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Non-communicable diseases account for 59% of all deaths worldwide the way the causative agent gets out of the reservoir (body fluid or
– estimated to rise from 28m in 1990 to 50m in 2020 skin)
About 60% of deaths caused by communicable diseases can be Reduce risk from portals of exit by:
attributed to:
• Covering coughs and sneezes with a tissue
HIV/AIDS • Handling body fluids with gloves, then doing hand hygiene
• Keeping draining wounds covered with a dressing
Malaria • Not working when you have exudative (wet) lesions or
weeping dermatitis
Mode of transmission
Tuberculosis
any mechanism by which a pathogen is spread from a source or
Measles
reservoir to a person
Diarrheal disease
unwashed hands, things which are not cleaned between patients,
droplets, or, for a few diseases, the air
Acute respiratory infection
Eliminate the mode of transmission by:
Philippines top 10 leading causes of morbidity & mortality in the
year 2007:
• Hand hygiene
• Wearing gloves to minimize contamination of hands and
1. Diarrhea discarding them after each patient
• Cleaning, disinfection, or sterilization of equipment used by
2. Bronchitis more than one patient
• Cleaning of the environment, especially high-touch surfaces
3. Pneumonia Portal of entry
4. Influenza hole in the skin that allows the infectious agent to get into the body
(mouth, nose, eyes, rashes, cuts, needlestick injuries, surgical wounds
5. Hypertension and IV sites)
6. Tuberculosis Protect portals of entry (our own and our patients) by:
Definition:
Chain of Infection
Symptoms
Pathogen or causative agent
evidence of disease that is experienced or perceived (subjective)
biologic agent (organism) capable of causing disease
subjective changes in body function noted by
Eliminate organism by:
patient but not apparent to an observer
• Sterilizing surgical instruments and anything that touches
sterile spaces of the body Signs
• Using good food safety methods
• Providing safe drinking water objective evidence of a disease the physician can
• Vaccinating people so they do not become reservoirs of
illness
observe and measure
• Treating people who are ill
Reservoir
Syndrome
Any person, animal, arthropod, plant, soil, or substance (or
combination of these) in which an causative agent normally lives and a specific group of signs and symptoms that
multiplies, on which it depends primarily for survival, and where it
reproduces in such numbers that it can be transmitted to a susceptible accompany a particular disease
host
Incidence
Eliminate reservoirs by:
the number of people in a population who
• Treating people who are ill
• Vaccinating people develop a disease during a particular time period
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
disease that easily spreads from one person to another pre diseased state
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
Susceptible Host
Pandemic Disease
Recognition of high risk patients
epidemic disease that occurs worldwide
• Immunocompromised
i.e. HIV infection
• DM
• Surgery
Based on Severity or Duration of Disease • Burns
• Elderly
Acute Disease Percentage Nosocomial Infection
early, mild symptoms of disease i.e. burns, surgical wounds, trauma, IV site
IMMUNITY IMMUNIZATION
AND VACCINES
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 IMMUNIZATION
immunity
Process inducing immunity artificially by either vaccination (active) or
Functions of Immune System administration of antibody (passive)
1. Protects the body from internal threats Active : stimulates the immune system to produce antibodies, cellular
immune responses to protect against infectious agent
2. Maintains the internal environment by removing dead or damaged
cells. Passive : provides temporary protection through administration of
exogenous antibody
3. Provides protection against invasion from outside the body.
IMMUNIZING AGENTS
• Oral preparation - live attenuated Sabin, trivalent OPV It is safe to vaccinate a sick child who is suffering from a minor illness
• Dose : 2 drops; as early as 6 weeks old, 4 weeks apart (cough, cold, diarrhea, fever or malnutrition) or who has already been
• Booster dose : 1 year after last dose of primary series and vaccinated against measles
between 4 to 6 years old
DIPHTHERIA, TETANUS,PERTUSSIS (DTP) If the vaccination schedule is interrupted, it is not necessary to restart.
Instead, the schedule should be resumed using minimal intervals
• Diphtheria and tetanus toxoid, inactivated pertussis between doses to catch up as quickly as possible.
adsorbed into aluminum salts
• Dose : 0.5 ml IM x 3 doses as early as 6 weeks old, 4 weeks A "first expiry and first out" (FEFO) vaccine system is practiced to
apart assure that all vaccines are utilized before its expiry date. Vaccine
• Booster doses : 1 year after last dose of primary series and temperature is monitored twice a day in all health facilities and plotted
between 4 to 6 years old to monitor break in the cold chain.
