CD Handouts

COMMUNICABLE DISEASE NURSING Handouts for ISU-Ilagan Student Nurses
By: Charles ZipaganAriola Jr., MSN, LPT.
COMMUNICABLE DISEASES
 Diseases caused by pathogenic microorganisms, which can be transmitted from
an infected person to a susceptible person by direct, indirect means or through a
break in skin integrity
Communicable Diseases are transmitted through:
1. Direct Mode of Transmission

 A person to person transmission
 Most common is through Droplet transmission
 Examples:
o Kissing
o Sexual Contact
 Happens in humans
2. Indirect Mode of Transmission
 From a source of transmission to a new host with intermediary object
 A bridge connects you to an infected person
 Bridges or intermediate objects
 Examples:
o Vehicle-borne Transmission
 Non-living things
 Articles used by patient like catheter, tubings, linens
 Vector-borne Transmission
 Living things but are non-human
 Insects, arthropods, rodents
3. Break in Skin Transmission
 Inoculation
 Contaminated sharps or needles
 Animal Bites
4. Airborne Transmission
 Microorganisms are suspended in air
 There is no limitation to the distance traveled by microorganism
 Different from Droplet transmission
 Microorganism remains on surface
 Travel is limited to a maximum distance of three (3) feet.
Concept:
 All these modes are classified under Horizontal Transmission
Horizontal Transmission
 Manner of transfer of microorganisms is in a horizontal position
Vertical Transmission
 Manner in which microorganisms are transferred is in a vertical manner – from
up going down
 Example:
o Infected mother to newborn child transmission
Infectious Diseases
 Diseases wherein there is a presence of a living microorganism in the body,
which may not be transmitted through ordinary contact
 Need not be transferred from one person to another
Contagious Diseases
 Diseases that can easily be transmitted
Concepts:
 All communicable diseases are infectious but not contagious
 Because there is the presence of a living microorganism
 Because not all of the microorganisms can be easily transmitted
 All contagious diseases are infectious
 All contagious diseases are communicable diseases
 Diphtheria is a disease, which is
o Contagious
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o Communicable
o Infectious
 Malaria is a disease, which is
o Communicable
o Infectious
o But not contagious
 Tetanus is a disease, which is
o Infectious only
Epidemiological Triad
Three (3) factors for a disease to take place
1. HOST
 A person
 An animal
Concept:
 Consider the susceptibility of the host
 Susceptibility
o Pertains to degree of resistance
 If resistance is low, susceptible person is prone to infection
Types of Hosts:
1.1) Patient
 A person infected manifesting signs and symptoms
1.2) Carrier
 Individual who harbors microorganisms but shows no signs and symptoms
1.3) Suspect
 Individual whose medical history and symptoms suggests that he may be
developing a specific infection
 Signs and symptoms are suggestive
1.4) Contact
 Individuals who come in close association or in contact or exposed to infected
person
Concepts:
 The PATIENT is the least source of infection
 The PATIENT has the least chance to spread microorganisms
o Because he manifests signs and symptoms of the disease, he is isolated
o Precautionary measures are now taken
 The CARRIER has the highest potential to spread infection
o Because he does not manifest signs and symptoms of the disease
o However, he has the microorganisms
2. AGENT
 Microorganisms
 They have the highest population among all living things
 Not all are susceptible to microorganisms
 Not all microorganisms are virulent
Concepts:
Virulence
 Strength and power of microorganisms to cause infection
Pathogenicity of microorganisms
 Capacity of microorganisms to cause infection
Two (2) most common microorganisms causing infections

 Bacteria
 Viruses
Bacteria
 Can multiply in both living and non-living things
 Cannot pass through filters in the body because they are big
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 Therefore, it is okay to have bacterial infection even during pregnancy, except for
Treponema pallidum, which passes through the placental barrier after the 16 th
week of pregnancy.
 Syphilis is not fatal in the first trimester
 Syphilis is fatal in the third trimester
 Anti-bacterial medications give only temporary immunity
Viruses
 Can only multiply in living things
 Reservoir is a living thing
 Can pass through the body filters:
o Blood Brain Barrier
o Placental Barrier
 It gives rise to self-limiting diseases
 Viral infections have own time frame
 Example:
o Colds last for 2-3 days with watery secretions as symptoms
 After this, complications would be the one present with yellowish or
mucoid discharges probably indicative of sinusitis
o Influenza is present for one week
 After one week, pneumonia sets in.
 Medical management for viral infections:
o Treated symptomatically not by anti-viral agents
o Antibiotics may be used to treat secondary bacterial infections
o Purpose is to increase body resistance
3. ENVIRONMENT
 Must be conducive and favorable to growth of microorganisms
 Example:
o Clostridium tetani will not cause infection in the presence of oxygen
because it is an anaerobic microorganism
Concept:
There must be an interplay between the three factors:
 Host
 Agent
 Environment
for infection to set in.
CHAIN OF INFECTIOUS PROCESS

 A cycle
 It is continuous
Six (6) Factors

1. Causative agent
 Microorganisms
2. Reservoir
 A place where microorganisms can live and multiply
 Examples:
o T. pallidum’s reservoir is the human genitalia
o Measles virus reservoir is the nasopharynx
o Salmonella typhosa’s reservoir are the Peyer’s patches of the small
intestines
3. Portal of Exit
 From the reservoir, microorganisms look for a way out
 This pertains to the individual’s body system
 Examples:
o T. pallidum’s portal of exit is the genitourinary system
o Measles’ virus portal of exit is the respiratory system
o Salmonella typhosa’s portal of exit is the gastrointestinal tract
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4. Mode of Transmission
 When outside of the host, this pertains to the microorganism’s means of
transportation
 Examples:
o T. pallidum’s mode of transmission is sexual contact
o Measles’ virus mode of transmission is airborne nuclei
o Salmonella typhosa’s mode of transmission is fecal-oral ingestion
5. Portal of Entry
 A microorganism’s way in to the new host
 Also corresponds to the individual’s body system
 Examples:
o T. pallidum’s portal of entry is the genitourinary system
o Measles’ virus portal of entry is the respiratory system
o Salmonella typhosa’s portal of entry is the gastrointestinal tract
6. Susceptible Host
Concept:
 Objective or goal is to limit, prevent or control spread of communicable diseases
by breaking the chain of diseases
 Look for the weakest link in the chain
 Among the six (6) factors, the MODE OF TRANSMISSION is the weakest link
o It is not the CAUSATIVE AGENT because of its huge population
o It is not the RESERVOIR (i.e. you cannot remove the nasopharynx in
humans infected by measles virus)
o It is not the PORTAL OF EXIT nor the PORTAL OF ENTRY (i.e. you cannot
remove the genitals of humans infected by T. pallidum)
o It is not the SUSCEPTIBLE HOST for you cannot kill it.
IMPORTANT CONCEPTS!!!
 Typhoid mode of transmission is fecal-oral ingestion
 First word is the PORTAL OF EXIT
 Second word is the PORTAL OF ENTRY
 DO NOT INTERCHANGE THIS!!!
IMMUNITY
 State of having resistance
 State of being free from infection
Two (2) Types of Immunity
 Natural Immunity
 Acquired Immunity
1. Natural Immunity
 Inherent in an individual’s body tissues and fluids
 A person is born with it
 A person dies with it
 It is within the genes that you have these antibodies
 This is a rare type of immunity
 Example:
o Race
2. Acquired Immunity
 This is the more common type of immunity
 It is either a person is able to PRODUCE it or a person is able to GET it
Two (2) Types of Acquired Immunity
2.1) Active Acquired Immunity

 An actual participation of the individual’s body tissues and fluid in PRODUCING
immunity
 You produce the antibodies yourself when microorganisms are given to you
Two (2) Ways of Producing Antibodies:

2.1.1) Naturally Acquired Active Immunity
 Antibodies are produced by nature
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 Unintentionally
 Examples:
o Previous attack of a disease
o Chicken pox attack wherein antibodies are produced by nature
o Measles attack wherein antibodies are produced by nature
 Sub-clinical immunity
o Developed due to constant exposure to certain infection
o Body produces antibodies non-intentionally by nature that provides
immunity
2.1.2) Artificially Acquired Active Immunity

 Body produces antibodies because it was intentionally done
 Examples:
o Vaccines
 Attenuated (weakened) microorganisms
o Toxoids
 Attenuated toxins (poisonous substances) produced by
microorganisms
Concepts!
 When administering vaccines or toxoids, alcohol is NOT used to clean injection
site.
 Use instead cotton balls with a clean bowl of water.
 When alcohol is used, be sure alcohol HAS DRIED OFF before administration of
the vaccine or toxoid
 If the site has not dried off, there will be VACCINE FAILURE!
 Therefore, squeeze off excess alcohol
2.2) Passive Acquired Immunity

 Immunity is developed due to presence of antibodies within the serum, which is
not coming from the individual itself
 You get it or it is given to you
Two (2) Types of Passive Immunity

2.2.1) Naturally Acquired Passive Immunity
 Done by nature
 Antibodies given or obtained by nature, in an unintentional manner
 Examples:
o Infants below six (6) months seldom develop infection
o Maternal transfer of antibodies
o Placental transfer of antibodies
o Infants who are breast-fed
 Colostrum intake
 Contains antibodies from mother given unintentionally
2.2.2) Artificially Acquired Passive Immunity
 Administration of substances containing antibodies in an intentional manner
 Examples:
o Anti-toxins
o Anti-serum
o Gamma globulin
o Immunoglobulins
 If both microorganisms and antibodies are to be given, do not give both injections
on the same site
 Artificially Acquired Passive Immunity
o Provides immediate protection
o Provides immunity for only a short period as there are no reserves of it.
o Immunity is lost once exhausted
 Active Immunity (i.e. – vaccines and toxoids) provide longer protection
o Because you produced the antibodies yourself, they would be there
anytime they are needed.
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 Pregnant mother can be given tetanus toxoid

 Newborn receives naturally acquired passive immunity
o Natural because it is from mother
o Passive because it is done via placental transfer
 Mother receives Artificially Acquired Active Immunity
Three (3) Factors to Know before taking care of Patients with Communicable
Disease
 Know the CAUSATIVE AGENT
 Know what BODY SECRETION harbors the microorganism
 Know the MODE OF TRANSMISSION
GENERAL CARE FOR PATIENTS WITH COMMUNICABLE DISEASES
Two (2) Aspects

 Preventive Aspect
 Control Aspect
1. PREVENTIVE ASPECT
 You do not have infection yet
1.1) Health Education
 Main goal is to effect change in knowledge, skills and attitude
 Change in behavior towards health
1.2) Immunization
Three (3) Laws in Immunization
 Presidential Decree 996 – Compulsory Immunization for Children below Eight (8)
years old
 Proclamation No. 6 – United Nations’ Universal Child Immunization
 Proclamation No.46 of 2000 – National Immunization Day
Common Goal is to prevent the seven (7) Childhood Diseases

 Tuberculosis (give Bacillus Calmette Guerin or BCG)
 Diphtheria
 Pertussis
 Tetanus
 Poliomyelitis (give Oral Polio Vaccine or OPV)
 Hepatitis B
 Measles (give anti-measles vaccine)
IMPORTANT CONCEPT
There are only two (2) PERMANENT CONTRAINDICATIONS to Immunization
 Allergy
 Encephalopathy without known cause or convulsions within seven (7) days after
pertussis vaccine administration
There are four (4) TEMPORARY CONTRAINDICATIONS for Immunization

 Pregnancy
o (i.e. MMR vaccine)
 Recent receipt of blood products
o Wait two (2) to three (3) months
 Very severe disease
o Hospital confinement
o Hospital personnel will decide when immunization would be given
 Immunocompromised situation
 Fever, diarrhea and colds are NOT CONTRAINDICATIONS to Immunization.

Immunization can still be given despite their presence
 In a private setting, the physician can POSTPONE IMMUNIZATION in the

presence of fever, diarrhea, colds because patient is returned by mother to the
physician once these conditions are resolved.
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 Current target group of Expanded Program on Immunization of the Department

of Health is composed of CHILDREN BELOW FIVE (5) YEARS OLD
CDT VACCINE
Cholera, Dysentery, Typhoid Vaccine
 Given by DOH for free
 Adult dose is 0.5 cc
 Adult injection site is the deltoid muscle
 Child dose is 0.25 cc
 Child injection site is the vastus lateralis
 Given INTRAMUSCULARLY (I.M.)
 Given when there are outbreaks of epidemic
 Immunity lasts only for six (6) months.
Anti-Rabies Vaccine
 Target group would be the animals
 Animals are brought to the Barangay for free immunization
 Barangay Captain is responsible for obtaining vaccines from DOH
 Dogs must initially be registered before this vaccine could be administered
1.3) Environmental Sanitation
 Objective:
o No proliferation of arthropods, rodents (both of which are good vectors)
Presidential Decree 856
Sanitation Code
 Also includes submission of sex workers in determination of sexually transmitted
diseases
o For gonorrhea – two times a month
o For syphilis – once a month
o Physical Examination – once a month
Presidential Decree 825

 Anti-Littering Law
 Proper disposal of garbage
 Anyone caught littering would have a penalty of Php2,000 to Php5,000 and
imprisonment for one (1) year.
1.4) Proper Supervision of Food Handlers

 A responsibility of the Department of Health facilitated by its Sanitary Inspectors
 Also a responsibility of the Bureau of Food and Drug
 Monitors food and drug sold to public to assure that it is safe for consumption
2. CONTROL ASPECT
 Done when signs and symptoms are already present
 There is already the presence of infection
 Goal is to limit the infection
2.1) Isolation
 Separation of an infected person during period of communicability
Two (2) ways of Isolation

2.1.1) Strict Isolation
 Intended to protect other persons (not the patient) from infection
 It intends to limit the microorganisms to be within the patient
2.1.2) Reverse Isolation
 Also called Protective Isolation
 Intended to protect the immunocompromised patient from infection
 Intends to keep microorganisms out of the patient
Concepts:
Quarantine
 Limitation of freedom of movement of a well person during the longest incubation
period
 It involves the separation of persons who are carriers
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 These are persons who are not sick

 These are persons who do not manifest signs and symptoms of the disease
Center for Disease Control’s two (2) Revised Isolation Precautions

1) Standard Precaution
 Best strategy to prevent nosocomial infection
 Slowly taking place of Universal Precaution
 Applies to all patients regardless of their diagnosis
 Applies to blood and all body fluids, excretions and secretions except sweat.
 Applies to mucous membrane and non-intact skin
Concept:
Universal Precaution
 Has double standards
 Used only if patient is diagnosed or suspected of having blood-borne diseases
Elements included in Standard Precautions
1. Practice hand washing for each patient care
 For contact with body fluids of patient
 Duration is 10 – 15 seconds
 Length of washing is not important
 What is important is the friction that is applied
Concepts:
For Medical Asepsis:
 Hand is lower than the elbow
 Hand is the dirtiest part
 Elbow is the cleaner part
For Surgical Asepsis:

 Hand is placed up and remains up
 Hand is the cleanest portion
 Elbow is less clean than the hands
2. Use of Protective Barriers or Use of Personal Protective Equipment (PPEs)

 If you wear them all, the correct sequence for wearing them would be:
o Mask
o Goggles
o Cap / Bonnet
o Gown
o Gloves
 If you are about to remove them, the correct sequence is:
o Gloves
o Do hand washing
o Gown
o Cap / Bonnet
o Goggles
o Mask
3. Avoidance of Needle Stick or Sharps Injury

 Do not recap, bend or break needles
 There must be puncture-resistant sharps collector
IMPORTANT CONCEPT!!!
 If patient is diagnosed as having communicable disease, practice both Standard
Precaution and Transmission-based Precaution
Transmission Based Precaution

Airborne Precaution
 Use of mask
 Special ultrafilterable mask
 Particulate mask
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o For measles, chicken pox, TB
Droplet Precaution
 No contact to mucous membrane, nose, mouth
 Use mask – ordinary mask will do
 Use goggles
o For meningitis, mumps, pertussis, German measles, diphtheria
Contact Precaution
 Avoid person to person contact
 Use gloves
 Use gown
 For diarrheal diseases, typhoid, cholera, hepatitis, skin diseases like ringworm,
scabies and pediculosis
Control Measures other than Isolation

1. Disinfection
 Killing of pathogenic microorganisms by physical or chemical means (i.e. boiling,
soaking)
Types of Disinfection
Concurrent Disinfection
 Done when the person is still a source of infection
 Example:
o When patient is still in the hospital
 Boil all patient gowns
Terminal Disinfection
 Done when person is no longer a source of infection
 Example:
o Room of patient is cleaned upon discharge of patient using UV rays or
Lysol
2. Disinfestation
 Killing of undesirable small animal forms such as arthropods, rodents, insects by
physical or chemical means
3. Fumigation
 Use of gaseous agents to kill arthropods, rodents and insects.
4. Medical Asepsis
 Hand washing
 Gloving
 Gowning
 Masking
 Placarding
o Placing “NO SMOKING” sign when there is oxygen inhalation in progress.
COMMUNICABLE DISEASES OF THE CENTRAL NERVOUS SYSTEM
Bacterial infections
 Tetanus
 Meningitis
Viral Infections
 Encephalitis
 Poliomyelitis
 Rabies
TETANUS
 Also called LOCKJAW
 With painful muscular spasms
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 Ten times more painful than leg cramps
 Clostridium tetani
o Causative agent of Tetanus
o Anaerobic microorganism
o Abundant in soil, dust, clothing
o It exists in the form of a SPORE outside the human body
o That is why it survives outside the human body even in the presence of
oxygen
o Sterilization is needed to kill the microorganism
Important Concepts:
 When inside the human being, the spore transforms into a VEGETATIVE FORM,
which can be destroyed by the presence of oxygen
 Why is Clostridium tetani abundant in soil?
o Normal habitat of C. tetani is in the intestines of herbivorous animals (i.e.
cows, carabaos, goats, sheep, horses)
o Manure of these animals is used as fertilizer
 Mode of Transmission of C. tetani
o Break in skin integrity
 Person is at risk for infection when there is any kind of would (i.e. splinter or
salubsob, tooth decay, otitis media)
Important Concepts!
 You need not be wounded by a RUSTY OBJECT to acquire tetanus
 In the newborn, tetanus neonatorum is caused by poor cord care.
 When C. tetani enters the body, it seldom migrates to the bloodstream where
oxygen is present
 C. tetani remains in the wound but the effects are systemic
IMPORTANT CONCEPT!
 Toxin is released to the blood and is responsible for the manifesting signs and
symptoms of the disease
Two (2) Types of Toxins in Tetanus
1. Tetanolysin
 Dissolves red blood cells
 Results to anemia
 Thus, patient is pale-looking
2. Tetanospasmin
 Causes muscle spasm
 Acts on MYONEURAL JUNCTION of the muscles and on the INTERNUNCIAL
FIBERS of the spinal cord and the brain.
 Results into multiple muscle spasms
 Inhibits the spastic muscle from sending transmissions to the brain, which
would inhibit progression of spasms. Due to this, adjacent muscles will also
undergo spasm similar to a chain reaction or a domino reaction.
In the wound, there would be an inflammatory response:

