnostic Test for Chicken Pox
 Clinical Observation
Key Concept!
 Period of Communicability Medical Management of Chicken
o Until the LAST RASH Pox
has crusted!!!  Symptomatic management as
o Easily and highly- causative agent is a virus
contagious upon the
appearance of rashes Additional Concepts!
 Zovirax or Acyclovir
Important Concepts! o Not a treatment for
 During the summer season, if chicken pox
you have not had chicken pox o Virus is not always
and if you are responsive to this drug
immunocompromised, DO o Some viruses are
NOT GO OUT resistant (drug has no
 Duration of the Disease effect) while some are
o Two (2) weeks sensitive to it and
patient will heal within
Important Characteristic of three (3) days
Chicken Pox Rashes o Dosage is four (4) to
 Rashes have UNIFOCULAR five (5) tablets per day
appearance for one week
 They have one focus  Zovirax Cream
 Rashes appear one at a time o Protects skin from
and they NEVER FUSE infection but does not
TOGETHER protect against pox
 There is always a gap marks
between one rash to another  Zovirax may be effective but it
rash does not allow the patient to
o If rashes get into produce antibodies.
contact with each  Therefore, let the normal
other, it is no longer course of Chicken Pox occur
Chicken Pox.
o It is HERPES ZOSTER Nursing Care for Chicken Pox

47
  Same as in measles the nerve and become
 But more focus should be dormant
given on SKIN CARE  Therefore, next exposure to it
o Rationale: will not give you Chicken Pox
 To prevent skin  New Varicella Zoster Virus will
infection go to the nerve and activate
 Complication is dormant virus to give you
encephalitis Herpes Zoster
 Herpes Zoster is the dormant
Important Concepts! or inactive type of Chicken
 Attack of Chicken Pox gives Pox
permanent immunity  You CANNOT have Herpes
 Period of Communicability Zoster until you have obtained
o Until last rash has Chicken Pox
crusted  Adults usually affected by
Herpes Zoster because what
Preventive Measures is affected is the ganglion of
1. Immunization posterior nerve root
 Varivax
o Varicella Vaccine HERPES ZOSTER
 Dosage  Also called
o 0.5 cc o Shingles
 Route o Zone
o Subcutaneous o Acute Posterior
 For children below thirteen Ganglionitis
(13) years old
o Single dose is given Causative Agent
o Site of administration is  Varicella Zoster Virus
the deltoid muscle
 For those thirteen (13) years Mode of Transmission
old and above  Droplet
o Two doses are given
o With one (1) month Manifestations of Herpes Zoster
 Same as those of Chicken
interval
Pox
 Rashes are also
2.Proper disposal of nasopharyngeal
vesiculopustular
secretions
 However, there are
differences in the
3.Cover nose and mouth when
characteristics of rashes
sneezing or when coughing
 Herpes Zoster rashes are:
o Not itchy
Important Concepts!
 Not all of the Chicken Pox o More of painful
virus would leave your body. because nerves are
Some are left behind, travel to affected

48
 o Even if patient has and
recovered and rashes remove
are long gone, pain the fishy
may be persistent up to odor
two (2) months. This is
NORMAL Important Concept!
o Rashes do not have  An attack of Herpes Zoster
generalized distribution does not give permanent
o Has a unilateral immunity
distribution because it  Most common complications
follows the nerve of Herpes Zoster
pathway o Skin infection
o Always vertical or o Encephalitis
longitudinal (on one
side) Preventive Measures
o Rashes do not have  Same as that of Chicken Pox
unifocular appearance
but APPEARS IN Important Concepts!!!
CLUSTERS  Children are mostly affected
in:
Diagnostic Test and Medical o German Measles
Management for Herpes Zoster o Measles
 Same as in Chicken Pox o Chicken Pox
Additional Medical Management  Adults are mostly affected in:
 Application of Potassium o Herpes Zoster
Permanganate (KMnO4)
compress over the rashes of COMMUNICABLE DISEASES OF
the patient THE RESPIRATORY SYSTEM
 Rationale:
o To obtain three-fold Bacterial
effect  Diphtheria
 Astringent effect  Pertussis
 To dry the  Tuberculosis
rashes  Pneumonia
 Bactericidal
effect Viral
 To  Colds
decrease  Influenza
chances
of skin Causative Agent
infection  Corynebacterium diphtheriae
 Oxidizing effect  (Klebs-Loeffler Bacillus)
 To  This bacteria does not only
deodorize affect the respiratory tract
the o If it affects the mucous
rashes membrane, this is

49
 called CUTANEOUS bloody, smells like a
DIPHTHERIA rat)
 Types of Cutaneous  Due to rubbing of nose, this
Diphtheria results to upper lip and nasal
o Conjunctival Diphtheria excoriation
 Conjuctiva is  Pathognomonic Sign
affected o Presence of
o Vaginal Diphtheria pseudomembrane
 Vaginal mucosa o However, not
is affected appreciable in the
o Diphtheria of the NASAL TYPE
Prepuce o This is found within the
 Affectation of the nasal septum
uncircumcised o Speculum is needed
prepuce of the o But is usually covered
male by irritating nasal
o Wound Diphtheria discharge
 Affects wounds
 Especially of 2. Pharyngeal Type or Faucial
burn patients Type
 Affects the pharynx and the
Important Concepts! tonsils
 Respiratory Diphtheria  Patient complains of:
o Is the more common o Sore Throat
type of diphtheria o Dysphagia
 Wound Diphtheria  Presence of
o Is the rare type of pseudomembrane, which is
diphtheria visible upon opening of the
mouth
Mode of Transmission  Pseudomembrane is present
 Droplet on the following:
o Soft palate,
Manifestations of Diphtheria o Uvula
 Depends upon its o Pillars of the tonsils
classification  The pseudomembrane can be
Three (3) Types of Respiratory described as:
Tract Infections o Grayish-white
membrane
1. Nasal Type o Like cigarette ash
 Nasal passages are affected
 Patient also has a BULL
 With irritating nasal discharge
NECK appearance
o Characterized by
o Enlargement of the
serosanguinous
neck
secretion with foul
mousy odor (whitish,

50
 o Specifically of the
anterior upper aspect Important Concepts!!!
of the neck  Normally, when a person
o This is due to breathes in, the chest
inflammation and expands
enlargement of cervical  But with over usage of
lymph nodes accessory muscles, chest wall
o Anterior upper aspect does not expand, rather, it
of the neck is: DRAWS IN!!!
 Reddish  In order to detect chest
 Warm to touch indrawing, look at the
 There is pain subcostal area (lower area of
 Tenderness the chest region). This
 The difference between a elevates due to severe
person with Pharyngeal Type dyspnea
of Diphtheria and a person  Do not look at the sternum or
with double chin is that double at the intercostals spaces
chin people have on their  Check for chest indrawing
necks: when:
o Normal skin color o The patient is calm
o Normal temperature o The patient is not
o No pain crying
o The patient is not
breast-feeding (chest
indrawing is NORMAL
3. Laryngeal Type under this condition)
 Affects the larynx or the voice o The patient is bottle-
box feeding (chest
 With hoarseness of voice indrawing is NORMAL
 With loss of voice under this condition)
o Aphonia but only  Chest indrawing is constant in
temporary a patient with diphtheria
 Larynx also serves as airway  Chest indrawing is always
passage present in any position in a
o Therefore, there is: patient with diphtheria
 Dyspnea
 Difficulty Important Concepts!!!
of  Pseudomembrane is also
breathing present
 Body compensates and uses o Present in the larynx
accessory muscles o Laryngoscope is
needed to see the
Important Concepts! pseudomembranes
 Overuse of accessory  Pseudomembranes may
muscles results to chest trigger cough
retractions or chest indrawing  Characteristics of cough:

51
 o Barking cough  Confirmatory Test
o Dry o To identify the
o Metallic microorganism
o Croupy o To determine if
o Husky patient is still
 Due to hoarseness of voice communicable
 Important Concept!
Key Concept! o Patient is still
 Laryngeal Type of Diphtheria communicable until
may become severe three (3)
consecutive results
LARNGEAL TYPE OF DIPHTHERIA of negative (-) nose
▼▼▼ and throat culture
Laryngeal Edema are obtained
▼▼▼
Airway Obstruction Medical Management for
▼▼▼ Diphtheria
Respiratory Obstruction Three (3) Objectives:
▼▼▼
Respiratory Distress 1. Neutralize the toxin
▼▼▼  The toxin brings about
Death systemic effects
 Therefore, give anti-diphtheria
 Therefore, management is toxin
EMERGENCY o Do skin test first
TRACHEOSTOMY o If positive for the skin
 Among the three types of test
Diphtheria, Laryngeal  Give drug
Diphtheria is the most fatal  Because there is
due to the possibility of no Diphtheria Ig
respiratory obstruction, which  But give in
may lead to death. fractional doses
 Also have ready and handy
Diagnostic Tests for Diphtheria the following:
o Epinephrine
1. Schick’s Test o Corticosteroid
 Test for immunity or
susceptibility to diphtheria 2. Kill microorganism
 Give anti-biotics
2. Moloney Test  Drug of Choice
 Test to determine o Penicillin
hypersensitivity to diphtheria  Important Concept!
toxin  Scraping the
pseudomembrane does not
Nose and Throat Swab kill the microorganism
 Most commonly done test  It only causes bleeding

