HANDOUTS CD DR SALVADOR  Treating people who are ill

 Vaccinating people
COMMUNICABLE DISEASES  Handling and disposing of body fluids responsibly
 Handling food safely
Communicable Diseases are Primary Cause of Mortality Gap between  Monitoring soil and contaminated water in sensitive areas of
Rich and Poor Countries the hospital and washing hands carefully after contact with
either
Non-communicable diseases account for 59% of all deaths worldwide Portal of exit
– estimated to rise from 28m in 1990 to 50m in 2020
the way the causative agent gets out of the reservoir (body fluid or
About 60% of deaths caused by communicable diseases can be skin)
attributed to:
Reduce risk from portals of exit by:
 HIV/AIDS
 Covering coughs and sneezes with a tissue
 Malaria  Handling body fluids with gloves, then doing hand hygiene
 Keeping draining wounds covered with a dressing
 Tuberculosis  Not working when you have exudative (wet) lesions or
weeping dermatitis
 Measles Mode of transmission

 Diarrheal disease any mechanism by which a pathogen is spread from a source or

reservoir to a person
 Acute respiratory infection
unwashed hands, things which are not cleaned between patients,
Philippines top 10 leading causes of morbidity & mortality in the droplets, or, for a few diseases, the air
year 2007:
Eliminate the mode of transmission by:
1. Diarrhea
 Hand hygiene
2. Bronchitis  Wearing gloves to minimize contamination of hands and
discarding them after each patient
3. Pneumonia  Cleaning, disinfection, or sterilization of equipment used by
more than one patient
4. Influenza  Cleaning of the environment, especially high-touch surfaces
Portal of entry
5. Hypertension
hole in the skin that allows the infectious agent to get into the body
6. Tuberculosis (mouth, nose, eyes, rashes, cuts, needlestick injuries, surgical wounds
and IV sites)
7. Malaria
Protect portals of entry (our own and our patients) by:
8. Heart diseases
 Dressings on surgical wounds
9. Cancer  IV site dressings and care
 Elimination of tubes as soon as possible
10. Accidents  Masks, goggles and face shields
 Keeping unwashed hands and objects away from the mouth
11. Chronic obstructive pulmonary disease and other  Actions and devices to prevent needlesticks
respiratory diseases  Food and water safety
Susceptible host
12. Diabetes and Kidney diseases.
a person or animal lacking effective resistance to a particular infectious
agent

Goal of WHO Minimize risk to susceptible hosts by:

1. Prevention of disease  Vaccinating people against illnesses to which they may be

exposed
2. Prevention of disability and death from infection  Preventing new exposure to infection in people who are
already ill, are receiving immunocompromising treatment, or
3.Prevention through immunization are infected with HIV
 Maintaining good nutrition
 Maintaining good skin condition
 Covering skin breaks
Chain of Infection  Encouraging rest and balance in our lives
MICROBES against HUMAN
Pathogen or causative agent
Definition:
biologic agent (organism) capable of causing disease
Symptoms
Eliminate organism by:
evidence of disease that is experienced or perceived (subjective)
 Sterilizing surgical instruments and anything that touches
sterile spaces of the body subjective changes in body function noted by
 Using good food safety methods
 Providing safe drinking water patient but not apparent to an observer
 Vaccinating people so they do not become reservoirs of
illness Signs
 Treating people who are ill
Reservoir objective evidence of a disease the physician can

Any person, animal, arthropod, plant, soil, or substance (or observe and measure
combination of these) in which an causative agent normally lives and
multiplies, on which it depends primarily for survival, and where it Syndrome
reproduces in such numbers that it can be transmitted to a susceptible
host a specific group of signs and symptoms that

Eliminate reservoirs by: accompany a particular disease

Incidence early, mild symptoms of disease

the number of people in a population who Period of Illness

develop a disease during a particular time period overt s/sx of disease

Prevalence WBC may increase or decrease

the number of people in a population who develop a disease, can result to death if immune response or medical
regardless of when it appeared refers to both old and new cases
intervention fails
Classification of Infectious Disease
Period of Decline
Based on Behavior within host
s/sx subside
Infectious Disease
vulnerable to secondary infection
- Any disease caused by invasion and multiplication of
microorganisms Period of Convalescence

Contagious Disease regains strength and the body returns to its

disease that easily spreads from one person to another pre diseased state

recovery has occurred

Based on Occurrence of Disease Mode of Transmission

Sporadic Disease The process of the infectious agent moving from the reservoir to the
susceptible host
disease occurs only occasionally
Contact Transmission
i.e. botulism, tetanus
- the most important and frequent mode of transmission
Endemic Disease
Type of Contact Transmission
constantly present in a population, country or
Direct Contact Transmission
community
 Person to person transmission of an agent by
i.e. Pulmonary Tuberculosis  physical contact between its source and
 susceptible host
Epidemic Disease  No intermediate object involved
 i.e. kissing, touching, sexual contact
acquire disease in a relatively short period  Source → Susceptible Host
Indirect Contact Transmission
greater than normal number of cases in an area
 reservoir to a susceptible host by means of a
within a short period of time  non living object (fomites)
 Source → Non Living Object → Susceptible Host
Pandemic Disease Susceptible Host

epidemic disease that occurs worldwide Recognition of high risk patients

i.e. HIV infection  Immunocompromised

 DM
Based on Severity or Duration of Disease  Surgery
 Burns
Acute Disease  Elderly
Percentage Nosocomial Infection
develops rapidly (rapid onset) but lasts only a short time
 17% Surgical
i.e. measles, mumps, influenza  34% UTI
 13% LRI
Chronic Disease  14% Bacteremia
 22% Other (incldng skin Infxn)
Develops slowly, milder but longer lasting clinical manifestation Factors for Nosocomial Infection

Based on State of Host Resistance Microorganism/Hospital Environment

Primary Infection Most common cause

acute infection that causes the initial illness  Staph aureus, Coag Neg Staph Enterococci
 E. coli, Pseudomonas, Enterobacter, Klebsiella
Secondary Infection
 Clostridium Difficile
 Fungi ( C. Albicans)
one caused by an opportunistic pathogen after primary infection
 Other ( Gram (-) bacteria)
has weakened the body’s defenses
 70% are drug resistant bacteria
Compromised Host

One whose resistance to infection is impaired by

Stages of Disease
broken skin, mucous membranes and a suppressed immune
Incubation Period system
time interval between the initial infection and the

1st appearance of any s/sx Skin and Mucous Membrane

Prodromal Period
 physical barrier
i.e. burns, surgical wounds, trauma, IV site
invasive procedures
Suppressed Immune System
i.e. drugs, radiation, steroids, DM, AIDS
IMMUNITY
The human body has the ability to resist almost all types of organisms
or toxins that tend to damage the tissues and organs. This is called
immunity
Functions of Immune System
1. Protects the body from internal threats
2. Maintains the internal environment by removing dead or damaged
cells.
3. Provides protection against invasion from outside the body.
The immune system
The major components of the immune system includes the bone
marrow which produces the white blood cells (WBC), the lymphoid
tissues which includes the thymus, spleen, lymphnodes, tonsils and
adenoids.
Natural Immunity (INNATE)
Non-specific immunity present at birth. This includes;
a. Phagocytosis of bacteria and other invaders by white
blood cells and cells of the tissue macrophage system
b. Destruction by the acid secretions of the stomach and by
the digestive enzymes on organisms swallowed into the stomach.
c. Resistance of the skin invasion by organisms
d. Presence in the blood of certain chemical compounds that
attach to foreign organism or toxins and destroy them like lysozyme,
natural killer cells and complement complex.
Acquired Immunity
The human body has the ability to develop extremely
powerful specific immunity against individual invading agents. It usually
develops as a result of prior exposure to an antigen through
immunization or by contracting a disease.
Active Acquired Immunity - immune defense are developed by the
person’s own body. This immunity last many years or a lifetime.
Passive Acquired Immunity - temporary immunity from another source
that has developed immunity through previous disease or
immunization. It is used in emergencies to provide immediate, short
acting immunity when the risk is high.
ANTIBODIES
Agglutination - clumping effect of antibodies between two antigen. It
helps to clear the body of invading organisms by facilitating
phagocytosis.
Opsonization – in this process, the antigen-antibody molecule is
coated with a sticky substance that facilitates phagocytosis.
1. IgG (75%)
 Appears in serum and tissues
 Assumes a major role in bloodborne and tissue infections
 Activates the complement system
 Enhances phagocytosis
 Crosses placenta
2. IgA (15%)
 Appears in body fluids (blood,saliva, tears, breat milk)
 Protects against respiratory, GIT and GUT
 Prevents absorption of antigens from food
 Passes to neonate in breast milk for protection
3. IgM (10%)
 Appears mostly in intravascular serum
 First immunoglobulin produced in response to bacterial or
viral infection
 Activates complement systems
4. IgD (.2%)
Appears in small amount in serum
5. IgE (.004%)
Allergic and hypersensitivity reactions
Combats parasitic infections
IMMUNIZATION
AND VACCINES
IMMUNIZATION
Process inducing immunity artificially by either vaccination (active) or
administration of antibody (passive)
Active : stimulates the immune system to produce antibodies, cellular
immune responses to protect against infectious agent
Passive : provides temporary protection through administration of
exogenous antibody
IMMUNIZING AGENTS
Vaccines : a preparation of proteins, polysaccharides or nucleic acids
of pathogens that are administered inducing specific responses that
inactivate or destroy or suppress the pathogen
Toxoid : a modified bacterial toxin that has been made nontoxic but
retains the capacity to stimulate the formation of antitoxin
IMMUNIZING AGENTS
Immune globulin : an antibody containing solution derived from human
blood obtained by cold ethanol fractionation of large pools of plasma
and used primarily for immunodeficient persons or for passive
immunization
Antitoxin : an antibody derived from serum of human or animals after
stimulation with specific antigens used for passive immunity
Expanded Program of Immunization
launched in July 1976 by DOH with cooperation with WHO and
UNICEF.
Objective was to reduce the mortality and morbidity among infants and
children caused by the six childhood immunizable diseases.
PKI, Diptheria, Polio, Measles and tetanus
PD no. 996 (September 16, 1976)- compulsory immunization
for children below the age of eight.
 RA 7896 (December 30,1994) – compulsory hepatitis B for
children below eight years old
 PP no.1066 (August 26,1997) – national tetanus elimination
starting 1997
APPROACH TO ACTIVE IMMUNIZATION
LIVE ATTENUATED VACCINES
- induce response similar to an active infection
- Organisms in live vaccines : multiply in recipient until desired
immune response occurs, considered to confer lifelong
protection
- Ex. Measles, mumps, rubella
APPROACH TO ACTIVE IMMUNIZATION
INACTIVATED OR DETOXIFIED VACCINE
- include whole organisms, detoxified exotoxin, purified protein
antigens, polysaccharide
- Lesser antigenic mass, requires booster vaccinations to
provide protection
- Ex. Hepa B, pertussis, tetanus, diphtheria, influenza B,
pneumococcal
EXPANDED PROGRAM OF IMMUNIZATION
A fully immunized child under EPI (before 12 months of age)
  1 BCG at birth or before 12 months PNEUMOCOCCAL
 3 DPT and 3OPV > 6weeks old, 4 weeks apart
 3 Hepa B >6 weeks old, 4 weeks apart -23-valent pneumococcal vaccine is composed of purified
capsular polysaccharide antigen of 23 serotypes
- Given SC or IM
BACILLE-CALMETTE-GUERIN (BCG) - Reactivation after 3-5 years is recommended for children 10
years or younger who are at high risk of severe
 Only intradermal vaccine Pneumococcal infection
 Attenuated bovine strains of tubercle bacilli (M.bovis) - Can be given concurrently with other vaccines
PNEUMOCOCCAL
 Freeze-dried, easily destroyed by heat and sunlight
 Dose : 0.05 ml ID
The following serious patients should be immunized :
 Normal course : wheal disappears in 30 mins; induration-2 to
3 wks later; pustular formation-4 to 6 wks; full scarification-6
to 12 wks later - sickle cell disease
 Usually at right deltoid or buttocks (upper quadrant)
BACILLE-CALMETTE-GUERIN (BCG) - Functional or anatomical asplenia