 Rubor - rednes
 Calor - heat
 Tumor - swelling
 Dolor - pain
 Functiolaesa – loss of function
Signs and Symptoms of Tetanus

 The patient manifests:
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o Restlessness
o Fever
o Profuse Sweating
 Masseter muscle is involved
o It functions for mastication, for opening and closing of the mouth
o Tetanus affects strong muscles
o Therefore, it affects the closing of the mouth muscle
o This is called LOCKJAW or TRISMUS
 Facial muscle is affected
o Gives rise to “risus sardonicus”
o Known as the “Sardonic Smile”
o Also known as “Ngiting Aso”
o Patient is smiling but his eyebrows are raised.
 Spinal muscle is affected
o Resulting into the Ophistotonus position
o This is the arching of the back
o In the vernacular, it is called “LIAD”
 Respiratory muscles are affected
o Results to difficulty of breathing, dyspnea and chest heaviness
 Genitourinary tract muscles are affected
o Results into urinary retention
o Intervention would involve catheterization
 Gastrointestinal muscles are affected
o Resulting into constipation
 Abdominal muscles are affected
o Results into abdominal rigidity
o Abdomen is hard as a board
o This sign serves as a basis for recovery
o If abdominal rigidity decreases, it means that the patient is on his way to
recovery
 Extremity muscles are affected
o Results into stiffness of extremities
o There is difficulty in flexing
o Robot gait is evident
Concept!
 Thus, almost all of the muscles are rigid and stiff in Tetanus!
Diagnostics for Tetanus:
1. Clinical Observation
 Assess patient physically
 Assess for the presence of lockjaw
 If this is positive, a logical question would be – “Do you have a wound”
2. Obtain history of wound

 Wound Culture
 If there is a fresh wound, microorganism is still present there
Concept:
 The shorter the incubation period, the poorer the prognosis
 Shortest incubation period is 2 – 3 days.
 An incubation period of one month has a better prognosis than an incubation
period of 2 – 3 days.
Three (3) Objectives of Medical Management
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Neutralize the toxin

 This is the top priority
 The toxin is responsible for the signs and symptoms of the disease and the
systemic infection
 Give anti-tetanus serum or tetanus anti-toxin
o It comes from a horse serum
o Do skin testing first
o If (+) for skin testing, DO NOT GIVE the drug.
 Resort to human serum – tetanus immunoglobulin
Concept:
 In the Philippine setting, the horse serum is still given despite a positive skin
test.
 This is done by giving fractional doses.
 Example:
o Initial administration of 0.01 of drug and 0.99 PNSS
o After 30 minutes, 0.05 of the drug and 0.95 of PNSS
o After another 30 minutes, another increase in the dose of the drug
 When administering tetanus horse serum, always have ready the following:
o EPINEPHRINE
o CORTICOSTEROID
 These would be necessary to counteract any delayed reaction, which may cause
hypersensitivity reactions leading to anaphylaxis and eventually the death of the
patient.
2. Kill the Microorganism
 Give Penicillin
o This is the drug of choice to kill the bacteria
 In the fresh wound, do daily cleansing with the use of hydrogen peroxide
 Then apply antiseptic solution like Betadine or Povidone
 Then cover wound with THIN DRESSING to allow air to circulate through the
wound.
 It may also be good to expose the wound but avoid contact with flies.
3. Prevent and Control Spasm

 Give muscle relaxant
o Given during the acute phase of tetanus
o Done via the I.V. route
 Give Diazepam / Valium
o Use I.V. push or I.V. drip
Concepts:
 I.V. drip regulation is titrated based on the frequency of the spasm.
o The more frequent the spasm, the faster the rate of the titration
 When the patient is on his way to recovery, muscle relaxants per orem may be
used:
o Methocarbamol or Robaxin
o Lionesal or Baclofen
o Eperison or Myonal
Proceed with other supportive management

 For urinary retention, do catheterization
 For constipation, administer laxatives as ordered
Nursing Management in tetanus
 Muscle spasms are the first concern
Concept:
 Stimuli trigger spasms.
Types of Stimuli:
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1. Exteroceptive
 Comes from outside environment of the patient
 Examples are bright light and noise
 Place the patient in dim and quiet environment
2. Interoceptive
 Comes from inside or within the patient
 Examples are stress, pain, coughing, passage of flatus
3. Proprioceptive
 There is participation of patient and other persons
 Examples are touching, turning, jarring the bed of the patient
Nursing Care in Tetanus
 Done to prevent patient from having spasms
 Place the patient in a dim and quiet environment
 Practice minimal handling of the patient
o Avoid unnecessary disturbance of the patient
 Practice Cluster Care
o Do all nursing care activities in one setting
o Do other nursing care activities with vital signs taking
 Gentle handling of the patient
 Touching is not contraindicated
 Turning is not contraindicated
o However, do these as gently as possible
o Inform the patient before proceeding with any procedure
 Concept:
o Tetanus patients are isolated so as not to be exposed to stimuli
Prevent injury:
Respiratory injury
 Airway obstruction
 Tongue could be drawn back and cause blockage or obstruction
 Use padded tongue depressor for retaining patency of the airway
Respiratory Infection
 Turning to side is usually not done
o This results to pooling of respiratory secretions in the lungs
o This leads to pulmonary infection
 Profuse sweating and draft exposure also leads to pulmonary infection
 Therefore, always keep patient dry; especially at the back.
Physical Injury
 For falls:
o Never leave the patient alone
o If you do leave the patient, keep the padded side rails up
o Keep call light within the reach of the patient
 Fractures due to spasm:
o Caused by restraining by relatives
Provide Patient with Comfort Measures

 Oral care
o To prevent mouth sores
o Cotton swab used on inner and outer chick
o Do not use toothbrush
 Attack of tetanus does not give permanent immunity
Vaccine Given:
Diphtheria Pertussis Tetanus Vaccine or DPT vaccine
 When given:
o 1st Dose: 6 weeks after birth; 0.5 ml
o 2nd Dose: 10 weeks after birth; 0.5 ml
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o 3rd Dose: 14 weeks after birth; 0.5 ml

 Number of Doses:
o Three (3)
 Interval between Doses:
o Four (4) weeks
 Administration Site:
o Vastus lateralis muscle
 Route:
o Intramuscular
 Expect fever to set in after administration of DPT vaccine
o Give paracetamol
o Apply warm compress for better drug absorption
o Immediately follow up with cold compress to avoid soreness
 If tenderness or swelling on site of injection is present:
o Do cold compress within twenty-four (24) hours
o Then do warm compress
 Observe for signs of convulsions within seven (7) days after DPT immunization
o This indicates that child has reaction with the pertussis component of the
drug
o Therefore, succeeding doses of DPT will NOT BE GIVEN
o Give ONLY the DT components
o If DPT is given again, this predisposes the child to neurologic disorders
 Observe if child cries uncontrollably
 This is an indication of development of neurologic disorders.
DPT Immunization for Pregnant Individuals

 Dose: 0.5 ml
 Route: Intramuscular
 Number of Doses given:
o Two (2) doses with three (3) booster doses or;
o Two (2) doses with booster dose given every pregnancy
 When given:
o 1st Dose: Anytime during second trimester of pregnancy
o 2nd Dose: With one (1) month interval
o Booster Dose: Given with successive pregnancy/ies
For High-Risk Individual

 1st Dose given:
o 03-05-2005
 2nd Dose given:
o 04-05-2005
rd
 3 Dose given:
o 10-05-2005 (six months after the LAST dose)
 4th Dose given:
o 10-05-2006 (After one (1) year from the LAST dose)
th
 5 Dose given:
o 10-05-2007 (After one (1) year from the LAST dose)
 Succeeding doses of Tetanus Toxoid are given based on DATE OF LAST DOSE
 If a person is high-risk, give booster dose every five (5) years
 If a person is low risk, give booster dose every ten (10) years
 Effect of Tetanus Toxoid administration on the Mother
 Slight soreness or heaviness on site of injection
Wound Care
 Wash wound with soap and running water
 Place antiseptic solution on wound
14
 Use thin dressing

 Band Aid Plastic Strips are allowable as they have air ventilation holes
 Do not use plaster
 Use only those types of plasters with air ventilation holes to introduce oxygen to
the wound
Key Concept!!!
 Avoid Wounds
MENINGITIS
 Inflammation of the meninges (covering of the brain and spinal cord)
Concepts!
 Meninges are composed of:
o Dura mater
o Arachnoid mater
o Pia mater
 Cerebrospinal Fluid or CSF is found in the SUBARACHNOID SPACE
Causative Agents in Meningitis

 Viral
o CMV – Cytomegalovirus
 Opportunistic infection for AIDS
 Fungal
o Cryptococcal Meningitis
 Source is excreta of fowls and feathered animals
 Another form of opportunistic infection for AIDS
 Bacterial
o Tubercle Bacilli
 TB meningitis
 Staphylococcal meningitis
o Secondary to skin infection
 Haemophilus influenzae bacilli
o Common cause of meningitis in the United States
 Meningococcemia
o Meningococcemial meningitis
o Spotted Fever Disease
o Most fatal
o The only type of meningitis where the VASCULAR SYSTEM is affected
o Bleeding is triggered
o Disseminated Intravascular Coagulation occurs and leads to vascular
collapse
o Vascular collapse leads to death in ten percent (10%) of patients
o This ten percent (10%) has the FULMINANT TYPE or the Waterhouse-
Freiderichen Syndrome (characterized by vascular collapse)
o Causative agent is Neisseria meningitides
Important Concept!
 In children below four (4) years old, Neisseria meningitidis is a normal flora in the
nasopharynx.
 If resistance goes down, these children become prone to infection
Mode of Transmission
 Droplet transmission
 In cryptococcal meningitis:
o Inhalation of spores
Portal of Entry
 Respiratory system via the nasopharynx
Pathophysiology of Meningitis
 From the nasopharynx, the microorganism goes to the bloodstream
 Once in the bloodstream, the microorganism causes petechiae formation (pin
point red spots on the skin)
 From the bloodstream, microorganism goes to the meninges and irritates them
15
o There is inflammation of the meninges and accumulation of substances in

the meninges
 This results into increased Intracranial Pressure (ICP)
o Increased ICP leads to:
 Severe headache
 Projectile Vomiting
 Two (2) to three (3) feet away from patient
o Management involves turning patient to side
 Position kidney basin about two (2) to three (3) feet away
 Altered Vital Signs
o Increased Temperature
o Decreased Pulse Rate
o Decreased Respiratory Rate
o Increase in Systolic Blood Pressure and Normal Diastolic Pressure
 This results in the widening of the Pulse Pressure
 Convulsions (seizures)
 Diplopia
o Due to choking of optic discs
o Double vision but not crossed eyed
o Determined by finger counting
 Altered level of consciousness
Pathophysiology of Meningococcemia
 Portal of entry of Neisseria meningitidis is also the nasopharynx
 The bacteria then goes to the bloodstream
 Presence of bacteria in the bloodstream causes ecchymosis
o These ecchymoses are blotchy (pantal-pantal) purpuric lesions
o They are purplish in color
o Usually found on the wrist and the ankles
 From the bloodstream, they go to the meninges and irritate them.
 Same sequence of events follow as mentioned above
Signs and Symptoms of Meningitis

 Once the microorganism is at the nasopharynx:
o Fever
o Headache
o Sore throat
o Cough
o Colds
 Other signs and symptoms present as discussed in the pathophysiology
Pathognomonic Sign of Meningitis

 Nuchal Rigidity
 Stiffening of the neck
o No flexing of the neck
o No hyperextending of the neck
o No turning from side to side
 Abnormal Reflexes
o Positive for Kernig’s Sign
 Place patient in supine position
 Flex both knees toward the abdomen
 Then ask the patient to extend the legs
 If pain is present, the patient is said to be positive (+) for Kernig’s
Sign or difficulty of extending the leg
 Positive for Brudzinski’s Sign
o Place the patient in supine position
o Flex the neck
o If there is no reaction, the patient is said to be negative (-) for Brudzinski’s
Sign.
16
o If there is INVOLUNTARY DRAWING UP of the LEGS / HIP upon flexion of

the neck, the patient is said to be positive (+) for Brudzinski’s Sign
Diagnostic Tests for Meningitis
1. Lumbar Puncture
 Cerebrospinal Fluid (CSF) is the specimen used
o Assess for the color of the CSF
 Bacterial infection is present if:
o CSF is yellowish, turbid, cloudy
 Viral infection is present if:
o CSF is clear
 No infection is present if:
o CSF is clear
Send CSF for Laboratory Examination
 Laboratory findings would show:
o Increased protein levels
o Increased White Blood Cell levels
o Decreased Sugar content
Concepts
 If caused by bacteria, do Culture and Sensitivity test
o This is done to know what bacteria caused the infection
o This is also done to determine what drug will be used to kill the offending
microorganism
 If CSF is clear, it is subjected to Counter Immuno-Electrophoresis (CIE)

 This is done to determine if causative agent or a protozoa
 IMPORTANT CONCEPT!!!
In patients with HIGHLY INCREASED INTRACRANIAL PRESSURE due to CNS
infection, lumbar puncture or aspiration of the CSF is CONTRAINDICATED
o This will bring about HERNIATION OF THE BRAIN and would eventually
lead to death
 Therefore, it is important that the nurse performs Physical Assessment before
doing a lumbar tap.
2. Blood Culture
 Done because microorganism can travel to the bloodstream
Medical Management of Meningitis
 If bacterial
o Give anti-bacterial agent in the form of antibiotics
 If viral
o Symptomatic
 If fungal
o Give Amphotericin B
 If with inflammation
o Give corticosteroids in the form of DEXAMETHASONE
o Never give PREDNISONE
 Prednisone does not cross the Blood-Brain barrier
 Prednisone causes sodium retention
 Retains CSF
 If with excess CSF
o Give osmotic diuretic in the form of MANNITOL
o Check blood pressure before administration as it causes hypotension
o Monitor the intake and output to evaluate the effectiveness of Mannitol
o Expect that after two (2) to three (3) hours, the urine output must increase
by thirty (30) to fifty (50) ml.
o If no changes in urine output occurs, then Mannitol is not effective
o Refer this to the physician
 If there are convulsions due to CNS infection
o Give anti-convulsants
 Dilantin
17
 Phenytoin
 Routes of Administration of Dilantin
o Per Intravenous
 Nursing Care for I.V. administration of Dilantin
 Sandwich Dilantin with NSS
 NSS – Dilantin – NSS
 Rationale:
 Dilantin would crystallize
o Per Orem
 Nursing Care for P.O. administration of Dilantin
 Do frequent oral care
 Do gum massage
o Rationale:
 Dilantin causes gingival hyperplasia or overgrowth of the gums
Important Concept!
 Dilantin is never given Intramuscularly
o This is irritating to the tissues
o This has an erratic effect
Nursing Care
 Symptomatic
 Supportive
Nursing Diagnoses
1. Alteration in body temperature related to infection

 Priority is to lower body temperature
o Do TSB
o Provide cold compress
o Provide loose clothing
2. Pain: Alteration in comfort related to increased Intracranial Pressure
 Priority is to relieve headache within thirty (30) minutes
o Provide diversion
o Provide proper positioning
 Low-Fowler’s position (30° incline)
o Provide comfort measures
o Massage the forehead
o Do petrissage with circular action
3. Potential for injury related to altered level of consciousness
 Never leave the patient alone
 Place call switch and light within reach of patient
4. Potential for fluid and electrolyte imbalance due to projectile vomiting
 Monitor intake and output
 Provide fluids per orem
Important Concept
 An attack of meningitis does not provide permanent immunity
Preventive Measures
1.Proper disposal of nasopharyngeal secretions

 Burning
 Burying
 Proper procedure for disposal of nasopharyngeal secretions
o Use tissue paper
o Put it in a plastic bag after use
o Knot the plastic bag
o Dispose plastic bag in a trashcan
18
Important Concepts!
 The best and most economic way preventing spread of infection is through
swallowing of nasopharyngeal secretions
o This brings the secretions to the stomach and to the intestines and would
then be eliminated in the stool
 Children have less chance of spreading infection because they swallow
nasopharyngeal secretions.
 This is contraindicated, however, for tuberculosis patients
 Thus, for TB patients, they have to spit out nasopharygeal secretions
 Swallowing is allowable for other respiratory infections
2. Cover nose and mouth when sneezing and coughing
Important Concepts!
 When you transfer patient…
o Make the patient wear a mask so as not to infect people in the hallway,
elevator, etc.
 Wear mask when you enter the patient’s room
3. Vaccine
 Hib vaccine for Haemophilus influenza
BRAIN FEVER
 Arbovirus
 Arthropod-borne Virus
Primary cause
 St. Louise
 Japan B
 Australian X: Equine (E-W)
 Mosquito bites
o Aedes Sollicitans
o Culex tarsalis
 Ticks of horse
 Migratory birds
Secondary cause
 Post racene encephalitis
Toxic
 Metal poisoning
o Lead poisoning
o Mercury poisoning
ENCEPHALITIS
Signs and Symptoms

 With altered level of consciousness
 With lethargy
o Difficult to awaken
o Patient is abnormally sleepy
 With behavioral changes
 Brain is immediately affected relative to meningitis
Diagnostic Tests
1. Lumbar Puncture
 Specimen is cerebrospinal fluid (CSF)
 Laboratory Results would indicate:
o Increased Proteins
o Increased White Blood Cells
o Normal Sugar Content
19
2. Electroencephalogram (EEG)
 To assess extent of brain damage
 Patient recovers but because he is epileptic, he develops irreversible brain
damage
Medical Management
 Symptomatic due to viral cause
Concepts!
 No permanent immunity is obtained from attack of encephalitis, only temporary
immunity, due to causation by various viruses
 Source of infection is mosquito
Preventive Management:
 CLEAN PROGRAM
o C – Chemically Treated Mosquito Net
o L – Lavivorous fishes
o E – Environmental Sanitation
o A – Anti-mosquito Soap (Basic Soap)
o N – Neem Trees or Eucalyptus Tree (draws away mosquitoes)
Concepts!
 To kill mosquitoes in canal, pour oil or gas in canal
o This depletes oxygen present in the canal
o There is no need to light it up
POLIOMYELITIS
 Also called:
o Infantile Paralysis
o Heine-Medin Disease
 Affects children below ten (10) years of age
 Less risk for people above ten (10) years Old
Causative Agent
 Virus
o Legiodebilitans
 Type 1 – Brunhilde
 Type 2 – Lansing
 Type 3 – Leon
 If Brunhilde
o Gives permanent immunity
 If Lansing or Leon
o Gives temporary immunity
Important Concepts!
 When Brunhilde infects you, Leon or Lansing will no longer affect you!
 In the Philippines, the most prominent type is Brunhilde!