• Complications :
– Pertussis : not used in > 6 y/o because of increased risk of
neuroparalytic reaction
MEASLES
Most sensitive to Heat – Oral polio vaccine, Measles
– Live attenuated vaccine; freeze-dried
Least Sensitive to Heat – DPT vaccine, Hepa B, BCG, tetanus Toxoid
– Dose : 0.5 ml SC at 9 months, as early as 6 months
– Booster dose : 12 to 15 months old as MMR (Measles,
Mumps, Rubella) INFECTION CONTROL PROCEDURE
– Transplacental maternal IgG interferes with antibody
formation Medical Asepsis
MEASLES/MMR
– CLEAN Technique
– First dose at 12 to 15 months – Involves procedures and practices that reduce the number
– Second dose between 4-6 y/o and transfer of pathogens
– Mumps vaccine usually >15 months old given as MMR – Will exclude pathogens ONLY
HEPATITIS B Attain by:
– Infants born o HbsAg-positive mothers should receive HepB – Frequent and thorough hand washing
vaccine (below 7 days) plus 0.5 ml Hepa B immunoglobulin – Personal grooming
(HBIG) within 12 hours of birth at 2 diff.sites – Proper cleaning of supplies and equipment
– 2nd dose is recommended at 1-2 months and 3rd dose at 6 – Disinfection
months of age – Proper disposal of needles, contaminated materials and
– Infants born to mothers whose HbsAg is unknown should infectious waste
receive HepB vaccine within 12 hours of birth – Sterilization
Haemophilus Influenza type B (HIB) Surgical Asepsis
– Old pure capsular polysaccharide vaccine effective for > 18 STERILE technique
months
– HiB cause meningitis and serious respiratory infections in – Practices used to render and keep objects and areas sterile
<12 months
TYPHOID – Exclude ALL microorganism
Attain by:
– Live oral Ty21A. Thermolabile given 3 doses at 2 days
interval and 25-95% effective for 3 years – Use strict aseptic precautions for invasive procedures
– Vi Antigen typhoid vaccine (Typhim Vi).capsular – Scrub hands and fingernails before entering O.R.
polysaccharide of the organisms. Given 0.5 ml SC or IM with – Use sterile gloves, masks, gowns and shoe covers
75% effectivity for 3 years – Use sterile solutions and dressings
HEPATITIS A – Use sterile drapes and create an sterile field
– Heat –sterilized surgical instruments
– Vaccine contains formaldehyde-inactivated Hep A containing Universal Precautions
720 ELISA units
– 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 – Infection control guidelines designed to protect workers from
INFLUENZA exposure to diseases spread by blood and certain body
fluids.
– Immunogenic, safe and associated with minimal side effects – For prevention of transmission of blood-borne pathogens in
– 6months to <36 months, 2 doses of vaccine 1 month apart health care settings to prevent contact with patient blood and
– Protection is 70 to 80% with range of 50 to 95% body fluids
– Duration or protection is <1 year – Stress that all patients should be assumed to be infectious
PNEUMOCOCCAL for blood-borne diseases such as AIDS and hepatitis B.
– Universal Precautions
–23-valent pneumococcal vaccine is composed of purified Followed when workers are exposed to blood and certain other body
capsular polysaccharide antigen of 23 serotypes fluids, including:
– Given SC or IM
– Reactivation after 3-5 years is recommended for children 10 – semen
years or younger who are at high risk of severe – vaginal secretions
Pneumococcal infection – synovial fluid
– Can be given concurrently with other vaccines – cerebrospinal fluid
PNEUMOCOCCAL – pleural fluid
– peritoneal fluid
The following serious patients should be immunized : – pericardial fluid
– amniotic fluid
– Universal Precautions
– sickle cell disease
do not apply to: – All persons entering the room of these patients must wear a
personal respirator that filters 1 µm particles with a n
– feces efficiency of at least 95% (N95 mask)
– nasal secretions – Gowns and gloves are used as dictated by standard
– sputum precautions
– sweat 1. Disseminated zoster
– tears 2. Measles
– urine 3. Smallpox
– vomitus 4. SARS
– saliva (except in the dental setting, where saliva is likely to 5. Tuberculosis (pulmonary or laryngeal)
be contaminated with blood) 6. Varicella
Standard Precautions 7.
Standard Precautions – Patient placed in a private room with monitored negative air
pressure in relation to surrounding areas, and the room air
Replaced universal precautions must undergo at least 6 exchanges per hour
– Door to the isolation room must remain closed
– Air from the isolation room should be exhausted directly to
Apply to all patients
the outside, away from air intakes, and not recirculated (high
efficiency filters may be used also)
Stipulate that gloves should be worn to touch any of the following: – Cough etiquette
– Patients should be instructed to cover his/her mouth and
- blood nose with tissue when coughing or sneezing
- non-intact skin (unlike droplet nuclei, droplets are larger, do not remain suspended
in the air, and do not travel long distances)
- mucous membranes
Droplets are produced when the infected patient talks, coughs, or
Standard Precautions sneezes and during some procedures (e.g., suctioning, bronchoscopy)
Gloves A susceptible host may become infected if the infectious droplets land
on the mucosal surfaces of the nose, mouth, or eye.
