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GASTROINTESTINAL communicable diseases

LEPTOSPIROSIS/WEILS DISEASE/CANICOLA FEVER/MUD FEVER/


SWINEHERD’S DISEASE
Causative Agent: Leptospira interrogans
Mode of Transmission:
Inoculation into broken skin, mucous membrane
ingestion of urine/fecally contaminated food and water
Source of Infection
Urine and excreta of rodents, infected farm and pet animals
Incubation Period: 7 – 13 days
LEPTOSPIROSIS
Signs and Symptoms:
Septicimic Stage - High remittent fever, myalgia/myosites, particularly calf pain,
abdominal pain
Anicteric Stage – conjuctival suffusion, disorientation
Icteric Stage - acute renal failure
Diagnostic Examination:
1. Blood culture
2. Leprospira agglutination test LAT)
Treatment: Penicillin or Tetracycline
Nursing Care:
1. Symptomatic 3. Environmental Sanitation
2. Urine precaution
Prevention: Eradication of rodents
TYPHOID FEVER/ENTERIC FEVER
Causative Agent: Salmonella Typhosa
Mode of Transmission: Fecal – oral, Principle vehicle is food and water. Direct/Indirect
contact
Incubation: 7-14 days
Source of infection: Feces and urine of infected
Period of communicability – first week throughout the convalescence.

TYPHOID FEVER
Signs and Symptoms:
1. Prodromal: headache, fever, anorexia, lethargy, constipation or diarrhea, vomiting
abdominal pain, feeling of unwellness
2. Fastigial: ladder-like curve of temperature, rose spots, spleenomegaly, typhoid state
3. Defervescence: fever gradually subsides, severity of previous conditions onset of
complications:
1) Hemorrhage and 2) Peritonitis
4. Lysis/Convalescence: signs and symptoms gradually disappear
TYPHOID FEVER
Diagnostic Examinations:
Hemoculture
Widal’s test/Typhidot
Stool exam
Rectal swab
Treatment: Chloramphenicol
Nursing Care:
1. Enteric precaution
2. Observe character of stool
Prevention:
Avoid MOT
Handwashing
Immunization
TYHPHOD FEVER
Prevention: Sanitary disposal of feces, handwashing, fly control to protect foods,
isolation, avoid eating, raw, unpeeled, uncooked foods
Nursing Responsibility: Teach family, guide and supervise members of the family.
CHOLERA
Causative Agent: Vibrio-Cholerae (El Tor); vibrio comma
Mode of Transmission: Fecal – oral
Incubation: 1 – 3 days
Signs and Symptoms:
rapid onset characterized by explosive or watery diarrhea and vomiting
symptoms of severe dehydration: washer woman’s hand, etc.
stool: rice-water stool
CHOLERA
Treatment: IVF
Tetracycline, Cotrimoxazole
Nursing Care: Enteric Precaution
Prevention: 5 F (Feces, Flies, Food, fluids, fomites)
DYSENTERY/SHIGELLOSIS

Causative Agent: Shigella Dysenteriae


Mode of Transmission: Fecally contaminated food and water
Incubation: 3 – 4 days
Signs and Symptoms:
High grade fever
colicky abdominal pain with tenderness
diarrhea with tenesmus-straining (watery, mucoid, with blood streaks)
DYSENTERY
Diagnostic Examination: Stool exam
Treatment: Co-trimoxazole, Chloramphenicol
Nursing Care:
Monitor I and O – frequency and amount, consistency of stool
Replacement of fluids and electrolytes lost with IVF as ordered, ORESOL, oral fluids
Enteric precaution
Peri-anal care
Prevention:
Immunization
Good sanitation/hygienic practices
Safe water supply
Handwashing
Avoid 5 F’s – feces, fomites, flies, food, fluids
HEPATITIS A
Synonyms – Infectious HEPA
Causative Agent – HAV
Source of Infection - Feces
Mode of Trans. - Fecal – oral
Incubation period- 2 – 7 weeks

TYPES OF HEPATITIS
TYPE
SOURCE

TRANSMISSION

OTHER NAME

ANTIBODY

HbsAg

RISK PERSONS

COMPLICATIONS

HEPATITIS A
Risk - food handlers, poor sanitation, unsafe water supply
Prevention - Proper handwashing, sanitation, screen food handlers, enteric precautions

HEPA B
Synonyms- Serum hepatitis
Causative Agent- HBV
Source of Infection -Blood, semen, cervical secretions
Mode of Trans. - Person to person parenteral/percutaneous, placental
Incubation period- 6 wks – 6 mos.
HEPA B
Risk - Multiple sex partners, members of medical team, blood, drug addicts, Screen blood
donors Immunization Use of sterile disposal needles
Prevention - Monogamous sex
HEPA C
Synonyms- Post-transfusion,
Causative Agent- HCV
Source of Infection - blood
Mode of Trans. – Percutaneous, BT
Incubation period- 5 wks-6 wks.