 Droplet
o In early stage of infection, virus if found at nasopharyngeal secretions
 Fecal-Oral Route
o In late stage of transmission, virus is found at the mouth
Portal of Entry
 Gastrointestinal Tract
Pathophysiology
 Legiodebilitans goes to the nasopharynx or the mouth
 If in the nasopharynx, it goes to the tonsils and causes:
o Sore throat
o Fever and chills
20
o Headache with body malaise

 If at the mouth, it goes to the Peyer’s patches and causes:
o Abdominal pain
o Anorexia
o Nausea and Vomiting
o Diarrhea or Constipation
STAGES of POLIOMYELITIS
1ST Stage: Invasive Stage or Abortive Stage

 All the abovementioned signs and symptoms will appear
 Patient recovers
 Disease process is aborted
 But there will be instances when disease process will not be aborted
Tonsils Peyer’s Patches

▼ ▼
Cervical Mesenteric
Lymph Lymph
Nodes Nodes
▼▼▼ ▼▼▼
BLOODSTREAM
▼▼▼
Central Nervous System
2nd Stage: Pre-paralytic Stage of Poliomyelitis

 Central Nervous System is already involved but there will be no paralysis
Signs and Symptoms:

 Once in the CNS, microorganism will cause:
o Sever muscle pain
 Do not keep on turning or holding patient
 Do not do massage
 No positioning will relieve patient
o Instead, what would relieve the patient would be:
 Application of warm packs
 Analgesics
o Never administer Morphine
 It is a narcotic analgesic that would cause respiratory depression
 Once in the CNS, the microorganism will also cause:

o Stiffness of the hamstring
o Patient will be positive for HOYNE’S Sign and exhibit a HEAD DROP
o To check for Hoyne’s Sign
 Lift shoulders of patient when lying supine or extend head of
patient beyond the edge of the bed
 If head of patient drops, he is said to be positive (+) for Hoyne’s Sign
 Once in the microorganism is in the CNS, the patient would elicit a POKER
SPINE
o Ophistotonus with head retraction
o Sitting position cannot be assumed
o Therefore, patient will assume a TRIPOD POSITION
Central Nervous System

▼▼▼
Paralysis
Concept!
 From the CNS, the patient will experience paralysis.
21
 This leads to the third (3rd) stage of the disease

rd
3 Stage: Paralytic Stage
 Presence of paralysis
 Characteristics of Paralysis:
o Flaccid
 Soft
 Flabby
 Limp
Important Concept!
 Flaccid Paralysis is PATHOGNOMONIC SIGN of Poliomyelitis
Three (3) Types of Paralysis
1. Bulbar Type
 Cranial nerves are affected
 9Th cranial nerve (Glossopharyngeal Nerve) and 10 th cranial nerve (Vagus Nerve)
affectations give rise to:
o Respiratory problems
o Vocal cord swelling / paralysis
o Excessive salivation
o Aspiration
o Regurgitation
2. Spinal Type
 Most common type of paralysis
 Affects ANTERIOR HORN CELLS
 Affects MOTOR FUNCTION
o Paralysis of extremities
o Paralysis of intercostal muscles leads to DIFFICULTY OF BREATHING
3. Bulbo-Spinal Type
 Combination of Bulbar and Spinal types
 Patient has cranial nerve affectations and anterior horn cell affectations
Important Concepts!!!
Not all patients will develop paralysis
 If patient is non-paralytic,
o He has GOOD PROGNOSIS
Diagnostic Tests
1. Lumbar Puncture
 Laboratory results would reveal:
o Increased White Blood Cell levels
o Increased Protein levels
o Normal Sugar levels
2. Muscle Testing
 To determine what specific muscle is affected
3. Electromyelogram
 To determine extent of muscle involvement
4. Stool Examination
 Perfomed at the late stage
 About ten (10) days after being affected
5. Nasopharyngeal Examination
 Performed at the early stage
Medical Management
 Symptomatic
 Causative agent is viral
If there is respiratory paralysis
 Place patient in a MECHANICAL VENTILATOR
 Use the IRON LUNG MACHING
o This works on the principle of Negative Pressure Breathing
22
oNo tracheostomy tube needed (tracheostomy tube or endotracheal tube

work on the principle of Positive Pressure Breathing)
o Capsular in shape
o With glass windows
o With metal plate
o Works on electricity
o During brownout or power shortages, operate the machine manually
o It has a steering wheel, which can be manipulated manually
o Patient stays in the Iron Lung Machine for months
Nursing Care for Poliomyelitis
 Symptomatic and Supportive
 Psychological Aspect of Care
o Use empathy
Preventive Measures
1. Immunization
 Vaccine given:
o Oral Polio Vaccine (OPV) or Sabin
o Dose:
 Two (2) to three (3) drops
o Route:
 Oral
o Number of Doses:
 Three (3)
o Interval:
 Four (4) weeks
o When given:
 1st Dose – at six (6) weeks old
 2nd Dose – at ten (10) weeks old
 3rd Dose – at fourteen (14) weeks old
o Important Concepts!!!
 Do not feed child for thirty (30) minutes after administration of OPV
o Rationale:
 For better absorption
o If child vomits, REPEAT!!!
o If child has diarrhea
 Give OPV
 But do not record it
 Not all of the vaccine may be absorbed properly
 When OPV 3 is given four weeks after, record it as OPV 2
 Integrated Management of Childhood Illnesses (IMCI)

o Tell mother also that she should be very careful in handling stool of child
because this vaccine eliminates virus to the stool
o If significant others at home are immunocompromised
o Do not administer OPV
o Due to feces of child
o Rather give, IPV or Inactivated Polio Vaccine / SALK
o Dose:
 0.5 cc
o Route:
 Intramuscular
o Number of Doses:
 Three (3)
o Interval:
 Four (4) weeks
o When given:
 1st Dose – at six (6) weeks old
 2nd Dose – at ten (10) weeks old
23
 3rd Dose – at fourteen (14) weeks old

o Rationale:
 Because stool of child may contain the virus if OPV is given
2. Avoid mode of transmission

 Proper disposal of nasopharyngeal secretions
 Cover mouth when coughing
 Do not put anything through the mouth
RABIES
 Also called:
o Hydrophobia
o Lyssa
o La Rage
 A disease of a low form of animal
o Not a human infection
o Only accidentally transmitted to man
 Occurs in canine animals or animals with fangs:
o Fox
o Wolves
o Boar
o Monkeys
o Bats
o Cats
o Dogs
Causative Agent:
 Rhabdovirus
o A neurotropic virus
o Has special affinity to neurons and the Central Nervous System
R H A B D O V I R U S
▼▼▼ ▼▼▼
Peripheral Efferent
Nerves Nerves
▼▼▼ ▼▼▼
CNS Salivary
Pathologic Gland
Lesions of Rabid
(negri bodies) Animal
Important Concept!
 Pathologic lesions that are formed as microorganism multiplies
 If there is no multiplication of the microorganisms at the Central Nervous
System, there will be NO negri bodies.
 Contact with saliva of a rabid animal
Important Concept!
 Therefore, you need not be bitten
 Even a scratch could cause rabies as animals lick their paws
 Infection may occur through:
o Corneal transplantation
o Kissing animal
o Dog licking wounds
Manifestation:
 In Animals
24
o Incubation Period
 Three (3) to eight (8) weeks
Stages of Manifestations in Animals
Stage 1 – Dumb Stage

 Animal will have complete change in disposition
 May show any of the following behaviors:
o Withdrawn
o Stays in one corner
o Depressed
o May be overly affectionate
 Can lick wounds
o May be walking to and from
o Hyperactive
o Manic
 It is better if the animal is withdrawn as it is easy to note
Stage 2 – Furious Stage

 Easily agitated
 Easily bites
 With vicious look
 With drooling of the saliva
 Expect the animal to die
 Dying and biting happens on this stage
 Animal can die without biting
Manifestation:
 In Humans
o Incubation Period
 Ten (10) days to twenty one (21) years (this is the longest incubation
period recorded in the Philippines)
Stage 1 – Invasive Stage
 Numbness on the site of the bite
 Itchiness on the site of the bite
 Flu-like symptoms
o Fever
o Headache
o Sore throat
 Marked Insomnia
 Restless
 Irritable
 Apprehensive
 Slight photosensitivity
 Vague symptoms
Important Concept!
 When a family member at home is bitten by a rabid animal, vaccinate all people
at home because patient has virus at saliva
Stage 2 – Excitement Stage

 Acrophobia
o Fear of Air
 Hydrophobia
o Fear of Water
Important Concept!
 Air and Water both cause PHARYNGOLARYNGEAL SPASM
 This is characterized by:
o A drowning sensation
o Strangulation to death syndrome
25
o Like breathing in thick smoke

 Other signs and symptoms
o Photosensitivity
o Maniacal behavior
o Resembles attitude of a rabid animal
o Easily agitated
o Runs after people
o Violent
o Club walls
o Jumps out of window
Important Concepts!
 Before, THORAZINE and BENADRYL were given for maniacal behavior but had
proven to be ineffective
 Now, HALOPERIDOL and BENADRYL are administered and are very effective
against maniacal behavior
Stage 3 – Paralytic Sage
 Patient’s spasms will stop
 He can be fed, etc.,
 Paralysis sets in from toes going upwards
 If respiratory system is affected, the patient will die
 Manifestation of signs and symptoms sets within 24 hours and death follows
Important Concept!!!
 Rabies is a preventable but not a curable disease
 Maximum time before death occurs is seventy-two (72) hours.
Diagnostic Tests Done Before Patient Manifests Signs and Symptoms
Important Concept!
 There is no diagnostic examination done to humans, ONLY TO ANIMALS
Brain Biopsy of the Animal
 Identifies presence of negri bodies
 10% of animals have rabies but are negative for negri bodies
o Because virus may travel through efferent nerves and may not have
reached the CNS before death
 Therefore, do the next test…
Direct Fluorescent Antibody Test (DFA Test)

 Confirmatory test for rabies
Observation of the Animal
 Done for ten (10) days
 Important Concept!
o Submit yourself for treatment if, within ten (10) days:
 Animal dies
 Animal shows behavioral changes
 Consider the following:
o Site of Bite
 If above waist
 Submit yourself for treatment as soon as possible
 This is due to the proximity of the bite to the brain
o Velocity of Virus
 Three millimeters per hour (3mm/hr)
o Extent of Bite
 Submit yourself for treatment at once if:
 You have multiple bites
 You have a deep bite
o Reason for the Bite
 If bite is provoked
 Example:
 You stepped on the dog’s tail
 Do not worry
26
If unprovoked

Example:

 There is no reason
 Then, WORRY, because IT IS A RABID DOG!!!
Medical Management
Post-Exposure Prophylaxis Vaccines
Active Form of Vaccine

 Made up of microorganisms
 Purified Vero Cell Vaccine
o PVCV
o One of the more common types
o Verorab
o Stock dose is 0.5 cc / vial
 Purified Duck Embryo Virus

o PDEV
o Lyssavac
 Purified Chick Embryo Cell

o PCEC
o Also one of the more common types
o Rabipur
 If given intramuscularly (I.M.)
o Do skin testing first
 If given intradermally (I.D.)
o No skin testing is done
 Site
o Deltoid
o Vastus lateralis
If active form of vaccine
If via I.M.
 Schedule is:
Dose Day Exampl Dosage Remarks
e
1st 00 03/05/ 2 vials 1 cc on
2005 each
site; One
on the
left and
one on
the right
2nd 07 3/12/ 1 vial One site
2005 only
rd
3 21 3/26/ 1 vial One site
2005 only
 Counting is ALWAYS BASED on the FIRST DOSE!!!
 You can afford not to continue vaccine if dog does not die after ten (10) days
 However, continuance is encouraged because doing so would give three (3) years
of immunity
 If you abort vaccination, you will not get three (3) years of immunity
 When you get bitten again, you start all over again
 In case the dog:
o Died
27
o Disappeared
o Was killed within (3) days
 Avail of complete doses plus a BOOSTER DOSE
o Booster Dose
 Given at DAY 91
 In the tabulated example
 Schedule would be at 6/05/2005
 Dosage is one vial
If via I.D.
 Schedule is:
Dose Day Example Dosage Remarks
st
1 00 03/05/ 0.1 cc if Verorab Given on each site:
2005 or Right and Left
0.2 cc if
Lyssavac
Or
Rabipur
2nd 03 3/08/ 0.1 cc if Verorab Given on each site:
0.2 cc if
Lyssavac
Or
Rabipur
3rd 07 3/12/ 0.1 cc if Verorab Given on each site:
0.2 cc if
Lyssavac
Or
Rabipur
4th 28 04/01/ 0.1 cc if Verorab Given on one site
to 2005 or only
30 to 0.2 cc if
04/03/ Lyssavac
2005 Or
Rabipur
5th 90 06/03/ 0.1 cc if Verorab Given on one site
2005 or only
0.2 cc if
Lyssavac
Or
Rabipur
 Verorab
o Once reconstituted is only potent for eight (8) hours
 Antibodies are produced in about seven (7) days
 Therefore, also give passive form of vaccine.
Passive Forms
Temporary antibodies
Animal Serum
 Equine Rabies Immunoglobulin (ERIG)
o Anti-rabies serum
o HyperRab
o FaviRab
Important Concepts!
 Do skin test first
o If negative for skin test, give drug
 Dosage is based on body weight and is provided in direct proportion
 0.2 cc / kg body weight is the standard
 Example:
28
 A 50 kg person would receive 10 ml of ERIG

 Cost is approximately Php1,800 / 5.0 cc
o If positive for skin test, give HRIG or Human Rabies Immunolobulin
 Imogam
 Rabuman
 0.133 cc / kg body weight is the standard dose
 Example:
 A 50 kg person would receive 6.65 cc of HRIG
 Cost is approximately Php4,500 / 2.0 cc
o This is given as a single dose within seven (7) days from the date of the
bite
o After seven days, patient already has antibodies
o Computed Dosage is divided in two
 Half is given Intramuscular
 On the ventrogluteal muscle or at the side of the buttocks
o Other half is...
 Infiltrated around site of bite using four distinct points or
 Given inside the wound of the patient
o This is prophylactic and is not considered as a treatment
Nursing Care
 Place patient in a dim and quiet environment
 Keep patient away from sub-utility room
 Restrain the patient before he exhibits maniacal behavior
 Wear all Personal Protective Equipment when you enter the room because patient
continues to spit
Preventive Measures
 Be a responsible pet owner
o Have pets immunized
 Wash wound with soap, water and antiseptic
 Then observe the dog
 Virus rabies is destroyed by 60°C heat for thirty-five (35) seconds
 Therefore, you will not acquire rabies from eating dog meat
COMMUNICABLE DISEASES OF THE CIRCULATORY SYSTEM
DENGUE HEMORRHAGIC FEVER

