Comhealth Nursing

Nurse Licensure Examination Review Handouts

THE COMMUNITY HEALTH NURSING AND

COMMUNICABLE DISEASES

Community Health NursingCOMMUNITY HEALTH NURSING

I - Definition of Terms Community- derived from a latin word “comunicas” which means a group of people. · a group of people with common characteristics or interests living together within a territory or geographical boundary · place where people under usual conditions are found Health - is the OLOF (Optimum Level of Functioning) Community Health - part of paramedical and medical intervention/approach which is concerned on the health of the whole population Aims: 1. health promotion 2. disease prevention 3. management of factors affecting health Nursing - both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness

II - Community Health Nursing The utilization of the nursing process in the different levels of clientele-individuals, families,

population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.

Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness”

MISSION OF CHN · Health Promotion – activities related to enhancement of health· Health Protection – activities designed to protect the people· Health Balance – activities designed to maintain well being· Disease prevention – activities relate to avoid complication · Social Justice – activities related to practice equity among clients

PHILOSOPHY OF CHN ACCORDING TO DR. MARGARET SHETLAND The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.

Principles of Community Health: 1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community.

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2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care 3. CHN practice is affected by developments in health technology, in particular, changes in society, in general 4. The goal of CHN is achieved through multi-sectoral efforts 5. CHN is a part of health care system and the larger human services system.

Role of CH Nurse: · Clinician - who is a health care provider, taking care of the sick people at home or in the RHU · Health Advocator – speaks on behalf of the client · Advocator – act on behalf of the client · Supervisor - who monitors and supervises the performance of midwives · Facilitator - who establishes multi-sectoral linkages by referral system · Collaborator – working with other health team member

COMMON PROCEDURE IN CHN:

· HOME VISIT· BAG TECHNIQUE· STERILIZATION· SPECIMEN COLLECTION- URINE – sterile bottle; midstream collection- FECES - clean container; small amount of feces only- SPUTUM - NPO midnight 1st collection early AM then submit at the health center immediately then 2nd collection following day early in the Am then submit at the health center then collect the 3rd sputum; instruct patient to take a deep breath 4 times then cough out

Levels of Client in CHN: 1. Application of Nursing Process to:

1.a Family 1.a.1 Family Coping Index · Physical Independence - ability of the family to move in & out of bed & performed activities of daily living

· Therapeutic Independence - ability of the family to comply with the therapeutic regimen (diet, medication & usage of appliances) · Knowledge of Health Condition- wisdom of the family to understand the disease process · Application of General &Personal Hygiene- ability of the family to perform hygiene & maintain environment conducive for living · Emotional Competence – ability of the family to make decision maturely & appropriately (facing the reality of life) · Family Living Pattern- the relationship of the family towards each other with love, respect & trust · Utilization of Community Resources – ability of the family to know the function & existence of resources within the vicinity · Health Care Attitude – relationship of the family with the health care provider · Physical Environment – ability of the family to maintain environment conducive for living

1.a.2 Family Life Cycle · Stage I – Beginning Family (newly wed couples) TASK: compliance with the PD 965 & acceptance of the new member of the family · Stage II – Early Child Bearing Family(0-30 months old)

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TASK: emphasize the importance of pregnancy & immunization & learn the concept of parenting · Stage III –Family with Pre- school Children (3-6yrs old) TASK: learn the concept of responsible parenthood · Stage IV – Family with School age Children (6-12yrs old) TASK: Reinforce the concept of responsible parenthood · Stage V - Family with Teen Agers (13-25yrs old) TASK: Parents to learn the concept of “let go system” and understands the “generation gap” · Stage VI – Launching Center (1st child will get married up to the last child) TASK: compliance with the PD 965 & acceptance of the new member of the family · Stage VII -Family with Middle Adult parents (36-60yrs old) TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect · Stage VIII – Aging Family (61yrs old up to death) TASK: learn the concept of death positively

1.b Community COMMUNITY ASSESSMENT: · Status – information about morbidity, mortality & life expectancy · Structure – information about age, gender and socio economic · Process – information about how the community function

TYPES OF COMMUNITY ASSESSMENT:

1. COMMUNITY DIAGNOSISA process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies.

2 Types: Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis- aims to obtain general information about the community

- type of assessment responds to a particular need

STEPS: · Preparatory Phase

1. site selection 2. preparation of the community 3. statement of the objectives 4. determine the data to be collected 5. identify methods and instruments for data collection 6. finalize sampling design and methods 7. make a timetable

· Implementation Phase 1. data utilization 2. data collection 3. data organization/collation 4. data presentation 5. data analysis

· Evaluation Phase

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2. BIOSTATISTICS

2.1 DEMOGRAPHY - study of population size, composition and spatial distribution as affected by births, deaths and migration.Sources : Census – complete enumeration of the population 2 Ways of Assigning People: 1. De Jure - People were assigned to the place where assigned to the place they usually live regardless of where they are at the time of census. 2.De Facto - People were assigned to the place where they are physically present at are at the time of census regardless, of their usual place of residence.

Components: 1. Population size 2. Population composition * Age Distribution * Sex Ratio * Population Pyramid * Median age - age below which 50% of the population fall and above which 50% of the population fall. The lower the median age, the younger the population (high fertility, high death rates). * Age – Dependency Ratio - used as an index of age-induced economic drain on human resources * Other characteristics: - occupational groups - economic groups - educational attainment - ethnic group 3. Population Distribution * Urban-Rural - shows the proportion of people living in urban compared to the rural areas * Crowding Index - indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host. * Population Density - determines congestion of the place

3. VITAL STATISTICS the application of statistical measures to vital events (births, deaths and common illnesses) that is

utilized to gauge the levels of health, illness and health services of a community.

TYPES: A. Fertility Rate

A. CRUDE BIRTH RATE total # of livebirths in a given calendar year X 1000 estimated population as of July 1 of the same given year

B. GENERAL FERTILITY RATE total # of livebirths in a given calendar year X 1000 Total number of reproductive age

B. Mortality Rate

A. CRUDE DEATH RATE Total # of death in a given calendar year X 1000Estimated population as of July 1 of the same calendar year

B. INFANT MORTALITY RATE Total # of death below 1 yr in a given calendar year X 1000Estimated population as of July 1 of the same calendar year

C. MATERNAL MORTALITY RATE Total # of death among all maternal cases in a given calendar year X 1000Estimated population as of July 1 of the same calendar year

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C. Morbidity Rate

A. PREVALENCE RATE Total # of new & old cases in a given calendar year X 100Total # of persons examined at same given timeB. INCIDENCE RATE Total # of new cases in a given calendar year X 100Estimated population as of July 1 of the same yearC. ATTACK RATE Total # of person who are exposed to the disease X 100# of persons exposed to the same disease in same given year

III - Epidemiology

· the study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution · the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations

A. Patterns of disease occurrence:Epidemic - a situation when there is a high incidence of new cases of a specific disease in excess of the expected. - when the proportion of the susceptibles are high compared to the proportion of the immunes Endemic - habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles e.g. Malaria is a disease endemic at Palawan. - the causative factor of the disease is constantly available or present to the area. Sporadic - disease occurs every now and then affecting only a small number of people relative to the total population- intermittent Pandemic - global occurrence of a disease Steps in EPIDEMIOLOGICAL IVESTIGATION: 1. Establish fact of presence of epidemic 2. Establish time and space relationship of the disease 3. Relate to characteristics of the group in the community 4. Correlate all data obtained B. Role of the Nurse · Case Finding · Health Teaching · Counseling · Follow up visit

IV. Health Situation of the Philippines

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Philippine Scenario: · In the past 20 years some infectious degenerative diseases are on the rise.· Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver the health services they need· The scarcity of doctors, nurses and midwives add to the poor health delivery system to the poor

VITAL HEALTH STATISTICS 2005

• PROJECTED POPULATION :MALE - 42,874,766 FEMALE - 42,362,147 BOTH SEXES - 85,236,913 • LIFE EXPECTANCYFEMALE - 70 yrs. oldMALE - 64 yrs. Old

LEADING CAUSES OF MORBIDITY · Most of the top ten leading causes of morbidity are communicable disease· These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella· Leading non CD are heart problem, HPN, accidents and malignant neoplasmsLEADING CAUSES OF MORTALITY · The top 10 leading causes of mortality are due to non CD· Diseases of the heart and vascular system are the 2 most common causes of deaths.· Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of deaths.

V. Health Care Delivery System · the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.

HEALTH SECTORS · GOVERNMENT SECTORSDepartment of Health Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020 Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized

5 Major Functions:

1. Ensure equal access to basic health services 2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions 3. Ensure a minimum level of implementation nationwide of services regarded as public health goods 4. Plan and establish arrangements for the public health systems to achieve economies of scale5. maintain a medium of regulations and standards to protect consumers and guide providers

· NON GOVERNMENT SECTORS – provides manpower in the execution of the program

· PRIVATE SECTORS – provides financial aspect in the execution of programs

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

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· Support for health goal· Assurance of health care· Increasing investment for PHC· Development of National Standard

MILESTONE IN HEALTH CARE DELIVRY SYSTEM

· RA 1082 - RHU Act· RA 1891 - Strengthen Health Services· PD 568 - Restructuring HCDS· RA 7160 - LGU Code

VI – National Health Plan

· National Health Plan is a long-term directional plan for health; the blueprint defining the country’s health – PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS

GOAL : · to enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economically-productive life, with longer life expectancy, low infant mortality, low maternal mortality and less disability through measures that will guarantee access of everyone to essential health care

OBJECTIVES: · promote equity in health status among all segments of society · address specific health problems of the population · upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to changing the health needs of the population · promote active and sustained people’s participation in health care

“ MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020”

A. MAJOR HEALTH PLAN · 23 IN 93 · Health for more in 94· Think health…… Health Link· 5 in 95

B. PRIORITY PROGRAM IN YEAR 2000 · Plan 50 (Pharmaceutical Plan)· Plan 500 ( Phil Health Insurance Plan)· Women’s health· Children’s health· Healthy Lifestyle· Prevention & Control of Infectious Disease

C. PRIORITY PROGRAM IN THE YEAR 2005 · Ligtas Buntis Campaign· Mag healthy Lifestlye tayo· TB Network

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· Blood Donation Program (RA 7719)· DTOMIS· Ligtas Tigdas Campaign· Murang Gamot· Anti Tobacco Signature Campaign· Doctors to the Barrios Program· Food Fortification Program· Sentrong Sigla Movement

D. NATIONAL HEALTH EVENTS FOR 2006

JANUARY · National Cancer Consciousness Week - (16-22)

FEBRUARY · Heart Month · Dental Health Month · Responsible Parenthood Campaign National Health Insurance Program

MARCH · Women's Health Month · Rabies Awareness Month · Burn Injury Prevention Month · Responsible Parenthood Campaign· Colon and Rectal Cancer Awareness Month· World TB Day - (24)

APRIL · Cancer in Children Awareness Month · World Health Day - (7)· Bright Child Week Phase I - · Garantisadong Pambata (11-17)

MAY · Natural Family Planning Month · Cervical Cancer Awareness Month · AIDS Candlelight Memorial Day - (21) · World No Tobacco Day - (31)

JUNE · Dengue Awareness Month · No Smoking Month · National Kidney Month · Prostate Cancer Awareness Month

JULY · Nutrition Month · National Blood Donation Month · National Disaster Consciousness Month

AUGUST

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· National Lung Month · National Tuberculosis Awareness Month · Sight-Saving Month · Family Planning Month · Lung Cancer Awareness Month

SEPTEMBER · Generics Awareness Month · Liver Cancer Awareness Month

OCTOBER · National Children's Month · Breast Cancer Awareness Month · National Newborn Screening Week (3-9) · Bright Child Week Phase II Garantisadong Pambata (10-16)

NOVEMBER · Filariasis Awareness Month· Cancer Pain Management Awareness Month· Traditional and Alternative Health Care Month · Campaign on Violence Against Women and Children

DECEMBER · Firecracker Injury Prevention Campaign:· “OPLAN IWAS PAPUTOK”

VII - INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

· IMCI is an integrated approach to child health that focuses on the well-being of the whole child. · IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in children under five

Goal: · By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015.