Complications : - Nephrotic syndrome or CRF

- deep abscess at vaccination site due to subQ or deeper - Immunosuppressive conditions

injection
- HIV infections
- Indolent ulcer >12 weeks
MENINGOCOCCAL
- Regional lymphadenitis
- Approved for children 2 years older
ORAL POLIO VACCINE (OPV) - 0.5 ml SC
- Can be given concurrently with other vaccines
 Oral preparation - live attenuated Sabin, trivalent OPV
 Dose : 2 drops; as early as 6 weeks old, 4 weeks apart
EXPANDED PROGRAM OF IMMUNIZATION (WHO)
 Booster dose : 1 year after last dose of primary series and
between 4 to 6 years old
DIPHTHERIA, TETANUS,PERTUSSIS (DTP) It is safe to vaccinate a sick child who is suffering from a minor illness
(cough, cold, diarrhea, fever or malnutrition) or who has already been
vaccinated against measles
 Diphtheria and tetanus toxoid, inactivated pertussis
adsorbed into aluminum salts
If the vaccination schedule is interrupted, it is not necessary to restart.
 Dose : 0.5 ml IM x 3 doses as early as 6 weeks old, 4 weeks
Instead, the schedule should be resumed using minimal intervals
apart
between doses to catch up as quickly as possible.
 Booster doses : 1 year after last dose of primary series and
between 4 to 6 years old
A "first expiry and first out" (FEFO) vaccine system is practiced to
 Complications : assure that all vaccines are utilized before its expiry date. Vaccine
- Pertussis : not used in > 6 y/o because of increased risk of temperature is monitored twice a day in all health facilities and plotted
neuroparalytic reaction to monitor break in the cold chain.
MEASLES

- Live attenuated vaccine; freeze-dried

- Dose : 0.5 ml SC at 9 months, as early as 6 months
Most sensitive to Heat – Oral polio vaccine, Measles
- Booster dose : 12 to 15 months old as MMR (Measles,
Mumps, Rubella)
- Transplacental maternal IgG interferes with antibody Least Sensitive to Heat – DPT vaccine, Hepa B, BCG, tetanus Toxoid
formation
MEASLES/MMR INFECTION CONTROL PROCEDURE

- First dose at 12 to 15 months Medical Asepsis

- Second dose between 4-6 y/o
- Mumps vaccine usually >15 months old given as MMR - CLEAN Technique
HEPATITIS B - Involves procedures and practices that reduce the number
and transfer of pathogens
- Infants born o HbsAg-positive mothers should receive HepB - Will exclude pathogens ONLY
vaccine (below 7 days) plus 0.5 ml Hepa B immunoglobulin Attain by:
(HBIG) within 12 hours of birth at 2 diff.sites
- 2nd dose is recommended at 1-2 months and 3rd dose at 6 - Frequent and thorough hand washing
months of age - Personal grooming
- Infants born to mothers whose HbsAg is unknown should - Proper cleaning of supplies and equipment
receive HepB vaccine within 12 hours of birth - Disinfection
Haemophilus Influenza type B (HIB) - Proper disposal of needles, contaminated materials and
infectious waste
- Old pure capsular polysaccharide vaccine effective for > 18 - Sterilization
months Surgical Asepsis
- HiB cause meningitis and serious respiratory infections in
<12 months STERILE technique
TYPHOID
- Practices used to render and keep objects and areas sterile
- Live oral Ty21A. Thermolabile given 3 doses at 2 days - Exclude ALL microorganism
interval and 25-95% effective for 3 years Attain by:
- Vi Antigen typhoid vaccine (Typhim Vi).capsular
polysaccharide of the organisms. Given 0.5 ml SC or IM with - Use strict aseptic precautions for invasive procedures
75% effectivity for 3 years - Scrub hands and fingernails before entering O.R.
HEPATITIS A - Use sterile gloves, masks, gowns and shoe covers
- Use sterile solutions and dressings
- Vaccine contains formaldehyde-inactivated Hep A containing - Use sterile drapes and create an sterile field
720 ELISA units - Heat –sterilized surgical instruments
- Given at 1 to 16 years of age at a dose of 0.5 ml IM or SC Universal Precautions
followed by a booster dose 6 to 12 months after
- Effectivity of 99% and side effects are mild and uncommon Universal Precautions
INFLUENZA
- Infection control guidelines designed to protect workers from
- Immunogenic, safe and associated with minimal side effects exposure to diseases spread by blood and certain body
- 6months to <36 months, 2 doses of vaccine 1 month apart fluids.
- Protection is 70 to 80% with range of 50 to 95%
- Duration or protection is <1 year
 - For prevention of transmission of blood-borne pathogens in Apply to selected patients based on a suspected or confirmed clinical
health care settings to prevent contact with patient blood and syndrome, a specific diagnosis, or colonization or infection with
body fluids epidemiologically important organisms
- Stress that all patients should be assumed to be infectious
for blood-borne diseases such as AIDS and hepatitis B. Always implemented in conjunction with standard precautions
- Universal Precautions
Followed when workers are exposed to blood and certain other body 3 types:
fluids, including:
- Airborne
- semen - Droplet
- vaginal secretions - Contact
- synovial fluid Airborne Precautions
- cerebrospinal fluid Droplet Precautions
- pleural fluid Contact Precautions
- peritoneal fluid
- pericardial fluid Airborne Precautions
- amniotic fluid
- Universal Precautions - Prevent transmission of diseases by droplet nuclei (particles
do not apply to: smaller than 5 µm) or dust particles containing the infectious
agent
- feces - Airborne Precautions
- nasal secretions - All persons entering the room of these patients must wear a
- sputum personal respirator that filters 1 µm particles with a n
- sweat efficiency of at least 95% (N95 mask)
- tears - Gowns and gloves are used as dictated by standard
- urine precautions
- vomitus 1. Disseminated zoster
- saliva (except in the dental setting, where saliva is likely to 2. Measles
be contaminated with blood) 3. Smallpox
Standard Precautions 4. SARS
5. Tuberculosis (pulmonary or laryngeal)
Standard Precautions 6. Varicella
7.
Replaced universal precautions
- Patient placed in a private room with monitored negative air
Apply to all patients pressure in relation to surrounding areas, and the room air
must undergo at least 6 exchanges per hour
Stipulate that gloves should be worn to touch any of the following: - Door to the isolation room must remain closed
- Air from the isolation room should be exhausted directly to
- blood the outside, away from air intakes, and not recirculated (high
efficiency filters may be used also)
- all body fluids - Cough etiquette
- Patients should be instructed to cover his/her mouth and
- secretions and excretions, except sweat, regardless of nose with tissue when coughing or sneezing
whether they are visibly bloody

- non-intact skin Droplet Precautions

- mucous membranes Prevent transmission by large-particle (droplet) aerosols

Standard Precautions
Gloves
- Prevent contamination of the hands with microorganisms
- Prevent exposure of the HCW to blood-borne pathogens
- Reduce the risk of transmission of microorganisms from the
hands of HCWs to the patient
- Do not replace the need for hand hygiene
Standard Precautions
Hands washed immediately after gloves are removed and between
patient contacts
- For procedures that are likely to generate splashes or sprays
of body fluid, a mask with eye protection or a face shield and
a gown should be worn
- Disposable gowns should be constructed of an impervious
material to prevent penetration and subsequent
contamination of the skin or clothing
Standard Precautions
- Needles should not be recapped, bent, or broken but should
be disposed of in puncture-resistant containers
Standard Precautions
Hand Hygiene
- Single most important means to prevent transmission of
nosocomial pathogens
- Removes the transient flora recently acquired by contact
with patients or environmental surfaces
- Alcohol-based hand rubs are recommended (if hands are
visibly soiled, washing with soap and water is
recommended)
- Ring removal prior to patient care
Transmission-Based Precautions
Transmission-Based Precautions
(unlike droplet nuclei, droplets are larger, do not remain suspended
in the air, and do not travel long distances)
Droplets are produced when the infected patient talks, coughs, or
sneezes and during some procedures (e.g., suctioning, bronchoscopy)
A susceptible host may become infected if the infectious droplets land
on the mucosal surfaces of the nose, mouth, or eye.
- Require patients to be placed in a private room, but no
special air handling is necessary (patients with same
disease can be placed in the same room if private rooms are
not available)
- Droplets do not travel long distances (generally no more
than 3 feet), the door to the room may remain open
- HCW should wear a standard surgical mask when working
within 3 feet of the patient
- Gowns and gloves should be worn by HCWs when dictated
by standard precautions
1. Diphtheria, pharyngeal
2. H. influenzae meningitis, epiglottitis, pneumonia
3. Influenza
4. Meningococcal infections
5. Multi-drug resistant pneumococcal disease
6. Mumps
7. Mycoplasma pneumonia
8. Parvovirus B19 infections
9. Pertussis
10. Plague, pneumonic
11. Rubella
12. Streptococcal pharyngitis
Contact Precautions
- Prevent the transmission of epidemiologically important
organisms from an infected or colonized patient through
direct contact (touching the patient) or indirect contact
(touching contaminated objects or surfaces in the patient’s
environment)
- Patients are placed in a private room or patients infected
with same organism may be placed in the same roo
 - Barrier precautions to prevent contamination should be
employed
- Gloves and Hand hygiene
- Gowns – worn if the HCW anticipates substantial contact of
his or her clothing with the patient or surfaces in the patient’s
environment or there is an increased risk of contact with
potentially infective material
- Noncritical patient care equipment should remain in the room
and not used for other patients, if items must be shared, they
should be cleaned and disinfected before reuse
- 7th – 10th day – Convalescent or recovery stage – after 3 days of
1. Acute diarrheal illnesses likely to be infectious in origin
2. Acute viral conjunctivitis
3. Clostridium difficile diarrhea
4. Ectoparasistic infections (lies and scabies)
5. HSV/Varicella/Disseminated zoster
6. MDR bacteria (MRSA, VRE, VISA, VRSA) infection or
colonization
7. SARS
8. Smallpox
9. Streptococcal (group A) major skin, burn or wound infection
10. Viral hemorrhagic fevers
ISOLATION OF PATIENTS
First 4 days – Febrile or Invasive stage – high grade fever, headache,
body malaise, conjuctival injection, vomitting, epistaxis or gum
bleeding, positive tornique test.
4th – 7th day – Toxic or Hemorrhagic Stage – After the lyze of the
fever, this is were the complication of dengue is expected to come out
as manifested by abdominal pain, melena, indicating bleeding in the
upper gastrointestinal tract, Unstable BP, narrow pulse pressure and
shock.
afebrile stage and the patient was properly hydrated and monitored BP
will become stable and laboratory values of platelet count and bleeding
parameters will begin to normalize.
Classification of Dengue Fever according to severity
1. Grade I – Dengue fever, saddleback fever plus constitutional
signs and symptoms plus positive tornique test
2. Grade II – Stage I plus spontaneous bleeding, epistaxis, GI,
cutaneous bleeding
3. Grade III – Dengue Shock Syndrome, all of the following
signs and symptoms plus evidence of circulatory failure
4. Grade IV – Grade III plus irreversible shock and massive
bleeding

Source Isolation
Diagnostics
Reverse Isolation
Tournique test or Rumpel Leede Test – presumptive test for capillary
- Protective or neutropenic isolation fragility
- Used for patients with severe burns, leukemia, transplant,
immuno deficient persons, receiving radiation treatment, - keep cuff inflated for 6-10 mins (child), 10-15 min (adults)
leukopenic patients - count the petechiae formation 1 sq inch (>10-15
- Those that enter the room must wear masks and sterile petechiae/sq inch)
gowns to prevent from introducing microorganisms to the
room
Laboratory Procedures

- CBC
AFB ISOLATION - Bleeding Parameters
- Serologic test
- Dengue blot, Dengue Igm
- VISITORS - report to nurses’ station before entering the - Other :
room - PT (Prothrombin Time)
- APTT (Activated Partial Thromboplastin Time)
- MASKS – worn in patients room - Bleeding time
- Coagulation time
- GOWNS – prevent clothing contamination