52
  When the above signs and
3.Prevent Respiratory Obstruction symptoms are observed,
 Performance of emergency immediately seek consultation
tracheostomy
2. Maintenance of Patent Airway
Nursing Management for  Proper position of patient
Diphtheria o Upright
o Semi-Fowler’s
1. Place patient on complete bed  Encourage Deep Breathing
rest until two (2) weeks after Exercises and coughing
recovery exercises with pursed lip
 Rationale:  Chest Physiotherapy
o To prevent the number  Increased oral fluid intake to
one complication – liquefy the secretions
MYOCARDITIS  Frequent turning to sides to
o Myocarditis leads to prevent pooling of secretions
death  Do inhalation therapy with
o Toxin released by doctor’s order.
microorganism has o Nebulization
special affinity for heart o Steam Inhalation
muscles  Perform Postural Drainage
o Toxin released travels with doctor’s order
to the bloodstream  If patient cannot expectorate,
o Goes to the heart suction secretions as needed
o Waits for opportunities
when heart’s resistance 3. Provide adequate nutritious diet
to go down: Soft diet due to the presence of
 When the heart dysphagia
is overloaded
with work 4. Other nursing managements
 When the heart are symptomatic and supportive
is under
stressful Important Concept!!!
activities  An attack of diphtheria does
 Therefore, provide not provide permanent
COMPLETE BED REST immunity since the causative
agent is a bacteria
Signs and Symptoms of
Myocarditis Preventive Measures
 Marked facial pallor
 Very irregular pulse rate 1. Immunization
 Hypotension  DPT vaccine
 Chest pain or epigastric pain
Important Concept! 2.Proper disposal of nasopharyngeal
secretions

53
3. Cover the nose and the mouth  To loosen thick and tenacious
when sneezing or coughing secretions
 Therefore, child coughs for
4. Never kiss the patient. five (5) to ten (10) times
 Diphtheria affects all ages  When patient is unsuccessful
 Common in children in expectorating narrow
passageway requires long
PERTUSSIS inhalation
 Also called  If patient keeps on coughing
o Whoofing cough o He may choke on his
o Chin cough mucous
 Only affects children below six o This results to vomiting
(6) years old o Therefore, the patient
is positive for vomiting
Causative Agent  Due to pressure exerted on
 Cocobacillus vomiting, there could be
 Both aerobic and anaerobic o Congested face
o Bordatella pertussis (bloated face)
o Haemophilus pertussis o Congested tongue
 Purple in color
Mode of Transmission  Due to pressure
 Droplet exerted on the
Manifestations of Pertussis tongue by the
Three (3) Stages teeth when
coughing
1. Catarrhal Stage o Teary-red eyes with
 Highly contagious protrusion due to
 Colds pressure exerted when
 Nocturnal coughing coughing
o Coughing is present at o Distention of face and
night neck veins
 Fever o Involuntary micturition
 Tiredness and defecation
 Listlessness o Abdominal hernia due
to pressure exerted on
2. Paroxysmal or Spasmodic abdominal wall when
Stage coughing
 With five (5) to ten (10)  If patient is vomiting:
successive, forceful o Metabolic alkalosis
coughings, which ends on a occurs
prolonged inspiratory phase  This will trigger convulsions
or a WHOOF due to electrolyte imbalance
 To loosen mucous plug on
airway (this causes the patient Convalescent Stage
to cough)  Patient is no longer
communicable

54
  Signs and symptoms will now  Decreases oxygen demand
start to subside  Decreases oxygen
 Patient is now on the road to consumption
recovery
2. Prevent Aspiration
Diagnostic Tests for Pertussis  Proper position of patient
o Upright position in
1. Nasal Swab feeding
 During spasmodic attacks of
2. Bordet-Gengou Test cough
 Specimen is nasopharyngeal o Hold all feedings and
secretion keep patient on NPO
(nothing per orem)
3. Agar Plates  For children below six (6)
 Specimen is nasopharyngeal years old:
secretion o If bottle-fed
 Inform mother
4. Cough Plate that nipples in
 Specimen is nasopharyngeal bottle should
secretion only have a
SMALL BORE to
Medical Management lessen chances
 Anti-biotic Treatment of aspiration
o Drug of Choice o Feed child with a
 Erythromycin medicine dropper
 Pertussis Immune Globulin
 For nocturnal cough 3. To manage vomiting:
o Give mild sedation  Monitor Intake and Output
 Replace fluids and  Assess for signs of
electrolytes lost due to dehydration
vomiting  Provide proper I.V. regulation
 Important Concept!!!  Provide adequate fluids with
o No expectorant should extra aspiration precaution
be given to pertussis
patient 4.Application of Abdominal Binder
o This stimulates  To prevent abdominal hernia
coughing
o Mucolytics are Important Concept!
allowable  No permanent immunity from
an attack of Pertussis is
Nursing Management for acquired. However, second
Pertussis attacks are rare. Age
decreases risks
1. Complete Bed Rest
 To conserve the energy of the Preventive Measures
patient  Same as for Diphtheria

55
  But you can kiss the patient o Eating of the bird is not
because you (adults) are necessary to get
above six (6) years old (in infected
Diphtheria, all ages are  Mycobacterium avium
affected) Complex
o Most common
TUBERCULOSIS opportunistic infection
 Also called for AIDS patients in the
o Koch’s infection United States
o Phthisis
o Galloping Consumption Important Concept!
o Pulmonary  Patients infected with
Tuberculosis Tuberculosis bacilli are most
of the time asymptomatic
Causative Agent  Symptoms are usually seen
 Mycobacterium tuberculosis after four (4) to eight (8)
o Acid-fast bacteria weeks.
o Also known as tubercle
bacilli Manifestations of Tuberculosis
 Afternoon low-grade fever
with night sweats
Mode of Transmission  Anorexia
 Airborne (most common)  Weight loss
 Fatigability
Important Concept!  Body malaise
 Therefore, there is no need to  Chest pain / back pain
separate eating utensils!  Positive for productive cough
 Tuberculosis is not acquired  Hemoptysis
through shared utensils.  Difficulty of Breathing
 Tuberculosis is also acquired  Anemia
through ingestion of  Amenorrhea in females
contaminated milk
o Causative agent is Three (3) Classifications of
Mycobacterium bovis Patients
or Mycobacterium
bovine 1. According to Extent of Disease
o Tuberculosis of Cattle  Basis is on the CAVITATIONS
IN THE LUNGS as seen
o From improperly
through Chest X-ray
pasteurized or
o Minimal Pulmonary
improperly boiled milk
Tuberculosis
 Tuberculosis may also be
o Moderately Advanced
acquired from birds
o Mycobacterium avium Pulmonary
Tuberculosis
is the causative agent
o Obtained when taking
care of infected bird

56
 o Far Advanced Equipment (PPEs); and
Pulmonary increased body resistance
Tuberculosis through vitamins, adequate
rest and adequate hand
2.According to CLINICAL washing
MANIFESTATIONS
 Basis is the presence or TB2
absence of clinical  Positive ( + ) to TB exposure
manifestations  Positive ( + ) to TB infection
o Active Pulmonary  Positive ( + ) to TB testing
Tuberculosis  Negative ( - ) to TB symptoms
 Infected; with  Inactive PTB patients and
signs and carriers are under this
symptoms category
o Inactive Pulmonary  They are given prophylactic
Tuberculosis management so that they
 Infective; without would not exhibit signs and
signs and symptoms
symptoms; with  Start on Anti-Tuberculosis
medication drugs
o INH
o Isoniazid
3.According to American  The most
Pulmonary Society effective TB
drug
TB0  Side Effect
 Negative ( - ) to TB exposure  Peripheral
 Negative ( - ) to TB infection Neuritis
 Negative ( - ) to TB testing  Give Vitamin B6 or pyridoxine
 Newborns are under this to counteract INH side effect
classification  Increase Vitamin B6 by intake
 They are given preventive of:
management in the form of o Beans
BCG vaccine immediately  Mongo
after birth  Red beans
 White beans
TB1  Black beans
 Positive ( + ) to TB exposure o Prophylaxis is given for
 Negative ( - ) to TB infection six (6) months
 Negative ( - ) to TB testing  For children
 Medical and other healthcare o Prophylaxis is given for
workers are under this nine (9) months
classification  For Immunocompromised
 They are given preventive patients
management in the form of o Prophylaxis is given for
Personal Protective twelve (12) months