AIM: · to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. · IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

IMCI OBJECTIVES: · To reduce significantly global mortality and morbidity associated with the major causes of disease in children· To contribute to the healthy growth & development of children

IMCI COMPONENTS OF STRATEGY: · Improving case management skills of health workers

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· Improving the health systems to deliver IMCI· Improving family and community practices**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:· Cough and/or fast breathing· Lethargy/Unconsciousness· Measles rash· “Very sick” young infant

Possible course/ associated condition:· Pneumonia, Severe anemia, P. falciparum malaria· Cerebral malaria, meningitis, severe dehydration· Pneumonia, Diarrhea, Ear infection· Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI: · Acute Respiratory Infection· Diarrhea· Fever· Malaria· Measles· Dengue Fever· Ear Infection· MalnutritionTHE IMCI CASE MANAGEMENT PROCESS · Assess and classify· Identify appropriate treatment· Treat/refer· Counsel· Follow-up

THE INTEGRATED CASE MANAGEMENT PROCESS

Check for General Danger Signs: · A general danger sign is present if:- the child is not able to drink or breastfeed- the child vomits everything- the child has had convulsions- the child is lethargic or unconscious ASSESS MAIN SYMPTOMS· Cough/DOB· Diarrhea· Fever· Ear problemsIMCI COLOR CODING

PINK (URGENT REFERRAL) YELLOW (Treatment at outpatient health facility)

GREEN (Home management)

OUTPATIENT HEALTH FACILITY •Pre-referral

OUTPATIENT HEALTH FACILITY •Treat local

HOME Caretaker is counseled on: •Home

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treatments •Advise parents •Refer child

infection •Give oral drugs •Advise and teach caretaker Follow-up

treatment/s •Feeding and fluids •When to return immediately Follow-up

REFERRAL FACILITY •Emergency Triage and Treatment ( ETAT) •Diagnosis, Treatment •Monitoring, follow-up

Treat oral infection Give oral drugs Advise & teach

caretaker Follow up

Caretaker is counseled on: Home treatments Feeding & fluids When to return

immediately Follow up

ASSESS AND CLASSIFY COUGH OR DIFFICULTY OF BREATHING

- Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs. Assess and classify PNEUMONIA · cough or difficult breathing · an infection of the lungs · Both bacteria and viruses can cause pneumonia · Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection).** A child with cough or difficult breathing is assessed for:· How long the child has had cough or difficult breathing · Fast breathing – increase in RR· Chest indrawing – Visible mark of ICS upon inhalation· Stridor in a calm child – adventitious sounds heard even without the aid of stethoscope.REMEMBER: ** If the child is 0 months up to 2 months the child has fast breathing if you count 60 breaths per minute or more ** If the child is 2 months up to 1 year old the child has fast breathing if you count 50 breaths per minute or more.** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more.PNEUMONIA – TREATMENT SCHEME

•Any general danger sign or •Chest indrawing or •Stridor in calm child

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

•Give first dose of an appropriate antobiotic •Give Vitamin A •Treat the child to prevent low blood sugar •Refer urgently to the hospital •Give paracetamol for fever > 38.5oC

• Fast breathing PNEUMONIA

•Give an appropriate antibiotic for 5 days •Soothe the throat and relieve cough with a safe remedy •Advise mother when to return immediately •Follow up in 2 days •Give Paracetamol for fever > 38.5oC

•No signs of pneumonia or very severe disease

NO PNEUMONIA : COUGH OR COLD

•If coughing more than more than 30 days, refer for assessment •Soothe the throat and relieve the cough

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with a safe remedy •Advise mother when to return immediately Follow up in 5 days if not improving

Assess and classify DIARRHEA

A child with diarrhea is assessed for:· how long the child has had diarrhea· blood in the stool to determine if the child has dysentery· signs of dehydration.Classify DYSENTERY · child with diarrhea and blood in the stool

Two of the following signs ? • Abnormally sleepy or difficult to awaken • Sunken eyes • Not able to drink or drinking poorly Skin pinch goes back very slowly

SEVERE DEHYDRATION

•If child has no other severe classification: - Give fluid for severe dehydration ( Plan C ) OR • If child has another severe classification : - Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way - Advise the mother to continue breastfeeding • If child is 2 years or older and there is cholera in your area, give antibiotic for cholera

Two of the following signs : • Restless, irritable • Sunken eyes • Drinks eagerly, thirsty Skin pinch goes back slowly

SOME DEHYDRATION

•Give fluid and food for some dehydration ( Plan B ) • If child also has a severe classification : - Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way - Advise mother when to return immediately • Follow up in 5 days if not improving

•Not enough signs to classify as some or severe dehydration

NO DEHYDRATION

•Home Care • Give fluid and food to treat diarrhea at home ( Plan A ) •Advise mother when to return immediately •Follow up in 5 days if not improving

Types of Diarrhea

Dehydration present SEVERE PERSISTENT DIARRHEA

•Treat dehydration before referral unless the child has another severe classification • Give Vitamin a • Refer to hospital

No dehydrationPERSISTENT DIARRHEA

•Advise the mother on feeding a child who has persistent diarrhea • Give Vitamin A • Follow up in 5 days

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Blood in the stool DYSENTERY

•Treat for 5 days with an oral antibiotic recommended for Shigella in your area • Follow up in 2 days Give also referral treatment

Does the child have fever? **Decide : - Malaria Risk - No Malaria Risk - Measles - Dengue Malaria Risk

•Any general danger sign or • Stiff neck

VERY SEVERE FEBRILE DISEASE / MALARIA

•Give first dose of quinine ( under medical supervision or if a hospital is not accessible within 4hrs ) • Give first dose of an appropriate antibiotic • Treat the child to prevent low blood sugar • Give one dose of paracetamol in health center for high fever (38.5oC) or above • Send a blood smear with the patient • Refer URGENTLY to hospital

•Blood smear ( + ) If blood smear not done: • NO runny nose, and • NO measles, and NO other causes of fever

MALARIA

•Treat the child with an oral antimalarial • Give one dose of paracetamol in health center for high fever (38.5oC) or above • Advise mother when to return immediately • Follow up in 2 days if fever persists • If fever is present everyday for more than 7 days, refer for assessment

•Blood smear ( - ), or • Runny nose, or • Measles, or Other causes of fever

FEVER : MALARIA UNLIKELY

•Give one dose of paracetamol in health center for high fever (38.5oC) or above • Advise mother when to return immediately • Follow up in 2 days if fever persists • If fever is present everyday for more than 7 days, refer for assessment

No Malaria Risk

•Any general danger sign or • Stiff neck

VERY SEVERE FEBRILE DISEASE

•Give first dose of an appropriate antibiotic • Treat the child to prevent low blood sugar • Give one dose of paracetamol in health center for high fever (38.5oC) or above • Refer URGENTLY to hospital

•No signs of very severe febrile disease

FEVER : NO MALARIA •Give one dose of paracetamol in health center for high fever (38.5oC) or above • Advise mother when to return immediately • Follow up in 2 days if fever persists • If fever is present everyday for more

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than 7 days, refer for assessmentMeasles

•Clouding of cornea or • Deep or extensive mouth ulcers

SEVERE COMPLICATED MEASLES

•Give Vitamin A • Give first dose of an appropriate antibiotic • If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment • Refer URGENTLY to hospital

•Pus draining from the eye or • Mouth ulcers

MEASLES WITH EYE OR MOUTH COMPLICATIONS

•Give Vitamin A • If pus draining from the eye, apply tetracycline eye ointment If mouth ulcers, teach the mother to treat with gentian violet

•Measles now or within the last 3 months

MEASLES •Give Vitamin A

Dengue Fever •Bleeding from nose or gums or • Bleeding in stools or vomitus or • Black stools or vomitus or • Skin petechiae or • Cold clammy extremities or • Capillary refill more than 3 seconds or • Abdominal pain or • Vomiting • Tourniquet test ( + )

SEVERE DENGUE HEMORRHAGIC FEVER

•If skin petechiae or Tourniquet test,are the only positive signs give ORS • If any other signs are positive, give fluids rapidly as in Plan C • Treat the child to prevent low blood sugar • DO NOT GIVE ASPIRIN • Refer all children Urgently to hospital

No signs of severe dengue hemorrhagic fever

FEVER: DENGUE HEMORRHAGIC UNLIKELY

•DO NOT GIVE ASPIRIN • Give one dose of paracetamol in health center for high fever (38.5oC) or above • Follow up in 2 days if fever persists or child shows signs of bleeding • Advise mother when to return immediately

Does the child have an ear problem?

•Tender swelling behind the ear

MASTOIDITIS •Give first dose of appropriate antibiotic • Give paracetamol for pain • Refer URGENTLY

•Pus seen draining from the ear and discharge is reported for less than 14 days or • Ear pain

ACUTE EAR INFECTION

•Give antibiotic for 5 days • Give paracetamol for pain • Dry the ear by wicking • Follow up in 5 days

•Pus seen draining from the ear and discharge is reported for less than 14 days

CHRONIC EAR INFECTION•Dry the ear by wicking • Follow up in 5 days

•No ear pain and no pus seen draining from the ear

NO EAR INFECTION •No additional treatment

Check for Malnutrition and AnemiaGive an Appropriate Antibiotic: A. For Pneumonia, Acute ear infection or Very Severe disease

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COTRIMOXAZOLE

BID FOR 5 DAYS

AMOXYCILLIN

BID FOR 5 DAYS Age or Weight Adult tablet Syrup Tablet Syrup 2 months up to 12 months ( 4 - < 9 kg )

1 / 2 5 ml 1 / 2 5 ml

12 months up to 5 years ( 10 – 19kg )

1 7.5 ml 1 10 ml

B. For Dysentery COTRIMOXAZOLE BID FOR 5 DAYS AMOXYCILLIN BID FOR 5 DAYS

AGE OR WEIGHT TABLET SYRUP SYRUP 250MG/5ML 2 – 4 months ( 4 - < 6kg )

½ 5 ml 1.25 ml ( ¼ tsp )

4 – 12 months ( 6 - < 10 kg )

½ 5 ml 2.5 ml ( ½ tsp )

1 – 5 years old ( 10 – 19 kg )

1 7.5 ml ( 1 tsp )

C. For Cholera TETRACYCLINE QID FOR 3 DAYS

COTRIMOXAZOLE BID FOR 3 DAYS

AGE OR WEIGHT Capsule 250mg Tablet Syrup2 – 4 months ( 4 - < 6kg ) ¼ 1 / 2 5ml4 – 12 months ( 6 - < 10 kg ) ½ 1 / 2 5 ml1 – 5 years old ( 10 – 19 kg 1 1 7.5mlGive an Oral Antimalarial

CHOLOROQUINE Give for 3 days

Primaquine Give single dose in health center for P. Falciparum

Primaquine Give daily for 14 days for P. Vivax

Sulfadoxine + Pyrimethamine Give single dose

AGE TABLET ( 150MG ) TABLET ( 15MG) TABLET ( 15MG) TABLET ( 15MG)DAY1 DAY2 DAY3

2months – 5months

½ ½ ½ ¼

5 months – 12 months

½ ½ ½ 1/2

12months – 3 years old

1 1 ½ ½ ¼ ¾

3 years old - 5 years old

1 ½ 1 ½ 1 3/4 1/2 1

GIVE VITAMIN A AGE VITAMIN A CAPSULES 200,000 IU 6 months – 12 months 1//2 ( 100,000 IU) red capsules12 months – 5 years old 1 ( 200,000 IU) blue capsulesGIVE IRON

AGE or WEIGHT Iron/Folate Tablet FeSo4 200mg + 250mcg Folate (60mg elemental iron)

Iron Syrup FeSo4 150 mg/5ml ( 6mg elemental iron per ml )

2months-4months ( 4 - <6kg ) 2.5 ml4months – 12months ( 6 - <10kg ) 4 ml 12months – 3 years ( 10 - <14kg ) 1/2 5 ml 3years – 5 years ( 14 – 19kg ) 1/2 7.5 ml

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GIVE PARACETAMOL FOR HIGH FEVER ( 38.5oC OR MORE ) OR EAR PAIN

AGE OR WEIGHT TABLET ( 500MG )

SYRUP ( 120MG / 5ML )

2 months – 3 years ( 4 - <14kg ) ¼ 5 ml3 years up to 5 years ( 14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE · Give 500mg Mebendazole as a single dose in health center if : > hookworm / whipworm are a problem in children in your area, and > the child is 2 years of age or older, and > the child has not had a dose in the previous 6 months

VIII - DOH PROGRAMS DENTAL HEALTH PROGRAM • To improve the quality of life of the people through the attainment of the highest possible oral health.• Objective: To prevent and control dental diseases and conditions like dental caries and periodontal diseases thus reducing their prevalence.