Important Concept!
 Dengue Fever is different from Dengue Hemorrhagic Fever!
 Dengue fever is an affectation of the circulatory system without bleeding
o It is a mild form of hemorrhagic fever
Causative Agent:
 Arbovirus
 Carried from one person to another by an Arthropod
Types of Dengue Viruses
 Type 1 – Onyong-nyong virus
 Type 2 – Chikungunya
 Type 3 – West Nile
 Type 4 – Flavivirus
o Brought epidemics in several areas in the Philippines
 Mosquito Bite
 Biological Transmitters
o Aedes aegypti
o Aedes albopectus
 Mechanical Transmitter
o Culex fatigans
29
Biological Transmitter
 After this mosquito has bitten an infected person, after eight (8) to ten (10) days,
it can transfer virus to other people
 Virus becomes a part of the system of the mosquito as long as it is alive
 Life span of these types of mosquitoes is four (4) months
Mechanical Transmitter
 After this mosquito bites an infected person, the very next person it bites is the
only person who gets the virus.
 One is to one
 Immediate transfer of virus
Aedes aegypti
 More common in the Philippines
 Day-biting
 Low-flying
 Low-extremity biting
 Breeds on clear, stagnant water usually in urban area
o Old tires
o Flower vases
o Plant cans
 In the Philippines, any area is a dengue risk area
 Other information:
o When it lands on a surface, body of mosquito is on a PARALLEL POSITION
and two (2) legs are raised
o It has white stripes on legs
o It has a gray-millennium color
Four Classifications of Dengue Hemorrhagic Fever
DHF Grade 1
 Increased grade fever (lasts 3 – 5 days)
o Even if antipyretics are given, fever will persist
o Fever will come down but the patient is still febrile
o Important Concept!
 Therefore, give antipyretic round the clock
 Pain is present
o Headache
o Periorbital pain
o Pain behind the eyes
o Joint and bone pain
o Abdominal Pain
 Nausea and Vomiting
 Presence of Pathological Vascular Changes
o Petechiae
o Herman’s Sign
 Generalized redness
 Flushing of the skin
INFECTED MOSQUITO
▼▼▼
BLOODSTREAM (multiplies)
▼▼▼
Multiple lesions in the bloodstream
▼▼▼▼ ▼▼▼▼
Increased Increased
Capillary Capillary
Fragility Permeability
(causes easy (allows shifting
bleeding; of fluid from
difficult to stop one
30
due to compartment
thrombocytopenia; to
poor clotting another leads
to ascites;
hemo-
concentration
Important Concept!
 If patient recovers, he only has Dengue Fever (and not Dengue Hemorrhagic
Fever)
 Dengue Fever is also called:
o Dandy Fever
o Breakbone Fever
DHF Grade 2
 If there is persistence of signs and symptoms of DHF Grade 1
 If there is bleeding from:
o Nose – epistaxis
o Gums – gum bleeding
o Vomiting of blood – Hematamesis (coffee ground appearance from the
stomach)
 Upper Gastro-Intestinal Tract Bleeding
o Melena
 Passing of black tarry stool
 Acted upon by digestive enzymes
 Lower Gastro-Intestinal Tract Bleeding
o Hematochezia
 Passing of fresh blood in the stool
 Then, these signs and symptoms indicate the START OF HEMORRHAGIC FEVER
DHF Grade 3
 Persistence of signs and symptoms of DHF Grade 2
 With signs of circulatory collapse or failure
 With cold clammy skin
 Nursing Alert!
o Check for capillary refill
o How?
 Apply pressure on nailbeds
 Normal capillary refill time is about one (1) to two (2) seconds
 If capillary refill time is about three (3) seconds or more, blood flow
is sluggish due to circulatory failure
 Check Vital Signs
o Indicators of Circulatory Failure:
 Hypotension or decreased blood pressure
 Rapid but weak pulse
 Rapid respiration
DHF Grade 4
 With signs and symptoms of DHF Grade 3
 With shock
 Hypovolemic shock due to excessive blood loss due to uncontrolled bleeding
Diagnostic Tests for Dengue Hemorrhagic Fever
1. Tourniquet or RumpelLeede’s Test

 Test for capillary fragility
 Concept!
o This is only a presumptive test for DHF (not a confirmatory test)
o Not all patients are subjected to this test
 Three (3) criteria that must be present before you perform the tourniquet test:
o Person must be at least six (6) months old
31
o Fever should be more than three (3) days

o No other signs of DHF are present
 Patient only feels fever
 If there are other manifestations (i.e. stomachache), do not do tourniquet test
 How is it done?
o Get the blood pressure of the patient
o Add systolic and diastolic pressures
o Divide the sum by two
o Apply that pressure on the cuff. . .
 For five (5) minutes if the patient is pediatric
 For ten (10) minutes if the patient is an adult
o Deflate the Blood Pressure Cuff
o Check for the presence of petechial formation
o If greater than or equal to petechial formations per square inch, then
patient is positive (+) to Tourniquet Test
o Therefore, patient is probably suffering from Dengue Hemorrhagic Fever
 To confirm the diagnosis, do the next test. . .
2. Blood Examination
 Platelet Count
o Normal value is 150,000 to 400,000 platelets per cubic millimeter
o Values lower than the normal indicate that patient is positive (+) for
Dengue Hemorrhagic Fever
 Hematocrit Determination
o Measures degree of hemoconcentration
o Normal value is 37% to 54%
o Values higher than the normal indicate that patient is positive (+) for
Dengue Hemorrhagic Fever
Medical Management
 Symptomatic
 No specific treatment
Important Concepts!
 If patient is febrile
o Administer antipyretic
o But never use aspirin
 Potentiates clumping of platelets
 Results to bleeding
o ASA is not given to children below twelve (12) years old and when cause of
disease is unknown.
 Side effect is Reye’s Syndrome
 A neurologic disorder associated with viral infection
 If there is bleeding
o Give coagulants
 Vitamin K
 Aquamephyton
 Konakion
Vitamin C
To increase capillary resistance
 Provide blood transfusion
Nursing Management
 Prioritize bleeding prevention and control
 For gum bleeding
o Use cotton swab
o This is softer than any toothbrush
 Provide ice chips
 Advise patient to gargle
o It will not cause injury
o Use mouthwash
 Use soft-bristled toothbrush
32
oConsider this as the last measure to be taken compared with the three
others above
 Keep patient on NPO if patient vomits blood
 Apply ice pack over epigastric region of patient
 Doctor may order NGT insertion
 For gastric lavage, use ice cold NSS or coagulant
 Provide adequate nutrition
 Avoid dark colored foods
Important Concept!
 Attack of Dengue Hemorrhagic Fever does not give permanent immunity
Prevention:
 Practice CLEAN PROGRAM of the DOH
MALARIA
 Also called Ague
 King of tropical diseases
 Manifested by indefinite periods of chills and fever
Important Concepts!
 Microorganism is a PROTOZOA
 Plasmodium has four species
o Plasmodium malariae
o Plasmodium ovale
o Plasmodium vivax
 One of the most common in the Philippines
o Plasmodium falciparum
 Another of the most common in the Philippines
o The most fatal due to its tendency to multiply rapidly
 Plasmodium is acquired through a mosquito bite – Anopheles mosquito
 Blood is needed by the female Anopheles mosquito for the fertilization of its eggs
Important Concepts!
 Anopheles mosquito is
o A NIGHT biting mosquito
 It bites from sunset to sunrise or from dusk to dawn
o It breeds in CLEAR, SLOW FLOWING WATER
o It is common in
 Rural Areas
 Mountainous Areas
 Forested Areas
 Palawan
 Dumaguete
 Surigao
o It lands on the surface on a forty-five (45) degree angle or in a slanting
position
Pathophysiology of Malaria
PLASMODIUM
▼▼▼
BLOODSTREAM
▼▼▼▼ ▼▼▼▼
Inside RBC (for Those that don’t
reproduction) penetrate RBC
go to the LIVER.
They do nothing
and may remain
dormant for
3 – 5 years.
They wait for the
liver to release
the RBC for
them to
33
penetrate other
RBC
▼▼▼
Inside RBC
 Once inside the Red Blood Cells (RBC), the microorganism multiplies and
destroys the RBC.
 This leads to ANEMIA!
 Rupturing of membranes of Plasmodium coincides with the presence of CHILLS
in the patient
 Presence of more or new microorganisms in the bloodstream causes FEVER!
Important Concepts!
 If you have malaria and your last attack is more than five (5) years ago, then you
can be a blood donor
 If your last attack is less than five (5) years ago, you CANNOT BE A BLOOD
DONOR
 Malaria can also be obtained by BLOOD TRANSFUSION
Manifestations of Malaria
Stage 1 – Cold Stage

 Lasts for ten (10) to fifteen (15) minutes
 Chilling sensation is present
 Shaking, chattering of the lips is present
 Nursing Responsibilities
o Provide warmth
o Blankets
o Warm drinks
o Not warm compress
o Hot water bag on soles of the feet
o Expose to heat lamp or droplight
Stage 2 – Hot Stage
 Last for four (4) to six (6) hours
 The patient has:
o Fever
o Headache
o Abdominal Pain
o Vomiting
o Lower the body temperature
o Provide tepid sponge bath
o Provide cold compress
o Increase fluid intake
o Provide light, loose clothing
o Provide antipyretic as ordered
Stage 3 – Wet Stage
 Patient exhibits:
o Profuse sweating
o Feeling of weakness
o Make patient comfortable
o Keep patient dry and warm
o Provide fluids to prevent dehydration
o Make patient rest comfortably in bed
 In other types of sicknesses or disorders, chills occur before fever
 This is due to body’s response to heat loss
 In ordinary infections, higher temperatures are seen during CHILLS because
patient is trying to retain heat
34
 In malaria, increased temperature occurs on FEVER or HOT STAGE

 There is no fever during the cold stage
 Chills occur due to the release of Plasmodium
Key Concept!
 If causative agent is P. falciparum, its rapid multiplication and RBC destruction
would lead to…
o Anemia
o Liver then compensates and results to HEPATOMEGALY
o Splenomegaly
o Mild jaundice sometimes occurs
o Cerebral Hypoxia
 Restlessness
 Confusion
 Delirium
 Convulsions
 Loss of consciousness
 Coma
o Black Water Fever
 Passing out black urine or dark red urine due to rapid RBC
destruction
 This may lead to death
Diagnostic Tests for Malaria
Blood Smear or Malarial Smear

 Best time to collect
o At the HOT STAGE
o At the peak of fever (this is when the microorganism is in the blood
stream)
Concepts!
 During the Hot Stage, the microorganism is in the bloodstream
 During the Cold Stage, the microorganism is inside the red blood cells
Quantitative Buffy Coat (QBC)
 This is seldom done
 This test is expensive
 Specimen used is blood
 A rapid test for malaria
 You do not have to wait for fever to set in to undergo this test
 You can extract blood earlier
Medical Management of Malaria
 Anti-malarial Agents
 Drug of Choice
o Chloroquine
 Other Drugs used:
o Primaquine
o Atabrine
o Pancidar
o Quinine
 A reserve drug for severe type of malaria
Important Concepts!
 Anti-malarial agents are cautiously used in pregnant women
 They are considered as ABOTIFACIENT AGENTS
o They can cause ABORTION
 However, this is NOT CONTRAINDICATED because if mother (infected with
malaria) is not treated, the child may be born with NEONATAL MALARIA
 Child with Neonatal Malaria exhibits the following:
o Decreased levels of RBC
o Immature liver
o Severe anemia
 Child may die
35
Key Concepts!
 Malaria may be acquired through:
o Blood Transfusion
o Vertical Transfusion
 RBC passes through the placenta (not the microorganism)
Important Concept!
 An attack of Malaria does not provide permanent immunity
 A repeat bite from a malaria mosquito is not needed because the microorganism
may be dormant in the liver
Prevention
 Practice the CLEAN PROGRAM of the DOH
COMMUNICABLE DISEASES OF THE INTEGUMENTARY SYSTEM
Viral Communicable Diseases

 Measles
 German Measles
 Chicken Pox
 Herpes Zoster
MEASLES
Causative Agent
 Morbilli
o Paramyxovirus
 Rubeola Virus
Manifestations of Measles
1. Pre-eruptive Stage
 Three (3) C’s
o Coryza
o Cough
o Conjunctivitis
 Kuplick Spots
o Fine red spots with bluish white spot at the center
o Found at the inner cheeks
o This is the PATHOGNOMONIC SIGN of Measles
Eruptive Stage
 Rashes are now present
 Maculopapular Rashes
o Flat to elevated
o Reddish in color
o With blotchy appearance
o In the vernacular, pantal-pantal
o Face of the patient looks bloated
o Cephalocaudal distribution
 Appears first on the hairline
 Head to toe distribution
o Appears on the 3RD DAY of illness
o Within two (2) to three (3) days, the entire body will be covered with rashes
3. Post-eruptive Stage
 Time when rashes start to disappear
 Fine, branny desquamation appears
 Then the desquamation peels off
 Peeling off proceeds in a cephalocaudal manner
 It is only the rashes that will be peeling off, NOT THE SKIN of the patient
 Concept!
o Use of Colantro
o Has a burning effect
o Causes skin to likewise peel off
o Use of colantro is now discouraged
36
Diagnostic Tests for Measles
Concept!
 There is no specific diagnostic test for measles
1.Clinical Observation
Medical Management for Measles
 Symptomatic Management
 Recovery dependent on Nursing Care
Nursing Care
 Maintain and increase body resistance of the patient
 Provide the following:
 Adequate rest
 Adequate nutrition
o No diet restrictions
o Provided that patient is not a hypersentitive individual (i.e. prone to
allergies)
o Seafood or poultry products are contraindicated if the patient is allergic to
these foods
o Increase oral fluid intake
o Especially those rich in Vitamin C
 Keep patient’s back dry and warm
o Rationale
 Exposure to draft gives rise to cough and cold
 It gives rise to a good medium for growth of microorganisms
 Leads to pulmonary complications like pneumonia, which could
lead to death
 Provide hygienic measures
o Eye care
 Measles patients have much “MUTA”
 To prevent eye complications
o Ear care
 To prevent otitis media
o Mouth care
o Nasal care
o Skin care
 Taking a bath or taking a sponge bath is not contraindicated
 However, do not expose the patient to draft
Other Nursing Care
 Symptomatic nursing care
 Patient is photophobic
o Provide dim and quiet environment
Important Concept!
 Attack of measles gives permanent immunity to the disease
Key Concept!
 When is the patient communicable?
 Patient is communicable before rashes appear or during the pre-eruptive stage.
Preventive Measures
1. Immunization
 Anti-measles vaccine (AMV)
 When given:
o Age of nine (9) months
 Dosage:
o 0.5 cc
 Route:
o Subcutaneous
 Site:
o Deltoid muscle
 Important Instructions to be given to the mother of the patient!
37
o Child may experience fever

o Give paracetamol to lower the body temperature
o After three (3) to four (4) days, child will have a rash formation. This is a
NORMAL REACTION to the vaccine
o In fact, it is a good reaction, indicating that the patient’s body has
produced anti-bodies to measles
Important Concepts!
 In the private setting, MMR vaccine is given…
 When:
o Age of fifteen (15) months
 Dosage:
o 0.5 cc
 Route:
o Subcutaneous
 Site:
o Deltoid muscle
 Ask mother if the child has allergies to egg and neomycin
o MMR is made up of duck embryo and neomycin
o If patient is allergic to egg
 Give vaccine
 But observe for signs and symptoms of allergies
o If patient is allergic to neomycin
 Do NOT give MMR vaccine
 It may cause anaphylaxis
Important Concept!
 DOH Program on Measles
o LigtasTigdas Immunization Program in 2004
 Airborne
Prevention
 Proper disposal of nasopharyngeal secretions
 Cover the mouth when coughing or sneezing
Key Concepts!!!
 Measles is not fatal by itself
 Common complications
o Bronchopneumonia
o Encephalitis
GERMAN MEASLES
 Also called:
o Rubella
o Three (3) day disease
o Poteln
Causative Agent
 Pseudoparamyxovirus
o Rubella Virus
 Togavirus
 Droplet (not airborne)
Manifestations of German Measles

1. Pre-eruptive Stage
 Fever may be present or absent
 If patient has fever, it lasts only for one (1) to two (2) days
 Patient has mild cough and mild cold
 NO CONJUNCTIVITIS
38
o Therefore, he only has two (2) C’s.

o Enanthem of German Measles are called FORSCHEIMER SPOTS
 Fine red spots
 Also called petechial spots
 Appears on the soft palate
nd
2 Stage – Eruptive Stage
 With maculopapular rashes
o Not reddish but pinkish
o Not blotchy but discreet
o Appearance is fine
o Slightly unnoticeable
o Rashes are smaller compared with those of measles
o Also has cephalocaudal distribution
o Appears first at the head
o Once the rashes appear, within twenty-four (24) hours, the entire body is
filled with rashes
o However, head-to-toe distribution is not as distinct as in measles
 Key Concepts!
o Patient is positive for enlargement of lymph nodes
 Suboccipital lymph nodes
 Posterior auricular lymph nodes
 Posterior cervical lymph nodes
o This is a differentiating factor between German Measles (positive for
enlargement of lymph nodes) and Measles (negative for enlargement of
lymph nodes).
3rd Stage – Post-Eruptive Stage

 Rashes now start to disappear
 But they disappear at the third (3rd) day of illness
o In measles, rashes just start to manifest themselves by the third (3 rd) day
of the illness
o Enlarged lymph nodes will gradually subside
Diagnostic Tests, Medical Management, Nursing Managementand Preventive

Measures for German Measles are THE SAME AS THAT FOR MEASLES
Important Concepts!
 An attack of German Measles gives permanent immunity
 When is German Measles communicable?
o During the entire course of the disease.
o Until enlarged lymph nodes return to normal
 German Measles is NOT FATAL
 It can become fatal if patient is on her first trimester of pregnancy due to chances
of giving birth to a child with congenital anomalies:
o Microcephaly
o Congenital Defect (Tetralogy of Fallot, etc.)
o Cataract leading to blindness
o Deafness and mutism
 Mere exposure of pregnant woman to German Measles MUST BE AVOIDED
o If exposed during the first trimester of pregnancy, pregnant mother must
immediately receive immunoglobulin or gamma globulin within seventy-
two (72) hours.
 After three (3) days, the virus has already passes through the placenta
o Therefore, once pregnant, women should be already given gamma globulin
 German Measles is more fatal to pregnant women relative to Measles
 All people have been exposed to measles, therefore, anti-bodies to measles have
already been developed.
39
 Not all have been exposed to German Measles, therefore, not all have developed
anti-bodies to German Measles
 MMR vaccine
o Measles, Mumps, Rubella vaccine
o If you are an adolescent, you can receive this but do not be pregnant
within the next three (3) months because you may give birth to a child
with congenital anomalies
CHICKEN POX
 Also called Varicella
Causative Agent
 Varicella Zoster Virus
o Can be found both on:
 Nasopharyngeal Secretions
 Secretions of rashes
o But only causes infection if. . .
 It enters the nasopharynx
o Does NOT cause infection by skin to skin contact
 Airborne
Three (3) Stages of Manifestation
Stage 1 – Pre-Eruptive Stage