– Prevent contamination of the hands with microorganisms
– Prevent exposure of the HCW to blood-borne pathogens – Require patients to be placed in a private room, but no
– Reduce the risk of transmission of microorganisms from the special air handling is necessary (patients with same
hands of HCWs to the patient disease can be placed in the same room if private rooms are
– Do not replace the need for hand hygiene not available)
Standard Precautions – Droplets do not travel long distances (generally no more
than 3 feet), the door to the room may remain open
Hands washed immediately after gloves are removed and between – HCW should wear a standard surgical mask when working
patient contacts within 3 feet of the patient
– Gowns and gloves should be worn by HCWs when dictated
– For procedures that are likely to generate splashes or sprays by standard precautions
of body fluid, a mask with eye protection or a face shield and 1. Diphtheria, pharyngeal
a gown should be worn 2. H. influenzae meningitis, epiglottitis, pneumonia
– Disposable gowns should be constructed of an impervious 3. Influenza
material to prevent penetration and subsequent 4. Meningococcal infections
contamination of the skin or clothing 5. Multi-drug resistant pneumococcal disease
Standard Precautions 6. Mumps
7. Mycoplasma pneumonia
– Needles should not be recapped, bent, or broken but should 8. Parvovirus B19 infections
be disposed of in puncture-resistant containers 9. Pertussis
Standard Precautions 10. Plague, pneumonic
11. Rubella
Hand Hygiene 12. Streptococcal pharyngitis
– Protective or neutropenic isolation Tournique test or Rumpel Leede Test – presumptive test for capillary
– Used for patients with severe burns, leukemia, transplant, fragility
immuno deficient persons, receiving radiation treatment,
leukopenic patients – keep cuff inflated for 6-10 mins (child), 10-15 min (adults)
– Those that enter the room must wear masks and sterile – count the petechiae formation 1 sq inch (>10-15
gowns to prevent from introducing microorganisms to the petechiae/sq inch)
room
Laboratory Procedures
- 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
1. Grade I – Dengue fever, saddleback fever plus constitutional Two biological type
signs and symptoms plus positive tornique test
2. Grade II – Stage I plus spontaneous bleeding, epistaxis, GI, Nocturnal
cutaneous bleeding
3. Grade III – Dengue Shock Syndrome, all of the following microfilaria circulate in peripheral blood at night (10pm – 2am)
signs and symptoms plus evidence of circulatory failure
Diurnal Shock, coma, CHF
Specific
Laboratory Diagnosis
Penicillin 50000 units/kg/day
– Blood smear – presence of microfilaria
– Immunochromatographic Test (ICT) Tetracycline 20-40mg/kg/day
– Eosinophil count
Non-specific
Management Guidelines Supportive and symptomatic
– Specific Therapy Administration of fluids
– Dietylcarbamazine (DEC) 6mg/KBW in divided doses for 12
consecutive days
Peritoneal dialysis for renal failure
– Ivermectine (Mectican)
– Supportive Therapy
– Paracetamol Educate public regarding the mode of transmission, avoid swimming or
– Antihistamine for allergic reaction due to DEC wadding in potentially contaminated waters and use proper protective
– Vitamin B complex equipment.
– Elevation of infected limb, elastic stocking
It may cause loss of vision, night blindness, or tunnel vision with 1. Dispose and isolate urine of patient.
prolonged used.
2. Environmental sanitation like cleaning the esteros or dirty places
Ivermectin is best taken as single dose with a full glass of water in en with stagnant water, eradication of rats and avoidance of wading or
empty stomach. bathing in contaminated pools of water.
Cannot be used in patient with asthma 3. Give supportive and asymptomatic therapy
Preventive Measures 5. Assist in peritoneal dialysis for renal failure patient (The most
important sign of renal failure is presence of oliguria.)
Health teachings
MALARIA
Environmental Sanitation
– Malaria
– “King of the Tropical Disease”
– an acute and chronic infection caused by protozoa
plasmodia
Leptosiprosis (Weil’s disease)
– Infectious but not contagious
– transmitted through the bite of female anopheles mosquito
a zoonotic systemic infection caused by Leptospires, that penetrate – Malaria Exacts Heavy Toll in Africa
intact and abraded skin through exposure to water, wet soil – Malaria
contaminated with urine of infected animals. – There are 300-500m new cases annually
– Over 1m die every year – almost 3000 per day
– 90% of deaths are in Sub-Saharan Africa
– Cost of malaria in Africa is $100bn
Anicteric Type (without jaundice) – Vector: (night biting)
– anopheles mosquito
manifested by fever, conjunctival injection – or minimus flavire
Life cycle:
signs of meningeal irritation
– Sexual cycle/sporogony (mosquito)
– sporozoites injected into humans
– Asexual cycle/schizogony (human)
Icteric Type (Weil Syndrome) – gametes is the infective stage taken up by biting mosquito
Plasmodium Vivax
Hepatic and renal manifestation
– more widely distributed
Jaundice, hepatomegally – causes benign tertian malaria
– chills and fever every 48 hours in 3 days
Plasmodium Falciparum
Oliguris, anuria which prigress to renal failure
– common in the Philippines – insect repellant, nets
– Causes the most serious type of malaria because of high
parasitic densities in blood.