- GLOVES – for body fluids and non intact skin Mgmt: symptomatic and supportive

- HANDWASHING - after touching patient or potentially Management

contaminated articles and after removing gloves
- Specific Therapy – none
- articles discarded, cleaned or sent for decontamination and - Symptomatic/Supportive therapy
reprocessing - Intravenous Fluids (IVF)
- with hemoconcentration, 5-7 ml/kg/hr
- room remains closed - with shock, 10-30ml/kg in <20mins
- Use of Blood/Blood Products
- patients wear masks during transport - Platelet concentrate 1 unit/5-7kg
- Cryoprecipitate, 1unit/5kg
Personal Protective Equipment - FFP, 15ml/kg x 2-4hrs
- given in patient in impending shock and unresponsive
- mask to isotonic or colloid transfusion.
- gloves - Prolonged PT
- gown - FWB 20cc/kg
- shoe cover - active bleeding
- goggles - check serum calcium
- PRBC 10cc/kg

BLOOD/VECTOR BORNE DISEASES

Nursing Intervention
Prevention
- Paracetamol (no aspirin)
Eradicate the source DOH CLEAN - Giving of cytoprotectors
- Gastric Lavage
- C – chemically treated mosquito net - trendelenberg position for shock
- L - larvae eating fish - Nasal packing with epinephrine
- E – environmental sanitation - No intramuscular injections
- A – anti-mosquito - manage anxiety of patient and family
- N – neem tree (oregano, eucalyptus)
Dengue Hemorrhagic Fever
Preventive measures
- caused by dengue virus (Flaviviridae) with 4 serotypes
- transmitted to a bite of female aedes aegypti mosquito Department of Health program for the control of Dengue
- incubation period 2-7 days Hemorrhagic Fever
- Vectors: (day biting)
- Aedes aegypti (breeds in water stored in houses) S eek and destroy breeding places
- Aedes albopictus
- Culex fatigans S ay no to left and right defogging
Clinical manifestation
S eek early consultation

Leptosiprosis (Weil’s disease)

FILARIASIS a zoonotic systemic infection caused by Leptospires, that penetrate

intact and abraded skin through exposure to water, wet soil
- The disease often progresses to become chronic, debilitating contaminated with urine of infected animals.
and disfiguring disease since it’s symptoms are unnoticed or
unfamiliar to health workers.
- High rates in region 5(bicol), 8 (samar and leyte, II (davao)
- Wuchereria bancrofti and Bulgaria malayi Anicteric Type (without jaundice)
- Transmitted to the bite of infected female mosquito (Aedes,
Anopheles, Mansonia) manifested by fever, conjunctival injection
- The larvae are carried in the blood stream and lodged in
lymphatic vessels and lymph glands where they mature in signs of meningeal irritation
adult form

Two biological type Icteric Type (Weil Syndrome)

Nocturnal Hepatic and renal manifestation

microfilaria circulate in peripheral blood at night (10pm – 2am) Jaundice, hepatomegally

Diurnal Oliguris, anuria which prigress to renal failure

microfilaria circulate in greater concentration at daytime Shock, coma, CHF

Convalescent Period

Clinical Manifestation

Acute stage Diagnosis

- filarial fever and lymphatic inflammation tha occurs frequently as 10 Clinical history and manifestation
times per year and usually abates spontaneously after 7 days
Culture
- Lymphadenitis (Inflammation of the lymphnodes)
Blood: during the 1st week
- Lymphangitis (Inflammation of the lymph vessels)
CSF: from the 5th to the 12th day
Chronic Stage (10-15 years from the onset of the first attack)
Urine: after the 1st week until convalescent period
- Hydrocele (Swelling of the scotum)
LAAT (Leptospira Agglutination Test)
- Lymphedema (Temporary swelling of the upper and lower
extremities) other laboratory
- Elephantiasis (enlargement and thickening of the skin of the lower or BUN,CREA, liver enzymes
upper extremities)

Treatment
Laboratory Diagnosis
Specific
- Blood smear – presence of microfilaria
- Immunochromatographic Test (ICT)
Penicillin 50000 units/kg/day
- Eosinophil count
Tetracycline 20-40mg/kg/day
Management Guidelines
Non-specific
- Specific Therapy
- Dietylcarbamazine (DEC) 6mg/KBW in divided doses for 12 Supportive and symptomatic
consecutive days
- Ivermectine (Mectican) Administration of fluids
- Supportive Therapy
- Paracetamol Peritoneal dialysis for renal failure
- Antihistamine for allergic reaction due to DEC
- Vitamin B complex Educate public regarding the mode of transmission, avoid swimming or
- Elevation of infected limb, elastic stocking wadding in potentially contaminated waters and use proper protective
equipment.

DEC should be taken immediately after meals

It may cause loss of vision, night blindness, or tunnel vision with Nursing Responsibilities
prolonged used.
1. Dispose and isolate urine of patient.
Ivermectin is best taken as single dose with a full glass of water in en
empty stomach. 2. Environmental sanitation like cleaning the esteros or dirty places
with stagnant water, eradication of rats and avoidance of wading or
Cannot be used in patient with asthma bathing in contaminated pools of water.

3. Give supportive and asymptomatic therapy

Preventive Measures 4. Administration of fluids and electrolytes.

Health teachings 5. Assist in peritoneal dialysis for renal failure patient (The most
important sign of renal failure is presence of oliguria.)
Environmental Sanitation
MALARIA
 - Malaria Treatment for P. Vivax
- “King of the Tropical Disease”
- an acute and chronic infection caused by protozoa 1. Choloroquine, Day 1,2,3 (4,4,2)
plasmodia 2. Primaquine 1 tab OD for 14 days
- Infectious but not contagious
- transmitted through the bite of female anopheles mosquito
- Malaria Exacts Heavy Toll in Africa Treatment for mixed
- Malaria
- There are 300-500m new cases annually - chloroquine (4,4,2)
- Over 1m die every year – almost 3000 per day - Sulfadoxine/Pyrimethamine 3 tabs once
- 90% of deaths are in Sub-Saharan Africa - Primaquine 1 tab for 14 days
- Cost of malaria in Africa is $100bn
- Vector: (night biting)
- anopheles mosquito Multi-drug resistant P. Falciparum
- or minimus flavire
Life cycle: quinine plus doxycycline, or tetracycline and primaquine
- Sexual cycle/sporogony (mosquito) Complications
- sporozoites injected into humans
- Asexual cycle/schizogony (human)
- severe anemia
- gametes is the infective stage taken up by biting mosquito
- cerebral malaria
Plasmodium Vivax
- hypoglycemia
- more widely distributed
- causes benign tertian malaria
Prevention and Control
- chills and fever every 48 hours in 3 days
Plasmodium Falciparum
- Eliminate anopheles mosquito vectors
- Advise travelers
- common in the Philippines
- limit dusk to dawn outdoor exposure
- Causes the most serious type of malaria because of high
- insect repellant, nets
parasitic densities in blood.
- Causes malignant tertian malaria
Plasmodium malaria
Nursing Care
- much less frequent
- causes quartan malaria, fever and chills every 72 hrs in 4 1. Consider a patient with cerebral malaria to be an emergency
days
- Plasmodium Ovale - Administer IV quinine as IV infusion
- rarely seen.
Pathology - Watch for neurologic toxicity from quinine transfusion like delirium,
confusion, convulsion and coma
- the most characteristic pathology of malaria is destruction of
red blood cells, hypertrophy of the spleen and liver and 2. Watch for jaundice – this is related to the density of the falciparum
pigmentation of organs. parasitemia,
- The pigmentation is due to the phagocytocis of malarial
pigments released into the blood stream upon rupture of red 3. Evaluate degree of anemia
cells
Clinical Manifestation 4. Watch for abnormal bleeding that are may be due to decrease
production of clotting factors by damage liver.
uncomplicated
Chemoprophylaxis
- fever, chills, sweating every 24 – 36 hrs
Complicated - doxycycline 100mg/tab, 2-3 days prior to travel, continue up
to 4 weeks upon leaving the area
- sporulation or segmentation and rupture of erythrocytes - Mefloquine 250mg/tab, 1 week before travel, continue up to
occurs in the brain and visceral organs. four weeks upon leaving the area
- Cerebral malaria - Pregnant, 1st trimester, chloroquine, 2 tabs weekly, 2 weeks
- changes of sensorium, severe headache and vomiting before travel, during stay and until 4 weeks after leaving
- seizures - 2nd and 3rd trimester, Pyrimethamine-sulfadoxine

clinical manifestation Category of provinces

1. Cold stage – 10-15 mins, chills, shakes Category A – no significant improvement in malaria for the past 10
2. hot stage – 4-6 hours, recurring high grade fever, severe years. >1000
headache, vomitting, abdominal pain, face is blue
3. Diaphoretic Stage – excessive sweating - Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao, kalinga

Category B - <1000/year
Diagnosis
- Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan, zambales,
- Malarial smear bataan, laguna
- Quantitative Buffy Coat (QBC)
Travel in endemic areas Category C – significant reduction

Treatment: -pampanga, la union, batangas, cavite, albay

Determine the species of parasite

Objectives of treatment CENTRAL NERVOUS SYSTEM DISEASES

1. Destroy all sexual forms of parasite to cure the clinical attack Inflammation of the meniges
2. Destroy the excerythrocytes (EE) to prevent relapse
3. Destroy gametocytes to prevent mosquito infections Caused by bacterial pathogen, N. menigitidis, H. Influenza, Strep.
Pneumoniae, Mycobacterium Tuberculosis

Treatment for P. Falciparum PATHOLOGY

1. chloroquine tablet (150mg/base/tab) Day 1,2,3 (4,4,2) Primary – spread of bacteria from the bloodstream to the meniges
2. Sulfadoxine/Pyrimethamine 500mg/25mg/tab, 3tab single
dose Secondary – results from direct spread of infection from other sources
3. Primaquine (15mg/tab) 3 tabs single dose or focus of infection.
 - Check signs of dehydration

The disease usually begins as an infection by normal body flora, of: Prevent Spread of the disease

1. The ear (otitis media) - Haemophilus influenzae - Having proper disposal of secretions

2. The lung (lobar pneumoniae) - Streptococcus pneumoniae - Emphasize the importance of masking

3. The upper respiratory tract (rhinopharyngitis) - Neisseria - Explain the importance of isolation
meningitidis, Haemophilus
influenzae, Streptococcus, Group B Ensure patient’s full recovery

4 The skin and subcutaneous tissue (furunculosis) S. aureus - Maintain side rails up in episodes of siezures

5. The bone (osteomyelitis) - S. aureus - Prevent sudden jar of bed

6. The intestine - E. coli - Keep patient in a dark room and complete physical rest

Clinical manifestation - Diversional activities and passive exercises

- Fever
- Rapid pulse, respiratory arrythmia
- Soreness of skin and muscles MENINGOCOCCEMIA
- Convulsion/seizures
- headache - caused by Neisseria meningitides, a gram negative
- irritability diplococcus
- fever - transmitted through airborne or close contact
- neck stiffness - incubation is 1-3 days
- pathologic reflexes: kernig’s, Babinski, Brudzinski - natural reservoir is human nasopharynx

Diagnosis Clinical Manifestation

- Lumbar puncture sudden onset of high grade fever, rash and rapid deterioration of
- Blood C/S clinical condition within 24 hours
- other laboratories
S/sx:
umbar Puncture 1. Meningococcemia – spiking fever, chills, arthralgia, sudden
appearance of hemorrhagic rash
- To obtain specimen of CSF
- To reduce ICP 2. Fulminant Meningococcemia (Waterhouse Friderichsen) –
- To Introduce medication septic shock; hypotension, tachycardia, enlarging petecchial
- To inject anesthetic rash, adrenal insufficiency

Laboratory
CSF Examination
- Blood Culture
- Fluid is turbid/purulent >1000cc/mm cells - Gram stain of peripheral smear, CSF and skin lesions
- WBC count increase - CBC
- Sugar content markedly reduced Treatment:
- CHON increased
- Presence of microorganism
antimicrobial

