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Communicable and Infectious Disease Nursing

Communicable Disease= caused by a pathogenic microorganism from an infected person


to a non-infected person through direct contact, a break in the skin integrity or any other
means.

Infectious Disease= characterized by the presence of microorganisms in the body which


cannot be transmitted through ordinary means.

Contagious Disease= a disease that can easily be transmitted.

Common Causes of Infectious or Communicable Diseases


1. Bacterial invasion
2. Viruses
3. Fungal infection
4. Protozoan infection
5. Algae
6. Parasitic or Helminthic

Usual Modes of Transmission of Infectious Diseases


1. Direct contact- may be transmitted from person to person, sexual intercourse or
through blood
2. Respiratory droplets
3. Aerosol
4. Food and water-borne
5. Zoonotic- transmission from animals to man
6. Vertical- congenital syndromes and other perinatal infections

The Epidemiologic Triad


1. Host- a man or other organism that harbors the infection. The host may be classified
as a suspect, patient, carrier or contact.
2. Agent- an organism that causes the infection
3. Environment- a medium conducive to the growth and development of the
microorganisms and may be said as either symbiotic, commensalism or parasitic.

General Aspects of Care to Communicable Disease Patients


1. Preventive aspect- happens when a person is not yet infected with the disease but
the occurrence is likely and must be stopped. This can be carried out through
performance of health education classes, immunization, environmental sanitation
and proper ways of food handling and storage.
2. Control aspect- happens when a disease is already present but the spread is to be
limited to the present infection rate. This can be done through isolation, disinfection,
disinfestations and fumigation practices.
3. Isolation Precautions- instituted to isolate the infection and not the patient; also
instituted to protect other people from contracting the disease the patient may be
carrying and also to protect an immunocompromised patient from any other
pathogenic organism that may bring about an infection.

Diseases Affecting the Central Nervous System

Meningitis

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An inflammatory disease involving the meninges and other surrounding structures of
the brain and is usually brought upon by arboviruses (arthropod-borne viruses).
The etiology may be bacterial as in the case of Neisseria meningitides infection,
Streptococcus pneumoniae, and Haemophilus influenza B bacilli. It may also be viral as in
the case of HIV patients, or those infected with the West Nile Strain of the Dengue Virus.
Fungal causes are related to cryptococcal infection, while other causes include previous
syphilis and Tuberculosis infection.

Risk Factors
a. Hematogenous spread: from the respiratory tract
b. Parameningeal focus (from conditions such as otitis media, odontogenic
causes and sinusitis)
c. Penetrating head trauma
d. Previous neurosurgical procedures or shunting
e. Cancer, alcoholism and other immunodeficient states

Manifestations
a. Fever, malaise, irritability, restlessness
b. Patients with advanced meningeal irritation may present with positive
Kernig’s and Brudzinski’s signs
c. Signs of increased intracranial pressure for children: increased head
circumference (if the child is below 18 months old), nausea, vomiting, poor
feeding.
d. Signs of increased intracranial pressure in older children and adults:
headache, neck stiffness (Nuchal rigidity), confusion, projectile vomiting
(2-3 feet), alteration in the level of consciousness, seizures, widened pulse
pressure, decreased respiratory rate, and other alterations in the vital
signs.
e. Patients with untreated infection may progress to coma which can
eventually cause death.

Diagnostic Examinations
a. Lumbar Puncture- reveals CSF that may be infected with bacterial, viral or
other etiologic agent. CSF return that is cloudy and reveals low glucose
levels is suspected for bacterial infection, while a clear CSF return is
subjected to CIE (counter-immuno electrophoresis) to determine viral or
other infection.
b. Gram staining and culture and sensitivity studies for CSF may also be done
to determine the right drug to be used.
c. CT Scans, MRI and EEG are also done to determine exact involvement of
the CNS in the disease process.

Medical Management
a. Patients are usually given penicillin and a third generation cephalosphorin
as treatment for bacterial infection; dexamethasone is also given to
reduce inflammation.
b. Patients are also given anti-convulsants to decrease seizure activity;
diuretics to relieve intracranial pressure and other anti-microbial agents to
treat a disease caused by other etiologies.

Encephalitis
An infectious disease characterized by the inflammation of the brain matter itself.
The disease may be brought about by the invasion of arboviruses, bacterial, fungal or
parasitic infection.
The disease has four primary classifications:

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a. Primary- the virus attacks the brain directly, causing infection and
inflammation
1. Eastern Equine- considered a serious epidemic disease of the horses and
principally affects children under five years of age and is brought about by
a bite from the Aedes solisitans mosquito.
2. Western Equine- a milder form of the previous classification and usually
affects adults.
3. St. Louis Encephalitis- believed to be brought about by an organism that
enters the olfactory tract; but may also be caused by the bite of an
infected mosquito
4. Japanese Encephalitis- a potentially severe form that is spread by the bite
of an infected Culex triteaniorhynchus mosquito
b. Secondary encephalitis- an infection brought about by a previous infection
that has spread into the brain like meningitis
c. Toxic encephalitis- inflammation of the brain that is caused by metal
poisoning, specifically lead
d. Post Vaccine Encephalitis- commonly an adverse reaction to rabies vaccine

The manifestations of the disease is similar to that of meningitis but with more
pronounced changes in mentation and levels of consciousness of the patient. Treatment is
also similar.