– Causes malignant tertian malaria Nursing Care
Plasmodium malaria
1. Consider a patient with cerebral malaria to be an emergency
– much less frequent
– causes quartan malaria, fever and chills every 72 hrs in 4 – Administer IV quinine as IV infusion
days
– Plasmodium Ovale - Watch for neurologic toxicity from quinine transfusion like delirium,
– rarely seen. confusion, convulsion and coma
Pathology
2. Watch for jaundice – this is related to the density of the falciparum
– the most characteristic pathology of malaria is destruction of parasitemia,
red blood cells, hypertrophy of the spleen and liver and
pigmentation of organs.
3. Evaluate degree of anemia
– The pigmentation is due to the phagocytocis of malarial
pigments released into the blood stream upon rupture of red
cells 4. Watch for abnormal bleeding that are may be due to decrease
Clinical Manifestation production of clotting factors by damage liver.
uncomplicated Chemoprophylaxis
– fever, chills, sweating every 24 – 36 hrs – doxycycline 100mg/tab, 2-3 days prior to travel, continue up
Complicated to 4 weeks upon leaving the area
– Mefloquine 250mg/tab, 1 week before travel, continue up to
four weeks upon leaving the area
– sporulation or segmentation and rupture of erythrocytes
– Pregnant, 1st trimester, chloroquine, 2 tabs weekly, 2 weeks
occurs in the brain and visceral organs.
before travel, during stay and until 4 weeks after leaving
– Cerebral malaria
– 2nd and 3rd trimester, Pyrimethamine-sulfadoxine
– changes of sensorium, severe headache and vomiting
– seizures
Category of provinces
clinical manifestation
Category A – no significant improvement in malaria for the past 10
years. >1000
1. Cold stage – 10-15 mins, chills, shakes
2. hot stage – 4-6 hours, recurring high grade fever, severe
headache, vomitting, abdominal pain, face is blue - Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao, kalinga
3. Diaphoretic Stage – excessive sweating
Category B - <1000/year
Diagnosis - Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan, zambales,
bataan, laguna
– Malarial smear
– Quantitative Buffy Coat (QBC) Category C – significant reduction
Travel in endemic areas
-pampanga, la union, batangas, cavite, albay
Treatment:
PATHOLOGY
Treatment for P. Falciparum
Primary – spread of bacteria from the bloodstream to the meniges
1. chloroquine tablet (150mg/base/tab) Day 1,2,3 (4,4,2)
2. Sulfadoxine/Pyrimethamine 500mg/25mg/tab, 3tab single Secondary – results from direct spread of infection from other sources
dose or focus of infection.
3. Primaquine (15mg/tab) 3 tabs single dose
Treatment for P. Vivax
1. Choloroquine, Day 1,2,3 (4,4,2) The disease usually begins as an infection by normal body flora, of:
2. Primaquine 1 tab OD for 14 days
1. The ear (otitis media) - Haemophilus influenzae
Diagnosis sudden onset of high grade fever, rash and rapid deterioration of
clinical condition within 24 hours
– Lumbar puncture
– Blood C/S S/sx:
– other laboratories
1. Meningococcemia – spiking fever, chills, arthralgia, sudden
appearance of hemorrhagic rash
umbar Puncture
2. Fulminant Meningococcemia (Waterhouse Friderichsen) –
– To obtain specimen of CSF septic shock; hypotension, tachycardia, enlarging petecchial
– To reduce ICP rash, adrenal insufficiency
– To Introduce medication
– To inject anesthetic Laboratory
– Blood Culture
CSF Examination – Gram stain of peripheral smear, CSF and skin lesions
– CBC
– Fluid is turbid/purulent >1000cc/mm cells Treatment:
– WBC count increase
– Sugar content markedly reduced antimicrobial
– CHON increased
– Presence of microorganism – Benzyl Penicillin 250-400000 u/kg/day
– Chloramphenicol 100mg/kg/day
Symptomatic and supportive
– Treatment
Bacterial meningitis – fever
– TB meningitis – seizures
– Intensive Phase – hydration
– Maintainance Phase – respiratory function
– Fungal meningitis
– cryptococcal meningitis – fluconazole or amphotericin B
2. Supportive/Symptomatic Chemoprophylaxis
c. Control of seizures
Nursing Intervention
d. adequate nutrition
– Provide strict isolation
Nursing Intervention – Wearing of PPE
– Health teaching
– Contact tracing
Prevent occurrence of further complication
– Prophylaxis
– Meninggococcal vaccine for high risk patient
– Maintain strict aseptic technique when doing dressing or
lumbar puncture.