- Benzyl Penicillin 250-400000 u/kg/day

- Treatment - Chloramphenicol 100mg/kg/day
Bacterial meningitis Symptomatic and supportive
- TB meningitis
- Intensive Phase
- fever
- Maintainance Phase
- seizures
- Fungal meningitis
- hydration
- cryptococcal meningitis – fluconazole or amphotericin B
- respiratory function
2. Supportive/Symptomatic

a. Antipyretic
Chemoprophylaxis
b. treat signs of increased ICP
1. Rifampicin 300-600mg q 12hrs x 4 doses
2. Ofloxacin 400mg single dose
c. Control of seizures 3. Ceftriaxone 125-250mg IM single dose
d. adequate nutrition
Nursing Intervention
Nursing Intervention
- Provide strict isolation
Prevent occurrence of further complication - Wearing of PPE
- Health teaching
- Maintain strict aseptic technique when doing dressing or - Contact tracing
lumbar puncture. - Prophylaxis
- Meninggococcal vaccine for high risk patient
- Early symptom should be recognize

- Vital signs monitoring RABIES

- Observe signs of increase ICP - acute viral encephalomyelitis

- incubation period is 4 days up to 19 years
- Protect eyes from light and noises - risk of developing rabies, face bite 60%, upper extremities
15-40%, lower extremities 10%
Maintain normal amount of fluid and electrolyte balance - 100% fatal

- Note and record the amount of vomitus

Clinical Manifestation
 - pain or numbness at the site of bite 2. Pre-paralytic stage - flaccid asymetrical ascending paralysis
- fear of water (Landry’s sign), Hayne’s sign (head drop), Pofer’s sign (opisthotonus)
- fear of air
3. Paralytic stage

4 STAGES bulbar or spinal

1. prodrome - fever, headache, paresthesia, Mode of Transmission

2. encephalitic – excessive motor activity, hypersensitivity to - Droplet infection – in early infection

bright light, loud noise, - Body secretions – nasopharyngeal
- Fecal oral – during late stage
hypersalivation, dilated pupils - Flies may act as mechanical vectors

3. brainstem dysfunction – dysphagia,

hydrophobia, apnea B. I – Abortive or inapparent
C. II – Meningitis (non-paralytic)
4. death D. III – Paralytic (anterior horn of spinal cord)
E. IV – Bulbar (encephalitis)

Diagnosis Dx: Pandy’s test - CSF (increased CHON)

- FAT (fluorescent antibody test) MGMT:

- Clinical history and signs and symptoms
Active – OPV (Sabin) and IPV (Salk)

Management Immunity is acquired for 3 strains

- No treatment for clinical rabies A. Legio brunhilde (fatal)

- Prophylaxis B. Legio lansing
C. Legio leon

Postexposure prophylaxis
Respiratory distress

A. Respirator
A. Active vaccine (PDEV,PCEC,PVRV) B. Tracheostomy – life saving procedure when
Intradermal (0,3,7,30,90) respiratory failure and inability to swallow are not
corrected
Intramuscular (0,3,7,14,28) C. Oxygen therapy
D. Rehabilitation
(0,7,21)

B. Passive Vaccine SNAKEBITE

a. ERIG wt in kg x .2 = cc to be injected im (ANST) Management

b. HRIG wt in Kg x .1333 - Lie the victim flat

- ice compress and constrictives materials are
contraindicated
- Transport the patient to the nearest hospital
- Antivenim administration in patient’s with signs of
Pre-exposure Prophylaxis
envenomation
- It is never too late to give anti-venim
Intradermal/Intramuscular (0,7,21) - Antivenim is given thru intravenous infusion, which is
the safest and most effective route. 2-5 ampules plus
D5W to run iver 1-2 hours every 2 hours
- Antimicrobial therapy
Infection control - sulbactam/Ampicillin or co-amoxiclav
- Substitute
- Patient is isolated to prevent exposure of hospital personnel, - Prostigmine IVinfusion, 50-100ug/kg/dose q 8hrs
watchers and visitors - Atropine
- PPE
- Preventive Measures
- Education TETANUS
- Post-exposure and Pre-exposure Prophylaxis
- caused by Clostridium tetani, grows anaeronically
- Tetanus spores are introduced into the wound contaminated
Poliomyelitis with soil.
- Incubation period 4-21 days
- RNA, Polio virus
- Fecal oral route/droplets
- IP 7-12 days Clinical manifestation
- Disease of the lower motor neurin involving the anterior horn
cells - Difficulty of opening the mouth (trismus or lockjaw)
- Infantile paralysis; Helne-Medin disease - Risus sardonicus
Predisposing Factors - Abdominal rigidity
- Localized or generalized muscle spasm
- Children below 10 years old
- Male more often affected
- Poor environmental and hygienic conditions Treatment
Causative Agent: Legio debilitans
1. Neutralize the toxin
- Brunhilde (permanent)
- Lansing and Leon (temporary) 2. Kill the microorganism
- May exist in contaminated water, sewage and milk
S/sx: disease manifestations:
3. Prevent and control the spasm
1. mild febrile illness – fever, malaise, sore throat (abortive stage)
- muscle relaxants
- Sedatives - Occurs more common in may to august

- Tranquilizers
MOT: oral fecal route
4. Tracheostomy
- S/sx: Rose spot (abdominal rashes), more than 7days Step
ladder fever 40-41 deg, headache, abdominal pain,
constipation (adults), mild diarrhea (children)
Treatment:

anti-toxin Diagnosis

Tetanus Anti-Toxin (TAT) Blood examination WBC usually leukopenia with lymphocytosis

- Adult,children,infant 40,000 IU ½ IM,1/2 IV Isolation

- Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
TIG - Blood culture 1st week\

- Neonates 1000 IU, IV drip or IM - Urine culture 2nd week

- Adult, infant, children 3000 IU, IV drip or IM
Antimicrobial Therapy - Stool culture 3rd week

Penicillin !-3 mil units q 4hours - Widal test O or H

- 1st week step ladder fever (BLOOD)
Pedia 500000 – 2mil units q 4 hrs - 2nd week rose spot and fastidial
- typhoid psychosis (URINE & STOOL)
Neonatal 200000 units IVP q 12hrs or q8hrs

Control of spasms Mgmt: Chloramphenicol, Amoxicillin, Sulfonamides,

Ciprofloxacin, Ceftriaxone
- diazepam
- chlorpromazine
Nursing care
Watch for complication
- Patient should be in a quiet, darkened room, well ventilated.
- Minimal/gentle handling of patient a. Perforation – symptoms of sharp abdominal pain,
- Liquid diet via NGT abdominal rigidity and absent of bowel sounds.
- Prevent Injury
- Preventive Measures - prepare for intestinal decompression or surgical intervention
- Treatment of wounds
- Tetanus toxoid (0,1,6,1,1) b. Intestinal hemorrhage - withold food and give blood
transfusion

HEPATO-ENTERIC DISEASES Nursing Interventions

SCHISTOSOMIASIS - Environmental Sanitation

- Food handlers sanitation permit
- caused by blood flukes, Schistosoma - Supportive therapy
- has 3 species, S. haematobium, S. Mansoni, S. japonicum - Assessment of complication (occuring on the 2nd to 3rd week
- S. japonicum is endemic in the Philippines (leyte, Samar, of infection )
Sorsogon, Mindoro,Bohol) - typhoid psychosis, typhoid meningitis
- Intermediate host, Oncomelania Quadrasi - typhoid ileitis

DIAGNOSIS Hepatitis

- Schistosoma eggs in stool - Hepa A – fecal oral route

- Rectal bipsy - Hepa B – body fluids
- Kato Katz - Hepa C – non A non B, BT, body fluids
- Ultrasound of HBT - Hepa D – hypodermic, body fluids
- Hepa E – fecal oral route, fatal and common among
pregnant women
Clinical Manifestation - Hepa G – BT, parenteral

- severe jaundice
- edema Hepatitis A
- ascites
- hepatosplenomegally - Infectious hepatitis, epidemic hepatitis
- S/S of portal hypertention - Young people especially school children are most commonly
affected.
- Predisposing factors:
Management - Poor sanitation, contaminated water supply, unsanitary
preparation of food, malnutrition, disaster conditions
- Praziquantrel 60mg/kg Once dosing
- Supportive and sympromatic
Incubation Period: 15-50 days

Methods of Control Signs/Symptoms:

- Educate the public regarding the mode of transmission and - Influenza

methods of protection.
- Proper disposal of feces and urine - Malaise and easy fatigability
- Prevent exposure to contaminated water. To minimize
penetration after accidental water exposure, towel dry and - Anorexia and abdominal discomfort
apply 70% alcohol.
The organism is pathogenic only in man - Nausea and vomiting

TYPHOID FEV ER - Fever, CLAD

- Spread chiefly by carriers, ingestion of infected foods - jaundice

- Endemic particularly in areas of low sanitation levels
 o HBcAg = found only in the liver cells
- (+) Anti-HBc = acute infection
Dx: Anti HAV IgM – active infection - (+) Anti-HBe = reduced infectiousness
- (+) Anti-HBs = with antibodies (FROM vaccine or
Anti HAV IgG – old infection; no active disease disease)
- Blood Chem. Analysis (to monitor progression)
Management: - Liver biopsy (to detect progression to CA)

- Prophylaxis
Mgmt:
- Complete bed rest
- Prevention of spread – Immunization and Health Education
- Low fat diet but high sugar - Enteric and Universal precautions
- Assess LOC
- Ensure safe water for drinking - Bed rest
- ADEK deficiency intervention
- Sanitary method in preparing handling and serving of food.
- Proper disposal of feces and urine. - High CHO, Moderate CHON, Low fat
- Washing hands before eating and after toilet use. - FVE prevention
- Separate and proper cleaning of articles used by patient
Cx:
Hepatitis B
1. Fulminant Hepatitis – s/sx of encephalopathy
- DNA, Hepa B virus
- Serum hepa 2. Chronic Hepatitis - lack of complete resolution of clinical sx and
- Worldwide distribution persistence of hepatomegaly
- Main cause of liver cirrhosis and liver cancer
3. HBsAg carrier

IP: 2-5 months ERUPTIVE FEVER

Mode of Transmission MEASLES

- From person to person through - Extremely contagious

- contact with infected blood through broken skin and mucous - Breastfed babies of mothers have 3 months immunity for
membrane measles
- sexual contact - The most common complication is otitis media
- sharing of personal items - The most serious complications are bronchopneumonia and
- Parenteral transmission through encephalitis
- blood and blood products
- use of contaminated materials
- Perinatal transmission Measles, Rubeola, 7 Day Fever, Hard Red Measles
High Risk group
- RNA, Paramyxoviridae
- Newborns and infants of infected mothers - Active MMR and Measles vaccine
- Health workers exposed to handling blood - Passive Measles immune globulin
- Persons requiring frequent transfusions - Lifetime Immunity
- Sexually promiscuous individuals - IP: 7-14 days
- Commercial sex workers
- Drug addicts
MOT: droplets, airborne

Possible Outcome - *Contagious 4 days before rash and 4 days after rash

- Most get well completely and develop life long immunity.