HEPA C
Risk - Blood recipients Drug addicts
Prevention – Screen blood donors

HEPATITIS
Signs and Symptoms:
Pre-icteric: flu-like symptoms, Slight RUQ pain
Icteric: Jaundice, Tea-colored urine, Alcoholic stool, Pruritus
Post-icteric: Symptoms gradually subsides
Diagnostic Examinations:
Liver function test
Hemagglutination test
Ultrasound of liver
Liver biopsy
Treatment: no specific supportive
Nursing Care: Bed rest, High CHO, high CHON, low fat diet, Oral skin care,
Psychological support
SCHISTOSOMIASIS
Shistosomiasis (Snail Fever)
Agent: Schistosoma Japonicum by snail (oncomelania quadrasi)
Areas: Bicol, Samar, Leyte, Davao
Dx Test: Stool exam

Shistosomiasis (Snail Fever)


Signs:
Diarrhea,
Bloody stool,
Anemia
Weakness
Inflamed liver
Enlargement of the Abdomen
Spleenomegaly

Shistosomiasis (Snail Fever)


Treatment
Praziquantel (Biltricide) – drug of choice
Oxamniquine – S. Mansoni & metrifonate, S. haematobium

Shistosomiasis (Snail Fever)


Prevention
Health Education
Dispose feces and urine,
Proper irrigation of all stagnant bodies of water
Prevent exposure to contaminated water (rubber boots)
Treat Patient in endemic areas

ENTEROBIASIS/OXYURIASIS
Causative Agent: Enterobius vermicularis/ human pinworm or seatworm
Sx/Symptoms: perianal itching-disturbed sleep & nervousness, irritability
Source – overcrowding & water supply is inadequate for personal hygiene, eggs-
fingernail cuttings
Mode of Trans – ingestion or inhalation of eggs
Incubation – 4 to 6 hours
ENTEROBIASIS
Dx – Scotch tape swab (perianal region) done in the morning prior to bath
Prevention – personal hygiene, handwashing, keeping fingernails short
Control – sterilization of contaminated linens, clothing
Treatment – Mebendazole 100mg single dose repeated once at 2nd week for effectivity
ASCARIASIS
Causative Agent: Ascaris lumbricoides (round worm)
Source – soil (no sanitary toilets)
Mode of Trans – fecal oral
Diagnostic – Fecalysis, Kato Katz

ASCARIASIS
Sx – pulmonary symptoms like cough and fever, abdominal pain, vomiting of worms
(erratic)
Treatment – antihelminthic (Mebendazole 100mg BID for 3 days
Prevention – Proper disposal of feces-not used as fertilizer, handwashing, washing of
vegetables before consumption.
ANCYLOSTOSOMIASIS
Causative Agent: Necator americanus (found in the Philippines) and Ancylostoma
duodenale – blood sucking roundworms of the intestine
Source – Soil
Mode of Trans – direct contact (skin)
ANCYLOSTOSOMIASIS
Symptoms – Ground/Dew itch dermatitis, pulmonary symptoms (coughing & wheezing),
abdominal pain, anemia
Dx – Fecalysis, FECT (direct fecal smear)
Tx – antihelminthic Mebendazole 100mg BID for 3 days, Iron supplementation, diet,
health education, use of footwear
Diarrhea
Is the passage of loose watery stools at least 3 times a day
First time of loose stool: Tx – oral rehydration
Goal of management: maintenance and restoration of fluid and electrolyte balance
because diarrheal disorders are self limiting
*cholera- warrants the use of antibiotics

Antihelminthic is required if there is:


Amoebiasis
Giardiasis
First Level Assessment
initial action- assess for dehydration:
eyes-absence for tears
mouth and tongue
level of thirst
skin turgor

Second Level Assessment


Problems to look out for:
1. Presence of blood in the stools- shigellosis/ bacillary dysentery.
If antibiotics are given, expect improvement after 2 days
Chronic diarrhea- check the onset
Diarrhea that has lasted for 14 days or 2 weeks, if this happens consider the following:
Hospitalization if:
Chronic diarrhea in a point younger than 6 months
Chronic diarrhea (+) plus signs of dehydration
Home management- provide adequate nutrition
Home management for chronic diarrhea is only 5 days, if still without improvement,
hospitalization is needed.

Second Level Assessment

Severe under nutrition- warrants hospitalization


Check for why? because it is a complication of diarrhea
Check out for body temperature
-if a point younger than 2 months and has a temperature of 38.5 Celsius or higher refer
the patient to the hospital – give antipyretic
Take note:
In the community- antipyretics is the answer and never use cooling measures for this is
done only in the hospital
Treatment plan A – Home Management
Main task: Give instruction to the mother regarding the following:
1. Increase fluids of the child
Give oral: KCl, K citrate, NaCO3, C6H12O6, constituted in 1L H2O
Home made oresol
A mixture of 1 tsp. of rock salt, 8 tsp. or 2 tbsp of sugar dissolve in 1L H2O

Treatment plan A – Home Management


2. Give adequate food
Continue breastfeeding
Offer food 6 times a day
Continue introducing solid foods (cereals, seeds of beans and peas)
If bottle feeding – dilute the formula
If the child is ok, give extra meal for 2 weeks
Treatment plan A – Home Management
Take note
3. Danger signs
If the child is not better for 3 days or if the child always
Increase vomiting and diarrhea
Increase signs of dehydration
Treatment Plan B
Amount of ORS in the 4 hrs – wt in kg x 75 ml/kg of BW
Ex: 10 kg-wt. = give 750 ml of ORS within 4 hrs
Important- observe for puffiness of the eyelids- indicating edema therefore withhold
oresol; give water or breast milk until edema is resolved. When resolved, check for signs
of dehydration.
Treatment Plan C
Treatment of choice – IV fluid- Lactated Ringers solution to run for 6 hours

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