RABIES
– Early symptom should be recognize
– acute viral encephalomyelitis
– Vital signs monitoring – incubation period is 4 days up to 19 years
– risk of developing rabies, face bite 60%, upper extremities
– Observe signs of increase ICP 15-40%, lower extremities 10%
– 100% fatal
– Protect eyes from light and noises
– Note and record the amount of vomitus – pain or numbness at the site of bite
– fear of water
– Check signs of dehydration – fear of air
Intramuscular (0,3,7,14,28)
SNAKEBITE
(0,7,21)
Management
B. Passive Vaccine
– Lie the victim flat
a. ERIG wt in kg x .2 = cc to be injected im (ANST) – ice compress and constrictives materials are
contraindicated
– Transport the patient to the nearest hospital
b. HRIG wt in Kg x .1333
– Antivenim administration in patient’s with signs of
envenomation
– It is never too late to give anti-venim
– Antivenim is given thru intravenous infusion, which is
Pre-exposure Prophylaxis the safest and most effective route. 2-5 ampules plus
D5W to run iver 1-2 hours every 2 hours
Intradermal/Intramuscular (0,7,21) – Antimicrobial therapy
– sulbactam/Ampicillin or co-amoxiclav
– Substitute
– Prostigmine IVinfusion, 50-100ug/kg/dose q 8hrs
Infection control – Atropine
Poliomyelitis
Clinical manifestation
– RNA, Polio virus
– Fecal oral route/droplets – Difficulty of opening the mouth (trismus or lockjaw)
– IP 7-12 days – Risus sardonicus
– Disease of the lower motor neurin involving the anterior horn – Abdominal rigidity
cells – Localized or generalized muscle spasm
– Infantile paralysis; Helne-Medin disease
Predisposing Factors
Treatment
– Children below 10 years old
– Male more often affected 1. Neutralize the toxin
– Poor environmental and hygienic conditions
Causative Agent: Legio debilitans 2. Kill the microorganism
bulbar or spinal
Treatment:
Mode of Transmission
anti-toxin
– Droplet infection – in early infection
Tetanus Anti-Toxin (TAT)
– Body secretions – nasopharyngeal
– Fecal oral – during late stage
– Flies may act as mechanical vectors – Adult,children,infant 40,000 IU ½ IM,1/2 IV
– Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
TIG
A. I – Abortive or inapparent
B. II – Meningitis (non-paralytic) – Neonates 1000 IU, IV drip or IM
C. III – Paralytic (anterior horn of spinal cord)
D. IV – Bulbar (encephalitis)
– Adult, infant, children 3000 IU, IV drip or IM
Antimicrobial Therapy
Dx: Pandy’s test - CSF (increased CHON) Penicillin !-3 mil units q 4hours
Active – OPV (Sabin) and IPV (Salk) Neonatal 200000 units IVP q 12hrs or q8hrs
Nursing Interventions
HEPATO-ENTERIC DISEASES
– Environmental Sanitation
SCHISTOSOMIASIS – Food handlers sanitation permit
– Supportive therapy
– caused by blood flukes, Schistosoma – Assessment of complication (occuring on the 2nd to 3rd week
– has 3 species, S. haematobium, S. Mansoni, S. japonicum
of infection )
– S. japonicum is endemic in the Philippines (leyte, Samar,
– typhoid psychosis, typhoid meningitis
Sorsogon, Mindoro,Bohol)
– typhoid ileitis
– Intermediate host, Oncomelania Quadrasi
Hepatitis
DIAGNOSIS
– Hepa A – fecal oral route
– Schistosoma eggs in stool
– Hepa B – body fluids
– Rectal bipsy
– Hepa C – non A non B, BT, body fluids
– Kato Katz
– Hepa D – hypodermic, body fluids
– Ultrasound of HBT
– Hepa E – fecal oral route, fatal and common among
pregnant women
– Hepa G – BT, parenteral
Clinical Manifestation
Signs/Symptoms:
Methods of Control
– Influenza
– Educate the public regarding the mode of transmission and
methods of protection.