OSTEOPOROSIS PROGRAM • It is characterized by a decrease in bone mass and density that progresses without a symptom or pain until a fracture occurs generally in the hip, spine or wrist. • Objectives: • To increase awareness on the prevention and control of osteoporosis as a chronic debilitating condition; • To increase awareness by physicians and other health professionals on the screening, treatment and rehabilitation of osteoporosis; • To empower people with knowledge and skills to adopt healthy lifestyle in preventing the occurrence of osteoporosis.

HEALTH EDUCATION & CO · Accepted activity at all levels of public health used as a means of improving the health of the people through techniques which may influence peoples thought motivation, judgment and action. Three aspects of health education: · Information · Communication · Education Sequence of steps in health education: · Creating awareness · Creating motivation · Decision making action

REPRODUCTIVE HEALTH 1. Family Planning2. MCH & Nutrition3. Prevention / treatment of Reproductive Tract Infection & STD4. Prevention of abortion & its complication5. Education & counseling on sexuality & sexual health6. Adolescent sexual reproductive health 7. Violence against women8. Men’s reproductive health ( Male sexual disorder )9. Breast CA & other gyne problem10. Prevention / treatment of infertility

OLDER PERSONS HEALTH SERVICES

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· Participation in the celebration of Healthy National Elderly Week ( Oct 1-7)- Lecture on healthy lifestyle for the elderly· Provision of drugs for the elderly( 20% discount)

GUIDELINES FOR GOOD NUTRITION · Nutritional Guidelines are primary recommendations to promote good health through proper nutrition. ACTIVITIES: 1.Malnutrition Rehabilitation Program

• Targeted Food Task Force Assistance Program (TFAP)• Nutrition Rehabilitation Ward

• Akbayan sa Kalusugan sa Kabataan (ASK Project)2.Micronutrient Supplementation Program· “23 in ‘93”· Fortified Vitamin Rice· “Health for More in ‘94”· “Buwan ng Kabataan, Pag-asa ng Bayan”· National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy”

PROTEIN ENERGY MALNUTRITION 1. Marasmus – looks like an old worried man - less subcutaneous fats 2. Kwashiorkor - a moon face child - with flag sign (hair changes) VITAMIN A DEFICIENCY Early symptoms: Xeropthalmia (Nigtblindess)

Bitot’s spot (silvery foamy spot located @ lateral sclera)

Corneal Xerosis (eye lesion)

Conjunctival Xerosis(scar in the eyes)

Keratomalacia ( whitish to grayish sclera)

BLINDNESS

RESPIRATORY INFECTION CONTROL • Provision of medicines • Consultative meetings with CARI coordinators • Monitoring of health facilities on the implementation of the program

ALTERNATIVE MEDICINE · RA 8423· 23 IN 93

A. The 10 Herbal Medicine(LUBBY SANTA)

Herbal Medicine USES

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Lagundi ( Vitex Negundo) SHARED Skin diseases Headache, Asthma,fever,cough&colds Rheumatism Eczema Dysentery

Ulasimang Bato (Peperonia Pellucida) RA

Lowers uric acid Rheumatism Arthritis

Bawang ( Allium Sativum) HAT Headache and TootacheBayabas ( Psidium Guajava) Anti septic, Anti-diarrheal

Yerba Buena (Mentha Cordifolia) SPITMAND

Swollen gums, Pain, Insect bites, Toothache, Menstrual & gas pain, Arthritis & rheumatism, Nausea & vomiting & Diarrhea

Sambong (Blumea Balsamifera) ADA

Anti - edema, Diuretics, Anti uro-lithiasis

Akapulko Fungal infection, skin diseasesNiog Niogan (Quisqualis Indica) Anti-helminthicTsaang Gubat (Carmona Retusa)SAD

Stomachache & Diarrhea

Ampalaya (Momordica Charantia) DM

MATERNAL- CHILD CARE I - Maternal Care

A. FAMILY PLANNING I. Spacing / Artificial MethodA. HormonalB. Mechanical & Barrier C. Biologic D. Natural II. Permanent (surgical/irreversible)A. Tubal Ligation B. Vasectomy III. Behavioral Method B. BREASTFEEDING

II - CHILD CARE

A. UNDER FIVE CARE PROGRAM · A package of child health-related services focused to the 0-59 months old children to assure their wellness and survivalGrowth Monitoring Chart (GMC) · A standard tool used in health centers to record vital information related to child growth and development, to assess signs of malnutrition. B. EXPANDED PROGRAM ON IMMUNIZATION · LEGAL BASIS· PD #996 – Compulsory basic · PP #147 – National Immunization Day· PP #773 – Knock out Polio Days· PP # 1064 – polio eradication campaign

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· PP #4 - Ligtas Tigdas month

MENTAL HEALTH · a state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work productively

Components of Mental Health Program · Stress Management and Crisis Intervention · Drugs and Alcohol Abuse Rehabilitation · Treatment and Rehabilitation of Mentally-Ill Patients · Special Project for Vulnerable Groups

SENTRONG SIGLA MOVEMENT AIM: to promote availability of quality health services 4 pillars: · Quality assurance · Grants & technical assistance · Health promotion · Award

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

Community Organizing · a continuous and sustained process of· EDUCATING THE PEOPLE, · CRITICAL AWARENESS · MOBILIZING

Participatory Action Research · A combination of education, research and action.· The purpose is the EMPOWERMENT of people

4 Phases: · Pre entry· Entry· Organizational Building· Sustenance and Strengthening

Laws Affecting CHN Implementation: RA 8749 - Clean Air Act (2000) RA 6425 – Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishable by law RA 9173 – Philippine Nursing act of 2002 RA 2382 – Philippines Medical Act: define the practice of medicine in the Philippines RA 1082 – Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural areas to help raise the health condition. RA 3573 - Reporting of Communicable Disease RA 6675 – Generic Act: promotes, requires and ensures the production of an adequate supply, distribution, use of drugs identified by their generic names. RA 6365 RA 6758 RA 4703 Advocates Home Treatment for all Leprae PatientRA 7305 – Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to promote and improve the social and economic well being of health workers, their living and conditions. RA 7160 – Local Government Code: responsibility for the delivery of basic services of the national government

IX - CHRONIC COMMUNICABLE DISEASES

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I - TUBERCULOSIS · TB is a highly infectious chronic disease that usually affects the lungs. Causative Agent: Mycobacterium Tuberculosis S/S: · cough · afternoon fever · weight loss · night sweat · blood stain sputum Prevalence/Incidence: · ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines · sixth leading cause of mortality (with 28507 cases) in the Philippines. Nursing and Medical Management · Ventilation systems · Ultraviolet lighting · Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine · drug therapy Preventing Tuberculosis · BCG vaccination · Adequate rest · Balanced diet · Fresh air · Adequate exercise · Good personal Hygiene DOTS (Direct Observed Treatment Short Course)Regimen Type of TB Patient

Regimen I 2RIPE / 4RI

New pulmonary smear (+) cases · New seriously ill pulmonary smear (-) cases w/ extensive lung lesions · New severely ill extra-pulmo TB

Regimen II 2RIPES/ 1RIPE / 5RIE

· New pulmonary smear (+) case · New seriously ill pulmonary smear (-) cases w/ extensive lung lesions · New severely ill extra-pulmo TB

Regimen III 2RIP / 4RI · New smear(-) but with minimal pulmonary TB on radiography as confirmed by a medical officer · New extra-pulmo TB (not serious)

II - LEPROSY · Sometimes known as Hansen's disease · is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium · Gerhard Armauer Hansen - discovered the microbes· Historically, leprosy was an incurable and disfiguring disease · Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms Early stage(CLUMP) Change in skin color Loss in sensation Ulcers that do not heal Muscle weakness Painful nerves Late Stage(GMISC) GynocomastiaMadarosis(loss of eyebrows)Inability to close eyelids (Lagopthalmos) Sinking nosebridge Clawing/contractures of fingers & nose

Prevalence Rate · Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.

MANAGEMENT: · Dapsone, Lamprene · clofazimine and rifampin · Multi-Drug-Therapy (MDT) · six month course of tablets for the milder form of leprosy and two years for the more severe form

X - Vector Borne Communicable Disease

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I – LEPTOSPIROSIS · an infectious disease that affects humans and animals, is considered the most common zoonosis in the world Causative Agent: Leptospira interrogans S/S: -high fever -severe headache -chills -muscle aches -vomiting -may include jaundice (yellow skin and eyes) -red eyes -abdominal pain -diarrhea TREATMENT: PET - > Penicillins , Erythromycin, Tetracycline

II - MALARIA · Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease that is widespread in many tropical and subtropical regions. Causative Agent: Anopheles female mosquito Signs & Symptoms: Chills to convulsion Hepatomegaly Anemia Sweats profusely Elevated temperatureTreatment: Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area. Preventive Measures: (CLEAN) Chemically treated mosquito netsLarvae eating fish Environmental clean up Anti mosquito soap/lotion Neem trees/eucalyptus tree

III - FILIARIASIS · name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae · larvae transmit the disease to humans through a mosquito bite · can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis S/S:

Asymptomatic Stage · Characterized by the presence of microfilariae in the peripheral blood · No clinical signs and symptoms of the disease · Some remain asymptomatic for years and in some instances for life

Acute Stage · Lymphadenitis (inflammation of lymph nodes) · Lymphangitis (inflammation of lymph vessels) · In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)

Chronic Stage · Hydrocoele (swelling of the scrotum) · Lyphedema (temporary swelling of the upper and lower extremities · Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)

MANAGEMENT: · Diethylcarbamazine · Ivermectin, · Albendazolethe · No treatment can reverse elephantiasis

VI – SCHISTOSOMIASIS · parasitic disease caused by a larvae

Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni Signs & Symptoms: (BALLIPS) Bulging abdomen

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Abdominal pain Loose bowel movement Low grade fever Inflammation of liver & spleen Pallor Seizure

Treatment: Diethylcarbamazepine citrate (DEC) or Hetrazan (drug of choice)

VII – DENGUE · DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern..· It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas. S/S: (VLINOSPARD) · Vomiting · Low platelet Increase Platelet count· Nausea · Onset of fever · Severe headache · Pain of the muscle and joint · Abdominal pain · Rashes · Diarhhea

TREATMENT: · The mainstay of treatment is supportive therapy.- intravenous fluids - A platelet transfusion - No aspirin

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http://en.wikipedia.org/wiki/Blood_transfusion

http://en.wikipedia.org/wiki/Intravenous_drip


Communicable Disease

Module on Communicable Diseases Community Health Nursing is faced with problems regarding communicable diseases. It is important therefore that the nurse poses basic knowledge on how to deal with related problems and more so prevent its occurrence, since this is like wise the focus of community health nursing.

INTRODUCTION

This module focuses on the basic communicable diseases affecting the patterns of mortality and morbidity in the Philippine community. It will give you the basic information regarding the description, etiology, mode of transmission, incubation period, signs and symptoms, diagnostic procedures and management of these diseases. As an added bonus each topic is carefully selected to prepare you both in the practical application in the community setting and the board exam most especially. Due to this you are advised to be familiarized with the following phrases:

ON THE BOARD refers to common question that comes out in the board exam.

CLINICAL FOCUS refers to the important reminders that are crucial in the actual practice.

GROUP ALERT refers to age group variation that also demand different approaches. A post test is prepared for your satisfaction so that you will be able to measure your knowledge. It is recommended that you supplement your studies with text books which focus on the said topic. This is just a guide and although careful review has been made the author waive any responsibility that may negatively occur due to application of the concepts learned here in.

OBJECTIVE GENERAL To study the different communicable diseases affecting man and the family as a component of the community

SPECIFIC By the end of the module in 7 days you should be able to; 1. Understand the basic concepts of CD 2. Familiarize with the basic control and method of prevention to the said diseases. 3. be able to apply to practice the concepts learned by effectively giving health education all these is expected to be attained by you none the less, by passing at least 65% of the final assessment questions.

What is infection? Infection is the successful entry and multiplication of micro-organism in the human body. Usually their entrance results in the appearance of the disease. But it doesn’t always follow the same. Some organism may enter the body but no obvious illness is apparent.

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What are the types of infection? There are two types of infection it could be nosocomial or opportunistic. Nosocomial – refers to hospital acquired infection with sets in within the premises of the hospital during confinement. Remember an infection is considered nosocomial if it sets in after 72 hours upon admission. Most of the time the responsible organism are hospital pathogens such as pseudomonas, klebsiella etc. Opportunistic – refers to the type infection acquired due to the failure of the immune defenses. Usually this is caused by the normal microflora.

What are communicable diseases and contagious diseases? Communicable diseases are any disease that are caused by microorganism and can be transferred from one body to another, hence it is communicable. Contagious diseases are any communicable infection that are easily transmissible. ON THE BOARD! Keep in mind that every contagious disease is communicable and all communicable diseases are infection but never the other way around.