- Some become carriers of the virus and transmit disease to Clinical Manifestation
others.
- Almost 90% of infected newborns become carriers Pre eruptive stage

- Patient is highly communicable

Hepatitis C
- 4 characteristic features
- Post transfusion Hepatitis
- Mode of transmission – percutaneous, BT A. Coryza
- Predisposing factors – paramedical teams and blood B. Conjunctivitis
recepients C. Photophobia
- Incubation period – 2weeks – 6 months D. Cough
- Koplik’s spots
- Stmsons line
Hepatitis D

- Dormant type Eruptive stage

- Can be acquired only if with hepatitis B
- Maculopapular rashes appears first on the hairline, forehead,
post auricular area the spread to the extremities
Hepatitis E (cephalocaudal)

- If hepatitis E recurs at age 20-30, it can lead to cancer of the - Rashes are too hot to touch and dry
liver
- Enteric hepatitis - High grade fever and increases steadily at the height of the
- Fecal-oral route rashes

Stage of convalescence
DX:
- Rashes fade in the same manner leaving a dirty brownish
- Elevated AST or SGPT (specific) and ALT or SGOT pigmentation (desquamation)
- Increased IgM during acute phase
- (+) or REACTIVE HBsAg = INFECTED, may be acute, - Black measles – severe form of measles with hemorrhagic
chronic or carrier rashes, epistaxis and melena
- (+) HBeAg = highly infectious
- ALT – 1st to increase in liver damage
Rashes: maculopapaular, cephalocaudal (hairline and behind the ears - S/sx:
to trunk and limbs), confluent, desquamation, pruritus fever, malaise, headache
- Rashes: Maculopapulovesicular (covered areas),
Complication Centrifugal, starts on face and trunk and spreads to entire
body
- Bronchopneumonia - Leaves a pitted scar (pockmark)
- Secondary infections - CX furunculosis, erysipelas, meningoencephalitis
- Encephalitis - Dormant: remain at the dorsal root ganglion and may recur
- Increase predisposition to TB as shingles (VZV)

MANAGEMENT Mgmt:

1. Supportive a. oral acyclovir

2. Hydration b. Tepid water and wet compresses for pruritus

3. Proper nutrition c. Aluminum acetate soak for VZV

4. Vitamin A d. Potassium Permanganate (ABO)

5. Antibiotics a. Astringent effect

6. Vaccine b. Bactericidal effect

Nursing Care c. Oxidizing effect (deodorize the rash)

- Respiratory precautions Small Pox, Variola

- Restrict to quite environment
- Dim light if photophobia is present - DNA, Pox virus
- Administer antipyretic - Last case 1977
- Use cool mist vaporizer for cough - spreads from man-to-man only
- Active: Vaccinia pox virus
- IP: 1-3 weeks
German Measles (rubella) S/sx:

- Acute infection caused by rubella virus characterized by - Rashes:

fever, exanthem and retroauricular adenopathy. - Maculopapulovesiculopustular
- Has a teratogenic potential on the fetuse of women in the 1st - Centripetal
trimester - contagious until all crusts disappeared
s/sx: Dx:

- forschheimer’s (petecchial lesion on buccal cavity or soft - Paul’s test - instilling of vesicular fluid w/ small pox into the
palate), cornea; if keratitis develops, small pox
- cervical lymphadenopathy, low grade fever - Cx: same with chicken pox
- “ Oval, rose red papules about the size of pinhead

KAWASAKI DISEASE
Dx: clinical
- Mucocutaneous lymph node syndrome
CX: rare; pneumonia, meningoencephalitis - Children younger than 5 years old are primarily affected.
- Associated with large coronary blood vessel vasculitits
CX to pregnant women: - A febrile, exanthematous, multisystem illness characterized
by
- 1st tri-congenital anomalies o Acute febrile phase manifested by high spiking
- 2nd tri-abortion fever, rash, adenopathy, peripheral edema,
- 3rd tri-pre mature delivery conjunctivitis and exanthem
Rashes: Maculopapular, Diffuse/not confluent, No desquamation, o sub acute phase, thrombocytosis, desquamation
spreads from the face downwards and resolution of fever.
o Convalescent stage
Manifestations

Roseola Infantum, - bilateral, non purulent conjuctivitis

Exanthem Subitum, Sixth disease - congested oropharynx, strawberry tongue, erythematous
lymphs
- erythematous palms/soles, edematous hands/feet
- Human herpes virus 6
- periungal desquamation, truncal rash
- 3mos-4 yo, peak 6-24 mos
- CLADP ( 1node >1.5cm)
- MOT: probably respiratory secretions
S/sx:

Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear
after fever subsides, Mild pharyngitis and lymph node enlargement
Diagnosis

- CBC: leukocytosis
- Platelet count >400000
Chicken Pox, Varicella
- 2D echo (if coronary artery involvement is highly suggestive
- ESR and CRP elevated
- Herpes zoster virus (shingles),
varicella zoster virus(chocken pox)
- Active : Varicella vaccine
Management
- Passive: VZIG, ZIG – given 72-96 hrs
w/n exposure
- Lifetime Immunity - IV Gamma globulin – 2g/kg as single dose for 10-12 hours.
Effective to prevent coronary vascular damage if given within
- IP: 14-21 days
10 days of onset.
- Salicylates: 80-100mg/kg/24 hours in 4 divided doses
- Symptomatic and supportive therapy
MOT: Respiratory route

* Contagious 1 day before rash and 6 days after first crop of vesicles
Respiratory System

Mumps
 - RNA, Mumps virus B. Kill the microorganism – penicillin
- Mumps vaccine - > 1yo C. Prevent respiratory obstruction – tracheostomy, intubation
- MMR – 15 mos
- Lifetime Immunity
- IP: 12-16 days Treatment
- MOT: Droplet, saliva, fomites
Serum therapy (Diptheria antitoxin)

S/sx: Unilateral or bilateral - early administration aimed at neutralizing the toxin present in the
general circulation
- parotitis, Orchitis - sterility if bilateral,
- Oophoritis, Stimulating food cause severe pain, aseptic Antibiotics
meningitis
- Dx: serologic testing, ELISA - Penicillin G 100000mg/kg.day

- Erythromycin 40mg/kg
Mgmt: supportive
Nursing Intervention
Nursing care
- Rest.
- Respiratory precautions - Patient should be confined to bed for at least 2 weeks
- Bed rest until the parotid gland swelling subsides - Prevent straining on defecation
- Avoid foods that require Chewing - vomiting is very exhausting, do not do procedures that may
- Apply hot or cold compress cause nausea
- To relieve orchitis, apply warmth and local support with tight - Care for the nose and throat
fitting underpants - Ice collar to reduce the pain of sorethroat
Diptheria - Soft and liquid diet

- Acute contagious disease

- Characterized by generalized systemic toxemia from a Whooping Cough, 100 day fever
localized inflammatory focus
- Infants immune for 6 months of life Bordetella pertussis, B. parapertussis, B. bronchiseptica, gram (-)
- Produces exotoxin
- Capable of damaging muscles especially cardiac, nerve, IP: 3-21 days
kidney and liver
- Increase incidence prevalence during cooler months
MOT: airborne/droplet
- Mainly a disease of childhood with peak at 2-5 years,
uncommon in >6months
Signs and symptoms

Corynebacterium diphtheriae, gram (+), slender, curved clubbed
organism “Klebs-Loeffler Bacillus”
IP: 2-6 days
Mode of transmission is direct or indirect contact
1. Nasal – invades nose by extension from pharynx
2. Pharygeal
- Invasion or catarrhal stage (7-14days) starts with ordinary
cough
- Spasmodic or paroxysmal
- 5-10 spasms of explosive cough (no time to catch breath. A
peculiar inspiratory crowing sound followed by prolonged
expiration and a sudden noisy inspiration with a long high
pitched “whoop”
- During attack the child becomes cyanotic and the eyes
appear to bulge or popping out of the eyeball and tongue
protrudes

- sorethroat causing dysphagia Diagnosis

- Pseudomembrane in uvula, tonsils, soft palate - WBC count 20000-50000

- Culture with Bordet Gengou Agar
- Bullneck – inflammation of cervical LN

3. Laryngeal Treatment

- increasing hoarseness until aphonia - Erythromycin shorten the period of communicability

- Ampicillin if with allergy to erythromycin
- wheezing on expiration - Heperimmune pertusis gamma globulin in <2 years old
(1.25ml IM)
- dyspnea - Control of cough with sedatives

Diagnosis
Dx: WHO - >21 days cough + close contact w/ pertussis px + (+)
- Nose and throat swab using loeffler’s medium culture OR rise in Ab to FHA or pertussis toxin
- Schick test – determine susceptibility or immunity in diptheria
- Maloney test – determines hypersensitivity to diptheria * throat culture w/ Bordet gengou agar
toxoid
Management

Complications - CBR to conserve energy

- Prevent aspiration
Toxic myocarditis – due to action of toxin in the heart muscles (1 10-
st
- High calorie, bland diet
14 days) - Omit milk and milk product because it increases the mucous
- Refeeding of infants 20 min after vomitting
Neuritis caused by absorption of toxin in the nerve - Milk should be given at room temperature

- Palate paralysis (2nd week)

complications
- Ocular palsy (5th week)
- Bronchopneumonia
- Diapgram paralysis (6-10wk causing GBS) - Abdominal hernia
- Severe malnutrition
- Motor and skeletal muscle paralysis - TB, asthma
- encephalitis
Treatment

A. Neutralize the toxins – antidiptheria serum Pre exposure prophylaxis for Diphtheria, Pertussis, Tetanus
DPT- 0.5 ml IM long course – 9-12 months

- 1 - 1 ½ months old Follow-up

2 - after 4 weeks
3 - after 4 weeks  2 wks after medications – non communicable
- 1st booster – 18 mos o 3 successive (-) sputum - non communicable
- 2nd booster – 4-6 yo o rifampicin - prophylactic
- subsequent booster – every 10 yrs thereafter

MDT side effects

Infectious Mononucleosis
 r-orange urine
- Epstein Barr virus  i-neuritis and hepatitis
- Inc. period: 4-6 weeks  p-hyperuricemia
- Communication period: Unknown, virus is shed before the  e-impairment of vision
onset of the dse until 6 months or longer after recovery
 s-8th cranial nerve damage
- Source: oral secretions Methods of Control
- Transmission: Direct intimate contact, infected blood
 Prompt treatment and diagnosis
 BCG vaccination
Assessment
 Educate the public in mode of transmission and importance
of early diagnosid
- Fever, sorethroat, malaise, headache, fatigue, nausea,
abdominal pain  Improve social condition

- CLADP, hepatosplenomegally
Pneumonia
Nursing care
1. Community acquired
- Supportive
- Monitor signs of splenic rupture, which include abdominal
pain, left upper quadrant pain or left shoulder pain Typical– Strep. Pneumoniae, H. Influenzae type B

Atypical Pneumonia – S. Aureus, M. Pneumoniae, L. Pneumophila, P.

PULMONARY TUBERCULOSIS Cariini

- The world’s deadliest disease and remains as a major public 2. Nosocomial – Pseudomonas, S. Aureus
health problem.
- Badly nourished, neglected and fatigued individuals are MOT: aspiration, inhalation, hematogenous, direct inoculation,
more prone contiguous spread
- Susceptibility is highest in children under 3 years
- AKA: Koch’s disease: Galloping consumption CHILDHOOD PNEUMONIA

1. No pneumonia
S/sx:
- infant, 60/min and no chest indrawing
- Wt loss
- night sweats 2. Pneumonia
- low fever,
- non productive to productive cough - young infant >60/min, fast breathing without chest indrawing
- anorexia,
- Pleural effusion and hypoxemia 3. Severe pneumonia
- cervical lymphadenopathy
- fast breathing, severe chest indrawing, with one of danger signs

PPD – ID 4. Very severe pneumonia

- macrophages in skin take up Ag and deliver it to T cells - below 2 mos old, fast breathing, chest indrawing, with danger signs
- T cells move to skin site, release lymphokines
- activate macrophages and in 48-72 hrs, skin becomes 4 Danger Signs
indurated
- > 10 mm is (+) 1. Vomits
Dx:
2. Convulsion
- Chest xray - cavitary lesion
- Sputum exam 3. Drowsiness/lethargy
- sputum culture
4. Difficulty of swallowing or feeding
The National Tuberculosis Control Program
S/sx:
- Vision: A country where TB is no longer a public health
1. Typical – sudden onset Fever of > 38 x 7-10 days,
problem.
productive cough, pleuritic chest pain, dullness,
- Mission: Ensure that TB DOTS services are available to the
inc fremitus, rales
communities.
- Goal: To reduce the prevalence and mortality from TB by
2. Atypical – gradual onset, dry cough, headache, myalgia,
half by the year 2015
sore throat

Watch out for complications; In 24 hours death will occur from

Targets:
respiratory failure
1. To cure at least 85% of the sputum smear positive TB
patient discovered.
Nursing Diagnosis
2. Detect at least 70% of the estimated new sputum smear
positive TB cases.
 Ineffective airway clearance
Mgmt:  Ineffective breathing pattern
 Impaired gas exchange
short course – 6-9 months  Risk for activity intolerance
Mgmt:
  Antibiotics, hydration, nutrition, nebulization S/sx: Rice watery stool with flecks of mucus, s/sx of severe
 CARI-health teaching dehydration ie Washerwoman’s skin, poor skin turgor
 Nursing Interventions
 Respiratory support Dx: stool culture
- oxygen supplementation
- mechanical ventilation mgmt: IV fluids, Tetracycline, Doxycycline, Erythromycin,
 Positioning Quinolones, Furazolidone and Sulfonamides (children)
 Rest
 Suctioning of secretions Via the skin
 Antipyretic and TSB
 Nutrition Hookworm (Roundworm)