 Presence or absence of low-grade fever
 Headache
 Body malaise
 Muscle pain
 Lasts for twenty-four (24) to forty-eight (48) hours
Stage 2 – Eruptive Stage
 Presence of rashes
o Vesiculopustular rashes
 Development of Vesiculopustular Rashes:
o Initially, these rashes are macules – FLAT RASHES
o They will become elevated or become PAPULES
o Then, another set of macules appear
o The original rashes (now papules) will become vesicles
o Pus then develops
o It is only during the eruptive fever stage that you can see all the following:
 Macules
 Papules
 Vesicle
 Vesiculopustular Rashes
Additional Concepts!!!
 These rashes are itchy
 Therefore, it is a MUST that the patient takes a bath DAILY
 If the patient does not take a bath. . .
o Patient will perspire
o Patient will accumulate dirt
o Dirt + Wetness + Itchy rashes will lead to greater itching and would
eventually result into SCRATCHING
 Scratching may be avoided while the patient is awake
 However, scratching during sleep is common among Chicken Pox patients
Key Concept!
 Do not scratch rashes
 Scratching results to infection or pox marks!!!
SCRATCHING WHILE ASLEEP

▼▼▼
40
RUPTURES THE VESICLES

▼▼▼ ▼▼▼
Leads to skin Permanent
Infection Scar
▼▼▼ (Pox mark)
Becomes a
Boil,
or a Furuncle
(big Boil),
or a Carbuncle
(several boils
attached to one
another)
▼▼▼
Results to cellulitis
or gangrene
Important Concepts:
 The distribution of the rashes are:
o Generalized
o Found all over the body
 Found first on the trunk
 Found on the covered parts of the body
 Then found on the scalp
 Abundantly found on the covered parts of the body and then on the exposed
parts of the body
Key Concept!
 Period of Communicability
o Until the LAST RASH has crusted!!!
o Easily and highly-contagious upon the appearance of rashes
Important Concepts!
 During the summer season, if you have not had chicken pox and if you are
immunocompromised, DO NOT GO OUT
 Duration of the Disease
o Two (2) weeks
Important Characteristic of Chicken Pox Rashes
 Rashes have UNIFOCULAR appearance
 They have one focus
 Rashes appear one at a time and they NEVER FUSE TOGETHER
 There is always a gap between one rash to another rash
o If rashes get into contact with each other, it is no longer Chicken Pox.
o It is HERPES ZOSTER
3rd Stage – Post-Eruptive Stage

 Rashes now start to crust
 They start to dry
 They start to peel off
 If rashes start to dry, let them peel off by themselves
 If allowed to dry and peel off, there will be no infection
 However, it leaves a pox mark
Diagnostic Test for Chicken Pox
 Clinical Observation
Medical Management of Chicken Pox
 Symptomatic management as causative agent is a virus
Additional Concepts!
 Zovirax or Acyclovir
o Not a treatment for chicken pox
o Virus is not always responsive to this drug
o Some viruses are resistant (drug has no effect) while some are sensitive to
it and patient will heal within three (3) days
o Dosage is four (4) to five (5) tablets per day for one week
41
 Zovirax Cream
o Protects skin from infection but does not protect against pox marks
 Zovirax may be effective but it does not allow the patient to produce antibodies.
 Therefore, let the normal course of Chicken Pox occur
Nursing Care for Chicken Pox

 Same as in measles
 But more focus should be given on SKIN CARE
o Rationale:
 To prevent skin infection
 Complication is encephalitis
Important Concepts!
 Attack of Chicken Pox gives permanent immunity
 Period of Communicability
o Until last rash has crusted
Preventive Measures
1. Immunization
 Varivax
o Varicella Vaccine
 Dosage
o 0.5 cc
 Route
o Subcutaneous
 For children below thirteen (13) years old
o Single dose is given
o Site of administration is the deltoid muscle
 For those thirteen (13) years old and above
o Two doses are given
o With one (1) month interval
3.Cover nose and mouth when sneezing or when coughing

Important Concepts!
 Not all of the Chicken Pox virus would leave your body. Some are left behind,
travel to the nerve and become dormant
 Therefore, next exposure to it will not give you Chicken Pox
 New Varicella Zoster Virus will go to the nerve and activate dormant virus to give
you Herpes Zoster
 Herpes Zoster is the dormant or inactive type of Chicken Pox
 You CANNOT have Herpes Zoster until you have obtained Chicken Pox
 Adults usually affected by Herpes Zoster because what is affected is the ganglion
of posterior nerve root
HERPES ZOSTER
 Also called
o Shingles
o Zone
o Acute Posterior Ganglionitis
Causative Agent
 Varicella Zoster Virus
 Droplet
Manifestations of Herpes Zoster
 Same as those of Chicken Pox
 Rashes are also vesiculopustular
 However, there are differences in the characteristics of rashes
 Herpes Zoster rashes are:
o Not itchy
o More of painful because nerves are affected
42
o Even if patient has recovered and rashes are long gone, pain may be
persistent up to two (2) months. This is NORMAL
o Rashes do not have generalized distribution
o Has a unilateral distribution because it follows the nerve pathway
o Always vertical or longitudinal (on one side)
o Rashes do not have unifocular appearance but APPEARS IN CLUSTERS
Diagnostic Test and Medical Management for Herpes Zoster
 Same as in Chicken Pox
Additional Medical Management
 Application of Potassium Permanganate (KMnO 4) compress over the rashes of the
patient
 Rationale:
o To obtain three-fold effect
 Astringent effect
 To dry the rashes
 Bactericidal effect
 To decrease chances of skin infection
 Oxidizing effect
 To deodorize the rashes and remove the fishy odor
Important Concept!
 An attack of Herpes Zoster does not give permanent immunity
 Most common complications of Herpes Zoster
o Skin infection
o Encephalitis
Preventive Measures
 Same as that of Chicken Pox
 Children are mostly affected in:
o German Measles
o Measles
o Chicken Pox
 Adults are mostly affected in:
o Herpes Zoster
COMMUNICABLE DISEASES OF THE RESPIRATORY SYSTEM

Bacterial
 Diphtheria
 Pertussis
 Tuberculosis
 Pneumonia
Viral
 Colds
 Influenza
Causative Agent
 Corynebacterium diphtheriae
 (Klebs-Loeffler Bacillus)
 This bacteria does not only affect the respiratory tract
o If it affects the mucous membrane, this is called CUTANEOUS
DIPHTHERIA
 Types of Cutaneous Diphtheria
o Conjunctival Diphtheria
 Conjuctiva is affected
o Vaginal Diphtheria
 Vaginal mucosa is affected
o Diphtheria of the Prepuce
 Affectation of the uncircumcised prepuce of the male
o Wound Diphtheria
 Affects wounds
 Especially of burn patients
43
Important Concepts!
 Respiratory Diphtheria
o Is the more common type of diphtheria
 Wound Diphtheria
o Is the rare type of diphtheria
 Droplet
Manifestations of Diphtheria
 Depends upon its classification
Three (3) Types of Respiratory Tract Infections
1. Nasal Type
 Nasal passages are affected
 With irritating nasal discharge
o Characterized by serosanguinous secretion with foul mousy odor (whitish,
bloody, smells like a rat)
 Due to rubbing of nose, this results to upper lip and nasal excoriation
 Pathognomonic Sign
o Presence of pseudomembrane
o However, not appreciable in the NASAL TYPE
o This is found within the nasal septum
o Speculum is needed
o But is usually covered by irritating nasal discharge
2. Pharyngeal Type or Faucial Type
 Affects the pharynx and the tonsils
 Patient complains of:
o Sore Throat
o Dysphagia
 Presence of pseudomembrane, which is visible upon opening of the mouth
 Pseudomembrane is present on the following:
o Soft palate,
o Uvula
o Pillars of the tonsils
 The pseudomembrane can be described as:
o Grayish-white membrane
o Like cigarette ash
 Patient also has a BULL NECK appearance
o Enlargement of the neck
o Specifically of the anterior upper aspect of the neck
o This is due to inflammation and enlargement of cervical lymph nodes
o Anterior upper aspect of the neck is:
 Reddish
 Warm to touch
 There is pain
 Tenderness
 The difference between a person with Pharyngeal Type of Diphtheria and a
person with double chin is that double chin people have on their necks:
o Normal skin color
o Normal temperature
o No pain
3. Laryngeal Type
 Affects the larynx or the voice box
 With hoarseness of voice
 With loss of voice
o Aphonia but only temporary
 Larynx also serves as airway passage
o Therefore, there is:
 Dyspnea
 Difficulty of breathing
44
 Body compensates and uses accessory muscles

Important Concepts!
 Overuse of accessory muscles results to chest retractions or chest indrawing
 Normally, when a person breathes in, the chest expands
 But with over usage of accessory muscles, chest wall does not expand, rather, it
DRAWS IN!!!
 In order to detect chest indrawing, look at the subcostal area (lower area of the
chest region). This elevates due to severe dyspnea
 Do not look at the sternum or at the intercostals spaces
 Check for chest indrawing when:
o The patient is calm
o The patient is not crying
o The patient is not breast-feeding (chest indrawing is NORMAL under this
condition)
o The patient is bottle-feeding (chest indrawing is NORMAL under this
condition)
 Chest indrawing is constant in a patient with diphtheria
 Chest indrawing is always present in any position in a patient with diphtheria
 Pseudomembrane is also present
o Present in the larynx
o Laryngoscope is needed to see the pseudomembranes
 Pseudomembranes may trigger cough
 Characteristics of cough:
o Barking cough
o Dry
o Metallic
o Croupy
o Husky
 Due to hoarseness of voice
Key Concept!
 Laryngeal Type of Diphtheria may become severe
LARNGEAL TYPE OF DIPHTHERIA

▼▼▼
Laryngeal Edema
▼▼▼
Airway Obstruction
▼▼▼
Respiratory Obstruction
▼▼▼
Respiratory Distress
▼▼▼
Death
 Therefore, management is EMERGENCY TRACHEOSTOMY

 Among the three types of Diphtheria, Laryngeal Diphtheria is the most fatal due
to the possibility of respiratory obstruction, which may lead to death.
Diagnostic Tests for Diphtheria
1. Schick’s Test
 Test for immunity or susceptibility to diphtheria
2. Moloney Test
 Test to determine hypersensitivity to diphtheria toxin
Nose and Throat Swab
 Most commonly done test
45
 Confirmatory Test
o To identify the microorganism
o To determine if patient is still communicable
o Patient is still communicable until three (3) consecutive results of
negative (-) nose and throat culture are obtained
Medical Management for Diphtheria
Three (3) Objectives:
1. Neutralize the toxin

 The toxin brings about systemic effects
 Therefore, give anti-diphtheria toxin
o Do skin test first
o If positive for the skin test
 Give drug
 Because there is no Diphtheria Ig
 But give in fractional doses
 Also have ready and handy the following:
o Epinephrine
o Corticosteroid
2. Kill microorganism
 Give anti-biotics
 Drug of Choice
o Penicillin
 Scraping the pseudomembrane does not kill the microorganism
 It only causes bleeding
3.Prevent Respiratory Obstruction
 Performance of emergency tracheostomy
Nursing Management for Diphtheria

1. Place patient on complete bed rest until two (2) weeks after recovery
 Rationale:
o To prevent the number one complication – MYOCARDITIS
o Myocarditis leads to death
o Toxin released by microorganism has special affinity for heart muscles
o Toxin released travels to the bloodstream
o Goes to the heart
o Waits for opportunities when heart’s resistance to go down:
 When the heart is overloaded with work
 When the heart is under stressful activities
 Therefore, provide COMPLETE BED REST
Signs and Symptoms of Myocarditis

 Marked facial pallor
 Very irregular pulse rate
 Hypotension
 Chest pain or epigastric pain
Important Concept!
 When the above signs and symptoms are observed, immediately seek
consultation
2. Maintenance of Patent Airway
 Proper position of patient
o Upright
o Semi-Fowler’s
 Encourage Deep Breathing Exercises and coughing exercises with pursed lip
 Chest Physiotherapy
 Increased oral fluid intake to liquefy the secretions
 Frequent turning to sides to prevent pooling of secretions
 Do inhalation therapy with doctor’s order.
46
o Nebulization
o Steam Inhalation
 Perform Postural Drainage with doctor’s order
 If patient cannot expectorate, suction secretions as needed
3. Provide adequate nutritious diet
Soft diet due to the presence of dysphagia
4. Other nursing managements are symptomatic and supportive
 An attack of diphtheria does not provide permanent immunity since the
causative agent is a bacteria
Preventive Measures
1. Immunization
 DPT vaccine
3. Cover the nose and the mouth when sneezing or coughing
4. Never kiss the patient.
 Diphtheria affects all ages
 Common in children
PERTUSSIS
 Also called
o Whoofing cough
o Chin cough
 Only affects children below six (6) years old
Causative Agent
 Cocobacillus
 Both aerobic and anaerobic
o Bordatella pertussis
o Haemophilus pertussis
 Droplet
Manifestations of Pertussis
Three (3) Stages
1. Catarrhal Stage
 Highly contagious
 Colds
 Nocturnal coughing
o Coughing is present at night
 Fever
 Tiredness
 Listlessness
2. Paroxysmal or Spasmodic Stage
 With five (5) to ten (10) successive, forceful coughings, which ends on a prolonged
inspiratory phase or a WHOOF
 To loosen mucous plug on airway (this causes the patient to cough)
 To loosen thick and tenacious secretions
 Therefore, child coughs for five (5) to ten (10) times
 When patient is unsuccessful in expectorating narrow passageway requires long
inhalation
 If patient keeps on coughing
o He may choke on his mucous
o This results to vomiting
o Therefore, the patient is positive for vomiting
 Due to pressure exerted on vomiting, there could be
o Congested face (bloated face)
o Congested tongue
 Purple in color
 Due to pressure exerted on the tongue by the teeth when coughing
o Teary-red eyes with protrusion due to pressure exerted when coughing
47
oDistention of face and neck veins

oInvoluntary micturition and defecation
oAbdominal hernia due to pressure exerted on abdominal wall when
coughing
 If patient is vomiting:
o Metabolic alkalosis occurs
 This will trigger convulsions due to electrolyte imbalance
Convalescent Stage
 Patient is no longer communicable
 Signs and symptoms will now start to subside
 Patient is now on the road to recovery
Diagnostic Tests for Pertussis
1. Nasal Swab
2. Bordet-Gengou Test
 Specimen is nasopharyngeal secretion
3. Agar Plates
4. Cough Plate
Medical Management
 Anti-biotic Treatment
o Drug of Choice
 Erythromycin
 Pertussis Immune Globulin
 For nocturnal cough
o Give mild sedation
 Replace fluids and electrolytes lost due to vomiting
 Important Concept!!!
o No expectorant should be given to pertussis patient
o This stimulates coughing
o Mucolytics are allowable
Nursing Management for Pertussis
1. Complete Bed Rest

 To conserve the energy of the patient
 Decreases oxygen demand
 Decreases oxygen consumption
2. Prevent Aspiration
 Proper position of patient
o Upright position in feeding
 During spasmodic attacks of cough
o Hold all feedings and keep patient on NPO (nothing per orem)
 For children below six (6) years old:
o If bottle-fed
 Inform mother that nipples in bottle should only have a SMALL
BORE to lessen chances of aspiration
o Feed child with a medicine dropper
3. To manage vomiting:
 Monitor Intake and Output
 Assess for signs of dehydration
 Provide proper I.V. regulation
 Provide adequate fluids with extra aspiration precaution
4.Application of Abdominal Binder
 To prevent abdominal hernia
Important Concept!
48
 No permanent immunity from an attack of Pertussis is acquired. However,

second attacks are rare. Age decreases risks
Preventive Measures
 Same as for Diphtheria
 But you can kiss the patient because you (adults) are above six (6) years old (in
Diphtheria, all ages are affected)
TUBERCULOSIS
 Also called
o Koch’s infection
o Phthisis
o Galloping Consumption
o Pulmonary Tuberculosis
Causative Agent
 Mycobacterium tuberculosis
o Acid-fast bacteria
o Also known as tubercle bacilli
 Airborne (most common)
Important Concept!
 Therefore, there is no need to separate eating utensils!
 Tuberculosis is not acquired through shared utensils.
 Tuberculosis is also acquired through ingestion of contaminated milk
o Causative agent is Mycobacterium bovis or Mycobacterium bovine
o Tuberculosis of Cattle
o From improperly pasteurized or improperly boiled milk
 Tuberculosis may also be acquired from birds
o Mycobacterium avium is the causative agent
o Obtained when taking care of infected bird
o Eating of the bird is not necessary to get infected
 Mycobacterium avium Complex
o Most common opportunistic infection for AIDS patients in the United
States
Important Concept!
 Patients infected with Tuberculosis bacilli are most of the time asymptomatic
 Symptoms are usually seen after four (4) to eight (8) weeks.
Manifestations of Tuberculosis
 Afternoon low-grade fever with night sweats
 Anorexia
 Weight loss
 Fatigability
 Body malaise
 Chest pain / back pain
 Positive for productive cough
 Hemoptysis
 Difficulty of Breathing
 Anemia
 Amenorrhea in females
Three (3) Classifications of Patients
1. According to Extent of Disease