Poliomyelitis
Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious
disease spread from person to person, primarily via the fecal-oral route. The term derives
from the Greek poliós (πολιός), meaning "grey", myelós (µυελός), referring to the "spinal
cord", and the suffix -itis, which denotes inflammation. Poliomyelitis is highly contagious and
spreads easily by human-to-human contact. The time between first exposure and first
symptoms, known as the incubation period, is usually 6 to 20 days, with a maximum range
of 3 to 35 days.
The disease is transmitted primarily via the fecal-oral route, by ingesting
contaminated food or water. It is occasionally transmitted via the oral-oral route, a mode
especially visible in areas with good sanitation and hygiene. Polio is most infectious between
7–10 days before and 7–10 days after the appearance of symptoms, but transmission is
possible as long as the virus remains in the saliva or feces.
Spinal polio is the most common form of paralytic poliomyelitis; it results from viral
invasion of the motor neurons of the anterior horn cells, or the ventral (front) gray matter
section in the spinal column, which are responsible for movement of the muscles, including
those of the trunk, limbs and the intercostal muscles.
The extent of spinal paralysis depends on the region of the cord affected, which may
be cervical, thoracic, or lumbar. The virus may affect muscles on both sides of the body, but
more often the paralysis is asymmetrical. Any limb or combination of limbs may be affected
—one leg, one arm, or both legs and both arms. Paralysis is often more severe proximally
(where the limb joins the body) than distally (the fingertips and toes).
A laboratory diagnosis is usually made based on recovery of poliovirus from a stool
sample or a swab of the pharynx. Antibodies to poliovirus can be diagnostic, and are
generally detected in the blood of infected patients early in the course of infection. [4]
Analysis of the patient's cerebrospinal fluid (CSF), which is collected by a lumbar puncture
("spinal tap"), reveals an increased number of white blood cells (primarily lymphocytes) and
a mildly elevated protein level.
There is no cure for polio. The focus of modern treatment has been on providing relief
of symptoms, speeding recovery and preventing complications. Supportive measures
include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate

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exercise and a nutritious diet.[56] Treatment of polio often requires long-term rehabilitation,
including physical therapy, braces, corrective shoes and, in some cases, orthopedic surgery.

Tetanus
Tetanus, also called lockjaw, is a medical condition characterized by a prolonged
contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin,
a neurotoxin produced by the Gram-positive, obligate anaerobic bacterium Clostridium
tetani. Infection generally occurs through wound contamination and often involves a cut or
deep puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus
the name "lockjaw") and elsewhere in the body.
Generalized tetanus is the most common type of tetanus, representing about 80%
of cases. The generalized form usually presents with a descending pattern. The first sign is
trismus, or lockjaw, and the facial spasms called rhisus sardonicus, followed by stiffness of
the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms
include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart
rate. Spasms may occur frequently and last for several minutes with the body shaped into a
characteristic form called opisthotonos. Spasms continue for 3–4 weeks, and complete
recovery may take months.
There are no blood tests that can be used to diagnose tetanus. The diagnosis is
based on the presentation of tetanus symptoms and does not depend upon isolation of the
bacteria.
The wound must be cleaned. Dead and infected tissue should be removed by surgical
debridement. Administration of the antibiotic metronidazole decreases the number of
bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus,
but is no longer the treatment of choice, owing to a theoretical risk of increased spasms.
However, its use is recommended if metronidazole is not available. Passive immunization
with human anti-tetanospasmin immunoglobulin or tetanus immune globulin is crucial. If
specific anti-tetanospasmin immunoglobulin is not available, then normal human
immunoglobulin may be given instead. All tetanus victims should be vaccinated against the
disease or offered a booster shot.