- Necator Americanus, Ancylostoma Duodenale

Scarlet fever - Leads to iron deficiency and hypochromic microcytic anemia
- Gain entry via the skin
- Group A beta hemolytic streptococcus - Dx: microscopic exam (stool exam)
- Respiratory - Mgmt: Pyrantel Pamoate and Mebendazole
- Incubation 2-5 days - don’t give drug without (+) stool exam
- Fever, red sandpaper rash, white strawberry tongue, flushed - members of the family must be examined and treated also
cheeks, red strawberry tongue
- Diagnostics is throat culture
- Penicillin for 10 days Paragonimiasis

- Chronic parasitic infection

GIT - Closely resembles PTB
- Endemic areas: mindoro, camarines sur, norte, samar,
Amoebiasis sorsogon, leyte, albay, basilan
- Paragonimiasis
- Entamoeba Hystolitica, protozoa - AKA: Lung fluke disease
- IP: few days to months to years, - causative agent: paragonimus westermani; Trematode
- usually 2- 4 weeks - Eating raw or partially cooked fish or fresh water crabs
- MOT: Ingestion of cysts from fecally contaminated sources
(Oral fecal route)
oral and anal sexual practices Signs and symptoms
- Extraintestinal amoebiasis- genitalia, spleen, liver, anal,
lungs and meninges - Cough of long duration
s/sx: - Hemoptysis
- Chest/back pain
- Blood streaked, watery mucoid diarrhea, foul smelling, - PTB not responding to anti-koch’s meds
- abdominal cramps
- Pain on defecation (tenesmus)
- Hyperactive bowel sounds Diagnosis

- sputum examination – eggs in brown spots

Diagnostic test
Treatment
- Stool culture of 3 stool specimens
- Sigmoidoscopy 1. Praziquantrel (biltrizide)
- Recto-sigmoidoscopy and coloscopy for intestinal
amoebiasis 2. Bithionol

Medical treatment

- Metronidazole – trichomonocide and amoebicide for

intestinal and extra intestinal sites (monitor liver function Ascariasis
test)
- Diloxanide furoate – luminal amoebicide - Common worldwide with greatest frequency in tropical
- Paromomycin – eradicate cyst of histolytica countries.
- Tinidazole – hepatic amebic abscess - Has an infection rate of 70-90% in rural areas
- MOT: ingestion of embryonated egss (fecal-oral)
- Worms reach maturity 2 months after ingestion of eggs.
Bacillary Dysentery - Adult worms live less than 10 months(18 months max.)
Shigellosis - Female can produce up to 200000 eggs per day
- Eggs may be viable in soils for months or years
- Shiga bacillus: dysenteriae (fatal), flexneri (Philippines), - Worms can reach 10-30cm in length
boydii, sonnei; gram (-)
- Shiga toxin destroys intestinal mucosa
- Humans are the only hosts Initial symptom:
- Not part of normal intestinal flora
- IP: 1-7 days - loss of appetite
- MOT : oral fecal route - Worms in the stool
S/sx: fever, severe abdominal pain, diarrhea is watery to bloody - Fever
with pus, tenesmus - Wheezing
- Vomiting
Dx: stool culture - Abdominal distention
- Diarhea
Mgmt: Oresol, Ampicillin, Trimethoprim-Sulfamethoxazole, - dehydration
Chloramphenicol, Tetracycline, Ciprofloxacin

Medical Management

Cholera A. Mebendazole (antihelmintic) effect occurs by blocking the

glucose uptake of the organisms, reducing the energy until
- Vibrio coma (inaba, ogawa, hikojima), vibrio cholerae, vibrio death
el tor; gram (-) B. Pyrantel pamoate: neuromuscular blocking effect which
- Choleragen toxin induces active secretion of NaCl paralyze the helminth, allowing it to be expelled in the feces
- Active Immunization C. Pierazine citrate: paralyze muscles of parasite, this
- IP: few hours to 5 days dislodges the parasites promoting their elimination
- MOT: oral fecal route
Nursing Intervention - A True poison known to be one of the deadliest substance
and usually released into the food shortly after it has been
- Environmental sanitation canned
- Health teachings - Botulism
- Assessment of hydration status - Clostridium Botulinum, gram (+), spore forming
- Use of ORS - Ingestion of contaminated foods (canned foods), wound
- Proper waste disposal contamination, infant botulism (most common; ingestion of
- Enteric precautions honey)
- Neurotoxins block AcH
- IP: 12-36H (canned food)
Complications - IP: 4-14 days (wound)
- Active and passive immunization
- Migration of the worm to different parts of the body Ears, S/sx: Diplopia, dysphagia, symmetric descending flaccid paralysis,
mouth,nose ptosis, depressed gag reflex, nausea, vomiting, dry mouth, respiratory
- Loefflers Pneumonia paralysis
- Energy protein malnutrition
- Intestinal obstruction Dx: gastric siphoning, wound culture, serum bioassay (food borne)

Mgmt: respiratory support, antitoxin

Tapeworm (Flatworms)

- Taenia Saginata (cattle), Taenia Solium (pigs)

- MOT: fecal oral route CONTACT
(ingestion of food contaminated by the agent)
- s/sx: neurocysticercosis – seizures, hydrocephalus Pediculosis
- Dx: Stool Exam
- Mgmt: Praziquantel, Niclosamide Blood sucking lice/Pediculus humanus

Pinworm
- Enterobius Vermicularis
- MOT: fecal oral route
- S/sx: Itchiness at the anal area d/t eggs of the agent
- Dx: tape test at night time
(agents release their eggs during night time)
- flashlight
- Mgmt: Pyrantel Pamoate, Mebendazole
Nursing Intervention
- Promote hygiene
- Environmental Sanitation
- Proper waste and sewage disposal
- Antihelmintic medications repeated after 2 weeks (entire
family)
PARALYTIC SHELLFISH POISONING
- A syndrome of characteristic symptoms predominantly
neurologic which occurs within minutes or several hours
after ingestion of poisonous shellfish
- Single celled dinoflagellates (red planktons) become
poisonous after heavy rain fall preceded by prolonged
summer
- Common in seas around manila bay, samar, bataan and
zambales
MOT = Ingestion of contaminated bi-valve shellfish
IP = within 30 minutes
CLINICAL MANIFESTATIONS:
- NUMBNESS OF THE FACE ESPECIALLY AROUND THE
MOUTH
- VOMITING, DIZZINESS, HEADACHE
- TINGLING SENSATION, WEAKNESS
- RAPID PULSE, DIFFICULTY OF SPEECH (ATAXIA),
DYSPHAGIA, RESPI PARALYSIS, DEATH.
MANAGEMENT AND CONTROL MEASURES:
- NO DEFINITE MEDICATIONS
- INDUCE VOMITING (EARLY INTERVENTION)
- DRINKING PURE COCONUT MILK (WEAKENS TOXIC
EFFECT) DON’T GIVE DURING LATE STAGE IT MAY
WORSEN THE CONDITION.
- NaHCO3 SOLUTION (25 GRAMS IN ½ GLASS OF
WATER)
- RESPIRATORY SUPPORT
- AVOID USING VINEGAR IN COOKING SHELLFISH
AFFECTED BY RED TIDE (15X virulence)
- TOXIN OF RED TIDE IS NOT TOTALLY DESTROYED IN
COOKING.
- AVOID TAHONG, TALABA, HALAAN, KABIYA,
ABANIKO. WHEN RED TIDE IS ON THE RISE.
BOTULISM
p. capitis-scalp
p. palpebrarum-eyelids and eyelashes
p. pubis-pubic hair
p. corporis-body
MOT: skin contact, sharing of grooming implements
s/sx: nits in hair/clothing, irritating maculopapular or urticarial rash
Mgmt: disinfect implements, Lindane (Kwell) topical
Permethrin (Nix) topical
Scabies
- Sarcoptes scabiei
- Pruritus (excreta of mites)
- Mites come-out from burrows to mate at night
- MOT: skin contact
s/sx: itching worse at night and after hot shower; rash; burrows (dark
wavy lines that end in a bleb w/ female mite) in between fingers, volar
wrists, elbow, penis; papules and vesicles in navel, axillae, belt line,
buttocks, upper thighs and scrotum
Dx: biopsies/scrapings of lesions
Mgmt: Permethrin (Nix) cream, crotamiton cream, Sulfur soap,
antihistamines and calamine for pruritus, wash linens with hot water,
single dose of Ivermectin, treat close contacts
Dx: biopsies/scrapings of lesions
NURSING CARE
A. Administer antihistamines or topical steroids to relieve
itching.
B. Apply topical antiscabies creams or lotion like
lindasne(kwell), Crotamiton (Eurax), permithrin
C. d. Lindane (kwell) not used in <2 years old, causes
neurotoxicity and seizures
D. e. Apply thinly from the neck down and leave for 12-14hrs
then rinse
E. f. Apply to dry skin, moist skin increases absorption
F. g. All family members and close contacts
G. h. Beddings and clothings should be washed in very hot
water and dried on hot dryer
Leprosy
- Chronic infectious and communicable disease
- No new case arises without previous contact
- Majority are contracted in childhood, manifestation arises by
15 yrs old and will definitely diagnose at 20
- it is no hereditary
- Does not cross placenta
 Spectrum of Activity of Anti-infectives

Cardinal Sign - Anti-infectives that interfere with the ability of the cell to
reproduce/replicate without killing them are called
A. Presence of Hansen’s bacilli in stained smear or dried BACTERIOSTATIC drugs. Tetracycline is an example.
biopsy material. - Antibiotics that can aggressively cause bacterial death are
B. Presence of localized areas of anesthesia called BACTERICIDAL. These properties (-cidal and –static)
can also depend on the antibiotic concentration in the blood.

* Lepromatous or malignant
Common Adverse Reactions to Anti-infective Therapy
- many microorganisms
- open or infectious cases The most common adverse effects are due to the direct action of the
- negative lepromin test drugs in the following organ system- Neuro, nephro and GI system
* Tuberculoid or benign
1. Nephrotoxicity
- few organism
- noninfectious Antibiotics that are metabolized and excreted in the kidney most
- positive reaction to lepromin test frequently cause kidney damage..

Common Adverse Reactions to Anti-infective Therapy

s/sx:
• Early/Indeterminate – hypopigmented / hyperpigmented
anesthetic macules/plaques
• Tuberculoid – solitary hypopigmened hypesthetic macule,
neuritic pain, contractures of hand and foot, ulcers, eye
involvement ie keratitis
2. Gastro-intestinal toxicity
Direct toxic effect to the cells of the GI tract can cause nausea,
vomiting, stomach pain and diarrhea. Some drugs are toxic to liver
cells and can cause hepatitis or liver failure.
Common Adverse Reactions to Anti-infective Therapy

• Lepromatous – multiple lesions, Loss of lateral portion of 3. CNS toxicity

eyebrows (madarosis), corugated skin (leonine facies),
septal collapse (saddlenose) When drugs can pass through the brain barrier and
accumulate in the nervous tissues, they can interfere with neuronal
Diagnosis function.

- Skin smear test Common Adverse Reactions to Anti-infective Therapy

- Skin lesion biopsy
- Lepromin test - 4. Hypersensitivity

Most protein antibiotics can induce the body’s immune

Mgmt: system to produce allergic responses. Drugs are considered foreign
substances and when taken by the individual, it encounters the body’s
MDT-RA 4073 (home meds) immune cells.

Paucibacillary - 6-9 months Common Adverse Reactions to Anti-infective Therapy

1. Dapsone
5. Superinfections
2. Rifampicin
Opportunistic infections that develop during the course of
Multibacillary- 12-24 months antibiotic therapy are called SUPERINFECTIONS.

