Communicable Disease Nursing

CD Terminology

Inflammation - a non-specific reaction that is immediate and provides short-term protection

Incubation Period - time interval between the first exposure to the disease of the susceptible person or animal & the appearance of the first signs & symptoms of the disease

more of the terms

Period of Communicability - period where the infecting organism is capable of infecting another host Reservoir - the environment in which pathogen lives and multiply Portal of Entry - corresponds to the route by which the organism gains its entrance Portal of Exit - corresponds to the site where the organism escapes and becomes communicable

Terms to remember

Mode of Transmission - corresponds to the way organism infect a host. Normally, portal of exit determines the mode by which the infecting organism can invade the host Direct Transmission - pathogens infect the host by body contact like touch, kiss (contagious) Indirect Transmission - occurs through an intermediate host, a vector or inanimate object

Board Question!
The time interval between the first exposure to the disease of the susceptible person or animal & the appearance of the first signs & symptoms of the disease is called: A. Incubation period B. Resting period of disease C. Immunity D. Resistance

Correct Answer: A
Your key word is the TIME INTERVAL which is related to the word PERIOD, therefore it is the INCUBATION where the organisms are infecting the body and causes the development of signs and symptoms

Standard Precautions

Correlates with UNIVERSAL PRECAUTION

Added AIRBORNE, CONTACT and DROPLET routes as categories of Precautions Focused on the use of protective barrier in order to interrupt transmission and to break the chain of infection.

Hand Hygiene

Most effective means of preventing the spread of nosocomial infections. Essential components: Friction: To remove visible soiling, dead skin cells, and other material which may harbor pathogenic microorganisms. Soap: To loosen skin oils as well as to remove dirt and body fluids. Warm Water: To rinse off loosened dirt, debris, and pathogenic particles.

Hand Hygiene
1. Before patient contact. 2. After having patient contact. 3. As needed during the care of an individual patient 4. Immediately and thoroughly when the hands are accidentally contaminated with blood or body substances. 5. After gloves are removed. 6. After using toilet facilities.

Hand washing

Barrier Protection

Protective apparel Considerations:

a. Probability of exposure to blood and body substances b. Amount of blood or body substances likely to be encountered c. Probable route of transmission

Gloves

Use to protect hands from contamination Wear gloves when: a. Procedures with direct contact to blood and body substances of any patient. b. Procedures where contact with blood and body substances might be expected to occur. c. Procedures involving direct or potential contact with the mucous membranes of any patient.

On the use of Gloves

d. Procedures involving direct or potential contact with the non-intact skin of any patient. ( cut, chapped, abraded, cracked, afflicted with weeping or exudative lesions, or is otherwise broken) e. Touching or handling any instruments, equipment, or surfaces that have been, or may have been, in contact with blood or body substances.

More on the use of Gloves

f. Providing care to a patient or in managing equipment when the health care worker has cuts, scratches, or other breaks in the skin on his/her hands. g. Sterile gloves should be used for all sterile procedures and for activities that involve contact with areas of the body that are normally sterile.

Gown

Use to prevent clothing from becoming soiled with blood and body substances. Gowns should be worn: a. During activities that involve the management of large amounts of blood or body substances that may be difficult to contain properly. b. During procedures that may result in the splashing or splattering of blood or body substances.

Dos on Gowning

Dos
a. Large enough to cover the clothing which is likely to be contaminated. Made of a moisture-resistant material that provides an effective barrier to body substances. b. Sterile gowns should be worn for procedures that require a sterile field.

More on Dos of Gowning

c. After giving care to an individual patient. d. After performing any procedure involving instruments, equipment, or surfaces contaminated by blood or body substances.

Eye Wear

Protective eyewear is worn to prevent blood and body substances from contaminating the mucous membranes of the eyes Protective eyewear should be worn during procedures where blood and body substances may be expected to splash or splatter.

Face Shields

Face shields are worn to prevent blood and body substances from contaminating the mucous membranes of the eyes, nose, and mouth during procedures which may cause splashing or splattering.

Mask

When splashing, splattering, or spraying of blood or body fluids is likely in order to prevent exposure to the mucous membranes of the nose/mouth. When within 3 feet of a patient on Droplet Precautions. When working in a sterile field to prevent droplets from contaminating the field.