What is pathogenicity? It is the over all ability of the organism to cause pathogenic changes in the body. Which is further described by the following terms:

Mode of action – manner by which organism damages the host. Example clostridium tetani releases toxin while plasmodium falciparum kills the RBC. Virulence – it is the over all strength of the microorganism Dose – the number of the organism required to cause infection for example as little as 4 tubercle bacilli inhaled is sufficient to cause Tuberculosis among high risk patient. Invasiveness – the ability of the organism to penetrate an intact barrier Toxigenicity – the ability of the organism to produce toxins Specificity – is the ability of the organism to attach on specific cellular surface receptors. Viability – the ability to sustain life outside the body of the host Antigenicity – the ability of the organism to stimulate and or resist antibody response

THE 3 LEVELS OF PREVENTION

PRIMARY – focuses on health promotion and disease prevention Promotive – there is no risk of having the disease. Activity is directed in promoting healthy lifestyle, proper nutrition, adequate exercise and environmental sanitation. Preventive – risk of having the disease is already existing and activity is directed in avoiding the risk ergo the disease it self. Example are EPI, Pap smear, BSE and STE. SECONDARY – focuses on the Curative aspect of care. Curative – effort is directed for early treatment. Move is also undertaken to avoid possible complications TERTIARY – focuses on the rehabilitative aspect Rehabilitative – effort of helping the patient adjust with the limitations and disability brought about by the previous disease.

ELEMENTS OF DISEASE CAUSATION Refers to the relationship of the Agent (microorganism), Host (Human) and the Environment (reservoir). If balance between the three is present disease is absent but if one of the three gain advantage over the other it

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may compromise one element and cause disease.

STAGES OF INFECTION a) Exposure – the stage of contact with the infectious agent b) Incubation or latent – the organism successfully entered the body. No apparent illness is present. The organism is still multiplying so as to manifest an actual illness. c) Prodromal – the manifestation of vague signs and symptoms start to appear. Example fever, cough, pain etc. d) Acute disease – an acute disruption in the physiologic mechanism. Disease due to the infecting organism is already present. e) Convalescence – the stage of resolution. The body is able to maintain homeostasis. The infectious organism is under controlf) Relapse – a stage of reactivation of a previous infection which may be due to re-exposure or waning immunity.

CHAIN OF INFECTION The series of events that takes place in order for infection to occur.

The following subtopics describe each component of the chain.

ON THE BOARD! Remember infection will never occur unless the six chain are completed.

a) Causative agent – refers to the microorganism such as fungi, protozoa, parasite, viruses, bacteria etc. b) Reservoir – the medium or body which the microorganism thrive and survive. c) Portal of Entry – opening in the body where in the microorganism could use as passageway to reach the internal physiological structures. For example mouth, nose, wound etc. d) Portal of exit – any opening to which the organism uses to exit from the body. Example are anus, nose, vagina, penis, etc. e) Mode of transmission – the method on how the organism travels from one infected host to another.i. Direct – requires physical contact from the point source of infection. Such as kissing and unprotected sexual intercourse. ii. Indirect – transmitted through fomites and other non living organism. Contaminated surgical instruments. iii. Vector borne – relies greatly on the presence of the secondary host to cause infection. e.g. mosquitos, flies and rats iv. Droplet – organism travels through droplet nuclei that comes out during coughing, sneezing etc. v. Airborne – the organism can uniquely suspend in the air and carried on air current and the like method. f) Susceptible host – any person whose immune defenses are weak or those who are healthy but do not posses adequate specific immunity

ON THE BOARD! Remember that the mode of transmission is the chain that is easiest to

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break!

THE DEFENSE MECHANISM OF THE BODY The defensive mode is divided into three, namely:i. 1st line of defense ii. 2nd line of defenseiii. 3rd line of defense 1st LINE OF DEFENSE Non specific defense mechanism this is the first to come in contact with harmful organism. E.g. skin, saliva,. Tears, stomach acids, urine etc. 2ND LINE OF DEFENSE Non specific phagocytic response. E.g. phagocytosis by neutrophils.3RD LINE OF DEFENSE Specific immune response dependent upon the presence of specific anti bodies. E.g. immunity against chickenpox

IMMUNITY Ability of the body to effectively mount an immune response to prevent infection. it is usually dependent on the presence of antibodies. a. Natural active – contact with infectious organism and the immunity that follows after that. b. Natural passive – immunity received from the mother through the placenta c. Artificial active – immunity gained after the administration of vaccines d. Artificial passive – immunity gained after receiving immune serum or immune globulin.

EPIDEMIOLOGY Refers to study of the pattern and distribution of diseases among the identified population. a. Endemic – the disease is always present in a community the rise and fall remains steadily predictable. b. Epidemic – there is a sharp increase in the number of disease as it affects the population over a period of time and specific locality. c. Pandemic – nations are affected by a disease. It is commonly referred to as international epidemic. d. Sporadic – patches in appearance. The disease does not manifest it self as a dominant entity. Most often the disease affects only a small portion of the community.e. Out break – the disease has affected the population but the number of the people afflicted is above the endemic proportion but lower than epidemic levels. An outbreak is an indicator of impending epidemic.

GENERAL MEASURES TO CONTROL COMMUNICABLE DISEASES Hand washing – the most basic of infection control practices. It is the use of soap and water to remove contaminant from our hands.

Disinfection – the use of chemicals like alcohol or other physical means to destroy disease causing organism outside the body. a. Terminal disinfection – disinfecting the surroundings of the patient b. Concurrent disinfection – disinfection of substances and materials discharged from the body.

Sterilization – all forms of microbial life are eliminated.

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Isolation – the act of separating an infected patient to prevent cross infection. The following are the types of isolation precaution. i. First Tier – Standard precaution ; applied to all patient regardless of their clinical diagnosis. It is desired that the application of this tie will protect the nurse and the patient from body fluids including blood as well as wounds or any break in the skin and mucous membrane. Use of gloves.ii. Second Tier – Transmission based precaution refers to any patient who require more stringent control that necessitates deeper method than those identified above. These includes contact, airborne and droplet precaution. a. Contact precaution – to protect against direct and indirect transmission. Mask and gown are added. b. Airborne precaution – the use of air filters to prevent infection due to organism suspended in the air.c. Droplet precaution – maintaining a distance of 3 feet from the point source of infection to avoid droplet nuclei. The use of high particulate mask and goggles are added.

Quarantine – the act of limiting the movement and freedom of travel of any patient who have been exposed from an infectious organism. The length of time is dependent to the maximum incubation period of the suspected disease. Surveillance - monitoring of patients, high risk groups or families to predict, identify and control infection.

CHEMICAL DISINFECTANTS THAT ARE COMMONLY USED Germicide – also known as disinfectant this can kill disease causing organism. Bactericidal – refers to its ability to kill bacteria only. Bacteriostatic – the ability of a chemical agent to halt bacterial reproduction Antiseptic – chemicals that can kill or control the growth of microorganism. This are usually applied on the skin to prevent wound infection. Soaps and detergents – effective against bacteria found in clothes.Phenols (Lysol) – effective against gram negative bacteria. Alcohol – ideally isopropyl alcohol in 70% solution. Effective in killing broad range of microbes. Chlorine – one of the most effective water disinfectants Iodine – equally effective with chlorine in antimicrobial activity. This is also used in skin disinfection (Betadine) Hydrogen Peroxide – wound cleanser and disinfectant for surgical devices.

COMMUNICABLE DISEASES NEUROLOGICAL SYSTEM

TETANUS ALSO KNOWN AS LOCK JAW Description: An acute infection associated with painful muscular spasmEtiology: Caused by Clostridium tetani which are found on soils and human fecesMode of transmission:

Contamination of wound

Incubation period: 5 – 10 days

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Signs and symptomsFever, lock jaw, the most important sign is trismus and risus sardonicus. While laryngospasm is the most life threatening condition.

Diagnostic procedure

None. History of wound and possible contamination are usually enough to arouse suspicion and take necessary management.

Management

Wash wound, apply wound antiseptic. Assess for history of immunization Give tetanus toxoid for negative history of immunization Administer Antitoxin after negative skin test Penicillin is the drug of choice Prepare for intubation. NGT feeding may become necessary. Avoid over stimulation to prevent painful muscle contraction. Diazepam is the drug of choice for muscle spasm

MENINGITIS Description: An acute inflammation of the meninges

Etiology:Caused by Nesseria meningitides this is usually a normal inhabitant of the nasopharynx.

Mode of transmission:

Droplet infection


Pathophysiology:

The organism enters the bloodstream after invading the respiratory tissues. Reaches the spinal cord and of course the meninges. It stimulates chemotaxis that leads to leukocyte infiltration of the meninges. As a result inflammation follows. This build up pressure, pus and compresses sensitive nervous tissues, that may decrease the level of consciousness and in more severe cases pus could impede blood flow and brain infarct my ensue.

Signs and symptomsThe most significant finding indicating meningeal irritation: brudzinski and kernigs sign. Other sign observable are headache, opisthotonus, fever and petechiae


Lumbar puncture (CSF analysis)

Management

Institute droplet precaution Rifampicin or Ciprofloxacin for prophylaxis Ampicillin is the drug of choice Ceftriaxone for systemic and CNS infection given in combination with Ampicillin to combat resistant organism. Mass prophylaxis is not needed provided that all children in day care centers who have been exposed are exempted hence they need prophylaxis, this also includes all other children who are close to the infected patient such as when they share eating utensils. Nurses and Doctors are not at risk of having the disease except when close contact occurred like in mouth to mouth resuscitation.

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ENCEPHALITIS Description: Inflammation of the tissues of the Brain

Etiology:Mosquito borne – Japanese enceph, West Nile enceph etc Viral borne – Complication of chicken pox or measles Amebic – Acanthamoeba hystolytica


Mosquito borne – bite of the infected mosquito Viral – may be droplet or airborne Amebic – accidental entry in the naso - pharynx due to swimming in infested waters.

Incubation period: Mosquito borne – varied Viral – 5 – 15 days Amebic – 3 – 7 days

Pathophysiology:

The infectious organism regardless of the type penetrate the brain and causes inflammation of the brain tissues it self. the inflammatory response compresses the brain structure which explains the rapid deterioration of the LOC. Encephalitis is more severe than meningitis.

Signs and symptomsMarked decrease in LOC. Brudzinski and kernigs may also be present if meningeal irritation result. The most significant though is the appearance of decorticate and decerebate rigidity.


Lumbar Tap (CSF analysis) EEG

Management

Primarily supportive. The body can neutralize the organism thru the presence of antibody. Amebic encephalitis may benefit from metronidazole. Anti inflammatory may be given Mannitol could decrease ICP

POLIOMYELITIS Description: An acute paralytic infection that destroys the affected nerves. Etiology: Caused by polio virus 1 (Brunhilde), 2 (Lansing), 3 (Leon) Mode of transmission:

Fecal – oral route. Particularly rampant among those in the squatters area who have no access to sanitary toilet facilities


Pathophysiology:

The virus enters the oral cavity and reproduces in the intestines which later penetrate the intestinal wall causing viremia and reaching the motor nerves and the spinal cord. The virus reproduces inside the nerve and as they are released, the infected cell die, hence paralysis results.

Signs and symptomsPokers sign, Haynes sign, tonsillitis, abdominal pain and flaccid paralysis


Stool exam, pandys test, EMG

Management

Prevention OPV No anti viral therapy. Toilet hygiene must be reinforced Watch out for respiratory paralysis Assist in rehabilitation (physical therapy and comfort measures OPV is preferred over IPV because the latter can only provide

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RABIES Description: Another acute viral infection which have a zoonotic origin

Etiology:Primarily carried by mammals specially land and aerial mammals. In the Philippines Dogs and Cats are among the most important reservoir. The causative organism is Rhabdo Virus


Bite of infected animal. Scratch wound from cats can also cause infection since cats usually lick their paws.

Incubation period: 10 days for man 14 days for animals

Pathophysiology:

The virus replicates at sight of infection which later proceeds to infect the nearby axons and then reaches the nerve it self. From that point onwards the virus travels along the nerve pathway to reach the brain. In the brain the virus insights inflammatory reaction that give rise to the appearance of encephalitis like symptoms later the organism descends from the brain and exit to affect other nerves in he body. The affectation of trigeminal nerve causes throat spasms which gives rise to its classic finding “hydrophobia”

Signs and symptomsHydrophobia, aerophobia, laryngeal, Pharyngeal spasm excessive salivation.