– Malaise and easy fatigability
– Proper disposal of feces and urine
– 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
Blood examination WBC usually leukopenia with lymphocytosis – Low fat diet but high sugar
Possible Outcome – *Contagious 4 days before rash and 4 days after rash
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,
chronic or carrier – Black measles – severe form of measles with hemorrhagic
rashes, epistaxis and melena
– (+) HBeAg = highly infectious
– ALT – 1st to increase in liver damage Rashes: maculopapaular, cephalocaudal (hairline and behind the ears
○ HBcAg = found only in the liver cells to trunk and limbs), confluent, desquamation, pruritus
– (+) Anti-HBc = acute infection Complication
– (+) Anti-HBe = reduced infectiousness
– Bronchopneumonia
– (+) Anti-HBs = with antibodies (FROM vaccine or
– Secondary infections
disease) – Encephalitis
– Blood Chem. Analysis (to monitor progression) – Increase predisposition to TB
– Liver biopsy (to detect progression to CA)
MANAGEMENT
Mgmt:
1. Supportive
– Prevention of spread – Immunization and Health Education
– Enteric and Universal precautions
2. Hydration
– Assess LOC
– Bed rest
– ADEK deficiency intervention 3. Proper nutrition
– High CHO, Moderate CHON, Low fat
– FVE prevention 4. Vitamin A
5. Antibiotics
Cx:
6. Vaccine
1. Fulminant Hepatitis – s/sx of encephalopathy
Nursing Care
2. Chronic Hepatitis - lack of complete resolution of clinical sx and
persistence of hepatomegaly – Respiratory precautions
– Restrict to quite environment
3. HBsAg carrier – Dim light if photophobia is present
– Administer antipyretic
ERUPTIVE FEVER – Use cool mist vaporizer for cough
MEASLES
German Measles (rubella)
– Extremely contagious
– Breastfed babies of mothers have 3 months immunity for – Acute infection caused by rubella virus characterized by
measles fever, exanthem and retroauricular adenopathy.
– The most common complication is otitis media – Has a teratogenic potential on the fetuse of women in the 1st
– The most serious complications are bronchopneumonia and trimester
encephalitis s/sx:
– forschheimer’s (petecchial lesion on buccal cavity or soft – Cx: same with chicken pox
palate),
– cervical lymphadenopathy, low grade fever
– “ Oval, rose red papules about the size of pinhead KAWASAKI DISEASE
Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear Diagnosis
after fever subsides, Mild pharyngitis and lymph node enlargement
– CBC: leukocytosis
– Platelet count >400000
– 2D echo (if coronary artery involvement is highly suggestive
Chicken Pox, Varicella – ESR and CRP elevated
* Contagious 1 day before rash and 6 days after first crop of vesicles Mumps
– Paul’s test - instilling of vesicular fluid w/ small pox into the IP: 2-6 days
cornea; if keratitis develops, small pox
Mode of transmission is direct or indirect contact expiration and a sudden noisy inspiration with a long high
pitched “whoop”
1. Nasal – invades nose by extension from pharynx – During attack the child becomes cyanotic and the eyes
appear to bulge or popping out of the eyeball and tongue
2. Pharygeal protrudes
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
Treatment
Pre exposure prophylaxis for Diphtheria, Pertussis, Tetanus
A. Neutralize the toxins – antidiptheria serum
B. Kill the microorganism – penicillin DPT- 0.5 ml IM
C. Prevent respiratory obstruction – tracheostomy, intubation
– 1 - 1 ½ months old
Treatment 2 - after 4 weeks
3 - after 4 weeks
Serum therapy (Diptheria antitoxin) – 1st booster – 18 mos
Antibiotics
Infectious Mononucleosis
- Penicillin G 100000mg/kg.day
– Epstein Barr virus
– Inc. period: 4-6 weeks
- Erythromycin 40mg/kg – Communication period: Unknown, virus is shed before the
onset of the dse until 6 months or longer after recovery
Nursing Intervention
– Source: oral secretions
– Rest. – Transmission: Direct intimate contact, infected blood
– Patient should be confined to bed for at least 2 weeks
– Prevent straining on defecation
– vomiting is very exhausting, do not do procedures that may Assessment
cause nausea
– Care for the nose and throat – Fever, sorethroat, malaise, headache, fatigue, nausea,
– Ice collar to reduce the pain of sorethroat abdominal pain
– Soft and liquid diet
– CLADP, hepatosplenomegally
MOT: airborne/droplet
PULMONARY TUBERCULOSIS
Signs and symptoms
– The world’s deadliest disease and remains as a major public
– Invasion or catarrhal stage (7-14days) starts with ordinary health problem.
cough – Badly nourished, neglected and fatigued individuals are
– Spasmodic or paroxysmal more prone
– 5-10 spasms of explosive cough (no time to catch breath. A – Susceptibility is highest in children under 3 years
peculiar inspiratory crowing sound followed by prolonged – AKA: Koch’s disease: Galloping consumption
S/sx: 2. Pneumonia
- below 2 mos old, fast breathing, chest indrawing, with danger signs
PPD – ID
4 Danger Signs
– macrophages in skin take up Ag and deliver it to T cells
– T cells move to skin site, release lymphokines
1. Vomits
– activate macrophages and in 48-72 hrs, skin becomes
indurated
– > 10 mm is (+) 2. Convulsion
Dx:
3. Drowsiness/lethargy
– Chest xray - cavitary lesion
– Sputum exam 4. Difficulty of swallowing or feeding
– sputum culture
S/sx:
The National Tuberculosis Control Program 1. Typical – sudden onset Fever of > 38 x 7-10 days,
productive cough, pleuritic chest pain, dullness,
– Vision: A country where TB is no longer a public health inc fremitus, rales
problem.
