Disease Tuberculo sis Kochs Disease, Phthisis, Galloping consumptio n, TB

Causative agent Mycobacter ium tuberculosi s, M. bovis

MOT Droplet infection, Cows Milk containing Mycobacte rium bovis

Pathogno monic sign Hemopt ysis

Diagnosis AFB SMEAR Chest Xray Tuberculi n testing/ Mantoux Test

Specific s/sx

DOC DIRECTLY Observed Treatment Short Course (DOTS) RIPES

Nursing intervention 1. Diet- if with anorexiaSFF; high protein 2. Drugstrict compliance 3. Rest Contraindicat e: Chest Clapping (stimulates hemoptysis )

Prevention Immunizatio n BCG at birth 1 dose @ Right deltoid Proper disposal of nasopharyng eal secretion Covering of nose and mouth when coughing or sneezing Preventive: Proper disposal of nasopharyngeal secretions Covering of nose and mouth when sneezing and coughing (cough manners)

Pneumoni a

Pneumococ cus

droplet infection/i ndirect contact

Rusty or prune juice sputum

sputum exam chest x-ray

DIPHTHER IA

Coryneba cterium diptheriae or the Klebs-

Respirator y droplets

Formati on of pseudo membra ne

Nose and throat swab /culture

Fever, Dyspnea , Cyanosis Productive cough Chest pain aggravated by coughing Increase RR, shallow Stabbing chest pain when coughing In children: Nasal flaring Chest retraction Nasal Sero-sanguinos secretion with foul mousyodor

Procaine penicillin Less than 2 months = 200,000 IU 2-12 months = 400,000 IU 1-5 years = 800,000 IU

1. Mainte nance of proper airway 2. Relieve chest pain 3. Adequ ate nutrition 4. Preven t spread of infection by disposing secretions properly

1. antidiphtheria serum 2. AntibioticsPenicillin

1. Place the patient in CBR until 2 weeks after recovery

Immunizatio n-DPT at 6 weeks after birth at one month

Loeffler Bacillus

Schick Test Moloneys test

Nasopharyngeal Marked degree of toxemia Swollen lymph nodes Dysphagia Laryngeal Aphonia BOD, chest indrawing Croup

3. To prevent respiratory obstruction Tracheosto my

Pertussis Whooping cough

Hemophilu s pertusis, Bordetella pertusis

Nasophary ngeal secretions; Droplet

Bordet Gengou Agar plate

INFLUENZ A Flu

Myxovirus Influenza virus A, B, C

Droplet, contact with nasophary

Catarrhal Erythromycin -Colds, cough at , Penicillin night, fever,listlessne ss (balisa) Spasmodic/ Paroxysmal -5 to 10 forceful successive coughing w/c ends in a prolonged inspiratory phase or a whoop -Vomiting -Teary red eyes and protrusion of eyeballs Convulsion Convalescence - s/s subside and patient can recover a. Respiratory most common b. Intestinal c. Nervous

(to prevent myocarditis ) 2. Maintenanc e of proper airway 3. Small frequent feedings (soft) 4. Use ice collar to relieve pain 1. Complete bed rest 2. Prevent Aspiration 3. Application of abdominal binder

interval Cover of nose and mouth when sneezing and coughing Never kiss the patient

Immunizatio n - DPT Proper disposal of nasopharyngeal secretions

a. Adequate rest and good ventilation b. TSB

Annual vaccination for high risk people or for

ngeal secretions

c. Monitor vital signs d. Adequate nutrition Fever, body weakness or muscle pain, cough, sore throat, sore eyes, DOB Sudden onset of high grade fever Headaches/body aches Ist day- mild respiratory symptoms After 2 days- dry cough and respiratory difficulty Supportive treatment as needed (e.g. oxygen, fluids). >Empiric broad spectrum antibiotics also given against communityacquired pneumonia and atypical pneumonia a. Adequate rest and good ventilation b. TSB c. Monitor vital signs d. Adequate nutrition

individuals who wish to reduce chances of getting flu avoid migratory birds, Thorough cooking of poultry meat Containmen t Mask N95 Strict quarantine and isolation measures

Avian Influenza Bird flu, AI

Influenza A H5N1 virus

Direct contact with droppings of infected bird Person-toperson through respiratory droplets and direct contact with body fluids of a person with SARS.