Fluorescent antibody Staining, Negri bodies found in brain biopsy of the infected animal

Management

Human Diploid Cell Vaccine, Rabies Immunoglobulin, Rabies Anti serum. tetanus anti serum is also given if with negative or inadequate immunization history Wash wound with soap and water, may apply wound antiseptic Once sign and symptoms are present passive immunization is already useless. Supportive therapy comes next. Protect from glare and sunlight, protect from water and air current. Cover IV bottle and tubing with carbon paper or any other else that can effectively hide the iv fluids. Secure consent and restrain the patient. Observed contact and droplet precaution.

LEPROSY

Description:A chronic infection that usually affects the peripheral nerves and leads to paresthesias

Etiology:A possible zoonotic infection which is rarely cultured in laboratory but seen to be growing freely among armadillo. Causative organism is Mycobacterium leprae


Droplet infection is the most important transmission. Skin contact may cause infection only if there is an open lesion with prolonged contact.

Incubation period: 6 months to 8 years Pathophysiology: The organism enters the body via droplet infection. It is ingested by

macrophages but can’t be killed, as this circulating macrophage reaches the skin the bacteria penetrate the nerves. Later due to immune

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recognition WBC attacks the infected cell which results to the destruction of the affected cell hence the appearance of paresthesias and consumption of the involved extremity becomes apparent due to immune response it self.

Signs and symptoms Painless wound, paresthesias, ulcer that does not heal, leonine appearance, maderosis. Nerve involvement with acid fast bacilli is the pathognomic sign of leprosy


Scraped incision method.

ManagementInstitute concurrent disinfection specially of nasal discharge. Prevention is achieved by BCG immunization Rifampin, Dapsone and lampreme are effective treatment against this infection

CIRCULATORY SYSTEM

DENGUE HEMORRHAGIC SHOCK SYNDROME Description: An acute arthropod borne infection which causes massive bleeding.

Etiology:

Causative organism is Dengue virus 1, 2, 3 and 4 the primary vector is Aedes egypti other wise known as tiger mosquito because of the black stripes present at the dorsal legs of the insect. The mosquito prefers to thrive on clean stagnant water.


Bite of the infected vector mosquito

Incubation period:

6 – 7 days

Pathophysiology:

The virus is carried by the infected mosquito and transferred through bites in the victim. Once the proboscis pierced the capillaries it also leaves the viral organism. The virus mixes in the bloodstream survive and reproduce causing viremia which explains the appearance of generalized flushing. The virus will then successfully enters the bone marrow and arrest the maturation of megakaryocyte. Since the precursor of platelets can not take full course it will result to massive drop in the patient’s platelet count which significantly raises the risk for hemorrhage.

Signs and symptoms

Petechiae, bleeding, epitaxis, Herman’s sign and fever


Tourniquet test, platelet count.

Management Watch out for bleeding. Minimize injections and other parenteral procedures if possible. Apply pressure for 10 minutes on injection site. Avoid aspirin use acetaminophen provide TSB as an adjunct to anti pyretics. Monitor platelet closely. Prepare for platelet concentrate or fresh whole blood as the need may call for it. Hydrate

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with PNSS Preventive measure focuses on 4 o clock habit Use DEET as an effective mosquito repellant Use mosquito nets

MALARIA Description:

Another type of mosquito borne infection most common in the tropics

Etiology:The causative organisms are Plasmodium Vivax, Falciparum, Ovale, and Malariae. The primary vectors are anopheles mosquitoes.


Bite of the infected mosquito

Incubation period:

For Falciparum 12 days, for Vivax and Ovale 14 days and for Malariae 30 days

Pathophysiology:

From the bite of the infected mosquito the organism enters the body via bloodstream and immediately proceed to the liver in the form of sporozoites. Inside the hepatocytes reproduction continues until the host burst releasing the parasite in the form trophozoites that enters the RBC, inside it the organism divides and form schizont. This will later produce merozoites that enters RBC the process causes drop in the number of circulating RBC leading to anemia and cachexia.

Signs and symptoms

A cycle of hot stage (high fever) followed by diaphoretic stage (sweating) and then cold stage (chilling). The cycle repeats leading to malarial cachexia


Malarial smear or peripheral blood smear

ManagementChloroquine is the drug of choice. Primaquine must be given to prevent relapse. Prevent by using mosquito repellant and mosquito net Chloroquine is the drug of choice for prophylaxis.

FILIRIASIS Description: A chronic lymphatic disorder that is related to elephantiasisEtiology: Causative organism is Wuchereria bancrofti primary vector Culex spp.Mode of transmission:

Bite of the infected mosquito

Incubation period: 6 – 12 months

Pathophysiology:

The organism enters the body after the vectors’ bite, it then matures and migrate on the lymphatic vessels but it usually affects those in the lower extremity. The protozoal parasite crowds and destroy the filtering ability of the lymph nodes which then leads to the accumulation of lymph or body fluids causing edema and at worst cases gross deformity hence it could lead to elephantiasis.

Signs and symptomsRecurrent low grade fever, lymphangitis, nocturnal asthma and in worst cases elephantiasis

Diagnostic Microscopic examination of peripheral blood.

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procedure

ManagementUse of mosquito repellant and nets Hetrazan is effective against Filiriasis adverse reaction though are seen in a number of patients, if such may be present may use Ivermectin

RESPIRATORY SYSTEM

DIPHTHERIA Description:

An acute infection of the upper respiratory system whose complication may include the lower respiratory tract.

Etiology: The organism, Corynebacterium diphtheriae is ubiquitous.Mode of transmission:

Droplet infection is the means of spread


Pathophysiology:

The organism infects the oral cavity which later due to its ability of releasing toxins causes the death of the involved tissues. This gives rise to the appearance of psudomembarne which may be dislodge and block the airway. As toxins are secreted the heart, kidney and the nerves absorb it, this toxins halt protein synthesis of the infected cell which later on causes its death.

Signs and symptomsPathognomonic Sign is pseudo membrane. Tonsillitis may also be present. Fever and malaise. If complication arises paralysis, endocarditis and kidney failure may be seen.


Throat swab

ManagementGather specimen for culture Prepare for epinephrine and possible intubation Be ready for antitoxin therapy after checking for allergy Administer penicillin or erythromycin

PERTUSIS

Description:A widespread organism that threaten any one who have no immunity against it.

Etiology: Causative organism is Bordetella pertussis Mode of transmission:

Droplet infection

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Pathophysiology:

The organism enters the upper respiratory tract attaches to the respiratory epithelium and causes an increased production of cyclic amino phosphate that essentially leads to hyperactivity of the mucous secreting cells. Thick tenacious secretions blocks the airway. The organism also halts the mucociliary escalator leaving coughing reflex the last effective protective mechanism of expelling sputum. Due to its relative tenaciousness the body experiences difficulty in coughing out phlegm thus we observe patient to manifest violent cough.

Signs and symptoms

Pathognomonic of this infection is violent cough w/out intervening inhalation followed by an inspiratory whoop. Vomiting may be present, Increased in ICP and IOP are also seen. Hernia is also a high risk incident.


Throat swab

ManagementPenicillin, Erythromycin ; Mucolytic may be ordered. Nebulization may also be indicated; Provide small feedings Apply abdominal binder ; Avoid dust and drafts

TUBERCULOSIS Description: A chronic lung infection that leads to consumption of alveolar tissuesEtiology: Causative organism is acid fast bacillus mycobacterium tuberculosis.Mode of transmission:

Droplet infection as well as airborne

Incubation period: 2 – 4 weeks

Pathophysiology:

The bacilli is inhaled and taken in the alveoli where macrophage will ingest but fail to kill the organism. As these macrophages migrate to nearby lymph nodes it will die and leave the capsulated bacteria undigested. Once the body’s immune system dropped, the bacteria will be activated and stimulate immune response which likewise damage the alveolar tissues leading to casseation necrosis and could eventually consume the entire lungs if the process is repeated frequently

Signs and symptoms Afternoon fever, night sweats, cough for 2 weeks, anorexia weight loss.Diagnostic procedure

Sputum microscopy, CXR, Mantoux test

Management

Institute DOTS Give as ordered; Pyrazinamide, Izoniazid, Rifampicin, Ethambutol and Streptomycin. Check for sensitivity to any of the drug mentioned Provide B6 if receiving Izoniazid Watch out for visual problem if receiving Ethambutol Ethambutol is contra indicated for children who cant verbalize visual problems yet.

PNEUMONIA

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Description: an acute usually bacterial in nature

Etiology:

the most common causative organism is strptococcus pneumoniae ubiquitous, orgainsm and may be transferred among population that has poor ventilation and impaired respiratory cilliary function. certain disease like measles may promote the development of pneumonia


Droplet infection

Incubation period: 24 to 72 hrs usually 48 hrs

Pathophysiology:

the organism enters the respiratory tract and if the cilliary mechanism fails to prevent its further entry the organism then infects the lower respiratory centers where it stimulate an inflammatory reaction. this response leads to migration of WBC in particular with neutrophil hence leukocyte infiltration is seen in chest x-rays as consolidation. the build up puss increases the alveolar presure causing in atelectasis once collapsed alveoli cant participate in gas exchange anymore leading to impaired DOB.

Signs and symptomsRusty colored sputum is the pathognomonic sign this is caused by WBC infiltrates, RBC and sputum. DOB, increased RR, coughing and in late cases lethargy, cyanosis and death.


sputum exam

Management

Co Trimoxazole and gentamycin are the drug of choice. although Co-tri is used more widely than gentamycin because of its oral preparation which are allowed to be administered by midwives for patient in far flung areas. instruct the mothers to continue the administration of antibiotic for 5 straight days TSB if in case fever may arise Promote proper room ventilation avoid crowding as much as possible Use Pneumococcal vaccine as indicated

COLDS (CORYZA) Description: The causative agent comes from adenovirus and rhino virus.Mode of transmission:

Droplet infection, direct contact.


Pathophysiology:

As the virus enters the respiratory tract, it attaches itself to the mucous membrane and causes local irritation and inflammation. In response, the mucous membrane releases mucous to flush out the virus. Since there is an increased in the production of the mucous it usually flows back and causes rhino rhea and because of the naso-lacrymal duct, increased mucous production impedes the drainage of tears thus watery eyes is present. Complications: Children – otitis media and bronchopneumonia Adult – sinusitis

Signs and symptoms General malaise Fever, chills Sneezing, dry and scratchy throat

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Teary eyes, headache Continues water discharge from nares

Managementa. Provide adequate rest and sleep b. Increase fluid intake c. Provide adequate and nutritious diet d. Encourage vitamins specially vitamin C

INFLUENZA (LA GRIPPE OF FLU) Description:

A highly contagious disease characterized by sudden onset of aches and pains.

Etiology: Influenza virus A, B, CMode of transmission:

Droplet infection, contact with nasopharyngeal secretions

Incubation period: 24 – 48 hrs.

Pathophysiology:

Upon entry in the upper respiratory tract, it is deposited in the same site and penetrates the mucosal cells. Causing lysis and destruction of the ciliated epithelium the virus releases neuramidase that decreases the viscosity of the mucosa. Facilitating the spread of the infected exudates to the lower respiratory tract, this causes intestinal inflammation, and necrosis of the alveolar and bronchiolar epithelium. Thus, the alveoli are filled with exudates containing WBC, RBC and hyaline cartilage. This places the patient to increased possibility of acquiring bacterial pneumonia usually caused by S. Aureus.

Signs and symptoms

Respiratory – most common fever anorexia chills muscle pain and aches coryza sore throat bitter taste orbital pain

Intestinal vomiting severe abdominal pain fever obstinate constipation severe diarrhea

Nervous headache

Management

a. provide adequate rest and ventilation b. tepid sponge bath to reduce the temperature c. monitor the vital signs d. provide adequate nutrition e. assist the patient in conserving strength when she is very weak f. drug of choice: · antibiotics · sulfonamides

INTEGUMENTARY SYSTEM

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SCARLET FEVER (SCARLATINA)

Description:

Is an acute, febrile, contagious condition characterized by sudden onset usually with vomiting and by punctuate erythematous skin eruption followed by characteristic exfoliation of the skin during convalescence, rapid pulse and sore throat.