57
 o Orange tears
TB3 o Orange secretions and
 Positive ( + ) to TB exposure excretions
 Positive ( + ) to TB infection o Orange saliva
 Positive ( + ) to TB testing o Orange sputum
 Positive ( + ) to TB symptoms o Orange feces
 Active PTB patients are under  Nursing Management
this classification o Inform the patient that
 They are given curative
this normally happens
management
o Therefore, remove soft
 Combination of Anti-
contact lenses
Tuberculosis drugs to prevent
 These may be
drug resistance
permanently
 Short-Course Chemotherapy
stained with
o Composed of RIP(E)
orange color
 Rifampicin
o Advise the patient to
 Isoniazid
use eyeglasses instead
 Pyrazinamide
 Ethambutol
Isoniazid
 May or
 Side effect is peripheral
may not
neuritis
be given
 Standard Regimen
 Nursing Management
o Composed of SI(E)
o Give Vitamin B6 or
 Streptomycin
pyridoxine
 Isoniazid
 Ethambutol
Pyrazinamide
 May or PZA
may not  Side effect is hyperuricemia
be given  Patient is predisposed to
stone formation
Important Concepts!!!  Therefore, make urine
 Short-Course Chemotherapy alkaline
Side Effects  Nursing Management
 Causes hepatotoxicity o To alkalinize the urine
 Nursing Management
o Increase fluid intake
o Therefore, monitor liver
o Increase intake of
enzyme tests
vegetables
 Advise patient to avoid
alcoholic beverages, which
Ethambutol
increase hepatotoxic effects
 Side effect is Optic Neuritis
o Causes color blindness
Key Concept!
Rifampicin or inability to
 Side effects are: distinguish red from
o Orange urine green

58
  Nursing Management  If result is CONSISTENTLY
o IMMEDIATELY STOP POSITIVE, it means that the
the medication patient is sensitive to the
because this side effect organism
is IRREVERSIBLE  Important Concepts!!!
o This test uses Purified
Important Concepts!!! Protein Derivative or
Standard Regimen PPD
 Streptomycin o PPD is administered
o No hepatotoxicity intradermally
o But causes RENAL o Tubercullin testing is
TOXICITY interpreted after forty-
o Nursing Management eight (48) to seventy-
o Monitor the following: two (72) hours
 Creatinine levels o A positive result would
 Blood Urea give you an induration
Nitrogen (BUN) of greater than ten (10)
levels mm.
 Monitor Intake o If patient is positive for
and Output HIV, a positive result
o Also causes would give the patient
OTOTOXICITY an induration of greater
o Nursing Management than five (5) mm
o Assess patient for Three (3) Ways of Performing
tinnitus or ringing of the Tubercullin Testing
ears
o Assess patient for 1.1) Mantoux Test
vertigo, which is  Just like a skin test
another sign indicative  Utilizes the same technique
of ototoxicity as a skin test
 Uses PPD
Key Concept!  Interpreted after forty-eight
 The American Pulmonary (48) to seventy-two (72) hours
Society classification is the  Positive result is bigger wheal
best classification!!! induration

Diagnostic Examinations for 1.2) Tine Test or Multi-puncture

Tuberculosis
1. Tubercullin Testing
 This is only a screening test
for Tuberculosis
 If result is positive ( + ), it
does not mean that the
person is infected but the
person may have an exposure
Test
 Soak sterile needle in PPD for
three (3) to four (4) hours
 Get arm
 Puncture for six (6) to eight
(8) times in a circular manner
 This is commercially prepared

59
  This utilizes a special syringe o As the back of tongue
with four (4) small needles for curves upon spitting,
one simultaneous application phlegm goes out
 Key Concept!!!
1.3) Vollmer and Pirquet Test o Continuous receipt of
 Skin scratch or skin patch test anti-Tuberculosis drugs
 Get sterile needle for two (2) weeks will
 Get gauze containing PPD give the patient a
 Apply this gauze over the negative ( - ) result
scratch or tape this gauze o Therefore, patient is no
over the scratch longer communicable
 Keep gauze on for seventy-
two (72) to ninety-six (96) 3. Chest X-Ray
hours  Shows extent of lung
 Remove after three (3) to four involvement
(4) days  Does not reveal causative
 Results cannot be interpreted agent
yet  Not a confirmatory
 Wait for another forty-eight examination
(48) to seventy-two (72) hours
 Therefore, results could be Medical Management for
obtained after five (5) to Tuberculosis
seven (7) days!!!  Short-Course Chemotherapy
 Standard Regimen

Important Concept!
 Mantoux Test is the best type Nursing Care for Pulmonary
of test!!! Tuberculosis
o Easier to perform  Diet
o Less pain to patient  Drugs
o Most accurate results o Most important
 Rest
2. Sputum Examination
 This is the CONFIRMATORY Important Concept!
TEST for Tuberculosis  Do not perform Chest
 Done in the morning upon Physiotherapy on PTB patient
rising before oral care  This can stimulate or
 Collection of Sputum aggravate the following:
o Do deep breathing o Hemoptysis
exercises for three (3) o Frank Bleeding
times
o Open mouth widely Key Concept!
o Put tongue at the back  An attack of PTB only gives
of the lower teeth temporary immunity

Preventive Measures

60
1. Immunization (i.e. mother who is
 Bacillus Calmette Guerin asymptomatic)
(BCG) vaccine  Nursing Management
 Number of Doses: o Bring the child to the
o Two health center or clinic
 When Given: for INCISION
o 1st Dose – At Birth DRAINAGE
o 2nd Dose – Upon school o Then give prophylactic
entrance INH for nine (9) months
 Dosage of First Dose
o 0.05 cc Additional Concepts!!!
 Route of First Dose At school entrance
o Intradermal  Give booster dose of BCG
 Site of First Dose  When given:
o Right deltoid muscle o About six (6) to seven
 Important Concepts!!! (7) years old
o Do not massage site of  Dosage of Booster Dose
injection o 0.01 cc
o Rationale:  Route of Booster Dose:
 It will spill the o Intradermal
drug  Site of Booster Dose
o Child may experience o Left Deltoid muscle
fever  Important Concepts!!!
 Nursing Management o No abscess formation
o Give paracetamol on site of booster dose
o On site of injection, o Site depends on
there will be an preference of the
abscess formation, mother in a private
which will develop into setting
a scar within two (2) to
three (3) months Preventive Measures (continued)
o If after three (3) 2.Proper disposal of nasopharyngeal
months, abscess is still secretions
present, this is called 3. Cover nose and mouth when
an INDOLENT sneezing or coughing
ABSCESS caused by: 4. Proper pasteurization of milk
 Wrong technique
 Given PNEUMONIA
subcutaneously  Inflammation of the lung
instead of parenchyma
intradermally  Caused by several organisms
 Child’s
Causative Agents:
exposure to a
 Virus
person with TB
o Cytomegalovirus

61
  Common about by
opportunistic ASPIRATION
infection in AIDS PNEUMONIA
 Protozoa  Important Concept!
o Pneumocystis carinii o Lipid Pneumonia
Pneumonia  Occurs when oil
 Also a common is used in
opportunistic cleaning the
infection in AIDS nose
 Bacteria  Oil is not
o Most common cause absorbed by the
o Can be caused by lungs
primary infection  Therefore, do not use oil-
o Can be secondary to based lubricants in
previous infection: nasogastric tubes.
 A complication  4, Productive Cough
 A debilitating  5. Presence of Chest Pain or
disease Pleuritic Pain
o Aggravated when
coughing
Mode of Transmission o Use of chest binder is
 Droplet encouraged

Manifestations of Pneumonia Important Concepts!!!