Severe Acute Respirator y Syndrome (SARS)

Corona virus, SARS CoV

GONORRH EA Gonococcu s (GC), Gonoclap, Jack, Gleet, Morning Drop

Direct contact with exudate via sexual contact transmissi on to the neonate during the passage through the birth canal

Neisseria gonorrhea

Positive gram stain smear of discharge or secretion Positive culture

Male - purulent discharge - pyuria - redness and edema of urinary meatus - protatitis - chronic-scar in epididymis -obstruct flow of sperms- sterility Female burning sensation upon urination if urinary meatus is involved - (+/-) of purulent discharge abscess formation in Bartholins/Ske nes glands

Tetracycline 500mg QID for 7 days Ceftriaxone for pregnant women Penicillin Other treatment for patients with coexisting chlamidial infection

SYPHILLIS Pox, Lues, Bad Blood Disease

Treponema pallidum

Sexual contact Blood transfusi on Placenta l transmis sion(5th mo of gestatio n)

VDRLvenereal disease researsh lab RPR- rapid plasma reagin test Fluorescen t Treponem al

Primary : chancre Secondary : condyloma lata, Mucous patches mouth, throat, cervix, patchy alopecia, moth eaten appearance, iritis, arthritic and bone pain

Penicillin G Newborn = 100,000 units/kg single IM dose Adult = 2.4 million units IM single dose

>Erythromyci n prophylaxis for ophthalmia neonatorum >Encourage follow up cultures in 4 to 7 days after treatment and again at 6 months >Teach importance of abstinence from sexual intercourse until cultures are negative >stress Importance to take full course of antibiotics >stress importance of treating partner too Patient Education Bed rest Aspirin Warn patient of Jarish Herxheimer reaction

Safe sex, Monogamous relationship

Antibody Absorption Test (FTA-ABS)

Latent stage Not infectious except to the fetus of the pregnant Tertiary syphilisGummas Itching, beefy red irritation, inflammation of the vaginal epithelium White, cheese-like, odorless discharge Patches of curdlike, cheesy material that adhere to the vaginal mucosa

CANDIDIA SIS Moniliasis

Candida albicans

CHLAMIDI AL INFECTIO N

Chlamydia trachomati s

Sexual contact

isolation of the organism in a tissue culture or

a. Pruritus in vagina b. Burning sensation in vagina

Nystatin vaginal suppositor y twice a day for 714 days vaginal douche of 2 tsp ordinary baking powder dissolved in 1 quart of warm water application of gentian violet to the vagina and perineum to prevent staining of undergarm ents Antibiotics: doxycyclin e and azithromyc in

1. Urge client to have sexual partner treated

serological complement fixation

c. Painful intercourse d. Pruritus of urethral infection in men e. Burning sensation during urination

TRICHOM ONIASIS

Trichomona s vaginalis

Sexual contact

Yellow green frothy vaginal discharge Burning and pruritus of vagina Dysuria, dyspareunia Usually asymptomatic in men ELISA screening test Western blot confirmato ry test CD4 T cell count (1000) Persistent fever within 1 month Chronic diarrhea Stunted growth 10 weight loss 6 minor Persistent cough Persistent genaralized lymphadenop

Metronidazol e (Flagyl) 250mg TID for 1 week.