Patient Placement

A private room is necessary if a patient:

1. Has an infection that is transmitted in whole or in part by the airborne or droplet routes. 2. Has an infection or is colonized with a microorganism that is transmitted in whole or in part by contact.

Patient Placement
3. Produces body fluids or bloody drainage that is large in quantity and/or cannot be properly contained by the patient or by personnel.

Patient Placement
4. Has poor personal hygiene. This includes patients who:
Are unwilling and/or unable to wash their hands thoroughly, either independently or with the after touching infective materials. Contaminate the environment with potentially infectious materials. Share contaminated articles with other patients.

Transmission Based Precautions

designed for patients documented or suspected to be infected/colonized with highly transmissible or epidemiologically important pathogens for which additional precautions beyond Standard Precautions are needed to interrupt transmission.

Airborne Precautions

designed to reduce the risk or eliminate the airborne transmission of infectious agents. transmission occurs by dissemination of either airborne droplet nuclei (smallparticle residue-5 um or smaller sized evaporated droplets which remain suspended in the air for long periods of time) or dust particles containing the infectious agent.

Airborne Precautions

Dispersed through air currents Inhaled and deposited on susceptible host e.g. Mycobacterium Tuberculosis

Droplet Precautions

designed to reduce the risk of droplet transmission of infectious agents.

transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with largeparticle droplets (larger than 5 um in size) containing microorganisms

Droplet Precautions

generated by the source person during coughing, sneezing, or talking and/or during the performance of certain procedures such as suctioning and bronchoscopy.

Contact Precautions
designed to reduce the risk of transmission of epidemiologically important microorganisms by direct or indirect contact. a. Direct Contact - involves skin-toskin contact and physical transfer of microorganisms such as occurs when personnel turn patients

Contact Precautions
b. Indirect Contact - involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patient's environment

Board Question!
When leaving the room of a patient in strict isolation, the nurse should remove which protective equipment first? A. Cap B. Mask C. Gown D. Gloves

Correct Answer: D
Gloves is the most contaminated article therefore it has to be removed first before leaving the patients room

Board Question!
When caring for a client and following standard precautions, what is the nurses primary responsibility?
A. Wear gloves whenever on contact with the client B. Consider all body substances potentially infectious C. Place a body substance isolation on the clients door D. Wear a gown and gloves when caring for a client in respiratory isolation

Correct Answer: B
Standard precaution dictates that all body substances are considered potentially infectious therefore we need to put gloves when handling body fluids of patients

Principles of Immunity

Humoral Immune Response

Humoral Immune Response

Cell Mediated Immune Response

Memory Cells

Types of Immunity

Types of Immunity
A. Natural (Innate) Immunity also known as genetically acquired immunity It exists without prior exposure to an immunologically active substance B. Acquired Immunity a response that develop during the course of persons lifetime

Classification of Acquired Immunity

Active Immunity results when the body produces its own antibodies in response to an antigen

1. Natural Acquired Active Immunity - results from having the disease 2. Natural Acquired Passive Immunity - antibodies obtained through placenta or breast milk

Classification of Acquired Immunity

Passive Immunity results when the antibody is transferred artificially

1. Artificially Acquired Active Immunity - conferred by immunization with an antigen 2. Artificially Acquired Passive Immunity antibodies transferred from sensitized person

Tuberculosis

Tuberculosis (TB) is a type of pneumonia caused by the acid-fact bacillus,

mycobacterium tuberculosis

Tuberculosis

Lung of a TB Patient

Typical TB Patient

Other Sites of Tuberculosis

Signs and Symptoms

Sample Question
Tuberculosis is primarily a respiratory disease caused by tubercle bacilli. Which mode of transmission is extremely contagious?
A. B. C. D. Ingestion of food Airborne Animal handling Skin contact

Correct Answer: B
Respiratory infection specifically tuberculosis is transmitted through airborne route and highly contagious

Board Question!
Which of the following is a priority objective in PTB control? A. Sputum treatment B. Reduction of risk C. Distribution of medicine D. Referral to health centers

Correct Answer: C
The priority goal of the DOH in TB control is to distribute medications to known and identified TB

Possible Board Question!