 Basis is on the CAVITATIONS IN THE LUNGS as seen through Chest X-ray
o Minimal Pulmonary Tuberculosis
o Moderately Advanced Pulmonary Tuberculosis
o Far Advanced Pulmonary Tuberculosis
2. According to CLINICAL MANIFESTATIONS
 Basis is the presence or absence of clinical manifestations
o Active Pulmonary Tuberculosis
49
 Infected; with signs and symptoms

oInactive Pulmonary Tuberculosis
 Infective; without signs and symptoms; with medication
3. According to American Pulmonary Society
TB0
 Negative ( - ) to TB exposure
 Negative ( - ) to TB infection
 Negative ( - ) to TB testing
 Newborns are under this classification
 They are given preventive management in the form of BCG vaccine immediately
after birth
TB1
 Positive ( + ) to TB exposure
 Negative ( - ) to TB infection
 Negative ( - ) to TB testing
 Medical and other healthcare workers are under this classification
 They are given preventive management in the form of Personal Protective
Equipment (PPEs); and increased body resistance through vitamins, adequate
rest and adequate hand washing
TB2
 Positive ( + ) to TB infection
 Positive ( + ) to TB testing
 Negative ( - ) to TB symptoms
 Inactive PTB patients and carriers are under this category
 They are given prophylactic management so that they would not exhibit signs
and symptoms
 Start on Anti-Tuberculosis drugs
o INH
o Isoniazid
 The most effective TB drug
 Side Effect
 Peripheral Neuritis
 Give Vitamin B6 or pyridoxine to counteract INH side effect
 Increase Vitamin B6 by intake of:
o Beans
 Mongo
 Red beans
 White beans
 Black beans
o Prophylaxis is given for six (6) months
 For children
o Prophylaxis is given for nine (9) months
 For Immunocompromised patients
o Prophylaxis is given for twelve (12) months
TB3
 Positive ( + ) to TB infection
 Positive ( + ) to TB testing
 Positive ( + ) to TB symptoms
 Active PTB patients are under this classification
 They are given curative management
 Combination of Anti-Tuberculosis drugs to prevent drug resistance
 Short-Course Chemotherapy
o Composed of RIP(E)
 Rifampicin
 Isoniazid
 Pyrazinamide
 Ethambutol
50
 May or may not be given

 Standard Regimen
o Composed of SI(E)
 Streptomycin
 Isoniazid
 Ethambutol
 May or may not be given
 Short-Course Chemotherapy Side Effects
 Causes hepatotoxicity
 Nursing Management
o Therefore, monitor liver enzyme tests
 Advise patient to avoid alcoholic beverages, which increase hepatotoxic effects
Key Concept!
Rifampicin
 Side effects are:
o Orange urine
o Orange tears
o Orange secretions and excretions
o Orange saliva
o Orange sputum
o Orange feces
o Inform the patient that this normally happens
o Therefore, remove soft contact lenses
 These may be permanently stained with orange color
o Advise the patient to use eyeglasses instead
Isoniazid
 Side effect is peripheral neuritis
o Give Vitamin B6 or pyridoxine
Pyrazinamide
PZA
 Side effect is hyperuricemia
 Patient is predisposed to stone formation
 Therefore, make urine alkaline
o To alkalinize the urine
o Increase fluid intake
o Increase intake of vegetables
Ethambutol
 Side effect is Optic Neuritis
o Causes color blindness or inability to distinguish red from green
o IMMEDIATELY STOP the medication because this side effect is
IRREVERSIBLE
Standard Regimen
 Streptomycin
o No hepatotoxicity
o But causes RENAL TOXICITY
o Nursing Management
o Monitor the following:
 Creatinine levels
 Blood Urea Nitrogen (BUN) levels
 Monitor Intake and Output
o Also causes OTOTOXICITY
51
o Nursing Management
o Assess patient for tinnitus or ringing of the ears
o Assess patient for vertigo, which is another sign indicative of ototoxicity
Key Concept!
 The American Pulmonary Society classification is the best classification!!!
Diagnostic Examinations for Tuberculosis
1. Tubercullin Testing
 This is only a screening test for Tuberculosis
 If result is positive ( + ), it does not mean that the person is infected but the
person may have an exposure
 If result is CONSISTENTLY POSITIVE, it means that the patient is sensitive to the
organism
 Important Concepts!!!
o This test uses Purified Protein Derivative or PPD
o PPD is administered intradermally
o Tubercullin testing is interpreted after forty-eight (48) to seventy-two (72)
hours
o A positive result would give you an induration of greater than ten (10) mm.
o If patient is positive for HIV, a positive result would give the patient an
induration of greater than five (5) mm
Three (3) Ways of Performing Tubercullin Testing
1.1) Mantoux Test
 Just like a skin test
 Utilizes the same technique as a skin test
 Uses PPD
 Interpreted after forty-eight (48) to seventy-two (72) hours
 Positive result is bigger wheal induration
1.2) Tine Test or Multi-puncture Test
 Soak sterile needle in PPD for three (3) to four (4) hours
 Get arm
 Puncture for six (6) to eight (8) times in a circular manner
 This is commercially prepared
 This utilizes a special syringe with four (4) small needles for one simultaneous
application
1.3) Vollmer and Pirquet Test
 Skin scratch or skin patch test
 Get sterile needle
 Get gauze containing PPD
 Apply this gauze over the scratch or tape this gauze over the scratch
 Keep gauze on for seventy-two (72) to ninety-six (96) hours
 Remove after three (3) to four (4) days
 Results cannot be interpreted yet
 Wait for another forty-eight (48) to seventy-two (72) hours
 Therefore, results could be obtained after five (5) to seven (7) days!!!
Important Concept!
 Mantoux Test is the best type of test!!!
o Easier to perform
o Less pain to patient
o Most accurate results
2. Sputum Examination
 This is the CONFIRMATORY TEST for Tuberculosis
 Done in the morning upon rising before oral care
 Collection of Sputum
o Do deep breathing exercises for three (3) times
o Open mouth widely
o Put tongue at the back of the lower teeth
o As the back of tongue curves upon spitting, phlegm goes out
52
 Key Concept!!!
o Continuous receipt of anti-Tuberculosis drugs for two (2) weeks will give
the patient a negative ( - ) result
o Therefore, patient is no longer communicable
3. Chest X-Ray
 Shows extent of lung involvement
 Does not reveal causative agent
 Not a confirmatory examination
Medical Management for Tuberculosis

 Short-Course Chemotherapy
 Standard Regimen
Nursing Care for Pulmonary Tuberculosis
 Diet
 Drugs
o Most important
 Rest
Important Concept!
 Do not perform Chest Physiotherapy on PTB patient
 This can stimulate or aggravate the following:
o Hemoptysis
o Frank Bleeding
Key Concept!
 An attack of PTB only gives temporary immunity
Preventive Measures
1. Immunization
 Bacillus Calmette Guerin (BCG) vaccine
o Two
 When Given:
o 1st Dose – At Birth
o 2nd Dose – Upon school entrance
 Dosage of First Dose
o 0.05 cc
 Route of First Dose
o Intradermal
 Site of First Dose
o Right deltoid muscle
o Do not massage site of injection
o Rationale:
 It will spill the drug
o Child may experience fever
o Give paracetamol
o On site of injection, there will be an abscess formation, which will develop
into a scar within two (2) to three (3) months
o If after three (3) months, abscess is still present, this is called an
INDOLENT ABSCESS caused by:
 Wrong technique
 Given subcutaneously instead of intradermally
 Child’s exposure to a person with TB (i.e. mother who is
asymptomatic)
o Bring the child to the health center or clinic for INCISION DRAINAGE
o Then give prophylactic INH for nine (9) months
Additional Concepts!!!
At school entrance
53
 Give booster dose of BCG

 When given:
o About six (6) to seven (7) years old
 Dosage of Booster Dose
o 0.01 cc
 Route of Booster Dose:
o Intradermal
 Site of Booster Dose
o Left Deltoid muscle
o No abscess formation on site of booster dose
o Site depends on preference of the mother in a private setting
Preventive Measures (continued)
3. Cover nose and mouth when sneezing or coughing
4. Proper pasteurization of milk
PNEUMONIA
 Inflammation of the lung parenchyma
 Caused by several organisms
Causative Agents:
 Virus
o Cytomegalovirus
 Common opportunistic infection in AIDS
 Protozoa
o Pneumocystis carinii Pneumonia
 Also a common opportunistic infection in AIDS
 Bacteria
o Most common cause
o Can be caused by primary infection
o Can be secondary to previous infection:
 A complication
 A debilitating disease
 Droplet
Manifestations of Pneumonia
Five (5) Cardinal Signs of Pneumonia
 1. Fever
 2. Shaking Chills
 3. Sputum Production
o Rusty sputum
o Depends on causative agent
o If sputum is creamy yellow
 Causative agent is Staphylococcus
o If sputum is currant jelly
 Causative agent is Klebsiella
o If sputum is clear
 There is no infection
 This may also be brought about by ASPIRATION PNEUMONIA
o Lipid Pneumonia
 Occurs when oil is used in cleaning the nose
 Oil is not absorbed by the lungs
 Therefore, do not use oil-based lubricants in nasogastric tubes.
 4, Productive Cough
 5. Presence of Chest Pain or Pleuritic Pain
o Aggravated when coughing
o Use of chest binder is encouraged
Presence of fast breathing is common in Pneumonia
In Children:
54
 If two (2) weeks to two (2) months old (1 month and 29 days)
o Cut off is sixty (60) breaths per minute
o If respiratory rate is 61 breaths per minute and above, this is indicative of
Pneumonia
 If two (2) months to twelve (12) months
o Cut off is fifty (50) breaths per minute
Pneumonia
 If twelve (12) months to five (5) years
o Cut off is forty (40) breaths per minute
Pneumonia
 Therefore, if there is fast breathing, automatically, it is Pneumonia
 Home management involves antibiotic therapy
Important Concept!
 Check for the presence of the following:
o Chest Indrawing
o Stridor
 Harsh breath sound heard during inspiration
 To check, place ear on nose or mouth of patient
o Cough
 If these three signs are present, then there is SEVERE PNEUMONIA
Diagnostic Tests for Pneumonia
1. Chest X-ray
 Expect infiltrations
 Lung consolidation
 This is the confirmatory examination
2. Sputum Examination
 Purpose is to know what microorganism brought pneumonia
3. Auscultation
 For crackles
 For ronchi
o Decreased vocal fremitus
 ‘Ninety-nine’ verbalized
o Decreased breath sounds
4. Percussion
 Dullness upon percussion
Medical Management
 Depends on causative agent
 If viral
o Symptomatic management
 If protozoal (PCP)
o Drug of choice is Pentamidine
 If bacterial
o Administer anti-biotics
o In the hospital setting, drug of choice is Penicillin
o In the community setting, drug of choice is Cotrimoxazole (administered
T.I.D.)
Nursing Care for Pneumonia Patients

 Priority
o Ineffective airway clearance
 Management
o Maintain patent airway
o Adequate rest
o Adequate nutrition
Preventive Measures
1. Immunization
55
 Pneumovax
 For prevention of secondary pneumonia
 Given to adults
 Given to the elderly with Community-Acquired Pneumonia (CAP)
2. Proper disposal of nasopharyngeal secretions
3. Cover the nose and mouth while coughing or sneezing
COMMUNICABLE DISEASES OF THE GASTROINTESTINAL TRACT
Bacterial
 Gastroenteritis
 Inflammation of the gastric mucosa and the mucosa of the intestines
Key Concepts!
 Main Sign and Symptom of Gastroenteritis is diarrhea
 Diarrhea is a general term caused by various microorganisms
Causative Agents:
 Salmonella typhosa
o For typhoid fever
 Salmonella Newport
o For food poisoning or salmonellosis
 Staphylococcus enterococcus
o For staphylococcal food poisoning
 Clostridium botulinum
o For botulism
 Shigella dysenterieae
o For shigellosis
o For bloody flax
o For bacillary dysentery
 Vibrio coma or Vibrio cholera
o Coma-shaped
o Cholera or El tor
o Give rise to violent dysentery due to violent diarrhea (which occurs
continuously)
 Fecal – Oral route
Source of Infection
 Food
 Water
If food poisoning:
 Salmonellosis
o Foods rich in protein
 Meat products
 Poultry
 Eggs
 Cheese
 Milk
o Incubation Period
 Six (6) to eight (8) hours
o Then you manifest the symptoms
 Staphylococcal
o Carbohydrate-rich foods
 Cereals
 Rice
 Pastries
 Bread
 Cakes
 Pasta
 Noodles
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oIncubation Period
 Two (2) to six (6) hours
o Then you manifest the symptoms
 Botulism
o Caused by canned or preserved foods
o Incubation Period
 Eight (8) to twenty-four (24) hours
o General manifestation is diarrhea
o Borborygmi is present
 Gurgling sound on the abdomen
 Typhoid Fever
o Three (3) Clinical Features
o 1. Rose spots
 This is the PATHOGNOMONIC SIGN for typhoid fever
o 2. Ladder-like fever
o 3. Splenomegaly
 Dysentery
o Characteristics of Stool
o If Bacillary Dysentery
 Mucoid Stool
 Which could become blood streaked if severe
 Microorganism’s endotoxin destroys the intestinal wall
o If Cholera
 Rice-watery stool, which is one after the other
 The microorganisms do not destroy the intestinal wall
 They only stimulate peristalsis
 Rapid dehydration occurs
o Manifested by washer woman’s hand
 Decreased skin integrity
 Poor skin turgor
 Very dry
o Patient is placed on a special bed called the WATEN BED – bed with a hole
o Pail is positioned underneath the hole on the bed
o Bed pan is not advised
o Continuous diarrhea makes the bedpan inadequate in containing all the
fecal material
o Vomiting also contributes to dehydration
 Number 1 indicator of dehydration in a patient with diarrhea is LOSS OF
WEIGHT
o This occurs within or before forty-eight (48) hours
 Other manifestations of dehydration, which are seen after forty-eight (48) hours
are:
o Thirst
o Sunken eyes
o Sunken fontanelles
o Poor skin turgor
Diagnostic Tests for Patients with Gastroenteritis
1. Stool Examination
 Most common diagnostic examination
 For Typhoid Fever
o Stool examination is not a good test
o Blood examinations are done
o Blood culture is also done to identify the microorganism
o Done during initial manifestation of the disease
 In the Philippines, the WIDAL TEST is done for Typhoid Fever
57
o The antigen is detected

o Antigen O
 Somatic antigen
 If present, the patient is positive for infection
o Antigen H
 Flagellar antigen
 If present, patient has been previously exposed to typhoid fever or
immunization
 In TYPHIDOT, a blood examination is conducted and an antibody is detected
2. Rectal Swab
 If patient is positive for gastroenteritis
Medical Management for Gastroenteritis
1. Fluid and electrolyte replacement

 Oresol
 I.V. fluid
 Gatorade
2. Antibiotics
 In typhoid fever, the drug of choice is CHLORAMPHENICOL
o This drug gives rise to bone marrow depression, which leads to anemia
and even leukemia
 In dysentery, particularly bacillary dysentery, the drug of choice is
COTRIMOXAZOLE
 In cholera, the drug of choice is TETRACYCLINE
Important Concepts on the Administration of Tetracycline
 Tetracycline should not be given with the following:
o Milk or calcium-rich foods
o Antacids
o Iron-preparation medication
 For better Tetracycline absorption
o Give Tetracycline with one full glass of water
 This drug should not be given to children below eight (8) years of age because it
causes staining of teeth
 This drug is not given to pregnant women
o It is TERATOGENIC to bone growth of the fetus because it binds to
calcium
 Once Tetracycline is expired, discard it because it will increase the toxic effect of
the drug
 It must be kept away from sunlight
 It must be placed in an amber bottle
 Sunlight destroys component of tetracycline
Important Concept!
 Gastroenteritis attack does not give permanent immunity
Preventive Management
1. Immunization
 CDT immunization
 Given only free during epidemic
 Provides six (6) months immunity
2. Avoid the five (5) Fs

 Usual source of infection are the Five (5) Fs:
 Feces
o Proper excreta disposal
 Food
o Proper food preparation
o Proper food handling
o Proper food storage
o Avoid eating in unsanitary places
58
 Fingers
o Hand washing
 Flies
o Eradicate
o Environmental Sanitation
o Insecticide
o Screening
 Fomites
o Do not put anything into your mouth
o Most common is the ball pen
LEPTOSPIROSIS
 Also called
o Mud Fever
o Swamp Fever
o Canicola Fever
o Pre-tibia
o Weil’s Disease
o Swine Herd’s Disease
o Ictero-hemorrhagic disease
 A disease of a low form of animal found in the farm
RATS
▼▼▼
Source of Infection
Excreta of Rats
Urine of Rats
▼▼▼
Causative Agent (Spirochetes)
Leptospira canicola
Leptospira interrogans
(most common in the Philippines – infects rats)
Leptospira hemorragica
 Skin penetration
Important Concept!
 No need to have a break in the skin or to have a wound to have leptospirosis
Individuals who are High-Risk for Leptospirosis:

 Sewage Workers
o Those working in drainage systems
 Farmers
 Miners
 Slaughterhouse workers (pigs, cattle are sources of infection)
 Manilenos
o Due to flooding
 Incidence of leptospirosis increases during the rainy season
Key Concepts!
 When the microorganism enters, it travels along the bloodstream
 It affects other organs
o Striated Muscles
o Liver
o Kidneys
 Spirochetes have a special affinity here
 They destroy the nephrons
o Most common complication of Leptospirosis, which brings about death is
Kidney Failure
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Manifestations of Leptospirosis
 Fever with chills
 Presence of intense itchiness of the conjunctiva
 Abdominal Pain
 Nausea and Vomiting
 Muscle tenderness and pain on the calf muscle (gastrocnemius)
o Therefore, the patient does not like to walk or stand
 For ictero-hemorrhagic type of leptospirosis:
o Jaundice
o Hemorrhages on skin and mucous membrane
Important Concept!
 Pathognomonic sign of leptospirosis are the orange eyes or orange sclera of the
eyes
Important Concept!
 If the kidney is affected, there would be signs and symptoms of kidney failure:
o Decreased urine output
o Leading to anuria
Diagnostic Tests for Leptospirosis

 Blood Examinations
o Leptospira Agglutination Test (LAT)
o Leptospira Antigen-Antibody Test (LAAT)
o Microscopic Agglutination Test (MAT)
 Reveals the microorganism
Medical Management of Leptospirosis
Anti-biotics
 Drug of Choice is TETRACYCLINE
 If patient does not tolerate Tetracycline, give Penicillin instead
Important Concepts on Penicillin

If given per orem:
 Give one (1) hour before meals or two (2) hours after meals
o It binds with food and becomes digested
o When this happens, it will be metabolized and would have no effect
o Therefore, it is best to give Penicillin on an empty stomach
 Do not give with fruit juices or citrus juices
o These juices destroy the component of Penicillin
o Therefore, give with a full glass of water!!!
Nursing Management for Leptospirosis