ACQUIRED IMMUNOD EFICIENCY SYNDROM E (AIDS)

HIV

blood 90% Sexual contact 0.1 to . 5% Sharps or needle 0.1 % to .5%

1. Mononucleo side Reverse Transcriptase Inhibitors (Azidothymidi ne , Zidovudine ,Lamivudine , Retrovir) 2. NonMNRTI

2. Emphasize the importance of long term drug therapy because of the pathogens unique life cycle, which make it difficult to eliminate Do not give metronidaz ole during the first trimester of pregnancy Sitz bath Acid douches (1 tablespoon of vinegar in 1L of water) Symptomatic A abstinence and B be faithful supportive C condom D dont use drug

athy Sarcoma Pharyngeal candidiasis Recurrent herpes zoster Progressive disseminated herpes simplex

Dideoxyinosi ne (Didanosine), Dideixycytidi ne ( Zalcitabine) 3. Protease inhibitors - Saquinavir, Indanavir, -Ritonavir,Nel finavir Monotherap y: Dapsone Multi drug therapy (MDT) (Treatment approach: depends on microorganis ms in skin lesions) a. Paucibacill ary: >Rifampici n once a month >Dapsone OD (6-9 mos) b. Multibacilla ry: >Rifampici n once a month >Dapsone OD(24-30 mos) >Lampren

Leprosy Hansens disease

Mycobacter ium leprae

Prolonged intimate skin to skin contact Droplet Infection

Skin smear test Skin lesion biopsy Lepromin skin test

1. Psychologi cal aspect of care 2. S kin care: -prevent injury 3. A ctive and passive exercise to avoid contracture s 4. Health education Dapsone: may increase the number of lesion also iritis, orchitis Lamprene: may cause skin discoloratio

e OD (2430 mos) (clofazimi ne) Measles Rubeola; First disease, Little red disease Paramyxovi rus droplet Koplik spots Clinical signs & symptoms 1. Pre-eruptive: > 3 Cs: Cough, coryza, conjunctivitis 2. Eruptive: > Koplik spots > Rashes Cephalocaudal maculopapular rash 3. Posteruptive: > fine branny desquamatio n 1. Pre-eruptive Forscheimer spots (fine red spots found on soft palate) 2. Eruptive > rashes exanthem maculopapul ar (smaller than measles) ; no desquamatio n nor pigmentation > enlargement of lymph Symptomatic

n, dryness and flakiness > Complete bed rest > Adequate nutrition > Increase fluid intake > Increase vitamin C & A > Keep patient warm & dry > darken the room 1. Immunization 0.5 ml SC deltoid Precaution: fever, mild rash MMR- given at 15 months - check for allergy to eggs 2. Proper disposal of nasal secretions

German Measles Rubella, 3 day measles, Third disease

Togavirus

droplet

Chicken pox Varicella; Bulutong

Varicella Zoster virus

Airborne

Clinical

HerpesZoster (Shingles)

Varicella zoster virus

Occurs in a partially immune individual due to a previous varicella infection

Clinical

nodes: suboccipital, post. Auricular, post. Cervical 1. Pre-eruptive > fever, headache, body malaise, muscle pain 2. Eruptive phase described as vesiculopustular, more abundant in covered parts of the body > unilocular appearance of lesions 3. Post-eruptive Superficial depigmented scars rashes are clustered, follows a nerve pathway (unilateral), itchy, painful

Symptomatic antiviral (acyclovir)

> prevention of secondary infection of the skin lesions > cut fingernails short & wash hands to minimize bacterial infections > isolation of patient > Cool soda bath/ baking soda paste reduce itchiness

> Immunization Varivax 2 doses in adult, 1 month interval 1 dose in child

Symptomatic > acyclovir (anti-viral) > KMnO4 A: astringent effect B: bactericidal > analgesics are necessary for weeks or even months after blisters

> use of mask, gown, proper disposal of nasopharynge al secretions

have dried up

RABIES Hydrophobi a, Lyssa, La Rage

Rhabdoviru s

Bite, abrasion or lick on a damaged skin or mucous membrane

Brain Biopsy negri bodies Virus culture and isolation Observat ion of dog for 10 days

Invasive stagenumbness on site, flu like symptoms, marked insomnia, restless, irritable, apprehensive , with slight photosensitiv ity. Excitement stageaerophobia, hydrophobia, px fears water due to laryngospas m, difficulty in swallowing, photosensitiv ity Paralytic stageparalysis