1. Dapsone – mainstay; hemolysis, agranulocytosis Teaching about anti-infective therapy

2. Clofazimine – reddish skin pimentation, intestinal toxicity - Take the drug exactly as prescribed. Complete the entire
prescribe regiment, comply with instruction RTC
3. Rifampicin – bactericidal; renal and liver toxicity - Report unusual reactions such as rash, fever or chills
- Check the drug expiration date before using it. Discard
unused drug
- Don’t share the drug with family or friends
- Don’t stop taking the drug, even if symptoms are relieved.
- Don’t take drug left over from a previous illness or someone
Nursing Intervention else drugs
- Don’t take over the counter drugs or herbal products without
- Health teachings consulting a doctor
- Counseling involving the family members and even the - Take drug with full glass of water
community - Follow the manufacturer’s directions for reconstituting,
- Prevention of transmission ( use of mask ) dilution and storing drugs . Check expiration dates.
- Refrigerate oral suspension (stable 14 days), shake well
before administering to ensure dosage
Anthrax - Give I.M dose into large muscle mass. Rotate injection site
to minimize tissue injury
- Bacillus anthracis, gram (+)
- Releases exotoxin
Penicillin – interfere with bacterial cell wall synthesis; broad spectrum
- Cattle, sheep, goat and pig
- IP: 1-3 days
- Dx: gram stain, culture, Ab testing a. Amoxicillin, ampicilin, methicillin, Penicillin
- Mgmt: parenteral Penicillin G, cutaneous lesions should be
cleaned Cephalosporin

a. 1st generation – cefazolin, cephalexin, cephalothin

MOT
b. 2nd generation – Cefaclor, Cefamandole
- Inhalation (Woolsorter’s disease)
URTI (fever x 3-5 days) lower infection (alveoli) metabolic c. 3rd generation – Ceftriaxone, cefotaxime
acidosis hypoxia
Inhibits cell wall synthesis
- Skin (most common)
itchiness papule-vesicle depressed black eschars - Erythromycin
(painless) septicemia
- Tetracycline
- Aminoglycosides 6. Roth’s spots- pale hemorrhages in the retina

- Chloramphenicol 7. Heart murmurs

Side Effects 8. Heart failure

Tetracycline – hepatotoxic, phototoxicity, hyperurecemia, enamel

hypoplasia
Prevention
Aminoglycosides – ototoxicity, leukopenia, thrombocytopenia,
neurotoxicity Antibiotic prophylaxis if patient is undergoing procedures like
dental extractions, bronchoscopy, surgery, etc.
Chloramphenicol – bone marrow depression, hypersensitivity
LABORATORY EXAM

Blood Cultures to determine the exact organism

Infective endocarditis
Nursing management
Infection of the heart valves and the endothelial surface of the
heart 1. regular monitoring of temperature, heart sounds

Can be acute or chronic 2. manage infection

Etiologic factors 3. long-term antibiotic therapy

1. Bacteria- Organism depends on several factors Medical management

2. Fungi 1. Pharmacotherapy

IV antibiotic for 2-6 weeks

Risk factors Antifungal agents are given – amphotericin B

1. Prosthetic valves 2. Surgery

2. Congenital malformation Valvular replacement

3. Cardiomyopathy Prevention

4. IV drug users - AnTibiotic prophylaxis is recommended for high risk patients

before or after procedure
5. Valvular dysfunctions

Rheumatic Endocarditis

Dukes criteria - Occurs most often in children

- Grp A beta hemolytic streptococcal pharyngitis
I. Criteria for IE - It is a preventable disease
- Penicillin therapy can prevent RHD
- Two major criteria or - Throat culture
- One major and three minor - The heart itself must receive enough oxygenated blood.
- Five major criteria - Blood is supplied to the heart through the coronary arteries,
Major criteria two main branches which originate just above the aortic
valve.
- Positive blood culture typical for IE
- Positive echocardiogram study
Minor criteria Signs and Symptoms

- Predisposing heart condition - Fever (38.9-40C)

- Febrile syndrome - Chills
- Vascular phenomena: conjuctival hemorrhage, janeway - Sore throat
lesions - Diffuse redness of throat
- Immunologic phenomena - CLADP
- Osler nodes and roth spots - Abdominal pain (children)
- Echocardiogram suggestive of IE but not classified as major - Tiny translucent vegetations or growths, which resemble
pinhead size beads at the valves.
- Cause valvular regurgitation (mitral valve)
Acute - MV (Left sided heart failure)
- Risk for embolic phenomena on the lungs , kidney, spleen,
- nafcillin or oxacillin heart, brain

- gentamycin
Urinary Tract Infection (UTI)
Subacute
Bacterial invasion of the kidneys or bladder (CYSTITIS) usually
caused by Escherichia coli
- penicillin
1. Bacterial infections of urinary tract are a very common
- gentamycin
reason to seek health services
Assessment findings
2. Common in young females and uncommon in males under
age 50
1. Intermittent fever
3. Common causative organisms
2. anorexia, weight loss
a. Escherichia coli (gram-negative enteral bacteria) causes
3. cough, back pain and joint pain
most community acquired infections
4. splinter hemorrhages under nails
b. Staphylococcus saprophyticus, gram-positive organism
causes 10 – 15%
5. Osler’s nodes- painful nodules on fingerpads
c. Catheter-associated UTI’s caused by gram-negative o All men
bacteria: Proteus, Klebsiella, Seratia, Pseudomonas o All children
o Women with commpromised IS
Normal mechanisms that maintain sterility of urine o DM pt
o Recent documentation
a. Adequate urine volume o Prolonged or persistent uti
o >3 UTI/year
b. Free-flow from kidneys through urinary meatus o Pregnant women
o Women sexually active or have new partners
c. Complete bladder emptying

d. Normal acidity of urine 5. Readily responds to treatment

e. Peristaltic activity of ureters and competent ureterovesical 6. Untreated, may involve kidneys
junction
7. Severe or prolonged may cause sloughing of bladder
f. Increased intravesicular pressure preventing reflux mucosa with ulcer formation

g. In males, antibacterial effect of zinc in prostatic fluid 8. Chronic cystitis may lead to bladder stone formation

Pathophysiology

1. Pathogens which have colonized urethra, vagina, or perineal Pyelonephritis

area enter urinary tract by ascending mucous membranes of perineal
area into lower urinary tract 1. Inflammation of renal pelvis and parenchyma (functional
kidney tissue)
2. Bacteria can ascend from bladder to infect the kidneys
2. Acute pyelonephritis
3. Classifications of infections
a. Results from an infection that ascends to kidney from lower
a. Lower urinary tract infections: urethritis, prostatitis, cystitis urinary tract

b. Upper urinary tract infection: pyelonephritis (inflammation of Risk factors

kidney and renal pelvis)
1. Pregnancy
Urethrovesical reflux – backward flow of urine from the urethra to the
badder 2. Urinary tract obstruction and congenital malformation

Ureterovesical reflux – backward flow of urine from the bladder to the 3. Urinary tract trauma, scarring
ureters
4. Renal calculi
Risk Factors
5. Polycystic or hypertensive renal disease
1. Aging
6. Chronic diseases, i.e. diabetes mellitus
a. Increased incidence of diabetes mellitus
7. Vesicourethral reflux
b. Increased risk of urinary stasis

c. Impaired immune response

Manifestations
2. Females: short urethra, having sexual intercourse, use of
contraceptives that alter normal bacteria flora of vagina and perineal 1. Rapid onset with chills and fever
tissues; with age increased incidence of cystocele, rectocele
(incomplete emptying) 2. Malaise

3. Males: prostatic hypertrophy, bacterial prostatitis, anal 3. Vomiting

intercourse
4. Flank pain
4. Urinary tract obstruction: tumor or calculi, strictures
5. Costovertebral tenderness
5. Impaired bladder innervation
6. Urinary frequency, dysuria
6. Bowel incontinence
Assessment findings: Upper UTI
7. Diabetes mellitus
o Fever and CHIILS
8. Instrumentation of urinary tract o Flank pain
o Costovertebral angle tenderness

Cystitis Laboratory Examination

o Most common UTI Urinalysis: assess pyuria, bacteria, blood cells in urine; Bacterial
o Remains superficial, involving bladder mucosa, count >100,000 /ml indicative of infection
which becomes hyperemic and may hemorrhage
o General manifestations of cystitis b. Rapid tests for bacteria in urine
o Dysuria
o Frequency and urgency 1. Nitrite dipstick (turning pink = presence of bacteria)
o Nocturia
o flank or low back pain 2. Leukocyte esterase test (identifies WBC in urine)
o Suprapubic pain and tenderness
c. Gram stain of urine: identify by shape and characteristic
(gram positive or negative); obtain by clean catch urine or
Assessment and laboratories catheterization

o Urinalysis – bactereriuria >10’5 colonies of bacteria/ml Urinary Tract Infection (UTI)

o E.coli – 55%
o Pseudomonas and enterrococcus – catheter associated UTI Nursing interventions
o Urine culture- gold standard
Criteria
 o Administer antibiotics as ordered Hospital setting
o Provide warm baths and allow client to void in water to
alleviate painful voiding. 1. Monitor intake and output
o Force fluids. Nurses may give 3 liters of fluid per day
o Encourage measures to acidify urine (cranberry juice, 2. High carbohydrate to provide energy and reduce catabolism
acid-ash diet). of protein
o Provide client teaching and discharge planning
concerning 3. Bp monitoring
a. Avoidance of tub baths
b. Avoidance of bubble baths that might irritate Home Care
urethra
c. Importance for girls to wipe perineum from
Health education regarding
front to back
d. Increase in foods/fluids that acidify urine.
1. Notify physician of renal failure symptoms.

2. Fluid and diet restrictions to avoid worsening of edema and

Pharmacology
HPN
1. Sulfa drugs
3. Importance of follow up evaluations of BP, Urinalysis protein,
BUN, CREA
Highly concentrated in the urine
Nephrotic syndrome
Effective against E. coli!
a. Group of clinical findings, not specific disorder
Can cause CRYSTALLURIA
b. Characterized by
2. Quinolones
1. Massive proteinuria
Not given to less than 18 because they can cause cartilage
degradation
2. Hypoalbuminemia
3. Pyridium= urinary antiseptic
3. Hyperlipidemia
Can cause urine discoloration
4. Edema (often facial and periorbital)
Acute Glomerulonephritis
Pathophysiology
o Inflammation of the glomerular capillaries
Characterized by loss of plasma protein (albumin) in the urine.
o Disease of children older than 2 years old
o Preceded by a throat infection due to Grp A betahemolytic
streptococal infection The liver cannot keep up with the daily loss of albumin in the urine

Clinical manifestation
Clinical Manifestation
Edema – soft and pitting
o Hematuria –microscopic, gross
o Coca cola colored urine due to RBC and protein cast - periorbital, in dependent areas, ascites
o Abrupt onset, 10 days after streptococcal infection
o May be mild or severe presenting with ARF with oliguria - Headache
o Proteinuria due to increased permeability of the glomerular
membrane - Irritability
o Edema and hypertension in 75%
o Headache, malaise and flank pain - fatigue

Diagnosis
Diagnostic findings
Proteinuria > 3-3.5g/day
o Serial Anti-streptolysin O
o Serum IgA and complement level Protein electrophoresis and immunophoresis
o Electron microscopy and immunofluorescent identify the
nature of the lesion Needle biopsy of the kidney
o Kidney biopsy – definitive diagnosis
Complications

Complications o Infection
o Thromboembolism (renal vein)
o Hypertensive Encephalopathy o Pulmonary emboli
o Pulmonary edema o Accelerated atherosclerosis
o RPGN, rapid and progressive decline in renal function. Will o ARF (hypovolemia)
go to ESRD in weeks to months
o Crescent shaped cells accumulate in Bowman’s space,
disrupting the filtering surface. Medical Management

o to preserve the renal function

Medical Management o Diuretics with ACE inhibitors to reduce the degree of
proteinuria
Goals o Low sodium diet, liberal potassium diet
o Protein intake .8g/kg/day (eggs, meats, dairy products)
1. Treating symptoms Nursing Intervention

2. Preserve kidney function o Provide bed rest

o conserve energy
3. Treatment of complications o quiet play
o Provide high protein and low sodium diet
Antibiotics - penicillin o Maintain skin integrity
o Avoid IM-edematous
o Corticosteroid and Immunosuppressants o Turn frequently
o Protein and sodium restriction o Obtain morning urine for protein studies
o Loop diuretics o Provide scrotal support
Nursing Management o Monitor I and O, VS, Weigh daily
o Administer Steroids
o Protect for infection
 Chest X-ray, CBC, Isolation of virus