Rabies
Also known as Lyssa and Le Rage, is an acute viral infection communicated to man
by the saliva of an infected animal. The disease is zoonotic, occuring only in low-form
mammals such as felines and canines and is transmitted only to man through the
contaminated saliva. The causative agent is Rhabdovirus, a neurotrophic organism, which
can cause infection anywhere from 3 weeks to years from the time of its inoculation into the
site of the bite.
Manifestations of the disease is divided into three phases.
a. Prodromal phase- patient experiences sore throat, numbness on the site of
the bite, restlessness, irritability, and apprehension, slight
photosensitivity, insomnia and flu-like symptoms.
b. Excitement or Maniacal- the patient presents with hydrophobia,
aerophobia, behavior similar to that or a rabid animal, vicious look on the
face. Profuse drooling of saliva
c. Paralytic Stage- paralysis sets in and the patient becomes quiet and
unconscious; there is associated loss of bowel and urinary control; spasms
of the cardiac and respiratory muscles lead to eventual coma and death.
Diagnosis of the disease is based on the patient’s symptoms and based on the
behavior of the animal that has bit the patient. A brain biopsy of the animal may also be
done 10-14 days after the bite incident to detect the presence of Negri bodies, the
pathologic lesions found in the brain of at least 70% of all rabid animals. Animals which yield
negative results for the Negri bodies are then subjected to a fluorescent antibody test to
confirm rabies infection.

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Medical management of the patient includes provision of both passive and active
rabies vaccine to the person bitten by the infected animal, tetanus toxoid injections on the
site of the bite and thorough washing of the wound.
Nursing management is focused towards provision of patient comfort and support
both the patient and his family. Prevention is the major focus of nursing interventions.

Diseases Affecting the Respiratory Tract

Pneumonia
Pneumonia is the infection of the lung parenchyma. It is brought about by several
factors such as impairment in lung defenses as in people who are smoking cigarettes,
inhaling toxic substances, people who suffer from aspiration, those with mechanical
obstruction and are intubated and immunocompromised.
Pneumonia may present with both typical and atypical symptoms.
a. Typical- dyspnea, chest discomforts, productive or purulent coughing,
blood tinged or frothy sputum; tachypnea, tachycardia, cyanosis and
confusion; rales, wheezing. Decreased tactile fremitus.
b. Atypical- insidious onset of fever, nonproductive cough, headache,
malaise, fever.
Diagnostic examinations include sputum cultures, chest x-ray films, arterial blood gas
studies and bronchoscopic examinations.
Treatment includes administration of antibiotics or other anti-infective agents to the
patient and treating the underlying cause. The patient may also be given mucolytics and
oxygen inhalation therapy in cases of severe pneumonia.

Tuberculosis
Tuberculosis is a chronic sub-acute or acute respiratory disease commonly affecting
the lungs characterized by the formation of tubercles in the tissues which tends to undergo
casseation, necrosis and calcification. The infection is brought about by the inoculation of
Mycobacterium tuberculosis into the respiratory tract, which is transmitted through droplet.
The infection may also occur in other areas of the body such as the bones, gastrointestinal
tract and urinary tract.
Usual manifestations of the disease include low grade afternoon, fever, anorexia,
weight loss, body malaise, chest and back pains, productive cough and dyspnea. Some
patients may present with blood tinged sputum or even cough out blood.
Diagnosis to confirm the presence of the disease is through AFB staining using the
patient’s sputum as sample. Three consecutive positive readings of the AFB test will
automatically mean a positive diagnosis for PTB. The patient may also be asked to undergo
chest x-rays and tuberculin testing (for those in areas where TB is not endemic).
Medical management of patients in the Philippines follow the DOTS program of the
Department of Health, which is geared towards eradication of the disease in the country.
Nursing management includes maintenance of the patient in respiratory isolation
until the first two weeks of treatment, administration of the medication through the entire
treatment regimen, encouragement of smoking cessation, increasing fluid and nutritional
intake and activity modifications. The patient should also be taught proper disposal of
nasopharyngeal secretions and the importance of avoiding the modes of transmission of the
disease. Vaccines (BCG) are also helpful for infants.

Diphtheria
Diphtheria is an acute bacterial disease that infects the person’s mucus membranes,
conjunctiva, genitals and respiratory system. It is an infection brought about by the
Corynebacterium diphtheria and is transmitted through droplet. Direct and indirect contacts.
The disease has three main types:
a. Nasal- the presence of irritating nasal discharges characterized by sero-
sanginous foul, musty odor secretions and present with pseudomembrane

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b. Pharyngeal or Facial- the patient feels difficulty swallowing and
membranes turn grayish-white; the patient also exhibits a bull neck
appearance.
c. Laryngeal- affects the larynx and airway passages; the patient
experiences dyspnea, sterna retractions, dry metallic or barking cough and
pseudomembrane formation in the larynx which leads to airway
obstruction.
Diagnosis is confirmed through nose and throat cultures to detect the presence of the
causative agent. If the disease is confirmed, the patient is usually treated with anti-
diphtheria serum, Penicillin, and oxygen therapy. In instances wherein the patient
experiences respiratory arrest, a tracheostomy may be performed.
` Nursing care for patients with diphtheria includes maintenance of patients on bed
rest, provision of adequate fluid and nutritional intake and oral hygiene, instructing the
patient not to touch or scrape the pseudomembrane and other comfort measures.
Prevention of the disease includes having at risk population vaccinated, teaching about
proper disposal of nasopharyngeal secretions and avoiding the mode of transmission of the
disease.