When an older person is affected with PTB, which of the following measures will you advise to effectively prevent the spread of the disease to other members of the family? A. Cover mouth & nose when coughing or sneezing B. Isolate the person C. X-ray members of the family D. Continue taking medications

Correct Answer: A
Cover the mouth and nose when coughing and sneezing will prevent the spread of mycobacterium

T
R E A T M E

Isoniazid (INH)

Rifampin (Rifadin)

Ethambutol (EMB) Streptomycin (SM)

Pyrazinamide (PZA)

Anti-infective agents

N
T

Prevention

Hepatitis

Hepatitis

An acute inflammatory disease of the liver resulting in cellular damage from degeneration and necrosis

Pathophysiologic Mechanism

Virus invades liver cells, inflammation and mononuclear infiltration of the hepatic cells, necrosis ensues. Proliferation of kupffer cells, necrotic debris accumulates and eventually lobules and portal ducts are occluded resulting to disturbance in bilirubin excretion

Causes of Hepatitis

Assessment

Assessment

Continuum of Hepatitis

Diagnostic Tests

HAV (Hepatitis A Virus) Anti HAV HBsAG (Hepatitis B surface antigen)

Classifications of Hepatitis

Classifications of Hepatitis

Management

Anti viral therapy (e.g. Ribavirin) Corticosteroids Vitamin K Anti Emetics Symptomatic Treatment like: a. Paracetamol/Antipyretic b. Calamine lotion

Hepatitis Vaccine

Nursing Care

Bed rest Isolation Decrease fat, high calorie and CHON Calamine lotion Clean and cut nails No blood donation

Board Question!
A patient in the community is admitted to the emergency hospital with a diagnosis of hepatitis B. The patient should be placed on which of these types of precautions? A. Contact B. Standard C. Airborne D. Droplet

Correct Answer: A
Hepatitis a contagious disease that is transferred through direct contact

Board Question!
There are several types of Hepatitis, nale the type which is sexually transmitted & is considered as the most serious: A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

Correct Answer: B
Hepatitis B is sexually transmitted type of infection

Board Question!
Elsa, 15 years old came to the health center because of a yellowish discoloration of the skin. The physicians tentative diagnosis is hepatitis. During assessment, the nurse should check the sclera for: A. Hemorrhage B. Petechiae C. Yellowish discoloration D. Opacity

Correct Answer: C
Icteric sclera is also known as yellowish discoloration

RUBEOLA
Rubeola, Morbilli, 7-day measles extremely contagious exanthematous disease acute onset which most often affects children Chief symptoms are referrable to upper respiratory passages. Causative agent: paramyxovirus Incidence: endemic in all large cities of the world recurring in epidemic form every 2 years usually occurs during cold weather. Incubation Period: 3 - 20 days

RUBEOLA
Mode of Transmission: nasal throat secretions, droplet infection, indirect contact with articles. Period of communicability: Prodromal stage Stages: 1. Incubation period (10 days) 2. Pre-eruptive stage (3-6 days) - appearance of the first sign/symptom to the earliest evidence of the eruption - fever, severe cold, frequent sneezing, profuse nasal discharge, eyes red and swollen with mucopurulent discharge (lids stick together)

RUBEOLA
True measles rash - slightly elevated small red papules, hot, dry, elevated sensation to touch. Appears first on the face and spread downward over neck, chest, trunk, limbs and appearing last on the wrists and back of the hand (Cephalocaudal-Proximo distal) 3. Eruptive stage: intensification of all local constitutional symptoms with the development of complications like bronchitis

RUBEOLA
4. Desquamation Stage - follows after the rash fades, follows the order of distribution of eruption or rashes.

Diagnostic Test
No specific exam except only for the presence of leukopenia

RUBEOLA
Management

Drugs (Antibiotics, Sulfodiazine) Isolation

Nursing Care

Meticulous skin care - warm alcohol rub. Good oral and nasal hygiene Increase oral fluids Proper care of the eyes - screen to avoid direct light; dark eye glasses Ears should be cleaned after bath if w/ discharge should lie the affected ear down or towards the bed.

Board Question!
Which of the following complications should be watched closely in measles? A. Meningitis B. Pneumonia C. Otitis media D. Laryngitis

Correct Answer: B
Since measles is a respiratory infection, the most common affectation that the nurse should observe is the development of pneumonia

VARICELLA
A very contagious acute disease characterized by the rash appearance:
a. vesicles b. papules c. pustules but ending in crusting.