Etiology: Group A hemolytic streptococcus groupMode of transmission:

Direct contact, droplet infection and indirect contact


Pathophysiology:

The bacterium releases erythrogenic toxins, which causes sensitivity reaction in the body. The toxin can cause toxic injury to the small capillaries of vascular epithelium found in the body. The skin is the site where the manifestations are most visible where one will observed strawberry like tongue, rashes, etc. Complications: · sinusitis · nephritis · otitis media · myocarditis/endocarditis · mastoiditis

Signs and symptoms

I. Prodomal stage fever tachycardia sore throat vomiting headache abdominal pain body malaise

II. Eruptive stage rashes: appears at the end of 24 hours on the chest spread

gradually upward and downward enanthem: macular eruption on the hard palate pastia’s line: due to the grouping of macules found around the

folds of the skin particularly on the elbow tiny subcuticular vesicles: found in the cuticles of the nails strawberry tongue: tongue becomes red at the edges and enlarged

papillae show raspberry tongue: circumoral pallor

III. Desquamation (8 – 10 days) · skin begins to peel · shedding of the hair and nails

Diagnostic procedure Scultz-Charlton rash extinction or blanching test – for sensitivity

to scarlet fever antitoxin Dick test – determines whether or not a person is naturally

immune to scarlatine nasal swab

Laboratory: positive throat culture for strep elevated ASO titer

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white and differentiated count high as 50,000 increae in eosinophils

Management

1. isolation – medical aseptic technique 2. bed rest 3. keep the patient warm at all times and avoid drafts 4. apply ice cap/packs for high fever 5. give TSB for high temperature 6. increase oral fluid intake 7. take vital signs q 3 – 4 hrs 8. daily bath should be given: sodium bicarbonate or starch is

used in excessive itching and oil rub after bath is useful 9. use of mouthwashes and gargles for good oral hygiene 10.prevent exoriations by wiping nasal discharges with soft

tissues and application of cold creams 11.encourage daily elimination 12.diet should be of high calorie foods and fruit juices, milk

cream and soups Medical management: a. antitoxins b. convalescent serum c. samma globin – administered IM d. sulfonamides e. antibiotics – penicillin (for cleaning the throat of streptococcus)

LEPROSY (HANSEN’S DISEASE, HANSENOSIS, LEPRAE, LEONTHIASIS) Description:

A chronic infectious disease characterized by the appearance of modules in the skin or mucous membranes or by changes in the nerves leading to anesthesia, paralysis or other changes

Etiology:

Mycobacterium leprae (acid fast bacillus), sporadic/endemic cases, occurs in tropical and semitropical countries throughout the world. It can be contracted in childhood (manifested at age 15 and diagnosed by the age of 20 years). Prognosis: > the longer the time of active disease, severe lesions, the more rapidly they have advanced without ability to produce the lepromin reaction – the poorer the prognosis > case under 21 years old – high relapse rate


Prolonged intimate skin to skin contact, nasal secretions

Incubation period: Prolonged, undetermined and varies from one to many years

Pathophysiology:The bacterium, which is an acid-fast bacillus, attacks the skin tissues and peripheral nerve, which causes skin lesions, anesthesia, infection and deformities

Signs and symptoms Assessment:1. Tuberculoid type – shows high resistance to Hansen’s bacilli.

Clinical manifestations are mainly in the skin and nerves and usually are used or non-infectious.

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2. Lepromatous type – minimal resistance to the multiplication, existence of the bacillus, constant presence of large numbers in the lesions and form globi (characteristic manifestations in the skin and mucus membranes) and peripheral nerves.

3. Open or infectious cases 4. Inderterminate type – clinical manifestations are located chiefly in

skin and nerves; lesions are flat macules. 5. Borderline

Clinical Manifestations: 1. Early stage · loss of sensation · paralysis of extremities · absence of sweating (anhydrosis) · nasal obstruction · loss of hair (eyebrows) · eye redness · change in the skin color · ulcers that does not heal · muscle weakness 2. Late symptoms · contractures · leonine appearance (due to nodular and thickened skin of the forehead and face) · madarosis (falling of eyebrows) · synecomastia · sinking of bridge of nose 3. Cardinal signs · presence of Hansen’s bacilli · presence of localized areas of anesrhesia · peripheral nerve enlargement


1. Lepromin reaction – a positive test develops a nodule at the site of inoculation (first and third week)

2. Wassermann reaction

Management

Planning and implementation 1. Prevention

o separate infants from lepromatous parents at birth o segregate and treat open cases of leprosy o require public health supervision and control of cases of

Hansen’s disease 2. Medical management

1. Multiple drug therapy · paucibacillary treatment – six months or until negative (-) results occur · refampicin – once a month · dapsone - once a day 2. Multibacillary treatment – for 2 consecutive years or until negative (-) for leprosy test · rifampicin once a month · lamprene once a day · dapsone once a day

3. full, wholesome generous diet 4. alcohol or TSB may be used for high fever 5. patient should have a daily cleansing bath and change of clothing 6. good oral hygiene 7. normal elimination should be maintained

h. meticulous skin care for ulcers

MEASLES (RUBEOLA, MORBILLI, 7 – DAY MEASLES) Description:

An extremely contagious exanthematous disease of acute onset which most often affects children and the chief symptoms of which are referable to the upper respiratory passages.

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Etiology: The causative agent is the paramyxo virus Mode of transmission:

Nasal throat secretions, droplet infection, indirect contact with articles


Pathophysiology:

As the virus enters the body it immediately multiplies in the respiratory epiyhelium. It disseminate by way of the lymphatic system causing hyperplasia of the infected lymphoid tissue. As a result there is a primary viremia which infects the leukocyte and involves the whole reticuloendothelial system. As the infected cells die it necrose and release more viruses to infect other leukocytes leading to secondary viremia, which also causes edema of upper respiratory tract producing its symptoms and it may predispose to pneumonia. Complications: · otitis media · bronchopnuemonia · severe bronchitis Prognosis: · death rate is highest in the first two years of life (20%) · after 4 years – uncommon · over all mortality – less than

Signs and symptoms

Assessment:1. Stages

1. incubation period (average of 10 days)

2. Pre-eruptive stage or stage of invasion (3-6 days) · from the appearance of the first signs and symptoms to the earliest evidence of the eruption. · fever, severe cold · frequent sneezing · profuse nasal discharge · eyes are red and swollen with mucopurulent discharge (lids stick together) · Stimson’s sign (puffiness of lower eyelids with definite line of congestion on the conjunctivae) · redness of both eardrums · vomiting, drowsiness · hard, dry cough · Koplik’s spot (appears on second day): small bright, red macules or papules with a tiny or bluish-white specks on the center and can be found on the buccal cavity · macupapular rashes (seen late in 4th day): appears first on the cheeks or at the hairline · true measles rash: slightly elevated sensation to touch, appears first on the face and spreads downward over neck, chest trunk, limbs and appearing last on the wrist and back of the hand

3. Eruptive stage · characterized by a general intensification of all local constitutional symptoms of the pre-eruptive stage with the appearance of bronchitis and loose bowels · irritability and restlessness · red and swollen throat · enlargement of cervical glands · fever subsides 4. Desquamation stage · follows after the rash fades · follows the order of distribution seen in the formation of eruption


No specific diagnostic exam except only for the presence of leucopenia.

Management a. prevention · education of parents regarding the disease · passive immunization of infants and children (gammaglobulin) · active immunization (1st year of life)

b. management · drugs Ø antibiotics Ø sulfodiazine · isolation ·

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meticulous skin care – warm alcohol rub to prevent pressure sores · good oral and nasal hygiene · increase oral fluid intake · proper care of the eyes – eye screen to avoid direct light; wear dark glasses · ears should be cleaned after bath if there is discharges – patient should lie the affected ear down or towards the bed ·

give ample of fluids during febrile stage

GERMAN MEASLES (RUBELLA, ROTHEIN, ROSEOLA, 3-DAY MEASLES) Description:

An acute infectious disease characterized by mild constitutional symptoms, rose colored macular eruption which may resembles measles and enlargement and tenderness

Etiology:Caused by myxovirus. Occurs mostly in spring and seen mostly in children over 5 years of age


Direct contact

Incubation period:14 – 21 days Period of communicability – 7 days before to 5 days after the rash appears

Pathophysiology:

As the virus gains entrance to the nasopharynx, it immediately invades the nearest lymph gland causing lymphadenopathy. Later on, the virus enters the blood stream that stimulates the immune response, which is the cause of rashes found in the body of infected individual. If rashes has appeared it means that viremia has subsided. Since the disease is generally mild and serious complication has ha been very rare, what should be watched out rather are its congenital effects because it can cross the placental barrier, which may kill the fetus or cause congenital rubella syndrome. Complications: · otitis media · encephalitis · transient albuminuria · arthritis · congenital defects for babies who’s mother were exposed in early pregnancy Prognosis: very favorable

Signs and symptoms

· fever, cough · loss of appetite · enlargement of lymph nodes · sweating · leucopenia · vomiting (in some cases) · headache, mild sore throat · desquamation follows the rash · enanthem of uvula with tiny red spots · rash (cardinal symptom) accompanied with cervical adenitis: begins on the face including the area around the mouth; oval, pale, rose-red papules about the size of a pinhead; covers the body within 24 hours and gone by the end of the 4th day

Management Planning and implementation

a. Prevention: vaccination · gamma globulin – given to pregnant women with negative history and who have been exposed in the first trimester of pregnancy · include in MMR given at 15months to the baby

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b. management · isolation – (catarrhal stage – to prevent infection to others) · bed rest for first few days · meticulous skin care especially after the rash fades · good oral and nasal hygiene (use of petroleum jelly if lips become dry) · no special diet is necessary, increase oral fluid intake

VARICELLA (CHICKEN POX) Description:

A very contagious acute disease usually occurring in small children, characterized by the appearance of vesicles frequently preceded by papules, occasionally followed by postules but ending in crusting

Etiology: Varicella zoster virus (airborne)Mode of transmission:

Droplet infection, direct contact

Incubation period: 2 -3 weeks

Pathophysiology:

The virus gain entrance via the upper respiratory tract it crosses the mucous membrane and cause systemic infection followed by appearance of numerous macupapular rash. The rash are fluid filled that contain polymorphonuclear leukocytes. Period of communicability: highly contagious from 2 days prior to rash to 6 days after rash erupt. Full blown case imports permanent immunity. Complications: · pneumonia · nephritis · encephalitis · impetigo · pitting or scarring of the skin

Signs and symptoms

· slight fever: first to appear · body malaise, muscle pain · eruption (maculopapular) then progresses to vesicle (3-4 days); begins on trunk and spreads to extremities and face (even on the scalp, throat and mucus membranes) · intense pruritus · vesicles ended as a granular scab · irritability

Management

1. Drugs · penicillin – can be used when the crusts are severe or infected to prevent scarring or secondary invasion · alkalinizing agent to prevent nephritis and to stop vomiting · acyclovir, immunosin – antiviral · hydrocortisone lotion 1% for itching2. isolation in a room by itself 3. provide a well ventilated, warm room to the patient 4. warm bath should be given daily to relieve itching; use a calamine lotion 5. avoid injuring the lesions by using soft absorbent towel and the patient should be patted dry instead of rubbed dry 6. maintain good oral hygiene, if lesions are found in the mouth or nasal passages, antiseptic prep may be used 7. diet should be regular

HERPES ZOSTER (SHINGLES) Description: Acute viral infection of the peripheral nervous system due to reactivation

of varicella zoster virus. The virus causes an inflammatory reaction in

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isolated spinal and cranial sensory ganglia and the posterior gray matter of the spinal cord. Contagious to anyone who has not had varicella or who immunosupressed.

Signs and symptoms· neuralgic pain · malaise · burning · fever · cluster of skin vesicles along course of peripheral sensory nerves (unilateral and found in trunk, thorax or face); appears 3-4 days

Management

1. drugs o analgesics o corticosteroids o acetic acid compresses or white petrolatum o anti-viral (acyclovir)

2. isolate client 3. apply drying lotion 4. administer medications as ordered 5. instruct client to preventive measures

SCABIES Description:

An infection of the skin produced by burrowing action of a parasite mite resulting in irritation and the formation of vesicles or postules.

Etiology:Itchmite, sarcoptes scabei, occurs in individual living in area of poverty where cleanliness is lacking.


Direct contact with infected persons, indirect contact through soiled bed linens, clothing and others.

Incubation period: -

Pathophysiology:

Both female and male parasites live on the skin. A female parasite burrows into the superficial skin to deposit eggs. Pruritus occurs and scratching of skin may produce secondary infection. Scattered follicular. Eruption contains immature mites. Inflammation may produce postules and crust. Eggs is hatched in 4 days. Larvae undergo a series of matts before becoming adult. Life cycle is complete in 1-2 weeks.