Diseases Affecting the Cardiovascular System

Dengue Fever
Also called Breakbone Fever, is an acute febrile disease caused by the infection with
one of the serotypes of the dengue virus which is transmitted by the mosquito Aedes
Aegypti. The disease can manifest in for different serologic types commonly known as the
Onyong-nyong, Chikunggunya, West Nile and Flavivirus.
Dengue fever is not always hemorrhagic. The disease has four different stages.
a. Grade I (Dengue Fever Syndrome)- the patient usually experiences flu-like
symptoms, a positive Herman’s sign, petechiae and intermittent fever
b. Grade II (Dengue Hemorrhagic Fever)- manifestations of Grade I plus
spontaneous bleeding (hematemesis, hematochezia, melena, gum
bleeding and epistaxis)
c. Grade III (Hypovolemia)- manifestations of Grade II plus beginning
symptoms of circulatory failure (cold and clammy skin)
d. Grade IV (Dengue Shock Syndrome)- manifestations of Grade III plus shock
Diagnostic tests done to confirm the presence of the disease includes tourniquet test,
platelet counts and hematocrit and hemoglobin determination.
The treatment is usually supportive and symptomatic, including administration of
paracetamol for fever, IV replacement of lost fluids, provision of oxygen therapy to alleviate
difficulty of breathing, blood transfusions in cases of massive blood loss and addressing any
other problems that may arise in conjunction with the disease.
Nursing management focuses on provision of comfort and ensuring patient safety
because of his risk for uncontrolled bleeding episode should platelet counts fall below the
normal.

Malaria
Also called Ague, the King of Tropical Diseases, is an infectious disease characterized
by indefinite chills and fever, brought about by the Plasmodium parasite, carried by the
female Anopheles mosquito.
The most common causative agent is the Plasmodium falciparum. It also the most
life-threatening strain since this is known to multiply rapidly and cause massive destruction
of the red blood cells of an individual.
The disease progress in three distinct stages:
a. Cold Stage- chilling sensation, shaking of the body (chills)
b. Hot Stage- fever may rise up to 41 degrees Centigrade (lasting from 4 to 6
hours),hradaches, abdominal pains and vomiting

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c. Diaphoretic Stage- excessive sweating, feeling of weakness, subsiding
fever
Diagnosis of the disease includes obtaining blood samples for Malarial Smears. The
samples are best taken at the height of the fever because the more malarial parasites are
seen on film during this stage.
Treatment includes administration of anti-malarial agents such as Chloroquine,
Quinine, Sulfadoxine and Primaquine to patients infected with the disease. Transfusion of
erythrocytes and oxygen inhalation therapy may also be prescribed for patients who have
suffered from Black Water fever brought about by the falciparum strain.
Nursing management varies depending on the stage of the disease progression and
is therefore supportive and symptomatic. Patient comfort is given priority as well as
adequate nutritional and fluid intake. Bleeding episodes should also be watched out for and
signs such as melena, hematochezia or decreasing levels of consciousness need to be
reported.

Diseases Affecting the Integumentary System

Leprosy
Hansen’s disease or Hansenosis is a chronic systemic infection characterized by
progressive cutaneous lesions. The disease is transmitted through skin contact, droplet and
fomites and is caused by the etiologic agent Mycobacterium leprae. The etiologic agent is an
acid fast bacilli which belongs to the same classification as the TB bacilli. Usual incubation
periods last from 5 months to 8 years.
The most common type of the disease are:
a. Tuberculoid- non-infectious type and is usually benign; the patient has a
few Mycobacterium leprae on skin; appears mostly on the face, the eyes,
and testes, as well as on the nerves and skin; more clearly defined.
b. Lepromatous- the most infectious type, with a lot of pathogenic organism
present on skin; causes damage to the respiratory tract. Presents with a
gradual thickening of the skin with the development of a granulomatous
condition.
c. Borderline- possesses some of the characteristics of the first two subtypes.
The skin lesions are diffused and poorly defined.
Signs and symptoms of the disease include pain and redness around the eyes,
muscle weakness and paralysis of the affected extremity, nasal obstruction and nose
bleeding, color changes in the skin, non-healing skin ulcers (sometimes mistaken for
diabetic wound); drooping of the eyelids (lagupthalmos), falling off of the eyebrows
(madarosis), sinking of the bridge of the nose (painless and natural amputation,
irreversible), leonine face, chronic skin ulcers, contractures and other symptoms.
Diagnostic tests include skin smear test and skin lesion biopsy to determine the
presence of Mycobacterium leprae on the skin.
Medical management is geared towards eradicating the etiologic agent on the skin of
the patient. The treatment has two types:
a. Paucibacillary- given for patients with tuberculoid type of leprosy and
includes administration of Rifampicin and Dapsone, with the treatment
period lasting from 6 to nine months
b. Multibacillary- administered to patients with borderline and lepromatous
type of leprosy. The drugs usually part of this treatment plan are
Rifampicin, Dapsone and Lamprene. The treatment course ranges from 24
months to 30 months.
Nursing management includes stressing out the patient’s adherence to the treatment
plan to decrease the risk of the development of drug resistant strains; provision of adequate
skin care; promotion of range of motion exercises to reduce the risks of development of
contractures and preventing disease transmission.