Causative Agent: Varicella zooster virus (airborne) Incidence: occurs before the 6th year of life. Mode of transmission: droplet infection, direct contact

VARICELLA
Incubation Period: 2 - 3 weeks Period of communicability: highly contagious from 2 days prior to rash and 6 days after rash erupts. Clinical Manifestations: a. slight fever (first to appear) b. body malaise, muscle pain c. eruption (maculopapular) then progresses to vesicle (3 -4 days); begins on trunk and spread to extremities and face (even on the scalp, throat and mucus membranes) d. intense pruritus, vesicles ended as a granular scab

VARICELLA
Management
Drugs a. Penicillin: can be used when the crust are severe or infected to prevent scarring or secondary invasion b. Anti Viral: Acyclovir, Immunosin c. Hydrocortisone lotion 1% for itching. Isolation in a room by itself

Nursing Care

Provide a well-ventilated Warm bath should be given daily to relieve itching Use of calamine lotion. Avoid injuring the lesions by using soft absorbent towel (how?) Maintain good oral hygiene Regular diet.

Varicella Rashes

Board Question!
A 15-year old girl came to the Health Center for consultation because of fever & body weakness. You suspect that she is having varicella. In your assessment you will take note of the following:
A. Rashes appear profusely on trunk & sparse on extremities B. Rashes which appear beginning on face & gradually spreading downwards C. Photophobia & conjunctivitis D. Malaise & extreme pruritis

Correct Answer: A
Characteristic rash eruption of chicken pox is from trunk then to extremities

Sample Question
Which of the following home regimens should the nurse suggest to relieve itching in children with chicken pox? Applying
A. generous amounts of fine baby powder B. a paste of baking soda and water C. cloth towels moistened with hydrogen peroxide D. cool compress moistened with weak salt solutions

Correct Answer: B
Baking soda and water often helps relieve itching associate with chicken pox. Calamine lotion can be used.

DIPTHERIA
An acute contagious disease characterized by a general systemic toxemia emanating from a localized inflammatory focus. Causative Agent: Corynebacterium diphtheriae or Klebs Toffler bacillus

DIPTHERIA
Mode of Transmission: Discharge from respiratory passages and Saliva Incubation Period: 4 - 7 days

DIPTHERIA
Clinical Manifestations:
a. Nasal Diphtheria

irritating, bloody discharges excoriated nares and upper lip nose almost or completely stopped up

Signs and Symptoms

DIPTHERIA
b. Pharyngeal Diphtheria Sore throat Pseudo membrane on throat and uvula fever tonsillitis with exudative membrane bull neck appearance

Signs and Symptoms

Signs and Symptoms

Normal Tonsils

Tonsilitis

Signs and Symptoms

DIPTHERIA
c. Laryngeal Diphtheria hoarseness of voice croupy cough inflammation of larynx thus obstructing passage of air to the lungs difficulty of breathing profuse perspiration cyanosis

DIPTHERIA
Diagnostic Exam: Nose and throat culture Shicks Test - determines susceptibility and immunity to diphtheria. Maloneys Test - determine hypersensitivity to diphtheria anti-toxin.

Nursing Care

Tepid sponge bath for fever Provide liquid or soft diet with minimal protein requirement and sufficient carbohydrates Maintain good oral hygiene Maintain patent airway Complete bed rest Monitor fluid intake and output Throat irrigation to ease the pain and clear the throat of mucus and fragments of membranes

Treatment

Drugs (Anti-diphtheria serum to neutralize toxins) Epinephrine Corticosteroids Penicillin Tracheostomy if respiratory obstruction occurs

Board Question!
Question

A. B. C. D.

Correct Answer: ?
answer

PERTUSSIS

A contagious disease characterized by a peculiar paroxysmal cough ending in a whoop.