Five (5) Cardinal Signs of Presence of fast breathing is
Pneumonia common in Pneumonia
 1. Fever In Children:
 2. Shaking Chills  If two (2) weeks to two (2)
 3. Sputum Production months old (1 month and 29
o Rusty sputum days)
o Depends on causative o Cut off is sixty (60)
agent breaths per minute
o If sputum is creamy o If respiratory rate is 61
yellow breaths per minute and
 Causative agent above, this is indicative
is of Pneumonia
Staphylococcus  If two (2) months to twelve
o If sputum is currant (12) months
jelly o Cut off is fifty (50)
 Causative agent breaths per minute
is Klebsiella o If respiratory rate is 51
o If sputum is clear breaths per minute and
 There is no above, this is indicative
infection of Pneumonia
 This may also  If twelve (12) months to five
be brought (5) years

62
 o Cut off is forty (40) o Decreased vocal
breaths per minute fremitus
o If respiratory rate is 41  ‘Ninety-nine’
breaths per minute and verbalized
above, this is indicative o Decreased breath
of Pneumonia sounds
 Therefore, if there is fast
breathing, automatically, it is 4. Percussion
Pneumonia  Dullness upon percussion
 Home management involves
antibiotic therapy Medical Management
 Depends on causative agent
Important Concept!  If viral
 Check for the presence of the o Symptomatic
following: management
o Chest Indrawing  If protozoal (PCP)
o Stridor o Drug of choice is
 Harsh breath Pentamidine
sound heard  If bacterial
during o Administer anti-biotics
inspiration o In the hospital setting,
 To check, place drug of choice is
ear on nose or Penicillin
mouth of patient o In the community
o Cough setting, drug of choice
 If these three signs are is Cotrimoxazole
present, then there is (administered T.I.D.)
SEVERE PNEUMONIA
Nursing Care for Pneumonia
Diagnostic Tests for Pneumonia Patients
 Priority
1. Chest X-ray o Ineffective airway
 Expect infiltrations clearance
 Lung consolidation  Management
 This is the confirmatory o Maintain patent airway
examination o Adequate rest
o Adequate nutrition
2. Sputum Examination
 Purpose is to know what
Preventive Measures
microorganism brought
1. Immunization
pneumonia
 Pneumovax
 For prevention of secondary
3. Auscultation
pneumonia
 For crackles
 Given to adults
 For ronchi

63
  Given to the elderly with
Community-Acquired
Pneumonia (CAP)
2. Proper disposal
nasopharyngeal secretions
3. Cover the nose and mouth while
coughing or sneezing
violent diarrhea (which
occurs continuously)
Mode of Transmission
of  Fecal – Oral route
Source of Infection
 Food
 Water

COMMUNICABLE DISEASES OF If food poisoning:

THE GASTROINTESTINAL TRACT  Salmonellosis
o Foods rich in protein
Bacterial  Meat products
 Gastroenteritis  Poultry
 Inflammation of the gastric  Eggs
mucosa and the mucosa of  Cheese
the intestines  Milk
o Incubation Period
Key Concepts!  Six (6) to eight
 Main Sign and Symptom of (8) hours
Gastroenteritis is diarrhea o Then you manifest the
 Diarrhea is a general term symptoms
caused by various  Staphylococcal
microorganisms o Carbohydrate-rich
foods
Causative Agents:  Cereals
 Salmonella typhosa  Rice
o For typhoid fever  Pastries
 Salmonella Newport  Bread
o For food poisoning or  Cakes
salmonellosis  Pasta
 Staphylococcus enterococcus  Noodles
o For staphylococcal o Incubation Period
food poisoning  Two (2) to six (6)
 Clostridium botulinum hours
o For botulism o Then you manifest the
 Shigella dysenterieae symptoms
o For shigellosis  Botulism
o For bloody flax o Caused by canned or
o For bacillary dysentery preserved foods
 Vibrio coma or Vibrio cholera o Incubation Period
o Coma-shaped  Eight (8) to
o Cholera or El tor twenty-four (24)
o Give rise to violent hours
dysentery due to

64
 o General manifestation  Poor skin turgor
is diarrhea  Very dry
o Borborygmi is present  Nursing Management
 Gurgling sound o Patient is placed on a
on the abdomen special bed called the
 Typhoid Fever WATEN BED – bed
o Three (3) Clinical with a hole
Features o Pail is positioned
o 1. Rose spots underneath the hole on
 This is the the bed
PATHOGNOMONIC o Bed pan is not advised
SIGN for typhoid o Continuous diarrhea
fever makes the bedpan
o 2. Ladder-like fever inadequate in
o 3. Splenomegaly containing all the fecal
 Dysentery material
o Characteristics of Stool o Vomiting also
o If Bacillary Dysentery contributes to
 Mucoid Stool dehydration
 Which could  Number 1 indicator of
become blood dehydration in a patient with
streaked if diarrhea is LOSS OF
severe WEIGHT
 Microorganism’s o This occurs within or
endotoxin before forty-eight (48)
destroys the hours
intestinal wall  Other manifestations of
dehydration, which are seen
o If Cholera after forty-eight (48) hours
 Rice-watery are:
stool, which is o Thirst
one after the o Sunken eyes
other o Sunken fontanelles
 The o Poor skin turgor
microorganisms
do not destroy Diagnostic Tests for Patients with
the intestinal Gastroenteritis
wall
 They only 1. Stool Examination
stimulate  Most common diagnostic
peristalsis examination
 Rapid dehydration occurs  For Typhoid Fever
o Manifested by washer o Stool examination is
woman’s hand not a good test
 Decreased skin o Blood examinations are
integrity done

65
 o Blood culture is also depression, which
done to identify the leads to anemia and
microorganism even leukemia
o Done during initial  In dysentery, particularly
manifestation of the bacillary dysentery, the drug
disease of choice is
 In the Philippines, the WIDAL COTRIMOXAZOLE
TEST is done for Typhoid  In cholera, the drug of choice
Fever is TETRACYCLINE
o The antigen is detected
o Antigen O Important Concepts on the
 Somatic antigen Administration of Tetracycline
 If present, the
patient is  Tetracycline should not be
positive for given with the following:
infection o Milk or calcium-rich
o Antigen H foods
 Flagellar antigen o Antacids
 If present, o Iron-preparation
patient has been medication
previously  For better Tetracycline
exposed to absorption
typhoid fever or o Give Tetracycline with
immunization one full glass of water
 In TYPHIDOT, a blood  This drug should not be given
examination is conducted and to children below eight (8)
an antibody is detected years of age because it
causes staining of teeth
2. Rectal Swab  This drug is not given to
 If patient is positive for pregnant women
gastroenteritis o It is TERATOGENIC to
bone growth of the
Medical Management for fetus because it binds
Gastroenteritis to calcium
 Once Tetracycline is expired,
1. Fluid and electrolyte replacement discard it because it will
 Oresol increase the toxic effect of the
 I.V. fluid drug
 Gatorade  It must be kept away from
sunlight
2. Antibiotics  It must be placed in an amber
 In typhoid fever, the drug of bottle
choice is  Sunlight destroys component
CHLORAMPHENICOL of tetracycline
o This drug gives rise to
bone marrow Important Concept!

66
  Gastroenteritis attack does o Swine Herd’s Disease
not give permanent immunity o Ictero-hemorrhagic
disease
Preventive Management  A disease of a low form of
1. Immunization animal found in the farm
 CDT immunization
 Given only free during RATS
epidemic ▼▼▼
 Provides six (6) months Source of Infection
immunity Excreta of Rats
Urine of Rats
2. Avoid the five (5) Fs ▼▼▼
 Usual source of infection are Causative Agent (Spirochetes)
the Five (5) Fs: Leptospira canicola
 Feces Leptospira interrogans
o Proper excreta (most common in the Philippines –
disposal infects rats)
 Food Leptospira hemorragica
o Proper food
preparation Mode of Transmission
o Proper food handling  Skin penetration
o Proper food storage Important Concept!
o Avoid eating in  No need to have a break in
unsanitary places the skin or to have a wound to
 Fingers have leptospirosis
o Hand washing
 Flies Individuals who are High-Risk for
o Eradicate Leptospirosis:
o Environmental  Sewage Workers
o Those working in
Sanitation
o Insecticide drainage systems
 Farmers
o Screening
 Miners
 Fomites
 Slaughterhouse workers
o Do not put anything
(pigs, cattle are sources of
into your mouth infection)
o Most common is the  Manilenos
ball pen o Due to flooding
 Incidence of leptospirosis
LEPTOSPIROSIS increases during the rainy
 Also called season
o Mud Fever
o Swamp Fever Key Concepts!
o Canicola Fever  When the microorganism
o Pre-tibia enters, it travels along the
o Weil’s Disease bloodstream

67
  It affects other organs
o Striated Muscles Diagnostic Tests for Leptospirosis
o Liver  Blood Examinations
o Kidneys o Leptospira
 Spirochetes Agglutination Test
have a special (LAT)
affinity here o Leptospira Antigen-
 They destroy the Antibody Test (LAAT)
nephrons o Microscopic
o Most common Agglutination Test
complication of (MAT)
Leptospirosis, which  Reveals the
brings about death is microorganism
Kidney Failure
Medical Management of
Manifestations of Leptospirosis Leptospirosis
 Fever with chills
 Presence of intense itchiness Anti-biotics
of the conjunctiva  Drug of Choice is
 Abdominal Pain TETRACYCLINE
 Nausea and Vomiting  If patient does not tolerate
 Muscle tenderness and pain Tetracycline, give Penicillin
on the calf muscle instead
(gastrocnemius)
o Therefore, the patient Important Concepts on Penicillin
does not like to walk or If given per orem:
stand  Give one (1) hour before
 For ictero-hemorrhagic type of meals or two (2) hours after
leptospirosis: meals
o Jaundice o It binds with food and
o Hemorrhages on skin becomes digested
and mucous o When this happens, it
membrane will be metabolized and
would have no effect
Important Concept! o Therefore, it is best to
 Pathognomonic sign of give Penicillin on an
leptospirosis are the orange empty stomach
eyes or orange sclera of the  Do not give with fruit juices or
eyes citrus juices
o These juices destroy
Important Concept! the component of
 If the kidney is affected, there Penicillin
would be signs and symptoms o Therefore, give with a
of kidney failure: full glass of water!!!
o Decreased urine output
o Leading to anuria

68
Nursing Management for
Leptospirosis Nursing Care for Mumps Patients
 Symptomatic and supportive
 Monitor urine output due to 1. Provide Complete Bed Rest
possible kidney failure (CBR) until swelling subsides
 Immediately refer to doctor for  Rationale:
any signs and symptoms of o To prevent glandular
kidney failure complications:
o In Females:
Preventive Measures  Oophoresis or
 Eradicate rats by inflammation of
environmental sanitation the ovaries
o Use of rat poison o In Males:
 Avoid walking through flooded  Orchitis or
areas inflammation of
o Wash with soap and the testes
running water after
walking in floods 2. For males, wear well-fitted
supporters to prevent pulling of
MUMPS gravity on the testes and blood
 Infectious parotitis vessels.
 Rationale:
Causative Agent o This predisposes the
 Paramyxovirus patient to orchitis and
o Found on the saliva of atrophy leading to
the infected individual sterility

Mode of Transmission Important Concepts!