 Symptomatic and supportive
 Monitor urine output due to possible kidney failure
 Immediately refer to doctor for any signs and symptoms of kidney failure
Preventive Measures
 Eradicate rats by environmental sanitation
o Use of rat poison
 Avoid walking through flooded areas
o Wash with soap and running water after walking in floods
MUMPS
 Infectious parotitis
Causative Agent
 Paramyxovirus
o Found on the saliva of the infected individual
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 Droplet
Manifestations of Mumps
 High-grade fever
 Earache
o Ear pain
 Pain upon mastication or chewing
 Swelling of the parotid glands
Diagnostic Tests for Mumps
 Clinical Observation
Medical Management for Mumps
 Symptomatic as the causative organism is viral
 Recovery depends on nursing care provided
Nursing Care for Mumps Patients
1. Provide Complete Bed Rest (CBR) until swelling subsides

 Rationale:
o To prevent glandular complications:
o In Females:
 Oophoresis or inflammation of the ovaries
o In Males:
 Orchitis or inflammation of the testes
2. For males, wear well-fitted supporters to prevent pulling of gravity on the
testes and blood vessels.
 Rationale:
o This predisposes the patient to orchitis and atrophy leading to sterility
Important Concepts!
 Glandular complications are manifested only by:
o Adolescents
o Adults
 In people twelve (12) years old and above, there is complete descent of the testes
into the scrotal sac
 Therefore, there is greater pull of gravity on the patient
 Glandular complications are absent among Children
 If orchitis is positive, its location depends on the location of the mumps
o If mumps is on the right side, orchitis is also on the right side
o If mumps is on the left side, orchitis is also on the left side
o If mumps is bilateral, orchitis is also bilateral
3. Provide adequate nutrition
 Provide the following types of diet:
o Soft diet
 Because there is pain upon chewing
o Bland diet
 Sour and spicy foods are irritating
 They increase salivation and increase pain
 Thus, kalamansi is contraindicated for mumps patients
o Apple juice and water are allowed in mumps patients
4. Apply ice cap or ice cooler to relieve pain

 Cold application deadens the nerve endings temporarily
 This results to numbness
Important Concept!
 Aniel (composed of vinegar and dye) has a cold effect that decreases pain
 This is colored blue so that the person with mumps could be easily identified
while he is still far away
Key Concept!
 Mumps attack gives permanent immunity
 When is the person with Mumps communicable?
o He is communicable until swelling subsides
o Highly-contagious two (2) days after onset of swelling
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Preventive Measures
 Immunization
o MMR vaccine
 Proper disposal of salivary secretions
 Cover nose and mouth while coughing and sneezing
COMMUNICABLE DISEASES OF THE GASTROINTESTINAL TRACT AND ITS
ACCESSORY ORGANS
HEPATITIS
 Inflammation of the liver
 Brought about by several causes:
o Alcoholism
o Drug intoxication
 Hepatotoxic Drugs
 Anti-Tuberculosis drugs
 Tylenol
 Acetaminophen
o Chemical Intoxication
 Arsenic
o Microorganisms
 Viral
 Communicable microorganisms
Important Concept!
Current Number of Viruses causing Hepatitis
 Capable of Infecting Humans
o Hepatitis A virus
o Hepatitis B virus
o Hepatitis C virus
o Hepatitis D virus
o Hepatitis E virus
o Hepatitis G virus
 Non-pathogenic in Man
o Hepatitis H
HEPATITIS A
 Also called:
o Infectious Hepatitis
o Catarrhal Jaundice Hepatitis
o Epidemic hepatitis
 Incidence is in epidemic proportions
Causative Agent
 Hepatitis A virus
o RNA-containing virus
Important Concepts!
 In Hepatitis A infected individuals:
o The feces
 Harbors the microorganism in abundant amounts
o The blood
 Harbors the microorganism in minimal amounts
 Fecal – Oral Transmission
 Rarely percutaneous or by blood transmission
Individuals AT RISK for Hepatitis A:
 Those living in unsanitary conditions
 Those who practice anal – oral sex
Incubation Period:
 Two (2) to six (6) weeks
HEPATITIS B
 Also called:
o Serum Hepatitis
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o Homologous Hepatitis
o Viral Hepatitis
 The most fatal form of hepatitis
 The most fulminant form of hepatitis
Causative Agent
 Hepatitis B virus
o DNA-containing virus
Important Concept!
 In Hepatitis B infected individuals
o The Blood
 Harbors the microorganism
o Other body fluids
 Tears
 Saliva
 Sweat
 Cerebrospinal Fluid
 Milk
 Urine
 Semen
o In fact, all fluids
 Harbor the microorganism
 Percutaneous
o Use of contaminated sharps and needles
o Blood Transfusion
 Oral to oral Transmission
o In saliva
 Sexual Transmission
o Seminal fluid
o Cervical fluid
 Vertical Transmission
 Swallowing of amniotic fluid by the baby
Individuals AT RISK for Hepatitis B:
 Healthcare workers
o All who are in contact with body fluids of patients
 Blood recipients
 Hemodialyzing patients
 Drug addicts
 Promiscuous individuals with multiple sex partners
Incubation Period
 Six (6) weeks to six (6) months
HEPATITIS C
 Also called:
o Post-transfusion Hepatitis
 Rationale:
o Because people who develop this are those who have undergone blood
transfusion
Causative Agent
 Hepatitis C virus
Important Concept!
 In Hepatitis C infected individuals
 Blood
 Harbors the microorganism
 Percutaneous
Individuals AT RISK for Hepatitis C:
63
 Drug addicts
 Blood Recipients
Incubation Period
 Five (5) to twelve (12) weeks
HEPATITIS D
 Also called
 Dormant Type of Hepatitis B
Important Concepts!
 A person must have Hepatitis B before he could be infected with Hepatitis D
 Hepatitis D cannot multiply by itself
 It cannot bring about infection
 If Hepatitis B is present in the body, Delta virus activates Hepatitis B virus to
help the Delta virus multiply
Causative Agent
 Hepatitis D virus
 Delta virus
Important Concept!
 In Hepatitis D infected individuals
o Blood
o Other body fluids
 Tears
 Saliva
 Sweat
 Cerebrospinal Fluid
 Milk
 Urine
 Semen
o In fact, all fluids
 Harbor the microorganism
 Percutaneous
o Use of contaminated sharps and needles
o Blood Transfusion
 Oral to oral Transmission
o In saliva
 Sexual Transmission
o Seminal fluid
o Cervical fluid
 Vertical Transmission
 Swallowing of amniotic fluid by the baby
Individuals AT RISK for Hepatitis D:
o All who are in contact with body fluids of patients
 Blood recipients
 Drug addicts
 Promiscuous individuals with multiple sex partners
Incubation Period
 Three (3) weeks to twelve (12) weeks
HEPATITIS E
 Also called
o Enteric Hepatitis
Causative Agent
 Hepatitis E virus
Important Concept!
 In individuals with Hepatitis E
o The Feces
64

 Fecal – Oral route
Individuals AT RISK for Hepatitis E:
 Those living in unsanitary conditions
 Those who practice anal – oral sex
Incubation Period:
 Two (2) to six (6) weeks
HEPATITIS G
 No synonyms
Causative Agent
 Hepatitis G virus
Important Concept!
 In individuals with Hepatitis G
o The Blood
 Percutaneous
Individuals AT RISK for Hepatitis G:

 Drug addicts
 Blood Recipients
Incubation Period
 Unknown
Similar Types or Partner Types
 Hepatitis A and Hepatitis E
 Hepatitis B and Hepatitis D
 Hepatitis C and Hepatitis G
Manifestations of Hepatitis
Three (3) Stages
1st Stage – Pre-Icteric Stage

This occurs before jaundice arises
The patient experiences:
 1. Fever
o Due to infection
 2. Right Upper Quadrant pain
o Due to inflammation and infiltration of the liver
 3. Fatigability
 4. Weight Loss
 5. Body Malaise
o The three (3) manifestations above are due to the inability of the liver to
convert glucose to glycogen
o Body compensates by breaking down protein
o End-product of protein breakdown would be amino acids
o Amino acids are normally deaminated by the liver so that they could be
eliminated
 6. Anorexia
 7. Nausea
 8. Vomiting
o Above three (3) manifestations are due to inability of the liver to deaminase
proteins
 Anemia
 Paleness
 Pallor
65
The above three (3) manifestations are due to decreased life span of Red
o
Blood Cells (RBC)
o Normal live span of RBCs is one hundred twenty (120) days
o In hepatitis patients, RBCs live for less than one hundred twenty (120)
days
 End-product of RBC breakdown is bilirubin
o Accumulation of bilirubin into the system leads to the 2 nd Stage – Icteric
Stage
2nd Stage – Icteric Stage

Patient exhibits:
 Jaundice
o Due to inability of the liver to eliminate normal amounts of bilirubin
o Body compensates by eliminating bilirubin through sweat
 Pruritus
o Due to accumulation of bile salts in the skin
 Tea-colored Urine or Brown-colored Urine
o Due to excess bilirubin thrown out by the kidney in the urine
 Acholic Stool or Clay-colored Stool
o Due to absence of bilirubin (conjugated bilirubin) that normally goes to the
duodenum to color the stool
 Hepatomegaly
o Enlargement of the liver
o Due to an overworked liver
o Viral infections are self-limiting
 If no complication arises, this would lead to the 3 rd Stage – Post-Icteric Stage
3rd Stage – Post-Icteric Stage

 Jaundice disappears
 Signs and symptoms subside
 Energy level increases
 Patient is on the road to recovery
o It takes three (3) to four (4) months for the liver to regenerate or recover
o Physician usually advices rest for complete liver recovery or regeneration
 Most important Health Teaching:
o Avoid alcohol for a period of one (1) year
o Avoid over the counter drugs (OTCs) that are hepatotoxic for one (1) year
o Consult physician prior to use of over the counter drugs.
Diagnostic Tests for Hepatitis
1. Liver Enzyme Tests

 Tests for extent of liver damage
1.1) ALT
 Alanine Aminotransferase
 Formerly SGPT
 Serum Glutamic-Pyruvic Transaminase
 If increased, there is a liver problem
 First enzyme to increase in the presence of a liver problem
1.2) AST
 Aspartate Transaminase
 Formerly SGOT
 Serum Glutamic-Oxaloacetic Transaminase
 Increases only upon the onset of jaundice
1.3) ALP
 Alkaline Phosphatase
 Increase indicates:
66
o Obstructive Jaundice
o Obstructive Hepatitis
o Obstruction in the Biliary Tract
1.4) GGT
 Gamma Glutamyl Transferase
 When increased
o Patient is experiencing TOXIC HEPATITIS
 Due to toxic substances
 Alcohol
 Hepatotoxic agents
1.5) LDH
 Lactate Dehydrogenase
 When identified, it indicates liver organ damage
2. Serum Antigen-Antibody Test for Hepatitis

2.1) For Hepatitis A
 HAsAg
 Hepatitis A Surface Antigen
 Anti-HAV
 Presence of IgG
 Presence of IgM
2.2) For Hepatitis B
 HBsAg
 Hepatitis B Surface Antigen
 Anti-HBs
2.3) For Hepatitis E
 HBeAg
 Protein-independent Antigen
 Anti-HBe
2.4) For Hepatitis C
 HCsAg
 Hepatitis C Surface Antigen
 Anti-HCs
Medical Management of Hepatitis
 No specific treatment
 Treatment is symptomatic as causative agent is a virus
Most Common Drugs used in Hepatitis:

 Essentiale
 Jetipar
 Silymarine
o The above three (3) drugs are:
 Hepatic protectors
 Composed of multivitamins, phospholipids and nutrients needed by
the body so that the liver would not be overworked and be relaxed,
and thus, recover
Latest Trend in Pharmacological Management of Hepatitis

Utilizes a combination of:
 1) Lamivudine
o Anti-viral drug
o Dosage:
 Once daily for one year
o Action:
 Inhibits multiplication of the virus
o Cost:
 Approximately Php200 / tablet
 2) BRM
o Biologic Response Modifiers
o An immunomodulating drug
67
oInterferons
 Injectable form of BRM
 Normal substance produced by the body when virus enters the
human cell
o Dosage:
 Two (2) to three (3) times a week for six (6) months
o Action:
 Kills the virus
o Cost:
 Approximately Php85,000!!!
Nursing Care for Hepatitis
Two (2) Important Aspects
1. Provide Complete Bed Rest (CBR)

 To promote liver regeneration and recovery
 When rested, there is decreased metabolism
 Less metabolism leads to decreased liver load
 Liver relaxes and liver recovers
2. Diet
 Low fat diet
o Because there is not enough bile released or produced by the liver
 Increased Carbohydrate Intake
o To spare protein metabolism
o To decrease amino acids
o Accumulation of protein breakdown products like ammonia would lead to
hepatic encephalopathy
 Butterball Diet
o Produces energy
o These are hard candies
o Chocolates are contraindicated
 They contain fat
 Protein Intake
o Depends on the situation
o If the patient is infected
 Provide moderate protein intake
o If the patient is in the recovery stage
 Provide increased protein intake
o If complications arise
 Provide decreased protein intake
Key Concept!
 The most fatal form of hepatitis is HEPATITIS B!
 Even if patient recovers, after twenty (20) or thirty (30) years, the patient would
develop cancer of the liver or cirrhosis of the liver
Preventive Measures for Hepatitis
1. Immunization
 Hepatitis B vaccine
o Three (3)
 Interval between doses:
o Four (4) weeks
 When given:
o 1st Dose – Six (6) weeks from birth
o 2nd Dose – Ten (10) weeks from birth
o 3rd Dose – Fourteen (14) weeks from birth
 Dosage:
o 0.5 cc
 Route:
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o Intramuscular
 Site:
o Vastus lateralis
o Inform the mother that there would be pain and soreness on the injection
site
o A slight elevation on liver enzyme tests is a NORMAL REACTION to the
vaccine
2. Avoid the different modes of transmission
 For Hepatitis B, C, and D
o Blood-borne diseases
 There is a Needle-exchange Program in the United States and in Australia
o Every 6:00 PM a healthcare worker is given a knapsack with needles and
sharps
o He then proceed to areas of distribution – alleys
o Exchanges new syringes with old syringes used by drug addicts.
COMMUNICABLE DISEASES OF THE GENITOURINARY SYSTEM – SEXUALLY

TRANSMITTED DISEASES
Bacterial
 Gonorrhea
 Syphilis
Viral
 HIV Infection
 AIDS
GONORRHEA
 Also called
 Clap
 Microorganism resembles hands clapping together
 Strain
 Gleet
 Jack
 GC
 Morning Drop
Causative Agent
 Neisseria gonorrhea
 Sexual contact
 Important Concepts!
o Most of the time, MALES are infected
 Urethra are affected leading to urethritis
 Females can also be infected
o Cervix is affected
o Signs and symptoms develop at a later stage
Manifestations of Gonorrhea
In males:
 Burning pain, burning sensation upon urination
o Due to redness and edema of urinary meatus brought about by acidic
urine
 Prostatitis
o Abscess formation on the prostate gland
 Purulent Discharges
o Mostly abundant in the morning
 If gonorrhea is persistent, a scar develops on the EPIDIDYMIS
o Scar obstructs the flow of the sperm cells
 Sterility
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o Due to obstruction of sperm cell flow
In females:
 Burning sensation upon urination if urinary meatus is involved
o Urinary meatus is seldom involved in gonorrhea.
o Cervix is usually the one that is affected
 Presence or absence of purulent discharges
o If there is no burning pain and no purulent discharge, the patient may not
know that she is infected
o Presence of abscess formation on the Bartholin’s Gland or the Skeene’s
Gland
o When this abscess goes up, it gives rise to ENDOCERVICITIS or
ENDOMETRITIS
 Hypogastric Pain
o Due to presence of endocervicitis or endometritis
o Either of Endocervicitis or Endometritis could give rise to Pelvic
Inflammatory Disease
o Pelvic Inflammatory Disease
 A systemic disease characterized by:
 Fever
 Severe abdominal pain
 Nausea and Vomiting
 This is secondary to gonococcal infections
 Sterility and Ectopic Pregnancy
o If gonorrhea persists, it causes a narrowing of the Fallopian Tube
 Gonococcal Septicemia
o Occurs when gonorrhea is already systemic
o Signs and symptoms would include:
 Presence of Gonococcal Rashes
 Papular
 Elevated Rashes
 Pustular
 With pus
 May be necrotic gonococcal rashes
 Polyarthritis develops
 Tenosynovitis
o Tendons and synovium are affected
o Effect of disease to child of mother with gonorrhea:
 Opthalmic neonatorum
o Management:
 Give CREEDE’S PROPHYLAXIS to prevent blindness in the newborn
Diagnostic Tests for Gonorrhea
1. Culture and Sensitivity

 Collect urethral discharges
 Done by scraping mucosa of the urethra
2. Papanicolau’s Smear or Vaginal Smear
 For females
Medical Management of Gonorrhea
1. Anti-biotics
 Drug of Choice
o Penicillin
o Benzathine Pen G (Penadur)
o Given also to Rheumatic Heart Disease patients
70
Penicillin G is NEVER GIVEN PER I.V.

o
For I.M. use only
o
Rationale:
o
 If given per I.V., it will KILL THE PATIENT!!!!
 It is oil based
 It forms into an EMBOLUS that would kill the patient
o When given per I.M.
 Use big gauge needle
 Gauge 16 – 18
 This drug easily coagulates
 This drug easily clots
 Therefore, administer this drug QUICKLY
 Dilute with one (1) cc of LIDOCAINE
 One cubic centiliter (1cc) of Lidocaine plus four (4) cubic centiliters
of Plain Normal Saline Solution is used to provide less pain
o Rationale:
 Due to the incorporation of an anesthetic in the form of Lidocaine
 Key Concept!
o If the patient is
 Pregnant
 Sensitive to Penicillin
o Administer SPECTINOMYCIN instead!!!
 Key Concept!
o If patient with gonorrhea has chlamydial infection or vice versa (Gonorrhea
and Chlamydia are TWIN SISTERS)
 Do not give Penicillin
 Do not give Spectinomycin
o Administer DOXYCYCLINE instead!!!
Nursing Care for Patients with Gonorrhea