A. Active 1. verorab : 0.50 cc/vial (IM) Site: Deltoid or Vastus lateralis 2. Purified duck embryo IM deltoid or SubQ OD for 14 days 1. Lyssavac N 2. Lyssavac plain B. Passive immunization : > Given up to 7 days after being bitten, >Deep IM at buttocks area >Single dose >Animal Serum (ERIG) equine rabies immunoglobu lin Eg. ARS (antirabies serum); HyperRAB 0.2cc/kg BW

Provid e a dim & quiet environme nt Room should be away from sub-utility rooms (area for washing: avoid sound of water) Restrai n patient even before aggressive behavior sets in Wear protective barriers

Immuniz ation of animals All animals should be caged or chained Stay away from stray animals

>Human serum (HRIG) human rabies immunoglobu lin E.g. Rabuman; Imogam 0.133 cc/Kg BW POLIOMYE LITIS Infantile paralysis, Heinemedin disease Legio Debelitans 1. Type 1 - L.D. Brunhilde 2. Type 2 - L.D. Lansing 3. Type 3- L.D. Leon 1. Fecal oral route 2. Droplets Lumbar Puncture protein content of CSF is increase: (+) Pandys test EMG Muscle Stool exam. done 10 days after infection Invasive stage or abortive stage Abdominal pain, anorexia, nausea, vomiting, diarrhea, constipationpayers patches Pre- paralytic stage Involvement of the CNS but w/out paralysis Char. by TRIPOD POSITION Haynes sign: Pokers sign: Paralytic Stage FLACCID PARALYSIS Masseter muscle trismus or lockjaw Facial musclePatient is treated symptomatic ally Bedrest Use hot compress for spasm PROM when pain and spasms are gone In case of respiratory paralysis, px is placed in mechanica l ventilator called iron lung machine. Immunization OPV or Sabin(3doses @ 6wks with 1 month interval) Salk - IM Avoid mode of transmission droplet a. Proper disposal of secretions b. Proper handling of food c. Handwashing

TETANUS Lockjaw

Clostridiu m tetani

Acquired thru wound (any kind of wound)

1. ATSantibodies -Prepare epinephrine and

Dim light, quiet environment Minimal and gentle

Immunization (DPT, Tetanus toxoid)

laceration, burn, bite, umbilical stump

risus sardonicus or sardonic grin Muscle of spineopisthotonus or arching of the back Respiratory muscledyspnea and chest heaviness Abdominal muscleabdominal rigidity(1st) Extremity musclesstiffness of extremities

corticosteroid in cases of delayed hypersensitiv ity reaction 2. ABPenicillin 3. muscle relaxant (DiazephamValium)

handling of patient Protect patient from injury Provide px comfort Always have padded tongue depressor Watch for urinary retention Wound Care: Washing with antiseptic Thin dressing Debride necrotic tissues

Clean wound immediately

MENINGITI Fungal S meningiti sCryptococ cal meningiti s Meningoc occal meningiti smeningoc oxemia or spotted feverNeisseria meningiti s

Respirator y droplet

Lumbar tap or Lumbar puncture Secure consent Fetal position during; flat on bed after Increase WBC; increase protein; decrease sugar

Clinical Manifestation s: 1. Meningococc emia - Fever, chills, N/V, malaise, headache Rashes, petechia, or blotchy purpuric lesion appear Waterhouse Friederichsen syndrome (+) shock and rashes

Antimicrobi al agent Rifampicin, Penicillin, Chloramphe nicol Steroidsantiinflamm atory agent Osmotic diuretics mannitol to reduce CSF fluid Anticonvuls ants Dilantin

(symptomatic and supportive) Promote rest and safety Monitor VS and neurologic status Fever provide TSB Convulsion s protect from injury

Proper disposing of tissues used for nasopharen geal secretions ( in plastic bags) Covering of nose and mouth when coughing and sneezing.