 Droplet  Glandular complications are
manifested only by:
Manifestations of Mumps o Adolescents
 High-grade fever o Adults
 Earache  In people twelve (12) years
o Ear pain old and above, there is
 Pain upon mastication or complete descent of the
chewing testes into the scrotal sac
 Swelling of the parotid glands  Therefore, there is greater pull
of gravity on the patient
Diagnostic Tests for Mumps  Glandular complications are
 Clinical Observation absent among Children
 If orchitis is positive, its
Medical Management for Mumps location depends on the
 Symptomatic as the causative location of the mumps
organism is viral o If mumps is on the right
 Recovery depends on nursing side, orchitis is also on
care provided the right side

69
 o If mumps is on the left  Mumps attack gives
side, orchitis is also on permanent immunity
the left side  When is the person with
o If mumps is bilateral, Mumps communicable?
orchitis is also bilateral o He is communicable
until swelling subsides
3. Provide adequate nutrition o Highly-contagious two
 Provide the following types of (2) days after onset of
diet: swelling
o Soft diet
 Because there is Preventive Measures
pain upon  Immunization
chewing o MMR vaccine
o Bland diet  Proper disposal of salivary
 Sour and spicy secretions
foods are  Cover nose and mouth while
irritating coughing and sneezing
 They increase
salivation and
increase pain COMMUNICABLE DISEASES OF
 Thus, kalamansi THE GASTROINTESTINAL TRACT
is AND ITS ACCESSORY ORGANS
contraindicated
for mumps HEPATITIS
patients  Inflammation of the liver
o Apple juice and water  Brought about by several
are allowed in mumps causes:
patients o Alcoholism
o Drug intoxication
4. Apply ice cap or ice cooler to  Hepatotoxic
relieve pain Drugs
 Cold application deadens the  Anti-
nerve endings temporarily Tuberculosis
 This results to numbness drugs
 Tylenol
Important Concept!  Acetaminophen
 Aniel (composed of vinegar o Chemical Intoxication
and dye) has a cold effect that  Arsenic
decreases pain o Microorganisms
 This is colored blue so that  Viral
the person with mumps could  Communicable
be easily identified while he is microorganisms
still far away
Important Concept!
Key Concept! Current Number of Viruses
causing Hepatitis

70
  Capable of Infecting Humans  Those who practice anal –
o Hepatitis A virus oral sex
o Hepatitis B virus
o Hepatitis C virus Incubation Period:
o Hepatitis D virus  Two (2) to six (6) weeks
o Hepatitis E virus
o Hepatitis G virus HEPATITIS B
 Also called:
 Non-pathogenic in Man
o Serum Hepatitis
o Hepatitis H
o Homologous Hepatitis
HEPATITIS A o Viral Hepatitis
 Also called:  The most fatal form of
o Infectious Hepatitis hepatitis
o Catarrhal Jaundice  The most fulminant form of
hepatitis
Hepatitis
o Epidemic hepatitis
Causative Agent
 Incidence is in
 Hepatitis B virus
epidemic
o DNA-containing virus
proportions
Causative Agent
Important Concept!
 Hepatitis A virus
 In Hepatitis B infected
o RNA-containing virus
individuals
Important Concepts!
o The Blood
 In Hepatitis A infected
 Harbors the
individuals:
microorganism
o The feces
o Other body fluids
 Harbors the
 Tears
microorganism
 Saliva
in abundant
 Sweat
amounts
 Cerebrospinal
o The blood
Fluid
 Harbors the
 Milk
microorganism
 Urine
in minimal
 Semen
amounts
o In fact, all fluids
 Harbor the
Mode of Transmission
microorganism
 Fecal – Oral Transmission
 Rarely percutaneous or by
Mode of Transmission
blood transmission
 Percutaneous
o Use of contaminated
Individuals AT RISK for Hepatitis
A: sharps and needles
 Those living in unsanitary o Blood Transfusion
conditions  Oral to oral Transmission
o In saliva

71
  Sexual Transmission  Hemodialyzing patients
o Seminal fluid  Healthcare workers
o Cervical fluid  Drug addicts
 Vertical Transmission  Blood Recipients
 Swallowing of amniotic fluid
by the baby Incubation Period
 Five (5) to twelve (12) weeks
Individuals AT RISK for Hepatitis
B: HEPATITIS D
 Healthcare workers  Also called
o All who are in contact  Dormant Type of Hepatitis B
with body fluids of
patients Important Concepts!
 Blood recipients  A person must have Hepatitis
 Hemodialyzing patients B before he could be infected
 Drug addicts with Hepatitis D
 Promiscuous individuals with  Hepatitis D cannot multiply by
multiple sex partners itself
 It cannot bring about infection
Incubation Period  If Hepatitis B is present in the
 Six (6) weeks to six (6) body, Delta virus activates
months Hepatitis B virus to help the
Delta virus multiply
HEPATITIS C
 Also called: Causative Agent
o Post-transfusion  Hepatitis D virus
Hepatitis  Delta virus
 Rationale:
o Because people who Important Concept!
develop this are those  In Hepatitis D infected
who have undergone individuals
blood transfusion o Blood
Causative Agent  Harbors the
 Hepatitis C virus microorganism
o Other body fluids
Important Concept!  Tears
 In Hepatitis C infected  Saliva
individuals  Sweat
 Blood  Cerebrospinal
 Harbors the microorganism Fluid
 Milk
Mode of Transmission  Urine
 Percutaneous  Semen
o In fact, all fluids
Individuals AT RISK for Hepatitis  Harbor the
C: microorganism

72
Mode of Transmission
 Percutaneous
o Use of contaminated
sharps and needles
o Blood Transfusion
 Oral to oral Transmission
o In saliva
 Sexual Transmission
o Seminal fluid
o Cervical fluid
 Vertical Transmission
 Swallowing of amniotic fluid
by the baby
Individuals AT RISK for Hepatitis
D:
 Healthcare workers
o All who are in contact
with body fluids of
patients
 Blood recipients
 Hemodialyzing patients
 Drug addicts
 Promiscuous individuals with
multiple sex partners
Incubation Period
 Three (3) weeks to twelve
(12) weeks
HEPATITIS E
 Also called
o Enteric Hepatitis
Causative Agent
 Hepatitis E virus
Important Concept!
 In individuals with Hepatitis E
o The Feces
 Harbors
microorganism
Mode of Transmission
 Fecal – Oral route
Individuals AT RISK for Hepatitis
E:
 Those living in unsanitary
conditions
 Those who practice anal –
oral sex
Incubation Period:
 Two (2) to six (6) weeks
HEPATITIS G
 No synonyms
Causative Agent
 Hepatitis G virus
Important Concept!
 In individuals with Hepatitis G
o The Blood
 Harbors the
microorganism
Mode of Transmission
 Percutaneous
Individuals AT RISK for Hepatitis
G:
 Hemodialyzing patients
 Healthcare workers
 Drug addicts
 Blood Recipients
Incubation Period
 Unknown
IMPORTANT CONCEPTS!!!
Similar Types or Partner Types
 Hepatitis A and Hepatitis E
 Hepatitis B and Hepatitis D
 Hepatitis C and Hepatitis G
the
Manifestations of Hepatitis
Three (3) Stages
1st Stage – Pre-Icteric Stage
73
This occurs before jaundice arises one hundred twenty
The patient experiences: (120) days
 1. Fever  End-product of RBC
o Due to infection breakdown is bilirubin
 2. Right Upper Quadrant pain o Accumulation of
o Due to inflammation bilirubin into the system
and infiltration of the leads to the 2nd Stage –
liver Icteric Stage
 3. Fatigability
 4. Weight Loss 2nd Stage – Icteric Stage
 5. Body Malaise Patient exhibits:
o The three (3)  Jaundice
manifestations above o Due to inability of the
are due to the inability liver to eliminate
of the liver to convert normal amounts of
glucose to glycogen bilirubin
o Body compensates by o Body compensates by
breaking down protein eliminating bilirubin
o End-product of protein through sweat
breakdown would be  Pruritus
amino acids o Due to accumulation of
o Amino acids are bile salts in the skin
normally deaminated  Tea-colored Urine or Brown-
by the liver so that they colored Urine
could be eliminated o Due to excess bilirubin
 6. Anorexia thrown out by the
 7. Nausea kidney in the urine
 8. Vomiting  Acholic Stool or Clay-colored
o Above three (3) Stool
manifestations are due o Due to absence of
to inability of the liver to bilirubin (conjugated
deaminase proteins bilirubin) that normally
 Anemia goes to the duodenum
 Paleness to color the stool
 Pallor  Hepatomegaly
o The above three (3) o Enlargement of the
manifestations are due liver
to decreased life span o Due to an overworked
of Red Blood Cells liver
(RBC)  Important Concept!
o Normal live span of o Viral infections are self-
RBCs is one hundred limiting
twenty (120) days  If no complication arises, this
o In hepatitis patients, would lead to the 3rd Stage –
RBCs live for less than Post-Icteric Stage