Causative Agent: Hemophilus pertussis or Bordetella pertussis (An aerobic and anaerobic bacteria) Mode of Transmission: Nasopharyngeal secretion Incubation period: 7 - 21 days

Clinical Manifestations
1. Invasive or catarrhal stage Fever watery eyes sneezing cough is worse at night (slight, dry, irritative) restlessness

more on Clinical Manifestations

2. Spasmodic Stage Pathognomonic sign: crowing sound which becomes the typical whoop Paroxysmal cough 3 - 10 times during expiration with prolonged inspiratory phase the whoop follows the end of a series of short explosive coughs with no time to catch a break between cough protrusion of eyeballs, protruded tongue swollen head and neck veins abdominal hernia 3. Convalescent Stage - symptoms subsides

PERTUSSIS
Diagnostic exam

cough plate - Bordet Gengou test

Nursing Care

Provide quiet and non-stimulating room Complete bed rest Keep patient warm and out of drafts or wind Mouth and nose must be kept clean Small frequent feedings to lessen vomiting A light but nutritious diet with plenty of fruit juices but no seasoned foods Fluids given between meals Apply abdominal binder for hernia

Treatment

Oxygen inhalation Drug (Penicillin)

RUBELLA

an acute infectious disease characterized by mild constitutional symptoms, rose colored macular (enanthem) eruption which may resembles measles.

Causative agent: Myxovirus Mode of Transmission: direct contact Incubation Period: 14 - 21 days

RUBELLA
Clinical Manifestations:

fever, cough, loss of appetite, enlargement of lymph nodes, sweating, leukopenia, vomiting (in some cases), headache, mild sore throat (Constitutional S/Sx) desquamation follows the rash

RUBELLA
Management

Isolation (Catarrhal stage) to prevent infection to others Bed rest for first few days No special diet is necessary Symptomatic Treatment

Nursing Care

Meticulous skin care especially after the rash fades Good oral and nasal hygiene (use of petroleum jelly if lips become dry) Increase fluid intake

Poliomyelitis

An acute communicable systemic viral infection affecting the CNS Target Site: Motor cells of the anterior horn of the nerves specifically in the spinal cord

Risk Factors

lack of immunization against polio travel to an area that has experienced a polio outbreak pregnancy; very old or very young age trauma to the mouth/nose/throat, such as recent tonsillectomy or dental surgery unusual stress or physical exertion after an exposure to poliovirus (emotional and physical stress can weaken the immune system)

Stages of Poliomyelitis

Systemic Stage - low grade fever, headache, nausea, mild tonsilitis and pharyngitis Central Nervous System Invasion - high fever, frontal headache, vomiting, hyperhidrosis of the neck and head Paralytic Stage - nuchal and spinal stiffness as a result of spasm of muscle of the back and hamstring muscles

Pathophysiologic Mechanism

Virus enters the body through contaminated food and water through the nasal cavity Sore throat develops and virus multiplies in the pharynx, gaining entrance to the GI and the circulation. In the blood, virus localizes on the meninges and invades anterior horn of the motor nerves

Treatment

Lifesaving measures, particularly assistance with breathing, may be necessary in severe cases. Analgesics are used to reduce headache and muscle pain Narcotics are not usually given because they increase the risk of breathing difficulty

more on treatment

Physical therapy, braces or corrective shoes, orthopedic surgery, or similar interventions to maximize recovery of muscle strength and function Moist heat (heating pads, warm towels, etc.) may reduce muscle pain and spasm

Sexually Transmitted Diseases

Large group of disease syndromes that can be transmitted sexually irrespective of whether the disease has genital pathologic manifestations

GONORRHEA

Strain, Clap, jack, morning drop (tulo), G. C. Gleet) an infectious disease which causes inflammation of the mucus membranes of the genitourinary tract.

Causative agent: Neisseria Gonorrheae Mode of transmission: sexual contact Incubation period: 2 - 5 days

GONORRHEA
Clinical Manifestations 1. Male - burning sensation in the urethra upon urination, passage of purulent (yellowish) discharge, pelvic pain, fever, painful urination 2. Female - burning sensation upon urination, presence or absence of vaginal discharges, pelvic pain, abdominal distention, nausea and vomiting, urinary frequency.

Diagnostic Exam - C&S, paps smear or cervical smear, urethral smear, VDRL

SYPHILLIS

(Lues, Pox, bad blood disease) a contagious disease that leads to many structural and cutaneous lesions.

Causative Agent: Treponema pallidum Mode of Transmission: sexual contact Incubation Period: 3 - 6 weeks lymph nodes, painful or painless.