 Blood Culture

Symptoms of meningeal irritation 1. nuchal rigidity 2. increase ICP 3. altered LOC 4. convulsive seizures Kernigs sign brudzinskis sign Opistothonus

JAPANESE ENCEPHAL ITIS Brain fever

Arbovirus

Mosquito bite (Culex)

Lumbar puncture EEG

Clinical Manifestati ons- s/s Altered LOC lethargic Fever, chills and vomiting Convulsion Signs of neurologic damage

patient is treated symptomatic ally

Typhoid Fever Enteric fever

Salmonell a typhosa

Fecal-oral route ingestion of contamina ted food and water Source of Infection: 5 Fs

Rose Spots

Blood culturedone during prodromal stage Widal Test antibody test Becomes

1. Prodromal Stage-Fever, dull headache, abdominal pain, nausea and vomiting, diarrhea or constipation. 2. Fastidial/Pyre xial Stage-

Antibiotic: Chloramphen icol 100mg/kg in 4 doses for 14 days (side effect is bone marrow depression)

(symptomatic and supportive) Promote rest and safety Monitor VS and neurologic status Fever provide TSB Convulsions protect from injury 1. Maintenanc e of fluid and electrolyte imbalance - Proper regulation of IVF - Adequate fluids

- eradicate mosquito thru DOH program

CDT Immunizati on-adults: 0.5 cc IM deltoid -children: <10 years old 0.25cc IM deltoid *6 months immunity

Feces, Finger, Food, Flies, Fomites

positive on the 2nd week Typhidot Stool culture done on the 2nd week

3 Clinical Features of Typhoid Presence of Rose Spots (abdomen and chest)only symptom specific to typhoid Ladderlike fever Splenomegal y 3.Defervescenc e Stage a. Intestinal Hemorrhages -melena, hematochezi a b. Intestinal Perforationperitonitis - Sudden, severe, abdominal pain, persistence of fever, rigid abdomen 4.Lysis/Convale scence- s/s will subside

- Assess for the sign of dehydration 2. Maintenanc e of nutrition - High calorie, low residue diet - Do not give milk which can lead to increase acidity and diarrhea 3. Isolation of patients

Vivotif- in capsule form - 3 doses: 1 hour before meal q other day - 3 years immunity Protect / Purify water supplies Proper excreta disposal Hand washing Proper preparatio n and handling of food Avoid eating fresh and uncooked vegetables and fruits in endemic areas Do not put anything in your mouth

Leptospir osis(orang e eye) Mud fever, Swamp fever, Canicola fever, Weils Disease, Swine herds Disease, IcteroHemorrhagi a

Leptospira interrogans spirochetes

Can be transmitt ed by the semen of infected animal Skin penetrati on, ingestion of infected or carcasse s of either wild or domestic animals

Dysentery

1.

Bacil

lary Dysenter yShigellosi s 2. Viole nt Dysentery - Cholera 3. Amo

Fecal oral route

Cholera: RICE WATER STOOL

BLOOD septic stage EXAMINAT high fever ION 4-7 days, >LATheadache, Leptospir N/V, a abdominal Agglutinat pain, joint ion Test pain, >LAATrespiratory Leptospir distress a Antigen- Immune or Antibody toxic stageTest with or Liver without function jaundice- 4-30 test. BUN days CREATINE o Anicteric low grade fever, meningeal manifestation (convulsion, disorientation) Icteric (Weils syndrome) jaundice, hemorrhages, hepatomegaly , renal involvement (RF) Stool Examinati onamoebiasi s Rectal Swab for cholera and shigellosis

Antibiotics: penicillin, doxycycline,T etracycline (not given to < 8 yrs old and pregnant women) ***Do not give calciumrich foods (tetracycline binds with calcium) Prophylaxisdoxy 100 mg p.o q12 x 7 days

1. Sympt omatic and supportiv e 2. Monito r urine output

Eradicate rats Avoid wading in contaminate d pool of water/ swamps

Shigellosis: Cotrimoxazole, ciprofloxacin Cholera: Cotrimoxazole, Tetracycline Amoebiasis:

Control of fever Maintenanc e of fluid and electrolyte balance Oral Rehydratio n Salt (ORS)