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Chickenpox and Herpes Zoster
Qualities Chickenpox Herpes Zoster
Defining Characteristics An acute and highly An acute viral infection of the
contagious disease of viral sensory nerve occurring in
etiology characterized by partially immune individuals
vesicular eruptions on the to a previous infection or
skin and mucus membranes exposure to Chickenpox
with mild systemic
symptoms.
Causative Agent Varicella zoster Herpes zoster
Incubation period and 10 to 21 days; transmitted 13 to 17 days; transmitted
Mode of Transmission through droplet and direct through direct contact with
contact an infected person
Signs and Symptoms Low grade fever, headache, Vesiculo-pustular rashes
body malaise, muscle pains, unilaterally distributed along
rashes starting from the a nerve pathway
trunk, vesicles
Diagnostic Tests Presence of the virus on the History and viral isolation
lesions from the lesions
Medical Management Usually supportive and Acyclovir and Potassium
symptomatic; Acyclovir is the Permanganate (three effects:
drug of choice astringent, bactericidal and
oxidative)
Nursing Care Comfort measures, Avoiding infection, provision
prevention of superimposed of psychological support
infection on lesions,
adequate fluid and
nutritional intake

Measles and German Measles


Qualities Measles German Measles
Defining Characteristics An acute and contagious A mild viral illness
exanthematous disease that characterized by feverish
usually affects children which episodes with rashes and
are susceptible to upper joint aches.
respiratory tract infections.
Causative Agent Paramyxiviridae Pseudoparamyxoviridae
Incubation period and Variable, averaging 7-12 14 to 21 days; transmitted
Mode of Transmission days; transmitted through through droplet
droplet nuclei
Signs and Symptoms High grade fever for three to Fever for 1-2 days, mild
four days, excessive cough and colds; malaise;
lacrimation, colds and mild conjunctivitis;
cough; macula-papular lymphadenopathy; transient
rashes appearing from the polyarthralgia and
head to the feet; Koplik’s polyarthritis; Forscheimer’s
spots spots
Diagnostic Tests Nose and throat swabs, Usually none, the disease
blood examinations lasts approximately 3days
Medical Management Symptomatic and supportive; Symptomatic
calamine lotion for itchiness,
anti-virals and analgesics
Nursing Care Proper skin care, prevention Supportive
of mouth sores; oral care;

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adequate rest and nutrition

Diseases Affecting the Gastro-Intestinal Tract

Typhoid Fever
The disease is also known as Enteric Fever, a bacterial infection transmitted by
contaminated water, milk, shellfish, or other food stuff. It is an infection that primarily
affects the lymphoid tissues of the small intestines (Peyer’s patches). The causative agent is
the bacteria Salmonella typhosa which is transmitted through the fecal-oral route.
Manifestations
a. Prodromal Stage- presence of fever, dull headache, abdominal pain,
vomiting, diarrhea (which sometimes alternate with constipation), nausea
and vomiting, and decreased pulse rate.
b. Pyrexia- also called as Fastigial Stage; characterized by the presence of
Rose Spots in the abdomen, ladder-like fever, splenomegaly. Patients
sometimes present with Typhoid psychosis, an alteration in mental
functioning brought about by the disease process.
c. Defervescence- the bacteria continuously multiplies in this stage; patients
may present with melena or hematochezia, ulcerations in the linings of the
intestinal wall, persistence of fever and sometimes abdominal tenderness
d. Lysis or Convalescent- gradual relief from the signs and symptoms of the
disease.
Diagnosis is usually confirmed through the performance of Typhidot, the confirmatory
test. Other tests that may be performed for the patient includes blood cultures, Widal Test,
stool and urine examinations.
The drug of choice is Chloramphenicol, which is best administered via the IV route.
Other drugs given to the patient may include, but are not limited to Ampicillin, Co-
trimoxazole, Ciprofloxacin and Ceftriaxone.
The focus of nursing management is restoration of fluid and electrolyte balance;
vigilant monitoring of the patient’s vital signs; maintaining patient safety especially in the
stage of altered mental functioning and prevention of bleeding. Preventive measures focus
on teaching proper waste disposal, food preparation and handling and the practice of
handwashing.