– Mission: Ensure that TB DOTS services are available to the 2. Atypical – gradual onset, dry cough, headache, myalgia,
communities. sore throat
– Goal: To reduce the prevalence and mortality from TB by
half by the year 2015 Watch out for complications; In 24 hours death will occur from
respiratory failure
Targets:
Amoebiasis
– Metronidazole – trichomonocide and amoebicide for – Common worldwide with greatest frequency in tropical
intestinal and extra intestinal sites (monitor liver function countries.
test) – Has an infection rate of 70-90% in rural areas
– Diloxanide furoate – luminal amoebicide – MOT: ingestion of embryonated egss (fecal-oral)
– Paromomycin – eradicate cyst of histolytica – Worms reach maturity 2 months after ingestion of eggs.
– Tinidazole – hepatic amebic abscess – Adult worms live less than 10 months(18 months max.)
– Female can produce up to 200000 eggs per day
– Eggs may be viable in soils for months or years
Bacillary Dysentery – Worms can reach 10-30cm in length
Shigellosis
Hookworm (Roundworm) – Migration of the worm to different parts of the body Ears,
mouth,nose
– Necator Americanus, Ancylostoma Duodenale – Loefflers Pneumonia
– Leads to iron deficiency and hypochromic microcytic anemia – Energy protein malnutrition
– Gain entry via the skin – Intestinal obstruction
– Dx: microscopic exam (stool exam)
– Mgmt: Pyrantel Pamoate and Mebendazole
– don’t give drug without (+) stool exam Tapeworm (Flatworms)
– members of the family must be examined and treated also
– Taenia Saginata (cattle), Taenia Solium (pigs)
– MOT: fecal oral route
Paragonimiasis (ingestion of food contaminated by the agent)
– s/sx: neurocysticercosis – seizures, hydrocephalus
– Chronic parasitic infection – Dx: Stool Exam
– Closely resembles PTB – Mgmt: Praziquantel, Niclosamide
– Endemic areas: mindoro, camarines sur, norte, samar,
sorsogon, leyte, albay, basilan
– Paragonimiasis Pinworm
– AKA: Lung fluke disease
– causative agent: paragonimus westermani; Trematode – Enterobius Vermicularis
– Eating raw or partially cooked fish or fresh water crabs – MOT: fecal oral route
– S/sx: Itchiness at the anal area d/t eggs of the agent
Signs and symptoms – Dx: tape test at night time
(agents release their eggs during night time)
– Cough of long duration – flashlight
– Hemoptysis – Mgmt: Pyrantel Pamoate, Mebendazole
– Chest/back pain
– PTB not responding to anti-koch’s meds
Nursing Intervention
1. Praziquantrel (biltrizide)
PARALYTIC SHELLFISH POISONING
2. Bithionol
– A syndrome of characteristic symptoms predominantly s/sx: itching worse at night and after hot shower; rash; burrows (dark
neurologic which occurs within minutes or several hours wavy lines that end in a bleb w/ female mite) in between fingers, volar
after ingestion of poisonous shellfish wrists, elbow, penis; papules and vesicles in navel, axillae, belt line,
– Single celled dinoflagellates (red planktons) become buttocks, upper thighs and scrotum
poisonous after heavy rain fall preceded by prolonged
summer Dx: biopsies/scrapings of lesions
– Common in seas around manila bay, samar, bataan and
zambales Mgmt: Permethrin (Nix) cream, crotamiton cream, Sulfur soap,
MOT = Ingestion of contaminated bi-valve shellfish antihistamines and calamine for pruritus, wash linens with hot water,
single dose of Ivermectin, treat close contacts
IP = within 30 minutes
Dx: biopsies/scrapings of lesions
CLINICAL MANIFESTATIONS:
NURSING CARE
– NUMBNESS OF THE FACE ESPECIALLY AROUND THE
MOUTH A. Administer antihistamines or topical steroids to relieve
– VOMITING, DIZZINESS, HEADACHE itching.