Signs and symptoms· intense itching especially at night · sites – between fingers or flexor surfaces of wrists and palms, around nipples, umbilicus, in axillary folds, near groin or gluteal folds, penis, scrotum.


Presence on skin of female mite, ova and feces upon skin scrapping.

Management

1. Take a warm soapy shower bath or bath to remove scaling debris from crusts.

2. Apply prescribed scabicide such as: o lindane lotion (kwell) 1% o crotamiton (Eurax) cream or lotion o 6-10% precipitate of sulfur in petrolatum

3. encourage to change clothing frequently

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RINGWORM (TRICHOPHYTOSIS) Description:

A group of diseases caused by a number of vegetable fungi and affecting various portion of the body in different ways (skin, hair, nails)

Etiology:

TINEA PEDIS (Athlete’s foot) – a superficial fungal infection due to trichophyton Rubrum, mentagrophytes, or epidermophyton floccosum which may manifest itself as an acute, inflammatory, vesicular process or as chronic rash involving the soles of the feet and the inter-digital web spaces. particularly common in summer, contracted swimming area and locker rooms. TINEA CORPORIS or TINEA CIRCINATA – ringworm of the body. TINEA CRURIS (Jock itch) – superficial fungal infection of the groin which may extend to the inner thigh and buttocks areas and commonly associated with tinea pedis. TINEA CAPITIS (ringworm of the scalp) – caused by microsporum canis, trichophyton tonsurans. · usually spread through child to child contact, use of towels, combs, brushes and hats · kitten and puppies may be the source of the infection · primarily seen in children before puberty ·

Signs and symptoms

TINEA PEDIS · scaly fissures between toes, vesicles on sides of feet · pruritus · burning and erethema · lymphangitis and cellulites may occur TINEA CORPORIS or TINEA CIRCINATA · intense itching · appearance: begins as scaling erythematous lesions advancing to rings of vesicles with central clearing and appears on exposed areas of body. TINEA CRURIS · dull red brown eruption of the upper thighs and extends to form circular plaques with elevated scaly or vesicular borders. · itching · seen most in joggers, obese individuals and those wearing tight undercoating. TINEA CAPITIS · reddened, oval or round areas of alopecia · presence of kerion: an acute inflammation that produces edema, postules and granulomatous swelling


TINEA PEDIS · direct examination of scrapings (skin, nails, hair) · isolation of the organisms in culture TINEA CAPITIS · wood’s lamp · microscopic evaluation

Management TINEA PEDIS1. Prevention: instruct client to keep feet dry such as by using

talcum powder. 2. Management:

o Drugs: topical agent, clotrimazole, miconazole, tolnaftate o Systemic anti-fungal therapy: griseofulvin, ketoconazole o Elevate feet for vesicular type o pain infection.

TINEA CORPORIS or TINEA CIRCINATA 1. Prevention: infected pet is a common source and should be

inspected and treated by a veterinarian. 2. Management

o see treatment for tinea pedis o wear clean cotton clothing next to skin o use clean towel daily o dry all areas and skin folds thoroughly

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o use self monitoring for signs of re-infection after a course of therapy.

TINEA CRURIS 1. Prevention: avoid nylon underclothing, tight-fitting underwear and

prolonged wearing of wet bathing suit. 2. Management:

o Drugs – topical therapy (miconazole cream); griseofulvin (oral)

o avoid excessive washing or scrubbing; wear cotton underwear.

TINEA CAPITIS – same with other fungal infection GASTROINTESTINAL DISORDERS

TYPHOID FEVER (ENTERIC FEVER)

Description:

A general infection characterized by the hyperplasia of the lymphoid tissues, especially enlargement and ulcerations of the Peyer’s patches and enlargement of the spleen, by parechymatous changes in various organs and liberation of an endotoxin in the blood.

Etiology:Salmonella typhosa, prevalent in temperate climates, high incidence in fall, and mostly affected are the males and in youth and infant.


Infected urine and feces and intake of contaminated food and water

Pathophysiology:

The organism enters the body via the GI tract and invades the walls of the GI tract leading to bacteremia that localizes in mesenteric lymph nodes, in the masses of lymphatic tissue, in the mucus membrane of the intestinal wall (Peyer’s patches) and in small, solitary lymph follicles in the ileum and colon thus ulceration of the intestines may result. Complication: · perforation of the intestine – from erosion of one of the ulcers · intestinal hemorrhage – from erosion of blood vessels · relapse · thrombophlebitis · urinary infection · meningitis

Signs and symptoms

1. Gradual onset o severe headache, malaise, muscle pains, non-productive

cough o chills and fever, temperature rises slowly o pulse is full and slow o skin eruption – irregularly spaced small rose spots on the

abdomen, chest and back; fades 3-4 days o splenomegally

2. Second week · fever remains consistently high · abdominal distention and tenderness, constipation or diarrhea · delirium in severe infection · coma-vigil look; pupils dilate and patient appears to stare without seeing · sultus tendium –twitching of the tendon sets

3. Third week · gradual decline in fever and symptoms subsides

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· white blood cell counts · blood or bone marrow culture · positive urine and stool cultures in later stage · blood serum agglutination – (+) at the end of scond week

Management

1. Prevention: decontamination of water sources, milk pasteurization, individual vaccination of high risk persons, control carriers.

2. Drugs o chloramphenicol o ampicillin o sulfamethoxazole o trimethoprim o furazolidone

3. intravenous infusion – to treat dehydration and diarrhea 4. Nursing care

o give supportive care o position the patient to prevent aspiration o use of enteric precautions o TSB for high fever o encourage high fluid intake o monitor for complications

5. intestinal decompression procedure, IV fluids and surgical intervention – for perforation

6. withhold food, blood transfusions and bowel resection – for intestinal hemorrhage

LEPTOSPIROSIS (WEIL’S DISEASE, CANICOLA FEVER, HEMMORHAGIC JAUNDICE, ICTEROHEMORRHAGIC SPIROCHETOSIS, SWINEHERD’S DISEASE, MUD FEVER)

Description:Worldwide in its distribution and especially in areas where sanitation is poorest; common in Japan. Usually those who are affected are the sewer workers, miners and swimmers in polluted water.

Etiology: Leptospira icterohaemorrhagiae carried by wild rat Incubation period: 5 – 6 daysSigns and symptoms

sudden onset with chills, vomiting and headache by severe fever and pains in the extremities

intense itching of the conjunctivae severe jaundice with hemorrhage in the skin and mucus

membranes

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hematemesis, hematuria and hepatomegaly for severe cases convalescence occurs in the third week unless there is a

complication Diagnostic procedure

Positive agglutination test

ManagementPrevention – eradication of rats and environmental sanitation Drugs – antiserum or convalescent serum; penicillin Nursing care – supportive and symptomatic

DYSENTERY

Etiology:

BACILLARY DYSENTERY (shigellosis, bloody flux) – caused by shigella dyseteriae and shigella paradysenteriae coming from bowel discharges of infected persons and carriers. VIOLENT DYSENTERY (Cholera) – caused by vibrio cholera, vibrio comma (ogawa and inaba) from infected feces or vomitus.


BACILLARY DYSENTERY – eating of contaminated foods, hand to mouth transfer of contaminated material, flies, objects soiled with discharges of infected person, contaminated water. VIOLENT DYSENTERY – direct or indirect fecal contamination of water or food supplies by soiled hands, utensils or mechanical carriers such as flies.

Incubation period:

BACILLARY DYSENTERY – 1-7 days (average of 4 days) · period of communicability – during acute phase and until (-) stool exam VIOLENT DYSENTERY – from a few hours to five days (average 3 days) · period of communicability – until the infectious organism is absent from the bowel discharges (7-14 days) ·

Signs and symptoms

BACILLARY DYSENTERY · chills · fever · nausea and vomiting · tenesmus · severe fiarrhea accompanied by blood and mucus · alternating episodes of diarrhea and constipation (chronic) VIOLENT DYSENTERY

1. Onset o acute colicky pain in the abdomen o mild diarrhea (yellowish) o marked mental depression o headache, vomiting o fever, may or may not be present

2. Collapse stage – after 1 or 2 days· profuse watery stools (grayish white or rice water) · thirst · severe/violent cramps in the legs and feet · thickly furred tongue · sunken eyeballs · ash-gray colored skin

3. Reaction stage – after 3 days · increased consistency of stools · skin becomes warm and cyanosis disappear · peripheral circulation improves · urine formation increases


BACILLARY DYSENTERY stool exam serologic test

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VIOLENT DYSENTERY (+) stool exam/vomitus

Management

BACILLARY DYSENTERY 1. Methods of control and prevention

o recognition of disease and reporting o concurrent disinfection from bowel discharges o investigation of source of infection (food, water and milk

supplies, general sanitation and search for carriers) o prevention of flybreeding, screening o sanitary disposal of human excreta o protection and purification of public water supplies and

prevention of subsequent contamination 2. Drugs

· kaolin · bismuth and paregoric (combination of sulfonamide) · chloramphenicol

3. Nursing care · isolation by medical aseptic technique · daily cleansing bath · increase oral fluids in acute stage · TSB for fever · record and the character of stools passed, amount and frequency of vomiting VIOLENT DYSENTERY

1. Prevention · immunization · screen the sickroom from flies · protect the food supplies for contamination b. Drugs – tetracycline c. Replacement of fluids and electrolytes d. Isolation e. Patient should be spared all unnecessary efforts during the acute stage f. Buttocks should be kept clean with warm water and soap and rubbed dry g. antiseptic mouthwash in case of vomiting h. fluids is given as soon as they can be tolerated

MUMPS (INFECTIOUS OR EPIDEMIC PAROTITIS) Description:

An acute contagious disease the characteristic feature of which is the swelling of one or both of the parotid glands usually occurring in epidemic form.

Etiology:

Filterable virus, member of myxovirus family, infected oral and nasal secretions is the source of infection Complication: orchitis or epididymp-orchitis Prognosis: favorable in most cases of mumps, complete recovery ordinarily takes place even complications take place.


Direct contact with a person who has the disease or by contact with articles which is contaminated.

Incubation period:14 – 21 days

period of communicability: before the glands is swollen to the time present of localized swelling

Signs and symptoms pain in the parotid region headache earache

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fever difficulty to open the mouth wide general malaise sore throat


moderate leukocytosis complement fixation test skin test for susceptibility to mumps

Management

a. Prevention: immunization (MMR given at 15 months) b. Drugs – aspirin for fever, cortisone c. isolation d. absolute bed rest to prevent complications (at least 4 days) e. daily bath should be given f. soft bland diet for sore jaw g. advise male to wear well fitting support to relieve the pull of gravity on the testes and blood vessels h. TSB for fever i. ice pack/collar application

PARASITISMDescription:

Etiology:

· PINWORM (Enteropiasis) – oxyuris vermicularis, occurs from fomites, autoinfection, fecal contamination, affects one in family and invariably infects entire family. · GIANT INTESTINAL ROUNDWORMS (Ascariasis) – ascaris lumbricoides, from sputum and ova in soil. · THREADWORM –strongyloides stercoralis, from fecal soil contamination · WHIPWORM (trichuriasis) – from fecal soil contamination · HOOKWORM (ancylostomiasis) – from larvae in fecal soil contamination · TAPEWORM (taeniasis) Types:

hymenolepis nana – from fecal contamination taenia saginata (beef) – from insufficiently cooked meat taenia solium (pork) – contaminated meat diphyllobothrium latun – poorly cooked infested fish


PINWORM – mouth GIANT INTESTINAL ROUNDWORMS – mouth THREADWORM – enter usually through the skin or feet WHIPWORM – mouth HOOKWORM – through skin of the feet TAPEWORM - mouth

Signs and symptoms

PINWORM eosinophilia, itching around the anus, convulsions in children.

GIANT INTESTINAL ROUNDWORMS chest pain, cough after two months, malnutrition, indigestion,

diarrhea, colicky abdominal pain. THREADWORM

intermittent diarrhea WHIPWORM – nausea and vomiting, diarrhea, anemia, stunted growth; may cause prolapse of rectum in children and occasionally appendicitis. HOOKWORM – anemia, diarrhea, stunted growth, bronchial symptoms, obstruction of the biliary and pancreatic duct.


PINWORM – adults and ova in stool GIANT INTESTINAL ROUNDWORMS – adults and ova in stool THREADWORM – larvae WHIPWORM – ova in

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stool HOOKWORM – ova in stool TAPEWORM – ova and segments of the worm in the stool

Management

THREADWORM – Prevention: wear shoes and use sanitary toilets use of sanitary toilets provide hygiene education of the family dispose of the infected stools carefully meticulous cleansing of skin especially anal region, hands and

nails drugs – antihelminthic drugs, piperazine citrate, pyrantel pamoate,

mebendazole

HEPATITIS

Description:

Widespread inflammation of the liver tissue with liver cell damage due to hepatic cell degeneration and necrosis; proliferation and enlargement of the Kuffer cells and inflammation of the periportal areas thus may cause interruption of bile flow.