Amoebiasis
Amoebiasis is an infectious disease brought about by the invasion of the pathologic
agent Entamoeba histolytica. Reservoir of the agent is usually infected persons and is
transmitted through the fecal-oral route. The disease is most prevalent in areas of poor
sanitation such as crowded living environements and near sewerage systems.
Clinical features if the disease includes, but is not limited to:
a. Dysentery-like symptoms- abdominal pain, cramping, colitis, low-grade
fever with profuse diarrhea
b. Weight loss
c. Anorexia
The patient’s stool is usually tested for the presence of cysts and trophozoites before
the diagnosis is confirmed.
Treatment includes administration of metronidazole, correction of fluid and
electrolyte imbalances caused by diarrhea and treating any co-existing disease if present.
Nursing management is focused on maintenance of enteric precautions on infected
patients, ensuring an adequate fluid and nutritional intake, preventing perianal skin from
breakdown and prevention of the transmission of the disease to non-infected persons.

Shigellosis
Also known as Bloody flux or Shigal, is an infectious disease brought about by the
ingestion of a gram negative organism that invades the lumen of the intestines and causes

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the disease which manifests itself as severe watery diarrhea. The most common causative
agent is the Shigella (flexneri, boydii or sonnei), which is transmitted through fecal-oral
route.
The usual signs and symptoms include the presence of fever (although some patients
do not experience fever), vomiting, abdominal pain and diarrhea which is accompanied by
straining (tenesmus).
The disease is confirmed through the performance of stool examinations and rectal
swabbing to determine presence of shigella.
Medical management focuses on the eradication of the causative agent through the
administration of anti-microbial agents and oral dehydration of the patient.
Nursing management includes encouraging an increased fluid intake, providing
adequate nutrition, patient teaching about prevention of infection and prevention of
complications.

Schistosomiasis
Alson known as Bilharziasis, Snail fever, Swimmer’s fever, blood Fluke, and Katayama
Fever, is a slowly progressive disease caused by blood flukes of the class trematoda and is
common among farmers in the southern part of the country. The source of infection are the
parasitic worm Schistosoma japonicum, found in the snails called Oncomelania quadrasi.
There are three major types of organism which causes the infection, these are:
a. Schistosoma japonica- the most common or endemic in the Philippines, and infects
the intestinal tract of the individual.
b. Schistosoma mansoni- common in other tropical countries like Africa and South
America
c. Schistosoma haematobium- affects mostly the urinary tract and is common in Middle
Eastern countries

The sources of infection are infected man and animals and the disease is transmitted
through inoculation in broken skin or ingestion of water contaminated with the eggs of the
fluke.
Signs and symptoms of the disease includes:
a. Low grade fever
b. Abdominal pain
c. Vomiting and diarrhea
d. Abdominal distention
e. Emaciation
f. Jaundice
g. Itchiness at the site of entry of the microorganism

Tests that determine the presence of flukes in the patient’s body includes stool
examinations, blood tests (COPT and ELISA) and rectal biopsy
Treatment includes administration of anti-Schistosomal agents (Fuadin and
Praziquantel) and supportive management for any symptoms present on the patient.
Prevention of infection is the primary thrust of the nurse, and this includes:
a. Checking at risk individuals (stool exam)
b. Eradication of breeding and resting sites of the snail
c. Advising farmers to wear proper foot protection
d. Protect the skin integrity to avoid creating a portal of entry of the organism
e. Boiling water before drinking or use for cooking in endemic areas

Viral Hepatitis
Viral hepatitis is an acute inflammation of the liver marked by liver-cell destruction,
necrosis, and autolysis. In most patients hepatic cells eventually regenerate with little or no
residual damage.

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There are five major forms of viral hepatitis which are currently recognized, each
caused by a different virus:
1. Type A is transmitted almost exclusively by the fecal-oral route, and outbreaks
are common in areas of overcrowding and poor sanitation. Day-care centers and
other institutional settings are common sources of outbreaks. The incidence is
also increasing among homosexuals and in people with human immunodeficiency
virus (HIV) infection.
2. Type B, also increasing among HIV-positive people, accounts for 5% to 10% of
posttransfusion, hepatitis cases in the US. Vaccinations are available and are now
required for health care workers and school children in many states.
3. Type C accounts for about 20% of all viral hepatitis as well as most cases that
follow transfusion
4. Type D is confined to people frequently exposed to blood and blood products,
such as IV drug users and hemophiliacs
5. Type E was formerly grouped with Type C under the name non-A, non-B hepatitis.

All forms of viral hepatitis are caused by hepatitis viruses A, B, C, D, or E.