Clinical Manifestations
1. Primary Syphilis - chancre on genitalia, mouth or anus, serous drainage from chancre

on clinical manifestations
2. Secondary Syphilis - skin rash on palms and soles of feet, reddish copper-colored lesions on palms of hands and soles of feet. Condylomata lesions/sores that fused together, erosions of oral mucus membranes, alopecia, enlarged lymph nodes, fever headache, sore throat and general malaise 3. Tertiary Syphilis - Gummas the characteristic lesion, cardiovascular changes, ataxia, stroke, blindness, paralysis, insanity

Board Question!
Mr. Jay came for consultation because of pus-like discharge & painful micturation. These are indicative of: A. Syphilis B. Gonorrhea C. Chancre D. Herpes Zoster

Correct Answer: B
Characteristic discharge of syphillis is purulent and it is always associated with painful urination

Board Question!
Gonorrhea is a sexually transmitted disease which may be asymptomatic for: A. Males B. Females C. Adolescents D. Elderly

Correct Answer: ?
answer

Sample Question
The typical chancre of syphilis appears as:
A. a grouping of small, tender pimples B. a painless, moist ulcer C. an elevated wart D. an itching, crusted area

Correct Answer: C
The chancre is characteristically a painless moist ulcer. The serous discharge is infectious

HERPES GENITALIA

Is a systemic viral infection characterized by a localized primary lesions Etiologic Agent: Herpes Simplex virus Associated with menstruation, emotional stress and immunosuppression. Manifestations: Burning or pruritis in areas of lesions; fever; malaise and urinary retention

Sample Question
A client develops herpes genitalis and is counseled by the nurse concerning follow up care. Women who have this disease are at risk for developing A. sterility B. cervical cancer C. uterine fibroid tumors D. irregular menses

Correct Answer: B
Women who have herpes genitalis are more likely to develop cervical cancer than women who have never had the disease

AIDS

a serious deficits in cellular immune function opportunistic infections enteric pathogens malignancies

HIV / AIDS
High Risks 1. Homosexual/Bisexual with multiple partners 2. IV drug users 3. Hemophiliacs 4. Heterosexual partners of infected persons

Mode of Transmission

Contaminated blood and body fluids Sharing of IV needles Sexual contacts Transplacental transfer

Diagnostic Tests

ELISA- Enzyme linked immunosorbent assay IFA- indirect immunoflouresence assay HIV Viral Culture RIPA- Radio immunoprecipitation assay CBC

Management

Administer antiviral agents e.g. Acyclovir Treatment specific to presenting condition 1. Kaposi Sarcoma - single agent chemotherapy

Opportunistic Infections

Pneumocystis Carinii Pneumonia

Assessment: worsening chest pain, SOB, non productive cough, rales, low grade fever, hypoxemia

Candida Ablicans Stomatitis

Assessment: Taste alterations, dyspahgia, retrosternal pain, white buccal exuadation

Opportunistic Infections

Cytomegalovirus - significant factor in morbidity and mortality

Assessment: fever, weight loss, fatigue, lymphadenopathy, retinochoroiditis

Board Question!
Extreme precaution must be observed properly by health workers dealing with AIDS patients. Which among these must be done as a priority?
A. Boil used syringes & needles B. Use gloves when handling specimen C. Reverse isolation D. Label personal belongings

Correct Answer: B
Universal Precaution involves use of gloves when handling contaminated materials

Board Question!
Causative organism in AIDS is one of the following: A. Fungus B. Bacteria C. Retrovirus D. Parasites

Correct Answer: C
AIDS is caused by virus

Parasitism
1. ENTEROBIASIS - pinworm mild infection of the cecum and colon producing mild symptoms of pruritus Agent: Enterobius Vermicularis Incubation Period: 2- 6 weeks Diagnostic Test: Stool Exam/Transparent adhesive tape

ENTEROBIASIS

Management

Antihelmintic Agent- Mebendazole Fe+ therapy Nutritional Supplement

Nursing Care

Avoid sharing of clothing/linens Emphasize proper food handling techniques

Parasitism
2. Ascariasis - round worm chronic infection of the SI producing vague GI symptoms and sometimes acute and severe infection of the other organs like the lungs Agent: Ascaris lumbricoides Incubation Period: 2 months