 Gonorrhea patients are not confined
 They are treated on an outpatient basis
1. Psychological Aspect of Care

 STD patients have low self-esteem
2. Health Education and Patient Teaching

 To prevent recurrence of infection
Preventive Measures
 Safe Sex
 According to the Center for Disease Control, “safe sex” means:
o No sex
o Mutual monogamous relationship
o Mutual masturbation without direct contact
 Holding of body parts but no sex
o Condom is not an example of safe sex
o Condom use is not 100% guaranteed in preventing infection
o Best way to prevent spread of infection is through BEHAVIOR
MODIFICATION
o Also called LOW-RISK Behavior
SYPHILIS
 Also called:
o Pox
o Lues
o Sy
o Bad Blood Disease
Causative Agent
 Treponema pallidum
71
 Sexual Contact
 May be transmitted vertically
o May pass placental barrier after sixteenth (16th) week of pregnancy
 Rarely transmitted thorough Blood Transfusion
Manifestations of Syphilis
Three (3) Stages
Primary Stage of Syphilis
Patient exhibits:
 Chancre
o Characteristic lesion
o Painless popular lesions that heal spontaneously without treatment
o Found on the:
 Genitals
 Face
 Lips
 Tongue
 Under the breasts
 On fingers
o If without treatment, chancre disappears, it will signal the start of the
Secondary Stage
Secondary Stage of Syphilis
Patient exhibits:
 Flu-like symptoms
o Sore throat
o Headache
o Fever
 Several forms of dermatitis
o Rashes (Kulugo)
 All over the body
o Presence of dry, hard wart-like lesions
 Condylomalata
o Infectious lesions that are fused together
o Found under the breast and on the genitals
o Highly infectious lesions
 Key Concept!
o Secondary Stage is highly infectious
o Also called Infectious Stage
 Changes in hair growth
o Patchy Alopecia all over
o Patient has MOTH-EATEN APPEARANCE
 Affects growth of pubic hair
o Thinning of pubic hair
o Management:
 Patient uses aloe vera
 Patient uses Mane and Tail
 Key Concept!!!
o Before the Tertiary Stage of Syphilis occurs, the patient becomes
ASYMPTOMATIC
o This may be called the LATENT PHASE
 A transition period of one (1) to two (2) years.
Tertiary Stage of Syphilis
Patient exhibits:
 Gummatous Lesions or Gumma
o Characteristic lesion
o Lesions that are found on deeper tissues and organs of the body
o Some are in the form of infiltrating tumors
 Other organs of the body are also affected
72
o Most commonly affected is the HEART

o This gives rise to CARDIOVASCULAR SYPHILIS
 Neurosyphilis
o Central Nervous System affectation
o Neurologic symptoms are present
 Lack of Balance
 Dementia
Diagnostic Tests for Syphilis
1. Culture and Sensitivity

 Done by mucosal scraping
2. Dark Field Microscopy
3. Blood Examination
3.1) FTA-ABS
 Fluorescent Treponema Antibody Absorption Test
o This is the confirmatory test for syphilis
3.2) VDRL
 Venereal Disease Research Laboratory
o This is not a definitive test
3.3) RPR
 Reactive Plasma Reagent
o Non-definitive test for syphilis
Medical Management of Syphilis
1. Anti-biotics
 Drug of Choice
o Penicillin
 If patient is sensitive to Penicillin
o Administer a Cephalosporin instead
o Choice of Cephalosporin
 Ceptriaxone or Rocephin
 Given per I.M. or per I.V.
o Different diluents are used:
o When given I.V.
 Diluent used is Sterile Water
o When given I.M.
 Diluent used is Xylocaine
o Do NOT INTERCHANGE diluents!
o If I.M. preparation is given via I.V.
 Patient dies due to dysrhythmias
o If I.V. preparation is given via I.M.
 Viscous medication would give rise to pain upon administration
Nursing Management in Syphilis

 Same as in gonorrhea
Preventive Management of Syphilis
 Same as in gonorrhea
 Effect of syphilis to child whose mother developed syphilis during pregnancy:
o Still Birth (baby dies)
o Syphilitic Baby
 Placenta is bigger than the baby
 Baby resembles the appearance of an old man
 Baby has linear scars at angles of the mouth
 Baby has persistent vesicular eruptions or blisters
 Baby has nasal discharges
73
 Mother may NOT give birth to a child with syphilis but may give birth to a child
with LATE SYPHILIS
o Two (2) years after birth, the child will manifest:
 Hutchinson’s Teeth
 Saw-like teeth
 Anterior Bowing of the Tibia
 Fractured Tibia
 Backward Tibial growth
 Saddle nose with high palate
 Deafness
 Persistence of dactylitis
o If child with Late Syphilis is not given prophylaxis upon adolescence
 Child develops neurosyphilis
 Child will eventually die
 Mother may NOT give birth to a child with syphilis
o Child may be born NORMAL
o Child may be ALIVE and NORMAL
o But wait for two (2) years to really declare that child is normal
 If you are pregnant, do not be infected with syphilis
 Do not get infected with syphilis, particularly in the third (3 rd) trimester of
pregnancy.
 The nearer you give birth to a child, the greater is the chance that the child
would develop congenital anomalies
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

 Acquired Immune Deficiency Syndrome (AIDS) is DIFFERENT from HIV Infection
HIV Infection
 Means that you are infected with the virus
 Initial stage of AIDS
AIDS
 Means that you are infected
 You manifest a group of signs and symptoms
 With decreased or weakened immune system
 This is the end-stage of HIV infection
Key Concepts!
 All patients with HIV infection will develop into AIDS
 All AIDS patients have passed through the HIV stage
Causative Agent
Human Immuno-Deficiency Virus
 A Retrovirus
 A very fragile virus
 Can easily be destroyed by:
o Seventy percent (70%) alcohol
o A temperature of fifty-six degrees Celsius (56°C)
o Chlorine
 Therefore, AIDS cannot be acquired through the swimming pool
o By Ordinary House Bleaching Soap with Sodium Hypochlorite
 Zonrox
 Chlorox
 Purex
 Domex
 Proportion of bleaching soap to water is 1:10
o If virus leaves the body of an individual infected with AIDS (i.e. through
the semen), the virus will survive for only four (4) hours
o If it does not penetrate another person, the virus WILL DIE
74
o But if the virus goes out with blood, the VIRUS WILL REMAIN ALIVE, as
long as the BLOOD IS FRESH!!!
o Once a person dies with AIDS, the virus remains in the body of the
individual, as long as, the body is HUMID
o Therefore, the body of an AIDS victim should be cremated within twenty-
four hours after death or sealed in a metal coffin, also within twenty-four
(24) hours from death.
o The body of an AIDS victim COULD NOT BE EMBALMED
 The virus will INFECT THE EMBALMERS
Modes of Transmission
Blood Transfusion per Single Exposure

 Single Blood Transfusion
o Provides 90% chance of infection
Sexual Contact
 Pandemically, the number one mode of transmission
o Single exposure gives 0.1% to 1.0% chance of infection
o However, due to repeated sexual encounters, chance of infection increases
Contaminated Sharps and Needles
 Single exposure gives 0.1% to 0.5% chance of infection
Vertical Transmission
 From the infected mother to the unborn fetus
o Gives 30% chance of infection
 If a child is born to a mother who is HIV positive, the child would ALWAYS have a
POSITIVE RESULT for HIV TESTING
o HIV testing identifies the presence of antibodies in the blood
 Child possesses maternal antibodies
o Therefore, child is positive for HIV but may this may not mean the child is
infected
 Child is given up to eighteen (18) months for HIV testing
o After eighteen (18) months, child must be negative for HIV testing
o If child is still positive for HIV testing after eighteen (18) months, then the
child is REALLY INFECTED!!!
NORMAL IMMUNE RESPONSE
Microorganism
▼▼▼
Detected by the Macrophages
▼▼▼
Macrophages will alert T cells
▼▼▼
Alerted T cells reproduce and multiply
▼▼▼
T cells stimulate the B cells
▼▼▼
B cells reproduce and multiply
▼▼▼
B cells release the antibody
▼▼▼
Antibody produced attacks the invading microorganism
▼▼▼
Antigen-Antibody reaction occurs
▼▼▼
Manifestation of Disease will be present
Important Concept!
 In HIV Infection, there is an alteration in the NORMAL Immune Response
75
HIV (Retrovirus)
Has special affinity for T cells
▼▼▼
Retrovirus is NOT DETECTED by the Macrophages
▼▼▼
Macrophages will NOT BE ABLE TO ALERT the T cells
▼▼▼
Retrovirus ENTERS the T cell
▼▼▼
Retrovirus releases the enzyme
REVERSE TRANSCRIPTASE
This resembles the genetic make-up of the T cell
▼▼▼
T cell does not destroy the virus
▼▼▼
T cell BECOMES a PRO-VIRUS
▼▼▼
Virus multiplies within the T cell
▼▼▼
T cell is DAMAGED
▼▼▼
Virus will retrovert before leaving the T cell
▼▼▼
Virus leaves T cell
▼▼▼
Virus attacks another T cell
▼▼▼
Net effect: No T cells will be present to stimulate the B cells
▼▼▼
No B cell stimulation
▼▼▼
No antibody production
▼▼▼
No antigen-antibody reaction occurs
▼▼▼
Person is infected but remains asymptomatic
Important Concept!
 In the course of the HIV infection, the macrophages CANNOT IDENTIFY the HIV
 As the body takes more time to develop antibodies to the HIV, the person
BECOMES INFECTED but REMAINS ASYMPTOMATIC
A WELL-WORRIED INDIVIDUAL
▼▼▼
▼▼▼
▼▼▼
Infected with HIV but is ASYMPTOMATIC
▼▼▼
▼▼▼
▼▼▼ After six (6) weeks to six (6)
▼▼▼ months (called the WINDOW
▼▼▼ PERIOD or the time interval
▼▼▼ between the infection of the
▼▼▼ individual to the production of
▼▼▼ the antibodies), where the
▼▼▼ body produces antibodies
▼▼▼
▼▼▼
▼▼▼
▼▼▼
( + ) for HIV infection
76
With AID Related Complex (ARC) Symptoms

▼▼▼
▼▼▼
▼▼▼ Months to years
▼▼▼
▼▼▼
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
▼▼▼
▼▼▼
▼▼▼ Months to years
▼▼▼
▼▼▼
DEATH occurs
Important Concepts!
AIDS Related Complex Symptoms include the following:
 Fever with night sweats without a cause
o All laboratory works are negative
 Enlargement of lymph nodes without a cause
o All laboratory works are negative
 Fatigability
 Weight Loss
 Altered Sleeping Patterns
 Temporary Memory Loss
 Altered Gait
Manifestations of AIDS
 For adults
o Two (2) major symptoms
o One (1) minor symptom
 For Children
o Two (2) minor symptoms
Major Symptoms
 Fever: One (1) month and above in duration and is recurrent
 Diarrhea: One (1) month and above
 Ten percent (10%) weight loss
o Staunted growth in children
Minor Symptoms
 Persistent generalized lymphadenopathy
 Generalized pruritic dermatitis
 Persistent cough: One (1) month and above
 Oropharyngeal Candidiasis
 Recurrent Herpes Zoster
 Progressive Disseminated Herpes Simplex
 Continually multiplying and continually growing mouth sores
Important Concepts!
 False-Negative Result for AIDS
o No antibodies are identified but patient is already infected
o This occurs during the WINDOW PERIOD
 The person who undergoes HIV testing undergoes counseling
o This person should not engage in any of the modes of transmission of
AIDS before the window period ends
 The ACTIVE PARTNER
o Considered the GIVER
o Has less chances of becoming infected
 The PASSIVE PARTNER
o Considered the RECEIVER
o Has greater chances of being infected
77
 AGAIN, DO NOT ENGAGE in any of the modes of transmission of AIDS DURING

the WINDOW PERIOD!!!
 If an adult manifests the following:
o One (1) minor symptom
o Then, that adult is AIDS BONAFIDE
 If a child manifests the following:
o Two (2) minor symptoms
o Then, that child is AIDS BONAFIDE
Key Concepts!
 When a person has AIDS, all microorganisms entering his body gives rise to
infections
 These are called OPPORTUNISTIC INFECTIONS
 In the Philippines, the Number One Opportunistic Infection is TUBERCULOSIS
 Cancers Associated with AIDS
o Caposi Sarcoma
 A malignancy of blood vessel wall or the vascular endothelium
 Manifested through the skin
 With pink or purple, painless spots on the skin
 Gives rise to a “LEOPARD-LOOK”
o Non-Hodgkin’s Disease
 Cancer of the lymph nodes
Diagnostic Tests for AIDS
1. ELISA
 Enzyme-Linked Immunosorbent Assay
o This is only a SCREENING TEST for AIDS
2. PCR Test
 Polymerase Chain Reaction Test
o Likewise, a SCREENING TEST for AIDS
o Relatively expensive
o Costs approximately Php5,000 to Php7,000 per test
o Results are known within two (2) to three (3) hours
Important Concept!
 If a person
o Has been twice positive for ELISA and;
o Has been positive once for PCR
 Then confirm the results by doing the next test…
3. Western Blot
If a person is diagnosed with HIV
 Tests continue
 Monitor the following:
o 3.1) Viral Load
o Monitors replicating activity of the virus
o Negative ( - ) Viral Load
 Means virus is not actively multiplying but is still present
o 3.2) CD4 and T cell Count
o Establishes STAGE OF INFECTION, whether it is HIV or AIDS
 Indicates HIV infection
 If greater than or equal to 200
 Indicates AIDS
 If less than 200
Medical Management for AIDS
 Symptomatic management as virus is the causative agent
 Latest Trend in Pharmacologic Management of AIDS
o COCKTAIL DRUGS
78
Patient must take medication composed of at least twenty-one (21)


tablets per day
 Patient spends approximately Php1,000 per day on drugs
 Prevents multiplication of the virus but DOES NOT KILL THE
VIRUS
1.Nucleoside Reverse Transcriptase Inhibitors
 NRTIs
o AZT Azidothymidine
 Retrovir
 Zidovudine
o ddc
 Dideoxycitidine
 Zalcitadine
o ddI
 Dideoxyinosine
 Didanosine
 Tastes sour
 Give together with fruit juice
o Lamivudine
o Stavudine
2.Non-nucleoside Reverse Transcriptase Inhibitors

 Non-NRTIs
o Delavirdine
o Nevirapine
3. Protease Inhibitors
 PIs
o Saquinavir
o Indinavir
o Pitonavir
o Delfinavir
Important Concept!
 All of the abovementioned drugs inhibit multiplication of the virus but DOES
NOT KILL THE VIRUS
Nursing Care for AIDS

 Symptomatic as causative agent is a virus
 Psychological Care
 Promotion of Homeostasis
Important Concept!
 Role of the Nurse in AIDS
o A counselor
Preventive Measures
 A for Abstinence
 B for Be Truthful
 C for Condom use
 D for Do not use Drugs
Important Concept!
 Virus can be found on all body fluids but will not be enough to cause infections
 Example:
o Six (6) to eight (8) gallons of saliva are needed to transmit HIV
79
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COMMUNICABLE DISEASE NURSING Handouts for ISU-Ilagan Student Nurses

By: Charles ZipaganAriola Jr., MSN, LPT.

Communicable Diseases are transmitted through:

1. Direct Mode of Transmission

Two (2) most common microorganisms causing infections

CHAIN OF INFECTIOUS PROCESS

Six (6) Factors

Two (2) Types of Acquired Immunity

2.1) Active Acquired Immunity

Two (2) Ways of Producing Antibodies:

2.1.2) Artificially Acquired Active Immunity

2.2) Passive Acquired Immunity

Two (2) Types of Passive Immunity

 Pregnant mother can be given tetanus toxoid

GENERAL CARE FOR PATIENTS WITH COMMUNICABLE DISEASES

Two (2) Aspects

Common Goal is to prevent the seven (7) Childhood Diseases

There are four (4) TEMPORARY CONTRAINDICATIONS for Immunization

 Fever, diarrhea and colds are NOT CONTRAINDICATIONS to Immunization.

 In a private setting, the physician can POSTPONE IMMUNIZATION in the

 Current target group of Expanded Program on Immunization of the Department

Presidential Decree 825

1.4) Proper Supervision of Food Handlers

Two (2) ways of Isolation

 These are persons who are not sick

Center for Disease Control’s two (2) Revised Isolation Precautions

For Surgical Asepsis:

2. Use of Protective Barriers or Use of Personal Protective Equipment (PPEs)

3. Avoidance of Needle Stick or Sharps Injury

Transmission Based Precaution

o For measles, chicken pox, TB

Control Measures other than Isolation

COMMUNICABLE DISEASES OF THE CENTRAL NERVOUS SYSTEM

 Ten times more painful than leg cramps

Two (2) Types of Toxins in Tetanus

In the wound, there would be an inflammatory response:

Signs and Symptoms of Tetanus

Diagnostics for Tetanus:

2. Obtain history of wound

Three (3) Objectives of Medical Management

Neutralize the toxin

3. Prevent and Control Spasm

Proceed with other supportive management

Provide Patient with Comfort Measures

o 3rd Dose: 14 weeks after birth; 0.5 ml

DPT Immunization for Pregnant Individuals

For High-Risk Individual

 Use thin dressing

Causative Agents in Meningitis

o There is inflammation of the meninges and accumulation of substances in

Signs and Symptoms of Meningitis

Pathognomonic Sign of Meningitis

o If there is INVOLUNTARY DRAWING UP of the LEGS / HIP upon flexion of

Diagnostic Tests for Meningitis

 If CSF is clear, it is subjected to Counter Immuno-Electrophoresis (CIE)

1. Alteration in body temperature related to infection

1.Proper disposal of nasopharyngeal secretions

2. Cover nose and mouth when sneezing and coughing

Signs and Symptoms

 Source of infection is mosquito

 In the Philippines, the most prominent type is Brunhilde!

o Headache with body malaise