Signs and symptoms in the preicteric phase:
• Fatigue, malaise, arthralgia, myalgia, photophobia, and headache
• Loss of appetite, nausea, and vomiting
• Altered sense of taste and smell
• Fever, possibly with liver and lymph node enlargement
Signs and symptoms in icteric phase (lasts 1 to 2 weeks):
• Mild weight loss
• Dark urine and clay-colored stools
• Yellow sclera and skin
• Continued hepatomegaly with tenderness
Signs and symptoms in the convalescent phase (lasts 2 to 12 weeks or longer):
• Continued fatigue
• Flatulence, abdominal pain or tenderness, and indigestion
Diagnostic tests include:
• The presence of hepatitis B surface antigens and hepatitis B antibodies confirms a
diagnosis of type B hepatitis
• Detection of an antibody to type A hepatitis confirms past or present infection with
type A hepatitis
• Detection of an antibody to type C confirms a diagnosis of type C hepatitis. Viral load
is measured by quantitative polymerase chain reaction assay and is useful in
determining need for treatment and monitoring therapy.
• PT is prolonged (more than 3 seconds longer than normal indicates sever liver
damage).
• Serum transaminase levels (ALT and AST) are elevated
• Serum alkaline phosphatase levels are elevated
• Serum and urine bilirubin levels are elevated (with jaundice)
• Serum albumin levels are low, and serum globulin levels are high
• Liver biopsy and scan show patchy necrosis

Treatment includes:
• The patient should rest in the early stages of the illness and combat anorexia by
eating small meals high in calories and protein. Large meals are usually better
tolerated in the morning.
• Chronic hepatitis B with liver inflammation is treated with interferon alfa-2b for 16
weeks. Monitoring of blood counts is essential during treatment.
• Lamivudine is another therapy for hepatitis B to decrease the viral load of hepatitis B

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• Therapy for hepatitis C includes interferon or a combined interferon and ribavirin
therapy. The patient needs instruction on self-injection and adverse effects
• Laboratory tests-including CBC with differential, thyroid studies, liver function tests,
and hepatitis quantitative studies-help determine the effectiveness if therapy and
prevent complications during treatment.
• Caution patients against becoming pregnant during the course of therapy or in the 6
months immediately following treatment
• Adverse effect of medications include depression, flulike syndrome, fatigue, malaise,
and GI disturbance
• Patients need to be proactive in their treatment to properly monitor and succeed in
taking their medication.
• Antiemetics may be given 30 minutes before meals to relieve nausea and prevent
vomiting. If vomiting persists, the patient needs IV infusions
• In severe hepatitis, corticosteroids may give the patient a sense of well-being and
may stimulate the appetite while decreasing itching and inflammation.

Nursing care includes:


• Observe enteric and blood and body fluid precautions for all types of hepatitis. Inform
visitors about isolation precautions
• Give patient plenty of fluids. Encourage the anorexic patient to drink fruit juices.
• Record weight daily, and keep accurate intake and output records
• Observe the patient’s stool for color, consistency, frequency, and amount
• Watch for signs of hepatic coma, dehydration, pneumonia, vascular problems, and
pressure ulcers
• Report all cases of hepatitis to health officials. Ask the patient to name the persons
he came in contact with recently.
• Evaluate the patient

Filariasis
Also known as Elephantiasis; a parasitic disease caused by an African eye worm
transmitted through person to person by mosquito bites.
It is caused by three types of worms: Wuchereria bancrofti, Brugia malayi, Brugia
timori. Symptoms may vary depending on the type of parasitic worm but usual symptoms in
all cases include, but are not limited to the following:
a. Chills
b. Headache
c. Fever
d. Swelling
e. Redness and pain in the arms, legs or scrotum
f. Areas of abscess

Diagnostic exams include blood tests, Circulating Filarial Antigen (CFA) , and taking
the patient’s history.
Medical management includes the administration of Ivermectin, albendazole or
diethycarbamazine; or surgery to remove the enlarged tissue and drain the lymph nodes.
Nursing care is supportive and management focuses on the prevention of the disease
rather than its treatment
a. Use of mosquito nets when sleeping
b. Eradication of breeding and/or resting sites of mosquitoes
c. Adherence to the treatment regimen
d. Practicing proper environmental sanitation

Sexually Transmitted Disease

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HIV/AIDS
Acquired immunodeficiency syndrome (AIDS) is marked by progressive weakening of
cell-mediated immunity, AIDS increases susceptibility to opportunistic infections and unusual
cancers.
AIDS is caused by infection with HIV, a retrovirus present in body fluids, such as
blood and semen. Modes of HIV transmission include:
• Sexual contact, especially associated with trauma to the rectal or vaginal
mucosa
• Transfusion of contaminated blood or blood products
• Use of contaminated needles
• Placental transmission from an infected mother to a fetus through cervical or
blood contact at delivery
• Breast milk from an infected mother
Risk factors for AIDS include:
• Multiple sexual contacts with homosexual or bisexual men
• Heterosexual contact with someone who has AIDS or is at risk for it
• Present or past abuse of IV drugs
• Transfusion of blood or blood products
After initial exposure, an infected person may have no signs or symptoms-or may
have a flulike illness and then remain asymptomatic for years.
The Centers for Disease Control and Prevention defines AIDS as a CD4+ cell count
below 200 cells/µl or when a patient has an opportunistic infection in the setting of HIV
infection. Enzyme-linked immunosorbent assay and a confirmatory Western blot assay
detect HIV antibodies to diagnose HIV infection. Levels of circulating HIV are measured
regularly to assess the risk of disease progression and the patient’s response to therapy.
Although no cure exists for AIDS, signs and symptoms can be managed with
treatment. Primary therapy for HIV infection includes three different types of antiretroviral
drugs:
• Protease inhibitors, such as ritonavir, indinavir, nelfinavir, and saquinavir
• Nucleoside reverse transcriptase inhibitors, such as zidovudine (AZT),
didanosine, zalcitabine, lamivudine, and stavudine
• Nonnucleoside reverse transcriptase inhibitors, such as nevirapine and
delaviridine
Used in various combinations, these drugs are designed to inhibit HIV viral
replication.