ASCARIASIS

ASCARIASIS

Management

Mebendazole therapy 100 mg 2 x a day for 3 days Fe+ therapy Nutritional supplement

Nursing Care

Emphasize proper food handling

Board Question!
As a Public Health Nurse, you are concerned with disease prevention. Which of the following should you include as part of your first level prevention program against ascariasis?
1. 2. 3. 4. Health teaching of children on personal hygiene Encourage mass immunization Teachings on proper disposal of excreta Discourage nail-biting

A. 1 and 2 only B. 1,2 and 3 C. 1,3 and 4 D. 2,3 and 4

Correct Answer: C
Hygiene, proper disposal of excreta and nail biting will prevent spread of infection

TINEA CAPITIS

Ringworm of the scalp

Causative agent: Trichophyton tonsurans Incidence: Usually spread through child to child contact, use of towels, combs, brushes and hats, kitten and puppies are sources of infection

TINEA CAPITIS
Assessment: a. reddened, oval or round areas of alopecia, b. presence of kerion: an acute inflammation that produces edema, pustules and granulomatous swelling. Diagnostic Exam: Woods lamp- green flourescence in UV Microscopic evaluation

DERMATOPHYTOSES

TINEA CORPORIS

Ringworm of the body

Clinical Manifestations: intense itching appearance: begins as scaling erythematous lesions advancing to rings of vesicles with central clearing and appears on exposed areas of body.

TINEA CORPORIS
Management Wear clean cotton clothing next to skin Use clean towel daily; dry all areas and skin folds thoroughly.

DERMATOPHYTOSES

TINEA CRURIS

Fungal infection of the groin extending to the inner thighs and buttocks commonly associated with tinea pedis seen most in joggers, obese individuals and those wearing tight underclothing

Clinical Manifestations Dull red brown eruption of the upper thighs and extend to form circular plaques with elevated scaly or vesicular borders itchiness

TINEA CRURIS
Management 1. Drugs - Miconazole cream (Topical) - Griseofulvin (Oral) 2. Avoid excessive washing / scrubbing 3. Wear cotton underwear

DERMATOPHYTOSES

TINEA PEDIS

Fungal infection due to Trichophyton rubrum

Manifesting as an acute inflammatory, vesicular process or as a chronic rash involving the soles of the feet and the interdigital web spaces. Common in summer Contracted in swimming area and locker rooms.

TINEA PEDIS
Clinical Manifestations Scaly fissures between toes Vesicles on sides of feet Pruritus Burning and erythema

TINEA PEDIS
Management:
1. Drugs - Clotrimazole, Miconazole, Tolnaftate (topical) Griseoflvin, ketoconazone (oral) Side Effects: headache, nausea, urticarial rxn., photosensitivity 2. Elevate feet for vesicular type of painful infection

PEDICULOSIS

Is an infestation of lice; also known as crabs

- blood sucking insect; injects saliva to the skin - gray brown-1mm to 2mm crab like insect

Characteristics:

Mode of Transmission: Close personal contact;

sharing of articles

Manifestation: severe itchiness; redness, inflammation Management:

1. Nix lotion 2. Kwell or Lindane ( to be used by adults only because of neurotoxin)

Nursing Care

Segregate articles and clothing Shaving not necessary Articles to be washed in hot water Emphasize personal hygiene

PEDICULOSIS

Sample Question
Which of the following instructions should be given to the parents about the treatment of hair lice?

A. the treatment is repeated in 7 days to 12 days B. treatment is to be repeated everyday for 1 week C. if treated with shampoo, combing to remove eggs isnt necessary D. all contacts with infested child should be treated even without evidence of infestation

Correct Answer: A
Treatment should be repeated in 7-12 days to ensure that all eggs are killed

SCABIES

Is an infestation of the skin produced by the burrowing action of a parasite mite resulting in irritation and the formation of vesicles or pustules.