CDT Vaccine (Cholera/Dys entery/Typh oid) 6 months immunity given only on outbreaks. Personal hygiene -

ebic Dysentery Amoebiasi s

Metronidazol e

o NaCl, Sodium Bicarbonat e, Potassium Chloride, Glucose

Schistoso miasis Snail fever, Bilharziasis, Blood fluke

Schistoso ma japonicum , S. mansoni, S. hematobi um

Parotitis Mumps

Paramyxovi rus

penetratio n of free swimming fork-tailed cercaria, ingestion of contamina ted water Sources of infection Feces of infected person Dogs, pigs, carabao s, monkey s and wild rats tiny snail called Oncome lania quadrasi Droplet or by direct contact with saliva of infected

Stool exam look for egg of parasite, kato katz technique o Blood exam COPT (circumov al precipitin test) o ELISA

1. swimmer s itch 2. Low grade Fever, myalgia and cough 3. Dysentery like symptoms 4. Emaciatio ns from chronic disease 5. Hepatom egaly, splenomegaly, lymphadenop athy

given early at the course of disease Praziquant el (Biltricide) = 30 mg/kg BID Fuadin IM OR IV

handwashin g Environment sanitation boiling of water, protect food from flies Snail Control (Oncomelani a quadrasi) use of molluscides Environment al Sanitation proper disposal of excretion

Clinical

a. Prodromal: Headache, fever, malaise b. Acute phase:

1. Place patient on CBR until swelling subside

MMR vaccine given on 1518 months (1dose)

person

Swelling of the salivary glands leading to difficulty in swallowing and chewing; + earache peaks at two days and stays up to 10 days

DENGUE Dandy Fever, Break bone fever

ArthropodBorne virus (arbovirus) belonging to the family Flaviviridae 4 serotypes (DENV1, 2, 3, 4)

Vectors: Aedes aegypti Aedes albopict us- tiger mosquit o Culex fatigans

1. Grade I - High grade fever (3-5 days) - Headache, peri-orbital pain - Joint & bone pain - Abdominal pain - Nausea & vomiting - Petechial formation Hermans sign generalized flushing of

Symtomatic and supportive 1. Oral fluids and electrolyte 2. Antipyreti cs (dont use aspirin) 3. Platelet transfusio n 4. Convulsio ns Dilantin

2. Wear fitted supporter to prevent pulling gravity in testes 3. Soft, bland diet 4. Hot or cold application over parotid gland to relieve pain 5. Patient should be excluded from school/work for 9 days after onset Watch for bleeding: Nosebleed cold compress over forehead Melena cold compress over stomach area, avoid eating dark colored foods

Proper covering of mouth and nose when coughing and sneezing

DOH CLEAN Program C hemically treated mosquito nets L arvae eating fish E nvironmental sanitation (4pm habit) A ntimosquito soaps (basil, citronel) N atural mosquito repellants (neem tree,

MALARIA Ague, King of Tropical Diseases

Plasmodiu m

1. Malarial Smear 2. Quantitati ve Buffy Coat (QBC)rapid test for malaria

the skin 2. Grade II signs & symptoms of grade I + bleeding - Epistaxis - GI bleeding - Gum bleeding 3. Grade III grade II + circulatory failure - Cold, clammy skin - Altered VS decreased BP, rapid, weak pulse, increased RR 4. Grade IV grade III + hypovolemic shock 1. Cold stage - Chilling manifestation s (10-15 mins) nursing responsibility : provide warmth to patient 2. Hot stage Characterized by fever, headache, abdominal pain &

Gingival bleeding offer ice chips, use soft bristle toothbrus h Hematem esis - NPO Observe for signs of shock

eucalyptus, oregano)

Anti-malarial agents -Chloroquine (drug of Choice) -Quinineneurologic toxicity, muscular twitching, delirium, convulsion -Primaquine -Fansidar

Keep patient comfortabl e with dry, warm clothes, replace fluid loss. Monitor V/S Diet high calories, vitamins and minerals Fluid and

1. Advise malaria chemoprophy laxis when travelling to malaria endemic areas 2. Limit dusk to dawn exposure, 3. wear protective clothing 4. sleep under mosquito nets

vomiting - Lasts for 4-6 hours Nursing responsibility : lower body temperature 3. Diaphoretic stage Excessive sweating/ feeling of weakness due to the past stages px underwent

electrolyte 5. use topical s balance repellents