74
3rd Stage – Post-Icteric Stage  Formerly SGOT
 Jaundice disappears  Serum Glutamic-Oxaloacetic
 Signs and symptoms subside Transaminase
 Energy level increases  Increases only upon the onset
 Patient is on the road to of jaundice
recovery
 Important Concept! 1.3) ALP
o It takes three (3) to four  Alkaline Phosphatase
(4) months for the liver  Increase indicates:
to regenerate or o Obstructive Jaundice
recover o Obstructive Hepatitis
o Physician usually o Obstruction in the
advices rest for Biliary Tract
complete liver recovery
or regeneration 1.4) GGT
 Most important Health  Gamma Glutamyl Transferase
Teaching:  When increased
o Avoid alcohol for a o Patient is experiencing
period of one (1) year TOXIC HEPATITIS
o Avoid over the counter  Due to toxic
drugs (OTCs) that are substances
hepatotoxic for one (1)  Alcohol
year  Hepatotoxic
o Consult physician prior agents
to use of over the
counter drugs. 1.5) LDH
 Lactate Dehydrogenase
Diagnostic Tests for Hepatitis  When identified, it indicates
liver organ damage
1. Liver Enzyme Tests
 Tests for extent of liver 2. Serum Antigen-Antibody Test
damage for Hepatitis

1.1) ALT 2.1) For Hepatitis A

 Alanine Aminotransferase  HAsAg
 Formerly SGPT  Hepatitis A Surface Antigen
 Serum Glutamic-Pyruvic  Anti-HAV
Transaminase  Presence of IgG
 If increased, there is a liver  Presence of IgM
problem
 First enzyme to increase in 2.2) For Hepatitis B
the presence of a liver  HBsAg
problem  Hepatitis B Surface Antigen
 Anti-HBs
1.2) AST
 Aspartate Transaminase 2.3) For Hepatitis E

75
  HBeAg  Inhibits
 Protein-independent Antigen multiplication of
 Anti-HBe the virus
o Cost:
2.4) For Hepatitis C  Approximately
 HCsAg Php200 / tablet
 Hepatitis C Surface Antigen  2) BRM
 Anti-HCs o Biologic Response
Modifiers
Medical Management of Hepatitis o An immunomodulating
 No specific treatment drug
 Treatment is symptomatic as o Interferons
causative agent is a virus  Injectable form
of BRM
Most Common Drugs used in  Normal
Hepatitis: substance
 Essentiale produced by the
 Jetipar body when virus
 Silymarine enters the
o The above three (3) human cell
drugs are: o Dosage:
 Hepatic  Two (2) to three
protectors (3) times a week
 Composed of for six (6)
multivitamins, months
phospholipids o Action:
and nutrients  Kills the virus
needed by the o Cost:
body so that the
 Approximately
liver would not
Php85,000!!!
be overworked
and be relaxed,
and thus,
Nursing Care for Hepatitis
recover
Two (2) Important Aspects
Latest Trend in Pharmacological
1. Provide Complete Bed Rest
Management of Hepatitis
(CBR)
Utilizes a combination of:
 To promote liver regeneration
 1) Lamivudine
and recovery
o Anti-viral drug
 When rested, there is
o Dosage: decreased metabolism
 Once daily for  Less metabolism leads to
one year decreased liver load
o Action:  Liver relaxes and liver
recovers

76
2. Diet years, the patient would
 Low fat diet develop cancer of the liver or
o Because there is not cirrhosis of the liver
enough bile released or
produced by the liver Preventive Measures for Hepatitis
 Increased Carbohydrate
Intake 1. Immunization
o To spare protein  Hepatitis B vaccine
metabolism  Number of Doses:
o To decrease amino o Three (3)
acids  Interval between doses:
o Accumulation of protein o Four (4) weeks
breakdown products  When given:
like ammonia would o 1st Dose – Six (6)
lead to hepatic weeks from birth
encephalopathy o 2nd Dose – Ten (10)
weeks from birth
 Butterball Diet o 3rd Dose – Fourteen
o Produces energy (14) weeks from birth
o These are hard  Dosage:
candies o 0.5 cc
o Chocolates are  Route:
contraindicated o Intramuscular
 They contain fat  Site:
 Protein Intake o Vastus lateralis
o Depends on the  Important Concepts!!!
situation o Inform the mother that
o If the patient is infected there would be pain
 Provide and soreness on the
moderate injection site
protein intake o A slight elevation on
o If the patient is in the liver enzyme tests is a
recovery stage NORMAL REACTION
 Provide to the vaccine
increased
protein intake 2. Avoid the different modes of
o If complications arise transmission
 Provide  For Hepatitis B, C, and D
decreased o Blood-borne diseases
protein intake  There is a Needle-exchange
Program in the United States
Key Concept! and in Australia
 The most fatal form of o Every 6:00 PM a
hepatitis is HEPATITIS B! healthcare worker is
 Even if patient recovers, after given a knapsack with
twenty (20) or thirty (30) needles and sharps

77
 o He then proceed to o Signs and symptoms
areas of distribution – develop at a later stage
alleys
o Exchanges new Manifestations of Gonorrhea
syringes with old
syringes used by drug In males:
addicts.  Burning pain, burning
sensation upon urination
COMMUNICABLE DISEASES OF o Due to redness and
THE GENITOURINARY SYSTEM – edema of urinary
SEXUALLY TRANSMITTED meatus brought about
DISEASES by acidic urine
 Prostatitis
Bacterial o Abscess formation on
 Gonorrhea the prostate gland
 Syphilis  Purulent Discharges
o Mostly abundant in the
Viral morning
 HIV Infection  If gonorrhea is persistent, a
 AIDS scar develops on the
EPIDIDYMIS
GONORRHEA o Scar obstructs the flow
 Also called of the sperm cells
 Clap  Sterility
 Microorganism resembles o Due to obstruction of
hands clapping together sperm cell flow
 Strain
 Gleet
 Jack
 GC In females:
 Morning Drop  Burning sensation upon
urination if urinary meatus is
Causative Agent involved
 Neisseria gonorrhea o Urinary meatus is
seldom involved in
Mode of Transmission gonorrhea.
 Sexual contact o Cervix is usually the
 Important Concepts!
one that is affected
o Most of the time,
 Presence or absence of
MALES are infected purulent discharges
 Urethra are  Important Concept!
affected leading o If there is no burning
to urethritis
pain and no purulent
 Females can also be infected
discharge, the patient
o Cervix is affected
may not know that she
is infected

78
 o Presence of abscess  Presence of
formation on the Gonococcal
Bartholin’s Gland or the Rashes
Skeene’s Gland  Papular
o When this abscess  Elevated
goes up, it gives rise to Rashes
ENDOCERVICITIS or  Pustular
ENDOMETRITIS  With pus
 Hypogastric Pain  May be necrotic
o Due to presence of gonococcal
endocervicitis or rashes
endometritis  Polyarthritis develops
 Important Concept!  Tenosynovitis
o Either of Endocervicitis o Tendons and synovium
or Endometritis could are affected
give rise to Pelvic  Important Concept!
Inflammatory Disease o Effect of disease to
o Pelvic Inflammatory child of mother with
Disease gonorrhea:
 A systemic  Opthalmic
disease neonatorum
characterized o Management:
by:  Give CREEDE’S
 Fever PROPHYLAXIS
 Severe to prevent
abdominal blindness in the
pain newborn
 Nausea Diagnostic Tests for Gonorrhea
and
Vomiting 1. Culture and Sensitivity
 This is  Collect urethral discharges
secondary  Done by scraping mucosa of
to the urethra
gonococcal 2. Papanicolau’s Smear or Vaginal
infections Smear
 Sterility and Ectopic  For females
Pregnancy
o If gonorrhea persists, it Medical Management of
causes a narrowing of Gonorrhea
the Fallopian Tube
 Gonococcal Septicemia 1. Anti-biotics
o Occurs when  Drug of Choice
o Penicillin
gonorrhea is already
systemic o Benzathine Pen G
o Signs and symptoms (Penadur)
would include:

79
 o Given also to  Key Concept!
Rheumatic Heart o If the patient is
Disease patients  Pregnant
 Important Concepts!!!  Sensitive to
o Penicillin G is NEVER Penicillin
GIVEN PER I.V. o Administer
o For I.M. use only SPECTINOMYCIN
o Rationale: instead!!!
 If given per I.V.,  Key Concept!
it will KILL THE o If patient with
PATIENT!!!! gonorrhea has
 It is oil based chlamydial infection or
 It forms into an vice versa (Gonorrhea
EMBOLUS that and Chlamydia are
would kill the TWIN SISTERS)
patient  Do not give
o When given per I.M. Penicillin
 Use big gauge  Do not give
needle Spectinomycin
 Gauge 16 – 18 o Administer
 This drug easily DOXYCYCLINE
coagulates instead!!!
 This drug easily
clots Nursing Care for Patients with
 Therefore, Gonorrhea
administer this  Gonorrhea patients are not
drug QUICKLY confined
 Dilute with one  They are treated on an
(1) cc of outpatient basis
LIDOCAINE
 One cubic 1. Psychological Aspect of Care
centiliter (1cc) of  STD patients have low self-
Lidocaine plus esteem
four (4) cubic
centiliters of 2. Health Education and Patient
Plain Normal Teaching
Saline Solution  To prevent recurrence of
is used to infection
provide less
pain Preventive Measures
o Rationale:  Safe Sex
 Due to the  According to the Center for
incorporation of Disease Control, “safe sex”
an anesthetic in means:
the form of o No sex
Lidocaine

80
 o Mutual monogamous o Painless popular
relationship lesions that heal
o Mutual masturbation spontaneously without
without direct contact treatment
 Holding of body o Found on the:
parts but no sex  Genitals
 Important Concepts!  Face
o Condom is not an  Lips
example of safe sex  Tongue
o Condom use is not  Under the
100% guaranteed in breasts
preventing infection  On fingers
o Best way to prevent o If without treatment,
spread of infection is chancre disappears, it
through BEHAVIOR will signal the start of
MODIFICATION the Secondary Stage
o Also called LOW-RISK
Behavior Secondary Stage of Syphilis
Patient exhibits:
SYPHILIS  Flu-like symptoms
 Also called: o Sore throat
o Pox o Headache
o Lues o Fever
o Sy  Several forms of dermatitis
o Bad Blood Disease o Rashes (Kulugo)
 All over the body
Causative Agent o Presence of dry, hard
 Treponema pallidum wart-like lesions
Mode of Transmission  Condylomalata
 Sexual Contact o Infectious lesions that
 May be transmitted vertically are fused together
o May pass placental o Found under the breast
barrier after sixteenth and on the genitals
(16th) week of o Highly infectious
pregnancy lesions
 Rarely transmitted thorough
Blood Transfusion  Key Concept!
o Secondary Stage is
Manifestations of Syphilis highly infectious
Three (3) Stages o Also called Infectious
Stage
Primary Stage of Syphilis  Changes in hair growth
Patient exhibits: o Patchy Alopecia all
 Chancre over
o Characteristic lesion

81
 o Patient has MOTH- Diagnostic Tests for Syphilis
EATEN APPEARANCE
 Affects growth of pubic hair 1. Culture and Sensitivity
o Thinning of pubic hair  Done by mucosal scraping
o Management:
 Patient uses 2. Dark Field Microscopy
aloe vera
 Patient uses 3. Blood Examination
Mane and Tail
 Key Concept!!! 3.1) FTA-ABS
o Before the Tertiary  Fluorescent Treponema
Stage of Syphilis Antibody Absorption Test
occurs, the patient o This is the confirmatory
becomes test for syphilis
ASYMPTOMATIC
o This may be called the 3.2) VDRL
LATENT PHASE  Venereal Disease Research
 A transition Laboratory
period of one (1) o This is not a definitive
to two (2) years. test

Tertiary Stage of Syphilis 3.3) RPR

Patient exhibits:  Reactive Plasma Reagent
 Gummatous Lesions or o Non-definitive test for
Gumma syphilis
o Characteristic lesion
o Lesions that are found Medical Management of Syphilis
on deeper tissues and
organs of the body 1. Anti-biotics
o Some are in the form of  Drug of Choice
infiltrating tumors o Penicillin
 Other organs of the body are  If patient is sensitive to
also affected Penicillin
o Most commonly o Administer a
affected is the HEART Cephalosporin instead
o This gives rise to o Choice of
CARDIOVASCULAR Cephalosporin
SYPHILIS  Ceptriaxone or
 Neurosyphilis Rocephin
o Central Nervous  Given per I.M. or
System affectation per I.V.
o Neurologic symptoms o Different diluents are
are present used:
 Lack of Balance o When given I.V.
 Dementia  Diluent used is
Sterile Water

82
 o When given I.M.  Baby has nasal
 Diluent used is discharges
Xylocaine  Mother may NOT give birth to
 Important Concepts!!! a child with syphilis but may
o Do NOT give birth to a child with LATE
INTERCHANGE SYPHILIS
diluents! o Two (2) years after
o If I.M. preparation is birth, the child will
given via I.V. manifest:
 Patient dies due  Hutchinson’s
to dysrhythmias Teeth
o If I.V. preparation is  Saw-like
given via I.M. teeth
 Viscous  Anterior Bowing
medication of the Tibia
would give rise  Fractured
to pain upon Tibia
administration  Backward
Tibial
Nursing Management in Syphilis growth
 Same as in gonorrhea  Saddle nose
with high palate
Preventive Management of  Deafness
Syphilis  Persistence of
 Same as in gonorrhea dactylitis
o If child with Late
Important Concepts!!! Syphilis is not given
 Effect of syphilis to child prophylaxis upon
whose mother developed adolescence
syphilis during pregnancy:  Child develops
o Still Birth (baby dies) neurosyphilis
o Syphilitic Baby  Child will
 Placenta is eventually die
bigger than the  Mother may NOT give birth to
baby a child with syphilis
 Baby resembles o Child may be born
the appearance NORMAL
of an old man o Child may be ALIVE
 Baby has linear and NORMAL
scars at angles o But wait for two (2)
of the mouth years to really declare
 Baby has that child is normal
persistent
vesicular Important Concepts!!!
eruptions or  If you are pregnant, do not be
blisters infected with syphilis

83
  Do not get infected with  Therefore, AIDS
syphilis, particularly in the cannot be
third (3rd) trimester of acquired
pregnancy. through the
 The nearer you give birth to a swimming pool
child, the greater is the o By Ordinary House
chance that the child would Bleaching Soap with
develop congenital anomalies Sodium Hypochlorite
 Zonrox
ACQUIRED IMMUNE DEFICIENCY  Chlorox
SYNDROME (AIDS)  Purex
 Domex
Important Concept!!!  Proportion of
 Acquired Immune Deficiency bleaching soap
Syndrome (AIDS) is to water is 1:10
DIFFERENT from HIV  Important Concepts!
Infection o If virus leaves the body
of an individual infected
HIV Infection with AIDS (i.e. through
 Means that you are infected the semen), the virus
with the virus will survive for only four
 Initial stage of AIDS (4) hours
AIDS o If it does not penetrate
 Means that you are infected another person, the
 You manifest a group of signs virus WILL DIE
and symptoms o But if the virus goes out
 With decreased or weakened with blood, the VIRUS
immune system WILL REMAIN ALIVE,
 This is the end-stage of HIV as long as the BLOOD
infection IS FRESH!!!
Key Concepts! o Once a person dies
 All patients with HIV infection with AIDS, the virus
will develop into AIDS remains in the body of
 All AIDS patients have passed the individual, as long
through the HIV stage as, the body is HUMID
Causative Agent o Therefore, the body of
Human Immuno-Deficiency Virus
an AIDS victim should
 A Retrovirus
be cremated within
 A very fragile virus
twenty-four hours after
 Can easily be destroyed by:
death or sealed in a
o Seventy percent (70%)
metal coffin, also within
alcohol twenty-four (24) hours
o A temperature of fifty- from death.
six degrees Celsius o The body of an AIDS
(56°C) victim COULD NOT BE
o Chlorine EMBALMED