Causative Agent: itchmite, Sarcoptes scabiei Incidence: occurs in individuals living in area of poverty where cleanliness is lacking. Mode of Transmission: direct contact with infected persons, indirect contact through soiled bed lines and clothing

SCABIES
Clinical Manifestations: intense itching especially at night
Diagnostic exam: presence on skin of female mite, ova and feces upon skin scraping

MANAGEMENT

a. Lindane lotion (kwell) 1% b. Eurex cream / lotion c. 6 -10% precipitate of sulfur in petrolatum

Take a warm soapy shower/bath to remove scaling debris from crusts. Apply prescribed scabicide as:

S C A B I E S

Sample Question
A mother is concerned that her 9 month old has scabies. Which of the following assessment findings is associated with this infestation? A. diffuse pruritic wheals B. oval white dots stuck to the hair shafts C. pain, erythema and edema with an embedded stinger D. pruritic papules, pustules and linear burrows of the finger and toe webs

Correct Answer: D
Pruritic papules, vesicles and linear burrows are diagnostic for scabies

HERPES ZOSTER

Acute viral infection of the peripheral nervous system due to reactivation of varicella zoster virus. The virus causes an inflammatory reaction in isolated spinal and cranial sensory ganglia and the posterior gray matter of the spinal cord. Contagious to anyone who has not had varicella or who is immunosuppressed.

HERPES ZOSTER
Clinical Manifestations:
1. neuralgic pain 2. malaise

3. fever
4. cluster of skin vesicles along course of peripheral sensory nerves (unilateral and found in trunk, thorax or face) appears 3 - 4 days

HERPES ZOSTER
Management: Drug
a. Analgesics b. Corticosteroids c. Acetic acid compresses or white petrolatum d. anti-virals (acyclovir)

Isolate client Apply drying lotions (calamine)

HERPES ZOSTER

EBOLA
A

virulent viral disease causing 50-90% of clinical cases Mode of Transmission: direct contact with blood and secretions

Board Question!
Question

A. B. C. D.

Correct Answer: ?
answer

EBOLA
Incubation Period: 2-21 days Manifestations: sudden onset of fever; weakness; muscle pain, headache, sore throat, diarrhea and bleeding Treatment: No specific treatment or vaccine available; Intensive supportive care; Strict Isolation Nursing Care: Symptomatic care; Strict Nursing Barrier

MENINGITIS

Signs and Symptoms

MENINGITIS
Treatment: Massive doses of intravenous antibiotics
Nursing Care: Provide for rest; decrease stimulation; respiratory isolation; positioning; decrease fluids; I&O

Board Question!
Question

A. B. C. D.

Correct Answer: ?
answer

R A B I E S

RABIES

Caused by virus in the saliva of infected animal; virus affects the CNS which causes hemorrhages and neuronal destruction

Manifestations: headache, stiff neck, photophobia, respiratory difficulty, excessive salivation, aerophobia, hydrophobia

RABIES
Management: Sedative, anticonvulsants, tracheostomy, human rabies immune globulin
Nursing Care: Isolation Technique, Keep room dark and quiet, prevent drafts

Board Question!
Question

A. B. C. D.

Correct Answer: ?
answer

ANTHRAX

Board Question!
Anthrax is defined as:
A. A viral infection of the liver introduced by fecally contaminated food & water B. An acute bacterial disease usually affecting the skin but which may involve the oropharynx, lower respiratory tract or intestinal tract C. An acute viral encephalomyelitis caused by rhabdovirus D. A systemic infection characterized by continued fever, malaria, anorexia & rose spots

Correct Answer: B
Anthrax is a bacterial infection

Board Question!
The causative agent for anthrax is Bacillus anthraces, a gram positive, encapsulated, spore-forming, non-motile rod. What is the incubation period of anthrax? A. a few hours to 7 days B. 1 to 7 days C. 7 to 10 days D. 3 to 5 days

Correct Answer: B
answer

SMALL POX

An infectious disease that causes debilitating conditions characterized by hard pustules spreading to trunk and legs.

Etiologic agent: Variola Major Incubation period: 12 to 14 days Mode of transmission: spreads through air, from mouth or throat of an infected person when they cough or sneeze

SMALL POX
Manifestations:

High fever 104oF Malaise Body aches & headaches Extreme fatigue Rash appears on the lining of mouth, face & forearms Within 2 days hard pustules begins to form Scabs

Treatment

No specific treatment only supportive measures

Nursing Care

Isolation Supportive nursing care like TSB Correct positioning Change of linens and clothing Proper disinfection

SMALL POX

The End