Etiology:

TYPE A (infectious hepatitis) – occurs in crowded living conditions; with poor personal hygiene or from contaminated food, milk, water or shellfish. Common occurrence during fall and winter months usually affecting children and young adults. TYPE B (serum hepatitis, SH virus, viral hepatitis, transfusion hepatitis, homologous serum jaundice) TYPE C (non-A, non-B hepatitis)


TYPE A – fecal/oral route TYPE B – blood and body fluids (saliva, semen, vaginal secretions), often from contaminated needles among IV drug abusers, intimate/sexual contact. TYPE C – by parenteral route, through blood and blood products, needles and syringes

Incubation period:

TYPE A – 15-45 days period of communicability – 3 weeks prior and one week after

developing jaundice TYPE B – 50-180 days TYPE C – 7-50 days

Pathophysiology: -

Signs and symptoms

a. Pre-icteric stage · anorexia · nausea and vomiting · fatigue · constipation or diarrhea · weight loss · right upper quadrant discomfort · hepatomegaly · spleenomegaly · lymphadenopathy b. Icteric stage · fatigue · weight loss · light colored stools · dark urine · jaundice · pruritus · continued hepatomegaly with tenderness c. Post-icteric stage · fatigue but increased sense of well being · hepatomegaly: gradually decreasing


a. All 3 types · SGPT, SGOT, alkaline phospatase, bilirubin, ER – all increased in pre-icteric · leukocytes, lymphocytes, neutrophils – all decreased · prolonged PT b. HEPA A: Hepa A (HAV) in stool before onset · Anti-HAV (IgG) – appears soon after onset of jaundice, peaks in 1-2 months and persist indefinitely · Anti-HA (IgM) – positive in acute infection lasts 4-6 weeks c. HEPA B · HbsAG (surface antigen) – positive, develops 4-12 weeks after infection · Anti-HbsAg – negative in 80%

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cases · Anti-HBC associated with infectivity, develops 2-16 weeks after infection · ABeAG – associated with ineffectively and disappears before jaundice · Anti-Hbe – present in carriers, represents low ineffectivity

Management

a. Prevention I. Type A · good hand washing · good personal hygiene · control and screening of food handlers · passive immunization – ISG, to exposed individuals and prophylaxis for travelers to developing countries II. Type B · screen blood donors HB3Ag · use disposable needles and syringes · registration of all carriers · passive immunization – ISG · active immunization – hepatavax B vaccine and formalin treated hepatitis B vaccine given in 3 doses b. Nursing management · promote adequate nutrition – small frequent meals of high CHO, moderate to high CHON, high vitamin, high caloric diet, avoid very hot or cold foods. · ensure rest and relaxation · monitor/relive pruritus – cool, moist compresses, emollient lotion · administer corticosteroid as ordered · isolation procedures as required · provide client teaching and discharge planning with regards to: Ø importance of avoiding alcohol Ø importance of not donating blood Ø recognition/reporting of signs of inadequate convalescence Ø avoidance of persons with known infections · Drugs – liver protector (essentiale, jectofer, interferon drug)

FOOD POISONING Description:

A gastroenteritis often produced by the presence of a disease organism or its toxins.

Etiology:

SALMONELLA GASTROENTERITIS – salmonella typhimurium, salmonella paratyphi A, B, and C; salmonella newport STAPHYLOCOCCUS GASTROENTERITIS – coagulase – positive, gram positive: grows rapidly on food containing carbohydrates Recovery: within 24 – 36 hours BOTILISM – clostridium botulinum

Incubation period:SALMONELLA GASTROENTERITIS – 6 to 48 hours after the ingestion of contaminated food STAPHYLOCOCCUS GASTROENTERITIS – 2 to 6 hours after ingestion BOTILISM – 24 hours after the ingestion

Signs and symptoms SALMONELLA GASTROENTERITIS headache nausea and vomiting diarrhea (stools are usually fluid and contain mucus; bloody if in

severe infection) STAPHYLOCOCCUS GASTROENTERITIS

sudden abdominal pain excessive perspiration vomiting diarrhea pallor weakness

BOTILISM peripheral nervous system

Ø vomiting Ø ataxia Ø constipation Ø ocular paralysis Ø aphonia Ø other

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neufromascular signs paralysis of the respiratory system which may lead to death


SALMONELLA GASTROENTERITIS – history of illness after ingestion of certain foods

Management

SALMONELLA GASTROENTERITIS/STAPHYLOCOCCUS GASTROENTERITIS

replacement of fluids and salts sedatives and anticholinergic to reduce hypermobility of the

intestine good oral hygiene application of heat to abdomen to relieve cramps

BOTILISM prevention

Ø regulation of commercial processing of canned foods Ø education of housewives concerning proper processing of home canned foods Ø canned foods should be boiled first to destroy the toxins Ø polyvalent antitoxins (botulinum antitoxin)

patient with botulinum should be placed on quiet room and avoidance of unnecessary activity

symptomatic intubation for feeding tracheostomy – in respiratory failure oxygen by IPPB

SEXUALLY TRANSMITTED DISEASE

GONORRHEA (STRAIN, CLAP, JACK, MORNING DROP, G.C. GLEET) Description:

An infectious disease, which causes inflammation of the mucous membranes of the genitourinary tract. Complications: MALE – bilateral epididymitis, sterility FEMALE – pelvic inflammatory disease, sterility NEWBORN – opthalmia neonatorum – mother to child

Etiology: Neisseria gonorrhea

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Sexual contact


Signs and symptoms

MALE burning sensation in the urethra upon urination passage of purulent (yellowish) discharge pelvic pain fever painful urination

FEMALE burning sensation upon urination presence or absence of vaginal discharge pelvic pain abdominal distention nausea and vomiting urinary frequency


culture and sensitivity female: pap smear or cervical smear; male: urethral smear blood exam – VDRL

Management

educate men and women to recognize signs of gonorrhea and to seek immediate treatment

monitor urinary and vowel elimination important to treat sexual partner, as client may become re-infected make arrangements for follow-up culture 2 weeks after therapy is

initiated Drugs – penicillin: drug of choice

Ø tetracyclines Ø ceftriaxone sodium (rocephin) Ø amoxicillin (augmentin)

SYPHILIS (LEUS, POX, BAD BLOOD DISEASE)

Description:

A contagious disease that leads to many structural and cutaneous lesions Complications: a. still birth b. child born with syphilis · placenta is bigger than the baby · persistent vesicular eruptions and nasal discharges · old man feature · mucus patches on mouth and anus c. child born with late syphilis (signs and symptoms after 2 years) · hutchinson’s teeth · deafness · saddle nose · high palate

Etiology: Treponema pallidum Mode of transmission:

Sexual contact

Incubation period: 3 – 6 weeks

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Signs and symptoms

a. Primary syphilis chancre on genitalia, mouth or anus serous drainage from chancre enlarge lymph nodes maybe painful or painless highly infectious

b. Secondary syphilis skin rash on palms and soles of feet reddish copper – colored lesions on palms of hands and soles of

feet condylomas: lesions/sores that fused together erosions of oral mucus membranes alopecia enlarged lymph nodes fever, headache, sore throat and general malaise

c. Tertiary syphilis gumma – the characteristic lesions cardiovascular changes ataxia stroke, blindness


a. positive test for syphilis · venereal disease research laboratory (VDRL) · rapid plasma reagin circle card test (CRPR-CT) · automate reagin test (ART) · fluorescent treponemal antibody absorption test (FTA-ABS) · wessermann test · khan precipitation test · kline, hinton and mazzin tests b. darkfield examination c. culture and sensitivity d.

Management

strict personal hygiene is an absolute requirement assist in case finding instruct client to avoid sexual contact until clearance is given by

physician encourage monogamous relationship explain need to complete course of antibiotic therapy Drugs – penicillin, tetracyclins/kithramycin

ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) Description:

An acquired immune deficiency characterized by a defect in natural immunity

Etiology:Retrovirus, human immunodeficiency virus (HIV-1 and HIV-2) previously referred to as human T-lymphotropic virus type III (HTLV-III)


Blood transfusion, sexual contact, contaminated needles, perinatal transmission

Incubation period: 6 months to 9 years

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Pathophysiology:

Signs and symptoms

anorexia fatigue dyspnea night sweats fever diarrhea enlarged lymph nodes HIV encephalopathy: memory loss, lack of coordination, partial

paralysis, mental deterioration HIV wasting syndrome, emaciation positive test for HIV antibody positive test for presence of HIV itself opportunistic infection: neumocystic carinii, cystomegalovirus,

kaposi’s sarcoma


ELISA test (enzyme-linked immunosorbent assay) – a screening test

western blot – a confirmatory test

Management

provide frequent rest periods provide skin care provide high-calorie, high protein diet to prevent weight loss provide good oral hygiene provide oxygen and maintain pulmonary function provide measures to reduce pain protect the client from secondary infection; carefully assess for

early signs encourage verbalization of feelings teach client the importance of:

Ø informing sexual contacts of diagnosis Ø not sharing needle with other individuals Ø continuing medical supervision

CHLAMYDIAL INFECTION Description:

A sexually transmitted disease that is highly contagious caused by chlamydial organism

Etiology: Chlamydia trachomatis Mode of transmission:

2 -3 weeks for males

Incubation period: Sexual intercourse Pathophysiology: -Signs and symptoms

pruritus in vagina burning sensation in vagina

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painful intercourse pruritus of urethral meatus in men burning sensation during urination


Culture of aspirated material from vaginal, anal or penile discharges

Management doxycycline or azithromycin (recommended for pregnant woman) universal precaution should be practiced

TRICHOMONIASIS Description:

Another type of sexually transmitted disease that may also be transmitted by other means such as handling of infected fomites. It is caused by a protozoan parasites.

Etiology: Trichomonas vaginalis Mode of transmission:

Sexual intercourse, contact with wet towels and wash clothes infected by the organism

Incubation period: 4 – 20 days, usually 7 days

Signs and symptoms vaginal discharge burning and pruritus of vagina redness of the introitus usually asymptomatic in men


culture of obtained specimen

Management metronidazole sitz bath may relieve symptom acid douches tetracyclines may be given on male who are also infected

BIOTERRORISM AND PANDEMICS Ø

In the recent course of international conflicts, which has lead to war, has used weapon that are quite different from the conventional ones used before. The medical science is being used not to prolong life but to cause immediate death by infection of various biological organisms. The following gives an insight of these dangerous biological terrorism leading to pandemics.

SMALL POX Description:

For about two decades the WHO has declared that the world is already “small pox free”. Although eliminated in the world over, the specimen is still kept in two laboratory facility in the United States.

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Etiology: Variola virus (DNA virus)Mode of transmission:

Direct contact or by droplet from person to person

Incubation period: 12 days

Signs and symptoms

high fever malaise headache back ache maculopapular rash in the face, mouth and pharynx (the patients

are contagious after the appearance of the rash)

Management

generally supportive care before rendering care transmission precaution should be

specifically indicated autoclaving of soiled linens is needed isolation is necessary until no longer contagious

ANTHRAX Description:

Also known as whoolsorters disease, the capsulated form of this organism is found in soil worldwide. The organism needs to take about 8,000 to 50,000 to put a person at risk of contracting the disease.

Etiology: Bacillus anthracis


inhalation of spores ingestion of spores entrance through skin lesions

Incubation period: For inhalation anthrax 60 days, for cutaneous anthrax 1-6 days

Signs and symptoms

a. Inhalation anthrax · cough · headache · fever · vomiting · chills · weakness · dyspnea · syncope b. Cutaneous anthrax · nausea and vomiting · abdominal pain · hematochexia · ascites · massive diarrhea

Management

a. standard precaution is already sufficient to control the spread of the infection b. ciprofloxacin/doxycycline is prescribed for mass exposure/casualty with infecting organism c. important pharmacologic interventions are penicillin, erythromycin, chlorampenicol and gentamycin

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Description:Latest among all the rest of pandemics which has its origin from China and has spread to USA, Canada, Philippines and other South East Asian Country

Etiology: Corona virus Mode of transmission:

Airborne

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Signs and symptoms

fever cough rapid respiratory compromise dyspnea atelectasis

Management supportive treatment provide ventilatory assistance use N95 mask to avoid infection

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