Nursing responsibilities include:


• Monitor the patient for fever, noting its pattern
• Assess for tender, swollen lymph nodes, and check laboratory values regularly
• Watch for signs and symptoms of infection, such as skin breakdown, cough, sore
throat, and diarrhea
• Encourage daily oral rinsing with normal saline or bicarbonate solution
• Follow standard precautions as directed by your facility, depending on patient’s
disease stage and condition
• Offer support in coping with the social impact and discouraging prognosis of AIDS
• Evaluate the patient.

STDs
Sexually transmitted disease (STD) is the most common infections present, and
Chlamydia is the most common STD.
Transmission of the causative organism, which may include bacteria, viruses,
protozoans, fungi, or ectoparasites, leads to infection. Patient high at risk include those (1)
under age 25, (2) with multiple sexual partners, and (3) with a history of STD.

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Signs and symptoms of STDs are vaginitis, recurrent vaginitis, vaginal or penile
discharge, epididymitis, lower abdominal pain, pharyngitis, proctitis, and skin or mucous
membrane lesions.
The diagnosis of a specific STD is made by physical examination, patient history, and
laboratory tests to determine the causative organism.
Treatment is based on the specific causative organism.
Name and Possible signs and Treatment Special
Organism symptoms considerations
Chlamydia >purulent discharge Doxycycline or >all sexual contacts
Chlamydia >Males: burning on azithromycin must be treated
trachomatis urination and >potential
symptoms of complications in
epididymitis females are pelvic
>Females: usually inflammatory disease
asymptomatic (PID), infertility, and
spontaneous
abortion; in males,
urethritis,
epididymitis, and
prostatitis.
>patient should take
medication as
prescribed, follow up
in 7 to 10 days, and
abstain from sexual
activity until
treatment is
completed.
Genital herpes >Females: purulent Famciclovir, >warm baths and
Herpes simplex type vaginal discharge valacyclovir, mild analgesics may
2 >multiple vesicles on acyclovir, topical relieve pain
genital area, anesthetic ointment >patient should
buttocks or thighs avoid sexual activity
>painful dysuria during the prodromal
>fever stage and during
>headache outbreaks until all
>malaise lesions have dried up
>many patients have
recurrences every 2
to 3 months; local
hyperesthesias may
occur 24 hours
before outbreak of
lesions
Gonorrhea >purulent discharge Ceftriaxone plus >all sexual contacts
Neisseria >dysuria azithromycin or must be treated
gonorrhoeae >urinary frequency doxycycline >potential
complications in
females are PID,
sterility and ectopic
pregnancy; in males,
prostatitis, urethritis,
epididymitis, and
sterility
>patient should take

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medication as
prescribed, follow up
in 7 to 10 days, and
abstain from sexual
activity until
treatment is
completed
Human >pink-gray soft Podophyllin 10% to >patient should
papilomavirus lesions, singularly or 25% to lesions, receive frequent
(HPV) in clusters cryosurgery Papanicolaou tests
>HPV has an 80%
chance of recurrence
>HPV is the most
common cause of
cervical cancer
Syphilis >chancre on penicillin >syphilis may be
Treponema pallidum genitalia, mouth, lips, characterized as
or rectum primary, secondary,
>fever or tertiary.
>lymphadenopathy >all sexual conrtacts
>positive results for must be treated
Venereal Disease >patient should take
Research medication as
Laboratories test, prescribed, follow up
fluorescent in 7 to 10 days, and
treponemal abstain from sexual
antibodies test, and activity until
rapid plasma regain treatment is
test completed
Trichomoniasis >Males: urethritis or metronidazole >all sexual contacts
Trichomonas penile lesions; must be treated
vaginalis usually >complications in
asymptomatic females include
>Females: frothy recurrent infections
vaginal discharge and salpingitis
with erythema and >patient should take
pruritus; may be medication as
asymptomatic prescribed, follow up
in 7 to 10 days, and
abstain from sexual
activity until
treatment is
completed

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