Acne Vulgaris Mgt:

o Common, self limiting, multifactorial skin disease Supportive

o Over production of sebum, propionibacterium acnes,
hormonal, Treat as Atypical Pneumonia
o Closed comedones – whiteheads
o Open comedones – blackheads Quarantine
o Requires active treatment
o Intervention: don’t squeeze, prick or pick, Isotretinoin AVIAN INFLUENZA
Accutane (avoid sunlight and vit A, may increase
triglycerides), antibiotics Serious consequences for ASIA
o No evidence that chocolate, nuts, fatty foods or cosmetics
affects acne Avian Influenza…..
o Exacerbation coincides with menstrual activity.
o Heat, increase sweat increase acne
o
Is an infectious disease of birds caused by Type A strains of
the influenza virus
o First identified in Italy more than 100 years ago
Nursing care o Occurs worldwide
o Infection causes a wide spectrum of symptoms in birds,
o Use of topical or oral antibiotics ranging from mild illness to a highly contagious and rapidly
o Instruct in the use of isotretinoin (ACCUTANE) to decrease fatal disease resulting in severe epidemics
sebum production o “ highly pathogenic avian influenza”
o Adverse effect, cheilitis, skin dryness, elevated triglycerides Pathogenesis
and eye discomfort
o Stop Vit A supplement during treatment o Avian influenza do not normally infect species other than
o Instruct not to squeeze, prick or pick at lesions birds and pigs
o Use products labeled noncomedogenic and cosmetics that
o First documented infection of humans with avian flu occurred
are water based in Hong Kong in 1997
o Affected 18 humans, 6 died
Bird Flu
Decubitus Ulcer
Human cases of influenza A (H5N1) infection have been reported
o Skin impairment secondary to immobility in Cambodia, China, Indonesia, Thailand, and Vietnam.
o Common to immobilized and with decreased sensory
perception patient Clinical manifestations
Risk Factors
Patients develop fever, sore throat, cough, in fatal cases, severe
o Malnutrition
respiratory distress may result secondary to pneumonia
o Incontinence
o Immobility
A constantly mutating virus
o Skin shearing
o Decreased sensory perception
Nursing care All type A influenza virus, including those that regularly cause seasonal
epidemics of influenza in humans are genetically labile and well
adapted to elude host defenses
o Institute measures to prevent decubitus ulcer
o Assess the nutritional status
o Provide adequate nutritional intake to promote skin integrity So far bird flu is mainly transmitted between birds, but experts fear the
o Monitor for alteration in skin integrity H5N1 virus could be devastating to humans if it genetically mutates
o Relieve or remove pressure on skin and develops the capacity to be transmitted from human to human.
o Turn every 2 hours
o Ambulate the patient Deadly Avian Flu
o Provide active and passive exercise q 8hrs
o Keep skin clean and dry and bed wrinkle free The WHO has warned that if this happens it could trigger a new human
o Apply medications or dressing on the wound flu pandemic, potentially killing up to 50 million people worldwide

A total of 55 people have died from the H5N1 virus since the beginning
Emerging Diseases of the epidemic in 2003

Severe Acute Respiratory Syndrome Trivalent Inactivated Vaccine (TIV)

o Coronavirus o Most widely used influenza vaccine

o Severe acute respiratory syndrome o Administered IM
o IP: 2-7 days o Indicated for all persons older than 6 months of age
o Mortality rate – 5% only o Studies in children have shown efficacy from 30-90%
Risk Factors:

o history of recent travel to China, Hong Kong, singapore STD

Taiwan, vietnam, canada. or close contact w/ ill persons with
a hx of recent travel to such areas, OR Gonorrhea, Morning drop, Clap, Jack
o Is employed in an occupation at particular risk for SARS
exposure, healthcare worker with direct patient contact or a o Neisseria gonorrheae, gram (+)
worker in a laboratory that contains live SARS, OR o IP: 3-7 days
o Is part of a cluster of cases of atypical pneumonia without an S/sx:
alternative diagnosis
- Females: usually asymptomatic or minimal urethral
discharge w/ lower abdominal pain
Clinical Manifestations sterility or ectopic pregnancy
- Male: Mucopurulent discharge, Painful urination
o History of travel to SARS affected country or close contact decreased sperm count
with persons suspected of having SARS and within 14 days DX:
manifest the ff
o High grade fever (>38.0 c) -gram stain and culture of cervical secretions on Thayer
o Headache, body malaise, muscle pain Martin VCN medium
o Cough, sneezing, nasal congestion Mgmt: single dose only
o Difficulty of breathing after 2-7 days
SARS suspect - Ceftriaxone (Rocephin) 125 mg IM
- Ofloxacin (Floxin) 400 mg orally
Probable SARS - treat concurrently with Doxycycline or Azithromycin for 50%
infected w/ Clamydia
Diagnosis: CX:
 PID, ectopic pregnancy and infertility, peritonitis,  S/sx: Single or multiple soft, fleshy painless growth of the
perihepatitis, Ophthalmia neonatorum, sepsis and arthritis vulva, vagina, cervix, urethra, or anal area, Vaginal bleeding,
discharge, odor and dyspareunia
Syphilis DX:

Treponema pallidum, spirochete  Pap smear-shows cellular changes (koilocytosis)

 Acetic acid swabbing (will whiten lesion)
“ Beautiful” fast moving but delicate spiral thread  Cauliflower or hyperkeratotic papular lesions
Treatment
IP: 10-90 days
- liquid nitrogen
Primary (3-6 wks after contact) – nontender lymphadenopathy and
chancre; most infectious; resolves 4-6 wks - podophylin resin

Chancre – painless ulcer with heaped up firm edges appears at the

site where the treponema enters. Related to pattern of sexual behavior
(genitalia, rectal, oral, lips) Mgmt:

BUBO – swelling of the regional lymphnode Laser treatment is more effective

Secondary – systemic; generalized macular papular rash including CX:

palms and soles and painless wartlike lesions in vulva or scrotum
(condylomata lata) and lymphadenopathy  Neoplasia
 Neonatal laryngeal papillomatosis (vaginal birth)
Tertiary – (6-40 years) - neurosyphilis/permanent damage (insanity);
gumma (necrotic granulomatous lesions), aortic aneurysm
Candidiasis, Moniliasis
DX:
 Candida Albicans, Yeast or fungus
Dark-field examination of lesion- 1st and 2nd stage  S/sx: Cheesy white discharge,
 \Extreme itchiness
Non specific VDRL and RPR DX:
FTA-ABS KOH (wet smear indicate positive result)
Mgmt Mgmt:
- Primary and secondary - Pen G Imidazole, Monistat, Diflucan
- Tertiary - IV Pen G
CX:
Chlamydia
Oral thrush to baby (vaginal birth)
- Chlamydia trachomatis, gram (-) Trichomoniasis
- IP: 2-10 days
- S/sx:
- Maybe asymptomatic  Trichomona vaginalis, parasite
- Gray white discharge, Burning and itchiness at the urethral  S/sx: Females: itching, burning on urination, Yellow gray
opening frothy malodorous vaginal discharge, Foul smelling
DX:  Males: usually asymptomatic
 Dx: microscopic exam of vaginal discharge
- Gram stain  Mgmt: Metronidazole (Flagyl); include partners
- Antigen detection test on cervical smear  CX: PROM
- Urinalysis
Mgmt:
HIV and AIDS
- Doxycycline or Azithromycin
- Erythromycin and Ofloxacin  Retrovirus (HIV1 & HIV2)
CX:  Attacks and kills CD4+ lymphocytes (T-helper)
 Capable of replicating in the lymphocytes undetected by the
- PID immune system
- Ectopic pregnancy  Immunity declines and opportunistic microbes set in
- Fetus transmittal (vaginal birth)  No known cure
 HIV/AIDS Reverses Development and Poses Serious Threat
to Future Generations
Herpes Genitalis  Since 1980s, 60m have been infected and 25m have died
 About 40m live with HIV/AIDS – 38m in developing countries
HSV 2 and 28m in Africa alone
 The spread is accelerating in India, Russia, the Caribbean
S/sx: Painful sexual intercourse, Painful vesicles (cervix, vagina, and China
perineum, glans penis)  AIDS is stretching health care systems beyond their limits
 There are 12m AIDS orphans – they are estimated to rise to
- Dx: 40m by 2010
- Viral culture  In Sub-Saharan Africa, 58% of HIV/AIDS infected adults are
- Pap smear (shows cellular changes) women. More than two-thirds of newly infected teenagers
- Tzanck smear (scraping of ulcer for staining) are female.
Mgmt:  Life expectancy has declined by more than 10 years in
South Africa and Botswana – Swaziland faces the risk of
Anti viral - acyclovir (zovirax) extinction
 Most HIV/AIDS Infected Live in Africa and South Asia
 CX: Health
 Meningitis
 Neonatal infection (vaginal birth) Health care workers often have rates of infection as high or higher than
adults in general

Genital Warts, Illness and death of skilled personnel further weakens the sector
Condyloma Acuminatum
Education
 HPV type 6 & 11, papilloma virus
Education faces decimation of skilled teachers
Children of families struck by AIDS often have to leave school to help  A – ABSTINENCE
generate income or undertake basic household tasks  B – BE FAITHFUL
 C – CONDOMS
MOT:  D – DON’T USE DRUGS


Sexual intercourse (oral, vaginal and anal)

Exposure to contaminated blood, semen, breast milk and
other body fluids
 Blood Transfusion
 IV drug use
 Transplacental Integrated Management of Childhood Diseases
 Needlestick injuries
HIGH RISK GROUP IMCI process can be used by doctors, nurses and other health care
personnel in a primary health care facility like health centers, clinics or
 Homosexual or bisexual OPD.
 Intravenous drug users
 BT recipients before 1985 Components of IMCI
 Sexual contact with HIV+
 Babies of mothers who are HIV+ A. Upgrading the case management and counseling skills of
s/sx: health care providers.
B. Strengthening the health care system for effective
1. Acute viral illness (1 mo after initial exposure) – fever, management of childhood illness
malaise, lymphadenopathy C. Improving family and community practices related to child
health and nutrition.
2. Clinical latency – 8 yrs w/ no sx; towards end, bacterial and
skin infections and constitutonal sx – AIDS related complex;
CD4 counts 400-200 Focused on the common childhood diseases.

3. AIDS – 2 yrs; CD4 T lymphocyte < 200 w/ (+) ELISA or A. Pneumonia

Western Blot and opportunistic infections B. Measles
C. Malaria
HIV CLASSIFICATION D. Diarrhea
E. Malnutrition
CATEGORY 1 – CD4+ 500 OR MORE F. Ear infection
G. Dengue
CATEGORY 2 – CD4+ 200-499
IMCI case management process
CATEGORY 3 – CD4+ LESS THAN 200
Assess a child by checking first for danger signs, examining the child,
HIV TEST
checking nutritional and immunization status.
 Elisa
Classify the child illness using the color coded triage system
 Western Blot
 Rapid hiv test - (pink) urgent

- (yellow) OPD treatment

How to Diagnose
- (green) Home management
HIV+
2 consecutive positive ELISA and
1 positive Western Blot Test  Identify the specific treatments for the child. If the child
needs urgent referral, give essential treatment before the
patient is transferred.
AIDS+
 Provide practical treatment instructions
HIV+
CD4+ count below 500/ml  Assess feeding problems
Exhibits one or more of the ff: (next slide)  Follow up care
Danger signs
Full blown AIDS
CD4 is less than 200/ml  Not able to drink
 Vomiting
Exhibits one or more of the ff:  Convulsions
 Abnormally sleepy
o Extreme fatigue
o Intermittent fever
o Night sweats Parameters for assessing dehydration
o Chills
o Lymphadenopathy  Eyes – sunken, absent of tears, lack of laster
o Enlarged spleen  Fontanelles
o Anorexia  Skin turgor
o Weight loss  Mouth
o Severe diarrhea  Abnormally sleepy
o Apathy and depression  Level of thirst
o PTB END
o Kaposis sarcoma
o Pneumocystis carinii
o AIDS dementia
 Kaposis

Treatment

Anti-retroviral Therapy (ART) – ziduvirine (AZT)

a. Prolong life

b. Reduce risk of opportunistic infection

c. Prolong incubation period

PREVENTION