– TINGLING SENSATION, WEAKNESS
– RAPID PULSE, DIFFICULTY OF SPEECH (ATAXIA), B. Apply topical antiscabies creams or lotion like
DYSPHAGIA, RESPI PARALYSIS, DEATH. lindasne(kwell), Crotamiton (Eurax), permithrin
Mgmt: disinfect implements, Lindane (Kwell) topical MDT-RA 4073 (home meds)
Antibiotics that are metabolized and excreted in the kidney most Infection of the heart valves and the endothelial surface of the
frequently cause kidney damage.. heart
Direct toxic effect to the cells of the GI tract can cause nausea, 1. Bacteria- Organism depends on several factors
vomiting, stomach pain and diarrhea. Some drugs are toxic to liver
cells and can cause hepatitis or liver failure. 2. Fungi
Common Adverse Reactions to Anti-infective Therapy
Opportunistic infections that develop during the course of – Two major criteria or
antibiotic therapy are called SUPERINFECTIONS. – One major and three minor
– Five major criteria
Major criteria
Teaching about anti-infective therapy
– Positive blood culture typical for IE
– Take the drug exactly as prescribed. Complete the entire
– Positive echocardiogram study
prescribe regiment, comply with instruction RTC
Minor criteria – Fever (38.9-40C)
– Chills
– Predisposing heart condition – Sore throat
– Febrile syndrome – Diffuse redness of throat
– Vascular phenomena: conjuctival hemorrhage, janeway – CLADP
lesions – Abdominal pain (children)
– Immunologic phenomena – Tiny translucent vegetations or growths, which resemble
– Osler nodes and roth spots pinhead size beads at the valves.
– Echocardiogram suggestive of IE but not classified as major – Cause valvular regurgitation (mitral valve)
– MV (Left sided heart failure)
– Risk for embolic phenomena on the lungs , kidney, spleen,
Acute heart, brain
- nafcillin or oxacillin
Urinary Tract Infection (UTI)
- gentamycin
Bacterial invasion of the kidneys or bladder (CYSTITIS) usually
Subacute caused by Escherichia coli
3. long-term antibiotic therapy 2. Bacteria can ascend from bladder to infect the kidneys
IV antibiotic for 2-6 weeks b. Upper urinary tract infection: pyelonephritis (inflammation of
kidney and renal pelvis)
Antifungal agents are given – amphotericin B
Urethrovesical reflux – backward flow of urine from the urethra to the
2. Surgery badder
Valvular replacement Ureterovesical reflux – backward flow of urine from the bladder to the
ureters
Prevention
Risk Factors
– AnTibiotic prophylaxis is recommended for high risk patients
before or after procedure 1. Aging
Cystitis
Laboratory Examination
○ Most common UTI
○ Remains superficial, involving bladder mucosa, Urinalysis: assess pyuria, bacteria, blood cells in urine; Bacterial
which becomes hyperemic and may hemorrhage count >100,000 /ml indicative of infection
○ General manifestations of cystitis
○ Dysuria b. Rapid tests for bacteria in urine
○ Frequency and urgency
○ Nocturia 1. Nitrite dipstick (turning pink = presence of bacteria)
○ flank or low back pain
○ Suprapubic pain and tenderness 2. Leukocyte esterase test (identifies WBC in urine)
2. Acute pyelonephritis Not given to less than 18 because they can cause cartilage
degradation
a. Results from an infection that ascends to kidney from lower
urinary tract 3. Pyridium= urinary antiseptic
2. Urinary tract obstruction and congenital malformation ○ Inflammation of the glomerular capillaries
○ Disease of children older than 2 years old
3. Urinary tract trauma, scarring ○ Preceded by a throat infection due to Grp A betahemolytic
streptococal infection
4. Renal calculi
○ Infection
Complications ○ Thromboembolism (renal vein)
○ Pulmonary emboli
○ Hypertensive Encephalopathy ○ Accelerated atherosclerosis
○ Pulmonary edema ○ ARF (hypovolemia)
○ RPGN, rapid and progressive decline in renal function. Will
go to ESRD in weeks to months
○ Crescent shaped cells accumulate in Bowman’s space, Medical Management
disrupting the filtering surface.
○ to preserve the renal function
○ Diuretics with ACE inhibitors to reduce the degree of
Medical Management proteinuria
○ Low sodium diet, liberal potassium diet
Goals ○ Protein intake .8g/kg/day (eggs, meats, dairy products)
Nursing Intervention
1. Treating symptoms
○ Provide bed rest
2. Preserve kidney function ○ conserve energy
○ quiet play
3. Treatment of complications ○ Provide high protein and low sodium diet
○ Maintain skin integrity
Antibiotics - penicillin ○ Avoid IM-edematous
○ Turn frequently
○ Corticosteroid and Immunosuppressants ○ Obtain morning urine for protein studies
○ Protein and sodium restriction ○ Provide scrotal support
○ Loop diuretics ○ Monitor I and O, VS, Weigh daily
Nursing Management ○ Administer Steroids
○ Protect for infection
Hospital setting
Treatment
a. Prolong life
PREVENTION
• A – ABSTINENCE
• B – BE FAITHFUL
• C – CONDOMS
• D – DON’T USE DRUGS
IMCI process can be used by doctors, nurses and other health care
personnel in a primary health care facility like health centers, clinics or
OPD.
Components of IMCI
A. Pneumonia
B. Measles
C. Malaria
D. Diarrhea
E. Malnutrition
F. Ear infection
G. Dengue
Assess a child by checking first for danger signs, examining the child,
checking nutritional and immunization status.
Classify the child illness using the color coded triage system
- (pink) urgent