84
  The virus will o Therefore, child is
INFECT THE positive for HIV but
EMBALMERS may this may not mean
the child is infected
Modes of Transmission  Child is given up to eighteen
(18) months for HIV testing
Blood Transfusion per Single o After eighteen (18)
Exposure months, child must be
 Single Blood Transfusion negative for HIV testing
o Provides 90% chance o If child is still positive
of infection for HIV testing after
eighteen (18) months,
Sexual Contact then the child is
 Pandemically, the number one REALLY INFECTED!!!
mode of transmission
o Single exposure gives NORMAL IMMUNE RESPONSE
0.1% to 1.0% chance
of infection Microorganism
o However, due to ▼▼▼
repeated sexual Detected by the Macrophages
encounters, chance of ▼▼▼
infection increases Macrophages will alert T cells
▼▼▼
Contaminated Sharps and Alerted T cells reproduce and
Needles multiply
 Single exposure gives 0.1% to ▼▼▼
0.5% chance of infection T cells stimulate the B cells
▼▼▼
Vertical Transmission B cells reproduce and multiply
 From the infected mother to ▼▼▼
the unborn fetus B cells release the antibody
o Gives 30% chance of ▼▼▼
infection Antibody produced attacks the
invading microorganism
Important Concepts!!! ▼▼▼
 If a child is born to a mother Antigen-Antibody reaction occurs
who is HIV positive, the child ▼▼▼
would ALWAYS have a Manifestation of Disease will be
POSITIVE RESULT for HIV present
TESTING
o HIV testing identifies Important Concept!
the presence of  In HIV Infection, there is an
antibodies in the blood alteration in the NORMAL
 Child possesses maternal Immune Response
antibodies
HIV (Retrovirus)

85
 Has special affinity for T cells  As the body takes more time
▼▼▼ to develop antibodies to the
Retrovirus is NOT DETECTED by HIV, the person BECOMES
the Macrophages INFECTED but REMAINS
▼▼▼ ASYMPTOMATIC
Macrophages will NOT BE ABLE TO
ALERT the T cells A WELL-WORRIED INDIVIDUAL
▼▼▼ ▼▼▼
Retrovirus ENTERS the T cell ▼▼▼
▼▼▼ ▼▼▼
Retrovirus releases the enzyme Infected with HIV but is
REVERSE TRANSCRIPTASE ASYMPTOMATIC
This resembles the genetic make-up ▼▼▼
of the T cell ▼▼▼
▼▼▼ ▼▼▼ After six (6) weeks to six (6)
T cell does not destroy the virus ▼▼▼ months (called the WINDOW
▼▼▼ ▼▼▼ PERIOD or the time interval
T cell BECOMES a PRO-VIRUS ▼▼▼ between the infection of the
▼▼▼ ▼▼▼ individual to the production of
Virus multiplies within the T cell ▼▼▼ the antibodies), where the
▼▼▼ ▼▼▼ body produces antibodies
T cell is DAMAGED ▼▼▼
▼▼▼ ▼▼▼
Virus will retrovert before leaving the ▼▼▼
T cell ▼▼▼
▼▼▼ ( + ) for HIV infection
Virus leaves T cell With AID Related Complex (ARC)
▼▼▼ Symptoms
Virus attacks another T cell ▼▼▼
▼▼▼ ▼▼▼
Net effect: No T cells will be present ▼▼▼ Months to years
to stimulate the B cells ▼▼▼
▼▼▼ ▼▼▼
No B cell stimulation ACQUIRED IMMUNE DEFICIENCY
▼▼▼ SYNDROME (AIDS)
No antibody production ▼▼▼
▼▼▼ ▼▼▼
No antigen-antibody reaction occurs ▼▼▼ Months to years
▼▼▼ ▼▼▼
Person is infected but remains ▼▼▼
asymptomatic DEATH occurs

Important Concept! Important Concepts!

 In the course of the HIV AIDS Related Complex Symptoms
infection, the macrophages include the following:
CANNOT IDENTIFY the HIV

86
  Fever with night sweats  Continually multiplying and
without a cause continually growing mouth
o All laboratory works are sores
negative
 Enlargement of lymph nodes Important Concepts!
without a cause  False-Negative Result for
o All laboratory works are AIDS
negative o No antibodies are
 Fatigability identified but patient is
 Weight Loss already infected
 Altered Sleeping Patterns o This occurs during the
 Temporary Memory Loss WINDOW PERIOD
 Altered Gait  The person who undergoes
HIV testing undergoes
Manifestations of AIDS counseling
 For adults o This person should not
o Two (2) major engage in any of the
symptoms modes of transmission
o One (1) minor of AIDS before the
symptom window period ends
 For Children  The ACTIVE PARTNER
o Two (2) major o Considered the GIVER
symptoms o Has less chances of
o Two (2) minor becoming infected
symptoms  The PASSIVE PARTNER
o Considered the
Major Symptoms RECEIVER
 Fever: One (1) month and o Has greater chances of
above in duration and is being infected
recurrent  AGAIN, DO NOT ENGAGE in
 Diarrhea: One (1) month and any of the modes of
above transmission of AIDS
 Ten percent (10%) weight loss DURING the WINDOW
o Staunted growth in PERIOD!!!
children
Minor Symptoms
 Persistent generalized Important Concepts!!!
lymphadenopathy  If an adult manifests the
 Generalized pruritic dermatitis following:
 Persistent cough: One (1) o Two (2) major
month and above symptoms
 Oropharyngeal Candidiasis o One (1) minor
 Recurrent Herpes Zoster symptom
 Progressive Disseminated o Then, that adult is
Herpes Simplex AIDS BONAFIDE

87
  If a child manifests the  Enzyme-Linked
following: Immunosorbent Assay
o Two (2) major o This is only a
symptoms SCREENING TEST for
o Two (2) minor AIDS
symptoms
o Then, that child is AIDS 2. PCR Test
BONAFIDE  Polymerase Chain Reaction
Test
Key Concepts! o Likewise, a
 When a person has AIDS, all SCREENING TEST for
microorganisms entering his AIDS
body gives rise to infections o Relatively expensive
 These are called o Costs approximately
OPPORTUNISTIC Php5,000 to Php7,000
INFECTIONS per test
 In the Philippines, the Number o Results are known
One Opportunistic Infection is within two (2) to three
TUBERCULOSIS (3) hours

Important Concepts!!! Important Concept!

 Cancers Associated with AIDS  If a person
o Caposi Sarcoma o Has been twice
 A malignancy of positive for ELISA and;
blood vessel o Has been positive once
wall or the for PCR
vascular  Then confirm the results by
endothelium doing the next test…
 Manifested 3. Western Blot
through the skin If a person is diagnosed with HIV
 With pink or  Tests continue
purple, painless  Monitor the following:
spots on the o 3.1) Viral Load
skin o Monitors replicating
 Gives rise to a activity of the virus
“LEOPARD- o Negative ( - ) Viral
LOOK”
Load
o Non-Hodgkin’s Disease
 Means virus is
 Cancer of the not actively
lymph nodes multiplying but is
still present
o 3.2) CD4 and T cell
Count
Diagnostic Tests for AIDS
o Establishes STAGE OF
INFECTION, whether it
1. ELISA
is HIV or AIDS

88
  Indicates HIV  Tastes
infection sour
 If greater  Give
than or together
equal to with fruit
200 juice
 Indicates AIDS o Lamivudine
 If less o Stavudine
than 200
2.Non-nucleoside Reverse
Medical Management for AIDS Transcriptase Inhibitors
 Symptomatic management as  Non-NRTIs
virus is the causative agent o Delavirdine
 Latest Trend in o Nevirapine
Pharmacologic Management
of AIDS 3. Protease Inhibitors
o COCKTAIL DRUGS  PIs
 Patient must o Saquinavir
take medication o Indinavir
composed of at o Pitonavir
least twenty-one
o Delfinavir
(21) tablets per
day
Important Concept!
 Patient spends
 All of the abovementioned
approximately
drugs inhibit multiplication of
Php1,000 per
the virus but DOES NOT KILL
day on drugs
THE VIRUS
 Prevents
multiplication of
Nursing Care for AIDS
the virus but
 Symptomatic as causative
DOES NOT
agent is a virus
KILL THE
 Psychological Care
VIRUS
 Promotion of Homeostasis
1.Nucleoside Reverse
Transcriptase Inhibitors
 NRTIs
Important Concept!
o AZT Azidothymidine
 Role of the Nurse in AIDS
 Retrovir
o A counselor
 Zidovudine
o ddc
Preventive Measures
 Dideoxycitidine
 A for Abstinence
 Zalcitadine
 B for Be Truthful
o ddI
 C for Condom use
 Dideoxyinosine  D for Do not use Drugs
 Didanosine
Important Concept!

89
 Virus can be found on all body
fluids but will not be enough to
cause infections
 Example:
o Six (6) to eight (8)
gallons of saliva are
needed to transmit HIV

90